1.Short title; table of
contents
(a)This Act may be cited
as the Telehealth Promotion Act of
2012
.
(b)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.
<enum>I</enum><header>Removing arbitrary
coverage restrictions on telehealth from Federal health care programs</header>
<section id="HF8EB4E180D22409A9CE679ADEEA7EFA7"><enum>101.</enum><header>Medicare;
Medicaid; CHIP</header>
<subsection id="H2A53186C4594459AA485FAD2262A0F95"><enum>(a)</enum><header>In
general</header><text>Title XI of the Social Security Act is amended by
inserting after section 1150B the following new section:</text>
<quoted-block display-inline="no-display-inline" id="HCF2767FA56924AD0909A117E4838B712" style="traditional">
<section id="H4E6ADF5ACA8A48A5BA701AA9C4F057B4"><enum>1150C.</enum><header>Removal of limitation on coverage of services provided via a
telecommunications system under Medicare, Medicaid, and
CHIP</header><subsection commented="no" display-inline="yes-display-inline" id="H788339D6B0874FBFABD88B6C251C8B6B"><enum>(a)</enum><header>Medicare</header><text display-inline="yes-display-inline">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.</text>
</subsection><subsection id="HF4AF924C15374D5CAFA3B0733D9ED472"><enum>(b)</enum><header>Medicaid</header><text display-inline="yes-display-inline">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.</text>
</subsection><subsection id="H5980D30B33164737A6AAFB25A730E0AF"><enum>(c)</enum><header>CHIP</header><text display-inline="yes-display-inline">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.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H14DA261EDEBB4AF780B89BCFB6897EFB"><enum>(b)</enum><header>Conforming
Medicare part B coverage provisions</header><text display-inline="yes-display-inline"></text>
<paragraph id="HA8F4A0C580D24092A2803A1C7BAA0219"><enum>(1)</enum><header>Removal of
limitation on telehealth services</header><text display-inline="yes-display-inline">Section 1834(m)(4) of the Social Security
Act (42 U.S.C. 1395m(m)(4)) is amended by striking subparagraph (F).</text>
</paragraph><paragraph id="HB0A65FF3E3CA44B0A37BA20837C1A50A"><enum>(2)</enum><header>Expansion of
telecommunications system</header><text>The second sentence of section
1834(m)(1) of the Social Security Act (42 U.S.C. 1835m(m)(1)) is amended by
striking <quote>in the case of any Federal telemedicine demonstration program
conducted in Alaska or Hawaii,</quote>.</text>
</paragraph><paragraph id="HE78D9DA3477A43C19574D807A50C4D64"><enum>(3)</enum><header>Expansion of
telehealth providers to all health care professionals</header><text>Section
1834(m) of such Act (42 U.S.C. 1395m(m)) is amended—</text>
<subparagraph id="H971D7FA0EBA541B689D6E5C7F44D526C"><enum>(A)</enum><text>in paragraph
(1)—</text>
<clause id="H169E771601B44E228C70B56616150428"><enum>(i)</enum><text>by
inserting <quote>or other health care professional</quote> after
<quote>(described in section 1842(b)(18)(C))</quote>; and</text>
</clause><clause id="H9A000E5C2EC240CCA30A883D39059437"><enum>(ii)</enum><text>by
inserting <quote>or other health care professional</quote> after
<quote>individual physician or practitioner</quote>; and</text>
</clause></subparagraph><subparagraph id="H37946374D39F4E0CBBF3C94C5DCDD8D8"><enum>(B)</enum><text>in paragraphs
(2)(A), (2)(C), (3)(A), and (4)(A) by inserting <quote>or other health care
professional</quote> after <quote>physician or practitioner</quote> each place
it appears.</text>
</subparagraph></paragraph><paragraph id="H6EC5A6AF3CB34E738C3BB8880242C42A"><enum>(4)</enum><header>Removal of
limitations on originating sites</header><text display-inline="yes-display-inline">Section 1834(m)(4)(C) of such Act (42
U.S.C. 1395m(m)(4)(C)) is amended—</text>
<subparagraph id="H0023D4098918463B9E60AD9E70CA32D6"><enum>(A)</enum><text>by inserting
<quote>The term <term>originating site</term> means one of the following
sites:</quote> after <quote><header-in-text level="subparagraph" style="OLC">Originating site.—</header-in-text></quote>;</text>
</subparagraph><subparagraph id="H1DCBCDA6352C45ADABA5B680806F07E4"><enum>(B)</enum><text>by striking clause
(i) and all that follows up to subclause (I) of clause (ii); and</text>
</subparagraph><subparagraph id="H50B835A294A84F8AA92A751FD6D72195"><enum>(C)</enum><text>by redesignating
subclauses (I) through (VIII) of clause (ii) as clauses (i) through (viii),
respectively.</text>
</subparagraph></paragraph><paragraph id="H41E655B9380F43B79711ED11D5F3FEB2"><enum>(5)</enum><header>Location of
furnishing telehealth services</header><text display-inline="yes-display-inline">Section 1834(m) of such Act is further
amended by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H950E645AFC644F0088E52F614B63BC8C" style="OLC">
<paragraph id="H04B38F8F9B074175B562006E4140B7E6"><enum>(5)</enum><header>Treatment of
location in furnishing telehealth services</header><text>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.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HCBFB0CDDE7054357ABEA7B5A314D1228"><enum>(6)</enum><header>Payment methods
for other patient sites</header><text>Section 1834(m)(2) of such Act is further
amended by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="HC918ADA2C0844093A9AED3268EACC08C" style="OLC">
<subparagraph id="H2102A7BF5BD3420989F4BA23996606DE"><enum>(D)</enum><header>Payment methods
for other patient sites</header><text display-inline="yes-display-inline">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.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection></section><section id="H203373AB3BB54536A1431C262249633C"><enum>102.</enum><header>Federal
employees health, dental, and vision benefits programs</header>
<subsection id="H0DE6078EAF594D578E38EB589683043B"><enum>(a)</enum><header>Health benefits
(FEHBP)</header><text display-inline="yes-display-inline">Section 8904 of title
5, United States Code, is amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H8BC3B48A846742F4B4394605A7825136" style="traditional">
<subsection id="HE86D8FAEE41941EC9298F5DB19DFC907"><enum>(c)</enum><text display-inline="yes-display-inline">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.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection display-inline="no-display-inline" id="H3C2E76F777394DC4B28ED5C61B90DA09"><enum>(b)</enum><header>Dental
benefits</header><text display-inline="yes-display-inline">Section 8954 of
title 5, United States Code, is amended by adding at the end the
following:</text>
<quoted-block display-inline="no-display-inline" id="HEB130CCC1F9A497E99D073FB0F4BC14F" style="traditional">
<subsection id="HB873066E770F4E20ABADE8CDD9FDBE77"><enum>(f)</enum><text display-inline="yes-display-inline">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.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HA87D0A39B9B54944B1ACAEB6A3EF3D31"><enum>(c)</enum><header>Vision
benefits</header><text display-inline="yes-display-inline">Section 8984 of
title 5, United States Code, is amended by adding at the end the
following:</text>
<quoted-block display-inline="no-display-inline" id="H00D0995509F7462A9BB9BED14869B4C7" style="traditional">
<subsection id="H19CC2091C61D47ED9813044DF28359B4"><enum>(f)</enum><text display-inline="yes-display-inline">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.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="HE166E406EC0B45C38E47D09B6F898F42" section-type="subsequent-section"><enum>103.</enum><header>TRICARE</header>
<subsection id="H5049EF30CBAB4F7090D9CAB137597B45"><enum>(a)</enum><header>Care provided at
military medical treatment facilities</header><text display-inline="yes-display-inline">Section 1077 of title 10, United States
Code, is amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HB8CEBC14183E452AB9C249FC1BB5E200" style="USC">
<subsection id="H19473E1A8E9540DCA340416C1B27F82B"><enum>(g)</enum><text display-inline="yes-display-inline">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.</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H8EFE3B081F5543CE9582155A64A78FA8"><enum>(b)</enum><header>Care provided at
private facilities</header>
<paragraph id="H156E064516F64374BF85829D6DA5DA6B"><enum>(1)</enum><header>Certain
dependents</header><text>Section 1079 of title 10, United States Code, is
amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H7E664C6D7EF3415D903C866E1EADB9FA" style="USC">
<subsection id="H3EF28CA73BFF4D03A66185A28016DBE9"><enum>(r)</enum><paragraph commented="no" display-inline="yes-display-inline" id="HCC31E83C7BF84A9B85B27FD1BC95CAB3"><enum>(1)</enum><text display-inline="yes-display-inline">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.</text>
</paragraph><paragraph id="H00813F3BD8EF44999AB4639E964C7D12" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">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.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H4E9E68CCFFB541FD9687EA51417C95DA"><enum>(2)</enum><header>Certain members
and former members</header><text>Section 1086 of title 10, United States Code,
is amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H7240142DE7734D22A5531C8082E4F9B5" style="USC">
<subsection id="H8B81CA7F328247398495F9FD896CEF0D"><enum>(i)</enum><paragraph commented="no" display-inline="yes-display-inline" id="H4F027E4C70A74899827B2CFBDF60545A"><enum>(1)</enum><text display-inline="yes-display-inline">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.</text>
</paragraph><paragraph id="H2C4C3E07D643469D9A58AD54FB3DD86C" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">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.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection></section><section id="HBFCBD33DDCF8411997B9BF11DE421C0D"><enum>104.</enum><header>Health care
provided by the Department of Veterans Affairs</header>
<subsection id="H6836CB3B493844F2A44ABCCE9BAC8F6F"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Subchapter I of
chapter 17 of title 38, United States Code, is amended by inserting after
section 1709A the following new section:</text>
<quoted-block display-inline="no-display-inline" id="H65631E4A76EA4D0FB350EF640909DB58" style="USC">
<section id="HBC023C09E9AE454DA848DD3C8FE5FAE6"><enum>1709B.</enum><header>Provision of
health care via telecommunications system</header>
<subsection id="HA113704F35F04AA7A0FD24D6CEA067E3"><enum>(a)</enum><header>Direct
care</header><text display-inline="yes-display-inline">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.</text>
</subsection><subsection id="H2D9119F8EA76445D98068CE06F2B3CAC"><enum>(b)</enum><header>Contracted
care</header><paragraph commented="no" display-inline="yes-display-inline" id="H38C9B2EEDBF44AB49376E2D040E64FA2"><enum>(1)</enum><text display-inline="yes-display-inline">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.</text>
</paragraph><paragraph id="H73CF9A03B44E43D69AFA157C290A2AE1" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">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.</text>
</paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H25A35E56A71440A8B95EF6C738440214"><enum>(b)</enum><header>Clerical
amendment</header><text display-inline="yes-display-inline">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:</text>
<quoted-block display-inline="no-display-inline" id="H15BDC788911B4F38A39AA2C8853C9252" style="USC">
<toc regeneration="no-regeneration">
<toc-entry level="section">1709B. Provision of health care via
telecommunications
system.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="HF1B59839D9184DF5B46C5C4F14C54C56"><enum>105.</enum><header>Effective
date</header><text display-inline="no-display-inline">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.</text>
</section><enum>II</enum><header>Additional
Improvements to Medicare</header>
<section id="HAE033DE8804F4C678AC4E19EC0FF9226"><enum>201.</enum><header>Positive
incentive for Medicare’s hospital readmissions reduction program</header><text display-inline="no-display-inline">Section 1886(q) of the Social Security Act
(42 U.S.C. 1395ww(q)) is amended by adding at the end the following new
paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HB5039F884A4C4B3E81C5E610034C9E8C" style="OLC">
<paragraph id="HE87F7E4DBCCF40D486C48C9A22F4ABCB"><enum>(9)</enum><header>Positive
incentive for reduced readmissions</header>
<subparagraph id="HEAED3563ADCB4B9C96597F17F601AD33"><enum>(A)</enum><header>In
general</header><text>With respect to payment for discharges occurring during a
fiscal year beginning on or after October 1, 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.</text>
</subparagraph><subparagraph id="H2F93C86B924944B5AF36AAFECA419B31"><enum>(B)</enum><header>Hospital
described</header><text display-inline="yes-display-inline">A hospital
described in this subparagraph is an applicable hospital (as defined in
paragraph (5)(C)) not subject to a payment change under paragraph (1) and for
which the positive readmission ratio (described in subparagraph (C)) is greater
than 1.</text>
</subparagraph><subparagraph id="HFCD854F6627C4010BC0311026F05D561"><enum>(C)</enum><header>Positive
readmission ratio</header><text>The positive readmission ratio described in
this subparagraph for a hospital is the ratio of—</text>
<clause id="H4EBC5B3A47C7448E86BADE34C0169954"><enum>(i)</enum><text>the risk adjusted
expected readmissions (described in subclause (II) of paragraph (4)(C)(i));
to</text>
</clause><clause id="HDA6CC72220EF48E7B7F0FB4878EAC937"><enum>(ii)</enum><text>the risk adjusted
readmissions based on actual readmissions (described in subclause (I) of such
paragraph).</text>
</clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="H68EE469D7B034452A1A4F92153FA4CC0"><enum>202.</enum><header>Health homes
and medical homes</header>
<subsection id="HA9ACDC75F14F4D259D00AA07C868E153"><enum>(a)</enum><header>Medicare chronic
care counterpart to Medicaid <quote>health home</quote></header>
<paragraph id="H772565076E5D49EEB9CABBCBF2881155"><enum>(1)</enum><header>In
general</header><text>Title XVIII of the Social Security Act is amended by
adding at the end the following new section:</text>
<quoted-block id="HB1421BD106D744B895892FBC7EA14C11" style="OLC">
<section id="H239BFC166E494B2AA058EA08D6B07618"><enum>1899B.</enum><header>Medicare
health home for individuals with chronic conditions</header>
<subsection id="HA184765DC9264161995CA63FD8D707E8"><enum>(a)</enum><header>In
general</header><text>In the case of a State that has amended its State plan
under title XIX in accordance with the option described in section 1945, the
Secretary may contract with the State medical assistance agency with a program
under such section to serve eligible individuals with chronic conditions who
select a designated provider, a team of health care professionals operating
with such a provider, or a health team as the individual’s health home for
purposes of providing the individual with health home services in the same
manner as provided under its State plan amendment.</text>
</subsection><subsection id="H6CFFECB3AEC546778AD70BA11EA3E678"><enum>(b)</enum><header>Health home
qualification standards</header><text>The standards established by the
Secretary under section 1945(b) for qualification as a designated provider
shall apply under this section for the purpose of being eligible to be a health
home for purposes of section 1945.</text>
</subsection><subsection id="H92922BF032374B7DA5552549376FC74C"><enum>(c)</enum><header>Payments</header><text display-inline="yes-display-inline">Payments shall be made under this section
in the same manner to a provider or team as payments are made under subsection
(c) of section 1945, including the use of the payment methodology described in
paragraph (2) of such subsection.</text>
</subsection><subsection id="HFC019C4294E544F986B09C8ABD379E08"><enum>(d)</enum><header>Hospital
referrals</header><text>Hospitals that are participating providers under this
section shall establish procedures for referring any eligible individuals with
chronic conditions who seek or need treatment in a hospital emergency
department to designated providers in the same manner as required under section
1945(d).</text>
</subsection><subsection id="HE2EEE9697B2C42ADB2FE7719E93CE454"><enum>(e)</enum><header>Monitoring and
report on quality</header><text>The methodology and proposal required under
subsection (f) of section 1945 and the report on quality measures under
subsection (f) of such section shall also apply under this section.</text>
</subsection><subsection id="H0E73B448A3C14053BFC3C6E17D353743"><enum>(f)</enum><header>Report on
quality measures</header><text display-inline="yes-display-inline">As a
condition for receiving payment for health home services provided to an
eligible individual with chronic conditions, a designated provider shall
report, in accordance with such requirements as the Secretary shall specify,
including a plan for the use of remote patient monitoring, on all applicable
measures for determining the quality of such services. When appropriate and
feasible, a designated provider shall use health information technology in
providing the Secretary with such information.</text>
</subsection><subsection id="HB5CE960C30474A4282BA85FCAE9FBD6C"><enum>(g)</enum><header>Definitions</header><text>In
this section, the provisions and definitions contained in subsection (h) of
section 1945 shall also apply for purposes of this section except that, instead
of the requirement specified in clause (i) of subsection (h)(1)(A) of such
section, an individual must be eligible for services under parts A and B and
covered for medical assistance for health home services under section 1945 in
order to be an eligible individual with chronic conditions.</text>
</subsection><subsection id="HD46E007329EF477880711C57A2949702"><enum>(h)</enum><header>Evidence-Based
and reporting</header><text>In contracting with a State under this section, the
State—</text>
<paragraph id="HBB93B3BDBED84F7595D02E7CA73FCCB7"><enum>(1)</enum><text>shall follow
evidence-based guidelines for chronic care; and</text>
</paragraph><paragraph id="HE26493E89A4C4628AE25DC783BC8D4BF"><enum>(2)</enum><text display-inline="yes-display-inline">shall report at least by the end of every
month data specified by the Secretary, including an assessment of the use of
remote patient monitoring and quality measures of process, outcome, and
structure.</text>
</paragraph></subsection><subsection id="H18B4C4E0A0F0405CADAD5AAAA487B48E"><enum>(i)</enum><header>Waiver
authority</header>
<paragraph id="H681A3EE785FC406FAFF832E90363E80C"><enum>(1)</enum><header>In
general</header><text>The limitations on telehealth under section 1834(m) shall
not apply for purposes of this section.</text>
</paragraph><paragraph id="H82C2B4EE396A4557921AC5D35E57BE47"><enum>(2)</enum><header>Secretary
authority</header><text>The Secretary may waive such other requirements of this
title and title XIX as may be necessary to carry out the provisions of this
section.</text>
</paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HB837B1C0A513484BA9B64BA2F7CCF649"><enum>(2)</enum><header>Reporting</header>
<subparagraph id="HBAA6CAA856914292823DE272144491AD"><enum>(A)</enum><header>In
general</header><text display-inline="yes-display-inline">Not later than 2
years after the date of the enactment of this Act, the Secretary of Health and
Human Services shall survey States contracting under section 1899B of the
Social Security Act, as added by paragraph (1), on the nature, extent, and use
of the option under such section particularly as it pertains to—</text>
<clause id="H113D27D0E5E747189DC28FC6E2E5E7C6"><enum>(i)</enum><text>hospital admission
rates;</text>
</clause><clause id="HBB99D86B2CBF4A9C89D1959AD3B2C55D"><enum>(ii)</enum><text>chronic disease
management;</text>
</clause><clause id="HB862D45A2A6946C384C8A80799FD2EDC"><enum>(iii)</enum><text>coordination of
care for individuals with chronic conditions;</text>
</clause><clause id="H174BDE4B85354368B31F46A1D4DD7956"><enum>(iv)</enum><text>assessment of
program implementation;</text>
</clause><clause id="HD0A62047050644EB833A5EEA36DD5445"><enum>(v)</enum><text>processes and
lessons learned (as described in subparagraph (B));</text>
</clause><clause id="HE8D4D20AA2B84A4580BC0B9F685F68E8"><enum>(vi)</enum><text>assessment of
quality improvements and clinical outcomes under such option; and</text>
</clause><clause id="H89A6634C6BC040E6810D437CF6A2F33D"><enum>(vii)</enum><text>estimates of
cost savings.</text>
</clause></subparagraph><subparagraph id="H6A2BE9B913184A888F00C33223229725"><enum>(B)</enum><header>Implementation
reporting</header><text>Such a State shall report to the Secretary, as
necessary, on processes that have been developed and lessons learned regarding
provision of coordinated care through a health home for beneficiaries with
chronic conditions under such option.</text>
</subparagraph></paragraph></subsection><subsection id="HAC92A0B57D204488BF94F9BA2C58245F"><enum>(b)</enum><header>Specialty
medical homes</header><text>Title XVIII of the Social Security Act, as amended
by subsection (a), is further amended by adding at the end the following new
section:</text>
<quoted-block display-inline="no-display-inline" id="H1F59AB2244B642E39320C02B1B61F828" style="OLC">
<section id="H747CC6B8E4C24376A396F973315EA0B6"><enum>1899C.</enum><header>Specialty
medical homes</header>
<subsection id="H83E30A03AF004BD6A503A3A67FB2AD0A"><enum>(a)</enum><header>In
general</header><text>Beginning not later than 30 days after the date of the
enactment of this section, the Secretary may contract with a national or
multi-state regional center of excellence with a network of affiliated local
providers to provide through one or more medical homes for targeted,
accessible, continuous, and coordinated care to individuals under this title
and title XIX with a long-term illness or medical condition that requires
regular medical treatment, advising, and monitoring.</text>
</subsection><subsection id="HCF94B9173E2C43E4B846A59BAFC25CDE"><enum>(b)</enum><header>Medical home
defined</header><text>In this section, the term <term>medical home</term> means
a medical entity that—</text>
<paragraph id="H182A7444D1C14DA7BB7BA0A759A07C29"><enum>(1)</enum><text>specializes in the
care for a specific long-term illness or medical condition, including related
comorbidities;</text>
</paragraph><paragraph id="H25034B9B59F848A0AF997D49AA838959"><enum>(2)</enum><text>leads the
development of related evidence-based clinical standards and research;</text>
</paragraph><paragraph id="HC306577235F54B5DB1BC907293FBE145"><enum>(3)</enum><text>has a network of
affiliated personal physicians and patient treatment facilities;</text>
</paragraph><paragraph id="HC1774946BCCC405FA2F67121D1F1C9D5"><enum>(4)</enum><text>maintains an
online Web Site for patient and provider communication and collaboration and
patient access to the patient’s health information;</text>
</paragraph><paragraph id="HDE7999788A524D5FB883CA346D621E5A"><enum>(5)</enum><text display-inline="yes-display-inline">has a plan for use of health information
technology in providing services under this section and improving service
delivery and coordination across the care continuum (including the use of
wireless patient technology to improve coordination and remote patient
monitoring management of care and patient adherence to recommendations made by
their provider);</text>
</paragraph><paragraph id="H6FBCDEB012C84F86B2283C83BF860D88"><enum>(6)</enum><text>provides
deidentified demographic data sets for clinical, statistical, and social
science research to develop culturally-competent best practices and clinical
decision support mechanisms for the long-term illness or medical
condition;</text>
</paragraph><paragraph id="HA355197C18C1448BA8FED5BDA8D793BB"><enum>(7)</enum><text display-inline="yes-display-inline">uses a health assessment tool for the
individuals targeted, including a means for identifying those most likely to
benefit from remote patient monitoring; and</text>
</paragraph><paragraph id="H4067F7597C92412583DBF3D684867E59"><enum>(8)</enum><text>provides training
programs for personnel involved in the coordination of care.</text>
</paragraph></subsection><subsection id="H4774060E8098436CBBE6253116788A51"><enum>(c)</enum><header>Personal
physician defined</header>
<paragraph id="HEE301F5411D2410A98FA9C1B49EC254D"><enum>(1)</enum><header>In
general</header><text>In this section, the term <term>personal physician</term>
means a physician (as defined in section 1861(r)(1)) who meets the requirements
described in paragraphs (2) and (3). Nothing in this paragraph shall be
construed as preventing a personal physician from being a specialist or
subspecialist for an individual requiring ongoing care for a specific chronic
condition or multiple chronic conditions or for an individual with a long-term
illness or medical condition.</text>
</paragraph><paragraph id="HA76AA74BFE6F47CEA4B5429FE5AD13D9"><enum>(2)</enum><header>General
requirements</header><text>The requirements described in this paragraph for a
personal physician for care of an individual are as follows:</text>
<subparagraph id="H4DE0D5D6E6CE4F5BAF982DD648D6E4C6"><enum>(A)</enum><text>The physician is
board certified for care of the specific illness or condition of the individual
and manages continuous care for the individual.</text>
</subparagraph><subparagraph id="H4B040B99B5064F1C848C9455E9AECA4D"><enum>(B)</enum><text>The physician has
the staff and resources to manage the comprehensive and coordinated health care
of such individual.</text>
</subparagraph></paragraph><paragraph id="HB972A7C53B71406B944A39EA125E1916"><enum>(3)</enum><header>Service-related
requirements</header><text>The requirements described in this paragraph for a
personal physician are as follows:</text>
<subparagraph id="H314348006F2548B8B3219A218DE57EB6"><enum>(A)</enum><text>The personal
physician advocates for and provides ongoing support, oversight, and guidance
to implement a plan of care that provides an integrated, coherent,
cross-discipline plan for ongoing medical care developed in partnership with
patients and including all other physicians furnishing care to the patient
involved and other appropriate medical personnel or agencies (such as home
health agencies).</text>
</subparagraph><subparagraph id="HE8A2B651F1654F01A536F7DC73390D2E"><enum>(B)</enum><text>The personal
physician uses evidence-based medicine and clinical decision support tools to
guide decisionmaking at the point-of-care based on patient-specific
factors.</text>
</subparagraph><subparagraph id="HA1F56421078C48C7A18014D676827395"><enum>(C)</enum><text display-inline="yes-display-inline">The personal physician is in compliance
with the standards for meaningful use of electronic health records under this
title.</text>
</subparagraph><subparagraph id="H17AD6B0D79034992B8E3D59BDAA12BF8"><enum>(D)</enum><text display-inline="yes-display-inline">The personal physician participates with
the State’s health information exchange, as available, or the
federally-sponsored Direct Project.</text>
</subparagraph><subparagraph id="H7FEA91A4462241798724D2EDD099D6B4"><enum>(E)</enum><text display-inline="yes-display-inline">The personal physician uses health
information technology, including appropriate remote monitoring, to monitor and
track the health status of patients and to provide patients with enhanced and
convenient access to health care services.</text>
</subparagraph><subparagraph id="H5AFF3E8980164098866F081E399704E5"><enum>(F)</enum><text display-inline="yes-display-inline">The personal physician uses electronic
prescribing and provides medication management.</text>
</subparagraph><subparagraph id="HD1E8AE80C34D437CB676C4A859061125"><enum>(G)</enum><text display-inline="yes-display-inline">The personal physician encourages patients
to engage in the management of their own health through education and support
systems.</text>
</subparagraph><subparagraph id="HF8B910A04EFD4311BEA86A2E1DD45108"><enum>(H)</enum><text display-inline="yes-display-inline">The personal physician utilizes the
services of related health professionals, including nurse practitioners and
physician assistants.</text>
</subparagraph></paragraph></subsection><subsection id="HE52EF398DAC247BB886D78E995B272E8"><enum>(d)</enum><header>Long-Term
illness or medical condition defined</header><text display-inline="yes-display-inline">In this section, the term <term>long-term
illness or medical condition</term>—</text>
<paragraph id="H59F26BAAA017498AAB44E7EACC55B3A9"><enum>(1)</enum><text>includes a chronic
condition which meets criteria specified by the Secretary for a specialized MA
plan for special needs individuals; and</text>
</paragraph><paragraph id="H2A56F7C56DBE493EAADEF64041D79174"><enum>(2)</enum><text>also includes
another condition that the Secretary determines would provide a beneficial
focus for an effective and efficient medical home.</text>
</paragraph></subsection><subsection id="H6DAD7B645CE04AABADE581FBAF79F3B7"><enum>(e)</enum><header>Payment
mechanisms</header>
<paragraph id="HCF56CC754F334284A947CE4650AD6743"><enum>(1)</enum><header>Medical home
care management fee and medical home sharing in savings</header><text display-inline="yes-display-inline">Except as provided in paragraph (2)—</text>
<subparagraph id="H6ECB499957744E5D8AA650C8C958553D"><enum>(A)</enum><header>Medical home
care management fee</header><text>Under this section the Secretary shall
provide for payment under section 1848 of a care management fee to the medical
home and may include performance incentives. The medical home shall arrange for
payment for the services of affiliated physicians and facilities.</text>
</subparagraph><subparagraph id="H0D23E470D5134DDDA79E7BA5A7A968B7"><enum>(B)</enum><header>Medical home
sharing in savings</header><text>The Secretary shall provide for payment under
this section of a medical home based on the payment methodology applied to
health group practices under section 1866A. Under such methodology, 80 percent
of the reductions in expenditures under this title and title XIX resulting from
participation of individuals that are attributable to the medical home (as
reduced by the total care management fees paid to the medical home under this
section) shall be paid to the medical home. The amount of such reductions in
expenditures shall be determined by using assumptions with respect to
reductions in the occurrence of health complications, hospitalization rates,
medical errors, and adverse drug reactions.</text>
</subparagraph></paragraph><paragraph id="HCD10532AD0444FACBC047E833DBF48EE"><enum>(2)</enum><header>Alternative
payment model</header>
<subparagraph id="H4593A223561C413DAE044B94318B50B6"><enum>(A)</enum><header>In
general</header><text>The Secretary may provide for payment under this
paragraph instead of the amounts otherwise payable under paragraph (1).</text>
</subparagraph><subparagraph commented="no" id="H67B71256BB8546FBABCCFF8D759FC4CE"><enum>(B)</enum><header>Establishment of
target spending level</header><text>For purposes of this paragraph, the
Secretary shall compute an estimated annual spending target based on the amount
the Secretary estimates would have been spent in the absence of this section,
for items and services covered under parts A and B furnished to applicable
beneficiaries for each qualifying medical home under this section. Such
spending targets shall be determined on a per capita basis. Such spending
targets shall include a risk corridor that takes into account normal variation
in expenditures for items and services covered under parts A and B furnished to
such beneficiaries with the size of the corridor being related to the number of
applicable beneficiaries furnished services by each medical home. The spending
targets may also be adjusted for such other factors as the Secretary determines
appropriate.</text>
</subparagraph><subparagraph commented="no" id="H902D9B28E78F4240AD070E9A628D5B53"><enum>(C)</enum><header>Incentive
payments</header><text>Subject to performance on quality measures, a qualifying
medical home is eligible to receive an incentive payment under this section if
actual expenditures for a year for the applicable beneficiaries it enrolls are
less than the estimated spending target established under subparagraph (B) for
such year. An incentive payment for such year shall be equal to a portion (as
determined by the Secretary) of the amount by which actual expenditures
(including incentive payments under this paragraph) for applicable
beneficiaries under parts A and B for such year are estimated to be less than
95 percent of the estimated spending target for such year, as determined under
subparagraph (B).</text>
</subparagraph></paragraph><paragraph id="H70A14D22963244A28594B07E71ED1E69"><enum>(3)</enum><header>Source</header><text>Payments
paid under this section shall be made in appropriate proportions (as specified
by the Secretary) from the Hospital Insurance Trust Fund, the Federal
Supplementary Medical Insurance Trust Fund, and funds appropriated to carry out
title XIX.</text>
</paragraph></subsection><subsection id="H9CC046C35E604CECB81F2A4DD74C784D"><enum>(f)</enum><header>Evidence-Based</header><text>The
contracting entity shall follow evidence-based guidelines for care of the
long-term illness or medical condition under this section.</text>
</subsection><subsection id="HECE353CF673040A3A802385E5D211FED"><enum>(g)</enum><header>Patient services
quality and performance reporting</header><text>The contracting entity shall
report at least by the end of every month data specified by the Secretary on
the operation of this section, including quality measures of process, outcome,
and structure.</text>
</subsection><subsection id="HDD5A42FD9D604ABD87C6A75DD856D69C"><enum>(h)</enum><header>Waiver
authority</header>
<paragraph id="H6956C3C4C1964AFD9CFF0BE01DCB599B"><enum>(1)</enum><header>In
general</header><text>The limitations on telehealth under section 1834(m) shall
not apply for purposes of this section.</text>
</paragraph><paragraph id="HADFEF58613F94217A5BBA75C6538089E"><enum>(2)</enum><header>Secretary
authority</header><text>The Secretary may waive such other requirements of this
title and title XIX as may be necessary to carry out the provisions of this
section.</text>
</paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="HB8AFD2455F434758A123BBE34CED7853"><enum>203.</enum><header>Flexibility in
accountable care organizations coverage of telehealth</header><text display-inline="no-display-inline">Section 1899 of the Social Security Act (42
U.S.C. 1395jjj) is amended by adding at the end the following new
subsection:</text>
<quoted-block display-inline="no-display-inline" id="H2FF2964564DA4D2C867433977F19D868" style="OLC">
<subsection id="H392A9D351BFB4672A3FE30E89FD69CE2"><enum>(l)</enum><header>Flexibility for
telehealth</header>
<paragraph id="H0B986C8E2220480A951C90F18E3A2141"><enum>(1)</enum><header>Provision as
supplemental benefits</header><text display-inline="yes-display-inline">Notwithstanding any other provision of this
section, an ACO may include coverage of telehealth and remote patient
monitoring services as supplemental health care benefits to the same extent as
a Medicare Advantage plan is permitted to provide coverage of such services as
supplemental health care benefits under 1852(a)(3)(A).</text>
</paragraph><paragraph id="H0C438C3283984E02BB09FA2B710B8F4D"><enum>(2)</enum><header>Provision in
connection with home health services</header><text display-inline="yes-display-inline">Nothing in this section shall be construed
as preventing an ACO from including payments for remote patient monitoring and
home-based video conferencing services in connection with the provision of home
health services (under conditions for which payment for such services would not
be made under section 1895 for such services) in a manner that is financially
equivalent to the furnishing of a home health
visit.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section commented="no" id="H5D279C250E9A4C6E854D8152CEB3800D"><enum>204.</enum><header>Recognizing
telehealth services and remote patient monitoring in national pilot program on
payment bundling</header><text display-inline="no-display-inline">Section
1866D(a)(2) of the Social Security Act (42 U.S.C. 1395cc–4(a)(2)) is
amended—</text>
<paragraph commented="no" id="HEC15D633A3914309BCDCFAB712F9EAFD"><enum>(1)</enum><text display-inline="yes-display-inline">in subparagraph (B), by striking <quote>10
conditions</quote> and inserting <quote>the conditions</quote>;</text>
</paragraph><paragraph commented="no" id="HCD80954BCDB6462C96492F1DD92D4682"><enum>(2)</enum><text>in subparagraph
(C)—</text>
<subparagraph id="HDB55FBF4D81E4328918AA977188EB3CB"><enum>(A)</enum><text>by redesignating
clause (v) as clause (vi); and</text>
</subparagraph><subparagraph id="H94416C782E0148D2B60156E7A437F9E5"><enum>(B)</enum><text>by inserting after
clause (iv) the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="H28124995F3314380B875682FBE23F459" style="OLC">
<clause commented="no" id="H8807FD8BDD08427AB73C8F07072271B9"><enum>(v)</enum><text display-inline="yes-display-inline">Telehealth and remote patient monitoring
services.</text>
</clause><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph commented="no" id="H0D8D208F5E9F40888CDEB4CF0D527711"><enum>(3)</enum><text>in subparagraph
(D)(i)(III), by inserting before the period at the end the following:
<quote>(and such longer period in the case of the use of telehealth and remote
patient monitoring services as the Secretary may specify)</quote>.</text>
</paragraph></section><section commented="no" id="HC8A0FD1E26854EEF9CE1685CE1A2143B"><enum>205.</enum><header>Adjustment in
Medicare home health payments to account for use of remote patient
monitoring</header>
<subsection id="HC8E50D61F59E4422B505836CB158191D"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">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:</text>
<quoted-block display-inline="no-display-inline" id="H25384A04C85F41EA9CFF36D7FB48B4C9" style="OLC">
<paragraph id="HE5FE8DA9346B4FE987F1C55793F327EF"><enum>(7)</enum><header>Increase for the
use of remote patient monitoring</header>
<subparagraph id="HEAB2185D35A1447B86B3DAA0822E418D"><enum>(A)</enum><header>In
general</header><text>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.</text>
</subparagraph><subparagraph id="H8D8FABC10CC74760987C2D065DCE575A"><enum>(B)</enum><header>Limitation</header><text>The
increase under this paragraph shall be—</text>
<clause id="HB87BE3637FEA449796AFF41FFB376DCF"><enum>(i)</enum><text>applied only in
2014, 2015, and 2016; and</text>
</clause><clause id="HC113593F53454A55B8FC8BB3884D3F4F"><enum>(ii)</enum><text>reduced in the
case of 2016.</text>
</clause></subparagraph><subparagraph id="H9FA0640C5F774937996B04E1A03D2621"><enum>(C)</enum><header>Using remote
patient monitoring defined</header><text>In this paragraph, the term
<term>using remote patient monitoring</term> means using devices and
communications networks to remotely collect and send diagnostic data to a
monitoring station for
interpretation.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H859BFB18042F408C926A55FD388F2878"><enum>(b)</enum><header>Application on a
budget neutral basis</header><text>Paragraph (3) of such section is amended by
adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H964FEC7D7DA245D4B08E80499EEE74CE" style="OLC">
<subparagraph id="H129E11230B3242949827BDED7085E0F3"><enum>(D)</enum><header>Budget-neutrality
adjustment to offset cost of increased payment for using remote patient
monitoring</header><text display-inline="yes-display-inline">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.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section commented="no" id="HC993EBEB13F94AA6B32FE8E81FEC0015"><enum>206.</enum><header>Including
telehealth and remote patient monitoring services as part of an intervention
proposal under the Medicare Community-Based Care Transitions
Program</header><text display-inline="no-display-inline">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:</text>
<quoted-block display-inline="no-display-inline" id="H04BED4AEEC0D48C085A332EA3948AD28" style="OLC">
<clause commented="no" id="H2507150B1D604D08BB30E5FBB51271CA"><enum>(vi)</enum><text display-inline="yes-display-inline">Monitoring a high-risk Medicare beneficiary
through the use of telehealth or remote patient monitoring
services.</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</section><enum>III</enum><header>Additional
Improvement to Medicaid</header>
<section id="HB300BA4C33894B0D9B3BC694FD5203D5"><enum>301.</enum><header>Medicaid option
for high-risk pregnancies and births</header>
<subsection id="HA3B072E7180240428C04712630BD5815"><enum>(a)</enum><header>In
general</header><text>Title XIX of the Social Security Act is amended by adding
at the end the following new section:</text>
<quoted-block id="H012573A6834A4F8F890711F894112E35" style="OLC">
<section id="HEE493230C7BA4583B614DE5C0DCB8AF3"><enum>1947.</enum><header>State option
to provide coordinated care for enrollees with high-risk pregnancies and
births</header>
<subsection id="H1AB82C205A3341319F6244F609E0D686"><enum>(a)</enum><header>In
general</header><text>Notwithstanding section 1902(a)(1) (relating to
statewideness), section 1902(a)(10)(B) (relating to comparability), and any
other provision of this title for which the Secretary determines it is
necessary to waive in order to implement this section, beginning 6 months after
the date of the enactment of this section, a State, at its option as a State
plan amendment, may provide for medical assistance under this title to eligible
individuals for maternal-fetal and neonatal care who select a designated
provider (as described under subsection (h)(5)), a team of health care
professionals (as described under subsection (h)(6)) operating with such a
provider, or a health team (as described under subsection (h)(7)) as the
individual’s birthing network for purposes of providing the individual with
pregnancy-related services.</text>
</subsection><subsection id="H640DBC29ADF843CB9101DF56C2BB8BC3"><enum>(b)</enum><header>Qualification
standards</header><text>The Secretary shall establish standards for
qualification as a designated provider for the purpose of being eligible to be
a birthing network for purposes of this section.</text>
</subsection><subsection id="H434898D3BAFD43AD8FB8A3543B841F5E"><enum>(c)</enum><header>Payments</header>
<paragraph id="HB949A7FCAAE349A6B7DAE971A4B82800"><enum>(1)</enum><header>In
general</header><text>A State shall provide a designated provider, a team of
health care professionals operating with such a provider, or a health team with
payments for the provision of birthing network services to each eligible
individual for maternal-fetal and neonatal care that selects such provider,
team of health care professionals, or health team as the individual’s birthing
network. Payments made to a designated provider, a team of health care
professionals operating with such a provider, or a health team for such
services shall be treated as medical assistance for purposes of section
1903(a), except that, during the first 8 fiscal year quarters that the State
plan amendment is in effect, the Federal medical assistance percentage
applicable to such payments shall be equal to 90 percent.</text>
</paragraph><paragraph id="HCB603F84BEBE4351ADBDE206496DDF57"><enum>(2)</enum><header>Savings
target</header><text>As a condition for approval of a State plan amendment and
payment methodology under this section, the State shall provide the Secretary
with assurances that the amendment and methodology shall be projected to reduce
the amount of expenditures for pregnancy-related services otherwise made under
this title by one percent for each 4-calendar-quarter period during the first
40 calendar quarters in which the amendment is in effect.</text>
</paragraph><paragraph id="HF25036A7D70D44F0AC1F9405923DA7E3"><enum>(3)</enum><header>Methodology</header>
<subparagraph id="H882557D1D3C547E99EF359D09288329F"><enum>(A)</enum><header>In
general</header><text>The State shall specify in the State plan amendment the
methodology the State will use for determining payment for the provision of
birthing network services. Such methodology for determining payment shall be
established consistent with section 1902(a)(30)(A).</text>
</subparagraph><subparagraph id="H218FE85E34B3484A99DD1BD1AF1B252A"><enum>(B)</enum><header>Innovative
models of payment</header><text>The methodology for determining payment for
provision of birthing network services under this section shall not be limited
to a per-member per-month basis and may provide (as proposed by the State and
subject to approval by the Secretary) for alternate models of payment,
including bundled per episode, performance incentives, and shared
savings.</text>
</subparagraph></paragraph><paragraph id="H03E793E327034D478F40981545FACF74"><enum>(4)</enum><header>Planning
grants</header>
<subparagraph id="H8BE75F9E235049FAAE912F880D190012"><enum>(A)</enum><header>In
general</header><text>Beginning 30 days after the date of the enactment of this
section, the Secretary may award planning grants to States for purposes of
developing a State plan amendment under this section. A planning grant awarded
to a State or a multi-state collaborative under this paragraph shall remain
available until expended.</text>
</subparagraph><subparagraph id="HCEF96B4FF8C44525B26E05E38F53CD2D"><enum>(B)</enum><header>Limitation</header><text>The
total amount of payments made to States under this paragraph shall not exceed
$25,000,000.</text>
</subparagraph></paragraph></subsection><subsection id="HDCE7D9C1D0C74E7A850C18B64D5C8F84"><enum>(d)</enum><header>Report on
quality measures</header><text>As a condition for receiving payment for
birthing network services provided to an eligible individual for maternal-fetal
and neonatal care, a designated provider shall report monthly to the State, in
accordance with such requirements as the Secretary shall specify, on all
applicable measures for determining the quality of such services. When
appropriate and feasible, a designated provider shall use health information
technology in providing the State with such information.</text>
</subsection><subsection id="H29377026E4C041AB81B21CB492D9AD05"><enum>(e)</enum><header>Evidence-Based</header><text>The
birthing network shall adapt, update, and follow evidence-based guidelines for
maternal-fetal and neonatal care.</text>
</subsection><subsection id="H99455AC0D6A64D93B6C40BDB5B635ABE"><enum>(f)</enum><header>Definitions</header><text>In
this section:</text>
<paragraph id="H2AB23812E270431C9F284356384C9194"><enum>(1)</enum><header>Eligible
individual for maternal-fetal and neonatal care</header>
<subparagraph id="HEC18BB88156F4D1F8E3478C2C1F36317"><enum>(A)</enum><header>In
general</header><text>Subject to subparagraph (B), the term <term>eligible
individual</term> means an individual who—</text>
<clause id="HFDDBCB47E53943929C4EF0D705A74B89"><enum>(i)</enum><text>is
eligible for medical assistance under the State plan or under a waiver of such
plan; and</text>
</clause><clause display-inline="no-display-inline" id="H68BF17EB184B49EB89781FCEFB1F3E70"><enum>(ii)</enum><subclause commented="no" display-inline="yes-display-inline" id="H61FA9A2872244E109FE70D9797993CCC"><enum>(I)</enum><text>is pregnant (or was
pregnant during the immediately preceding 30 day period); or</text>
</subclause><subclause id="H9EDB810380B7471286B1305AF136C798" indent="up1"><enum>(II)</enum><text>is the child of an individual described
in clause (i) and under 30 days old.</text>
</subclause></clause></subparagraph><subparagraph id="HAB9B1099458E49C3B2ACAE817F15ACC3"><enum>(B)</enum><header>Rule of
construction</header><text>Nothing in this paragraph shall prevent the
Secretary from establishing other requirements for purposes of determining
eligibility for receipt of birthing network services under this section.</text>
</subparagraph></paragraph><paragraph id="H2F71A9125B45417698000BEA8C6A92F7"><enum>(2)</enum><header>Birthing
network</header><text>The term <term>birthing network</term> means a designated
provider (including a provider that operates in coordination with a team of
health care professionals) or a health team selected by an eligible individual
to provide birthing network services.</text>
</paragraph><paragraph id="H4CC0A1DF7DA3405890FAE668487B7AA1"><enum>(3)</enum><header>Birthing network
services</header>
<subparagraph id="H6AAD0A99D9CD4C298F76A929458E9A6B"><enum>(A)</enum><header>In
general</header><text>The term <term>birthing network services</term> means
comprehensive and timely high-quality services described in subparagraph (B)
that are provided by a designated provider, a team of health care professionals
operating with such a provider, or a health team and are identified in a
provider registry.</text>
</subparagraph><subparagraph id="H4385814A86554A748CBE1E1EA3B7E733"><enum>(B)</enum><header>Services
described</header><text>The services described in this subparagraph are—</text>
<clause id="H0AFD46A13D3244A5A9A713AF01337669"><enum>(i)</enum><text>comprehensive care
coordination;</text>
</clause><clause id="HBF2E01330BA64FEC811225C4C8E7AB7D"><enum>(ii)</enum><text>health
promotion;</text>
</clause><clause id="H2CD6A188ADE1416C83EF4B90CC2B8172"><enum>(iii)</enum><text>a call center to
offer 24-hour physician support for consultations with maternal-fetal medicine
specialists, when requested, regarding patient management issues;</text>
</clause><clause id="H99BE7DB974D641E5A481F4157AD523D5"><enum>(iv)</enum><text>newborn
screening, including for heart defects and to reduce newborn hospital
readmissions;</text>
</clause><clause id="id63ACACEB9BEF4B30AB14D978F8786FD3"><enum>(v)</enum><text>patient and
family support (including authorized representatives);</text>
</clause><clause id="HA351DBDE60DD42529BD646E01AB326FE"><enum>(vi)</enum><text>referral to
community and social support services, if relevant; and</text>
</clause><clause id="HE4A80711919044E09EEDB82A4DF8C38D"><enum>(vii)</enum><text>use of health
information technology to link services and provide monitoring, as feasible and
appropriate.</text>
</clause></subparagraph></paragraph><paragraph id="H1459D090632F48D78FA0599AE11BB6F6"><enum>(4)</enum><header>Designated
provider</header><text>The term <term>designated provider</term> means a
physician, clinical practice or clinical group practice, rural clinic,
community health center, public health agency, home health agency, or any other
entity or provider (including pediatricians, gynecologists, and obstetricians)
that is determined by the State and approved by the Secretary to be qualified
to be a birthing network for eligible individuals on the basis of documentation
evidencing that the physician, practice, or clinic—</text>
<subparagraph id="HF2C48605BA6E46BC96EA84F4048E65AE"><enum>(A)</enum><text>has the systems
and infrastructure in place to provide birthing network services; and</text>
</subparagraph><subparagraph id="HEA11B92011304A4784EB4561107D68D5"><enum>(B)</enum><text>satisfies the
qualification standards established by the Secretary under subsection (b) and
paragraph (7)(B).</text>
</subparagraph></paragraph><paragraph id="H0DED78764CA0426CA85D2A7C70C4E976"><enum>(5)</enum><header>Team of health
care professionals</header><text>The term <term>team of health care
professionals</term> means a team of health professionals (as described in the
State plan amendment) that may—</text>
<subparagraph id="HDE740B09F3D84DDCB8B725118DD312B3"><enum>(A)</enum><text>include physicians
and other professionals, such as a nurse care coordinator, midwife,
nutritionist, social worker, behavioral health professional, or any
professionals deemed appropriate by the State; and</text>
</subparagraph><subparagraph id="H177327D521174B199061A7BA04283E6C"><enum>(B)</enum><text>be free standing,
virtual, or based at a hospital, community health center, rural clinic,
clinical practice or clinical group practice, academic health center, or any
entity deemed appropriate by the State and approved by the Secretary.</text>
</subparagraph></paragraph><paragraph id="HE1142A9FC0CF422F8FC618F3AC2226D3"><enum>(6)</enum><header>Health
team</header><text>The term <term>health team</term> has the meaning given such
term for purposes of section 3502 of the Patient Protection and Affordable Care
Act.</text>
</paragraph><paragraph id="H80E808308F2C4673A7A4EDEAEA2D70B5"><enum>(7)</enum><header>Birthing data
and exchange</header>
<subparagraph id="HB42570A97FCD49AF968ED95FBBABB145"><enum>(A)</enum><header>Proposal for use
of health information technology</header><text>A State shall include in the
State plan amendment a proposal for use of health information technology in
providing birthing network services under this section and improving service
delivery and coordination across the care continuum (including the use of
wireless patient technology to improve coordination and management of care and
patient adherence to recommendations made by their provider).</text>
</subparagraph><subparagraph id="HC352F8C2158F4D4487A6DDB7EAC3906C"><enum>(B)</enum><header>Information
requirements for birthing networks</header><text>The birthing network
shall—</text>
<clause id="H6380D675FBA54EAEB459C00F92707B2D"><enum>(i)</enum><text>be
in compliance with the Medicaid standards for meaningful use of electronic
health records;</text>
</clause><clause id="HED9787D7C8ED4004BA9028B3F1377F80"><enum>(ii)</enum><text>participate with
the State’s health information exchange, as available, or operate an exchange
among the birthing network;</text>
</clause><clause id="H2DC0B36657BF4E36917817C53186D0A7"><enum>(iii)</enum><text>collect
demographic information on participating newborns and mothers;</text>
</clause><clause id="H28A7B10D90034F81A6741BC21F11B2DF"><enum>(iv)</enum><text>use demographic
and event-based data to identify patients that are likely going to need short
or long-term follow-up; and</text>
</clause><clause id="H13BFAC5FEB904010A22C4741B13D6868"><enum>(v)</enum><text>providing
de-identified demographic data sets for statistical and social science research
to develop culturally-competent best practices and clinical decision support
mechanisms for maternal-fetal and neonatal
care.</text>
</clause></subparagraph></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H2E3AE727378444F7A583A23899C3B7C8"><enum>(b)</enum><header>Patient services
quality and performance reporting</header>
<paragraph id="H438B10F9D6114AD690931C4F605816E1"><enum>(1)</enum><header>In
general</header><text>Not later than 3 years after the date of the enactment of
this Act, the Secretary of Health and Human Services shall survey States that
have elected the option under section 1947 of the Social Security Act, as added
by section (a), on the nature, extent, and use of such option, particularly as
it pertains to—</text>
<subparagraph id="H9BF7B173108D43E89501872F8673FC21"><enum>(A)</enum><text>terms of
pregnancies;</text>
</subparagraph><subparagraph id="HC98D2A4CC9FC4439BC8993CB35D530B5"><enum>(B)</enum><text>use of prenatal
fetal monitoring;</text>
</subparagraph><subparagraph id="HABD68E5715DC42439F432C1376C5FF6E"><enum>(C)</enum><text>use of Caesarean
section procedures;</text>
</subparagraph><subparagraph id="H3B69BF49FBD74AC0A38D4702A59C52CD"><enum>(D)</enum><text>use of neonatal
intensive care services;</text>
</subparagraph><subparagraph id="H44AD0460CDE84805AAF1F1AD1B01EFE0"><enum>(E)</enum><text>incidence of
birthing complications;</text>
</subparagraph><subparagraph id="H4C8D5CBA71814320A91F5A64F36CED5C"><enum>(F)</enum><text>incidence of
infant and maternal mortality;</text>
</subparagraph><subparagraph id="H1FA3572227A04937B852D88777780B0B"><enum>(G)</enum><text>coordination of
maternal-fetal and neonatal care for individuals;</text>
</subparagraph><subparagraph id="H4FCA9B54577C4C878E305DD341BD77A6"><enum>(H)</enum><text>assessment of
program implementation;</text>
</subparagraph><subparagraph id="HC84DCBEBFA014F3AB4EB81C0EE6016A9"><enum>(I)</enum><text>processes and
lessons learned (as described in subparagraph (B));</text>
</subparagraph><subparagraph id="H6C42F49061DC408BA978BACABB3174FF"><enum>(J)</enum><text>assessment of
quality improvements and clinical outcomes under such option; and</text>
</subparagraph><subparagraph id="H07E04D9839F94C59B0651ABA65C635AD"><enum>(K)</enum><text>participating
mothers’ assessment of performance, quality, convenience, and
satisfaction.</text>
</subparagraph></paragraph><paragraph id="HCF30E93AA541408DA54B6AD9EF8E2BBB"><enum>(2)</enum><header>Implementation
reporting</header><text>A State that has elected the option under such section
shall report to the Secretary, as necessary, on processes that have been
developed and lessons learned regarding provision of coordinated care through a
birthing network for Medicaid beneficiaries for maternal-fetal and neonatal
care under such option.</text>
</paragraph></subsection></section>