To amend title XVIII of the Social Security Act to provide for access to telehealth services in the home.

Summary: Medicare Home Health Telehealth Access Act of 2005 - Amends title XVIII (Medicare) of the Social Security Act to revise the current requirements for Medicare coverage of telehealth services under the prospective payment system.

Requires the Secretary of Health and Human Services to treat as a home health visit any telehealth services furnished by a home health agency via a telecommunication system to an individual receiving home health services, if the telehealth services: (1) are ordered as part of a plan of care certified by a physician; (2) (as under current law) do not substitute for in-person home health services ordered as part of a plan of care certified by a physician; and (3) are considered the equivalent of a visit under criteria developed by the Secretary.

Directs the Secretary to initiate and carry out projects in a variety of geographic locations that provide incentives to home health agencies to utilize home monitoring and communications technologies that will: (1) enhance health outcomes for individuals enrolled under Medicare parts A and B; and (2) reduce part A and B program expenditures for institutional and other providers, practitioners, and suppliers of health care items and services.

Authorizes the Secretary to pay incentive payments to each home health agency participating in a pilot project.

Provides that, if the Secretary determines that any of the pilot projects results in decreased federal Medicare expenditures, and maintains or enhances health outcomes for the participating beneficiaries, the Secretary may initiate or extend comparable projects in additional areas.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Home Health Telehealth 
Access Act of 2005''.

SEC. 2. ACCESS TO TELEHEALTH SERVICES IN THE HOME.

    (a) In General.--Section 1895(e) of the Social Security Act (42 
U.S.C. 1395fff(e)) is amended to read as follows:
    ``(e) Coverage of Telehealth Services.--
            ``(1) In general.--The Secretary shall include telehealth 
        services that are furnished via a telecommunication system by a 
        home health agency to an individual receiving home health 
        services under section 1814(a)(2)(C) or 1835(a)(2)(A) as a home 
        health visit for purposes of eligibility and payment under this 
        title if the telehealth services--
                    ``(A) are ordered as part of a plan of care 
                certified by a physician pursuant to section 
                1814(a)(2)(C) or 1835(a)(2)(A);
                    ``(B) do not substitute for in-person home health 
                services ordered as part of a plan of care certified by 
                a physician pursuant to such respective section; and
                    ``(C) are considered the equivalent of a visit 
                under criteria developed by the Secretary under 
                paragraph (3).
            ``(2) Physician certification.--Nothing in this section 
        shall be construed as waiving the requirement for a physician 
        certification under section 1814(a)(2)(C) or 1835(a)(2)(A) for 
        the payment for home health services, whether or not furnished 
        via a telecommunication system.
            ``(3) Criteria for visit equivalency.--
                    ``(A) Standards.--The Secretary shall establish 
                standards and qualifications for categorizing and 
                coding under HCPCS codes telehealth services under this 
                subsection as equivalent to an in-person visit for 
                purposes of eligibility and payment for home health 
                services under this title. In establishing the 
                standards and qualifications, the Secretary may 
                distinguish between varying modes and modalities of 
                telehealth services and shall consider--
                            ``(i) the nature and amount of service time 
                        involved; and
                            ``(ii) the functions of the 
                        telecommunications.
                    ``(B) Limitation.--A telecommunication that 
                consists solely of a telephone audio conversation, 
                facsimile, electronic text mail, or consultation 
                between two health care practitioners is not considered 
                a visit under this subsection.
            ``(4) Telehealth service.--
                    ``(A) Definition.--For purposes of this section, 
                the term `telehealth service' means technology-based 
                professional consultations, patient monitoring, patient 
                training services, clinical observation, assessment, or 
                treatment, and any additional services that utilize 
                technologies specified by the Secretary as HCPCS codes 
                developed under paragraph (3).
                    ``(B) Update of hcpcs codes.--The Secretary shall 
                establish a process for the updating, not less 
                frequently than annually, of HCPCS codes for telehealth 
                services.
            ``(5) Conditions for payment and coverage.--Nothing in this 
        subsection shall be construed as waiving any condition of 
        payment under sections 1814(a)(2)(C) or 1835(a)(2)(A) or 
        exclusion of coverage under section 1862(a)(1).
            ``(6) Cost reporting.--Notwithstanding any provision to the 
        contrary, the Secretary shall provide that the costs of 
        telehealth services under this subsection shall be reported as 
        a reimbursable cost center on any cost report submitted by a 
        home health agency to the Secretary.''.
    (b) Effective Date.--
            (1) The amendment made by subsection (a) shall apply to 
        telehealth services furnished on or after October 1, 2006. The 
        Secretary of Health and Human Services shall develop and 
        implement criteria and standards under section 1895(e)(3) of 
        the Social Security Act, as amended by subsection (a), by no 
        later than July 1, 2006.
            (2) In the event that the Secretary has not complied with 
        these deadlines, beginning October 1, 2006, a home health visit 
        for purpose of eligibility and payment under title XVIII of the 
        Social Security Act shall include telehealth services under 
        section 1895(e) of such Act with the aggregate of 
        telecommunication encounters in a 24-hour period considered the 
        equivalent of one in-person visit.

SEC. 3. REMOTE MONITORING PILOT PROJECTS.

    (a) Pilot Program Authorized.--The Secretary of Health and Human 
Services (in this section referred to as the ``Secretary'') shall 
initiate and carry out pilot projects (each in this section referred to 
as a ``pilot project'') in a variety of geographic locations that 
provide incentives to home health agencies to utilize home monitoring 
and communications technologies that will--
            (1) enhance health outcomes for individuals enrolled under 
        parts A and B of title XVIII of the Social Security Act; and
            (2) reduce part A and B program expenditures for 
        institutional and other providers, practitioners, and suppliers 
        of health care items and services.
    (b) Individuals Within the Scope of Pilot.--
            (1) In general.--The Secretary shall specify, in accordance 
        with this subsection, the criteria for identifying those 
        individuals who shall be considered within the scope of the 
        pilot projects under this section for purposes of the incentive 
        payments under subsection (c) and for assessment of the 
        effectiveness of the home health agency in achieving the 
        objectives of the section.
            (2) Participation of individuals not receiving home health 
        services.--Participation in these pilot projects shall not be 
        limited to individuals receiving home health services under 
        part A or part B of title XVIII of the Social Security Act.
    (c) Incentive Payments.--
            (1) In general.--Subject to paragraph (2), the Secretary 
        shall pay to each home health agency participating in a pilot 
        project an amount for each year under the pilot project equal 
        to at least 50 percent of the reduction in expenditures under 
        such parts realized for such year due to the agency's 
        participation in the project. The computation of such reduction 
        shall be based on the Secretary's estimate of the amount by 
        which the amount of expenditures under such parts for the 
        individuals under the pilot project is less than the amount 
        that would have been expended under such parts for such 
        individuals if the project were not implemented. In determining 
        the estimate, the Secretary may use estimates for expenditures 
        for individuals who are not participating in the project and 
        who are comparable to individuals participating in the project.
            (2) Limitation on expenditures.--The Secretary shall limit 
        incentive payments under this subsection as necessary to ensure 
        that the aggregate expenditures under title XVIII of the Social 
        Security Act (inclusive of such incentive payments) with 
        respect to patients within the scope of the pilot projects do 
        not exceed the amount that the Secretary estimates would be 
        expended under such title if the pilot projects under this 
        section were not implemented.
    (d) Construction.--Nothing in this section shall limit the amount 
of payment (other than under subsection (c)) a home health agency may 
receive for home health services provided to eligible individuals under 
part A or part B of title XVIII of the Social Security Act.
    (e) Implementation Date.--The Secretary shall implement the pilot 
projects authorized by this section no later than nine months after the 
date of the enactment of this Act.
    (f) Expansion of the Pilot Project.--If the Secretary determines 
that any of the pilot projects--
            (1) result in a decrease in Federal expenditures under 
        title XVIII of the Social Security Act; and
            (2) maintain or enhance health outcomes for the 
        participating beneficiaries,
the Secretary may initiate or extend comparable projects in additional 
areas.