,,ii  #aae? ,,congress  #a/ ,session    
,s4 #ajaf  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,may #c1 #bjag ,mr4    
,s*atz 7= himself1 ,mr4 ,wick]1 ,mr4    
,co*ran1 ,mr4 ,c>d91 ,mr4 ,?une1 & ,mr4 
,w>n]7 introduc$ ! foll[+ bill2 :i* 0   
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
exp& access to teleheal? s]vices1 & =   
o!r purposes4  #a4 ,%ort title2 table ( 
cont5ts  7a7 ,%ort title  ,?is ,act may 
be cit$ z ! ,creat+ ,opportunities ,n[ =
 ,necess>y & ,effective ,c>e            
,te*nologies 7,,connect7 = ,heal? ,act (
 #bjag or ! ,,connect = ,heal? ,act (   
#bjag4  7b7 ,table ( cont5ts ,! table ( 
cont5ts ( ?is ,act is z foll[s3 ,sec4   
#a4 ,%ort title2 table ( cont5ts4 ,sec4 
#b4 ,provid+ acc\ntable c>e             
organizations ! ability to exp& ! use ( 
teleheal?4 ,sec4 #c4 ,exp&+ access to   
home dialysis !rapy4 ,sec4 #d4 ,exp&+ ! 
use ( teleheal? = individuals ) /roke4  
,sec4 #e4 ,increas+ access to digital   

tools = ,m$ic>e ,advantage enrollees    
?r\gh teleheal? & remote pati5t         
monitor+4 ,sec4 #f4 ,cov]age ( remote   
pati5t monitor+ s]vices furni%$ to c]ta9
 individuals4 ,sec4 #g4 ,rural heal?    
cl9ics & ,f$]ally qualifi$ heal? c5t]s4 
,sec4 #h4 ,all[+ ,native ,am]ican heal? 
s]vice facilities z sites eligible =    
teleheal? paym5t4 ,sec4 #i4             
,cl>ification reg>d+ teleheal? & remote 
pati5t monitor+ te*nologies provid$ to  
b5efici>ies4 ,sec4 #aj4 ,all[+ teleheal?
 & remote pati5t monitor+ s]vices to be 
includ$ 9 bundl$ or global paym5ts4     
,sec4 #aa4 ,exp&+ ! use ( teleheal?     
?r\gh ! waiv] ( c]ta9 requirem5ts4 ,sec4
 #ab4 ,exp&+ ! use ( teleheal? = m5tal  
heal? s]vices4 ,sec4 #ac4 ,,hhs         
evaluation & report on ! use ( teleheal?
 & remote pati5t monitor+ "u all        
demon/ration programs & pilots ) a      
teleheal? waiv]4 ,sec4 #ad4 ,te/+ (     
models to exam9e ! use ( teleheal? &    
remote pati5t monitor+ "u ! ,m$ic>e     
program4 ,sec4 #ae4 ,s5se ( ,congress   

reg>d+ ! remote practice ( m$ic9e4  #b4 
,provid+ acc\ntable c>e organizations ! 
ability to exp& ! use ( teleheal?  7a7  
,9 g5]al ,section #ahii ( ! ,social     
,security ,act 7#db ,u4,s4,c4 #acie;jjj7
 is am5d$ by add+ at ! end ! foll[+ new 
subsection3  7l7 ,provid+ ,a,c,os !     
ability ,to exp& ! use ( teleheal?      
s]vices  7#a7 ,9 g5]al  7,a7 ,exp&+ use 
( teleheal? s]vices ,9 ! case (         
teleheal? s]vices = :i* paym5t w\ld     
o!rwise be made "u ?is title furni%$ on 
or aft] ,janu>y #a1 #bjah1 = purposes ( 
?is subsection only1 ! re/rictions      
applicable to ! cov]age ( teleheal?     
s]vices "u section #ahcd7m7 describ$ 9  
subp>agraph 7,b7 %all n apply ) respect 
to su* s]vices furni%$ to a ,m$ic>e     
fee-=-s]vice b5efici>y assign$ to an    
applicable ,,aco 7z def9$ 9 p>agraph    
7#b774  7,b7 ,re/rictions describ$ ,=   
purposes ( ?is subsection1 re/rictions  
applicable to ! cov]age ( teleheal?     
s]vices "u section #ahcd7m7 %all include
 requirem5ts relat+ to qualifications = 

an orig9at+ site "u p>agraph            
7#d77;,c77ii7 ( su* section1 any        
geographic limitations "u p>agraph      
7#d77;,c77i7 ( su* section 7o!r ?an     
applicable ,/ate law requirem5ts1       
includ+ ,/ate lic5sure requirem5ts71 any
 limitation on ! use ( /ore-&-=w>d      
te*nologies describ$ 9 p>agraph 7#a7 (  
su* section1 any limitation on ! type ( 
heal? c>e provid] :o may furni% su*     
s]vices 7o!r ?an ! requirem5t t !       
provid] is a ,m$ic>e-enroll$ provid]71  
or any limitation on specific codes     
designat$ z teleheal? s]vices t are     
cov]$ "u ?is title pursuant to su*      
section 7provid$ su* codes are cl9ically
 appropriate to furni% remotely74  7#b7 
,def9ition ( applicable ,,aco ,9 ?is    
subsection1 ! t]m applicable ,,aco means
 an ,,aco p>ticipat+ 9 a model te/$ or  
exp&$ "u section #aaae;,a or "u ?is     
section--  7,a7 t op]ates "u a two-sid$ 
model-- 7i7 describ$ 9 section          
#dbe4fjj7;a7 ( title #db1 ,code ( ,f$]al
 ,regulations2 or  7ii7 te/$ or exp&$ "u

 section #aaae;,a2 &  7,b7 = :i* ,m$ic>e
 fee-=-s]vice b5efici>ies are assign$ to
 ! ,,aco us+ a prospective assignm5t    
me?od1 z det]m9$ appropriate by !       
,secret>y4  7#c7 ,no orig9at+ site      
facility fee = new sites ,! ,secret>y   
%all n pay an orig9at+ site facility fee
 7z describ$ 9 p>agraph 7#b77;,b7 (     
section #ahcd7m77 ) respect to teleheal?
 s]vices describ$ 9 p>agraph 7#a7 if su*
 s]vices w\ld n h be5 cov]$ "u ?is title
 z ( ! date ( enactm5t ( ?is subsection4
  7#d7 ,annual submission ( data ,an    
applicable ,,aco t furni%es teleheal?   
s]vices describ$ 9 p>agraph 7#a7 %all1  
on an annual basis1 submit to !         
,secret>y in=mation reque/$ by !        
,secret>y = evaluation ( ! implem5tation
 ( ?is subsection1 includ+ in=mation on 
utilization & exp5ditures = teleheal? "u
 ?is subsection dur+ ! prec$+ ye> & data
 on any applicable quality measures1    
consi/5t ) sections #ahdh & #ahcc7z74  4
  7b7 ,evaluation & report  7#a7        
,evaluation  7,a7 ,9 g5]al ,! ,secret>y 

( ,heal? & ,human ,s]vices 79 ?is       
subsection ref]r$ to z ! ,secret>y7 %all
 conduct an evaluation on !             
implem5tation ( section #ahii7l7 ( !    
,social ,security ,act1 z add$ by       
subsection 7a74 ,su* evaluation %all    
include an analysis ( ! utilization (1 &
 exp5ditures =1 teleheal? s]vices "u su*
 section1 includ+ a comp>ison ( !       
utilization (1 & exp5ditures =1 ! same  
s]vices provid$ 9 ! (fice sett+4  7,b7  
,collection ( data ,! ,secret>y may     
collect su* data z ! ,secret>y det]m9es 
necess>y to c>ry out ! evaluation "u ?is
 p>agraph4  7#b7 ,report ,n lat] ?an    
,janu>y #a1 #bjbe1 ! ,secret>y %all     
submit to ,congress a report conta9+ !  
results ( ! evaluation conduct$ "u      
p>agraph 7#a71 toge!r ) recomm5dations =
 su* legislation & adm9i/rative action z
 ! ,secret>y det]m9es appropriate4  #c4 
,exp&+ access to home dialysis !rapy    
7a7 ,9 g5]al ,section #ahha7;b77#c7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#acierr7b77#c77 is am5d$-- 7#a7 by      

r$esignat+ subp>agraphs 7,a7 & 7,b7 z   
clauses 7i7 & 7ii71 respectively2  7#b7 
9 clause 7ii71 z r$esignat$ by          
subp>agraph 7,a71 /rike on a            
compreh5sive & ins]t subject to         
subp>agraph 7,b71 on a compreh5sive2    
7#c7 by /rik+ ,) respect to & ins]t+    
7,a7 ,) respect to2 &  7#d7 by add+ at !
 end ! foll[+ new subp>agraph3  7,b7 ,= 
purposes ( subp>agraph 7,a77ii71 an     
individual det]m9$ to h end /age r5al   
disease receiv+ home dialysis may *oose 
to receive ! mon?ly end /age r5al       
disease-relat$ visits furni%$ on or aft]
 ,janu>y #a1 #bjah1 via teleheal?1 if ! 
individual receives a face-to-face      
visit1 )\t ! use ( teleheal?1 at lea/   
once e ?ree consecutive mon?s4  4  7b7  
,orig9at+ site requirem5ts  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 #bjah1 = 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 &     
ind5t+ appropriately2  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 p>agraph 7#d77;,c77ii77,x74  
4  7c7 ,con=m+ am5dm5t ,section         
#ahha7;b77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acierr7b77#a77 is am5d$
 by /rik+ p>agraph 7#c77;,a7 & ins]t+   
p>agraph 7#c77;,a77i74  #d4 ,exp&+ ! use
 ( teleheal? = individuals ) /roke      
,section #ahcd7m7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciem7m771 z am5d$ 
by section #c7;b71 is am5d$ by add+ at !
 end ! foll[+ new p>agraph3  7#f7       
,treatm5t ( /roke teleheal? s]vices     
7,a7 ,nonapplication ( orig9at+ site    
requirem5ts ,! requirem5ts describ$ 9   
p>agraph 7#d77;,c7 %all n apply )       
respect to teleheal? s]vices furni%$ on 
or aft] ,janu>y #a1 #bjah1 = purposes ( 

evaluation ( an acute /roke1 z det]m9$  
by ! ,secret>y1 subject to applicable   
,/ate law requirem5ts1 includ+ ,/ate    
lic5sure requirem5ts4  7,b7 ,no orig9at+
 site facility fee = new sites ,!       
,secret>y %all n pay an orig9at+ site   
facility fee 7z describ$ 9 p>agraph     
7#b77;,b77 ) respect to teleheal?       
s]vices describ$ 9 subp>agraph 7,a7 if !
 s]vices w\ld n h be5 cov]$ "u ?is title
 z ( ! date ( enactm5t ( ?is p>agraph4  
4  #e4 ,increas+ access to digital tools
 = ,m$ic>e ,advantage enrollees ?r\gh   
teleheal? & remote pati5t monitor+  7a7 
,9 g5]al ,section #aheb ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#aciew-#bb7 is am5d$-- 7#a7 9 subsection
 7a77#a77;,b77i71 by ins]t+ 1 subject to
 subsection 7m71 aft] means2 &  7#b7 by 
add+ at ! end ! foll[+ new subsection3  
7m7 ,provision ( additional teleheal?   
b5efits & treatm5t ( remote pati5t      
monitor+  7#a7 ,,ma plan option ,= plan 
ye> #bjah & subsequ5t plan ye>s1 subject
 to ! requirem5ts ( p>agraph 7#c71 an   

,,ma plan may provide additional        
teleheal? b5efits 7z def9$ 9 p>agraph   
7#b77 to individuals enroll$ "u ?is "p4 
7#b7 ,additional teleheal? b5efits def9$
  7,a7 ,9 g5]al ,= purposes ( ?is       
subsection & section #ahed3 7i7         
,def9ition ,! t]m additional teleheal?  
b5efits means s]vices = :i* b5efits are 
available "u "p ,b1 not)/&+ !           
re/rictions applicable to ! cov]age (   
teleheal? s]vices "u section #ahcd7m7   
describ$ 9 subp>agraph 7,b74  7ii7      
,exclusion ( capital & infra/ructure    
co/s & inve/m5ts ,! t]m additional      
teleheal? b5efits does n include capital
 & infra/ructure co/s & inve/m5ts relat+
 to su* b5efits4  7,b7 ,re/rictions     
describ$ ,= purposes ( ?is subsection1  
re/rictions applicable to ! cov]age (   
teleheal? s]vices "u section #ahcd7m7   
%all include requirem5ts relat+ to      
qualifications = an orig9at+ site "u    
p>agraph 7#d77;,c77ii7 ( su* section1   
any geographic limitations "u p>agraph  
7#d77;,c77i7 ( su* section 7o!r ?an     

applicable ,/ate law requirem5ts1       
includ+ ,/ate lic5sure requirem5ts71 any
 limitation on ! use ( /ore-&-=w>d      
te*nologies describ$ 9 p>agraph 7#a7 (  
su* section1 any limitation on ! type ( 
heal? c>e provid] :o may furni% su*     
s]vices 7o!r ?an ! requirem5t t !       
provid] is a ,m$ic>e-enroll$ provid]71  
or any limitation on specific codes     
designat$ z teleheal? s]vices t are     
cov]$ "u ?is title pursuant to su*      
section 7provid$ su* codes are cl9ically
 appropriate to furni% remotely74  7,c7 
,public comm5t ,n lat] ?an ,novemb] #cj1
 #bjag1 ! ,secret>y %all solicit comm5ts
 on :at types ( teleheal? s]vices %\ld  
be consid]$ to meet ! def9ition (       
additional teleheal? b5efits "u ?is     
p>agraph4  7#c7 ,requirem5ts =          
additional teleheal? b5efits ,!         
,secret>y %all specify requirem5ts = !  
provision or furni%+ ( additional       
teleheal? b5efits1 includ+ ) respect to 
! foll[+3  7,a7 ,physician1 practition]1
 or o!r heal? c>e provid] lic5sure      

consi/5t ) ,/ate law & o!r requirem5ts  
su* z specific tra9+4  7,b7 ,factors    
necess>y to ensure ! coord9ation ( su*  
b5efits ) items & s]vices furni%$       
9-p]son4  7,c7 ,su* o!r areas z det]m9$ 
by ! ,secret>y4  7#d7 ,enrollee *oice   
,if an ,,ma plan provides a s]vice z an 
additional teleheal? b5efit 7z def9$ 9  
p>agraph 7#b771 an individual enrollee  
%all h discretion z to :e!r to receive  
su* s]vice z an additional teleheal?    
b5efit4  7#e7 ,con/ruction reg>d+       
network access adequacy ,provision (    
additional teleheal? b5efits "u ?is     
subsection %all n be con/ru$ z mak+ su* 
b5efits available & accessible =        
purposes ( compliance ) subsection 7d74 
7#f7 ,treatm5t "u ,,ma ,= purposes ( ?is
 subsection & section #ahed1 additional 
teleheal? b5efits %all be treat$ z if !y
 7 b5efits "u ! orig9al ,m$ic>e         
fee-=-s]vice program option4  7#g7      
,con/ruction ,no?+ 9 ?is subsection %all
 be con/ru$ z affect+ ! requirem5t "u   
subsection 7a77#a7 t ,,ma plans provide 

enrollees ) items & s]vices 7o!r ?an    
hospice c>e7 = :i* b5efits are available
 "u p>ts ,a & ,b1 includ+ b5efits       
available "u section #ahcd7m74  7#h7    
,cl>ification reg>d+ remote pati5t      
monitor+ s]vices ,= purposes ( ?is      
subsection & section #ahed1 remote      
pati5t monitor+ s]vices %all be treat$ z
 if !y 7 b5efits "u ! orig9al ,m$ic>e   
fee-=-s]vice program option s long z su*
 treatm5t does n increase ! bid am\nt   
attributable to su* b5efits f ! am\nt x 
w\ld o!rwise be1 z det]m9$ by !         
,secret>y4  7#i7 ,provision ( data ,an  
,,ma plan t provides additional         
teleheal? b5efits or remote pati5t      
monitor+ s]vices ) respect to a plan ye>
 %all provide to ! ,secret>y 7at su* "t 
& 9 su* mann] z ! ,secret>y may specify7
 data on exp5ditures & utilization =    
teleheal? or remote pati5t monitor+     
s]vices "u ! plan = enrollees dur+ t    
plan ye>4  4  7b7 ,cl>ification reg>d+  
inclusion 9 bid am\nt ,section          
#ahed7;a77#f77;,a77ii77,i7 ( ! ,social  

,security ,act 7#db ,u4,s4,c4           
#aciew-#bd7;a77#f77;,a77ii77,i77 is     
am5d$ by ins]t+ 1 includ+1 = plan ye>   
#bjai & subsequ5t plan ye>s1 ! provision
 ( additional teleheal? b5efits & remote
 pati5t monitor+ z describ$ 9 section   
#aheb7m7 be=e ! semicolon at ! end4  #f4
 ,cov]age ( remote pati5t monitor+      
s]vices furni%$ to c]ta9 individuals    
7a7 ,9 g5]al ,section #ahdh7;b7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#d7;b77 is am5d$ by add+ at ! end
 ! foll[+ new p>agraph3  7#ab7 ,cov]age 
( remote pati5t monitor+ s]vices furni%$
 to c]ta9 individuals  7,a7 ,9 g5]al ,! 
,secret>y %all1 subject to subp>agraph  
7,b71 make paym5t 7z ! ,secret>y        
det]m9es to be appropriate7 "u ?is      
section = remote pati5t monitor+ s]vices
 7z def9$ 9 subp>agraph 7,c77iii77      
furni%$ on or aft] ,janu>y #a1 #bjah1 to
 an applicable individual 7z def9$ 9    
subp>agraph 7,c77i77 by an eligible     
provid] 7z def9$ 9 subp>agraph          
7,c77ii774  7,b7 ,requirem5ts  ,! foll[+

 %all apply ) respect to remote pati5t  
monitor+ s]vices "u ?is p>agraph3  7i7  
,cov]age ( su* remote pati5t monitor+   
s]vices %all be 9 addition to cov]age = 
*ronic c>e managem5t s]vices or         
transitional c>e managem5t s]vices      
furni%$ to an applicable individual "u  
?is section4  7ii7 ,! ,secret>y %all    
consult ) public & private /akehold]s 9 
det]m9+ ! am\nt ( paym5t = remote pati5t
 monitor+ s]vices "u ?is section4  7iii7
 ,paym5t1 pric+1 & cov]age = su* remote 
pati5t monitor+ s]vices may occur ?r\gh 
! unbundl+1 modification1 or e/abli%m5t 
( c]ta9 codes4  7iv7 ,su* remote pati5t 
monitor+ s]vices 7o!r ?an ^? s]vices t  
are physicians' s]vices7 %all be furni%$
 "u ! g5]al sup]vision ( an eligible    
provid]4  7,c7 ,def9itions ,9 ?is       
p>agraph3 7i7 ,applicable individual ,! 
t]m applicable individual means an      
individual--  7,i7 receiv+ *ronic c>e   
managem5t s]vices or transitional c>e   
managem5t s]vices "u ?is section2       
7,,ii7 :o is 9 ! top five p]c5t (       

,m$ic>e co/ utilization & has two or m  
*ronic diseases1 z det]m9$ on a ye>ly   
basis by ! ,secret>y2 or  7,,iii7 :o has
 any o!r condition or ) respect to an   
episode ( c>e t ! ,secret>y may specify1
 s long z ! ,*ief ,actu>y ( ! ,c5t]s =  
,m$ic>e  ,m$icaid ,s]vices c]tifies t   
provid+ cov]age = remote pati5t monitor+
 s]vices ) respect to su* individuals   
w\ld--  7aa7 r$uce sp5d+ "u ?is title   
)\t r$uc+ ! quality ( c>e2 or  7bb7     
improve ! quality ( pati5t c>e )\t      
increas+ sp5d+4  7ii7 ,eligible provid] 
,! t]m eligible provid] means a         
physician 7z def9$ 9 section #ahfa7r77  
or a practition] describ$ 9 section     
#ahdb7;b77#ah77;,c74  7iii7 ,remote     
pati5t monitor+ s]vices ,! t]m remote   
pati5t monitor+ s]vices means cl9ical   
data transmitt$ f an applicable         
individual 9 "o location via electronic 
communications te*nologies t are devices
 z def9$ 9 section #bja7;h7 ( ! ,f$]al  
,food1 ,drug1 & ,cosmetic ,act to an    
eligible provid] 9 a diff]5t location & 

us$ by ! eligible provid] 9 furni%+ su* 
s]vices to su* individual t complies ) !
 ,f$]al regulations 7conc]n+ ! privacy &
 security ( individually id5tifiable    
heal? in=mation7 promulgat$ "u section  
#bfd7;c7 ( ! ,heal? ,insurance          
,portability & ,acc\ntability ,act (    
#aiif1 z "p ( an e/abli%$ plan ( c>e = !
 applicable individual t includes !     
review & int]pretation ( t data by an   
eligible provid]4 ,su* t]m includes ^?  
s]vices furni%$ 9 a ,f$]ally qualifi$   
heal? c5t] or a rural heal? cl9ic4 ,su* 
t]m %all n include a communication t    
consi/s solely ( a telephone audio      
conv]sation1 facsimile1 or electronic   
text message betwe5 an eligible provid] 
& ! applicable individual4  4  7b7      
,exp&+ ! use ( remote pati5t monitor+   
s]vices "u alt]native paym5t models     
,section #ahdh7;b77#ab7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#aciew-#d7;b77#ab771 z add$ by          
subsection 7a71 is am5d$ by add+ at !   
end ! foll[+ new subp>agraph3  7,d7     

,application to alt]native paym5t models
 ,= purposes ( apply+ ?is p>agraph )    
respect to remote pati5t monitor+       
s]vices furni%$ by an eligible provid]  
p>ticipat+ 9 an alt]native paym5t model 
7z def9$ 9 section #ahcc7z77#c77;,c771 !
 t]m applicable individual %all mean any
 b5efici>y assign$ to ! alt]native      
paym5t model4  4  #g4 ,rural heal?      
cl9ics & ,f$]ally qualifi$ heal? c5t]s  
7a7 ,expansion ( orig9at+ sites         
,section #ahcd7m77#d77;,c7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#aciem7m77#d77;,c77 is am5d$-- 7#a7 9   
clause 7i71 by /rik+ ,! t]m & ins]t+    
,subject to clause 7iii71 ! t]m2 &  7#b7
 by add+ at ! end ! foll[+ new clause3  
7iii7 ,rural heal? cl9ics & ,f$]ally    
qualifi$ heal? c5t]s ,9 ! case ( a      
s]vice furni%$ on or aft] ! date t is #f
 mon?s aft] ! date ( ! enactm5t ( !     
,,connect = ,heal? ,act ( #bjag1 ! t]m  
orig9at+ site %all also include any     
,f$]ally qualifi$ heal? c5t] & any rural
 heal? cl9ic 7z su* t]ms are def9$ 9    

section #ahfa7;aa77 at :i* ! eligible   
teleheal? individual is locat$ at ! "t !
 s]vice is furni%$ via a                
telecommunications sy/em1 :e!r or n !y  
are locat$ 9 an area describ$ 9 clause  
7i71 ins(> z su* sites are n o!rwise    
includ$ 9 ! def9ition ( orig9at+ site "u
 su* clause1 subject to applicable ,/ate
 law requirem5ts1 includ+ ,/ate lic5sure
 requirem5ts4  4  7b7 ,expansion (      
di/ant sites ,section #ahcd7m7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7m77 is am5d$-- 7#a7 9 ! fir/     
s5t5ce ( p>agraph 7#a7--  7,a7 by /rik+ 
or a practition] 7describ$ 9 section    
#ahdb7;b77#ah77;,c77 & ins]t+ 1 a       
practition] 7describ$ 9 section         
#ahdb7;b77#ah77;,c771 a ,f$]ally        
qualifi$ heal? c5t]1 or a rural heal?   
cl9ic2 &  7,b7 by /rik+ or practition] &
 ins]t+ 1 practition]1 ,f$]ally qualifi$
 heal? c5t]1 or rural heal? cl9ic2  7#b7
 9 p>agraph 7#b77;,a7--  7,a7 by ins]t+ 
! foll[+ aft] eligible teleheal?        
individual3 or to a ,f$]ally qualifi$   

heal? c5t] or rural heal? cl9ic t s]ves 
z a di/ant site & furni%es a teleheal?  
s]vice to an eligible teleheal?         
individual2 &  7,b7 by /rik+ su*        
physician or practition] & ins]t+ su*   
physician1 practition]1 ,f$]ally        
qualifi$ heal? c5t]1 or rural heal?     
cl9ic2 &  7#c7 9 p>agraph 7#d77;,a71 by 
ins]t+ ! foll[+ be=e ! p]iod at ! end3 &
 includes a ,f$]ally qualifi$ heal? c5t]
 or rural heal? cl9ic t furni%es a      
teleheal? s]vice to an eligible         
individual4  7c7 ,effective date ,!     
am5dm5ts made by ?is section %all apply 
to s]vices furni%$ on or aft] ,janu>y   
#a1 #bjah4  #h4 ,all[+ ,native ,am]ican 
heal? s]vice facilities z sites eligible
 = teleheal? paym5t  7a7 ,9 g5]al       
,section #ahcd7m77#d77;,c7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#aciem7m77#d77;,c771 z am5d$ by section 
#g1 is am5d$--  7#a7 9 clause 7i71 by   
/rik+ clause 7iii7 & ins]t+ clauses     
7iii7 & 7iv72 &  7#b7 by add+ at ! end !
 foll[+ new clause3  7iv7 ,native       

,am]ican heal? s]vice facilities ,!     
orig9at+ site requirem5ts describ$ 9    
clauses 7i7 & 7ii7 %all n apply )       
respect to a facility ( ! ,indian ,heal?
 ,s]vice1 :e!r op]at$ by su* ,s]vice1 or
 by an ,indian tribe 7z t t]m is def9$ 9
 section #d ( ! ,indian ,heal? ,c>e     
,improvem5t ,act 7#be ,u4,s4,c4 #afjc77 
or a tribal organization 7z t t]m is    
def9$ 9 section #d ( ! ,indian          
,self-,det]m9ation & ,education         
,assi/ance ,act 7#be ,u4,s4,c4 #dej;b771
 or a facility ( ! ,native ,hawaiian    
heal? c>e sy/ems au?oriz$ "u ! ,native  
,hawaiian ,heal? ,c>e ,improvem5t ,act  
7#db ,u4,s4,c4 #aagja et seq474  4  7b7 
,no orig9at+ site facility fee = new    
sites ,section #ahcd7m77#b77;,b7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7m77#b77;,b77 is am5d$1 9 ! matt] 
prec$+ clause 7i71 by ins]t+ 7o!r ?an an
 orig9at+ site t is only describ$ 9     
clause 7iv7 ( p>agraph 7#d77;,c71 & does
 n meet ! requirem5t = an orig9at+ site 
"u clause 7i7 ( su* p>agraph7 aft] !    

orig9at+ site4  7c7 ,effective date ,!  
am5dm5ts made by ?is section %all apply 
to s]vices furni%$ on or aft] ,janu>y   
#a1 #bjah4  #i4 ,cl>ification reg>d+    
teleheal? & remote pati5t monitor+      
te*nologies provid$ to b5efici>ies      
,section #aabh;,a7i77#f7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acbj;a-#g;a7i77#f77 is am5d$--  7#a7 9 
subp>agraph 7,h71 by /rik+ 2 or & ins]t+
 a semicolon2  7#b7 9 subp>agraph 7,i71 
by /rik+ ! p]iod at ! end & ins]t+ 2 or2
 &  7#c7 by add+ at ! end ! foll[+ new  
subp>agraph3  7,j7 ! provision (        
teleheal? or remote pati5t monitor+     
te*nologies to individuals "u title     
,,xviii by a heal? c>e provid] = !      
purpose ( furni%+ teleheal? or remote   
pati5t monitor+ s]vices4  4  #aj4 ,all[+
 teleheal? & remote pati5t monitor+     
s]vices to be includ$ 9 bundl$ or global
 paym5ts ,title ,,xviii ( ! ,social     
,security ,act 7#db ,u4,s4,c4 #acie et  
seq47 is am5d$ by add+ at ! end ! foll[+
 new section3  #ahii;,c4 ,all[+         

teleheal? & remote pati5t monitor+      
s]vices to be includ$ 9 bundl$ or global
 paym5ts ,not)/&+ any o!r provision (   
?is title1 ! ,secret>y may include "u   
any bundl$ or global paym5t "u ?is title
 ! foll[+3  7#a7 ,teleheal? s]vices     
,not)/&+ requirem5ts o!rwise applicable 
"u section #ahcd7m71 includ+ any        
requirem5ts relat+ to qualifications =  
an orig9at+ site "u p>agraph            
7#d77;,c77ii7 ( su* section1 any        
geographic limitations "u p>agraph      
7#d77;,c77i7 ( su* section 7o!r ?an     
applicable ,/ate law requirem5ts1       
includ+ ,/ate lic5sure requirem5ts71 any
 limitation on ! use ( /ore-&-=w>d      
te*nologies describ$ 9 p>agraph 7#a7 (  
su* section1 any limitation on ! type ( 
heal? c>e provid] :o may furni% su*     
s]vices 7o!r ?an ! requirem5t t !       
provid] is a ,m$ic>e-enroll$ provid]71  
any items & s]vices = :i* paym5t w\ld   
o!rwise be made "u ?is title t are      
furni%$ us+ teleheal?1 or any limitation
 on specific codes designat$ z teleheal?

 s]vices t are cov]$ "u ?is title       
pursuant to section #ahcd7m7 7provid$   
su* codes are cl9ically appropriate to  
furni% remotely74  7#b7 ,remote pati5t  
monitor+ s]vices ,not)/&+ section       
#ahdh7;b77#ab71 remote pati5t monitor+  
s]vices 7z def9$ 9 su* section7 furni%$ 
to any individual "u ?is title4  4  #aa4
 ,exp&+ ! use ( teleheal? ?r\gh ! waiv] 
( c]ta9 requirem5ts ,section #ahcd7m7 ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#aciem7m771 z am5d$ by sections #c7;b7 &
 #d1 is am5d$ by add+ at ! end ! foll[+ 
new p>agraph3  7#g7 ,au?ority to waive  
requirem5ts & limitations if c]ta9      
conditions met  7,a7 ,9 g5]al ,9 ! case 
( teleheal? s]vices furni%$ on or aft]  
,janu>y #a1 #bjah1 ! ,secret>y may waive
 any re/riction applicable to ! cov]age 
( teleheal? s]vices "u ?is subsection   
describ$ 9 subp>agraph 7,b7 ) respect to
 c]ta9 provid]s ( s]vices1 suppli]s1    
provid] gr\ps1 sites ( c>e1 s]vices1    
conditions1 individuals receiv+ !       
s]vices1 or ,/ates1 z det]m9$ by !      

,secret>y1 if ea* ( ! requirem5ts       
describ$ 9 subp>agraph 7,c7 is met )    
respect to ! waiv]4  7,b7 ,re/rictions  
describ$ ,= purposes ( ?is p>agraph1    
re/rictions applicable to ! cov]age (   
teleheal? s]vices "u ?is subsection %all
 include requirem5ts relat+ to          
qualifications = an orig9at+ site "u    
p>agraph 7#d77;,c77ii71 any geographic  
limitations "u p>agraph 7#d77;,c77i7    
7o!r ?an applicable ,/ate law           
requirem5ts1 includ+ ,/ate lic5sure     
requirem5ts71 any limitation on ! use ( 
/ore-&-=w>d te*nologies describ$ 9      
p>agraph 7#a71 any limitation on ! type 
( heal? c>e provid] :o may furni% su*   
s]vices 7o!r ?an ! requirem5t t !       
provid] is a ,m$ic>e-enroll$ provid]71  
or any limitation on specific codes     
designat$ z teleheal? s]vices t are     
cov]$ "u ?is title pursuant to ?is      
subsection 7provid$ su* codes are       
cl9ically appropriate to furni%         
remotely74  7,c7 ,requirem5ts = waiv] ,!
 requirem5ts describ$ 9 ?is subp>agraph 

are1 ) respect to ! waiv] ( a re/riction
 describ$ 9 subp>agraph 7,b71 ! foll[+3 
7i7 ,! ,secret>y det]m9es t ! waiv] is  
expect$ to-- 7,i7 r$uce sp5d+ "u ?is    
title )\t r$uc+ ! quality ( c>e2 or     
7,,ii7 improve ! quality ( pati5t c>e   
)\t increas+ sp5d+4  7ii7 ,! ,*ief      
,actu>y ( ! ,c5t]s = ,m$ic>e  ,m$icaid  
,s]vices c]tifies t su* waiv] w\ld r$uce
 7or w\ld n result 9 any increase 97 net
 program sp5d+ "u ?is title4  7iii7 ,!  
,secret>y det]m9es t su* waiv] w\ld n   
d5y or limit ! cov]age or provision (   
b5efits "u ?is title = individuals4     
7,d7 ,public comm5t ,! ,secret>y %all   
e/abli% a process by :i* /akehold]s may 
7on at lea/ an annual basis7 submit     
reque/s = a waiv] "u ?is p>agraph4  4   
#ab4 ,exp&+ ! use ( teleheal? = m5tal   
heal? s]vices ,section #ahcd7m7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7m771 z am5d$ by sections #c7;b71 
#d1 & #aa1 is am5d$ by add+ at ! end !  
foll[+ new p>agraph3  7#h7 ,treatm5t (  
m5tal heal? s]vices deliv]$ via         

teleheal?  7,a7 ,9 g5]al  ,re/rictions  
applicable to ! cov]age ( teleheal?     
s]vices "u ?is subsection describ$ 9    
subp>agraph 7,b7 %all n apply ) respect 
to teleheal? s]vices t are m5tal heal?  
s]vices 7z det]m9$ by ! ,secret>y7 & are
 furni%$ on or aft] ,janu>y #a1 #bjah4  
7,b7 ,re/rictions describ$ ,= purposes (
 ?is p>agraph1 re/rictions applicable to
 ! cov]age ( teleheal? s]vices "u ?is   
subsection %all include requirem5ts     
relat+ to qualifications = an orig9at+  
site "u p>agraph 7#d77;,c77ii71 any     
geographic limitations "u p>agraph      
7#d77;,c77i7 7o!r ?an applicable ,/ate  
law requirem5ts1 includ+ ,/ate lic5sure 
requirem5ts71 any limitation on ! use ( 
/ore-&-=w>d te*nologies describ$ 9      
p>agraph 7#a71 any limitation on ! type 
( heal? c>e provid] :o may furni% su*   
s]vices 7o!r ?an ! requirem5t t !       
provid] is a ,m$ic>e-enroll$ provid]71  
or any limitation on specific codes     
designat$ z teleheal? s]vices t are     
cov]$ "u ?is title pursuant to ?is      

subsection 7provid$ su* codes are       
cl9ically appropriate to furni%         
remotely74  4  #ac4 ,,hhs evaluation &  
report on ! use ( teleheal? & remote    
pati5t monitor+ "u all demon/ration     
programs & pilots ) a teleheal? waiv]   
7a7 ,/udy  ,! ,secret>y ( ,heal? &      
,human ,s]vices 79 ?is subsection ref]r$
 to z ! ,secret>y7 %all conduct an      
evaluation on ! use ( teleheal? & remote
 pati5t monitor+ "u all programs &      
pilots "u ! ,m$ic>e program "u title    
,,xviii ( ! ,social ,security ,act & !  
,m$icaid program "u title ,,xix ( su*   
,act ) a waiv] ( teleheal? re/rictions  
o!rwise applicable "u su* titles ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7m774 ,su* evaluation %all include
 an analysis ( ! foll[+3  7#a7 ,! numb] 
( provid]s & pay]s us+ teleheal? &      
remote pati5t monitor+ "u su* programs &
 pilots4  7#b7 ,! co/ impact among !    
b5efici>ies receiv+ teleheal? & remote  
pati5t monitor+ "u su* programs &       
pilots1 includ+ ) respect to prev5table 

hospitalizations1 hospital readmissions1
 & em]g5cy room visits1 & ! total co/ ( 
items & s]vices "u ! ,m$ic>e & ,m$icaid 
programs4  7#c7 ,b5efici>y & family     
c>egiv] satisfaction ) ! use ( teleheal?
 & remote pati5t monitor+ "u su*        
programs & pilots4  7#d7 ,a comp>ison ( 
! utilization (1 & exp5ditures =1 ! same
 s]vices furni%$ "u ! ,m$ic>e & ,m$icaid
 programs 9 ! (fice sett+4  7b7 ,report 
,n lat] ?an #b ye>s aft] ! date ( !     
enactm5t ( ?is ,act1 ! ,secret>y %all   
submit to ,congress a report conta9+ !  
results ( ! evaluation conduct$ "u      
subsection 7a71 toge!r ) recomm5dations 
= su* legislation & adm9i/rative action 
z ! ,secret>y det]m9es appropriate4     
#ad4 ,te/+ ( models to exam9e ! use (   
teleheal? & remote pati5t monitor+ "u ! 
,m$ic>e program ,section #aaae;,a7b77#b7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acae;a7b77#b77 is am5d$ by   
add+ at ! end ! foll[+ new subp>agraph3 
7,d7 ,te/+ models to exam9e use (       
teleheal? & remote pati5t monitor+ "u   

,m$ic>e ,! ,secret>y %all consid] te/+  
"u ?is subsection models to exam9e ! use
 ( teleheal? & remote pati5t monitor+ "u
 title ,,xviii4  4  #ae4 ,s5se (        
,congress reg>d+ ! remote practice (    
m$ic9e  7a7 ,f9d+s ,congress f9ds t !   
laws ( all #ej ,/ates & ! ,di/rict (    
,columbia-- 7#a7 consid] ! practice (   
m$ic9e to include remote visits2 &  7#b7
 recognize t any remote practice (      
m$ic9e is gov]n$ by ! same m$ical       
practice /atutes z 9-p]son c>e4  7b7    
,s5se ( ,congress ,x is ! s5se (        
,congress t-- 7#a7 telem$ic9e is !      
deliv]y ( safe1 effective1 quality heal?
 c>e s]vices1 by a heal? c>e provid]1   
us+ te*nology-bas$ modalities to deliv] 
m$ical c>e2  7#b7 ,/ates h recogniz$ ?is
 by treat+ telem$ic9e z ! practice (    
m$ic9e2 &  7#c7 ! ,m$ic>e program "u    
title ,,xviii ( ! ,social ,security ,act
 %\ld cov] ! deliv]y ( remote pati5t    
s]vices4