,,ii #aac? ,,congress #b;d ,session ,s4 #bffb ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,july #bd1 #bjad ,mr4 ,co*ran 7= himself & ,mr4 ,wick]7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to promote & exp& ! application ( teleheal? "u ,m$ic>e & o!r ,f$]al heal? c>e programs1 & = o!r purposes4 #a4 ,%ort title2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,teleheal? ,enhancem5t ,act ( #bjad4 7b7 ,table ( cont5ts ,! table ( cont5ts ( ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 table ( cont5ts4 ,title ,i--,/r5g!n+ ,m$ic>e ?r\gh teleheal? ,sec4 #aja4 ,positive inc5tive = ,m$ic>e's hospital readmissions r$uction program4 ,sec4 #ajb4 ,heal? homes & m$ical homes4 ,sec4 #ajc4 ,flexibility 9 acc\ntable c>e organizations cov]age ( teleheal?4 ,sec4 #ajd4 ,recogniz+ teleheal? s]vices & remote pati5t monitor+ 9 national pilot program on paym5t bundl+4 ,sec4 #aje4 ,additional sites to be consid]$ orig9at+ sites = purposes ( paym5ts = teleheal? s]vices "u ,m$ic>e4 ,title ,,ii--,enhanc+ ,m$icaid ?r\gh teleheal? ,sec4 #bja4 ,m$icaid option = high-risk pregnancies & bir?s4 ,title ,,iii--,improv+ telecommunications = m$ical deliv]y ,sec4 #cja4 ,additional provid]s consid]$ heal? c>e provid]s = purposes ( univ]sal s]vice support4 ,sec4 #cjb4 ,no consid]ation ( provid] location 9 rules enhanc+ heal? c>e provid] access to advanc$ telecommunications & in=mation s]vices4 ,i ,/r5g!n+ ,m$ic>e ?r\gh teleheal? #aja4 ,positive inc5tive = ,m$ic>e's hospital readmissions r$uction program ,section #ahhf7q7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7q77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#i7 ,positive inc5tive = r$uc$ readmissions 7,a7 ,9 g5]al ,) respect to paym5t = dis*>ges occurr+ dur+ a fiscal ye> beg9n+ on or aft] ,octob] #a1 #bjad1 9 ord] to provide a positive inc5tive = hospitals describ$ 9 subp>agraph 7,b7 to l[] _! excess readmission ratios1 ! ,secret>y %all make an additional paym5t to a hospital 9 su* proportion z provides = a %>+ ( ! sav+s f su* bett]-?an-expect$ p]=mance betwe5 ! hospital & ! program "u ?is title4 7,b7 ,hospital describ$ ,a hospital describ$ 9 ?is subp>agraph is an applicable hospital 7z def9$ 9 p>agraph 7#e77;,c77 n subject to a paym5t *ange "u p>agraph 7#a7 & = :i* ! positive readmission ratio 7describ$ 9 subp>agraph 7,c77 is great] ?an #a4 7,c7 ,positive readmission ratio ,! positive readmission ratio describ$ 9 ?is subp>agraph = a hospital is ! ratio (-- 7i7 ! risk adju/$ expect$ readmissions 7describ$ 9 subclause 7,,ii7 ( p>agraph 7#d77;,c77i772 to 7ii7 ! risk adju/$ readmissions bas$ on actual readmissions 7describ$ 9 subclause 7,i7 ( su* p>agraph74 4 #ajb4 ,heal? homes & m$ical homes 7a7 ,m$ic>e *ronic c>e c\nt]p>t to ,m$icaid heal? home 7#a7 ,9 g5]al ,title ,,xviii ( ! ,social ,security ,act is am5d$ by add+ at ! end ! foll[+ new section3 #ahii;,b4 ,m$ic>e heal? home = individuals ) *ronic conditions 7a7 ,9 g5]al ,9 ! case ( a ,/ate t has am5d$ its ,/ate plan "u title ,,xix 9 accordance ) ! option describ$ 9 section #aide1 ! ,secret>y may contract ) ! ,/ate m$ical assi/ance ag5cy ) a program "u su* section to s]ve eligible individuals ) *ronic conditions :o select a designat$ provid]1 a team ( heal? c>e pr(essionals op]at+ ) su* a provid]1 or a heal? team z ! individual's heal? home = purposes ( provid+ ! individual ) heal? home s]vices 9 ! same mann] z provid$ "u its ,/ate plan am5dm5t4 7b7 ,heal? home qualification /&>ds ,! /&>ds e/abli%$ by ! ,secret>y "u section #aide7;b7 = qualification z a designat$ provid] %all apply "u ?is section = ! purpose ( be+ eligible to be a heal? home = purposes ( section #aide4 7c7 ,paym5ts ,paym5ts %all be made "u ?is section 9 ! same mann] to a provid] or team z paym5ts are made "u subsection 7c7 ( section #aide1 includ+ ! use ( ! paym5t me?odology describ$ 9 p>agraph 7#b7 ( su* subsection4 7d7 ,hospital ref]rals ,hospitals t are p>ticipat+ provid]s "u ?is section %all e/abli% proc$ures = ref]r+ any eligible individuals ) *ronic conditions :o seek or ne$ treatm5t 9 a hospital em]g5cy dep>tm5t to designat$ provid]s 9 ! same mann] z requir$ "u section #aide7;d74 7e7 ,monitor+ & report on quality ,! me?odology & proposal requir$ "u subsection 7f7 ( section #aide & ! report on quality measures "u subsection 7f7 ( su* section %all also apply "u ?is section4 7f7 ,report on quality measures ,z a condition = receiv+ paym5t = heal? home s]vices provid$ to an eligible individual ) *ronic conditions1 a designat$ provid] %all report1 9 accordance ) su* requirem5ts z ! ,secret>y %all specify1 includ+ a plan = ! use ( remote pati5t monitor+1 on all applicable measures = det]m9+ ! quality ( su* s]vices4 ,:5 appropriate & feasible1 a designat$ provid] %all use heal? in=mation te*nology 9 provid+ ! ,secret>y ) su* in=mation4 7g7 ,def9itions ,9 ?is section1 ! provisions & def9itions conta9$ 9 subsection 7h7 ( section #aide %all also apply = purposes ( ?is section except t1 in/ead ( ! requirem5t specifi$ 9 clause 7i7 ( subsection 7h77#a77;,a7 ( su* section1 an individual mu/ be eligible = s]vices "u p>ts ,a & ,b & cov]$ = m$ical assi/ance = heal? home s]vices "u section #aide 9 ord] to be an eligible individual ) *ronic conditions4 7h7 ,evid5ce-,bas$ & report+ ,9 contract+ ) a ,/ate "u ?is section1 ! ,/ate-- 7#a7 %all foll[ evid5ce-bas$ guidel9es = *ronic c>e2 & 7#b7 %all report at lea/ by ! end ( e mon? data specifi$ by ! ,secret>y1 includ+ an assessm5t ( ! use ( remote pati5t monitor+ & quality measures ( process1 outcome1 & /ructure4 7i7 ,waiv] au?ority 7#a7 ,9 g5]al ,! limitations on teleheal? "u section #ahcd7m7 %all n apply = purposes ( ?is section4 7#b7 ,secret>y au?ority ,! ,secret>y may waive su* o!r requirem5ts ( ?is title & title ,,xix z may be necess>y to c>ry out ! provisions ( ?is section4 4 7#b7 ,report+ 7,a7 ,9 g5]al ,n lat] ?an #b ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices %all survey ,/ates contract+ "u section #ahii;,b ( ! ,social ,security ,act1 z add$ by p>agraph 7#a71 on ! nature1 ext5t1 & use ( ! option "u su* section p>ticul>ly z x p]ta9s to-- 7i7 hospital admission rates2 7ii7 *ronic disease managem5t2 7iii7 coord9ation ( c>e = individuals ) *ronic conditions2 7iv7 assessm5t ( program implem5tation2 7v7 processes & lessons le>n$ 7z describ$ 9 subp>agraph 7,b772 7vi7 assessm5t ( quality improvem5ts & cl9ical outcomes "u su* option2 & 7vii7 e/imates ( co/ sav+s4 7,b7 ,implem5tation report+ ,su* a ,/ate %all report to ! ,secret>y1 z necess>y1 on processes t h be5 develop$ & lessons le>n$ reg>d+ provision ( coord9at$ c>e ?r\gh a heal? home = b5efici>ies ) *ronic conditions "u su* option4 7b7 ,specialty m$ical homes ,title ,,xviii ( ! ,social ,security ,act1 z am5d$ by subsection 7a71 is fur!r am5d$ by add+ at ! end ! foll[+ new section3 #ahii;,c4 ,specialty m$ical homes 7a7 ,9 g5]al ,beg9n+ n lat] ?an #cj days aft] ! date ( ! enactm5t ( ?is section1 ! ,secret>y may contract ) a national or multi-/ate regional c5t] ( excell5ce ) a network ( affiliat$ local provid]s to provide ?r\gh "o or m m$ical homes = t>get$1 accessible1 cont9u\s1 & coord9at$ c>e to individuals "u ?is title & title ,,xix ) a long-t]m illness or m$ical condition t requires regul> m$ical treatm5t1 advis+1 & monitor+4 7b7 ,m$ical home def9$ ,9 ?is section1 ! t]m m$ical home means a m$ical entity t-- 7#a7 specializes 9 ! c>e = a specific long-t]m illness or m$ical condition1 includ+ relat$ comorbidities2 7#b7 leads ! developm5t ( relat$ evid5ce-bas$ cl9ical /&>ds & rese>*2 7#c7 has a network ( affiliat$ p]sonal physicians & pati5t treatm5t facilities2 7#d7 ma9ta9s an onl9e ,web site = pati5t & provid] communication & collaboration & pati5t access to ! pati5t's heal? in=mation2 7#e7 has a plan = use ( heal? in=mation te*nology 9 provid+ s]vices "u ?is section & improv+ s]vice deliv]y & coord9ation across ! c>e cont9uum 7includ+ ! use ( wireless pati5t te*nology to improve coord9ation & remote pati5t monitor+ managem5t ( c>e & pati5t adh]5ce to recomm5dations made by _! provid]72 7#f7 provides deid5tifi$ demographic data sets = cl9ical1 /ati/ical1 & social sci5ce rese>* to develop culturally compet5t be/ practices & cl9ical decision support me*anisms = ! long-t]m illness or m$ical condition2 7#g7 uses a heal? assessm5t tool = ! individuals t>get$1 includ+ a means = id5tify+ ^? mo/ likely to b5efit f remote pati5t monitor+2 & 7#h7 provides tra9+ programs = p]sonnel involv$ 9 ! coord9ation ( c>e4 7c7 ,p]sonal physician def9$ 7#a7 ,9 g5]al ,9 ?is section1 ! t]m p]sonal physician means a physician 7z def9$ 9 section #ahfa7r77#a77 :o meets ! requirem5ts describ$ 9 p>agraphs 7#b7 & 7#c74 ,no?+ 9 ?is p>agraph %all be con/ru$ z prev5t+ a p]sonal physician f be+ a speciali/ or subspeciali/ = an individual requir+ ongo+ c>e = a specific *ronic condition or multiple *ronic conditions or = an individual ) a long-t]m illness or m$ical condition4 7#b7 ,g5]al requirem5ts ,! requirem5ts describ$ 9 ?is p>agraph = a p]sonal physician = c>e ( an individual are z foll[s3 7,a7 ,! physician is bo>d c]tifi$ = c>e ( ! specific illness or condition ( ! individual & manages cont9u\s c>e = ! individual4 7,b7 ,! physician has ! /aff & res\rces to manage ! compreh5sive & coord9at$ heal? c>e ( su* individual4 7#c7 ,s]vice-relat$ requirem5ts ,! requirem5ts describ$ 9 ?is p>agraph = a p]sonal physician are z foll[s3 7,a7 ,! p]sonal physician advocates = & provides ongo+ support1 ov]sight1 & guidance to implem5t a plan ( c>e t provides an integrat$1 coh]5t1 cross-discipl9e plan = ongo+ m$ical c>e develop$ 9 p>tn]%ip ) pati5ts & includ+ all o!r physicians furni%+ c>e to ! pati5t involv$ & o!r appropriate m$ical p]sonnel or ag5cies 7su* z home heal? ag5cies74 7,b7 ,! p]sonal physician uses evid5ce-bas$ m$ic9e & cl9ical decision support tools to guide decisionmak+ at ! po9t-(-c>e bas$ on pati5t-specific factors4 7,c7 ,! p]sonal physician is 9 compliance ) ! /&>ds = mean+ful use ( electronic heal? records "u ?is title4 7,d7 ,! p]sonal physician p>ticipates ) ! ,/ate's heal? in=mation ex*ange1 z available1 or ! f$]ally sponsor$ ,direct ,project4 7,e7 ,! p]sonal physician uses heal? in=mation te*nology1 includ+ appropriate remote monitor+1 to monitor & track ! heal? /atus ( pati5ts & to provide pati5ts ) enhanc$ & conv5i5t access to heal? c>e s]vices4 7,f7 ,! p]sonal physician uses electronic prescrib+ & provides m$ication managem5t4 7,g7 ,! p]sonal physician enc\rages pati5ts to engage 9 ! managem5t ( _! own heal? ?r\gh education & support sy/ems4 7,h7 ,! p]sonal physician utilizes ! s]vices ( relat$ heal? pr(essionals1 includ+ nurse practition]s & physician assi/ants4 7d7 ,long-,t]m illness or m$ical condition def9$ ,9 ?is section1 ! t]m long-t]m illness or m$ical condition-- 7#a7 includes a *ronic condition :i* meets crit]ia specifi$ by ! ,secret>y = a specializ$ ,,ma plan = special ne$s individuals2 & 7#b7 also includes ano!r condition t ! ,secret>y det]m9es w\ld provide a b5eficial focus = an effective & effici5t m$ical home4 7e7 ,paym5t me*anisms 7#a7 ,m$ical home c>e managem5t fee & m$ical home %>+ 9 sav+s ,except z provid$ 9 p>agraph 7#b7-- 7,a7 ,m$ical home c>e managem5t fee ,"u ?is section ! ,secret>y %all provide = paym5t "u section #ahdh ( a c>e managem5t fee to ! m$ical home & may include p]=mance inc5tives4 ,! m$ical home %all arrange = paym5t = ! s]vices ( affiliat$ physicians & facilities4 7,b7 ,m$ical home %>+ 9 sav+s ,! ,secret>y %all provide = paym5t "u ?is section ( a m$ical home bas$ on ! paym5t me?odology appli$ to heal? gr\p practices "u section #ahff;,a4 ,"u su* me?odology1 #hj p]c5t ( ! r$uctions 9 exp5ditures "u ?is title & title ,,xix result+ fro 7,c7 m p>ticipation ( individuals t are attributable to ! m$ical home 7z r$uc$ by ! total c>e managem5t fees paid to ! m$ical home "u ?is section7 %all be paid to ! m$ical home4 ,! am\nt ( su* r$uctions 9 exp5ditures %all be det]m9$ by us+ assumptions ) respect to r$uctions 9 ! occurr5ce ( heal? complications1 hospitalization rates1 m$ical errors1 & adv]se drug reactions4 7#b7 ,alt]native paym5t model 7,a7 ,9 g5]al ,! ,secret>y may provide = paym5t "u ?is p>agraph in/ead ( ! am\nts o!rwise payable "u p>agraph 7#a74 7,b7 ,e/abli%m5t ( t>get sp5d+ level ,= purposes ( ?is p>agraph1 ! ,secret>y %all compute an e/imat$ annual sp5d+ t>get bas$ on ! am\nt ! ,secret>y e/imates w\ld h be5 sp5t 9 ! abs5ce ( ?is section1 = items & s]vices cov]$ "u p>ts ,a & ,b furni%$ to applicable b5efici>ies = ea* qualify+ m$ical home "u ?is section4 ,su* sp5d+ t>gets %all be det]m9$ on a p] capita basis4 ,su* sp5d+ t>gets %all include a risk corridor t takes into acc\nt normal v>iation 9 exp5ditures = items & s]vices cov]$ "u p>ts ,a & ,b furni%$ to su* b5efici>ies ) ! size ( ! corridor be+ relat$ to ! numb] ( applicable b5efici>ies furni%$ s]vices by ea* m$ical home4 ,! sp5d+ t>gets may also be adju/$ = su* o!r factors z ! ,secret>y det]m9es appropriate4 7,c7 ,inc5tive paym5ts ,subject to p]=mance on quality measures1 a qualify+ m$ical home is eligible to receive an inc5tive paym5t "u ?is section if actual exp5ditures = a ye> = ! applicable b5efici>ies x enrolls are less ?an ! e/imat$ sp5d+ t>get e/abli%$ "u subp>agraph 7,b7 = su* ye>4 ,an inc5tive paym5t = su* ye> %all be equal to a portion 7z det]m9$ by ! ,secret>y7 ( ! am\nt by :i* actual exp5ditures 7includ+ inc5tive paym5ts "u ?is p>agraph7 = applicable b5efici>ies "u p>ts ,a & ,b = su* ye> are e/imat$ to be less ?an #ie p]c5t ( ! e/imat$ sp5d+ t>get = su* ye>1 z det]m9$ "u subp>agraph 7,b74 7#c7 ,s\rce ,paym5ts paid "u ?is section %all be made 9 appropriate proportions 7z specifi$ by ! ,secret>y7 f ! ,hospital ,insurance ,tru/ ,fund1 ! ,f$]al ,supplem5t>y ,m$ical ,insurance ,tru/ ,fund1 & funds appropriat$ to c>ry out title ,,xix4 7f7 ,evid5ce-,bas$ ,! contract+ entity %all foll[ evid5ce-bas$ guidel9es = c>e ( ! long-t]m illness or m$ical condition "u ?is section4 7g7 ,pati5t s]vices quality & p]=mance report+ ,! contract+ entity %all report at lea/ by ! end ( e mon? data specifi$ by ! ,secret>y on ! op]ation ( ?is section1 includ+ quality measures ( process1 outcome1 & /ructure4 7h7 ,waiv] au?ority 7#a7 ,9 g5]al ,! limitations on teleheal? "u section #ahcd7m7 %all n apply = purposes ( ?is section4 7#b7 ,secret>y au?ority ,! ,secret>y may waive su* o!r requirem5ts ( ?is title & title ,,xix z may be necess>y to c>ry out ! provisions ( ?is section4 4 #ajc4 ,flexibility 9 acc\ntable c>e organizations cov]age ( teleheal? ,section #ahii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;jjj7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7l7 ,flexibility = teleheal? 7#a7 ,provision z supplem5tal b5efits ,not)/&+ any o!r provision ( ?is section1 an ,,aco may include cov]age ( teleheal? & remote pati5t monitor+ s]vices z supplem5tal heal? c>e b5efits to ! same ext5t z a ,m$ic>e ,advantage plan is p]mitt$ to provide cov]age ( su* s]vices z supplem5tal heal? c>e b5efits "u section #aheb7;a77#c77;,a74 7#b7 ,provision 9 connection ) home heal? s]vices ,no?+ 9 ?is section %all be con/ru$ z prev5t+ an ,,aco f includ+ paym5ts = remote pati5t monitor+ & home-bas$ video conf]5c+ s]vices 9 connection ) ! provision ( home heal? s]vices 7"u conditions = :i* paym5t = su* s]vices w\ld n be made "u section #ahie = su* s]vices7 9 a mann] t is f9ancially equival5t to ! furni%+ ( a home heal? visit4 4 #ajd4 ,recogniz+ teleheal? s]vices & remote pati5t monitor+ 9 national pilot program on paym5t bundl+ ,section #ahff;,d7a77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc-#d7;a77#b77 is am5d$-- 7#a7 9 subp>agraph 7,b71 by /rik+ #aj conditions & ins]t+ ! conditions2 7#b7 9 subp>agraph 7,c7-- 7,a7 by r$esignat+ clause 7v7 z clause 7vi72 & 7,b7 by ins]t+ aft] clause 7iv7 ! foll[+ new clause3 7v7 ,teleheal? & remote pati5t monitor+ s]vices4 2 & 7#c7 9 subp>agraph 7,d77i77,,iii71 by ins]t+ be=e ! p]iod at ! end ! foll[+3 7& su* long] p]iod 9 ! case ( ! use ( teleheal? & remote pati5t monitor+ s]vices z ! ,secret>y may specify74 #aje4 ,additional sites to be consid]$ orig9at+ sites = purposes ( paym5ts = teleheal? s]vices "u ,m$ic>e 7a7 ,9 g5]al ,section #ahcd7m77#d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77 is am5d$-- 7#a7 9 subp>agraph 7,c7-- 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 orig9at+ sites ,! t]m orig9at+ site also includes ! foll[+ sites1 :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 ,a critical access hospital 7z describ$ 9 clause 7ii77,,ii774 7,,ii7 ,a sole community hospital 7z def9$ 9 section #ahhf7;d77#e77;,d77iii774 7,,iii7 ,a home teleheal? site 7z def9$ 9 subp>agraph 7,g77i774 7,,iv7 ,a site describ$ 9 clause 7ii7 t is locat$ 9 a c\nty ) a population ( less ?an #be1jjj1 accord+ to ! mo/ rec5t dec5nial c5sus or 9 an area t 0 n includ$ 9 a ,metropolitan ,/ati/ical ,area on any date 9 #bjjj4 7,v7 ,a site describ$ 9 clause 7ii7 ) respect to s]vices relat$ to ! evaluation or treatm5t ( an acute /roke4 2 & 7#b7 by add+ at ! end ! foll[+ new subp>agraph3 7,g7 ,home teleheal? site 7i7 ,home teleheal? site ,! 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 is a teleheal? s]vice t is-- 7,i7 relat$ to ! provision ( hospice c>e or home dialysis2 or 7,,ii7 furni%$ to an individual :o is det]m9$ to be homeb\nd 7z def9$ = purposes ( sections #ahad7;a77#b77;,c7 & #ahce7;a77#b77;,a77i771 includ+ su* an individual = :om a c]tification or rec]tification describ$ 9 su* section is 9 effect ) respect to home heal? s]vices4 4 7b7 ,no orig9at+ site facility fee = new sites ,section #ahcd7m77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#b77;,b77 is am5d$ by ins]t+ aft] ! orig9at+ site ! foll[+3 7o!r ?an an additional orig9at+ site describ$ 9 p>agraph 7#d77;,c77iii774 7c7 ,application ( telecommunication sy/ems def9ition to critical access hospitals & sole community hospitals ,! second s5t5ce ( section #ahcd7m77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77 is am5d$ by ins]t+ any teleheal? s]vices furni%$ or receiv$ at a critical access hospital 7z describ$ 9 p>agraph 7#d77;,c77ii77,,ii77 or a sole community hospital 7z def9$ 9 section #ahhf7;d77#e77;,d77iii77 or ( aft] 9 ! case (4 7d7 ,site ( c>e = purposes ( det]m9+ heal? c>e liability ,section #ahcd7m7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#e7 ,site ( c>e = purposes ( heal? c>e liability ,= purposes ( det]m9+ heal? c>e liability ) respect to teleheal? s]vices = :i* paym5t is made "u ?is subsection1 su* s]vice %all be consid]$ to be furni%$ at ! di/ant site4 4 7e7 ,effective date 7#a7 ,9 g5]al ,except z provid$ 9 p>agraph 7#b71 ! am5dm5ts made by ?is section %all apply to s]vices furni%$ on or aft] ,janu>y #a1 #bjad4 7#b7 ,*ange 9 ,,msa rule ,! am5dm5t made by subsection 7a77#a77;,b77ii7 %all apply ) respect to teleheal? s]vices furni%$ on or aft] ,febru>y #bh1 #bjac4 ,,ii ,enhanc+ ,m$icaid ?r\gh teleheal? #bja4 ,m$icaid option = high-risk pregnancies & bir?s 7a7 ,9 g5]al ,title ,,xix ( ! ,social ,security ,act is am5d$ by add+ at ! end ! foll[+ new section3 #aidg4 ,/ate option to provide coord9at$ c>e = enrollees ) high-risk pregnancies & bir?s 7a7 ,9 g5]al ,not)/&+ section #aijb7;a77#a7 7relat+ to /atewid5ess71 section #aijb7;a77#aj77;,b7 7relat+ to comp>ability71 & any o!r provision ( ?is title = :i* ! ,secret>y det]m9es x is necess>y to waive 9 ord] to implem5t ?is section1 beg9n+ #f mon?s aft] ! date ( ! enactm5t ( ?is section1 a ,/ate1 at its option z a ,/ate plan am5dm5t1 may provide = m$ical assi/ance "u ?is title to eligible individuals = mat]nal-fetal & neonatal c>e :o select a designat$ provid] 7z describ$ "u subsection 7h77#e771 a team ( heal? c>e pr(essionals 7z describ$ "u subsection 7h77#f77 op]at+ ) su* a provid]1 or a heal? team 7z describ$ "u subsection 7h77#g77 z ! individual's bir?+ network = purposes ( provid+ ! individual ) pregnancy-relat$ s]vices4 7b7 ,qualification /&>ds ,! ,secret>y %all e/abli% /&>ds = qualification z a designat$ provid] = ! purpose ( be+ eligible to be a bir?+ network = purposes ( ?is section4 7c7 ,paym5ts 7#a7 ,9 g5]al ,a ,/ate %all provide a designat$ provid]1 a team ( heal? c>e pr(essionals op]at+ ) su* a provid]1 or a heal? team ) paym5ts = ! provision ( bir?+ network s]vices to ea* eligible individual = mat]nal-fetal & neonatal c>e t selects su* provid]1 team ( heal? c>e pr(essionals1 or heal? team z ! individual's bir?+ network4 ,paym5ts made to a designat$ provid]1 a team ( heal? c>e pr(essionals op]at+ ) su* a provid]1 or a heal? team = su* s]vices %all be treat$ z m$ical assi/ance = purposes ( section #aijc7;a71 except t1 dur+ ! fir/ #h fiscal ye> qu>t]s t ! ,/ate plan am5dm5t is 9 effect1 ! ,f$]al m$ical assi/ance p]c5tage applicable to su* paym5ts %all be equal to #ij p]c5t4 7#b7 ,sav+s t>get ,z a condition = approval ( a ,/ate plan am5dm5t & paym5t me?odology "u ?is section1 ! ,/ate %all provide ! ,secret>y ) assurances t ! am5dm5t & me?odology %all be project$ to r$uce ! am\nt ( exp5ditures = pregnancy-relat$ s]vices o!rwise made "u ?is title by "o p]c5t = ea* #d-;cal5d>-qu>t] p]iod dur+ ! fir/ #dj cal5d> qu>t]s 9 :i* ! am5dm5t is 9 effect4 7#c7 ,me?odology 7,a7 ,9 g5]al ,! ,/ate %all specify 9 ! ,/ate plan am5dm5t ! me?odology ! ,/ate w use = det]m9+ paym5t = ! provision ( bir?+ network s]vices4 ,su* me?odology = det]m9+ paym5t %all be e/abli%$ consi/5t ) section #aijb7;a77#cj77;,a74 7,b7 ,innovative models ( paym5t ,! me?odology = det]m9+ paym5t = provision ( bir?+ network s]vices "u ?is section %all n be limit$ to a p]-memb] p]-mon? basis & may provide 7z propos$ by ! ,/ate & subject to approval by ! ,secret>y7 = alt]nate models ( paym5t1 includ+ bundl$ p] episode1 p]=mance inc5tives1 & %>$ sav+s4 7#d7 ,plann+ grants 7,a7 ,9 g5]al ,beg9n+ #cj days aft] ! date ( ! enactm5t ( ?is section1 ! ,secret>y may aw>d plann+ grants to ,/ates = purposes ( develop+ a ,/ate plan am5dm5t "u ?is section4 ,a plann+ grant aw>d$ to a ,/ate or a multi-/ate collaborative "u ?is p>agraph %all rema9 available until exp5d$4 7,b7 ,limitation ,! total am\nt ( paym5ts made to ,/ates "u ?is p>agraph %all n exce$ #be1jjj1jjj4 7d7 ,report on quality measures ,z a condition = receiv+ paym5t = bir?+ network s]vices provid$ to an eligible individual = mat]nal-fetal & neonatal c>e1 a designat$ provid] %all report mon?ly to ! ,/ate1 9 accordance ) su* requirem5ts z ! ,secret>y %all specify1 on all applicable measures = det]m9+ ! quality ( su* s]vices4 ,:5 appropriate & feasible1 a designat$ provid] %all use heal? in=mation te*nology 9 provid+ ! ,/ate ) su* in=mation4 7e7 ,evid5ce-,bas$ ,! bir?+ network %all adapt1 update1 & foll[ evid5ce-bas$ guidel9es = mat]nal-fetal & neonatal c>e4 7f7 ,def9itions ,9 ?is section3 7#a7 ,eligible individual = mat]nal-fetal & neonatal c>e 7,a7 ,9 g5]al ,subject to subp>agraph 7,b71 ! t]m eligible individual means an individual :o-- 7i7 is eligible = m$ical assi/ance "u ! ,/ate plan or "u a waiv] ( su* plan2 & 7ii7 7,i7 is pregnant 7or 0 pregnant dur+ ! imm$iately prec$+ #cj day p]iod72 or 7,,ii7 is ! *ild ( an individual describ$ 9 clause 7i7 & "u #cj days old4 7,b7 ,rule ( con/ruction ,no?+ 9 ?is p>agraph %all prev5t ! ,secret>y f e/abli%+ o!r requirem5ts = purposes ( det]m9+ eligibility = receipt ( bir?+ network s]vices "u ?is section4 7#b7 ,bir?+ network ,! t]m bir?+ network means a designat$ provid] 7includ+ a provid] t op]ates 9 coord9ation ) a team ( heal? c>e pr(essionals7 or a heal? team select$ by an eligible individual to provide bir?+ network s]vices4 7#c7 ,bir?+ network s]vices 7,a7 ,9 g5]al ,! t]m bir?+ network s]vices means compreh5sive & timely high-quality s]vices describ$ 9 subp>agraph 7,b7 t are provid$ by a designat$ provid]1 a team ( heal? c>e pr(essionals op]at+ ) su* a provid]1 or a heal? team & are id5tifi$ 9 a provid] regi/ry4 7,b7 ,s]vices describ$ ,! s]vices describ$ 9 ?is subp>agraph are-- 7i7 compreh5sive c>e coord9ation2 7ii7 heal? promotion2 7iii7 a call c5t] to (f] #bd-;h\r physician support = consultations ) mat]nal-fetal m$ic9e speciali/s1 :5 reque/$1 reg>d+ pati5t managem5t issues2 7iv7 newborn scre5+1 includ+ = he>t defects & to r$uce newborn hospital readmissions2 7v7 pati5t & family support 7includ+ au?oriz$ repres5tatives72 7vi7 ref]ral to community & social support s]vices1 if relevant2 & 7vii7 use ( heal? in=mation te*nology to l9k s]vices & provide monitor+1 z feasible & appropriate4 7#d7 ,designat$ provid] ,! t]m designat$ provid] means a physician1 cl9ical practice or cl9ical gr\p practice1 rural cl9ic1 community heal? c5t]1 public heal? ag5cy1 home heal? ag5cy1 or any o!r entity or provid] 7includ+ p$iatricians1 gynecologi/s1 & ob/etricians7 t is det]m9$ by ! ,/ate & approv$ by ! ,secret>y to be qualifi$ to be a bir?+ network = eligible individuals on ! basis ( docum5tation evid5c+ t ! physician1 practice1 or cl9ic-- 7,a7 has ! sy/ems & infra/ructure 9 place to provide bir?+ network s]vices2 & 7,b7 satisfies ! qualification /&>ds e/abli%$ by ! ,secret>y "u subsection 7b7 & p>agraph 7#g77;,b74 7#e7 ,team ( heal? c>e pr(essionals ,! t]m team ( heal? c>e pr(essionals means a team ( heal? pr(essionals 7z describ$ 9 ! ,/ate plan am5dm5t7 t may-- 7,a7 include physicians & o!r pr(essionals1 su* z a nurse c>e coord9ator1 midwife1 nutritioni/1 social work]1 behavioral heal? pr(essional1 or any pr(essionals deem$ appropriate by ! ,/ate2 & 7,b7 be free /&+1 virtual1 or bas$ at a hospital1 community heal? c5t]1 rural cl9ic1 cl9ical practice or cl9ical gr\p practice1 academic heal? c5t]1 or any entity deem$ appropriate by ! ,/ate & approv$ by ! ,secret>y4 7#f7 ,heal? team ,! t]m heal? team has ! mean+ giv5 su* t]m = purposes ( section #cejb ( ! ,pati5t ,protection & ,af=dable ,c>e ,act4 7#g7 ,bir?+ data & ex*ange 7,a7 ,proposal = use ( heal? in=mation te*nology ,a ,/ate %all include 9 ! ,/ate plan am5dm5t a proposal = use ( heal? in=mation te*nology 9 provid+ bir?+ network s]vices "u ?is section & improv+ s]vice deliv]y & coord9ation across ! c>e cont9uum 7includ+ ! use ( wireless pati5t te*nology to improve coord9ation & managem5t ( c>e & pati5t adh]5ce to recomm5dations made by _! provid]74 7,b7 ,in=mation requirem5ts = bir?+ networks ,! bir?+ network %all-- 7i7 be 9 compliance ) ! ,m$icaid /&>ds = mean+ful use ( electronic heal? records2 7ii7 p>ticipate ) ! ,/ate's heal? in=mation ex*ange1 z available1 or op]ate an ex*ange among ! bir?+ network2 7iii7 collect demographic in=mation on p>ticipat+ newborns & mo!rs2 7iv7 use demographic & ev5t-bas$ data to id5tify pati5ts t are likely go+ to ne$ %ort or long-t]m foll[-up2 & 7v7 provid+ de-id5tifi$ demographic data sets = /ati/ical & social sci5ce rese>* to develop culturally compet5t be/ practices & cl9ical decision support me*anisms = mat]nal-fetal & neonatal c>e4 4 7b7 ,pati5t s]vices quality & p]=mance report+ 7#a7 ,9 g5]al ,n lat] ?an #c ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices %all survey ,/ates t h elect$ ! option "u section #aidg ( ! ,social ,security ,act1 z add$ by section 7a71 on ! nature1 ext5t1 & use ( su* option1 p>ticul>ly z x p]ta9s to-- 7,a7 t]ms ( pregnancies2 7,b7 use ( pr5atal fetal monitor+2 7,c7 use ( ,caes>ean section proc$ures2 7,d7 use ( neonatal int5sive c>e s]vices2 7,e7 incid5ce ( bir?+ complications2 7,f7 incid5ce ( infant & mat]nal mortality2 7,g7 coord9ation ( mat]nal-fetal & neonatal c>e = individuals2 7,h7 assessm5t ( program implem5tation2 7,i7 processes & lessons le>n$ 7z describ$ 9 subp>agraph 7,b772 7,j7 assessm5t ( quality improvem5ts & cl9ical outcomes "u su* option2 & 7,k7 p>ticipat+ mo!rs' assessm5t ( p]=mance1 quality1 conv5i5ce1 & satisfaction4 7#b7 ,implem5tation report+ ,a ,/ate t has elect$ ! option "u su* section %all report to ! ,secret>y1 z necess>y1 on processes t h be5 develop$ & lessons le>n$ reg>d+ provision ( coord9at$ c>e ?r\gh a bir?+ network = ,m$icaid b5efici>ies = mat]nal-fetal & neonatal c>e "u su* option4 ,,iii ,improv+ telecommunications = m$ical deliv]y #cja4 ,additional provid]s consid]$ heal? c>e provid]s = purposes ( univ]sal s]vice support ,subp>agraph 7,b7 ( section #bed7;h77#g7 ( ! ,communications ,act ( #aicd 7#dg ,u4,s4,c4 #bed7;h77#g77 is am5d$-- 7#a7 9 clause 7vi71 by /rik+ &2 7#b7 9 clause 7vii71 by /rik+ clauses 7i7 ?r\gh 7vi7 & ins]t+ clauses 7i7 ?r\gh 7ix72 7#c7 by r$esignat+ clause 7vii7 z clause 7x72 & 7#d7 by ins]t+ aft] clause 7vi7 ! foll[+ new clauses3 7vii7 ambulance provid]s & o!r em]g5cy m$ical transport provid]s2 7viii7 heal? cl9ics ( elem5t>y & second>y s*ools & po/-second>y educational in/itutions2 7ix7 sites :]e teleheal? s]vices are provid$ "u section #ahcd7m7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77 or "u a ,/ate plan "u title ,,xix ( su* ,act 7#db ,u4,s4,c4 #acif et seq472 & 4 #cjb4 ,no consid]ation ( provid] location 9 rules enhanc+ heal? c>e provid] access to advanc$ telecommunications & in=mation s]vices ,section #bed7;h77#b77;,a7 ( ! ,communications ,act ( #aicd 7#dg ,u4,s4,c4 #bed7;h77#b77;,a77 is am5d$ by ins]t+ 7reg>dless ( ! location ( su* provid]s7 aft] heal? c>e provid]s4