Medicare Telehealth Parity Act of 2014 - Amends title XVIII (Medicare) of the Social Security Act with regard to payment for telehealth services to include in the term "originating site" additional sites, including any federally qualified health center and any rural health clinic, at which the eligible telehealth individual is located at the time the service is furnished via a telecommunications system.
Prohibits application of the originating site facility fee to the additional sites.
Authorizes additional telehealth providers, including a certified diabetes educator or licensed respiratory therapist, audiologist, occupational therapist, physical therapist, or speech language pathologist.
Extends Medicare coverage to remote patient management services for certain chronic health conditions.
Directs the Comptroller General (GAO) to study the effectiveness of remote patient monitoring on decreasing hospital readmissions for specified chronic conditions, and the savings to the Medicare program associated with use of such monitoring.
Authorizes home telehealth sites as additional originating sites.
Directs GAO to study the effectiveness of using described telehealth services between therapy providers and patients, any associated savings, and the potential for greater use of telehealth services for other forms of therapy
Authorizes the Secretary of Health and Human Services (HHS) to develop and implement payment methods to apply in the case of anyone who would be an eligible telehealth individual except that the telehealth services are furnished at a site other than an originating site.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5380 Introduced in House (IH)]
113th CONGRESS
2d Session
H. R. 5380
To amend title XVIII of the Social Security Act to provide for a
phased-in expansion of telehealth coverage under the Medicare program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 31, 2014
Mr. Thompson of California (for himself, Mr. Harper, and Mr. Welch)
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 a
phased-in 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
2014''.
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 2014, 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 2014, 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), by striking ``or a
practitioner (described in section 1842(b)(18)(C))''
and inserting ``or a practitioner (as defined in
paragraph (4)(E))''; and
(B) in paragraph (4), by--
(i) striking subparagraph (E); and
(ii) inserting after subparagraph (D) the
following new subparagraph:
``(E) Practitioner.--The term `practitioner'
means--
``(i) a practitioner described in section
1842(b)(18)(C); and
``(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 2014, a certified
diabetes educator or licensed--
``(I) respiratory therapist;
``(II) audiologist;
``(III) occupational therapist;
``(IV) physical therapist; or
``(V) speech language
pathologist.''.
(4) Coverage of remote patient management services for
certain chronic health conditions.--
(A) In general.--Section 1861(s)(2) of the Social
Security Act (42 U.S.C. 1395x(s)(2)) is amended--
(i) in subparagraph (EE), by striking
``and'' at the end;
(ii) in subparagraph (FF), by inserting
``and'' at the end; and
(iii) by inserting after subparagraph (FF)
the following new subparagraph:
``(GG) remote patient management services (as defined in
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 Management Services for Chronic Health
Conditions.--(1) The term `remote patient management services' means
the remote monitoring, evaluation, and management of an individual with
a covered chronic health condition (as defined in paragraph (2)),
insofar as such monitoring, evaluation, and management is with respect
to such condition, 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 (as defined in
subsection (r)) or practitioner or other supplier (as defined in
subsection (d)) for the purposes of clinical review. Such services
shall include in-home technology based professional consultations,
patient monitoring, patient training services, clinical observation,
assessment, treatment, and any other services that utilize technologies
specified by the Secretary. Such term shall not include a
telecommunication that consists solely of a telephone audio
conversation, facsimile, or electronic text mail between a health care
professional and patient.
``(2) For purposes of paragraph (1), the term `covered chronic
health condition' means--
``(A) congestive heart failure;
``(B) chronic obstructive pulmonary disease; and
``(C) in the case of services furnished at a federally
qualified health center, diabetes.
``(3)(A) The Secretary, in consultation with appropriate physician,
practitioner, and supplier groups, shall 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 shall do the following:
``(i) Not later than 2 years after the date of the
enactment of this subsection, develop, in consultation with
appropriate physician, practitioner, and supplier groups,
standards (governing such matters as qualifications of
personnel and the maintenance of equipment) for remote patient
management services for the covered chronic health conditions
specified in paragraph (2).
``(ii) Periodically review and update such 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--
(i) in subsection (c)--
(I) in paragraph (2)((B)--
(aa) in clause (ii)(II), by
striking ``and (v)'' and
inserting ``(v), and (vii)'';
and
(bb) 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 remote patient management services.--
``(A) In determining relative value units for
remote patient management services (as defined in
section 1861(iii)), 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
management 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 management
services.''; and
(ii) in subsection (j)(3), by inserting
``(2)(GG),'' after ``health risk
assessment),''.
(D) Effective date.--
(i) 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 subparagraph
(B), have been developed.
(ii) 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
remote patient management services (as
defined in paragraph (1) 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) GAO study and report.--
(i) Study.--The Comptroller General of the
United States shall conduct a study that
includes, at a minimum, the following:
(I) The effectiveness of remote
patient monitoring on decreasing
hospital readmissions for the chronic
conditions described in subsection
(iii)(2) of section 1861 of the Social
Security Act (42 U.S.C. 1395x), as
added by subparagraph (A).
(II) The savings to the Medicare
program under title XVIII of such Act
associated with remote patient
monitoring use with respect to such
chronic conditions.
(III) The potential for greater use
of remote patient monitoring for other
chronic conditions.
(IV) Potential implications of
greater use of remote patient
monitoring with respect to payment and
delivery system transformations under
the Medicare program under such title.
(ii) Report.--Not later than 2 years after
the date of the enactment of this Act, the
Comptroller General shall submit to Congress a
report containing the results of the study
conducted under clause (i).
(5) Expansion of telecommunications system.--The second
sentence of section 1834(m)(1) of the Social Security Act (42
U.S.C. 1835m(m)(1)) is amended by striking ``in the case of any
Federal telemedicine demonstration program conducted in Alaska
or Hawaii,''.
(b) Second Phase.--
(1) Further expansion of originating sites.--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:
``(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 2014, 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.
``(V) 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 2014, a home telehealth site, as
defined in subparagraph (G).''; 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
telehealth service described in clause (ii)
furnished to an individual, in a place of
residence used as the home of such individual.
``(ii) Telehealth services described.--A
telehealth service described in this clause--
``(I) is a telehealth service that
is related to the provision of hospice
care, home dialysis, home health
services, or durable medical equipment;
and
``(II) shall include the use of
video conferencing.''.
(2) Additional covered telehealth services.--Section
1834(m)(4)(F)(i) of the Social Security Act (42 U.S.C.
139m(m)(4)(F)(i)) is amended by adding at the end the following
new sentence: ``Beginning on the date that is 2 years after the
date of the enactment of the Medicare Telehealth Parity Act of
2014, 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.''
(3) GAO 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
paragraph (2), between therapy providers and
patients.
(ii) The savings to the Medicare program
under title XVIII of such Act associated with
telehealth services utilization for therapy for
such services described in such sentence.
(iii) The potential for greater use of
telehealth services for forms of therapy not
described in such sentence.
(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 by adding at the end the
following new subclause:
``(VI) 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 2014, 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 2014, 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.''.
<all>
Introduced in House
Introduced in House
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.
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.
Referred to the Subcommittee on Health.
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