I 116TH CONGRESS 1ST SESSION H. R. 4013 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 HOUSE OF REPRESENTATIVES JULY 25, 2019 Mr. CURTIS (for himself and Mr. NEGUSE) 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 provi- sions as fall within the jurisdiction of the committee concerned 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 VerDate Sep 11 2014 01:10 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4013.IH H4013 kjohnson on DSK79L0C42 with BILLS 2 •HR 4013 IH SEC. 2. CMI TESTING OF COVERAGE OF EXPANDED TELE- 1 HEALTH SERVICES. 2 (a) IN GENERAL.—Section 1115A of the Social Secu- 3 rity Act (42 U.S.C. 1315a) is amended— 4 (1) in subsection (b)(2)— 5 (A) in subparagraph (A), by adding at the 6 end the following new sentence: ‘‘The models 7 selected under this subparagraph shall include 8 the model described in subparagraph (D), which 9 shall be implemented by not later than January 10 1, 2020.’’; and 11 (B) by adding at the end the following new 12 subparagraph: 13 ‘‘(D) TELEHEALTH SERVICES IN DELIVERY 14 REFORM MODELS.—The model described in this 15 subparagraph is a model that meets the re- 16 quirements of subsection (h) with respect to 17 coverage of, and payment for, expanded tele- 18 health services, which shall include remote mon- 19 itoring services, furnished in conjunction with 20 models that test the use of accountable care or- 21 ganizations under title XVIII, bundled pay- 22 ments under such title, and such other coordi- 23 nated care models under such title as the Sec- 24 retary determines to be appropriate.’’; 25 VerDate Sep 11 2014 01:10 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4013.IH H4013 kjohnson on DSK79L0C42 with BILLS 3 •HR 4013 IH (2) in subsection (b)(4), by striking ‘‘EVALUA- 1 TION.—’’ and inserting ‘‘EVALUATION.—Subject to 2 subsection (h)(6):’’; and 3 (3) by adding at the end the following new sub- 4 section: 5 ‘‘(h) MEDICARE COVERAGE OF EXPANDED TELE- 6 HEALTH SERVICES UNDER ACCOUNTABLE CARE ORGANI- 7 ZATION MODELS, BUNDLED PAYMENT MODELS, AND 8 OTHER APPROPRIATE MODELS TESTED BY THE SEC- 9 RETARY.— 10 ‘‘(1) ESTABLISHMENT OF TELEHEALTH SERV- 11 ICE MODELS.— 12 ‘‘(A) IN GENERAL.—Subject to the suc- 13 ceeding provisions of this subsection, for the 5- 14 year period that begins on January 1, 2020, the 15 Secretary shall test coverage of, and payment 16 for, expanded telehealth services (as defined in 17 paragraph (2)) furnished to applicable individ- 18 uals who are Medicare beneficiaries (as defined 19 in paragraph (3)(B)) in conjunction with mod- 20 els tested under subsection (b), and expanded 21 under subsection (c) (if applicable), that test 22 the use of accountable care organizations under 23 title XVIII, bundled payments under such title, 24 and such other coordinated care models under 25 VerDate Sep 11 2014 01:10 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4013.IH H4013 kjohnson on DSK79L0C42 with BILLS 4 •HR 4013 IH such title as the Secretary determines to be ap- 1 propriate. 2 ‘‘(B) MODEL DESIGN CONSIDERATIONS.— 3 In establishing models to be tested for enhanced 4 telehealth services under subsection (b)(2)(D), 5 the Secretary shall design such models in a 6 manner to permit comparisons of Medicare 7 beneficiaries who are participating in models 8 under subsection (b) that include access to ex- 9 panded telehealth services with Medicare bene- 10 ficiaries in models under subsection (b) who do 11 not have access to such services. 12 ‘‘(2) EXPANDED TELEHEALTH SERVICES DE- 13 FINED.— 14 ‘‘(A) IN GENERAL.—Subject to subpara- 15 graphs (B) and (C), in this subsection, the term 16 ‘expanded telehealth services’ means services 17 furnished by an eligible physician or practi- 18 tioner to a Medicare beneficiary as part of an 19 episode of care for one or more of the condi- 20 tions specified under paragraph (4) through one 21 or more of the following: 22 ‘‘(i) Remote monitoring technologies, 23 including remote device management for 24 purposes of remotely interrogating or pro- 25 VerDate Sep 11 2014 01:10 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4013.IH H4013 kjohnson on DSK79L0C42 with BILLS 5 •HR 4013 IH gramming a medical device (such as a 1 pacemaker or a cardiac resynchronization 2 therapy device) outside the office of the 3 physician specialist involved. 4 ‘‘(ii) Bi-directional audio/video tech- 5 nologies. 6 ‘‘(iii) Physiologic and behavioral moni- 7 toring technologies. 8 ‘‘(iv) Engagement prompt technolo- 9 gies. 10 ‘‘(v) Store and forward technologies. 11 ‘‘(vi) Point-of-care testing technolo- 12 gies. 13 ‘‘(vii) Such other technologies as the 14 Secretary may specify. 15 ‘‘(B) INCLUSION OF MEDICARE TELE- 16 HEALTH SERVICES; NON-APPLICATION OF CER- 17 TAIN RESTRICTIONS.— 18 ‘‘(i) INCLUSION OF MEDICARE TELE- 19 HEALTH SERVICES.—The term ‘expanded 20 telehealth services’ shall include a tele- 21 health service, as defined in section 22 1834(m)(4)(F), without regard to the limi- 23 tations specified under section 1834(m)(4). 24 VerDate Sep 11 2014 01:10 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4013.IH H4013 kjohnson on DSK79L0C42 with BILLS 6 •HR 4013 IH ‘‘(ii) RULE OF CONSTRUCTION.— 1 Nothing in this section shall be construed 2 as imposing a requirement on the fur- 3 nishing of expanded telehealth services 4 that such services be furnished in real time 5 through interactive audio or video tele- 6 communications systems between the eligi- 7 ble physician or practitioner and the Medi- 8 care beneficiary. 9 ‘‘(iii) NO LIMITATIONS ON GEO- 10 GRAPHIC AREAS OR LOCATION OF PA- 11 TIENT.—The term ‘expanded telehealth 12 services’ shall include services furnished 13 (as described in subparagraph (A)) without 14 regard to the location of the Medicare ben- 15 eficiary at the time the telehealth service is 16 furnished and without regard to the area 17 in which the Medicare beneficiary resides. 18 ‘‘(C) REQUIREMENTS.—The term ‘ex- 19 panded telehealth services’ shall not include a 20 service furnished (as described in subparagraph 21 (A)) unless it can be demonstrated that the 22 service, when furnished as an expanded tele- 23 health service, is likely to do one or more of the 24 following: 25 VerDate Sep 11 2014 01:10 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4013.IH H4013 kjohnson on DSK79L0C42 with BILLS 7 •HR 4013 IH ‘‘(i) The service assists eligible physi- 1 cians or practitioners to coordinate care 2 for patients. 3 ‘‘(ii) The service enhances collabora- 4 tion among providers of services and sup- 5 pliers, including eligible physicians and 6 practitioners, in the provision of care to 7 patients. 8 ‘‘(iii) The service improves quality of 9 care furnished to patients. 10 ‘‘(iv) The service results in reduced 11 hospital admissions and readmissions. 12 ‘‘(v) The service reduces or sub- 13 stitutes for physician office visits. 14 ‘‘(vi) The service results in reduced 15 utilization of skilled nursing facility serv- 16 ices. 17 ‘‘(vii) The service facilitates the re- 18 turn of patients to the community more 19 quickly than would otherwise occur in the 20 absence of the service. 21 ‘‘(3) ADDITIONAL DEFINITIONS.—In this sub- 22 section: 23 VerDate Sep 11 2014 01:10 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4013.IH H4013 kjohnson on DSK79L0C42 with BILLS 8 •HR 4013 IH ‘‘(A) ELIGIBLE PHYSICIAN OR PRACTI- 1 TIONER.—The term ‘eligible physician or prac- 2 titioner’ means— 3 ‘‘(i) a physician (as defined in section 4 1861(r)); and 5 ‘‘(ii) a practitioner (as defined in sec- 6 tion 1842(b)(18)(C)). 7 ‘‘(B) MEDICARE BENEFICIARY.—The term 8 ‘Medicare beneficiary’ means an individual who 9 is entitled to benefits under part A or enrolled 10 under part B of title XVIII who is not enrolled 11 in a Medicare Advantage plan under part C of 12 such title, an eligible organization under section 13 1876, or a PACE program under section 1894. 14 ‘‘(4) CONDITIONS.—For purposes of paragraph 15 (2)(A), the conditions with respect to which a cov- 16 erage of an expanded telehealth service is furnished 17 under this subsection shall include the following con- 18 ditions or diseases: chronic hypertension, ischemic 19 heart diseases, chronic obstructive pulmonary dis- 20 ease, heart failure, heart attack, osteoarthritis, dia- 21 betes, chronic kidney disease, depression, atrial fi- 22 brillation, cancer, asthma, stroke, total hip replace- 23 ment procedures, total knee replacement procedures, 24 Parkinson’s disease, and such other conditions or 25 VerDate Sep 11 2014 01:10 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H4013.IH H4013 kjohnson on DSK79L0C42 with BILLS 9 •HR 4013 IH diseases with respect to which the Secretary deter- 1 mines that expanded telehealth services would sat- 2 isfy one or more of the requirements of clauses (i) 3 through (vii) of paragraph (2)(C). 4 ‘‘(5) PAYMENT.— 5 ‘‘(A) IN GENERAL.—Subject to subpara- 6 graph (B), with respect to expanded telehealth 7 services furnished under a model tested under 8 subsection (b) and expanded under subsection 9 (c) (if applicable), the Secretary shall establish 10 payment amounts under this subsection for 11 such services. The Secretary may use one or 12 more of the following payment methodologies 13 for expanded telehealth services: 14 ‘‘(i) MEDICARE FEE SCHEDULE.—Fee 15 schedules established under title XVIII for 16 telehealth services and remote monitoring 17 services. 18 ‘‘(ii) NEW FEE SCHEDULE.—A new 19 fee schedule that the Secretary establishes 20 for expanded telehealth services covered by 21 reason of this subsection. 22 ‘‘(iii) PAYMENT AMOUNTS BASED ON 23 SHARED RISK.—A payment methodology 24 for shared savings and losses that is de- 25 VerDate Sep 11 2014 01:10 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H4013.IH H4013 kjohnson on DSK79L0C42 with BILLS 10 •HR 4013 IH signed to ensure savings with respect to 1 expanded telehealth services covered under 2 the model. 3 ‘‘(B) CONSIDERATION OF CERTAIN 4 COSTS.—In determining the amount of payment 5 for an expanded telehealth service under the 6 payment methodologies referred to in subpara- 7 graph (A), the Secretary shall take into account 8 costs incurred by eligible physicians and practi- 9 tioners— 10 ‘‘(i) for the acquisition and implemen- 11 tation of information systems necessary to 12 furnish such services, including costs of 13 equipment and requisite software; 14 ‘‘(ii) for non-physician clinical per- 15 sonnel in conjunction with such service; 16 and 17 ‘‘(iii) for physician interpretation of 18 clinical data through the expanded tele- 19 health service as well as for the supervision 20 or oversight of the system for such service. 21 ‘‘(6) EVALUATION OF MODELS.— 22 ‘‘(A) USE OF INDEPENDENT ENTITY.—In 23 lieu of the evaluations conducted by the Sec- 24 retary under subsection (b)(4) for models tested 25 VerDate Sep 11 2014 01:10 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H4013.IH H4013 kjohnson on DSK79L0C42 with BILLS 11 •HR 4013 IH under subsection (b), the Secretary shall pro- 1 vide for evaluations of enhanced telehealth serv- 2 ice models under subsection (b)(2)(D) by an 3 independent entity. Such evaluation shall be 4 conducted with respect to the specific enhanced 5 telehealth service and condition or conditions 6 involved that are tested under such models. 7 ‘‘(B) TIMING OF EVALUATION.—An eval- 8 uation of such enhanced telehealth service and 9 condition or conditions involved conducted by 10 the independent entity under this paragraph 11 shall begin three years after the implementation 12 of the model that provides for coverage of and 13 payment for the expanded telehealth service 14 with respect to such condition. 15 ‘‘(C) CRITERIA.—An evaluation of such en- 16 hanced telehealth service models conducted by 17 the independent entity under this paragraph 18 shall include an analysis of— 19 ‘‘(i) the quality of care furnished 20 under the model, including the measure- 21 ment of patient-level outcomes and patient- 22 centeredness criteria determined appro- 23 priate by the Secretary; 24 VerDate Sep 11 2014 01:10 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H4013.IH H4013 kjohnson on DSK79L0C42 with BILLS 12 •HR 4013 IH ‘‘(ii) the changes in spending under 1 parts A and B of title XVIII by reason of 2 the model, taking into account costs and 3 savings under such parts across the con- 4 tinuum of care for the episode of care and 5 condition or conditions involved; and 6 ‘‘(iii) any impediments that were en- 7 countered under the model, such as— 8 ‘‘(I) explicit telehealth restric- 9 tions under Federal or State laws that 10 are not related to health care reim- 11 bursement, such as scope of practice 12 limitations; 13 ‘‘(II) licensing or credentialing 14 barriers; and 15 ‘‘(III) limited broadband access 16 or limited health information tech- 17 nology capabilities. 18 ‘‘(D) INFORMATION.—The provisions of 19 subsection (b)(4)(B) shall apply to evaluations 20 conducted under this paragraph in the same 21 manner as such provisions apply to evaluations 22 conducted under subsection (b)(4). 23 ‘‘(7) APPLICATION OF EXPANDED TELEHEALTH 24 SERVICES TO ALL CMI MODELS.—The Secretary 25 VerDate Sep 11 2014 01:10 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H4013.IH H4013 kjohnson on DSK79L0C42 with BILLS 13 •HR 4013 IH shall expand the application of an enhanced tele- 1 health service with respect to the condition or condi- 2 tions involved to all models tested under subsection 3 (b), and expanded under subsection (c) (if applica- 4 ble), that apply with respect to services furnished 5 under title XVIII to provide for coverage of, and 6 payment for, such enhanced telehealth service or 7 services with respect to such condition or conditions 8 under all such models for years beginning after the 9 5-year period described in paragraph (1)(A) if— 10 ‘‘(A) the indep [Text truncated for display. 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