[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2291 Introduced in House (IH)]

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115th CONGRESS
  1st Session
                                H. R. 2291

To amend title XVIII of the Social Security Act to expand the coverage 
of telehealth services under the Medicare program, to provide coverage 
  for home-based monitoring for congestive heart failure and chronic 
    obstructive pulmonary disease under such program, and for other 
                               purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 2, 2017

  Mr. Duffy 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 expand the coverage 
of telehealth services under the Medicare program, to provide coverage 
  for home-based monitoring for congestive heart failure and chronic 
    obstructive pulmonary disease under such program, and for other 
                               purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Helping Expand Access to Rural 
Telemedicine Act of 2017'' or as the ``HEART Act of 2017''.

SEC. 2. EXPANSIONS OF COVERAGE OF TELEHEALTH SERVICES.

    (a) Counties in MSAs With Populations Less Than 70,000 
Individuals.--Section 1834(m)(4)(C) of the Social Security Act (42 
U.S.C. 1395m(m)(4)(C)(i)) is amended in clause (i)(II) by inserting 
``both a county that has a population of greater than 70,000 
individuals, according to the most recent decennial census, and a 
county that is'' before ``included in a Metropolitan Statistical 
Area''.
    (b) Critical Access and Sole Community Hospitals.--Section 
1834(m)(4)(C) of the Social Security Act (42 U.S.C. 1395m(m)(4)(C)), as 
amended by subsection (a), is further amended--
            (1) in clause (i), by inserting ``, in the case that such 
        site is not a site described in subclause (II) or (IX) of such 
        clause,'' after ``via a telecommunications system and''; and
            (2) in clause (ii), by adding at the end the following new 
        subclause:
                                    ``(IX) A sole community hospital 
                                (as defined in section 
                                1886(d)(5)(D)(iii)).''.
    (c) Store-and-Forward Technologies.--Section 1834(m)(1) of the 
Social Security Act (42 U.S.C. 1395m(m)(1)) is amended by inserting 
``any telehealth services that are furnished from a distant site, or to 
an originating site, that is a critical access hospital (as described 
in paragraph subclause (II) of paragraph (4)(C)(ii)), a rural health 
clinic (as described in subclause (III) of such paragraph), or a sole 
community hospital (as described in subclause (IX) of such paragraph), 
or of'' after ``in the case of''.
    (d) Rural Health Clinics as Distant Sites.--Section 1834(m)(4)(A) 
of the Social Security Act (42 U.S.C. 1395m(m)(4)(A)) is amended--
            (1) by striking ``site.--The term'' and inserting:
                    ``Site.--
                            ``(i) In general.--The term''; and
            (2) by adding at the end the following new clause:
                            ``(ii) Treatment of rural health clinics.--
                        A site described in clause (i) includes a rural 
                        health clinic (as defined in section 
                        1861(aa)(2)). In any case in which such a 
                        clinic 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, and payment 
                        may not otherwise be made under this title with 
                        respect to such service provided to such 
                        individual.''.
    (e) Covered Services.--Section 1834(m)(4)(F)(i) of the Social 
Security Act (42 U.S.C. 1395m(m)(4)(F)(i)) is amended--
            (1) by striking ``and office'' and inserting ``office''; 
        and
            (2) by inserting by adding at the end the following new 
        sentence: ``respiratory services, audiology services (as 
        defined in section 1861(ll)), outpatient therapy services 
        (including physical therapy, occupational therapy, and speech-
        language pathology services)'' after ``the Secretary)),''.
    (f) Providers.--Subsection (m) of section 1834 of such Act (42 
U.S.C. 1395m) is amended--
            (1) in paragraph (1), by striking ``or a practitioner 
        (described in section 1842(b)(18)(C))'' and inserting ``, a 
        practitioner (described in section 1842(b)(18)(C)), or an 
        applicable professional (as defined in paragraph (4)(G))'';
            (2) by striking ``physician or practitioner'' each time it 
        appears in such subsection and inserting ``physician, 
        practitioner, or applicable professional'';
            (3) in paragraph (3)(A)--
                    (A) in the heading, by striking ``Physician and 
                practitioner'' and inserting ``Physician, practitioner, 
                and applicable professional''; and
                    (B) by striking ``physicians or practitioners'' and 
                inserting ``physicians, suppliers, or practitioners''; 
                and
            (4) in paragraph (4), by adding at the end the following 
        new subparagraph:
                    ``(G) Applicable professional.--The term 
                `applicable professional' means, with respect to 
                services furnished on or after the date that is 6 
                months after the date of the enactment of this 
                subparagraph, a certified diabetes educator or 
                licensed--
                            ``(i) respiratory therapist;
                            ``(ii) audiologist;
                            ``(iii) occupational therapist;
                            ``(iv) physical therapist; or
                            ``(v) speech language pathologist.''.

SEC. 3. HOME-BASED MONITORING SERVICES FOR CONGESTIVE HEART FAILURE AND 
              CHRONIC OBSTRUCTIVE PULMONARY DISEASE.

    (a) 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));''.
    (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 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 applicable conditions (as defined in and 
applied under section 1886(q)(5)) 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.''.
    (c) Payment Under the Physician Fee Schedule.--Section 1848 of the 
Social Security Act (42 U.S.C. 1395w-4) is amended--
            (1) in subsection (c)--
                    (A) 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
                    (B) 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
            (2) in subsection (j)(3), by inserting ``(2)(GG),'' after 
        ``health risk assessment),''.

SEC. 4. EFFECTIVE DATE.

    The amendments made by this Act shall apply to items or services 
furnished on or after the date that is 6 months after the date of the 
enactment of the this Act.
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