tinguish these items as compared to other types of 
Medicare-covered medical items and equipment. 
(3) This current lack of definitional clarity for 
complex rehabilitation technology items results in ac-
cess challenges for beneficiaries with significant dis-
abilities and medical conditions, as these items are 
often grouped with standardized, nonspecialized 
products that significantly differ with respect to the 
complexity and the individualized configuration in-
volved, as well as certain evaluation requirements, 
clinical coverage criteria, and other considerations. 
(4) To provide adequate access for the small 
population of Medicare beneficiaries with significant 
disabilities and medical conditions who require these 
complex, specialized, and individually configured 
items a distinct Medicare benefit category for com-
plex rehabilitative technology items is needed. This 
will allow for related improvements to clarify appli-
cable coding, coverage, payment, and supplier stand-
ards for such items. A separate benefit category is 
needed to ensure appropriate access to these items 
for individuals with significant disabilities and med-
ical conditions, and will help prevent potential over-
utilization of CRT by individuals for whom such 
items are not medically necessary. 
VerDate Sep 11 2014 
21:29 May 02, 2019
Jkt 089200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H2408.IH
H2408
pbinns on DSK79D2C42PROD with BILLS
SEC. 3. ESTABLISHING SEPARATE BENEFIT CATEGORY FOR 
COMPLEX REHABILITATION TECHNOLOGIES 
WITHIN MEDICARE. 
Section 1861 of the Social Security Act (42 U.S.C. 
1395x) is amended— 
(1) in subsection (s)(2)— 
(A) in subparagraph (GG), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (HH), by inserting 
‘‘and’’ at the end; and 
(C) by inserting after subparagraph (HH) 
the following new paragraph: 
‘‘(II) complex rehabilitation technology 
items (as defined in subsection (kkk));’’; and 
(2) by adding at the end, the following new sub-
sections: 
‘‘(kkk) COMPLEX REHABILITATION TECHNOLOGY 
ITEM.— 
‘‘(1) The terms ‘complex rehabilitation tech-
nology item’ and ‘CRT item’ mean an item that— 
‘‘(A) is designed, manufactured, individ-
ually configured, adjusted, or modified for a 
specific individual to meet the individual’s 
unique medical, physical, or functional needs 
and capacities; 
VerDate Sep 11 2014 
21:29 May 02, 2019
Jkt 089200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H2408.IH
H2408
pbinns on DSK79D2C42PROD with BILLS
‘‘(B) is primarily used to serve a medical, 
physical, or functional purpose and is generally 
not useful to a person in the absence of dis-
ability, illness, injury, or other medical condi-
tion; and 
‘‘(C) requires certain services to ensure ap-
propriate use of such item, including one or 
more of the following— 
‘‘(i) an evaluation of the features and 
functions of CRT items to the specific indi-
vidual who will use such an item, as re-
quired under section 1834(x)(2)(B)(ii)(II); 
or 
‘‘(ii) configuring, fitting, program-
ming, adjusting, or adapting the particular 
complex rehabilitation technology item for 
use by such individual. 
‘‘(2)(A) CRT items shall include— 
‘‘(i) complex rehabilitation manual and 
power wheelchairs, options, and accessories; 
‘‘(ii) specialized seating and positioning 
items, options, and accessories; 
‘‘(iii) adaptive equipment such as standing 
frames and gait trainers and options and acces-
sories; and 
VerDate Sep 11 2014 
21:29 May 02, 2019
Jkt 089200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H2408.IH
H2408
pbinns on DSK79D2C42PROD with BILLS
‘‘(iv) other items that meet the definition 
in subparagraph (1), as determined by the Sec-
retary. 
‘‘(B) In determining which items meet the defi-
nition of a CRT item under this subsection, the Sec-
retary shall review existing and new technologies on 
at least a yearly basis, and in a manner that takes 
into consideration technological differences in avail-
able items and equipment, as well as the varying 
clinical needs of individuals who rely on such items 
and equipment. 
‘‘(3)(A) Not later than six months after the 
date of enactment of this subsection, the Secretary 
shall publish a list of HCPCS codes that meet the 
definition of CRT items under this subsection. In 
considering and publishing the list of codes that 
meet such definition, the Secretary must ensure that 
the HCPCS code set provides adequate and appro-
priate access to existing and new technologies that 
may improve medical, physical, or functional out-
comes for beneficiaries with significant disabilities 
and medical conditions, taking into consideration 
technological differences, clinical application, and the 
unique medical, physical, and functional needs of 
VerDate Sep 11 2014 
21:29 May 02, 2019
Jkt 089200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H2408.IH
H2408
pbinns on DSK79D2C42PROD with BILLS
beneficiaries who rely on medically necessary CRT 
items. 
‘‘(B) In establishing the list under subpara-
graph (A), the Secretary shall— 
‘‘(i) identify and include existing HCPCS 
codes that are exclusively CRT items, including 
items that, as of January 1, 2019, were classi-
fied within the following HCPCS codes: E0637, 
E0638, E0641, E0642, E0953, E0954, E0986, 
E1002, E1003, E1004, E1005, E1006, E1007, 
E1008, E1009, E1010, E1011, E1012, E1014, 
E1037, E1161, E1220, E1228, E1229, E1231, 
E1232, E1233, E1234, E1235, E1236, E1237, 
E1238, E1239, E2209, E2291, E2292, E2293, 
E2294, E2295, E2300, E2301, E2310, E2311, 
E2312, E2313, E2321, E2322, E2323, E2324, 
E2325, E2326, E2327, E2328, E2329, E2330, 
E2331, E2351, E2373, E2374, E2376, E2377, 
E2609, E2610, E2617, E8000, E8001, E8002, 
K0005, 
K0835, 
K0836, 
K0837, 
K0838, 
K0839, 
K0840, 
K0841, 
K0842, 
K0843, 
K0848, 
K0849, 
K0850, 
K0851, 
K0852, 
K0853, 
K0854, 
K0855, 
K0856, 
K0857, 
K0858, 
K0859, 
K0860, 
K0861, 
K0862, 
K0863, 
K0864, 
K0868, 
K0869, 
K0870, 
VerDate Sep 11 2014 
21:29 May 02, 2019
Jkt 089200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H2408.IH
H2408
pbinns on DSK79D2C42PROD with BILLS
K0871, 
K0877, 
K0878, 
K0879, 
K0880, 
K0884, K0885, K0886, K0890, K0891, and 
K0898; 
‘‘(ii) create and include in the list new 
HCPCS codes and appropriate code descriptors 
for CRT items that are currently considered to 
be included in existing HCPCS codes that in-
clude both CRT and non-CRT items, including 
CRT items that, as of January 1, 2019, were 
classified within the following HCPCS codes: 
E0143, E0950, E0951, E0952, E0955, E0956, 
E0957, E0960, E0967, E0978, E0990, E0995, 
E1015, E1016, E1028, E1029, E1030, E2205, 
E2208, E2231, E2368, E2369, E2370, E2605, 
E2606, E2607, E2608, E2613, E2614, E2615, 
E2616, E2620, E2621, E2622, E2623, E2624, 
E2625, K0004, K0009, K0040, K0108, and 
K0669; and 
‘‘(iii) create new HCPCS codes for other 
miscellaneous, otherwise not classified, or cus-
tom CRT items. 
‘‘(C) For each year subsequent to the year dur-
ing which the Secretary publishes the list under sub-
paragraph (A), the Secretary shall publish any nec-
essary updates to such list (including additions of 
VerDate Sep 11 2014 
21:29 May 02, 2019
Jkt 089200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H2408.IH
H2408
pbinns on DSK79D2C42PROD with BILLS
new CRT items and any changes in applicable 
HCPCS codes and/or code descriptors) as needed to 
ensure appropriate access to the full range of medi-
cally necessary CRT items and technologies.’’. 
SEC. 4. PAYMENT RULES. 
Section 1834 of the Social Security Act (42 U.S.C. 
1395m) is amended by adding at the end the following: 
‘‘(x) PAYMENT FOR CRT ITEMS.— 
‘‘(1) GENERAL RULE FOR PAYMENT.— 
‘‘(A) IN
GENERAL.—Not later than the 
date that is one year after the date of the en-
actment of this subsection, subject to subpara-
graph (B), the Secretary shall establish a fee 
schedule that shall apply to CRT items as de-
fined at section 1861(kkk) and shall ensure 
that such fee schedule considers the potential 
impact on quality, access, and beneficiary liabil-
ity, including the likely effects on assignment 
rates and participation rates, and facilitates ap-
propriate access to medically necessary CRT 
items and technologies. 
‘‘(B) METHODOLOGY.—In establishing the 
CRT fee schedule payment system under sub-
paragraph (A), the Secretary shall include in 
such fee schedule, at a minimum, the allowance 
VerDate Sep 11 2014 
21:29 May 02, 2019
Jkt 089200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H2408.IH
H2408
pbinns on DSK79D2C42PROD with BILLS
of purchase of items identified at section 
1861(kkk)(3) and— 
‘‘(i) shall set the CRT fee schedule 
payment amounts for CRT items identified 
by 
the 
codes 
listed 
in 
section 
1861(kkk)(3)(B)(i) at a purchase price de-
rived from payment amounts from the 
January 1, 2015 Medicare fee schedule 
plus annual Consumer Price Index-Urban 
All Item updates for each subsequent year 
to such items, as applicable, under this 
section; 
‘‘(ii) shall calculate the payment 
amounts for CRT items identified by the 
codes 
created 
pursuant 
to 
section 
1861(kkk)(3)(B)(ii) in accordance with the 
methodology described in subparagraph 
(C); 
‘‘(iii) 
shall 
permit 
the 
payment 
amounts for CRT items identified by codes 
for miscellaneous, otherwise not classified, 
or custom items, created pursuant to sec-
tion 1861(kkk)(3)(B)(iii), to be calculated 
based on the methodology described in sub-
VerDate 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
paragraph (C) applied to the specific item 
billed under this subsection; and 
‘‘(iv) shall require that payment 
amounts for CRT items be adjusted annu-
ally by the increase in the Consumer Price 
Index-Urban All Item for the 12-month pe-
riod ending the preceding June 30th. 
‘‘(C) PAYMENT AMOUNT CALCULATION.— 
For purposes of subparagraph (B)(ii), the 
methodology described in this subparagraph for 
calculating payment amounts for CRT items 
identified by the codes specified in such sub-
paragraph is as follows: 
‘‘(i) Identify commercial price infor-
mation (such as manufacturer suggested 
retail price lists, but not mail order prices 
or internet retail prices) for CRT items in 
the applicable code in effect during the 
base year (which, for purposes of this sub-
paragraph is the calendar year ending De-
cember 1986), except that if the only avail-
able commercial price information is from 
a period other than the base year, the Sec-
retary shall use the oldest available pricing 
for the items and deflate the pricing data 
VerDate Sep 11 2014 
21:29 May 02, 2019
Jkt 089200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H2408.IH
H2408
pbinns on DSK79D2C42PROD with BILLS
to the mid-point of the base year using the 
deflation factors used by the Centers for 
Medicare & Medicaid Services for durable 
medical equipment at the time of enact-
ment of this section. 
‘‘(ii) Using the base year prices, iden-
tify the median price for all CRT items in 
the code. 
‘‘(iii) Increase the median price by 1.7 
percent and inflate to the payment year 
using the durable medical equipment fee 
schedule update factors required by law 
through 2005 and full consumer price 
index for all urban consumers update fac-
tors starting in 2006 and for each subse-
quent year, adjusted to reflect applicable 
sales tax circumstances, if applicable. 
‘‘(D) USED EQUIPMENT.—For used equip-
ment, the Secretary shall set payment at 75 
percent of the CRT fee schedule amount for the 
CRT item as determined pursuant to the meth-
odology set forth in subparagraph (B). 
‘‘(E) PAYMENT
FOR
TEMPORARY
RENT-
AL.— 
VerDate Sep 11 2014 
21:29 May 02, 2019
Jkt 089200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H2408.IH
H2408
pbinns on DSK79D2C42PROD with BILLS
‘‘(i) IN
GENERAL.—If a CRT item 
owned by a qualified individual needs to be 
repaired, payment may be made under this 
subsection for the temporary rental of a 
CRT item while the CRT item owned by 
such individual is being repaired. 
‘‘(ii) BASIS; 
LIMITATION.—Payment 
permitted under clause (i) shall be made 
on a monthly basis, and the period of rent-
al may not exceed one month. 
‘‘(iii) 
PAYMENT
AMOUNT.—The 
amount of payment allowed under clause 
(i) for a month for the rental of a CRT 
item shall be 10 percent of the purchase 
price for the CRT item. 
‘‘(F) REPLACEMENT OF ITEMS.— 
‘‘(i) ESTABLISHMENT
OF
REASON-
ABLE
USEFUL
LIFETIME.—In accordance 
with clause (ii), not later than two years of 
the date of enactment of this subsection, 
the Secretary shall determine and estab-
lish, through a rulemaking process involv-
ing advance public notice and an oppor-
tunity for stakeholder input and public 
comments, a reasonable useful lifetime for 
VerDate Sep 11 2014 
21:29 May 02, 2019
Jkt 089200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H2408.IH
H2408
pbinns on DSK79D2C42PROD with BILLS
CRT items for which payment may be 
made under this paragraph. 
‘‘(ii) LENGTH OF REASONABLE USE-
FUL
LIFETIME.—The reasonable useful 
lifetime of items of CRT items under this 
subsection shall be established based on 
the intended use and continued efficacy, 
but shall not in any event exceed five years 
for any CRT item. The Secretary shall en-
sure that the length of reasonable useful 
lifetime is appropriate for each sub-cat-
egory of items within the CRT category. 
‘‘(G) EXCLUSIVE
PAYMENT
RULE.—This 
subsection shall constitute the exclusive provi-
sion under this title for payment for CRT items 
under this part. 
‘‘(2) CONDITIONS FOR PAYMENT.— 
‘‘(A) LIMITATION ON PAYMENT.—No pay-
ment shall be made under this subsection for a 
CRT item unless such CRT item— 
‘‘(i) meets the clinical conditions for 
payment set forth under subparagraph 
(B); and 
‘‘(ii) is furnished by a supplier accred-
ited pursuant to subparagraph (D) and 
VerDate Sep 11 2014 
21:29 May 02, 2019
Jkt 089200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H2408.IH
H2408
pbinns on DSK79D2C42PROD with BILLS
meets the supplier and quality standards 
specified under subparagraph (C). 
‘‘(B) CLINICAL
CONDITIONS
FOR
PAY-
MENT.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall establish standards for clinical condi-
tions for payment for CRT items under 
this subsection. 
‘‘(ii) REQUIREMENTS.—The standards 
established under clause (B)(i) shall re-
quire the following: 
‘‘(I) WRITTEN ORDER.—A quali-
fied ordering practitioner, as defined 
in section 1861(mmm) of the Act, 
shall provide a written order for a 
CRT item for a specific individual be-
fore the Secretary may provide pay-
ment for such item for such individual 
under this subsection. 
‘‘(II) CRT EVALUATION.—In the 
case of a CRT item that is cat-
egorized by the Secretary, for pur-
poses of the program under this title, 
as a manual wheelchair or a power 
wheelchair, 
the 
qualified 
ordering 
VerDate Sep 11 2014 
21:29 May 02, 2019
Jkt 089200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H2408.IH
H2408
pbinns on DSK79D2C42PROD with BILLS
practitioner may not provide a written 
order under subclause (I) unless the 
individual has undergone a CRT eval-
uation conducted by a licensed phys-
ical therapist or occupational therapist 
who has no financial relationship with 
the CRT supplier. The performance of 
such a CRT evaluation by a licensed 
physical or occupational therapist 
shall not be subject (or counted to-
wards) the limitation on certain ther-
apy services under section 1833(g). 
‘‘(III) DOCUMENTATION OF MED-
ICAL NECESSITY.—A qualified order-
ing practitioner who provides a writ-
ten order under subclause (I) shall 
maintain documentation of the med-
ical necessity of such order for a pe-
riod of seven years and shall make 
such documentation available to the 
Secretary upon request. The docu-
mentation of medical necessity under 
this clause shall include evidence that 
the individual for whom the order was 
written has medical, physical, and/or 
VerDate Sep 11 2014 
21:29 May 02, 2019
Jkt 089200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H2408.IH
H2408
pbinns on DSK79D2C42PROD with BILLS
functional needs and capacities that 
require the use of the prescribed CRT 
item. 
‘‘(IV) COVERAGE.—In developing 
the standards under subparagraph 
(B), the coverage of CRT items shall 
be based on the individual’s specific 
medical, physical, or functional needs 
and capacities for basic and instru-
mental activities of daily living in any 
setting in which life activities take 
place. For purposes of this subclause, 
basic and instrumental activities of 
daily living include, but are not lim-
ited to, moving from place to place; 
transferring; maintaining or changing 
body position; caring for one’s self 
(such as toileting, bathing, dressing, 
eating, housekeeping and household 
management); acquiring necessities, 
goods and services; engaging in edu-
cation, employment and economic life; 
or using transportation. 
‘‘(V) 
COVERAGE
REQUIRE-
MENT.—Nothing in this subsection or 
VerDate Sep 11 2014 
21:29 May 02, 2019
Jkt 089200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H2408.IH
H2408
pbinns on DSK79D2C42PROD with BILLS
section 1861(s)(2)(II) shall be con-
strued as requiring the Secretary to 
provide for coverage under this title of 
any item that would not otherwise be 
covered under this title without appli-
cation of the amendments made by 
the Ensuring Access to Quality Com-
plex Rehabilitation Technology Act of 
2019, or as changing any coverage re-
quirements in existence as of the date 
of the enactment of this subsection, 
including any prior authorization cov-
erage requirements or advance deter-
minations of Medicare coverage re-
quirements that may apply to CRT 
items. 
‘‘(C) ESTABLISHMENT OF SUPPLIER AND 
QUALITY STANDARDS FOR CRT.— 
‘‘(i) ESTABLISHMENT.—The Secretary 
shall establish and implement supplier and 
quality standards for suppliers of CRT 
items to be applied by recognized inde-
pendent accreditation organizations (as 
designated 
under 
subparagraph 
(D)), 
which as set forth below, incorporate exist-
VerDate 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
ing standards as well as creating new 
CRT-specific standards. Such standards 
shall be applied prospectively and shall be 
published on the Internet website of the 
Centers for Medicare & Medicaid Services. 
‘‘(ii) 
REQUIREMENTS
OF
STAND-
ARDS.—In establishing the supplier and 
quality standards under clause (i), the Sec-
retary shall require that each supplier of 
CRT items meets the following require-
ments: 
‘‘(I) DME AND MEDICAL EQUIP-
MENT
AND
SUPPLIES
STANDARDS.— 
The supplier complies with all of the 
standards that are applicable to sup-
pliers of durable medical equipment 
under subsection (a)(20) and sup-
pliers of medical equipment and sup-
plies under subsection (j). 
‘‘(II) QUALIFIED
CRT
PROFES-
SIONAL STANDARDS.—The supplier of 
a CRT item makes available, in each 
service area served by such supplier, 
at least one qualified CRT profes-
sional to analyze the needs and capac-
VerDate 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
ities of individuals for a CRT item in 
collaboration with the clinical team; 
assist in selecting any appropriate 
CRT items for such an individual, 
given such needs and capacities; and 
provide technology-related training to 
such an individual in the proper use 
and maintenance of the CRT items. 
‘‘(III) 
SERVICE
AND
REPAIR 
STANDARDS.—The supplier of the 
CRT item— 
‘‘(aa) makes available, in 
each service area served by such 
supplier, at least one qualified 
CRT service technician to service 
and repair CRT items that are 
furnished by such supplier; and 
‘‘(bb) provides the individual 
with written information on ac-
cessing service and repair for the 
CRT item before the CRT item is 
ordered for the individual in-
volved. 
‘‘(D) ACCREDITATION FOR SUPPLIERS OF 
CRT ITEMS.— 
VerDate Sep 11 2014 
21:29 May 02, 2019
Jkt 089200
PO 00000
Frm 00020
Fmt 6652
Sfmt 6201
E:\BILLS\H2408.IH
H2408
pbinns on DSK79D2C42PROD with BILLS
‘‘(i) REQUIREMENT FOR PROVIDER OR 
SUPPLIER NUMBER.—The Secretary shall 
not provide a supplier of CRT items with 
a provider or supplier number to submit 
claims for payment under this subsection 
unless the supplier is in compliance with 
the requirements under this subparagraph. 
‘‘(ii) APPLICATION OF ACCREDITATION 
REQUIREMENT.—In implementing supplier 
and quality standards under paragraph 
(C), the Secretary shall require suppliers 
furnishing CRT items, on or after one year 
after the standards are published under 
such paragraph, directly or as a subcon-
tractor for another entity— 
‘‘(I) to comply with such stand-
ards; and 
‘‘(II) to have submitted to the 
Secretary evidence of accreditation by 
an accreditation organization des-
ignated under subparagraph (iii) dem-
onstrating that the supplier is com-
plying with such standards. 
‘‘(iii) DESIGNATION OF INDEPENDENT 
ACCREDITATION
ORGANIZATIONS.—Not 
VerDate Sep 11 2014 
21:29 May 02, 2019
Jkt 089200
PO 00000
Frm 00021
Fmt 6652
Sfmt 6201
E:\BILLS\H2408.IH
H2408
pbinns on DSK79D2C42PROD with BILLS
later than the date that is one year after 
the date on which the Secretary imple-
ments the supplier and quality standards 
under subparagraph (C), the Secretary 
shall designate and approve one or more 
independent 
accreditation 
organizations 
that— 
‘‘(I) are approved under sub-
section (a)(20)(B), which set forth the 
designation of independent accredita-
tion organizations for suppliers of du-
rable medical equipment; and 
‘‘(II) have the capability to as-
sess whether suppliers of CRT items 
meet the supplier and quality stand-
ards established under subparagraph 
(C). 
‘‘(3) DEFINITIONS.—For purposes of this sub-
section: 
‘‘(A) QUALIFIED CRT PROFESSIONAL.— 
‘‘(i) IN GENERAL.—The term ‘quali-
fied CRT professional’ means an individual 
who— 
‘‘(I) is certified by the Rehabili-
tation 
Engineering 
and 
Assistive 
VerDate Sep 11 2014 
21:29 May 02, 2019
Jkt 089200
PO 00000
Frm 00022
Fmt 6652
Sfmt 6201
E:\BILLS\H2408.IH
H2408
pbinns on DSK79D2C42PROD with BILLS
Technology Society of North America 
as an assistive technology professional 
or is certified by another organization 
designated by the Secretary (acting in 
consultation with relevant parties, in-
cluding manufacturers and suppliers 
of CRT items, relevant consumer or-
ganizations, and clinicians with knowl-
edge of CRT items and direct experi-
ence working with individuals who use 
CRT items) as providing a certifi-
cation that is equivalent to, or more 
stringent than, the assistive tech-
nology professional certification; and 
‘‘(II) beginning 2 years after the 
establishment 
of 
the 
designation 
under clause (ii), subject to clause 
(ii)(II), achieves an additional des-
ignation that demonstrates the indi-
vidual’s competencies and experience 
in supplying CRT items. 
‘‘(ii) ADDITIONAL DESIGNATION.— 
‘‘(I) Not later than one year 
after the date of the enactment of this 
subparagraph, the Secretary, with 
VerDate Sep 11 2014 
21:29 May 02, 2019
Jkt 089200
PO 00000
Frm 00023
Fmt 6652
Sfmt 6201
E:\BILLS\H2408.IH
H2408
pbinns on DSK79D2C42PROD with BILLS
stakeholder input, including manufac-
turers and suppliers of CRT items, 
relevant consumer organizations, and 
clinicians with knowledge of CRT 
items and direct experience working 
with patients who use CRT items, 
shall establish the additional designa-
tion under clause (i)(II). 
‘‘(II) Until such time as the addi-
tional designation is established, the 
term 
‘qualified 
CRT 
professional’ 
shall include an individual meeting the 
requirements in clause (i)(I) only. 
‘‘(B) QUALIFIED
CRT
SERVICE
TECHNI-
CIAN.—The term ‘qualified CRT service techni-
cian’ means an individual who, with respect to 
a CRT item— 
‘‘(i) has successfully completed a 
training program approved by the manu-
facturer of the CRT item; 
‘‘(ii) is trained and educated (includ-
ing through on-the-job training) to assem-
ble, program, adjust, service, and repair 
CRT items; and 
VerDate Sep 11 2014 
21:29 May 02, 2019
Jkt 089200
PO 00000
Frm 00024
Fmt 6652
Sfmt 6201
E:\BILLS\H2408.IH
H2408
pbinns on DSK79D2C42PROD with BILLS
‘‘(iii) on an annual basis, completes at 
least 10 hours of education specific to the 
assembly, programming, service, adjusting, 
and repairing of CRT items. 
‘‘(C) 
QUALIFIED
ORDERING
PRACTI-
TIONER.—The term ‘qualified ordering practi-
tioner’ means a physician (as defined in section 
1861(r)), a physician assistant, nurse practi-
tioner, or a clinical nurse specialist (as those 
terms are defined in section 1861(aa)(5)).’’. 
SEC. 5. CONFORMING AMENDMENTS. 
(a) EXEMPTION
FROM
COMPETITIVE
ACQUISI-
TION.—Section 1847(a)(7) of the Social Security Act (42 
U.S.C. 1395w–3(a)(7)) is amended by adding at the end 
the following new subparagraph: 
‘‘(C) CRT 
ITEMS.—For calendar year 
2020 and subsequent years, complex rehabilita-
tion technology items (as defined in section 
1861(kkk)).’’. 
(b) PAYMENT EXCLUSIONS.—Section 1834(a) of the 
Social Security Act (42 U.S.C. 1395m(a)) is amended— 
(1) in paragraph (4), by adding at the end the 
following sentence ‘‘For calendar year 2020 and sub-
sequent years, the items covered by this paragraph 
shall not include CRT items (as defined in section 
VerDate Sep 11 2014 
21:29 May 02, 2019
Jkt 089200
PO 00000
Frm 00025
Fmt 6652
Sfmt 6201
E:\BILLS\H2408.IH
H2408
pbinns on DSK79D2C42PROD with BILLS
1861(kkk)), which shall be paid pursuant to the fee 
schedule and methodology for CRT items described 
in section 1834(x) beginning on January 1, 2020, 
and in subsequent years.’’; 
(2) in paragraph (7)(A), by adding at the end 
the following: ‘‘For calendar year 2020 and subse-
quent years, this paragraph shall not apply to CRT 
items under section 1861(kkk).’’; and 
(3) in paragraph (16), by inserting at the end 
the following: ‘‘The Secretary shall impose (and, 
may, as allowed by the second sentence of this para-
graph, waive) the requirements of the first sentence 
of this paragraph to suppliers of complex rehabilita-
tion technology items, except that, in order to avoid 
duplicate bonds, the Secretary shall not impose such 
requirements with respect to suppliers of complex re-
habilitation technology items if such suppliers also 
participate in the Medicare program as suppliers of 
durable medical equipment.’’. 
(c) REQUIREMENTS FOR SUPPLIERS OF MEDICAL 
EQUIPMENT AND SUPPLIES.—Section 1834(j)(5) of the 
Social Security Act (42 U.S.C. 1395m(j)(5)) is amend-
ed— 
(1) by redesignating subparagraphs (E) and 
(F) as subparagraphs (F) and (G), respectively; and 
VerDate Sep 11 2014 
21:29 May 02, 2019
Jkt 089200
PO 00000
Frm 00026
Fmt 6652
Sfmt 6201
E:\BILLS\H2408.IH
H2408
pbinns on DSK79D2C42PROD with BILLS
(2) by inserting after subparagraph (D) the fol-
lowing new subparagraph: 
‘‘(E) complex rehabilitation technology 
items (as defined in section 1861(kkk));’’. 
SEC. 6. CONTINUED COVERAGE OF CRT ITEMS. 
The amendments made by this Act do not change the 
availability of coverage in existence as of the date of the 
enactment of this Act, including prior authorization cov-
erage requirements, for CRT items under title XVIII of 
the Social Security Act or title XIX of such Act, or any 
other payor or program, including in the case in which 
CRT items are covered, as of such date of enactment, as 
durable medical equipment or under a home health ben-
efit, including the home health benefit under section 1902 
of such Act and the regulations implementing such sec-
tion; nor do the amendments made by this Act change the 
existing definitions of durable medical equipment or med-
ical equipment and supplies under such Act or as estab-
lished by any other payor or program, including where 
CRT items may also fit those definitions. In the case that 
a CRT item also satisfies the definition of durable medical 
equipment, or medical equipment and supplies, or another 
benefit category as defined by an applicable payor, the 
amendments of this Act shall apply only for purposes of 
payment of the CRT item under title XVIII of such Act. 
VerDate Sep 11 2014 
21:29 May 02, 2019
Jkt 089200
PO 00000
Frm 00027
Fmt 6652
Sfmt 6201
E:\BILLS\H2408.IH
H2408
pbinns on DSK79D2C42PROD with BILLS
SEC. 7. EFFECTIVE DATE. 
The amendments made by this Act shall be effective 
beginning on the date that is 30 days after the date of 
the enactment of this Act, unless otherwise specified in 
a provision of, including amendment made by, this Act. 
Æ 
VerDate Sep 11 2014 
21:29 May 02, 2019
Jkt 089200
PO 00000
Frm 00028
Fmt 6652
Sfmt 6301
E:\BILLS\H2408.IH
H2408
pbinns on DSK79D2C42PROD with BILLS