,i #aacth ,,congress #ast ,session ,h4 ,r4 #ccjf ,,in ,,the ,,house ,,of ,,representatives ,october #bb1 #bjac,mr4 ,harper 7for himself1 ,mr4 ,thompson of ,california1 ,mr4 ,nunes1 and ,mr4 ,welch7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to promote and expand the application of telehealth under ,medicare and other ,federal health care programs1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,telehealth ,enhancement ,act of #bjac4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4,title ,i--,strengthening ,medicare through telehealth,sec4 #aja4 ,positive incentive for ,medicare's hospital readmissions reduction program4,sec4 #ajb4 ,health homes and medical homes4,sec4 #ajc4 ,flexibility in accountable care organizations coverage of telehealth4,sec4 #ajd4 ,recognizing telehealth services and remote patient monitoring in national pilot program on payment bundling4,sec4 #aje4 ,additional sites to be considered originating sites for purposes of payments for telehealth services under ,medicare4,title ,,ii--,enhancing ,medicaid through telehealth,sec4 #bja4 ,medicaid option for high-risk pregnancies and births4,title ,,iii--,improving telecommunications for medical delivery,sec4 #cja4 ,additional providers considered health care providers for purposes of universal service support4,sec4 #cjb4 ,no consideration of provider location in rules enhancing health care provider access to advanced telecommunications and information services4 ,i ,strengthening ,medicare through telehealth #aja4 ,positive incentive for ,medicare's hospital readmissions reduction program ,section #ahhf7q7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7q77 is amended by adding at the end the following new paragraph3 7#i7 ,positive incentive for reduced readmissions 7,a7 ,in general ,with respect to payment for discharges occurring during a fiscal year beginning on or after ,october #a1 #bjad1 in order to provide a positive incentive for hospitals described in subparagraph 7,b7 to lower their excess readmission ratios1 the ,secretary shall make an additional payment to a hospital in such proportion as provides for a sharing of the savings from such better-than-expected performance between the hospital and the program under this title4 7,b7 ,hospital described ,a hospital described in this subparagraph is an applicable hospital 7as defined in paragraph 7#e77;,c77 not subject to a payment change under paragraph 7#a7 and for which the positive readmission ratio 7described in subparagraph 7,c77 is greater than #a4 7,c7 ,positive readmission ratio ,the positive readmission ratio described in this subparagraph for a hospital is the ratio of-- 7i7 the risk adjusted expected readmissions 7described in subclause 7,,ii7 of paragraph 7#d77;,c77i772 to 7ii7 the risk adjusted readmissions based on actual readmissions 7described in subclause 7,i7 of such paragraph74 4 #ajb4 ,health homes and medical homes 7a7 ,medicare chronic care counterpart to ,medicaid health home 7#a7 ,in general ,title ,,xviii of the ,social ,security ,act is amended by adding at the end the following new section3 #ahii;,b4 ,medicare health home for individuals with chronic conditions 7a7 ,in general ,in the case of a ,state that has amended its ,state plan under title ,,xix in accordance with the option described in section #aide1 the ,secretary may contract with the ,state medical assistance agency with a program under such section to serve eligible individuals with chronic conditions who select a designated provider1 a team of health care professionals operating with such a provider1 or a health team as the individual's health home for purposes of providing the individual with health home services in the same manner as provided under its ,state plan amendment4 7b7 ,health home qualification standards ,the standards established by the ,secretary under section #aide7;b7 for qualification as a designated provider shall apply under this section for the purpose of being eligible to be a health home for purposes of section #aide4 7c7 ,payments ,payments shall be made under this section in the same manner to a provider or team as payments are made under subsection 7c7 of section #aide1 including the use of the payment methodology described in paragraph 7#b7 of such subsection4 7d7 ,hospital referrals ,hospitals that are participating providers under this section shall establish procedures for referring any eligible individuals with chronic conditions who seek or need treatment in a hospital emergency department to designated providers in the same manner as required under section #aide7;d74 7e7 ,monitoring and report on quality ,the methodology and proposal required under subsection 7f7 of section #aide and the report on quality measures under subsection 7f7 of such section shall also apply under this section4 7f7 ,report on quality measures ,as a condition for receiving payment for health home services provided to an eligible individual with chronic conditions1 a designated provider shall report1 in accordance with such requirements as the ,secretary shall specify1 including a plan for the use of remote patient monitoring1 on all applicable measures for determining the quality of such services4 ,when appropriate and feasible1 a designated provider shall use health information technology in providing the ,secretary with such information4 7g7 ,definitions ,in this section1 the provisions and definitions contained in subsection 7h7 of section #aide shall also apply for purposes of this section except that1 instead of the requirement specified in clause 7i7 of subsection 7h77#a77;,a7 of such section1 an individual must be eligible for services under parts ,a and ,b and covered for medical assistance for health home services under section #aide in order to be an eligible individual with chronic conditions4 7h7 ,evidence-,based and reporting ,in contracting with a ,state under this section1 the ,state-- 7#a7 shall follow evidence-based guidelines for chronic care2 and 7#b7 shall report at least by the end of every month data specified by the ,secretary1 including an assessment of the use of remote patient monitoring and quality measures of process1 outcome1 and structure4 7i7 ,waiver authority 7#a7 ,in general ,the limitations on telehealth under section #ahcd7m7 shall not apply for purposes of this section4 7#b7 ,secretary authority ,the ,secretary may waive such other requirements of this title and title ,,xix as may be necessary to carry out the provisions of this section4 4 7#b7 ,reporting 7,a7 ,in general ,not later than #b years after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall survey ,states contracting under section #ahii;,b of the ,social ,security ,act1 as added by paragraph 7#a71 on the nature1 extent1 and use of the option under such section particularly as it pertains to-- 7i7 hospital admission rates2 7ii7 chronic disease management2 7iii7 coordination of care for individuals with chronic conditions2 7iv7 assessment of program implementation2 7v7 processes and lessons learned 7as described in subparagraph 7,b772 7vi7 assessment of quality improvements and clinical outcomes under such option2 and 7vii7 estimates of cost savings4 7,b7 ,implementation reporting ,such a ,state shall report to the ,secretary1 as necessary1 on processes that have been developed and lessons learned regarding provision of coordinated care through a health home for beneficiaries with chronic conditions under such option4 7b7 ,specialty medical homes ,title ,,xviii of the ,social ,security ,act1 as amended by subsection 7a71 is further amended by adding at the end the following new section3 #ahii;,c4 ,specialty medical homes 7a7 ,in general ,beginning not later than #cj days after the date of the enactment of this section1 the ,secretary may contract with a national or multi-state regional center of excellence with a network of affiliated local providers to provide through one or more medical homes for targeted1 accessible1 continuous1 and coordinated care to individuals under this title and title ,,xix with a long-term illness or medical condition that requires regular medical treatment1 advising1 and monitoring4 7b7 ,medical home defined ,in this section1 the term medical home means a medical entity that-- 7#a7 specializes in the care for a specific long-term illness or medical condition1 including related comorbidities2 7#b7 leads the development of related evidence-based clinical standards and research2 7#c7 has a network of affiliated personal physicians and patient treatment facilities2 7#d7 maintains an online ,web site for patient and provider communication and collaboration and patient access to the patient's health information2 7#e7 has a plan for use of health information technology in providing services under this section and improving service delivery and coordination across the care continuum 7including the use of wireless patient technology to improve coordination and remote patient monitoring management of care and patient adherence to recommendations made by their provider72 7#f7 provides deidentified demographic data sets for clinical1 statistical1 and social science research to develop culturally competent best practices and clinical decision support mechanisms for the long-term illness or medical condition2 7#g7 uses a health assessment tool for the individuals targeted1 including a means for identifying those most likely to benefit from remote patient monitoring2 and 7#h7 provides training programs for personnel involved in the coordination of care4 7c7 ,personal physician defined 7#a7 ,in general ,in this section1 the term personal physician means a physician 7as defined in section #ahfa7r77#a77 who meets the requirements described in paragraphs 7#b7 and 7#c74 ,nothing in this paragraph shall be construed as preventing a personal physician from being a specialist or subspecialist for an individual requiring ongoing care for a specific chronic condition or multiple chronic conditions or for an individual with a long-term illness or medical condition4 7#b7 ,general requirements ,the requirements described in this paragraph for a personal physician for care of an individual are as follows3 7,a7 ,the physician is board certified for care of the specific illness or condition of the individual and manages continuous care for the individual4 7,b7 ,the physician has the staff and resources to manage the comprehensive and coordinated health care of such individual4 7#c7 ,service-related requirements ,the requirements described in this paragraph for a personal physician are as follows3 7,a7 ,the personal physician advocates for and provides ongoing support1 oversight1 and guidance to implement a plan of care that provides an integrated1 coherent1 cross-discipline plan for ongoing medical care developed in partnership with patients and including all other physicians furnishing care to the patient involved and other appropriate medical personnel or agencies 7such as home health agencies74 7,b7 ,the personal physician uses evidence-based medicine and clinical decision support tools to guide decisionmaking at the point-of-care based on patient-specific factors4 7,c7 ,the personal physician is in compliance with the standards for meaningful use of electronic health records under this title4 7,d7 ,the personal physician participates with the ,state's health information exchange1 as available1 or the federally sponsored ,direct ,project4 7,e7 ,the personal physician uses health information technology1 including appropriate remote monitoring1 to monitor and track the health status of patients and to provide patients with enhanced and convenient access to health care services4 7,f7 ,the personal physician uses electronic prescribing and provides medication management4 7,g7 ,the personal physician encourages patients to engage in the management of their own health through education and support systems4 7,h7 ,the personal physician utilizes the services of related health professionals1 including nurse practitioners and physician assistants4 7d7 ,long-,term illness or medical condition defined ,in this section1 the term long-term illness or medical condition-- 7#a7 includes a chronic condition which meets criteria specified by the ,secretary for a specialized ,,ma plan for special needs individuals2 and 7#b7 also includes another condition that the ,secretary determines would provide a beneficial focus for an effective and efficient medical home4 7e7 ,payment mechanisms 7#a7 ,medical home care management fee and medical home sharing in savings ,except as provided in paragraph 7#b7-- 7,a7 ,medical home care management fee ,under this section the ,secretary shall provide for payment under section #ahdh of a care management fee to the medical home and may include performance incentives4 ,the medical home shall arrange for payment for the services of affiliated physicians and facilities4 7,b7 ,medical home sharing in savings ,the ,secretary shall provide for payment under this section of a medical home based on the payment methodology applied to health group practices under section #ahff;,a4 ,under such methodology1 #hj percent of the reductions in expenditures under this title and title ,,xix resulting from participation of individuals that are attributable to the medical home 7as reduced by the total care management fees paid to the medical home under this section7 shall be paid to the medical home4 ,the amount of such reductions in expenditures shall be determined by using assumptions with respect to reductions in the occurrence of health complications1 hospitalization rates1 medical errors1 and adverse drug reactions4 7#b7 ,alternative payment model 7,a7 ,in general ,the ,secretary may provide for payment under this paragraph instead of the amounts otherwise payable under paragraph 7#a74 7,b7 ,establishment of target spending level ,for purposes of this paragraph1 the ,secretary shall compute an estimated annual spending target based on the amount the ,secretary estimates would have been spent in the absence of this section1 for items and services covered under parts ,a and ,b furnished to applicable beneficiaries for each qualifying medical home under this section4 ,such spending targets shall be determined on a per capita basis4 ,such spending targets shall include a risk corridor that takes into account normal variation in expenditures for items and services covered under parts ,a and ,b furnished to such beneficiaries with the size of the corridor being related to the number of applicable beneficiaries furnished services by each medical home4 ,the spending targets may also be adjusted for such other factors as the ,secretary determines appropriate4 7,c7 ,incentive payments ,subject to performance on quality measures1 a qualifying medical home is eligible to receive an incentive payment under this section if actual expenditures for a year for the applicable beneficiaries it enrolls are less than the estimated spending target established under subparagraph 7,b7 for such year4 ,an incentive payment for such year shall be equal to a portion 7as determined by the ,secretary7 of the amount by which actual expenditures 7including incentive payments under this paragraph7 for applicable beneficiaries under parts ,a and ,b for such year are estimated to be less than #ie percent of the estimated spending target for such year1 as determined under subparagraph 7,b74 7#c7 ,source ,payments paid under this section shall be made in appropriate proportions 7as specified by the ,secretary7 from the ,hospital ,insurance ,trust ,fund1 the ,federal ,supplementary ,medical ,insurance ,trust ,fund1 and funds appropriated to carry out title ,,xix4 7f7 ,evidence-,based ,the contracting entity shall follow evidence-based guidelines for care of the long-term illness or medical condition under this section4 7g7 ,patient services quality and performance reporting ,the contracting entity shall report at least by the end of every month data specified by the ,secretary on the operation of this section1 including quality measures of process1 outcome1 and structure4 7h7 ,waiver authority 7#a7 ,in general ,the limitations on telehealth under section #ahcd7m7 shall not apply for purposes of this section4 7#b7 ,secretary authority ,the ,secretary may waive such other requirements of this title and title ,,xix as may be necessary to carry out the provisions of this section4 4 #ajc4 ,flexibility in accountable care organizations coverage of telehealth ,section #ahii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;jjj7 is amended by adding at the end the following new subsection3 7l7 ,flexibility for telehealth 7#a7 ,provision as supplemental benefits ,notwithstanding any other provision of this section1 an ,,aco may include coverage of telehealth and remote patient monitoring services as supplemental health care benefits to the same extent as a ,medicare ,advantage plan is permitted to provide coverage of such services as supplemental health care benefits under section #aheb7;a77#c77;,a74 7#b7 ,provision in connection with home health services ,nothing in this section shall be construed as preventing an ,,aco from including payments for remote patient monitoring and home-based video conferencing services in connection with the provision of home health services 7under conditions for which payment for such services would not be made under section #ahie for such services7 in a manner that is financially equivalent to the furnishing of a home health visit4 4 #ajd4 ,recognizing telehealth services and remote patient monitoring in national pilot program on payment bundling ,section #ahff;,d7a77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc-#d7;a77#b77 is amended-- 7#a7 in subparagraph 7,b71 by striking #aj conditions and inserting the conditions2 7#b7 in subparagraph 7,c7-- 7,a7 by redesignating clause 7v7 as clause 7vi72 and 7,b7 by inserting after clause 7iv7 the following new clause3 7v7 ,telehealth and remote patient monitoring services4 2 and 7#c7 in subparagraph 7,d77i77,,iii71 by inserting before the period at the end the following3 7and such longer period in the case of the use of telehealth and remote patient monitoring services as the ,secretary may specify74 #aje4 ,additional sites to be considered originating sites for purposes of payments for telehealth services under ,medicare 7a7 ,in general ,section #ahcd7m77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77 is amended-- 7#a7 in subparagraph 7,c7-- 7,a7 in clause 7i71 by striking ,the term and inserting ,subject to clause 7iii71 the term2 and 7,b7 by adding at the end the following new clause3 7iii7 ,additional originating sites ,the term originating site also includes the following sites1 whether or not they are located in an area described in clause 7i71 insofar as such sites are not otherwise included in the definition of originating site under such clause3 7,i7 ,a critical access hospital 7as described in clause 7ii77,,ii774 7,,ii7 ,a sole community hospital 7as defined in section #ahhf7;d77#e77;,d77iii774 7,,iii7 ,a home telehealth site 7as defined in subparagraph 7,g77i774 7,,iv7 ,a site described in clause 7ii7 that is located in a county with a population of less than #be1jjj1 according to the most recent decennial census or in an area that was not included in a ,metropolitan ,statistical ,area on any date in #bjjj4 7,v7 ,a site described in clause 7ii7 with respect to services related to the evaluation or treatment of an acute stroke4 2 and 7#b7 by adding at the end the following new subparagraph3 7,g7 ,home telehealth site 7i7 ,home telehealth site ,the term home telehealth site means1 with respect to a telehealth service described in clause 7ii7 furnished to an individual1 the in a place of residence used as the home of such individual4 7ii7 ,telehealth services described ,a telehealth service described in this clause is a telehealth service that is-- 7,i7 related to the provision of hospice care or home dialysis2 or 7,,ii7 furnished to an individual who is determined to be homebound 7as defined for purposes of sections #ahad7;a77#b77;,c7 and #ahce7;a77#b77;,a77i771 including such an individual for whom a certification or recertification described in such section is in effect with respect to home health services4 4 7b7 ,no originating site facility fee for new sites ,section #ahcd7m77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#b77;,b77 is amended by inserting after the originating site the following3 7other than an additional originating site described in paragraph 7#d77;,c77iii774 7c7 ,application of telecommunication systems definition to critical access hospitals and sole community hospitals ,the second sentence of section #ahcd7m77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77 is amended by inserting any telehealth services furnished or received at a critical access hospital 7as described in paragraph 7#d77;,c77ii77,,ii77 or a sole community hospital 7as defined in section #ahhf7;d77#e77;,d77iii77 or of after in the case of4 7d7 ,site of care for purposes of determining health care liability ,section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77 is amended by adding at the end the following new paragraph3 7#e7 ,site of care for purposes of health care liability ,for purposes of determining health care liability with respect to telehealth services for which payment is made under this subsection1 such service shall be considered to be furnished at the distant site4 4 7e7 ,effective date 7#a7 ,in general ,except as provided in paragraph 7#b71 the amendments made by this section shall apply to services furnished on or after ,january #a1 #bjad4 7#b7 ,change in ,,msa rule ,the amendment made by subsection 7a77#a77;,b77ii7 shall apply with respect to telehealth services furnished on or after ,february #bh1 #bjac4 ,,ii ,enhancing ,medicaid through telehealth #bja4 ,medicaid option for high-risk pregnancies and births 7a7 ,in general ,title ,,xix of the ,social ,security ,act is amended by adding at the end the following new section3 #aidg4 ,state option to provide coordinated care for enrollees with high-risk pregnancies and births 7a7 ,in general ,notwithstanding section #aijb7;a77#a7 7relating to statewideness71 section #aijb7;a77#aj77;,b7 7relating to comparability71 and any other provision of this title for which the ,secretary determines it is necessary to waive in order to implement this section1 beginning #f months after the date of the enactment of this section1 a ,state1 at its option as a ,state plan amendment1 may provide for medical assistance under this title to eligible individuals for maternal-fetal and neonatal care who select a designated provider 7as described under subsection 7h77#e771 a team of health care professionals 7as described under subsection 7h77#f77 operating with such a provider1 or a health team 7as described under subsection 7h77#g77 as the individual's birthing network for purposes of providing the individual with pregnancy-related services4 7b7 ,qualification standards ,the ,secretary shall establish standards for qualification as a designated provider for the purpose of being eligible to be a birthing network for purposes of this section4 7c7 ,payments 7#a7 ,in general ,a ,state shall provide a designated provider1 a team of health care professionals operating with such a provider1 or a health team with payments for the provision of birthing network services to each eligible individual for maternal-fetal and neonatal care that selects such provider1 team of health care professionals1 or health team as the individual's birthing network4 ,payments made to a designated provider1 a team of health care professionals operating with such a provider1 or a health team for such services shall be treated as medical assistance for purposes of section #aijc7;a71 except that1 during the first #h fiscal year quarters that the ,state plan amendment is in effect1 the ,federal medical assistance percentage applicable to such payments shall be equal to #ij percent4 7#b7 ,savings target ,as a condition for approval of a ,state plan amendment and payment methodology under this section1 the ,state shall provide the ,secretary with assurances that the amendment and methodology shall be projected to reduce the amount of expenditures for pregnancy-related services otherwise made under this title by one percent for each #d-;calendar-quarter period during the first #dj calendar quarters in which the amendment is in effect4 7#c7 ,methodology 7,a7 ,in general ,the ,state shall specify in the ,state plan amendment the methodology the ,state will use for determining payment for the provision of birthing network services4 ,such methodology for determining payment shall be established consistent with section #aijb7;a77#cj77;,a74 7,b7 ,innovative models of payment ,the methodology for determining payment for provision of birthing network services under this section shall not be limited to a per-member per-month basis and may provide 7as proposed by the ,state and subject to approval by the ,secretary7 for alternate models of payment1 including bundled per episode1 performance incentives1 and shared savings4 7#d7 ,planning grants 7,a7 ,in general ,beginning #cj days after the date of the enactment of this section1 the ,secretary may award planning grants to ,states for purposes of developing a ,state plan amendment under this section4 ,a planning grant awarded to a ,state or a multi-state collaborative under this paragraph shall remain available until expended4 7,b7 ,limitation ,the total amount of payments made to ,states under this paragraph shall not exceed #be1jjj1jjj4 7d7 ,report on quality measures ,as a condition for receiving payment for birthing network services provided to an eligible individual for maternal-fetal and neonatal care1 a designated provider shall report monthly to the ,state1 in accordance with such requirements as the ,secretary shall specify1 on all applicable measures for determining the quality of such services4 ,when appropriate and feasible1 a designated provider shall use health information technology in providing the ,state with such information4 7e7 ,evidence-,based ,the birthing network shall adapt1 update1 and follow evidence-based guidelines for maternal-fetal and neonatal care4 7f7 ,definitions ,in this section3 7#a7 ,eligible individual for maternal-fetal and neonatal care 7,a7 ,in general ,subject to subparagraph 7,b71 the term eligible individual means an individual who-- 7i7 is eligible for medical assistance under the ,state plan or under a waiver of such plan2 and 7ii7 7,i7 is pregnant 7or was pregnant during the immediately preceding #cj day period72 or 7,,ii7 is the child of an individual described in clause 7i7 and under #cj days old4 7,b7 ,rule of construction ,nothing in this paragraph shall prevent the ,secretary from establishing other requirements for purposes of determining eligibility for receipt of birthing network services under this section4 7#b7 ,birthing network ,the term birthing network means a designated provider 7including a provider that operates in coordination with a team of health care professionals7 or a health team selected by an eligible individual to provide birthing network services4 7#c7 ,birthing network services 7,a7 ,in general ,the term birthing network services means comprehensive and timely high-quality services described in subparagraph 7,b7 that are provided by a designated provider1 a team of health care professionals operating with such a provider1 or a health team and are identified in a provider registry4 7,b7 ,services described ,the services described in this subparagraph are-- 7i7 comprehensive care coordination2 7ii7 health promotion2 7iii7 a call center to offer #bd-;hour physician support for consultations with maternal-fetal medicine specialists1 when requested1 regarding patient management issues2 7iv7 newborn screening1 including for heart defects and to reduce newborn hospital readmissions2 7v7 patient and family support 7including authorized representatives72 7vi7 referral to community and social support services1 if relevant2 and 7vii7 use of health information technology to link services and provide monitoring1 as feasible and appropriate4 7#d7 ,designated provider ,the term designated provider means a physician1 clinical practice or clinical group practice1 rural clinic1 community health center1 public health agency1 home health agency1 or any other entity or provider 7including pediatricians1 gynecologists1 and obstetricians7 that is determined by the ,state and approved by the ,secretary to be qualified to be a birthing network for eligible individuals on the basis of documentation evidencing that the physician1 practice1 or clinic-- 7,a7 has the systems and infrastructure in place to provide birthing network services2 and 7,b7 satisfies the qualification standards established by the ,secretary under subsection 7b7 and paragraph 7#g77;,b74 7#e7 ,team of health care professionals ,the term team of health care professionals means a team of health professionals 7as described in the ,state plan amendment7 that may-- 7,a7 include physicians and other professionals1 such as a nurse care coordinator1 midwife1 nutritionist1 social worker1 behavioral health professional1 or any professionals deemed appropriate by the ,state2 and 7,b7 be free standing1 virtual1 or based at a hospital1 community health center1 rural clinic1 clinical practice or clinical group practice1 academic health center1 or any entity deemed appropriate by the ,state and approved by the ,secretary4 7#f7 ,health team ,the term health team has the meaning given such term for purposes of section #cejb of the ,patient ,protection and ,affordable ,care ,act4 7#g7 ,birthing data and exchange 7,a7 ,proposal for use of health information technology ,a ,state shall include in the ,state plan amendment a proposal for use of health information technology in providing birthing network services under this section and improving service delivery and coordination across the care continuum 7including the use of wireless patient technology to improve coordination and management of care and patient adherence to recommendations made by their provider74 7,b7 ,information requirements for birthing networks ,the birthing network shall-- 7i7 be in compliance with the ,medicaid standards for meaningful use of electronic health records2 7ii7 participate with the ,state's health information exchange1 as available1 or operate an exchange among the birthing network2 7iii7 collect demographic information on participating newborns and mothers2 7iv7 use demographic and event-based data to identify patients that are likely going to need short or long-term follow-up2 and 7v7 providing de-identified demographic data sets for statistical and social science research to develop culturally competent best practices and clinical decision support mechanisms for maternal-fetal and neonatal care4 4 7b7 ,patient services quality and performance reporting 7#a7 ,in general ,not later than #c years after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall survey ,states that have elected the option under section #aidg of the ,social ,security ,act1 as added by section 7a71 on the nature1 extent1 and use of such option1 particularly as it pertains to-- 7,a7 terms of pregnancies2 7,b7 use of prenatal fetal monitoring2 7,c7 use of ,caesarean section procedures2 7,d7 use of neonatal intensive care services2 7,e7 incidence of birthing complications2 7,f7 incidence of infant and maternal mortality2 7,g7 coordination of maternal-fetal and neonatal care for individuals2 7,h7 assessment of program implementation2 7,i7 processes and lessons learned 7as described in subparagraph 7,b772 7,j7 assessment of quality improvements and clinical outcomes under such option2 and 7,k7 participating mothers' assessment of performance1 quality1 convenience1 and satisfaction4 7#b7 ,implementation reporting ,a ,state that has elected the option under such section shall report to the ,secretary1 as necessary1 on processes that have been developed and lessons learned regarding provision of coordinated care through a birthing network for ,medicaid beneficiaries for maternal-fetal and neonatal care under such option4 ,,iii ,improving telecommunications for medical delivery #cja4 ,additional providers considered health care providers for purposes of universal service support ,subparagraph 7,b7 of section #bed7;h77#g7 of the ,communications ,act of #aicd 7#dg ,u4,s4,c4 #bed7;h77#g77 is amended-- 7#a7 in clause 7vi71 by striking and2 7#b7 in clause 7vii71 by striking clauses 7i7 through 7vi7 and inserting clauses 7i7 through 7ix72 7#c7 by redesignating clause 7vii7 as clause 7x72 and 7#d7 by inserting after clause 7vi7 the following new clauses3 7vii7 ambulance providers and other emergency medical transport providers2 7viii7 health clinics of elementary and secondary schools and post-secondary educational institutions2 7ix7 sites where telehealth services are provided under section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77 or under a ,state plan under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq472 and 4 #cjb4 ,no consideration of provider location in rules enhancing health care provider access to advanced telecommunications and information services ,section #bed7;h77#b77;,a7 of the ,communications ,act of #aicd 7#dg ,u4,s4,c4 #bed7;h77#b77;,a77 is amended by inserting 7regardless of the location of such providers7 after health care providers4