Sec. 2. Establishing separate benefit category for complex rehabilitation technologies within Medicare
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Section 1861 of the Social Security Act ( 42 U.S.C. 1395x ) is amended— in subsection (s)(2)— in subparagraph (EE), by striking and at the end; in subparagraph (FF), by inserting and at the end; and by inserting after subparagraph
(FF)the following new paragraph: complex rehabilitation technology items (as defined in subsection (iii)); ; and by adding at the end the following new subsection: The terms complex rehabilitation technology item and CRT item mean an item that— is designed and configured for a specific qualified individual to meet the individual’s unique— medical, physical, and functional needs related to a medical condition; and capacities for basic activities of daily living and instrumental activities of daily living; is primarily used to serve a medical purpose and is generally not useful to a person in the absence of illness or injury; and requires certain services to ensure appropriate design, configuration, and use of such item, including— 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 item; and configuring, fitting, programming, adjusting, or adapting the particular complex rehabilitation technology item for use by such individual. The Secretary, in consultation with the Director of Office on Disability, the Chairman of the National Council on Disability, the Executive Director on the Interagency Committee on Disability, the Director of the National Institute on Disability and Rehabilitation Research of the Department of Education, and the Co-Chairmen of the Senior Oversight Committee’s Care Management Reform Team of the Department of Defense and the Veterans Administration, shall, by regulation— designate items as complex rehabilitation technology items; and 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
(E). The items designated as complex rehabilitation technology items under subparagraph (A)(i) shall include items which, as of January 1, 2013 , were classified within the following HCPCS codes: E0637, E0638, E0641, E0642, E0986, E1002, E1003, E1004, E1005, E1006, E1007, E1008, E1009, E1010, E1011, 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. The items designated as complex rehabilitation technology items under subparagraph (A)(i) shall include each item that— as of January 1, 2013, was classified within the HCPCS codes under clause (ii); and the Secretary, acting in consultation with suppliers and manufacturers of CRT items, determines which item should be removed from such code and assigned a new HCPCS code because such item is a complex rehabilitation technology item. The HCPCS codes under this clause are the following: E0143, E0950, E0951, E0952, E0955, E0956, E0957, E0958, E0960, E0967, E0978, E0990, E1015, E1016, E1028, E1029, E1030, E2205, E2208, E2231, E2368, E2369, E2370, E2605, E2606, E2607, E2608, E2613, E2614, E2615, E2616, E2620, E2621, E2624, E2625, K0004, K0009, K0040, K0108, and K0669. The Secretary may not designate as a complex rehabilitation technology item— adaptive equipment to operate motor vehicles; prosthetic devices described in subsection (s)(8); or orthotics and prosthetics described in subsection (s)(9). In establishing the eligibility criteria under subparagraph (A)(ii) , the Secretary shall include appropriate physical and functional needs and capacities arising from any of the following medical conditions: Congenital disorders, progressive or degenerative neuromuscular diseases, or injuries or trauma that result in significant physical or functional needs and capacities. Spinal cord injury, traumatic brain injury, cerebral palsy, muscular dystrophy, spina bifida, osteogenesis imperfecta, arthrogryposis, amyotrophic lateral sclerosis, multiple sclerosis, demyelinating disease, myelopathy, myopathy, progressive muscular atrophy, anterior horn cell disease, post-polio syndrome, cerebellar degeneration, dystonia, Huntington’s disease, or spinocerebellar disease. Certain types of amputation, paralysis, or paresis that result in significant physical or functional needs and capacities. For 2014, the Secretary shall publish— a list of items designated under subparagraph (A)(i) and the HCPCS codes for such items; and the eligibility criteria established under subparagraph (A)(ii) . For 2015 and each subsequent year, the Secretary shall publish any necessary updates to such list (including additions of new CRT items and any changes in applicable HCPCS codes) and to such eligibility criteria. The Secretary shall make available, on a public Web site, the process by which the Secretary will consider requests from members of the public that the Secretary— designate an item as a CRT item under subparagraph (A)(i) ; or amend the eligibility criteria established under subparagraph (A)(ii) . For purposes of this subsection: The term capacity for basic activities of daily living means an individual’s capacity to safely participate in mobility and self-care activities including— maintaining and changing body position; transferring to or from one surface to another; walking; moving from place to place using mobility equipment, in a safe and timely manner; washing one’s self; caring for the body; toileting; dressing; eating; drinking; looking after one’s health; and carrying, moving, and handling objects to perform and participate in other activities under this subparagraph and subparagraph
(B). The term capacity for instrumental activities of daily living means an individual’s capacity to safely participate in life situations in the home and community, including— communicating; moving around using transportation; acquiring necessities, goods, and services; performing household tasks; caring for household members and family members; caring for household objects; engaging in education, work, employment and economic life; and participating in community, social, and civic activities. The term HCPCS refers to the Health Care Procedure Coding System. The term individually-configured means, with respect to an item, that— the item has a combination of features, adjustments, or modifications that are specific to the individual who uses such item; and the supplier of such item must measure the individual and configure, fit, program, adjust, or adapt the item, as appropriate, so that the item is consistent with— an assessment or evaluation of the individual by an appropriate licensed clinician; the written order required under section 1834(p)(2)(B)(i); and medical condition, physical and functional needs and capacities, and body size of the individual who will use the item, the period for which such individual will need such item, and the intended use of such item by such individual. The term qualified individual means an individual who— is enrolled under part B; and has physical and functional needs and capacities that arise from a medical condition that meet the eligibility criteria established by the Secretary under paragraph (2)(A)(ii) . .
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Sec. 2
Establishing separate benefit category for complex rehabilitation technologies within Medicare
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