[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 596 Introduced in Senate (IS)]

113th CONGRESS
  1st Session
                                 S. 596

   To establish pilot projects under the Medicare program to provide 
     incentives for home health agencies to furnish remote patient 
    monitoring services that reduce expenditures under such program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 18, 2013

Mr. Thune (for himself and Mr. Franken) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
   To establish pilot projects under the Medicare program to provide 
     incentives for home health agencies to furnish remote patient 
    monitoring services that reduce expenditures under such program.

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

SECTION 1. SHORT TITLE; FINDINGS.

    (a) Short Title.--This Act may be cited as the ``Fostering 
Independence Through Technology Act of 2013''.
    (b) Findings.--Congress makes the following findings:
            (1) Allowing seniors to remain in their homes longer can 
        delay unnecessary, costly transfers to higher acuity care 
        settings.
            (2) Remote patient monitoring provides opportunities to 
        control chronic conditions and research shows that 
        approximately 66 percent of total health care spending is 
        associated with care for the over one-in-four Americans with 
        multiple chronic conditions.
            (3) Current remote patient monitoring programs report 
        patient satisfaction rates of over 90 percent.
            (4) Due to changes enacted by Congress, hospitals are 
        facing payment penalties for patients that are readmitted to 
        the hospital within 30 days of discharge.
            (5) Current remote patient monitoring programs that use 
        technology to monitor discharged patients in non-invasive ways 
        have experienced a reduction in hospital readmissions.

SEC. 2. REMOTE PATIENT MONITORING AND SUPPORT PILOT PROJECTS.

    (a) Pilot Projects.--
            (1) In general.--Not later than 9 months after the date of 
        the enactment of this Act, the Secretary of Health and Human 
        Services (in this section referred to as the ``Secretary'') 
        shall conduct pilot projects under title XVIII of the Social 
        Security Act for the purpose of providing incentives to home 
        health agencies to furnish remote patient monitoring services 
        that reduce expenditures under such title.
            (2) Site requirements.--
                    (A) Urban and rural.--The Secretary shall conduct 
                the pilot projects under this section in both urban and 
                rural areas.
                    (B) Site in a small state.--The Secretary shall 
                conduct at least 1 of the pilot projects in a State 
                with a population of less than 1,000,000.
            (3) Definitions.--In this section:
                    (A) Home health agency.--The term ``home health 
                agency'' has the meaning given that term in section 
                1861(o) of the Social Security Act (42 U.S.C. 
                1395x(o)).
                    (B) Remote patient monitoring services.--
                            (i) In general.--The term ``remote patient 
                        monitoring services'' means services furnished 
                        in the home using remote patient monitoring 
                        technology, including in-home technology based 
                        professional consultations, patient monitoring, 
                        patient training services, clinical 
                        observation, assessment, treatment, and any 
                        additional services that utilize technologies 
                        specified by the Secretary.
                            (ii) Limitation.--The term ``remote patient 
                        monitoring services'' shall not include a 
                        telecommunication that consists solely of a 
                        telephone audio conversation, facsimile, or 
                        electronic text mail between a health care 
                        professional and a patient.
                    (C) Remote patient monitoring technology.--The term 
                ``remote patient monitoring technology'' means a 
                coordinated system that uses one or more home-based or 
                mobile monitoring devices that are accessed by a 
                patient and automatically transmit clinical data and 
                responses to assessment questions collected on the 
                devices wirelessly or through a telecommunications 
                connection to a server that complies with the Federal 
                regulations (concerning the privacy of individually 
                identifiable health information) promulgated under 
                section 264(c) of the Health Insurance Portability and 
                Accountability Act of 1996, as part of an established 
                plan of care for that patient that includes the review 
                and interpretation of that data by a health care 
                professional.
    (b) Medicare Beneficiaries Within the Scope of Projects.--
            (1) In general.--The Secretary shall specify the criteria 
        for identifying those Medicare beneficiaries who shall be 
        considered within the scope of the pilot projects under this 
        section for purposes of the application of subsection (c) and 
        for the assessment of the effectiveness of the home health 
        agency in achieving the objectives of this section.
            (2) The criteria specified under paragraph (1)--
                    (A) shall include conditions and clinical 
                circumstances, including congestive heart failure, 
                diabetes, and chronic pulmonary obstructive disease, 
                and other conditions determined appropriate by the 
                Secretary; and
                    (B) may provide for the inclusion in the projects 
                of Medicare beneficiaries who begin receiving home 
                health services under title XVIII of the Social 
                Security Act after the date of the implementation of 
                the projects.
    (c) Incentives.--
            (1) Performance targets.--The Secretary shall establish for 
        each home health agency participating in a pilot project under 
        this section a performance target using one of the following 
        methodologies, as determined appropriate by the Secretary:
                    (A) Adjusted historical performance target.--The 
                Secretary shall establish for the agency--
                            (i) a base expenditure amount equal to the 
                        average total payments made under parts A, B, 
                        and D of title XVIII of the Social Security Act 
                        for Medicare beneficiaries determined to be 
                        within the scope of the pilot project in a base 
                        period determined by the Secretary; and
                            (ii) an annual per capita expenditure 
                        target for such beneficiaries, reflecting the 
                        base expenditure amount adjusted for risk, 
                        changes in costs, and growth rates.
                    (B) Comparative performance target.--The Secretary 
                shall establish for the agency a comparative 
                performance target equal to the average total payments 
                under such parts A, B, and D during the pilot project 
                for comparable individuals in the same geographic area 
                that are not determined to be within the scope of the 
                pilot project.
            (2) Payment.--Subject to paragraph (3), the Secretary shall 
        pay to each participating home care agency a payment for each 
        year under the pilot project equal to a 75 percent share of the 
        total Medicare cost savings realized for such year relative to 
        the performance target under paragraph (1).
            (3) Limitation on expenditures.--The Secretary shall limit 
        payments under this section in order to ensure that the 
        aggregate expenditures under title XVIII of the Social Security 
        Act (including payments under this subsection) do not exceed 
        the amount that the Secretary estimates would have been 
        expended if the pilot projects under this section had not been 
        implemented, including any reasonable costs incurred by the 
        Secretary in the administration of the pilot projects.
            (4) No duplication in participation in shared savings 
        programs.--A home health agency that participates in any of the 
        following shall not be eligible to participate in the pilot 
        project under this section:
                    (A) A model tested or expanded under section 1115A 
                that involves shared savings under this title or any 
                other program or demonstration project that involves 
                such shared savings.
                    (B) The independence at home medical practice pilot 
                program under section 1866E.
    (d) Waiver Authority.--The Secretary may waive such provisions of 
titles XI and XVIII of the Social Security Act as the Secretary 
determines to be appropriate for the conduct of the pilot projects 
under this section.
    (e) Report to Congress.--Not later than 3 years after the date that 
the first pilot project under this section is implemented, the 
Secretary shall submit to Congress a report on the projects. Such 
report shall contain--
            (1) a detailed description of the projects, including any 
        changes in clinical outcomes for Medicare beneficiaries under 
        the projects, Medicare beneficiary satisfaction under the 
        projects, utilization of items and services under Medicare 
        parts A, B, and D by Medicare beneficiaries under the projects, 
        and Medicare per-beneficiary and Medicare aggregate spending 
        under the projects;
            (2) a detailed description of issues related to the 
        expansion of the projects under subsection (f);
            (3) recommendations for such legislation and administrative 
        actions as the Secretary considers appropriate; and
            (4) other items considered appropriate by the Secretary.
    (f) Expansion.--If the Secretary determines that any of the pilot 
projects under this section enhance health outcomes for Medicare 
beneficiaries and reduce expenditures under title XVIII of the Social 
Security Act, the Secretary shall initiate comparable projects in 
additional areas.
    (g) Payments Have No Effect on Other Medicare Payments to 
Agencies.--A payment under this section shall have no effect on the 
amount of payments that a home health agency would otherwise receive 
under title XVIII of the Social Security Act for the provision of home 
health services.
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