,,ii  #aad? ,,congress  #a/ ,session    
,s4 #abec  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,may #g1 #bjae,mr4     
,burr 7= himself & ,mr4 ,b5net7         
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
provide cov]age ( c]ta9 disposable      
m$ical te*nologies "u ! ,m$ic>e program1
 & = o!r purposes4  #a4 ,%ort title ,?is
 ,act may be cit$ z ! ,pati5t ,access to
 ,disposable ,m$ical ,te*nology ,act (  
#bjae4  #b4 ,cov]age ( c]ta9 disposable 
m$ical te*nologies "u ! ,m$ic>e program 
7a7 ,cov]age ,section #ahfa ( ! ,social 
,security ,act 7#db ,u4,s4,c4 #aciex7 is
 am5d$--  7#a7 9 subsection 7n7-- 7,a7  
by ins]t+ sub/itute disposable m$ical   
te*nologies 7z def9$ 9 subsection 7iii77
 & s]vices & supplies us$ 9 conjunction 
) su* te*nologies1 aft] hospital b$s12 &
  7,b7 by ins]t+ 7unless su* equipm5t is
 a sub/itute disposable m$ical te*nology
 or a s]vice or supply us$ 9 conjunction

 ) su* a te*nology7 aft] r5tal basis2 & 
7#b7 by add+ at ! end ! foll[+ new      
subsection3  7iii7 ,sub/itute disposable
 m$ical te*nology ,! t]m sub/itute      
disposable m$ical te*nology means m$ical
 equipm5t t-- 7#a7 is prim>ily &        
cu/om>ily us$ to s]ve a m$ical purpose2 
7#b7 w\ld o!rwise be cov]$ z durable    
m$ical equipm5t "u ?is title b = ! fact 
t su* equipm5t is n durable 7z def9$ by 
! ,secret>y = purposes ( cov]age (      
durable m$ical equipm5t "u ?is title72 &
  7#c7 ! ,secret>y det]m9es sub/itutes =
 durable m$ical equipm5t4  ,9 mak+ !    
det]m9ation "u p>agraph 7#c71 !         
,secret>y %all consult ) m$ical         
specialty societies1 m$ical device      
manufactur]s1 pati5t gr\ps1 & o!r       
/akehold]s z "p ( ! annual rulemak+     
process = durable m$ical equipm5t "u ?is
 title4  4  7b7 ,paym5t provisions      
,section #ahcd7;a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #aciem7a77 is am5d$
 by add+ at ! end ! foll[+ new p>agraph3
  7#bc7 ,special paym5t rule = sub/itute

 disposable m$ical te*nologies ,not)/&+ 
! prec$+ provisions ( ?is subsection1 ! 
,secret>y %all det]m9e ! paym5t am\nt "u
 ?is subsection = a sub/itute disposable
 m$ical te*nology 7z def9$ 9 section    
#ahfa7;iii771 & = any relat$ supplies & 
s]vice fees incurr$ 9 conjunction ) !   
use & ma9t5ance ( su* te*nology1 9      
accordance ) ! foll[+3  7,a7 ,s+le      
paym5t am\nt ,! ,secret>y %all det]m9e a
 s+le paym5t am\nt t %all be paid = a   
sub/itute disposable m$ical te*nology & 
= any relat$ supplies & s]vice fees     
incurr$ 9 conjunction ) ! use &         
ma9t5ance ( su* te*nology4 ,a paym5t =  
su* a te*nology & = any su* relat$      
supplies & s]vice fees made 9 ! am\nt ( 
su* s+le paym5t am\nt %all con/itute    
full paym5t "u ?is title = su* te*nology
 & su* relat$ supplies & s]vice fees4   
7,b7 ,calculation ( paym5t am\nt ,! s+le
 paym5t am\nt describ$ 9 subp>agraph    
7,a7 = a sub/itute disposable m$ical    
te*nology & = any relat$ supplies &     
s]vice fees incurr$ 9 conjunction ) !   

use & ma9t5ance ( su* te*nology %all be 
calculat$ by--  7i7 calculat+ ! sum ( ! 
am\nts ( paym5t t o!rwise w\ld be made  
"u ?is section =-- 7,i7 ! item ( durable
 m$ical equipm5t = :i* ! ,secret>y      
det]m9es1 pursuant to section           
#ahfa7;iii77#c71 t su* sub/itute        
disposable m$ical te*nology sub/itutes2 
&  7,,ii7 all relat$ supplies & s]vice  
fees incurr$ 9 conjunction ) ! use &    
ma9t5ance ( su* item ( durable m$ical   
equipm5t2  7ii7 calculat+ ! am\nt t is  
#ie p]c5t ( ! sum calculat$ "u clause   
7i72 &  7iii7 calculat+ ! s+le paym5t   
am\nt = ! sub/itute disposable m$ical   
te*nology & = any relat$ supplies &     
s]vice fees incurr$ 9 conjunction ) !   
use & ma9t5ance ( su* te*nology su* t ! 
sum ( ! paym5ts "u ?is subsection =--   
7,i7 all sub/itute disposable m$ical    
te*nologies t ! ,secret>y det]m9es1     
pursuant to section #ahfa7;iii77#c71 w  
be necess>y to provide a sub/itute = !  
item ( durable m$ical equipm5t describ$ 
9 clause 7i77,i72 &  7,,ii7 any relat$  

supplies & s]vice fees incurr$ 9        
conjunction ) ! use & ma9t5ance ( su*   
te*nologies1  & is equal to ! am\nt     
calculat$ "u clause 7ii74 ,9 mak+ su*   
calculation1 ! ,secret>y %all consult ) 
m$ical specialty societies1 m$ical      
device manufactur]s1 pati5t gr\ps1 & o!r
 /akehold]s to ensure t an appropriate  
comp>ison is made t captures use ( !    
v>i\s te*nologies 7includ+ relat$       
supplies1 if any7 ov] an av]age c\rse ( 
!rapy = a typical pati5t4  7,c7         
,lump-sum paym5t ,! s+le paym5t am\nt   
describ$ 9 subp>agraph 7,a7 = a         
sub/itute disposable m$ical te*nology & 
= any relat$ supplies & s]vice fees     
incurr$ 9 conjunction ) ! use &         
ma9t5ance ( su* te*nology %all be made 9
 a lump-sum am\nt4  7,d7 ,paym5t =      
physicians' & hospital outpati5t        
dep>tm5t s]vices ,no?+ 9 ?is p>agraph   
%\ld be con/ru$ z limit+ or *ang+ paym5t
 = items or s]vices = :i* paym5t is made
 "u section #ahdh or section #ahcc7t74  
4  7c7 ,con=m+ am5dm5t ,section         

#ahdg7;a77#g77;,b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#aciew-#c7;a77#g77;,b77 is am5d$-- 7#a7 
9 clause 7i71 by /rik+ & at ! end2  7#b7
 9 clause 7ii71 by /rik+ ! p]iod at !   
end & ins]t+ 2 &2 &  7#c7 by add+ at !  
end ! foll[+ new clause3  7iii7 t are   
sub/itute disposable m$ical te*nologies 
7z def9$ 9 section #ahfa7;iii774  4  7d7
 ,effective date ,! provisions (1 &     
am5dm5ts made by1 ?is section %all apply
 ) respect to items & s]vices furni%$ on
 or aft] ,janu>y #a1 #bjaf4  7e7 ,rule (
 con/ruction2 implem5tation  7#a7 ,rule 
( con/ruction ,no?+ 9 ?is section or !  
am5dm5ts made by ?is section %all be    
con/ru$ z-- 7,a7 affect+ ! ability ( a  
physician 7or any o!r prescrib+         
practition]7 to ex]cise _! judgm5t 9    
prescrib+ or ord]+ = a ,m$ic>e b5efici>y
 appropriate durable m$ical equipm5t or 
o!r m$ical device or te*nology = !      
treatm5t ( an illness1 injury1 or       
condition ( ! ,m$ic>e b5efici>y2 or     
7,b7 affect+ ! ability ( ! ,m$ic>e      

b5efici>y to access appropriate durable 
m$ical equipm5t or o!r appropriate      
m$ical device or te*nology = su*        
treatm5t4  7#b7 ,implem5tation ,!       
,secret>y %all implem5t ! provisions (1 
& am5dm5ts made by1 ?is section 9 a     
mann] su* t ! me?odologies = det]m9+    
cov]age ( an item ( durable m$ical      
equipm5t 7z def9$ 9 section #ahfa7n7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#aciex7n777 7o!r ?an su* an item t is a 
sub/itute disposable m$ical te*nology 7z
 def9$ 9 section #ahfa7;iii777 & !      
paym5t am\nt = ! item ( durable m$ical  
equipm5t 7o!r ?an su* an item t is a    
sub/itute disposable m$ical te*nology 7z
 s def9$77 "u section #ahcd or #ahdg (  
su* ,act 7#db ,u4,s4,c4 #aciem1         
#aciew-#c71 z ! case may be1 is n       
affect$ by ! cov]age ( & paym5t am\nt = 
a sub/itute disposable m$ical te*nology 
"u sections #ahfa7;iii7 & #ahcd7;a77#bc7
 ( su* ,act1 respectively1 z add$ by    
subsections 7a7 & 7b71 respectively4