[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6260 Introduced in House (IH)]








109th CONGRESS
  2d Session
                                H. R. 6260

To amend title XVIII of the Social Security Act to provide for coverage 
under the Medicare Program of certain medical mobility devices approved 
                     as class III medical devices.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 29, 2006

  Mr. Bass (for himself, Mr. Langevin, Mr. Ramstad, Mr. Ferguson, Mr. 
 Nunes, Mr. Issa, and Mr. Jindal) introduced the following bill; which 
 was referred to the Committee on Energy and Commerce, and in addition 
  to the Committee on Ways and Means, for a period to be subsequently 
   determined by the Speaker, in each case for consideration of such 
 provisions as fall within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to provide for coverage 
under the Medicare Program of certain medical mobility devices approved 
                     as class III medical devices.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. MEDICARE COVERAGE OF CLASS III MEDICAL MOBILITY DEVICES.

    (a) Covered Benefit.--Section 1861(s)(2) of the Social Security Act 
(42 U.S.C. 1395x(s)(2)) is amended--
            (1) in subparagraph (Z), by striking ``and'' at the end;
            (2) in subparagraph (AA), by inserting ``and'' at the end; 
        and
            (3) by adding at the end the following new subparagraph:
            ``(BB) class III medical mobility devices (as defined in 
        subsection (ccc)(1)) furnished to a class III medical mobility-
        device eligible individual (as defined in subsection 
        (ccc)(2));''.
    (b) Definitions.--Section 1861 of such Act (42 U.S.C. 1395x) is 
amended by adding at the end the following new subsection:

``Class III Medical Mobility Device; Class III Medical Mobility-Device 
                          Eligible Individual

    ``(ccc)(1) The term `class III medical mobility device' means a 
medical mobility device that has been approved as a class III medical 
device pursuant to a premarket approval application under the Federal 
Food, Drug, and Cosmetic Act and that--
            ``(A) is able, among other functions--
                    ``(i) to ascend and descend stairs using a climbing 
                and descending function;
                    ``(ii) to traverse different terrain and various 
                obstacles (including uneven terrain, curbs of 5 inches 
                in height, grass, gravel and other soft surfaces) using 
                a 4-wheel drive function; and
                    ``(iii) to provide mobility in a seated position at 
                an elevated height using a balance function;
            ``(B) has been prescribed for a class III medical mobility-
        device eligible individual (as defined in paragraph (2)) by the 
        individual's treating physician (as defined in subsection 
        (r)(1)) for an approved indication of the class III medical 
        mobility device; and
            ``(C) is only dispensed after an assessment of the class 
        III medical mobility-device eligible individual has been 
        completed by a health care professional specified in paragraph 
        (3) who has successfully completed training in making such 
        assessments under standards specified by the Secretary in 
        consultation with representatives of appropriate industry and 
        medical organizations.
    ``(2) The term `class III medical mobility-device eligible 
individual' means, with respect to a class III medical mobility device, 
an individual who, at the time the prescription for the device is 
written, meets each of the following requirements:
            ``(A) The individual suffers from a functional limitation 
        of mobility that hinders the individual's ability to perform 
        mobility-related activities of daily living.
            ``(B) The individual demonstrates sufficient cognitive and 
        physical ability for the proper and safe operation of the 
        device (such as sufficient use of one upper extremity and the 
        ability to dial a push button telephone or operate a hand 
        operated joystick) under such medical standards as the 
        Secretary may specify.
            ``(C) The individual meets drivers licensing criteria 
        established in 1996 by the Epilepsy Foundation of America.
            ``(D) The individual does not require mechanical 
        ventilation.
            ``(E) The individual is not a resident of an institution 
        that meets the requirements of subsection (e)(1) or section 
        1819(a)(1).
            ``(F) The individual has completed a comprehensive training 
        program (that meets standards developed by the Secretary in 
        consultation with appropriate industry representatives) on the 
        safe operation of the class III medical mobility device and its 
        functions.
    ``(3) A health care professional specified in this paragraph is any 
of the following:
            ``(A) A physician (as defined in subsection (r)(1)).
            ``(B) A physician assistant.
            ``(C) A nurse practitioner.
            ``(D) A qualified physical therapist.
            ``(E) A qualified occupational therapist.''.
    (c) Conforming Amendments.--
            (1) Provision of class iii medical mobility device only to 
        class iii medical mobility-device eligible individuals; medical 
        necessity.--Section 1862 of such Act (42 U.S.C. 1395y) is 
        amended--
                    (A) in subsection (a)(1)--
                            (i) in subparagraph (M), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (N), by striking the 
                        semicolon at the end and inserting ``, and''; 
                        and
                            (iii) by inserting after subparagraph (N) 
                        the following new subparagraph:
                    ``(O) in the case of a class III medical mobility 
                device (as defined in paragraph (1) of section 
                1861(ccc)), which is furnished other than to a class 
                III medical mobility-device eligible individual (as 
                defined in paragraph (2) of such section);''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(n) Clarification of Coverage of and Payment for All Functions of 
Class Iii Medical Mobility Devices.--In the case of a class III medical 
mobility device (as defined in section 1861(ccc)(1)) furnished to a 
class III medical mobility-device eligible individual, each function of 
such device, including the functions described in subparagraph (A) of 
such section, are deemed for purposes of subsection (a)(1), to be 
reasonable and necessary for the treatment of an illness or injury or 
to improve the functioning of a malformed body member.''.
            (2) Payment in connection with covered items; purchase 
        agreement option; maintenance.--Section 1834(a) of such Act (42 
        U.S.C. 1395m(a)) is amended--
                    (A) in paragraph (1)(B)(ii), by inserting ``and 
                (22) in the case of a class III medical mobility 
                device,'' after ``(7)'';
                    (B) in paragraph (13), by inserting before the 
                period at the end the following: ``, and also includes 
                a class III medical mobility device (as defined in 
                section 1861(ccc)(1))''; and
                    (C) by adding at the end the following new 
                paragraph:
            ``(22) Payment for class iii medical mobility devices.--
                    ``(A) In general.--Subject to the succeeding 
                provisions of this paragraph, in the case of a class 
                III medical mobility device (as defined in section 
                1861(ccc)(1)), the provisions of paragraph (7) 
                (including the option for a purchase agreement under 
                subparagraph (A)(iii) of such paragraph) shall apply to 
                such device under this paragraph in the same manner as 
                those provisions apply to a covered item under 
                paragraph (7).
                    ``(B) Payment for all functions of class iii 
                medical mobility devices.--In the case of a class III 
                medical mobility device, payment under this paragraph 
                for such device shall be made taking into account all 
                functions of such device, consistent with section 
                1862(n).
                    ``(C) Limitation on aggregate number of devices 
                covered during 2007 through 2011.--With respect to 
                class III medical mobility devices furnished during 
                each of 2007 through 2011, payment shall only be made 
                under this subsection for 1,000 such devices furnished 
                in each such year. The limitation on payment under the 
                preceding sentence for class III medical mobility 
                devices shall not apply with respect to any year 
                beginning after 2011.''.
            (3) Requirement for face-to-face encounter with a physician 
        and for written prescription.--Clause (iv) of section 
        1834(a)(1)(E) of such Act (42 U.S.C. 1395m(a)(1)(E)) is 
        amended--
                    (A) by adding at the end the following: ``In the 
                case of a covered item consisting of a class III 
                medical mobility device (as defined in paragraph (1) of 
                section 1861(ccc)) for a class III medical mobility-
                device eligible individual (as defined in paragraph (2) 
                of such section), payment may not be made for such item 
                unless a physician (as so defined) has conducted a 
                face-to-face examination and written a prescription for 
                the item, and after an assessment of such individual 
                has been completed by a health care professional 
                specified in paragraph (3) of such section.''; and
                    (B) in the heading, by inserting ``and class iii 
                medical mobility devices'' after ``wheelchairs''.
    (d) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2007.
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