,i  #aaeth ,,congress  #ast ,session    
,h4 ,r4 #beej  ,,in ,,the ,,house ,,of  
,,representatives  ,may #ai1 #bjag,mr4  
,thompson of ,california 7for himself1  
,mrs4 ,black1 ,mr4 ,welch1 and ,mr4     
,harper7 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 provide for an        
incremental expansion of telehealth     
coverage under the ,medicare program4   
#a4 ,short title ,this ,act may be cited
 as the ,medicare ,telehealth ,parity   
,act of #bjag4  #b4 ,phased-in expansion
 of telehealth coverage under ,medicare 
7a7 ,initial phase  7#a7 ,expansion of  
originating sites ,section              
#ahcd7m77#d77;,c7 of the ,social        

,security ,act 7#db ,u4,s4,c4           
#aciem7m77#d77;,c77 is amended--  7,a7  
in clause 7i71 by striking ,the term and
 inserting ,subject to clause 7iii71 the
 term2 and  7,b7 by adding at the end   
the following new clause3  7iii7        
,additional sites ,the term originating 
site shall also include the following   
sites at which the eligible telehealth  
individual is located at the time the   
service is furnished via a              
telecommunications system1 whether or   
not they are located in an area         
described in clause 7i71 insofar as such
 sites are not otherwise included in the
 definition of originating site under   
such clause3  7,i7 ,in the case of such 
a service furnished on or after the date
 that is #f months after the date of the
 enactment of the ,medicare ,telehealth 
,parity ,act of #bjag1 any ,federally   
qualified health center and any rural   
health clinic 7as such terms are defined
 in section #ahfa7;aa774  7,,ii7 ,in the
 case of such a service furnished on or 

after the date that is #f months after  
the date of the enactment of the        
,medicare ,telehealth ,parity ,act of   
#bjag1 any site described in clause 7ii7
 that is located in a county within a   
,metropolitan ,statistical ,area with a 
population of fewer than #ej1jjj        
individuals1 according to the most      
recent decennial census4  4  7#b7       
,originating site fee not to apply to   
additional sites ,section               
#ahcd7m77#b77;,b7 of such ,act 7#db     
,u4,s4,c4 #aciem7m77#d77;,c77 is amended
 by inserting after and below clause    
7ii7 the following3  ,the facility fee  
under this subparagraph shall not apply 
to any site included as an originating  
site pursuant to clause 7iii7 of        
paragraph 7#d77;,c7 that would not      
otherwise be included as an originating 
site without application of such clause4
 4  7#c7 ,additional telehealth         
providers ,section #ahcd7m7 of such ,act
 7#db ,u4,s4,c4 #aciem7m77 is amended-- 
7,a7 in paragraph 7#a7--  7i7 by        

striking or a practitioner 7described in
 section #ahdb7;b77#ah77;,c77 and       
inserting or a professional described in
 paragraph 7#d77;,e772 and  7ii7 by     
striking individual physician or        
practitioner and inserting individual   
physician or professional2 and  7,b7 in 
paragraph 7#d71 by-- 7i7 striking       
subparagraph 7,e72 and  7ii7 inserting  
after subparagraph 7,d7 the following   
new subparagraph3  7,e7 ,professional   
described ,for purposes of paragraph    
7#a71 a professional described in this  
subparagraph is--  7i7 a practitioner   
described in section                    
#ahdb7;b77#ah77;,c72 or  7ii7 with      
respect to services furnished on or     
after the date that is #f months after  
the date of the enactment of the        
,medicare ,telehealth ,parity ,act of   
#bjag1 a certified diabetes educator or 
licensed--  7,i7 respiratory therapist2 
7,,ii7 audiologist2  7,,iii7            
occupational therapist2  7,,iv7 physical
 therapist2 or  7,v7 speech language    

pathologist4  4  7#d7 ,additional       
covered telehealth services ,section    
#ahcd7m77#d77;,f77i7 of the ,social     
,security ,act 7#db ,u4,s4,c4           
#aciem7m77#d77;,f77i77 is amended by    
adding at the end the following new     
sentence3 ,such term shall include      
respiratory services1 audiology services
 7as defined in section #ahfa7ll771 and 
outpatient therapy services1 including  
physical therapy1 occupational therapy1 
and speech-language pathology services44
  7#e7 ,expansion of telecommunications 
system ,the second sentence of section  
#ahcd7m77#a7 of the ,social ,security   
,act 7#db ,u4,s4,c4 #aciem7m77#a77 is   
amended by striking in the case of any  
,federal telemedicine demonstration     
program conducted in ,alaska or         
,hawaii14  7#f7 ,rural health clinics   
and ,federally qualified health centers 
authorized to be 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 inserting
  site4-- 7i7 ,in general ,the term  2  
and  7,b7 by adding at the end the      
following new clause3  7ii7 ,treatment  
of rural health clinics and ,federally  
qualified health centers ,a site        
described in clause 7i7 includes a rural
 health clinic 7as defined in section   
#ahfa7;aa77#b77 and a ,federally        
qualified health center 7as defined in  
section #ahfa7;aa77#d774 ,in any case in
 which such a clinic or center 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 service
 or ,federally qualified health center  
service1 respectively1 and payment may  
not otherwise be made under this title  
with respect to such service provided to
 such individual4  4  7b7 ,second phase 
7#a7 ,in general ,section #ahcd7m77#d7  
of the ,social ,security ,act 7#db      

,u4,s4,c4 #aciem7m77#d77 is amended--   
7,a7 in clause 7iii7 of subparagraph    
7,c71 as added by subsection 7a77#a71 by
 adding at the end the following new    
subclauses3  7,,iii7 ,in the case of    
such a service furnished on or after the
 date that is #b years after the date of
 the enactment of the ,medicare         
,telehealth ,parity ,act of #bjag1 any  
site described in clause 7ii7 that is   
located in a county within a            
,metropolitan ,statistical ,area with a 
population of at least #ej1jjj          
individuals but fewer than #ajj1jjj     
individuals1 according to the most      
recent decennial census4  7,,iv7 ,in the
 case of such a service furnished on or 
after the date that is #b years after   
the date of the enactment of the        
,medicare ,telehealth ,parity ,act of   
#bjag1 a home telehealth site1 as       
defined in subparagraph 7,g74  7,v7 ,in 
the case of such a service that is      
related to the evaluation or treatment  
of an acute stroke and that is furnished

 on or after the date described in      
subclause 7,,iv7 during the             
evidence-based window of treatment1 any 
site at which the eligible telehealth   
individual is located at the time the   
service is furnished via a              
telecommunications system1 regardless of
 where the site is located4  2 and  7,b7
 by adding at the end the following new 
subparagraph3  7,g7 ,home telehealth    
site  7i7 ,in general ,the term home    
telehealth site means1 with respect to a
 service described in clause 7ii7       
furnished to an individual1 a place of  
residence used as the home of such      
individual4  7ii7 ,services described ,a
 service described in this clause is--  
7,i7 a telehealth service that is       
related to the provision of outpatient  
mental or behavioral health and shall   
include the use of video conferencing2  
and  7,,ii7 a service described in      
subparagraph 7,f77iii7 that is treated  
as a telehealth service under such      
subparagraph4  4  7#b7 ,home telehealth 

services ,section #ahcd7m77#d77;,f7 of  
the ,social ,security ,act 7#db         
,u4,s4,c4 #aciem7m77#d77;,f77 is amended
 by adding at the end the following new 
clause3  7iii7 ,treatment of home       
telehealth services ,for purposes of    
subparagraph 7,g77ii77,,ii71 beginning  
#b years after the date of the enactment
 of the ,medicare ,telehealth ,parity   
,act of #bjag1 services 7including the  
use of video conferencing7 furnished at 
an originating site that is a home      
telehealth site to an individual that is
 related to the provision of hospice    
care1 home dialysis1 or home health     
services shall be treated as a          
telehealth service under this           
subparagraph4  4  7c7 ,final phase  7#a7
 ,further expansion of originating sites
 ,clause 7iii7 of section               
#ahcd7m77#d77;,c7 of the ,social        
,security ,act 7#db ,u4,s4,c4           
#aciem7m77#d771 as added by subsection  
7a77#a7 and amended by subsection       
7b77#a71 is further amended--  7,a7 by  

redesignating subclause 7,v7 as         
subclause 7,,vi72 and  7,b7 by inserting
 after clause 7,,iv7 the following new  
subclause3  7,v7 ,in the case of such a 
service furnished on or after the date  
that is #d years after the date of the  
enactment of the ,medicare ,telehealth  
,parity ,act of #bjag1 any site         
described in clause 7ii7 that is located
 in a county within a ,metropolitan     
,statistical ,area with a population of 
at least #ajj1jjj individuals1 according
 to the most recent decennial census4  4
  7#b7 ,payment methods for other       
patient sites ,section #ahcd7m77#b7 of  
the ,social ,security ,act 7#db         
,u4,s4,c4 #aciem7m77#b77 is amended by  
adding at the end the following new     
subparagraph3  7,d7 ,payment methods for
 other patient sites ,with respect to   
services furnished on or after the date 
that is #d years after the date of the  
enactment of the ,medicare ,telehealth  
,parity ,act of #bjag1 the ,secretary   
may develop and implement payment       

methods that would apply under this     
subsection in the case of an individual 
who would be an eligible telehealth     
individual except that the telehealth   
services are furnished at a site other  
than an originating site4 ,such methods 
shall be designed to take into account  
the costs related to the site involved  
and reduced costs for the distant site4 
4  7d7 ,incremental 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,,ff71 by striking and at 
the end2  7,b7 in subparagraph 7,,gg71  
by inserting and at the end2 and  7,c7  
by inserting after subparagraph 7,,gg7  
the following new subparagraph3  7,,hh7 
applicable remote patient monitoring    
services 7as defined in paragraph       
7#a77;,a7 of subsection 7iii772 4  7#b7 
,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 applicable 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      
remote patient monitoring services means
 services furnished through remote      
patient monitoring technology 7as       
defined in subparagraph 7,c774  7,c7    
,the term remote 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 covered chronic health         
condition means-- 7,a7 in the case of   
applicable remote patient monitoring    
services furnished on or after the date 
that is #f months after the date of the 
enactment of the ,medicare ,telehealth  
,parity ,act of #bjag1 applicable       
conditions 7as defined in and applied   
under section #ahhf7q77#e771 relating to
 heart failure and chronic obstructive  
pulmonary disease and related chronic   

comorbidities when under chronic care   
management 7identified as of ,july #a1  
#bjae1 by ,,hcpcs code #iidij 7and as   
subsequently modified by the            
,secretary772  7,b7 in the case of      
applicable remote patient monitoring    
services furnished on or after the date 
that is #b years after the date of the  
enactment of the ,medicare ,telehealth  
,parity ,act of #bjag1 in addition to   
the conditions described in subparagraph
 7,a71 diabetes and related chronic     
comorbidities when under chronic care   
management 7identified as of ,july #a1  
#bjae1 by ,,hcpcs code #iidij 7and as   
subsequently modified by the            
,secretary772 and  7,c7 in the case of  
applicable remote patient monitoring    
services furnished on or after the date 
that is #d years after the date of the  
enactment of the ,medicare ,telehealth  
,parity ,act of #bjag1 in addition to   
the conditions described in subparagraph
 7,a7 and 7,b71 such other conditions   
that could be specified by the          

,secretary that qualify for chronic care
 management and related chronic         
comorbidities 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  7#c7
 ,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--  
7i7 in paragraph 7#b77;,b7-- 7,i7 in    
clause 7ii77,,ii71 by striking and 7v7  

and inserting 7v71 and 7vii72 and       
7,,ii7 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  7ii7 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;,,hh71 after health risk          
assessment714  7#d7 ,effective date     
7,a7 ,in general ,the amendments made by
 this subsection shall apply to services
 furnished on or after the date that is 
#f months after the date of the         
enactment of this ,act1 without regard  
to whether the guidelines under         
paragraph 7#c77;,a7 or the standards    
under paragraph 7#c77;,b7 of section    
#ahfa7;iii7 of the ,social ,security    
,act1 as added by paragraph 7#b71 have  
been developed4  7,b7 ,availability of  
codes as of date of enactment ,the      
,secretary of ,health and ,human        
,services shall-- 7i7 promptly evaluate 
existing codes that would be used to    
bill for applicable remote patient      
monitoring services 7as defined in      
paragraph 7#a77;,a7 of such section     

#ahfa7;iii71 as so added7 under title   
,,xviii of the ,social ,security ,act2  
and  7ii7 if the ,secretary determines  
that new codes are necessary to ensure  
accurate reporting and billing of such  
services under such title1 issue such   
codes so that they are available for use
 as of the date of the enactment of this
 ,act4  7e7 ,home dialysis service  7#a7
 ,in general ,section #ahha7;b77#c7 of  
the ,social ,security ,act 7#db         
,u4,s4,c4 #acierr7b77#c77 is amended--  
7,a7 by redesignating subparagraphs 7,a7
 and 7,b7 as clauses 7i7 and 7ii71      
respectively2  7,b7 in clause 7ii71 as  
redesignated by subparagraph 7,a71      
strike on a comprehensive and insert    
subject to subparagraph 7,b71 on a      
comprehensive2  7,c7 by striking ,with  
respect to and inserting 7,a7 ,with     
respect to2 and  7,d7 by adding at the  
end the following new subparagraph3     
7,b7 ,for purposes of subparagraph      
7,a77ii71 the following shall apply3    
7i7 ,the monthly fee or other basis of  

payment described in such subparagraph  
shall allow for a patient-specific      
waiver process to allow a physician1    
clinical nurse specialist1 nurse        
practitioner1 or physician's assistant  
to request a waiver under this title of 
face-to-face visit requirements for home
 dialysis furnished to individuals      
determined to have end stage renal      
disease4  7ii7 ,any request under clause
 7i7 shall include documentation by the 
physician or practitioner involved that 
supports active and adequate care of    
such individual receiving home dialysis4
  7iii7 ,any patient-specific waiver    
under clause 7i7 that is granted shall  
remain effective until such date that   
the ,secretary1 including through       
contractor under this title1 requests   
that additional information or a new    
waiver application be filed4  7iv7 ,all 
individuals determined to have end stage
 renal disease receiving home dialysis  
shall receive a face-to-face examination
 at least once every three consecutive  

months and1 in the intervening months1  
shall receive a monthly clinical        
assessment which may be furnished1 if   
the patient so chooses1 via remote      
monitoring by a physician1 clinical     
nurse specialist1 nurse practitioner1 or
 physician's assistant4  4  7#b7        
,conforming amendment ,section          
#ahha7;b77#a7 of such ,act 7#db         
,u4,s4,c4 #acierr7b77#a77 is amended by 
striking paragraph 7#c77;,a7 and        
inserting paragraph 7#c77;,a77i74  7#c7 
,effective date ,the amendments made by 
this subsection shall apply with respect
 to the monthly fee or other basis of   
payment for home dialysis services      
furnished on or after ,january #a1      
#bjah4  7f7 ,appropriate valuation of   
remote diagnostic test services ,section
 #ahdh7;c77#b7 of the ,social ,security 
,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b77  
is amended by adding at the end the     
following new subparagraph3  7,p7       
,adjustments for remote diagnostic tests
 ,in determining practice expense       

relative value units for diagnostic     
tests described in section #ahfa7s77#c7 
that are provided remotely1 the         
,secretary shall1 in consultation with  
suppliers of remote diagnostic testing  
services1 include in direct costs of    
supplies and equipment1 the costs of the
 diagnostic device1 clinical systems    
7including hardware and software71      
information transmission1 and device    
delivery and installation4 ,for purposes
 of this subsection1 diagnostic tests   
described in section #ahfa7s77#c7 that  
are provided remotely are such tests    
that are provided through the           
utilization of a system of technology   
that allows a remote interface to       
collect and transmit clinical data      
between the individual and a supplier4  
,this subsection shall be implemented in
 a budget neutral manner4  4  7g7 ,study
 and report2 ,sense of ,congress  7#a7  
,study and report  7,a7 ,study ,the     
,comptroller ,general of the ,united    
,states shall conduct a study that      

includes1 at a minimum1 the following3  
7i7 ,the effectiveness of using         
telehealth services described in the    
second sentence of section              
#ahcd7m77#d77;,f77i7 of the ,social     
,security ,act 7#db ,u4,s4,c4           
#aciem7m77#d77;,f77i771 as added by     
subsection 7a77#d71 between             
practitioners described in subparagraph 
7,e77ii7 of section #ahcd7m77#d7 of the 
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7m77#d771 as inserted by          
subsection 7a77#c77;,b77ii71 and        
patients1 including with respect to     
patient satisfaction1 provider          
responsiveness to patient needs and     
concerns1 and the extent to which such  
telehealth services are at least        
comparable to face-to-face encounters4  
7ii7 ,the savings to the ,medicare      
program under title ,,xviii of such ,act
 associated with telehealth services    
utilization for therapy for the         
additional telehealth services described
 in such sentence4  7iii7 ,the potential

 for greater use of telehealth services 
for forms of additional telehealth      
services not described in such sentence4
  7,b7 ,report ,not later than two years
 after the date of the enactment of this
 ,act1 the ,comptroller ,general shall  
submit to ,congress a report on the     
findings of the study conducted under   
subparagraph 7,a74  7#b7 ,sense of      
,congress ,it is the sense of ,congress 
that the telehealth expansion efforts   
initiated by the studies and reports on 
the use of telehealth and remote patient
 monitoring services under the ,medicare
 ,access and ,,chip ,reauthorization    
,act of #bjae are continued and         
furthered through the incremental       
expansion of telehealth and remote      
patient monitoring services under this  
,act4