The new CONNECT for Health Act bill is seeking to lift the several barriers providers experience when trying to use remote monitoring technologies to treat patients with chronic conditions. Optimism on alternate payment models is also being established within the bill.
IN Â THE Â SENATE Â OF Â THE Â UNITED Â STATES
Mr.  SCHATZ  (for  himself,  Mr.  WICKER,  Mr.  COCHRAN,  Mr.  CARDIN,  Mr.THUNE, and Mr. WARNER) introduced the following bill; which was read twice and referred to the Committee on
AÂ BILL
To amend titles XVIII and XI of the Social Security Act to promote cost savings and quality care under the Medi- care program through the use of telehealth and remote patient monitoring services, and for other purposes.
- 1 Be it enacted by the Senate and House of Representa-
- 2 tives of the United States of America in Congress assembled,
- 3 SECTION SHORT TITLE; TABLE OF CONTENTS.
- 4 (a) SHORT TITLE.—This Act may be cited as the
5     ‘‘Creating Opportunities Now for Necessary and Effective
6     Care Technologies (CONNECT) for Health Act’’ or the
7     ‘‘CONNECT for Health Act’’.
- 1 (b) TABLE OF CONTENTS.—The table of contents of
2Â Â Â Â Â this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE  I—TELEHEALTH  AND  REMOTE  PATIENT  MONITORING SERVICES ‘‘BRIDGE’’ DEMONSTRATION WAIVERS
Sec. 101. Telehealth and remote patient monitoring services ‘‘bridge’’ dem- onstration waivers.
TITLE II—TELEHEALTH AND  REMOTE PATIENT  MONITORING SERVICES FURNISHED BY QUALIFYING APM PARTICIPANTS
Sec. 201. Telehealth and remote patient monitoring services furnished by quali- fying APM participants.
TITLE  III—MEDICARE  COVERAGE  OF  TELEHEALTH  AND  REMOTE PATIENT MONITORING SERVICES
Sec. 301. Remote patient monitoring services for individuals with certain chron- ic health conditions.
Sec. 302. Allowing telehealth to meet monthly clinician in-person visit require- ment for certain home dialysis.
Sec. 303. Allowing stroke evaluation sites and Native American health service facilities as sites eligible for telehealth payment.
Sec. 304. Rural health clinics and Federally qualified health centers authorized to be distant sites.
Sec. 305. Addressing gaps in quality measures for telehealth and remote pa- tient monitoring services.
TITLE IV—USE OF TELEHEALTH AND REMOTE PATIENT MONI- TORING SERVICES TO PROVIDE BASIC BENEFITS UNDER MEDI- CARE PART C
Sec. 401. Use of telehealth and remote patient monitoring services to provide basic benefits under Medicare part C.
TITLE V—CLARIFICATION REGARDING TELEHEALTH AND RE- MOTE PATIENT MONITORING TECHNOLOGIES PROVIDED TO BENEFICIARIES
Sec. 501. Clarification regarding telehealth and remote patient monitoring tech- nologies provided to beneficiaries.
1     TITLE I—TELEHEALTH AND RE-
- 2 MOTEÂ Â PATIENTÂ MONITORING
- 3 SERVICES     ‘‘BRIDGE’’    DEM-
- 4 ONSTRATION WAIVERS
- 5  101.  TELEHEALTH  AND  REMOTE  PATIENT  MONI-
- 6 TORING SERVICES  ‘‘BRIDGE’’  DEMONSTRA-
- 7 TION
8Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Title XVIII of the Social Security Act (42 U.S.C.
9Â Â Â Â Â 1395 et seq.) is amended by adding at the end the fol-
10Â Â Â Â Â lowing new section:
- 11 ‘‘SEC.  TELEHEALTH  AND  REMOTE  PATIENT  MONI-
- 12 TORING   SERVICES  ‘BRIDGE’  DEMONSTRA-
- 13 TION
- 14 ‘‘(a) IMPLEMENTATION.—
- 15 ‘‘(1) IN GENERAL.—Subject to the succeeding
16Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â provisions of this subsection, the Secretary shall so-
17Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â licit proposals from, and issue telehealth or remote
18                    patient monitoring services ‘bridge’ demonstration
19Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â waivers under this title to, eligible applicants who,
20Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â for the duration of time for which the demonstration
21Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â waiver would apply, are furnishing telehealth or re-
22Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â mote patient monitoring services (as defined in sec-
23Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â tion 1861(iii)) to individuals under this title in a
24Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â manner that is consistent with the goals of the
25Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Merit-based Incentive Payment System under sec-
1Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â tion 1848(q), including the goals of quality, resource
2Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â utilization, and clinical practice improvement (in-
3Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â cluding care coordination and patient engagement),
4Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â or the incentive payments for participation in eligible
5Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â alternative payment models under section 1833(z).
- 6 ‘‘(2) ELIGIBLE  APPLICANT  DEFINED.—In  this
7                    section, the term ‘eligible applicant’ means the fol-
8Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â lowing:
9                                                   ‘‘(A) A professional described in section
10Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 1848(q)(1)(C)(i)(I).
11                                                   ‘‘(B) A qualifying APM participant (as de-
12Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â fined in section 1833(z)(2)).
13                                                   ‘‘(C) Any other provider, including a pro-
14                                    fessional            described            in           section
15Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 1848(q)(1)(C)(i)(II), determined appropriate by
16Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â the Secretary, and a group that includes such
17Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â providers.
- 18 ‘‘(b) DEMONSTRATION   WAIVER   APPLICATION   RE-
19     QUIREMENTS.—An eligible applicant seeking a demonstra-
20Â Â Â Â Â tion waiver under this section shall submit an application
21Â Â Â Â Â to the Secretary on an annual basis that includes the fol-
22Â Â Â Â Â lowing:
23                                    ‘‘(1) An attestation of the intent of the appli-
24Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â cant to use telehealth or remote patient monitoring
25Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â services to meet the goals described in subsection
1Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â (a)(1), and details (as specified by the Secretary) on
2Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â how the eligible applicant will use those services to
3Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â meet such goals.
4                                    ‘‘(2) An agreement by the applicant to—
5                                                   ‘‘(A) submit the information described in
6Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â subsection (d) in accordance with such sub-
7Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â section; and
8                                                   ‘‘(B)  cooperate   in  any  audit   conducted
9Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â under subsection (e) with respect to claims for
10Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â telehealth or remote patient monitoring services
11Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â furnished by the applicant under the waiver.
- 12 ‘‘(c) WAIVER OF LIMITATIONS FOR TELEHEALTH OR
- 13 REMOTE PATIENT MONITORING SERVICES.—
- 14 ‘‘(1) IN GENERAL.—The Secretary shall waive
15Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â certain applicable provisions of sections 1834(m)
16Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â and 1861(iii) as a condition of payment for tele-
17Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â health or remote patient monitoring services for eli-
18Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â gible applicants whose application for a demonstra-
19Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â tion waiver was approved under this section. The
20Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â provisions to be waived under the preceding sentence
21Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â include any limitation on what qualifies as an origi-
22Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â nating site, any geographic limitation (subject to
23Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â State licensing requirements), any limitation on the
24Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â use of store-and-forward technologies, or any limita-
25Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â tion on the type of health care provider who may
1Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â furnish such services (provided the provider is a
2Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Medicare enrolled provider).
- 3 ‘‘(2) GENERAL SUPERVISION.—The Secretary
4Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â shall permit an eligible applicant whose application
5Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â for a demonstration waiver was approved under this
6Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â section to furnish telehealth or remote patient moni-
7Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â toring services under the general supervision of the
8Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â applicant.
- 9 ‘‘(d) ANNUAL SUBMISSION OF DATA.—An eligible ap-
10Â Â Â Â Â plicant whose application for a demonstration waiver
11Â Â Â Â Â under this section was approved shall, on an annual basis,
12     submit to the Secretary—
13                                    ‘‘(1) information requested by the Secretary for
14Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â evaluation of the demonstration, including informa-
15Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â tion on utilization and expenditures for telehealth or
16Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â remote patient monitoring services under the dem-
17Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â onstration waiver during the preceding year;
18                                    ‘‘(2) data on applicable quality measures during
19Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â the preceding year, consistent with sections 1848
20Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â and 1833(z); and
21                                    ‘‘(3) such other information as the Secretary
22Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â determines is necessary to complete the report under
23Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â subsection (g).
- 24 ‘‘(e) RANDOM AUDITS.—The Secretary shall conduct
25Â Â Â Â Â audits of randomly selected claims under the demonstra-
- 1 tion waiver program under this section to ensure that
2Â Â Â Â Â waivers under the program are being used as intended to
3Â Â Â Â Â furnish telehealth or remote patient monitoring services.
- 4 ‘‘(f) IMPLEMENTATION.—
5                                    ‘‘(1)  SUNSET.—Except  as  provided  in  para-
6Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â graph (2), the authority to carry out the demonstra-
7Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â tion waiver program under this section shall expire
8Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â on December 31, 2019.
9                                    ‘‘(2) EXPANSION.—Taking into account the re-
10                    port   under   subsection    (g),   the   Secretary    may,
11Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â through rulemaking, expand (including implementa-
12Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â tion on a nationwide basis) the duration and the
13Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â scope of the demonstration waiver program under
14Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â this section, to the extent determined appropriate by
15                    the Secretary, if—
16                                                   ‘‘(A) the Secretary determines that such
17                                    expansion is expected to—
18                                                                   ‘‘(i) reduce spending under this title
19Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â without reducing the quality of care; or
20                                                                   ‘‘(ii) improve the quality of patient
21Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â care without increasing spending;
22                                                   ‘‘(B) the Chief Actuary of the Centers for
23                                    Medicare   &  Medicaid   Services    certifies   that
24Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â such expansion would reduce (or would not re-
- 1 sult in any increase in) net program spending
2Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â under this title; and
3                                                   ‘‘(C) the Secretary determines that such
4Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â expansion would not deny or limit the coverage
5Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â or provision of benefits under this title for indi-
6Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â viduals.
- 7 ‘‘(g) REPORT TO CONGRESS.—Not later than Decem-
8Â Â Â Â Â ber 31, 2020, the Chief Actuary of the Centers for Medi-
9Â Â Â Â Â care & Medicaid Services shall submit to Congress a report
10Â Â Â Â Â containing an evaluation of the impact of telehealth and
11Â Â Â Â Â remote patient monitoring services under the demonstra-
12     tion waiver program on—
13                                    ‘‘(1) spending under this title; and
14                                    ‘‘(2) achieving the additional MIPS adjustment
15Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â factors for exceptional performance described in sec-
16Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â tion 1848(q)(6)(C) and incentive payments for par-
17Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â ticipation in eligible alternative payment models de-
18                    scribed in section 1833(z)(1).’’.
1     TITLE II—TELEHEALTH AND RE-
- 2 MOTEÂ Â PATIENTÂ MONITORING
- 3 SERVICESÂ Â Â Â Â FURNISHEDÂ Â Â Â BY
- 4 QUALIFYINGÂ Â Â APMÂ Â Â PARTICI-
- 5 PANTS
- 6  201.  TELEHEALTH  AND  REMOTE  PATIENT  MONI-
- 7 TORINGÂ SERVICESÂ Â FURNISHEDÂ Â BYÂ Â QUALI-
- 8 FYING APM
9                    (a) IN GENERAL.—Title XVIII of the Social Security
10Â Â Â Â Â Act (42 U.S.C. 1395 et seq.), as amended by section 101,
11Â Â Â Â Â is amended by adding at the end the following new section:
- 12 ‘‘SEC.  TELEHEALTH  AND  REMOTE  PATIENT  MONI-
- 13 TORINGÂ SERVICESÂ Â FURNISHEDÂ Â BYÂ Â QUALI-
- 14 FYING APM
15                    ‘‘(a) IN  GENERAL.—The Secretary shall waive cer-
16Â Â Â Â Â tain applicable provisions of section 1834(m) and section
17Â Â Â Â Â 1861(iii) as a condition of payment for telehealth or re-
18Â Â Â Â Â mote patient monitoring services for a qualifying APM
19Â Â Â Â Â participant (as defined in section 1833(z)(2)). The provi-
20Â Â Â Â Â sions to be waived under the preceding sentence include
21Â Â Â Â Â any limitation on what qualifies as an originating site, any
22Â Â Â Â Â geographic limitation (subject to State licensing require-
23Â Â Â Â Â ments), any limitation on the use of store-and-forward
24Â Â Â Â Â technologies, or any limitation on the type of health care
- 1 provider who may furnish such services (provided the pro-
2Â Â Â Â Â vider is a Medicare enrolled provider).
- 3 ‘‘(b) ANNUAL  SUBMISSION  OF  DATA.—A  qualifying
4Â Â Â Â Â APM participant (as so defined) who furnishes telehealth
5Â Â Â Â Â or remote patient monitoring services under this section
6Â Â Â Â Â shall, on an annual basis, submit to the Secretary informa-
7Â Â Â Â Â tion requested by the Secretary for evaluation of the im-
8Â Â Â Â Â plementation of this section, including information on uti-
9Â Â Â Â Â lization and expenditures for telehealth or remote patient
10Â Â Â Â Â monitoring services under this section during the pre-
11Â Â Â Â Â ceding year and data on any applicable quality measures,
12Â Â Â Â Â consistent with sections 1848 and 1833(z).
- 13 ‘‘(c) NO  INCREASE  IN  EXPENDITURES.—If  the  Sec-
14Â Â Â Â Â retary determines payments for telehealth or remote pa-
15Â Â Â Â Â tient monitoring services under this section will increase
16Â Â Â Â Â expenditures under this title, the Secretary shall make ad-
17Â Â Â Â Â justments to such payments to eliminate such increased
18     expenditures.’’.
- 19 (b) EFFECTIVE  DATE.—The  amendment  made  by
20Â Â Â Â Â this section shall apply with respect to services furnished
21Â Â Â Â Â on or after January 1, 2017.
1     TITLE      III—MEDICARE      COV-
- 2 ERAGE OF TELEHEALTH AND
- 3 REMOTEÂ Â Â Â Â PATIENTÂ Â Â Â Â MONI-
- 4 TORING SERVICES
- 5 301. Â REMOTE Â PATIENT Â MONITORING Â SERVICES Â FOR
- 6 INDIVIDUALSÂ Â Â Â WITHÂ Â Â Â CERTAINÂ Â Â Â CHRONIC
- 7 HEALTH
- 8 (a) COVERAGE.—
- 9 (1) IN  GENERAL.—Section  1861(s)(2)  of  the
10                    Social   Security    Act   (42   U.S.C.   1395x(s)(2))   is
11                    amended—
12                                                   (A)  in  subparagraph    (EE),  by  striking
13                                    ‘‘and’’ at the end;
14Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â (B) in subparagraph (FF), by inserting
15                                    ‘‘and’’ at the end; and
16Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â (C) by inserting after subparagraph (FF)
17Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â the following new subparagraph:
18                                    ‘‘(GG)   applicable   remote   patient   monitoring
19Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â services for individuals with certain chronic health
20                    conditions (as defined in subsection (iii));’’.
- 21 (2) COVERAGE AS RURAL HEALTH CLINIC SERV-
- 22 ICES AND Â FEDERALLY Â QUALIFIED Â HEALTH Â CENTER
23                    SERVICES.—Section 1861(aa) of the Social Security
24                    Act (42 U.S.C. 1395x(aa)) is amended—
25                                                   (A) in paragraph (1)—
- 1 (i) in subparagraph (B), by striking ‘‘,
2                                                   and’’ and inserting a comma;
3Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â (ii) in subparagraph (C), by inserting
4                                                   ‘‘and’’ after the comma at the end; and
5Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â (iii) by inserting after subparagraph
6Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â (C) the following new subparagraph:
7                                    ‘‘(D) applicable remote patient monitoring serv-
8Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â ices for individuals with certain chronic health condi-
9                    tions (as defined in subsection (iii)),’’; and
10                                                   (B) in paragraph (3)—
11                                                                   (i) in subparagraph (A), by striking ‘‘;
12                                                   and’’ and inserting a semicolon;
13Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â (ii) in subparagraph (B), by striking
14                                                   the comma and inserting ‘‘; and’’; and
15Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â (iii) by inserting after subparagraph
16Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â (B) the following new subparagraph:
17                                                   ‘‘(C) applicable remote patient monitoring
18                                    services   for  individuals   with   certain   chronic
19                                    health   conditions   (as   defined   in  subsection
20                 (iii)),’’.
- 21 (b) SERVICES DESCRIBED.—Section 1861 of the So-
22Â Â Â Â Â cial Security Act (42 U.S.C. 1395x) is amended by adding
23Â Â Â Â Â at the end the following new subsection:
- 24 ‘‘(iii) REMOTE PATIENT  MONITORING  SERVICES  FOR
- 25 INDIVIDUALS WITH CERTAIN CHRONIC HEALTH CONDI-
- 1 TIONS.—(1)(A) The term ‘applicable remote patient moni-
2Â Â Â Â Â toring services for individuals with certain chronic health
3     conditions’ means remote patient monitoring services (as
4Â Â Â Â Â defined in subparagraph (B)) furnished to an applicable
5Â Â Â Â Â individual (as defined in subparagraph (C)) under general
6Â Â Â Â Â supervision of the provider, with the exception of those
7Â Â Â Â Â services covered under subsection (s)(1).
8                    ‘‘(B) The term ‘remote patient monitoring services’
9Â Â Â Â Â means personal medical data transmitted from an applica-
10Â Â Â Â Â ble individual in one location via electronic communica-
11Â Â Â Â Â tions technologies to an eligible provider (as defined in
12Â Â Â Â Â subparagraph (D)) in a different location and used by the
13Â Â Â Â Â eligible provider in furnishing remote patient monitoring
14Â Â Â Â Â services to such individual that complies with the Federal
15Â Â Â Â Â regulations (concerning the privacy and security of indi-
16     vidually   identifiable   health   information)    promulgated
17Â Â Â Â Â under section 264(c) of the Health Insurance Portability
18Â Â Â Â Â and Accountability Act of 1996, as part of an established
19Â Â Â Â Â plan of care for that individual that includes the review
20Â Â Â Â Â and interpretation of that data by an eligible provider.
21Â Â Â Â Â Such term includes those services furnished in a Federally
22Â Â Â Â Â qualified health center or a rural health clinic
23                    ‘‘(C) The term ‘applicable individual’ means an indi-
24     vidual—
- 1 ‘‘(i) with 2 or more covered chronic conditions
2Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â (as defined in paragraph (2)); and
3                                    ‘‘(ii) who has a history of 2 or more hospitaliza-
4Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â tions or emergency room visits related to such cov-
5Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â ered chronic conditions of the individual in the pre-
6Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â ceding 12 months.
7                    ‘‘(D) The term ‘eligible provider’ means a physician
8Â Â Â Â Â (as defined in section 1861(r)) or a practitioner described
9 in section 1842(b)(18)(C).
10                    ‘‘(E) The Secretary shall establish procedures under
11Â Â Â Â Â which eligible providers who furnish remote patient moni-
12Â Â Â Â Â toring services are required to annually submit data on
13Â Â Â Â Â applicable quality measures under sections 1848 and
14 Â 1833(z).
15                    ‘‘(2)(A) For purposes of paragraph (1)(C), subject to
16     subparagraph (B), the term ‘covered chronic condition’
17     means—
18                                    ‘‘(i) a condition that qualifies an individual for
19                    chronic   care   management   services   under   section
20Â Â Â Â Â Â Â Â Â 1848(b)(8); and
21                                    ‘‘(ii) any other condition the Secretary may
22Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â specify.
23                    ‘‘(B) If the Chief Actuary of the Centers for Medicare
24Â Â Â Â Â & Medicaid Services determines that the inclusion of a
25Â Â Â Â Â condition described in subparagraph (A) in the definition
- 1 of the term ‘covered chronic condition’ under such sub-
2Â Â Â Â Â paragraph will result in increased expenditures under this
3Â Â Â Â Â title, the Secretary shall make adjustments to such defini-
4Â Â Â Â Â tion to eliminate such increased expenditures.
5                    ‘‘(3)(A) Payment may be made under this part for
6Â Â Â Â Â applicable remote patient monitoring services for individ-
7Â Â Â Â Â uals with certain chronic health conditions furnished to
8Â Â Â Â Â an applicable individual during a period of up to 90 days
9Â Â Â Â Â (beginning with the commencement of such services) and
10Â Â Â Â Â such additional period as provided for under subparagraph
11 Â (B).
12                    ‘‘(B) The 90-day period described in subparagraph
13Â Â Â Â Â (A), with respect to an applicable individual, may be re-
14Â Â Â Â Â newed by the eligible provider who provides chronic care
15Â Â Â Â Â management services to such individual if the individual
16Â Â Â Â Â has had one or more hospitalizations, not including emer-
17Â Â Â Â Â gency room visits, related to the covered chronic conditions
18Â Â Â Â Â of the individual described in paragraph (1)(C) since the
19     beginning of such period.’’.
- 20 (c) PAYMENT.—
- 21 (1) IN  GENERAL.—Section  1848(j)(3)  of  the
22                    Social Security Act (42 U.S.C. 1395w–4(j)(3)) is
23                    amended by inserting ‘‘(2)(GG),’’ after ‘‘health risk
24                    assessment),’’.
- 1 (2) RURAL HEALTH CLINIC SERVICES AND FED-
- 2 ERALLY QUALIFIED  HEALTH  CENTER  SERVICES.—
3Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Section 1833 of the Social Security Act (42 U.S.C.
4Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 1395l) is amended by adding at the end the fol-
5Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â lowing new subsection:
- 6 ‘‘(aa) PAYMENT FOR APPLICABLE REMOTE PATIENT
- 7 MONITORING SERVICES FOR INDIVIDUALS WITH CERTAIN
- 8 CHRONIC HEALTH CONDITIONS FURNISHED BY A RURAL
- 9 HEALTH CLINIC Â OR Â A Â FEDERALLY Â QUALIFIED Â HEALTH
10     CENTER.—Notwithstanding any other provision of law, in
11Â Â Â Â Â the case of applicable remote patient monitoring services
12Â Â Â Â Â for individuals with certain chronic health conditions (as
13Â Â Â Â Â defined in section 1861(iii)) furnished by a rural health
14Â Â Â Â Â clinic or a Federally qualified health center under para-
15Â Â Â Â Â graphs (1) and (3), respectively, of section 1861(aa), pay-
16Â Â Â Â Â ment shall be made in an amount equal to the national
17Â Â Â Â Â average payment amount for such service, as determined
18Â Â Â Â Â by the Secretary, in accordance with section 1848 (without
19Â Â Â Â Â regard to any adjustment under subsections (a)(5), (a)(7),
20     (a)(8), (p), or (q) of such section).’’.
- 21 (d) EFFECTIVE DATE.—The amendments made by
22Â Â Â Â Â this section shall apply to services furnished on or after
23Â Â Â Â Â January 1, 2017.
- 1 302. ALLOWING TELEHEALTH TO MEET MONTHLY CLI-
- 2 NICIAN IN-PERSON VISIT REQUIREMENT FOR
- 3 CERTAIN HOME
4                    (a) IN GENERAL.—Section 1881(b)(3) of the Social
5     Security Act (42 U.S.C. 1395rr(b)(3)) is amended—
6Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â (1) by redesignating subparagraphs (A) and
7Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â (B) as clauses (i) and (ii), respectively;
8Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â (2) in clause (ii), as redesignated by subpara-
9                    graph (A), strike ‘‘on a comprehensive’’ and insert
10                    ‘‘subject to subparagraph (B), on a comprehensive’’;
11                                    (3) by striking ‘‘With respect to’’ and inserting
12                    ‘‘(A) With respect to’’; and
13Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â (4) by adding at the end the following new sub-
14Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â paragraph:
15                                    ‘‘(B) For purposes of subparagraph (A)(ii), an
16Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â individual determined to have end stage renal dis-
17Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â ease receiving home dialysis may elect to receive the
18Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â monthly end stage renal disease-related visits via
19Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â telehealth if the individual receives an in-person ex-
20                    amination   at  least   once   every   three   consecutive
21Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â months. For purposes of the preceding sentence, a
22Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â dialysis facility shall be the originating site at which
23Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â the individual is located at the time the service is
24                    furnished via telehealth.’’.
- 25 (b) CONFORMING AMENDMENT.—Section 1881(b)(1)
26Â Â Â Â Â of such Act (42 U.S.C. 1395rr(b)(1)) is amended by strik-
1  ing   ‘‘paragraph     (3)(A)’’    and   inserting    ‘‘paragraph
2  (3)(A)(i)’’.
- 3 (c) EFFECTIVE DATE.—The amendments made by
4Â Â Â Â Â this subsection shall apply with respect to the monthly fee
5Â Â Â Â Â or other basis of payment for home dialysis services fur-
6Â Â Â Â Â nished on or after January 1, 2017.
- 7 303. ALLOWING STROKE EVALUATION SITES AND NA-
- 8 TIVE AMERICAN Â HEALTH Â SERVICE Â FACILI-
- 9 TIES AS Â SITES Â ELIGIBLE Â FOR Â TELEHEALTH
- 10
- 11 (a)      STROKE          EVALUATION           SITES.—Section
12Â Â Â Â Â 1834(m)(4)(C) of the Social Security Act (42 U.S.C.
13 1395m(m)(4)(C)) is amended—
14                                    (1) in clause (i), by striking ‘‘The term’’ and
15                    inserting ‘‘Subject to clause (iii), the term’’; and
16Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â (2) by adding at the end the following new
17Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â clause:
- 18 ‘‘(iii)   STROKE     TELEHEALTH      SERV-
19                                                   ICES.—The originating site requirements
20Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â described in clauses (i) and (ii) shall not
21Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â apply with respect to services related to the
22                                                   evaluation   or  management    of  an  acute
23Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â stroke for the purpose of determining opti-
24                                                   mal acute stroke therapy.’’.
- 1 (b) NATIVE Â AMERICAN Â HEALTH Â SERVICE Â FACILI-
2     TIES.—Section 1834(m)(4)(C) of the Social Security Act
3Â Â Â Â Â (42 U.S.C. 1395m(m)(4)(C)), as amended by subsection
4     (a), is amended—
5                                    (1) in clause (i), by striking ‘‘clause (iii)’’ and
6                    inserting ‘‘clauses (iii) and (iv)’’; and
7Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â (2) by adding at the end the following new
8Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â clause:
- 9 ‘‘(iv)    NATIVE      AMERICAN     HEALTH
- 10 SERVICE FACILITIES.—The originating site
11Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â requirements described in clauses (i) and
12Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â (ii) shall not apply with respect to a facil-
13Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â ity of the Indian Health Service, whether
14Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â operated by such Service, or by an Indian
15Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â tribe (as that term is defined in section 4
16Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â of the Indian Health Care Improvement
17Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Act (25 U.S.C. 1603)) or a tribal organiza-
18Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â tion (as that term is defined in section 4
19Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â of the Indian Self-Determination and Edu-
20Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â cation Assistance Act (25 U.S.C. 450b)),
21Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â or a facility of the Native Hawaiian health
22Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â care systems authorized under the Native
23Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Hawaiian Health Care Improvement Act
24                         (42 U.S.C. 11701 et seq.).’’.
- 1 (c) NO ORIGINATING SITE FACILITY FEE FOR NEW
2     SITES.—Section 1834(m)(2)(B) of the Social Security Act
3Â Â Â Â Â (42 U.S.C. 1395m(m)(2)(B)) is amended, in the matter
4     preceding clause (i), by inserting ‘‘(other than an origi-
5Â Â Â Â Â nating site that is only described in clause (iii) or (iv) of
6Â Â Â Â Â paragraph (4)(C), and does not meet the requirement for
7     an originating site under clause (i) of such paragraph)’’
8     after ‘‘the originating site’’.
- 9 (d) EFFECTIVE DATE.—The amendments made by
10Â Â Â Â Â this section shall apply to services furnished on or after
11Â Â Â Â Â January 1, 2017.
- 12 304. RURAL HEALTH CLINICS AND FEDERALLY QUALI-
- 13 FIED HEALTH CENTERS AUTHORIZED TO BE
- 14 DISTANT
15                    (a) IN GENERAL.—Section 1834(m) of the Social Se-
16     curity Act (42 U.S.C. 1395m(m)) is amended—
17                                    (1) in the first sentence of paragraph (1)—
18                                                   (A)  by  striking  ‘‘or  a  practitioner  (de-
19                                    scribed in section 1842(b)(18)(C))’’ and insert-
20                                    ing   ‘‘,   a  practitioner    (described    in  section
21Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 1842(b)(18)(C)), a Federally qualified health
22                                    center, or a rural health clinic’’; and
23                                                   (B) by striking ‘‘or practitioner’’ and in-
24                                    serting    ‘‘,   practitioner,     Federally     qualified
25                                    health center, or rural health clinic’’;
- 1 (2) in paragraph (2)(A)—
2                                                   (A) by inserting the following after ‘‘eligi-
3                                    ble telehealth individual’’: ‘‘or to a Federally
4Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â qualified health center or rural health clinic
5Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â that serves as a distant site and whose clinician
6Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â furnishes a telehealth service to an eligible tele-
7                                    health individual’’; and
8                                                   (B) by striking ‘‘such physician or practi-
9                                    tioner’’ and inserting ‘‘such physician, practi-
10                                    tioner,   Federally    qualified   health   center,   or
11                                    rural health clinic’’; and
12Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â (3) in paragraph (4)(A), by inserting the fol-
13                    lowing before the period at the end: ‘‘and includes
14Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â a Federally qualified health center or rural health
15Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â clinic whose clinician furnishes a telehealth service to
16                    an eligible individual’’.
- 17 (b) EFFECTIVE DATE.—The amendments made by
18Â Â Â Â Â this section shall apply to services furnished on or after
19Â Â Â Â Â January 1, 2017.
- 20 305. ADDRESSING GAPS IN QUALITY MEASURES FOR
- 21 TELEHEALTH AND Â REMOTE Â PATIENT Â MONI-
- 22 TORING
23Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Section 1848(s)(1)(C) of the Social Security Act (42
24 U.S.C. 1395w–4(s)(1)(C)) is amended—
- 1 (1) by redesignating clauses (i) through (iv) as
2Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â subclauses (I) through (IV), respectively, and in-
3Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â denting appropriately;
- 4 (2) by  striking  ‘‘CONSIDERATION.—In  devel-
- 5 oping’’ and inserting ‘‘CONSIDERATION.—
- 6 ‘‘(i) IN GENERAL.—Subject to clause
7                                                   (ii), in developing’’; and
8Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â (3) by adding at the end the following new
9Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â clause:
- 10 ‘‘(ii) ADDRESSING GAPS IN MEASURES
- 11 FOR TELEHEALTH Â AND Â REMOTE Â PATIENT
- 12 MONITORING   SERVICES.—Consistent     with
13Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â this subsection, the Secretary shall ensure
14Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â that the plan identifying measure develop-
15                                                   ment   priorities   and  timelines   developed
16Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â under this subsection addresses relevant
17Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â gaps in measures with respect to telehealth
18Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â services, remote patient monitoring serv-
19Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â ices, and the use of such services to ad-
20Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â dress health disparities (as described in
21Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â section 1890(b)(1)(B)(ii)) that are not oth-
22Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â erwise addressed through existing quality
23                                                   measures.’’.
1     TITLE IV—USE OF TELEHEALTH
- 2 AND REMOTE PATIENT MONI-
- 3 TORINGÂ Â SERVICESÂ Â Â TOÂ Â PRO-
- 4 VIDE BASIC BENEFITS UNDER
- 5 MEDICARE PART C
- 6 401. Â USE Â OF Â TELEHEALTH Â AND Â REMOTE Â PATIENT
- 7 MONITORING SERVICES Â TO Â PROVIDE Â BASIC
- 8 BENEFITS UNDER MEDICARE PART
9                    (a) IN GENERAL.—Section 1852 of the Social Secu-
10     rity Act (42 U.S.C. 1395w–22) is amended—
11                                    (1) in subsection (a)(1)(B)(i), by striking ‘‘part,
12                    the term’’ and inserting ‘‘part, subject to subsection
13                    (m), the term’’; and
14Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â (2) by adding at the end the following new sub-
15Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â section:
- 16 ‘‘(m) USE OF TELEHEALTH AND REMOTE PATIENT
- 17 MONITORING SERVICES TO PROVIDE BASIC BENEFITS.—
18Â Â Â Â Â For plan year 2017 and subsequent plan years, the fol-
19Â Â Â Â Â lowing shall apply:
- 20 ‘‘(1) IN GENERAL.—An MA plan may elect to
21Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â use telehealth or remote patient monitoring services
22Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â to provide benefits under the original medicare fee-
23Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â for-service program option, including items or serv-
24Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â ices furnished to treat medical or behavioral health
25Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â conditions.
- 1 ‘‘(2)    WAIVER      OF       LIMITATIONS.—Notwith-
2Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â standing any other provision of law, in the case
3Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â where an MA plan elects to use telehealth or remote
4Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â patient monitoring services to provide such benefits,
5Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â with respect to enrollees, such services may be fur-
6Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â nished without application of any provision under
7Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â section 1834(m) or any other provision of this Act
8Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â that applies a limitation on what qualifies as an
9Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â originating site, any geographic limitation (subject
10Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â to State licensing requirements), any limitation on
11Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â the use of store-and-forward technologies, or any
12Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â limitation on the type of health care provider who
13Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â may furnish such services (provided the provider is
14Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â a Medicare enrolled provider).
- 15 ‘‘(3) TREATMENT AS  BASIC  BENEFITS.—In the
16Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â case where an MA plan makes such election under
17Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â paragraph (1), the use of such telehealth or remote
18Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â patient monitoring services shall be considered part
19Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â of the provision of benefits under the original medi-
20Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â care fee-for-service program option for purpose of
21Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â this part.
- 22 ‘‘(4) AVAILABILITY OF  BENEFITS  IN  PERSON.—
23Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â In the case where an MA plan makes such election
24Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â under paragraph (1), any benefits provided using
1Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â such telehealth services shall continue to be made
2Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â available in person to enrollees under the plan.
- 3 ‘‘(5) PROVISION  OF  DATA.—An  MA  plan  that
4Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â makes such an election under paragraph (1) with re-
5Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â spect to a plan year shall provide to the Secretary
6Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â (at such time and in such manner as the Secretary
7Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â may specify) data on expenditures and utilization for
8                    telehealth   or  remote   patient   monitoring   services
9                    under the plan for enrollees during that plan year.’’.
- 10 (b) CLARIFICATION REGARDING Â INCLUSION Â IN Â BID
11     AMOUNT.—Section 1854(a)(6)(A)(ii)(I) of the Social Se-
12  curity  Act   (42   U.  S.C.  1395w–24(a)(6)(A)(ii)(I))     is
13     amended by inserting ‘‘, including, for plan year 2017 and
14Â Â Â Â Â subsequent plan years, the use of telehealth or remote pa-
15Â Â Â Â Â tient monitoring services to provide such benefits as de-
16     scribed in section 1852(m)’’ before the semicolon at the
17Â Â Â Â Â end.
- 18 (c) RULE OF  CONSTRUCTION.—Nothing in this sec-
19Â Â Â Â Â tion shall be construed as affecting the furnishing of items
20Â Â Â Â Â or services under the original Medicare fee-for-service pro-
21Â Â Â Â Â gram.
1     TITLE   V—CLARIFICATION   RE-
- 2 GARDINGÂ Â TELEHEALTHÂ Â AND
- 3 REMOTEÂ Â Â Â Â PATIENTÂ Â Â Â Â MONI-
- 4 TORING TECHNOLOGIES PRO-
- 5 VIDED TO BENEFICIARIES
- 6 501. Â CLARIFICATION Â REGARDING Â TELEHEALTH Â AND
- 7 REMOTEÂ Â Â Â PATIENTÂ Â Â Â Â Â MONITORINGÂ Â Â Â Â Â TECH-
- 8 NOLOGIES PROVIDED TO
9Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Section 1128A(i)(6) of the Social Security Act (42
10 U.S.C. 1320a–7a(i)(6)) is amended—
11                                    (1) in subparagraph (H), by striking ‘‘; or’’ and
12Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â inserting a semicolon;
13Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â (2) in subparagraph (I), by striking the period
14                    at the end and inserting ‘‘; or’’; and
15Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â (3) by adding at the end the following new sub-
16Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â paragraph:
17                                                   ‘‘(J) the provision of telehealth or remote
18Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â patient monitoring technologies to individuals
19Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â under title XVIII by a health care provider for
20Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â the purpose of furnishing telehealth or remote
patient monitoring services.’’.