,i #aaf? ,,congress #a/ ,session ,h4 ,r4 #bdjh ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,april #cj1 #bjai,mr4 ,s5s5br5n] 7= himself & ,mr4 ,higg9s ( ,new ,york7 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 update & cl>ify ! classification ( & applicable paym5t me?odology = complex rehabilitation te*nology items "u ! ,m$ic>e program1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,ensur+ ,access to ,quality ,complex ,rehabilitation ,te*nology ,act ( #bjai4 #b4 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,!re is a small & specific population ( ,m$ic>e b5efici>ies :o h significant disabilities & m$ical conditions :o require complex & individually configur$ m$ical equipm5t1 items1 & te*nologies4 ,^! items & te*nologies are ref]r$ to z complex rehabilitation te*nology 7or ,,crt7 & include specializ$ :eel*airs1 specializ$ seat+ & position+1 & o!r types ( adaptive equipm5t & items t are uniquely configur$ & fitt$ to ! specific individual4 ,individuals 9 ?is population (t5 qualify = ,m$ic>e bas$ on _! disability 7r ?an _! age7 & h significant disabilities & m$ical conditions t may include1 b are n limit$ to1 c]ebral palsy1 muscul> dy/rophy1 multiple scl]osis1 sp9al cord injury1 amyotrophic lat]al scl]osis 7,,als71 traumatic bra9 injury1 & sp9a bifida4 ,?is small population comprises less ?an #ae p]c5t ( ! ,m$ic>e b5efici>ies :o receive :eel*airs4 7#b7 ,curr5t provisions address+ ,m$ic>e b5efit categories & relat$ def9itions d n suffici5tly def9e c]ta9 complex rehabilitation te*nology items & d n adequately describe & di/+ui% ^! items z comp>$ to o!r types ( ,m$ic>e-cov]$ m$ical items & equipm5t4 7#c7 ,?is curr5t lack ( def9itional cl>ity = complex rehabilitation te*nology items results 9 access *all5ges = b5efici>ies ) significant disabilities & m$ical conditions1 z ^! items are (t5 gr\p$ ) /&>diz$1 nonspecializ$ products t significantly diff] ) respect to ! complexity & ! individualiz$ configuration involv$1 z well z c]ta9 evaluation requirem5ts1 cl9ical cov]age crit]ia1 & o!r consid]ations4 7#d7 ,to provide adequate access = ! small population ( ,m$ic>e b5efici>ies ) significant disabilities & m$ical conditions :o require ^! complex1 specializ$1 & individually configur$ items a di/9ct ,m$ic>e b5efit category = complex rehabilitative te*nology items is ne$$4 ,?is w all[ = relat$ improvem5ts to cl>ify applicable cod+1 cov]age1 paym5t1 & suppli] /&>ds = su* items4 ,a sep>ate b5efit category is ne$$ to ensure appropriate access to ^! items = individuals ) significant disabilities & m$ical conditions1 & w help prev5t pot5tial ov]utilization ( ,,crt by individuals = :om su* items are n m$ically necess>y4 #c4 ,e/abli%+ sep>ate b5efit category = complex rehabilitation te*nologies )9 m$ic>e ,section #ahfa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is am5d$-- 7#a7 9 subsection 7s77#b7-- 7,a7 9 subp>agraph 7,,gg71 by /rik+ & at ! end2 7,b7 9 subp>agraph 7,,hh71 by ins]t+ & at ! end2 & 7,c7 by ins]t+ aft] subp>agraph 7,,hh7 ! foll[+ new p>agraph3 7,,ii7 complex rehabilitation te*nology items 7z def9$ 9 subsection 7kkk772 2 & 7#b7 by add+ at ! end1 ! foll[+ new subsections3 7kkk7 ,complex ,rehabilitation ,te*nology ,item 7#a7 ,! t]ms complex rehabilitation te*nology item & ,,crt item mean an item t-- 7,a7 is design$1 manufactur$1 individually configur$1 adju/$1 or modifi$ = a specific individual to meet ! individual's unique m$ical1 physical1 or functional ne$s & capacities2 7,b7 is prim>ily us$ to s]ve a m$ical1 physical1 or functional purpose & is g5]ally n useful to a p]son 9 ! abs5ce ( disability1 illness1 injury1 or o!r m$ical condition2 & 7,c7 requires c]ta9 s]vices to ensure appropriate use ( su* item1 includ+ "o or m ( ! foll[+-- 7i7 an evaluation ( ! features & functions ( ,,crt items to ! specific individual :o w use su* an item1 z requir$ "u section #ahcd7x77#b77;,b77ii77,,ii72 or 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 ,,crt items %all include-- 7i7 complex rehabilitation manual & p[] :eel*airs1 options1 & accessories2 7ii7 specializ$ seat+ & position+ items1 options1 & accessories2 7iii7 adaptive equipm5t su* z /&+ frames & gait tra9]s & options & accessories2 & 7iv7 o!r items t meet ! def9ition 9 subp>agraph 7#a71 z det]m9$ by ! ,secret>y4 7,b7 ,9 det]m9+ :i* items meet ! def9ition ( a ,,crt item "u ?is subsection1 ! ,secret>y %all review exi/+ & new te*nologies on at lea/ a ye>ly basis1 & 9 a mann] t takes into consid]ation te*nological diff]5ces 9 available items & equipm5t1 z well z ! v>y+ cl9ical ne$s ( individuals :o rely on su* items & equipm5t4 7#c7 7,a7 ,n lat] ?an six mon?s aft] ! date ( enactm5t ( ?is subsection1 ! ,secret>y %all publi% a li/ ( ,,hcpcs codes t meet ! def9ition ( ,,crt items "u ?is subsection4 ,9 consid]+ & publi%+ ! li/ ( codes t meet su* def9ition1 ! ,secret>y mu/ ensure t ! ,,hcpcs code set provides adequate & appropriate access to exi/+ & new te*nologies t may improve m$ical1 physical1 or functional outcomes = b5efici>ies ) significant disabilities & m$ical conditions1 tak+ into consid]ation te*nological diff]5ces1 cl9ical application1 & ! unique m$ical1 physical1 & functional ne$s ( b5efici>ies :o rely on m$ically necess>y ,,crt items4 7,b7 ,9 e/abli%+ ! li/ "u subp>agraph 7,a71 ! ,secret>y %all-- 7i7 id5tify & include exi/+ ,,hcpcs codes t are exclusively ,,crt items1 includ+ items t1 z ( ,janu>y #a1 #bjai1 7 classifi$ )9 ! foll[+ ,,hcpcs codes3 ,e#jfcg1 ,e#jfch1 ,e#jfda1 ,e#jfdb1 ,e#jiec1 ,e#jied1 ,e#jihf1 ,e#ajjb1 ,e#ajjc1 ,e#ajjd1 ,e#ajje1 ,e#ajjf1 ,e#ajjg1 ,e#ajjh1 ,e#ajji1 ,e#ajaj1 ,e#ajaa1 ,e#ajab1 ,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#abci1 ,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#jhih2 7ii7 create & include 9 ! li/ new ,,hcpcs codes & appropriate code descriptors = ,,crt items t are curr5tly consid]$ to be includ$ 9 exi/+ ,,hcpcs codes t include bo? ,,crt & non-,,crt items1 includ+ ,,crt items t1 z ( ,janu>y #a1 #bjai1 7 classifi$ )9 ! foll[+ ,,hcpcs codes3 ,e#jadc1 ,e#jiej1 ,e#jiea1 ,e#jieb1 ,e#jiee1 ,e#jief1 ,e#jieg1 ,e#jifj1 ,e#jifg1 ,e#jigh1 ,e#jiij1 ,e#jiie1 ,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#bfbb1 ,e#bfbc1 ,e#bfbd1 ,e#bfbe1 ,k#jjjd1 ,k#jjji1 ,k#jjdj1 ,k#jajh1 & ,k#jffi2 & 7iii7 create new ,,hcpcs codes = o!r miscellane\s1 o!rwise n classifi$1 or cu/om ,,crt items4 7,c7 ,= ea* ye> subsequ5t to ! ye> dur+ :i* ! ,secret>y publi%es ! li/ "u subp>agraph 7,a71 ! ,secret>y %all publi% any necess>y updates to su* li/ 7includ+ additions ( new ,,crt items & any *anges 9 applicable ,,hcpcs codes &_/or code descriptors7 z ne$$ to ensure appropriate access to ! full range ( m$ically necess>y ,,crt items & te*nologies4 4 #d4 ,paym5t rules ,section #ahcd ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7 is am5d$ by add+ at ! end ! foll[+3 7x7 ,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 e/abli% a fee s*$ule t %all apply to ,,crt items z def9$ at section #ahfa7kkk7 & %all ensure t su* fee s*$ule consid]s ! pot5tial impact on quality1 access1 & b5efici>y liability1 includ+ ! likely effects on assignm5t rates & p>ticipation rates1 & facilitates appropriate access to m$ically necess>y ,,crt items & te*nologies4 7,b7 ,me?odology ,9 e/abli%+ ! ,,crt fee s*$ule paym5t sy/em "u subp>agraph 7,a71 ! ,secret>y %all include 9 su* fee s*$ule1 at a m9imum1 ! all[ance ( pur*ase ( items id5tifi$ at section #ahfa7kkk77#c7 &-- 7i7 %all set ! ,,crt fee s*$ule paym5t am\nts = ,,crt items id5tifi$ by ! codes li/$ 9 section #ahfa7kkk77#c77;,b77i7 at a pur*ase price d]iv$ f paym5t am\nts f ! ,janu>y #a1 #bjae ,m$ic>e fee s*$ule plus annual ,consum] ,price ,index-,urban ,all ,item updates = ea* subsequ5t ye> to su* items1 z applicable1 "u ?is section2 7ii7 %all calculate ! paym5t am\nts = ,,crt items id5tifi$ by ! codes creat$ pursuant to section #ahfa7kkk77#c77;,b77ii7 9 accordance ) ! me?odology describ$ 9 subp>agraph 7,c72 7iii7 %all p]mit ! paym5t am\nts = ,,crt items id5tifi$ by codes = miscellane\s1 o!rwise n classifi$1 or cu/om items1 creat$ pursuant to section #ahfa7kkk77#c77;,b77iii71 to be calculat$ bas$ on ! me?odology describ$ 9 subp>agraph 7,c7 appli$ to ! specific item bill$ "u ?is subsection2 & 7iv7 %all require t paym5t am\nts = ,,crt items be adju/$ annually by ! increase 9 ! ,consum] ,price ,index-,urban ,all ,item = ! #ab-mon? p]iod end+ ! prec$+ ,june #cj?4 7,c7 ,paym5t am\nt calculation ,= purposes ( subp>agraph 7,b77ii71 ! me?odology describ$ 9 ?is subp>agraph = calculat+ paym5t am\nts = ,,crt items id5tifi$ by ! codes specifi$ 9 su* subp>agraph is z foll[s3 7i7 ,id5tify comm]cial price in=mation 7su* z manufactur] sugge/$ retail price li/s1 b n mail ord] prices or int]net retail prices7 = ,,crt items 9 ! applicable code 9 effect dur+ ! base ye> 7:i*1 = purposes ( ?is subp>agraph is ! cal5d> ye> end+ ,decemb] #aihf71 except t if ! only available comm]cial price in=mation is f a p]iod o!r ?an ! base ye>1 ! ,secret>y %all use ! olde/ available pric+ = ! items & deflate ! pric+ data to ! mid-po9t ( ! base ye> us+ ! deflation factors us$ by ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices = durable m$ical equipm5t at ! "t ( enactm5t ( ?is section4 7ii7 ,us+ ! base ye> prices1 id5tify ! m$ian price = all ,,crt items 9 ! code4 7iii7 ,increase ! m$ian price by #a4g p]c5t & inflate to ! paym5t ye> us+ ! durable m$ical equipm5t fee s*$ule update factors requir$ by law ?r\gh #bjje & full consum] price index = all urban consum]s update factors />t+ 9 #bjjf & = ea* subsequ5t ye>1 adju/$ to reflect applicable sales tax circum/ances1 if applicable4 7,d7 ,us$ equipm5t ,= us$ equipm5t1 ! ,secret>y %all set paym5t at #ge p]c5t ( ! ,,crt fee s*$ule am\nt = ! ,,crt item z det]m9$ pursuant to ! me?odology set =? 9 subp>agraph 7,b74 7,e7 ,paym5t = tempor>y r5tal 7i7 ,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$4 7ii7 ,basis2 limitation ,paym5t p]mitt$ "u clause 7i7 %all be made on a mon?ly basis1 & ! p]iod ( r5tal may n exce$ "o mon?4 7iii7 ,paym5t am\nt ,! am\nt ( paym5t all[$ "u clause 7i7 = a mon? = ! r5tal ( a ,,crt item %all be #aj p]c5t ( ! pur*ase price = ! ,,crt item4 7,f7 ,replacem5t ( items 7i7 ,e/abli%m5t ( reasonable useful lifetime ,9 accordance ) clause 7ii71 n lat] ?an two ye>s ( ! date ( enactm5t ( ?is subsection1 ! ,secret>y %all det]m9e & e/abli%1 ?r\gh a rulemak+ process involv+ advance public notice & an opportunity = /akehold] input & public comm5ts1 a reasonable useful lifetime = ,,crt items = :i* paym5t may be made "u ?is p>agraph4 7ii7 ,l5g? ( reasonable useful lifetime ,! reasonable useful lifetime ( items ( ,,crt items "u ?is subsection %all be e/abli%$ bas$ on ! int5d$ use & cont9u$ efficacy1 b %all n 9 any ev5t exce$ five ye>s = any ,,crt item4 ,! ,secret>y %all ensure t ! l5g? ( reasonable useful lifetime is appropriate = ea* sub-category ( items )9 ! ,,crt category4 7,g7 ,exclusive paym5t rule ,?is subsection %all con/itute ! exclusive provision "u ?is title = paym5t = ,,crt items "u ?is "p4 7#b7 ,conditions = paym5t 7,a7 ,limitation on paym5t ,no paym5t %all be made "u ?is subsection = a ,,crt item unless su* ,,crt item-- 7i7 meets ! cl9ical conditions = paym5t set =? "u subp>agraph 7,b72 & 7ii7 is furni%$ by a suppli] accr$it$ pursuant to subp>agraph 7,d7 & meets ! suppli] & quality /&>ds specifi$ "u subp>agraph 7,c74 7,b7 ,cl9ical conditions = paym5t 7i7 ,9 g5]al ,! ,secret>y %all e/abli% /&>ds = cl9ical conditions = paym5t = ,,crt items "u ?is subsection4 7ii7 ,requirem5ts ,! /&>ds e/abli%$ "u clause 7,b77i7 %all require ! foll[+3 7,i7 ,writt5 ord] ,a qualifi$ ord]+ practition]1 z def9$ 9 section #ahfa7mmm7 ( ! ,act1 %all provide a writt5 ord] = a ,,crt item = a specific 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 ! qualifi$ ord]+ practition] may n provide a writt5 ord] "u subclause 7,i7 unless ! 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 ,! p]=mance ( su* a ,,crt evaluation by a lic5s$ physical or occupational !rapi/ %all n be subject 7or c\nt$ t[>ds7 ! limitation on c]ta9 !rapy s]vices "u section #ahcc7;g74 7,,iii7 ,docum5tation ( m$ical necessity ,a qualifi$ ord]+ practition] :o provides a writt5 ord] "u subclause 7,i7 %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 evid5ce t ! individual = :om ! ord] 0 writt5 has m$ical1 physical1 &_/or functional ne$s & capacities t require ! use ( ! prescrib$ ,,crt item4 7,,iv7 ,cov]age ,9 develop+ ! /&>ds "u subp>agraph 7,b71 ! cov]age ( ,,crt items %all be bas$ on ! individual's specific m$ical1 physical1 or functional ne$s & capacities = basic & in/rum5tal activities ( daily liv+ 9 any sett+ 9 :i* life activities take place4 ,= purposes ( ?is subclause1 basic & in/rum5tal activities ( daily liv+ include1 b are n limit$ to1 mov+ f place to place2 transf]r+2 ma9ta9+ or *ang+ body position2 c>+ = "o's self 7su* z toilet+1 ba?+1 dress+1 eat+1 h\sekeep+ & h\sehold managem5t72 acquir+ necessities1 goods & s]vices2 engag+ 9 education1 employm5t & economic life2 or us+ transportation4 7,v7 ,cov]age requirem5t ,no?+ 9 ?is subsection or section #ahfa7s77#b77;,,ii7 %all be con/ru$ z requir+ ! ,secret>y to provide = cov]age "u ?is title ( any item t w\ld n o!rwise be cov]$ "u ?is title )\t application ( ! am5dm5ts made by ! ,ensur+ ,access to ,quality ,complex ,rehabilitation ,te*nology ,act ( #bjai1 or z *ang+ any cov]age requirem5ts 9 exi/5ce z ( ! date ( ! enactm5t ( ?is subsection1 includ+ any prior au?orization cov]age requirem5ts or advance det]m9ations ( ,m$ic>e cov]age requirem5ts t may apply to ,,crt items4 7,c7 ,e/abli%m5t ( suppli] & quality /&>ds = ,,crt 7i7 ,e/abli%m5t ,! ,secret>y %all e/abli% & implem5t suppli] & quality /&>ds = suppli]s ( ,,crt items to be appli$ by recogniz$ indep5d5t accr$itation organizations 7z designat$ "u subp>agraph 7,d771 :i* z set =? bel[1 incorporate exi/+ /&>ds z well z creat+ new ,,crt-specific /&>ds4 ,su* /&>ds %all be appli$ prospectively & %all be publi%$ on ! ,int]net website ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices4 7ii7 ,requirem5ts ( /&>ds ,9 e/abli%+ ! suppli] & quality /&>ds "u clause 7i71 ! ,secret>y %all require t ea* suppli] ( ,,crt items meets ! foll[+ requirem5ts3 7,i7 ,,dme & m$ical equipm5t & supplies /&>ds ,! suppli] complies ) all ( ! /&>ds t are applicable to suppli]s ( durable m$ical equipm5t "u subsection 7a77#bj7 & suppli]s ( m$ical equipm5t & supplies "u subsection 7j74 7,,ii7 ,qualifi$ ,,crt pr(essional /&>ds ,! 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 analyze ! ne$s & capacities ( individuals = a ,,crt item 9 collaboration ) ! cl9ical team2 assi/ 9 select+ any appropriate ,,crt items = su* an individual1 giv5 su* ne$s & capacities2 & provide te*nology-relat$ tra9+ to su* an individual 9 ! prop] use & ma9t5ance ( ! ,,crt items4 7,,iii7 ,s]vice & repair /&>ds ,! suppli] ( ! ,,crt item-- 7aa7 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 are furni%$ by su* suppli]2 & 7bb7 provides ! individual ) writt5 in=mation on access+ s]vice & repair = ! ,,crt item be=e ! ,,crt item is ord]$ = ! individual involv$4 7,d7 ,accr$itation = suppli]s ( ,,crt items 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 subsection unless ! suppli] is 9 compliance ) ! requirem5ts "u ?is subp>agraph4 7ii7 ,application ( accr$itation requirem5t ,9 implem5t+ suppli] & quality /&>ds "u p>agraph 7,c71 ! ,secret>y %all require suppli]s furni%+ ,,crt items1 on or aft] "o ye> aft] ! /&>ds are publi%$ "u su* p>agraph1 directly or z a subcontractor = ano!r entity-- 7,i7 to comply ) su* /&>ds2 & 7,,ii7 to h submitt$ to ! ,secret>y evid5ce ( accr$itation by an accr$itation organization designat$ "u subp>agraph 7iii7 demon/rat+ t ! suppli] is comply+ ) su* /&>ds4 7iii7 ,designation ( indep5d5t accr$itation organizations ,n lat] ?an ! date t is "o ye> aft] ! date on :i* ! ,secret>y implem5ts ! suppli] & quality /&>ds "u subp>agraph 7,c71 ! ,secret>y %all designate & approve "o or m indep5d5t accr$itation organizations t-- 7,i7 are approv$ "u subsection 7a77#bj77;,b71 :i* set =? ! designation ( indep5d5t accr$itation organizations = suppli]s ( durable m$ical equipm5t2 & 7,,ii7 h ! capability to assess :e!r suppli]s ( ,,crt items meet ! suppli] & quality /&>ds e/abli%$ "u subp>agraph 7,c74 7#c7 ,def9itions ,= purposes ( ?is subsection3 7,a7 ,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>ties1 includ+ manufactur]s & suppli]s ( ,,crt items1 relevant consum] organizations1 & cl9icians ) k ( ,,crt items & direct exp]i5ce work+ ) individuals :o use ,,crt items7 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+ #b ye>s aft] ! e/abli%m5t ( ! designation "u clause 7ii71 subject to clause 7ii77,,ii71 a*ieves an additional designation t demon/rates ! individual's compet5cies & exp]i5ce 9 supply+ ,,crt items4 7ii7 ,additional designation 7,i7 ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is subp>agraph1 ! ,secret>y1 ) /akehold] input1 includ+ manufactur]s & suppli]s ( ,,crt items1 relevant consum] organizations1 & cl9icians ) k ( ,,crt items & direct exp]i5ce work+ ) pati5ts :o use ,,crt items1 %all e/abli% ! additional designation "u clause 7i77,,ii74 7,,ii7 ,until su* "t z ! additional designation is e/abli%$1 ! t]m qualifi$ ,,crt pr(essional %all include an individual meet+ ! requirem5ts 9 clause 7i77,i7 only4 7,b7 ,qualifi$ ,,crt s]vice te*nician ,! t]m qualifi$ ,,crt s]vice te*nician means an individual :o1 ) respect to a ,,crt item-- 7i7 has successfully complet$ a tra9+ program approv$ by ! manufactur] ( ! ,,crt item2 7ii7 is tra9$ & educat$ 7includ+ ?r\gh on-!-job tra9+7 to assemble1 program1 adju/1 s]vice1 & repair ,,crt items2 & 7iii7 on an annual basis1 completes at lea/ #aj h\rs ( education specific to ! assembly1 programm+1 s]vice1 adju/+1 & repair+ ( ,,crt items4 7,c7 ,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 ,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 ,= cal5d> ye> #bjbj & subsequ5t ye>s1 complex rehabilitation te*nology items 7z def9$ 9 section #ahfa7kkk774 4 7b7 ,paym5t exclusions ,section #ahcd7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7a77 is am5d$-- 7#a7 9 p>agraph 7#d71 by add+ at ! end ! foll[+ s5t5ce ,= cal5d> ye> #bjbj & subsequ5t ye>s1 ! items cov]$ by ?is p>agraph %all n include ,,crt items 7z def9$ 9 section #ahfa7kkk771 :i* %all be paid pursuant to ! fee s*$ule & me?odology = ,,crt items describ$ 9 section #ahcd7x7 beg9n+ on ,janu>y #a1 #bjbj1 & 9 subsequ5t ye>s42 7#b7 9 p>agraph 7#g77;,a71 by add+ at ! end ! foll[+3 ,= cal5d> ye> #bjbj & subsequ5t ye>s1 ?is p>agraph %all n apply to ,,crt items "u section #ahfa7kkk742 & 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 7c7 ,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 #ahfa7kkk772 4 #f4 ,cont9u$ cov]age ( ,,crt items ,! am5dm5ts made by ?is ,act d n *ange ! availability ( cov]age 9 exi/5ce z ( ! date ( ! enactm5t ( ?is ,act1 includ+ prior au?orization cov]age requirem5ts1 = ,,crt items "u title ,,xviii ( ! ,social ,security ,act or title ,,xix ( su* ,act1 or any o!r payor or program1 includ+ 9 ! case 9 :i* ,,crt items are cov]$1 z ( su* date ( enactm5t1 z durable m$ical equipm5t or "u a home heal? b5efit1 includ+ ! home heal? b5efit "u section #aijb ( su* ,act & ! regulations implem5t+ su* section2 nor d ! am5dm5ts made by ?is ,act *ange ! exi/+ def9itions ( durable m$ical equipm5t or m$ical equipm5t & supplies "u su* ,act or z e/abli%$ by any o!r payor or program1 includ+ :]e ,,crt items may also fit ^? def9itions4 ,9 ! case t a ,,crt item also satisfies ! def9ition ( durable m$ical equipm5t1 or m$ical equipm5t & supplies1 or ano!r b5efit category z def9$ by an applicable payor1 ! am5dm5ts ( ?is ,act %all apply only = purposes ( paym5t ( ! ,,crt item "u title ,,xviii ( su* ,act4 #g4 ,effective date ,! am5dm5ts made by ?is ,act %all be effective beg9n+ on ! date t is #cj days aft] ! date ( ! enactm5t ( ?is ,act1 unless o!rwise specifi$ 9 a provision (1 includ+ am5dm5t made by1 ?is ,act4