[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2948 Introduced in House (IH)]
114th CONGRESS
1st Session
H. R. 2948
To amend title XVIII of the Social Security Act to provide for an
incremental expansion of telehealth coverage under the Medicare
program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 7, 2015
Mr. Thompson of California (for himself, Mr. Harper, Mrs. Black, 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 an
incremental 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
2015''.
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 2015, 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 2015, 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)--
(i) by striking ``or a practitioner
(described in section 1842(b)(18)(C))'' and
inserting ``or a professional described in
paragraph (4)(E))''; and
(ii) by striking ``individual physician or
practitioner'' and inserting ``individual
physician or professional''; and
(B) in paragraph (4), by--
(i) striking subparagraph (E); and
(ii) inserting after subparagraph (D) the
following new subparagraph:
``(E) Professional described.--For purposes of
paragraph (1), a professional described in this
subparagraph is--
``(i) a practitioner described in section
1842(b)(18)(C); or
``(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 2015, a certified
diabetes educator or licensed--
``(I) respiratory therapist;
``(II) audiologist;
``(III) occupational therapist;
``(IV) physical therapist; or
``(V) speech language
pathologist.''.
(4) Additional covered telehealth services.--Section
1834(m)(4)(F)(i) of the Social Security Act (42 U.S.C.
1395m(m)(4)(F)(i)) is amended by adding at the end the
following new sentence: ``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.''.
(5) Expansion of telecommunications system.--The second
sentence of section 1834(m)(1) of the Social Security Act (42
U.S.C. 1395m(m)(1)) is amended by striking ``in the case of any
Federal telemedicine demonstration program conducted in Alaska
or Hawaii,''.
(6) Rural health clinics and federally qualified health
centers authorized to be distant sites.--Section 1834(m)(4)(A)
of the Social Security Act (42 U.S.C. 1395m(m)(4)(A)) is
amended--
(A) by striking ``site.--The term'' and inserting
``site.--
``(i) In general.--The term''; and
(B) by adding at the end the following new clause:
``(ii) Treatment of rural health clinics
and federally qualified health centers.--A site
described in clause (i) includes a rural health
clinic (as defined in section 1861(aa)(2)) and
a Federally qualified health center (as defined
in section 1861(aa)(4)). In any case in which
such a clinic or center is treated as a distant
site with respect to the provision of a
telehealth service to an eligible telehealth
individual for which payment is made under this
subsection, such service shall not be treated
as a rural health clinic service or Federally
qualified health center service, respectively,
and payment may not otherwise be made under
this title with respect to such service
provided to such individual.''.
(b) Second Phase.--
(1) In general.--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:
``(III) 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 2015, 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.
``(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 2015, a home telehealth
site, as defined in subparagraph (G).
``(V) In the case of such a service
that is related to the evaluation or
treatment of an acute stroke and that
is furnished on or after the date
described in subclause (IV) during the
evidence-based window of treatment, any
site at which the eligible telehealth
individual is located at the time the
service is furnished via a
telecommunications system, regardless
of where the site is located.''; 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
service described in clause (ii) furnished to
an individual, a place of residence used as the
home of such individual.
``(ii) Services described.--A service
described in this clause is--
``(I) a telehealth service that is
related to the provision of outpatient
mental or behavioral health and shall
include the use of video conferencing;
and
``(II) a service described in
subparagraph (F)(iii) that is treated
as a telehealth service under such
subparagraph.''.
(2) Home telehealth services.--Section 1834(m)(4)(F) of the
Social Security Act (42 U.S.C. 1395m(m)(4)(F)) is amended by
adding at the end the following new clause:
``(iii) Treatment of home telehealth
services.--For purposes of subparagraph
(G)(ii)(II), beginning 2 years after the date
of the enactment of the Medicare Telehealth
Parity Act of 2015, services (including the use
of video conferencing) furnished at an
originating site that is a home telehealth site
to an individual that is related to the
provision of hospice care, home dialysis, or
home health services shall be treated as a
telehealth service under this subparagraph.''.
(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--
(A) by redesignating subclause (V) as subclause
(VI); and
(B) by inserting after clause (IV) the following
new subclause:
``(V) 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 2015, 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 2015, 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.''.
(d) Incremental Coverage of Remote Patient Monitoring Services for
Certain Chronic Health Conditions.--
(1) In general.--Section 1861(s)(2) of the Social Security
Act (42 U.S.C. 1395x(s)(2)) is amended--
(A) in subparagraph (EE), by striking ``and'' at
the end;
(B) in subparagraph (FF), by inserting ``and'' at
the end; and
(C) by inserting after subparagraph (FF) the
following new subparagraph:
``(GG) applicable remote patient monitoring services (as
defined in paragraph (1)(A) of subsection (iii));''.
(2) 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 Monitoring Services for Chronic Health
Conditions.--(1)(A) The term `applicable remote patient monitoring
services' means remote patient monitoring services (as defined in
subparagraph (B)) furnished to provide for the monitoring, evaluation,
and management of an individual with a covered chronic condition (as
defined in paragraph (2)), insofar as such services are for the
management of such chronic condition.
``(B) The term `remote patient monitoring services' means services
furnished through remote patient monitoring technology (as defined in
subparagraph (C)).
``(C) The term `remote patient monitoring technology' means a
coordinated system that uses one or more home-based or mobile
monitoring devices that automatically transmit vital sign data or
information on activities of daily living and may include 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.
``(2) For purposes of paragraph (1), the term `covered chronic
health condition' means--
``(A) in the case of applicable remote patient monitoring
services furnished on or after the date that is 6 months after
the date of the enactment of the Medicare Telehealth Parity Act
of 2015, applicable conditions (as defined in and applied under
section 1886(q)(5)), relating to heart failure and chronic
obstructive pulmonary disease and related chronic comorbidities
when under chronic care management (identified as of July 1,
2015, by HCPCS code 99490 (and as subsequently modified by the
Secretary));
``(B) in the case of applicable remote patient monitoring
services furnished on or after the date that is 2 years after
the date of the enactment of the Medicare Telehealth Parity Act
of 2015, in addition to the conditions described in
subparagraph (A), diabetes and related chronic comorbidities
when under chronic care management (identified as of July 1,
2015, by HCPCS code 99490 (and as subsequently modified by the
Secretary)); and
``(C) in the case of applicable remote patient monitoring
services furnished on or after the date that is 4 years after
the date of the enactment of the Medicare Telehealth Parity Act
of 2015, in addition to the conditions described in
subparagraph (A) and (B), such other conditions that could be
specified by the Secretary that qualify for chronic care
management and related chronic comorbidities when under chronic
care management (identified as of July 1, 2015, by HCPCS code
99490 (and as subsequently modified by the Secretary)).
``(3)(A) Payment may be made under this part for applicable remote
patient monitoring services provided to an individual during a period
of up to 90 days and such additional period as provided for under
subparagraph (B).
``(B) The 90-day period described in subparagraph (A), with respect
to an individual, may be renewed by the physician who provides chronic
care management to such individual if the individual continues to
qualify for such management.''.
(3) Payment under the physician fee schedule.--Section 1848
of the Social Security Act (42 U.S.C. 1395w-4) is amended--
(A) in subsection (c)--
(i) in paragraph (2)(B)--
(I) in clause (ii)(II), by striking
``and (v)'' and inserting ``(v), and
(vii)''; and
(II) 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 applicable remote patient monitoring
services.--
``(A) In determining relative value units for
applicable remote patient monitoring services (as
defined in section 1861(iii)(1)(A)), 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
monitoring 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 monitoring
services.''; and
(B) in subsection (j)(3), by inserting ``(2)(GG),''
after ``health risk assessment),''.
(4) Effective date.--
(A) 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 paragraph (2), have
been developed.
(B) 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 applicable remote
patient monitoring services (as defined in
paragraph (1)(A) 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) Home Dialysis Service.--
(1) In general.--Section 1881(b)(3) of the Social Security
Act (42 U.S.C. 1395rr(b)(3)) is amended--
(A) by redesignating subparagraphs (A) and (B) as
clauses (i) and (ii), respectively;
(B) in clause (ii), as redesignated by subparagraph
(A), strike ``on a comprehensive'' and insert ``subject
to subparagraph (B), on a comprehensive'';
(C) by striking ``With respect to'' and inserting
``(A) With respect to''; and
(D) by adding at the end the following new
subparagraph:
``(B) For purposes of subparagraph (A)(ii), the following
shall apply:
``(i) The monthly fee or other basis of payment
described in such subparagraph shall allow for a
patient-specific waiver process to allow a physician,
clinical nurse specialist, nurse practitioner, or
physician's assistant to request a waiver under this
title of face-to-face visit requirements for home
dialysis furnished to individuals determined to have
end stage renal disease.
``(ii) Any request under clause (i) shall include
documentation by the physician or practitioner involved
that supports active and adequate care of such
individual receiving home dialysis.
``(iii) Any patient-specific waiver under clause
(i) that is granted shall remain effective until such
date that the Secretary, including through contractor
under this title, requests that additional information
or a new waiver application be filed.
``(iv) All individuals determined to have end stage
renal disease receiving home dialysis shall receive a
face-to-face examination at least once every three
consecutive months and, in the intervening months,
shall receive a monthly clinical assessment which may
be furnished, if the patient so chooses, via remote
monitoring by a physician, clinical nurse specialist,
nurse practitioner, or physician's assistant.''.
(2) Conforming amendment.--Section 1881(b)(1) of such Act
(42 U.S.C. 1395rr(b)(1)) is amended by striking ``paragraph
(3)(A)'' and inserting ``paragraph (3)(A)(i)''.
(3) Effective date.--The amendments made by this subsection
shall apply with respect to the monthly fee or other basis of
payment for home dialysis services furnished on or after
January 1, 2016.
(f) Appropriate Valuation of Remote Diagnostic Test Services.--
Section 1848(c)(2) of the Social Security Act (42 U.S.C. 1395w-4(c)(2))
is amended by adding at the end the following new subparagraph:
``(P) Adjustments for remote diagnostic tests.--In
determining practice expense relative value units for
diagnostic tests described in section 1861(s)(3) that
are provided remotely, the Secretary shall, in
consultation with suppliers of remote diagnostic
testing services, include in direct costs of supplies
and equipment, the costs of the diagnostic device,
clinical systems (including hardware and software),
information transmission, and device delivery and
installation. For purposes of this subsection,
diagnostic tests described in section 1861(s)(3) that
are provided remotely are such tests that are provided
through the utilization of a system of technology that
allows a remote interface to collect and transmit
clinical data between the individual and a supplier.
This subsection shall be implemented in a budget
neutral manner.''.
(g) Study and Report; Sense of Congress.--
(1) 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
subsection (a)(4), between practitioners
described in subparagraph (E)(ii) of section
1834(m)(4) of the Social Security Act (42
U.S.C. 1395m(m)(4)), as inserted by subsection
(a)(3)(B)(ii), and patients, including with
respect to patient satisfaction, provider
responsiveness to patient needs and concerns,
and the extent to which such telehealth
services are at least comparable to face-to-
face encounters.
(ii) The savings to the Medicare program
under title XVIII of such Act associated with
telehealth services utilization for therapy for
the additional telehealth services described in
such sentence.
(iii) The potential for greater use of
telehealth services for forms of additional
telehealth services not described in such
sentence.
(B) Report.--Not later than two years after the
date of the enactment of this Act, the Comptroller
General shall submit to Congress a report on the
findings of the study conducted under subparagraph (A).
(2) Sense of congress.--It is the sense of Congress that
the telehealth expansion efforts initiated by the studies and
reports on the use of telehealth and remote patient monitoring
services under the Medicare Access and CHIP Reauthorization Act
of 2015 are continued and furthered through the incremental
expansion of telehealth and remote patient monitoring services
under this Act.
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