What This Bill Does
This bill creates a test program (called the VBID demonstration program) that allows certain Medicare patients to get medical tests and telehealth consultations at home. The bill also gives grants to some states to offer these same services through Medicaid, and creates a pilot program for veterans to access home tests and telehealth services through the Department of Veterans Affairs.
##
Who It Affects
* Medicare beneficiaries who are age 65 or older, receive certain subsidies, or qualify as dual eligible individuals
* States that receive grants to expand Medicaid coverage
* Veterans enrolled in the Department of Veterans Affairs patient system
* Medicare Advantage organizations (insurance companies that serve Medicare patients)
* Physicians and healthcare practitioners who order tests and provide telehealth consultations
##
Key Provisions
* The federal government will set up a demonstration program limited to no more than 25 Medicare Advantage insurance plans (with at least 10 serving rural or underserved areas) that covers at-home tests for conditions like COVID-19, cancer screening, diabetes, and other diseases, as well as telehealth consultations to assess and order these tests (Sec. 2(a))
* The bill covers specific at-home medical tests including diagnostic tests for influenza, COVID-19 serology tests, cancer screenings, allergy tests, and other tests identified by the federal government as appropriate for home use (Sec. 2(a))
* States can apply for grants (up to 10 states or territories) to provide these same tests and telehealth consultations to people covered by Medicaid state programs, with each grant lasting four years and not exceeding twelve million dollars (Sec. 2(b))
* The Department of Veterans Affairs will select at least five facilities (with at least three serving veterans in rural areas) to provide eligible veterans with at-home tests and telehealth consultations at no cost to the veteran (Sec. 3(a))
* The federal government will evaluate whether the Medicare program improves patient care, reduces hospitalizations, delays nursing facility admissions, and addresses disparities for underserved populations (Sec. 2(a))
##
What Changes
If this bill becomes law, Medicare Advantage insurance plans participating in the program will be required to cover certain at-home diagnostic tests and telehealth consultations that they do not currently cover. Eligible Medicare patients will be able to get these tests and consultations without requiring the doctor ordering the test to be in the same location. Some states will receive federal funding to offer similar services through Medicaid. Veterans will gain access to at-home tests and telehealth services through the Department of Veterans Affairs at no cost to them.
##
Important Definitions
* **Assistive telehealth consultation**: A telehealth service that includes evaluation and management, assessment of whether a home test is necessary, ordering a test, assessment after a test, help collecting images or data for a test, referral for in-person care, or review of test results (Sec. 2(a))
* **Eligible Medicare beneficiary**: Medicare beneficiaries who are age 65 or older and receive certain subsidies, or people who qualify as dual eligible individuals or qualified Medicare beneficiaries and receive Medicaid assistance (Sec. 2(a))
* **Eligible MA plan**: An insurance plan offered by Medicare Advantage organizations that covers the specified at-home tests, telehealth consultations, and other services like fitness benefits, meal benefits, transportation, and equipment (Sec. 2(a))
* **Medical device**: Not specified in bill text
##
Effective Date
The Medicare demonstration program must be implemented no later than January 1 of the second year after the bill is enacted (Sec. 2(a)). States must apply for grants within one year of the bill's enactment (Sec. 2(b)). The Department of Veterans Affairs must establish the veteran pilot program within 180 days of the bill's enactment (Sec. 3(a)).
I
118TH CONGRESS
1ST SESSION
H. R. 207
To amend title XVIII of the Social Security Act to provide coverage and
payment for certain tests and assistive telehealth consultations, and for
other purposes.
IN THE HOUSE OF REPRESENTATIVES
JANUARY 9, 2023
Mr. SCHWEIKERT introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees
on Ways and Means, and Veterans’ Affairs, for a period to be subse-
quently 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
coverage and payment for certain tests and assistive
telehealth consultations, and for other purposes.
Be it enacted by the Senate and House of Representa-
1
tives of the United States of America in Congress assembled,
2
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
3
(a) SHORT TITLE.—This Act may be cited as the
4
‘‘Advanced Safe Testing at Residence Telehealth Act of
5
2023’’.
6
(b) TABLE OF CONTENTS.—The table of contents is
7
as follows:
8
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Sec. 1. Short title.
Sec. 2. Coverage and payment for certain tests and assistive telehealth con-
sultations; demonstration program under certain State Med-
icaid programs.
‘‘Sec. 1859A. Tests and assistive telehealth consultations demonstration.
Sec. 3. Pilot program on improved access to certain tests and assistive tele-
health consultations for veterans.
SEC. 2. COVERAGE AND PAYMENT FOR CERTAIN TESTS
1
AND
ASSISTIVE
TELEHEALTH
CONSULTA-
2
TIONS; DEMONSTRATION PROGRAM UNDER
3
CERTAIN STATE MEDICAID PROGRAMS.
4
(a) TESTS AND ASSISTIVE TELEHEALTH CONSULTA-
5
TIONS DEMONSTRATION.—Part C of title XVIII of the So-
6
cial Security Act is amended by inserting after section
7
1859 (42 U.S.C. 1395w–28) the following new subsection:
8
‘‘SEC. 1859A. TESTS AND ASSISTIVE TELEHEALTH CON-
9
SULTATIONS DEMONSTRATION.
10
‘‘(a) ESTABLISHMENT.—
11
‘‘(1) IN GENERAL.—The Secretary shall estab-
12
lish a Value-Based Insurance Design Model dem-
13
onstration program (in this section referred to as
14
the ‘VBID demonstration program’) to provide to el-
15
igible Medicare beneficiaries—
16
‘‘(A) an assistive telehealth consultation
17
that is furnished via a telecommunications sys-
18
tem by a physician or practitioner to an eligible
19
telehealth individual enrolled under part B not-
20
withstanding that the individual physician or
21
practitioner ordering the test did not furnish
22
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•HR 207 IH
the test or that the individual physician or
1
practitioner providing the assistive telehealth
2
consultation is not at the same location as the
3
beneficiary; and
4
‘‘(B) home and community-based care.
5
‘‘(2) AGREEMENTS.—The Secretary shall enter
6
into agreements with eligible MA organizations
7
under which such organizations shall offer eligible
8
MA plans under the VBID demonstration program
9
to eligible Medicare beneficiaries.
10
‘‘(3) LIMITATIONS ON NUMBER OF PLANS FOR
11
VBID DEMONSTRATION PROGRAM.—The VBID dem-
12
onstration program shall be carried out with respect
13
to not greater than 25 MA plans, with a minimum
14
of 10 MA plans that serve rural or underserved
15
areas.
16
‘‘(4) ELIGIBLE MA PLANS DEFINED.—For pur-
17
poses of this section, the term ‘eligible MA plan’
18
means a plan that, in addition to items and services
19
for which coverage is otherwise provided under this
20
part (including benefits under section 1852(a)(3)
21
and notwithstanding any waivers under section
22
1915(c)), provides for coverage of—
23
‘‘(A) tests that are medical devices (as de-
24
fined in section 201(h) of the Federal Food,
25
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•HR 207 IH
Drug, and Cosmetic Act or wearable patient
1
monitoring device, including adaptive artificial
2
intelligence, machine learning, and software as
3
a medical device (SaMD) technologies that op-
4
erate to the full scope of medical purpose de-
5
fined by the Administrator of the Food and
6
Drug Administration) and are identified by the
7
Secretary as having appropriate at home use
8
that is approved under section 505 of the Fed-
9
eral Food, Drug, and Cosmetic Act, and are ei-
10
ther—
11
‘‘(i) a diagnostic test or screening for
12
the diagnosis of influenza or a similar res-
13
piratory condition that is required to ob-
14
tain a final diagnosis of COVID–19 for an
15
individual when such test is ordered by a
16
physician or practitioner in conjunction
17
with a COVID–19 diagnostic test or
18
screening for purposes of discounting a di-
19
agnosis of influenza or a related diagnosis
20
for such individual;
21
‘‘(ii) a serology test for COVID–19;
22
‘‘(iii) a diagnostic test or screening for
23
the diagnosis of prostate cancer, ovarian
24
cancer, breast cancer, hypothyroidism,
25
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rheumatoid arthritis, celiac disease, vas-
1
cular inflammation, cardiovascular health,
2
strep throat, or lipoprotein (A);
3
‘‘(iv) a haptoglobin genetic test;
4
‘‘(v)
a
prediabetes
and
diabetes
5
screening;
6
‘‘(vi) an IgE allergy test;
7
‘‘(vii) a screening or diagnostic cap-
8
sule endoscopy; or
9
‘‘(viii) any other test identified by the
10
Secretary, including those proposed by the
11
MA organization, as having appropriate for
12
at-home use that is approved under section
13
505 of the Federal Food, Drug, and Cos-
14
metic Act;
15
‘‘(B) assistive telehealth consultations;
16
‘‘(C) telehealth services;
17
‘‘(D) fitness benefits;
18
‘‘(E) meal benefits (beyond limited basis);
19
‘‘(F) transportation services;
20
‘‘(G) safety and other equipment not oth-
21
erwise covered under this title; and
22
‘‘(H) care in rural or highly rural areas (as
23
determined in consultation with the Secretary
24
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•HR 207 IH
of Agriculture using the Rural-Urban Com-
1
muting Areas coding system).
2
‘‘(5) OTHER
MATTERS
RELATING
TO
DOCU-
3
MENTATION
AND
CLAIMS
REVIEW.—The require-
4
ments of paragraphs (2) and (3) of section
5
410.32(d) of title 42, Code of Federal Regulations
6
(as in effect on the date of the enactment of this
7
paragraph), relating to documentation and claims
8
review, respectively, shall apply to a test described in
9
paragraph (4)(A) and an assistive telehealth con-
10
sultation.
11
‘‘(6) DEMOGRAPHIC DATA.—To be eligible for
12
reimbursement under this paragraph, each claim for
13
reimbursement shall include, with respect to each el-
14
igible Medicare beneficiary, the following demo-
15
graphic data:
16
‘‘(A) Age.
17
‘‘(B) Race and ethnicity.
18
‘‘(C) Gender.
19
‘‘(D) An affirmative or negative statement
20
of the existence of any chronic condition.
21
‘‘(E) Any other information the Secretary
22
determines appropriate.
23
‘‘(7)
ASSISTIVE
TELEHEALTH
CONSULTA-
24
TION.—In this subsection, the term ‘assistive tele-
25
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•HR 207 IH
health consultation’ means a telehealth service (as
1
defined in section 1834(m)(4)(F)) that is—
2
‘‘(A) an evaluation and management serv-
3
ice;
4
‘‘(B) an assessment of any evidence of sys-
5
tems which would make a diagnostic test or
6
screening necessary to be furnished in the home
7
of an eligible telehealth individual;
8
‘‘(C) the ordering of a diagnostic test or
9
screening;
10
‘‘(D) an assessment of an individual suc-
11
ceeding the delivery of a diagnostic test or
12
screening;
13
‘‘(E) any assistance in the collection (or
14
transmission) of images or data necessary for a
15
diagnostic test or screening and securing the
16
sample for shipping;
17
‘‘(F) the referral of an eligible telehealth
18
individual to a physician or practitioner for in-
19
person treatment; or
20
‘‘(G) the review of a diagnostic test or
21
screening by a physician or practitioner.
22
‘‘(b) ELIGIBLE MA ORGANIZATIONS.—For purposes
23
of this section, the term ‘eligible MA organization’ means
24
an MA organization that—
25
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•HR 207 IH
‘‘(1) is located in a State that the Secretary has
1
determined is able to participate in the VBID dem-
2
onstration program by agreeing to make available
3
data necessary for purposes of conducting the inde-
4
pendent evaluation required under subsection (h);
5
and
6
‘‘(2) meets such other criteria as the Secretary
7
may require.
8
‘‘(c)
ELIGIBLE
MEDICARE
BENEFICIARY
DE-
9
FINED.—In this section, the term ‘eligible Medicare bene-
10
ficiary’ means a Medicare beneficiary who—
11
‘‘(1) is eligible for benefits under this title
12
and—
13
‘‘(A) is eligible to enroll in an eligible MA
14
plan under the VBID demonstration program;
15
‘‘(B) is a subsidy-eligible individual (as de-
16
fined in section 1860D–14(a)(3)(A)); and
17
‘‘(C) is age 65 or older; or
18
‘‘(2) is a dual eligible individual (as defined in
19
section 1915(h)(2)(B)) or qualified medicare bene-
20
ficiary (as defined in section 1905(p)(1)) who is eli-
21
gible for medical assistance under a State plan
22
under title XIX.
23
‘‘(d) PAYMENTS.—The Secretary shall establish pay-
24
ment rates for eligible MA organizations offering eligible
25
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•HR 207 IH
MA plans under the VBID demonstration program for
1
benefits covered under such program (and not otherwise
2
covered under part C) and provided to eligible Medicare
3
beneficiaries under such plans. Such payment rates
4
shall—
5
‘‘(1) be based upon payment rates established
6
for purposes of payment under section 1853;
7
‘‘(2) be in addition to payments otherwise made
8
to such organization with respect to such plans
9
under part C;
10
‘‘(3) be adjusted to reflect the costs of treating
11
eligible Medicare beneficiaries under this section;
12
and
13
‘‘(4) not be made for a test via a telecommuni-
14
cations system described in subsection (a)(4), unless
15
the physician or practitioner determines such a test
16
is medically necessary and appropriate (as deter-
17
mined by the Secretary).
18
‘‘(e) SPECIAL ELECTION PERIOD.—Notwithstanding
19
sections 1852(e)(2)(C) and 1860D–1(b)(1)(B)(iii), an eli-
20
gible Medicare beneficiary may, other than during the an-
21
nual, coordinated election periods under such sections dis-
22
continue enrollment in an MA plan not participating in
23
the VBID demonstration program and enroll in an MA
24
plan participating in such program.
25
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•HR 207 IH
‘‘(f) BENEFICIARY EDUCATION.—The Secretary shall
1
help to educate, through State Health Insurance Assist-
2
ance Programs and other organizations that assist seniors
3
with respect to benefits and enrollment under this title,
4
eligible Medicare beneficiaries on the availability of the
5
VBID demonstration program.
6
‘‘(g) IMPLEMENTATION.—
7
‘‘(1) DEADLINE.—The VBID demonstration
8
program shall be implemented not later than Janu-
9
ary 1 of the second year beginning after the date of
10
the enactment of this section.
11
‘‘(2) DURATION.—Subject to paragraph (3), the
12
VBID demonstration program shall be conducted for
13
a period of five years.
14
‘‘(3) EXTENSION OR EXPANSION.—Taking into
15
account the report under subsection (h)(2), the Sec-
16
retary may, through notice and comment rule-
17
making, expand the duration, scope, or both the du-
18
ration and scope of the VBID demonstration pro-
19
gram (including implementation on a nationwide or
20
permanent basis or both), other than under the
21
original Medicare fee-for-service program under
22
parts A and B of such title, to the extent determined
23
appropriate by the Secretary, unless the Secretary
24
determines that such expansion is expected to—
25
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•HR 207 IH
‘‘(A)
increase
aggregate
expenditures
1
under this title and title XIX with respect to el-
2
igible Medicare beneficiaries participating in the
3
VBID demonstration program; or
4
‘‘(B) decrease the quality of health care
5
services furnished to eligible Medicare bene-
6
ficiaries participating in the VBID demonstra-
7
tion program.
8
‘‘(h) INDEPENDENT EVALUATION AND REPORTS.—
9
‘‘(1) INDEPENDENT EVALUATION.—
10
‘‘(A) IN
GENERAL.—The Secretary shall
11
provide for the evaluation of the VBID dem-
12
onstration program by an independent third
13
party.
14
‘‘(B)
EVALUATION
OBJECTIVES.—Such
15
evaluation shall determine the extent to which
16
the VBID demonstration program has resulted
17
in—
18
‘‘(i) improved patient care;
19
‘‘(ii) reduced hospitalizations or rehos-
20
pitalizations;
21
‘‘(iii) reduced or delayed nursing facil-
22
ity admissions and lengths of stay under
23
title XIX;
24
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•HR 207 IH
‘‘(iv) reduced spend down of income
1
and assets for purposes of becoming eligi-
2
ble for medical assistance under a State
3
plan under title XIX;
4
‘‘(v) improved quality of life for the
5
eligible Medicare beneficiaries enrolled in
6
an eligible MA plan participating in the
7
VBID demonstration program;
8
‘‘(vi) improved caregiver satisfaction;
9
and
10
‘‘(vii) addressing disparities and ac-
11
cess for underserved populations.
12
‘‘(C) EVALUATION
PROCESS.—Such eval-
13
uation shall be completed in accordance with
14
the following process:
15
‘‘(i) The Secretary shall, prior to the
16
implementation of such program, establish
17
goals for such program with respect to the
18
evaluation objectives described in subpara-
19
graph (B) and criteria for measuring the
20
extent to which an eligible MA plan par-
21
ticipating in the
[Text truncated for display. Full text available on Congress.gov.]