115 HR 3360 IH: Telehealth Enhancement Act of 2017
U.S. House of Representatives
2017-07-24
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of contents
(a)This Act may be cited as the Telehealth Enhancement Act of 2017
. (b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Title I—Strengthening Medicare through telehealth
Sec. 101. Positive incentive for Medicare’s hospital readmissions reduction program.
Sec. 102. Health homes and medical homes.
Sec. 103. Flexibility in accountable care organizations coverage of telehealth.
Sec. 104. Recognizing telehealth services and remote patient monitoring in national pilot program
on payment bundling.
Sec. 105. Additional sites to be considered originating sites for purposes of payments for
telehealth services under Medicare.
Title II—Enhancing Medicaid through telehealth
Sec. 201. Medicaid option for high-risk pregnancies and births.
Title III—Improving telecommunications for medical delivery
Sec. 301. Additional providers considered health care providers for purposes of universal service
support.
Sec. 302. No consideration of provider location in rules enhancing health care provider access to
advanced telecommunications and information services.
<enum>I</enum><header>Strengthening Medicare through telehealth</header>
<section id="HCC3B4D6B3A654CFCAE94A69890B55593"><enum>101.</enum><header>Positive incentive for Medicare’s hospital readmissions reduction program</header><text display-inline="no-display-inline">Section 1886(q) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(q)</external-xref>) is amended by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H85D6C3E284AD43F4A8458BBA89FD4022" style="OLC">
<paragraph id="HC4DF98360DD54683ABCB9E504349C48C"><enum>(9)</enum><header>Positive incentive for reduced readmissions</header>
<subparagraph id="H5010A8E128874CB5A587AEC19301A7F1"><enum>(A)</enum><header>In general</header><text>With respect to payment for discharges occurring during a fiscal year beginning on or after October 1, 2017, in order to provide a positive incentive for hospitals described in subparagraph (B) to lower their excess readmission ratios, the Secretary shall make an additional payment to a hospital in such proportion as provides for a sharing of the savings from such better-than-expected performance between the hospital and the program under this title.</text>
</subparagraph><subparagraph id="HB219A444894749E58F2F57445EA0285C"><enum>(B)</enum><header>Hospital described</header><text display-inline="yes-display-inline">A hospital described in this subparagraph is an applicable hospital (as defined in paragraph (5)(C)) not subject to a payment change under paragraph (1) and for which the positive readmission ratio (described in subparagraph (C)) is greater than 1.</text>
</subparagraph><subparagraph id="H689AE55A32734890941F1C58002A603F"><enum>(C)</enum><header>Positive readmission ratio</header><text>The positive readmission ratio described in this subparagraph for a hospital is the ratio of—</text> <clause id="H390893E243F74638AAE8F13722A55C34"><enum>(i)</enum><text>the risk adjusted expected readmissions (described in subclause (II) of paragraph (4)(C)(i)); to</text>
</clause><clause id="H6FE2D4140CA64D63BFB59495391720A5"><enum>(ii)</enum><text>the risk adjusted readmissions based on actual readmissions (described in subclause (I) of such paragraph).</text></clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="HDBC63AA5D3204570A25338F16D5A16D2"><enum>102.</enum><header>Health homes and medical homes</header>
<subsection id="H5451FF15C10748BC925ACDAA5D394EAA"><enum>(a)</enum><header>Medicare chronic care counterpart to Medicaid <quote>health home</quote></header>
<paragraph id="H1800C15C14724E16944F7FE6A45B1E3C"><enum>(1)</enum><header>In general</header><text>Title XVIII of the Social Security Act is amended by adding at the end the following new section:</text> <quoted-block id="H17D4E21557E14344953B962EBDE14D19" style="OLC"> <section id="H869BF06825904A06B37C592286B2CC91"><enum>1899C.</enum><header>Medicare health home for individuals with chronic conditions</header> <subsection id="H4A0C9C4C58674E9F925345CC3020C14F"><enum>(a)</enum><header>In general</header><text>In the case of a State that has amended its State plan under title XIX in accordance with the option described in section 1945, the Secretary may contract with the State medical assistance agency with a program under such section to serve eligible individuals with chronic conditions who select a designated provider, a team of health care professionals operating with such a provider, or a health team as the individual’s health home for purposes of providing the individual with health home services in the same manner as provided under its State plan amendment.</text>
</subsection><subsection id="H73B608D3B8714290B467F3CBB301583B"><enum>(b)</enum><header>Health home qualification standards</header><text>The standards established by the Secretary under section 1945(b) for qualification as a designated provider shall apply under this section for the purpose of being eligible to be a health home for purposes of section 1945.</text>
</subsection><subsection id="H354F76479A394AD3866F19DB33156F93"><enum>(c)</enum><header>Payments</header><text display-inline="yes-display-inline">Payments shall be made under this section in the same manner to a provider or team as payments are made under subsection (c) of section 1945, including the use of the payment methodology described in paragraph (2) of such subsection.</text>
</subsection><subsection id="HAE3AFDFB58C84DE2ADA82F92027C956A"><enum>(d)</enum><header>Hospital referrals</header><text>Hospitals that are participating providers under this section shall establish procedures for referring any eligible individuals with chronic conditions who seek or need treatment in a hospital emergency department to designated providers in the same manner as required under section 1945(d).</text>
</subsection><subsection id="HBB22458C3D8047AABEB9EEEDD79A0425"><enum>(e)</enum><header>Monitoring and report on quality</header><text>The methodology and proposal required under subsection (f) of section 1945 and the report on quality measures under subsection (f) of such section shall also apply under this section.</text>
</subsection><subsection id="H9978CF403853412F8FDCDEF28119557A"><enum>(f)</enum><header>Report on quality measures</header><text display-inline="yes-display-inline">As a condition for receiving payment for health home services provided to an eligible individual with chronic conditions, a designated provider shall report, in accordance with such requirements as the Secretary shall specify, including a plan for the use of remote patient monitoring, on all applicable measures for determining the quality of such services. When appropriate and feasible, a designated provider shall use health information technology in providing the Secretary with such information.</text>
</subsection><subsection id="H649E26BA837C4640A9F2E25D433D9DEE"><enum>(g)</enum><header>Definitions</header><text>In this section, the provisions and definitions contained in subsection (h) of section 1945 shall also apply for purposes of this section except that, instead of the requirement specified in clause (i) of subsection (h)(1)(A) of such section, an individual must be eligible for services under parts A and B and covered for medical assistance for health home services under section 1945 in order to be an eligible individual with chronic conditions.</text>
</subsection><subsection id="HB3DE2E83D588420AB25A1FC1A8A44808"><enum>(h)</enum><header>Evidence-Based and reporting</header><text>In contracting with a State under this section, the State—</text> <paragraph id="H596835FAA7FA4CE9A3C152CCEAA1742E"><enum>(1)</enum><text>shall follow evidence-based guidelines for chronic care; and</text>
</paragraph><paragraph id="HF242F14277B844B7B679E1A2FDFA338E"><enum>(2)</enum><text display-inline="yes-display-inline">shall report at least by the end of every month data specified by the Secretary, including an assessment of the use of remote patient monitoring and quality measures of process, outcome, and structure.</text>
</paragraph></subsection><subsection id="H44E5DD83A1C04079BECF4F6F44704236"><enum>(i)</enum><header>Waiver authority</header>
<paragraph id="H9444078E238C4903995CBB1D810A0356"><enum>(1)</enum><header>In general</header><text>The limitations on telehealth under section 1834(m) shall not apply for purposes of this section.</text> </paragraph><paragraph id="H6B5C2429F7D440F5936AFB0DE37AB590"><enum>(2)</enum><header>Secretary authority</header><text>The Secretary may waive such other requirements of this title and title XIX as may be necessary to carry out the provisions of this section.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H8D379B2D96C8498D97745B19F14BFA21"><enum>(2)</enum><header>Reporting</header>
<subparagraph id="H2A8D7DC6E3E843FFACF294B2F226F44D"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than 2 years after the date of the enactment of this Act, the Secretary of Health and Human Services shall survey States contracting under section 1899B of the Social Security Act, as added by paragraph (1), on the nature, extent, and use of the option under such section particularly as it pertains to—</text>
<clause id="H61E4471534294DE39F7A1464C3DE75E8"><enum>(i)</enum><text>hospital admission rates;</text> </clause><clause id="H08BA1323BCE345B6A2F4A5CC8C46FD4D"><enum>(ii)</enum><text>chronic disease management;</text>
</clause><clause id="H2757A87A9CEF4AECAB252224D9A454C6"><enum>(iii)</enum><text>coordination of care for individuals with chronic conditions;</text> </clause><clause id="HD9B1A89784DD46E2979D4F5C5E697BF7"><enum>(iv)</enum><text>assessment of program implementation;</text>
</clause><clause id="H3FF8CEC6112547B7AC161233190AB692"><enum>(v)</enum><text>processes and lessons learned (as described in subparagraph (B));</text> </clause><clause id="HC5668E98BBAD4A8A815454041A6D4D28"><enum>(vi)</enum><text>assessment of quality improvements and clinical outcomes under such option; and</text>
</clause><clause id="H409BCFA779A945A0BF0BEF1698BEAA76"><enum>(vii)</enum><text>estimates of cost savings.</text> </clause></subparagraph><subparagraph id="H0EA12BB211394DAFACDCBAC7F5D48B17"><enum>(B)</enum><header>Implementation reporting</header><text>Such a State shall report to the Secretary, as necessary, on processes that have been developed and lessons learned regarding provision of coordinated care through a health home for beneficiaries with chronic conditions under such option.</text>
</subparagraph></paragraph></subsection><subsection id="HB31A01C14F0C48678B57D87C89FE288D"><enum>(b)</enum><header>Specialty medical homes</header><text>Title XVIII of the Social Security Act, as amended by subsection (a), is further amended by adding at the end the following new section:</text>
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<section id="HE7937360F2164483BEF2B6267F613825"><enum>1899D.</enum><header>Specialty medical homes</header>
<subsection id="HECD6413C64D8470FB41ADBD47BD797C8"><enum>(a)</enum><header>In general</header><text>Beginning not later than 30 days after the date of the enactment of this section, the Secretary may contract with a national or multi-state regional center of excellence with a network of affiliated local providers to provide through one or more medical homes for targeted, accessible, continuous, and coordinated care to individuals under this title and title XIX with a long-term illness or medical condition that requires regular medical treatment, advising, and monitoring.</text>
</subsection><subsection id="H47F30A720A29441D82207102B8DA6087"><enum>(b)</enum><header>Medical home defined</header><text>In this section, the term <term>medical home</term> means a medical entity that—</text> <paragraph id="H418C76D60BC94D6DA7669798042B9945"><enum>(1)</enum><text>specializes in the care for a specific long-term illness or medical condition, including related comorbidities;</text>
</paragraph><paragraph id="H21D454F14EBD43AA98D6F393752D8037"><enum>(2)</enum><text>leads the development of related evidence-based clinical standards and research;</text> </paragraph><paragraph id="HB4D26383B89E478CBF714A8CB6C68BEB"><enum>(3)</enum><text>has a network of affiliated personal physicians and patient treatment facilities;</text>
</paragraph><paragraph id="HA159357031964D31AD78CFFC6EC37932"><enum>(4)</enum><text>maintains an online Web site for patient and provider communication and collaboration and patient access to the patient’s health information;</text>
</paragraph><paragraph id="H8376ABD23DE141F2A0B7C9C5DE147C74"><enum>(5)</enum><text display-inline="yes-display-inline">has a plan for use of health information technology in providing services under this section and improving service delivery and coordination across the care continuum (including the use of wireless patient technology to improve coordination and remote patient monitoring management of care and patient adherence to recommendations made by their provider);</text>
</paragraph><paragraph id="H3E5A707C659D402AABD48153D0B441E5"><enum>(6)</enum><text>provides deidentified demographic data sets for clinical, statistical, and social science research to develop culturally competent best practices and clinical decision support mechanisms for the long-term illness or medical condition;</text>
</paragraph><paragraph id="H08A3CEFB992B4249A12A07C61A2C2A20"><enum>(7)</enum><text display-inline="yes-display-inline">uses a health assessment tool for the individuals targeted, including a means for identifying those most likely to benefit from remote patient monitoring; and</text>
</paragraph><paragraph id="HEA652B896259478C813827CA2868F013"><enum>(8)</enum><text>provides training programs for personnel involved in the coordination of care.</text> </paragraph></subsection><subsection id="H6A01045FC1364A4AB670DB23F42A060F"><enum>(c)</enum><header>Personal physician defined</header> <paragraph id="H46E7DD2E0DB5486899ECAB2C71AD6225"><enum>(1)</enum><header>In general</header><text>In this section, the term <term>personal physician</term> means a physician (as defined in section 1861(r)(1)) who meets the requirements described in paragraphs (2) and (3). Nothing in this paragraph shall be construed as preventing a personal physician from being a specialist or subspecialist for an individual requiring ongoing care for a specific chronic condition or multiple chronic conditions or for an individual with a long-term illness or medical condition.</text>
</paragraph><paragraph id="H9B216DA5674F4F40A28D0900FA4B9F75"><enum>(2)</enum><header>General requirements</header><text>The requirements described in this paragraph for a personal physician for care of an individual are as follows:</text>
<subparagraph id="H877A436F29F7467083A7A6CB5B63135D"><enum>(A)</enum><text>The physician is board certified for care of the specific illness or condition of the individual and manages continuous care for the individual.</text>
</subparagraph><subparagraph id="H3833B865816C4C8097FFCCE522969FA2"><enum>(B)</enum><text>The physician has the staff and resources to manage the comprehensive and coordinated health care of such individual.</text>
</subparagraph></paragraph><paragraph id="HA413BB48D36E4C11A7C8ABA12A40DDB2"><enum>(3)</enum><header>Service-related requirements</header><text>The requirements described in this paragraph for a personal physician are as follows:</text> <subparagraph id="HB332CE844E1D477898170F01AD66A213"><enum>(A)</enum><text>The personal physician advocates for and provides ongoing support, oversight, and guidance to implement a plan of care that provides an integrated, coherent, cross-discipline plan for ongoing medical care developed in partnership with patients and including all other physicians furnishing care to the patient involved and other appropriate medical personnel or agencies (such as home health agencies).</text>
</subparagraph><subparagraph id="HF0246AB081AC486F839130FAA33E1B7A"><enum>(B)</enum><text>The personal physician uses evidence-based medicine and clinical decision support tools to guide decisionmaking at the point-of-care based on patient-specific factors.</text>
</subparagraph><subparagraph id="HF7C07BF5C17E4B36A98DE47C69FD72F3"><enum>(C)</enum><text display-inline="yes-display-inline">The personal physician is in compliance with the standards for meaningful use of electronic health records under this title.</text>
</subparagraph><subparagraph id="H52445AA732B04438BF5B8ACC12075F8D"><enum>(D)</enum><text display-inline="yes-display-inline">The personal physician participates with the State’s health information exchange, as available, or the federally sponsored Direct Project.</text>
</subparagraph><subparagraph id="H1A0BABFF1C2C4759A2291EDA16C15ABE"><enum>(E)</enum><text display-inline="yes-display-inline">The personal physician uses health information technology, including appropriate remote monitoring, to monitor and track the health status of patients and to provide patients with enhanced and convenient access to health care services.</text>
</subparagraph><subparagraph id="HE333F67FC2054D54AE90403FEEF1640F"><enum>(F)</enum><text display-inline="yes-display-inline">The personal physician uses electronic prescribing and provides medication management.</text> </subparagraph><subparagraph id="HF00E6060A9C540D6B71CA2212D210575"><enum>(G)</enum><text display-inline="yes-display-inline">The personal physician encourages patients to engage in the management of their own health through education and support systems.</text>
</subparagraph><subparagraph id="H4B5D13EA67564FBA87572770B1D43F18"><enum>(H)</enum><text display-inline="yes-display-inline">The personal physician utilizes the services of related health professionals, including nurse practitioners and physician assistants.</text>
</subparagraph></paragraph></subsection><subsection id="HEA7EEA456C6442469F70410B9D0D3A95"><enum>(d)</enum><header>Long-Term illness or medical condition defined</header><text display-inline="yes-display-inline">In this section, the term <term>long-term illness or medical condition</term>—</text> <paragraph id="HD722B31BA6F5494994778E2996B81455"><enum>(1)</enum><text>includes a chronic condition which meets criteria specified by the Secretary for a specialized MA plan for special needs individuals; and</text>
</paragraph><paragraph id="H924B6EB39AB84BDB912A38331DD428E3"><enum>(2)</enum><text>also includes another condition that the Secretary determines would provide a beneficial focus for an effective and efficient medical home.</text>
</paragraph></subsection><subsection id="H8002483A73094A57A5A1C5D93DBE49D3"><enum>(e)</enum><header>Payment mechanisms</header>
<paragraph id="H4C6C4EB50D1D40C194280CF51091A028"><enum>(1)</enum><header>Medical home care management fee and medical home sharing in savings</header><text display-inline="yes-display-inline">Except as provided in paragraph (2)—</text> <subparagraph id="H97DA85D889184B35ADC5E597EEDA939A"><enum>(A)</enum><header>Medical home care management fee</header><text>Under this section the Secretary shall provide for payment under section 1848 of a care management fee to the medical home and may include performance incentives. The medical home shall arrange for payment for the services of affiliated physicians and facilities.</text>
</subparagraph><subparagraph id="H9067EED81F7A4A63B58DB7C05D081D6C"><enum>(B)</enum><header>Medical home sharing in savings</header><text>The Secretary shall provide for payment under this section of a medical home based on the payment methodology applied to health group practices under section 1866A. Under such methodology, 80 percent of the reductions in expenditures under this title and title XIX resulting from participation of individuals that are attributable to the medical home (as reduced by the total care management fees paid to the medical home under this section) shall be paid to the medical home. The amount of such reductions in expenditures shall be determined by using assumptions with respect to reductions in the occurrence of health complications, hospitalization rates, medical errors, and adverse drug reactions.</text>
</subparagraph></paragraph><paragraph id="H2E0DF87D92CD4BB4BF1B8AE7DB9C7664"><enum>(2)</enum><header>Alternative payment model</header>
<subparagraph id="HCCBFEBD08FDE426DAE7D7CBCF22E24AF"><enum>(A)</enum><header>In general</header><text>The Secretary may provide for payment under this paragraph instead of the amounts otherwise payable under paragraph (1).</text>
</subparagraph><subparagraph commented="no" id="H582EE71A090D4D1C953C0F1B36478B43"><enum>(B)</enum><header>Establishment of target spending level</header><text>For purposes of this paragraph, the Secretary shall compute an estimated annual spending target based on the amount the Secretary estimates would have been spent in the absence of this section, for items and services covered under parts A and B furnished to applicable beneficiaries for each qualifying medical home under this section. Such spending targets shall be determined on a per capita basis. Such spending targets shall include a risk corridor that takes into account normal variation in expenditures for items and services covered under parts A and B furnished to such beneficiaries with the size of the corridor being related to the number of applicable beneficiaries furnished services by each medical home. The spending targets may also be adjusted for such other factors as the Secretary determines appropriate.</text>
</subparagraph><subparagraph commented="no" id="H938943ACE3BE4436BCEB0C22F3C22646"><enum>(C)</enum><header>Incentive payments</header><text>Subject to performance on quality measures, a qualifying medical home is eligible to receive an incentive payment under this section if actual expenditures for a year for the applicable beneficiaries it enrolls are less than the estimated spending target established under subparagraph (B) for such year. An incentive payment for such year shall be equal to a portion (as determined by the Secretary) of the amount by which actual expenditures (including incentive payments under this paragraph) for applicable beneficiaries under parts A and B for such year are estimated to be less than 95 percent of the estimated spending target for such year, as determined under subparagraph (B).</text>
</subparagraph></paragraph><paragraph id="HA9D4B2690C3C4B638B1DCCC28E247B07"><enum>(3)</enum><header>Source</header><text>Payments paid under this section shall be made in appropriate proportions (as specified by the Secretary) from the Hospital Insurance Trust Fund, the Federal Supplementary Medical Insurance Trust Fund, and funds appropriated to carry out title XIX.</text>
</paragraph></subsection><subsection id="H99EF4CF9EB03476EB15C1E86D5D0C2D7"><enum>(f)</enum><header>Evidence-Based</header><text>The contracting entity shall follow evidence-based guidelines for care of the long-term illness or medical condition under this section.</text>
</subsection><subsection id="H975C1CFC496F42D7811592DFF01F72F0"><enum>(g)</enum><header>Patient services quality and performance reporting</header><text>The contracting entity shall report at least by the end of every month data specified by the Secretary on the operation of this section, including quality measures of process, outcome, and structure.</text>
</subsection><subsection id="H159579D10B90452AB1A2C5EBEE402474"><enum>(h)</enum><header>Waiver authority</header>
<paragraph id="H0F4D3B028DB04465A477FD06E1CC2BC4"><enum>(1)</enum><header>In general</header><text>The limitations on telehealth under section 1834(m) shall not apply for purposes of this section.</text> </paragraph><paragraph id="H39A45DD476A8477BACAAF68F4848A1AD"><enum>(2)</enum><header>Secretary authority</header><text>The Secretary may waive such other requirements of this title and title XIX as may be necessary to carry out the provisions of this section.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="H01E83B1D798C4A258E9E4052FBB8E69A"><enum>103.</enum><header>Flexibility in accountable care organizations coverage of telehealth</header><text display-inline="no-display-inline">Section 1899 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395jjj">42 U.S.C. 1395jjj</external-xref>) is amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H212648BF1C4D4A6492A6DA16C66F4293" style="OLC">
<subsection id="H439DCFEC3D0A444EAB9A6BD23CD4A072"><enum>(l)</enum><header>Flexibility for telehealth</header>
<paragraph id="H26A86E22C9564967B0801D2EDCC7F54C"><enum>(1)</enum><header>Provision as supplemental benefits</header><text display-inline="yes-display-inline">Notwithstanding any other provision of this section, an ACO may include coverage of telehealth and remote patient monitoring services as supplemental health care benefits to the same extent as a Medicare Advantage plan is permitted to provide coverage of such services as supplemental health care benefits under section 1852(a)(3)(A).</text>
</paragraph><paragraph id="HE02FB34A398642818C8D9B7DF18B061D"><enum>(2)</enum><header>Provision in connection with home health services</header><text display-inline="yes-display-inline">Nothing in this section shall be construed as preventing an ACO from including payments for remote patient monitoring and home-based video conferencing services in connection with the provision of home health services (under conditions for which payment for such services would not be made under section 1895 for such services) in a manner that is financially equivalent to the furnishing of a home health visit.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section commented="no" id="HF0768D1A2ED841C3829E99B26EF01E2C"><enum>104.</enum><header>Recognizing telehealth services and remote patient monitoring in national pilot program on payment
bundling</header><text display-inline="no-display-inline">Section 1866D(a)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395cc-4">42 U.S.C. 1395cc–4(a)(2)</external-xref>) is amended—</text> <paragraph commented="no" id="H2626F05D02A846259700BFE62C4867A4"><enum>(1)</enum><text display-inline="yes-display-inline">in subparagraph (B), by striking <quote>10 conditions</quote> and inserting <quote>the conditions</quote>;</text>
</paragraph><paragraph commented="no" id="HDFA1576AAF6641AFAA5BA1143FA1A4B1"><enum>(2)</enum><text>in subparagraph (C)—</text> <subparagraph id="HC7A7FE17FD754A0F987B48EA029DB800"><enum>(A)</enum><text>by redesignating clause (v) as clause (vi); and</text>
</subparagraph><subparagraph id="H231CBD431BD6499BAE8E30BF2B797F39"><enum>(B)</enum><text>by inserting after clause (iv) the following new clause:</text> <quoted-block display-inline="no-display-inline" id="H5E6444F2E1D84CAF9BFED3A81377E2C0" style="OLC"> <clause commented="no" id="HAEEF86172787478AA47A938BD1A3A628"><enum>(v)</enum><text display-inline="yes-display-inline">Telehealth and remote patient monitoring services.</text></clause><after-quoted-block>; and</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph commented="no" id="HB2A619F0563B41E38B86EFAF1410BA40"><enum>(3)</enum><text>in subparagraph (D)(i)(III), by inserting before the period at the end the following: <quote>(and such longer period in the case of the use of telehealth and remote patient monitoring services as the Secretary may specify)</quote>.</text>
</paragraph></section><section id="HC245B73CF0194AE8AEDE716730AF4D5C"><enum>105.</enum><header>Additional sites to be considered originating sites for purposes of payments for telehealth
services under Medicare</header>
<subsection id="H2AF01A9646254FD5939E5E8584E44C64"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1834(m)(4) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(m)(4)</external-xref>) is amended—</text> <paragraph id="H55A7604D43234891BA5CF9B838EE241C"><enum>(1)</enum><text>in subparagraph (C)—</text>
<subparagraph id="H4D7502AB740E4A64B83AAAF937FADDF6"><enum>(A)</enum><text display-inline="yes-display-inline">in clause (i), by striking <quote>The term</quote> and inserting <quote>Subject to clause (iii), the term</quote>; and</text> </subparagraph><subparagraph id="H6419603322FA476AB25372C583F4E797"><enum>(B)</enum><text>by adding at the end the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="H8CCCDF509CC54555B0E324337E523C1E" style="OLC">
<clause id="HDE725B9A226D49B78E19F88109687E46"><enum>(iii)</enum><header>Additional originating sites</header><text display-inline="yes-display-inline">The term <term>originating site</term> also includes the following sites, whether or not they are located in an area described in clause (i), insofar as such sites are not otherwise included in the definition of originating site under such clause:</text>
<subclause id="H6970C75F8F09401193CAB6D1A26E1037"><enum>(I)</enum><text display-inline="yes-display-inline">A critical access hospital (as described in clause (ii)(II)).</text> </subclause><subclause id="HCCB3EAFA6E8D4C08AD091BE28A5654B9"><enum>(II)</enum><text>A sole community hospital (as defined in section 1886(d)(5)(D)(iii)).</text>
</subclause><subclause id="HCC20871C5E8D4857874085F8E12046A4"><enum>(III)</enum><text>A home telehealth site (as defined in subparagraph (G)(i)).</text> </subclause><subclause id="HFB8DE37F950F43469BEB915FF294E93B"><enum>(IV)</enum><text display-inline="yes-display-inline">A site described in clause (ii) that is located in a county with a population of less than 25,000, according to the most recent decennial census or in an area that was not included in a Metropolitan Statistical Area on any date in 2000.</text>
</subclause><subclause id="HAB82A2A71D904A888B6FA3AA25BC6638"><enum>(V)</enum><text>A site described in clause (ii) with respect to services related to the evaluation or treatment of an acute stroke.</text></subclause></clause><after-quoted-block>; and</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="H642C2A607C5C4D63911C3C3971C6E2EC"><enum>(2)</enum><text>by adding at the end the following new subparagraph:</text> <quoted-block display-inline="no-display-inline" id="H10A664467CA84BEF83B3CDA00C4D15B7" style="OLC"> <subparagraph id="HC46F82DE788842F69F59BDE9F0C93C75"><enum>(G)</enum><header>Home telehealth site</header> <clause id="H7840C846FC464428AC63DED08CD2040E"><enum>(i)</enum><header>Home telehealth site</header><text>The term <term>home telehealth site</term> means, with respect to a telehealth service described in clause (ii) furnished to an individual, the in a place of residence used as the home of such individual.</text>
</clause><clause id="H834E928078CF49F5BF22D7A2EAFF28AE"><enum>(ii)</enum><header>Telehealth services described</header><text display-inline="yes-display-inline">A telehealth service described in this clause is a telehealth service that is—</text> <subclause id="HBB99506B50A7469694D61EDF6D027B93"><enum>(I)</enum><text display-inline="yes-display-inline">related to the provision of hospice care or home dialysis; or</text>
</subclause><subclause id="HB60809F9EDB14302A4B238046B09E322"><enum>(II)</enum><text display-inline="yes-display-inline">furnished to an individual who is determined to be homebound (as defined for purposes of sections 1814(a)(2)(C) and 1835(a)(2)(A)(i)), including such an individual for whom a certification or recertification described in such section is in effect with respect to home health services.</text></subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H1E0F3C62E75443178F0BDA3AACE0DF6E"><enum>(b)</enum><header>No originating site facility fee for new sites</header><text display-inline="yes-display-inline">Section 1834(m)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(m)(2)(B)</external-xref>) is amended by inserting after <quote>the originating site</quote> the following: <quote>(other than an additional originating site described in paragraph (4)(C)(iii))</quote>.</text>
</subsection><subsection id="H7A74A2214C22467DB5F8660D495467E9"><enum>(c)</enum><header>Application of telecommunication systems definition to critical access hospitals and sole community
hospitals</header><text>The second sentence of section 1834(m)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(m)</external-xref>) is amended by inserting <quote>any telehealth services furnished or received at a critical access hospital (as described in paragraph (4)(C)(ii)(II)) or a sole community hospital (as defined in section 1886(d)(5)(D)(iii)) or of</quote> after <quote>in the case of</quote>.</text>
</subsection><subsection id="HD1197800E0A94A0CAFBE0E21986A9512"><enum>(d)</enum><header>Effective date</header><text display-inline="yes-display-inline">The amendments made by this section shall apply to services furnished on or after January 1, 2018.</text> </subsection></section><enum>II</enum><header>Enhancing Medicaid through telehealth</header> <section id="H294A697716AC4F04B0CFE23E235BD85F"><enum>201.</enum><header>Medicaid option for high-risk pregnancies and births</header> <subsection id="HDB5396EA356D4213B05E4E331875131A"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Title XIX of the Social Security Act is amended by adding at the end the following new section:</text>
<quoted-block id="H842448C094544AC599CD09AF2FA9DD57" style="OLC">
<section id="HD8C46F10FB6240DDA9302E60C1031FFA"><enum>1947.</enum><header>State option to provide coordinated care for enrollees with high-risk pregnancies and births</header>
<subsection id="H5C4873DBA5D74807AB5C9E0018874C99"><enum>(a)</enum><header>In general</header><text>Notwithstanding section 1902(a)(1) (relating to statewideness), section 1902(a)(10)(B) (relating to comparability), and any other provision of this title for which the Secretary determines it is necessary to waive in order to implement this section, beginning 6 months after the date of the enactment of this section, a State, at its option as a State plan amendment, may provide for medical assistance under this title to eligible individuals for maternal-fetal and neonatal care who select a designated provider (as described under subsection (h)(5)), a team of health care professionals (as described under subsection (h)(6)) operating with such a provider, or a health team (as described under subsection (h)(7)) as the individual’s birthing network for purposes of providing the individual with pregnancy-related services.</text>
</subsection><subsection id="H894FD51F84174BD1935C3ED15C6529BF"><enum>(b)</enum><header>Qualification standards</header><text>The Secretary shall establish standards for qualification as a designated provider for the purpose of being eligible to be a birthing network for purposes of this section.</text>
</subsection><subsection id="HB4ACC13296754664B8C8EDA5137ABDCC"><enum>(c)</enum><header>Payments</header>
<paragraph id="H0B8F08E6544D473D8458627EEDAEA017"><enum>(1)</enum><header>In general</header><text>A State shall provide a designated provider, a team of health care professionals operating with such a provider, or a health team with payments for the provision of birthing network services to each eligible individual for maternal-fetal and neonatal care that selects such provider, team of health care professionals, or health team as the individual’s birthing network. Payments made to a designated provider, a team of health care professionals operating with such a provider, or a health team for such services shall be treated as medical assistance for purposes of section 1903(a), except that, during the first 8 fiscal year quarters that the State plan amendment is in effect, the Federal medical assistance percentage applicable to such payments shall be equal to 90 percent.</text>
</paragraph><paragraph id="H86A0356896244DCFBD5EED732ED29CCD"><enum>(2)</enum><header>Savings target</header><text>As a condition for approval of a State plan amendment and payment methodology under this section, the State shall provide the Secretary with assurances that the amendment and methodology shall be projected to reduce the amount of expenditures for pregnancy-related services otherwise made under this title by one percent for each 4-calendar-quarter period during the first 40 calendar quarters in which the amendment is in effect.</text>
</paragraph><paragraph id="H39261FDC41674D9EBC7FBD916F988CA7"><enum>(3)</enum><header>Methodology</header>
<subparagraph id="HEBE8B984FB1F43EA8B2428D57003D73B"><enum>(A)</enum><header>In general</header><text>The State shall specify in the State plan amendment the methodology the State will use for determining payment for the provision of birthing network services. Such methodology for determining payment shall be established consistent with section 1902(a)(30)(A).</text>
</subparagraph><subparagraph id="HF87C44599E0C48D3A2A6F2DBB7741705"><enum>(B)</enum><header>Innovative models of payment</header><text>The methodology for determining payment for provision of birthing network services under this section shall not be limited to a per-member per-month basis and may provide (as proposed by the State and subject to approval by the Secretary) for alternate models of payment, including bundled per episode, performance incentives, and shared savings.</text>
</subparagraph></paragraph><paragraph id="H0945EB4E36E947B499BF037FB00685B5"><enum>(4)</enum><header>Planning grants</header>
<subparagraph id="HE27BA4314B494FE7B4225B6AF301A25D"><enum>(A)</enum><header>In general</header><text>Beginning 30 days after the date of the enactment of this section, the Secretary may award planning grants to States for purposes of developing a State plan amendment under this section. A planning grant awarded to a State or a multi-state collaborative under this paragraph shall remain available until expended.</text>
</subparagraph><subparagraph id="H1595B55D33DE4709BC96690BB8E7025F"><enum>(B)</enum><header>Limitation</header><text>The total amount of payments made to States under this paragraph shall not exceed $25,000,000.</text> </subparagraph></paragraph></subsection><subsection id="H67A0608F36654FB8A4800A1A00EBE28A"><enum>(d)</enum><header>Report on quality measures</header><text>As a condition for receiving payment for birthing network services provided to an eligible individual for maternal-fetal and neonatal care, a designated provider shall report monthly to the State, in accordance with such requirements as the Secretary shall specify, on all applicable measures for determining the quality of such services. When appropriate and feasible, a designated provider shall use health information technology in providing the State with such information.</text>
</subsection><subsection id="HBF0921B078EF436C9AF4448D3FABD964"><enum>(e)</enum><header>Evidence-Based</header><text>The birthing network shall adapt, update, and follow evidence-based guidelines for maternal-fetal and neonatal care.</text>
</subsection><subsection id="H81EC9E4B9D704725A2F91AC3C0B2799C"><enum>(f)</enum><header>Definitions</header><text>In this section:</text> <paragraph id="HA7006FDE58E344339D04159CC4FE90FB"><enum>(1)</enum><header>Eligible individual for maternal-fetal and neonatal care</header> <subparagraph id="H0D882AFA1CA54B4A88569CA049C4495E"><enum>(A)</enum><header>In general</header><text>Subject to subparagraph (B), the term <term>eligible individual</term> means an individual who—</text>
<clause id="H6137AC852AF446DE925ED889D5071178"><enum>(i)</enum><text>is eligible for medical assistance under the State plan or under a waiver of such plan; and</text> </clause><clause display-inline="no-display-inline" id="H399DE17A466440DFA069E578A8A79716"><enum>(ii)</enum> <subclause commented="no" display-inline="yes-display-inline" id="HA3EA33AF3E734B0F84B345DF2765FE5C"><enum>(I)</enum><text>is pregnant (or was pregnant during the immediately preceding 30-day period); or</text>
</subclause><subclause id="H158436BC5B914909B16B183873E3D202" indent="up1"><enum>(II)</enum><text>is the child of an individual described in clause (i) and under 30 days old.</text> </subclause></clause></subparagraph><subparagraph id="H0E00899413124189BD350EC9B5097449"><enum>(B)</enum><header>Rule of construction</header><text>Nothing in this paragraph shall prevent the Secretary from establishing other requirements for purposes of determining eligibility for receipt of birthing network services under this section.</text>
</subparagraph></paragraph><paragraph id="H6F093AB156494D3A89D14D6857BFE175"><enum>(2)</enum><header>Birthing network</header><text>The term <term>birthing network</term> means a designated provider (including a provider that operates in coordination with a team of health care professionals) or a health team selected by an eligible individual to provide birthing network services.</text>
</paragraph><paragraph id="H53083453A398473CAC164C21F96CAD94"><enum>(3)</enum><header>Birthing network services</header>
<subparagraph id="HB356436018FF4C8E9526CBED2527B16F"><enum>(A)</enum><header>In general</header><text>The term <term>birthing network services</term> means comprehensive and timely high-quality services described in subparagraph (B) that are provided by a designated provider, a team of health care professionals operating with such a provider, or a health team and are identified in a provider registry.</text>
</subparagraph><subparagraph id="HB38E9CC6B9494F4F9DA16A0A653C59ED"><enum>(B)</enum><header>Services described</header><text>The services described in this subparagraph are—</text> <clause id="H569C238A39A34410BF59F4E81A054501"><enum>(i)</enum><text>comprehensive care coordination;</text>
</clause><clause id="H79D0E5AAE38C4FB081CF54F941CBA223"><enum>(ii)</enum><text>health promotion;</text> </clause><clause id="HD6C80242F29F4390B78516F7C78DDC6E"><enum>(iii)</enum><text>a call center to offer 24-hour physician support for consultations with maternal-fetal medicine specialists, when requested, regarding patient management issues;</text>
</clause><clause id="H7C5E459D53704736AA79486F5C11CBAA"><enum>(iv)</enum><text>newborn screening, including for heart defects and to reduce newborn hospital readmissions;</text> </clause><clause id="H5C62EE80A7734E9C9021DFA40371C3FC"><enum>(v)</enum><text>patient and family support (including authorized representatives);</text>
</clause><clause id="H4411168846B14881A56A399C5D1ACEC8"><enum>(vi)</enum><text>referral to community and social support services, if relevant; and</text> </clause><clause id="H758305B5660D4F83AAE011DA57DBCA52"><enum>(vii)</enum><text>use of health information technology to link services and provide monitoring, as feasible and appropriate.</text>
</clause></subparagraph></paragraph><paragraph id="HC76498DA1B614E15A460485129719F0C"><enum>(4)</enum><header>Designated provider</header><text>The term <term>designated provider</term> means a physician, clinical practice or clinical group practice, rural clinic, community health center, public health agency, home health agency, or any other entity or provider (including pediatricians, gynecologists, and obstetricians) that is determined by the State and approved by the Secretary to be qualified to be a birthing network for eligible individuals on the basis of documentation evidencing that the physician, practice, or clinic—</text>
<subparagraph id="HD3384584EF9842AAA95D990ABF2B29C7"><enum>(A)</enum><text>has the systems and infrastructure in place to provide birthing network services; and</text> </subparagraph><subparagraph id="H59D4C2B17C6147639CFE4822F4C079C9"><enum>(B)</enum><text>satisfies the qualification standards established by the Secretary under subsection (b) and paragraph (7)(B).</text>
</subparagraph></paragraph><paragraph id="H5ED60AAD83B040EDAE0BB3FB304E3122"><enum>(5)</enum><header>Team of health care professionals</header><text>The term <term>team of health care professionals</term> means a team of health professionals (as described in the State plan amendment) that may—</text> <subparagraph id="H1917EF078B414C3AAE64C0871C97AB77"><enum>(A)</enum><text>include physicians and other professionals, such as a nurse care coordinator, midwife, nutritionist, social worker, behavioral health professional, or any professionals deemed appropriate by the State; and</text>
</subparagraph><subparagraph id="H21931CBA10324724B2F1BADC231C1182"><enum>(B)</enum><text>be free standing, virtual, or based at a hospital, community health center, rural clinic, clinical practice or clinical group practice, academic health center, or any entity deemed appropriate by the State and approved by the Secretary.</text>
</subparagraph></paragraph><paragraph id="HADDD87FC29534CB2A6E0B1276DF75049"><enum>(6)</enum><header>Health team</header><text>The term <term>health team</term> has the meaning given such term for purposes of section 3502 of the Patient Protection and Affordable Care Act.</text>
</paragraph><paragraph id="HC8DE3C0DDACE40F5BDD0463C92D2421F"><enum>(7)</enum><header>Birthing data and exchange</header>
<subparagraph id="H0EAA99C290A3434EA518718BA357DF8E"><enum>(A)</enum><header>Proposal for use of health information technology</header><text>A State shall include in the State plan amendment a proposal for use of health information technology in providing birthing network services under this section and improving service delivery and coordination across the care continuum (including the use of wireless patient technology to improve coordination and management of care and patient adherence to recommendations made by their provider).</text>
</subparagraph><subparagraph id="HCDF1EEDD543C4230BC4455453F55BC7B"><enum>(B)</enum><header>Information requirements for birthing networks</header><text>The birthing network shall—</text> <clause id="H3ABB1510F249478A9365BD207921AD08"><enum>(i)</enum><text>be in compliance with the Medicaid standards for meaningful use of electronic health records;</text>
</clause><clause id="H6293BCDCD0934AE8BA2E9281F52ECB29"><enum>(ii)</enum><text>participate with the State’s health information exchange, as available, or operate an exchange among the birthing network;</text>
</clause><clause id="H93CF7FFC0BD248179D399675CBA00A69"><enum>(iii)</enum><text>collect demographic information on participating newborns and mothers;</text> </clause><clause id="H46A4299709004B74B450A6D8505CEE2C"><enum>(iv)</enum><text>use demographic and event-based data to identify patients that are likely going to need short- or long-term follow-up; and</text>
</clause><clause id="HDDB049DAA77344ECA3E3DADA6D944A72"><enum>(v)</enum><text>providing de-identified demographic data sets for statistical and social science research to develop culturally competent best practices and clinical decision support mechanisms for maternal-fetal and neonatal care.</text></clause></subparagraph></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H0347EF925254494CBE8BE5F1C143F003"><enum>(b)</enum><header>Patient services quality and performance reporting</header>
<paragraph id="H32554AFEF6F947608688FBCB3C62F2B2"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than 3 years after the date of the enactment of this Act, the Secretary of Health and Human Services shall survey States that have elected the option under section 1947 of the Social Security Act, as added by section (a), on the nature, extent, and use of such option, particularly as it pertains to—</text>
<subparagraph id="HD6AF7F30EF9F45B7BCFA0B7CD1194F8D"><enum>(A)</enum><text>terms of pregnancies;</text> </subparagraph><subparagraph id="HB149CB00849E42AEBC298A32E11E6414"><enum>(B)</enum><text>use of prenatal fetal monitoring;</text>
</subparagraph><subparagraph id="H27042EE6EAC549DB80E597DFDBC61AE2"><enum>(C)</enum><text>use of Caesarean section procedures;</text> </subparagraph><subparagraph id="H865D65F03F984296A91ADA266377D329"><enum>(D)</enum><text>use of neonatal intensive care services;</text>
</subparagraph><subparagraph id="H983EC627B04748108778E5237123DAA1"><enum>(E)</enum><text>incidence of birthing complications;</text> </subparagraph><subparagraph id="H4DFB66793A6B48848A30C2BA3B9625C1"><enum>(F)</enum><text>incidence of infant and maternal mortality;</text>
</subparagraph><subparagraph id="HFE784F560D5043FD96F745C7CC945CD3"><enum>(G)</enum><text>coordination of maternal-fetal and neonatal care for individuals;</text> </subparagraph><subparagraph id="H9B38F05855E048798D397D32B015443C"><enum>(H)</enum><text>assessment of program implementation;</text>
</subparagraph><subparagraph id="H09F3888266D54718A98A050209C713E8"><enum>(I)</enum><text>processes and lessons learned (as described in subparagraph (B));</text> </subparagraph><subparagraph id="H1ACEA4C6C8EC4D9DAB47EC7A0B490070"><enum>(J)</enum><text>assessment of quality improvements and clinical outcomes under such option; and</text>
</subparagraph><subparagraph id="H6F26AFA3484240818A47BB9BB2E26758"><enum>(K)</enum><text>participating mothers’ assessment of performance, quality, convenience, and satisfaction.</text> </subparagraph></paragraph><paragraph id="H24974F1397F444248EE5568C5FC3394C"><enum>(2)</enum><header>Implementation reporting</header><text>A State that has elected the option under such section shall report to the Secretary, as necessary, on processes that have been developed and lessons learned regarding provision of coordinated care through a birthing network for Medicaid beneficiaries for maternal-fetal and neonatal care under such option.</text>
</paragraph></subsection></section><enum>III</enum><header>Improving telecommunications for medical delivery</header>
<section id="HB8EA10B501404C1CA01A450C9D8B9C15"><enum>301.</enum><header>Additional providers considered health care providers for purposes of universal service support</header><text display-inline="no-display-inline">Subparagraph (B) of section 254(h)(7) of the Communications Act of 1934 (<external-xref legal-doc="usc" parsable-cite="usc/47/254">47 U.S.C. 254(h)(7)</external-xref>) is amended—</text>
<paragraph id="HCCDB4C8D50DD49BB9899C1EAB61CDA9E"><enum>(1)</enum><text>in clause (vii), by striking <quote>and</quote>;</text> </paragraph><paragraph commented="no" id="HD2466F4B883D420D82AE55B5920EA947"><enum>(2)</enum><text>in clause (viii), by striking <quote>clauses (i) through (vii)</quote> and inserting <quote>clauses (i) through (x)</quote>;</text>
</paragraph><paragraph id="H0E86545C3D0A4EC0B8B04FFF470DF7F9"><enum>(3)</enum><text>by redesignating clause (viii) as clause (xi); and</text> </paragraph><paragraph id="HD02178618C5F40F09BBCE5BF2F2BBEFA"><enum>(4)</enum><text>by inserting after clause (vii) the following new clauses:</text>
<quoted-block display-inline="no-display-inline" id="HAEEC42915B0F4E389A9762E7800A066E" style="OLC">
<clause id="HDFD50FB13B8244699A70A205B421CAD2"><enum>(viii)</enum><text display-inline="yes-display-inline">ambulance providers and other emergency medical transport providers;</text> </clause><clause id="H279EECA56BB24CA4A8422C9AD226916E"><enum>(ix)</enum><text display-inline="yes-display-inline">health clinics of elementary and secondary schools and post-secondary educational institutions;</text>
</clause><clause id="HD6A6F623575241FDAEE9A95C2EC6F8C0"><enum>(x)</enum><text display-inline="yes-display-inline">sites where telehealth services are provided under section 1834(m) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(m)</external-xref>) or under a State plan under title XIX of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396</external-xref> et seq.); and</text></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section><section id="H93773F2FEEC149D9AE726320E595E7DF"><enum>302.</enum><header>No consideration of provider location in rules enhancing health care provider access to advanced
telecommunications and information services</header><text display-inline="no-display-inline">Section 254(h)(2)(A) of the Communications Act of 1934 (<external-xref legal-doc="usc" parsable-cite="usc/47/254">47 U.S.C. 254(h)(2)(A)</external-xref>) is amended by inserting <quote>(regardless of the location of such providers)</quote> after <quote>health care providers</quote>.</text>
</section>