[Congressional Record Volume 151, Number 152 (Wednesday, November 16, 2005)]
[Senate]
[Pages S12955-S12956]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. COLEMAN (for himself and Mr. Bingaman):
  S. 2022. A bill to amend title XVIII of the Social Security Act to 
provide for coverage of remote patient management services for chronic 
health care conditions under the Medicare program; to the Committee on 
Finance.
  Mr. COLEMAN. Mr. President, constituents across the country in rural 
areas face serious health care issues, not only in terms of illness but 
also in lack of easily accessible services. One out of every five 
Americans lives in rural areas however only one out of every ten 
physicians practice in rural areas. Forty percent of our rural 
population lives in a medically underserved area. With access to care 
an average of thirty miles away, rural areas have much to gain from the 
ability to access healthcare information at a distance. We depend on 
our farmers and ranchers--they are the lifeblood of America and take 
care of the essentials in our lives such as feeding us and clothing us. 
We should make sure to take care of them as well.
  Today, I am proud to be joined by my friend, Senator Bingaman in 
introducing the Remote Monitoring Access Act of 2005 to overcome the 
barriers to more rapid diffusion of innovative new technologies that 
will improve quality and access to care for Medicare beneficiaries, by 
implementing changes in Medicare fee-for-service reimbursements. Our 
legislation would create a new benefit category for remote patient 
management services in the Medicare physician fee schedule. Under this 
category, Medicare would cover physician services involved with the 
remote management of specific medical conditions.
  New technology that collects, analyzes, and transmits clinical health 
information is in development or has recently been introduced to the 
market. The promise of this remote management technology is clear: 
better information on the patient's condition--collected and stored 
electronically, analyzed for clinical value, and transmitted to the 
physician or the patient--should improve patient care and access.
  Remote monitoring technology is also emerging to extend the provision 
of health care services to areas where there is a shortage of 
physicians. This technology allows physicians to monitor and treat 
patients without a face-to-face office visit, thereby increasing access 
to physicians for patients living in rural areas.
  In its March 2001 report, ``Crossing the Quality Chasm,'' the 
Institute of Medicine stated that the automation of clinical and other 
health transactions was an essential factor for improving quality, 
preventing errors, enhancing consumer confidence in the health care 
system, and improving efficiency, yet ``health care delivery has been 
relatively untouched by the revolution in information technology that 
has been transforming nearly every other aspect of society.''
  Three major areas in which remote management technologies are 
emerging in health care are the treatment of congestive heart failure 
(CHF), diabetes and cardiac arrhythmia.
  Despite these innovations and their ability to improve care, many new 
clinical information and remote management technologies have failed to 
diffuse rapidly. A significant barrier to wider adoption and evolution 
of the technologies is the relative lack of payment mechanisms in fee-
for-service Medicare to reimburse for remote, non-face-to-face 
management and disease management services provided by a physician.
  Under existing Medicare fee schedules, physicians generally receive a 
fixed, predetermined amount for a given service. The cost of devices 
used or supplied in the service is usually bundled into the payment, 
and payments are primarily provided for face-to-face interactions 
between the physician and patient. The payment structure creates at 
least two problems for the wider adoption of patient management 
approaches using remote management technology.
  To overcome the barriers to more rapid diffusion of innovative new 
technology for Medicare beneficiaries, changes in Medicare fee-for-
service reimbursements are necessary. This legislation would create a 
new benefit category for remote patient management services in the 
Medicare physician fee schedule. Under this category, Medicare would 
cover physician services involved with the remote management of 
specific medical conditions.
  The quality of care provided through remote management would allow 
physicians to qualify for bonus payments conditioned on specific 
quality measures. This legislation directs the Secretary, through the 
Agency for Health Care Research and Quality (AHRQ) to develop standards 
of care and quality standards for the remote management services 
provided for each medical condition covered. AHRQ would develop these 
standards working in conjunction with appropriate physician groups. The 
Secretary is also given the authority to develop guidelines on the 
frequency of billing for remote patient management services.
  I urge my fellow colleagues to join me in ensuring rural Americans 
have the access to remote monitoring and the opportunity to keep pace 
with health technology by supporting the Remote Monitoring Access Act 
of 2005.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2022

       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 ``Remote Monitoring Access Act 
     of 2005''.

     SEC. 2. COVERAGE OF REMOTE PATIENT MANAGEMENT SERVICES FOR 
                   CHRONIC HEALTH CARE CONDITIONS.

       (a) In General.--Section 1861(s)(2) of the Social Security 
     Act (42 U.S.C. 1395x(s)(2)) is amended--
       (1) in subparagraph (Y), by striking ``and'' at the end;
       (2) in subparagraph (Z), by inserting ``and'' at the end; 
     and
       (3) by inserting after subparagraph (Z) the following new 
     subparagraph:
       ``(AA) remote patient management services (as defined in 
     subsection (bbb));''.
       (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:

                  ``Remote Patient Management Services

       ``(bbb)(1) The term `remote patient management services' 
     means the remote monitoring and management of an individual

[[Page S12956]]

     with a covered chronic health condition (as defined in 
     paragraph (2)) through the utilization of a system of 
     technology that allows a remote interface to collect and 
     transmit clinical data between the individual and the 
     responsible physician or supplier for the purposes of 
     clinical review or response by the physician or supplier.
       ``(2) For purposes of paragraph (1), the term `covered 
     chronic health condition' includes--
       ``(A) heart failure;
       ``(B) diabetes;
       ``(C) cardiac arrhythmia; and
       ``(D) any other chronic condition determined by the 
     Secretary to be appropriate for treatment through remote 
     patient management services.
       ``(3)(A) The Secretary, in consultation with appropriate 
     physician groups, may develop guidelines on the frequency of 
     billing for remote patient management services. Such 
     guidelines shall be determined based on medical necessity and 
     shall be sufficient to ensure appropriate and timely 
     monitoring of individuals being furnished such services.
       ``(B) The Secretary, acting through the Agency for Health 
     Care Research and Quality, shall do the following:
       ``(i) Not later than 1 year after the date of enactment of 
     the Remote Monitoring Access Act of 2005, develop, in 
     consultation with appropriate physician groups, a standard of 
     care and quality standards for remote patient management 
     services for the covered chronic health conditions specified 
     in subparagraphs (A), (B), and (C) of paragraph (2).
       ``(ii) If the Secretary makes a determination under 
     paragraph (2)(D) with respect to a chronic condition, 
     develop, in consultation with appropriate physician groups, a 
     standard of care and quality standards for remote patient 
     management services for such condition within 1 year of such 
     determination.
       ``(iii) Periodically review and update such standards of 
     care and quality standards under this subparagraph as 
     necessary.''.
       (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)(2)--
       (A) in subparagraph (B)--
       (i) in clause (ii)(II), by striking ``clause (iv)'' and 
     inserting ``clauses (iv) and (v)''; and
       (ii) by adding at the end the following new clause:
       ``(v) Budgetary treatment of certain services.--The 
     additional expenditures attributable to services described in 
     section 1861(s)(2)(AA) shall not be taken into account in 
     applying clause (ii)(II) for 2006.''; and
       (B) by adding at the end the following new paragraph:
       ``(7) Treatment of remote patient management services.--In 
     determining relative value units for remote patient 
     management services (as defined in section 1861(bbb)), the 
     Secretary, in consultation with appropriate physician groups, 
     shall take into consideration--
       ``(A) costs associated with such services, including 
     physician time involved, installation and information 
     transmittal costs, costs of remote patient management 
     technology (including devices and software), 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
       ``(B) 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 amount of time necessary for, and 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.''; and
       (2) in subsection (j)(3), by inserting ``(2)(AA),'' after 
     ``(2)(W),''.
       (d) Incentive Payments.--Section 1833 of the Social 
     Security Act (42 U.S.C. 1395l) is amended by adding at the 
     end the following new subsection:
       ``(v) Incentive for Meeting Certain Standards of Care and 
     Quality Standards in the Furnishing of Remote Patient 
     Management Services.--In the case of remote patient 
     management services (as defined in section 1861(bbb)) that 
     are furnished by a physician who the Secretary determines 
     meets or exceeds the standards of care and quality standards 
     developed by the Secretary under paragraph (3)(B) of such 
     section for such services, in addition to the amount of 
     payment that would otherwise be made for such services under 
     this part, there shall also be paid to the physician (or to 
     an employer or facility in cases described in clause (A) of 
     section 1842(b)(6)) (on a monthly or quarterly basis) from 
     the Federal Supplementary Medical Insurance Trust Fund an 
     amount equal to 10 percent of the payment amount for the 
     service under this part.''.
       (e) Effective Date.--The amendments made by this section 
     shall apply to services furnished on or after January 1, 
     2006.
                                 ______