Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013 - Amends title XVIII (Medicare) of the Social Security Act to cover, as medical and other health services, complex rehabilitation technology items designed and configured for a specific qualified individual to meet that individual's unique: (1) medical, physical, and functional needs related to a medical condition; and (2) capacities for basic activities of daily living (ADLs) and instrumental ADLs.
Directs the Secretary of Health and Human Services (HHS) to: (1) designate complex rehabilitation technology items (excluding adaptive equipment to operate motor vehicles or certain prosthetic devices and orthotics); and (2) establish eligibility criteria for them.
Prescribes requirements for payments for CRT items.
Directs the Secretary to establish standards for clinical conditions for CRT item payment as well as quality standards for suppliers of such items.
Directs the Secretary to establish a Healthcare Procedure Coding System (HCPCS) coding subset that uses specified HCPCS codes for CRT items.
Requires payment for replacement of a CRT item (or any part of one), without regard to certain continuous use or useful lifetime restrictions established for items of durable medical equipment (DME), if a qualified ordering practitioner determines that a replacement item (or part) is necessary.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 942 Introduced in House (IH)]
113th CONGRESS
1st Session
H. R. 942
To amend title XVIII of the Social Security Act to provide for coverage
and payment for complex rehabilitation technology items under the
Medicare program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 4, 2013
Mr. Crowley (for himself and Mr. Sensenbrenner) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committee on Ways and Means, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for coverage
and payment for complex rehabilitation technology items under the
Medicare program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Ensuring Access to Quality Complex
Rehabilitation Technology Act of 2013''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Individuals with disabilities and significant medical
conditions such as Cerebral Palsy, Muscular Dystrophy, Multiple
Sclerosis, Spinal Cord Injury, Amyotrophic Lateral Sclerosis,
and Spina Bifida experience physical, functional, and cognitive
challenges every day.
(2) Complex rehabilitation technology items (in this Act
referred to as ``CRT items''), including products such as
complex rehabilitation power wheelchairs, highly configurable
manual wheelchairs, adaptive seating and positioning systems,
and other specialized equipment, such as standing frames and
gait trainers, enable individuals to maximize their function
and minimize the extent and costs of their medical care.
(3) Access to CRT items and related services can be
threatened by inadequate coding, coverage, and payment policies
for such items and services. These policies have restricted
access to existing complex rehabilitation technology and
stifled innovation. Access challenges have increased over the
past several years and, without meaningful change to these
policies, will only become greater in the future.
(4) Current Medicare policies often fail to adequately
address the needs of individuals with disabilities, to consider
the range of services furnished by complex rehabilitation
technology suppliers, and to recognize and account for the
complexity and unique nature of the equipment itself.
(5) A significant factor responsible for such access
challenges is that individually-configurable CRT items do not
have a distinct payment category under the Medicare program,
but instead are classified within the broad category of durable
medical equipment (DME). CRT items serve patients with serious
medical conditions that require a broader range of services and
specialized personnel than what is required for standard DME.
Customizable CRT items also require more resources in the areas
configuring, training, and education to ensure appropriate use
and to optimize results.
(6) Unlike most DME, a medical model incorporating an
interdisciplinary team approach is necessary to ensure proper
customization and use of a CRT item. This team typically
includes a physician, a licensed physical or licensed
occupational therapist (with no financial relationship with the
CRT supplier), a qualified CRT professional, the individual
using such item, and sometimes a caregiver for such individual.
(7) The Medicare program should recognize the specialized
nature of the CRT service delivery model, the required
supporting processes and technology-related CRT services, the
credentials and competencies needed by the providing suppliers
and critical staff, and the related costs involved. A separate
benefit category for CRT items would allow for unique coding,
coverage, and payment rules and policies that address the
unique needs of persons with disabilities and acknowledge the
extensive service component.
(8) Congress and the Centers for Medicare & Medicaid
Services have previously recognized the benefits of a separate
classification for unique, customized products. In 2008,
Congress exempted certain CRT items from inclusion in the
Medicare DME competitive bidding program, and Congress has
created a separate and distinct benefit category for orthotics
and prosthetics (custom braces and artificial limbs), which
have their own medical policies, accreditation standards, and
payment calculations.
SEC. 3. ESTABLISHING SEPARATE BENEFIT CATEGORY FOR COMPLEX
REHABILITATION TECHNOLOGIES WITHIN MEDICARE.
(a) New Category.--Section 1861 of the Social Security Act (42
U.S.C. 1395x) is amended--
(1) in subsection (s)(2)--
(A) in subparagraph (EE), by striking ``and'' at
the end;
(B) in subparagraph (FF), by inserting ``and'' at
the end; and
(C) by inserting after subparagraph (FF) the
following new paragraph:
``(GG) complex rehabilitation technology items (as
defined in subsection (iii));''; and
(2) by adding at the end the following new subsection:
``Complex Rehabilitation Technology Item
``(iii)(1) The terms `complex rehabilitation technology item' and
`CRT item' mean an item that--
``(A) is designed and configured for a specific qualified
individual to meet the individual's unique--
``(i) medical, physical, and functional needs
related to a medical condition; and
``(ii) capacities for basic activities of daily
living and instrumental activities of daily living;
``(B) is primarily used to serve a medical purpose and is
generally not useful to a person in the absence of illness or
injury; and
``(C) requires certain services to ensure appropriate
design, configuration, and use of such item, including--
``(i) an evaluation of needs and capacities and
matching of the features and functions of CRT items to
the qualified individual who will use such an item; and
``(ii) configuring, fitting, programming,
adjusting, or adapting the particular complex
rehabilitation technology item for use by such
individual.
``(2)(A) The Secretary, in consultation with the Director of Office
on Disability, the Chairman of the National Council on Disability, the
Executive Director on the Interagency Committee on Disability, the
Director of the National Institute on Disability and Rehabilitation
Research of the Department of Education, and the Co-Chairmen of the
Senior Oversight Committee's Care Management Reform Team of the
Department of Defense and the Veterans Administration, shall, by
regulation--
``(i) designate items as complex rehabilitation technology
items; and
``(ii) establish eligibility criteria to determine if an
individual is a qualified individual based on the level of
physical and functional needs and capacities related to a
medical condition or conditions described in subparagraph (E).
``(B) The items designated as complex rehabilitation technology
items under subparagraph (A)(i) shall include items which, as of
January 1, 2013 , were classified within the following HCPCS codes:
E0637, E0638, E0641, E0642, E0986, E1002, E1003, E1004, E1005, E1006,
E1007, E1008, E1009, E1010, E1011, E1014, E1037, E1161, E1220, E1228,
E1229, E1231, E1232, E1233, E1234, E1235, E1236, E1237, E1238, E1239
E2209, E2291, E2292, E2293, E2294, E2295, E2300, E2301, E2310, E2311,
E2312, E2313, E2321, E2322, E2323, E2324, E2325, E2326, E2327, E2328,
E2329, E2330, E2331, E2351, E2373, E2374, E2376, E2377, E2609, E2610,
E2617, E8000, E8001, E8002, K0005, K0835, K0836, K0837, K0838, K0839,
K0840, K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853,
K0854, K0855, K0856, K0857, K0858, K0859, K0860, K0861, K0862, K0863,
K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884,
K0885, K0886, K0890, K0891, and K0898.
``(C)(i) The items designated as complex rehabilitation technology
items under subparagraph (A)(i) shall include each item that--
``(I) as of January 1, 2013, was classified within the
HCPCS codes under clause (ii); and
``(II) the Secretary, acting in consultation with suppliers
and manufacturers of CRT items, determines should be removed
from such code and assigned a new HCPCS code because such item
is a complex rehabilitation technology item.
``(ii) The HCPCS codes under this clause are the following: E0143,
E0950, E0951, E0952, E0955, E0956, E0957, E0958, E0960, E0967, E0978,
E0990, E1015, E1016, E1028, E01029, E1030, E2205, E2208, E2231, E2368,
E2369, E2370, E2605, E2606, E2607, E2608, E2613, E2614, E2615, E2616,
E2620, E2621, E2624, E2625, K0004, K0009, K0040, K0108, and K0669.
``(D) The Secretary may not designate as a complex rehabilitation
technology item--
``(i) adaptive equipment to operate motor vehicles;
``(ii) prosthetic devices described in subsection (s)(8);
or
``(iii) orthotics and prosthetics described in subsection
(s)(9).
``(E) In establishing the eligibility criteria under subparagraph
(A)(ii), the Secretary shall include appropriate physical and
functional needs and capacities arising from any of the following
medical conditions:
``(i) Congenital disorders, progressive or degenerative
neuromuscular diseases, or injuries or trauma that result in
significant physical or functional needs and capacities.
``(ii) Spinal cord injury, traumatic brain injury, cerebral
palsy, muscular dystrophy, spina bifida, osteogenesis
imperfecta, arthrogryposis, amyotrophic lateral sclerosis,
multiple sclerosis, demyelinating disease, myelopathy,
myopathy, progressive muscular atrophy, anterior horn cell
disease, post-polio syndrome, cerebellar degeneration,
dystonia, Huntington's disease, or spinocerebellar disease.
``(iii) Certain types of amputation, paralysis, or paresis
that result in significant physical or functional needs and
capacities.
``(F)(i) For 2014, the Secretary shall publish--
``(I) a list of items designated under subparagraph (A)(i)
and the HCPCS codes for such items; and
``(II) the eligibility criteria established under
subparagraph (A)(ii).
``(ii) For 2015 and each subsequent year, the Secretary shall
publish any necessary updates to such list (including additions of new
CRT items and any changes in applicable HCPCS codes) and to such
eligibility criteria.
``(G) The Secretary shall make available, on a public Web site, the
process by which the Secretary will consider requests from members of
the public that the Secretary--
``(i) designate an item as a CRT item under subparagraph
(A)(i); or
``(ii) amend the eligibility criteria established under
subparagraph (A)(ii).
``(3) For purposes of this subsection:
``(A) The term `capacity for basic activities of daily
living' means an individual's capacity to safely participate in
mobility and self-care activities including--
``(i) maintaining and changing body position;
``(ii) transferring to or from one surface to
another;
``(iii) walking;
``(iv) moving from place to place using mobility
equipment, in a safe and timely manner;
``(v) washing one's self;
``(vi) caring for the body;
``(vii) toileting;
``(viii) dressing;
``(ix) eating;
``(x) drinking;
``(xi) looking after one's health; and
``(xii) carrying, moving, and handling objects to
perform and participate in other activities under this
subparagraph and subparagraph (B).
``(B) The term `capacity for instrumental activities of
daily living' means an individual's capacity to safely
participate in life situations in the home and community,
including--
``(i) communicating;
``(ii) moving around using transportation;
``(iii) acquiring necessities, goods, and services;
``(iv) performing household tasks;
``(v) caring for household members and family
members;
``(vi) caring for household objects;
``(vii) engaging in education, work, employment and
economic life; and
``(viii) participating in community, social, and
civic activities.
``(C) The term `HCPCS' refers to the Health Care Procedure
Coding System.
``(D) The term `individually-configured' means, with
respect to an item, that--
``(i) the item has a combination of features,
adjustments, or modifications that are specific to the
individual who uses such item; and
``(ii) the supplier of such item must measure the
individual and configure, fit, program, adjust, or
adapt the item, as appropriate, so that the item is
consistent with--
``(I) an assessment or evaluation of the
individual by an appropriate licensed
clinician;
``(II) the written order required under
section 1834(p)(2)(B)(i); and
``(III) medical condition, physical and
functional needs and capacities, and body size
of the individual who will use the item, the
period for which such individual will need such
item, and the intended use of such item by such
individual.
``(E) The term `qualified individual' means an individual
who--
``(i) is enrolled under part B; and
``(ii) has physical and functional needs and
capacities that arise from a medical condition that
meet the eligibility criteria established by the
Secretary under paragraph (2)(A)(ii).''.
SEC. 4. PAYMENT RULES.
Section 1834 of the Social Security Act (42 U.S.C. 1395m) is
amended by adding at the end the following:
``(p) Coverage and Payment for CRT Items.--
``(1) General rule for payment.--
``(A) In general.--Not later than the date that is
one year after the date of the enactment of this
subsection, subject to subparagraph (B), the Secretary
shall determine a payment system that shall apply to
CRT items--
``(i) with HCPCS codes that were assigned
to the item under section
1861(iii)(2)(C)(i)(II);
``(ii) for which no HCPCS code was assigned
prior to such date; or
``(iii) which, prior to such date, was
classified under a miscellaneous HCPCS code.
``(B) Considerations.--In determining the payment
system under subparagraph (A), the Secretary--
``(i) may disregard the freezes on CPI
increases to the payment amounts for durable
medical equipment that occurred before the date
of the enactment of this subsection, when
determining the payment amount for CRT items;
and
``(ii) shall ensure that the payment
amounts for CRT items under such system are
adequate to provide qualified individuals with
access to such items and to encourage
innovation, taking into account--
``(I) the unique needs of qualified
individuals for access to CRT items;
``(II) the unique complexity of CRT
items; and
``(III) the resources and staff
needed to provide appropriate
customization of CRT items for a
qualified individual.
``(C) Exclusive payment rule.--This subsection
shall constitute the exclusive provision of this title
for payment for CRT items under this part or under part
A to a home health agency.
``(D) Limitation on payment.--No payment shall be
made under this subsection for a CRT item unless such
CRT item--
``(i) is provided to a qualified
individual;
``(ii) meets the clinical conditions for
coverage established under paragraph (2); and
``(iii) is furnished by a supplier
accredited pursuant to paragraph (3).
``(2) Clinical conditions for coverage.--
``(A) In general.--The Secretary shall establish
standards for clinical conditions for payment for CRT
items under this subsection.
``(B) Requirements.--The standards established
under subparagraph (A) shall require the following:
``(i) Written order.--
``(I) In general.--A qualified
ordering practitioner shall provide a
written order for a CRT item for a
qualified individual before the
Secretary may provide payment for such
item for such individual under this
subsection.
``(II) CRT evaluation.--In the case
of a CRT item that is categorized by
the Secretary, for purposes of the
program under this title, as a manual
wheelchair or a power wheelchair, and
is to be provided to a qualified
individual who has a diagnosis
specified under subparagraph (C), the
qualified ordering practitioner may not
provide a written order under subclause
(I) unless the qualified individual has
undergone a CRT evaluation conducted by
a licensed physical therapist or
occupational therapist who has no
financial relationship with the CRT
supplier.
``(ii) Documentation of medical
necessity.--A qualified ordering practitioner
who provides a written order under clause (i)
shall maintain documentation of the medical
necessity of such order for a period of seven
years and shall make such documentation
available to the Secretary upon request. The
documentation of medical necessity under this
clause shall include--
``(I) evidence that the individual
for whom the order was written has
physical and functional needs and
capacities related to a medical
condition that meet the eligibility
criteria established under section
1861(iii)(2)(A)(ii); and
``(II) evidence of any CRT
evaluation required under clause
(i)(II).
``(C) Specification of diagnosis for crt
evaluation.--The Secretary, in consultation with
relevant parties (including the agencies listed in
section 1861(iii)(2)(A), physicians, licensed physical
therapists, licensed occupational therapists, and
suppliers of complex rehabilitation technologies) shall
specify the diagnoses and other medical presentations
for which the requirement for a CRT evaluation under
subparagraph (B)(i)(II) shall apply.
``(D) Coverage determinations.--In developing the
standards under subparagraph (A), the coverage of CRT
items with respect to an individual shall be based on--
``(i) the specific medical, physical, and
functional needs of the individual;
``(ii) the individual's capacities for safe
participation in basic activities of daily
living and instrumental activities of daily
living in all routinely encountered
environments (as such terms are defined in
section 1861(iii)(3)); and
``(iii) the individual's expected
progression of such needs and capacities.
``(E) Payment for residents of skilled nursing
facilities.--In the case of a qualified individual who
is a resident of a skilled nursing facility, payment
may only be made under this subsection for a CRT item
for such individual if such CRT item is required as
part of a plan of care to allow the transition of such
individual from the skilled nursing facility to a home
or community setting.
``(3) Establishment of quality standards.--
``(A) Establishment.--The Secretary shall
establish, through regulation, quality standards for
suppliers of CRT items. Such standards shall be applied
prospectively and shall be published on the Internet
Web site of the Centers for Medicare and Medicaid
Services.
``(B) Consultation.--In establishing the quality
standards under subparagraph (A), the Secretary shall
consult with relevant parties (including clinicians,
consumer groups, suppliers, and manufacturers).
``(C) Requirements of standards.--In establishing
the quality standards under subparagraph (A), the
Secretary shall require that the suppliers of CRT items
meet the following requirements:
``(i) DME standards as minimum.--The
supplier complies with all of the standards
that are applicable to suppliers of durable
medical equipment under subsection (a)(20) and
suppliers of medical equipment and supplies
under subsection (j).
``(ii) Qualified crt professional.--The
supplier of a CRT item makes available, in each
service area served by such supplier, at least
one qualified CRT professional to--
``(I) analyze the needs and
capacities of individuals for a CRT
item in collaboration with the clinical
team;
``(II) assist in selecting an
appropriate CRT item for such
individual, given such needs and
capacities; and
``(III) provide technology-related
training to such individual in the
proper use and maintenance of the CRT
items.
``(iii) Trial equipment.--The supplier of
the CRT item provides the qualified individual
with appropriate equipment for trial and
simulation, if a physician, licensed physical
therapist, or licensed occupational therapist
determines that the provision of such equipment
is necessary.
``(iv) Information on repair.--The supplier
of the CRT item provides the qualified
individual with written information on the
service and repair of the CRT item provided to
such individual.
``(v) Repair.--The supplier of a CRT item--
``(I) makes available, in each
service area served by such supplier,
at least one qualified CRT service
technician to service and repair CRT
items that--
``(aa) are furnished by
such supplier; and
``(bb) at the time of the
need for repair, are located in
a service area of the supplier;
or
``(II) at the time of sale of the
CRT item, discloses to the qualified
individual that the supplier does not
provide repair service for such item
and provides contact information for
entities that do provide such repair
service.
``(vi) Rental equipment.--If payment is
allowed under paragraph (6), the supplier of
the CRT item provides temporary rental
equipment to the qualified individual when the
supplier is repairing a qualified individual's
CRT item that was paid for under this
subsection.
``(4) Application of standards and accreditation program
for suppliers of crt items.--
``(A) In general.--
``(i) Requirement for provider or supplier
number.--The Secretary shall not provide a
supplier of CRT items with a provider or
supplier number to submit claims for payment
under this title unless the supplier is in
compliance with the standards under paragraph
(3).
``(ii) Requirement for payment.--Payment
shall not be made under this part for CRT items
furnished by a supplier unless the supplier is
in compliance with the standards under
paragraph (3).
``(B) Application of accreditation requirement.--In
implementing quality standards under paragraph (3), the
Secretary shall require suppliers furnishing CRT items,
on or after one year after the standards are published
under such paragraph, directly or as a subcontractor
for another entity--
``(i) to comply with such standards; and
``(ii) to have submitted to the Secretary
evidence of accreditation by an accreditation
organization designated under subparagraph (C)
demonstrating that the supplier is complying
with such standards.
``(C) Designation of independent accreditation
organizations.--Not later than the date that is one
year after the date on which the Secretary implements
the quality standards under paragraph (3), the
Secretary shall designate and approve one or more
independent accreditation organizations that--
``(i) are approved under subsection
(a)(20)(B); and
``(ii) the Secretary has determined have
the capability to assess whether suppliers of
CRT items meet the quality standards
established under paragraph (3).
``(5) Coding system for complex rehabilitation
technologies.--
``(A) In general.--The Secretary shall, in
consultation with suppliers and manufacturers of CRT
items, and utilizing existing coding systems, establish
a HCPCS coding subset that shall utilize and include
HCPCS codes described in section 1861(iii)(2) for CRT
items for which payment may made under this subsection.
``(B) Treatment of existing products.--
``(i) In general.--With respect to CRT
items for which payment was available under
this title before the effective date of the
amendments made by Ensuring Access to Quality
Complex Rehabilitation Technology Act of 2013,
the Secretary shall assign such items to a code
in the coding subset established under
subparagraph (A).
``(ii) Updates.--After the initial
assignment under clause (i), the Secretary may
decide to reassign additional product
categories, or items within those categories,
that exist before the date of the enactment of
this subsection to the CRT coding subset.
``(iii) Consultation.--Before making
reassignments of CRT items under clause (ii),
the Secretary shall consult with suppliers and
manufacturers of such items. The Secretary
shall not require manufacturers of CRT items
for which payment was available under this
title before the effective date of the
amendments made by the Ensuring Access to
Quality Complex Rehabilitation Technology Act
of 2013 to submit requests for reassignment of
the code for such product to the coding subset
under subparagraph (A) as long as--
``(I) no changes have been made to
the code definitions, required code
characteristics or test requirements;
and
``(II) the item was previously
verified to meet the code requirements.
``(C) Removing complex rehabilitation technology
from dme codes.--The Secretary shall, in consultation
with suppliers and manufacturers of CRT items--
``(i) remove from the coding subset for
durable medical equipment any CRT items that
are included in the coding subset under
subparagraph (A); and
``(ii) assign new codes to such CRT items
for purposes of including such items in the
subset under subparagraph (A).
``(D) New technology.--
``(i) In general.--The Secretary shall
update as needed the HCPCS level II process
used to modify the code set to include CRT
items for the purposes of establishing new
codes and determining products to be classified
as CRT items. In determining if a product is a
CRT item, the Secretary shall consider--
``(I) if the product is novel;
``(II) the clinical application of
the product; and
``(III) the ability of the product
to address the unique needs and
capacities of a qualified individual.
``(ii) Inclusion of codes in list.--The
Secretary shall include the codes established
in clause (i) in the list under section
1861(iii)(2)(F).
``(E) Miscellaneous code for innovation and local
coverage determinations.--The coding subset established
under subparagraph (A) shall include at least one
miscellaneous code for items not otherwise classified.
``(6) Replacement of crt items.--
``(A) In general.--Payment shall be made for the
replacement of a CRT item (or for the replacement of
any part of such item) without regard to continuous use
or useful lifetime restrictions established under
section 1834(a)(7)(C) for items of durable medical
equipment if a qualified ordering practitioner
determines that the provision of a replacement item (or
a replacement part of such an item) is necessary
because--
``(i) there was a change in the
physiological condition of the qualified
individual to whom such item was provided;
``(ii) there was an irreparable change in
the condition of the CRT item (or, in the case
of the replacement of a part, in the part of
the CRT item); or
``(iii) the CRT item requires repairs and
the cost of such repairs would be more than 50
percent of the cost of a replacement of the CRT
item.
``(B) Deferral to providers.--
``(i) In general.--Subject to clause (ii),
if a qualified ordering practitioner determines
that a replacement of the CRT item, or the
replacement of a part of a CRT item, is
necessary pursuant to subparagraph (A), the
replacement item or part is deemed to be
reasonable and necessary for purposes of
section 1862(a)(1)(A).
``(ii) Exception for items under 3 years
old.--If the CRT item that is being replaced
(or the part of the CRT item that is being
replaced) under subparagraph (A) is less than 3
years old (calculated from the date on which
the qualified individual began to use the CRT
item or part), the Secretary may require the
qualified ordering practitioner to provide
confirmation of necessity of the replacement
item or replacement part, as the case may be.
``(7) Payment for temporary rental.--
``(A) In general.--If a CRT item owned by a
qualified individual needs to be repaired, payment may
be made under this subsection for the temporary rental
of a CRT item while the CRT item owned by such
individual is being repaired.
``(B) Basis; limitation.--Payment permitted under
subparagraph (A) shall be made on a monthly basis, and
the period of rental may not exceed two months.
``(C) Payment amount.--The amount of payment
allowed under subparagraph (A) for a month for the
rental of a CRT item shall be 10 percent of the
purchase price for the CRT item.
``(8) Definitions.--For purposes of this subsection:
``(A) HCPCS.--The term `HCPCS' refers to the Health
Care Procedure Coding System.
``(B) Qualified crt professional.--
``(i) In general.--The term `qualified CRT
professional' means an individual who--
``(I) is certified by the
Rehabilitation Engineering and
Assistive Technology Society of North
America as an assistive technology
professional or is certified by another
organization designated by the
Secretary (acting in consultation with
relevant parties) as providing a
certification that is equivalent to, or
more stringent than, the assistive
technology professional certification;
and
``(II) beginning two years after
the establishment of the designation
under clause (ii), achieves an
additional designation that
demonstrates the individual's
competencies and experience in
supplying CRT items.
``(ii) Establishment.--Not later than one
year after the date of the enactment of this
subsection, the Secretary, acting in
consultation with relevant parties, shall
establish the additional designation under
clause (i)(II).
``(iii) Relevant parties.--For purposes of
this subparagraph, the term `relevant parties'
includes clinicians, consumer groups, CRT
suppliers, and CRT manufacturers.
``(C) Qualified crt service technician.--The term
`qualified CRT service technician' means an individual
who--
``(i) is factory-trained by the
manufacturers of the CRT items being offered by
the suppler of such items;
``(ii) is trained and educated (including
through on the job training) to assemble, fit,
program, service, and repair CRT items; and
``(iii) on an annual basis, completes at
least 10 hours of continuing education specific
to the assembly, fitting, programming, service,
and repair of CRT items.
``(D) Qualified individual.--The term `qualified
individual' has the meaning given such term in section
1861(iii)(3)(E).
``(E) Qualified ordering practitioner.--The term
`qualified ordering practitioner' means a physician (as
defined in section 1861(r)), a physician assistant,
nurse practitioner, or a clinical nurse specialist (as
those terms are defined in section 1861(aa)(5)).''.
SEC. 5. CONFORMING AMENDMENTS.
(a) Exclusion From the In-Home Use Limitation for DME.--Section
1861(n) of the Social Security Act (42 U.S.C. 1395x(n)) is amended by
adding at the end the following: ``For 2014 and subsequent years, such
term does not include complex rehabilitation technologies (as defined
in subsection (iii)).''.
(b) Exemption From Competitive Acquisition.--Section 1847(a)(7) of
the Social Security Act (42 U.S.C. 1395w-3(a)(7)) is amended by adding
at the end the following new subparagraph:
``(C) CRT items.--For 2014 and subsequent years,
complex rehabilitation technology items (as defined in
section 1861(iii)).''.
(c) Exemption From SNF Consolidated Billing.--Section
1888(e)(2)(A)(iii) of the Social Security Act (42 U.S.C.
1395yy(e)(2)(A)(iii)) is amended by adding at the end the following:
``(VI) Complex rehabilitation
technology items (as defined in section
1861(iii)) if delivered to an inpatient
for use during the stay in the skilled
nursing facility as part of the plan of
care to allow the transition of such
qualified individuals from the skilled
nursing facility setting to the home
and community.''.
(d) Payment Exclusions.--Section 1834(a) of the Social Security Act
(42 U.S.C. 1395m(a)) is amended--
(1) in paragraph (4), by adding at the end the following
sentence ``For 2014 and subsequent years, the items covered by
this paragraph shall not include complex rehabilitation
technology items (as defined in section 1861(iii)).'';
(2) in paragraph (7)(A), by adding at the end the
following: ``For fiscal year 2014 and subsequent years, the
previous sentence shall not apply to power-driven wheelchairs
that are designated as CRT items under section 1861(iii).'';
and
(3) in paragraph (16), by inserting at the end the
following: ``The Secretary shall impose (and, may, as allowed
by the second sentence of this paragraph, waive) the
requirements of the first sentence of this paragraph to
suppliers of complex rehabilitation technology items, except
that, in order to avoid duplicate bonds, the Secretary shall
not impose such requirements with respect to suppliers of
complex rehabilitation technology items if such suppliers also
participate in the Medicare program as suppliers of durable
medical equipment.''.
(e) Requirements for Suppliers of Medical Equipment and Supplies.--
Section 1834(j)(5) of the Social Security Act (42 U.S.C. 1395m(j)(5))
is amended--
(1) by redesignating subparagraphs (E) and (F) as
subparagraphs (F) and (G), respectively;
(2) by inserting after subparagraph (D) the following new
subparagraph:
``(E) complex rehabilitation technology items (as
defined in section 1861(iii));''.
SEC. 6. EFFECTIVE DATE.
The amendments made by this Act shall apply to items and services
furnished on or after January 1, 2014.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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