,,ii #aaeth ,,congress #ast ,session ,s4 #ajaf ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #c1 #bjag ,mr4 ,schatz 7for himself1 ,mr4 ,wicker1 ,mr4 ,cochran1 ,mr4 ,cardin1 ,mr4 ,thune1 and ,mr4 ,warner7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to expand access to telehealth services1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,creating ,opportunities ,now for ,necessary and ,effective ,care ,technologies 7,,connect7 for ,health ,act of #bjag or the ,,connect for ,health ,act of #bjag4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,sec4 #b4 ,providing accountable care organizations the ability to expand the use of telehealth4 ,sec4 #c4 ,expanding access to home dialysis therapy4 ,sec4 #d4 ,expanding the use of telehealth for individuals with stroke4 ,sec4 #e4 ,increasing access to digital tools for ,medicare ,advantage enrollees through telehealth and remote patient monitoring4 ,sec4 #f4 ,coverage of remote patient monitoring services furnished to certain individuals4 ,sec4 #g4 ,rural health clinics and ,federally qualified health centers4 ,sec4 #h4 ,allowing ,native ,american health service facilities as sites eligible for telehealth payment4 ,sec4 #i4 ,clarification regarding telehealth and remote patient monitoring technologies provided to beneficiaries4 ,sec4 #aj4 ,allowing telehealth and remote patient monitoring services to be included in bundled or global payments4 ,sec4 #aa4 ,expanding the use of telehealth through the waiver of certain requirements4 ,sec4 #ab4 ,expanding the use of telehealth for mental health services4 ,sec4 #ac4 ,,hhs evaluation and report on the use of telehealth and remote patient monitoring under all demonstration programs and pilots with a telehealth waiver4 ,sec4 #ad4 ,testing of models to examine the use of telehealth and remote patient monitoring under the ,medicare program4 ,sec4 #ae4 ,sense of ,congress regarding the remote practice of medicine4 #b4 ,providing accountable care organizations the ability to expand the use of telehealth 7a7 ,in general ,section #ahii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;jjj7 is amended by adding at the end the following new subsection3 7l7 ,providing ,a,c,os the ability ,to expand the use of telehealth services 7#a7 ,in general 7,a7 ,expanding use of telehealth services ,in the case of telehealth services for which payment would otherwise be made under this title furnished on or after ,january #a1 #bjah1 for purposes of this subsection only1 the restrictions applicable to the coverage of telehealth services under section #ahcd7m7 described in subparagraph 7,b7 shall not apply with respect to such services furnished to a ,medicare fee-for-service beneficiary assigned to an applicable ,,aco 7as defined in paragraph 7#b774 7,b7 ,restrictions described ,for purposes of this subsection1 restrictions applicable to the coverage of telehealth services under section #ahcd7m7 shall include requirements relating to qualifications for an originating site under paragraph 7#d77;,c77ii7 of such section1 any geographic limitations under paragraph 7#d77;,c77i7 of such section 7other than applicable ,state law requirements1 including ,state licensure requirements71 any limitation on the use of store-and-forward technologies described in paragraph 7#a7 of such section1 any limitation on the type of health care provider who may furnish such services 7other than the requirement that the provider is a ,medicare-enrolled provider71 or any limitation on specific codes designated as telehealth services that are covered under this title pursuant to such section 7provided such codes are clinically appropriate to furnish remotely74 7#b7 ,definition of applicable ,,aco ,in this subsection1 the term applicable ,,aco means an ,,aco participating in a model tested or expanded under section #aaae;,a or under this section-- 7,a7 that operates under a two-sided model-- 7i7 described in section #dbe4fjj7;a7 of title #db1 ,code of ,federal ,regulations2 or 7ii7 tested or expanded under section #aaae;,a2 and 7,b7 for which ,medicare fee-for-service beneficiaries are assigned to the ,,aco using a prospective assignment method1 as determined appropriate by the ,secretary4 7#c7 ,no originating site facility fee for new sites ,the ,secretary shall not pay an originating site facility fee 7as described in paragraph 7#b77;,b7 of section #ahcd7m77 with respect to telehealth services described in paragraph 7#a7 if such services would not have been covered under this title as of the date of enactment of this subsection4 7#d7 ,annual submission of data ,an applicable ,,aco that furnishes telehealth services described in paragraph 7#a7 shall1 on an annual basis1 submit to the ,secretary information requested by the ,secretary for evaluation of the implementation of this subsection1 including information on utilization and expenditures for telehealth under this subsection during the preceding year and data on any applicable quality measures1 consistent with sections #ahdh and #ahcc7z74 4 7b7 ,evaluation and report 7#a7 ,evaluation 7,a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this subsection referred to as the ,secretary7 shall conduct an evaluation on the implementation of section #ahii7l7 of the ,social ,security ,act1 as added by subsection 7a74 ,such evaluation shall include an analysis of the utilization of1 and expenditures for1 telehealth services under such section1 including a comparison of the utilization of1 and expenditures for1 the same services provided in the office setting4 7,b7 ,collection of data ,the ,secretary may collect such data as the ,secretary determines necessary to carry out the evaluation under this paragraph4 7#b7 ,report ,not later than ,january #a1 #bjbe1 the ,secretary shall submit to ,congress a report containing the results of the evaluation conducted under paragraph 7#a71 together with recommendations for such legislation and administrative action as the ,secretary determines appropriate4 #c4 ,expanding access to home dialysis therapy 7a7 ,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 an individual determined to have end stage renal disease receiving home dialysis may choose to receive the monthly end stage renal disease-related visits furnished on or after ,january #a1 #bjah1 via telehealth1 if the individual receives a face-to-face visit1 without the use of telehealth1 at least once every three consecutive months4 4 7b7 ,originating site requirements 7#a7 ,in general ,section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77 is amended-- 7,a7 in paragraph 7#d77;,c77ii71 by adding at the end the following new subclauses3 7,,ix7 ,a renal dialysis facility1 but only for purposes of section #ahha7;b77#c77;,b74 7,x7 ,the home of an individual1 but only for purposes of section #ahha7;b77#c77;,b74 2 and 7,b7 by adding at the end the following new paragraph3 7#e7 ,treatment of home dialysis monthly ,,esrd-related visit ,the geographic requirements described in paragraph 7#d77;,c77i7 shall not apply with respect to telehealth services furnished on or after ,january #a1 #bjah1 for purposes of section #ahha7;b77#c77;,b71 at an originating site described in subclause 7,,vi71 7,,ix71 or 7,x7 of paragraph 7#d77;,c77ii771 subject to applicable ,state law requirements1 including ,state licensure requirements4 4 7#b7 ,no facility fee if originating site for home dialysis therapy is the home ,section #ahcd7m77#b77;,b7 of the ,social ,security 7#db ,u4,s4,c4 #aciem7m77#b77;,b77 is amended-- 7,a7 by redesignating clauses 7i7 and 7ii7 as subclauses 7,i7 and 7,,ii71 and indenting appropriately2 7,b7 in subclause 7,,ii71 as redesignated by subparagraph 7,a71 by striking clause 7i7 or this clause and inserting subclause 7,i7 or this subclause2 7,c7 by striking site4--,with respect to and inserting 8site4-- 7i7 ,in general ,subject to clause 7ii71 with respect to 2 and 7,d7 by adding at the end the following new clause3 7ii7 ,no facility fee if originating site for home dialysis therapy is the home ,no facility fee shall be paid under this subparagraph to an originating site described in paragraph 7#d77;,c77ii77,x74 4 7c7 ,conforming amendment ,section #ahha7;b77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acierr7b77#a77 is amended by striking paragraph 7#c77;,a7 and inserting paragraph 7#c77;,a77i74 #d4 ,expanding the use of telehealth for individuals with stroke ,section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m771 as amended by section #c7;b71 is amended by adding at the end the following new paragraph3 7#f7 ,treatment of stroke telehealth services 7,a7 ,nonapplication of originating site requirements ,the requirements described in paragraph 7#d77;,c7 shall not apply with respect to telehealth services furnished on or after ,january #a1 #bjah1 for purposes of evaluation of an acute stroke1 as determined by the ,secretary1 subject to applicable ,state law requirements1 including ,state licensure requirements4 7,b7 ,no originating site facility fee for new sites ,the ,secretary shall not pay an originating site facility fee 7as described in paragraph 7#b77;,b77 with respect to telehealth services described in subparagraph 7,a7 if the services would not have been covered under this title as of the date of enactment of this paragraph4 4 #e4 ,increasing access to digital tools for ,medicare ,advantage enrollees through telehealth and remote patient monitoring 7a7 ,in general ,section #aheb of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7 is amended-- 7#a7 in subsection 7a77#a77;,b77i71 by inserting 1 subject to subsection 7m71 after means2 and 7#b7 by adding at the end the following new subsection3 7m7 ,provision of additional telehealth benefits and treatment of remote patient monitoring 7#a7 ,,ma plan option ,for plan year #bjah and subsequent plan years1 subject to the requirements of paragraph 7#c71 an ,,ma plan may provide additional telehealth benefits 7as defined in paragraph 7#b77 to individuals enrolled under this part4 7#b7 ,additional telehealth benefits defined 7,a7 ,in general ,for purposes of this subsection and section #ahed3 7i7 ,definition ,the term additional telehealth benefits means services for which benefits are available under part ,b1 notwithstanding the restrictions applicable to the coverage of telehealth services under section #ahcd7m7 described in subparagraph 7,b74 7ii7 ,exclusion of capital and infrastructure costs and investments ,the term additional telehealth benefits does not include capital and infrastructure costs and investments relating to such benefits4 7,b7 ,restrictions described ,for purposes of this subsection1 restrictions applicable to the coverage of telehealth services under section #ahcd7m7 shall include requirements relating to qualifications for an originating site under paragraph 7#d77;,c77ii7 of such section1 any geographic limitations under paragraph 7#d77;,c77i7 of such section 7other than applicable ,state law requirements1 including ,state licensure requirements71 any limitation on the use of store-and-forward technologies described in paragraph 7#a7 of such section1 any limitation on the type of health care provider who may furnish such services 7other than the requirement that the provider is a ,medicare-enrolled provider71 or any limitation on specific codes designated as telehealth services that are covered under this title pursuant to such section 7provided such codes are clinically appropriate to furnish remotely74 7,c7 ,public comment ,not later than ,november #cj1 #bjag1 the ,secretary shall solicit comments on what types of telehealth services should be considered to meet the definition of additional telehealth benefits under this paragraph4 7#c7 ,requirements for additional telehealth benefits ,the ,secretary shall specify requirements for the provision or furnishing of additional telehealth benefits1 including with respect to the following3 7,a7 ,physician1 practitioner1 or other health care provider licensure consistent with ,state law and other requirements such as specific training4 7,b7 ,factors necessary to ensure the coordination of such benefits with items and services furnished in-person4 7,c7 ,such other areas as determined by the ,secretary4 7#d7 ,enrollee choice ,if an ,,ma plan provides a service as an additional telehealth benefit 7as defined in paragraph 7#b771 an individual enrollee shall have discretion as to whether to receive such service as an additional telehealth benefit4 7#e7 ,construction regarding network access adequacy ,provision of additional telehealth benefits under this subsection shall not be construed as making such benefits available and accessible for purposes of compliance with subsection 7d74 7#f7 ,treatment under ,,ma ,for purposes of this subsection and section #ahed1 additional telehealth benefits shall be treated as if they were benefits under the original ,medicare fee-for-service program option4 7#g7 ,construction ,nothing in this subsection shall be construed as affecting the requirement under subsection 7a77#a7 that ,,ma plans provide enrollees with items and services 7other than hospice care7 for which benefits are available under parts ,a and ,b1 including benefits available under section #ahcd7m74 7#h7 ,clarification regarding remote patient monitoring services ,for purposes of this subsection and section #ahed1 remote patient monitoring services shall be treated as if they were benefits under the original ,medicare fee-for-service program option so long as such treatment does not increase the bid amount attributable to such benefits from the amount it would otherwise be1 as determined by the ,secretary4 7#i7 ,provision of data ,an ,,ma plan that provides additional telehealth benefits or remote patient monitoring services with respect to a plan year shall provide to the ,secretary 7at such time and in such manner as the ,secretary may specify7 data on expenditures and utilization for telehealth or remote patient monitoring services under the plan for enrollees during that plan year4 4 7b7 ,clarification regarding inclusion in bid amount ,section #ahed7;a77#f77;,a77ii77,i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bd7;a77#f77;,a77ii77,i77 is amended by inserting 1 including1 for plan year #bjai and subsequent plan years1 the provision of additional telehealth benefits and remote patient monitoring as described in section #aheb7m7 before the semicolon at the end4 #f4 ,coverage of remote patient monitoring services furnished to certain individuals 7a7 ,in general ,section #ahdh7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;b77 is amended by adding at the end the following new paragraph3 7#ab7 ,coverage of remote patient monitoring services furnished to certain individuals 7,a7 ,in general ,the ,secretary shall1 subject to subparagraph 7,b71 make payment 7as the ,secretary determines to be appropriate7 under this section for remote patient monitoring services 7as defined in subparagraph 7,c77iii77 furnished on or after ,january #a1 #bjah1 to an applicable individual 7as defined in subparagraph 7,c77i77 by an eligible provider 7as defined in subparagraph 7,c77ii774 7,b7 ,requirements ,the following shall apply with respect to remote patient monitoring services under this paragraph3 7i7 ,coverage of such remote patient monitoring services shall be in addition to coverage for chronic care management services or transitional care management services furnished to an applicable individual under this section4 7ii7 ,the ,secretary shall consult with public and private stakeholders in determining the amount of payment for remote patient monitoring services under this section4 7iii7 ,payment1 pricing1 and coverage for such remote patient monitoring services may occur through the unbundling1 modification1 or establishment of certain codes4 7iv7 ,such remote patient monitoring services 7other than those services that are physicians' services7 shall be furnished under the general supervision of an eligible provider4 7,c7 ,definitions ,in this paragraph3 7i7 ,applicable individual ,the term applicable individual means an individual-- 7,i7 receiving chronic care management services or transitional care management services under this section2 7,,ii7 who is in the top five percent of ,medicare cost utilization and has two or more chronic diseases1 as determined on a yearly basis by the ,secretary2 or 7,,iii7 who has any other condition or with respect to an episode of care that the ,secretary may specify1 so long as the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services certifies that providing coverage for remote patient monitoring services with respect to such individuals would-- 7aa7 reduce spending under this title without reducing the quality of care2 or 7bb7 improve the quality of patient care without increasing spending4 7ii7 ,eligible provider ,the term eligible provider means a physician 7as defined in section #ahfa7r77 or a practitioner described in section #ahdb7;b77#ah77;,c74 7iii7 ,remote patient monitoring services ,the term remote patient monitoring services means clinical data transmitted from an applicable individual in one location via electronic communications technologies that are devices as defined in section #bja7;h7 of the ,federal ,food1 ,drug1 and ,cosmetic ,act to an eligible provider in a different location and used by the eligible provider in furnishing such services to such individual that complies with the ,federal regulations 7concerning the privacy and security 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 the applicable individual that includes the review and interpretation of that data by an eligible provider4 ,such term includes those services furnished in a ,federally qualified health center or a rural health clinic4 ,such term shall not include a communication that consists solely of a telephone audio conversation1 facsimile1 or electronic text message between an eligible provider and the applicable individual4 4 7b7 ,expanding the use of remote patient monitoring services under alternative payment models ,section #ahdh7;b77#ab7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;b77#ab771 as added by subsection 7a71 is amended by adding at the end the following new subparagraph3 7,d7 ,application to alternative payment models ,for purposes of applying this paragraph with respect to remote patient monitoring services furnished by an eligible provider participating in an alternative payment model 7as defined in section #ahcc7z77#c77;,c771 the term applicable individual shall mean any beneficiary assigned to the alternative payment model4 4 #g4 ,rural health clinics and ,federally qualified health centers 7a7 ,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 ,rural health clinics and ,federally qualified health centers ,in the case of a service furnished on or after the date that is #f months after the date of the enactment of the ,,connect for ,health ,act of #bjag1 the term originating site shall also include any ,federally qualified health center and any rural health clinic 7as such terms are defined in section #ahfa7;aa77 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 clause1 subject to applicable ,state law requirements1 including ,state licensure requirements4 4 7b7 ,expansion of distant sites ,section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77 is amended-- 7#a7 in the first sentence of paragraph 7#a7-- 7,a7 by striking or a practitioner 7described in section #ahdb7;b77#ah77;,c77 and inserting 1 a practitioner 7described in section #ahdb7;b77#ah77;,c771 a ,federally qualified health center1 or a rural health clinic2 and 7,b7 by striking or practitioner and inserting 1 practitioner1 ,federally qualified health center1 or rural health clinic2 7#b7 in paragraph 7#b77;,a7-- 7,a7 by inserting the following after eligible telehealth individual3 or to a ,federally qualified health center or rural health clinic that serves as a distant site and furnishes a telehealth service to an eligible telehealth individual2 and 7,b7 by striking such physician or practitioner and inserting such physician1 practitioner1 ,federally qualified health center1 or rural health clinic2 and 7#c7 in paragraph 7#d77;,a71 by inserting the following before the period at the end3 and includes a ,federally qualified health center or rural health clinic that furnishes a telehealth service to an eligible individual4 7c7 ,effective date ,the amendments made by this section shall apply to services furnished on or after ,january #a1 #bjah4 #h4 ,allowing ,native ,american health service facilities as sites eligible for telehealth payment 7a7 ,in general ,section #ahcd7m77#d77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,c771 as amended by section #g1 is amended-- 7#a7 in clause 7i71 by striking clause 7iii7 and inserting clauses 7iii7 and 7iv72 and 7#b7 by adding at the end the following new clause3 7iv7 ,native ,american health service facilities ,the originating site requirements described in clauses 7i7 and 7ii7 shall not apply with respect to a facility of the ,indian ,health ,service1 whether operated by such ,service1 or by an ,indian tribe 7as that term is defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc77 or a tribal organization 7as that term is defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej;b771 or a facility of the ,native ,hawaiian health care systems authorized under the ,native ,hawaiian ,health ,care ,improvement ,act 7#db ,u4,s4,c4 #aagja et seq474 4 7b7 ,no originating site facility fee for new sites ,section #ahcd7m77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#b77;,b77 is amended1 in the matter preceding clause 7i71 by inserting 7other than an originating site that is only described in clause 7iv7 of paragraph 7#d77;,c71 and does not meet the requirement for an originating site under clause 7i7 of such paragraph7 after the originating site4 7c7 ,effective date ,the amendments made by this section shall apply to services furnished on or after ,january #a1 #bjah4 #i4 ,clarification regarding telehealth and remote patient monitoring technologies provided to beneficiaries ,section #aabh;,a7i77#f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;a7i77#f77 is amended-- 7#a7 in subparagraph 7,h71 by striking 2 or and inserting a semicolon2 7#b7 in subparagraph 7,i71 by striking the period at the end and inserting 2 or2 and 7#c7 by adding at the end the following new subparagraph3 7,j7 the provision of telehealth or remote patient monitoring technologies to individuals under title ,,xviii by a health care provider for the purpose of furnishing telehealth or remote patient monitoring services4 4 #aj4 ,allowing telehealth and remote patient monitoring services to be included in bundled or global payments ,title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 is amended by adding at the end the following new section3 #ahii;,c4 ,allowing telehealth and remote patient monitoring services to be included in bundled or global payments ,notwithstanding any other provision of this title1 the ,secretary may include under any bundled or global payment under this title the following3 7#a7 ,telehealth services ,notwithstanding requirements otherwise applicable under section #ahcd7m71 including any requirements relating to qualifications for an originating site under paragraph 7#d77;,c77ii7 of such section1 any geographic limitations under paragraph 7#d77;,c77i7 of such section 7other than applicable ,state law requirements1 including ,state licensure requirements71 any limitation on the use of store-and-forward technologies described in paragraph 7#a7 of such section1 any limitation on the type of health care provider who may furnish such services 7other than the requirement that the provider is a ,medicare-enrolled provider71 any items and services for which payment would otherwise be made under this title that are furnished using telehealth1 or any limitation on specific codes designated as telehealth services that are covered under this title pursuant to section #ahcd7m7 7provided such codes are clinically appropriate to furnish remotely74 7#b7 ,remote patient monitoring services ,notwithstanding section #ahdh7;b77#ab71 remote patient monitoring services 7as defined in such section7 furnished to any individual under this title4 4 #aa4 ,expanding the use of telehealth through the waiver of certain requirements ,section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m771 as amended by sections #c7;b7 and #d1 is amended by adding at the end the following new paragraph3 7#g7 ,authority to waive requirements and limitations if certain conditions met 7,a7 ,in general ,in the case of telehealth services furnished on or after ,january #a1 #bjah1 the ,secretary may waive any restriction applicable to the coverage of telehealth services under this subsection described in subparagraph 7,b7 with respect to certain providers of services1 suppliers1 provider groups1 sites of care1 services1 conditions1 individuals receiving the services1 or ,states1 as determined by the ,secretary1 if each of the requirements described in subparagraph 7,c7 is met with respect to the waiver4 7,b7 ,restrictions described ,for purposes of this paragraph1 restrictions applicable to the coverage of telehealth services under this subsection shall include requirements relating to qualifications for an originating site under paragraph 7#d77;,c77ii71 any geographic limitations under paragraph 7#d77;,c77i7 7other than applicable ,state law requirements1 including ,state licensure requirements71 any limitation on the use of store-and-forward technologies described in paragraph 7#a71 any limitation on the type of health care provider who may furnish such services 7other than the requirement that the provider is a ,medicare-enrolled provider71 or any limitation on specific codes designated as telehealth services that are covered under this title pursuant to this subsection 7provided such codes are clinically appropriate to furnish remotely74 7,c7 ,requirements for waiver ,the requirements described in this subparagraph are1 with respect to the waiver of a restriction described in subparagraph 7,b71 the following3 7i7 ,the ,secretary determines that the waiver is expected to-- 7,i7 reduce spending under this title without reducing the quality of care2 or 7,,ii7 improve the quality of patient care without increasing spending4 7ii7 ,the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services certifies that such waiver would reduce 7or would not result in any increase in7 net program spending under this title4 7iii7 ,the ,secretary determines that such waiver would not deny or limit the coverage or provision of benefits under this title for individuals4 7,d7 ,public comment ,the ,secretary shall establish a process by which stakeholders may 7on at least an annual basis7 submit requests for a waiver under this paragraph4 4 #ab4 ,expanding the use of telehealth for mental health services ,section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m771 as amended by sections #c7;b71 #d1 and #aa1 is amended by adding at the end the following new paragraph3 7#h7 ,treatment of mental health services delivered via telehealth 7,a7 ,in general ,restrictions applicable to the coverage of telehealth services under this subsection described in subparagraph 7,b7 shall not apply with respect to telehealth services that are mental health services 7as determined by the ,secretary7 and are furnished on or after ,january #a1 #bjah4 7,b7 ,restrictions described ,for purposes of this paragraph1 restrictions applicable to the coverage of telehealth services under this subsection shall include requirements relating to qualifications for an originating site under paragraph 7#d77;,c77ii71 any geographic limitations under paragraph 7#d77;,c77i7 7other than applicable ,state law requirements1 including ,state licensure requirements71 any limitation on the use of store-and-forward technologies described in paragraph 7#a71 any limitation on the type of health care provider who may furnish such services 7other than the requirement that the provider is a ,medicare-enrolled provider71 or any limitation on specific codes designated as telehealth services that are covered under this title pursuant to this subsection 7provided such codes are clinically appropriate to furnish remotely74 4 #ac4 ,,hhs evaluation and report on the use of telehealth and remote patient monitoring under all demonstration programs and pilots with a telehealth waiver 7a7 ,study ,the ,secretary of ,health and ,human ,services 7in this subsection referred to as the ,secretary7 shall conduct an evaluation on the use of telehealth and remote patient monitoring under all programs and pilots under the ,medicare program under title ,,xviii of the ,social ,security ,act and the ,medicaid program under title ,,xix of such ,act with a waiver of telehealth restrictions otherwise applicable under such titles of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m774 ,such evaluation shall include an analysis of the following3 7#a7 ,the number of providers and payers using telehealth and remote patient monitoring under such programs and pilots4 7#b7 ,the cost impact among the beneficiaries receiving telehealth and remote patient monitoring under such programs and pilots1 including with respect to preventable hospitalizations1 hospital readmissions1 and emergency room visits1 and the total cost of items and services under the ,medicare and ,medicaid programs4 7#c7 ,beneficiary and family caregiver satisfaction with the use of telehealth and remote patient monitoring under such programs and pilots4 7#d7 ,a comparison of the utilization of1 and expenditures for1 the same services furnished under the ,medicare and ,medicaid programs in the office setting4 7b7 ,report ,not later than #b years after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress a report containing the results of the evaluation conducted under subsection 7a71 together with recommendations for such legislation and administrative action as the ,secretary determines appropriate4 #ad4 ,testing of models to examine the use of telehealth and remote patient monitoring under the ,medicare program ,section #aaae;,a7b77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b77 is amended by adding at the end the following new subparagraph3 7,d7 ,testing models to examine use of telehealth and remote patient monitoring under ,medicare ,the ,secretary shall consider testing under this subsection models to examine the use of telehealth and remote patient monitoring under title ,,xviii4 4 #ae4 ,sense of ,congress regarding the remote practice of medicine 7a7 ,findings ,congress finds that the laws of all #ej ,states and the ,district of ,columbia-- 7#a7 consider the practice of medicine to include remote visits2 and 7#b7 recognize that any remote practice of medicine is governed by the same medical practice statutes as in-person care4 7b7 ,sense of ,congress ,it is the sense of ,congress that-- 7#a7 telemedicine is the delivery of safe1 effective1 quality health care services1 by a health care provider1 using technology-based modalities to deliver medical care2 7#b7 ,states have recognized this by treating telemedicine as the practice of medicine2 and 7#c7 the ,medicare program under title ,,xviii of the ,social ,security ,act should cover the delivery of remote patient services4