[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5380 Introduced in House (IH)]

113th CONGRESS
  2d Session
                                H. R. 5380

   To amend title XVIII of the Social Security Act to provide for a 
 phased-in expansion of telehealth coverage under the Medicare program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 31, 2014

  Mr. Thompson of California (for himself, Mr. Harper, and Mr. Welch) 
 introduced the following bill; which was referred to the Committee on 
   Energy and Commerce, and in addition to the Committee on Ways and 
 Means, for a period to be subsequently determined by the Speaker, in 
   each case for consideration of such provisions as fall within the 
                jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
   To amend title XVIII of the Social Security Act to provide for a 
 phased-in expansion of telehealth coverage under the Medicare program.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Telehealth Parity Act of 
2014''.

SEC. 2. PHASED-IN EXPANSION OF TELEHEALTH COVERAGE UNDER MEDICARE.

    (a) Initial Phase.--
            (1) Expansion of originating sites.--Section 1834(m)(4)(C) 
        of the Social Security Act (42 U.S.C. 1395m(m)(4)(C)) is 
        amended--
                    (A) in clause (i), by striking ``The term'' and 
                inserting ``Subject to clause (iii), the term''; and
                    (B) by adding at the end the following new clause:
                            ``(iii) Additional sites.--The term 
                        `originating site' shall also include the 
                        following sites at which the eligible 
                        telehealth individual is located at the time 
                        the service is furnished via a 
                        telecommunications system, whether or not they 
                        are located in an area described in clause (i), 
                        insofar as such sites are not otherwise 
                        included in the definition of originating site 
                        under such clause:
                                    ``(I) In the case of such a service 
                                furnished on or after the date that is 
                                6 months after the date of the 
                                enactment of the Medicare Telehealth 
                                Parity Act of 2014, any Federally 
                                qualified health center and any rural 
                                health clinic (as such terms are 
                                defined in section 1861(aa)).
                                    ``(II) In the case of such a 
                                service furnished on or after the date 
                                that is 6 months after the date of the 
                                enactment of the Medicare Telehealth 
                                Parity Act of 2014, any site described 
                                in clause (ii) that is located in a 
                                county within a Metropolitan 
                                Statistical Area with a population of 
                                fewer than 50,000 individuals, 
                                according to the most recent decennial 
                                census.''.
            (2) Originating site fee not to apply to additional 
        sites.--Section 1834(m)(2)(B) of such Act (42 U.S.C. 
        1395m(m)(4)(C)) is amended by inserting after and below clause 
        (ii) the following:
                ``The facility fee under this subparagraph shall not 
                apply to any site included as an originating site 
                pursuant to clause (iii) of paragraph (4)(C) that would 
                not otherwise be included as an originating site 
                without application of such clause.''.
            (3) Additional telehealth providers.--Section 1834(m) of 
        such Act (42 U.S.C. 1395m(m)) is amended--
                    (A) in paragraph (1), by striking ``or a 
                practitioner (described in section 1842(b)(18)(C))'' 
                and inserting ``or a practitioner (as defined in 
                paragraph (4)(E))''; and
                    (B) in paragraph (4), by--
                            (i) striking subparagraph (E); and
                            (ii) inserting after subparagraph (D) the 
                        following new subparagraph:
                    ``(E) Practitioner.--The term `practitioner' 
                means--
                            ``(i) a practitioner described in section 
                        1842(b)(18)(C); and
                            ``(ii) with respect to services furnished 
                        on or after the date that is 6 months after the 
                        date of the enactment of the Medicare 
                        Telehealth Parity Act of 2014, a certified 
                        diabetes educator or licensed--
                                    ``(I) respiratory therapist;
                                    ``(II) audiologist;
                                    ``(III) occupational therapist;
                                    ``(IV) physical therapist; or
                                    ``(V) speech language 
                                pathologist.''.
            (4) Coverage of remote patient management services for 
        certain chronic health conditions.--
                    (A) In general.--Section 1861(s)(2) of the Social 
                Security Act (42 U.S.C. 1395x(s)(2)) is amended--
                            (i) in subparagraph (EE), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (FF), by inserting 
                        ``and'' at the end; and
                            (iii) by inserting after subparagraph (FF) 
                        the following new subparagraph:
            ``(GG) remote patient management services (as defined in 
        subsection (iii));''.
                    (B) Services described.--Section 1861 of the Social 
                Security Act (42 U.S.C. 1395x) is amended by adding at 
                the end the following new subsection:
    ``(iii) Remote Patient Management Services for Chronic Health 
Conditions.--(1) The term `remote patient management services' means 
the remote monitoring, evaluation, and management of an individual with 
a covered chronic health condition (as defined in paragraph (2)), 
insofar as such monitoring, evaluation, and management is with respect 
to such condition, through the utilization of a system of technology 
that allows a remote interface to collect and transmit clinical data 
between the individual and the responsible physician (as defined in 
subsection (r)) or practitioner or other supplier (as defined in 
subsection (d)) for the purposes of clinical review. Such services 
shall include in-home technology based professional consultations, 
patient monitoring, patient training services, clinical observation, 
assessment, treatment, and any other services that utilize technologies 
specified by the Secretary. Such term shall not include a 
telecommunication that consists solely of a telephone audio 
conversation, facsimile, or electronic text mail between a health care 
professional and patient.
    ``(2) For purposes of paragraph (1), the term `covered chronic 
health condition' means--
            ``(A) congestive heart failure;
            ``(B) chronic obstructive pulmonary disease; and
            ``(C) in the case of services furnished at a federally 
        qualified health center, diabetes.
    ``(3)(A) The Secretary, in consultation with appropriate physician, 
practitioner, and supplier groups, shall develop guidelines on the 
frequency of billing for remote patient management services. Such 
guidelines shall be determined based on medical necessity and shall be 
sufficient to ensure appropriate and timely monitoring of individuals 
being furnished such services.
    ``(B) The Secretary shall do the following:
            ``(i) Not later than 2 years after the date of the 
        enactment of this subsection, develop, in consultation with 
        appropriate physician, practitioner, and supplier groups, 
        standards (governing such matters as qualifications of 
        personnel and the maintenance of equipment) for remote patient 
        management services for the covered chronic health conditions 
        specified in paragraph (2).
            ``(ii) Periodically review and update such standards under 
        this subparagraph as necessary.''.
                    (C) Payment under the physician fee schedule.--
                Section 1848 of the Social Security Act (42 U.S.C. 
                1395w-4) is amended--
                            (i) in subsection (c)--
                                    (I) in paragraph (2)((B)--
                                            (aa) in clause (ii)(II), by 
                                        striking ``and (v)'' and 
                                        inserting ``(v), and (vii)''; 
                                        and
                                            (bb) by adding at the end 
                                        the following new clause:
                            ``(vii) Budgetary treatment of certain 
                        services.--The additional expenditures 
                        attributable to services described in section 
                        1861(s)(2)(GG) shall not be taken into account 
                        in applying clause (ii)(II).''; and
                                    (II) by adding at the end the 
                                following new paragraph:
            ``(7) Treatment of remote patient management services.--
                    ``(A) In determining relative value units for 
                remote patient management services (as defined in 
                section 1861(iii)), the Secretary, in consultation with 
                appropriate physician groups, practitioner groups, and 
                supplier groups, shall take into consideration--
                            ``(i) physician or practitioner resources, 
                        including physician or practitioner time and 
                        the level of intensity of services provided, 
                        based on--
                                    ``(I) the frequency of evaluation 
                                necessary to manage the individual 
                                being furnished the services;
                                    ``(II) the complexity of the 
                                evaluation, including the information 
                                that must be obtained, reviewed, and 
                                analyzed; and
                                    ``(III) the number of possible 
                                diagnoses and the number of management 
                                options that must be considered;
                            ``(ii) practice expense costs associated 
                        with such services, including the direct costs 
                        associated with installation and information 
                        transmission, costs of remote patient 
                        management technology (including equipment and 
                        software), device delivery costs, and resource 
                        costs necessary for patient monitoring and 
                        follow-up (but not including costs of any 
                        related item or non-physician service otherwise 
                        reimbursed under this title); and
                            ``(iii) malpractice expense resources.
                    ``(B) Using the relative value units determined in 
                subparagraph (A), the Secretary shall provide for 
                separate payment for such services and shall not adjust 
                the relative value units assigned to other services 
                that might otherwise have been determined to include 
                such separately paid remote patient management 
                services.''; and
                            (ii) in subsection (j)(3), by inserting 
                        ``(2)(GG),'' after ``health risk 
                        assessment),''.
                    (D) Effective date.--
                            (i) In general.--The amendments made by 
                        this subsection shall apply to services 
                        furnished on or after the date that is 6 months 
                        after the date of the enactment of this Act, 
                        without regard to whether the guidelines under 
                        paragraph (3)(A) or the standards under 
                        paragraph (3)(B) of section 1861(iii) of the 
                        Social Security Act, as added by subparagraph 
                        (B), have been developed.
                            (ii) Availability of codes as of date of 
                        enactment.--The Secretary of Health and Human 
                        Services shall--
                                    (I) promptly evaluate existing 
                                codes that would be used to bill for 
                                remote patient management services (as 
                                defined in paragraph (1) of such 
                                section 1861(iii), as so added) under 
                                title XVIII of the Social Security Act; 
                                and
                                    (II) if the Secretary determines 
                                that new codes are necessary to ensure 
                                accurate reporting and billing of such 
                                services under such title, issue such 
                                codes so that they are available for 
                                use as of the date of the enactment of 
                                this Act.
                    (E) GAO study and report.--
                            (i) Study.--The Comptroller General of the 
                        United States shall conduct a study that 
                        includes, at a minimum, the following:
                                    (I) The effectiveness of remote 
                                patient monitoring on decreasing 
                                hospital readmissions for the chronic 
                                conditions described in subsection 
                                (iii)(2) of section 1861 of the Social 
                                Security Act (42 U.S.C. 1395x), as 
                                added by subparagraph (A).
                                    (II) The savings to the Medicare 
                                program under title XVIII of such Act 
                                associated with remote patient 
                                monitoring use with respect to such 
                                chronic conditions.
                                    (III) The potential for greater use 
                                of remote patient monitoring for other 
                                chronic conditions.
                                    (IV) Potential implications of 
                                greater use of remote patient 
                                monitoring with respect to payment and 
                                delivery system transformations under 
                                the Medicare program under such title.
                            (ii) Report.--Not later than 2 years after 
                        the date of the enactment of this Act, the 
                        Comptroller General shall submit to Congress a 
                        report containing the results of the study 
                        conducted under clause (i).
            (5) 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,''.
    (b) Second Phase.--
            (1) Further expansion of originating sites.--Section 
        1834(m)(4) of the Social Security Act (42 U.S.C. 1395m(m)(4)) 
        is amended--
                    (A) in clause (iii) of subparagraph (C), as added 
                by subsection (a)(1), by adding at the end the 
                following new subclauses:
                                    ``(IV) In the case of such a 
                                service furnished on or after the date 
                                that is 2 years after the date of the 
                                enactment of the Medicare Telehealth 
                                Parity Act of 2014, any site described 
                                in clause (ii) that is located in a 
                                county within a Metropolitan 
                                Statistical Area with a population of 
                                at least 50,000 individuals but fewer 
                                than 100,000 individuals, according to 
                                the most recent decennial census.
                                    ``(V) In the case of such a service 
                                furnished on or after the date that is 
                                2 years after the date of the enactment 
                                of the Medicare Telehealth Parity Act 
                                of 2014, a home telehealth site, as 
                                defined in subparagraph (G).''; and
                    (B) by adding at the end the following new 
                subparagraph:
                    ``(G) Home telehealth site.--
                            ``(i) In general.--The term `home 
                        telehealth site' means, with respect to a 
                        telehealth service described in clause (ii) 
                        furnished to an individual, in a place of 
                        residence used as the home of such individual.
                            ``(ii) Telehealth services described.--A 
                        telehealth service described in this clause--
                                    ``(I) is a telehealth service that 
                                is related to the provision of hospice 
                                care, home dialysis, home health 
                                services, or durable medical equipment; 
                                and
                                    ``(II) shall include the use of 
                                video conferencing.''.
            (2) Additional covered telehealth services.--Section 
        1834(m)(4)(F)(i) of the Social Security Act (42 U.S.C. 
        139m(m)(4)(F)(i)) is amended by adding at the end the following 
        new sentence: ``Beginning on the date that is 2 years after the 
        date of the enactment of the Medicare Telehealth Parity Act of 
        2014, such term shall include respiratory services, audiology 
        services (as defined in section 1861(ll)), and outpatient 
        therapy services, including physical therapy, occupational 
        therapy, and speech-language pathology services.''
            (3) GAO study and report.--
                    (A) Study.--The Comptroller General of the United 
                States shall conduct a study that includes, at a 
                minimum, the following:
                            (i) The effectiveness of using telehealth 
                        services described in the second sentence of 
                        section 1834(m)(4)(F)(i) of the Social Security 
                        Act (42 U.S.C. 1395m(m)(4)(F)(i)), as added by 
                        paragraph (2), between therapy providers and 
                        patients.
                            (ii) The savings to the Medicare program 
                        under title XVIII of such Act associated with 
                        telehealth services utilization for therapy for 
                        such services described in such sentence.
                            (iii) The potential for greater use of 
                        telehealth services for forms of therapy not 
                        described in such sentence.
    (c) Final Phase.--
            (1) Further expansion of originating sites.--Clause (iii) 
        of section 1834(m)(4)(C) of the Social Security Act (42 U.S.C. 
        1395m(m)(4)), as added by subsection (a)(1) and amended by 
        subsection (b)(1), is further amended by adding at the end the 
        following new subclause:
                                    ``(VI) In the case of such a 
                                service furnished on or after the date 
                                that is 4 years after the date of the 
                                enactment of the Medicare Telehealth 
                                Parity Act of 2014, any site described 
                                in clause (ii) that is located in a 
                                county within a Metropolitan 
                                Statistical Area with a population of 
                                at least 100,000 individuals, according 
                                to the most recent decennial census.''.
            (2) Payment methods for other patient sites.--Section 
        1834(m)(2) of the Social Security Act (42 U.S.C. 1395m(m)(2)) 
        is amended by adding at the end the following new subparagraph:
                    ``(D) Payment methods for other patient sites.--
                With respect to services furnished on or after the date 
                that is 4 years after the date of the enactment of the 
                Medicare Telehealth Parity Act of 2014, 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 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.''.
                                 <all>