,,ii #aacth ,,congress #ast ,session ,s4 #idh ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #ad1 #bjac ,mr4 ,schumer 7for himself and ,mr4 ,cochran7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to provide for coverage and payment for complex rehabilitation technology items under the ,medicare program4 #a4 ,short title ,this ,act may be cited as the ,ensuring ,access to ,quality ,complex ,rehabilitation ,technology ,act of #bjac4 #b4 ,establishing separate benefit category for complex rehabilitation technologies within ,medicare 7a7 ,new category ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is amended-- 7#a7 in subsection 7s77#b7-- 7,a7 in subparagraph 7,,ee71 by striking and at the end2 7,b7 in subparagraph 7,,ff71 by inserting and at the end2 and 7,c7 by inserting after subparagraph 7,,ff7 the following new paragraph3 7,,gg7 complex rehabilitation technology items 7as defined in subsection 7iii772 2 and 7#b7 by adding at the end the following new subsection3 7iii7 ,complex rehabilitation technology item 7#a7 ,the terms complex rehabilitation technology item and ,,crt item mean an item that-- 7,a7 is designed and configured for a specific qualified individual to meet the individual's unique-- 7i7 medical1 physical1 and functional needs related to a medical condition2 and 7ii7 capacities for basic activities of daily living and instrumental activities of daily living2 7,b7 is primarily used to serve a medical purpose and is generally not useful to a person in the absence of illness or injury2 and 7,c7 requires certain services to ensure appropriate design1 configuration1 and use of such item1 including-- 7i7 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 item2 and 7ii7 configuring1 fitting1 programming1 adjusting1 or adapting the particular complex rehabilitation technology item for use by such individual4 7#b7 7,a7 ,the ,secretary1 in consultation with the ,director of ,office on ,disability1 the ,chairman of the ,national ,council on ,disability1 the ,executive ,director on the ,interagency ,committee on ,disability1 the ,director of the ,national ,institute on ,disability and ,rehabilitation ,research of the ,department of ,education1 and the ,co-,chairmen of the ,senior ,oversight ,committee's ,care ,management ,reform ,team of the ,department of ,defense and the ,veterans ,administration1 shall1 by regulation-- 7i7 designate items as complex rehabilitation technology items2 and 7ii7 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 described in subparagraph 7,e74 7,b7 ,the items designated as complex rehabilitation technology items under subparagraph 7,a77i7 shall include items which1 as of ,january #a1 #bjac 1 were classified within the following ,,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 and ,k#jhih4 7,c7 7i7 ,the items designated as complex rehabilitation technology items under subparagraph 7,a77i7 shall include each item that-- 7,i7 as of ,january #a1 #bjac1 was classified within the ,,hcpcs codes under clause 7ii72 and 7,,ii7 the ,secretary1 acting in consultation with suppliers and manufacturers of ,,crt items1 determines which item should be removed from such code and assigned a new ,,hcpcs code because such item is a complex rehabilitation technology item4 7ii7 ,the ,,hcpcs codes under this clause are the following3 ,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#ajbi1 ,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 and ,k#jffi4 7,d7 ,the ,secretary may not designate as a complex rehabilitation technology item-- 7i7 adaptive equipment to operate motor vehicles2 7ii7 prosthetic devices described in subsection 7s77#h72 or 7iii7 orthotics and prosthetics described in subsection 7s77#i74 7,e7 ,in establishing the eligibility criteria under subparagraph 7,a77ii71 the ,secretary shall include appropriate physical and functional needs and capacities arising from any of the following medical conditions3 7i7 ,congenital disorders1 progressive or degenerative neuromuscular diseases1 or injuries or trauma that result in significant physical or functional needs and capacities4 7ii7 ,spinal cord injury1 traumatic brain injury1 cerebral palsy1 muscular dystrophy1 spina bifida1 osteogenesis imperfecta1 arthrogryposis1 amyotrophic lateral sclerosis1 multiple sclerosis1 demyelinating disease1 myelopathy1 myopathy1 progressive muscular atrophy1 anterior horn cell disease1 post-polio syndrome1 cerebellar degeneration1 dystonia1 ,huntington's disease1 or spinocerebellar disease4 7iii7 ,certain types of amputation1 paralysis1 or paresis that result in significant physical or functional needs and capacities4 7,f7 7i7 ,for #bjad1 the ,secretary shall publish-- 7,i7 a list of items designated under subparagraph 7,a77i7 and the ,,hcpcs codes for such items2 and 7,,ii7 the eligibility criteria established under subparagraph 7,a77ii74 7ii7 ,for #bjae and each subsequent year1 the ,secretary shall publish any necessary updates to such list 7including additions of new ,,crt items and any changes in applicable ,,hcpcs codes7 and to such eligibility criteria4 7,g7 ,the ,secretary shall make available1 on a public ,web site1 the process by which the ,secretary will consider requests from members of the public that the ,secretary-- 7i7 designate an item as a ,,crt item under subparagraph 7,a77i72 or 7ii7 amend the eligibility criteria established under subparagraph 7,a77ii74 7#c7 ,for purposes of this subsection3 7,a7 ,the term capacity for basic activities of daily living means an individual's capacity to safely participate in mobility and self-care activities including-- 7i7 maintaining and changing body position2 7ii7 transferring to or from one surface to another2 7iii7 walking2 7iv7 moving from place to place using mobility equipment1 in a safe and timely manner2 7v7 washing one's self2 7vi7 caring for the body2 7vii7 toileting2 7viii7 dressing2 7ix7 eating2 7x7 drinking2 7xi7 looking after one's health2 and 7xii7 carrying1 moving1 and handling objects to perform and participate in other activities under this subparagraph and subparagraph 7,b74 7,b7 ,the term capacity for instrumental activities of daily living means an individual's capacity to safely participate in life situations in the home and community1 including-- 7i7 communicating2 7ii7 moving around using transportation2 7iii7 acquiring necessities1 goods1 and services2 7iv7 performing household tasks2 7v7 caring for household members and family members2 7vi7 caring for household objects2 7vii7 engaging in education1 work1 employment and economic life2 and 7viii7 participating in community1 social1 and civic activities4 7,c7 ,the term ,,hcpcs refers to the ,health ,care ,procedure ,coding ,system4 7,d7 ,the term individually-configured means1 with respect to an item1 that-- 7i7 the item has a combination of features1 adjustments1 or modifications that are specific to the individual who uses such item2 and 7ii7 the supplier of such item must measure the individual and configure1 fit1 program1 adjust1 or adapt the item1 as appropriate1 so that the item is consistent with-- 7,i7 an assessment or evaluation of the individual by an appropriate licensed clinician2 7,,ii7 the written order required under section #ahcd7p77#b77;,b77i72 and 7,,iii7 medical condition1 physical and functional needs and capacities1 and body size of the individual who will use the item1 the period for which such individual will need such item1 and the intended use of such item by such individual4 7,e7 ,the term qualified individual means an individual who-- 7i7 is enrolled under part ,b2 and 7ii7 has physical and functional needs and capacities that arise from a medical condition that meet the eligibility criteria established by the ,secretary under paragraph 7#b77;,a77ii74 4 #c4 ,payment rules ,section #ahcd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7 is amended by adding at the end the following3 7p7 ,coverage and payment for ,,crt items 7#a7 ,general rule for payment 7,a7 ,in general ,not later than the date that is one year after the date of the enactment of this subsection1 subject to subparagraph 7,b71 the ,secretary shall determine a payment system that shall apply to ,,crt items-- 7i7 with ,,hcpcs codes that were assigned to the item under section #ahfa7;iii77#b77;,c77i77,,ii72 7ii7 for which no ,,hcpcs code was assigned prior to such date2 or 7iii7 which1 prior to such date1 was classified under a miscellaneous ,,hcpcs code4 7,b7 ,considerations ,in determining the payment system under subparagraph 7,a71 the ,secretary-- 7i7 may disregard the freezes on ,,cpi increases to the payment amounts for durable medical equipment that occurred before the date of the enactment of this subsection1 when determining the payment amount for ,,crt items2 and 7ii7 shall ensure that the payment amounts for ,,crt items under such system are adequate to provide qualified individuals with access to such items and to encourage innovation1 taking into account-- 7,i7 the unique needs of qualified individuals for access to ,,crt items2 7,,ii7 the unique complexity of ,,crt items2 and 7,,iii7 the resources and staff needed to provide appropriate customization of ,,crt items for a qualified individual4 7,c7 ,exclusive payment rule ,this subsection shall constitute the exclusive provision of this title for payment for ,,crt items under this part or under part ,a to a home health agency4 7,d7 ,limitation on payment ,no payment shall be made under this subsection for a ,,crt item unless such ,,crt item-- 7i7 is provided to a qualified individual2 7ii7 meets the clinical conditions for coverage established under paragraph 7#b72 and 7iii7 is furnished by a supplier accredited pursuant to paragraph 7#c74 7#b7 ,clinical conditions for coverage 7,a7 ,in general ,the ,secretary shall establish standards for clinical conditions for payment for ,,crt items under this subsection4 7,b7 ,requirements ,the standards established under subparagraph 7,a7 shall require the following3 7i7 ,written order 7,i7 ,in general ,a qualified ordering practitioner shall provide a written order for a ,,crt item for a qualified individual before the ,secretary may provide payment for such item for such individual under this subsection4 7,,ii7 ,,crt evaluation ,in the case of a ,,crt item that is categorized by the ,secretary1 for purposes of the program under this title1 as a manual wheelchair or a power wheelchair1 and is to be provided to a qualified individual who has a diagnosis specified under subparagraph 7,c71 the qualified ordering practitioner may not provide a written order under subclause 7,i7 unless the qualified individual has undergone a ,,crt evaluation conducted by a licensed physical therapist or occupational therapist who has no financial relationship with the ,,crt supplier4 7ii7 ,documentation of medical necessity ,a qualified ordering practitioner who provides a written order under clause 7i7 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 request4 ,the documentation of medical necessity under this clause shall include-- 7,i7 evidence that the individual for whom the order was written has physical and functional needs and capacities related to a medical condition that meet the eligibility criteria established under section #ahfa7;iii77#b77;,a77ii72 and 7,,ii7 evidence of any ,,crt evaluation required under clause 7i77,,ii74 7,c7 ,specification of diagnosis for ,,crt evaluation ,the ,secretary1 in consultation with relevant parties 7including the agencies listed in section #ahfa7;iii77#b77;,a71 physicians1 licensed physical therapists1 licensed occupational therapists1 and suppliers of complex rehabilitation technologies7 shall specify the diagnoses and other medical presentations for which the requirement for a ,,crt evaluation under subparagraph 7,b77i77,,ii7 shall apply4 7,d7 ,coverage determinations ,in developing the standards under subparagraph 7,a71 the coverage of ,,crt items with respect to an individual shall be based on-- 7i7 the specific medical1 physical1 and functional needs of the individual2 7ii7 the individual's capacities for safe participation in basic activities of daily living and instrumental activities of daily living in all routinely encountered environments 7as such terms are defined in section #ahfa7;iii77#c772 and 7iii7 the individual's expected progression of such needs and capacities4 7,e7 ,payment for residents of skilled nursing facilities ,in the case of a qualified individual who is a resident of a skilled nursing facility1 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 setting4 7#c7 ,establishment of quality standards 7,a7 ,establishment ,the ,secretary shall establish1 through regulation1 quality standards for suppliers of ,,crt items4 ,such standards shall be applied prospectively and shall be published on the ,internet ,web site of the ,centers for ,medicare and ,medicaid ,services4 7,b7 ,consultation ,in establishing the quality standards under subparagraph 7,a71 the ,secretary shall consult with relevant parties 7including clinicians1 consumer groups1 suppliers1 and manufacturers74 7,c7 ,requirements of standards ,in establishing the quality standards under subparagraph 7,a71 the ,secretary shall require that the suppliers of ,,crt items meet the following requirements3 7i7 ,,dme standards as minimum ,the supplier complies with all of the standards that are applicable to suppliers of durable medical equipment under subsection 7a77#bj7 and suppliers of medical equipment and supplies under subsection 7j74 7ii7 ,qualified ,,crt professional ,the supplier of a ,,crt item makes available1 in each service area served by such supplier1 at least one qualified ,,crt professional to-- 7,i7 analyze the needs and capacities of individuals for a ,,crt item in collaboration with the clinical team2 7,,ii7 assist in selecting an appropriate ,,crt item for such individual1 given such needs and capacities2 and 7,,iii7 provide technology-related training to such individual in the proper use and maintenance of the ,,crt items4 7iii7 ,trial equipment ,the supplier of the ,,crt item provides the qualified individual with appropriate equipment for trial and simulation1 if a physician1 licensed physical therapist1 or licensed occupational therapist determines that the provision of such equipment is necessary4 7iv7 ,information on repair ,the supplier of the ,,crt item provides the qualified individual with written information on the service and repair of the ,,crt item provided to such individual4 7v7 ,repair ,the supplier of a ,,crt item-- 7,i7 makes available1 in each service area served by such supplier1 at least one qualified ,,crt service technician to service and repair ,,crt items that-- 7aa7 are furnished by such supplier2 and 7bb7 at the time of the need for repair1 are located in a service area of the supplier2 or 7,,ii7 at the time of sale of the ,,crt item1 discloses to the qualified individual that the supplier does not provide repair service for such item and provides contact information for entities that do provide such repair service4 7vi7 ,rental equipment ,if payment is allowed under paragraph 7#f71 the supplier of the ,,crt item provides temporary rental equipment to the qualified individual when the supplier is repairing a qualified individual's ,,crt item that was paid for under this subsection4 7#d7 ,application of standards and accreditation program for suppliers of ,,crt items 7,a7 ,in general 7i7 ,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 7#c74 7ii7 ,requirement for payment ,payment shall not be made under this part for ,,crt items furnished by a supplier unless the supplier is in compliance with the standards under paragraph 7#c74 7,b7 ,application of accreditation requirement ,in implementing quality standards under paragraph 7#c71 the ,secretary shall require suppliers furnishing ,,crt items1 on or after one year after the standards are published under such paragraph1 directly or as a subcontractor for another entity-- 7i7 to comply with such standards2 and 7ii7 to have submitted to the ,secretary evidence of accreditation by an accreditation organization designated under subparagraph 7,c7 demonstrating that the supplier is complying with such standards4 7,c7 ,designation of independent accreditation organizations ,not later than the date that is one year after the date on which the ,secretary implements the quality standards under paragraph 7#c71 the ,secretary shall designate and approve one or more independent accreditation organizations that-- 7i7 are approved under subsection 7a77#bj77;,b72 and 7ii7 the ,secretary has determined have the capability to assess whether suppliers of ,,crt items meet the quality standards established under paragraph 7#c74 7#e7 ,coding system for complex rehabilitation technologies 7,a7 ,in general ,the ,secretary shall1 in consultation with suppliers and manufacturers of ,,crt items1 and utilizing existing coding systems1 establish a ,,hcpcs coding subset that shall utilize and include ,,hcpcs codes described in section #ahfa7;iii77#b7 for ,,crt items for which payment may made under this subsection4 7,b7 ,treatment of existing products 7i7 ,in general ,with respect to ,,crt items for which payment was available under this title before the effective date of the amendments made by ,ensuring ,access to ,quality ,complex ,rehabilitation ,technology ,act of #bjac1 the ,secretary shall assign such items to a code in the coding subset established under subparagraph 7,a74 7ii7 ,updates ,after the initial assignment under clause 7i71 the ,secretary may decide to reassign additional product categories1 or items within those categories1 that exist before the date of the enactment of this subsection to the ,,crt coding subset4 7iii7 ,consultation ,before making reassignments of ,,crt items under clause 7ii71 the ,secretary shall consult with suppliers and manufacturers of such items4 ,the ,secretary shall not require manufacturers of ,,crt items for which payment was available under this title before the effective date of the amendments made by the ,ensuring ,access to ,quality ,complex ,rehabilitation ,technology ,act of #bjac to submit requests for reassignment of the code for such product to the coding subset under subparagraph 7,a7 as long as-- 7,i7 no changes have been made to the code definitions1 required code characteristics or test requirements2 and 7,,ii7 the item was previously verified to meet the code requirements4 7,c7 ,removing complex rehabilitation technology from ,,dme codes ,the ,secretary shall1 in consultation with suppliers and manufacturers of ,,crt items-- 7i7 remove from the coding subset for durable medical equipment any ,,crt items that are included in the coding subset under subparagraph 7,a72 and 7ii7 assign new codes to such ,,crt items for purposes of including such items in the subset under subparagraph 7,a74 7,d7 ,new technology 7i7 ,in general ,the ,secretary shall update as needed the ,,hcpcs level ,,ii process used to modify the code set to include ,,crt items for the purposes of establishing new codes and determining products to be classified as ,,crt items4 ,in determining if a product is a ,,crt item1 the ,secretary shall consider-- 7,i7 if the product is novel2 7,,ii7 the clinical application of the product2 and 7,,iii7 the ability of the product to address the unique needs and capacities of a qualified individual4 7ii7 ,inclusion of codes in list ,the ,secretary shall include the codes established in clause 7i7 in the list under section #ahfa7;iii77#b77;,f74 7,e7 ,miscellaneous code for innovation and local coverage determinations ,the coding subset established under subparagraph 7,a7 shall include at least one miscellaneous code for items not otherwise classified4 7#f7 ,replacement of ,,crt items 7,a7 ,in general ,payment shall be made for the replacement of a ,,crt item 7or for the replacement of any part of such item7 without regard to continuous use or useful lifetime restrictions established under section #ahcd7;a77#g77;,c7 for items of durable medical equipment if a qualified ordering practitioner determines that the provision of a replacement item 7or a replacement part of such an item7 is necessary because-- 7i7 there was a change in the physiological condition of the qualified individual to whom such item was provided2 7ii7 there was an irreparable change in the condition of the ,,crt item 7or1 in the case of the replacement of a part1 in the part of the ,,crt item72 or 7iii7 the ,,crt item requires repairs and the cost of such repairs would be more than #ej percent of the cost of a replacement of the ,,crt item4 7,b7 ,deferral to providers 7i7 ,in general ,subject to clause 7ii71 if a qualified ordering practitioner determines that a replacement of the ,,crt item1 or the replacement of a part of a ,,crt item1 is necessary pursuant to subparagraph 7,a71 the replacement item or part is deemed to be reasonable and necessary for purposes of section #ahfb7;a77#a77;,a74 7ii7 ,exception for items under #c years old ,if the ,,crt item that is being replaced 7or the part of the ,,crt item that is being replaced7 under subparagraph 7,a7 is less than #c years old 7calculated from the date on which the qualified individual began to use the ,,crt item or part71 the ,secretary may require the qualified ordering practitioner to provide confirmation of necessity of the replacement item or replacement part1 as the case may be4 7#g7 ,payment for temporary rental 7,a7 ,in general ,if a ,,crt item owned by a qualified individual needs to be repaired1 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 repaired4 7,b7 ,basis2 limitation ,payment permitted under subparagraph 7,a7 shall be made on a monthly basis1 and the period of rental may not exceed two months4 7,c7 ,payment amount ,the amount of payment allowed under subparagraph 7,a7 for a month for the rental of a ,,crt item shall be #aj percent of the purchase price for the ,,crt item4 7#h7 ,definitions ,for purposes of this subsection3 7,a7 ,,hcpcs ,the term ,,hcpcs refers to the ,health ,care ,procedure ,coding ,system4 7,b7 ,qualified ,,crt professional 7i7 ,in general ,the term qualified ,,crt professional means an individual who-- 7,i7 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 7acting in consultation with relevant parties7 as providing a certification that is equivalent to1 or more stringent than1 the assistive technology professional certification2 and 7,,ii7 beginning two years after the establishment of the designation under clause 7ii71 achieves an additional designation that demonstrates the individual's competencies and experience in supplying ,,crt items4 7ii7 ,establishment ,not later than one year after the date of the enactment of this subsection1 the ,secretary1 acting in consultation with relevant parties1 shall establish the additional designation under clause 7i77,,ii74 7iii7 ,relevant parties ,for purposes of this subparagraph1 the term relevant parties includes clinicians1 consumer groups1 ,,crt suppliers1 and ,,crt manufacturers4 7,c7 ,qualified ,,crt service technician ,the term qualified ,,crt service technician means an individual who-- 7i7 is factory-trained by the manufacturers of the ,,crt items being offered by the suppler of such items2 7ii7 is trained and educated 7including through on the job training7 to assemble1 fit1 program1 service1 and repair ,,crt items2 and 7iii7 on an annual basis1 completes at least #aj hours of continuing education specific to the assembly1 fitting1 programming1 service1 and repair of ,,crt items4 7,d7 ,qualified individual ,the term qualified individual has the meaning given such term in section #ahfa7;iii77#c77;,e74 7,e7 ,qualified ordering practitioner ,the term qualified ordering practitioner means a physician 7as defined in section #ahfa7r771 a physician assistant1 nurse practitioner1 or a clinical nurse specialist 7as those terms are defined in section #ahfa7;aa77#e774 4 #d4 ,conforming amendments 7a7 ,exclusion from the in-,home use limitation for ,,dme ,section #ahfa7n7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7n77 is amended by adding at the end the following3 ,for #bjad and subsequent years1 such term does not include complex rehabilitation technologies 7as defined in subsection 7iii7744 7b7 ,exemption from competitive acquisition ,section #ahdg7;a77#g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c7;a77#g77 is amended by adding at the end the following new subparagraph3 7,c7 ,,crt items ,for #bjad and subsequent years1 complex rehabilitation technology items 7as defined in section #ahfa7;iii774 4 7c7 ,exemption from ,,snf consolidated billing ,section #ahhh7;e77#b77;,a77iii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieyy7e77#b77;,a77iii77 is amended by adding at the end the following3 7,,vi7 ,complex rehabilitation technology items 7as defined in section #ahfa7;iii77 if delivered to an inpatient for use during the stay in the skilled 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 community4 4 7d7 ,payment exclusions ,section #ahcd7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7a77 is amended-- 7#a7 in paragraph 7#d71 by adding at the end the following sentence ,for #bjad and subsequent years1 the items covered by this paragraph shall not include complex rehabilitation technology items 7as defined in section #ahfa7;iii7742 7#b7 in paragraph 7#g77;,a71 by adding at the end the following3 ,for fiscal year #bjad and subsequent years1 the previous sentence shall not apply to power-driven wheelchairs that are designated as ,,crt items under section #ahfa7;iii742 and 7#c7 in paragraph 7#af71 by inserting at the end the following3 ,the ,secretary shall impose 7and1 may1 as allowed by the second sentence of this paragraph1 waive7 the requirements of the first sentence of this paragraph to suppliers of complex rehabilitation technology items1 except that1 in order to avoid duplicate bonds1 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 equipment44 7e7 ,requirements for suppliers of medical equipment and supplies ,section #ahcd7;j77#e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7j77#e77 is amended-- 7#a7 by redesignating subparagraphs 7,e7 and 7,f7 as subparagraphs 7,f7 and 7,g71 respectively2 and 7#b7 by inserting after subparagraph 7,d7 the following new subparagraph3 7,e7 complex rehabilitation technology items 7as defined in section #ahfa7;iii772 4 #e4 ,effective date ,the amendments made by this ,act shall apply to items and services furnished on or after ,january #a1 #bjad4