,i  #aaith ,,congress  #ast ,session    
,h4 ,r4 #cjcb  ,,in ,,the ,,house ,,of  
,,representatives  ,april #bh1 #bjbe,mr4
 ,balderson 7for himself1 ,mr4 ,dunn of 
,florida1 and ,mr4 ,murphy7 introduced  
the following bill2 which was referred  
to the ,committee on ,energy and        
,commerce1 and in addition to the       
,committee on ,ways and ,means1 for a   
period to be subsequently determined by 
the ,speaker1 in each case for          
consideration of such provisions as fall
 within the jurisdiction of the         
committee concerned  ,a ,,bill  ,to     
ensure appropriate access to remote     
monitoring services furnished under the 
,medicare program4  #a4 ,short title    
,this ,act may be cited as the          
,expanding ,remote ,monitoring ,access  
,act4  #b4 ,findings ,the ,congress     
finds the following3 7#a7 ,remote       
monitoring is an option that can help   
patients manage their health conditions 
from their homes with oversight from    
their health care providers1 which can  

improve patient health outcomes1 reduce 
long-term health costs1 and increase    
care options for patients4  7#b7 ,the   
,department of ,veterans ,affairs 7,,va7
 saw such results in a #bjai report4    
,veterans enrolled in remote patient    
monitoring had a #ec percent decrease in
 ,,va bed days of care and a #cc percent
 decrease in ,,va hospital admissions4  
7#c7 ,providers are currently required  
by ,medicare to collect #af days of     
patient data over a #cj-;day period in  
order to bill ,medicare for remote      
monitoring services1 even in cases where
 this full duration is not medically    
necessary to ensure the health and      
safety of the patient4 ,this can limit  
the use of remote monitoring in         
instances where it can promote patient  
health and safety and where it can      
reduce the overall cost on the health   
system4  7#d7 ,in the #bjba ,physician  
,fee ,schedule1 the ,centers for        
,medicare and ,medicaid ,services       
7,,cms7 issued an interim policy to     

lower the duration required by ,medicare
 to bill for remote monitoring services 
from #af days to #b days within a       
#cj-;day period1 but only for           
individuals who had been diagnosed with1
 or were suspected of having1           
,,covid-#ai4 ,this short-term           
flexibility called attention to the     
long-term need to reassess the minimum  
duration required for providers to bill 
for remote monitoring4  7#e7 ,as part of
 issuing the #bjba ,physician ,fee      
,schedule1 ,,cms studied comments in    
support of permanently lowering the     
minimum required duration of remote     
monitoring for all patients1 not just   
those with ,,covid-#ai4  7#f7 ,,cms     
concluded that we agree that a full #af 
days of monitoring may not always be    
reasonable and necessary but did not    
revise the #af day per #cj-;day period  
minimum duration for all patients       
because ,,cms did not believe they had  
received specific clinical examples to  
allow for understanding under what      

clinical circumstances fewer days of    
monitoring would be medically reasonable
 and necessary and allow a practitioner 
to establish clinically meaningful care4
  7#g7 ,clinical evidence shows numerous
 instances in which fewer than sixteen  
days of monitoring within a #cj-;day    
period establishes clinically meaningful
 care4 ,these include3 7,a7 ,sixteen    
days of monitoring per #cj-;day period  
may not be required to establish that a 
patient has sleep apnea4  7,b7 ,a       
patient prescribed a narcotic for pain  
may require their breathing to be       
monitored only while on the medication4 
7,c7 ,a patient with a chronic condition
 like diabetes1 congestive heart        
failure1 or obesity may have their      
weight monitored over a longer period of
 time1 but it is not clinically         
appropriate to have such patient step on
 a scale #af or more times in each      
#cj-;day period4  7,d7 ,a patient whose 
blood pressure or oxygen levels are     
monitored during physical therapy may   

not necessitate #af days of monitoring  
in each #cj-;day period given physical  
therapy is often ordered twice weekly4  
7,e7 ,a patient who wears a heart       
monitor to measure palpitations may wear
 the monitor continuously1 but the data 
only needs to be collected when the     
individual is experiencing symptoms4    
7,f7 ,a patient with hypertension is    
often monitored for long-term management
 of this condition on more of a weekly  
basis1 only needing more frequent data  
collection for active monitoring with   
changes in medication or dosages4  7,g7 
,a patient who suffers from ,muscular   
,sclerosis or ,muscular ,dystrophy may  
benefit from a provider tracking the    
patient's exercise between visits to    
monitor certain physiologic parameters  
such as muscle movement but may not     
produce #af days of data in a #cj-;day  
period4  7,h7 ,a patient who needs a    
total joint replacement may simply need 
pre-testing for surgery baselines1      
including to establish gait1 force1     

activity1 heart rate and other factors  
and then compare pre-surgery and        
post-surgery function4  7,i7 ,for a     
patient with urologic dysfunction1 male 
urine flow data obtained from the       
patient can be collected in two to four 
consecutive days4  7,j7 ,remote         
monitoring may allow a provider to      
assess a patient's adherence1 range of  
motion1 and response to physical therapy
 and occupational therapy regimens even 
though many such regimens are less than 
#af days per month4  7,k7 ,monitoring   
cognitive behavioral therapy for less   
than #af days in a #cj-;day period may  
provide clinically meaningful care while
 moderating a patient's anxiety and     
other symptoms4  7,l7 ,a patient with   
respiratory issues may not require a    
full #af days of monitoring of inhaler  
usage to get clinical benefits from     
remote monitoring4  7#h7 ,a two-day     
minimum duration would permit ,medicare 
coverage of the full range of remote    
monitoring services that can be         

beneficial to a patient without         
precluding the differential             
reimbursement of individual remote      
monitoring services based on patient    
acuity and cost4  #c4 ,ensuring         
appropriate access to remote monitoring 
services furnished under the medicare   
program  7a7 ,in general                
,notwithstanding any other provision of 
law1 the ,secretary of ,health and      
,human ,services 7in this section       
referred to as the ,secretary7 shall    
ensure that remote monitoring services  
furnished under title ,,xviii of the    
,social ,security ,act 7#db ,u4,s4,c4   
#acie et seq47 during the period        
beginning on the date of the enactment  
of this ,act and ending on the date that
 is #b years after such date of         
enactment are payable for a minimum of  
#b days of data collection over a       
#cj-;day period1 regardless of whether  
the individual receiving such services  
has been diagnosed with1 or is suspected
 of having1 ,,covid-#ai4  7b7 ,report   

7#a7 ,in general ,not later than #a year
 after the date of the enactment of this
 ,act1 the ,secretary shall1 after      
consulting with entities specified in   
paragraph 7#b71 submit to ,congress a   
report that includes the following3 7,a7
 ,a summary and analysis of previous    
experience with such remote monitoring  
services being payable under such title 
for a minimum of #b days of data        
collection over a #cj-;day period4  7,b7
 ,recommendations for implementing a    
reimbursement model that takes into     
account patient acuity and cost of      
providing remote monitoring services1   
including potentially creating          
differential reimbursements for periods 
with different durations1 such as fewer 
than and more than #af days4  7,c7 ,an  
analysis and justification for the      
appropriate place of service and        
supervision requirements for            
non-clinical staff reviewing and        
escalating patient data and provide     
recommendations4  7,d7 ,an analysis of  

the estimated savings resulting from    
earlier interventions and fewer days of 
hospitalizations among patients         
furnished remote monitoring services4   
7#b7 ,specified entities ,for purposes  
of paragraph 7#a71 the entities         
specified in this paragraph are the     
following3 7,a7 ,relevant agencies      
within the ,department of ,health and   
,human ,services 7including1 with       
respect to issues relating to waste1    
fraud1 or abuse1 the ,inspector ,general
 of such ,department74  7,b7 ,the       
,department of ,veterans ,affairs       
7including the ,office of ,connected    
,care of such ,department74  7,c7       
,licensed and practicing osteopathic and
 allopathic physicians1                 
anesthesiologists1 physician assistants1
 and nurse practitioners4  7,d7         
,hospitals1 health systems1 academic    
medical centers1 and other medical      
facilities1 such as acute care          
hospitals1 cancer hospitals1 psychiatric
 hospitals1 hospital emergency          

departments1 facilities furnishing      
urgent care services1 ambulatory        
surgical centers1 ,federally qualified  
health centers1 rural health clinics1   
and post-acute care and long-term care  
facilities4  7,e7 ,medical professional 
organizations and medical specialty     
organizations4  7,f7 ,organizations with
 expertise in the development of or     
operation of innovative remote          
physiologic monitoring services         
technologies4  7,g7 ,beneficiary        
advocacy organizations4  7,h7 ,the      
,american ,medical ,association ,current
 ,procedural ,terminology ,editorial    
,panel4  7,i7 ,commercial payers4  7,j7 
,any other entity determined appropriate
 by the ,secretary4  7c7 ,definitions   
,in this section3 7#a7 ,remote          
monitoring ,the term remote monitoring  
means remote physiologic monitoring and 
remote therapeutic monitoring4  7#b7    
,remote physiologic monitoring ,the term
 remote physiologic monitoring means    
non-face-to-face monitoring and analysis

 of physiologic factors used to         
understand a patient's health status1   
including the collection and analysis of
 patient physiologic data that are used 
to develop and manage a treatment plan  
related to chronic or acute conditions4 
7#c7 ,remote therapeutic monitoring ,the
 term remote therapeutic monitoring     
means the use of medical devices to     
monitor a patient's health or response  
to treatment using non-physiological    
data4