I 

115TH CONGRESS 

1ST SESSION H. R. 750 

To amend title XVIII of the Social Security Act to expand and revise the 

classification of and payment for complex rehabilitation technology items 

under the Medicare program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 30, 2017 

Mr. SENSENBRENNER (for himself and Mr. CROWLEY) 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 expand 

and revise the classification of and payment for complex 

rehabilitation technology items under the Medicare program, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Ensuring Access to 

5 Quality Complex Rehabilitation Technology Act of 2017’’. 


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1 SEC. 2. FINDINGS. 

2 Congress finds the following: 

3 (1) Individuals with disabilities and significant 

4 medical conditions such as Cerebral Palsy, Muscular 

5 Dystrophy, Multiple Sclerosis, Spinal Cord Injury, 

6 Amyotrophic Lateral Sclerosis, and Spina Bifida ex7 perience physical, functional, and cognitive chal8 lenges every day. 

9 (2) Complex rehabilitation technology items (in 

10 this Act referred to as ‘‘CRT items’’), including 

11 products such as complex rehabilitation power wheel12 chairs, highly configurable manual wheelchairs, 

13 adaptive seating and positioning systems, and other 

14 specialized equipment, such as standing frames and 

15 gait trainers, enable individuals to maximize their 

16 function and minimize the extent and costs of their 

17 medical care. 

18 (3) Access to CRT items and related services 

19 can be threatened by inadequate coding, coverage, 

20 and payment policies for such items and services. 

21 These policies have restricted access to existing com22 plex rehabilitation technology and stifled innovation. 

23 Access challenges have increased over the past sev24 eral years and, without meaningful change to these 

25 policies, will only become greater in the future. 


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1 (4) Current Medicare policies often fail to ade2 quately address the needs of individuals with disabil3 ities, to consider the range of services furnished by 

4 complex rehabilitation technology suppliers, and to 

5 recognize and account for the complexity and unique 

6 nature of the equipment itself. 

7 (5) A significant factor responsible for such ac8 cess challenges is that individually-configurable CRT 

9 items do not have a distinct payment category under 

10 the Medicare program, but instead are classified 

11 within the broad category of durable medical equip12 ment (DME). CRT items serve patients with serious 

13 medical conditions that require a broader range of 

14 services and specialized personnel than what is re15 quired for standard DME. Individually configured 

16 CRT items also require more resources in the areas 

17 of configuring, training, and education to ensure ap18 propriate use and to optimize results. 

19 (6) Unlike most DME, a medical model incor20 porating an interdisciplinary team approach is nec21 essary to ensure proper individual configuration and 

22 use of a CRT item. This team typically includes a 

23 physician, a licensed physical or licensed occupa24 tional therapist (with no financial relationship with 

25 the CRT supplier), a qualified CRT professional, the 


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1 individual using such item, and sometimes a care2 giver for such individual. 

3 (7) The Medicare program should recognize the 

4 specialized nature of the CRT service delivery model, 

5 the required supporting processes and technology-re6 lated CRT services, the credentials and competencies 

7 needed by the providing suppliers and critical staff, 

8 and the related costs involved. A separate benefit 

9 category for CRT items would allow for unique cod10 ing, coverage, and payment rules and policies that 

11 address the unique needs of persons with disabilities 

12 and acknowledge the extensive service component. 

13 (8) Congress and the Centers for Medicare & 

14 Medicaid Services have previously recognized the 

15 benefits of a separate classification for unique, indi16 vidually configured products. In 2008, Congress ex17 empted certain CRT items from inclusion in the 

18 Medicare DME competitive bidding program, and 

19 Congress has created a separate and distinct benefit 

20 category for orthotics and prosthetics (custom braces 

21 and artificial limbs), which have their own medical 

22 policies, accreditation standards, and payment cal23 culations. 


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1 SEC. 3. ESTABLISHING SEPARATE BENEFIT CATEGORY FOR 

2 COMPLEX REHABILITATION TECHNOLOGIES 

3 WITHIN MEDICARE. 

4 Section 1861 of the Social Security Act (42 U.S.C. 

5 1395x) is amended— 

6 (1) in subsection (s)(2)— 

7 (A) in subparagraph (FF), by striking 

8 ‘‘and’’ at the end; 

9 (B) in subparagraph (GG), by inserting 

10 ‘‘and’’ at the end; and 

11 (C) by inserting after subparagraph (GG) 

12 the following new paragraph: 

13 ‘‘(HH) complex rehabilitation technology 

14 items (as defined in subsection (jjj));’’; and 

15 (2) by adding at the end the following new sub16 section: 

17 ‘‘Complex Rehabilitation Technology Item 

18 ‘‘(jjj)(1) The terms ‘complex rehabilitation technology 

19 item’ and ‘CRT item’ mean an item that— 

20 ‘‘(A) is designed or individually configured for 

21 a specific qualified individual to meet the individ22 ual’s unique— 

23 ‘‘(i) medical, physical, or functional needs 

24 related to a medical condition; and 

25 ‘‘(ii) capacities for basic activities of daily 

26 living or instrumental activities of daily living; 


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1 ‘‘(B) is primarily used to serve a medical or 

2 functional purpose and is generally not useful to a 

3 person in the absence of illness or injury; and 

4 ‘‘(C) requires certain services to ensure appro5 priate design, configuration, and use of such item, 

6 including— 

7 ‘‘(i) an evaluation of needs and capacities 

8 and matching of the features and functions of 

9 CRT items to the qualified individual who will 

10 use such an item; and 

11 ‘‘(ii) configuring, fitting, programming, ad12 justing, or adapting the particular complex re13 habilitation technology item for use by such in14 dividual. 

15 ‘‘(2)(A) The Secretary, in consultation with the Di16 rector of the Office on Disability, the Chairman of the Na17 tional Council on Disability, the Executive Director on the 

18 Interagency Committee on Disability, the Director of the 

19 National Institute on Disability, Independent Living, and 

20 Rehabilitation Research (NIDILRR) of the Department 

21 of Health and Human Services, and the Co-Chairmen of 

22 the Senior Oversight Committee’s Care Management Re23 form Team of the Department of Defense and the Depart24 ment of Veterans Affairs, shall, by regulation— 


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1 ‘‘(i) designate items as complex rehabilitation 

2 technology items; and 

3 ‘‘(ii) establish eligibility criteria to determine if 

4 an individual is a qualified individual based on the 

5 level of physical and functional needs and capacities 

6 related to a medical condition or conditions de7 scribed in subparagraph (E). 

8 For purposes of the previous sentence, the Secretary 

9 shall issue final regulations not later than one year 

10 after the date of the enactment of this subsection. 

11 ‘‘(B) The items designated as complex rehabilitation 

12 technology items under subparagraph (A)(i) shall include 

13 items which, as of January 1, 2015 , were classified within 

14 the following HCPCS codes: E0637, E0638, E0641, 

15 E0642, E0986, E1002, E1003, E1004, E1005, E1006, 

16 E1007, E1008, E1009, E1010, E1011, E1012, E1014, 

17 E1037, E1161, E1220, E1228, E1229, E1231, E1232, 

18 E1233, E1234, E1235, E1236, E1237, E1238, E1239 

19 E2209, E2291, E2292, E2293, E2294, E2295, E2300, 

20 E2301, E2310, E2311, E2312, E2313, E2321, E2322, 

21 E2323, E2324, E2325, E2326, E2327, E2328, E2329, 

22 E2330, E2331, E2351, E2373, E2374, E2376, E2377, 

23 E2609, E2610, E2617, E8000, E8001, E8002, K0005, 

24 K0835, K0836, K0837, K0838, K0839, K0840, K0841, 

25 K0842, K0843, K0848, K0849, K0850, K0851, K0852, 


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1 K0853, K0854, K0855, K0856, K0857, K0858, K0859, 

2 K0860, K0861, K0862, K0863, K0864, K0868, K0869, 

3 K0870, K0871, K0877, K0878, K0879, K0880, K0884, 

4 K0885, K0886, K0890, K0891, and K0898. 

5 ‘‘(C)(i) The items designated as complex rehabilita6 tion technology items under subparagraph (A)(i) shall in7 clude each item that— 

8 ‘‘(I) as of January 1, 2015, was classified with9 in the HCPCS codes under clause (ii); and 

10 ‘‘(II) the Secretary, acting in consultation with 

11 suppliers and manufacturers of CRT items, deter12 mines which items should be removed from such 

13 code and assigned a new HCPCS code because such 

14 item is a complex rehabilitation technology item. 

15 ‘‘(ii) The HCPCS codes under this clause are the fol16 lowing: E0143, E0950, E0951, E0952, E0955, E0956, 

17 E0957, E0960, E0967, E0978, E0990, E0995, E1015, 

18 E1016, E1028, E01029, E1030, E2205, E2208, E2231, 

19 E2368, E2369, E2370, E2605, E2606, E2607, E2608, 

20 E2613, E2614, E2615, E2616, E2620, E2621, E2624, 

21 E2625, K0004, K0009, K0040, K0108, and K0669. 

22 ‘‘(D) The Secretary may not designate as a complex 

23 rehabilitation technology item— 

24 ‘‘(i) adaptive equipment to operate motor vehi25 cles; 


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1 ‘‘(ii) prosthetic devices described in subsection 

2 (s)(8); or 

3 ‘‘(iii) orthotics and prosthetics described in sub4 section (s)(9). 

5 ‘‘(E) The Secretary shall publish guidelines and im6 plement a process to facilitate the submission of com7 prehensive coding proposals addressing CRT items to be 

8 submitted to the CMS HCPCS Work Group and included 

9 in the HCPCS Work Group public meetings. 

10 ‘‘(F) In establishing the eligibility criteria under sub11 paragraph (A)(ii), the Secretary shall include appropriate 

12 physical and functional needs and capacities arising from 

13 any of the following medical conditions: 

14 ‘‘(i) Congenital disorders, progressive or degen15 erative neuromuscular diseases, or injuries or trau16 ma that result in significant physical or functional 

17 needs and capacities. 

18 ‘‘(ii) Spinal cord injury, traumatic brain injury, 

19 cerebral palsy, muscular dystrophy, spina bifida, 

20 osteogenesis imperfecta, arthrogryposis, amyotrophic 

21 lateral sclerosis, multiple sclerosis, demyelinating 

22 disease, myelopathy, myopathy, progressive muscular 

23 atrophy, anterior horn cell disease, post-polio syn24 drome, cerebellar degeneration, dystonia, Hunting25 ton’s disease, or spinocerebellar disease. 


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1 ‘‘(iii) Certain types of amputation, paralysis, or 

2 paresis that result in significant physical or func3 tional needs and capacities. 

4 ‘‘(G)(i) For 2018, the Secretary shall publish— 

5 ‘‘(I) a list of items designated under subpara6 graph (A)(i) and the HCPCS codes for such items; 

7 and 

8 ‘‘(II) the eligibility criteria established under 

9 subparagraph (A)(ii). 

10 ‘‘(ii) For 2019 and each subsequent year, the Sec11 retary shall publish any necessary updates to such list (in12 cluding additions of new CRT items and any changes in 

13 applicable HCPCS codes) and to such eligibility criteria. 

14 ‘‘(H) The Secretary shall make available, on a public 

15 Web site, the process by which the Secretary will consider 

16 requests from members of the public that the Secretary— 

17 ‘‘(i) designate an item as a CRT item under 

18 subparagraph (A)(i); or 

19 ‘‘(ii) amend the eligibility criteria established 

20 under subparagraph (A)(ii). 

21 ‘‘(I) Nothing in this subsection, subsection 

22 (s)(2)(GG), or section 1834(s) shall be construed as re23 quiring the Secretary to provide for coverage under this 

24 title of any item that would not otherwise be covered under 

25 this title without application of the amendments made by 


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1 the Ensuring Access to Quality Complex Rehabilitation 

2 Technology Act of 2017. 

3 ‘‘(3) For purposes of this subsection: 

4 ‘‘(A) The term ‘capacity for basic activities of 

5 daily living’ means an individual’s capacity to safely 

6 participate in mobility and self-care activities includ7 ing— 

8 ‘‘(i) maintaining and changing body posi9 tion; 

10 ‘‘(ii) transferring to or from one surface to 

11 another; 

12 ‘‘(iii) walking; 

13 ‘‘(iv) moving from place to place using mo14 bility equipment, in a safe and timely manner; 

15 ‘‘(v) washing one’s self; 

16 ‘‘(vi) caring for the body; 

17 ‘‘(vii) toileting; 

18 ‘‘(viii) dressing; 

19 ‘‘(ix) eating; 

20 ‘‘(x) drinking; 

21 ‘‘(xi) looking after one’s health; and 

22 ‘‘(xii) carrying, moving, and handling ob23 jects to perform and participate in other activi24 ties under this subparagraph and subparagraph 

25 (B). 


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1 ‘‘(B) The term ‘capacity for instrumental activi2 ties of daily living’ means an individual’s capacity to 

3 safely participate in life situations in the home and 

4 community, including— 

5 ‘‘(i) communicating; 

6 ‘‘(ii) moving around using transportation; 

7 ‘‘(iii) acquiring necessities, goods, and 

8 services; 

9 ‘‘(iv) performing household tasks; 

10 ‘‘(v) caring for household members and 

11 family members; 

12 ‘‘(vi) caring for household objects; 

13 ‘‘(vii) engaging in education, work, employ14 ment and economic life; and 

15 ‘‘(viii) participating in community, social, 

16 and civic activities. 

17 ‘‘(C) The term ‘HCPCS’ refers to the Health 

18 Care Procedure Coding System. 

19 ‘‘(D) The term ‘individually-configured’ means, 

20 with respect to an item, that— 

21 ‘‘(i) the item has features, adjustments, or 

22 modifications specific to the individual who uses 

23 such item or the item is used in combination 

24 with other CRT items specific to the individ25 ual’s needs; and 


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1 ‘‘(ii) the supplier of such item must meas2 ure the individual and configure, fit, program, 

3 adjust, or adapt the item, as appropriate, so 

4 that the item is consistent with— 

5 ‘‘(I) an assessment or evaluation of 

6 the individual by an appropriate licensed 

7 clinician; 

8 ‘‘(II) the written order required under 

9 section 1834(s)(2)(B)(i); and 

10 ‘‘(III) medical condition, physical and 

11 functional needs and capacities, and body 

12 size of the individual who will use the item, 

13 the period for which such individual will 

14 need such item, and the intended use of 

15 such item by such individual. 

16 ‘‘(E) The term ‘qualified individual’ means an 

17 individual who— 

18 ‘‘(i) is enrolled under part B; and 

19 ‘‘(ii) has physical and functional needs and 

20 capacities that arise from a medical condition 

21 that meet the eligibility criteria established by 

22 the Secretary under paragraph (2)(A)(ii).’’. 

23 SEC. 4. PAYMENT RULES. 

24 Section 1834 of the Social Security Act (42 U.S.C. 

25 1395m) is amended by adding at the end the following: 


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1 ‘‘(v) PAYMENT FOR CRT ITEMS.— 

2 ‘‘(1) GENERAL RULE FOR PAYMENT.— 

3 ‘‘(A) IN GENERAL.—Not later than the 

4 date that is one year after the date of the en5 actment of this subsection, subject to subpara6 graph (B), the Secretary shall determine a pay7 ment system that shall apply to CRT items— 

8 ‘‘(i) with HCPCS codes that were as9 signed to the item under section 

10 1861(jjj)(2)(C)(i)(II); 

11 ‘‘(ii) for which no HCPCS code was 

12 assigned prior to such date; or 

13 ‘‘(iii) which, prior to such date, was 

14 classified under a miscellaneous HCPCS 

15 code. 

16 ‘‘(B) CONSIDERATIONS.—In determining 

17 the payment system under subparagraph (A), 

18 the Secretary— 

19 ‘‘(i) shall ensure that the payment 

20 amounts for CRT items under such system 

21 are adequate to provide qualified individ22 uals with access to such items and to en23 courage innovation, taking into account— 

24 ‘‘(I) the unique needs of qualified 

25 individuals for access to CRT items; 


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1 ‘‘(II) the unique complexity of 

2 CRT items; and 

3 ‘‘(III) the resources and staff 

4 needed to provide appropriate indi5 vidual configuration of CRT items for 

6 a qualified individual; 

7 ‘‘(ii) shall set the payment amounts 

8 for pure CRT codes, identified in section 

9 1861(jjj)(2)(B), at payment amounts that 

10 were applied for 2015 to such items, as ap11 plicable, under this section; 

12 ‘‘(iii) shall set the payment amounts 

13 for new CRT codes, created pursuant to 

14 section 1861(jjj)(2)(C)(ii) and paragraph 

15 (5)(D), except those designated for mis16 cellaneous or custom CRT items, at a pur17 chase price derived from a ‘‘modified gap 

18 filling methodology’’ that will allow the in19 clusion of any increases in the Consumer 

20 Price Index-Urban All Item during 2006 

21 and through each subsequent year in the 

22 calculations; 

23 ‘‘(iv) shall permit the payment 

24 amounts for CRT codes for miscellaneous 

25 or custom items to be determined based 


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1 upon contractor individual consideration, 

2 as is permitted by the Centers for Medi3 care & Medicaid Services as of the date of 

4 the enactment of this subsection; 

5 ‘‘(v) shall provide that CRT codes will 

6 be paid on a purchase basis with a bene7 ficiary rental basis option; 

8 ‘‘(vi) shall provide that codes for du9 rable medical equipment classified as 

10 capped rental will have a beneficiary pur11 chase basis option when provided on a 

12 CRT base; and 

13 ‘‘(vii) shall provide that payment 

14 amounts for CRT codes be adjusted annu15 ally by the increase in the Consumer Price 

16 Index-Urban All Item for the 12-month pe17 riod ending the preceding June 30th. 

18 ‘‘(C) EXCLUSIVE PAYMENT RULE.—This 

19 subsection shall constitute the exclusive provi20 sion of this title for payment for CRT items 

21 under this part or under part A to a home 

22 health agency. 

23 ‘‘(D) LIMITATION ON PAYMENT.—No pay24 ment shall be made under this subsection for a 

25 CRT item unless such CRT item— 


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1 ‘‘(i) is provided to a qualified indi2 vidual; 

3 ‘‘(ii) meets the clinical conditions for 

4 coverage established under paragraph (2); 

5 and 

6 ‘‘(iii) is furnished by a supplier ac7 credited pursuant to paragraph (3). 

8 ‘‘(2) CLINICAL CONDITIONS FOR COVERAGE.— 

9 ‘‘(A) IN GENERAL.—The Secretary shall 

10 establish standards for clinical conditions for 

11 payment for CRT items under this subsection. 

12 ‘‘(B) REQUIREMENTS.—The standards es13 tablished under subparagraph (A) shall require 

14 the following: 

15 ‘‘(i) WRITTEN ORDER.— 

16 ‘‘(I) IN GENERAL.—A qualified 

17 ordering practitioner shall provide a 

18 written order for a CRT item for a 

19 qualified individual before the Sec20 retary may provide payment for such 

21 item for such individual under this 

22 subsection. 

23 ‘‘(II) CRT EVALUATION.—In the 

24 case of a CRT item that is cat25 egorized by the Secretary, for purVerDate Sep 11 2014 04:21 Feb 03, 2017 Jkt 069200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H750.IH H750

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1 poses of the program under this title, 

2 as a manual wheelchair or a power 

3 wheelchair, and is to be provided to a 

4 qualified individual who has a diag5 nosis specified under subparagraph 

6 (C), the qualified ordering practitioner 

7 may not provide a written order under 

8 subclause (I) unless the qualified indi9 vidual has undergone a CRT evalua10 tion conducted by a licensed physical 

11 therapist or occupational therapist 

12 who has no financial relationship with 

13 the CRT supplier. The performance of 

14 such a CRT evaluation by a licensed 

15 physical or occupational therapist 

16 shall not be subject (or counted to17 wards) the limitation on certain ther18 apy services under section 1833(g). 

19 ‘‘(ii) DOCUMENTATION OF MEDICAL

20 NECESSITY.—A qualified ordering practi21 tioner who provides a written order under 

22 clause (i) shall maintain documentation of 

23 the medical necessity of such order for a 

24 period of seven years and shall make such 

25 documentation available to the Secretary 


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1 upon request. The documentation of med2 ical necessity under this clause shall in3 clude— 

4 ‘‘(I) evidence that the individual 

5 for whom the order was written has 

6 physical and functional needs and ca7 pacities related to a medical condition 

8 that meet the eligibility criteria estab9 lished under section 

10 1861(jjj)(2)(A)(ii); and 

11 ‘‘(II) evidence of any CRT eval12 uation required under clause (i)(II). 

13 ‘‘(C) SPECIFICATION OF DIAGNOSIS FOR

14 CRT EVALUATION.—The Secretary, in consulta15 tion with relevant parties (including the agen16 cies listed in section 1861(jjj)(2)(A), physicians, 

17 licensed physical therapists, licensed occupa18 tional therapists, and suppliers of complex reha19 bilitation technologies) shall specify the diag20 noses and other medical presentations for which 

21 the requirement for a CRT evaluation under 

22 subparagraph (B)(i)(II) shall apply. 

23 ‘‘(D) COVERAGE DETERMINATIONS.—In 

24 developing the standards under subparagraph 


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1 (A), the coverage of CRT items with respect to 

2 an individual shall be based on— 

3 ‘‘(i) the specific medical, physical, and 

4 functional needs of the individual; 

5 ‘‘(ii) the individual’s capacities for 

6 safe participation in basic activities of 

7 daily living and instrumental activities of 

8 daily living in all routinely encountered en9 vironments (as such terms are defined in 

10 section 1861(jjj)(3)); and 

11 ‘‘(iii) the individual’s expected pro12 gression of such needs and capacities. 

13 ‘‘(E) CONTRACTOR INDIVIDUALIZED CON14 SIDERATION.—The Secretary shall instruct 

15 Medicare contractors to provide individual con16 sideration in cases that may lack one of the di17 agnoses identified, but that exhibit comparable 

18 functional presentations or deficits or (or both) 

19 and where the need for CRT items has been 

20 documented by the qualified clinical profes21 sional. 

22 ‘‘(F) PAYMENT FOR RESIDENTS OF

23 SKILLED NURSING FACILITIES.—In the case of 

24 a qualified individual who is a resident of a 

25 skilled nursing facility, payment may only be 


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1 made under this subsection for a CRT item for 

2 such individual if such CRT item is required as 

3 part of a plan of care to allow the transition of 

4 such individual from the skilled nursing facility 

5 to a home or community setting. 

6 ‘‘(3) ESTABLISHMENT OF QUALITY STAND7 ARDS.— 

8 ‘‘(A) ESTABLISHMENT.—The Secretary 

9 shall establish, through regulation, quality 

10 standards for suppliers of CRT items. Such 

11 standards shall be applied prospectively and 

12 shall be published on the Internet Web site of 

13 the Centers for Medicare and Medicaid Serv14 ices. 

15 ‘‘(B) CONSULTATION.—In establishing the 

16 quality standards under subparagraph (A), the 

17 Secretary shall consult with relevant parties (in18 cluding clinicians, consumer groups, suppliers, 

19 and manufacturers). 

20 ‘‘(C) REQUIREMENTS OF STANDARDS.—In 

21 establishing the quality standards under sub22 paragraph (A), the Secretary shall require that 

23 the suppliers of CRT items meet the following 

24 requirements: 


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1 ‘‘(i) DME STANDARDS.—The supplier 

2 complies with all of the standards that are 

3 applicable to suppliers of durable medical 

4 equipment under subsection (a)(20) and 

5 suppliers of medical equipment and sup6 plies under subsection (j). 

7 ‘‘(ii) QUALIFIED CRT PROFES8 SIONAL.—The supplier of a CRT item 

9 makes available, in each service area 

10 served by such supplier, at least one quali11 fied CRT professional to— 

12 ‘‘(I) analyze the needs and capac13 ities of individuals for a CRT item in 

14 collaboration with the clinical team; 

15 ‘‘(II) assist in selecting an appro16 priate CRT item for such individual, 

17 given such needs and capacities; and 

18 ‘‘(III) provide technology-related 

19 training to such individual in the 

20 proper use and maintenance of the 

21 CRT items. 

22 ‘‘(iii) TRIAL EQUIPMENT.—The sup23 plier of the CRT item provides the quali24 fied individual with appropriate equipment 

25 for trial and simulation, if a physician, liVerDate Sep 11 2014 04:21 Feb 03, 2017 Jkt 069200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\H750.IH H750

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1 censed physical therapist, or licensed occu2 pational therapist determines that the pro3 vision of such equipment is necessary. 

4 ‘‘(iv) INFORMATION ON SERVICE AND

5 REPAIR.—The supplier of the CRT item 

6 provides the qualified individual with writ7 ten information on accessing service and 

8 repair for the CRT item before the CRT 

9 item is ordered for the individual. 

10 ‘‘(v) REPAIR.—The supplier of a CRT 

11 item— 

12 ‘‘(I) makes available, in each 

13 service area served by such supplier, 

14 at least one qualified CRT service 

15 technician to service and repair CRT 

16 items that— 

17 ‘‘(aa) are furnished by such 

18 supplier; and 

19 ‘‘(bb) at the time of the 

20 need for repair, are located in a 

21 service area of the supplier; or 

22 ‘‘(II) if the qualified individual 

23 lives outside the service area served by 

24 such supplier at the time of order of 

25 the CRT item, the supplier shall disVerDate Sep 11 2014 04:21 Feb 03, 2017 Jkt 069200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\H750.IH H750

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1 close in writing to the qualified indi2 vidual that the supplier does not pro3 vide repair service for such item and 

4 provide contact information for enti5 ties that do provide such repair serv6 ice. 

7 ‘‘(vi) RENTAL EQUIPMENT.—If pay8 ment is allowed under paragraph (6), the 

9 supplier of the CRT item provides tem10 porary rental equipment to the qualified 

11 individual when the supplier is repairing a 

12 qualified individual’s CRT item that was 

13 paid for under this subsection. 

14 ‘‘(4) APPLICATION OF STANDARDS AND AC15 CREDITATION PROGRAM FOR SUPPLIERS OF CRT

16 ITEMS.— 

17 ‘‘(A) IN GENERAL.— 

18 ‘‘(i) REQUIREMENT FOR PROVIDER OR

19 SUPPLIER NUMBER.—The Secretary shall 

20 not provide a supplier of CRT items with 

21 a provider or supplier number to submit 

22 claims for payment under this title unless 

23 the supplier is in compliance with the 

24 standards under paragraph (3). 


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1 ‘‘(ii) REQUIREMENT FOR PAYMENT.— 

2 Payment shall not be made under this part 

3 for CRT items furnished by a supplier un4 less the supplier is in compliance with the 

5 standards under paragraph (3). 

6 ‘‘(B) APPLICATION OF ACCREDITATION RE7 QUIREMENT.—In implementing quality stand8 ards under paragraph (3), the Secretary shall 

9 require suppliers furnishing CRT items, on or 

10 after one year after the standards are published 

11 under such paragraph, directly or as a subcon12 tractor for another entity— 

13 ‘‘(i) to comply with such standards; 

14 and 

15 ‘‘(ii) to have submitted to the Sec16 retary evidence of accreditation by an ac17 creditation organization designated under 

18 subparagraph (C) demonstrating that the 

19 supplier is complying with such standards. 

20 ‘‘(C) DESIGNATION OF INDEPENDENT AC21 CREDITATION ORGANIZATIONS.—Not later than 

22 the date that is one year after the date on 

23 which the Secretary implements the quality 

24 standards under paragraph (3), the Secretary 


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1 shall designate and approve one or more inde2 pendent accreditation organizations that— 

3 ‘‘(i) are approved under subsection 

4 (a)(20)(B); and 

5 ‘‘(ii) the Secretary has determined 

6 have the capability to assess whether sup7 pliers of CRT items meet the quality 

8 standards established under paragraph (3). 

9 ‘‘(5) CODING SYSTEM FOR COMPLEX REHABILI10 TATION TECHNOLOGIES.— 

11 ‘‘(A) IN GENERAL.—The Secretary shall, 

12 in consultation with suppliers and manufactur13 ers of CRT items, establish a formal process to 

14 allow submission of CRT code set modification 

15 requests by stakeholder groups for comprehen16 sive coding changes related to entire policy 

17 groups. This process shall include a specific ap18 plication, public meeting participation and an 

19 appeals process. The Secretary shall then, in 

20 consultation with suppliers and manufacturers 

21 of CRT items, establish a HCPCS coding sub22 set that shall utilize and include HCPCS codes 

23 described in section 1861(jjj)(2) for CRT items 

24 for which payment may be made under this 

25 subsection. 


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1 ‘‘(B) TREATMENT OF EXISTING PROD2 UCTS.— 

3 ‘‘(i) IN GENERAL.—With respect to 

4 CRT items for which payment was avail5 able under this title before the effective 

6 date of the amendments made by Ensuring 

7 Access to Quality Complex Rehabilitation 

8 Technology Act of 2017, the Secretary 

9 shall assign such items to a code in the 

10 coding subset established under subpara11 graph (A). 

12 ‘‘(ii) UPDATES.—After the initial as13 signment under clause (i), the Secretary 

14 may decide to reassign additional product 

15 categories, or items within those cat16 egories, that exist before the date of the 

17 enactment of this subsection to the CRT 

18 coding subset. 

19 ‘‘(iii) CONSULTATION.—Before mak20 ing reassignments of CRT items under 

21 clause (ii), the Secretary shall consult with 

22 suppliers and manufacturers of such items. 

23 The Secretary shall not require manufac24 turers of CRT items for which payment 

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1 fective date of the amendments made by 

2 the Ensuring Access to Quality Complex 

3 Rehabilitation Technology Act of 2017 to 

4 submit requests for reassignment of the 

5 code for such product to the coding subset 

6 under subparagraph (A) as long as— 

7 ‘‘(I) no changes have been made 

8 to the code definitions, required code 

9 characteristics or test requirements; 

10 and 

11 ‘‘(II) the item was previously 

12 verified to meet the code require13 ments. 

14 ‘‘(C) REMOVING COMPLEX REHABILITA15 TION TECHNOLOGY FROM DME CODES.—The 

16 Secretary shall, in consultation with suppliers 

17 and manufacturers of CRT items— 

18 ‘‘(i) remove from the coding subset for 

19 durable medical equipment any CRT items 

20 that are included in the coding subset 

21 under subparagraph (A); and 

22 ‘‘(ii) assign new codes to such CRT 

23 items based on technological differences to 

24 support adequate access to meet clinical 

25 outcomes and for purposes of including 


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1 such items in the subset under subpara2 graph (A). 

3 ‘‘(D) NEW TECHNOLOGY.— 

4 ‘‘(i) IN GENERAL.—The Secretary 

5 shall update as needed the HCPCS level II 

6 process used to modify the code set to in7 clude CRT items for the purposes of estab8 lishing new codes and determining prod9 ucts to be classified as CRT items. In de10 termining if a product is a CRT item, the 

11 Secretary shall consider— 

12 ‘‘(I) if the product is novel; 

13 ‘‘(II) the clinical application of 

14 the product; and 

15 ‘‘(III) the ability of the product 

16 to address the unique needs and ca17 pacities of a qualified individual. 

18 ‘‘(ii) INCLUSION OF CODES IN LIST.— 

19 The Secretary shall include the codes es20 tablished in clause (i) in the list under sec21 tion 1861(jjj)(2)(F). 

22 ‘‘(E) MISCELLANEOUS CODE FOR INNOVA23 TION AND LOCAL COVERAGE DETERMINA24 TIONS.—The coding subset established under 

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1 cellaneous code for items not otherwise classi2 fied. 

3 ‘‘(F) ESTABLISHMENT OF ADEQUATE

4 HCPCS CODES TO REFLECT SPECIALIZED NA5 TURE OF CRT.—The Secretary shall ensure that 

6 HCPCS codes exist (or are developed) to rep7 resent the specialized nature of CRT, including 

8 codes to represent custom CRT manual and 

9 power wheelchairs and modifications to CRT 

10 manual and power wheelchair frames, and mis11 cellaneous codes for CRT manual and power 

12 wheelchairs that are otherwise classified. 

13 ‘‘(6) REPLACEMENT OF CRT ITEMS.— 

14 ‘‘(A) IN GENERAL.—Payment shall be 

15 made for the replacement of a CRT item (or for 

16 the replacement of any part of such item) with17 out regard to continuous use or useful lifetime 

18 restrictions established under subsection 

19 (a)(7)(C) for items of durable medical equip20 ment if a qualified ordering practitioner deter21 mines that the provision of a replacement item 

22 (or a replacement part of such an item) is nec23 essary because— 


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1 ‘‘(i) there was a change in the physio2 logical condition of the qualified individual 

3 to whom such item was provided; 

4 ‘‘(ii) there was an irreparable change 

5 in the condition of the CRT item (or, in 

6 the case of the replacement of a part, in 

7 the part of the CRT item); or 

8 ‘‘(iii) the CRT item requires repairs 

9 and the cost of such repairs would be more 

10 than 50 percent of the cost of a replace11 ment of the CRT item. 

12 ‘‘(B) DEFERRAL TO PROVIDERS.— 

13 ‘‘(i) IN GENERAL.—Subject to clause 

14 (ii), if a qualified ordering practitioner de15 termines that a replacement of the CRT 

16 item, or the replacement of a part of a 

17 CRT item, is necessary pursuant to sub18 paragraph (A), the replacement item or 

19 part is deemed to be reasonable and nec20 essary for purposes of section 

21 1862(a)(1)(A). 

22 ‘‘(ii) EXCEPTION FOR ITEMS UNDER 3

23 YEARS OLD.—If the CRT item that is 

24 being replaced (or the part of the CRT 

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1 graph (A) is less than 3 years old (cal2 culated from the date on which the quali3 fied individual began to use the CRT item 

4 or part), the Secretary may require the 

5 qualified ordering practitioner to provide 

6 confirmation of necessity of the replace7 ment item or replacement part, as the case 

8 may be. 

9 ‘‘(7) PAYMENT FOR TEMPORARY RENTAL.— 

10 ‘‘(A) IN GENERAL.—If a CRT item owned 

11 by a qualified individual needs to be repaired, 

12 payment may be made under this subsection for 

13 the temporary rental of a CRT item while the 

14 CRT item owned by such individual is being re15 paired. 

16 ‘‘(B) BASIS; LIMITATION.—Payment per17 mitted under subparagraph (A) shall be made 

18 on a monthly basis, and the period of rental 

19 may not exceed two months. 

20 ‘‘(C) PAYMENT AMOUNT.—The amount of 

21 payment allowed under subparagraph (A) for a 

22 month for the rental of a CRT item shall be 10 

23 percent of the purchase price for the CRT item. 

24 ‘‘(8) DEFINITIONS.—For purposes of this sub25 section: 


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1 ‘‘(A) HCPCS.—The term ‘HCPCS’ refers 

2 to the Health Care Procedure Coding System. 

3 ‘‘(B) QUALIFIED CRT PROFESSIONAL.— 

4 ‘‘(i) IN GENERAL.—The term ‘quali5 fied CRT professional’ means an individual 

6 who— 

7 ‘‘(I) is certified by the Rehabili8 tation Engineering and Assistive 

9 Technology Society of North America 

10 as an assistive technology professional 

11 or is certified by another organization 

12 designated by the Secretary (acting in 

13 consultation with relevant parties) as 

14 providing a certification that is equiv15 alent to, or more stringent than, the 

16 assistive technology professional cer17 tification; and 

18 ‘‘(II) beginning two years after 

19 the establishment of the designation 

20 under clause (ii), achieves an addi21 tional designation that demonstrates 

22 the individual’s competencies and ex23 perience in supplying CRT items. 

24 ‘‘(ii) ESTABLISHMENT.—Not later 

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1 ment of this subsection, the Secretary, act2 ing in consultation with relevant parties, 

3 shall establish the additional designation 

4 under clause (i)(II). 

5 ‘‘(iii) RELEVANT PARTIES.—For pur6 poses of this subparagraph, the term ‘rel7 evant parties’ includes clinicians, consumer 

8 groups, CRT suppliers, and CRT manufac9 turers. 

10 ‘‘(C) QUALIFIED CRT SERVICE TECHNI11 CIAN.—The term ‘qualified CRT service techni12 cian’ means an individual who— 

13 ‘‘(i) is factory-trained by the manufac14 turers of the CRT items being offered by 

15 the suppler of such items; 

16 ‘‘(ii) is trained and educated (includ17 ing through on-the-job training) to assem18 ble, fit, program, service, and repair CRT 

19 items; and 

20 ‘‘(iii) on an annual basis, completes at 

21 least 10 hours of continuing education spe22 cific to the assembly, fitting, programming, 

23 service, and repair of CRT items. 


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1 ‘‘(D) QUALIFIED INDIVIDUAL.—The term 

2 ‘qualified individual’ has the meaning given 

3 such term in section 1861(iii)(3)(E). 

4 ‘‘(E) QUALIFIED ORDERING PRACTI5 TIONER.—The term ‘qualified ordering practi6 tioner’ means a physician (as defined in section 

7 1861(r)), a physician assistant, nurse practi8 tioner, or a clinical nurse specialist (as those 

9 terms are defined in section 1861(aa)(5)). 

10 ‘‘(F) QUALIFIED LICENSED CLINICIAN.— 

11 The term ‘qualified licensed clinician’ means a 

12 licensed physical therapist or occupational ther13 apist or physician who possesses specialized 

14 training and experience in providing seating 

15 and mobility services and the skills to perform 

16 all aspects of the evaluation described in para17 graph (2)(B)(i)(II).’’. 

18 SEC. 5. CONFORMING AMENDMENTS. 

19 (a) EXCLUSION FROM THE IN-HOME USE LIMITA20 TION FOR DME.—Section 1861(n) of the Social Security 

21 Act (42 U.S.C. 1395x(n)) is amended by adding at the 

22 end the following: ‘‘For 2018 and subsequent years, such 

23 term does not include complex rehabilitation technologies 

24 (as defined in subsection (jjj)).’’. 


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1 (b) EXEMPTION FROM COMPETITIVE ACQUISI2 TION.—Section 1847(a)(7) of the Social Security Act (42 

3 U.S.C. 1395w–3(a)(7)) is amended by adding at the end 

4 the following new subparagraph: 

5 ‘‘(C) CRT ITEMS.—For 2018 and subse6 quent years, complex rehabilitation technology 

7 items (as defined in section 1861(iii)).’’. 

8 (c) EXEMPTION FROM SNF CONSOLIDATED BILL9 ING.—Section 1888(e)(2)(A)(iii) of the Social Security Act 

10 (42 U.S.C. 1395yy(e)(2)(A)(iii)) is amended by adding at 

11 the end the following: 

12 ‘‘(VI) Complex rehabilitation 

13 technology items (as defined in section 

14 1861(jjj)) if delivered to an inpatient 

15 for use during the stay in the skilled 

16 nursing facility as part of the plan of 

17 care to allow the transition of such 

18 qualified individuals from the skilled 

19 nursing facility setting to the home 

20 and community.’’. 

21 (d) PAYMENT EXCLUSIONS.—Section 1834(a) of the 

22 Social Security Act (42 U.S.C. 1395m(a)) is amended— 

23 (1) in paragraph (4), by adding at the end the 

24 following sentence ‘‘For 2018 and subsequent years, 

25 the items covered by this paragraph shall not include 


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1 complex rehabilitation technology items (as defined 

2 in section 1861(jjj)).’’; 

3 (2) in paragraph (7)(A), by adding at the end 

4 the following: ‘‘For fiscal year 2018 and subsequent 

5 years, the previous sentence shall not apply to 

6 power-driven wheelchairs that are designated as 

7 CRT items under section 1861(jjj).’’; and 

8 (3) in paragraph (16), by inserting at the end 

9 the following: ‘‘The Secretary shall impose (and, 

10 may, as allowed by the second sentence of this para11 graph, waive) the requirements of the first sentence 

12 of this paragraph to suppliers of complex rehabilita13 tion technology items, except that, in order to avoid 

14 duplicate bonds, the Secretary shall not impose such 

15 requirements with respect to suppliers of complex re16 habilitation technology items if such suppliers also 

17 participate in the Medicare program as suppliers of 

18 durable medical equipment.’’. 

19 (e) REQUIREMENTS FOR SUPPLIERS OF MEDICAL

20 EQUIPMENT AND SUPPLIES.—Section 1834(j)(5) of the 

21 Social Security Act (42 U.S.C. 1395m(j)(5)) is amend22 ed— 

23 (1) by redesignating subparagraphs (E) and 

24 (F) as subparagraphs (F) and (G), respectively; and 


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1 (2) by inserting after subparagraph (D) the fol2 lowing new subparagraph: 

3 ‘‘(E) complex rehabilitation technology 

4 items (as defined in section 1861(jjj));’’. 

5 SEC. 6. EFFECTIVE DATE. 

6 The amendments made by this Act shall apply to 

7 items and services furnished on or after January 1, 2018. 

Æ 


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