Telehealth Innovation and Improvement Act of 2019

II 116TH CONGRESS 1ST SESSION S. 773 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 13, 2019 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 Medi- care health care delivery reform models. 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. 3 This Act may be cited as the ‘‘Telehealth Innovation 4 and Improvement Act of 2019’’. 5 SEC. 2. CMI TESTING OF COVERAGE OF EXPANDED TELE- 6 HEALTH SERVICES. 7 (a) IN GENERAL.—Section 1115A of the Social Secu- 8 rity Act (42 U.S.C. 1315a) is amended— 9 VerDate Sep 11 2014 02:43 Mar 23, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S773.IS S773 kjohnson on DSK79L0C42 with BILLS 2 •S 773 IS (1) in subsection (b)(2)— 1 (A) in subparagraph (A), by adding at the 2 end the following new sentence: ‘‘The models 3 selected under this subparagraph shall include 4 the model described in subparagraph (D), which 5 shall be implemented by not later than January 6 1, 2020.’’; and 7 (B) by adding at the end the following new 8 subparagraph: 9 ‘‘(D) TELEHEALTH SERVICES IN DELIVERY 10 REFORM MODELS.—The model described in this 11 subparagraph is a model that meets the re- 12 quirements of subsection (h) with respect to 13 coverage of, and payment for, expanded tele- 14 health services, which shall include remote mon- 15 itoring services, furnished in conjunction with 16 models that test the use of accountable care or- 17 ganizations under title XVIII, bundled pay- 18 ments under such title, and such other coordi- 19 nated care models under such title as the Sec- 20 retary determines to be appropriate.’’; 21 (2) in subsection (b)(4), by striking ‘‘EVALUA- 22 TION.—’’ and inserting ‘‘EVALUATION.—Subject to 23 subsection (h)(6):’’; and 24 VerDate Sep 11 2014 02:43 Mar 23, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S773.IS S773 kjohnson on DSK79L0C42 with BILLS 3 •S 773 IS (3) by adding at the end the following new sub- 1 section: 2 ‘‘(h) MEDICARE COVERAGE OF EXPANDED TELE- 3 HEALTH SERVICES UNDER ACCOUNTABLE CARE ORGANI- 4 ZATION MODELS, BUNDLED PAYMENT MODELS, AND 5 OTHER APPROPRIATE MODELS TESTED BY THE SEC- 6 RETARY.— 7 ‘‘(1) ESTABLISHMENT OF TELEHEALTH SERV- 8 ICE MODELS.— 9 ‘‘(A) IN GENERAL.—Subject to the suc- 10 ceeding provisions of this subsection, for the 5- 11 year period that begins on January 1, 2020, the 12 Secretary shall test coverage of, and payment 13 for, expanded telehealth services (as defined in 14 paragraph (2)) furnished to applicable individ- 15 uals who are Medicare beneficiaries (as defined 16 in paragraph (3)(B)) in conjunction with mod- 17 els tested under subsection (b), and expanded 18 under subsection (c) (if applicable), that test 19 the use of accountable care organizations under 20 title XVIII, bundled payments under such title, 21 and such other coordinated care models under 22 such title as the Secretary determines to be ap- 23 propriate. 24 VerDate Sep 11 2014 02:43 Mar 23, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S773.IS S773 kjohnson on DSK79L0C42 with BILLS 4 •S 773 IS ‘‘(B) MODEL DESIGN CONSIDERATIONS.— 1 In establishing models to be tested for enhanced 2 telehealth services under subsection (b)(2)(D), 3 the Secretary shall design such models in a 4 manner to permit comparisons of Medicare 5 beneficiaries who are participating in models 6 under subsection (b) that include access to ex- 7 panded telehealth services with Medicare bene- 8 ficiaries in models under subsection (b) who do 9 not have access to such services. 10 ‘‘(2) EXPANDED TELEHEALTH SERVICES DE- 11 FINED.— 12 ‘‘(A) IN GENERAL.—Subject to subpara- 13 graphs (B) and (C), in this subsection, the term 14 ‘expanded telehealth services’ means services 15 furnished by an eligible physician or practi- 16 tioner to a Medicare beneficiary as part of an 17 episode of care for one or more of the condi- 18 tions specified under paragraph (4) through one 19 or more of the following: 20 ‘‘(i) Remote monitoring technologies, 21 including remote device management for 22 purposes of remotely interrogating or pro- 23 gramming a medical device (such as a 24 pacemaker or a cardiac resynchronization 25 VerDate Sep 11 2014 02:43 Mar 23, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S773.IS S773 kjohnson on DSK79L0C42 with BILLS 5 •S 773 IS therapy device) outside the office of the 1 physician specialist involved. 2 ‘‘(ii) Bi-directional audio/video tech- 3 nologies. 4 ‘‘(iii) Physiologic and behavioral moni- 5 toring technologies. 6 ‘‘(iv) Engagement prompt tech- 7 nologies. 8 ‘‘(v) Store and forward technologies. 9 ‘‘(vi) Point-of-care testing tech- 10 nologies. 11 ‘‘(vii) Such other technologies as the 12 Secretary may specify. 13 ‘‘(B) INCLUSION OF MEDICARE TELE- 14 HEALTH SERVICES; NON-APPLICATION OF CER- 15 TAIN RESTRICTIONS.— 16 ‘‘(i) INCLUSION OF MEDICARE TELE- 17 HEALTH SERVICES.—The term ‘expanded 18 telehealth services’ shall include a tele- 19 health service, as defined in section 20 1834(m)(4)(F), without regard to the limi- 21 tations specified under section 1834(m)(4). 22 ‘‘(ii) RULE OF CONSTRUCTION.— 23 Nothing in this section shall be construed 24 as imposing a requirement on the fur- 25 VerDate Sep 11 2014 02:43 Mar 23, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S773.IS S773 kjohnson on DSK79L0C42 with BILLS 6 •S 773 IS nishing of expanded telehealth services 1 that such services be furnished in real time 2 through interactive audio or video tele- 3 communications systems between the eligi- 4 ble physician or practitioner and the Medi- 5 care beneficiary. 6 ‘‘(iii) NO LIMITATIONS ON GEO- 7 GRAPHIC AREAS OR LOCATION OF PA- 8 TIENT.—The term ‘expanded telehealth 9 services’ shall include services furnished 10 (as described in subparagraph (A)) without 11 regard to the location of the Medicare ben- 12 eficiary at the time the telehealth service is 13 furnished and without regard to the area 14 in which the Medicare beneficiary resides. 15 ‘‘(C) REQUIREMENTS.—The term ‘ex- 16 panded telehealth services’ shall not include a 17 service furnished (as described in subparagraph 18 (A)) unless it can be demonstrated that the 19 service, when furnished as an expanded tele- 20 health service, is likely to do one or more of the 21 following: 22 ‘‘(i) The service assists eligible physi- 23 cians or practitioners to coordinate care 24 for patients. 25 VerDate Sep 11 2014 02:43 Mar 23, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S773.IS S773 kjohnson on DSK79L0C42 with BILLS 7 •S 773 IS ‘‘(ii) The service enhances collabora- 1 tion among providers of services and sup- 2 pliers, including eligible physicians and 3 practitioners, in the provision of care to 4 patients. 5 ‘‘(iii) The service improves quality of 6 care furnished to patients. 7 ‘‘(iv) The service results in reduced 8 hospital admissions and readmissions. 9 ‘‘(v) The service reduces or sub- 10 stitutes for physician office visits. 11 ‘‘(vi) The service results in reduced 12 utilization of skilled nursing facility serv- 13 ices. 14 ‘‘(vii) The service facilitates the re- 15 turn of patients to the community more 16 quickly than would otherwise occur in the 17 absence of the service. 18 ‘‘(3) ADDITIONAL DEFINITIONS.—In this sub- 19 section: 20 ‘‘(A) ELIGIBLE PHYSICIAN OR PRACTI- 21 TIONER.—The term ‘eligible physician or prac- 22 titioner’ means— 23 ‘‘(i) a physician (as defined in section 24 1861(r)); and 25 VerDate Sep 11 2014 02:43 Mar 23, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S773.IS S773 kjohnson on DSK79L0C42 with BILLS 8 •S 773 IS ‘‘(ii) a practitioner (as defined in sec- 1 tion 1842(b)(18)(C)). 2 ‘‘(B) MEDICARE BENEFICIARY.—The term 3 ‘Medicare beneficiary’ means an individual who 4 is entitled to benefits under part A or enrolled 5 under part B of title XVIII who is not enrolled 6 in a Medicare Advantage plan under part C of 7 such title, an eligible organization under section 8 1876, or a PACE program under section 1894. 9 ‘‘(4) CONDITIONS.—For purposes of paragraph 10 (2)(A), the conditions with respect to which a cov- 11 erage of an expanded telehealth service is furnished 12 under this subsection shall include the following con- 13 ditions or diseases: chronic hypertension, ischemic 14 heart diseases, chronic obstructive pulmonary dis- 15 ease, heart failure, heart attack, osteoarthritis, dia- 16 betes, chronic kidney disease, depression, atrial fi- 17 brillation, cancer, asthma, stroke, total hip replace- 18 ment procedures, total knee replacement procedures, 19 Parkinson’s disease, and such other conditions or 20 diseases with respect to which the Secretary deter- 21 mines that expanded telehealth services would sat- 22 isfy one or more of the requirements of clauses (i) 23 through (vii) of paragraph (2)(C). 24 ‘‘(5) PAYMENT.— 25 VerDate Sep 11 2014 02:43 Mar 23, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S773.IS S773 kjohnson on DSK79L0C42 with BILLS 9 •S 773 IS ‘‘(A) IN GENERAL.—Subject to subpara- 1 graph (B), with respect to expanded telehealth 2 services furnished under a model tested under 3 subsection (b) and expanded under subsection 4 (c) (if applicable), the Secretary shall establish 5 payment amounts under this subsection for 6 such services. The Secretary may use one or 7 more of the following payment methodologies 8 for expanded telehealth services: 9 ‘‘(i) MEDICARE FEE SCHEDULE.—Fee 10 schedules established under title XVIII for 11 telehealth services and remote monitoring 12 services. 13 ‘‘(ii) NEW FEE SCHEDULE.—A new 14 fee schedule that the Secretary establishes 15 for expanded telehealth services covered by 16 reason of this subsection. 17 ‘‘(iii) PAYMENT AMOUNTS BASED ON 18 SHARED RISK.—A payment methodology 19 for shared savings and losses that is de- 20 signed to ensure savings with respect to 21 expanded telehealth services covered under 22 the model. 23 ‘‘(B) CONSIDERATION OF CERTAIN 24 COSTS.—In determining the amount of payment 25 VerDate Sep 11 2014 02:43 Mar 23, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S773.IS S773 kjohnson on DSK79L0C42 with BILLS 10 •S 773 IS for an expanded telehealth service under the 1 payment methodologies referred to in subpara- 2 graph (A), the Secretary shall take into account 3 costs incurred by eligible physicians and practi- 4 tioners— 5 ‘‘(i) for the acquisition and implemen- 6 tation of information systems necessary to 7 furnish such services, including costs of 8 equipment and requisite software; 9 ‘‘(ii) for non-physician clinical per- 10 sonnel in conjunction with such service; 11 and 12 ‘‘(iii) for physician interpretation of 13 clinical data through the expanded tele- 14 health service as well as for the supervision 15 or oversight of the system for such service. 16 ‘‘(6) EVALUATION OF MODELS.— 17 ‘‘(A) USE OF INDEPENDENT ENTITY.—In 18 lieu of the evaluations conducted by the Sec- 19 retary under subsection (b)(4) for models tested 20 under subsection (b), the Secretary shall pro- 21 vide for evaluations of enhanced telehealth serv- 22 ice models under subsection (b)(2)(D) by an 23 independent entity. Such evaluation shall be 24 conducted with respect to the specific enhanced 25 VerDate Sep 11 2014 02:43 Mar 23, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S773.IS S773 kjohnson on DSK79L0C42 with BILLS 11 •S 773 IS telehealth service and condition or conditions 1 involved that are tested under such models. 2 ‘‘(B) TIMING OF EVALUATION.—An eval- 3 uation of such enhanced telehealth service and 4 condition or conditions involved conducted by 5 the independent entity under this paragraph 6 shall begin three years after the implementation 7 of the model that provides for coverage of and 8 payment for the expanded telehealth service 9 with respect to such condition. 10 ‘‘(C) CRITERIA.—An evaluation of such en- 11 hanced telehealth service models conducted by 12 the independent entity under this paragraph 13 shall include an analysis of— 14 ‘‘(i) the quality of care furnished 15 under the model, including the measure- 16 ment of patient-level outcomes and patient- 17 centeredness criteria determined appro- 18 priate by the Secretary; 19 ‘‘(ii) the changes in spending under 20 parts A and B of title XVIII by reason of 21 the model, taking into account costs and 22 savings under such parts across the con- 23 tinuum of care for the episode of care and 24 condition or conditions involved; and 25 VerDate Sep 11 2014 02:43 Mar 23, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S773.IS S773 kjohnson on DSK79L0C42 with BILLS 12 •S 773 IS ‘‘(iii) any impediments that were en- 1 countered under the model, such as— 2 ‘‘(I) explicit telehealth restric- 3 tions under Federal or State laws that 4 are not related to health care reim- 5 bursement, such as scope of practice 6 limitations; 7 ‘‘(II) licensing or credentialing 8 barriers; and 9 ‘‘(III) limited broadband access 10 or limited health information tech- 11 nology capabilities. 12 ‘‘(D) INFORMATION.—The provisions of 13 subsection (b)(4)(B) shall apply to evaluations 14 conducted under this paragraph in the same 15 manner as such provisions apply to evaluations 16 conducted under subsection (b)(4). 17 ‘‘(7) APPLICATION OF EXPANDED TELEHEALTH 18 SERVICES TO ALL CMI MODELS.—The Secretary 19 shall expand the application of an enhanced tele- 20 health service with respect to the condition or condi- 21 tions involved to all models tested under subsection 22 (b), and expanded under subsection (c) (if applica- 23 ble), that apply with respect to services furnished 24 under title XVIII to provide for coverage of, and 25 VerDate Sep 11 2014 02:43 Mar 23, 2019 Jkt 089200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S773.IS S773 kjohnson on DSK79L0C42 with BILLS 13 •S 773 IS payment for, such enhanced telehealth service or 1 services with respect to such condition or conditions 2 under all such models for years beginning after the 3 5-year period described in paragraph (1)(A) if— 4 ‘‘(A) the independent evaluation conducted 5 under paragraph (6) with respect to such mod- 6 els demonstrates that such enhanced telehealth 7 service or services with respect to the condition 8 or conditions involved resulted in— 9 ‘‘(i) reduced spending under parts A 1 [Text truncated for display. 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