Title: Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019
Policy area: Health

Summary:
Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019
This bill establishes a specific benefit category (i.e., classification) for complex rehabilitation technology items under Medicare.
The Centers for Medicare & Medicaid Services must set payment for such items in accordance with a specified methodology that includes certain clinical conditions and quality standards. The bill also excludes such items from Medicare's competitive acquisition program (in which rates are set through a competitive bidding program rather than by an established fee schedule).
The bill defines complex rehabilitation technology item to include complex rehabilitation manual and power wheelchairs, specialized seating and positioning items, and adaptive equipment such as standing frames and gait trainers, including associated accessories.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2408 Introduced in House (IH)]

<DOC>






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.

    Be it enacted by the Senate and House of Representatives 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 2019''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) There is a small and specific population of Medicare 
        beneficiaries who have significant disabilities and medical 
        conditions who require complex and individually configured 
        medical equipment, items, and technologies. These items and 
        technologies are referred to as complex rehabilitation 
        technology (or ``CRT'') and include specialized wheelchairs, 
        specialized seating and positioning, and other types of 
        adaptive equipment and items that are uniquely configured and 
        fitted to the specific individual. Individuals in this 
        population often qualify for Medicare based on their disability 
        (rather than their age) and have significant disabilities and 
        medical conditions that may include, but are not limited to, 
        cerebral palsy, muscular dystrophy, multiple sclerosis, spinal 
        cord injury, amyotrophic lateral sclerosis (ALS), traumatic 
        brain injury, and spina bifida. This small population comprises 
        less than 15 percent of the Medicare beneficiaries who receive 
        wheelchairs.
            (2) Current provisions addressing Medicare benefit 
        categories and related definitions do not sufficiently define 
        certain complex rehabilitation technology items and do not 
        adequately describe and distinguish 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 access challenges 
        for beneficiaries with significant disabilities 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 
        involved, 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 complex rehabilitative technology items is needed. 
        This will allow for related improvements to clarify applicable 
        coding, coverage, payment, and supplier standards for such 
        items. A separate benefit category is needed to ensure 
        appropriate access to these items for individuals with 
        significant disabilities and medical conditions, and will help 
        prevent potential overutilization of CRT by individuals for 
        whom such items are not medically necessary.

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 subsections:
    ``(kkk) Complex Rehabilitation Technology Item.--
            ``(1) The terms `complex rehabilitation technology item' 
        and `CRT item' mean an item that--
                    ``(A) is designed, manufactured, individually 
                configured, adjusted, or modified for a specific 
                individual to meet the individual's unique medical, 
                physical, or functional needs and capacities;
                    ``(B) is primarily used to serve a medical, 
                physical, or functional purpose and is generally not 
                useful to a person in the absence of disability, 
                illness, injury, or other medical condition; and
                    ``(C) requires certain services to ensure 
                appropriate 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 
                        individual who will use such an item, as 
                        required under section 1834(x)(2)(B)(ii)(II); 
                        or
                            ``(ii) configuring, fitting, programming, 
                        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 accessories; and
                    ``(iv) other items that meet the definition in 
                subparagraph (1), as determined by the Secretary.
            ``(B) In determining which items meet the definition of a 
        CRT item under this subsection, the Secretary shall review 
        existing and new technologies on at least a yearly basis, and 
        in a manner that takes into consideration technological 
        differences in available 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 appropriate access to 
        existing and new technologies that may improve medical, 
        physical, or functional outcomes for beneficiaries with 
        significant disabilities and medical conditions, taking into 
        consideration technological differences, clinical application, 
        and the unique medical, physical, and functional needs of 
        beneficiaries who rely on medically necessary CRT items.
            ``(B) In establishing the list under subparagraph (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 classified 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, 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 include 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 custom CRT 
                items.
            ``(C) For each year subsequent to the year during which the 
        Secretary publishes the list under subparagraph (A), the 
        Secretary shall publish any necessary updates to such list 
        (including additions of 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 medically 
        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 enactment of this 
                subsection, subject to subparagraph (B), the Secretary 
                shall establish a fee schedule that shall apply to CRT 
                items as defined at section 1861(kkk) and shall ensure 
                that such fee schedule considers the potential impact 
                on quality, access, and beneficiary liability, 
                including the likely effects on assignment rates and 
                participation rates, and facilitates appropriate access 
                to medically necessary CRT items and technologies.
                    ``(B) Methodology.--In establishing the CRT fee 
                schedule payment system under subparagraph (A), the 
                Secretary shall include in such fee schedule, at a 
                minimum, the allowance 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 derived 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 section 
                        1861(kkk)(3)(B)(iii), to be calculated based on 
                        the methodology described in subparagraph (C) 
                        applied to the specific item billed under this 
                        subsection; and
                            ``(iv) shall require that payment amounts 
                        for CRT items be adjusted annually by the 
                        increase in the Consumer Price Index-Urban All 
                        Item for the 12-month period 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 
                subparagraph is as follows:
                            ``(i) Identify commercial price information 
                        (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 subparagraph is the calendar 
                        year ending December 1986), except that if the 
                        only available commercial price information is 
                        from a period other than the base year, the 
                        Secretary shall use the oldest available 
                        pricing for the items and deflate the pricing 
                        data 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 enactment of 
                        this section.
                            ``(ii) Using the base year prices, identify 
                        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 factors starting in 2006 and 
                        for each subsequent year, adjusted to reflect 
                        applicable sales tax circumstances, if 
                        applicable.
                    ``(D) Used equipment.--For used equipment, the 
                Secretary shall set payment at 75 percent of the CRT 
                fee schedule amount for the CRT item as determined 
                pursuant to the methodology set forth in subparagraph 
                (B).
                    ``(E) Payment for temporary rental.--
                            ``(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 rental 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 reasonable 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 establish, through a rulemaking 
                        process involving advance public notice and an 
                        opportunity for stakeholder input and public 
                        comments, a reasonable useful lifetime for CRT 
                        items for which payment may be made under this 
                        paragraph.
                            ``(ii) Length of reasonable useful 
                        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 ensure that the length of 
                        reasonable useful lifetime is appropriate for 
                        each sub-category of items within the CRT 
                        category.
                    ``(G) Exclusive payment rule.--This subsection 
                shall constitute the exclusive provision under this 
                title for payment for CRT items under this part.
            ``(2) Conditions for payment.--
                    ``(A) Limitation on payment.--No payment 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 
                        accredited pursuant to subparagraph (D) and 
                        meets the supplier and quality standards 
                        specified under subparagraph (C).
                    ``(B) Clinical conditions for payment.--
                            ``(i) In general.--The Secretary shall 
                        establish standards for clinical conditions for 
                        payment for CRT items under this subsection.
                            ``(ii) Requirements.--The standards 
                        established under clause (B)(i) shall require 
                        the following:
                                    ``(I) Written order.--A qualified 
                                ordering practitioner, as defined in 
                                section 1861(mmm) of the Act, shall 
                                provide a written order for a CRT item 
                                for a specific individual before the 
                                Secretary may provide payment for such 
                                item for such individual under this 
                                subsection.
                                    ``(II) CRT evaluation.--In the case 
                                of a CRT item that is categorized by 
                                the Secretary, for purposes of the 
                                program under this title, as a manual 
                                wheelchair or a power wheelchair, the 
                                qualified ordering practitioner may not 
                                provide a written order under subclause 
                                (I) unless the individual has undergone 
                                a CRT evaluation conducted by a 
                                licensed physical 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 towards) the 
                                limitation on certain therapy services 
                                under section 1833(g).
                                    ``(III) Documentation of medical 
                                necessity.--A qualified ordering 
                                practitioner who provides a written 
                                order under subclause (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 medical necessity 
                                under this clause shall include 
                                evidence that the individual for whom 
                                the order was written has medical, 
                                physical, and/or 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 instrumental 
                                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 
                                limited 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 
                                education, employment and economic 
                                life; or using transportation.
                                    ``(V) Coverage requirement.--
                                Nothing in this subsection or section 
                                1861(s)(2)(II) shall be construed as 
                                requiring the Secretary to provide for 
                                coverage under this title of any item 
                                that would not otherwise be covered 
                                under this title without application of 
                                the amendments made by the Ensuring 
                                Access to Quality Complex 
                                Rehabilitation Technology Act of 2019, 
                                or as changing any coverage 
                                requirements in existence as of the 
                                date of the enactment of this 
                                subsection, including any prior 
                                authorization coverage requirements or 
                                advance determinations of Medicare 
                                coverage requirements 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 independent accreditation 
                        organizations (as designated under subparagraph 
                        (D)), which as set forth below, incorporate 
                        existing 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 standards.--In 
                        establishing the supplier and quality standards 
                        under clause (i), the Secretary shall require 
                        that each supplier of CRT items meets the 
                        following requirements:
                                    ``(I) DME and medical equipment and 
                                supplies 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 supplies under subsection 
                                (j).
                                    ``(II) Qualified crt professional 
                                standards.--The supplier of a CRT item 
                                makes available, in each service area 
                                served by such supplier, at least one 
                                qualified CRT professional to analyze 
                                the needs and capacities 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 accessing 
                                        service and repair for the CRT 
                                        item before the CRT item is 
                                        ordered for the individual 
                                        involved.
                    ``(D) Accreditation for suppliers of crt items.--
                            ``(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 subcontractor for another 
                        entity--
                                    ``(I) to comply with such 
                                standards; and
                                    ``(II) to have submitted to the 
                                Secretary evidence of accreditation by 
                                an accreditation organization 
                                designated under subparagraph (iii) 
                                demonstrating that the supplier is 
                                complying with such standards.
                            ``(iii) Designation of independent 
                        accreditation organizations.--Not later than 
                        the date that is one year after the date on 
                        which the Secretary implements 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 subsection 
                                (a)(20)(B), which set forth the 
                                designation of independent 
                                accreditation organizations for 
                                suppliers of durable medical equipment; 
                                and
                                    ``(II) have the capability to 
                                assess whether suppliers of CRT items 
                                meet the supplier and quality standards 
                                established under subparagraph (C).
            ``(3) Definitions.--For purposes of this subsection:
                    ``(A) Qualified crt professional.--
                            ``(i) In general.--The term `qualified CRT 
                        professional' means an individual who--
                                    ``(I) is certified by the 
                                Rehabilitation 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, including 
                                manufacturers and suppliers of CRT 
                                items, relevant consumer organizations, 
                                and clinicians with knowledge of CRT 
                                items and direct experience working 
                                with individuals who use CRT items) as 
                                providing a certification that is 
                                equivalent to, or more stringent than, 
                                the assistive technology professional 
                                certification; and
                                    ``(II) beginning 2 years after the 
                                establishment of the designation under 
                                clause (ii), subject to clause 
                                (ii)(II), achieves an additional 
                                designation that demonstrates the 
                                individual'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 
                                stakeholder input, including 
                                manufacturers 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 designation 
                                under clause (i)(II).
                                    ``(II) Until such time as the 
                                additional designation is established, 
                                the term `qualified CRT professional' 
                                shall include an individual meeting the 
                                requirements in clause (i)(I) only.
                    ``(B) Qualified crt service technician.--The term 
                `qualified CRT service technician' means an individual 
                who, with respect to a CRT item--
                            ``(i) has successfully completed a training 
                        program approved by the manufacturer of the CRT 
                        item;
                            ``(ii) is trained and educated (including 
                        through on-the-job training) to assemble, 
                        program, adjust, service, and repair CRT items; 
                        and
                            ``(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 practitioner.--The term 
                `qualified ordering practitioner' means a physician (as 
                defined in section 1861(r)), a physician assistant, 
                nurse practitioner, or a clinical nurse specialist (as 
                those terms are defined in section 1861(aa)(5)).''.

SEC. 5. CONFORMING AMENDMENTS.

    (a) Exemption From Competitive Acquisition.--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 rehabilitation 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 subsequent years, the 
        items covered by this paragraph shall not include CRT items (as 
        defined in section 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 subsequent 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 paragraph, waive) the 
        requirements of the first sentence of this paragraph to 
        suppliers of complex rehabilitation technology items, except 
        that, in order to avoid duplicate bonds, the Secretary shall 
        not impose such requirements with respect to suppliers of 
        complex rehabilitation 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 amended--
            (1) by redesignating subparagraphs (E) and (F) as 
        subparagraphs (F) and (G), respectively; and
            (2) by inserting after subparagraph (D) the following 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 coverage 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 benefit, including the home health benefit under 
section 1902 of such Act and the regulations implementing such section; 
nor do the amendments made by this Act change the existing definitions 
of durable medical equipment or medical equipment and supplies under 
such Act or as established 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.

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.
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