,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #bbia  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,may #b1 #bjag,mr4    
,duffy 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   
exp& ! cov]age ( teleheal? s]vices "u ! 
,m$ic>e program1 to provide cov]age =   
home-bas$ monitor+ = conge/ive he>t     
failure & *ronic ob/ructive pulmon>y    
disease "u su* program1 & = o!r         
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,help+ ,exp& ,access to    
,rural ,telem$ic9e ,act ( #bjag or z !  
,,he>t ,act ( #bjag4  #b4 ,expansions ( 
cov]age ( teleheal? s]vices  7a7        
,c\nties 9 ,m,s,as ) populations less   
?an #gj1jjj individuals ,section        
#ahcd7m77#d77;,c7 ( ! ,social ,security 

,act 7#db ,u4,s4,c4                     
#aciem7m77#d77;,c77i77 is am5d$ 9 clause
 7i77,,ii7 by ins]t+ bo? a c\nty t has a
 population ( great] ?an #gj1jjj        
individuals1 accord+ to ! mo/ rec5t     
dec5nial c5sus1 & a c\nty t is be=e     
includ$ 9 a ,metropolitan ,/ati/ical    
,area4  7b7 ,critical access & sole     
community hospitals ,section            
#ahcd7m77#d77;,c7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciem7m77#d77;,c771
 z am5d$ by subsection 7a71 is fur!r    
am5d$--  7#a7 9 clause 7i71 by ins]t+ 1 
9 ! case t su* site is n a site describ$
 9 subclause 7,,ii7 or 7,,ix7 ( su*     
clause1 aft] via a telecommunications   
sy/em &2 &  7#b7 9 clause 7ii71 by add+ 
at ! end ! foll[+ new subclause3  7,,ix7
 ,a sole community hospital 7z def9$ 9  
section #ahhf7;d77#e77;,d77iii774  4    
7c7 ,/ore-&-,=w>d te*nologies ,section  
#ahcd7m77#a7 ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #aciem7m77#a77 is am5d$  
by ins]t+ any teleheal? s]vices t are   
furni%$ f a di/ant site1 or to an       

orig9at+ site1 t is a critical access   
hospital 7z describ$ 9 p>agraph         
subclause 7,,ii7 ( p>agraph             
7#d77;,c77ii771 a rural heal? cl9ic 7z  
describ$ 9 subclause 7,,iii7 ( su*      
p>agraph71 or a sole community hospital 
7z describ$ 9 subclause 7,,ix7 ( su*    
p>agraph71 or ( aft] 9 ! case (4  7d7   
,rural heal? cl9ics z di/ant sites      
,section #ahcd7m77#d77;,a7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#aciem7m77#d77;,a77 is am5d$-- 7#a7 by  
/rik+ site4--,! t]m & ins]t+3  site  7i7
 ,9 g5]al ,! t]m  2 &  7#b7 by add+ at !
 end ! foll[+ new clause3  7ii7         
,treatm5t ( rural heal? cl9ics ,a site  
describ$ 9 clause 7i7 includes a rural  
heal? cl9ic 7z def9$ 9 section          
#ahfa7;aa77#b774 ,9 any case 9 :i* su* a
 cl9ic 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]vice1 & paym5t  

may n o!rwise be made "u ?is title )    
respect to su* s]vice provid$ to su*    
individual4  4  7e7 ,cov]$ s]vices      
,section #ahcd7m77#d77;,f77i7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7m77#d77;,f77i77 is am5d$-- 7#a7  
by /rik+ & (fice & ins]t+ (fice2 &  7#b7
 by ins]t+ by add+ at ! end ! foll[+ new
 s5t5ce3 respiratory s]vices1 audiology 
s]vices 7z def9$ 9 section #ahfa7ll771  
outpati5t !rapy s]vices 7includ+        
physical !rapy1 occupational !rapy1 &   
spee*-language pa?ology s]vices7 aft] ! 
,secret>y7714  7f7 ,provid]s ,subsection
 7m7 ( section #ahcd ( su* ,act 7#db    
,u4,s4,c4 #aciem7 is am5d$-- 7#a7 9     
p>agraph 7#a71 by /rik+ or a practition]
 7describ$ 9 section                    
#ahdb7;b77#ah77;,c77 & ins]t+ 1 a       
practition] 7describ$ 9 section         
#ahdb7;b77#ah77;,c771 or an applicable  
pr(essional 7z def9$ 9 p>agraph         
7#d77;,g772  7#b7 by /rik+ physician or 
practition] ea* "t x appe>s 9 su*       
subsection & ins]t+ physician1          

practition]1 or applicable pr(essional2 
7#c7 9 p>agraph 7#c77;,a7--  7,a7 9 !   
head+1 by /rik+ ,physician &            
,practition] & ins]t+ ,physician1       
,practition]1 & ,applicable             
,pr(essional2 &  7,b7 by /rik+          
physicians or practition]s & ins]t+     
physicians1 suppli]s1 or practition]s2 &
  7#d7 9 p>agraph 7#d71 by add+ at ! end
 ! foll[+ new subp>agraph3  7,g7        
,applicable pr(essional ,! t]m          
applicable pr(essional means1 ) respect 
to s]vices furni%$ on or aft] ! date t  
is #f mon?s aft] ! date ( ! enactm5t (  
?is subp>agraph1 a c]tifi$ diabetes     
educator or lic5s$--  7i7 respiratory   
!rapi/2  7ii7 audiologi/2  7iii7        
occupational !rapi/2  7iv7 physical     
!rapi/2 or  7v7 spee* language          
pa?ologi/4  4  #c4 ,home-bas$ monitor+  
s]vices = conge/ive he>t failure &      
*ronic ob/ructive pulmon>y disease  7a7 
,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  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 = *ronic
 heal? conditions  7#a7  7,a7 ,! t]m    
#8applicable 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 #8remote 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 
#8remote 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 #8cov]$ *ronic     
heal? condition' means applicable       
conditions 7z def9$ 9 & appli$ "u       
section #ahhf7q77#e77 :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  7c7 ,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--  7,a7 9 p>agraph       
7#b77;,b7-- 7i7 9 clause 7ii77,,ii71 by 
/rik+ & 7v7 & ins]t+ 7v71 & 7vii72 &    
7ii7 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,b7 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  #d4 ,effective date ,!    
am5dm5ts made by ?is ,act %all apply to 
items or s]vices furni%$ on or aft] !   
date t is #f mon?s aft] ! date ( !      
enactm5t ( ! ?is ,act4