,,ii  #aad? ,,congress  #b;d ,session   
,s4 #bdhd  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,febru>y #b1 #bjaf,mr4 
,s*atz 7= himself1 ,mr4 ,wick]1 ,mr4    
,co*ran1 ,mr4 ,c>d91 ,mr4 ,?une1 & ,mr4 
,w>n]7 introduc$ ! foll[+ bill2 :i* 0   
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to am5d titles     
,,xviii & ,,xi ( ! ,social ,security    
,act to promote co/ sav+s & quality c>e 
"u ! ,m$ic>e program ?r\gh ! use (      
teleheal? & remote pati5t monitor+      
s]vices1 & = o!r purposes4  #a4 ,%ort   
title2 table ( cont5ts  7a7 ,%ort title 
,?is ,act may be cit$ z ! ,creat+       
,opportunities ,n[ = ,necess>y &        
,effective ,c>e ,te*nologies 7,,connect7
 = ,heal? ,act or ! ,,connect = ,heal?  
,act4  7b7 ,table ( cont5ts ,! table (  
cont5ts ( ?is ,act is z foll[s3 ,sec4   
#a4 ,%ort title2 table ( cont5ts4       
,,title ,i--,teleheal? & remote pati5t  
monitor+ s]vices bridge demon/ration    
waiv]s ,sec4 #aja4 ,teleheal? & remote  
pati5t monitor+ s]vices bridge          

demon/ration waiv]s4 ,,title            
,,ii--,teleheal? & remote pati5t        
monitor+ s]vices furni%$ by qualify+    
,,apm p>ticipants ,sec4 #bja4 ,teleheal?
 & remote pati5t monitor+ s]vices       
furni%$ by qualify+ ,,apm p>ticipants4  
,,title ,,iii--,m$ic>e cov]age (        
teleheal? & remote pati5t monitor+      
s]vices ,sec4 #cja4 ,remote pati5t      
monitor+ s]vices = individuals ) c]ta9  
*ronic heal? conditions4 ,sec4 #cjb4    
,all[+ teleheal? to meet mon?ly cl9ician
 9-p]son visit requirem5t = c]ta9 home  
dialysis4 ,sec4 #cjc4 ,all[+ /roke      
evaluation sites & ,native ,am]ican     
heal? s]vice facilities z sites eligible
 = teleheal? paym5t4 ,sec4 #cjd4 ,rural 
heal? cl9ics & ,f$]ally qualifi$ heal?  
c5t]s au?oriz$ to be di/ant sites4 ,sec4
 #cje4 ,address+ gaps 9 quality measures
 = teleheal? & remote pati5t monitor+   
s]vices4 ,,title ,,iv--,use ( teleheal? 
& remote pati5t monitor+ s]vices to     
provide basic b5efits "u ,m$ic>e "p ,c  
,sec4 #dja4 ,use ( teleheal? & remote   

pati5t monitor+ s]vices to provide basic
 b5efits "u ,m$ic>e "p ,c4 ,,title      
,v--,cl>ification reg>d+ teleheal? &    
remote pati5t monitor+ te*nologies      
provid$ to b5efici>ies ,sec4 #eja4      
,cl>ification reg>d+ teleheal? & remote 
pati5t monitor+ te*nologies provid$ to  
b5efici>ies4  ,i ,teleheal? & remote    
pati5t monitor+ s]vices bridge          
demon/ration waiv]s  #aja4 ,teleheal? & 
remote pati5t monitor+ s]vices bridge   
demon/ration waiv]s ,title ,,xviii ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acie et seq47 is am5d$ by add+ at ! end
 ! foll[+ new section3  #ahii;,c4       
,teleheal? & remote pati5t monitor+     
s]vices bridge demon/ration waiv]s  7a7 
,implem5tation  7#a7 ,9 g5]al ,subject  
to ! succe$+ provisions ( ?is           
subsection1 ! ,secret>y %all solicit    
proposals f1 & issue teleheal? or remote
 pati5t monitor+ s]vices bridge         
demon/ration waiv]s "u ?is title to1    
eligible applicants :o1 = ! duration (  
"t = :i* ! demon/ration waiv] w\ld      

apply1 are furni%+ teleheal? or remote  
pati5t monitor+ s]vices 7z def9$ 9      
section #ahfa7;iii77 to individuals "u  
?is title 9 a mann] t is consi/5t ) !   
goals ( ! ,m]it-bas$ ,inc5tive ,paym5t  
,sy/em "u section #ahdh7q71 includ+ !   
goals ( quality1 res\rce utilization1 & 
cl9ical practice improvem5t 7includ+ c>e
 coord9ation & pati5t engagem5t71 or !  
inc5tive paym5ts = p>ticipation 9       
eligible alt]native paym5t models "u    
section #ahcc7z74  7#b7 ,eligible       
applicant def9$ ,9 ?is section1 ! t]m   
eligible applicant means ! foll[+3 7,a7 
,a pr(essional describ$ 9 section       
#ahdh7q77#a77;,c77i77,i74  7,b7 ,a      
qualify+ ,,apm p>ticipant 7z def9$ 9    
section #ahcc7z77#b774  7,c7 ,any o!r   
provid]1 includ+ a pr(essional describ$ 
9 section #ahdh7q77#a77;,c77i77,,ii71   
det]m9$ appropriate by ! ,secret>y1 & a 
gr\p t includes su* provid]s4  7b7      
,demon/ration waiv] application         
requirem5ts  ,an eligible applicant     
seek+ a demon/ration waiv] "u ?is       

section %all submit an application to ! 
,secret>y on an annual basis t includes 
! foll[+3  7#a7 ,an atte/ation ( ! int5t
 ( ! applicant to use teleheal? or      
remote pati5t monitor+ s]vices to meet !
 goals describ$ 9 subsection 7a77#a71 & 
details 7z specifi$ by ! ,secret>y7 on  
h[ ! eligible applicant w use ^? s]vices
 to meet su* goals4  7#b7 ,an agreem5t  
by ! applicant to-- 7,a7 submit !       
in=mation describ$ 9 subsection 7d7 9   
accordance ) su* subsection2 &  7,b7    
coop]ate 9 any audit conduct$ "u        
subsection 7e7 ) respect to claims =    
teleheal? or remote pati5t monitor+     
s]vices furni%$ by ! applicant "u !     
waiv]4  7c7 ,waiv] ( limitations =      
teleheal? or remote pati5t monitor+     
s]vices  7#a7 ,9 g5]al ,! ,secret>y %all
 waive c]ta9 applicable provisions (    
sections #ahcd7m7 & #ahfa7;iii7 z a     
condition ( paym5t = teleheal? or remote
 pati5t monitor+ s]vices = eligible     
applicants ^: application = a           
demon/ration waiv] 0 approv$ "u ?is     

section4 ,! provisions to be waiv$ "u ! 
prec$+ s5t5ce include any limitation on 
:at qualifies z an orig9at+ site1 any   
geographic limitation 7subject to ,/ate 
lic5s+ requirem5ts71 any limitation on !
 use ( /ore-&-=w>d te*nologies1 or any  
limitation on ! type ( heal? c>e provid]
 :o may furni% su* s]vices 7provid$ !   
provid] is a ,m$ic>e enroll$ provid]74  
7#b7 ,g5]al sup]vision ,! ,secret>y %all
 p]mit an eligible applicant ^:         
application = a demon/ration waiv] 0    
approv$ "u ?is section to furni%        
teleheal? or remote pati5t monitor+     
s]vices "u ! g5]al sup]vision ( !       
applicant4  7d7 ,annual submission (    
data ,an eligible applicant ^:          
application = a demon/ration waiv] "u   
?is section 0 approv$ %all1 on an annual
 basis1 submit to ! ,secret>y--  7#a7   
in=mation reque/$ by ! ,secret>y =      
evaluation ( ! demon/ration1 includ+    
in=mation on utilization & exp5ditures =
 teleheal? or remote pati5t monitor+    
s]vices "u ! demon/ration waiv] dur+ !  

prec$+ ye>2  7#b7 data on applicable    
quality measures dur+ ! prec$+ ye>1     
consi/5t ) sections #ahdh & #ahcc7z72 & 
7#c7 su* o!r in=mation z ! ,secret>y    
det]m9es is necess>y to complete !      
report "u subsection 7g74  7e7 ,r&om    
audits ,! ,secret>y %all conduct audits 
( r&omly select$ claims "u !            
demon/ration waiv] program "u ?is       
section to ensure t waiv]s "u ! program 
are be+ us$ z int5d$ to furni% teleheal?
 or remote pati5t monitor+ s]vices4  7f7
 ,implem5tation  7#a7 ,sunset ,except z 
provid$ 9 p>agraph 7#b71 ! au?ority to  
c>ry out ! demon/ration waiv] program "u
 ?is section %all expire on ,decemb]    
#ca1 #bjai4  7#b7 ,expansion ,tak+ into 
acc\nt ! report "u subsection 7g71 !    
,secret>y may1 ?r\gh rulemak+1 exp&     
7includ+ implem5tation on a nationwide  
basis7 ! duration & ! scope ( !         
demon/ration waiv] program "u ?is       
section1 to ! ext5t det]m9$ appropriate 
by ! ,secret>y1 if--  7,a7 ! ,secret>y  
det]m9es t su* expansion is expect$ to--

 7i7 r$uce sp5d+ "u ?is title )\t r$uc+ 
! quality ( c>e2 or  7ii7 improve !     
quality ( pati5t c>e )\t increas+ sp5d+2
  7,b7 ! ,*ief ,actu>y ( ! ,c5t]s =     
,m$ic>e  ,m$icaid ,s]vices c]tifies t   
su* expansion w\ld r$uce 7or w\ld n     
result 9 any increase 97 net program    
sp5d+ "u ?is title2 &  7,c7 ! ,secret>y 
det]m9es t su* expansion w\ld n d5y or  
limit ! cov]age or provision ( b5efits  
"u ?is title = individuals4  7g7 ,report
 to congress ,n lat] ?an ,decemb] #ca1  
#bjbj1 ! ,*ief ,actu>y ( ! ,c5t]s =     
,m$ic>e  ,m$icaid ,s]vices %all submit  
to ,congress a report conta9+ an        
evaluation ( ! impact ( teleheal? &     
remote pati5t monitor+ s]vices "u !     
demon/ration waiv] program on--  7#a7   
sp5d+ "u ?is title2 &  7#b7 a*iev+ !    
additional ,,mips adju/m5t factors =    
exceptional p]=mance describ$ 9 section 
#ahdh7q77#f77;,c7 & inc5tive paym5ts =  
p>ticipation 9 eligible alt]native      
paym5t models describ$ 9 section        
#ahcc7z77#a74  4  ,,ii ,teleheal? &     

remote pati5t monitor+ s]vices furni%$  
by qualify+ ,,apm p>ticipants  #bja4    
,teleheal? & remote pati5t monitor+     
s]vices furni%$ by qualify+ ,,apm       
p>ticipants  7a7 ,9 g5]al ,title ,,xviii
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acie et seq471 z am5d$ by    
section #aja1 is am5d$ by add+ at ! end 
! foll[+ new section3  #ahii;,d4        
,teleheal? & remote pati5t monitor+     
s]vices furni%$ by qualify+ ,,apm       
p>ticipants  7a7 ,9 g5]al ,! ,secret>y  
%all waive c]ta9 applicable provisions (
 section #ahcd7m7 & section #ahfa7;iii7 
z a condition ( paym5t = teleheal? or   
remote pati5t monitor+ s]vices = a      
qualify+ ,,apm p>ticipant 7z def9$ 9    
section #ahcc7z77#b774 ,! provisions to 
be waiv$ "u ! prec$+ s5t5ce include any 
limitation on :at qualifies z an        
orig9at+ site1 any geographic limitation
 7subject to ,/ate lic5s+ requirem5ts71 
any limitation on ! use ( /ore-&-=w>d   
te*nologies1 or any limitation on ! type
 ( heal? c>e provid] :o may furni% su*  

s]vices 7provid$ ! provid] is a ,m$ic>e 
enroll$ provid]74  7b7 ,annual          
submission ( data ,a qualify+ ,,apm     
p>ticipant 7z s def9$7 :o furni%es      
teleheal? or remote pati5t monitor+     
s]vices "u ?is section %all1 on an      
annual basis1 submit to ! ,secret>y     
in=mation reque/$ by ! ,secret>y =      
evaluation ( ! implem5tation ( ?is      
section1 includ+ in=mation on           
utilization & exp5ditures = teleheal? or
 remote pati5t monitor+ s]vices "u ?is  
section dur+ ! prec$+ ye> & data on any 
applicable quality measures1 consi/5t ) 
sections #ahdh & #ahcc7z74  7c7 ,no     
increase 9 exp5ditures ,if ! ,secret>y  
det]m9es paym5ts = teleheal? or remote  
pati5t monitor+ s]vices "u ?is section w
 increase exp5ditures "u ?is title1 !   
,secret>y %all make adju/m5ts to su*    
paym5ts to elim9ate su* increas$        
exp5ditures4  4  7b7 ,effective date ,! 
am5dm5t made by ?is section %all apply )
 respect to s]vices furni%$ on or aft]  
,janu>y #a1 #bjag4  ,,iii ,m$ic>e       

cov]age ( teleheal? & remote pati5t     
monitor+ s]vices  #cja4 ,remote pati5t  
monitor+ s]vices = individuals ) c]ta9  
*ronic heal? conditions  7a7 ,cov]age   
7#a7 ,9 g5]al ,section #ahfa7s77#b7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#aciex7s77#b77 is am5d$-- 7,a7 9        
subp>agraph 7,,ee71 by /rik+ & at ! end2
  7,b7 9 subp>agraph 7,,ff71 by ins]t+ &
 at ! end2 &  7,c7 by ins]t+ aft]       
subp>agraph 7,,ff7 ! foll[+ new         
subp>agraph3  7,,gg7 applicable remote  
pati5t monitor+ s]vices = individuals ) 
c]ta9 *ronic heal? conditions 7z def9$ 9
 subsection 7iii772 4  7#b7 ,cov]age z  
rural heal? cl9ic s]vices & ,f$]ally    
qualifi$ heal? c5t] s]vices ,section    
#ahfa7;aa7 ( ! ,social ,security ,act   
7#db ,u4,s4,c4 #aciex7aa77 is am5d$--   
7,a7 9 p>agraph 7#a7--  7i7 9           
subp>agraph 7,b71 by /rik+ 1 & & ins]t+ 
a comma2  7ii7 9 subp>agraph 7,c71 by   
ins]t+ & aft] ! comma at ! end2 &  7iii7
 by ins]t+ aft] subp>agraph 7,c7 !      
foll[+ new subp>agraph3  7,d7 applicable

 remote pati5t monitor+ s]vices =       
individuals ) c]ta9 *ronic heal?        
conditions 7z def9$ 9 subsection 7iii771
  2 &  7,b7 9 p>agraph 7#c7-- 7i7 9     
subp>agraph 7,a71 by /rik+ 2 & & ins]t+ 
a semicolon2  7ii7 9 subp>agraph 7,b71  
by /rik+ ! comma & ins]t+ 2 &2 &  7iii7 
by ins]t+ aft] subp>agraph 7,b7 ! foll[+
 new subp>agraph3  7,c7 applicable      
remote pati5t monitor+ s]vices =        
individuals ) c]ta9 *ronic heal?        
conditions 7z def9$ 9 subsection 7iii771
  4  7b7 ,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 =       
individuals ) c]ta9 *ronic heal?        
conditions  7#a7 7,a7 ,! t]m applicable 
remote pati5t monitor+ s]vices =        
individuals ) c]ta9 *ronic heal?        
conditions means remote pati5t monitor+ 
s]vices 7z def9$ 9 subp>agraph 7,b77    
furni%$ to an applicable individual 7z  
def9$ 9 subp>agraph 7,c77 "u g5]al      

sup]vision ( ! provid]1 ) ! exception ( 
^? s]vices cov]$ "u subsection 7s77#a74 
7,b7 ,! t]m remote pati5t monitor+      
s]vices means p]sonal m$ical data       
transmitt$ f an applicable individual 9 
"o location via electronic              
communications te*nologies to an        
eligible provid] 7z def9$ 9 subp>agraph 
7,d77 9 a diff]5t location & us$ by !   
eligible provid] 9 furni%+ remote pati5t
 monitor+ s]vices to su* individual t   
complies ) ! ,f$]al regulations 7conc]n+
 ! privacy & security ( individually    
id5tifiable heal? in=mation7 promulgat$ 
"u section #bfd7;c7 ( ! ,heal?          
,insurance ,portability & ,acc\ntability
 ,act ( #aiif1 z "p ( an e/abli%$ plan (
 c>e = t individual t includes ! review 
& int]pretation ( t data by an eligible 
provid]4 ,su* t]m includes ^? s]vices   
furni%$ 9 a ,f$]ally qualifi$ heal? c5t]
 or a rural heal? cl9ic  7,c7 ,! t]m    
applicable individual means an          
individual-- 7i7 ) #b or m cov]$ *ronic 
conditions 7z def9$ 9 p>agraph 7#b772 & 

7ii7 :o has a hi/ory ( #b or m          
hospitalizations or em]g5cy room visits 
relat$ to su* cov]$ *ronic conditions ( 
! individual 9 ! prec$+ #ab mon?s4  7,d7
 ,! t]m eligible provid] means a        
physician 7z def9$ 9 section #ahfa7r77  
or a practition] describ$ 9 section     
#ahdb7;b77#ah77;,c74  7,e7 ,! ,secret>y 
%all e/abli% proc$ures "u :i* eligible  
provid]s :o furni% remote pati5t        
monitor+ s]vices are requir$ to annually
 submit data on applicable quality      
measures "u sections #ahdh & #ahcc7z74  
7#b7 7,a7 ,= purposes ( p>agraph        
7#a77;,c71 subject to subp>agraph 7,b71 
! t]m cov]$ *ronic condition means-- 7i7
 a condition t qualifies an individual =
 *ronic c>e managem5t s]vices "u section
 #ahdh7;b77#h72 &  7ii7 any o!r         
condition ! ,secret>y may specify4  7,b7
 ,if ! ,*ief ,actu>y ( ! ,c5t]s =       
,m$ic>e  ,m$icaid ,s]vices det]m9es t ! 
inclusion ( a condition describ$ 9      
subp>agraph 7,a7 9 ! def9ition ( ! t]m  
cov]$ *ronic condition "u su*           

subp>agraph w result 9 increas$         
exp5ditures "u ?is title1 ! ,secret>y   
%all make adju/m5ts to su* def9ition to 
elim9ate su* increas$ exp5ditures4  7#c7
 7,a7 ,paym5t may be made "u ?is "p =   
applicable remote pati5t monitor+       
s]vices = individuals ) c]ta9 *ronic    
heal? conditions furni%$ to an          
applicable individual dur+ a p]iod ( up 
to #ij days 7beg9n+ ) ! comm5cem5t ( su*
 s]vices7 & 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 applicable        
individual1 may be r5ew$ by ! eligible  
provid] :o provides *ronic c>e managem5t
 s]vices to su* individual if !         
individual has _h "o or m               
hospitalizations1 n includ+ em]g5cy room
 visits1 relat$ to ! cov]$ *ronic       
conditions ( ! individual describ$ 9    
p>agraph 7#a77;,c7 s9ce ! beg9n+ ( su*  
p]iod4  4  7c7 ,paym5t  7#a7 ,9 g5]al   
,section #ahdh7;j77#c7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           

#aciew-#d7;j77#c77 is am5d$ by ins]t+   
7#b77;,,gg71 aft] heal? risk            
assessm5t714  7#b7 ,rural heal? cl9ic   
s]vices & ,f$]ally qualifi$ heal? c5t]  
s]vices ,section #ahcc ( ! ,social      
,security ,act 7#db ,u4,s4,c4 #aciel7 is
 am5d$ by add+ at ! end ! foll[+ new    
subsection3  7aa7 ,paym5t = applicable  
remote pati5t monitor+ s]vices =        
individuals ) c]ta9 *ronic heal?        
conditions furni%$ by a rural heal?     
cl9ic or a ,f$]ally qualifi$ heal? c5t] 
,not)/&+ any o!r provision ( law1 9 !   
case ( applicable remote pati5t monitor+
 s]vices = individuals ) c]ta9 *ronic   
heal? conditions 7z def9$ 9 section     
#ahfa7;iii77 furni%$ by a rural heal?   
cl9ic or a ,f$]ally qualifi$ heal? c5t] 
"u p>agraphs 7#a7 & 7#c71 respectively1 
( section #ahfa7;aa71 paym5t %all be    
made 9 an am\nt equal to ! national     
av]age paym5t am\nt = su* s]vice1 z     
det]m9$ by ! ,secret>y1 9 accordance )  
section #ahdh 7)\t reg>d to any adju/m5t
 "u subsections 7a77#e71 7a77#g71       

7a77#h71 7p71 or 7q7 ( su* section74  4 
7d7 ,effective date ,! am5dm5ts made by 
?is section %all apply to s]vices       
furni%$ on or aft] ,janu>y #a1 #bjag4   
#cjb4 ,all[+ teleheal? to meet mon?ly   
cl9ician 9-p]son visit requirem5t =     
c]ta9 home dialysis  7a7 ,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 an     
individual det]m9$ to h end /age r5al   
disease receiv+ home dialysis may elect 
to receive ! mon?ly end /age r5al       
disease-relat$ visits via teleheal? if !
 individual receives an 9-p]son         

exam9ation at lea/ once e ?ree          
consecutive mon?s4 ,= purposes ( !      
prec$+ s5t5ce1 a dialysis facility %all 
be ! orig9at+ site at :i* ! individual  
is locat$ at ! "t ! s]vice is furni%$   
via teleheal?4  4  7b7 ,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  7c7 ,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  
#bjag4  #cjc4 ,all[+ /roke evaluation   
sites & ,native ,am]ican heal? s]vice   
facilities z sites eligible = teleheal? 
paym5t  7a7 ,/roke evaluation 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 ,/roke teleheal? s]vices ,!       

orig9at+ site requirem5ts describ$ 9    
clauses 7i7 & 7ii7 %all n apply )       
respect to s]vices relat$ to !          
evaluation or managem5t ( an acute /roke
 = ! purpose ( det]m9+ optimal acute    
/roke !rapy4  4  7b7 ,native ,am]ican   
heal? s]vice facilities ,section        
#ahcd7m77#d77;,c7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciem7m77#d77;,c771
 z am5d$ by subsection 7a71 is am5d$--  
7#a7 9 clause 7i71 by /rik+ clause 7iii7
 & ins]t+ clauses 7iii7 & 7iv72 &  7#b7 
by add+ at ! end ! foll[+ new clause3   
7iv7 ,native ,am]ican heal? s]vice      
facilities ,! orig9at+ site requirem5ts 
describ$ 9 clauses 7i7 & 7ii7 %all n    
apply ) respect to a facility ( !       
,indian ,heal? ,s]vice1 :e!r op]at$ by  
su* ,s]vice1 or by an ,indian tribe 7z t
 t]m is def9$ 9 section #d ( ! ,indian  
,heal? ,c>e ,improvem5t ,act 7#be       
,u4,s4,c4 #afjc77 or a tribal           
organization 7z t t]m is def9$ 9 section
 #d ( ! ,indian ,self-,det]m9ation &    
,education ,assi/ance ,act 7#be         

,u4,s4,c4 #dej;b771 or a facility ( !   
,native ,hawaiian heal? c>e sy/ems      
au?oriz$ "u ! ,native ,hawaiian ,heal?  
,c>e ,improvem5t ,act 7#db ,u4,s4,c4    
#aagja et seq474  4  7c7 ,no orig9at+   
site facility fee = new sites ,section  
#ahcd7m77#b77;,b7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciem7m77#b77;,b77 
is am5d$1 9 ! matt] prec$+ clause 7i71  
by ins]t+ 7o!r ?an an orig9at+ site t is
 only describ$ 9 clause 7iii7 or 7iv7 ( 
p>agraph 7#d77;,c71 & does n meet !     
requirem5t = an orig9at+ site "u clause 
7i7 ( su* p>agraph7 aft] ! orig9at+     
site4  7d7 ,effective date ,! am5dm5ts  
made by ?is section %all apply to       
s]vices furni%$ on or aft] ,janu>y #a1  
#bjag4  #cjd4 ,rural heal? cl9ics &     
,f$]ally qualifi$ heal? c5t]s au?oriz$  
to be di/ant sites  7a7 ,9 g5]al        
,section #ahcd7m7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciem7m77 is       
am5d$--  7#a7 9 ! fir/ s5t5ce ( p>agraph
 7#a7-- 7,a7 by /rik+ or a practition]  
7describ$ 9 section #ahdb7;b77#ah77;,c77

 & ins]t+ 1 a practition] 7describ$ 9   
section #ahdb7;b77#ah77;,c771 a ,f$]ally
 qualifi$ heal? c5t]1 or a rural heal?  
cl9ic2 &  7,b7 by /rik+ or practition] &
 ins]t+ 1 practition]1 ,f$]ally qualifi$
 heal? c5t]1 or rural heal? cl9ic2  7#b7
 9 p>agraph 7#b77;,a7--  7,a7 by ins]t+ 
! foll[+ aft] eligible teleheal?        
individual3 or to a ,f$]ally qualifi$   
heal? c5t] or rural heal? cl9ic t s]ves 
z a di/ant site & ^: cl9ician furni%es a
 teleheal? s]vice to an eligible        
teleheal? individual2 &  7,b7 by /rik+  
su* physician or practition] & ins]t+   
su* physician1 practition]1 ,f$]ally    
qualifi$ heal? c5t]1 or rural heal?     
cl9ic2 &  7#c7 9 p>agraph 7#d77;,a71 by 
ins]t+ ! foll[+ be=e ! p]iod at ! end3 &
 includes a ,f$]ally qualifi$ heal? c5t]
 or rural heal? cl9ic ^: cl9ician       
furni%es a teleheal? s]vice to an       
eligible individual4  7b7 ,effective    
date ,! am5dm5ts made by ?is section    
%all apply to s]vices furni%$ on or aft]
 ,janu>y #a1 #bjag4  #cje4 ,address+    

gaps 9 quality measures = teleheal? &   
remote pati5t monitor+ s]vices ,section 
#ahdh7s77#a77;,c7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4                     
#aciew-#d7s77#a77;,c77 is am5d$--  7#a7 
by r$esignat+ clauses 7i7 ?r\gh 7iv7 z  
subclauses 7,i7 ?r\gh 7,,iv71           
respectively1 & ind5t+ appropriately2   
7#b7 by /rik+ ,consid]ation4--,9        
develop+ & ins]t+ 8,consid]ation4--  7i7
 ,9 g5]al ,subject to clause 7ii71 9    
develop+  2 &  7#c7 by add+ at ! end !  
foll[+ new clause3  7ii7 ,address+ gaps 
9 measures = teleheal? & remote pati5t  
monitor+ s]vices ,consi/5t ) ?is        
subsection1 ! ,secret>y %all ensure t ! 
plan id5tify+ measure developm5t        
priorities & timel9es develop$ "u ?is   
subsection addresses relevant gaps 9    
measures ) respect to teleheal? s]vices1
 remote pati5t monitor+ s]vices1 & ! use
 ( su* s]vices to address heal?         
disp>ities 7z describ$ 9 section        
#ahij7;b77#a77;,b77ii77 t are n o!rwise 
address$ ?r\gh exi/+ quality measures4  

4  ,,iv ,use ( teleheal? & remote pati5t
 monitor+ s]vices to provide basic      
b5efits "u ,m$ic>e "p ,c  #dja4 ,use (  
teleheal? & remote pati5t monitor+      
s]vices to provide basic b5efits "u     
,m$ic>e "p ,c  7a7 ,9 g5]al ,section    
#aheb ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #aciew-#bb7 is am5d$-- 7#a7 9 
subsection 7a77#a77;,b77i71 by /rik+ "p1
 ! t]m & ins]t+ "p1 subject to          
subsection 7m71 ! t]m2 &  7#b7 by add+  
at ! end ! foll[+ new subsection3  7m7  
,use ( teleheal? & remote pati5t        
monitor+ s]vices ,to provide basic      
b5efits ,= plan ye> #bjag & subsequ5t   
plan ye>s1 ! foll[+ %all apply3  7#a7 ,9
 g5]al ,an ,,ma plan may elect to use   
teleheal? or remote pati5t monitor+     
s]vices to provide b5efits "u ! orig9al 
m$ic>e fee-=-s]vice program option1     
includ+ items or s]vices furni%$ to     
treat m$ical or behavioral heal?        
conditions4  7#b7 ,waiv] ( limitations  
,not)/&+ any o!r provision ( law1 9 !   
case :]e an ,,ma plan elects to use     

teleheal? or remote pati5t monitor+     
s]vices to provide su* b5efits1 )       
respect to enrollees1 su* s]vices may be
 furni%$ )\t application ( any provision
 "u section #ahcd7m7 or any o!r         
provision ( ?is ,act t applies a        
limitation on :at qualifies z an        
orig9at+ site1 any geographic limitation
 7subject to ,/ate lic5s+ requirem5ts71 
any limitation on ! use ( /ore-&-=w>d   
te*nologies1 or any limitation on ! type
 ( heal? c>e provid] :o may furni% su*  
s]vices 7provid$ ! provid] is a ,m$ic>e 
enroll$ provid]74  7#c7 ,treatm5t z     
basic b5efits ,9 ! case :]e an ,,ma plan
 makes su* election "u p>agraph 7#a71 ! 
use ( su* teleheal? or remote pati5t    
monitor+ s]vices %all be consid]$ "p ( !
 provision ( b5efits "u ! orig9al m$ic>e
 fee-=-s]vice program option = purpose (
 ?is "p4  7#d7 ,availability ( b5efits 9
 p]son ,9 ! case :]e an ,,ma plan makes 
su* election "u p>agraph 7#a71 any      
b5efits provid$ us+ su* teleheal?       
s]vices %all cont9ue to be made         

available 9 p]son to enrollees "u !     
plan4  7#e7 ,provision ( data ,an ,,ma  
plan t makes su* an election "u p>agraph
 7#a7 ) respect to a plan ye> %all      
provide to ! ,secret>y 7at su* "t & 9   
su* mann] z ! ,secret>y may specify7    
data on exp5ditures & utilization =     
teleheal? or remote pati5t monitor+     
s]vices "u ! plan = enrollees dur+ t    
plan ye>4  4  7b7 ,cl>ification reg>d+  
inclusion 9 bid am\nt ,section          
#ahed7;a77#f77;,a77ii77,i7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#aciew-#bd7;a77#f77;,a77ii77,i77 is     
am5d$ by ins]t+ 1 includ+1 = plan ye>   
#bjag & subsequ5t plan ye>s1 ! use (    
teleheal? or remote pati5t monitor+     
s]vices to provide su* b5efits z        
describ$ 9 section #aheb7m7 be=e !      
semicolon at ! end4  7c7 ,rule (        
con/ruction ,no?+ 9 ?is section %all be 
con/ru$ z affect+ ! furni%+ ( items or  
s]vices "u ! orig9al ,m$ic>e            
fee-=-s]vice program4  ,v ,cl>ification 
reg>d+ teleheal? & remote pati5t        

monitor+ te*nologies provid$ to         
b5efici>ies  #eja4 ,cl>ification reg>d+ 
teleheal? & remote pati5t monitor+      
te*nologies provid$ to b5efici>ies      
,section #aabh;,a7i77#f7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acbj;a-#g;a7i77#f77 is am5d$-- 7#a7 9  
subp>agraph 7,h71 by /rik+ 2 or & ins]t+
 a semicolon2  7#b7 9 subp>agraph 7,i71 
by /rik+ ! p]iod at ! end & ins]t+ 2 or2
 &  7#c7 by add+ at ! end ! foll[+ new  
subp>agraph3  7,j7 ! provision (        
teleheal? or remote pati5t monitor+     
te*nologies to individuals "u title     
,,xviii by a heal? c>e provid] = !      
purpose ( furni%+ teleheal? or remote   
pati5t monitor+ s]vices4  4