,,ii #aafth ,,congress #ast ,session ,s4 #ggc ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #ac1 #bjai,mr4 ,gardner 7for himself and ,mr4 ,peters7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to require the ,center for ,medicare and ,medicaid ,innovation to test the effect of including telehealth services in ,medicare health care delivery reform models4 #a4 ,short title ,this ,act may be cited as the ,telehealth ,innovation and ,improvement ,act of #bjai4 #b4 ,,cmi testing of coverage of expanded telehealth services 7a7 ,in general ,section #aaae;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7 is amended-- 7#a7 in subsection 7b77#b7-- 7,a7 in subparagraph 7,a71 by adding at the end the following new sentence3 ,the models selected under this subparagraph shall include the model described in subparagraph 7,d71 which shall be implemented by not later than ,january #a1 #bjbj42 and 7,b7 by adding at the end the following new subparagraph3 7,d7 ,telehealth services in delivery reform models ,the model described in this subparagraph is a model that meets the requirements of subsection 7h7 with respect to coverage of1 and payment for1 expanded telehealth services1 which shall include remote monitoring services1 furnished in conjunction with models that test the use of accountable care organizations under title ,,xviii1 bundled payments under such title1 and such other coordinated care models under such title as the ,secretary determines to be appropriate4 2 7#b7 in subsection 7b77#d71 by striking ,evaluation4-- and inserting ,evaluation4--,subject to subsection 7h77#f732 and 7#c7 by adding at the end the following new subsection3 7h7 ,medicare coverage of expanded telehealth services under accountable care organization models1 bundled payment models1 and other appropriate models tested by the ,secretary 7#a7 ,establishment of telehealth service models 7,a7 ,in general ,subject to the succeeding provisions of this subsection1 for the #e-year period that begins on ,january #a1 #bjbj1 the ,secretary shall test coverage of1 and payment for1 expanded telehealth services 7as defined in paragraph 7#b77 furnished to applicable individuals who are ,medicare beneficiaries 7as defined in paragraph 7#c77;,b77 in conjunction with models tested under subsection 7b71 and expanded under subsection 7c7 7if applicable71 that test the use of accountable care organizations under title ,,xviii1 bundled payments under such title1 and such other coordinated care models under such title as the ,secretary determines to be appropriate4 7,b7 ,model design considerations ,in establishing models to be tested for enhanced telehealth services under subsection 7b77#b77;,d71 the ,secretary shall design such models in a manner to permit comparisons of ,medicare beneficiaries who are participating in models under subsection 7b7 that include access to expanded telehealth services with ,medicare beneficiaries in models under subsection 7b7 who do not have access to such services4 7#b7 ,expanded telehealth services defined 7,a7 ,in general ,subject to subparagraphs 7,b7 and 7,c71 in this subsection1 the term expanded telehealth services means services furnished by an eligible physician or practitioner to a ,medicare beneficiary as part of an episode of care for one or more of the conditions specified under paragraph 7#d7 through one or more of the following3 7i7 ,remote monitoring technologies1 including remote device management for purposes of remotely interrogating or programming a medical device 7such as a pacemaker or a cardiac resynchronization therapy device7 outside the office of the physician specialist involved4 7ii7 ,bi-directional audio_/video technologies4 7iii7 ,physiologic and behavioral monitoring technologies4 7iv7 ,engagement prompt technologies4 7v7 ,store and forward technologies4 7vi7 ,point-of-care testing technologies4 7vii7 ,such other technologies as the ,secretary may specify4 7,b7 ,inclusion of ,medicare telehealth services2 non-application of certain restrictions 7i7 ,inclusion of medicare telehealth services ,the term expanded telehealth services shall include a telehealth service1 as defined in section #ahcd7m77#d77;,f71 without regard to the limitations specified under section #ahcd7m77#d74 7ii7 ,rule of construction ,nothing in this section shall be construed as imposing a requirement on the furnishing of expanded telehealth services that such services be furnished in real time through interactive audio or video telecommunications systems between the eligible physician or practitioner and the ,medicare beneficiary4 7iii7 ,no limitations on geographic areas or location of patient ,the term expanded telehealth services shall include services furnished 7as described in subparagraph 7,a77 without regard to the location of the ,medicare beneficiary at the time the telehealth service is furnished and without regard to the area in which the ,medicare beneficiary resides4 7,c7 ,requirements ,the term expanded telehealth services shall not include a service furnished 7as described in subparagraph 7,a77 unless it can be demonstrated that the service1 when furnished as an expanded telehealth service1 is likely to do one or more of the following3 7i7 ,the service assists eligible physicians or practitioners to coordinate care for patients4 7ii7 ,the service enhances collaboration among providers of services and suppliers1 including eligible physicians and practitioners1 in the provision of care to patients4 7iii7 ,the service improves quality of care furnished to patients4 7iv7 ,the service results in reduced hospital admissions and readmissions4 7v7 ,the service reduces or substitutes for physician office visits4 7vi7 ,the service results in reduced utilization of skilled nursing facility services4 7vii7 ,the service facilitates the return of patients to the community more quickly than would otherwise occur in the absence of the service4 7#c7 ,additional definitions ,in this subsection3 7,a7 ,eligible physician or practitioner ,the term eligible physician or practitioner means-- 7i7 a physician 7as defined in section #ahfa7r772 and 7ii7 a practitioner 7as defined in section #ahdb7;b77#ah77;,c774 7,b7 ,medicare beneficiary ,the term ,medicare beneficiary means an individual who is entitled to benefits under part ,a or enrolled under part ,b of title ,,xviii who is not enrolled in a ,medicare ,advantage plan under part ,c of such title1 an eligible organization under section #ahgf1 or a ,,pace program under section #ahid4 7#d7 ,conditions ,for purposes of paragraph 7#b77;,a71 the conditions with respect to which a coverage of an expanded telehealth service is furnished under this subsection shall include the following conditions or diseases3 chronic hypertension1 ischemic heart diseases1 chronic obstructive pulmonary disease1 heart failure1 heart attack1 osteoarthritis1 diabetes1 chronic kidney disease1 depression1 atrial fibrillation1 cancer1 asthma1 stroke1 total hip replacement procedures1 total knee replacement procedures1 ,parkinson's disease1 and such other conditions or diseases with respect to which the ,secretary determines that expanded telehealth services would satisfy one or more of the requirements of clauses 7i7 through 7vii7 of paragraph 7#b77;,c74 7#e7 ,payment 7,a7 ,in general ,subject to subparagraph 7,b71 with respect to expanded telehealth services furnished under a model tested under subsection 7b7 and expanded under subsection 7c7 7if applicable71 the ,secretary shall establish payment amounts under this subsection for such services4 ,the ,secretary may use one or more of the following payment methodologies for expanded telehealth services3 7i7 ,medicare fee schedule ,fee schedules established under title ,,xviii for telehealth services and remote monitoring services4 7ii7 ,new fee schedule ,a new fee schedule that the ,secretary establishes for expanded telehealth services covered by reason of this subsection4 7iii7 ,payment amounts based on shared risk ,a payment methodology for shared savings and losses that is designed to ensure savings with respect to expanded telehealth services covered under the model4 7,b7 ,consideration of certain costs ,in determining the amount of payment for an expanded telehealth service under the payment methodologies referred to in subparagraph 7,a71 the ,secretary shall take into account costs incurred by eligible physicians and practitioners-- 7i7 for the acquisition and implementation of information systems necessary to furnish such services1 including costs of equipment and requisite software2 7ii7 for non-physician clinical personnel in conjunction with such service2 and 7iii7 for physician interpretation of clinical data through the expanded telehealth service as well as for the supervision or oversight of the system for such service4 7#f7 ,evaluation of models 7,a7 ,use of independent entity ,in lieu of the evaluations conducted by the ,secretary under subsection 7b77#d7 for models tested under subsection 7b71 the ,secretary shall provide for evaluations of enhanced telehealth service models under subsection 7b77#b77;,d7 by an independent entity4 ,such evaluation shall be conducted with respect to the specific enhanced telehealth service and condition or conditions involved that are tested under such models4 7,b7 ,timing of evaluation ,an evaluation of such enhanced telehealth service and condition or conditions involved conducted by the independent entity under this paragraph shall begin three years after the implementation of the model that provides for coverage of and payment for the expanded telehealth service with respect to such condition4 7,c7 ,criteria ,an evaluation of such enhanced telehealth service models conducted by the independent entity under this paragraph shall include an analysis of-- 7i7 the quality of care furnished under the model1 including the measurement of patient-level outcomes and patient-centeredness criteria determined appropriate by the ,secretary2 7ii7 the changes in spending under parts ,a and ,b of title ,,xviii by reason of the model1 taking into account costs and savings under such parts across the continuum of care for the episode of care and condition or conditions involved2 and 7iii7 any impediments that were encountered under the model1 such as-- 7,i7 explicit telehealth restrictions under ,federal or ,state laws that are not related to health care reimbursement1 such as scope of practice limitations2 7,,ii7 licensing or credentialing barriers2 and 7,,iii7 limited broadband access or limited health information technology capabilities4 7,d7 ,information ,the provisions of subsection 7b77#d77;,b7 shall apply to evaluations conducted under this paragraph in the same manner as such provisions apply to evaluations conducted under subsection 7b77#d74 7#g7 ,application of expanded telehealth services to all ,,cmi models ,the ,secretary shall expand the application of an enhanced telehealth service with respect to the condition or conditions involved to all models tested under subsection 7b71 and expanded under subsection 7c7 7if applicable71 that apply with respect to services furnished under title ,,xviii to provide for coverage of1 and payment for1 such enhanced telehealth service or services with respect to such condition or conditions under all such models for years beginning after the #e-year period described in paragraph 7#a77;,a7 if-- 7,a7 the independent evaluation conducted under paragraph 7#f7 with respect to such models demonstrates that such enhanced telehealth service or services with respect to the condition or conditions involved resulted in-- 7i7 reduced spending under parts ,a and ,b of title ,,xviii without reducing the quality of care2 or 7ii7 improved quality of patient care without increasing such spending2 and 7,b7 the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services certifies that such expansion would reduce net program spending under parts ,a and ,b of title ,,xviii4 4 7b7 ,coverage of and payment for certain enhanced telehealth services that are certified as providing savings under the medicare program 7#a7 ,coverage ,section #ahcd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7 is amended by adding at the end the following new subsection3 7x7 ,certified enhanced telehealth services 7#a7 ,in general ,the ,secretary shall pay for certified enhanced telehealth services 7as defined in paragraph 7#b77;,a77 furnished by a physician 7as defined in section #ahfa7r77 or a practitioner 7as defined in section #ahdb7;b77#ah77;,c77 to a ,medicare fee-for-service beneficiary 7as defined in paragraph 7#b77;,b77 for one or more of the conditions specified under section #aaae;,a7h77#d7 in an amount determined under paragraph 7#c7 without regard to-- 7,a7 the location of the ,medicare fee-for-service beneficiary at the time the certified enhanced telehealth service is furnished2 and 7,b7 the area in which the ,medicare fee-for-service beneficiary resides4 7#b7 ,definitions ,in this subsection3 7,a7 ,certified enhanced telehealth service ,the term certified enhanced telehealth service means1 with respect to a condition or conditions specified under section #aae;,a7h77#d71 an enhanced telehealth service 7as defined in section #aaae;,a7h77#b77 with respect to which-- 7i7 an independent evaluation conducted under section #aaae;,a7h77#f7 demonstrates that the service tested under a model under section #aaae;,a7b77#b77;,d7 with respect to the condition or conditions resulted in-- 7,i7 reduced spending under parts ,a and ,b without reducing the quality of care2 or 7,,ii7 improved quality of patient care without increasing such spending2 and 7ii7 the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services certifies that such expansion would reduce net program spending under such parts4 7,b7 ,medicare fee-for-service beneficiary ,the term ,medicare fee-for-service beneficiary has the meaning given such term in section #ahii7;h77#c74 7#c7 ,payment amount ,the amount of payment for certified enhanced telehealth services shall be determined in the same manner as payments for enhanced telehealth services are determined under section #aaae;,a7h77#e74 4 7#b7 ,payment ,section #ahcc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a77 is amended by striking and before 7,,cc7 and inserting before the semicolon at the end the following3 1 and 7,,cc7 with respect to certified enhanced telehealth services 7as defined in section #ahcd7x77#b77;,a771 the amount paid shall be an amount equal to #hj percent of the lesser of the actual charge for the services or the amount determined under section #ahcd7x77#c74