,i #aac? ,,congress #a/ ,session ,h4 ,r4 #idb ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,m>* #d1 #bjac ,mr4 ,cr[ley 7= himself & ,mr4 ,s5s5br5n]7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce1 & 9 addition to ! ,committee on ,ways & ,means1 = a p]iod to be subsequ5tly det]m9$ by ! ,speak]1 9 ea* case = consid]ation ( su* provisions z fall )9 ! jurisdiction ( ! committee conc]n$ ,a ,,bill ,to am5d title ,,xviii ( ! ,social ,security ,act to provide = cov]age & paym5t = complex rehabilitation te*nology items "u ! ,m$ic>e program4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,ensur+ ,access to ,quality ,complex ,rehabilitation ,te*nology ,act ( #bjac4 #b4 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,individuals ) disabilities & significant m$ical conditions su* z ,c]ebral ,palsy1 ,muscul> ,dy/rophy1 ,multiple ,scl]osis1 ,sp9al ,cord ,injury1 ,amyotrophic ,lat]al ,scl]osis1 & ,sp9a ,bifida exp]i5ce physical1 functional1 & cognitive *all5ges e day4 7#b7 ,complex rehabilitation te*nology items 79 ?is ,act ref]r$ to z ,,crt items71 includ+ products su* z complex rehabilitation p[] :eel*airs1 highly configurable manual :eel*airs1 adaptive seat+ & position+ sy/ems1 & o!r specializ$ equipm5t1 su* z /&+ frames & gait tra9]s1 enable individuals to maximize _! function & m9imize ! ext5t & co/s ( _! m$ical c>e4 7#c7 ,access to ,,crt items & relat$ s]vices c be ?reat5$ by inadequate cod+1 cov]age1 & paym5t policies = su* items & s]vices4 ,^! policies h re/rict$ access to exi/+ complex rehabilitation te*nology & /ifl$ innovation4 ,access *all5ges h increas$ ov] ! pa/ sev]al ye>s &1 )\t mean+ful *ange to ^! policies1 w only become great] 9 ! future4 7#d7 ,curr5t ,m$ic>e policies (t5 fail to adequately address ! ne$s ( individuals ) disabilities1 to consid] ! range ( s]vices furni%$ by complex rehabilitation te*nology suppli]s1 & to recognize & acc\nt = ! complexity & unique nature ( ! equipm5t itself4 7#e7 ,a significant factor responsible = su* access *all5ges is t individually-configurable ,,crt items d n h a di/9ct paym5t category "u ! ,m$ic>e program1 b in/ead are classifi$ )9 ! broad category ( durable m$ical equipm5t 7,,dme74 ,,crt items s]ve pati5ts ) s]i\s m$ical conditions t require a broad] range ( s]vices & specializ$ p]sonnel ?an :at is requir$ = /&>d ,,dme4 ,cu/omizable ,,crt items also require m res\rces 9 ! areas configur+1 tra9+1 & education to ensure appropriate use & to optimize results4 7#f7 ,unlike mo/ ,,dme1 a m$ical model incorporat+ an int]discipl9>y team approa* is necess>y to ensure prop] cu/omization & use ( a ,,crt item4 ,?is team typically includes a physician1 a lic5s$ physical or lic5s$ occupational !rapi/ 7) no f9ancial relation%ip ) ! ,,crt suppli]71 a qualifi$ ,,crt pr(essional1 ! individual us+ su* item1 & sometimes a c>egiv] = su* individual4 7#g7 ,! ,m$ic>e program %\ld recognize ! specializ$ nature ( ! ,,crt s]vice deliv]y model1 ! requir$ support+ processes & te*nology-relat$ ,,crt s]vices1 ! cr$5tials & compet5cies ne$$ by ! provid+ suppli]s & critical /aff1 & ! relat$ co/s involv$4 ,a sep>ate b5efit category = ,,crt items w\ld all[ = unique cod+1 cov]age1 & paym5t rules & policies t address ! unique ne$s ( p]sons ) disabilities & ackn[l$ge ! ext5sive s]vice compon5t4 7#h7 ,congress & ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices h previ\sly recogniz$ ! b5efits ( a sep>ate classification = unique1 cu/omiz$ products4 ,9 #bjjh1 ,congress exempt$ c]ta9 ,,crt items f inclusion 9 ! ,m$ic>e ,,dme competitive bidd+ program1 & ,congress has creat$ a sep>ate & di/9ct b5efit category = or?otics & pro/hetics 7cu/om braces & artificial limbs71 :i* h _! own m$ical policies1 accr$itation /&>ds1 & paym5t calculations4 #c4 ,e/abli%+ sep>ate b5efit category = complex rehabilitation te*nologies )9 ,m$ic>e 7a7 ,new category ,section #ahfa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is am5d$-- 7#a7 9 subsection 7s77#b7-- 7,a7 9 subp>agraph 7,,ee71 by /rik+ & at ! end2 7,b7 9 subp>agraph 7,,ff71 by ins]t+ & at ! end2 & 7,c7 by ins]t+ aft] subp>agraph 7,,ff7 ! foll[+ new p>agraph3 7,,gg7 complex rehabilitation te*nology items 7z def9$ 9 subsection 7iii772 2 & 7#b7 by add+ at ! end ! foll[+ new subsection3 7iii7 ,complex rehabilitation te*nology item 7#a7 ,! t]ms complex rehabilitation te*nology item & ,,crt item mean an item t-- 7,a7 is design$ & configur$ = a specific qualifi$ individual to meet ! individual's unique-- 7i7 m$ical1 physical1 & functional ne$s relat$ to a m$ical condition2 & 7ii7 capacities = basic activities ( daily liv+ & in/rum5tal activities ( daily liv+2 7,b7 is prim>ily us$ to s]ve a m$ical purpose & is g5]ally n useful to a p]son 9 ! abs5ce ( illness or injury2 & 7,c7 requires c]ta9 s]vices to ensure appropriate design1 configuration1 & use ( su* item1 includ+-- 7i7 an evaluation ( ne$s & capacities & mat*+ ( ! features & functions ( ,,crt items to ! qualifi$ individual :o w use su* an item2 & 7ii7 configur+1 fitt+1 programm+1 adju/+1 or adapt+ ! p>ticul> complex rehabilitation te*nology item = use by su* individual4 7#b7 7,a7 ,! ,secret>y1 9 consultation ) ! ,director ( ,(fice on ,disability1 ! ,*airman ( ! ,national ,c\ncil on ,disability1 ! ,executive ,director on ! ,int]ag5cy ,committee on ,disability1 ! ,director ( ! ,national ,in/itute on ,disability & ,rehabilitation ,rese>* ( ! ,dep>tm5t ( ,education1 & ! ,co-,*airm5 ( ! ,s5ior ,ov]sight ,committee's ,c>e ,managem5t ,re=m ,team ( ! ,dep>tm5t ( ,def5se & ! ,vet]ans ,adm9i/ration1 %all1 by regulation-- 7i7 designate items z complex rehabilitation te*nology items2 & 7ii7 e/abli% eligibility crit]ia to det]m9e if an individual is a qualifi$ individual bas$ on ! level ( physical & functional ne$s & capacities relat$ to a m$ical condition or conditions describ$ 9 subp>agraph 7,e74 7,b7 ,! items designat$ z complex rehabilitation te*nology items "u subp>agraph 7,a77i7 %all include items :i*1 z ( ,janu>y #a1 #bjac 1 7 classifi$ )9 ! foll[+ ,,hcpcs codes3 ,e#jfcg1 ,e#jfch1 ,e#jfda1 ,e#jfdb1 ,e#jihf1 ,e#ajjb1 ,e#ajjc1 ,e#ajjd1 ,e#ajje1 ,e#ajjf1 ,e#ajjg1 ,e#ajjh1 ,e#ajji1 ,e#ajaj1 ,e#ajaa1 ,e#ajad1 ,e#ajcg1 ,e#aafa1 ,e#abbj1 ,e#abbh1 ,e#abbi1 ,e#abca1 ,e#abcb1 ,e#abcc1 ,e#abcd1 ,e#abce1 ,e#abcf1 ,e#abcg1 ,e#abch1 ,e#abci ,e#bbji1 ,e#bbia1 ,e#bbib1 ,e#bbic1 ,e#bbid1 ,e#bbie1 ,e#bcjj1 ,e#bcja1 ,e#bcaj1 ,e#bcaa1 ,e#bcab1 ,e#bcac1 ,e#bcba1 ,e#bcbb1 ,e#bcbc1 ,e#bcbd1 ,e#bcbe1 ,e#bcbf1 ,e#bcbg1 ,e#bcbh1 ,e#bcbi1 ,e#bccj1 ,e#bcca1 ,e#bcea1 ,e#bcgc1 ,e#bcgd1 ,e#bcgf1 ,e#bcgg1 ,e#bfji1 ,e#bfaj1 ,e#bfag1 ,e#hjjj1 ,e#hjja1 ,e#hjjb1 ,k#jjje1 ,k#jhce1 ,k#jhcf1 ,k#jhcg1 ,k#jhch1 ,k#jhci1 ,k#jhdj1 ,k#jhda1 ,k#jhdb1 ,k#jhdc1 ,k#jhdh1 ,k#jhdi1 ,k#jhej1 ,k#jhea1 ,k#jheb1 ,k#jhec1 ,k#jhed1 ,k#jhee1 ,k#jhef1 ,k#jheg1 ,k#jheh1 ,k#jhei1 ,k#jhfj1 ,k#jhfa1 ,k#jhfb1 ,k#jhfc1 ,k#jhfd1 ,k#jhfh1 ,k#jhfi1 ,k#jhgj1 ,k#jhga1 ,k#jhgg1 ,k#jhgh1 ,k#jhgi1 ,k#jhhj1 ,k#jhhd1 ,k#jhhe1 ,k#jhhf1 ,k#jhij1 ,k#jhia1 & ,k#jhih4 7,c7 7i7 ,! items designat$ z complex rehabilitation te*nology items "u subp>agraph 7,a77i7 %all include ea* item t-- 7,i7 z ( ,janu>y #a1 #bjac1 0 classifi$ )9 ! ,,hcpcs codes "u clause 7ii72 & 7,,ii7 ! ,secret>y1 act+ 9 consultation ) suppli]s & manufactur]s ( ,,crt items1 det]m9es %\ld be remov$ f su* code & assign$ a new ,,hcpcs code because su* item is a complex rehabilitation te*nology item4 7ii7 ,! ,,hcpcs codes "u ?is clause are ! foll[+3 ,e#jadc1 ,e#jiej1 ,e#jiea1 ,e#jieb1 ,e#jiee1 ,e#jief1 ,e#jieg1 ,e#jieh1 ,e#jifj1 ,e#jifg1 ,e#jigh1 ,e#jiij1 ,e#ajae1 ,e#ajaf1 ,e#ajbh1 ,e#jajbi1 ,e#ajcj1 ,e#bbje1 ,e#bbjh1 ,e#bbca1 ,e#bcfh1 ,e#bcfi1 ,e#bcgj1 ,e#bfje1 ,e#bfjf1 ,e#bfjg1 ,e#bfjh1 ,e#bfac1 ,e#bfad1 ,e#bfae1 ,e#bfaf1 ,e#bfbj1 ,e#bfba1 ,e#bfbd1 ,e#bfbe1 ,k#jjjd1 ,k#jjji1 ,k#jjdj1 ,k#jajh1 & ,k#jffi4 7,d7 ,! ,secret>y may n designate z a complex rehabilitation te*nology item-- 7i7 adaptive equipm5t to op]ate motor vehicles2 7ii7 pro/hetic devices describ$ 9 subsection 7s77#h72 or 7iii7 or?otics & pro/hetics describ$ 9 subsection 7s77#i74 7,e7 ,9 e/abli%+ ! eligibility crit]ia "u subp>agraph 7,a77ii71 ! ,secret>y %all include appropriate physical & functional ne$s & capacities aris+ f any ( ! foll[+ m$ical conditions3 7i7 ,cong5ital disord]s1 progressive or deg5]ative neuromuscul> diseases1 or injuries or trauma t result 9 significant physical or functional ne$s & capacities4 7ii7 ,sp9al cord injury1 traumatic bra9 injury1 c]ebral palsy1 muscul> dy/rophy1 sp9a bifida1 o/eog5esis imp]fecta1 ar?rogryposis1 amyotrophic lat]al scl]osis1 multiple scl]osis1 demyel9at+ disease1 myelopa?y1 myopa?y1 progressive muscul> atrophy1 ant]ior horn cell disease1 po/-polio syndrome1 c]ebell> deg5]ation1 dy/onia1 ,hunt+ton's disease1 or sp9oc]ebell> disease4 7iii7 ,c]ta9 types ( amputation1 p>alysis1 or p>esis t result 9 significant physical or functional ne$s & capacities4 7,f7 7i7 ,= #bjad1 ! ,secret>y %all publi%-- 7,i7 a li/ ( items designat$ "u subp>agraph 7,a77i7 & ! ,,hcpcs codes = su* items2 & 7,,ii7 ! eligibility crit]ia e/abli%$ "u subp>agraph 7,a77ii74 7ii7 ,= #bjae & ea* subsequ5t ye>1 ! ,secret>y %all publi% any necess>y updates to su* li/ 7includ+ additions ( new ,,crt items & any *anges 9 applicable ,,hcpcs codes7 & to su* eligibility crit]ia4 7,g7 ,! ,secret>y %all make available1 on a public ,web site1 ! process by :i* ! ,secret>y w consid] reque/s f memb]s ( ! public t ! ,secret>y-- 7i7 designate an item z a ,,crt item "u subp>agraph 7,a77i72 or 7ii7 am5d ! eligibility crit]ia e/abli%$ "u subp>agraph 7,a77ii74 7#c7 ,= purposes ( ?is subsection3 7,a7 ,! t]m capacity = basic activities ( daily liv+ means an individual's capacity to safely p>ticipate 9 mobility & self-c>e activities includ+-- 7i7 ma9ta9+ & *ang+ body position2 7ii7 transf]r+ to or f "o surface to ano!r2 7iii7 walk+2 7iv7 mov+ f place to place us+ mobility equipm5t1 9 a safe & timely mann]2 7v7 wa%+ "o's self2 7vi7 c>+ = ! body2 7vii7 toilet+2 7viii7 dress+2 7ix7 eat+2 7x7 dr9k+2 7xi7 look+ aft] "o's heal?2 & 7xii7 c>ry+1 mov+1 & h&l+ objects to p]=m & p>ticipate 9 o!r activities "u ?is subp>agraph & subp>agraph 7,b74 7,b7 ,! t]m capacity = in/rum5tal activities ( daily liv+ means an individual's capacity to safely p>ticipate 9 life situations 9 ! home & community1 includ+-- 7i7 communicat+2 7ii7 mov+ ar\nd us+ transportation2 7iii7 acquir+ necessities1 goods1 & s]vices2 7iv7 p]=m+ h\sehold tasks2 7v7 c>+ = h\sehold memb]s & family memb]s2 7vi7 c>+ = h\sehold objects2 7vii7 engag+ 9 education1 "w1 employm5t & economic life2 & 7viii7 p>ticipat+ 9 community1 social1 & civic activities4 7,c7 ,! t]m ,,hcpcs ref]s to ! ,heal? ,c>e ,proc$ure ,cod+ ,sy/em4 7,d7 ,! t]m individually-configur$ means1 ) respect to an item1 t-- 7i7 ! item has a comb9ation ( features1 adju/m5ts1 or modifications t are specific to ! individual :o uses su* item2 & 7ii7 ! suppli] ( su* item mu/ measure ! individual & configure1 fit1 program1 adju/1 or adapt ! item1 z appropriate1 s t ! item is consi/5t )-- 7,i7 an assessm5t or evaluation ( ! individual by an appropriate lic5s$ cl9ician2 7,,ii7 ! writt5 ord] requir$ "u section #ahcd7p77#b77;,b77i72 & 7,,iii7 m$ical condition1 physical & functional ne$s & capacities1 & body size ( ! individual :o w use ! item1 ! p]iod = :i* su* individual w ne$ su* item1 & ! int5d$ use ( su* item by su* individual4 7,e7 ,! t]m qualifi$ individual means an individual :o-- 7i7 is enroll$ "u "p ,b2 & 7ii7 has physical & functional ne$s & capacities t arise f a m$ical condition t meet ! eligibility crit]ia e/abli%$ by ! ,secret>y "u p>agraph 7#b77;,a77ii74 4 #d4 ,paym5t rules ,section #ahcd ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7 is am5d$ by add+ at ! end ! foll[+3 7p7 ,cov]age & paym5t = ,,crt items 7#a7 ,g5]al rule = paym5t 7,a7 ,9 g5]al ,n lat] ?an ! date t is "o ye> aft] ! date ( ! enactm5t ( ?is subsection1 subject to subp>agraph 7,b71 ! ,secret>y %all det]m9e a paym5t sy/em t %all apply to ,,crt items-- 7i7 ) ,,hcpcs codes t 7 assign$ to ! item "u section #ahfa7;iii77#b77;,c77i77,,ii72 7ii7 = :i* no ,,hcpcs code 0 assign$ prior to su* date2 or 7iii7 :i*1 prior to su* date1 0 classifi$ "u a miscellane\s ,,hcpcs code4 7,b7 ,consid]ations ,9 det]m9+ ! paym5t sy/em "u subp>agraph 7,a71 ! ,secret>y-- 7i7 may disreg>d ! freezes on ,,cpi increases to ! paym5t am\nts = durable m$ical equipm5t t occurr$ be=e ! date ( ! enactm5t ( ?is subsection1 :5 det]m9+ ! paym5t am\nt = ,,crt items2 & 7ii7 %all ensure t ! paym5t am\nts = ,,crt items "u su* sy/em are adequate to provide qualifi$ individuals ) access to su* items & to enc\rage innovation1 tak+ into acc\nt-- 7,i7 ! unique ne$s ( qualifi$ individuals = access to ,,crt items2 7,,ii7 ! unique complexity ( ,,crt items2 & 7,,iii7 ! res\rces & /aff ne$$ to provide appropriate cu/omization ( ,,crt items = a qualifi$ individual4 7,c7 ,exclusive paym5t rule ,?is subsection %all con/itute ! exclusive provision ( ?is title = paym5t = ,,crt items "u ?is "p or "u "p ,a to a home heal? ag5cy4 7,d7 ,limitation on paym5t ,no paym5t %all be made "u ?is subsection = a ,,crt item unless su* ,,crt item-- 7i7 is provid$ to a qualifi$ individual2 7ii7 meets ! cl9ical conditions = cov]age e/abli%$ "u p>agraph 7#b72 & 7iii7 is furni%$ by a suppli] accr$it$ pursuant to p>agraph 7#c74 7#b7 ,cl9ical conditions = cov]age 7,a7 ,9 g5]al ,! ,secret>y %all e/abli% /&>ds = cl9ical conditions = paym5t = ,,crt items "u ?is subsection4 7,b7 ,requirem5ts ,! /&>ds e/abli%$ "u subp>agraph 7,a7 %all require ! foll[+3 7i7 ,writt5 ord] 7,i7 ,9 g5]al ,a qualifi$ ord]+ practition] %all provide a writt5 ord] = a ,,crt item = a qualifi$ individual be=e ! ,secret>y may provide paym5t = su* item = su* individual "u ?is subsection4 7,,ii7 ,,crt evaluation ,9 ! case ( a ,,crt item t is categoriz$ by ! ,secret>y1 = purposes ( ! program "u ?is title1 z a manual :eel*air or a p[] :eel*air1 & is to be provid$ to a qualifi$ individual :o has a diagnosis specifi$ "u subp>agraph 7,c71 ! qualifi$ ord]+ practition] may n provide a writt5 ord] "u subclause 7,i7 unless ! qualifi$ individual has und]gone a ,,crt evaluation conduct$ by a lic5s$ physical !rapi/ or occupational !rapi/ :o has no f9ancial relation%ip ) ! ,,crt suppli]4 7ii7 ,docum5tation ( m$ical necessity ,a qualifi$ ord]+ practition] :o provides a writt5 ord] "u clause 7i7 %all ma9ta9 docum5tation ( ! m$ical necessity ( su* ord] = a p]iod ( sev5 ye>s & %all make su* docum5tation available to ! ,secret>y ^u reque/4 ,! docum5tation ( m$ical necessity "u ?is clause %all include-- 7,i7 evid5ce t ! individual = :om ! ord] 0 writt5 has physical & functional ne$s & capacities relat$ to a m$ical condition t meet ! eligibility crit]ia e/abli%$ "u section #ahfa7;iii77#b77;,a77ii72 & 7,,ii7 evid5ce ( any ,,crt evaluation requir$ "u clause 7i77,,ii74 7,c7 ,specification ( diagnosis = ,,crt evaluation ,! ,secret>y1 9 consultation ) relevant p>ties 7includ+ ! ag5cies li/$ 9 section #ahfa7;iii77#b77;,a71 physicians1 lic5s$ physical !rapi/s1 lic5s$ occupational !rapi/s1 & suppli]s ( complex rehabilitation te*nologies7 %all specify ! diagnoses & o!r m$ical pres5tations = :i* ! requirem5t = a ,,crt evaluation "u subp>agraph 7,b77i77,,ii7 %all apply4 7,d7 ,cov]age det]m9ations ,9 develop+ ! /&>ds "u subp>agraph 7,a71 ! cov]age ( ,,crt items ) respect to an individual %all be bas$ on-- 7i7 ! specific m$ical1 physical1 & functional ne$s ( ! individual2 7ii7 ! individual's capacities = safe p>ticipation 9 basic activities ( daily liv+ & in/rum5tal activities ( daily liv+ 9 all r\t9ely enc\nt]$ environm5ts 7z su* t]ms are def9$ 9 section #ahfa7;iii77#c772 & 7iii7 ! individual's expect$ progression ( su* ne$s & capacities4 7,e7 ,paym5t = resid5ts ( skill$ nurs+ facilities ,9 ! case ( a qualifi$ individual :o is a resid5t ( a skill$ nurs+ facility1 paym5t may only be made "u ?is subsection = a ,,crt item = su* individual if su* ,,crt item is requir$ z "p ( a plan ( c>e to all[ ! transition ( su* individual f ! skill$ nurs+ facility to a home or community sett+4 7#c7 ,e/abli%m5t ( quality /&>ds 7,a7 ,e/abli%m5t ,! ,secret>y %all e/abli%1 ?r\gh regulation1 quality /&>ds = suppli]s ( ,,crt items4 ,su* /&>ds %all be appli$ prospectively & %all be publi%$ on ! ,int]net ,web site ( ! ,c5t]s = ,m$ic>e & ,m$icaid ,s]vices4 7,b7 ,consultation ,9 e/abli%+ ! quality /&>ds "u subp>agraph 7,a71 ! ,secret>y %all consult ) relevant p>ties 7includ+ cl9icians1 consum] gr\ps1 suppli]s1 & manufactur]s74 7,c7 ,requirem5ts ( /&>ds ,9 e/abli%+ ! quality /&>ds "u subp>agraph 7,a71 ! ,secret>y %all require t ! suppli]s ( ,,crt items meet ! foll[+ requirem5ts3 7i7 ,,dme /&>ds z m9imum ,! suppli] complies ) all ( ! /&>ds t are applicable to suppli]s ( durable m$ical equipm5t "u subsection 7a77#bj7 & suppli]s ( m$ical equipm5t & supplies "u subsection 7j74 7ii7 ,qualifi$ ,,crt pr(essional ,! suppli] ( a ,,crt item makes available1 9 ea* s]vice area s]v$ by su* suppli]1 at lea/ "o qualifi$ ,,crt pr(essional to-- 7,i7 analyze ! ne$s & capacities ( individuals = a ,,crt item 9 collaboration ) ! cl9ical team2 7,,ii7 assi/ 9 select+ an appropriate ,,crt item = su* individual1 giv5 su* ne$s & capacities2 & 7,,iii7 provide te*nology-relat$ tra9+ to su* individual 9 ! prop] use & ma9t5ance ( ! ,,crt items4 7iii7 ,trial equipm5t ,! suppli] ( ! ,,crt item provides ! qualifi$ individual ) appropriate equipm5t = trial & simulation1 if a physician1 lic5s$ physical !rapi/1 or lic5s$ occupational !rapi/ det]m9es t ! provision ( su* equipm5t is necess>y4 7iv7 ,in=mation on repair ,! suppli] ( ! ,,crt item provides ! qualifi$ individual ) writt5 in=mation on ! s]vice & repair ( ! ,,crt item provid$ to su* individual4 7v7 ,repair ,! suppli] ( a ,,crt item-- 7,i7 makes available1 9 ea* s]vice area s]v$ by su* suppli]1 at lea/ "o qualifi$ ,,crt s]vice te*nician to s]vice & repair ,,crt items t-- 7aa7 are furni%$ by su* suppli]2 & 7bb7 at ! "t ( ! ne$ = repair1 are locat$ 9 a s]vice area ( ! suppli]2 or 7,,ii7 at ! "t ( sale ( ! ,,crt item1 discloses to ! qualifi$ individual t ! suppli] does n provide repair s]vice = su* item & provides contact in=mation = entities t d provide su* repair s]vice4 7vi7 ,r5tal equipm5t ,if paym5t is all[$ "u p>agraph 7#f71 ! suppli] ( ! ,,crt item provides tempor>y r5tal equipm5t to ! qualifi$ individual :5 ! suppli] is repair+ a qualifi$ individual's ,,crt item t 0 paid = "u ?is subsection4 7#d7 ,application ( /&>ds & accr$itation program = suppli]s ( ,,crt items 7,a7 ,9 g5]al 7i7 ,requirem5t = provid] or suppli] numb] ,! ,secret>y %all n provide a suppli] ( ,,crt items ) a provid] or suppli] numb] to submit claims = paym5t "u ?is title unless ! suppli] is 9 compliance ) ! /&>ds "u p>agraph 7#c74 7ii7 ,requirem5t = paym5t ,paym5t %all n be made "u ?is "p = ,,crt items furni%$ by a suppli] unless ! suppli] is 9 compliance ) ! /&>ds "u p>agraph 7#c74 7,b7 ,application ( accr$itation requirem5t ,9 implem5t+ quality /&>ds "u p>agraph 7#c71 ! ,secret>y %all require suppli]s furni%+ ,,crt items1 on or aft] "o ye> aft] ! /&>ds are publi%$ "u su* p>agraph1 directly or z a subcontractor = ano!r entity-- 7i7 to comply ) su* /&>ds2 & 7ii7 to h submitt$ to ! ,secret>y evid5ce ( accr$itation by an accr$itation organization designat$ "u subp>agraph 7,c7 demon/rat+ t ! suppli] is comply+ ) su* /&>ds4 7,c7 ,designation ( indep5d5t accr$itation organizations ,n lat] ?an ! date t is "o ye> aft] ! date on :i* ! ,secret>y implem5ts ! quality /&>ds "u p>agraph 7#c71 ! ,secret>y %all designate & approve "o or m indep5d5t accr$itation organizations t-- 7i7 are approv$ "u subsection 7a77#bj77;,b72 & 7ii7 ! ,secret>y has det]m9$ h ! capability to assess :e!r suppli]s ( ,,crt items meet ! quality /&>ds e/abli%$ "u p>agraph 7#c74 7#e7 ,cod+ sy/em = complex rehabilitation te*nologies 7,a7 ,9 g5]al ,! ,secret>y %all1 9 consultation ) suppli]s & manufactur]s ( ,,crt items1 & utiliz+ exi/+ cod+ sy/ems1 e/abli% a ,,hcpcs cod+ subset t %all utilize & include ,,hcpcs codes describ$ 9 section #ahfa7;iii77#b7 = ,,crt items = :i* paym5t may made "u ?is subsection4 7,b7 ,treatm5t ( exi/+ products 7i7 ,9 g5]al ,) respect to ,,crt items = :i* paym5t 0 available "u ?is title be=e ! effective date ( ! am5dm5ts made by ,ensur+ ,access to ,quality ,complex ,rehabilitation ,te*nology ,act ( #bjac1 ! ,secret>y %all assign su* items to a code 9 ! cod+ subset e/abli%$ "u subp>agraph 7,a74 7ii7 ,updates ,aft] ! initial assignm5t "u clause 7i71 ! ,secret>y may decide to reassign additional product categories1 or items )9 ^? categories1 t exi/ be=e ! date ( ! enactm5t ( ?is subsection to ! ,,crt cod+ subset4 7iii7 ,consultation ,be=e mak+ reassignm5ts ( ,,crt items "u clause 7ii71 ! ,secret>y %all consult ) suppli]s & manufactur]s ( su* items4 ,! ,secret>y %all n require manufactur]s ( ,,crt items = :i* paym5t 0 available "u ?is title be=e ! effective date ( ! am5dm5ts made by ! ,ensur+ ,access to ,quality ,complex ,rehabilitation ,te*nology ,act ( #bjac to submit reque/s = reassignm5t ( ! code = su* product to ! cod+ subset "u subp>agraph 7,a7 z long z-- 7,i7 no *anges h be5 made to ! code def9itions1 requir$ code *>act]i/ics or te/ requirem5ts2 & 7,,ii7 ! item 0 previ\sly v]ifi$ to meet ! code requirem5ts4 7,c7 ,remov+ complex rehabilitation te*nology f ,,dme codes ,! ,secret>y %all1 9 consultation ) suppli]s & manufactur]s ( ,,crt items-- 7i7 remove f ! cod+ subset = durable m$ical equipm5t any ,,crt items t are includ$ 9 ! cod+ subset "u subp>agraph 7,a72 & 7ii7 assign new codes to su* ,,crt items = purposes ( includ+ su* items 9 ! subset "u subp>agraph 7,a74 7,d7 ,new te*nology 7i7 ,9 g5]al ,! ,secret>y %all update z ne$$ ! ,,hcpcs level ,,ii process us$ to modify ! code set to include ,,crt items = ! purposes ( e/abli%+ new codes & det]m9+ products to be classifi$ z ,,crt items4 ,9 det]m9+ if a product is a ,,crt item1 ! ,secret>y %all consid]-- 7,i7 if ! product is novel2 7,,ii7 ! cl9ical application ( ! product2 & 7,,iii7 ! ability ( ! product to address ! unique ne$s & capacities ( a qualifi$ individual4 7ii7 ,inclusion ( codes 9 li/ ,! ,secret>y %all include ! codes e/abli%$ 9 clause 7i7 9 ! li/ "u section #ahfa7;iii77#b77;,f74 7,e7 ,miscellane\s code = innovation & local cov]age det]m9ations ,! cod+ subset e/abli%$ "u subp>agraph 7,a7 %all include at lea/ "o miscellane\s code = items n o!rwise classifi$4 7#f7 ,replacem5t ( ,,crt items 7,a7 ,9 g5]al ,paym5t %all be made = ! replacem5t ( a ,,crt item 7or = ! replacem5t ( any "p ( su* item7 )\t reg>d to cont9u\s use or useful lifetime re/rictions e/abli%$ "u section #ahcd7;a77#g77;,c7 = items ( durable m$ical equipm5t if a qualifi$ ord]+ practition] det]m9es t ! provision ( a replacem5t item 7or a replacem5t "p ( su* an item7 is necess>y because-- 7i7 !re 0 a *ange 9 ! physiological condition ( ! qualifi$ individual to :om su* item 0 provid$2 7ii7 !re 0 an irrep>able *ange 9 ! condition ( ! ,,crt item 7or1 9 ! case ( ! replacem5t ( a "p1 9 ! "p ( ! ,,crt item72 or 7iii7 ! ,,crt item requires repairs & ! co/ ( su* repairs w\ld be m ?an #ej p]c5t ( ! co/ ( a replacem5t ( ! ,,crt item4 7,b7 ,def]ral to provid]s 7i7 ,9 g5]al ,subject to clause 7ii71 if a qualifi$ ord]+ practition] det]m9es t a replacem5t ( ! ,,crt item1 or ! replacem5t ( a "p ( a ,,crt item1 is necess>y pursuant to subp>agraph 7,a71 ! replacem5t item or "p is deem$ to be reasonable & necess>y = purposes ( section #ahfb7;a77#a77;,a74 7ii7 ,exception = items "u #c ye>s old ,if ! ,,crt item t is be+ replac$ 7or ! "p ( ! ,,crt item t is be+ replac$7 "u subp>agraph 7,a7 is less ?an #c ye>s old 7calculat$ f ! date on :i* ! qualifi$ individual began to use ! ,,crt item or "p71 ! ,secret>y may require ! qualifi$ ord]+ practition] to provide confirmation ( necessity ( ! replacem5t item or replacem5t "p1 z ! case may be4 7#g7 ,paym5t = tempor>y r5tal 7,a7 ,9 g5]al ,if a ,,crt item own$ by a qualifi$ individual ne$s to be repair$1 paym5t may be made "u ?is subsection = ! tempor>y r5tal ( a ,,crt item :ile ! ,,crt item own$ by su* individual is be+ repair$4 7,b7 ,basis2 limitation ,paym5t p]mitt$ "u subp>agraph 7,a7 %all be made on a mon?ly basis1 & ! p]iod ( r5tal may n exce$ two mon?s4 7,c7 ,paym5t am\nt ,! am\nt ( paym5t all[$ "u subp>agraph 7,a7 = a mon? = ! r5tal ( a ,,crt item %all be #aj p]c5t ( ! pur*ase price = ! ,,crt item4 7#h7 ,def9itions ,= purposes ( ?is subsection3 7,a7 ,,hcpcs ,! t]m ,,hcpcs ref]s to ! ,heal? ,c>e ,proc$ure ,cod+ ,sy/em4 7,b7 ,qualifi$ ,,crt pr(essional 7i7 ,9 g5]al ,! t]m qualifi$ ,,crt pr(essional means an individual :o-- 7,i7 is c]tifi$ by ! ,rehabilitation ,eng9e]+ & ,assi/ive ,te*nology ,society ( ,nor? ,am]ica z an assi/ive te*nology pr(essional or is c]tifi$ by ano!r organization designat$ by ! ,secret>y 7act+ 9 consultation ) relevant p>ties7 z provid+ a c]tification t is equival5t to1 or m /r+5t ?an1 ! assi/ive te*nology pr(essional c]tification2 & 7,,ii7 beg9n+ two ye>s aft] ! e/abli%m5t ( ! designation "u clause 7ii71 a*ieves an additional designation t demon/rates ! individual's compet5cies & exp]i5ce 9 supply+ ,,crt items4 7ii7 ,e/abli%m5t ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is subsection1 ! ,secret>y1 act+ 9 consultation ) relevant p>ties1 %all e/abli% ! additional designation "u clause 7i77,,ii74 7iii7 ,relevant p>ties ,= purposes ( ?is subp>agraph1 ! t]m relevant p>ties includes cl9icians1 consum] gr\ps1 ,,crt suppli]s1 & ,,crt manufactur]s4 7,c7 ,qualifi$ ,,crt s]vice te*nician ,! t]m qualifi$ ,,crt s]vice te*nician means an individual :o-- 7i7 is factory-tra9$ by ! manufactur]s ( ! ,,crt items be+ (f]$ by ! suppl] ( su* items2 7ii7 is tra9$ & educat$ 7includ+ ?r\gh on ! job tra9+7 to assemble1 fit1 program1 s]vice1 & repair ,,crt items2 & 7iii7 on an annual basis1 completes at lea/ #aj h\rs ( cont9u+ education specific to ! assembly1 fitt+1 programm+1 s]vice1 & repair ( ,,crt items4 7,d7 ,qualifi$ individual ,! t]m qualifi$ individual has ! mean+ giv5 su* t]m 9 section #ahfa7;iii77#c77;,e74 7,e7 ,qualifi$ ord]+ practition] ,! t]m qualifi$ ord]+ practition] means a physician 7z def9$ 9 section #ahfa7r771 a physician assi/ant1 nurse practition]1 or a cl9ical nurse speciali/ 7z ^? t]ms are def9$ 9 section #ahfa7;aa77#e774 4 #e4 ,con=m+ am5dm5ts 7a7 ,exclusion f ! 9-,home use limitation = ,,dme ,section #ahfa7n7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7n77 is am5d$ by add+ at ! end ! foll[+3 ,= #bjad & subsequ5t ye>s1 su* t]m does n include complex rehabilitation te*nologies 7z def9$ 9 subsection 7iii7744 7b7 ,exemption f competitive acquisition ,section #ahdg7;a77#g7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c7;a77#g77 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,c7 ,,crt items ,= #bjad & subsequ5t ye>s1 complex rehabilitation te*nology items 7z def9$ 9 section #ahfa7;iii774 4 7c7 ,exemption f ,,snf consolidat$ bill+ ,section #ahhh7;e77#b77;,a77iii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieyy7e77#b77;,a77iii77 is am5d$ by add+ at ! end ! foll[+3 7,,vi7 ,complex rehabilitation te*nology items 7z def9$ 9 section #ahfa7;iii77 if deliv]$ to an inpati5t = use dur+ ! /ay 9 ! skill$ nurs+ facility z "p ( ! plan ( c>e to all[ ! transition ( su* qualifi$ individuals f ! skill$ nurs+ facility sett+ to ! home & community4 4 7d7 ,paym5t exclusions ,section #ahcd7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7a77 is am5d$-- 7#a7 9 p>agraph 7#d71 by add+ at ! end ! foll[+ s5t5ce ,= #bjad & subsequ5t ye>s1 ! items cov]$ by ?is p>agraph %all n include complex rehabilitation te*nology items 7z def9$ 9 section #ahfa7;iii7742 7#b7 9 p>agraph 7#g77;,a71 by add+ at ! end ! foll[+3 ,= fiscal ye> #bjad & subsequ5t ye>s1 ! previ\s s5t5ce %all n apply to p[]-driv5 :eel*airs t are designat$ z ,,crt items "u section #ahfa7;iii742 & 7#c7 9 p>agraph 7#af71 by ins]t+ at ! end ! foll[+3 ,! ,secret>y %all impose 7&1 may1 z all[$ by ! second s5t5ce ( ?is p>agraph1 waive7 ! requirem5ts ( ! fir/ s5t5ce ( ?is p>agraph to suppli]s ( complex rehabilitation te*nology items1 except t1 9 ord] to avoid duplicate bonds1 ! ,secret>y %all n impose su* requirem5ts ) respect to suppli]s ( complex rehabilitation te*nology items if su* suppli]s also p>ticipate 9 ! ,m$ic>e program z suppli]s ( durable m$ical equipm5t44 7e7 ,requirem5ts = suppli]s ( m$ical equipm5t & supplies ,section #ahcd7;j77#e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7j77#e77 is am5d$-- 7#a7 by r$esignat+ subp>agraphs 7,e7 & 7,f7 z subp>agraphs 7,f7 & 7,g71 respectively2 7#b7 by ins]t+ aft] subp>agraph 7,d7 ! foll[+ new subp>agraph3 7,e7 complex rehabilitation te*nology items 7z def9$ 9 section #ahfa7;iii772 4 #f4 ,effective date ,! am5dm5ts made by ?is ,act %all apply to items & s]vices furni%$ on or aft] ,janu>y #a1 #bjad4