[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2550 Introduced in House (IH)]

<DOC>






115th CONGRESS
  1st Session
                                H. R. 2550

   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

                              May 19, 2017

Mr. Thompson of California (for himself, Mrs. Black, Mr. Welch, and Mr. 
   Harper) 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 
2017''.

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 2017, 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 2017, 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 2017, 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 2017, 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 2017, 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 2017, 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 2017, 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 2017, 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 (FF), by striking ``and'' at 
                the end;
                    (B) in subparagraph (GG), by inserting ``and'' at 
                the end; and
                    (C) by inserting after subparagraph (GG) the 
                following new subparagraph:
            ``(HH) 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 2017, 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 2017, 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 2017, 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)(HH),'' 
                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, 2018.
    (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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