Article

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  THE  SENATE  OF  THE  UNITED  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

A  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

2      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 MOTE   PATIENT  MONITORING
  • 3 SERVICES      ‘‘BRIDGE’’     DEM-
  • 4 ONSTRATION WAIVERS
  • 5  101.   TELEHEALTH   AND   REMOTE   PATIENT   MONI-
  • 6 TORING  SERVICES   ‘‘BRIDGE’’   DEMONSTRA-
  • 7 TION

8                     Title XVIII of the Social Security Act (42 U.S.C.

9      1395 et seq.) is amended by adding at the end the fol-

10      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

16                     provisions of this subsection, the Secretary shall so-

17                     licit proposals from, and issue telehealth or remote

18                     patient monitoring services ‘bridge’ demonstration

19                     waivers under this title to, eligible applicants who,

20                     for the duration of time for which the demonstration

21                     waiver would apply, are furnishing telehealth or re-

22                     mote patient monitoring services (as defined in sec-

23                     tion 1861(iii)) to individuals under this title in a

24                     manner that is consistent with the goals of the

25                     Merit-based Incentive Payment System under sec-

 

1                     tion 1848(q), including the goals of quality, resource

2                     utilization, and clinical practice improvement (in-

3                     cluding care coordination and patient engagement),

4                     or the incentive payments for participation in eligible

5                     alternative payment models under section 1833(z).

  • 6 ‘‘(2) ELIGIBLE  APPLICANT  DEFINED.—In  this

7                     section, the term ‘eligible applicant’ means the fol-

8                     lowing:

9                                                    ‘‘(A) A professional described in section

10                  1848(q)(1)(C)(i)(I).

11                                                    ‘‘(B) A qualifying APM participant (as de-

12                                     fined in section 1833(z)(2)).

13                                                    ‘‘(C) Any other provider, including a pro-

14                                     fessional             described             in            section

15                                     1848(q)(1)(C)(i)(II), determined appropriate by

16                                     the Secretary, and a group that includes such

17                                     providers.

  • 18 ‘‘(b)  DEMONSTRATION    WAIVER    APPLICATION    RE-

19      QUIREMENTS.—An eligible applicant seeking a demonstra-

20      tion waiver under this section shall submit an application

21      to the Secretary on an annual basis that includes the fol-

22      lowing:

23                                     ‘‘(1) An attestation of the intent of the appli-

24                     cant to use telehealth or remote patient monitoring

25                     services to meet the goals described in subsection

1                     (a)(1), and details (as specified by the Secretary) on

2                     how the eligible applicant will use those services to

3                     meet such goals.

4                                     ‘‘(2) An agreement by the applicant to—

5                                                    ‘‘(A) submit the information described in

6                                     subsection (d) in accordance with such sub-

7                                     section; and

8                                                    ‘‘(B)   cooperate    in   any   audit    conducted

9                                     under subsection (e) with respect to claims for

10                                     telehealth or remote patient monitoring services

11                                     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

15                     certain applicable provisions of sections 1834(m)

16                     and 1861(iii) as a condition of payment for tele-

17                     health or remote patient monitoring services for eli-

18                     gible applicants whose application for a demonstra-

19                     tion waiver was approved under this section. The

20                     provisions to be waived under the preceding sentence

21                     include any limitation on what qualifies as an origi-

22                     nating site, any geographic limitation (subject to

23                     State licensing requirements), any limitation on the

24                     use of store-and-forward technologies, or any limita-

25                     tion on the type of health care provider who may

1                     furnish such services (provided the provider is a

2                     Medicare enrolled provider).

  • 3 ‘‘(2) GENERAL SUPERVISION.—The Secretary

4                     shall permit an eligible applicant whose application

5                     for a demonstration waiver was approved under this

6                     section to furnish telehealth or remote patient moni-

7                     toring services under the general supervision of the

8                     applicant.

  • 9 ‘‘(d) ANNUAL SUBMISSION OF DATA.—An eligible ap-

10      plicant whose application for a demonstration waiver

11      under this section was approved shall, on an annual basis,

12      submit to the Secretary—

13                                     ‘‘(1) information requested by the Secretary for

14                     evaluation of the demonstration, including informa-

15                     tion on utilization and expenditures for telehealth or

16                     remote patient monitoring services under the dem-

17                     onstration waiver during the preceding year;

18                                     ‘‘(2) data on applicable quality measures during

19                     the preceding year, consistent with sections 1848

20                     and 1833(z); and

21                                     ‘‘(3) such other information as the Secretary

22                     determines is necessary to complete the report under

23                     subsection (g).

  • 24 ‘‘(e) RANDOM AUDITS.—The Secretary shall conduct

25      audits of randomly selected claims under the demonstra-

  • 1 tion waiver program under this section to ensure that

2      waivers under the program are being used as intended to

3      furnish telehealth or remote patient monitoring services.

  • 4 ‘‘(f) IMPLEMENTATION.—

5                                     ‘‘(1)  SUNSET.—Except  as  provided  in  para-

6                     graph (2), the authority to carry out the demonstra-

7                     tion waiver program under this section shall expire

8                     on December 31, 2019.

9                                     ‘‘(2) EXPANSION.—Taking into account the re-

10                     port    under    subsection     (g),    the    Secretary     may,

11                     through rulemaking, expand (including implementa-

12                     tion on a nationwide basis) the duration and the

13                     scope of the demonstration waiver program under

14                     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

19                                                    without reducing the quality of care; or

20                                                                    ‘‘(ii) improve the quality of patient

21                                                    care without increasing spending;

22                                                    ‘‘(B) the Chief Actuary of the Centers for

23                                     Medicare    &   Medicaid    Services     certifies    that

24                                     such expansion would reduce (or would not re-

 

  • 1 sult in any increase in) net program spending

2                                     under this title; and

3                                                    ‘‘(C) the Secretary determines that such

4                                     expansion would not deny or limit the coverage

5                                     or provision of benefits under this title for indi-

6                                     viduals.

  • 7 ‘‘(g) REPORT TO CONGRESS.—Not later than Decem-

8      ber 31, 2020, the Chief Actuary of the Centers for Medi-

9      care & Medicaid Services shall submit to Congress a report

10      containing an evaluation of the impact of telehealth and

11      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

15                     factors for exceptional performance described in sec-

16                     tion 1848(q)(6)(C) and incentive payments for par-

17                     ticipation in eligible alternative payment models de-

18                     scribed in section 1833(z)(1).’’.

1      TITLE II—TELEHEALTH AND RE-

  • 2 MOTE   PATIENT  MONITORING
  • 3 SERVICES      FURNISHED     BY
  • 4 QUALIFYING    APM    PARTICI-
  • 5 PANTS
  • 6  201.   TELEHEALTH   AND   REMOTE   PATIENT   MONI-
  • 7 TORING  SERVICES   FURNISHED   BY   QUALI-
  • 8 FYING APM

9                     (a) IN GENERAL.—Title XVIII of the Social Security

10      Act (42 U.S.C. 1395 et seq.), as amended by section 101,

11      is amended by adding at the end the following new section:

  • 12 ‘‘SEC.  TELEHEALTH  AND  REMOTE  PATIENT  MONI-
  • 13 TORING  SERVICES   FURNISHED   BY   QUALI-
  • 14 FYING APM

15                     ‘‘(a) IN  GENERAL.—The Secretary shall waive cer-

16      tain applicable provisions of section 1834(m) and section

17      1861(iii) as a condition of payment for telehealth or re-

18      mote patient monitoring services for a qualifying APM

19      participant (as defined in section 1833(z)(2)). The provi-

20      sions to be waived under the preceding sentence include

21      any limitation on what qualifies as an originating site, any

22      geographic limitation (subject to State licensing require-

23      ments), any limitation on the use of store-and-forward

24      technologies, or any limitation on the type of health care

  • 1 provider who may furnish such services (provided the pro-

2      vider is a Medicare enrolled provider).

  • 3 ‘‘(b) ANNUAL  SUBMISSION  OF  DATA.—A  qualifying

4      APM participant (as so defined) who furnishes telehealth

5      or remote patient monitoring services under this section

6      shall, on an annual basis, submit to the Secretary informa-

7      tion requested by the Secretary for evaluation of the im-

8      plementation of this section, including information on uti-

9      lization and expenditures for telehealth or remote patient

10      monitoring services under this section during the pre-

11      ceding year and data on any applicable quality measures,

12      consistent with sections 1848 and 1833(z).

  • 13 ‘‘(c) NO  INCREASE  IN  EXPENDITURES.—If  the  Sec-

14      retary determines payments for telehealth or remote pa-

15      tient monitoring services under this section will increase

16      expenditures under this title, the Secretary shall make ad-

17      justments to such payments to eliminate such increased

18      expenditures.’’.

  • 19 (b) EFFECTIVE  DATE.—The  amendment  made  by

20      this section shall apply with respect to services furnished

21      on or after January 1, 2017.

1      TITLE       III—MEDICARE       COV-

  • 2 ERAGE OF TELEHEALTH AND
  • 3 REMOTE      PATIENT      MONI-
  • 4 TORING SERVICES
  • 5 301.  REMOTE  PATIENT  MONITORING  SERVICES  FOR
  • 6 INDIVIDUALS     WITH     CERTAIN     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;

14                                                    (B) in subparagraph (FF), by inserting

15                                     ‘‘and’’ at the end; and

16                                                    (C) by inserting after subparagraph (FF)

17                                     the following new subparagraph:

18                                     ‘‘(GG)    applicable    remote    patient    monitoring

19                     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  FEDERALLY  QUALIFIED  HEALTH  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;

3                                                                    (ii) in subparagraph (C), by inserting

4                                                    ‘‘and’’ after the comma at the end; and

5                                                                    (iii) by inserting after subparagraph

6                                                    (C) the following new subparagraph:

7                                     ‘‘(D) applicable remote patient monitoring serv-

8                     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;

13                                                                    (ii) in subparagraph (B), by striking

14                                                    the comma and inserting ‘‘; and’’; and

15                                                                    (iii) by inserting after subparagraph

16                                                    (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-

22      cial Security Act (42 U.S.C. 1395x) is amended by adding

23      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-

2      toring services for individuals with certain chronic health

3      conditions’ means remote patient monitoring services (as

4      defined in subparagraph (B)) furnished to an applicable

5      individual (as defined in subparagraph (C)) under general

6      supervision of the provider, with the exception of those

7      services covered under subsection (s)(1).

8                     ‘‘(B) The term ‘remote patient monitoring services’

9      means personal medical data transmitted from an applica-

10      ble individual in one location via electronic communica-

11      tions technologies to an eligible provider (as defined in

12      subparagraph (D)) in a different location and used by the

13      eligible provider in furnishing remote patient monitoring

14      services to such individual that complies with the Federal

15      regulations (concerning the privacy and security of indi-

16      vidually    identifiable    health    information)     promulgated

17      under section 264(c) of the Health Insurance Portability

18      and Accountability Act of 1996, as part of an established

19      plan of care for that individual that includes the review

20      and interpretation of that data by an eligible provider.

21      Such term includes those services furnished in a Federally

22      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

2                     (as defined in paragraph (2)); and

3                                     ‘‘(ii) who has a history of 2 or more hospitaliza-

4                     tions or emergency room visits related to such cov-

5                     ered chronic conditions of the individual in the pre-

6                     ceding 12 months.

7                     ‘‘(D) The term ‘eligible provider’ means a physician

8      (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

11      which eligible providers who furnish remote patient moni-

12      toring services are required to annually submit data on

13      applicable quality measures under sections 1848 and

14  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

20          1848(b)(8); and

21                                     ‘‘(ii) any other condition the Secretary may

22                     specify.

23                     ‘‘(B) If the Chief Actuary of the Centers for Medicare

24      & Medicaid Services determines that the inclusion of a

25      condition described in subparagraph (A) in the definition

 

  • 1 of the term ‘covered chronic condition’ under such sub-

2      paragraph will result in increased expenditures under this

3      title, the Secretary shall make adjustments to such defini-

4      tion to eliminate such increased expenditures.

5                     ‘‘(3)(A) Payment may be made under this part for

6      applicable remote patient monitoring services for individ-

7      uals with certain chronic health conditions furnished to

8      an applicable individual during a period of up to 90 days

9      (beginning with the commencement of such services) and

10      such additional period as provided for under subparagraph

11  (B).

12                     ‘‘(B) The 90-day period described in subparagraph

13      (A), with respect to an applicable individual, may be re-

14      newed by the eligible provider who provides chronic care

15      management services to such individual if the individual

16      has had one or more hospitalizations, not including emer-

17      gency room visits, related to the covered chronic conditions

18      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.—

3                     Section 1833 of the Social Security Act (42 U.S.C.

4                     1395l) is amended by adding at the end the fol-

5                     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  OR  A  FEDERALLY  QUALIFIED  HEALTH

10      CENTER.—Notwithstanding any other provision of law, in

11      the case of applicable remote patient monitoring services

12      for individuals with certain chronic health conditions (as

13      defined in section 1861(iii)) furnished by a rural health

14      clinic or a Federally qualified health center under para-

15      graphs (1) and (3), respectively, of section 1861(aa), pay-

16      ment shall be made in an amount equal to the national

17      average payment amount for such service, as determined

18      by the Secretary, in accordance with section 1848 (without

19      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

22      this section shall apply to services furnished on or after

23      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—

6                                     (1) by redesignating subparagraphs (A) and

7                     (B) as clauses (i) and (ii), respectively;

8                                     (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

13                                     (4) by adding at the end the following new sub-

14                     paragraph:

15                                     ‘‘(B) For purposes of subparagraph (A)(ii), an

16                     individual determined to have end stage renal dis-

17                     ease receiving home dialysis may elect to receive the

18                     monthly end stage renal disease-related visits via

19                     telehealth if the individual receives an in-person ex-

20                     amination    at   least    once    every    three    consecutive

21                     months. For purposes of the preceding sentence, a

22                     dialysis facility shall be the originating site at which

23                     the individual is located at the time the service is

24                     furnished via telehealth.’’.

  • 25 (b) CONFORMING AMENDMENT.—Section 1881(b)(1)

26      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

4      this subsection shall apply with respect to the monthly fee

5      or other basis of payment for home dialysis services fur-

6      nished on or after January 1, 2017.

  • 7 303. ALLOWING STROKE EVALUATION SITES AND NA-
  • 8 TIVE AMERICAN  HEALTH  SERVICE  FACILI-
  • 9 TIES AS  SITES  ELIGIBLE  FOR  TELEHEALTH
  • 10
  • 11 (a)       STROKE           EVALUATION            SITES.—Section

12      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

16                                     (2) by adding at the end the following new

17                     clause:

  • 18 ‘‘(iii)    STROKE      TELEHEALTH       SERV-

19                                                    ICES.—The originating site requirements

20                                                    described in clauses (i) and (ii) shall not

21                                                    apply with respect to services related to the

22                                                    evaluation    or   management     of   an   acute

23                                                    stroke for the purpose of determining opti-

24                                                    mal acute stroke therapy.’’.

 

  • 1 (b) NATIVE  AMERICAN  HEALTH  SERVICE  FACILI-

2      TIES.—Section 1834(m)(4)(C) of the Social Security Act

3      (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

7                                     (2) by adding at the end the following new

8                     clause:

  • 9 ‘‘(iv)     NATIVE       AMERICAN      HEALTH
  • 10 SERVICE FACILITIES.—The originating site

11                                                    requirements described in clauses (i) and

12                                                    (ii) shall not apply with respect to a facil-

13                                                    ity of the Indian Health Service, whether

14                                                    operated by such Service, or by an Indian

15                                                    tribe (as that term is defined in section 4

16                                                    of the Indian Health Care Improvement

17                                                    Act (25 U.S.C. 1603)) or a tribal organiza-

18                                                    tion (as that term is defined in section 4

19                                                    of the Indian Self-Determination and Edu-

20                                                    cation Assistance Act (25 U.S.C. 450b)),

21                                                    or a facility of the Native Hawaiian health

22                                                    care systems authorized under the Native

23                                                    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

3      (42 U.S.C. 1395m(m)(2)(B)) is amended, in the matter

4      preceding clause (i), by inserting ‘‘(other than an origi-

5      nating site that is only described in clause (iii) or (iv) of

6      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

10      this section shall apply to services furnished on or after

11      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

21                                     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

4                                     qualified health center or rural health clinic

5                                     that serves as a distant site and whose clinician

6                                     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

12                                     (3) in paragraph (4)(A), by inserting the fol-

13                     lowing before the period at the end: ‘‘and includes

14                     a Federally qualified health center or rural health

15                     clinic whose clinician furnishes a telehealth service to

16                     an eligible individual’’.

  • 17 (b) EFFECTIVE DATE.—The amendments made by

18      this section shall apply to services furnished on or after

19      January 1, 2017.

  • 20 305. ADDRESSING GAPS IN QUALITY MEASURES FOR
  • 21 TELEHEALTH AND  REMOTE  PATIENT  MONI-
  • 22 TORING

23                     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

2                     subclauses (I) through (IV), respectively, and in-

3                     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

8                                     (3) by adding at the end the following new

9                     clause:

  • 10 ‘‘(ii) ADDRESSING GAPS IN MEASURES
  • 11 FOR TELEHEALTH  AND  REMOTE  PATIENT
  • 12 MONITORING    SERVICES.—Consistent      with

13                                                    this subsection, the Secretary shall ensure

14                                                    that the plan identifying measure develop-

15                                                    ment    priorities    and   timelines    developed

16                                                    under this subsection addresses relevant

17                                                    gaps in measures with respect to telehealth

18                                                    services, remote patient monitoring serv-

19                                                    ices, and the use of such services to ad-

20                                                    dress health disparities (as described in

21                                                    section 1890(b)(1)(B)(ii)) that are not oth-

22                                                    erwise addressed through existing quality

23                                                    measures.’’.

1      TITLE IV—USE OF TELEHEALTH

  • 2 AND REMOTE PATIENT MONI-
  • 3 TORING   SERVICES    TO   PRO-
  • 4 VIDE BASIC BENEFITS UNDER
  • 5 MEDICARE PART C
  • 6 401.  USE  OF  TELEHEALTH  AND  REMOTE  PATIENT
  • 7 MONITORING SERVICES  TO  PROVIDE  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

14                                     (2) by adding at the end the following new sub-

15                     section:

  • 16 ‘‘(m) USE OF TELEHEALTH AND REMOTE PATIENT
  • 17 MONITORING SERVICES TO PROVIDE BASIC BENEFITS.—

18      For plan year 2017 and subsequent plan years, the fol-

19      lowing shall apply:

  • 20 ‘‘(1) IN GENERAL.—An MA plan may elect to

21                     use telehealth or remote patient monitoring services

22                     to provide benefits under the original medicare fee-

23                     for-service program option, including items or serv-

24                     ices furnished to treat medical or behavioral health

25                     conditions.

 

  • 1 ‘‘(2)     WAIVER       OF        LIMITATIONS.—Notwith-

2                     standing any other provision of law, in the case

3                     where an MA plan elects to use telehealth or remote

4                     patient monitoring services to provide such benefits,

5                     with respect to enrollees, such services may be fur-

6                     nished without application of any provision under

7                     section 1834(m) or any other provision of this Act

8                     that applies a limitation on what qualifies as an

9                     originating site, any geographic limitation (subject

10                     to State licensing requirements), any limitation on

11                     the use of store-and-forward technologies, or any

12                     limitation on the type of health care provider who

13                     may furnish such services (provided the provider is

14                     a Medicare enrolled provider).

  • 15 ‘‘(3) TREATMENT AS  BASIC  BENEFITS.—In the

16                     case where an MA plan makes such election under

17                     paragraph (1), the use of such telehealth or remote

18                     patient monitoring services shall be considered part

19                     of the provision of benefits under the original medi-

20                     care fee-for-service program option for purpose of

21                     this part.

  • 22 ‘‘(4) AVAILABILITY OF  BENEFITS  IN  PERSON.—

23                     In the case where an MA plan makes such election

24                     under paragraph (1), any benefits provided using

1                     such telehealth services shall continue to be made

2                     available in person to enrollees under the plan.

  • 3 ‘‘(5) PROVISION  OF  DATA.—An  MA  plan  that

4                     makes such an election under paragraph (1) with re-

5                     spect to a plan year shall provide to the Secretary

6                     (at such time and in such manner as the Secretary

7                     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  INCLUSION  IN  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

14      subsequent plan years, the use of telehealth or remote pa-

15      tient monitoring services to provide such benefits as de-

16      scribed in section 1852(m)’’ before the semicolon at the

17      end.

  • 18 (c) RULE OF  CONSTRUCTION.—Nothing in this sec-

19      tion shall be construed as affecting the furnishing of items

20      or services under the original Medicare fee-for-service pro-

21      gram.

1      TITLE    V—CLARIFICATION    RE-

  • 2 GARDING   TELEHEALTH   AND
  • 3 REMOTE      PATIENT      MONI-
  • 4 TORING TECHNOLOGIES PRO-
  • 5 VIDED TO BENEFICIARIES
  • 6 501.  CLARIFICATION  REGARDING  TELEHEALTH  AND
  • 7 REMOTE     PATIENT       MONITORING       TECH-
  • 8 NOLOGIES PROVIDED TO

9                     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

12                     inserting a semicolon;

13                                     (2) in subparagraph (I), by striking the period

14                     at the end and inserting ‘‘; or’’; and

15                                     (3) by adding at the end the following new sub-

16                     paragraph:

17                                                    ‘‘(J) the provision of telehealth or remote

18                                     patient monitoring technologies to individuals

19                                     under title XVIII by a health care provider for

20                                     the purpose of furnishing telehealth or remote

patient monitoring services.’’.

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