1.Coverage of class iii medical
mobility devices
(a)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)Section
1861 of the Social Security Act (42 U.S.C. 1395x) is
amended by adding at the end the following new subsection:
(ccc)Class III medical
mobility-device; Class III medical
mobility-device eligible individual(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 has a functional
limitation of mobility that hinders the individual’s ability to perform
mobility-related activities of daily living.
(B)The individual’s use of the class III
medical mobility device is for approved intended uses of the device.
(C)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.
(D)The individual meets drivers licensing
criteria established in 1996 by the Epilepsy Foundation of America.
(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.
(G)The individual was initially entitled
to benefits under this title solely by reason of section 226(b).
(H)The residence of the
individual—
(i)has stairs that meet the conditions
of use of the class III medical mobility device for a stair as indicated in the
labeling of the device; and
(ii)does not have a mechanical method
to ascend or descend such a stair or stairs (such as an elevator or such other
mechanical methods as the Secretary may specify).
(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)
(1)Provision of
class iii medical mobility device only to class iii medical mobility-device
eligible individual; medical necessitySection 1862 of the
Social Security 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 devicesIn
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;
maintenanceSection 1834(a) of the Social Security
Act (42 U.S.C. 1395m(a)) is amended—
(A)in paragraph
(1)(B)(ii), by inserting and paragraph (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)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 devicesIn 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).
.
(3)Requirement for
face-to-face encounter with a physician and for written
prescriptionClause (iv) of section 1834(a)(1)(E) of the
Social Security 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 such examination and written such
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)The amendments made by this section shall apply to items and
services furnished on or after the date of the enactment of this Act.