,i #aaeth ,,congress #ast ,session ,h4 ,r4 #bbia ,,in ,,the ,,house ,,of ,,representatives ,may #b1 #bjag,mr4 ,duffy 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 expand the coverage of telehealth services under the ,medicare program1 to provide coverage for home-based monitoring for congestive heart failure and chronic obstructive pulmonary disease under such program1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,helping ,expand ,access to ,rural ,telemedicine ,act of #bjag or as the ,,heart ,act of #bjag4 #b4 ,expansions of coverage of telehealth services 7a7 ,counties in ,m,s,as with populations less than #gj1jjj individuals ,section #ahcd7m77#d77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,c77i77 is amended in clause 7i77,,ii7 by inserting both a county that has a population of greater than #gj1jjj individuals1 according to the most recent decennial census1 and a county that is before included in a ,metropolitan ,statistical ,area4 7b7 ,critical access and sole community hospitals ,section #ahcd7m77#d77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,c771 as amended by subsection 7a71 is further amended-- 7#a7 in clause 7i71 by inserting 1 in the case that such site is not a site described in subclause 7,,ii7 or 7,,ix7 of such clause1 after via a telecommunications system and2 and 7#b7 in clause 7ii71 by adding at the end the following new subclause3 7,,ix7 ,a sole community hospital 7as defined in section #ahhf7;d77#e77;,d77iii774 4 7c7 ,store-and-,forward technologies ,section #ahcd7m77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#a77 is amended by inserting any telehealth services that are furnished from a distant site1 or to an originating site1 that is a critical access hospital 7as described in paragraph subclause 7,,ii7 of paragraph 7#d77;,c77ii771 a rural health clinic 7as described in subclause 7,,iii7 of such paragraph71 or a sole community hospital 7as described in subclause 7,,ix7 of such paragraph71 or of after in the case of4 7d7 ,rural health clinics as distant sites ,section #ahcd7m77#d77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,a77 is amended-- 7#a7 by striking site4--,the term and inserting3 site 7i7 ,in general ,the term 2 and 7#b7 by adding at the end the following new clause3 7ii7 ,treatment of rural health clinics ,a site described in clause 7i7 includes a rural health clinic 7as defined in section #ahfa7;aa77#b774 ,in any case in which such a clinic is treated as a distant site with respect to the provision of a telehealth service to an eligible telehealth individual for which payment is made under this subsection1 such service shall not be treated as a rural health clinic service1 and payment may not otherwise be made under this title with respect to such service provided to such individual4 4 7e7 ,covered services ,section #ahcd7m77#d77;,f77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,f77i77 is amended-- 7#a7 by striking and office and inserting office2 and 7#b7 by inserting by adding at the end the following new sentence3 respiratory services1 audiology services 7as defined in section #ahfa7ll771 outpatient therapy services 7including physical therapy1 occupational therapy1 and speech-language pathology services7 after the ,secretary7714 7f7 ,providers ,subsection 7m7 of section #ahcd of such ,act 7#db ,u4,s4,c4 #aciem7 is amended-- 7#a7 in paragraph 7#a71 by striking or a practitioner 7described in section #ahdb7;b77#ah77;,c77 and inserting 1 a practitioner 7described in section #ahdb7;b77#ah77;,c771 or an applicable professional 7as defined in paragraph 7#d77;,g772 7#b7 by striking physician or practitioner each time it appears in such subsection and inserting physician1 practitioner1 or applicable professional2 7#c7 in paragraph 7#c77;,a7-- 7,a7 in the heading1 by striking ,physician and ,practitioner and inserting ,physician1 ,practitioner1 and ,applicable ,professional2 and 7,b7 by striking physicians or practitioners and inserting physicians1 suppliers1 or practitioners2 and 7#d7 in paragraph 7#d71 by adding at the end the following new subparagraph3 7,g7 ,applicable professional ,the term applicable professional means1 with respect to services furnished on or after the date that is #f months after the date of the enactment of this subparagraph1 a certified diabetes educator or licensed-- 7i7 respiratory therapist2 7ii7 audiologist2 7iii7 occupational therapist2 7iv7 physical therapist2 or 7v7 speech language pathologist4 4 #c4 ,home-based monitoring services for congestive heart failure and chronic obstructive pulmonary disease 7a7 ,coverage of remote patient monitoring 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-- 7,a7 in subparagraph 7,,ee71 by striking and at the end2 7,b7 in subparagraph 7,,ff71 by inserting and at the end2 and 7,c7 by inserting after subparagraph 7,,ff7 the following new subparagraph3 7,,gg7 applicable remote patient monitoring services 7as defined in paragraph 7#a77;,a7 of subsection 7iii772 4 7b7 ,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 monitoring services for chronic health conditions 7#a7 7,a7 ,the term #8applicable remote patient monitoring services' means remote patient monitoring services 7as defined in subparagraph 7,b77 furnished to provide for the monitoring1 evaluation1 and management of an individual with a covered chronic condition 7as defined in paragraph 7#b771 insofar as such services are for the management of such chronic condition4 7,b7 ,the term #8remote patient monitoring services' means services furnished through remote patient monitoring technology 7as defined in subparagraph 7,c774 7,c7 ,the term #8remote patient monitoring technology' means a coordinated system that uses one or more home-based or mobile monitoring devices that automatically transmit vital sign data or information on activities of daily living and may include responses to assessment questions collected on the devices wirelessly or through a telecommunications connection to a server that complies with the ,federal regulations 7concerning the privacy of individually identifiable health information7 promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif1 as part of an established plan of care for that patient that includes the review and interpretation of that data by a health care professional4 7#b7 ,for purposes of paragraph 7#a71 the term #8covered chronic health condition' means applicable conditions 7as defined in and applied under section #ahhf7q77#e77 when under chronic care management 7identified as of ,july #a1 #bjae1 by ,,hcpcs code #iidij 7and as subsequently modified by the ,secretary774 7#c7 7,a7 ,payment may be made under this part for applicable remote patient monitoring services provided to an individual during a period of up to #ij days and such additional period as provided for under subparagraph 7,b74 7,b7 ,the #ij-;day period described in subparagraph 7,a71 with respect to an individual1 may be renewed by the physician who provides chronic care management to such individual if the individual continues to qualify for such management4 4 7c7 ,payment under the physician fee schedule ,section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7 is amended-- 7#a7 in subsection 7c7-- 7,a7 in paragraph 7#b77;,b7-- 7i7 in clause 7ii77,,ii71 by striking and 7v7 and inserting 7v71 and 7vii72 and 7ii7 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,b7 by adding at the end the following new paragraph3 7#g7 ,treatment of applicable remote patient monitoring services 7,a7 ,in determining relative value units for applicable remote patient monitoring services 7as defined in section #ahfa7;iii77#a77;,a771 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 monitoring 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 monitoring services4 2 and 7#b7 in subsection 7j77#c71 by inserting 7#b77;,,gg71 after health risk assessment714 #d4 ,effective date ,the amendments made by this ,act shall apply to items or services furnished on or after the date that is #f months after the date of the enactment of the this ,act4