[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5765 Introduced in House (IH)]







110th CONGRESS
  2d Session
                                H. R. 5765

To amend title XVIII of the Social Security Act to cover remote patient 
  management services for certain chronic health conditions under the 
                           Medicare Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 10, 2008

  Ms. Eshoo (for herself, Mr. Pickering, Mr. Tanner, Mr. Hulshof, Mr. 
 Stupak, Mr. Ramstad, Mr. Camp of Michigan, and Mr. Linder) introduced 
 the following bill; which was referred to the Committee on Energy and 
  Commerce, and in addition to the Committee on Ways and Means, for a 
 period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to cover remote patient 
  management services for certain chronic health conditions under the 
                           Medicare Program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Remote Monitoring Access 
Act of 2008''.

SEC. 2. REMOTE PATIENT MANAGEMENT SERVICES FOR CHRONIC HEALTH 
              CONDITIONS UNDER THE MEDICARE PROGRAM.

    (a) Coverage of Remote Patient Management Services for Certain 
Chronic Health Conditions.--
            (1) In general.--Section 1861(s)(2) of the Social Security 
        Act (42 U.S.C. 1395x(s)(2)) is amended--
                    (A) in subparagraph (Z), by striking ``and'' at the 
                end;
                    (B) in subparagraph (AA), by inserting ``and'' at 
                the end; and
                    (C) by inserting after subparagraph (AA) the 
                following new subparagraph:
            ``(BB) remote patient management services (as defined in 
        subsection (ccc));''.
            (2) Services described.--Section 1861 of the Social 
        Security Act (42 U.S.C. 1395x) is amended by adding at the end 
        the following new subsection:
    ``(ccc) Remote Patient Management Services for Chronic Health 
Conditions.--(1) The term `remote patient management services' means 
the remote monitoring, evaluation, and management of an individual with 
a covered chronic health condition (as defined in paragraph (2)), 
insofar as such monitoring, evaluation, and management is with respect 
to such condition, through the utilization of a system of technology 
that allows a remote interface to collect and transmit clinical data 
between the individual and the responsible physician (as defined in 
subsection (r)) or supplier (as defined in subsection (d)) for the 
purposes of clinical review or response by the physician or supplier.
    ``(2) For purposes of paragraph (1), the term `covered chronic 
health condition' means--
            ``(A) heart failure; and
            ``(B) cardiac arrhythmia.
    ``(3)(A) Not later than January 1, 2010, the Secretary, in 
consultation with appropriate physician and supplier groups, shall 
develop guidelines on the frequency of billing for remote patient 
management services. Such guidelines shall be determined based on 
medical necessity and shall be sufficient to ensure appropriate and 
timely monitoring of individuals being furnished such services.
    ``(B) The Secretary shall do the following:
            ``(i) Not later than 2 years after the date of the 
        enactment of this subsection, develop, in consultation with 
        appropriate physician and supplier groups, standards (governing 
        such matters as qualifications of personnel and the maintenance 
        of equipment) for remote patient management services for the 
        covered chronic health conditions specified in subparagraphs 
        (A) and (B) of paragraph (2).
            ``(ii) Periodically review and update such standards under 
        this subparagraph as necessary.''.
            (3) Payment under the physician fee schedule.--Section 1848 
        of the Social Security Act (42 U.S.C. 1395w-4) is amended--
                    (A) in subsection (c)--
                            (i) in paragraph (2)((B)--
                                    (I) in clause (ii)(II), by striking 
                                ``and (v)'' and inserting ``(v), (and 
                                (vi)''; and
                                    (II) by adding at the end the 
                                following new clause:
                            ``(vi) Budgetary treatment of certain 
                        services.--The additional expenditures 
                        attributable to services described in section 
                        1861(s)(2)(BB) shall not be taken into account 
                        in applying clause (ii)(II) for 2010.''; and
                            (ii) by adding at the end the following new 
                        paragraph:
            ``(7) Treatment of remote patient management services.--
                    ``(A) In determining relative value units for 
                remote patient management services (as defined in 
                section 1861(ccc)), the Secretary, in consultation with 
                appropriate physician groups, shall take into 
                consideration--
                            ``(i) physician resources, including 
                        physician time and the level of intensity of 
                        services provided, based on--
                                    ``(I) the frequency of evaluation 
                                necessary to manage the individual 
                                being furnished the services;
                                    ``(II) the complexity of the 
                                evaluation, including the information 
                                that must be obtained, reviewed, and 
                                analyzed; and
                                    ``(III) the number of possible 
                                diagnoses and the number of management 
                                options that must be considered; and
                            ``(ii) practice expense costs associated 
                        with such services, including installation and 
                        information transmittal costs, costs of remote 
                        patient management technology (including 
                        equipment and software), and resource costs 
                        necessary for patient monitoring and follow-up 
                        (but not including costs of any related item or 
                        non-physician service otherwise reimbursed 
                        under this title).
                            ``(iii) malpractice expense resources.
                    ``(B) Using the relative value units determined in 
                subparagraph (A), the Secretary shall provide for 
                separate payment for such services and shall not adjust 
                the relative value units assigned to other services 
                that might otherwise have been determined to include 
                such separately paid remote patient management 
                services.''; and
                    (B) in subsection (j)(3), by inserting ``(2)(BB)'' 
                after ``(2)(AA),''.
            (4) Effective date.--
                    (A) In general.--The amendments made by this 
                section shall apply to services furnished on or after 
                January 1, 2010 without regard to whether the 
                guidelines under paragraph (3)(A) or the standards 
                under paragraph (3)(B) of section 1861(ccc) of the 
                Social Security Act (as added by paragraph (2)) have 
                been developed.
                    (B) Availability of codes as of january 1, 2010.--
                The Secretary of Health and Human Services shall--
                            (i) promptly evaluate existing codes that 
                        would be used to bill for remote patient 
                        management services (as defined in paragraph 
                        (1) of such section 1861(ccc), as so added) 
                        under title XVIII of the Social Security Act; 
                        and
                            (ii) if the Secretary determines that new 
                        codes are necessary to ensure accurate 
                        reporting and billing of such services under 
                        such title, issue such codes so that they are 
                        available for use as of January 1, 2010.
    (b) Demonstration Project for the Coverage of Remote Patient 
Management Services for Additional Chronic Health Conditions Under the 
Medicare Program.--
            (1) Establishment.--
                    (A) In general.--The Secretary shall establish a 
                demonstration project for the purpose of evaluating the 
                impact and benefits of covering under the Medicare 
                program remote patient management services for certain 
                chronic health conditions.
                    (B) Consultation.--In establishing the 
                demonstration project, the Secretary shall consult with 
                appropriate physician and supplier groups, eligible 
                beneficiaries, and organizations representing eligible 
                beneficiaries.
                    (C) Participation.--Any eligible beneficiary may 
                participate in the demonstration project on a voluntary 
                basis.
            (2) Conduct of the demonstration project.--
                    (A) Sites.--
                            (i) Selection of demonstration sites.--The 
                        Secretary shall conduct the demonstration 
                        project at 3 sites.
                            (ii) Geographic diversity.--In selecting 
                        the sites under clause (i), the Secretary shall 
                        ensure that at least 1 of the sites is in a 
                        rural area.
                    (B) Implementation; duration.--
                            (i) Implementation.--The Secretary shall 
                        implement the demonstration project not later 
                        than January 1, 2010.
                            (ii) Duration.--The Secretary shall 
                        complete the demonstration project by the date 
                        that is 2 years after the date on which the 
                        demonstration project is implemented.
            (3) Evaluation and report.--
                    (A) Evaluation.--The Secretary shall conduct an 
                evaluation of the demonstration project--
                            (i) to determine improvements in the 
                        quality of care and utilization of services 
                        received by eligible beneficiaries 
                        participating in the demonstration project;
                            (ii) to determine the cost of providing 
                        payment for remote monitoring services under 
                        the Medicare program;
                            (iii) to determine the satisfaction of 
                        eligible beneficiaries participating in the 
                        demonstration projects; and
                            (iv) to evaluate such other matters as the 
                        Secretary determines is appropriate.
            (4) Waiver authority.--The Secretary may waive such 
        provisions of titles XI and XVIII of the Social Security Act as 
        the Secretary determines to be appropriate for the conduct of 
        the demonstration project.
            (5) Funding.--
                    (A) Demonstration.--
                            (i) In general.--Subject to clause (ii), 
                        the Secretary shall provide for the transfer 
                        from the Federal Supplementary Medical Trust 
                        Fund under section 1841 of the Social Security 
                        Act (42 U.S.C. 1395t) of such funds as are 
                        necessary for the costs of carrying out the 
                        demonstration project.
                            (ii) Cap on expenditures.--The amount 
                        transferred under clause (i) for the period 
                        during which the demonstration project is 
                        conducted may not exceed an amount equal to the 
                        lesser of--
                                    (I) $9,000,000; or
                                    (II) an amount equal to the costs 
                                of providing remote monitoring services 
                                to 7,500 individuals during such 
                                period.
                    (B) Evaluation and report.--There are authorized to 
                be appropriated such sums as are necessary for the 
                purpose of conducting the evaluation and developing and 
                submitting the report to Congress under paragraph (3).
            (6) Definitions.--In this section:
                    (A) Remote patient management services.--The term 
                ``remote patient management services'' means the remote 
                monitoring, evaluation, and management of an individual 
                with a covered chronic health condition (as defined in 
                paragraph (B)), insofar as such monitoring, evaluation, 
                and management is with respect to such condition, 
                through the utilization of a system of technology that 
                allows a remote interface to collect and transmit 
                clinical data between the individual and the 
                responsible physician (as defined in subsection (r) of 
                section 1861 of the Social Security Act (42 U.S.C. 
                1395X))) or supplier (as defined in subsection (d) of 
                such section) for the purposes of clinical review or 
                response by the physician or supplier.
                    (B) Covered chronic health condition.--The term 
                ``covered chronic health condition'' means diabetes, 
                sleep apnea, or epilepsy.
                    (C) Demonstration project.--The term 
                ``demonstration project'' means a demonstration project 
                conducted under this subsection.
                    (D) Eligible beneficiary.--The term ``eligible 
                beneficiary'' means an individual who is enrolled under 
                part B of the Medicare program and has a covered 
                chronic health condition.
                    (E) Medicare program.--The term ``Medicare 
                program'' means the health benefits program under title 
                XVIII of the Social Security Act (42 U.S.C. 1395 et 
                seq.).
                    (F) Secretary.--The term ``Secretary'' means the 
                Secretary of Health and Human Services.
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