I 

116TH CONGRESS 

1ST SESSION H. R. 2408 

To amend title XVIII of the Social Security Act to update and clarify 

the classification of and applicable payment methodology for complex 

rehabilitation technology items under the Medicare program, and for 

other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 30, 2019 

Mr. SENSENBRENNER (for himself and Mr. HIGGINS of New York) 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 update 

and clarify the classification of and applicable payment 

methodology 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 2019’’. 


pbinns on DSK79D2C42PROD with BILLS
2 

•HR 2408 IH

1 SEC. 2. FINDINGS. 

2 Congress finds the following: 

3 (1) There is a small and specific population of 

4 Medicare beneficiaries who have significant disabil5 ities and medical conditions who require complex 

6 and individually configured medical equipment, 

7 items, and technologies. These items and tech8 nologies are referred to as complex rehabilitation 

9 technology (or ‘‘CRT’’) and include specialized 

10 wheelchairs, specialized seating and positioning, and 

11 other types of adaptive equipment and items that 

12 are uniquely configured and fitted to the specific in13 dividual. Individuals in this population often qualify 

14 for Medicare based on their disability (rather than 

15 their age) and have significant disabilities and med16 ical conditions that may include, but are not limited 

17 to, cerebral palsy, muscular dystrophy, multiple scle18 rosis, spinal cord injury, amyotrophic lateral scle19 rosis (ALS), traumatic brain injury, and spina 

20 bifida. This small population comprises less than 15 

21 percent of the Medicare beneficiaries who receive 

22 wheelchairs. 

23 (2) Current provisions addressing Medicare 

24 benefit categories and related definitions do not suf25 ficiently define certain complex rehabilitation tech26 nology items and do not adequately describe and disVerDate Sep 11 2014 21:29 May 02, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2408.IH H2408

pbinns on DSK79D2C42PROD with BILLS
3 

•HR 2408 IH

1 tinguish these items as compared to other types of 

2 Medicare-covered medical items and equipment. 

3 (3) This current lack of definitional clarity for 

4 complex rehabilitation technology items results in ac5 cess challenges for beneficiaries with significant dis6 abilities and medical conditions, as these items are 

7 often grouped with standardized, nonspecialized 

8 products that significantly differ with respect to the 

9 complexity and the individualized configuration in10 volved, as well as certain evaluation requirements, 

11 clinical coverage criteria, and other considerations. 

12 (4) To provide adequate access for the small 

13 population of Medicare beneficiaries with significant 

14 disabilities and medical conditions who require these 

15 complex, specialized, and individually configured 

16 items a distinct Medicare benefit category for com17 plex rehabilitative technology items is needed. This 

18 will allow for related improvements to clarify appli19 cable coding, coverage, payment, and supplier stand20 ards for such items. A separate benefit category is 

21 needed to ensure appropriate access to these items 

22 for individuals with significant disabilities and med23 ical conditions, and will help prevent potential over24 utilization of CRT by individuals for whom such 

25 items are not medically necessary. 


pbinns on DSK79D2C42PROD with BILLS
4 

•HR 2408 IH

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 (GG), by striking 

8 ‘‘and’’ at the end; 

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

10 ‘‘and’’ at the end; and 

11 (C) by inserting after subparagraph (HH) 

12 the following new paragraph: 

13 ‘‘(II) complex rehabilitation technology 

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

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

17 ‘‘(kkk) COMPLEX REHABILITATION TECHNOLOGY

18 ITEM.— 

19 ‘‘(1) The terms ‘complex rehabilitation tech20 nology item’ and ‘CRT item’ mean an item that— 

21 ‘‘(A) is designed, manufactured, individ22 ually configured, adjusted, or modified for a 

23 specific individual to meet the individual’s 

24 unique medical, physical, or functional needs 

25 and capacities; 


pbinns on DSK79D2C42PROD with BILLS
5 

•HR 2408 IH

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

2 physical, or functional purpose and is generally 

3 not useful to a person in the absence of dis4 ability, illness, injury, or other medical condi5 tion; and 

6 ‘‘(C) requires certain services to ensure ap7 propriate use of such item, including one or 

8 more of the following— 

9 ‘‘(i) an evaluation of the features and 

10 functions of CRT items to the specific indi11 vidual who will use such an item, as re12 quired under section 1834(x)(2)(B)(ii)(II); 

13 or 

14 ‘‘(ii) configuring, fitting, program15 ming, adjusting, or adapting the particular 

16 complex rehabilitation technology item for 

17 use by such individual. 

18 ‘‘(2)(A) CRT items shall include— 

19 ‘‘(i) complex rehabilitation manual and 

20 power wheelchairs, options, and accessories; 

21 ‘‘(ii) specialized seating and positioning 

22 items, options, and accessories; 

23 ‘‘(iii) adaptive equipment such as standing 

24 frames and gait trainers and options and acces25 sories; and 


pbinns on DSK79D2C42PROD with BILLS
6 

•HR 2408 IH

1 ‘‘(iv) other items that meet the definition 

2 in subparagraph (1), as determined by the Sec3 retary. 

4 ‘‘(B) In determining which items meet the defi5 nition of a CRT item under this subsection, the Sec6 retary shall review existing and new technologies on 

7 at least a yearly basis, and in a manner that takes 

8 into consideration technological differences in avail9 able items and equipment, as well as the varying 

10 clinical needs of individuals who rely on such items 

11 and equipment. 

12 ‘‘(3)(A) Not later than six months after the 

13 date of enactment of this subsection, the Secretary 

14 shall publish a list of HCPCS codes that meet the 

15 definition of CRT items under this subsection. In 

16 considering and publishing the list of codes that 

17 meet such definition, the Secretary must ensure that 

18 the HCPCS code set provides adequate and appro19 priate access to existing and new technologies that 

20 may improve medical, physical, or functional out21 comes for beneficiaries with significant disabilities 

22 and medical conditions, taking into consideration 

23 technological differences, clinical application, and the 

24 unique medical, physical, and functional needs of 


pbinns on DSK79D2C42PROD with BILLS
7 

•HR 2408 IH

1 beneficiaries who rely on medically necessary CRT 

2 items. 

3 ‘‘(B) In establishing the list under subpara4 graph (A), the Secretary shall— 

5 ‘‘(i) identify and include existing HCPCS 

6 codes that are exclusively CRT items, including 

7 items that, as of January 1, 2019, were classi8 fied within the following HCPCS codes: E0637, 

9 E0638, E0641, E0642, E0953, E0954, E0986, 

10 E1002, E1003, E1004, E1005, E1006, E1007, 

11 E1008, E1009, E1010, E1011, E1012, E1014, 

12 E1037, E1161, E1220, E1228, E1229, E1231, 

13 E1232, E1233, E1234, E1235, E1236, E1237, 

14 E1238, E1239, E2209, E2291, E2292, E2293, 

15 E2294, E2295, E2300, E2301, E2310, E2311, 

16 E2312, E2313, E2321, E2322, E2323, E2324, 

17 E2325, E2326, E2327, E2328, E2329, E2330, 

18 E2331, E2351, E2373, E2374, E2376, E2377, 

19 E2609, E2610, E2617, E8000, E8001, E8002, 

20 K0005, K0835, K0836, K0837, K0838, 

21 K0839, K0840, K0841, K0842, K0843, 

22 K0848, K0849, K0850, K0851, K0852, 

23 K0853, K0854, K0855, K0856, K0857, 

24 K0858, K0859, K0860, K0861, K0862, 

25 K0863, K0864, K0868, K0869, K0870, 


pbinns on DSK79D2C42PROD with BILLS
8 

•HR 2408 IH

1 K0871, K0877, K0878, K0879, K0880, 

2 K0884, K0885, K0886, K0890, K0891, and 

3 K0898; 

4 ‘‘(ii) create and include in the list new 

5 HCPCS codes and appropriate code descriptors 

6 for CRT items that are currently considered to 

7 be included in existing HCPCS codes that in8 clude both CRT and non-CRT items, including 

9 CRT items that, as of January 1, 2019, were 

10 classified within the following HCPCS codes: 

11 E0143, E0950, E0951, E0952, E0955, E0956, 

12 E0957, E0960, E0967, E0978, E0990, E0995, 

13 E1015, E1016, E1028, E1029, E1030, E2205, 

14 E2208, E2231, E2368, E2369, E2370, E2605, 

15 E2606, E2607, E2608, E2613, E2614, E2615, 

16 E2616, E2620, E2621, E2622, E2623, E2624, 

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

18 K0669; and 

19 ‘‘(iii) create new HCPCS codes for other 

20 miscellaneous, otherwise not classified, or cus21 tom CRT items. 

22 ‘‘(C) For each year subsequent to the year dur23 ing which the Secretary publishes the list under sub24 paragraph (A), the Secretary shall publish any nec25 essary updates to such list (including additions of 


pbinns on DSK79D2C42PROD with BILLS
9 

•HR 2408 IH

1 new CRT items and any changes in applicable 

2 HCPCS codes and/or code descriptors) as needed to 

3 ensure appropriate access to the full range of medi4 cally necessary CRT items and technologies.’’. 

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 ‘‘(x) 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 establish a fee 

14 schedule that shall apply to CRT items as de15 fined at section 1861(kkk) and shall ensure 

16 that such fee schedule considers the potential 

17 impact on quality, access, and beneficiary liabil18 ity, including the likely effects on assignment 

19 rates and participation rates, and facilitates ap20 propriate access to medically necessary CRT 

21 items and technologies. 

22 ‘‘(B) METHODOLOGY.—In establishing the 

23 CRT fee schedule payment system under sub24 paragraph (A), the Secretary shall include in 

25 such fee schedule, at a minimum, the allowance 


pbinns on DSK79D2C42PROD with BILLS
10 

•HR 2408 IH

1 of purchase of items identified at section 

2 1861(kkk)(3) and— 

3 ‘‘(i) shall set the CRT fee schedule 

4 payment amounts for CRT items identified 

5 by the codes listed in section 

6 1861(kkk)(3)(B)(i) at a purchase price de7 rived from payment amounts from the 

8 January 1, 2015 Medicare fee schedule 

9 plus annual Consumer Price Index-Urban 

10 All Item updates for each subsequent year 

11 to such items, as applicable, under this 

12 section; 

13 ‘‘(ii) shall calculate the payment 

14 amounts for CRT items identified by the 

15 codes created pursuant to section 

16 1861(kkk)(3)(B)(ii) in accordance with the 

17 methodology described in subparagraph 

18 (C); 

19 ‘‘(iii) shall permit the payment 

20 amounts for CRT items identified by codes 

21 for miscellaneous, otherwise not classified, 

22 or custom items, created pursuant to sec23 tion 1861(kkk)(3)(B)(iii), to be calculated 

24 based on the methodology described in subVerDate Sep 11 2014 21:29 May 02, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2408.IH H2408

pbinns on DSK79D2C42PROD with BILLS
11 

•HR 2408 IH

1 paragraph (C) applied to the specific item 

2 billed under this subsection; and 

3 ‘‘(iv) shall require that payment 

4 amounts for CRT items be adjusted annu5 ally by the increase in the Consumer Price 

6 Index-Urban All Item for the 12-month pe7 riod ending the preceding June 30th. 

8 ‘‘(C) PAYMENT AMOUNT CALCULATION.— 

9 For purposes of subparagraph (B)(ii), the 

10 methodology described in this subparagraph for 

11 calculating payment amounts for CRT items 

12 identified by the codes specified in such sub13 paragraph is as follows: 

14 ‘‘(i) Identify commercial price infor15 mation (such as manufacturer suggested 

16 retail price lists, but not mail order prices 

17 or internet retail prices) for CRT items in 

18 the applicable code in effect during the 

19 base year (which, for purposes of this sub20 paragraph is the calendar year ending De21 cember 1986), except that if the only avail22 able commercial price information is from 

23 a period other than the base year, the Sec24 retary shall use the oldest available pricing 

25 for the items and deflate the pricing data 


pbinns on DSK79D2C42PROD with BILLS
12 

•HR 2408 IH

1 to the mid-point of the base year using the 

2 deflation factors used by the Centers for 

3 Medicare & Medicaid Services for durable 

4 medical equipment at the time of enact5 ment of this section. 

6 ‘‘(ii) Using the base year prices, iden7 tify the median price for all CRT items in 

8 the code. 

9 ‘‘(iii) Increase the median price by 1.7 

10 percent and inflate to the payment year 

11 using the durable medical equipment fee 

12 schedule update factors required by law 

13 through 2005 and full consumer price 

14 index for all urban consumers update fac15 tors starting in 2006 and for each subse16 quent year, adjusted to reflect applicable 

17 sales tax circumstances, if applicable. 

18 ‘‘(D) USED EQUIPMENT.—For used equip19 ment, the Secretary shall set payment at 75 

20 percent of the CRT fee schedule amount for the 

21 CRT item as determined pursuant to the meth22 odology set forth in subparagraph (B). 

23 ‘‘(E) PAYMENT FOR TEMPORARY RENT24 AL.— 


pbinns on DSK79D2C42PROD with BILLS
13 

•HR 2408 IH

1 ‘‘(i) IN GENERAL.—If a CRT item 

2 owned by a qualified individual needs to be 

3 repaired, payment may be made under this 

4 subsection for the temporary rental of a 

5 CRT item while the CRT item owned by 

6 such individual is being repaired. 

7 ‘‘(ii) BASIS; LIMITATION.—Payment 

8 permitted under clause (i) shall be made 

9 on a monthly basis, and the period of rent10 al may not exceed one month. 

11 ‘‘(iii) PAYMENT AMOUNT.—The 

12 amount of payment allowed under clause 

13 (i) for a month for the rental of a CRT 

14 item shall be 10 percent of the purchase 

15 price for the CRT item. 

16 ‘‘(F) REPLACEMENT OF ITEMS.— 

17 ‘‘(i) ESTABLISHMENT OF REASON18 ABLE USEFUL LIFETIME.—In accordance 

19 with clause (ii), not later than two years of 

20 the date of enactment of this subsection, 

21 the Secretary shall determine and estab22 lish, through a rulemaking process involv23 ing advance public notice and an oppor24 tunity for stakeholder input and public 

25 comments, a reasonable useful lifetime for 


pbinns on DSK79D2C42PROD with BILLS
14 

•HR 2408 IH

1 CRT items for which payment may be 

2 made under this paragraph. 

3 ‘‘(ii) LENGTH OF REASONABLE USE4 FUL LIFETIME.—The reasonable useful 

5 lifetime of items of CRT items under this 

6 subsection shall be established based on 

7 the intended use and continued efficacy, 

8 but shall not in any event exceed five years 

9 for any CRT item. The Secretary shall en10 sure that the length of reasonable useful 

11 lifetime is appropriate for each sub-cat12 egory of items within the CRT category. 

13 ‘‘(G) EXCLUSIVE PAYMENT RULE.—This 

14 subsection shall constitute the exclusive provi15 sion under this title for payment for CRT items 

16 under this part. 

17 ‘‘(2) CONDITIONS FOR PAYMENT.— 

18 ‘‘(A) LIMITATION ON PAYMENT.—No pay19 ment shall be made under this subsection for a 

20 CRT item unless such CRT item— 

21 ‘‘(i) meets the clinical conditions for 

22 payment set forth under subparagraph 

23 (B); and 

24 ‘‘(ii) is furnished by a supplier accred25 ited pursuant to subparagraph (D) and 


pbinns on DSK79D2C42PROD with BILLS
15 

•HR 2408 IH

1 meets the supplier and quality standards 

2 specified under subparagraph (C). 

3 ‘‘(B) CLINICAL CONDITIONS FOR PAY4 MENT.— 

5 ‘‘(i) IN GENERAL.—The Secretary 

6 shall establish standards for clinical condi7 tions for payment for CRT items under 

8 this subsection. 

9 ‘‘(ii) REQUIREMENTS.—The standards 

10 established under clause (B)(i) shall re11 quire the following: 

12 ‘‘(I) WRITTEN ORDER.—A quali13 fied ordering practitioner, as defined 

14 in section 1861(mmm) of the Act, 

15 shall provide a written order for a 

16 CRT item for a specific individual be17 fore the Secretary may provide pay18 ment for such item for such individual 

19 under this subsection. 

20 ‘‘(II) CRT EVALUATION.—In the 

21 case of a CRT item that is cat22 egorized by the Secretary, for pur23 poses of the program under this title, 

24 as a manual wheelchair or a power 

25 wheelchair, the qualified ordering 


pbinns on DSK79D2C42PROD with BILLS
16 

•HR 2408 IH

1 practitioner may not provide a written 

2 order under subclause (I) unless the 

3 individual has undergone a CRT eval4 uation conducted by a licensed phys5 ical therapist or occupational therapist 

6 who has no financial relationship with 

7 the CRT supplier. The performance of 

8 such a CRT evaluation by a licensed 

9 physical or occupational therapist 

10 shall not be subject (or counted to11 wards) the limitation on certain ther12 apy services under section 1833(g). 

13 ‘‘(III) DOCUMENTATION OF MED14 ICAL NECESSITY.—A qualified order15 ing practitioner who provides a writ16 ten order under subclause (I) shall 

17 maintain documentation of the med18 ical necessity of such order for a pe19 riod of seven years and shall make 

20 such documentation available to the 

21 Secretary upon request. The docu22 mentation of medical necessity under 

23 this clause shall include evidence that 

24 the individual for whom the order was 

25 written has medical, physical, and/or 


pbinns on DSK79D2C42PROD with BILLS
17 

•HR 2408 IH

1 functional needs and capacities that 

2 require the use of the prescribed CRT 

3 item. 

4 ‘‘(IV) COVERAGE.—In developing 

5 the standards under subparagraph 

6 (B), the coverage of CRT items shall 

7 be based on the individual’s specific 

8 medical, physical, or functional needs 

9 and capacities for basic and instru10 mental activities of daily living in any 

11 setting in which life activities take 

12 place. For purposes of this subclause, 

13 basic and instrumental activities of 

14 daily living include, but are not lim15 ited to, moving from place to place; 

16 transferring; maintaining or changing 

17 body position; caring for one’s self 

18 (such as toileting, bathing, dressing, 

19 eating, housekeeping and household 

20 management); acquiring necessities, 

21 goods and services; engaging in edu22 cation, employment and economic life; 

23 or using transportation. 

24 ‘‘(V) COVERAGE REQUIRE25 MENT.—Nothing in this subsection or 


pbinns on DSK79D2C42PROD with BILLS
18 

•HR 2408 IH

1 section 1861(s)(2)(II) shall be con2 strued as requiring the Secretary to 

3 provide for coverage under this title of 

4 any item that would not otherwise be 

5 covered under this title without appli6 cation of the amendments made by 

7 the Ensuring Access to Quality Com8 plex Rehabilitation Technology Act of 

9 2019, or as changing any coverage re10 quirements in existence as of the date 

11 of the enactment of this subsection, 

12 including any prior authorization cov13 erage requirements or advance deter14 minations of Medicare coverage re15 quirements that may apply to CRT 

16 items. 

17 ‘‘(C) ESTABLISHMENT OF SUPPLIER AND

18 QUALITY STANDARDS FOR CRT.— 

19 ‘‘(i) ESTABLISHMENT.—The Secretary 

20 shall establish and implement supplier and 

21 quality standards for suppliers of CRT 

22 items to be applied by recognized inde23 pendent accreditation organizations (as 

24 designated under subparagraph (D)), 

25 which as set forth below, incorporate existVerDate Sep 11 2014 21:29 May 02, 2019 Jkt 089200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\H2408.IH H2408

pbinns on DSK79D2C42PROD with BILLS
19 

•HR 2408 IH

1 ing standards as well as creating new 

2 CRT-specific standards. Such standards 

3 shall be applied prospectively and shall be 

4 published on the Internet website of the 

5 Centers for Medicare & Medicaid Services. 

6 ‘‘(ii) REQUIREMENTS OF STAND7 ARDS.—In establishing the supplier and 

8 quality standards under clause (i), the Sec9 retary shall require that each supplier of 

10 CRT items meets the following require11 ments: 

12 ‘‘(I) DME AND MEDICAL EQUIP13 MENT AND SUPPLIES STANDARDS.— 

14 The supplier complies with all of the 

15 standards that are applicable to sup16 pliers of durable medical equipment 

17 under subsection (a)(20) and sup18 pliers of medical equipment and sup19 plies under subsection (j). 

20 ‘‘(II) QUALIFIED CRT PROFES21 SIONAL STANDARDS.—The supplier of 

22 a CRT item makes available, in each 

23 service area served by such supplier, 

24 at least one qualified CRT profes25 sional to analyze the needs and capacVerDate Sep 11 2014 21:29 May 02, 2019 Jkt 089200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\H2408.IH H2408

pbinns on DSK79D2C42PROD with BILLS
20 

•HR 2408 IH

1 ities of individuals for a CRT item in 

2 collaboration with the clinical team; 

3 assist in selecting any appropriate 

4 CRT items for such an individual, 

5 given such needs and capacities; and 

6 provide technology-related training to 

7 such an individual in the proper use 

8 and maintenance of the CRT items. 

9 ‘‘(III) SERVICE AND REPAIR

10 STANDARDS.—The supplier of the 

11 CRT item— 

12 ‘‘(aa) makes available, in 

13 each service area served by such 

14 supplier, at least one qualified 

15 CRT service technician to service 

16 and repair CRT items that are 

17 furnished by such supplier; and 

18 ‘‘(bb) provides the individual 

19 with written information on ac20 cessing service and repair for the 

21 CRT item before the CRT item is 

22 ordered for the individual in23 volved. 

24 ‘‘(D) ACCREDITATION FOR SUPPLIERS OF

25 CRT ITEMS.— 


pbinns on DSK79D2C42PROD with BILLS
21 

•HR 2408 IH

1 ‘‘(i) REQUIREMENT FOR PROVIDER OR

2 SUPPLIER NUMBER.—The Secretary shall 

3 not provide a supplier of CRT items with 

4 a provider or supplier number to submit 

5 claims for payment under this subsection 

6 unless the supplier is in compliance with 

7 the requirements under this subparagraph. 

8 ‘‘(ii) APPLICATION OF ACCREDITATION

9 REQUIREMENT.—In implementing supplier 

10 and quality standards under paragraph 

11 (C), the Secretary shall require suppliers 

12 furnishing CRT items, on or after one year 

13 after the standards are published under 

14 such paragraph, directly or as a subcon15 tractor for another entity— 

16 ‘‘(I) to comply with such stand17 ards; and 

18 ‘‘(II) to have submitted to the 

19 Secretary evidence of accreditation by 

20 an accreditation organization des21 ignated under subparagraph (iii) dem22 onstrating that the supplier is com23 plying with such standards. 

24 ‘‘(iii) DESIGNATION OF INDEPENDENT

25 ACCREDITATION ORGANIZATIONS.—Not 


pbinns on DSK79D2C42PROD with BILLS
22 

•HR 2408 IH

1 later than the date that is one year after 

2 the date on which the Secretary imple3 ments the supplier and quality standards 

4 under subparagraph (C), the Secretary 

5 shall designate and approve one or more 

6 independent accreditation organizations 

7 that— 

8 ‘‘(I) are approved under sub9 section (a)(20)(B), which set forth the 

10 designation of independent accredita11 tion organizations for suppliers of du12 rable medical equipment; and 

13 ‘‘(II) have the capability to as14 sess whether suppliers of CRT items 

15 meet the supplier and quality stand16 ards established under subparagraph 

17 (C). 

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

20 ‘‘(A) QUALIFIED CRT PROFESSIONAL.— 

21 ‘‘(i) IN GENERAL.—The term ‘quali22 fied CRT professional’ means an individual 

23 who— 

24 ‘‘(I) is certified by the Rehabili25 tation Engineering and Assistive 


pbinns on DSK79D2C42PROD with BILLS
23 

•HR 2408 IH

1 Technology Society of North America 

2 as an assistive technology professional 

3 or is certified by another organization 

4 designated by the Secretary (acting in 

5 consultation with relevant parties, in6 cluding manufacturers and suppliers 

7 of CRT items, relevant consumer or8 ganizations, and clinicians with knowl9 edge of CRT items and direct experi10 ence working with individuals who use 

11 CRT items) as providing a certifi12 cation that is equivalent to, or more 

13 stringent than, the assistive tech14 nology professional certification; and 

15 ‘‘(II) beginning 2 years after the 

16 establishment of the designation 

17 under clause (ii), subject to clause 

18 (ii)(II), achieves an additional des19 ignation that demonstrates the indi20 vidual’s competencies and experience 

21 in supplying CRT items. 

22 ‘‘(ii) ADDITIONAL DESIGNATION.— 

23 ‘‘(I) Not later than one year 

24 after the date of the enactment of this 

25 subparagraph, the Secretary, with 


pbinns on DSK79D2C42PROD with BILLS
24 

•HR 2408 IH

1 stakeholder input, including manufac2 turers and suppliers of CRT items, 

3 relevant consumer organizations, and 

4 clinicians with knowledge of CRT 

5 items and direct experience working 

6 with patients who use CRT items, 

7 shall establish the additional designa8 tion under clause (i)(II). 

9 ‘‘(II) Until such time as the addi10 tional designation is established, the 

11 term ‘qualified CRT professional’ 

12 shall include an individual meeting the 

13 requirements in clause (i)(I) only. 

14 ‘‘(B) QUALIFIED CRT SERVICE TECHNI15 CIAN.—The term ‘qualified CRT service techni16 cian’ means an individual who, with respect to 

17 a CRT item— 

18 ‘‘(i) has successfully completed a 

19 training program approved by the manu20 facturer of the CRT item; 

21 ‘‘(ii) is trained and educated (includ22 ing through on-the-job training) to assem23 ble, program, adjust, service, and repair 

24 CRT items; and 


pbinns on DSK79D2C42PROD with BILLS
25 

•HR 2408 IH

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

2 least 10 hours of education specific to the 

3 assembly, programming, service, adjusting, 

4 and repairing of CRT items. 

5 ‘‘(C) QUALIFIED ORDERING PRACTI6 TIONER.—The term ‘qualified ordering practi7 tioner’ means a physician (as defined in section 

8 1861(r)), a physician assistant, nurse practi9 tioner, or a clinical nurse specialist (as those 

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

11 SEC. 5. CONFORMING AMENDMENTS. 

12 (a) EXEMPTION FROM COMPETITIVE ACQUISI13 TION.—Section 1847(a)(7) of the Social Security Act (42 

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

15 the following new subparagraph: 

16 ‘‘(C) CRT ITEMS.—For calendar year 

17 2020 and subsequent years, complex rehabilita18 tion technology items (as defined in section 

19 1861(kkk)).’’. 

20 (b) PAYMENT EXCLUSIONS.—Section 1834(a) of the 

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

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

23 following sentence ‘‘For calendar year 2020 and sub24 sequent years, the items covered by this paragraph 

25 shall not include CRT items (as defined in section 


pbinns on DSK79D2C42PROD with BILLS
26 

•HR 2408 IH

1 1861(kkk)), which shall be paid pursuant to the fee 

2 schedule and methodology for CRT items described 

3 in section 1834(x) beginning on January 1, 2020, 

4 and in subsequent years.’’; 

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

6 the following: ‘‘For calendar year 2020 and subse7 quent years, this paragraph shall not apply to CRT 

8 items under section 1861(kkk).’’; and 

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

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

11 may, as allowed by the second sentence of this para12 graph, waive) the requirements of the first sentence 

13 of this paragraph to suppliers of complex rehabilita14 tion technology items, except that, in order to avoid 

15 duplicate bonds, the Secretary shall not impose such 

16 requirements with respect to suppliers of complex re17 habilitation technology items if such suppliers also 

18 participate in the Medicare program as suppliers of 

19 durable medical equipment.’’. 

20 (c) REQUIREMENTS FOR SUPPLIERS OF MEDICAL

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

22 Social Security Act (42 U.S.C. 1395m(j)(5)) is amend23 ed— 

24 (1) by redesignating subparagraphs (E) and 

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


pbinns on DSK79D2C42PROD with BILLS
27 

•HR 2408 IH

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

3 ‘‘(E) complex rehabilitation technology 

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

5 SEC. 6. CONTINUED COVERAGE OF CRT ITEMS. 

6 The amendments made by this Act do not change the 

7 availability of coverage in existence as of the date of the 

8 enactment of this Act, including prior authorization cov9 erage requirements, for CRT items under title XVIII of 

10 the Social Security Act or title XIX of such Act, or any 

11 other payor or program, including in the case in which 

12 CRT items are covered, as of such date of enactment, as 

13 durable medical equipment or under a home health ben14 efit, including the home health benefit under section 1902 

15 of such Act and the regulations implementing such sec16 tion; nor do the amendments made by this Act change the 

17 existing definitions of durable medical equipment or med18 ical equipment and supplies under such Act or as estab19 lished by any other payor or program, including where 

20 CRT items may also fit those definitions. In the case that 

21 a CRT item also satisfies the definition of durable medical 

22 equipment, or medical equipment and supplies, or another 

23 benefit category as defined by an applicable payor, the 

24 amendments of this Act shall apply only for purposes of 

25 payment of the CRT item under title XVIII of such Act. 


pbinns on DSK79D2C42PROD with BILLS
28 

•HR 2408 IH

1 SEC. 7. EFFECTIVE DATE. 

2 The amendments made by this Act shall be effective 

3 beginning on the date that is 30 days after the date of 

4 the enactment of this Act, unless otherwise specified in 

5 a provision of, including amendment made by, this Act. 

Æ 


pbinns on DSK79D2C42PROD with BILLS