,i #aacth ,,congress #b;d ,session ,h4 ,r4 #echj ,,in ,,the ,,house ,,of ,,representatives ,july #ca1 #bjad ,mr4 ,thompson of ,california 7for himself1 ,mr4 ,harper1 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 amend title ,,xviii of the ,social ,security ,act to provide for a phased-in expansion of telehealth coverage under the ,medicare program4 #a4 ,short title ,this ,act may be cited as the ,medicare ,telehealth ,parity ,act of #bjad4 #b4 ,phased-in expansion of telehealth coverage under ,medicare 7a7 ,initial phase 7#a7 ,expansion of originating sites ,section #ahcd7m77#d77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,c77 is amended-- 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 sites ,the term originating site shall also include the following sites at which the eligible telehealth individual is located at the time the service is furnished via a telecommunications system1 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 ,in the case of such a service furnished on or after the date that is #f months after the date of the enactment of the ,medicare ,telehealth ,parity ,act of #bjad1 any ,federally qualified health center and any rural health clinic 7as such terms are defined in section #ahfa7;aa774 7,,ii7 ,in the case of such a service furnished on or after the date that is #f months after the date of the enactment of the ,medicare ,telehealth ,parity ,act of #bjad1 any site described in clause 7ii7 that is located in a county within a ,metropolitan ,statistical ,area with a population of fewer than #ej1jjj individuals1 according to the most recent decennial census4 4 7#b7 ,originating site fee not to apply to additional sites ,section #ahcd7m77#b77;,b7 of such ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,c77 is amended by inserting after and below clause 7ii7 the following3 ,the facility fee under this subparagraph shall not apply to any site included as an originating site pursuant to clause 7iii7 of paragraph 7#d77;,c7 that would not otherwise be included as an originating site without application of such clause4 4 7#c7 ,additional telehealth providers ,section #ahcd7m7 of such ,act 7#db ,u4,s4,c4 #aciem7m77 is amended-- 7,a7 in paragraph 7#a71 by striking or a practitioner 7described in section #ahdb7;b77#ah77;,c77 and inserting or a practitioner 7as defined in paragraph 7#d77;,e772 and 7,b7 in paragraph 7#d71 by-- 7i7 striking subparagraph 7,e72 and 7ii7 inserting after subparagraph 7,d7 the following new subparagraph3 7,e7 ,practitioner ,the term practitioner means-- 7i7 a practitioner described in section #ahdb7;b77#ah77;,c72 and 7ii7 with respect to services furnished on or after the date that is #f months after the date of the enactment of the ,medicare ,telehealth ,parity ,act of #bjad1 a certified diabetes educator or licensed-- 7,i7 respiratory therapist2 7,,ii7 audiologist2 7,,iii7 occupational therapist2 7,,iv7 physical therapist2 or 7,v7 speech language pathologist4 4 7#d7 ,coverage of remote patient management services for certain chronic health conditions 7,a7 ,in general ,section #ahfa7s77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b77 is amended-- 7i7 in subparagraph 7,,ee71 by striking and at the end2 7ii7 in subparagraph 7,,ff71 by inserting and at the end2 and 7iii7 by inserting after subparagraph 7,,ff7 the following new subparagraph3 7,,gg7 remote patient management services 7as defined in subsection 7iii772 4 7,b7 ,services described ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is amended by adding at the end the following new subsection3 7iii7 ,remote patient management services for chronic health conditions 7#a7 ,the term remote patient management services means the remote monitoring1 evaluation1 and management of an individual with a covered chronic health condition 7as defined in paragraph 7#b771 insofar as such monitoring1 evaluation1 and management is with respect to such condition1 through the utilization of a system of technology that allows a remote interface to collect and transmit clinical data between the individual and the responsible physician 7as defined in subsection 7r77 or practitioner or other supplier 7as defined in subsection 7d77 for the purposes of clinical review4 ,such services shall include in-home technology based professional consultations1 patient monitoring1 patient training services1 clinical observation1 assessment1 treatment1 and any other services that utilize technologies specified by the ,secretary4 ,such term shall not include a telecommunication that consists solely of a telephone audio conversation1 facsimile1 or electronic text mail between a health care professional and patient4 7#b7 ,for purposes of paragraph 7#a71 the term covered chronic health condition means-- 7,a7 congestive heart failure2 7,b7 chronic obstructive pulmonary disease2 and 7,c7 in the case of services furnished at a federally qualified health center1 diabetes4 7#c7 7,a7 ,the ,secretary1 in consultation with appropriate physician1 practitioner1 and supplier groups1 shall develop guidelines on the frequency of billing for remote patient management services4 ,such guidelines shall be determined based on medical necessity and shall be sufficient to ensure appropriate and timely monitoring of individuals being furnished such services4 7,b7 ,the ,secretary shall do the following3 7i7 ,not later than #b years after the date of the enactment of this subsection1 develop1 in consultation with appropriate physician1 practitioner1 and supplier groups1 standards 7governing such matters as qualifications of personnel and the maintenance of equipment7 for remote patient management services for the covered chronic health conditions specified in paragraph 7#b74 7ii7 ,periodically review and update such standards under this subparagraph as necessary4 4 7,c7 ,payment under the physician fee schedule ,section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7 is amended-- 7i7 in subsection 7c7-- 7,i7 in paragraph 7#b777;,b7-- 7aa7 in clause 7ii77,,ii71 by striking and 7v7 and inserting 7v71 and 7vii72 and 7bb7 by adding at the end the following new clause3 7vii7 ,budgetary treatment of certain services ,the additional expenditures attributable to services described in section #ahfa7s77#b77;,,gg7 shall not be taken into account in applying clause 7ii77,,ii74 2 and 7,,ii7 by adding at the end the following new paragraph3 7#g7 ,treatment of remote patient management services 7,a7 ,in determining relative value units for remote patient management services 7as defined in section #ahfa7;iii771 the ,secretary1 in consultation with appropriate physician groups1 practitioner groups1 and supplier groups1 shall take into consideration-- 7i7 physician or practitioner resources1 including physician or practitioner time and the level of intensity of services provided1 based on-- 7,i7 the frequency of evaluation necessary to manage the individual being furnished the services2 7,,ii7 the complexity of the evaluation1 including the information that must be obtained1 reviewed1 and analyzed2 and 7,,iii7 the number of possible diagnoses and the number of management options that must be considered2 7ii7 practice expense costs associated with such services1 including the direct costs associated with installation and information transmission1 costs of remote patient management technology 7including equipment and software71 device delivery costs1 and resource costs necessary for patient monitoring and follow-up 7but not including costs of any related item or non-physician service otherwise reimbursed under this title72 and 7iii7 malpractice expense resources4 7,b7 ,using the relative value units determined in subparagraph 7,a71 the ,secretary shall provide for separate payment for such services and shall not adjust the relative value units assigned to other services that might otherwise have been determined to include such separately paid remote patient management services4 2 and 7ii7 in subsection 7j77#c71 by inserting 7#b77;,,gg71 after health risk assessment714 7,d7 ,effective date 7i7 ,in general ,the amendments made by this subsection shall apply to services furnished on or after the date that is #f months after the date of the enactment of this ,act1 without regard to whether the guidelines under paragraph 7#c77;,a7 or the standards under paragraph 7#c77;,b7 of section #ahfa7;iii7 of the ,social ,security ,act1 as added by subparagraph 7,b71 have been developed4 7ii7 ,availability of codes as of date of enactment ,the ,secretary of ,health and ,human ,services shall-- 7,i7 promptly evaluate existing codes that would be used to bill for remote patient management services 7as defined in paragraph 7#a7 of such section #ahfa7;iii71 as so added7 under title ,,xviii of the ,social ,security ,act2 and 7,,ii7 if the ,secretary determines that new codes are necessary to ensure accurate reporting and billing of such services under such title1 issue such codes so that they are available for use as of the date of the enactment of this ,act4 7,e7 ,,gao study and report 7i7 ,study ,the ,comptroller ,general of the ,united ,states shall conduct a study that includes1 at a minimum1 the following3 7,i7 ,the effectiveness of remote patient monitoring on decreasing hospital readmissions for the chronic conditions described in subsection 7iii77#b7 of section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex71 as added by subparagraph 7,a74 7,,ii7 ,the savings to the ,medicare program under title ,,xviii of such ,act associated with remote patient monitoring use with respect to such chronic conditions4 7,,iii7 ,the potential for greater use of remote patient monitoring for other chronic conditions4 7,,iv7 ,potential implications of greater use of remote patient monitoring with respect to payment and delivery system transformations under the ,medicare program under such title4 7ii7 ,report ,not later than #b years after the date of the enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report containing the results of the study conducted under clause 7i74 7#e7 ,expansion of telecommunications system ,the second sentence of section #ahcd7m77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #ahcem7m77#a77 is amended by striking in the case of any ,federal telemedicine demonstration program conducted in ,alaska or ,hawaii14 7b7 ,second phase 7#a7 ,further expansion of originating sites ,section #ahcd7m77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77 is amended-- 7,a7 in clause 7iii7 of subparagraph 7,c71 as added by subsection 7a77#a71 by adding at the end the following new subclauses3 7,,iv7 ,in the case of such a service furnished on or after the date that is #b years after the date of the enactment of the ,medicare ,telehealth ,parity ,act of #bjad1 any site described in clause 7ii7 that is located in a county within a ,metropolitan ,statistical ,area with a population of at least #ej1jjj individuals but fewer than #ajj1jjj individuals1 according to the most recent decennial census4 7,v7 ,in the case of such a service furnished on or after the date that is #b years after the date of the enactment of the ,medicare ,telehealth ,parity ,act of #bjad1 a home telehealth site1 as defined in subparagraph 7,g74 2 and 7,b7 by adding at the end the following new subparagraph3 7,g7 ,home telehealth site 7i7 ,in general ,the term home telehealth site means1 with respect to a telehealth service described in clause 7ii7 furnished to an individual1 in a place of residence used as the home of such individual4 7ii7 ,telehealth services described ,a telehealth service described in this clause-- 7,i7 is a telehealth service that is related to the provision of hospice care1 home dialysis1 home health services1 or durable medical equipment2 and 7,,ii7 shall include the use of video conferencing4 4 7#b7 ,additional covered telehealth services ,section #ahcd7m77#d77;,f77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acim7m77#d77;,f77i77 is amended by adding at the end the following new sentence3 ,beginning on the date that is #b years after the date of the enactment of the ,medicare ,telehealth ,parity ,act of #bjad1 such term shall include respiratory services1 audiology services 7as defined in section #ahfa7ll771 and outpatient therapy services1 including physical therapy1 occupational therapy1 and speech-language pathology services4 7#c7 ,,gao study and report 7,a7 ,study ,the ,comptroller ,general of the ,united ,states shall conduct a study that includes1 at a minimum1 the following3 7i7 ,the effectiveness of using telehealth services described in the second sentence of section #ahcd7m77#d77;,f77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,f77i771 as added by paragraph 7#b71 between therapy providers and patients4 7ii7 ,the savings to the ,medicare program under title ,,xviii of such ,act associated with telehealth services utilization for therapy for such services described in such sentence4 7iii7 ,the potential for greater use of telehealth services for forms of therapy not described in such sentence4 7c7 ,final phase 7#a7 ,further expansion of originating sites ,clause 7iii7 of section #ahcd7m77#d77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d771 as added by subsection 7a77#a7 and amended by subsection 7b77#a71 is further amended by adding at the end the following new subclause3 7,,vi7 ,in the case of such a service furnished on or after the date that is #d years after the date of the enactment of the ,medicare ,telehealth ,parity ,act of #bjad1 any site described in clause 7ii7 that is located in a county within a ,metropolitan ,statistical ,area with a population of at least #ajj1jjj individuals1 according to the most recent decennial census4 4 7#b7 ,payment methods for other patient sites ,section #ahcd7m77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#b77 is amended by adding at the end the following new subparagraph3 7,d7 ,payment methods for other patient sites ,with respect to services furnished on or after the date that is #d years after the date of the enactment of the ,medicare ,telehealth ,parity ,act of #bjad1 the ,secretary may develop and implement payment methods that would apply under this subsection in the case of an individual who would be an eligible telehealth individual except that the telehealth services are furnished at a site other than an originating site4 ,such methods shall be designed to take into account the costs related to the site involved and reduced costs for the distant site4 4