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.