I 
114TH CONGRESS 
1ST SESSION H. R. 1516 
To amend title XVIII of the Social Security Act to provide for coverage 
and payment for complex rehabilitation technology items under the Medi-
care program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 19, 2015 
Mr. SENSENBRENNER (for himself and Mr. CROWLEY) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
for coverage and payment for complex rehabilitation tech-
nology items under the Medicare program, and for other 
purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Ensuring Access to 
Quality Complex Rehabilitation Technology Act of 2015’’. 
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SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Individuals with disabilities and significant 
medical conditions such as Cerebral Palsy, Muscular 
Dystrophy, Multiple Sclerosis, Spinal Cord Injury, 
Amyotrophic Lateral Sclerosis, and Spina Bifida ex-
perience physical, functional, and cognitive chal-
lenges every day. 
(2) Complex rehabilitation technology items (in 
this Act referred to as ‘‘CRT items’’), including 
products such as complex rehabilitation power wheel-
chairs, highly configurable manual wheelchairs, 
adaptive seating and positioning systems, and other 
specialized equipment, such as standing frames and 
gait trainers, enable individuals to maximize their 
function and minimize the extent and costs of their 
medical care. 
(3) Access to CRT items and related services 
can be threatened by inadequate coding, coverage, 
and payment policies for such items and services. 
These policies have restricted access to existing com-
plex rehabilitation technology and stifled innovation. 
Access challenges have increased over the past sev-
eral years and, without meaningful change to these 
policies, will only become greater in the future. 
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(4) Current Medicare policies often fail to ade-
quately address the needs of individuals with disabil-
ities, to consider the range of services furnished by 
complex rehabilitation technology suppliers, and to 
recognize and account for the complexity and unique 
nature of the equipment itself. 
(5) A significant factor responsible for such ac-
cess challenges is that individually-configurable CRT 
items do not have a distinct payment category under 
the Medicare program, but instead are classified 
within the broad category of durable medical equip-
ment (DME). CRT items serve patients with serious 
medical conditions that require a broader range of 
services and specialized personnel than what is re-
quired for standard DME. Individually configured 
CRT items also require more resources in the areas 
of configuring, training, and education to ensure ap-
propriate use and to optimize results. 
(6) Unlike most DME, a medical model incor-
porating an interdisciplinary team approach is nec-
essary to ensure proper individual configuration and 
use of a CRT item. This team typically includes a 
physician, a licensed physical or licensed occupa-
tional therapist (with no financial relationship with 
the CRT supplier), a qualified CRT professional, the 
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individual using such item, and sometimes a care-
giver for such individual. 
(7) The Medicare program should recognize the 
specialized nature of the CRT service delivery model, 
the required supporting processes and technology-re-
lated CRT services, the credentials and competencies 
needed by the providing suppliers and critical staff, 
and the related costs involved. A separate benefit 
category for CRT items would allow for unique cod-
ing, coverage, and payment rules and policies that 
address the unique needs of persons with disabilities 
and acknowledge the extensive service component. 
(8) Congress and the Centers for Medicare & 
Medicaid Services have previously recognized the 
benefits of a separate classification for unique, indi-
vidually configured products. In 2008, Congress ex-
empted certain CRT items from inclusion in the 
Medicare DME competitive bidding program, and 
Congress has created a separate and distinct benefit 
category for orthotics and prosthetics (custom braces 
and artificial limbs), which have their own medical 
policies, accreditation standards, and payment cal-
culations. 
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SEC. 3. ESTABLISHING SEPARATE BENEFIT CATEGORY FOR 
COMPLEX REHABILITATION TECHNOLOGIES 
WITHIN MEDICARE. 
(a) NEW CATEGORY.—Section 1861 of the Social Se-
curity Act (42 U.S.C. 1395x) is amended— 
(1) in subsection (s)(2)— 
(A) in subparagraph (EE), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (FF), by inserting 
‘‘and’’ at the end; and 
(C) by inserting after subparagraph (FF) 
the following new paragraph: 
‘‘(GG) complex rehabilitation technology 
items (as defined in subsection (iii));’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘Complex Rehabilitation Technology Item 
‘‘(iii)(1) The terms ‘complex rehabilitation technology 
item’ and ‘CRT item’ mean an item that— 
‘‘(A) is designed or individually configured for 
a specific qualified individual to meet the individ-
ual’s unique— 
‘‘(i) medical, physical, or functional needs 
related to a medical condition; and 
‘‘(ii) capacities for basic activities of daily 
living or instrumental activities of daily living; 
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‘‘(B) is primarily used to serve a medical or 
functional purpose and is generally not useful to a 
person in the absence of illness or injury; and 
‘‘(C) requires certain services to ensure appro-
priate design, configuration, and use of such item, 
including— 
‘‘(i) an evaluation of needs and capacities 
and matching of the features and functions of 
CRT items to the qualified individual who will 
use such an item; and 
‘‘(ii) configuring, fitting, programming, ad-
justing, or adapting the particular complex re-
habilitation technology item for use by such in-
dividual. 
‘‘(2)(A) The Secretary, in consultation with the Di-
rector of Office on Disability, the Chairman of the Na-
tional Council on Disability, the Executive Director on the 
Interagency Committee on Disability, the Director of the 
National Institute on Disability and Rehabilitation Re-
search of the Department of Education, and the Co-Chair-
men of the Senior Oversight Committee’s Care Manage-
ment Reform Team of the Department of Defense and the 
Veterans Administration, shall, by regulation— 
‘‘(i) designate items as complex rehabilitation 
technology items; and 
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‘‘(ii) establish eligibility criteria to determine if 
an individual is a qualified individual based on the 
level of physical and functional needs and capacities 
related to a medical condition or conditions de-
scribed in subparagraph (E). 
‘‘(B) The items designated as complex rehabilitation 
technology items under subparagraph (A)(i) shall include 
items which, as of January 1, 2015 , were classified within 
the following HCPCS codes: E0637, E0638, E0641, 
E0642, E0986, E1002, E1003, E1004, E1005, E1006, 
E1007, E1008, E1009, E1010, E1011, 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, 
K0871, K0877, K0878, K0879, K0880, K0884, K0885, 
K0886, K0890, K0891, and K0898. 
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‘‘(C)(i) The items designated as complex rehabilita-
tion technology items under subparagraph (A)(i) shall in-
clude each item that— 
‘‘(I) as of January 1, 2015, was classified with-
in the HCPCS codes under clause (ii); and 
‘‘(II) the Secretary, acting in consultation with 
suppliers and manufacturers of CRT items, deter-
mines which items should be removed from such 
code and assigned a new HCPCS code because such 
item is a complex rehabilitation technology item. 
‘‘(ii) The HCPCS codes under this clause are the fol-
lowing: E0143, E0950, E0951, E0952, E0955, E0956, 
E0957, E0960, E0967, E0978, E0990, E1015, E1016, 
E1028, E01029, E1030, E2205, E2208, E2231, E2368, 
E2369, E2370, E2605, E2606, E2607, E2608, E2613, 
E2614, E2615, E2616, E2620, E2621, E2624, E2625, 
K0004, K0009, K0040, K0108, and K0669. 
‘‘(D) The Secretary may not designate as a complex 
rehabilitation technology item— 
‘‘(i) adaptive equipment to operate motor vehi-
cles; 
‘‘(ii) prosthetic devices described in subsection 
(s)(8); or 
‘‘(iii) orthotics and prosthetics described in sub-
section (s)(9). 
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‘‘(E) The Secretary shall publish guidelines and im-
plement a process to facilitate the submission of com-
prehensive coding proposals addressing CRT items to be 
submitted to the CMS HCPCS Work Group and included 
in the HCPCS Work Group public meetings. 
‘‘(F) In establishing the eligibility criteria under sub-
paragraph (A)(ii), the Secretary shall include appropriate 
physical and functional needs and capacities arising from 
any of the following medical conditions: 
‘‘(i) Congenital disorders, progressive or degen-
erative neuromuscular diseases, or injuries or trau-
ma that result in significant physical or functional 
needs and capacities. 
‘‘(ii) Spinal cord injury, traumatic brain injury, 
cerebral palsy, muscular dystrophy, spina bifida, 
osteogenesis imperfecta, arthrogryposis, amyotrophic 
lateral sclerosis, multiple sclerosis, demyelinating 
disease, myelopathy, myopathy, progressive muscular 
atrophy, anterior horn cell disease, post-polio syn-
drome, cerebellar degeneration, dystonia, Hunting-
ton’s disease, or spinocerebellar disease. 
‘‘(iii) Certain types of amputation, paralysis, or 
paresis that result in significant physical or func-
tional needs and capacities. 
‘‘(G)(i) For 2016, the Secretary shall publish— 
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‘‘(I) a list of items designated under subpara-
graph (A)(i) and the HCPCS codes for such items; 
and 
‘‘(II) the eligibility criteria established under 
subparagraph (A)(ii). 
‘‘(ii) For 2017 and each subsequent year, the Sec-
retary shall publish any necessary updates to such list (in-
cluding additions of new CRT items and any changes in 
applicable HCPCS codes) and to such eligibility criteria. 
‘‘(H) The Secretary shall make available, on a public 
Web site, the process by which the Secretary will consider 
requests from members of the public that the Secretary— 
‘‘(i) designate an item as a CRT item under 
subparagraph (A)(i); or 
‘‘(ii) amend the eligibility criteria established 
under subparagraph (A)(ii). 
‘‘(3) For purposes of this subsection: 
‘‘(A) The term ‘capacity for basic activities of 
daily living’ means an individual’s capacity to safely 
participate in mobility and self-care activities includ-
ing— 
‘‘(i) maintaining and changing body posi-
tion; 
‘‘(ii) transferring to or from one surface to 
another; 
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‘‘(iii) walking; 
‘‘(iv) moving from place to place using mo-
bility equipment, in a safe and timely manner; 
‘‘(v) washing one’s self; 
‘‘(vi) caring for the body; 
‘‘(vii) toileting; 
‘‘(viii) dressing; 
‘‘(ix) eating; 
‘‘(x) drinking; 
‘‘(xi) looking after one’s health; and 
‘‘(xii) carrying, moving, and handling ob-
jects to perform and participate in other activi-
ties under this subparagraph and subparagraph 
(B). 
‘‘(B) The term ‘capacity for instrumental activi-
ties of daily living’ means an individual’s capacity to 
safely participate in life situations in the home and 
community, including— 
‘‘(i) communicating; 
‘‘(ii) moving around using transportation; 
‘‘(iii) acquiring necessities, goods, and 
services; 
‘‘(iv) performing household tasks; 
‘‘(v) caring for household members and 
family members; 
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‘‘(vi) caring for household objects; 
‘‘(vii) engaging in education, work, employ-
ment and economic life; and 
‘‘(viii) participating in community, social, 
and civic activities. 
‘‘(C) The term ‘HCPCS’ refers to the Health 
Care Procedure Coding System. 
‘‘(D) The term ‘individually-configured’ means, 
with respect to an item, that— 
‘‘(i) the item has features, adjustments, or 
modifications specific to the individual who uses 
such item or the item is used in combination 
with other CRT items specific to the individ-
ual’s needs; and 
‘‘(ii) the supplier of such item must meas-
ure the individual and configure, fit, program, 
adjust, or adapt the item, as appropriate, so 
that the item is consistent with— 
‘‘(I) an assessment or evaluation of 
the individual by an appropriate licensed 
clinician; 
‘‘(II) the written order required under 
section 1834(r)(2)(B)(i); and 
‘‘(III) medical condition, physical and 
functional needs and capacities, and body 
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size of the individual who will use the item, 
the period for which such individual will 
need such item, and the intended use of 
such item by such individual. 
‘‘(E) The term ‘qualified individual’ means an 
individual who— 
‘‘(i) is enrolled under part B; and 
‘‘(ii) has physical and functional needs and 
capacities that arise from a medical condition 
that meet the eligibility criteria established by 
the Secretary under paragraph (2)(A)(ii).’’. 
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: 
‘‘(r) COVERAGE AND 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 determine a pay-
ment system that shall apply to CRT items— 
‘‘(i) with HCPCS codes that were as-
signed 
to 
the 
item 
under 
section 
1861(iii)(2)(C)(i)(II); 
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‘‘(ii) for which no HCPCS code was 
assigned prior to such date; or 
‘‘(iii) which, prior to such date, was 
classified under a miscellaneous HCPCS 
code. 
‘‘(B) CONSIDERATIONS.—In determining 
the payment system under subparagraph (A), 
the Secretary— 
‘‘(i) may disregard the freezes on CPI 
increases to the payment amounts for du-
rable medical equipment that occurred be-
fore the date of the enactment of this sub-
section, when determining the payment 
amount for CRT items; 
‘‘(ii) shall ensure that the payment 
amounts for CRT items under such system 
are adequate to provide qualified individ-
uals with access to such items and to en-
courage innovation, taking into account— 
‘‘(I) the unique needs of qualified 
individuals for access to CRT items; 
‘‘(II) the unique complexity of 
CRT items; and 
‘‘(III) the resources and staff 
needed to provide appropriate indi-
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vidual configuration of CRT items for 
a qualified individual; and 
‘‘(iii) shall provide that CRT codes 
will be paid on a purchase basis with a 
beneficiary rental basis option. 
‘‘(C) EXCLUSIVE
PAYMENT
RULE.—This 
subsection shall constitute the exclusive provi-
sion of this title for payment for CRT items 
under this part or under part A to a home 
health agency. 
‘‘(D) LIMITATION ON PAYMENT.—No pay-
ment shall be made under this subsection for a 
CRT item unless such CRT item— 
‘‘(i) is provided to a qualified indi-
vidual; 
‘‘(ii) meets the clinical conditions for 
coverage established under paragraph (2); 
and 
‘‘(iii) is furnished by a supplier ac-
credited pursuant to paragraph (3). 
‘‘(2) CLINICAL CONDITIONS FOR COVERAGE.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
establish standards for clinical conditions for 
payment for CRT items under this subsection. 
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‘‘(B) REQUIREMENTS.—The standards es-
tablished under subparagraph (A) shall require 
the following: 
‘‘(i) WRITTEN ORDER.— 
‘‘(I) IN
GENERAL.—A qualified 
ordering practitioner shall provide a 
written order for a CRT item for a 
qualified individual before the Sec-
retary may provide payment 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, and is to be provided to a 
qualified individual who has a diag-
nosis specified under subparagraph 
(C), the qualified ordering practitioner 
may not provide a written order under 
subclause (I) unless the qualified indi-
vidual has undergone a CRT evalua-
tion conducted by a licensed physical 
therapist or occupational therapist 
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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). 
‘‘(ii) DOCUMENTATION
OF
MEDICAL 
NECESSITY.—A qualified ordering practi-
tioner who provides a written order under 
clause (i) shall maintain documentation of 
the medical necessity of such order for a 
period of seven years and shall make such 
documentation available to the Secretary 
upon request. The documentation of med-
ical necessity under this clause shall in-
clude— 
‘‘(I) evidence that the individual 
for whom the order was written has 
physical and functional needs and ca-
pacities related to a medical condition 
that meet the eligibility criteria estab-
lished 
under 
section 
1861(iii)(2)(A)(ii); and 
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‘‘(II) evidence of any CRT eval-
uation required under clause (i)(II). 
‘‘(C) SPECIFICATION
OF
DIAGNOSIS
FOR 
CRT EVALUATION.—The Secretary, in consulta-
tion with relevant parties (including the agen-
cies listed in section 1861(iii)(2)(A), physicians, 
licensed physical therapists, licensed occupa-
tional therapists, and suppliers of complex reha-
bilitation technologies) shall specify the diag-
noses and other medical presentations for which 
the requirement for a CRT evaluation under 
subparagraph (B)(i)(II) shall apply. 
‘‘(D) COVERAGE
DETERMINATIONS.—In 
developing the standards under subparagraph 
(A), the coverage of CRT items with respect to 
an individual shall be based on— 
‘‘(i) the specific medical, physical, and 
functional needs of the individual; 
‘‘(ii) the individual’s capacities for 
safe participation in basic activities of 
daily living and instrumental activities of 
daily living in all routinely encountered en-
vironments (as such terms are defined in 
section 1861(iii)(3)); and 
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‘‘(iii) the individual’s expected pro-
gression of such needs and capacities. 
‘‘(E) CONTRACTOR INDIVIDUALIZED CON-
SIDERATION.—The Secretary shall instruct 
Medicare contractors to provide individual con-
sideration in cases that may lack one of the di-
agnoses identified, but that exhibit comparable 
functional presentations or deficits or (or both) 
and where the need for CRT items has been 
documented by the qualified clinical profes-
sional. 
‘‘(F) 
PAYMENT
FOR
RESIDENTS
OF 
SKILLED NURSING FACILITIES.—In the case of 
a qualified individual who is a resident of a 
skilled nursing facility, payment may only be 
made under this subsection for a CRT item for 
such individual if such CRT item is required as 
part of a plan of care to allow the transition of 
such individual from the skilled nursing facility 
to a home or community setting. 
‘‘(3) ESTABLISHMENT
OF
QUALITY
STAND-
ARDS.— 
‘‘(A) 
ESTABLISHMENT.—The 
Secretary 
shall establish, through regulation, quality 
standards for suppliers of CRT items. Such 
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standards shall be applied prospectively and 
shall be published on the Internet Web site of 
the Centers for Medicare and Medicaid Serv-
ices. 
‘‘(B) CONSULTATION.—In establishing the 
quality standards under subparagraph (A), the 
Secretary shall consult with relevant parties (in-
cluding clinicians, consumer groups, suppliers, 
and manufacturers). 
‘‘(C) REQUIREMENTS OF STANDARDS.—In 
establishing the quality standards under sub-
paragraph (A), the Secretary shall require that 
the suppliers of CRT items meet the following 
requirements: 
‘‘(i) DME STANDARDS.—The supplier 
complies with all of the standards that are 
applicable to suppliers of durable medical 
equipment under subsection (a)(20) and 
suppliers of medical equipment and sup-
plies under subsection (j). 
‘‘(ii) 
QUALIFIED
CRT
PROFES-
SIONAL.—The supplier of a CRT item 
makes available, in each service area 
served by such supplier, at least one quali-
fied CRT professional to— 
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‘‘(I) analyze the needs and capac-
ities of individuals for a CRT item in 
collaboration with the clinical team; 
‘‘(II) assist in selecting an appro-
priate CRT item for such individual, 
given such needs and capacities; and 
‘‘(III) provide technology-related 
training to such individual in the 
proper use and maintenance of the 
CRT items. 
‘‘(iii) TRIAL
EQUIPMENT.—The sup-
plier of the CRT item provides the quali-
fied individual with appropriate equipment 
for trial and simulation, if a physician, li-
censed physical therapist, or licensed occu-
pational therapist determines that the pro-
vision of such equipment is necessary. 
‘‘(iv) INFORMATION ON SERVICE AND 
REPAIR.—The supplier of the CRT item 
provides the qualified individual with writ-
ten information on accessing service and 
repair for the CRT item before the CRT 
item is ordered for the individual. 
‘‘(v) REPAIR.—The supplier of a CRT 
item— 
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‘‘(I) makes available, in each 
service area served by such supplier, 
at least one qualified CRT service 
technician to service and repair CRT 
items that— 
‘‘(aa) are furnished by such 
supplier; and 
‘‘(bb) at the time of the 
need for repair, are located in a 
service area of the supplier; or 
‘‘(II) if the qualified individual 
lives outside the service area served by 
such supplier at the time of order of 
the CRT item, the supplier shall dis-
close in writing to the qualified indi-
vidual that the supplier does not pro-
vide repair service for such item and 
provide contact information for enti-
ties that do provide such repair serv-
ice. 
‘‘(vi) RENTAL
EQUIPMENT.—If pay-
ment is allowed under paragraph (6), the 
supplier of the CRT item provides tem-
porary rental equipment to the qualified 
individual when the supplier is repairing a 
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qualified individual’s CRT item that was 
paid for under this subsection. 
‘‘(4) APPLICATION
OF
STANDARDS
AND
AC-
CREDITATION
PROGRAM
FOR
SUPPLIERS
OF
CRT 
ITEMS.— 
‘‘(A) IN GENERAL.— 
‘‘(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 title unless 
the supplier is in compliance with the 
standards under paragraph (3). 
‘‘(ii) REQUIREMENT FOR PAYMENT.— 
Payment shall not be made under this part 
for CRT items furnished by a supplier un-
less the supplier is in compliance with the 
standards under paragraph (3). 
‘‘(B) APPLICATION OF ACCREDITATION RE-
QUIREMENT.—In implementing quality stand-
ards under paragraph (3), 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— 
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‘‘(i) to comply with such standards; 
and 
‘‘(ii) to have submitted to the Sec-
retary evidence of accreditation by an ac-
creditation organization designated under 
subparagraph (C) demonstrating that the 
supplier is complying with such standards. 
‘‘(C) DESIGNATION OF INDEPENDENT AC-
CREDITATION ORGANIZATIONS.—Not later than 
the date that is one year after the date on 
which the Secretary implements the quality 
standards under paragraph (3), the Secretary 
shall designate and approve one or more inde-
pendent accreditation organizations that— 
‘‘(i) are approved under subsection 
(a)(20)(B); and 
‘‘(ii) the Secretary has determined 
have the capability to assess whether sup-
pliers of CRT items meet the quality 
standards established under paragraph (3). 
‘‘(5) CODING SYSTEM FOR COMPLEX REHABILI-
TATION TECHNOLOGIES.— 
‘‘(A) IN GENERAL.—The Secretary shall, 
in consultation with suppliers and manufactur-
ers of CRT items, establish a formal process to 
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allow submission of CRT code set modification 
requests by stakeholder groups for comprehen-
sive coding changes related to entire policy 
groups. This process shall include a specific ap-
plication, public meeting participation and an 
appeals process. The Secretary shall then, in 
consultation with suppliers and manufacturers 
of CRT items, establish a HCPCS coding sub-
set that shall utilize and include HCPCS codes 
described in section 1861(iii)(2) for CRT items 
for which payment may be made under this 
subsection. 
‘‘(B) TREATMENT
OF
EXISTING
PROD-
UCTS.— 
‘‘(i) IN
GENERAL.—With respect to 
CRT items for which payment was avail-
able under this title before the effective 
date of the amendments made by Ensuring 
Access to Quality Complex Rehabilitation 
Technology Act of 2015, the Secretary 
shall assign such items to a code in the 
coding subset established under subpara-
graph (A). 
‘‘(ii) UPDATES.—After the initial as-
signment under clause (i), the Secretary 
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may decide to reassign additional product 
categories, or items within those cat-
egories, that exist before the date of the 
enactment of this subsection to the CRT 
coding subset. 
‘‘(iii) CONSULTATION.—Before mak-
ing reassignments of CRT items under 
clause (ii), the Secretary shall consult with 
suppliers and manufacturers of such items. 
The Secretary shall not require manufac-
turers of CRT items for which payment 
was available under this title before the ef-
fective date of the amendments made by 
the Ensuring Access to Quality Complex 
Rehabilitation Technology Act of 2015 to 
submit requests for reassignment of the 
code for such product to the coding subset 
under subparagraph (A) as long as— 
‘‘(I) no changes have been made 
to the code definitions, required code 
characteristics or test requirements; 
and 
‘‘(II) the item was previously 
verified to meet the code require-
ments. 
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‘‘(C) REMOVING
COMPLEX
REHABILITA-
TION
TECHNOLOGY
FROM
DME
CODES.—The 
Secretary shall, in consultation with suppliers 
and manufacturers of CRT items— 
‘‘(i) remove from the coding subset for 
durable medical equipment any CRT items 
that are included in the coding subset 
under subparagraph (A); and 
‘‘(ii) assign new codes to such CRT 
items based on technological differences to 
support adequate access to meet clinical 
outcomes and for purposes of including 
such items in the subset under subpara-
graph (A). 
‘‘(D) NEW TECHNOLOGY.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall update as needed the HCPCS level II 
process used to modify the code set to in-
clude CRT items for the purposes of estab-
lishing new codes and determining prod-
ucts to be classified as CRT items. In de-
termining if a product is a CRT item, the 
Secretary shall consider— 
‘‘(I) if the product is novel; 
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‘‘(II) the clinical application of 
the product; and 
‘‘(III) the ability of the product 
to address the unique needs and ca-
pacities of a qualified individual. 
‘‘(ii) INCLUSION OF CODES IN LIST.— 
The Secretary shall include the codes es-
tablished in clause (i) in the list under sec-
tion 1861(iii)(2)(F). 
‘‘(E) MISCELLANEOUS CODE FOR INNOVA-
TION
AND
LOCAL
COVERAGE
DETERMINA-
TIONS.—The coding subset established under 
subparagraph (A) shall include at least one mis-
cellaneous code for items not otherwise classi-
fied. 
‘‘(F) 
ESTABLISHMENT
OF
ADEQUATE 
HCPCS CODES TO REFLECT SPECIALIZED NA-
TURE OF CRT.—The Secretary shall ensure that 
HCPCS codes exist (or are developed) to rep-
resent the specialized nature of CRT, including 
codes to represent custom CRT manual and 
power wheelchairs and modifications to CRT 
manual and power wheelchair frames, and mis-
cellaneous codes for CRT manual and power 
wheelchairs that are otherwise classified. 
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‘‘(6) REPLACEMENT OF CRT ITEMS.— 
‘‘(A) IN
GENERAL.—Payment shall be 
made for the replacement of a CRT item (or for 
the replacement of any part of such item) with-
out regard to continuous use or useful lifetime 
restrictions 
established 
under 
section 
1834(a)(7)(C) for items of durable medical 
equipment if a qualified ordering practitioner 
determines that the provision of a replacement 
item (or a replacement part of such an item) is 
necessary because— 
‘‘(i) there was a change in the physio-
logical condition of the qualified individual 
to whom such item was provided; 
‘‘(ii) there was an irreparable change 
in the condition of the CRT item (or, in 
the case of the replacement of a part, in 
the part of the CRT item); or 
‘‘(iii) the CRT item requires repairs 
and the cost of such repairs would be more 
than 50 percent of the cost of a replace-
ment of the CRT item. 
‘‘(B) DEFERRAL TO PROVIDERS.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), if a qualified ordering practitioner de-
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termines that a replacement of the CRT 
item, or the replacement of a part of a 
CRT item, is necessary pursuant to sub-
paragraph (A), the replacement item or 
part is deemed to be reasonable and nec-
essary 
for 
purposes 
of 
section 
1862(a)(1)(A). 
‘‘(ii) EXCEPTION FOR ITEMS UNDER 3 
YEARS
OLD.—If the CRT item that is 
being replaced (or the part of the CRT 
item that is being replaced) under subpara-
graph (A) is less than 3 years old (cal-
culated from the date on which the quali-
fied individual began to use the CRT item 
or part), the Secretary may require the 
qualified ordering practitioner to provide 
confirmation of necessity of the replace-
ment item or replacement part, as the case 
may be. 
‘‘(7) PAYMENT FOR TEMPORARY RENTAL.— 
‘‘(A) 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 
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CRT item owned by such individual is being re-
paired. 
‘‘(B) BASIS; LIMITATION.—Payment per-
mitted under subparagraph (A) shall be made 
on a monthly basis, and the period of rental 
may not exceed two months. 
‘‘(C) PAYMENT AMOUNT.—The amount of 
payment allowed under subparagraph (A) for a 
month for the rental of a CRT item shall be 10 
percent of the purchase price for the CRT item. 
‘‘(8) DEFINITIONS.—For purposes of this sub-
section: 
‘‘(A) HCPCS.—The term ‘HCPCS’ refers 
to the Health Care Procedure Coding System. 
‘‘(B) 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 
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) as 
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providing a certification that is equiv-
alent to, or more stringent than, the 
assistive technology professional cer-
tification; and 
‘‘(II) beginning two years after 
the establishment of the designation 
under clause (ii), achieves an addi-
tional designation that demonstrates 
the individual’s competencies and ex-
perience in supplying CRT items. 
‘‘(ii) 
ESTABLISHMENT.—Not 
later 
than one year after the date of the enact-
ment of this subsection, the Secretary, act-
ing in consultation with relevant parties, 
shall establish the additional designation 
under clause (i)(II). 
‘‘(iii) RELEVANT PARTIES.—For pur-
poses of this subparagraph, the term ‘rel-
evant parties’ includes clinicians, consumer 
groups, CRT suppliers, and CRT manufac-
turers. 
‘‘(C) QUALIFIED
CRT
SERVICE
TECHNI-
CIAN.—The term ‘qualified CRT service techni-
cian’ means an individual who— 
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‘‘(i) is factory-trained by the manufac-
turers of the CRT items being offered by 
the suppler of such items; 
‘‘(ii) is trained and educated (includ-
ing through on-the-job training) to assem-
ble, fit, program, service, and repair CRT 
items; and 
‘‘(iii) on an annual basis, completes at 
least 10 hours of continuing education spe-
cific to the assembly, fitting, programming, 
service, and repair of CRT items. 
‘‘(D) QUALIFIED INDIVIDUAL.—The term 
‘qualified individual’ has the meaning given 
such term in section 1861(iii)(3)(E). 
‘‘(E) 
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)). 
‘‘(F) QUALIFIED LICENSED CLINICIAN.— 
The term ‘qualified licensed clinician’ means a 
licensed physical therapist or occupational ther-
apist or physician who possesses specialized 
training and experience in providing seating 
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and mobility services and the skills to perform 
all aspects of the evaluation described in para-
graph (2)(B)(i)(II).’’. 
SEC. 5. CONFORMING AMENDMENTS. 
(a) EXCLUSION FROM THE IN-HOME USE LIMITA-
TION FOR DME.—Section 1861(n) of the Social Security 
Act (42 U.S.C. 1395x(n)) is amended by adding at the 
end the following: ‘‘For 2016 and subsequent years, such 
term does not include complex rehabilitation technologies 
(as defined in subsection (iii)).’’. 
(b) 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 2016 and subse-
quent years, complex rehabilitation technology 
items (as defined in section 1861(iii)).’’. 
(c) EXEMPTION FROM SNF CONSOLIDATED BILL-
ING.—Section 1888(e)(2)(A)(iii) of the Social Security Act 
(42 U.S.C. 1395yy(e)(2)(A)(iii)) is amended by adding at 
the end the following: 
‘‘(VI) 
Complex 
rehabilitation 
technology items (as defined in section 
1861(iii)) if delivered to an inpatient 
for use during the stay in the skilled 
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nursing facility as part of the plan of 
care to allow the transition of such 
qualified individuals from the skilled 
nursing facility setting to the home 
and community.’’. 
(d) 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 2016 and subsequent years, 
the items covered by this paragraph shall not include 
complex rehabilitation technology items (as defined 
in section 1861(iii)).’’; 
(2) in paragraph (7)(A), by adding at the end 
the following: ‘‘For fiscal year 2016 and subsequent 
years, the previous sentence shall not apply to 
power-driven wheelchairs that are designated as 
CRT items under section 1861(iii).’’; 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-
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habilitation technology items if such suppliers also 
participate in the Medicare program as suppliers of 
durable medical equipment.’’. 
(e) 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; 
(2) by inserting after subparagraph (D) the fol-
lowing new subparagraph: 
‘‘(E) complex rehabilitation technology 
items (as defined in section 1861(iii));’’. 
SEC. 6. EFFECTIVE DATE. 
The amendments made by this Act shall apply to 
items and services furnished on or after January 1, 2016. 
Æ 
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