[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5394 Introduced in House (IH)]

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118th CONGRESS
  1st Session
                                H. R. 5394

 To ensure appropriate access to remote monitoring services furnished 
                      under the Medicare program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 12, 2023

 Mr. Balderson (for himself, Ms. Porter, Mr. Dunn of Florida, and Mr. 
   Murphy) 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 ensure appropriate access to remote monitoring services furnished 
                      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 ``Expanding Remote Monitoring Access 
Act''.

SEC. 2. FINDINGS.

    The Congress finds the following:
            (1) Remote monitoring is an option that can help patients 
        manage their health conditions from their homes with oversight 
        from their health care providers, which can improve patient 
        health outcomes, reduce long-term health costs, and increase 
        care options for patients.
            (2) The Department of Veterans Affairs (VA) saw such 
        results in a 2019 report. Veterans enrolled in remote patient 
        monitoring had a 53 percent decrease in VA bed days of care and 
        a 33 percent decrease in VA hospital admissions.
            (3) Providers are currently required by Medicare to collect 
        16 days of patient data over a 30-day period in order to bill 
        Medicare for remote monitoring services, even in cases where 
        this full duration is not medically necessary to ensure the 
        health and safety of the patient. This can limit the use of 
        remote monitoring in instances where it can promote patient 
        health and safety and where it can reduce the overall cost on 
        the health system.
            (4) In the 2021 Physician Fee Schedule, the Centers for 
        Medicare and Medicaid Services (CMS) issued an interim policy 
        to lower the duration required by Medicare to bill for remote 
        monitoring services from 16 days to 2 days within a 30-day 
        period, but only for individuals who had been diagnosed with, 
        or were suspected of having, COVID-19. This short-term 
        flexibility called attention to the long-term need to reassess 
        the minimum duration required for providers to bill for remote 
        monitoring.
            (5) As part of issuing the 2021 Physician Fee Schedule, CMS 
        studied comments in support of permanently lowering the minimum 
        required duration of remote monitoring for all patients, not 
        just those with COVID-19.
            (6) CMS concluded that ``we agree that a full 16 days of 
        monitoring may not always be reasonable and necessary'' but did 
        not revise the 16 day per 30-day period minimum duration for 
        all patients because CMS did not believe they had received 
        ``specific clinical examples'' to allow for ``understanding 
        under what clinical circumstances fewer days of monitoring 
        would be medically reasonable and necessary and allow a 
        practitioner to establish clinically meaningful care''.
            (7) Clinical evidence shows numerous instances in which 
        fewer than sixteen days of monitoring within a 30-day period 
        establishes clinically meaningful care. These include:
                    (A) Sixteen days of monitoring per 30-day period 
                may not be required to establish that a patient has 
                sleep apnea.
                    (B) A patient prescribed a narcotic for pain may 
                require their breathing to be monitored only while on 
                the medication.
                    (C) A patient with a chronic condition like 
                diabetes, congestive heart failure, or obesity may have 
                their weight monitored over a longer period of time, 
                but it is not clinically appropriate to have such 
                patient step on a scale 16 or more times in each 30-day 
                period.
                    (D) A patient whose blood pressure or oxygen levels 
                are monitored during physical therapy may not 
                necessitate 16 days of monitoring in each 30-day period 
                given physical therapy is often ordered twice weekly.
                    (E) A patient who wears a heart monitor to measure 
                palpitations may wear the monitor continuously, but the 
                data only needs to be collected when the individual is 
                experiencing symptoms.
                    (F) A patient with hypertension is often monitored 
                for long-term management of this condition on more of a 
                weekly basis, only needing more frequent data 
                collection for active monitoring with changes in 
                medication or dosages.
                    (G) A patient who suffers from Muscular Sclerosis 
                or Muscular Dystrophy may benefit from a provider 
                tracking the patient's exercise between visits to 
                monitor certain physiologic parameters such as muscle 
                movement but may not produce 16 days of data in a 30-
                day period.
                    (H) A patient who needs a total joint replacement 
                may simply need pre-testing for surgery baselines, 
                including to establish gait, force, activity, heart 
                rate and other factors and then compare pre-surgery and 
                post-surgery function.
                    (I) For a patient with urologic dysfunction, male 
                urine flow data obtained from the patient can be 
                collected in two to four consecutive days.
                    (J) Remote monitoring may allow a provider to 
                assess a patient's adherence, range of motion, and 
                response to physical therapy and occupational therapy 
                regimens even though many such regimens are less than 
                16 days per month.
                    (K) Monitoring cognitive behavioral therapy for 
                less than 16 days in a 30-day period may provide 
                clinically meaningful care while moderating a patient's 
                anxiety and other symptoms.
                    (L) A patient with respiratory issues may not 
                require a full 16 days of monitoring of inhaler usage 
                to get clinical benefits from remote monitoring.
            (8) A two-day minimum duration would permit Medicare 
        coverage of the full range of remote monitoring services that 
        can be beneficial to a patient without precluding the 
        differential reimbursement of individual remote monitoring 
        services based on patient acuity and cost.

SEC. 3. ENSURING APPROPRIATE ACCESS TO REMOTE MONITORING SERVICES 
              FURNISHED UNDER THE MEDICARE PROGRAM.

    (a) In General.--Notwithstanding any other provision of law, the 
Secretary of Health and Human Services (in this section referred to as 
the ``Secretary'') shall ensure that remote monitoring services 
furnished under title XVIII of the Social Security Act (42 U.S.C. 1395 
et seq.) during the period beginning on the date of the enactment of 
this Act and ending on the date that is 2 years after such date of 
enactment are payable for a minimum of 2 days of data collection over a 
30-day period, regardless of whether the individual receiving such 
services has been diagnosed with, or is suspected of having, COVID-19.
    (b) Report.--
            (1) In general.--Not later than 1 year after the date of 
        the enactment of this Act, the Secretary shall, after 
        consulting with entities specified in paragraph (2), submit to 
        Congress a report that includes the following:
                    (A) A summary and analysis of previous experience 
                with such remote monitoring services being payable 
                under such title for a minimum of 2 days of data 
                collection over a 30-day period.
                    (B) Recommendations for implementing a 
                reimbursement model that takes into account patient 
                acuity and cost of providing remote monitoring 
                services, including potentially creating differential 
                reimbursements for periods with different durations, 
                such as fewer than and more than 16 days.
                    (C) An analysis and justification for the 
                appropriate place of service and supervision 
                requirements for non-clinical staff reviewing and 
                escalating patient data and provide recommendations.
                    (D) An analysis of the estimated savings resulting 
                from earlier interventions and fewer days of 
                hospitalizations among patients furnished remote 
                monitoring services.
            (2) Specified entities.--For purposes of paragraph (1), the 
        entities specified in this paragraph are the following:
                    (A) Relevant agencies within the Department of 
                Health and Human Services (including, with respect to 
                issues relating to waste, fraud, or abuse, the 
                Inspector General of such Department).
                    (B) The Department of Veterans Affairs (including 
                the Office of Connected Care of such Department).
                    (C) Licensed and practicing osteopathic and 
                allopathic physicians, anesthesiologists, physician 
                assistants, and nurse practitioners.
                    (D) Hospitals, health systems, academic medical 
                centers, and other medical facilities, such as acute 
                care hospitals, cancer hospitals, psychiatric 
                hospitals, hospital emergency departments, facilities 
                furnishing urgent care services, ambulatory surgical 
                centers, Federally qualified health centers, rural 
                health clinics, and post-acute care and long-term care 
                facilities.
                    (E) Medical professional organizations and medical 
                specialty organizations.
                    (F) Organizations with expertise in the development 
                of or operation of innovative remote physiologic 
                monitoring services technologies.
                    (G) Beneficiary advocacy organizations.
                    (H) The American Medical Association Current 
                Procedural Terminology Editorial Panel.
                    (I) Commercial payers.
                    (J) Any other entity determined appropriate by the 
                Secretary.
    (c) Definitions.--In this section:
            (1) Remote monitoring.--The term ``remote monitoring'' 
        means remote physiologic monitoring and remote therapeutic 
        monitoring.
            (2) Remote physiologic monitoring.--The term ``remote 
        physiologic monitoring'' means non-face-to-face monitoring and 
        analysis of physiologic factors used to understand a patient's 
        health status, including the collection and analysis of patient 
        physiologic data that are used to develop and manage a 
        treatment plan related to chronic or acute conditions.
            (3) Remote therapeutic monitoring.--The term ``remote 
        therapeutic monitoring'' means the use of medical devices to 
        monitor a patient's health or response to treatment using non-
        physiological data.
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