#aae? ,,congress  #a/ ,session  ,h4 ,r4 
#cagh  ,,an ,,act  ,to am5d title       
,,xviii ( ! ,social ,security ,act to   
improve ! deliv]y ( home infusion !rapy 
& dialysis & ! application ( ! ,/>k rule
 "u ! ,m$ic>e program1 & = o!r purposes4
  #a4 ,%ort title2 table ( cont5ts  7a7 
,%ort title ,?is ,act may be cit$ z !   
,m$ic>e ,"p ,b ,improvem5t ,act ( #bjag4
  7b7 ,table ( cont5ts ,! table (       
cont5ts ( ?is ,act is z foll[s3  ,sec4  
#a4 ,%ort title2 table ( cont5ts4 ,title
 ,i--,improvem5ts 9 ,provision ( ,home  
,infusion ,!rapy ,sec4 #aja4 ,home      
infusion !rapy s]vices tempor>y         
transitional paym5t4 ,sec4 #ajb4        
,ext5sion ( ,m$ic>e ,pati5t ,,ivig      
,access ,demon/ration ,project4 ,sec4   
#ajc4 ,or?oti/'s & pro/heti/'s cl9ical  
notes z "p ( ! pati5t's m$ical record4  
,title ,,ii--,improvem5ts 9 ,dialysis   
,s]vices ,sec4 #bja4 ,indep5d5t         
accr$itation = dialysis facilities &    
assurance ( high quality surveys4 ,sec4 
#bjb4 ,exp&+ access to home dialysis    

!rapy4 ,title ,,iii--,improvem5ts 9     
,application ( ,/>k ,rule ,sec4 #cja4   
,mod]niz+ ! application ( ! ,/>k rule "u
 ,m$ic>e4 ,sec4 #cjb4 ,funds f ! ,m$ic>e
 ,improvem5t ,fund4  ,i ,improvem5ts 9  
,provision ( ,home ,infusion ,!rapy     
#aja4 ,home infusion !rapy s]vices      
tempor>y transitional paym5t  7a7 ,9    
g5]al ,section #ahcd7u7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4 #aciem7u77
 is am5d$1 by add+ at ! end ! foll[+ new
 p>agraph3  7#g7 ,home infusion !rapy   
s]vices tempor>y transitional paym5t    
7,a7 ,tempor>y transitional paym5t  7i7 
,9 g5]al ,! ,secret>y %all1 9 accordance
 ) ! paym5t me?odology describ$ 9       
subp>agraph 7,b7 & subject to !         
provisions ( ?is p>agraph1 provide a    
home infusion !rapy s]vices tempor>y    
transitional paym5t "u ?is "p to an     
eligible home infusion suppli] 7z def9$ 
9 subp>agraph 7,f77 = items & s]vices   
describ$ 9 subp>agraphs 7,a7 & 7,b7 (   
section #ahfa7;iii77#b77 furni%$ dur+ ! 
p]iod specifi$ 9 clause 7ii7 by su*     

suppli] 9 coord9ation ) ! furni%+ (     
transitional home infusion drugs 7z     
def9$ 9 clause 7iii774  7ii7 ,p]iod     
specifi$ ,= purposes ( clause 7i71 !    
p]iod specifi$ 9 ?is clause is ! p]iod  
beg9n+ on ,janu>y #a1 #bjai1 & end+ on !
 day be=e ! date ( ! implem5tation ( !  
paym5t sy/em "u p>agraph 7#a77;,a74     
7iii7 ,transitional home infusion drug  
def9$ ,= purposes ( ?is p>agraph1 ! t]m 
transitional home infusion drug has !   
mean+ giv5 to ! t]m home infusion drug  
"u section #ahfa7;iii77#c77;,c771 except
 t clause 7ii7 ( su* section %all n     
apply if a drug describ$ 9 su* clause is
 id5tifi$ 9 clauses 7i71 7ii71 7iii7 or 
7iv7 ( subp>agraph 7,c7 z ( ! date ( !  
enactm5t ( ?is p>agraph4  7,b7 ,paym5t  
me?odology ,= purposes ( ?is p>agraph1 !
 ,secret>y %all e/abli% a paym5t        
me?odology1 ) respect to items & s]vices
 describ$ 9 subp>agraph 7,a77i74 ,"u su*
 paym5t me?odology ! ,secret>y %all--   
7i7 create ! ?ree paym5t categories     
describ$ 9 clauses 7i71 7ii71 & 7iii7 ( 

subp>agraph 7,c72  7ii7 assign drugs to 
su* categories1 9 accordance ) su*      
clauses2  7iii7 assign appropriate      
,heal?c>e ,common ,proc$ure ,cod+ ,sy/em
 7,,hcpcs7 codes to ea* paym5t category2
 &  7iv7 e/abli% a s+le paym5t am\nt =  
ea* su* paym5t category1 9 accordance ) 
subp>agraph 7,d71 = ea* infusion drug   
adm9i/ration cal5d> day 9 ! individual's
 home = drugs assign$ to su* category4  
7,c7 ,paym5t categories  7i7 ,paym5t    
category #a ,! ,secret>y %all create a  
paym5t category #a & assign to su*      
category drugs :i* are cov]$ "u ! ,local
 ,cov]age ,det]m9ation on ,ext]nal      
,infusion ,pumps 7,,lcd numb] ,l#ccgid7 
& bill$ ) ! foll[+ ,,hcpcs codes 7z     
id5tifi$ z ( ,july #a1 #bjag1 & z       
subsequ5tly modifi$ by ! ,secret>y73    
,j#jacc1 ,j#jbhe1 ,j#jbhg1 ,j#jbhh1     
,j#jbhi1 ,j#jhie1 ,j#aagj1 ,j#abej1     
,j#abfe1 ,j#acbe1 ,j#adee1 ,j#adeg1     
,j#aegj1 ,j#bage1 ,j#bbfj1 ,j#bbgj1     
,j#bbgd1 ,j#bbgh1 ,j#cjaj1 or ,j#cbhe4  
7ii7 ,paym5t category #b ,! ,secret>y   

%all create a paym5t category #b &      
assign to su* category drugs :i* are    
cov]$ "u su* local cov]age det]m9ation &
 bill$ ) ! foll[+ ,,hcpcs codes 7z      
id5tifi$ z ( ,july #a1 #bjag1 & z       
subsequ5tly modifi$ by ! ,secret>y73    
,j#aeei ,,jb1 ,j#aefa ,,jb1 ,j#aefb     
,,jb1 ,j#aefi ,,jb1 or ,j#aege ,,jb4    
7iii7 ,paym5t category #c ,! ,secret>y  
%all create a paym5t category #c &      
assign to su* category drugs :i* are    
cov]$ "u su* local cov]age det]m9ation &
 bill$ ) ! foll[+ ,,hcpcs codes 7z      
id5tifi$ z ( ,july #a1 #bjag1 & z       
subsequ5tly modifi$ by ! ,secret>y73    
,j#ijjj1 ,j#ijci1 ,j#ijdj1 ,j#ijfe1     
,j#iajj1 ,j#iaij1 ,j#ibjj1 ,j#icfj1 or  
,j#icgj4  7iv7 ,infusion drugs n o!rwise
 includ$ ,) respect to drugs t are n    
includ$ 9 paym5t category #a1 #b1 or #c 
"u clause 7i71 7ii71 or 7iii71          
respectively1 ! ,secret>y %all assign to
 ! mo/ appropriate ( su* categories1 z  
det]m9$ by ! ,secret>y1 drugs :i* are-- 
7,i7 cov]$ "u su* local cov]age         

det]m9ation & bill$ "u ,,hcpcs codes    
,j#ggii or ,j#giii 7z id5tifi$ z ( ,july
 #a1 #bjag1 & z subsequ5tly modifi$ by !
 ,secret>y72 or  7,,ii7 bill$ "u any    
code t is implem5t$ aft] ! date ( !     
enactm5t ( ?is p>agraph & includ$ 9 su* 
local cov]age det]m9ation or includ$ 9  
subregulatory guidance z a home infusion
 drug describ$ 9 subp>agraph 7,a77i74   
7,d7 ,paym5t am\nts  7i7 ,9 g5]al ,"u ! 
paym5t me?odology1 ! ,secret>y %all pay 
eligible home infusion suppli]s1 )      
respect to items & s]vices describ$ 9   
subp>agraph 7,a77i7 furni%$ dur+ ! p]iod
 describ$ 9 subp>agraph 7,a77ii7 by su* 
suppli] to an individual1 at am\nts     
equal to ! am\nts det]m9$ "u ! physician
 fee s*$ule e/abli%$ "u section #ahdh = 
s]vices furni%$ dur+ ! ye> = codes &    
units ( su* codes describ$ 9 clauses    
7ii71 7iii71 & 7iv7 ) respect to drugs  
includ$ 9 ! paym5t category "u          
subp>agraph 7,c7 specifi$ 9 ! respective
 clause1 det]m9$ )\t application ( !    
geographic adju/m5t "u subsection 7e7 ( 

su* section4  7ii7 ,paym5t am\nt =      
category #a ,= purposes ( clause 7i71 ! 
codes & units describ$ 9 ?is clause1 )  
respect to drugs includ$ 9 paym5t       
category #a describ$ 9 subp>agraph      
7,c77i71 are "o unit ( ,,hcpcs code     
#ifcfe plus f\r units ( ,,hcpcs code    
#ifcff 7z id5tifi$ z ( ,july #a1 #bjag1 
& z subsequ5tly modifi$ by ! ,secret>y74
  7iii7 ,paym5t am\nt = category #b ,=  
purposes ( clause 7i71 ! codes & units  
describ$ 9 ?is clause1 ) respect to     
drugs includ$ 9 paym5t category #b      
describ$ 9 subp>agraph 7,c77i71 are "o  
unit ( ,,hcpcs code #ifcfi plus f\r     
units ( ,,hcpcs code #ifcgj 7z id5tifi$ 
z ( ,july #a1 #bjag1 & z subsequ5tly    
modifi$ by ! ,secret>y74  7iv7 ,paym5t  
am\nt = category #c ,= purposes ( clause
 7i71 ! codes & units describ$ 9 ?is    
clause1 ) respect to drugs includ$ 9    
paym5t category #c describ$ 9           
subp>agraph 7,c77i71 are "o unit (      
,,hcpcs code #ifdac plus f\r units (    
,,hcpcs code #ifdae 7z id5tifi$ z (     

,july #a1 #bjag1 & z subsequ5tly modifi$
 by ! ,secret>y74  7,e7 ,cl>ifications  
7i7 ,infusion drug adm9i/ration day ,=  
purposes ( ?is subsection1 a ref]5ce1 ) 
respect to ! furni%+ ( transitional home
 infusion drugs or home infusion drugs  
to an individual by an eligible home    
infusion suppli]1 to paym5t to su*      
suppli] = an infusion drug adm9i/ration 
cal5d> day 9 ! individual's home %all   
ref] to paym5t only = ! date on :i*     
pr(essional s]vices 7z describ$ 9       
section #ahfa7;iii77#b77;,a77 7 furni%$ 
to adm9i/] su* drugs to su* individual4 
,= purposes ( ! previ\s s5t5ce1 an      
infusion drug adm9i/ration cal5d> day   
%all include all su* drugs adm9i/]$ to  
su* individual on su* day4  7ii7        
,treatm5t ( multiple drugs adm9i/]$ on  
same infusion drug adm9i/ration day ,9 !
 case t an eligible home infusion       
suppli]1 ) respect to an infusion drug  
adm9i/ration cal5d> day 9 an            
individual's home1 furni%es to su*      
individual transitional home infusion   

drugs :i* are n all assign$ to ! same   
paym5t category "u subp>agraph 7,c71    
paym5t to su* suppli] = su* infusion    
drug adm9i/ration cal5d> day 9 !        
individual's home %all be a s+le paym5t 
equal to ! am\nt ( paym5t "u ?is        
p>agraph = ! drug1 among all su* drugs s
 furni%$ to su* individual dur+ su*     
cal5d> day1 = :i* ! highe/ paym5t w\ld  
be made "u ?is p>agraph4  7,f7 ,eligible
 home infusion suppli]s ,9 ?is p>agraph1
 ! t]m eligible home infusion suppli]   
means a suppli] t is enroll$ "u ?is "p z
 a ph>macy t provides ext]nal infusion  
pumps & ext]nal infusion pump supplies &
 t ma9ta9s all ph>macy lic5sure         
requirem5ts 9 ! ,/ate 9 :i* ! applicable
 infusion drugs are adm9i/]$4  7,g7     
,implem5tation ,not)/&+ any o!r         
provision ( law1 ! ,secret>y may        
implem5t ?is p>agraph by program        
in/ruction or o!rwise4  4  7b7 ,con=m+  
am5dm5t ,section #ahdb7;b77#f77;,i7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#acieu7b77#f77;,i77 is am5d$ by ins]t+  

or1 9 ! case ( items & s]vices describ$ 
9 clause 7i7 ( section #ahcd7u77#g77;,a7
 furni%$ to an individual dur+ ! p]iod  
describ$ 9 clause 7ii7 ( su* section1   
paym5t %all be made to ! eligible home  
infusion !rapy suppli] aft] paym5t %all 
be made to ! qualifi$ home infusion     
!rapy suppli]4  #ajb4 ,ext5sion (       
,m$ic>e ,pati5t ,,ivig ,access          
,demon/ration ,project ,section #aja7;b7
 ( ! ,m$ic>e ,,ivig ,access & ,/r5g!n+  
,m$ic>e & ,repay+ ,taxpay]s ,act ( #bjab
 7#db ,u4,s4,c4 #aciel note7 is am5d$-- 
7#a7 9 p>agraph 7#a71 by ins]t+ aft] = a
 p]iod ( #c ye>s ! foll[+3  &1 subject  
to ! availability ( funds "u subsection 
7g7-- 7,a7 if ! date ( enactm5t ( !     
,m$ic>e ,"p ,b ,improvem5t ,act ( #bjag 
is on or be=e ,septemb] #cj1 #bjag1 = ! 
p]iod beg9n+ on ,octob] #a1 #bjag1 &    
end+ on ,decemb] #ca1 #bjbj2 &  7,b7 if 
! date ( enactm5t ( su* ,act is aft]    
,septemb] #cj1 #bjag1 = ! p]iod beg9n+  
on ! date ( enactm5t ( su* ,act & end+  
on ,decemb] #ca1 #bjbj0  2 &  7#b7 9    

p>agraph 7#b71 by add+ at ! end ! foll[+
 new s5t5ces3 ,subject to ! prec$+      
s5t5ce1 a ,m$ic>e b5efici>y enroll$ 9 ! 
demon/ration project on ,septemb] #cj1  
#bjag1 %all be automatically enroll$    
dur+ ! p]iod beg9n+ on ! date ( !       
enactm5t ( ! ,m$ic>e ,"p ,b ,improvem5t 
,act ( #bjag & end+ on ,decemb] #ca1    
#bjbj1 )\t submission ( ano!r           
application4 ,*apt] #ce ( title #dd1    
,unit$ ,/ates ,code1 %all n apply to any
 application =m us$ = a ,m$ic>e         
b5efici>y :o enrolls 9 ! demon/ration   
project on or aft] su* date ( enactm5t44
  #ajc4 ,or?oti/'s & pro/heti/'s cl9ical
 notes z "p ( ! pati5t's m$ical record  
,section #ahcd7;h7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #aciem7h77 is am5d$
 by add+ at ! end ! foll[+ new p>agraph3
  7#e7 ,docum5tation creat$ by or?oti/s 
& pro/heti/s ,= purposes ( det]m9+ !    
reasonabl5ess & m$ical necessity (      
or?otics & pro/hetics1 docum5tation     
creat$ by an or?oti/ or pro/heti/ %all  
be consid]$ "p ( ! individual's m$ical  

record to support docum5tation creat$ by
 eligible pr(essionals describ$ 9       
section #ahdh7k77#c77;,b74  4  ,,ii     
,improvem5ts 9 ,dialysis ,s]vices  #bja4
 ,indep5d5t accr$itation = dialysis     
facilities & assurance ( high quality   
surveys  7a7 ,accr$itation & surveys    
7#a7 ,9 g5]al ,section #ahfe ( ! ,social
 ,security ,act 7#db ,u4,s4,c4 #acie;bb7
 is am5d$-- 7,a7 9 subsection 7a7--  7i7
 9 p>agraph 7#a71 9 ! matt] prec$+      
subp>agraph 7,a71 by /rik+ or !         
conditions & requirem5ts "u section     
#ahha7;b72 &  7ii7 9 p>agraph 7#d71 by  
ins]t+ 7includ+ a r5al dialysis         
facility7 aft] facility2 &  7,b7 by add+
 at ! end ! foll[+ new subsection3  7e7 
,) respect to an accr$itation body t has
 receiv$ approval f ! ,secret>y "u      
subsection 7a77#c77;,a7 = accr$itation (
 provid] entities t are requir$ to meet 
! conditions & requirem5ts "u section   
#ahha7;b71 9 addition to review &       
ov]sight au?orities o!rwise applicable  
"u ?is title1 ! ,secret>y %all 7z !     

,secret>y det]m9es appropriate7 conduct1
 ) respect to su* accr$itation body &   
provid] entities1 any or all ( ! foll[+ 
z frequ5tly z is o!rwise requir$ to be  
conduct$ "u ?is title ) respect to o!r  
accr$itation bodies or o!r provid]      
entities3  7#a7 ,validation surveys     
ref]r$ to 9 subsection 7d74  7#b7       
,accr$itation program reviews 7z def9$ 9
 section #dhh4h7;c7 ( title #db ( !     
,code ( ,f$]al ,regulations1 or a       
successor regulation74  7#c7 ,p]=mance  
reviews 7z def9$ 9 section #dhh4h7;a7 ( 
title #db ( ! ,code ( ,f$]al            
,regulations1 or a successor            
regulation74  4  7#b7 ,tim+ = acceptance
 ( reque/s f accr$itation organizations 
,n lat] ?an #ij days aft] ! date (      
enactm5t ( ?is ,act1 ! ,secret>y (      
,heal? & ,human ,s]vices %all beg9      
accept+ reque/s f national accr$itation 
bodies = a f9d+ describ$ 9 section      
#ahfe7;a77#c77;,a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acie;bb7a77#c77;,a77 = purposes (      

accr$it+ provid] entities t are requir$ 
to meet ! conditions & requirem5ts "u   
section #ahha7;b7 ( su* ,act 7#db       
,u4,s4,c4 #acierr7b774  7b7 ,requirem5t 
= tim+ ( surveys ( new dialysis         
facilities ,section #ahha7;b77#a7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acierr7b77#a77 is am5d$ by add+ at !   
end ! foll[+ new s5t5ce3 ,beg9n+ #ahj   
days aft] ! date ( ! enactm5t ( ?is     
s5t5ce1 an initial survey ( a provid] ( 
s]vices or a r5al dialysis facility to  
det]m9e if ! conditions & requirem5ts "u
 ?is p>agraph are met %all be initiat$ n
 lat] ?an #ij days aft] su* date on :i* 
bo? ! provid] enrollm5t =m 7)\t reg>d to
 :e!r su* =m is submitt$ prior to or    
aft] su* date ( enactm5t7 has be5       
det]m9$ by ! ,secret>y to be complete & 
! provid]'s enrollm5t /atus indicates   
approval is p5d+ ! results ( su*        
survey44  #bjb4 ,exp&+ access to home   
dialysis !rapy  7a7 ,all[+ use (        
teleheal? = mon?ly end /age r5al        
disease-,relat$ visits  7#a7 ,9 g5]al   

,p>agraph 7#c7 ( section #ahha7;b7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acierr7b77 is am5d$--  7,a7 by         
r$esignat+ subp>agraphs 7,a7 & 7,b7 z   
clauses 7i7 & 7ii71 respectively2  7,b7 
9 clause 7i71 z r$esignat$ by           
subp>agraph 7,a71 by /rik+ "u ?is       
subp>agraph & ins]t+ "u ?is clause2     
7,c7 9 clause 7ii71 z r$esignat$ by     
subp>agraph 7,a71 by ins]t+ subject to  
subp>agraph 7,b71 be=e on a             
compreh5sive2  7,d7 by /rik+ ,) respect 
to & ins]t+ 7,a7 ,) respect to2 &  7,e7 
by add+ at ! end ! foll[+ new           
subp>agraph3  7,b7 7i7 ,subject to      
clause 7ii71 an individual :o is det]m9$
 to h end /age r5al disease & :o is     
receiv+ home dialysis may *oose to      
receive mon?ly end /age r5al            
disease-relat$ visits1 furni%$ on or    
aft] ,janu>y #a1 #bjai1 via teleheal?4  
7ii7 ,clause 7i7 %all apply to an       
individual only if ! individual receives
 a face-to-face visit1 )\t ! use (      
teleheal?-- 7,i7 9 ! case ( ! initial #c

 mon?s ( home dialysis ( su* individual1
 at lea/ mon?ly2 &  7,,ii7 aft] su*     
initial #c mon?s1 at lea/ once e #c     
consecutive mon?s4  4  7#b7 ,con=m+     
am5dm5t ,p>agraph 7#a7 ( su* section is 
am5d$ by /rik+ p>agraph 7#c77;,a7 &     
ins]t+ p>agraph 7#c77;,a77i74  7b7      
,exp&+ orig9at+ sites = teleheal? ,to   
include r5al dialysis facilities & !    
home = purposes ( mon?ly end /age r5al  
disease-,relat$ visits  7#a7 ,9 g5]al   
,section #ahcd7m7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciem7m77 is       
am5d$-- 7,a7 9 p>agraph 7#d77;,c77ii71  
by add+ at ! end ! foll[+ new           
subclauses3  7,,ix7 ,a r5al dialysis    
facility1 b only = purposes ( section   
#ahha7;b77#c77;,b74  7,x7 ,! home ( an  
individual1 b only = purposes ( section 
#ahha7;b77#c77;,b74  2 &  7,b7 by add+  
at ! end ! foll[+ new p>agraph3  7#e7   
,treatm5t ( home dialysis mon?ly        
,,esrd-relat$ visit ,! geographic       
requirem5ts describ$ 9 p>agraph         
7#d77;,c77i7 %all n apply ) respect to  

teleheal? s]vices furni%$ on or aft]    
,janu>y #a1 #bjai1 = purposes ( section 
#ahha7;b77#c77;,b71 at an orig9at+ site 
describ$ 9 subclause 7,,vi71 7,,ix71 or 
7,x7 ( p>agraph 7#d77;,c77ii771 subject 
to applicable ,/ate law requirem5ts1    
includ+ ,/ate lic5sure requirem5ts4  4  
7#b7 ,no facility fee if orig9at+ site =
 home dialysis !rapy is ! home ,section 
#ahcd7m77#b77;,b7 ( ! ,social ,security 
7#db ,u4,s4,c4 #aciem7m77#b77;,b77 is   
am5d$-- 7,a7 by r$esignat+ clauses 7i7 &
 7ii7 z subclauses 7,i7 & 7,,ii71       
respectively1 & by ind5t+ ea* ( su*     
subclauses #b ems to ! "r2  7,b7 9      
subclause 7,,ii71 z r$esignat$ by       
subp>agraph 7,a71 by /rik+ clause 7i7 or
 ?is clause & ins]t+ subclause 7,i7 or  
?is subclause2  7,c7 by /rik+ site4--,) 
respect to & ins]t+ 8site4--  7i7 ,9    
g5]al ,subject to clause 7ii71 ) respect
 to  2 &  7,d7 by add+ at ! end ! foll[+
 new clause3  7ii7 ,no facility fee if  
orig9at+ site = home dialysis !rapy is !
 home ,no facility fee %all be paid "u  

?is subp>agraph to an orig9at+ site     
describ$ 9 subclause 7,x7 ( p>agraph    
7#d77;,c77ii74  4  7c7 ,cl>ification    
reg>d+ teleheal? provid$ to b5efici>ies 
,section #aabh;,a7i77#f7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acbj;a-#g;a7i77#f77 is am5d$--  7#a7 9 
subp>agraph 7,h71 by /rik+ 2 or & ins]t+
 a semicolon2  7#b7 9 subp>agraph 7,i71 
by /rik+ ! p]iod at ! end & ins]t+ 2 or2
 &  7#c7 by add+ at ! end ! foll[+ new  
subp>agraph3  7,j7 ! provision (        
teleheal? te*nologies on or aft] ,janu>y
 #a1 #bjai1 to individuals ) end /age   
r5al disease "u title ,,xviii by a heal?
 c>e provid] = ! purpose ( furni%+ (    
teleheal?4  4  7d7 ,/udy & report on    
fur!r expansion  7#a7 ,/udy ,!          
,comptroll] ,g5]al ( ! ,unit$ ,/ates    
%all conduct a /udy to exam9e !         
feasibility1 b5efits1 & drawbacks (     
exp&+ ! use ( teleheal? & /ore-&-=w>d   
te*nologies "u ! ,m$ic>e program "u     
title ,,xviii ( ! ,social ,security ,act
 = items & s]vices includ$ 9 r5al       

dialysis s]vices1 z su* t]m is def9$ 9  
section #ahha7;b77#ad77;,b7 ( su* ,act  
7#db ,u4,s4,c4 #acierr7b77#ad77;,b774   
7#b7 ,report ,n lat] ?an #b ye>s aft] ! 
date ( ! enactm5t ( ?is ,act1 !         
,comptroll] ,g5]al %all submit to       
,congress a report on ! results ( ! /udy
 conduct$ "u p>agraph 7#a74  ,,iii      
,improvem5ts 9 ,application ( ,/>k ,rule
  #cja4 ,mod]niz+ ! application ( ! ,/>k
 rule "u ,m$ic>e  7a7 ,cl>ification ( ! 
writ+ requirem5t & signature requirem5t 
= arrangem5ts pursuant to ! ,/>k rule   
7#a7 ,writ+ requirem5t ,section         
#ahgg7;h77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acienn7h77#a77 is am5d$
 by add+ at ! end ! foll[+ new          
subp>agraph3  7,d7 ,writt5 requirem5t   
cl>ifi$ ,9 ! case ( any requirem5t      
pursuant to ?is section = a comp5sation 
arrangem5t to be 9 writ+1 su* requirem5t
 %all be satisfi$ by su* means z det]m9$
 by ! ,secret>y1 includ+ by a collection
 ( docum5ts1 includ+ contemporane\s     
docum5ts evid5c+ ! c\rse ( conduct      

betwe5 ! p>ties involv$4  4  7#b7       
,signature requirem5t ,section          
#ahgg7;h77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acienn7h77#a771 z am5d$
 by p>agraph 7#a71 is fur!r am5d$ by    
add+ at ! end ! foll[+ new subp>agraph3 
7,e7 ,special rule = signature          
requirem5ts ,9 ! case ( any requirem5t  
pursuant to ?is section = a comp5sation 
arrangem5t to be 9 writ+ & sign$ by !   
p>ties1 su* signature requirem5t %all be
 met if--  7i7 n lat] ?an #ij           
consecutive cal5d> days imm$iately      
foll[+ ! date on :i* ! comp5sation      
arrangem5t became noncompliant1 ! p>ties
 obta9 ! requir$ signatures2 &  7ii7 !  
comp5sation arrangem5t o!rwise complies 
) all crit]ia ( ! applicable exception4 
4  7b7 ,indef9ite holdov] = lease       
arrangem5ts & p]sonal s]vices           
arrangem5ts pursuant to ! ,/>k rule     
,section #ahgg7;e7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acienn7e77 is     
am5d$-- 7#a7 9 p>agraph 7#a71 by add+ at
 ! end ! foll[+ new subp>agraph3  7,c7  

,holdov] lease arrangem5ts ,9 ! case ( a
 holdov] lease arrangem5t = ! lease (   
(fice space or equipm5t1 :i* imm$iately 
foll[s a lease arrangem5t describ$ 9    
subp>agraph 7,a7 = ! use ( su* (fice    
space or subp>agraph 7,b7 = ! use ( su* 
equipm5t & t expir$ aft] a t]m ( at lea/
 #a ye>1 paym5ts made by ! lessee to !  
lessor pursuant to su* holdov] lease    
arrangem5t1 if-- 7i7 ! lease arrangem5t 
met ! conditions ( subp>agraph 7,a7 = ! 
lease ( (fice space or subp>agraph 7,b7 
= ! use ( equipm5t :5 ! arrangem5t      
expir$2  7ii7 ! holdov] lease arrangem5t
 is on ! same t]ms & conditions z !     
imm$iately prec$+ arrangem5t2 &  7iii7 !
 holdov] arrangem5t cont9ues to satisfy 
! conditions ( subp>agraph 7,a7 = !     
lease ( (fice space or subp>agraph 7,b7 
= ! use ( equipm5t4  2 &  7#b7 9        
p>agraph 7#c71 by add+ at ! end ! foll[+
 new subp>agraph3  7,c7 ,holdov] p]sonal
 s]vice arrangem5t ,9 ! case ( a holdov]
 p]sonal s]vice arrangem5t1 :i*         
imm$iately foll[s an arrangem5t describ$

 9 subp>agraph 7,a7 t expir$ aft] a t]m 
( at lea/ #a ye>1 remun]ation f an      
entity pursuant to su* holdov] p]sonal  
s]vice arrangem5t1 if--  7i7 ! p]sonal  
s]vice arrangem5t met ! conditions (    
subp>agraph 7,a7 :5 ! arrangem5t expir$2
  7ii7 ! holdov] p]sonal s]vice         
arrangem5t is on ! same t]ms &          
conditions z ! imm$iately prec$+        
arrangem5t2 &  7iii7 ! holdov]          
arrangem5t cont9ues to satisfy !        
conditions ( subp>agraph 7,a74  4  #cjb4
 ,funds f ! ,m$ic>e ,improvem5t ,fund   
,section #ahih7;b77#a7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acie;iii7b77#a77 is am5d$ by /rik+ dur+
 & aft] fiscal ye> #bjba1 #bgj1jjj1jjj &
 ins]t+ dur+ & aft] fiscal ye> #bjba1   
#bde1jjj1jjj4  ,pass$ ! ,h\se (         
,repres5tatives ,july #be1 #bjag4;,cl]k4