II 

113TH CONGRESS 

1ST SESSION S. 948 

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 SENATE OF THE UNITED STATES 

MAY 14, 2013 

Mr. SCHUMER (for himself and Mr. COCHRAN) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

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. 

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 2013’’. 


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1 SEC. 2. ESTABLISHING SEPARATE BENEFIT CATEGORY FOR 

2 COMPLEX REHABILITATION TECHNOLOGIES 

3 WITHIN MEDICARE. 

4 (a) NEW CATEGORY.—Section 1861 of the Social Se5 curity Act (42 U.S.C. 1395x) is amended— 

6 (1) in subsection (s)(2)— 

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

8 ‘‘and’’ at the end; 

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

10 ‘‘and’’ at the end; and 

11 (C) by inserting after subparagraph (FF) 

12 the following new paragraph: 

13 ‘‘(GG) complex rehabilitation technology 

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

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

17 ‘‘Complex Rehabilitation Technology Item 

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

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

20 ‘‘(A) is designed and configured for a specific 

21 qualified individual to meet the individual’s unique— 

22 ‘‘(i) medical, physical, and functional needs 

23 related to a medical condition; and 

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

25 living and instrumental activities of daily living; 


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1 ‘‘(B) is primarily used to serve a medical pur2 pose and is generally not useful to a person in the 

3 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 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 and Rehabilitation Re20 search of the Department of Education, and the Co-Chair21 men of the Senior Oversight Committee’s Care Manage22 ment Reform Team of the Department of Defense and the 

23 Veterans Administration, shall, by regulation— 

24 ‘‘(i) designate items as complex rehabilitation 

25 technology items; and 


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

2 an individual is a qualified individual based on the 

3 level of physical and functional needs and capacities 

4 related to a medical condition or conditions de5 scribed in subparagraph (E). 

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

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

8 items which, as of January 1, 2013 , were classified within 

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

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

11 E1007, E1008, E1009, E1010, E1011, E1014, E1037, 

12 E1161, E1220, E1228, E1229, E1231, E1232, E1233, 

13 E1234, E1235, E1236, E1237, E1238, E1239 E2209, 

14 E2291, E2292, E2293, E2294, E2295, E2300, E2301, 

15 E2310, E2311, E2312, E2313, E2321, E2322, E2323, 

16 E2324, E2325, E2326, E2327, E2328, E2329, E2330, 

17 E2331, E2351, E2373, E2374, E2376, E2377, E2609, 

18 E2610, E2617, E8000, E8001, E8002, K0005, K0835, 

19 K0836, K0837, K0838, K0839, K0840, K0841, K0842, 

20 K0843, K0848, K0849, K0850, K0851, K0852, K0853, 

21 K0854, K0855, K0856, K0857, K0858, K0859, K0860, 

22 K0861, K0862, K0863, K0864, K0868, K0869, K0870, 

23 K0871, K0877, K0878, K0879, K0880, K0884, K0885, 

24 K0886, K0890, K0891, and K0898. 


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1 ‘‘(C)(i) The items designated as complex rehabilita2 tion technology items under subparagraph (A)(i) shall in3 clude each item that— 

4 ‘‘(I) as of January 1, 2013, was classified with5 in the HCPCS codes under clause (ii); and 

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

7 suppliers and manufacturers of CRT items, deter8 mines which item should be removed from such code 

9 and assigned a new HCPCS code because such item 

10 is a complex rehabilitation technology item. 

11 ‘‘(ii) The HCPCS codes under this clause are the fol12 lowing: E0143, E0950, E0951, E0952, E0955, E0956, 

13 E0957, E0958, E0960, E0967, E0978, E0990, E1015, 

14 E1016, E1028, E1029, E1030, E2205, E2208, E2231, 

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

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

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

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

19 rehabilitation technology item— 

20 ‘‘(i) adaptive equipment to operate motor vehi21 cles; 

22 ‘‘(ii) prosthetic devices described in subsection 

23 (s)(8); or 

24 ‘‘(iii) orthotics and prosthetics described in sub25 section (s)(9). 


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1 ‘‘(E) In establishing the eligibility criteria under sub2 paragraph (A)(ii), the Secretary shall include appropriate 

3 physical and functional needs and capacities arising from 

4 any of the following medical conditions: 

5 ‘‘(i) Congenital disorders, progressive or degen6 erative neuromuscular diseases, or injuries or trau7 ma that result in significant physical or functional 

8 needs and capacities. 

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

10 cerebral palsy, muscular dystrophy, spina bifida, 

11 osteogenesis imperfecta, arthrogryposis, amyotrophic 

12 lateral sclerosis, multiple sclerosis, demyelinating 

13 disease, myelopathy, myopathy, progressive muscular 

14 atrophy, anterior horn cell disease, post-polio syn15 drome, cerebellar degeneration, dystonia, Hunting16 ton’s disease, or spinocerebellar disease. 

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

18 paresis that result in significant physical or func19 tional needs and capacities. 

20 ‘‘(F)(i) For 2014, the Secretary shall publish— 

21 ‘‘(I) a list of items designated under subpara22 graph (A)(i) and the HCPCS codes for such items; 

23 and 

24 ‘‘(II) the eligibility criteria established under 

25 subparagraph (A)(ii). 


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1 ‘‘(ii) For 2015 and each subsequent year, the Sec2 retary shall publish any necessary updates to such list (in3 cluding additions of new CRT items and any changes in 

4 applicable HCPCS codes) and to such eligibility criteria. 

5 ‘‘(G) The Secretary shall make available, on a public 

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

7 requests from members of the public that the Secretary— 

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

9 subparagraph (A)(i); or 

10 ‘‘(ii) amend the eligibility criteria established 

11 under subparagraph (A)(ii). 

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

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

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

15 participate in mobility and self-care activities includ16 ing— 

17 ‘‘(i) maintaining and changing body posi18 tion; 

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

20 another; 

21 ‘‘(iii) walking; 

22 ‘‘(iv) moving from place to place using mo23 bility equipment, in a safe and timely manner; 

24 ‘‘(v) washing one’s self; 

25 ‘‘(vi) caring for the body; 


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1 ‘‘(vii) toileting; 

2 ‘‘(viii) dressing; 

3 ‘‘(ix) eating; 

4 ‘‘(x) drinking; 

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

6 ‘‘(xii) carrying, moving, and handling ob7 jects to perform and participate in other activi8 ties under this subparagraph and subparagraph 

9 (B). 

10 ‘‘(B) The term ‘capacity for instrumental activi11 ties of daily living’ means an individual’s capacity to 

12 safely participate in life situations in the home and 

13 community, including— 

14 ‘‘(i) communicating; 

15 ‘‘(ii) moving around using transportation; 

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

17 services; 

18 ‘‘(iv) performing household tasks; 

19 ‘‘(v) caring for household members and 

20 family members; 

21 ‘‘(vi) caring for household objects; 

22 ‘‘(vii) engaging in education, work, employ23 ment and economic life; and 

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

25 and civic activities. 


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

2 Care Procedure Coding System. 

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

4 with respect to an item, that— 

5 ‘‘(i) the item has a combination of fea6 tures, adjustments, or modifications that are 

7 specific to the individual who uses such item; 

8 and 

9 ‘‘(ii) the supplier of such item must meas10 ure the individual and configure, fit, program, 

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

12 that the item is consistent with— 

13 ‘‘(I) an assessment or evaluation of 

14 the individual by an appropriate licensed 

15 clinician; 

16 ‘‘(II) the written order required under 

17 section 1834(p)(2)(B)(i); and 

18 ‘‘(III) medical condition, physical and 

19 functional needs and capacities, and body 

20 size of the individual who will use the item, 

21 the period for which such individual will 

22 need such item, and the intended use of 

23 such item by such individual. 

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

25 individual who— 


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

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

3 capacities that arise from a medical condition 

4 that meet the eligibility criteria established by 

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

6 SEC. 3. PAYMENT RULES. 

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

8 1395m) is amended by adding at the end the following: 

9 ‘‘(p) COVERAGE AND PAYMENT FOR CRT ITEMS.— 

10 ‘‘(1) GENERAL RULE FOR PAYMENT.— 

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

12 date that is one year after the date of the en13 actment of this subsection, subject to subpara14 graph (B), the Secretary shall determine a pay15 ment system that shall apply to CRT items— 

16 ‘‘(i) with HCPCS codes that were as17 signed to the item under section 

18 1861(iii)(2)(C)(i)(II); 

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

20 assigned prior to such date; or 

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

22 classified under a miscellaneous HCPCS 

23 code. 


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1 ‘‘(B) CONSIDERATIONS.—In determining 

2 the payment system under subparagraph (A), 

3 the Secretary— 

4 ‘‘(i) may disregard the freezes on CPI 

5 increases to the payment amounts for du6 rable medical equipment that occurred be7 fore the date of the enactment of this sub8 section, when determining the payment 

9 amount for CRT items; and 

10 ‘‘(ii) shall ensure that the payment 

11 amounts for CRT items under such system 

12 are adequate to provide qualified individ13 uals with access to such items and to en14 courage innovation, taking into account— 

15 ‘‘(I) the unique needs of qualified 

16 individuals for access to CRT items; 

17 ‘‘(II) the unique complexity of 

18 CRT items; and 

19 ‘‘(III) the resources and staff 

20 needed to provide appropriate 

21 customization of CRT items for a 

22 qualified individual. 

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

24 subsection shall constitute the exclusive provi25 sion of this title for payment for CRT items 


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1 under this part or under part A to a home 

2 health agency. 

3 ‘‘(D) LIMITATION ON PAYMENT.—No pay4 ment shall be made under this subsection for a 

5 CRT item unless such CRT item— 

6 ‘‘(i) is provided to a qualified indi7 vidual; 

8 ‘‘(ii) meets the clinical conditions for 

9 coverage established under paragraph (2); 

10 and 

11 ‘‘(iii) is furnished by a supplier ac12 credited pursuant to paragraph (3). 

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

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

15 establish standards for clinical conditions for 

16 payment for CRT items under this subsection. 

17 ‘‘(B) REQUIREMENTS.—The standards es18 tablished under subparagraph (A) shall require 

19 the following: 

20 ‘‘(i) WRITTEN ORDER.— 

21 ‘‘(I) IN GENERAL.—A qualified 

22 ordering practitioner shall provide a 

23 written order for a CRT item for a 

24 qualified individual before the Sec25 retary may provide payment for such 


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1 item for such individual under this 

2 subsection. 

3 ‘‘(II) CRT EVALUATION.—In the 

4 case of a CRT item that is cat5 egorized by the Secretary, for pur6 poses of the program under this title, 

7 as a manual wheelchair or a power 

8 wheelchair, and is to be provided to a 

9 qualified individual who has a diag10 nosis specified under subparagraph 

11 (C), the qualified ordering practitioner 

12 may not provide a written order under 

13 subclause (I) unless the qualified indi14 vidual has undergone a CRT evalua15 tion conducted by a licensed physical 

16 therapist or occupational therapist 

17 who has no financial relationship with 

18 the CRT supplier. 

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(iii)(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(iii)(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(iii)(3)); and 

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

13 ‘‘(E) PAYMENT FOR RESIDENTS OF

14 SKILLED NURSING FACILITIES.—In the case of 

15 a qualified individual who is a resident of a 

16 skilled nursing facility, payment may only be 

17 made under this subsection for a CRT item for 

18 such individual if such CRT item is required as 

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

20 such individual from the skilled nursing facility 

21 to a home or community setting. 

22 ‘‘(3) ESTABLISHMENT OF QUALITY STAND23 ARDS.— 

24 ‘‘(A) ESTABLISHMENT.—The Secretary 

25 shall establish, through regulation, quality 


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1 standards for suppliers of CRT items. Such 

2 standards shall be applied prospectively and 

3 shall be published on the Internet Web site of 

4 the Centers for Medicare and Medicaid Serv5 ices. 

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

7 quality standards under subparagraph (A), the 

8 Secretary shall consult with relevant parties (in9 cluding clinicians, consumer groups, suppliers, 

10 and manufacturers). 

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

12 establishing the quality standards under sub13 paragraph (A), the Secretary shall require that 

14 the suppliers of CRT items meet the following 

15 requirements: 

16 ‘‘(i) DME STANDARDS AS MINIMUM.— 

17 The supplier complies with all of the 

18 standards that are applicable to suppliers 

19 of durable medical equipment under sub20 section (a)(20) and suppliers of medical 

21 equipment and supplies under subsection 

22 (j). 

23 ‘‘(ii) QUALIFIED CRT PROFES24 SIONAL.—The supplier of a CRT item 

25 makes available, in each service area 


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1 served by such supplier, at least one quali2 fied CRT professional to— 

3 ‘‘(I) analyze the needs and capac4 ities of individuals for a CRT item in 

5 collaboration with the clinical team; 

6 ‘‘(II) assist in selecting an appro7 priate CRT item for such individual, 

8 given such needs and capacities; and 

9 ‘‘(III) provide technology-related 

10 training to such individual in the 

11 proper use and maintenance of the 

12 CRT items. 

13 ‘‘(iii) TRIAL EQUIPMENT.—The sup14 plier of the CRT item provides the quali15 fied individual with appropriate equipment 

16 for trial and simulation, if a physician, li17 censed physical therapist, or licensed occu18 pational therapist determines that the pro19 vision of such equipment is necessary. 

20 ‘‘(iv) INFORMATION ON REPAIR.—The 

21 supplier of the CRT item provides the 

22 qualified individual with written informa23 tion on the service and repair of the CRT 

24 item provided to such individual. 


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

2 item— 

3 ‘‘(I) makes available, in each 

4 service area served by such supplier, 

5 at least one qualified CRT service 

6 technician to service and repair CRT 

7 items that— 

8 ‘‘(aa) are furnished by such 

9 supplier; and 

10 ‘‘(bb) at the time of the 

11 need for repair, are located in a 

12 service area of the supplier; or 

13 ‘‘(II) at the time of sale of the 

14 CRT item, discloses to the qualified 

15 individual that the supplier does not 

16 provide repair service for such item 

17 and provides contact information for 

18 entities that do provide such repair 

19 service. 

20 ‘‘(vi) RENTAL EQUIPMENT.—If pay21 ment is allowed under paragraph (6), the 

22 supplier of the CRT item provides tem23 porary rental equipment to the qualified 

24 individual when the supplier is repairing a 


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1 qualified individual’s CRT item that was 

2 paid for under this subsection. 

3 ‘‘(4) APPLICATION OF STANDARDS AND AC4 CREDITATION PROGRAM FOR SUPPLIERS OF CRT

5 ITEMS.— 

6 ‘‘(A) IN GENERAL.— 

7 ‘‘(i) REQUIREMENT FOR PROVIDER OR

8 SUPPLIER NUMBER.—The Secretary shall 

9 not provide a supplier of CRT items with 

10 a provider or supplier number to submit 

11 claims for payment under this title unless 

12 the supplier is in compliance with the 

13 standards under paragraph (3). 

14 ‘‘(ii) REQUIREMENT FOR PAYMENT.— 

15 Payment shall not be made under this part 

16 for CRT items furnished by a supplier un17 less the supplier is in compliance with the 

18 standards under paragraph (3). 

19 ‘‘(B) APPLICATION OF ACCREDITATION RE20 QUIREMENT.—In implementing quality stand21 ards under paragraph (3), the Secretary shall 

22 require suppliers furnishing CRT items, on or 

23 after one year after the standards are published 

24 under such paragraph, directly or as a subcon25 tractor for another entity— 


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

2 and 

3 ‘‘(ii) to have submitted to the Sec4 retary evidence of accreditation by an ac5 creditation organization designated under 

6 subparagraph (C) demonstrating that the 

7 supplier is complying with such standards. 

8 ‘‘(C) DESIGNATION OF INDEPENDENT AC9 CREDITATION ORGANIZATIONS.—Not later than 

10 the date that is one year after the date on 

11 which the Secretary implements the quality 

12 standards under paragraph (3), the Secretary 

13 shall designate and approve one or more inde14 pendent accreditation organizations that— 

15 ‘‘(i) are approved under subsection 

16 (a)(20)(B); and 

17 ‘‘(ii) the Secretary has determined 

18 have the capability to assess whether sup19 pliers of CRT items meet the quality 

20 standards established under paragraph (3). 

21 ‘‘(5) CODING SYSTEM FOR COMPLEX REHABILI22 TATION TECHNOLOGIES.— 

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

24 in consultation with suppliers and manufactur25 ers of CRT items, and utilizing existing coding 


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1 systems, establish a HCPCS coding subset that 

2 shall utilize and include HCPCS codes de3 scribed in section 1861(iii)(2) for CRT items 

4 for which payment may made under this sub5 section. 

6 ‘‘(B) TREATMENT OF EXISTING PROD7 UCTS.— 

8 ‘‘(i) IN GENERAL.—With respect to 

9 CRT items for which payment was avail10 able under this title before the effective 

11 date of the amendments made by Ensuring 

12 Access to Quality Complex Rehabilitation 

13 Technology Act of 2013, the Secretary 

14 shall assign such items to a code in the 

15 coding subset established under subpara16 graph (A). 

17 ‘‘(ii) UPDATES.—After the initial as18 signment under clause (i), the Secretary 

19 may decide to reassign additional product 

20 categories, or items within those cat21 egories, that exist before the date of the 

22 enactment of this subsection to the CRT 

23 coding subset. 

24 ‘‘(iii) CONSULTATION.—Before mak25 ing reassignments of CRT items under 


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1 clause (ii), the Secretary shall consult with 

2 suppliers and manufacturers of such items. 

3 The Secretary shall not require manufac4 turers of CRT items for which payment 

5 was available under this title before the ef6 fective date of the amendments made by 

7 the Ensuring Access to Quality Complex 

8 Rehabilitation Technology Act of 2013 to 

9 submit requests for reassignment of the 

10 code for such product to the coding subset 

11 under subparagraph (A) as long as— 

12 ‘‘(I) no changes have been made 

13 to the code definitions, required code 

14 characteristics or test requirements; 

15 and 

16 ‘‘(II) the item was previously 

17 verified to meet the code require18 ments. 

19 ‘‘(C) REMOVING COMPLEX REHABILITA20 TION TECHNOLOGY FROM DME CODES.—The 

21 Secretary shall, in consultation with suppliers 

22 and manufacturers of CRT items— 

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

24 durable medical equipment any CRT items 


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1 that are included in the coding subset 

2 under subparagraph (A); and 

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

4 items for purposes of including such items 

5 in the subset under subparagraph (A). 

6 ‘‘(D) NEW TECHNOLOGY.— 

7 ‘‘(i) IN GENERAL.—The Secretary 

8 shall update as needed the HCPCS level II 

9 process used to modify the code set to in10 clude CRT items for the purposes of estab11 lishing new codes and determining prod12 ucts to be classified as CRT items. In de13 termining if a product is a CRT item, the 

14 Secretary shall consider— 

15 ‘‘(I) if the product is novel; 

16 ‘‘(II) the clinical application of 

17 the product; and 

18 ‘‘(III) the ability of the product 

19 to address the unique needs and ca20 pacities of a qualified individual. 

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

22 The Secretary shall include the codes es23 tablished in clause (i) in the list under sec24 tion 1861(iii)(2)(F). 


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1 ‘‘(E) MISCELLANEOUS CODE FOR INNOVA2 TION AND LOCAL COVERAGE DETERMINA3 TIONS.—The coding subset established under 

4 subparagraph (A) shall include at least one mis5 cellaneous code for items not otherwise classi6 fied. 

7 ‘‘(6) REPLACEMENT OF CRT ITEMS.— 

8 ‘‘(A) IN GENERAL.—Payment shall be 

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

10 the replacement of any part of such item) with11 out regard to continuous use or useful lifetime 

12 restrictions established under section 

13 1834(a)(7)(C) for items of durable medical 

14 equipment if a qualified ordering practitioner 

15 determines that the provision of a replacement 

16 item (or a replacement part of such an item) is 

17 necessary because— 

18 ‘‘(i) there was a change in the physio19 logical condition of the qualified individual 

20 to whom such item was provided; 

21 ‘‘(ii) there was an irreparable change 

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

23 the case of the replacement of a part, in 

24 the part of the CRT item); or 


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1 ‘‘(iii) the CRT item requires repairs 

2 and the cost of such repairs would be more 

3 than 50 percent of the cost of a replace4 ment of the CRT item. 

5 ‘‘(B) DEFERRAL TO PROVIDERS.— 

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

7 (ii), if a qualified ordering practitioner de8 termines that a replacement of the CRT 

9 item, or the replacement of a part of a 

10 CRT item, is necessary pursuant to sub11 paragraph (A), the replacement item or 

12 part is deemed to be reasonable and nec13 essary for purposes of section 

14 1862(a)(1)(A). 

15 ‘‘(ii) EXCEPTION FOR ITEMS UNDER 3

16 YEARS OLD.—If the CRT item that is 

17 being replaced (or the part of the CRT 

18 item that is being replaced) under subpara19 graph (A) is less than 3 years old (cal20 culated from the date on which the quali21 fied individual began to use the CRT item 

22 or part), the Secretary may require the 

23 qualified ordering practitioner to provide 

24 confirmation of necessity of the replaceVerDate Mar 15 2010 01:35 May 17, 2013 Jkt 029200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\S948.IS S948

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1 ment item or replacement part, as the case 

2 may be. 

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

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

5 by a qualified individual needs to be repaired, 

6 payment may be made under this subsection for 

7 the temporary rental of a CRT item while the 

8 CRT item owned by such individual is being re9 paired. 

10 ‘‘(B) BASIS; LIMITATION.—Payment per11 mitted under subparagraph (A) shall be made 

12 on a monthly basis, and the period of rental 

13 may not exceed two months. 

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

15 payment allowed under subparagraph (A) for a 

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

17 percent of the purchase price for the CRT item. 

18 ‘‘(8) DEFINITIONS.—For purposes of this sub19 section: 

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

21 to the Health Care Procedure Coding System. 

22 ‘‘(B) QUALIFIED CRT PROFESSIONAL.— 

23 ‘‘(i) IN GENERAL.—The term ‘quali24 fied CRT professional’ means an individual 

25 who— 


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1 ‘‘(I) is certified by the Rehabili2 tation Engineering and Assistive 

3 Technology Society of North America 

4 as an assistive technology professional 

5 or is certified by another organization 

6 designated by the Secretary (acting in 

7 consultation with relevant parties) as 

8 providing a certification that is equiv9 alent to, or more stringent than, the 

10 assistive technology professional cer11 tification; and 

12 ‘‘(II) beginning two years after 

13 the establishment of the designation 

14 under clause (ii), achieves an addi15 tional designation that demonstrates 

16 the individual’s competencies and ex17 perience in supplying CRT items. 

18 ‘‘(ii) ESTABLISHMENT.—Not later 

19 than one year after the date of the enact20 ment of this subsection, the Secretary, act21 ing in consultation with relevant parties, 

22 shall establish the additional designation 

23 under clause (i)(II). 

24 ‘‘(iii) RELEVANT PARTIES.—For pur25 poses of this subparagraph, the term ‘relVerDate Mar 15 2010 01:35 May 17, 2013 Jkt 029200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\S948.IS S948

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1 evant parties’ includes clinicians, consumer 

2 groups, CRT suppliers, and CRT manufac3 turers. 

4 ‘‘(C) QUALIFIED CRT SERVICE TECHNI5 CIAN.—The term ‘qualified CRT service techni6 cian’ means an individual who— 

7 ‘‘(i) is factory-trained by the manufac8 turers of the CRT items being offered by 

9 the suppler of such items; 

10 ‘‘(ii) is trained and educated (includ11 ing through on the job training) to assem12 ble, fit, program, service, and repair CRT 

13 items; and 

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

15 least 10 hours of continuing education spe16 cific to the assembly, fitting, programming, 

17 service, and repair of CRT items. 

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

19 ‘qualified individual’ has the meaning given 

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

21 ‘‘(E) QUALIFIED ORDERING PRACTI22 TIONER.—The term ‘qualified ordering practi23 tioner’ means a physician (as defined in section 

24 1861(r)), a physician assistant, nurse practiVerDate Mar 15 2010 01:35 May 17, 2013 Jkt 029200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\S948.IS S948

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1 tioner, or a clinical nurse specialist (as those 

2 terms are defined in section 1861(aa)(5)).’’. 

3 SEC. 4. CONFORMING AMENDMENTS. 

4 (a) EXCLUSION FROM THE IN-HOME USE LIMITA5 TION FOR DME.—Section 1861(n) of the Social Security 

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

7 end the following: ‘‘For 2014 and subsequent years, such 

8 term does not include complex rehabilitation technologies 

9 (as defined in subsection (iii)).’’. 

10 (b) EXEMPTION FROM COMPETITIVE ACQUISI11 TION.—Section 1847(a)(7) of the Social Security Act (42 

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

13 the following new subparagraph: 

14 ‘‘(C) CRT ITEMS.—For 2014 and subse15 quent years, complex rehabilitation technology 

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

17 (c) EXEMPTION FROM SNF CONSOLIDATED BILL18 ING.—Section 1888(e)(2)(A)(iii) of the Social Security Act 

19 (42 U.S.C. 1395yy(e)(2)(A)(iii)) is amended by adding at 

20 the end the following: 

21 ‘‘(VI) Complex rehabilitation 

22 technology items (as defined in section 

23 1861(iii)) if delivered to an inpatient 

24 for use during the stay in the skilled 

25 nursing facility as part of the plan of 


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1 care to allow the transition of such 

2 qualified individuals from the skilled 

3 nursing facility setting to the home 

4 and community.’’. 

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

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

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

8 following sentence ‘‘For 2014 and subsequent years, 

9 the items covered by this paragraph shall not include 

10 complex rehabilitation technology items (as defined 

11 in section 1861(iii)).’’; 

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

13 the following: ‘‘For fiscal year 2014 and subsequent 

14 years, the previous sentence shall not apply to 

15 power-driven wheelchairs that are designated as 

16 CRT items under section 1861(iii).’’; and 

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

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

19 may, as allowed by the second sentence of this para20 graph, waive) the requirements of the first sentence 

21 of this paragraph to suppliers of complex rehabilita22 tion technology items, except that, in order to avoid 

23 duplicate bonds, the Secretary shall not impose such 

24 requirements with respect to suppliers of complex re25 habilitation technology items if such suppliers also 


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1 participate in the Medicare program as suppliers of 

2 durable medical equipment.’’. 

3 (e) REQUIREMENTS FOR SUPPLIERS OF MEDICAL

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

5 Social Security Act (42 U.S.C. 1395m(j)(5)) is amend6 ed— 

7 (1) by redesignating subparagraphs (E) and 

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

9 (2) by inserting after subparagraph (D) the fol10 lowing new subparagraph: 

11 ‘‘(E) complex rehabilitation technology 

12 items (as defined in section 1861(iii));’’. 

13 SEC. 5. EFFECTIVE DATE. 

14 The amendments made by this Act shall apply to 

15 items and services furnished on or after January 1, 2014. 

Æ 


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