I 

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. 

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’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) Individuals with disabilities and significant 

2 medical conditions such as Cerebral Palsy, Muscular 

3 Dystrophy, Multiple Sclerosis, Spinal Cord Injury, 

4 Amyotrophic Lateral Sclerosis, and Spina Bifida ex5 perience physical, functional, and cognitive chal6 lenges every day. 

7 (2) Complex rehabilitation technology items (in 

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

9 products such as complex rehabilitation power wheel10 chairs, highly configurable manual wheelchairs, 

11 adaptive seating and positioning systems, and other 

12 specialized equipment, such as standing frames and 

13 gait trainers, enable individuals to maximize their 

14 function and minimize the extent and costs of their 

15 medical care. 

16 (3) Access to CRT items and related services 

17 can be threatened by inadequate coding, coverage, 

18 and payment policies for such items and services. 

19 These policies have restricted access to existing com20 plex rehabilitation technology and stifled innovation. 

21 Access challenges have increased over the past sev22 eral years and, without meaningful change to these 

23 policies, will only become greater in the future. 

24 (4) Current Medicare policies often fail to ade25 quately address the needs of individuals with disabilVerDate Mar 15 2010 02:56 Mar 05, 2013 Jkt 029200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H942.IH H942

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1 ities, to consider the range of services furnished by 

2 complex rehabilitation technology suppliers, and to 

3 recognize and account for the complexity and unique 

4 nature of the equipment itself. 

5 (5) A significant factor responsible for such ac6 cess challenges is that individually-configurable CRT 

7 items do not have a distinct payment category under 

8 the Medicare program, but instead are classified 

9 within the broad category of durable medical equip10 ment (DME). CRT items serve patients with serious 

11 medical conditions that require a broader range of 

12 services and specialized personnel than what is re13 quired for standard DME. Customizable CRT items 

14 also require more resources in the areas configuring, 

15 training, and education to ensure appropriate use 

16 and to optimize results. 

17 (6) Unlike most DME, a medical model incor18 porating an interdisciplinary team approach is nec19 essary to ensure proper customization and use of a 

20 CRT item. This team typically includes a physician, 

21 a licensed physical or licensed occupational therapist 

22 (with no financial relationship with the CRT sup23 plier), a qualified CRT professional, the individual 

24 using such item, and sometimes a caregiver for such 

25 individual. 


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1 (7) The Medicare program should recognize the 

2 specialized nature of the CRT service delivery model, 

3 the required supporting processes and technology-re4 lated CRT services, the credentials and competencies 

5 needed by the providing suppliers and critical staff, 

6 and the related costs involved. A separate benefit 

7 category for CRT items would allow for unique cod8 ing, coverage, and payment rules and policies that 

9 address the unique needs of persons with disabilities 

10 and acknowledge the extensive service component. 

11 (8) Congress and the Centers for Medicare & 

12 Medicaid Services have previously recognized the 

13 benefits of a separate classification for unique, cus14 tomized products. In 2008, Congress exempted cer15 tain CRT items from inclusion in the Medicare 

16 DME competitive bidding program, and Congress 

17 has created a separate and distinct benefit category 

18 for orthotics and prosthetics (custom braces and ar19 tificial limbs), which have their own medical policies, 

20 accreditation standards, and payment calculations. 

21 SEC. 3. ESTABLISHING SEPARATE BENEFIT CATEGORY FOR 

22 COMPLEX REHABILITATION TECHNOLOGIES 

23 WITHIN MEDICARE. 

24 (a) NEW CATEGORY.—Section 1861 of the Social Se25 curity Act (42 U.S.C. 1395x) is amended— 


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1 (1) in subsection (s)(2)— 

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

3 ‘‘and’’ at the end; 

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

5 ‘‘and’’ at the end; and 

6 (C) by inserting after subparagraph (FF) 

7 the following new paragraph: 

8 ‘‘(GG) complex rehabilitation technology 

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

10 (2) by adding at the end the following new sub11 section: 

12 ‘‘Complex Rehabilitation Technology Item 

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

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

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

16 qualified individual to meet the individual’s unique— 

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

18 related to a medical condition; and 

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

20 living and instrumental activities of daily living; 

21 ‘‘(B) is primarily used to serve a medical pur22 pose and is generally not useful to a person in the 

23 absence of illness or injury; and 


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1 ‘‘(C) requires certain services to ensure appro2 priate design, configuration, and use of such item, 

3 including— 

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

5 and matching of the features and functions of 

6 CRT items to the qualified individual who will 

7 use such an item; and 

8 ‘‘(ii) configuring, fitting, programming, ad9 justing, or adapting the particular complex re10 habilitation technology item for use by such in11 dividual. 

12 ‘‘(2)(A) The Secretary, in consultation with the Di13 rector of Office on Disability, the Chairman of the Na14 tional Council on Disability, the Executive Director on the 

15 Interagency Committee on Disability, the Director of the 

16 National Institute on Disability and Rehabilitation Re17 search of the Department of Education, and the Co-Chair18 men of the Senior Oversight Committee’s Care Manage19 ment Reform Team of the Department of Defense and the 

20 Veterans Administration, shall, by regulation— 

21 ‘‘(i) designate items as complex rehabilitation 

22 technology items; and 

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

24 an individual is a qualified individual based on the 

25 level of physical and functional needs and capacities 


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1 related to a medical condition or conditions de2 scribed in subparagraph (E). 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

21 K0886, K0890, K0891, and K0898. 

22 ‘‘(C)(i) The items designated as complex rehabilita23 tion technology items under subparagraph (A)(i) shall in24 clude each item that— 


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1 ‘‘(I) as of January 1, 2013, was classified with2 in the HCPCS codes under clause (ii); and 

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

4 suppliers and manufacturers of CRT items, deter5 mines should be removed from such code and as6 signed a new HCPCS code because such item is a 

7 complex rehabilitation technology item. 

8 ‘‘(ii) The HCPCS codes under this clause are the fol9 lowing: E0143, E0950, E0951, E0952, E0955, E0956, 

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

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

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

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

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

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

16 rehabilitation technology item— 

17 ‘‘(i) adaptive equipment to operate motor vehi18 cles; 

19 ‘‘(ii) prosthetic devices described in subsection 

20 (s)(8); or 

21 ‘‘(iii) orthotics and prosthetics described in sub22 section (s)(9). 

23 ‘‘(E) In establishing the eligibility criteria under sub24 paragraph (A)(ii), the Secretary shall include appropriate 


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1 physical and functional needs and capacities arising from 

2 any of the following medical conditions: 

3 ‘‘(i) Congenital disorders, progressive or degen4 erative neuromuscular diseases, or injuries or trau5 ma that result in significant physical or functional 

6 needs and capacities. 

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

8 cerebral palsy, muscular dystrophy, spina bifida, 

9 osteogenesis imperfecta, arthrogryposis, amyotrophic 

10 lateral sclerosis, multiple sclerosis, demyelinating 

11 disease, myelopathy, myopathy, progressive muscular 

12 atrophy, anterior horn cell disease, post-polio syn13 drome, cerebellar degeneration, dystonia, Hunting14 ton’s disease, or spinocerebellar disease. 

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

16 paresis that result in significant physical or func17 tional needs and capacities. 

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

19 ‘‘(I) a list of items designated under subpara20 graph (A)(i) and the HCPCS codes for such items; 

21 and 

22 ‘‘(II) the eligibility criteria established under 

23 subparagraph (A)(ii). 

24 ‘‘(ii) For 2015 and each subsequent year, the Sec25 retary shall publish any necessary updates to such list (inVerDate Mar 15 2010 02:56 Mar 05, 2013 Jkt 029200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H942.IH H942

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1 cluding additions of new CRT items and any changes in 

2 applicable HCPCS codes) and to such eligibility criteria. 

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

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

5 requests from members of the public that the Secretary— 

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

7 subparagraph (A)(i); or 

8 ‘‘(ii) amend the eligibility criteria established 

9 under subparagraph (A)(ii). 

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

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

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

13 participate in mobility and self-care activities includ14 ing— 

15 ‘‘(i) maintaining and changing body posi16 tion; 

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

18 another; 

19 ‘‘(iii) walking; 

20 ‘‘(iv) moving from place to place using mo21 bility equipment, in a safe and timely manner; 

22 ‘‘(v) washing one’s self; 

23 ‘‘(vi) caring for the body; 

24 ‘‘(vii) toileting; 

25 ‘‘(viii) dressing; 


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1 ‘‘(ix) eating; 

2 ‘‘(x) drinking; 

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

4 ‘‘(xii) carrying, moving, and handling ob5 jects to perform and participate in other activi6 ties under this subparagraph and subparagraph 

7 (B). 

8 ‘‘(B) The term ‘capacity for instrumental activi9 ties of daily living’ means an individual’s capacity to 

10 safely participate in life situations in the home and 

11 community, including— 

12 ‘‘(i) communicating; 

13 ‘‘(ii) moving around using transportation; 

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

15 services; 

16 ‘‘(iv) performing household tasks; 

17 ‘‘(v) caring for household members and 

18 family members; 

19 ‘‘(vi) caring for household objects; 

20 ‘‘(vii) engaging in education, work, employ21 ment and economic life; and 

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

23 and civic activities. 

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

25 Care Procedure Coding System. 


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

2 with respect to an item, that— 

3 ‘‘(i) the item has a combination of fea4 tures, adjustments, or modifications that are 

5 specific to the individual who uses such item; 

6 and 

7 ‘‘(ii) the supplier of such item must meas8 ure the individual and configure, fit, program, 

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

10 that the item is consistent with— 

11 ‘‘(I) an assessment or evaluation of 

12 the individual by an appropriate licensed 

13 clinician; 

14 ‘‘(II) the written order required under 

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

16 ‘‘(III) medical condition, physical and 

17 functional needs and capacities, and body 

18 size of the individual who will use the item, 

19 the period for which such individual will 

20 need such item, and the intended use of 

21 such item by such individual. 

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

23 individual who— 

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


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

2 capacities that arise from a medical condition 

3 that meet the eligibility criteria established by 

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

5 SEC. 4. PAYMENT RULES. 

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

7 1395m) is amended by adding at the end the following: 

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

9 ‘‘(1) GENERAL RULE FOR PAYMENT.— 

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

11 date that is one year after the date of the en12 actment of this subsection, subject to subpara13 graph (B), the Secretary shall determine a pay14 ment system that shall apply to CRT items— 

15 ‘‘(i) with HCPCS codes that were as16 signed to the item under section 

17 1861(iii)(2)(C)(i)(II); 

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

19 assigned prior to such date; or 

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

21 classified under a miscellaneous HCPCS 

22 code. 

23 ‘‘(B) CONSIDERATIONS.—In determining 

24 the payment system under subparagraph (A), 

25 the Secretary— 


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

2 increases to the payment amounts for du3 rable medical equipment that occurred be4 fore the date of the enactment of this sub5 section, when determining the payment 

6 amount for CRT items; and 

7 ‘‘(ii) shall ensure that the payment 

8 amounts for CRT items under such system 

9 are adequate to provide qualified individ10 uals with access to such items and to en11 courage innovation, taking into account— 

12 ‘‘(I) the unique needs of qualified 

13 individuals for access to CRT items; 

14 ‘‘(II) the unique complexity of 

15 CRT items; and 

16 ‘‘(III) the resources and staff 

17 needed to provide appropriate 

18 customization of CRT items for a 

19 qualified individual. 

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

21 subsection shall constitute the exclusive provi22 sion of this title for payment for CRT items 

23 under this part or under part A to a home 

24 health agency. 


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1 ‘‘(D) LIMITATION ON PAYMENT.—No pay2 ment shall be made under this subsection for a 

3 CRT item unless such CRT item— 

4 ‘‘(i) is provided to a qualified indi5 vidual; 

6 ‘‘(ii) meets the clinical conditions for 

7 coverage established under paragraph (2); 

8 and 

9 ‘‘(iii) is furnished by a supplier ac10 credited pursuant to paragraph (3). 

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

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

13 establish standards for clinical conditions for 

14 payment for CRT items under this subsection. 

15 ‘‘(B) REQUIREMENTS.—The standards es16 tablished under subparagraph (A) shall require 

17 the following: 

18 ‘‘(i) WRITTEN ORDER.— 

19 ‘‘(I) IN GENERAL.—A qualified 

20 ordering practitioner shall provide a 

21 written order for a CRT item for a 

22 qualified individual before the Sec23 retary may provide payment for such 

24 item for such individual under this 

25 subsection. 


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1 ‘‘(II) CRT EVALUATION.—In the 

2 case of a CRT item that is cat3 egorized by the Secretary, for pur4 poses of the program under this title, 

5 as a manual wheelchair or a power 

6 wheelchair, and is to be provided to a 

7 qualified individual who has a diag8 nosis specified under subparagraph 

9 (C), the qualified ordering practitioner 

10 may not provide a written order under 

11 subclause (I) unless the qualified indi12 vidual has undergone a CRT evalua13 tion conducted by a licensed physical 

14 therapist or occupational therapist 

15 who has no financial relationship with 

16 the CRT supplier. 

17 ‘‘(ii) DOCUMENTATION OF MEDICAL

18 NECESSITY.—A qualified ordering practi19 tioner who provides a written order under 

20 clause (i) shall maintain documentation of 

21 the medical necessity of such order for a 

22 period of seven years and shall make such 

23 documentation available to the Secretary 

24 upon request. The documentation of medVerDate Mar 15 2010 02:56 Mar 05, 2013 Jkt 029200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H942.IH H942

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1 ical necessity under this clause shall in2 clude— 

3 ‘‘(I) evidence that the individual 

4 for whom the order was written has 

5 physical and functional needs and ca6 pacities related to a medical condition 

7 that meet the eligibility criteria estab8 lished under section 

9 1861(iii)(2)(A)(ii); and 

10 ‘‘(II) evidence of any CRT eval11 uation required under clause (i)(II). 

12 ‘‘(C) SPECIFICATION OF DIAGNOSIS FOR

13 CRT EVALUATION.—The Secretary, in consulta14 tion with relevant parties (including the agen15 cies listed in section 1861(iii)(2)(A), physicians, 

16 licensed physical therapists, licensed occupa17 tional therapists, and suppliers of complex reha18 bilitation technologies) shall specify the diag19 noses and other medical presentations for which 

20 the requirement for a CRT evaluation under 

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

22 ‘‘(D) COVERAGE DETERMINATIONS.—In 

23 developing the standards under subparagraph 

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

25 an individual shall be based on— 


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

2 functional needs of the individual; 

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

4 safe participation in basic activities of 

5 daily living and instrumental activities of 

6 daily living in all routinely encountered en7 vironments (as such terms are defined in 

8 section 1861(iii)(3)); and 

9 ‘‘(iii) the individual’s expected pro10 gression of such needs and capacities. 

11 ‘‘(E) PAYMENT FOR RESIDENTS OF

12 SKILLED NURSING FACILITIES.—In the case of 

13 a qualified individual who is a resident of a 

14 skilled nursing facility, payment may only be 

15 made under this subsection for a CRT item for 

16 such individual if such CRT item is required as 

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

18 such individual from the skilled nursing facility 

19 to a home or community setting. 

20 ‘‘(3) ESTABLISHMENT OF QUALITY STAND21 ARDS.— 

22 ‘‘(A) ESTABLISHMENT.—The Secretary 

23 shall establish, through regulation, quality 

24 standards for suppliers of CRT items. Such 

25 standards shall be applied prospectively and 


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1 shall be published on the Internet Web site of 

2 the Centers for Medicare and Medicaid Serv3 ices. 

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

5 quality standards under subparagraph (A), the 

6 Secretary shall consult with relevant parties (in7 cluding clinicians, consumer groups, suppliers, 

8 and manufacturers). 

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

10 establishing the quality standards under sub11 paragraph (A), the Secretary shall require that 

12 the suppliers of CRT items meet the following 

13 requirements: 

14 ‘‘(i) DME STANDARDS AS MINIMUM.— 

15 The supplier complies with all of the 

16 standards that are applicable to suppliers 

17 of durable medical equipment under sub18 section (a)(20) and suppliers of medical 

19 equipment and supplies under subsection 

20 (j). 

21 ‘‘(ii) QUALIFIED CRT PROFES22 SIONAL.—The supplier of a CRT item 

23 makes available, in each service area 

24 served by such supplier, at least one quali25 fied CRT professional to— 


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1 ‘‘(I) analyze the needs and capac2 ities of individuals for a CRT item in 

3 collaboration with the clinical team; 

4 ‘‘(II) assist in selecting an appro5 priate CRT item for such individual, 

6 given such needs and capacities; and 

7 ‘‘(III) provide technology-related 

8 training to such individual in the 

9 proper use and maintenance of the 

10 CRT items. 

11 ‘‘(iii) TRIAL EQUIPMENT.—The sup12 plier of the CRT item provides the quali13 fied individual with appropriate equipment 

14 for trial and simulation, if a physician, li15 censed physical therapist, or licensed occu16 pational therapist determines that the pro17 vision of such equipment is necessary. 

18 ‘‘(iv) INFORMATION ON REPAIR.—The 

19 supplier of the CRT item provides the 

20 qualified individual with written informa21 tion on the service and repair of the CRT 

22 item provided to such individual. 

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

24 item— 


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1 ‘‘(I) makes available, in each 

2 service area served by such supplier, 

3 at least one qualified CRT service 

4 technician to service and repair CRT 

5 items that— 

6 ‘‘(aa) are furnished by such 

7 supplier; and 

8 ‘‘(bb) at the time of the 

9 need for repair, are located in a 

10 service area of the supplier; or 

11 ‘‘(II) at the time of sale of the 

12 CRT item, discloses to the qualified 

13 individual that the supplier does not 

14 provide repair service for such item 

15 and provides contact information for 

16 entities that do provide such repair 

17 service. 

18 ‘‘(vi) RENTAL EQUIPMENT.—If pay19 ment is allowed under paragraph (6), the 

20 supplier of the CRT item provides tem21 porary rental equipment to the qualified 

22 individual when the supplier is repairing a 

23 qualified individual’s CRT item that was 

24 paid for under this subsection. 


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1 ‘‘(4) APPLICATION OF STANDARDS AND AC2 CREDITATION PROGRAM FOR SUPPLIERS OF CRT

3 ITEMS.— 

4 ‘‘(A) IN GENERAL.— 

5 ‘‘(i) REQUIREMENT FOR PROVIDER OR

6 SUPPLIER NUMBER.—The Secretary shall 

7 not provide a supplier of CRT items with 

8 a provider or supplier number to submit 

9 claims for payment under this title unless 

10 the supplier is in compliance with the 

11 standards under paragraph (3). 

12 ‘‘(ii) REQUIREMENT FOR PAYMENT.— 

13 Payment shall not be made under this part 

14 for CRT items furnished by a supplier un15 less the supplier is in compliance with the 

16 standards under paragraph (3). 

17 ‘‘(B) APPLICATION OF ACCREDITATION RE18 QUIREMENT.—In implementing quality stand19 ards under paragraph (3), the Secretary shall 

20 require suppliers furnishing CRT items, on or 

21 after one year after the standards are published 

22 under such paragraph, directly or as a subcon23 tractor for another entity— 

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

25 and 


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1 ‘‘(ii) to have submitted to the Sec2 retary evidence of accreditation by an ac3 creditation organization designated under 

4 subparagraph (C) demonstrating that the 

5 supplier is complying with such standards. 

6 ‘‘(C) DESIGNATION OF INDEPENDENT AC7 CREDITATION ORGANIZATIONS.—Not later than 

8 the date that is one year after the date on 

9 which the Secretary implements the quality 

10 standards under paragraph (3), the Secretary 

11 shall designate and approve one or more inde12 pendent accreditation organizations that— 

13 ‘‘(i) are approved under subsection 

14 (a)(20)(B); and 

15 ‘‘(ii) the Secretary has determined 

16 have the capability to assess whether sup17 pliers of CRT items meet the quality 

18 standards established under paragraph (3). 

19 ‘‘(5) CODING SYSTEM FOR COMPLEX REHABILI20 TATION TECHNOLOGIES.— 

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

22 in consultation with suppliers and manufactur23 ers of CRT items, and utilizing existing coding 

24 systems, establish a HCPCS coding subset that 

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1 scribed in section 1861(iii)(2) for CRT items 

2 for which payment may made under this sub3 section. 

4 ‘‘(B) TREATMENT OF EXISTING PROD5 UCTS.— 

6 ‘‘(i) IN GENERAL.—With respect to 

7 CRT items for which payment was avail8 able under this title before the effective 

9 date of the amendments made by Ensuring 

10 Access to Quality Complex Rehabilitation 

11 Technology Act of 2013, the Secretary 

12 shall assign such items to a code in the 

13 coding subset established under subpara14 graph (A). 

15 ‘‘(ii) UPDATES.—After the initial as16 signment under clause (i), the Secretary 

17 may decide to reassign additional product 

18 categories, or items within those cat19 egories, that exist before the date of the 

20 enactment of this subsection to the CRT 

21 coding subset. 

22 ‘‘(iii) CONSULTATION.—Before mak23 ing reassignments of CRT items under 

24 clause (ii), the Secretary shall consult with 

25 suppliers and manufacturers of such items. 


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1 The Secretary shall not require manufac2 turers of CRT items for which payment 

3 was available under this title before the ef4 fective date of the amendments made by 

5 the Ensuring Access to Quality Complex 

6 Rehabilitation Technology Act of 2013 to 

7 submit requests for reassignment of the 

8 code for such product to the coding subset 

9 under subparagraph (A) as long as— 

10 ‘‘(I) no changes have been made 

11 to the code definitions, required code 

12 characteristics or test requirements; 

13 and 

14 ‘‘(II) the item was previously 

15 verified to meet the code require16 ments. 

17 ‘‘(C) REMOVING COMPLEX REHABILITA18 TION TECHNOLOGY FROM DME CODES.—The 

19 Secretary shall, in consultation with suppliers 

20 and manufacturers of CRT items— 

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

22 durable medical equipment any CRT items 

23 that are included in the coding subset 

24 under subparagraph (A); and 


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

2 items for purposes of including such items 

3 in the subset under subparagraph (A). 

4 ‘‘(D) NEW TECHNOLOGY.— 

5 ‘‘(i) IN GENERAL.—The Secretary 

6 shall update as needed the HCPCS level II 

7 process used to modify the code set to in8 clude CRT items for the purposes of estab9 lishing new codes and determining prod10 ucts to be classified as CRT items. In de11 termining if a product is a CRT item, the 

12 Secretary shall consider— 

13 ‘‘(I) if the product is novel; 

14 ‘‘(II) the clinical application of 

15 the product; and 

16 ‘‘(III) the ability of the product 

17 to address the unique needs and ca18 pacities of a qualified individual. 

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

20 The Secretary shall include the codes es21 tablished in clause (i) in the list under sec22 tion 1861(iii)(2)(F). 

23 ‘‘(E) MISCELLANEOUS CODE FOR INNOVA24 TION AND LOCAL COVERAGE DETERMINA25 TIONS.—The coding subset established under 


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1 subparagraph (A) shall include at least one mis2 cellaneous code for items not otherwise classi3 fied. 

4 ‘‘(6) REPLACEMENT OF CRT ITEMS.— 

5 ‘‘(A) IN GENERAL.—Payment shall be 

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

7 the replacement of any part of such item) with8 out regard to continuous use or useful lifetime 

9 restrictions established under section 

10 1834(a)(7)(C) for items of durable medical 

11 equipment if a qualified ordering practitioner 

12 determines that the provision of a replacement 

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

14 necessary because— 

15 ‘‘(i) there was a change in the physio16 logical condition of the qualified individual 

17 to whom such item was provided; 

18 ‘‘(ii) there was an irreparable change 

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

20 the case of the replacement of a part, in 

21 the part of the CRT item); or 

22 ‘‘(iii) the CRT item requires repairs 

23 and the cost of such repairs would be more 

24 than 50 percent of the cost of a replace25 ment of the CRT item. 


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1 ‘‘(B) DEFERRAL TO PROVIDERS.— 

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

3 (ii), if a qualified ordering practitioner de4 termines that a replacement of the CRT 

5 item, or the replacement of a part of a 

6 CRT item, is necessary pursuant to sub7 paragraph (A), the replacement item or 

8 part is deemed to be reasonable and nec9 essary for purposes of section 

10 1862(a)(1)(A). 

11 ‘‘(ii) EXCEPTION FOR ITEMS UNDER 3

12 YEARS OLD.—If the CRT item that is 

13 being replaced (or the part of the CRT 

14 item that is being replaced) under subpara15 graph (A) is less than 3 years old (cal16 culated from the date on which the quali17 fied individual began to use the CRT item 

18 or part), the Secretary may require the 

19 qualified ordering practitioner to provide 

20 confirmation of necessity of the replace21 ment item or replacement part, as the case 

22 may be. 

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

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

25 by a qualified individual needs to be repaired, 


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1 payment may be made under this subsection for 

2 the temporary rental of a CRT item while the 

3 CRT item owned by such individual is being re4 paired. 

5 ‘‘(B) BASIS; LIMITATION.—Payment per6 mitted under subparagraph (A) shall be made 

7 on a monthly basis, and the period of rental 

8 may not exceed two months. 

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

10 payment allowed under subparagraph (A) for a 

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

12 percent of the purchase price for the CRT item. 

13 ‘‘(8) DEFINITIONS.—For purposes of this sub14 section: 

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

16 to the Health Care Procedure Coding System. 

17 ‘‘(B) QUALIFIED CRT PROFESSIONAL.— 

18 ‘‘(i) IN GENERAL.—The term ‘quali19 fied CRT professional’ means an individual 

20 who— 

21 ‘‘(I) is certified by the Rehabili22 tation Engineering and Assistive 

23 Technology Society of North America 

24 as an assistive technology professional 

25 or is certified by another organization 


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1 designated by the Secretary (acting in 

2 consultation with relevant parties) as 

3 providing a certification that is equiv4 alent to, or more stringent than, the 

5 assistive technology professional cer6 tification; and 

7 ‘‘(II) beginning two years after 

8 the establishment of the designation 

9 under clause (ii), achieves an addi10 tional designation that demonstrates 

11 the individual’s competencies and ex12 perience in supplying CRT items. 

13 ‘‘(ii) ESTABLISHMENT.—Not later 

14 than one year after the date of the enact15 ment of this subsection, the Secretary, act16 ing in consultation with relevant parties, 

17 shall establish the additional designation 

18 under clause (i)(II). 

19 ‘‘(iii) RELEVANT PARTIES.—For pur20 poses of this subparagraph, the term ‘rel21 evant parties’ includes clinicians, consumer 

22 groups, CRT suppliers, and CRT manufac23 turers. 


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1 ‘‘(C) QUALIFIED CRT SERVICE TECHNI2 CIAN.—The term ‘qualified CRT service techni3 cian’ means an individual who— 

4 ‘‘(i) is factory-trained by the manufac5 turers of the CRT items being offered by 

6 the suppler of such items; 

7 ‘‘(ii) is trained and educated (includ8 ing through on the job training) to assem9 ble, fit, program, service, and repair CRT 

10 items; and 

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

12 least 10 hours of continuing education spe13 cific to the assembly, fitting, programming, 

14 service, and repair of CRT items. 

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

16 ‘qualified individual’ has the meaning given 

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

18 ‘‘(E) QUALIFIED ORDERING PRACTI19 TIONER.—The term ‘qualified ordering practi20 tioner’ means a physician (as defined in section 

21 1861(r)), a physician assistant, nurse practi22 tioner, or a clinical nurse specialist (as those 

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


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1 SEC. 5. CONFORMING AMENDMENTS. 

2 (a) EXCLUSION FROM THE IN-HOME USE LIMITA3 TION FOR DME.—Section 1861(n) of the Social Security 

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

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

6 term does not include complex rehabilitation technologies 

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

8 (b) EXEMPTION FROM COMPETITIVE ACQUISI9 TION.—Section 1847(a)(7) of the Social Security Act (42 

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

11 the following new subparagraph: 

12 ‘‘(C) CRT ITEMS.—For 2014 and subse13 quent years, complex rehabilitation technology 

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

15 (c) EXEMPTION FROM SNF CONSOLIDATED BILL16 ING.—Section 1888(e)(2)(A)(iii) of the Social Security Act 

17 (42 U.S.C. 1395yy(e)(2)(A)(iii)) is amended by adding at 

18 the end the following: 

19 ‘‘(VI) Complex rehabilitation 

20 technology items (as defined in section 

21 1861(iii)) if delivered to an inpatient 

22 for use during the stay in the skilled 

23 nursing facility as part of the plan of 

24 care to allow the transition of such 

25 qualified individuals from the skilled 


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1 nursing facility setting to the home 

2 and community.’’. 

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

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

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

6 following sentence ‘‘For 2014 and subsequent years, 

7 the items covered by this paragraph shall not include 

8 complex rehabilitation technology items (as defined 

9 in section 1861(iii)).’’; 

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

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

12 years, the previous sentence shall not apply to 

13 power-driven wheelchairs that are designated as 

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

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

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

17 may, as allowed by the second sentence of this para18 graph, waive) the requirements of the first sentence 

19 of this paragraph to suppliers of complex rehabilita20 tion technology items, except that, in order to avoid 

21 duplicate bonds, the Secretary shall not impose such 

22 requirements with respect to suppliers of complex re23 habilitation technology items if such suppliers also 

24 participate in the Medicare program as suppliers of 

25 durable medical equipment.’’. 


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1 (e) REQUIREMENTS FOR SUPPLIERS OF MEDICAL

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

3 Social Security Act (42 U.S.C. 1395m(j)(5)) is amend4 ed— 

5 (1) by redesignating subparagraphs (E) and 

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

7 (2) by inserting after subparagraph (D) the fol8 lowing new subparagraph: 

9 ‘‘(E) complex rehabilitation technology 

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

11 SEC. 6. EFFECTIVE DATE. 

12 The amendments made by this Act shall apply to 

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

Æ 


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