,i  #aad? ,,congress  #a/ ,session  ,h4 
,r4 #bidh  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,july #g1 #bjae ,mr4  
,?ompson ( ,cali=nia 7= himself1 ,mr4   
,h>p]1 ,mrs4 ,black1 & ,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 = an  
increm5tal expansion ( teleheal? cov]age
 "u ! ,m$ic>e program4  #a4 ,%ort title 
,?is ,act may be cit$ z ! ,m$ic>e       
,teleheal? ,p>ity ,act ( #bjae4  #b4    
,phas$-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$ic>e ,teleheal? ,p>ity ,act ( #bjae1 
any ,f$]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$ic>e ,teleheal? ,p>ity  
,act ( #bjae1 any site describ$ 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$-- 7,a7 9 p>agraph   
7#a7--  7i7 by /rik+ or a practition]   
7describ$ 9 section #ahdb7;b77#ah77;,c77
 & ins]t+ or a pr(essional describ$ 9   
p>agraph 7#d77;,e772 &  7ii7 by /rik+   
individual physician or practition] &   
ins]t+ individual physician or          
pr(essional2 &  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 ,pr(essional     
describ$ ,= purposes ( p>agraph 7#a71 a 

pr(essional describ$ 9 ?is subp>agraph  
is--  7i7 a practition] describ$ 9      
section #ahdb7;b77#ah77;,c72 or  7ii7 ) 
respect to s]vices furni%$ on or aft] ! 
date t is #f mon?s aft] ! date ( !      
enactm5t ( ! ,m$ic>e ,teleheal? ,p>ity  
,act ( #bjae1 a c]tifi$ diabetes        
educator or lic5s$--  7,i7 respiratory  
!rapi/2  7,,ii7 audiologi/2  7,,iii7    
occupational !rapi/2  7,,iv7 physical   
!rapi/2 or  7,v7 spee* language         
pa?ologi/4  4  7#d7 ,additional cov]$   
teleheal? s]vices ,section              
#ahcd7m77#d77;,f77i7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#aciem7m77#d77;,f77i77 is am5d$ by add+ 
at ! end ! foll[+ new s5t5ce3 ,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]vices44  7#e7 ,expansion (            
telecommunications sy/em ,! second      
s5t5ce ( section #ahcd7m77#a7 ( !       

,social ,security ,act 7#db ,u4,s4,c4   
#aciem7m77#a77 is am5d$ by /rik+ 9 !    
case ( any ,f$]al telem$ic9e            
demon/ration program conduct$ 9 ,alaska 
or ,hawaii14  7#f7 ,rural heal? cl9ics &
 ,f$]ally qualifi$ heal? c5t]s au?oriz$ 
to be di/ant sites ,section             
#ahcd7m77#d77;,a7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciem7m77#d77;,a77 
is am5d$-- 7,a7 by /rik+ site4--,! t]m &
 ins]t+  site4-- 7i7 ,9 g5]al ,! t]m  2 
&  7,b7 by add+ at ! end ! foll[+ new   
clause3  7ii7 ,treatm5t ( rural heal?   
cl9ics & ,f$]ally qualifi$ heal? c5t]s  
,a site describ$ 9 clause 7i7 includes a
 rural heal? cl9ic 7z def9$ 9 section   
#ahfa7;aa77#b77 & a ,f$]ally qualifi$   
heal? c5t] 7z def9$ 9 section           
#ahfa7;aa77#d774 ,9 any case 9 :i* su* a
 cl9ic or c5t] is treat$ z a di/ant site
 ) respect to ! provision ( a teleheal? 
s]vice to an eligible teleheal?         
individual = :i* paym5t is made "u ?is  
subsection1 su* s]vice %all n be treat$ 
z a rural heal? cl9ic s]vice or ,f$]ally

 qualifi$ heal? c5t] s]vice1            
respectively1 & paym5t may n o!rwise be 
made "u ?is title ) respect to su*      
s]vice provid$ to su* individual4  4    
7b7 ,second phase  7#a7 ,9 g5]al        
,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,,iii7 ,9 !    
case ( su* a s]vice furni%$ on or aft] !
 date t is #b ye>s aft] ! date ( !      
enactm5t ( ! ,m$ic>e ,teleheal? ,p>ity  
,act ( #bjae1 any site describ$ 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,,iv7 ,9 ! case ( su* a s]vice furni%$ 
on or aft] ! date t is #b ye>s aft] !   
date ( ! enactm5t ( ! ,m$ic>e ,teleheal?
 ,p>ity ,act ( #bjae1 a home teleheal?  
site1 z def9$ 9 subp>agraph 7,g74  7,v7 

,9 ! case ( su* a s]vice t is relat$ to 
! evaluation or treatm5t ( an acute     
/roke & t is furni%$ on or aft] ! date  
describ$ 9 subclause 7,,iv7 dur+ !      
evid5ce-bas$ w9d[ ( treatm5t1 any site  
at :i* ! eligible teleheal? individual  
is locat$ at ! "t ! s]vice is furni%$   
via a telecommunications sy/em1         
reg>dless ( :]e ! site is locat$4  2 &  
7,b7 by add+ at ! end ! foll[+ new      
subp>agraph3  7,g7 ,home teleheal? site 
7i7 ,9 g5]al ,! t]m home teleheal? site 
means1 ) respect to a s]vice describ$ 9 
clause 7ii7 furni%$ to an individual1 a 
place ( resid5ce us$ z ! home ( su*     
individual4  7ii7 ,s]vices describ$ ,a  
s]vice describ$ 9 ?is clause is-- 7,i7 a
 teleheal? s]vice t is relat$ to !      
provision ( outpati5t m5tal or          
behavioral heal? & %all include ! use ( 
video conf]5c+2 &  7,,ii7 a s]vice      
describ$ 9 subp>agraph 7,f77iii7 t is   
treat$ z a teleheal? s]vice "u su*      
subp>agraph4  4  7#b7 ,home teleheal?   
s]vices ,section #ahcd7m77#d77;,f7 ( !  

,social ,security ,act 7#db ,u4,s4,c4   
#aciem7m77#d77;,f77 is am5d$ by add+ at 
! end ! foll[+ new clause3  7iii7       
,treatm5t ( home teleheal? s]vices ,=   
purposes ( subp>agraph 7,g77ii77,,ii71  
beg9n+ #b ye>s aft] ! date ( ! enactm5t 
( ! ,m$ic>e ,teleheal? ,p>ity ,act (    
#bjae1 s]vices 7includ+ ! use ( video   
conf]5c+7 furni%$ at an orig9at+ site t 
is a home teleheal? site to an          
individual t is relat$ to ! provision ( 
hospice c>e1 home dialysis1 or home     
heal? s]vices %all be treat$ z a        
teleheal? s]vice "u ?is subp>agraph4  4 
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$--    
7,a7 by r$esignat+ subclause 7,v7 z     
subclause 7,,vi72 &  7,b7 by ins]t+ aft]
 clause 7,,iv7 ! foll[+ new subclause3  
7,v7 ,9 ! case ( su* a s]vice furni%$ on
 or aft] ! date t is #d ye>s aft] ! date

 ( ! enactm5t ( ! ,m$ic>e ,teleheal?    
,p>ity ,act ( #bjae1 any site describ$ 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$ic>e ,teleheal? ,p>ity  
,act ( #bjae1 ! ,secret>y may develop & 
implem5t paym5t me?ods t w\ld apply "u  
?is subsection 9 ! case ( an individual 
:o w\ld be an eligible teleheal?        
individual except t ! teleheal? s]vices 
are furni%$ 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  7d7 ,increm5tal      

cov]age ( remote pati5t monitor+ 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$-- 7,a7 9        
subp>agraph 7,,ee71 by /rik+ & at ! end2
  7,b7 9 subp>agraph 7,,ff71 by ins]t+ &
 at ! end2 &  7,c7 by ins]t+ aft]       
subp>agraph 7,,ff7 ! foll[+ new         
subp>agraph3  7,,gg7 applicable remote  
pati5t monitor+ s]vices 7z def9$ 9      
p>agraph 7#a77;,a7 ( 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 monitor+ s]vices = *ronic
 heal? conditions  7#a7  7,a7 ,! t]m    
applicable remote pati5t monitor+       
s]vices means remote pati5t monitor+    
s]vices 7z def9$ 9 subp>agraph 7,b77    
furni%$ to provide = ! monitor+1        
evaluation1 & managem5t ( an individual 
) a cov]$ *ronic condition 7z def9$ 9   
p>agraph 7#b771 ins(> z su* s]vices are 

= ! managem5t ( su* *ronic condition4   
7,b7 ,! t]m remote pati5t monitor+      
s]vices means s]vices furni%$ ?r\gh     
remote pati5t monitor+ te*nology 7z     
def9$ 9 subp>agraph 7,c774  7,c7 ,! t]m 
remote pati5t monitor+ te*nology means a
 coord9at$ sy/em t uses "o or m         
home-bas$ or mobile monitor+ devices t  
automatically transmit vital sign data  
or in=mation on activities ( daily liv+ 
& may include responses to assessm5t    
que/ions collect$ on ! devices          
wirelessly or ?r\gh a telecommunications
 connection to a s]v] t complies ) !    
,f$]al regulations 7conc]n+ ! privacy ( 
individually id5tifiable heal?          
in=mation7 promulgat$ "u section        
#bfd7;c7 ( ! ,heal? ,insurance          
,portability & ,acc\ntability ,act (    
#aiif1 z "p ( an e/abli%$ plan ( c>e = t
 pati5t t includes ! review &           
int]pretation ( t data by a heal? c>e   
pr(essional4  7#b7 ,= purposes (        
p>agraph 7#a71 ! t]m cov]$ *ronic heal? 
condition means-- 7,a7 9 ! case (       

applicable remote pati5t monitor+       
s]vices furni%$ on or aft] ! date t is  
#f mon?s aft] ! date ( ! enactm5t ( !   
,m$ic>e ,teleheal? ,p>ity ,act ( #bjae1 
applicable conditions 7z def9$ 9 &      
appli$ "u section #ahhf7q77#e771 relat+ 
to he>t failure & *ronic ob/ructive     
pulmon>y disease & relat$ *ronic        
comorbidities :5 "u *ronic c>e managem5t
 7id5tifi$ z ( ,july #a1 #bjae1 by      
,,hcpcs code #iidij 7& z subsequ5tly    
modifi$ by ! ,secret>y772  7,b7 9 ! case
 ( applicable remote pati5t monitor+    
s]vices furni%$ on or aft] ! date t is  
#b ye>s aft] ! date ( ! enactm5t ( !    
,m$ic>e ,teleheal? ,p>ity ,act ( #bjae1 
9 addition to ! conditions describ$ 9   
subp>agraph 7,a71 diabetes & relat$     
*ronic comorbidities :5 "u *ronic c>e   
managem5t 7id5tifi$ z ( ,july #a1 #bjae1
 by ,,hcpcs code #iidij 7& z subsequ5tly
 modifi$ by ! ,secret>y772 &  7,c7 9 !  
case ( applicable remote pati5t monitor+
 s]vices furni%$ on or aft] ! date t is 
#d ye>s aft] ! date ( ! enactm5t ( !    

,m$ic>e ,teleheal? ,p>ity ,act ( #bjae1 
9 addition to ! conditions describ$ 9   
subp>agraph 7,a7 & 7,b71 su* o!r        
conditions t c\ld be specifi$ by !      
,secret>y t qualify = *ronic c>e        
managem5t & relat$ *ronic comorbidities 
:5 "u *ronic c>e managem5t 7id5tifi$ z (
 ,july #a1 #bjae1 by ,,hcpcs code #iidij
 7& z subsequ5tly modifi$ by !          
,secret>y774  7#c7  7,a7 ,paym5t may be 
made "u ?is "p = applicable remote      
pati5t monitor+ s]vices provid$ to an   
individual dur+ a p]iod ( up to #ij days
 & su* additional p]iod z provid$ = "u  
subp>agraph 7,b74  7,b7 ,! #ij-;day     
p]iod describ$ 9 subp>agraph 7,a71 )    
respect to an individual1 may be r5ew$  
by ! physician :o provides *ronic c>e   
managem5t to su* individual if !        
individual cont9ues to qualify = su*    
managem5t4  4  7#c7 ,paym5t "u !        
physician fee s*$ule ,section #ahdh ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#d7 is am5d$-- 7,a7 9 subsection 
7c7--  7i7 9 p>agraph 7#b77;,b7-- 7,i7 9

 clause 7ii77,,ii71 by /rik+ & 7v7 &    
ins]t+ 7v71 & 7vii72 &  7,,ii7 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 & 
7ii7 by add+ at ! end ! foll[+ new      
p>agraph3  7#g7 ,treatm5t ( applicable  
remote pati5t monitor+ s]vices  7,a7 ,9 
det]m9+ relative value units =          
applicable remote pati5t monitor+       
s]vices 7z def9$ 9 section              
#ahfa7;iii77#a77;,a771 ! ,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 monitor+ 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 monitor+ s]vices4  2 
&  7,b7 9 subsection 7j77#c71 by ins]t+ 
7#b77;,,gg71 aft] heal? risk            
assessm5t714  7#d7 ,effective date  7,a7
 ,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       
p>agraph 7#b71 h be5 develop$4  7,b7    
,availability ( codes z ( date (        
enactm5t ,! ,secret>y ( ,heal? & ,human 
,s]vices %all-- 7i7 promptly evaluate   
exi/+ codes t w\ld be us$ to bill =     
applicable remote pati5t monitor+       
s]vices 7z def9$ 9 p>agraph 7#a77;,a7 ( 
su* section #ahfa7;iii71 z s add$7 "u   
title ,,xviii ( ! ,social ,security     
,act2 &  7ii7 if ! ,secret>y det]m9es t 
new codes are necess>y to ensure        
accurate report+ & bill+ ( su* s]vices  
"u su* title1 issue su* codes s t !y are
 available = use z ( ! date ( ! enactm5t
 ( ?is ,act4  7e7 ,home dialysis s]vice 
7#a7 ,9 g5]al ,section #ahha7;b77#c7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acierr7b77#c77 is am5d$-- 7,a7 by      

r$esignat+ subp>agraphs 7,a7 & 7,b7 z   
clauses 7i7 & 7ii71 respectively2  7,b7 
9 clause 7ii71 z r$esignat$ by          
subp>agraph 7,a71 /rike on a            
compreh5sive & ins]t subject to         
subp>agraph 7,b71 on a compreh5sive2    
7,c7 by /rik+ ,) respect to & ins]t+    
7,a7 ,) respect to2 &  7,d7 by add+ at !
 end ! foll[+ new subp>agraph3  7,b7 ,= 
purposes ( subp>agraph 7,a77ii71 !      
foll[+ %all apply3  7i7 ,! mon?ly fee or
 o!r basis ( paym5t describ$ 9 su*      
subp>agraph %all all[ = a               
pati5t-specific waiv] process to all[ a 
physician1 cl9ical nurse speciali/1     
nurse practition]1 or physician's       
assi/ant to reque/ a waiv] "u ?is title 
( face-to-face visit requirem5ts = home 
dialysis furni%$ to individuals det]m9$ 
to h end /age r5al disease4  7ii7 ,any  
reque/ "u clause 7i7 %all include       
docum5tation by ! physician or          
practition] involv$ t supports active & 
adequate c>e ( su* individual receiv+   
home dialysis4  7iii7 ,any              

pati5t-specific waiv] "u clause 7i7 t is
 grant$ %all rema9 effective until su*  
date t ! ,secret>y1 includ+ ?r\gh       
contractor "u ?is title1 reque/s t      
additional in=mation or a new waiv]     
application be fil$4  7iv7 ,all         
individuals det]m9$ to h end /age r5al  
disease receiv+ home dialysis %all      
receive a face-to-face exam9ation at    
lea/ once e ?ree consecutive mon?s &1 9 
! int]v5+ mon?s1 %all receive a mon?ly  
cl9ical assessm5t :i* may be furni%$1 if
 ! pati5t s *ooses1 via remote monitor+ 
by a physician1 cl9ical nurse speciali/1
 nurse practition]1 or physician's      
assi/ant4  4  7#b7 ,con=m+ am5dm5t      
,section #ahha7;b77#a7 ( su* ,act 7#db  
,u4,s4,c4 #acierr7b77#a77 is am5d$ by   
/rik+ p>agraph 7#c77;,a7 & ins]t+       
p>agraph 7#c77;,a77i74  7#c7 ,effective 
date ,! am5dm5ts made by ?is subsection 
%all apply ) respect to ! mon?ly fee or 
o!r basis ( paym5t = home dialysis      
s]vices furni%$ on or aft] ,janu>y #a1  
#bjaf4  7f7 ,appropriate valuation (    

remote diagno/ic te/ s]vices ,section   
#ahdh7;c77#b7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciew-#d7;c77#b77 is   
am5d$ by add+ at ! end ! foll[+ new     
subp>agraph3  7,p7 ,adju/m5ts = remote  
diagno/ic te/s ,9 det]m9+ practice      
exp5se relative value units = diagno/ic 
te/s describ$ 9 section #ahfa7s77#c7 t  
are provid$ remotely1 ! ,secret>y %all1 
9 consultation ) suppli]s ( remote      
diagno/ic te/+ s]vices1 include 9 direct
 co/s ( supplies & equipm5t1 ! co/s ( ! 
diagno/ic device1 cl9ical sy/ems        
7includ+ h>dw>e & s(tw>e71 in=mation    
transmission1 & device deliv]y &        
in/allation4 ,= purposes ( ?is          
subsection1 diagno/ic te/s describ$ 9   
section #ahfa7s77#c7 t are provid$      
remotely are su* te/s t are provid$     
?r\gh ! utilization ( a sy/em (         
te*nology t all[s a remote int]face to  
collect & transmit cl9ical data betwe5 !
 individual & a suppli]4 ,?is subsection
 %all be implem5t$ 9 a budget neutral   
mann]4  4  7g7 ,/udy & report2 ,s5se (  

,congress  7#a7 ,/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       
subsection 7a77#d71 betwe5 practition]s 
describ$ 9 subp>agraph 7,e77ii7 (       
section #ahcd7m77#d7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#aciem7m77#d771 z ins]t$ by subsection  
7a77#c77;,b77ii71 & pati5ts1 includ+ )  
respect to pati5t satisfaction1 provid] 
responsiv5ess to pati5t ne$s & conc]ns1 
& ! ext5t to :i* su* teleheal? s]vices  
are at lea/ comp>able to face-to-face   
enc\nt]s4  7ii7 ,! sav+s to ! ,m$ic>e   
program "u title ,,xviii ( su* ,act     
associat$ ) teleheal? s]vices           
utilization = !rapy = ! additional      
teleheal? s]vices describ$ 9 su* s5t5ce4
  7iii7 ,! pot5tial = great] use (      

teleheal? s]vices = =ms ( additional    
teleheal? s]vices n describ$ 9 su*      
s5t5ce4  7,b7 ,report ,n lat] ?an two   
ye>s aft] ! date ( ! enactm5t ( ?is     
,act1 ! ,comptroll] ,g5]al %all submit  
to ,congress a report on ! f9d+s ( !    
/udy conduct$ "u subp>agraph 7,a74  7#b7
 ,s5se ( ,congress ,x is ! s5se (       
,congress t ! teleheal? expansion ef=ts 
initiat$ by ! /udies & reports on ! use 
( teleheal? & remote pati5t monitor+    
s]vices "u ! ,m$ic>e ,access & ,,*ip    
,reau?orization ,act ( #bjae are cont9u$
 & fur!r$ ?r\gh ! increm5tal expansion (
 teleheal? & remote pati5t monitor+     
s]vices "u ?is ,act4