[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 787 Introduced in Senate (IS)]
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115th CONGRESS
1st Session
S. 787
To require the Center for Medicare and Medicaid Innovation to test the
effect of including telehealth services in Medicare health care
delivery reform models.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 30, 2017
Mr. Gardner (for himself and Mr. Peters) introduced the following bill;
which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To require the Center for Medicare and Medicaid Innovation to test the
effect of including telehealth services in Medicare health care
delivery reform models.
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 ``Telehealth Innovation and
Improvement Act of 2017''.
SEC. 2. CMI TESTING OF COVERAGE OF EXPANDED TELEHEALTH SERVICES.
(a) In General.--Section 1115A of the Social Security Act (42
U.S.C. 1315a) is amended--
(1) in subsection (b)(2)--
(A) in subparagraph (A), by adding at the end the
following new sentence: ``The models selected under
this subparagraph shall include the model described in
subparagraph (D), which shall be implemented by not
later than January 1, 2018.''; and
(B) by adding at the end the following new
subparagraph:
``(D) Telehealth services in delivery reform
models.--The model described in this subparagraph is a
model that meets the requirements of subsection (h)
with respect to coverage of, and payment for, expanded
telehealth services, which shall include remote
monitoring services, furnished in conjunction with
models that test the use of accountable care
organizations under title XVIII, bundled payments under
such title, and such other coordinated care models
under such title as the Secretary determines to be
appropriate.'';
(2) in subsection (b)(4), by striking ``Evaluation.--'' and
inserting ``Evaluation.--Subject to subsection (h)(6):''; and
(3) by adding at the end the following new subsection:
``(h) Medicare Coverage of Expanded Telehealth Services Under
Accountable Care Organization Models, Bundled Payment Models, and Other
Appropriate Models Tested by the Secretary.--
``(1) Establishment of telehealth service models.--
``(A) In general.--Subject to the succeeding
provisions of this subsection, for the 5-year period
that begins on January 1, 2018, the Secretary shall
test coverage of, and payment for, expanded telehealth
services (as defined in paragraph (2)) furnished to
applicable individuals who are Medicare beneficiaries
(as defined in paragraph (3)(B)) in conjunction with
models tested under subsection (b), and expanded under
subsection (c) (if applicable), that test the use of
accountable care organizations under title XVIII,
bundled payments under such title, and such other
coordinated care models under such title as the
Secretary determines to be appropriate.
``(B) Model design considerations.--In establishing
models to be tested for enhanced telehealth services
under subsection (b)(2)(D), the Secretary shall design
such models in a manner to permit comparisons of
Medicare beneficiaries who are participating in models
under subsection (b) that include access to expanded
telehealth services with Medicare beneficiaries in
models under subsection (b) who do not have access to
such services.
``(2) Expanded telehealth services defined.--
``(A) In general.--Subject to subparagraphs (B) and
(C), in this subsection, the term `expanded telehealth
services' means services furnished by an eligible
physician or practitioner to a Medicare beneficiary as
part of an episode of care for one or more of the
conditions specified under paragraph (4) through one or
more of the following:
``(i) Remote monitoring technologies,
including remote device management for purposes
of remotely interrogating or programming a
medical device (such as a pacemaker or a
cardiac resynchronization therapy device)
outside the office of the physician specialist
involved.
``(ii) Bi-directional audio/video
technologies.
``(iii) Physiologic and behavioral
monitoring technologies.
``(iv) Engagement prompt technologies.
``(v) Store and forward technologies.
``(vi) Point-of-care testing technologies.
``(vii) Such other technologies as the
Secretary may specify.
``(B) Inclusion of medicare telehealth services;
non-application of certain restrictions.--
``(i) Inclusion of medicare telehealth
services.--The term `expanded telehealth
services' shall include a telehealth service,
as defined in section 1834(m)(4)(F), without
regard to the limitations specified under
section 1834(m)(4).
``(ii) Rule of construction.--Nothing in
this section shall be construed as imposing a
requirement on the furnishing of expanded
telehealth services that such services be
furnished in real time through interactive
audio or video telecommunications systems
between the eligible physician or practitioner
and the Medicare beneficiary.
``(iii) No limitations on geographic areas
or location of patient.--The term `expanded
telehealth services' shall include services
furnished (as described in subparagraph (A))
without regard to the location of the Medicare
beneficiary at the time the telehealth service
is furnished and without regard to the area in
which the Medicare beneficiary resides.
``(C) Requirements.--The term `expanded telehealth
services' shall not include a service furnished (as
described in subparagraph (A)) unless it can be
demonstrated that the service, when furnished as an
expanded telehealth service, is likely to do one or
more of the following:
``(i) The service assists eligible
physicians or practitioners to coordinate care
for patients.
``(ii) The service enhances collaboration
among providers of services and suppliers,
including eligible physicians and
practitioners, in the provision of care to
patients.
``(iii) The service improves quality of
care furnished to patients.
``(iv) The service results in reduced
hospital admissions and readmissions.
``(v) The service reduces or substitutes
for physician office visits.
``(vi) The service results in reduced
utilization of skilled nursing facility
services.
``(vii) The service facilitates the return
of patients to the community more quickly than
would otherwise occur in the absence of the
service.
``(3) Additional definitions.--In this subsection:
``(A) Eligible physician or practitioner.--The term
`eligible physician or practitioner' means--
``(i) a physician (as defined in section
1861(r)); and
``(ii) a practitioner (as defined in
section 1842(b)(18)(C)).
``(B) Medicare beneficiary.--The term `Medicare
beneficiary' means an individual who is entitled to
benefits under part A or enrolled under part B of title
XVIII who is not enrolled in a Medicare Advantage plan
under part C of such title, an eligible organization
under section 1876, or a PACE program under section
1894.
``(4) Conditions.--For purposes of paragraph (2)(A), the
conditions with respect to which a coverage of an expanded
telehealth service is furnished under this subsection shall
include the following conditions or diseases: chronic
hypertension, ischemic heart diseases, chronic obstructive
pulmonary disease, heart failure, heart attack, osteoarthritis,
diabetes, chronic kidney disease, depression, atrial
fibrillation, cancer, asthma, stroke, total hip replacement
procedures, total knee replacement procedures, Parkinson's
disease, and such other conditions or diseases with respect to
which the Secretary determines that expanded telehealth
services would satisfy one or more of the requirements of
clauses (i) through (vii) of paragraph (2)(C).
``(5) Payment.--
``(A) In general.--Subject to subparagraph (B),
with respect to expanded telehealth services furnished
under a model tested under subsection (b) and expanded
under subsection (c) (if applicable), the Secretary
shall establish payment amounts under this subsection
for such services. The Secretary may use one or more of
the following payment methodologies for expanded
telehealth services:
``(i) Medicare fee schedule.--Fee schedules
established under title XVIII for telehealth
services and remote monitoring services.
``(ii) New fee schedule.--A new fee
schedule that the Secretary establishes for
expanded telehealth services covered by reason
of this subsection.
``(iii) Payment amounts based on shared
risk.--A payment methodology for shared savings
and losses that is designed to ensure savings
with respect to expanded telehealth services
covered under the model.
``(B) Consideration of certain costs.--In
determining the amount of payment for an expanded
telehealth service under the payment methodologies
referred to in subparagraph (A), the Secretary shall
take into account costs incurred by eligible physicians
and practitioners--
``(i) for the acquisition and
implementation information systems necessary to
furnish such services, including costs of
equipment and requisite software;
``(ii) for non-physician clinical personnel
in conjunction with such service; and
``(iii) for physician interpretation of
clinical data through the expanded telehealth
service as well as for the supervision or
oversight of the system for such service.
``(6) Evaluation of models.--
``(A) Use of independent entity.--In lieu of the
evaluations conducted by the Secretary under subsection
(b)(4) for models tested under subsection (b), the
Secretary shall provide for evaluations of enhanced
telehealth service models under subsection (b)(2)(D) by
an independent entity. Such evaluation shall be
conducted with respect to the specific enhanced
telehealth service and condition or conditions involved
that are tested under such models.
``(B) Timing of evaluation.--An evaluation of such
enhanced telehealth service and condition or conditions
involved conducted by the independent entity under this
paragraph shall begin three years after the
implementation of the model that provides for coverage
of and payment for the expanded telehealth service with
respect to such condition.
``(C) Criteria.--An evaluation of such enhanced
telehealth service models conducted by the independent
entity under this paragraph shall include an analysis
of--
``(i) the quality of care furnished under
the model, including the measurement of
patient-level outcomes and patient-centeredness
criteria determined appropriate by the
Secretary;
``(ii) the changes in spending under parts
A and B of title XVIII by reason of the model,
taking into account costs and savings under
such parts across the continuum of care for the
episode of care and condition or conditions
involved; and
``(iii) any impediments that were
encountered under the model, such as--
``(I) explicit telehealth
restrictions under Federal or State
laws that are not related to health
care reimbursement, such as scope of
practice limitations;
``(II) licensing or credentialing
barriers; and
``(III) limited broadband access or
limited health information technology
capabilities.
``(D) Information.--The provisions of subsection
(b)(4)(B) shall apply to evaluations conducted under
this paragraph in the same manner as such provisions
apply to evaluations conducted under subsection (b)(4).
``(7) Application of expanded telehealth services to all
cmi models.--The Secretary shall expand the application of an
enhanced telehealth service with respect to the condition or
conditions involved to all models tested under subsection (b),
and expanded under subsection (c) (if applicable), that apply
with respect to services furnished under title XVIII to provide
for coverage of, and payment for, such enhanced telehealth
service or services with respect to such condition or
conditions under all such models for years beginning after the
5-year period described in paragraph (1)(A) if--
``(A) the independent evaluation conducted under
paragraph (6) with respect to such models demonstrates
that such enhanced telehealth service or services with
respect to the condition or conditions involved
resulted in--
``(i) reduced spending under parts A and B
of title XVIII without reducing the quality of
care; or
``(ii) improved quality of patient care
without increasing such spending; and
``(B) the Chief Actuary of the Centers for Medicare
& Medicaid Services certifies that such expansion would
reduce net program spending under parts A and B of
title XVIII.''.
(b) Coverage of and Payment for Certain Enhanced Telehealth
Services That Are Certified as Providing Savings Under the Medicare
Program.--
(1) Coverage.--Section 1834 of the Social Security Act (42
U.S.C. 1395m) is amended by adding at the end the following new
subsection:
``(v) Certified Enhanced Telehealth Services.--
``(1) In general.--The Secretary shall pay for certified
enhanced telehealth services (as defined in paragraph (2)(A))
furnished by a physician (as defined in section 1861(r)) or a
practitioner (as defined in section 1842(b)(18)(C)) to a
Medicare fee-for-service beneficiary (as defined in paragraph
(2)(B)) for one or more of the conditions specified under
section 1115A(h)(4) in an amount determined under paragraph (3)
without regard to--
``(A) the location of the Medicare fee-for-service
beneficiary at the time the certified enhanced
telehealth service is furnished; and
``(B) the area in which the Medicare fee-for-
service beneficiary resides.
``(2) Definitions.--In this subsection:
``(A) Certified enhanced telehealth service.--The
term `certified enhanced telehealth service' means,
with respect to a condition or conditions specified
under section 115A(h)(4), an enhanced telehealth
service (as defined in section 1115A(h)(2)) with
respect to which--
``(i) an independent evaluation conducted
under section 1115A(h)(6) demonstrates that the
service tested under a model under section
1115A(b)(2)(D) with respect to the condition or
conditions resulted in--
``(I) reduced spending under parts
A and B without reducing the quality of
care; or
``(II) improved quality of patient
care without increasing such spending;
and
``(ii) the Chief Actuary of the Centers for
Medicare & Medicaid Services certifies that
such expansion would reduce net program
spending under such parts.
``(B) Medicare fee-for-service beneficiary.--The
term `Medicare fee-for-service beneficiary' has the
meaning given such term in section 1899(h)(3).
``(3) Payment amount.--The amount of payment for certified
enhanced telehealth services shall be determined in the same
manner as payments for enhanced telehealth services are
determined under section 1115A(h)(5).''.
(2) Payment.--Section 1833(a)(1) of the Social Security Act
(42 U.S.C. 1395l(a)(1)) is amended by striking ``and'' before
``(BB)'' and inserting before the semicolon at the end the
following: ``, and (CC) with respect to certified enhanced
telehealth services (as defined in section 1834(v)(2)(A)), the
amount paid shall be an amount equal to 80 percent of the
lesser of the actual charge for the services or the amount
determined under section 1834(v)(3)''.
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