,i  #aac? ,,congress  #b;d ,session  ,h4
 ,r4 #echj  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,july #ca1 #bjad ,mr4 
,?ompson ( ,cali=nia 7= himself1 ,mr4   
,h>p]1 & ,mr4 ,wel*7 introduc$ ! foll[+ 
bill2 :i* 0 ref]r$ to ! ,committee on   
,en]gy & ,comm]ce1 & 9 addition to !    
,committee on ,ways & ,means1 = a p]iod 
to be subsequ5tly det]m9$ by ! ,speak]1 
9 ea* case = consid]ation ( su*         
provisions z fall )9 ! jurisdiction ( ! 
committee conc]n$  ,a ,,bill  ,to am5d  
title ,,xviii ( ! ,social ,security ,act
 to provide = a phas$-9 expansion (     
teleheal? cov]age "u ! ,m$ic>e program4 
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,m$ic>e ,teleheal? ,p>ity ,act (      
#bjad4  #b4 ,phas$-9 expansion (        
teleheal? cov]age "u ,m$ic>e  7a7       
,initial phase  7#a7 ,expansion (       
orig9at+ sites ,section                 
#ahcd7m77#d77;,c7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciem7m77#d77;,c77 
is am5d$--  7,a7 9 clause 7i71 by /rik+ 
,! t]m & ins]t+ ,subject to clause      

7iii71 ! t]m2 &  7,b7 by add+ at ! end !
 foll[+ new clause3  7iii7 ,additional  
sites ,! t]m orig9at+ site %all also    
include ! foll[+ sites at :i* ! eligible
 teleheal? individual is locat$ at ! "t 
! s]vice is furni%$ via a               
telecommunications sy/em1 :e!r or n !y  
are locat$ 9 an area describ$ 9 clause  
7i71 ins(> z su* sites are n o!rwise    
includ$ 9 ! def9ition ( orig9at+ site "u
 su* clause3  7,i7 ,9 ! case ( su* a    
s]vice furni%$ on or aft] ! date t is #f
 mon?s aft] ! date ( ! enactm5t ( !     
,m$ic>e ,teleheal? ,p>ity ,act ( #bjad1 
any ,f$]ally qualifi$ heal? c5t] & any  
rural heal? cl9ic 7z su* t]ms are def9$ 
9 section #ahfa7;aa774  7,,ii7 ,9 ! case
 ( su* a s]vice furni%$ on or aft] !    
date t is #f mon?s aft] ! date ( !      
enactm5t ( ! ,m$ic>e ,teleheal? ,p>ity  
,act ( #bjad1 any site describ$ 9 clause
 7ii7 t is locat$ 9 a c\nty )9 a        
,metropolitan ,/ati/ical ,area ) a      
population ( few] ?an #ej1jjj           
individuals1 accord+ to ! mo/ rec5t     

dec5nial c5sus4  4  7#b7 ,orig9at+ site 
fee n to apply to additional sites      
,section #ahcd7m77#b77;,b7 ( su* ,act   
7#db ,u4,s4,c4 #aciem7m77#d77;,c77 is   
am5d$ by ins]t+ aft] & bel[ clause 7ii7 
! foll[+3  ,! facility fee "u ?is       
subp>agraph %all n apply to any site    
includ$ z an orig9at+ site pursuant to  
clause 7iii7 ( p>agraph 7#d77;,c7 t w\ld
 n o!rwise be includ$ z an orig9at+ site
 )\t application ( su* clause4 4  7#c7  
,additional teleheal? provid]s ,section 
#ahcd7m7 ( su* ,act 7#db ,u4,s4,c4      
#aciem7m77 is am5d$--  7,a7 9 p>agraph  
7#a71 by /rik+ or a practition]         
7describ$ 9 section #ahdb7;b77#ah77;,c77
 & ins]t+ or a practition] 7z def9$ 9   
p>agraph 7#d77;,e772 &  7,b7 9 p>agraph 
7#d71 by--  7i7 /rik+ subp>agraph 7,e72 
&  7ii7 ins]t+ aft] subp>agraph 7,d7 !  
foll[+ new subp>agraph3  7,e7           
,practition] ,! t]m practition] means-- 
7i7 a practition] describ$ 9 section    
#ahdb7;b77#ah77;,c72 &  7ii7 ) respect  
to s]vices furni%$ on or aft] ! date t  

is #f mon?s aft] ! date ( ! enactm5t ( !
 ,m$ic>e ,teleheal? ,p>ity ,act ( #bjad1
 a c]tifi$ diabetes educator or lic5s$--
  7,i7 respiratory !rapi/2  7,,ii7      
audiologi/2  7,,iii7 occupational       
!rapi/2  7,,iv7 physical !rapi/2 or     
7,v7 spee* language pa?ologi/4  4  7#d7 
,cov]age ( remote pati5t managem5t      
s]vices = c]ta9 *ronic heal? conditions 
7,a7 ,9 g5]al ,section #ahfa7s77#b7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#aciex7s77#b77 is am5d$--  7i7 9        
subp>agraph 7,,ee71 by /rik+ & at ! end2
  7ii7 9 subp>agraph 7,,ff71 by ins]t+ &
 at ! end2 &  7iii7 by ins]t+ aft]      
subp>agraph 7,,ff7 ! foll[+ new         
subp>agraph3  7,,gg7 remote pati5t      
managem5t s]vices 7z def9$ 9 subsection 
7iii772 4  7,b7 ,s]vices describ$       
,section #ahfa ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #aciex7 is am5d$ by 
add+ at ! end ! foll[+ new subsection3  
7iii7 ,remote pati5t managem5t s]vices =
 *ronic heal? conditions  7#a7 ,! t]m   
remote pati5t managem5t s]vices means ! 

remote monitor+1 evaluation1 & managem5t
 ( an individual ) a cov]$ *ronic heal? 
condition 7z def9$ 9 p>agraph 7#b771    
ins(> z su* monitor+1 evaluation1 &     
managem5t is ) respect to su* condition1
 ?r\gh ! utilization ( a sy/em (        
te*nology t all[s a remote int]face to  
collect & transmit cl9ical data betwe5 !
 individual & ! responsible physician 7z
 def9$ 9 subsection 7r77 or practition] 
or o!r suppli] 7z def9$ 9 subsection    
7d77 = ! purposes ( cl9ical review4 ,su*
 s]vices %all include 9-home te*nology  
bas$ pr(essional consultations1 pati5t  
monitor+1 pati5t tra9+ s]vices1 cl9ical 
obs]vation1 assessm5t1 treatm5t1 & any  
o!r s]vices t utilize te*nologies       
specifi$ by ! ,secret>y4 ,su* t]m %all n
 include a telecommunication t consi/s  
solely ( a telephone audio conv]sation1 
facsimile1 or electronic text mail      
betwe5 a heal? c>e pr(essional & pati5t4
  7#b7 ,= purposes ( p>agraph 7#a71 !   
t]m cov]$ *ronic heal? condition means--
  7,a7 conge/ive he>t failure2  7,b7    

*ronic ob/ructive pulmon>y disease2 &   
7,c7 9 ! case ( s]vices furni%$ at a    
f$]ally qualifi$ heal? c5t]1 diabetes4  
7#c7  7,a7 ,! ,secret>y1 9 consultation 
) appropriate physician1 practition]1 & 
suppli] gr\ps1 %all develop guidel9es on
 ! frequ5cy ( bill+ = remote pati5t     
managem5t s]vices4 ,su* guidel9es %all  
be det]m9$ bas$ on m$ical necessity &   
%all be suffici5t to ensure appropriate 
& timely monitor+ ( individuals be+     
furni%$ su* s]vices4  7,b7 ,! ,secret>y 
%all d ! foll[+3  7i7 ,n lat] ?an #b    
ye>s aft] ! date ( ! enactm5t ( ?is     
subsection1 develop1 9 consultation )   
appropriate physician1 practition]1 &   
suppli] gr\ps1 /&>ds 7gov]n+ su* matt]s 
z qualifications ( p]sonnel & !         
ma9t5ance ( equipm5t7 = remote pati5t   
managem5t s]vices = ! cov]$ *ronic heal?
 conditions specifi$ 9 p>agraph 7#b74   
7ii7 ,p]iodically review & update su*   
/&>ds "u ?is subp>agraph z necess>y4  4 
7,c7 ,paym5t "u ! physician fee s*$ule  
,section #ahdh ( ! ,social ,security    

,act 7#db ,u4,s4,c4 #aciew-#d7 is       
am5d$--  7i7 9 subsection 7c7--  7,i7 9 
p>agraph 7#b777;,b7--  7aa7 9 clause    
7ii77,,ii71 by /rik+ & 7v7 & ins]t+ 7v71
 & 7vii72 &  7bb7 by add+ at ! end !    
foll[+ new clause3  7vii7 ,budget>y     
treatm5t ( c]ta9 s]vices ,! additional  
exp5ditures attributable to s]vices     
describ$ 9 section #ahfa7s77#b77;,,gg7  
%all n be tak5 into acc\nt 9 apply+     
clause 7ii77,,ii74  2 &  7,,ii7 by add+ 
at ! end ! foll[+ new p>agraph3  7#g7   
,treatm5t ( remote pati5t managem5t     
s]vices  7,a7 ,9 det]m9+ relative value 
units = remote pati5t managem5t s]vices 
7z def9$ 9 section #ahfa7;iii771 !      
,secret>y1 9 consultation ) appropriate 
physician gr\ps1 practition] gr\ps1 &   
suppli] gr\ps1 %all take into           
consid]ation--  7i7 physician or        
practition] res\rces1 includ+ physician 
or practition] "t & ! level ( int5sity (
 s]vices provid$1 bas$ on--  7,i7 !     
frequ5cy ( evaluation necess>y to manage
 ! individual be+ furni%$ ! s]vices2    

7,,ii7 ! complexity ( ! evaluation1     
includ+ ! in=mation t mu/ be obta9$1    
review$1 & analyz$2 &  7,,iii7 ! numb] (
 possible diagnoses & ! numb] (         
managem5t options t mu/ be consid]$2    
7ii7 practice exp5se co/s associat$ )   
su* s]vices1 includ+ ! direct co/s      
associat$ ) in/allation & in=mation     
transmission1 co/s ( remote pati5t      
managem5t te*nology 7includ+ equipm5t & 
s(tw>e71 device deliv]y co/s1 & res\rce 
co/s necess>y = pati5t monitor+ &       
foll[-up 7b n includ+ co/s ( any relat$ 
item or non-physician s]vice o!rwise    
reimburs$ "u ?is title72 &  7iii7       
malpractice exp5se res\rces4  7,b7 ,us+ 
! relative value units det]m9$ 9        
subp>agraph 7,a71 ! ,secret>y %all      
provide = sep>ate paym5t = su* s]vices &
 %all n adju/ ! relative value units    
assign$ to o!r s]vices t might o!rwise h
 be5 det]m9$ to include su* sep>ately   
paid remote pati5t managem5t s]vices4  2
 &  7ii7 9 subsection 7j77#c71 by ins]t+
 7#b77;,,gg71 aft] heal? risk           

assessm5t714  7,d7 ,effective date  7i7 
,9 g5]al ,! am5dm5ts made by ?is        
subsection %all apply to s]vices furni%$
 on or aft] ! date t is #f mon?s aft] ! 
date ( ! enactm5t ( ?is ,act1 )\t reg>d 
to :e!r ! guidel9es "u p>agraph         
7#c77;,a7 or ! /&>ds "u p>agraph        
7#c77;,b7 ( section #ahfa7;iii7 ( !     
,social ,security ,act1 z add$ by       
subp>agraph 7,b71 h be5 develop$4  7ii7 
,availability ( codes z ( date (        
enactm5t ,! ,secret>y ( ,heal? & ,human 
,s]vices %all--  7,i7 promptly evaluate 
exi/+ codes t w\ld be us$ to bill =     
remote pati5t managem5t s]vices 7z def9$
 9 p>agraph 7#a7 ( su* section          
#ahfa7;iii71 z s add$7 "u title ,,xviii 
( ! ,social ,security ,act2 &  7,,ii7 if
 ! ,secret>y det]m9es t new codes are   
necess>y to ensure accurate report+ &   
bill+ ( su* s]vices "u su* title1 issue 
su* codes s t !y are available = use z (
 ! date ( ! enactm5t ( ?is ,act4  7,e7  
,,gao /udy & report  7i7 ,/udy ,!       
,comptroll] ,g5]al ( ! ,unit$ ,/ates    

%all conduct a /udy t includes1 at a    
m9imum1 ! foll[+3  7,i7 ,! effectiv5ess 
( remote pati5t monitor+ on decreas+    
hospital readmissions = ! *ronic        
conditions describ$ 9 subsection        
7iii77#b7 ( section #ahfa ( ! ,social   
,security ,act 7#db ,u4,s4,c4 #aciex71 z
 add$ by subp>agraph 7,a74  7,,ii7 ,!   
sav+s to ! ,m$ic>e program "u title     
,,xviii ( su* ,act associat$ ) remote   
pati5t monitor+ use ) respect to su*    
*ronic conditions4  7,,iii7 ,! pot5tial 
= great] use ( remote pati5t monitor+ = 
o!r *ronic conditions4  7,,iv7 ,pot5tial
 implications ( great] use ( remote     
pati5t monitor+ ) respect to paym5t &   
deliv]y sy/em trans=mations "u ! ,m$ic>e
 program "u su* title4  7ii7 ,report ,n 
lat] ?an #b ye>s aft] ! date ( !        
enactm5t ( ?is ,act1 ! ,comptroll]      
,g5]al %all submit to ,congress a report
 conta9+ ! results ( ! /udy conduct$ "u 
clause 7i74  7#e7 ,expansion (          
telecommunications sy/em ,! second      
s5t5ce ( section #ahcd7m77#a7 ( !       

,social ,security ,act 7#db ,u4,s4,c4   
#ahcem7m77#a77 is am5d$ by /rik+ 9 !    
case ( any ,f$]al telem$ic9e            
demon/ration program conduct$ 9 ,alaska 
or ,hawaii14  7b7 ,second phase  7#a7   
,fur!r expansion ( orig9at+ sites       
,section #ahcd7m77#d7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#aciem7m77#d77 is am5d$--  7,a7 9 clause
 7iii7 ( subp>agraph 7,c71 z add$ by    
subsection 7a77#a71 by add+ at ! end !  
foll[+ new subclauses3  7,,iv7 ,9 ! case
 ( su* a s]vice furni%$ on or aft] !    
date t is #b ye>s aft] ! date ( !       
enactm5t ( ! ,m$ic>e ,teleheal? ,p>ity  
,act ( #bjad1 any site describ$ 9 clause
 7ii7 t is locat$ 9 a c\nty )9 a        
,metropolitan ,/ati/ical ,area ) a      
population ( at lea/ #ej1jjj individuals
 b few] ?an #ajj1jjj individuals1       
accord+ to ! mo/ rec5t dec5nial c5sus4  
7,v7 ,9 ! case ( su* a s]vice furni%$ on
 or aft] ! date t is #b ye>s aft] ! date
 ( ! enactm5t ( ! ,m$ic>e ,teleheal?    
,p>ity ,act ( #bjad1 a home teleheal?   

site1 z def9$ 9 subp>agraph 7,g74  2 &  
7,b7 by add+ at ! end ! foll[+ new      
subp>agraph3  7,g7 ,home teleheal? site 
7i7 ,9 g5]al ,! t]m home teleheal? site 
means1 ) respect to a teleheal? s]vice  
describ$ 9 clause 7ii7 furni%$ to an    
individual1 9 a place ( resid5ce us$ z !
 home ( su* individual4  7ii7 ,teleheal?
 s]vices describ$ ,a teleheal? s]vice   
describ$ 9 ?is clause--  7,i7 is a      
teleheal? s]vice t is relat$ to !       
provision ( hospice c>e1 home dialysis1 
home heal? s]vices1 or durable m$ical   
equipm5t2 &  7,,ii7 %all include ! use (
 video conf]5c+4  4  7#b7 ,additional   
cov]$ teleheal? s]vices ,section        
#ahcd7m77#d77;,f77i7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#acim7m77#d77;,f77i77 is am5d$ by add+  
at ! end ! foll[+ new s5t5ce3 ,beg9n+ on
 ! date t is #b ye>s aft] ! date ( !    
enactm5t ( ! ,m$ic>e ,teleheal? ,p>ity  
,act ( #bjad1 su* t]m %all include      
respiratory s]vices1 audiology s]vices  
7z def9$ 9 section #ahfa7ll771 &        

outpati5t !rapy s]vices1 includ+        
physical !rapy1 occupational !rapy1 &   
spee*-language pa?ology s]vices4  7#c7  
,,gao /udy & report  7,a7 ,/udy ,!      
,comptroll] ,g5]al ( ! ,unit$ ,/ates    
%all conduct a /udy t includes1 at a    
m9imum1 ! foll[+3  7i7 ,! effectiv5ess (
 us+ teleheal? s]vices describ$ 9 !     
second s5t5ce ( section                 
#ahcd7m77#d77;,f77i7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#aciem7m77#d77;,f77i771 z add$ by       
p>agraph 7#b71 betwe5 !rapy provid]s &  
pati5ts4  7ii7 ,! sav+s to ! ,m$ic>e    
program "u title ,,xviii ( su* ,act     
associat$ ) teleheal? s]vices           
utilization = !rapy = su* s]vices       
describ$ 9 su* s5t5ce4  7iii7 ,!        
pot5tial = great] use ( teleheal?       
s]vices = =ms ( !rapy n describ$ 9 su*  
s5t5ce4  7c7 ,f9al phase  7#a7 ,fur!r   
expansion ( orig9at+ sites ,clause 7iii7
 ( section #ahcd7m77#d77;,c7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#aciem7m77#d771 z add$ by subsection    

7a77#a7 & am5d$ by subsection 7b77#a71  
is fur!r am5d$ by add+ at ! end ! foll[+
 new subclause3  7,,vi7 ,9 ! case ( su* 
a s]vice furni%$ on or aft] ! date t is 
#d ye>s aft] ! date ( ! enactm5t ( !    
,m$ic>e ,teleheal? ,p>ity ,act ( #bjad1 
any site describ$ 9 clause 7ii7 t is    
locat$ 9 a c\nty )9 a ,metropolitan     
,/ati/ical ,area ) a population ( at    
lea/ #ajj1jjj individuals1 accord+ to ! 
mo/ rec5t dec5nial c5sus4  4  7#b7      
,paym5t me?ods = o!r pati5t sites       
,section #ahcd7m77#b7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#aciem7m77#b77 is am5d$ by add+ at ! end
 ! foll[+ new subp>agraph3  7,d7 ,paym5t
 me?ods = o!r pati5t sites ,) respect to
 s]vices furni%$ on or aft] ! date t is 
#d ye>s aft] ! date ( ! enactm5t ( !    
,m$ic>e ,teleheal? ,p>ity ,act ( #bjad1 
! ,secret>y may develop & implem5t      
paym5t me?ods t w\ld apply "u ?is       
subsection 9 ! case ( an individual :o  
w\ld be an eligible teleheal? individual
 except t ! teleheal? s]vices are       

furni%$ at a site o!r ?an an orig9at+   
site4 ,su* me?ods %all be design$ to    
take into acc\nt ! co/s relat$ to ! site
 involv$ & r$uc$ co/s = ! di/ant site4  
4