,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #djac  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,july #be1 #bjai,mr4  
,curtis 7= himself & ,mr4 ,neguse7      
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce1 & 9 
addition to ! ,committee on ,ways &     
,means1 = a p]iod to be subsequ5tly     
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to require ! ,c5t] = ,m$ic>e &
 ,m$icaid ,innovation to te/ ! effect ( 
includ+ teleheal? s]vices 9 ,m$ic>e     
heal? c>e deliv]y re=m models4  #a4     
,%ort title ,?is ,act may be cit$ z !   
,teleheal? ,innovation & ,improvem5t    
,act ( #bjai4  #b4 ,,cmi te/+ ( cov]age 
( exp&$ teleheal? s]vices  7a7 ,9 g5]al 
,section #aaae;,a ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acae;a7 is am5d$-- 
7#a7 9 subsection 7b77#b7-- 7,a7 9      
subp>agraph 7,a71 by add+ at ! end !    
foll[+ new s5t5ce3 ,! models select$ "u 
?is subp>agraph %all include ! model    

describ$ 9 subp>agraph 7,d71 :i* %all be
 implem5t$ by n lat] ?an ,janu>y #a1    
#bjbj42 &  7,b7 by add+ at ! end !      
foll[+ new subp>agraph3  7,d7 ,teleheal?
 s]vices 9 deliv]y re=m models ,! model 
describ$ 9 ?is subp>agraph is a model t 
meets ! requirem5ts ( subsection 7h7 )  
respect to cov]age (1 & paym5t =1 exp&$ 
teleheal? s]vices1 :i* %all include     
remote monitor+ s]vices1 furni%$ 9      
conjunction ) models t te/ ! use (      
acc\ntable c>e organizations "u title   
,,xviii1 bundl$ paym5ts "u su* title1 & 
su* o!r coord9at$ c>e models "u su*     
title z ! ,secret>y det]m9es to be      
appropriate4  2  7#b7 9 subsection      
7b77#d71 by /rik+ ,evaluation4-- &      
ins]t+ ,evaluation4--,subject to        
subsection 7h77#f732 &  7#c7 by add+ at 
! end ! foll[+ new subsection3  7h7     
,m$ic>e cov]age ( exp&$ teleheal?       
s]vices "u acc\ntable c>e organization  
models1 bundl$ paym5t models1 & o!r     
appropriate models te/$ by ! ,secret>y  
7#a7 ,e/abli%m5t ( teleheal? s]vice     

models  7,a7 ,9 g5]al ,subject to !     
succe$+ provisions ( ?is subsection1 = !
 #e-ye> p]iod t beg9s on ,janu>y #a1    
#bjbj1 ! ,secret>y %all te/ cov]age (1 &
 paym5t =1 exp&$ teleheal? s]vices 7z   
def9$ 9 p>agraph 7#b77 furni%$ to       
applicable individuals :o are ,m$ic>e   
b5efici>ies 7z def9$ 9 p>agraph         
7#c77;,b77 9 conjunction ) models te/$  
"u subsection 7b71 & exp&$ "u subsection
 7c7 7if applicable71 t te/ ! use (     
acc\ntable c>e organizations "u title   
,,xviii1 bundl$ paym5ts "u su* title1 & 
su* o!r coord9at$ c>e models "u su*     
title z ! ,secret>y det]m9es to be      
appropriate4  7,b7 ,model design        
consid]ations ,9 e/abli%+ models to be  
te/$ = enhanc$ teleheal? s]vices "u     
subsection 7b77#b77;,d71 ! ,secret>y    
%all design su* models 9 a mann] to     
p]mit comp>isons ( ,m$ic>e b5efici>ies  
:o are p>ticipat+ 9 models "u subsection
 7b7 t include access to exp&$ teleheal?
 s]vices ) ,m$ic>e b5efici>ies 9 models 
"u subsection 7b7 :o d n h access to su*

 s]vices4  7#b7 ,exp&$ teleheal? s]vices
 def9$  7,a7 ,9 g5]al ,subject to       
subp>agraphs 7,b7 & 7,c71 9 ?is         
subsection1 ! t]m exp&$ teleheal?       
s]vices means s]vices furni%$ by an     
eligible physician or practition] to a  
,m$ic>e b5efici>y z "p ( an episode (   
c>e = "o or m ( ! conditions specifi$ "u
 p>agraph 7#d7 ?r\gh "o or m ( ! foll[+3
  7i7 ,remote monitor+ te*nologies1     
includ+ remote device managem5t =       
purposes ( remotely int]rogat+ or       
programm+ a m$ical device 7su* z a      
pacemak] or a c>diac resyn*ronization   
!rapy device7 outside ! (fice ( !       
physician speciali/ involv$4  7ii7      
,bi-directional audio_/video            
te*nologies4  7iii7 ,physiologic &      
behavioral monitor+ te*nologies4  7iv7  
,engagem5t prompt te*nologies4  7v7     
,/ore & =w>d te*nologies4  7vi7         
,po9t-(-c>e te/+ te*nologies4  7vii7    
,su* o!r te*nologies z ! ,secret>y may  
specify4  7,b7 ,inclusion ( ,m$ic>e     
teleheal? s]vices2 non-application (    

c]ta9 re/rictions  7i7 ,inclusion (     
m$ic>e teleheal? s]vices ,! t]m exp&$   
teleheal? s]vices %all include a        
teleheal? s]vice1 z def9$ 9 section     
#ahcd7m77#d77;,f71 )\t reg>d to !       
limitations specifi$ "u section         
#ahcd7m77#d74  7ii7 ,rule ( con/ruction 
,no?+ 9 ?is section %all be con/ru$ z   
impos+ a requirem5t on ! furni%+ ( exp&$
 teleheal? s]vices t su* s]vices be     
furni%$ 9 real "t ?r\gh int]active audio
 or video telecommunications sy/ems     
betwe5 ! eligible physician or          
practition] & ! ,m$ic>e b5efici>y4      
7iii7 ,no limitations on geographic     
areas or location ( pati5t ,! t]m exp&$ 
teleheal? s]vices %all include s]vices  
furni%$ 7z describ$ 9 subp>agraph 7,a77 
)\t reg>d to ! location ( ! ,m$ic>e     
b5efici>y at ! "t ! teleheal? s]vice is 
furni%$ & )\t reg>d to ! area 9 :i* !   
,m$ic>e b5efici>y resides4  7,c7        
,requirem5ts ,! t]m exp&$ teleheal?     
s]vices %all n include a s]vice furni%$ 
7z describ$ 9 subp>agraph 7,a77 unless x

 c be demon/rat$ t ! s]vice1 :5 furni%$ 
z an exp&$ teleheal? s]vice1 is likely  
to d "o or m ( ! foll[+3  7i7 ,! s]vice 
assi/s eligible physicians or           
practition]s to coord9ate c>e = pati5ts4
  7ii7 ,! s]vice enhances collaboration 
among provid]s ( s]vices & suppli]s1    
includ+ eligible physicians &           
practition]s1 9 ! provision ( c>e to    
pati5ts4  7iii7 ,! s]vice improves      
quality ( c>e furni%$ to pati5ts4  7iv7 
,! s]vice results 9 r$uc$ hospital      
admissions & readmissions4  7v7 ,!      
s]vice r$uces or sub/itutes = physician 
(fice visits4  7vi7 ,! s]vice results 9 
r$uc$ utilization ( skill$ nurs+        
facility s]vices4  7vii7 ,! s]vice      
facilitates ! return ( pati5ts to !     
community m quickly ?an w\ld o!rwise    
occur 9 ! abs5ce ( ! s]vice4  7#c7      
,additional def9itions ,9 ?is           
subsection3 7,a7 ,eligible physician or 
practition] ,! t]m eligible physician or
 practition] means--  7i7 a physician 7z
 def9$ 9 section #ahfa7r772 &  7ii7 a   

practition] 7z def9$ 9 section          
#ahdb7;b77#ah77;,c774  7,b7 ,m$ic>e     
b5efici>y ,! t]m ,m$ic>e b5efici>y means
 an individual :o is entitl$ to b5efits 
"u "p ,a or enroll$ "u "p ,b ( title    
,,xviii :o is n enroll$ 9 a ,m$ic>e     
,advantage plan "u "p ,c ( su* title1 an
 eligible organization "u section #ahgf1
 or a ,,pace program "u section #ahid4  
7#d7 ,conditions ,= purposes ( p>agraph 
7#b77;,a71 ! conditions ) respect to :i*
 a cov]age ( an exp&$ teleheal? s]vice  
is furni%$ "u ?is subsection %all       
include ! foll[+ conditions or diseases3
 *ronic hyp]t5sion1 is*emic he>t        
diseases1 *ronic ob/ructive pulmon>y    
disease1 he>t failure1 he>t attack1     
o/eo>?ritis1 diabetes1 *ronic kidney    
disease1 depression1 atrial             
fibrillation1 canc]1 a/hma1 /roke1 total
 hip replacem5t proc$ures1 total knee   
replacem5t proc$ures1 ,p>k9son's        
disease1 & su* o!r conditions or        
diseases ) respect to :i* ! ,secret>y   
det]m9es t exp&$ teleheal? s]vices w\ld 

satisfy "o or m ( ! requirem5ts (       
clauses 7i7 ?r\gh 7vii7 ( p>agraph      
7#b77;,c74  7#e7 ,paym5t  7,a7 ,9 g5]al 
,subject to subp>agraph 7,b71 ) respect 
to exp&$ teleheal? s]vices furni%$ "u a 
model te/$ "u subsection 7b7 & exp&$ "u 
subsection 7c7 7if applicable71 !       
,secret>y %all e/abli% paym5t am\nts "u 
?is subsection = su* s]vices4 ,!        
,secret>y may use "o or m ( ! foll[+    
paym5t me?odologies = exp&$ teleheal?   
s]vices3  7i7 ,m$ic>e fee s*$ule ,fee   
s*$ules e/abli%$ "u title ,,xviii =     
teleheal? s]vices & remote monitor+     
s]vices4  7ii7 ,new fee s*$ule ,a new   
fee s*$ule t ! ,secret>y e/abli%es =    
exp&$ teleheal? s]vices cov]$ by reason 
( ?is subsection4  7iii7 ,paym5t am\nts 
bas$ on %>$ risk ,a paym5t me?odology = 
%>$ sav+s & losses t is design$ to      
ensure sav+s ) respect to exp&$         
teleheal? s]vices cov]$ "u ! model4     
7,b7 ,consid]ation ( c]ta9 co/s ,9      
det]m9+ ! am\nt ( paym5t = an exp&$     
teleheal? s]vice "u ! paym5t            

me?odologies ref]r$ to 9 subp>agraph    
7,a71 ! ,secret>y %all take into acc\nt 
co/s incurr$ by eligible physicians &   
practition]s--  7i7 = ! acquisition &   
implem5tation ( in=mation sy/ems        
necess>y to furni% su* s]vices1 includ+ 
co/s ( equipm5t & requisite s(tw>e2     
7ii7 = non-physician cl9ical p]sonnel 9 
conjunction ) su* s]vice2 &  7iii7 =    
physician int]pretation ( cl9ical data  
?r\gh ! exp&$ teleheal? s]vice z well z 
= ! sup]vision or ov]sight ( ! sy/em =  
su* s]vice4  7#f7 ,evaluation ( models  
7,a7 ,use ( indep5d5t entity ,9 lieu ( !
 evaluations conduct$ by ! ,secret>y "u 
subsection 7b77#d7 = models te/$ "u     
subsection 7b71 ! ,secret>y %all provide
 = evaluations ( enhanc$ teleheal?      
s]vice models "u subsection 7b77#b77;,d7
 by an indep5d5t entity4 ,su* evaluation
 %all be conduct$ ) respect to !        
specific enhanc$ teleheal? s]vice &     
condition or conditions involv$ t are   
te/$ "u su* models4  7,b7 ,tim+ (       
evaluation ,an evaluation ( su* enhanc$ 

teleheal? s]vice & condition or         
conditions involv$ conduct$ by !        
indep5d5t entity "u ?is p>agraph %all   
beg9 ?ree ye>s aft] ! implem5tation ( ! 
model t provides = cov]age ( & paym5t = 
! exp&$ teleheal? s]vice ) respect to   
su* condition4  7,c7 ,crit]ia ,an       
evaluation ( su* enhanc$ teleheal?      
s]vice models conduct$ by ! indep5d5t   
entity "u ?is p>agraph %all include an  
analysis (--  7i7 ! quality ( c>e       
furni%$ "u ! model1 includ+ ! measurem5t
 ( pati5t-level outcomes &              
pati5t-c5t]$ness crit]ia det]m9$        
appropriate by ! ,secret>y2  7ii7 !     
*anges 9 sp5d+ "u p>ts ,a & ,b ( title  
,,xviii by reason ( ! model1 tak+ into  
acc\nt co/s & sav+s "u su* p>ts across !
 cont9uum ( c>e = ! episode ( c>e &     
condition or conditions involv$2 &      
7iii7 any imp$im5ts t 7 enc\nt]$ "u !   
model1 su* z-- 7,i7 explicit teleheal?  
re/rictions "u ,f$]al or ,/ate laws t   
are n relat$ to heal? c>e reimbursem5t1 
su* z scope ( practice limitations2     

7,,ii7 lic5s+ or cr$5tial+ b>ri]s2 &    
7,,iii7 limit$ broadb& access or limit$ 
heal? in=mation te*nology capabilities4 
7,d7 ,in=mation ,! provisions (         
subsection 7b77#d77;,b7 %all apply to   
evaluations conduct$ "u ?is p>agraph 9 !
 same mann] z su* provisions apply to   
evaluations conduct$ "u subsection      
7b77#d74  7#g7 ,application ( exp&$     
teleheal? s]vices to all ,,cmi models ,!
 ,secret>y %all exp& ! application ( an 
enhanc$ teleheal? s]vice ) respect to ! 
condition or conditions involv$ to all  
models te/$ "u subsection 7b71 & exp&$  
"u subsection 7c7 7if applicable71 t    
apply ) respect to s]vices furni%$ "u   
title ,,xviii to provide = cov]age (1 & 
paym5t =1 su* enhanc$ teleheal? s]vice  
or s]vices ) respect to su* condition or
 conditions "u all su* models = ye>s    
beg9n+ aft] ! #e-ye> p]iod describ$ 9   
p>agraph 7#a77;,a7 if--  7,a7 !         
indep5d5t evaluation conduct$ "u        
p>agraph 7#f7 ) respect to su* models   
demon/rates t su* enhanc$ teleheal?     

s]vice or s]vices ) respect to !        
condition or conditions involv$ result$ 
9--  7i7 r$uc$ sp5d+ "u p>ts ,a & ,b (  
title ,,xviii )\t r$uc+ ! quality ( c>e2
 or  7ii7 improv$ quality ( pati5t c>e  
)\t increas+ su* sp5d+2 &  7,b7 ! ,*ief 
,actu>y ( ! ,c5t]s = ,m$ic>e  ,m$icaid  
,s]vices c]tifies t su* expansion w\ld  
r$uce net program sp5d+ "u p>ts ,a & ,b 
( title ,,xviii4  4  7b7 ,cov]age ( &   
paym5t = c]ta9 enhanc$ teleheal? s]vices
 t are c]tifi$ z provid+ sav+s "u !     
m$ic>e program  7#a7 ,cov]age ,section  
#ahcd ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #aciem7 is am5d$ by add+ at ! 
end ! foll[+ new subsection3  7x7       
,c]tifi$ enhanc$ teleheal? s]vices  7#a7
 ,9 g5]al ,! ,secret>y %all pay =       
c]tifi$ enhanc$ teleheal? s]vices 7z    
def9$ 9 p>agraph 7#b77;,a77 furni%$ by a
 physician 7z def9$ 9 section #ahfa7r77 
or a practition] 7z def9$ 9 section     
#ahdb7;b77#ah77;,c77 to a ,m$ic>e       
fee-=-s]vice b5efici>y 7z def9$ 9       
p>agraph 7#b77;,b77 = "o or m ( !       

conditions specifi$ "u section          
#aaae;,a7h77#d7 9 an am\nt det]m9$ "u   
p>agraph 7#c7 )\t reg>d to--  7,a7 !    
location ( ! ,m$ic>e fee-=-s]vice       
b5efici>y at ! "t ! c]tifi$ enhanc$     
teleheal? s]vice is furni%$2 &  7,b7 !  
area 9 :i* ! ,m$ic>e fee-=-s]vice       
b5efici>y resides4  7#b7 ,def9itions ,9 
?is subsection3  7,a7 ,c]tifi$ enhanc$  
teleheal? s]vice ,! t]m c]tifi$ enhanc$ 
teleheal? s]vice means1 ) respect to a  
condition or conditions specifi$ "u     
section #aae;,a7h77#d71 an enhanc$      
teleheal? s]vice 7z def9$ 9 section     
#aaae;,a7h77#b77 ) respect to :i*--  7i7
 an indep5d5t evaluation conduct$ "u    
section #aaae;,a7h77#f7 demon/rates t ! 
s]vice te/$ "u a model "u section       
#aaae;,a7b77#b77;,d7 ) respect to !     
condition or conditions result$ 9--     
7,i7 r$uc$ sp5d+ "u p>ts ,a & ,b )\t    
r$uc+ ! quality ( c>e2 or  7,,ii7       
improv$ quality ( pati5t c>e )\t        
increas+ su* sp5d+2 &  7ii7 ! ,*ief     
,actu>y ( ! ,c5t]s = ,m$ic>e  ,m$icaid  

,s]vices c]tifies t su* expansion w\ld  
r$uce net program sp5d+ "u su* p>ts4    
7,b7 ,m$ic>e fee-=-s]vice b5efici>y ,!  
t]m ,m$ic>e fee-=-s]vice b5efici>y has !
 mean+ giv5 su* t]m 9 section           
#ahii7;h77#c74  7#c7 ,paym5t am\nt ,!   
am\nt ( paym5t = c]tifi$ enhanc$        
teleheal? s]vices %all be det]m9$ 9 !   
same mann] z paym5ts = enhanc$ teleheal?
 s]vices are det]m9$ "u section         
#aaae;,a7h77#e74  4  7#b7 ,paym5t       
,section #ahcc7;a77#a7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#aciel7a77#a77 is am5d$ by /rik+ & be=e 
7,,cc7 & ins]t+ be=e ! semicolon at !   
end ! foll[+3 1 & 7,,cc7 ) respect to   
c]tifi$ enhanc$ teleheal? s]vices 7z    
def9$ 9 section #ahcd7x77#b77;,a771 !   
am\nt paid %all be an am\nt equal to #hj
 p]c5t ( ! less] ( ! actual *>ge = !    
s]vices or ! am\nt det]m9$ "u section   
#ahcd7x77#c74