1.Short title; table of
contents
(a)This Act may be cited as the Craig Thomas Rural Hospital and Provider Equity Act of
2007
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Fairness in the Medicare disproportionate share
hospital (DSH) adjustment for rural hospitals.
Sec. 3. Revision of the Medicare hold harmless provision under
the prospective payment system for hospital outpatient department (HOPD)
services.
Sec. 4. Improvement of definition of low-volume hospital for
purposes of the Medicare inpatient hospital payment adjustment.
Sec. 5. Extension of Medicare wage index reclassifications for
certain hospitals.
Sec. 6. Extension of Medicare reasonable costs payments for
certain clinical diagnostic laboratory tests furnished to hospital patients in
certain rural areas.
Sec. 7. Critical access hospital improvements.
Sec. 8. Capital infrastructure revolving loan
program.
Sec. 9. Extension of Medicare incentive payment program for
physician scarcity areas.
Sec. 10. Extension of floor on Medicare work geographic
adjustment.
Sec. 11. Improving care planning for Medicare home health
services.
Sec. 12. Rural health clinic improvements.
Sec. 13. Community health center collaborative access
expansion.
Sec. 14. Application of the temporary Medicare payment increase
for home health services furnished in a rural area to 2008.
Sec. 15. Extension of increased Medicare payments for rural
ground ambulance services.
Sec. 16. Coverage of marriage and family therapist services and
mental health counselor services under part B
of the Medicare program.
Sec. 17. Extension of treatment of certain physician pathology
services under Medicare.
Sec. 18. Medicare remote monitoring pilot projects.
Sec. 19. Facilitating the provision of telehealth services
across State lines.
2.Fairness in the
Medicare disproportionate share hospital (DSH) adjustment for rural
hospitalsSection
1886(d)(5)(F)(xiv)(II) of the Social Security
Act (42 U.S.C. 1395ww(d)(5)(F)(xiv)(II)) is amended—
(1)by striking
or, in the case
and all that follows through subparagraph
(G)(iv)
; and
(2)by inserting at the end the following new
sentence: The preceding sentence shall not apply to any hospital with
respect to discharges occurring on or after October 1, 2008.
.
3.Revision of the
Medicare hold harmless provision under the prospective payment system for
hospital outpatient department (HOPD) servicesSection 1833(t)(7)(D)(i) of the Social
Security Act (42
U.S.C. 1395l(t)(7)(D)(i)) is amended—
(1)in subclause (II), by striking 85
percent
and inserting 100 percent
; and
(2)by adding at the
end the following new subclause:
(III)In the case of a sole community hospital
(as defined in section 1886(d)(5)(D)(iii)), for covered OPD services furnished
during 2008, for which the PPS amount is less than the pre-BBA amount, the
amount of payment under this subsection shall be increased by the amount of
such
difference.
.
4.Improvement of
definition of low-volume hospital for purposes of the Medicare inpatient
hospital payment adjustmentSection 1886(d)(12)(C)(i) of the
Social Security Act (42 U.S.C.
1395ww(d)(12)(C)(i)) is amended by inserting (or, beginning with fiscal
year 2008, 2,000 discharges)
after 800
discharges
.
5.Extension of
Medicare wage index reclassifications for certain hospitals
(a)Extension of
correction of mid-year reclassification expiration for certain
hospitals
(1)In the case of a hospital described in paragraph (2),
effective September 30, 2007, the Secretary of Health and Human Services shall
apply subsection (a) of section 106 of division B of the Tax Relief and Health
Care Act of 2006 (42 U.S.C. 1395ww note) by substituting September 30,
2008
for September 30, 2007
.
(2)A hospital described in this paragraph is a
hospital—
(A)that is described
in subsection (a) of such section 106; and
(B)(i)that is located in a
State with less than 10 people per square mile; or
(ii)(I)that is located in a
rural area; and
(II)for which the Secretary of Health
and Human Services has determined the extension under this subsection to be
appropriate.
(b)The Secretary of Health and Human Services shall extend
the special exception reclassification of a sole community hospital located in
a State with less than 10 people per square mile (made under the authority of
section 1886(d)(5)(I)(i) of the Social Security
Act (42 U.S.C. 1395ww(d)(5)(I)(i)) and contained in the final rule
promulgated by the Secretary in the Federal Register on August 11, 2004 (69
Fed. Reg. 49107)) for 1 year through September 30, 2008.
(c)The provisions of this section shall not be effected in a
budget-neutral manner.
6.Extension of
Medicare reasonable costs payments for certain clinical diagnostic laboratory
tests furnished to hospital patients in certain rural areasSection 416(b) of the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003 (42 U.S.C. 1395l–4(b)), as
amended by section 105 of division B of the Tax Relief and Health Care Act of
2006 (42 U.S.C. 1395l note), is amended by striking 3-year
and
inserting 5-year
.
7.Critical access
hospital improvements
(a)Clarification
of payment for clinical laboratory tests furnished by critical access
hospitals
(1)Section 1834(g)(4) of the
Social Security Act (42 U.S.C.
1395m(g)(4)) is amended—
(A)in the heading,
by striking no beneficiary
cost-sharing for
and inserting treatment of
; and
(B)by adding at the
end the following new sentence: “For purposes of the preceding sentence and
section 1861(mm)(3), clinical diagnostic laboratory services furnished by a
critical access hospital shall be treated as being furnished as part of
outpatient critical access services without regard to whether—
(A)the individual
with respect to whom such services are furnished is physically present in the
critical access hospital at the time the specimen is collected;
(B)such individual
is registered as an outpatient on the records of, and receives such services
directly from, the critical access hospital; or
(C)payment is (or,
but for this subsection, would be) available for such services under the fee
schedule established under section
1833(h).
.
(2)The amendments made by paragraph (1) shall apply to cost
reporting periods beginning on or after the date of enactment of this
Act.
(b)Elimination of
Isolation Test for cost-based ambulance reimbursement
(1)Section 1834(l)(8) of the Social Security Act (42 U.S.C. 1395m(l)(8)) is
amended—
(A)in subparagraph
(B)—
(i)by
striking owned and
; and
(ii)by
inserting (including when such services are provided by the entity under
an arrangement with the hospital)
after hospital
;
and
(B)by striking the
comma at the end of subparagraph (B) and all that follows and inserting a
period.
(2)The amendments made by this subsection shall apply to
services furnished on or after January 1, 2008.
8.Capital
infrastructure revolving loan program
(a)Part A of title XVI of the Public Health Service Act (42 U.S.C. 300q et
seq.) is amended by adding at the end the following new section:
1603.Capital infrastructure revolving loan
program(a)Authority To Make and
Guarantee Loans
(1)The Secretary may make loans from the fund established
under section 1602(d) to any rural entity for projects for capital
improvements, including—
(A)the acquisition
of land necessary for the capital improvements;
(B)the renovation or
modernization of any building;
(C)the acquisition
or repair of fixed or major movable equipment; and
(D)such other
project expenses as the Secretary determines appropriate.
(2)Authority to
guarantee loans
(A)The Secretary may guarantee the payment of principal and
interest for loans made to rural entities for projects for any capital
improvement described in paragraph (1) to any non-Federal lender.
(B)In the case of a guarantee of any loan made to a rural
entity under subparagraph (A), the Secretary may pay to the holder of such
loan, for and on behalf of the project for which the loan was made, amounts
sufficient to reduce (by not more than 3 percent) the net effective interest
rate otherwise payable on such loan.
(b)The principal amount of a loan directly made or guaranteed
under subsection (a) for a project for capital improvement may not exceed
$5,000,000.
(c)
(1)Government
credit subsidy exposureThe total of the Government credit
subsidy exposure under the Credit Reform Act of 1990 scoring protocol with
respect to the loans outstanding at any time with respect to which guarantees
have been issued, or which have been directly made, under subsection (a) may
not exceed $50,000,000 per year.
(2)Subject to paragraph (1), the total of the principal
amount of all loans directly made or guaranteed under subsection (a) may not
exceed $250,000,000 per year.
(d)Capital
Assessment and Planning Grants
(1)Subject to paragraph (2), the Secretary may make a grant
to a rural entity, in an amount not to exceed $50,000, for purposes of capital
assessment and business planning.
(2)The
cumulative total of grants awarded under this subsection may not exceed
$2,500,000 per year.
(e)The Secretary may not directly make or guarantee any
loan under subsection (a) or make a grant under subsection (d) after September
30,
2011.
.
(b)Section 1624 of the Public
Health Service Act (42 U.S.C. 300s–3) is amended by adding at the
end the following new paragraph:
(15)(A)The term rural
entity includes—
(i)a rural health clinic, as defined
in section 1861(aa)(2) of the Social Security
Act;
(ii)any medical facility with at least
1 bed, but with less than 50 beds, that is located in—
(I)a county that is not part of a
metropolitan statistical area; or
(II)a rural census tract of a metropolitan
statistical area (as determined under the most recent modification of the
Goldsmith Modification, originally published in the Federal Register on
February 27, 1992 (57 Fed. Reg. 6725));
(iii)a hospital that is classified as
a rural, regional, or national referral center under section 1886(d)(5)(C) of
the Social Security Act; and
(iv)a hospital that is a sole
community hospital (as defined in section 1886(d)(5)(D)(iii) of the
Social Security Act).
(B)For purposes of subparagraph (A), the
fact that a clinic, facility, or hospital has been geographically reclassified
under the Medicare program under title XVIII of the
Social Security Act shall not preclude
a hospital from being considered a rural entity under clause (i) or (ii) of
subparagraph
(A).
.
(c)Section 1602 of the Public Health Service Act (42 U.S.C. 300q–2) is
amended—
(1)in subsection
(b)(2)(D), by inserting or 1603(a)(2)(B)
after
1601(a)(2)(B)
; and
(2)in subsection
(d)—
(A)in paragraph
(1)(C), by striking section 1601(a)(2)(B)
and inserting
sections 1601(a)(2)(B) and 1603(a)(2)(B)
; and
(B)in paragraph
(2)(A), by inserting or 1603(a)(2)(B)
after
1601(a)(2)(B)
.
9.Extension of Medicare
incentive payment program for physician scarcity areasSection 1833(u)(1) of the Social Security
Act (42 U.S.C. 1395l(u)(1)) is amended by striking before January 1,
2008
and inserting before January 1, 2010
.
10.Extension of
floor on Medicare work geographic adjustmentSection 1848(e)(1)(E) of the Social Security
Act (42 U.S.C. 1395w–4(e)(1)(E)), as amended by section 102 of division B of
the Tax Relief and Health Care Act of 2006, is amended by striking
before January 1, 2008
and inserting before January 1,
2010
.
11.Improving care
planning for Medicare home health services
(a)Section 1814(a)(2) of the Social Security Act (42 U.S.C.
1395f(a)(2)), in the matter preceding subparagraph (A), is amended—
(1)by inserting
(as those terms are defined in section 1861(aa)(5))
after
clinical nurse specialist
; and
(2)by inserting
, or in the case of services described in subparagraph (C), a physician,
or a nurse practitioner or clinical nurse specialist who is working in
collaboration with a physician in accordance with State law, or a certified
nurse-midwife (as defined in section 1861(gg)) as authorized by State law, or a
physician assistant (as defined in section 1861(aa)(5)) under the supervision
of a physician
after collaboration with a
physician
.
(b)(1)Section 1814(a) of the
Social Security Act (42 U.S.C. 1395f(a)) is amended—
(A)in paragraph (2)(C), by inserting
, a nurse practitioner, a clinical nurse specialist, a certified
nurse-midwife, or a physician assistant (as the case may be)
after
physician
each place it appears;
(B)in the second sentence, by striking
or clinical nurse specialist
and inserting clinical nurse
specialist, certified nurse-midwife, or physician assistant
;
(C)in the third sentence—
(i)by striking physician
certification
and inserting certification
;
(ii)by inserting (or on January
1, 2008, in the case of regulations to implement the amendments made by section
2 of the Home Health Care Planning
Improvement Act of 2007)
after 1981
;
and
(iii)by striking a physician
who
and inserting a physician, nurse practitioner, clinical
nurse specialist, certified nurse-midwife, or physician assistant who
;
and
(D)in the fourth sentence, by inserting
, nurse practitioner, clinical nurse specialist, certified
nurse-midwife, or physician assistant
after
physician
.
(2)Section 1835(a) of the Social
Security Act (42 U.S.C. 1395n(a)) is amended—
(A)in paragraph (2)—
(i)in the matter preceding
subparagraph (A), by inserting or, in the case of services described in
subparagraph (A), a physician, or a nurse practitioner or clinical nurse
specialist (as those terms are defined in 1861(aa)(5)) who is working in
collaboration with a physician in accordance with State law, or a certified
nurse-midwife (as defined in section 1861(gg)) as authorized by State law, or a
physician assistant (as defined in section 1861(aa)(5)) under the supervision
of a physician
after a physician
; and
(ii)in each of clauses (ii) and (iii)
of subparagraph (A) by inserting , a nurse practitioner, a clinical
nurse specialist, a certified nurse-midwife, or a physician assistant (as the
case may be)
after physician
;
(B)in the third sentence, by inserting
, nurse practitioner, clinical nurse specialist, certified
nurse-midwife, or physician assistant (as the case may be)
after
physician;
(C)in the fourth sentence—
(i)by striking physician
certification
and inserting certification
;
(ii)by inserting (or on January
1, 2008, in the case of regulations to implement the amendments made by section
2 of the Home Health Care Planning
Improvement Act of 2007)
after 1981
;
and
(iii)by striking a physician
who
and inserting a physician, nurse practitioner, clinical
nurse specialist, certified nurse-midwife, or physician assistant who
;
and
(D)in the fifth sentence, by inserting
, nurse practitioner, clinical nurse specialist, certified
nurse-midwife, or physician assistant
after
physician
.
(3)Section 1861 of the Social Security
Act (42 U.S.C. 1395x) is amended—
(A)in subsection (m)—
(i)in the matter preceding paragraph
(1)—
(I)by inserting a nurse practitioner
or a clinical nurse specialist (as those terms are defined in subsection
(aa)(5)), a certified nurse-midwife (as defined in section 1861(gg)), or a
physician assistant (as defined in subsection (aa)(5))
after
physician
the first place it appears; and
(II)by inserting a nurse
practitioner, a clinical nurse specialist, a certified nurse-midwife, or a
physician assistant
after physician
the second place it
appears; and
(ii)in paragraph (3), by inserting
a nurse practitioner, a clinical nurse specialist, a certified
nurse-midwife, or a physician assistant
after physician
;
and
(B)in subsection (o)(2)—
(i)by inserting , nurse
practitioners or clinical nurse specialists (as those terms are defined in
subsection (aa)(5)), certified nurse-midwives (as defined in section 1861(gg)),
or physician assistants (as defined in subsection (aa)(5))
after
physicians
; and
(ii)by inserting , nurse
practitioner, clinical nurse specialist, certified nurse-midwife, physician
assistant,
after physician
.
(4)Section 1895 of the Social Security
Act (42 U.S.C. 1395fff) is amended—
(A)in subsection (c)(1), by inserting
, the nurse practitioner or clinical nurse specialist (as those terms
are defined in section 1861(aa)(5)), the certified nurse-midwife (as defined in
section 1861(gg)), or the physician assistant (as defined in section
1861(aa)(5)),
after physician
; and
(B)in subsection (e)—
(i)in paragraph (1)(A), by inserting
, a nurse practitioner or clinical nurse specialist (as those terms are
defined in section 1861(aa)(5)), a certified nurse-midwife (as defined in
section 1861(gg)), or a physician assistant (as defined in section
1861(aa)(5))
after physician
; and
(ii)in paragraph (2)—
(I)in the heading, by striking
Physician
certification
and inserting Rule of construction regarding requirement for
certification
; and
(II)by striking
physician
.
(c)The amendments made by this section shall apply to items and
services furnished on or after January 1, 2008.
12.Rural health
clinic improvementsSection
1833(f) of the Social Security Act (42
U.S.C. 1395l(f)) is amended—
(1)in paragraph (1),
by striking , and
at the end and inserting a semicolon;
(2)in paragraph
(2)—
(A)by inserting
(before 2008)
after in a subsequent year
;
and
(B)by striking the
period at the end and inserting a semicolon; and
(3)by adding at the
end the following new paragraphs:
(3)in 2008, at $92
per visit; and
(4)in a subsequent
year, at the limit established under this subsection for the previous year
increased by the percentage increase in the MEI (as so defined) applicable to
primary care services (as so defined) furnished as of the first day of that
year.
.
13.Community
health center collaborative access expansionSection 330 of the
Public Health Service Act (42 U.S.C.
254b) is amended by adding at the end the following:
(s)
(1)Rule of
construction with respect to rural health clinics
(A)Nothing in this section shall be construed to prevent a
community health center from contracting with a federally certified rural
health clinic (as defined by section 1861(aa)(2) of the
Social Security Act) for the delivery
of primary health care services that are available at the rural health clinic
to individuals who would otherwise be eligible for free or reduced cost care if
that individual were able to obtain that care at the community health center.
Such services may be limited in scope to those primary health care services
available in that rural health clinic.
(B)In
order for a rural health clinic to receive funds under this section through a
contract with a community health center under paragraph (1), such rural health
clinic shall establish policies to ensure—
(i)nondiscrimination
based upon the ability of a patient to pay; and
(ii)the
establishment of a sliding fee scale for low-income
patients.
.
14.Application of the
temporary Medicare payment increase for home health services furnished in a
rural area to 2008Section 421
of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003
(42 U.S.C.
1395fff note), as amended by section 5201(b) of the Deficit
Reduction Act of 2005 (42 U.S.C. 1395fff note), is
amended—
(1)in the section heading, by striking
One-year
and inserting
Temporary
; and
(2)in subsection (a), by inserting and
episodes and visits ending on or after January 1, 2008, and before January 1,
2009,
after January 1, 2007,
.
15.Extension of
increased Medicare payments for rural ground ambulance servicesSection 1834(l)(13) of the Social Security
Act (42 U.S.C. 1395m(l)(13)) is amended—
(1)in subparagraph
(A), in the heading, by striking In general
and inserting
For the second half of
2004 and for 2005 and 2006
;
(2)by redesignating
subparagraph (B) as subparagraph (C);
(3)by inserting the
following after subparagraph (A):
(B)For 2008 and
2009 for rural areasAfter computing the rates with respect to
ground ambulance services under the other applicable provisions of this
subsection, in the case of such services furnished on or after January 1, 2008,
and before January 1, 2010, for which the transportation originates in a rural
area described in paragraph (9) or in a rural census tract described in such
paragraph, the fee schedule established under this section shall provide that
the rate for the service otherwise established, after application of any
increase under paragraphs (11) and (12), shall be increased by 5
percent.
;
and
(4)in subparagraph
(C), as redesignated by paragraph (2)—
(A)in the heading,
by striking Application
of increased payments after 2006
and inserting
No effect on subsequent
periods
; and
(B)by adding at the
end the following new sentence: The increased payments under
subparagraph (B) shall not be taken into account in calculating payments for
services furnished after the period specified in such
subparagraph.
.
16.Coverage of
marriage and family therapist services and mental health counselor services
under part B of the Medicare program
(a)
(1)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
after the semicolon at the end;
(B)in subparagraph
(AA), by inserting and
after the semicolon at the end;
and
(C)by adding at the
end the following new subparagraph:
(BB)marriage and family therapist
services (as defined in subsection (ccc)(1)) and mental health counselor
services (as defined in subsection
(ccc)(3));
.
(2)Section
1861 of the Social Security Act (42
U.S.C. 1395x) is amended by adding at the end the following new
subsection:
(ccc)Marriage and Family Therapist Services; Marriage and Family
Therapist; Mental Health Counselor Services; Mental Health
Counselor(1)The term marriage
and family therapist services means services performed by a marriage and
family therapist (as defined in paragraph (2)) for the diagnosis and treatment
of mental illnesses, which the marriage and family therapist is legally
authorized to perform under State law (or the State regulatory mechanism
provided by State law) of the State in which such services are performed, as
would otherwise be covered if furnished by a physician or as an incident to a
physician’s professional service, but only if no facility or other provider
charges or is paid any amounts with respect to the furnishing of such
services.
(2)The term marriage and family
therapist means an individual who—
(A)possesses a master’s or doctoral
degree which qualifies for licensure or certification as a marriage and family
therapist pursuant to State law;
(B)after obtaining such degree has
performed at least 2 years of clinical supervised experience in marriage and
family therapy; and
(C)in the case of an individual
performing services in a State that provides for licensure or certification of
marriage and family therapists, is licensed or certified as a marriage and
family therapist in such State.
(3)The term mental health
counselor services means services performed by a mental health counselor
(as defined in paragraph (4)) for the diagnosis and treatment of mental
illnesses which the mental health counselor is legally authorized to perform
under State law (or the State regulatory mechanism provided by the State law)
of the State in which such services are performed, as would otherwise be
covered if furnished by a physician or as incident to a physician’s
professional service, but only if no facility or other provider charges or is
paid any amounts with respect to the furnishing of such services.
(4)The term mental health
counselor means an individual who—
(A)possesses a master’s or doctor’s
degree in mental health counseling or a related field;
(B)after obtaining such a degree has
performed at least 2 years of supervised mental health counselor practice;
and
(C)in the case of an individual
performing services in a State that provides for licensure or certification of
mental health counselors or professional counselors, is licensed or certified
as a mental health counselor or professional counselor in such
State.
.
(3)Provision for
payment under part BSection
1832(a)(2)(B) of the Social Security
Act (42 U.S.C. 1395k(a)(2)(B)) is amended by adding at the end the
following new clause:
(v)marriage and
family therapist services (as defined in section 1861(ccc)(1)) and mental
health counselor services (as defined in section
1861(ccc)(3));
.
(4)Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is
amended—
(A)by striking
and (V)
and inserting (V)
; and
(B)by inserting
before the semicolon at the end the following: , and (W) with respect to
marriage and family therapist services and mental health counselor services
under section 1861(s)(2)(BB), the amounts paid shall be 80 percent of the
lesser of the actual charge for the services or 75 percent of the amount
determined for payment of a psychologist under subparagraph (L)
.
(5)Exclusion of
marriage and family therapist services and mental health counselor services
from skilled nursing facility prospective payment systemSection
1888(e)(2)(A)(ii) of the Social Security
Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting
marriage and family therapist services (as defined in section
1861(ccc)(1)), mental health counselor services (as defined in section
1861(ccc)(3)),
after qualified psychologist
services,
.
(6)Inclusion of
marriage and family therapists and mental health counselors as practitioners
for assignment of claimsSection 1842(b)(18)(C) of the
Social Security Act (42 U.S.C.
1395u(b)(18)(C)) is amended by adding at the end the following new
clauses:
(vii)A marriage and family therapist (as
defined in section 1861(ccc)(2)).
(viii)A mental health counselor (as
defined in section
1861(ccc)(4)).
.
(b)Coverage of
Certain Mental Health Services Provided in Certain Settings
(1)Rural health
clinics and federally qualified health centersSection
1861(aa)(1)(B) of the Social Security
Act (42 U.S.C. 1395x(aa)(1)(B)) is amended by striking or by
a clinical social worker (as defined in subsection (hh)(1))
and
inserting , by a clinical social worker (as defined in subsection
(hh)(1)), by a marriage and family therapist (as defined in subsection
(ccc)(2)), or by a mental health counselor (as defined in subsection
(ccc)(4))
.
(2)Section 1861(dd)(2)(B)(i)(III) of the
Social Security Act (42 U.S.C.
1395x(dd)(2)(B)(i)(III)) is amended by inserting or one marriage and
family therapist (as defined in subsection (ccc)(2))
after
social worker
.
(c)Authorization
of Marriage and Family Therapists To Develop Discharge Plans for Post-Hospital
ServicesSection 1861(ee)(2)(G) of the
Social Security Act (42 U.S.C.
1395x(ee)(2)(G)) is amended by inserting marriage and family therapist
(as defined in subsection (ccc)(2)),
after social
worker,
.
(d)The amendments made by this section shall apply with respect
to services furnished on or after January 1, 2008.
17.Extension of
treatment of certain physician pathology services under MedicareSection 542(c) of the Medicare, Medicaid,
and SCHIP Benefits Improvement and Protection Act of 2000 (as enacted into law
by section 1(a)(6) of Public Law 106–554), as amended by section 732 of the
Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (42
U.S.C. 1395w–4 note) and section 104 of division B of the Tax Relief and Health
Care Act of 2006 (42 U.S.C. 1395w–4 note), is amended by striking and
2007
and inserting 2007, 2008, and 2009
.
18.Medicare remote
monitoring pilot projects
(a)
(1)Not later than 9
months after the date of enactment of this Act, the Secretary of Health and
Human Services (in this section referred to as the Secretary
)
shall conduct pilot projects under title XVIII of the Social Security Act for
the purpose of providing incentives to home health agencies to utilize home
monitoring and communications technologies that—
(A)enhance health
outcomes for Medicare beneficiaries; and
(B)reduce
expenditures under such title.
(2)
(A)The Secretary shall conduct the pilot projects under this
section in both urban and rural areas.
(B)The Secretary shall conduct at least 3 of the pilot
projects in a State with a population of less than 1,000,000.
(3)Definition of
home health agencyIn this section, the term home health
agency
has the meaning given that term in section 1861(o) of the Social
Security Act (42 U.S.C. 1395x(o)).
(b)Medicare
beneficiaries within the scope of projectsThe Secretary shall
specify the criteria for identifying those Medicare beneficiaries who shall be
considered within the scope of the pilot projects under this section for
purposes of the application of subsection (c) and for the assessment of the
effectiveness of the home health agency in achieving the objectives of this
section. Such criteria may provide for the inclusion in the projects of
Medicare beneficiaries who begin receiving home health services under title
XVIII of the Social Security Act after the date of the implementation of the
projects.
(c)
(1)The Secretary shall establish for each home health agency
participating in a pilot project under this section a performance target using
one of the following methodologies, as determined appropriate by the
Secretary:
(A)Adjusted
historical performance targetThe Secretary shall establish for
the agency—
(i)a
base expenditure amount equal to the average total payments made to the agency
under parts A and B of title XVIII of the Social Security Act for Medicare
beneficiaries determined to be within the scope of the pilot project in a base
period determined by the Secretary; and
(ii)an
annual per capita expenditure target for such beneficiaries, reflecting the
base expenditure amount adjusted for risk and adjusted growth rates.
(B)Comparative
performance targetThe Secretary shall establish for the agency a
comparative performance target equal to the average total payments under such
parts A and B during the pilot project for comparable individuals in the same
geographic area that are not determined to be within the scope of the pilot
project.
(2)Subject
to paragraph (3), the Secretary shall pay to each participating home care
agency an incentive payment for each year under the pilot project equal to a
portion of the Medicare savings realized for such year relative to the
performance target under paragraph (1).
(3)Limitation on
expendituresThe Secretary shall limit incentive payments under
this section in order to ensure that the aggregate expenditures under title
XVIII of the Social Security Act (including incentive payments under this
subsection) do not exceed the amount that the Secretary estimates would have
been expended if the pilot projects under this section had not been
implemented.
(d)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 pilot projects under this section.
(e)Not later than 5 years after the date that the first
pilot project under this section is implemented, the Secretary shall submit to
Congress a report on the pilot projects. Such report shall contain a detailed
description of issues related to the expansion of the projects under subsection
(f) and recommendations for such legislation and administrative actions as the
Secretary considers appropriate.
(f)If
the Secretary determines that any of the pilot projects under this section
enhance health outcomes for Medicare beneficiaries and reduce expenditures
under title XVIII of the Social Security Act, the Secretary may initiate
comparable projects in additional areas.
(g)Incentive
payments have no effect on other Medicare payments to agenciesAn
incentive payment under this section—
(1)shall be in
addition to the payments that a home health agency would otherwise receive
under title XVIII of the Social Security Act for the provision of home health
services; and
(2)shall have no
effect on the amount of such payments.
19.Facilitating
the provision of telehealth services across State lines
(a)For purposes of expediting the provision of telehealth
services, for which payment is made under the Medicare program, across State
lines, the Secretary of Health and Human Services shall, in consultation with
representatives of States, physicians, health care practitioners, and patient
advocates, encourage and facilitate the adoption of provisions allowing for
multistate practitioner practice across State lines.
(b)In
subsection (a):
(1)The term telehealth service has the meaning
given that term in subparagraph (F) of section 1834(m)(4) of the
Social Security Act (42 U.S.C.
1395m(m)(4)).
(2)The terms physician and
practitioner have the meaning given those terms in subparagraphs
(D) and (E), respectively, of such section.
(3)The term Medicare program
means the
program of health insurance administered by the Secretary of Health and Human
Services under title XVIII of the Social Security
Act (42 U.S.C. 1395 et seq.).