[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6719 Introduced in House (IH)]
112th CONGRESS
2d Session
H. R. 6719
To promote and expand the application of telehealth under Medicare and
other Federal health care programs, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
December 30, 2012
Mr. Thompson of California introduced the following bill; which was
referred to the Committee on Energy and Commerce, and in addition to
the Committees on Ways and Means, Oversight and Government Reform,
Armed Services, and Veterans' Affairs, 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 promote and expand the application of telehealth under Medicare and
other Federal health care programs, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Telehealth
Promotion Act of 2012''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--REMOVING ARBITRARY COVERAGE RESTRICTIONS ON TELEHEALTH FROM
FEDERAL HEALTH CARE PROGRAMS
Sec. 101. Medicare; Medicaid; CHIP.
Sec. 102. Federal employees health, dental, and vision benefits
programs.
Sec. 103. TRICARE.
Sec. 104. Health care provided by the Department of Veterans Affairs.
Sec. 105. Effective date.
TITLE II--ADDITIONAL IMPROVEMENTS TO MEDICARE
Sec. 201. Positive incentive for Medicare's hospital readmissions
reduction program.
Sec. 202. Health homes and medical homes.
Sec. 203. Flexibility in accountable care organizations coverage of
telehealth.
Sec. 204. Recognizing telehealth services and remote patient monitoring
in national pilot program on payment
bundling.
Sec. 205. Adjustment in Medicare home health payments to account for
use of remote patient monitoring.
Sec. 206. Including telehealth and remote patient monitoring services
as part of an intervention proposal under
the Medicare Community-Based Care
Transitions Program.
TITLE III--ADDITIONAL IMPROVEMENT TO MEDICAID
Sec. 301. Medicaid option for high-risk pregnancies and births.
TITLE I--REMOVING ARBITRARY COVERAGE RESTRICTIONS ON TELEHEALTH FROM
FEDERAL HEALTH CARE PROGRAMS
SEC. 101. MEDICARE; MEDICAID; CHIP.
(a) In General.--Title XI of the Social Security Act is amended by
inserting after section 1150B the following new section:
``removal of limitation on coverage of services provided via a
telecommunications system under medicare, medicaid, and chip
``Sec. 1150C. (a) Medicare.--An item or service under part A or
part B of title XVIII furnished to a Medicare beneficiary by an
individual or entity via a telecommunications system shall be covered
to the same extent the item or service would be covered if furnished in
the same location of the beneficiary, and benefits shall not be denied
under either such part solely on the basis that the item or service is
being furnished via a telecommunications system.
``(b) Medicaid.--Medical assistance under a State plan under title
XIX for an item or service furnished to a Medicaid beneficiary by an
individual or entity via a telecommunications system shall be available
to the same extent as such assistance would be available if furnished
in the same location as the beneficiary, and medical assistance shall
not be denied under such plan solely on the basis that the item or
service is being furnished via a telecommunications system, except as a
State may otherwise provide in its State plan under this title. For the
purposes of reimbursement, licensure, professional liability, and other
purposes under such title with respect to the provision of telehealth
services, practitioners, suppliers, and providers of such services are
considered to be furnishing such services at their location and not at
the originating site.
``(c) CHIP.--Child health assistance under a State child health
plan under title XXI for an item or service furnished to a CHIP
beneficiary by an individual or entity via a telecommunications system
shall be available to the same extent as such assistance would be
available if furnished in the same location as the beneficiary, and
child health assistance shall not be denied under such plan solely on
the basis that the item or service is being furnished via a
telecommunications system, except as a State may otherwise provide in
its State child health plan under this title. The previous sentence
applies with respect to items and services furnished through coverage
provided in the form described in section 2101(a)(1). For the purposes
of reimbursement, licensure, professional liability, and other purposes
under such title with respect to the provision of telehealth services,
practitioners, suppliers, and providers of such services are considered
to be furnishing such services at their location and not at the
originating site.''.
(b) Conforming Medicare Part B Coverage Provisions.--
(1) Removal of limitation on telehealth services.--Section
1834(m)(4) of the Social Security Act (42 U.S.C. 1395m(m)(4))
is amended by striking subparagraph (F).
(2) Expansion of telecommunications system.--The second
sentence of section 1834(m)(1) of the Social Security Act (42
U.S.C. 1835m(m)(1)) is amended by striking ``in the case of any
Federal telemedicine demonstration program conducted in Alaska
or Hawaii,''.
(3) Expansion of telehealth providers to all health care
professionals.--Section 1834(m) of such Act (42 U.S.C.
1395m(m)) is amended--
(A) in paragraph (1)--
(i) by inserting ``or other health care
professional'' after ``(described in section
1842(b)(18)(C))''; and
(ii) by inserting ``or other health care
professional'' after ``individual physician or
practitioner''; and
(B) in paragraphs (2)(A), (2)(C), (3)(A), and
(4)(A) by inserting ``or other health care
professional'' after ``physician or practitioner'' each
place it appears.
(4) Removal of limitations on originating sites.--Section
1834(m)(4)(C) of such Act (42 U.S.C. 1395m(m)(4)(C)) is
amended--
(A) by inserting ``The term `originating site'
means one of the following sites:'' after ``Originating
site.--'';
(B) by striking clause (i) and all that follows up
to subclause (I) of clause (ii); and
(C) by redesignating subclauses (I) through (VIII)
of clause (ii) as clauses (i) through (viii),
respectively.
(5) Location of furnishing telehealth services.--Section
1834(m) of such Act is further amended by adding at the end the
following new paragraph:
``(5) Treatment of location in furnishing telehealth
services.--For purposes of reimbursement, licensure,
professional liability, and other purposes under this title
with respect to the provision of telehealth services,
physicians, practitioners, suppliers, and providers of such
services are considered to be furnishing such services at their
location and not at the originating site.''.
(6) Payment methods for other patient sites.--Section
1834(m)(2) of such Act is further amended by adding at the end
the following new subparagraph:
``(D) Payment methods for other patient sites.--The
Secretary may develop and implement payment methods
that would apply under this subsection in the case of
an individual who would be an eligible telehealth
individual except that the telehealth services are
furnished the individual at a site other than an
originating site. Such methods shall be designed to
take into account the costs related to the site
involved and reduced costs for the distant site.''.
SEC. 102. FEDERAL EMPLOYEES HEALTH, DENTAL, AND VISION BENEFITS
PROGRAMS.
(a) Health Benefits (FEHBP).--Section 8904 of title 5, United
States Code, is amended by adding at the end the following:
``(c) Benefits for an item or service furnished by an individual or
entity via a telecommunications system shall be covered under a health
benefits plan under this chapter as if it were furnished in person at
the location of the beneficiary, and benefits shall not be denied under
such a plan solely on the basis that the item or service is being
furnished via a telecommunications system. For the purposes of
reimbursement, licensure, professional liability, and other purposes
under this chapter with respect to the provision of telehealth
services, practitioners, suppliers, and providers of such services are
considered to be furnishing such services at their location and not at
the originating site.''.
(b) Dental Benefits.--Section 8954 of title 5, United States Code,
is amended by adding at the end the following:
``(f) Benefits for an item or service furnished by an individual or
entity via a telecommunications system shall be covered under an
enhanced dental benefits plan under this chapter as if it were
furnished in person at the location of the beneficiary, and benefits
shall not be denied under such a plan solely on the basis that the item
or service is being furnished via a telecommunications system. For the
purposes of reimbursement, licensure, professional liability, and other
purposes under this chapter with respect to the provision of telehealth
services, practitioners, suppliers, and providers of such services are
considered to be furnishing such services at their location and not at
the originating site.''.
(c) Vision Benefits.--Section 8984 of title 5, United States Code,
is amended by adding at the end the following:
``(f) Benefits for an item or service furnished by an individual or
entity via a telecommunications system shall be covered under an
enhanced vision benefits plan under this chapter as if it were
furnished in person at the location of the beneficiary, and benefits
shall not be denied under such a plan solely on the basis that the item
or service is being furnished via a telecommunications system. For the
purposes of reimbursement, licensure, professional liability, and other
purposes under this chapter with respect to the provision of telehealth
services, practitioners, suppliers, and providers of such services are
considered to be furnishing such services at their location and not at
the originating site.''.
SEC. 103. TRICARE.
(a) Care Provided at Military Medical Treatment Facilities.--
Section 1077 of title 10, United States Code, is amended by adding at
the end the following new subsection:
``(g) In providing health care to a covered beneficiary under
section 1076 of this title at a military medical treatment facility,
the Secretary may furnish an item or service to the covered beneficiary
via a telecommunications system.''.
(b) Care Provided at Private Facilities.--
(1) Certain dependents.--Section 1079 of title 10, United
States Code, is amended by adding at the end the following new
subsection:
``(r)(1) An item or service furnished to a covered beneficiary via
a telecommunications system shall be covered by a plan described in
paragraph (2) to the same extent the item or service would be covered
if furnished in the same location of the covered beneficiary, and
benefits shall not be denied under such a plan solely on the basis that
the item or service is being furnished via a telecommunications system.
For the purposes of reimbursement, licensure, professional liability,
and other purposes under this section with respect to the provision of
telehealth services, practitioners, suppliers, and providers of such
services are considered to be furnishing such services at their
location and not at the originating site.
``(2) A plan described in this paragraph is a plan for which the
Secretary enters into a contract under subsection (a) to provide
dependents with medical care.''.
(2) Certain members and former members.--Section 1086 of
title 10, United States Code, is amended by adding at the end
the following new subsection:
``(i)(1) An item or service furnished to a covered beneficiary via
a telecommunications system shall be covered by a plan described in
paragraph (2) to the same extent the item or service would be covered
if furnished in the same location of the covered beneficiary, and
benefits shall not be denied under such a plan solely on the basis that
the item or service is being furnished via a telecommunications system.
For the purposes of reimbursement, licensure, professional liability,
and other purposes under this section with respect to the provision of
telehealth services, practitioners, suppliers, and providers of such
services are considered to be furnishing such services at their
location and not at the originating site.
``(2) A plan described in this paragraph is a plan for which the
Secretary enters into a contract under subsection (a) to provide
persons covered by subsection (c) with health benefits.''.
SEC. 104. HEALTH CARE PROVIDED BY THE DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Subchapter I of chapter 17 of title 38, United
States Code, is amended by inserting after section 1709A the following
new section:
``Sec. 1709B. Provision of health care via telecommunications system
``(a) Direct Care.--In providing health care directly to an
individual under this chapter or chapter 18 of this title, the
Secretary may furnish an item or service to the individual via a
telecommunications system.
``(b) Contracted Care.--(1) An item or service furnished to an
individual covered by a plan described in paragraph (2) via a
telecommunications system shall be covered by such a plan to the same
extent the item or service would be covered if furnished in the same
location of the individual, and benefits shall not be denied under such
a plan solely on the basis that the item or service is being furnished
via a telecommunications system. For the purposes of reimbursement,
licensure, professional liability, and other purposes under this
chapter and chapter 18 with respect to the provision of telehealth
services, practitioners, suppliers, and providers of such services are
considered to be furnishing such services at their location and not at
the originating site.
``(2) A plan described in this paragraph is a plan for which the
Secretary enters into a contract or agreement under this chapter or
chapter 18 of this title to furnish health care to an individual.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
1709A the following new item:
``1709B. Provision of health care via telecommunications system.''.
SEC. 105. EFFECTIVE DATE.
The amendments made by this title shall take effect on January 1,
2013, and shall apply to items and services furnished on or after such
date and contracts for health plans entered into on or after such date,
except that such amendments shall not apply to health plans for plan
years for which bids were submitted before the date of the enactment of
this Act.
TITLE II--ADDITIONAL IMPROVEMENTS TO MEDICARE
SEC. 201. POSITIVE INCENTIVE FOR MEDICARE'S HOSPITAL READMISSIONS
REDUCTION PROGRAM.
Section 1886(q) of the Social Security Act (42 U.S.C. 1395ww(q)) is
amended by adding at the end the following new paragraph:
``(9) Positive incentive for reduced readmissions.--
``(A) In general.--With respect to payment for
discharges occurring during a fiscal year beginning on
or after October 1, 2013, 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.
``(B) Hospital described.--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.
``(C) Positive readmission ratio.--The positive
readmission ratio described in this subparagraph for a
hospital is the ratio of--
``(i) the risk adjusted expected
readmissions (described in subclause (II) of
paragraph (4)(C)(i)); to
``(ii) the risk adjusted readmissions based
on actual readmissions (described in subclause
(I) of such paragraph).''.
SEC. 202. HEALTH HOMES AND MEDICAL HOMES.
(a) Medicare Chronic Care Counterpart to Medicaid ``Health
Home''.--
(1) In general.--Title XVIII of the Social Security Act is
amended by adding at the end the following new section:
``SEC. 1899B. MEDICARE HEALTH HOME FOR INDIVIDUALS WITH CHRONIC
CONDITIONS.
``(a) In General.--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.
``(b) Health Home Qualification Standards.--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.
``(c) Payments.--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.
``(d) Hospital Referrals.--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).
``(e) Monitoring and Report on Quality.--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.
``(f) Report on Quality Measures.--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.
``(g) Definitions.--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.
``(h) Evidence-Based and Reporting.--In contracting with a State
under this section, the State--
``(1) shall follow evidence-based guidelines for chronic
care; and
``(2) 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.
``(i) Waiver Authority.--
``(1) In general.--The limitations on telehealth under
section 1834(m) shall not apply for purposes of this section.
``(2) Secretary authority.--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.''.
(2) Reporting.--
(A) In general.--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--
(i) hospital admission rates;
(ii) chronic disease management;
(iii) coordination of care for individuals
with chronic conditions;
(iv) assessment of program implementation;
(v) processes and lessons learned (as
described in subparagraph (B));
(vi) assessment of quality improvements and
clinical outcomes under such option; and
(vii) estimates of cost savings.
(B) Implementation reporting.--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.
(b) Specialty Medical Homes.--Title XVIII of the Social Security
Act, as amended by subsection (a), is further amended by adding at the
end the following new section:
``SEC. 1899C. SPECIALTY MEDICAL HOMES.
``(a) In General.--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.
``(b) Medical Home Defined.--In this section, the term `medical
home' means a medical entity that--
``(1) specializes in the care for a specific long-term
illness or medical condition, including related comorbidities;
``(2) leads the development of related evidence-based
clinical standards and research;
``(3) has a network of affiliated personal physicians and
patient treatment facilities;
``(4) maintains an online Web Site for patient and provider
communication and collaboration and patient access to the
patient's health information;
``(5) 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);
``(6) 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;
``(7) uses a health assessment tool for the individuals
targeted, including a means for identifying those most likely
to benefit from remote patient monitoring; and
``(8) provides training programs for personnel involved in
the coordination of care.
``(c) Personal Physician Defined.--
``(1) In general.--In this section, the term `personal
physician' 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.
``(2) General requirements.--The requirements described in
this paragraph for a personal physician for care of an
individual are as follows:
``(A) The physician is board certified for care of
the specific illness or condition of the individual and
manages continuous care for the individual.
``(B) The physician has the staff and resources to
manage the comprehensive and coordinated health care of
such individual.
``(3) Service-related requirements.--The requirements
described in this paragraph for a personal physician are as
follows:
``(A) 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).
``(B) 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.
``(C) The personal physician is in compliance with
the standards for meaningful use of electronic health
records under this title.
``(D) The personal physician participates with the
State's health information exchange, as available, or
the federally-sponsored Direct Project.
``(E) 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.
``(F) The personal physician uses electronic
prescribing and provides medication management.
``(G) The personal physician encourages patients to
engage in the management of their own health through
education and support systems.
``(H) The personal physician utilizes the services
of related health professionals, including nurse
practitioners and physician assistants.
``(d) Long-Term Illness or Medical Condition Defined.--In this
section, the term `long-term illness or medical condition'--
``(1) includes a chronic condition which meets criteria
specified by the Secretary for a specialized MA plan for
special needs individuals; and
``(2) also includes another condition that the Secretary
determines would provide a beneficial focus for an effective
and efficient medical home.
``(e) Payment Mechanisms.--
``(1) Medical home care management fee and medical home
sharing in savings.--Except as provided in paragraph (2)--
``(A) Medical home care management fee.--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.
``(B) Medical home sharing in savings.--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.
``(2) Alternative payment model.--
``(A) In general.--The Secretary may provide for
payment under this paragraph instead of the amounts
otherwise payable under paragraph (1).
``(B) Establishment of target spending level.--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.
``(C) Incentive payments.--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).
``(3) Source.--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.
``(f) Evidence-Based.--The contracting entity shall follow
evidence-based guidelines for care of the long-term illness or medical
condition under this section.
``(g) Patient Services Quality and Performance Reporting.--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.
``(h) Waiver Authority.--
``(1) In general.--The limitations on telehealth under
section 1834(m) shall not apply for purposes of this section.
``(2) Secretary authority.--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.''.
SEC. 203. FLEXIBILITY IN ACCOUNTABLE CARE ORGANIZATIONS COVERAGE OF
TELEHEALTH.
Section 1899 of the Social Security Act (42 U.S.C. 1395jjj) is
amended by adding at the end the following new subsection:
``(l) Flexibility for Telehealth.--
``(1) Provision as supplemental benefits.--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
1852(a)(3)(A).
``(2) Provision in connection with home health services.--
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.''.
SEC. 204. RECOGNIZING TELEHEALTH SERVICES AND REMOTE PATIENT MONITORING
IN NATIONAL PILOT PROGRAM ON PAYMENT BUNDLING.
Section 1866D(a)(2) of the Social Security Act (42 U.S.C. 1395cc-
4(a)(2)) is amended--
(1) in subparagraph (B), by striking ``10 conditions'' and
inserting ``the conditions'';
(2) in subparagraph (C)--
(A) by redesignating clause (v) as clause (vi); and
(B) by inserting after clause (iv) the following
new clause:
``(v) Telehealth and remote patient
monitoring services.''; and
(3) in subparagraph (D)(i)(III), by inserting before the
period at the end the following: ``(and such longer period in
the case of the use of telehealth and remote patient monitoring
services as the Secretary may specify)''.
SEC. 205. ADJUSTMENT IN MEDICARE HOME HEALTH PAYMENTS TO ACCOUNT FOR
USE OF REMOTE PATIENT MONITORING.
(a) In General.--Section 1895(b) of the Social Security Act (42
U.S.C. 1395fff(b)) is amended by adding at the end the following new
paragraph:
``(7) Increase for the use of remote patient monitoring.--
``(A) In general.--The Secretary shall provide for
an increase in the standard prospective payment amount
(or amounts) under paragraph (3) applicable to home
health services furnished using remote patient
monitoring. No such increase shall be provided unless
the agency furnishing the services provides the
Secretary with such additional information on outcomes
from the use of such monitoring as the Secretary may
require.
``(B) Limitation.--The increase under this
paragraph shall be--
``(i) applied only in 2014, 2015, and 2016;
and
``(ii) reduced in the case of 2016.
``(C) Using remote patient monitoring defined.--In
this paragraph, the term `using remote patient
monitoring' means using devices and communications
networks to remotely collect and send diagnostic data
to a monitoring station for interpretation.''.
(b) Application on a Budget Neutral Basis.--Paragraph (3) of such
section is amended by adding at the end the following new subparagraph:
``(D) Budget-neutrality adjustment to offset cost
of increased payment for using remote patient
monitoring.--The Secretary shall reduce the standard
prospective payment amount (or amounts) under this
paragraph applicable to home health services furnished
during a period by such proportion as the Secretary
estimates will result in an aggregate reduction in
payments for the period equal to the total increase in
payments estimated to be made based on the application
of paragraph (7) for the period.''.
SEC. 206. INCLUDING TELEHEALTH AND REMOTE PATIENT MONITORING SERVICES
AS PART OF AN INTERVENTION PROPOSAL UNDER THE MEDICARE
COMMUNITY-BASED CARE TRANSITIONS PROGRAM.
Section 3026(c)(2)(B) of the Patient Protection and Affordable Care
Act of 2010 (Public Law 111-148; 42 U.S.C. 1395b-1 note) is amended by
adding at the end the following new clause:
``(vi) Monitoring a high-risk Medicare
beneficiary through the use of telehealth or
remote patient monitoring services.''.
TITLE III--ADDITIONAL IMPROVEMENT TO MEDICAID
SEC. 301. MEDICAID OPTION FOR HIGH-RISK PREGNANCIES AND BIRTHS.
(a) In General.--Title XIX of the Social Security Act is amended by
adding at the end the following new section:
``SEC. 1947. STATE OPTION TO PROVIDE COORDINATED CARE FOR ENROLLEES
WITH HIGH-RISK PREGNANCIES AND BIRTHS.
``(a) In General.--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.
``(b) Qualification Standards.--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.
``(c) Payments.--
``(1) In general.--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.
``(2) Savings target.--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.
``(3) Methodology.--
``(A) In general.--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).
``(B) Innovative models of payment.--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.
``(4) Planning grants.--
``(A) In general.--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.
``(B) Limitation.--The total amount of payments
made to States under this paragraph shall not exceed
$25,000,000.
``(d) Report on Quality Measures.--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.
``(e) Evidence-Based.--The birthing network shall adapt, update,
and follow evidence-based guidelines for maternal-fetal and neonatal
care.
``(f) Definitions.--In this section:
``(1) Eligible individual for maternal-fetal and neonatal
care.--
``(A) In general.--Subject to subparagraph (B), the
term `eligible individual' means an individual who--
``(i) is eligible for medical assistance
under the State plan or under a waiver of such
plan; and
``(ii)(I) is pregnant (or was pregnant
during the immediately preceding 30 day
period); or
``(II) is the child of an individual
described in clause (i) and under 30 days old.
``(B) Rule of construction.--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.
``(2) Birthing network.--The term `birthing network' 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.
``(3) Birthing network services.--
``(A) In general.--The term `birthing network
services' 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.
``(B) Services described.--The services described
in this subparagraph are--
``(i) comprehensive care coordination;
``(ii) health promotion;
``(iii) a call center to offer 24-hour
physician support for consultations with
maternal-fetal medicine specialists, when
requested, regarding patient management issues;
``(iv) newborn screening, including for
heart defects and to reduce newborn hospital
readmissions;
``(v) patient and family support (including
authorized representatives);
``(vi) referral to community and social
support services, if relevant; and
``(vii) use of health information
technology to link services and provide
monitoring, as feasible and appropriate.
``(4) Designated provider.--The term `designated provider'
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--
``(A) has the systems and infrastructure in place
to provide birthing network services; and
``(B) satisfies the qualification standards
established by the Secretary under subsection (b) and
paragraph (7)(B).
``(5) Team of health care professionals.--The term `team of
health care professionals' means a team of health professionals
(as described in the State plan amendment) that may--
``(A) 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
``(B) 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.
``(6) Health team.--The term `health team' has the meaning
given such term for purposes of section 3502 of the Patient
Protection and Affordable Care Act.
``(7) Birthing data and exchange.--
``(A) Proposal for use of health information
technology.--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).
``(B) Information requirements for birthing
networks.--The birthing network shall--
``(i) be in compliance with the Medicaid
standards for meaningful use of electronic
health records;
``(ii) participate with the State's health
information exchange, as available, or operate
an exchange among the birthing network;
``(iii) collect demographic information on
participating newborns and mothers;
``(iv) use demographic and event-based data
to identify patients that are likely going to
need short or long-term follow-up; and
``(v) 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.''.
(b) Patient Services Quality and Performance Reporting.--
(1) In general.--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--
(A) terms of pregnancies;
(B) use of prenatal fetal monitoring;
(C) use of Caesarean section procedures;
(D) use of neonatal intensive care services;
(E) incidence of birthing complications;
(F) incidence of infant and maternal mortality;
(G) coordination of maternal-fetal and neonatal
care for individuals;
(H) assessment of program implementation;
(I) processes and lessons learned (as described in
subparagraph (B));
(J) assessment of quality improvements and clinical
outcomes under such option; and
(K) participating mothers' assessment of
performance, quality, convenience, and satisfaction.
(2) Implementation reporting.--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.
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