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 Medicare health care delivery reform models. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Telehealth Innovation 

5 and Improvement Act of 2019’’. 

6 SEC. 2. CMI TESTING OF COVERAGE OF EXPANDED TELE7 HEALTH SERVICES. 

8 (a) IN GENERAL.—Section 1115A of the Social Secu9 rity Act (42 U.S.C. 1315a) is amended— 


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1 (1) in subsection (b)(2)— 

2 (A) in subparagraph (A), by adding at the 

3 end the following new sentence: ‘‘The models 

4 selected under this subparagraph shall include 

5 the model described in subparagraph (D), which 

6 shall be implemented by not later than January 

7 1, 2020.’’; and 

8 (B) by adding at the end the following new 

9 subparagraph: 

10 ‘‘(D) TELEHEALTH SERVICES IN DELIVERY

11 REFORM MODELS.—The model described in this 

12 subparagraph is a model that meets the re13 quirements of subsection (h) with respect to 

14 coverage of, and payment for, expanded tele15 health services, which shall include remote mon16 itoring services, furnished in conjunction with 

17 models that test the use of accountable care or18 ganizations under title XVIII, bundled pay19 ments under such title, and such other coordi20 nated care models under such title as the Sec21 retary determines to be appropriate.’’; 

22 (2) in subsection (b)(4), by striking ‘‘EVALUA23 TION.—’’ and inserting ‘‘EVALUATION.—Subject to 

24 subsection (h)(6):’’; and 


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1 (3) by adding at the end the following new sub2 section: 

3 ‘‘(h) MEDICARE COVERAGE OF EXPANDED TELE4 HEALTH SERVICES UNDER ACCOUNTABLE CARE ORGANI5 ZATION MODELS, BUNDLED PAYMENT MODELS, AND

6 OTHER APPROPRIATE MODELS TESTED BY THE SEC7 RETARY.— 

8 ‘‘(1) ESTABLISHMENT OF TELEHEALTH SERV9 ICE MODELS.— 

10 ‘‘(A) IN GENERAL.—Subject to the suc11 ceeding provisions of this subsection, for the 5- 

12 year period that begins on January 1, 2020, the 

13 Secretary shall test coverage of, and payment 

14 for, expanded telehealth services (as defined in 

15 paragraph (2)) furnished to applicable individ16 uals who are Medicare beneficiaries (as defined 

17 in paragraph (3)(B)) in conjunction with mod18 els tested under subsection (b), and expanded 

19 under subsection (c) (if applicable), that test 

20 the use of accountable care organizations under 

21 title XVIII, bundled payments under such title, 

22 and such other coordinated care models under 

23 such title as the Secretary determines to be ap24 propriate. 


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1 ‘‘(B) MODEL DESIGN CONSIDERATIONS.— 

2 In establishing models to be tested for enhanced 

3 telehealth services under subsection (b)(2)(D), 

4 the Secretary shall design such models in a 

5 manner to permit comparisons of Medicare 

6 beneficiaries who are participating in models 

7 under subsection (b) that include access to ex8 panded telehealth services with Medicare bene9 ficiaries in models under subsection (b) who do 

10 not have access to such services. 

11 ‘‘(2) EXPANDED TELEHEALTH SERVICES DE12 FINED.— 

13 ‘‘(A) IN GENERAL.—Subject to subpara14 graphs (B) and (C), in this subsection, the term 

15 ‘expanded telehealth services’ means services 

16 furnished by an eligible physician or practi17 tioner to a Medicare beneficiary as part of an 

18 episode of care for one or more of the condi19 tions specified under paragraph (4) through one 

20 or more of the following: 

21 ‘‘(i) Remote monitoring technologies, 

22 including remote device management for 

23 purposes of remotely interrogating or pro24 gramming a medical device (such as a 

25 pacemaker or a cardiac resynchronization 


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1 therapy device) outside the office of the 

2 physician specialist involved. 

3 ‘‘(ii) Bi-directional audio/video tech4 nologies. 

5 ‘‘(iii) Physiologic and behavioral moni6 toring technologies. 

7 ‘‘(iv) Engagement prompt tech8 nologies. 

9 ‘‘(v) Store and forward technologies. 

10 ‘‘(vi) Point-of-care testing tech11 nologies. 

12 ‘‘(vii) Such other technologies as the 

13 Secretary may specify. 

14 ‘‘(B) INCLUSION OF MEDICARE TELE15 HEALTH SERVICES; NON-APPLICATION OF CER16 TAIN RESTRICTIONS.— 

17 ‘‘(i) INCLUSION OF MEDICARE TELE18 HEALTH SERVICES.—The term ‘expanded 

19 telehealth services’ shall include a tele20 health service, as defined in section 

21 1834(m)(4)(F), without regard to the limi22 tations specified under section 1834(m)(4). 

23 ‘‘(ii) RULE OF CONSTRUCTION.— 

24 Nothing in this section shall be construed 

25 as imposing a requirement on the furVerDate Sep 11 2014 02:43 Mar 23, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S773.IS S773

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1 nishing of expanded telehealth services 

2 that such services be furnished in real time 

3 through interactive audio or video tele4 communications systems between the eligi5 ble physician or practitioner and the Medi6 care beneficiary. 

7 ‘‘(iii) NO LIMITATIONS ON GEO8 GRAPHIC AREAS OR LOCATION OF PA9 TIENT.—The term ‘expanded telehealth 

10 services’ shall include services furnished 

11 (as described in subparagraph (A)) without 

12 regard to the location of the Medicare ben13 eficiary at the time the telehealth service is 

14 furnished and without regard to the area 

15 in which the Medicare beneficiary resides. 

16 ‘‘(C) REQUIREMENTS.—The term ‘ex17 panded telehealth services’ shall not include a 

18 service furnished (as described in subparagraph 

19 (A)) unless it can be demonstrated that the 

20 service, when furnished as an expanded tele21 health service, is likely to do one or more of the 

22 following: 

23 ‘‘(i) The service assists eligible physi24 cians or practitioners to coordinate care 

25 for patients. 


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1 ‘‘(ii) The service enhances collabora2 tion among providers of services and sup3 pliers, including eligible physicians and 

4 practitioners, in the provision of care to 

5 patients. 

6 ‘‘(iii) The service improves quality of 

7 care furnished to patients. 

8 ‘‘(iv) The service results in reduced 

9 hospital admissions and readmissions. 

10 ‘‘(v) The service reduces or sub11 stitutes for physician office visits. 

12 ‘‘(vi) The service results in reduced 

13 utilization of skilled nursing facility serv14 ices. 

15 ‘‘(vii) The service facilitates the re16 turn of patients to the community more 

17 quickly than would otherwise occur in the 

18 absence of the service. 

19 ‘‘(3) ADDITIONAL DEFINITIONS.—In this sub20 section: 

21 ‘‘(A) ELIGIBLE PHYSICIAN OR PRACTI22 TIONER.—The term ‘eligible physician or prac23 titioner’ means— 

24 ‘‘(i) a physician (as defined in section 

25 1861(r)); and 


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1 ‘‘(ii) a practitioner (as defined in sec2 tion 1842(b)(18)(C)). 

3 ‘‘(B) MEDICARE BENEFICIARY.—The term 

4 ‘Medicare beneficiary’ means an individual who 

5 is entitled to benefits under part A or enrolled 

6 under part B of title XVIII who is not enrolled 

7 in a Medicare Advantage plan under part C of 

8 such title, an eligible organization under section 

9 1876, or a PACE program under section 1894. 

10 ‘‘(4) CONDITIONS.—For purposes of paragraph 

11 (2)(A), the conditions with respect to which a cov12 erage of an expanded telehealth service is furnished 

13 under this subsection shall include the following con14 ditions or diseases: chronic hypertension, ischemic 

15 heart diseases, chronic obstructive pulmonary dis16 ease, heart failure, heart attack, osteoarthritis, dia17 betes, chronic kidney disease, depression, atrial fi18 brillation, cancer, asthma, stroke, total hip replace19 ment procedures, total knee replacement procedures, 

20 Parkinson’s disease, and such other conditions or 

21 diseases with respect to which the Secretary deter22 mines that expanded telehealth services would sat23 isfy one or more of the requirements of clauses (i) 

24 through (vii) of paragraph (2)(C). 

25 ‘‘(5) PAYMENT.— 


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1 ‘‘(A) IN GENERAL.—Subject to subpara2 graph (B), with respect to expanded telehealth 

3 services furnished under a model tested under 

4 subsection (b) and expanded under subsection 

5 (c) (if applicable), the Secretary shall establish 

6 payment amounts under this subsection for 

7 such services. The Secretary may use one or 

8 more of the following payment methodologies 

9 for expanded telehealth services: 

10 ‘‘(i) MEDICARE FEE SCHEDULE.—Fee 

11 schedules established under title XVIII for 

12 telehealth services and remote monitoring 

13 services. 

14 ‘‘(ii) NEW FEE SCHEDULE.—A new 

15 fee schedule that the Secretary establishes 

16 for expanded telehealth services covered by 

17 reason of this subsection. 

18 ‘‘(iii) PAYMENT AMOUNTS BASED ON

19 SHARED RISK.—A payment methodology 

20 for shared savings and losses that is de21 signed to ensure savings with respect to 

22 expanded telehealth services covered under 

23 the model. 

24 ‘‘(B) CONSIDERATION OF CERTAIN

25 COSTS.—In determining the amount of payment 


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1 for an expanded telehealth service under the 

2 payment methodologies referred to in subpara3 graph (A), the Secretary shall take into account 

4 costs incurred by eligible physicians and practi5 tioners— 

6 ‘‘(i) for the acquisition and implemen7 tation of information systems necessary to 

8 furnish such services, including costs of 

9 equipment and requisite software; 

10 ‘‘(ii) for non-physician clinical per11 sonnel in conjunction with such service; 

12 and 

13 ‘‘(iii) for physician interpretation of 

14 clinical data through the expanded tele15 health service as well as for the supervision 

16 or oversight of the system for such service. 

17 ‘‘(6) EVALUATION OF MODELS.— 

18 ‘‘(A) USE OF INDEPENDENT ENTITY.—In 

19 lieu of the evaluations conducted by the Sec20 retary under subsection (b)(4) for models tested 

21 under subsection (b), the Secretary shall pro22 vide for evaluations of enhanced telehealth serv23 ice models under subsection (b)(2)(D) by an 

24 independent entity. Such evaluation shall be 

25 conducted with respect to the specific enhanced 


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1 telehealth service and condition or conditions 

2 involved that are tested under such models. 

3 ‘‘(B) TIMING OF EVALUATION.—An eval4 uation of such enhanced telehealth service and 

5 condition or conditions involved conducted by 

6 the independent entity under this paragraph 

7 shall begin three years after the implementation 

8 of the model that provides for coverage of and 

9 payment for the expanded telehealth service 

10 with respect to such condition. 

11 ‘‘(C) CRITERIA.—An evaluation of such en12 hanced telehealth service models conducted by 

13 the independent entity under this paragraph 

14 shall include an analysis of— 

15 ‘‘(i) the quality of care furnished 

16 under the model, including the measure17 ment of patient-level outcomes and patient18 centeredness criteria determined appro19 priate by the Secretary; 

20 ‘‘(ii) the changes in spending under 

21 parts A and B of title XVIII by reason of 

22 the model, taking into account costs and 

23 savings under such parts across the con24 tinuum of care for the episode of care and 

25 condition or conditions involved; and 


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1 ‘‘(iii) any impediments that were en2 countered under the model, such as— 

3 ‘‘(I) explicit telehealth restric4 tions under Federal or State laws that 

5 are not related to health care reim6 bursement, such as scope of practice 

7 limitations; 

8 ‘‘(II) licensing or credentialing 

9 barriers; and 

10 ‘‘(III) limited broadband access 

11 or limited health information tech12 nology capabilities. 

13 ‘‘(D) INFORMATION.—The provisions of 

14 subsection (b)(4)(B) shall apply to evaluations 

15 conducted under this paragraph in the same 

16 manner as such provisions apply to evaluations 

17 conducted under subsection (b)(4). 

18 ‘‘(7) APPLICATION OF EXPANDED TELEHEALTH

19 SERVICES TO ALL CMI MODELS.—The Secretary 

20 shall expand the application of an enhanced tele21 health service with respect to the condition or condi22 tions involved to all models tested under subsection 

23 (b), and expanded under subsection (c) (if applica24 ble), that apply with respect to services furnished 

25 under title XVIII to provide for coverage of, and 


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1 payment for, such enhanced telehealth service or 

2 services with respect to such condition or conditions 

3 under all such models for years beginning after the 

4 5-year period described in paragraph (1)(A) if— 

5 ‘‘(A) the independent evaluation conducted 

6 under paragraph (6) with respect to such mod7 els demonstrates that such enhanced telehealth 

8 service or services with respect to the condition 

9 or conditions involved resulted in— 

10 ‘‘(i) reduced spending under parts A 

11 and B of title XVIII without reducing the 

12 quality of care; or 

13 ‘‘(ii) improved quality of patient care 

14 without increasing such spending; and 

15 ‘‘(B) the Chief Actuary of the Centers for 

16 Medicare & Medicaid Services certifies that 

17 such expansion would reduce net program 

18 spending under parts A and B of title XVIII.’’. 

19 (b) COVERAGE OF AND PAYMENT FOR CERTAIN EN20 HANCED TELEHEALTH SERVICES THAT ARE CERTIFIED

21 AS PROVIDING SAVINGS UNDER THE MEDICARE PRO22 GRAM.— 

23 (1) COVERAGE.—Section 1834 of the Social Se24 curity Act (42 U.S.C. 1395m) is amended by adding 

25 at the end the following new subsection: 


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1 ‘‘(x) CERTIFIED ENHANCED TELEHEALTH SERV2 ICES.— 

3 ‘‘(1) IN GENERAL.—The Secretary shall pay for 

4 certified enhanced telehealth services (as defined in 

5 paragraph (2)(A)) furnished by a physician (as de6 fined in section 1861(r)) or a practitioner (as de7 fined in section 1842(b)(18)(C)) to a Medicare fee8 for-service beneficiary (as defined in paragraph 

9 (2)(B)) for one or more of the conditions specified 

10 under section 1115A(h)(4) in an amount determined 

11 under paragraph (3) without regard to— 

12 ‘‘(A) the location of the Medicare fee-for13 service beneficiary at the time the certified en14 hanced telehealth service is furnished; and 

15 ‘‘(B) the area in which the Medicare fee16 for-service beneficiary resides. 

17 ‘‘(2) DEFINITIONS.—In this subsection: 

18 ‘‘(A) CERTIFIED ENHANCED TELEHEALTH

19 SERVICE.—The term ‘certified enhanced tele20 health service’ means, with respect to a condi21 tion or conditions specified under section 

22 115A(h)(4), an enhanced telehealth service (as 

23 defined in section 1115A(h)(2)) with respect to 

24 which— 


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1 ‘‘(i) an independent evaluation con2 ducted under section 1115A(h)(6) dem3 onstrates that the service tested under a 

4 model under section 1115A(b)(2)(D) with 

5 respect to the condition or conditions re6 sulted in— 

7 ‘‘(I) reduced spending under 

8 parts A and B without reducing the 

9 quality of care; or 

10 ‘‘(II) improved quality of patient 

11 care without increasing such spend12 ing; and 

13 ‘‘(ii) the Chief Actuary of the Centers 

14 for Medicare & Medicaid Services certifies 

15 that such expansion would reduce net pro16 gram spending under such parts. 

17 ‘‘(B) MEDICARE FEE-FOR-SERVICE BENE18 FICIARY.—The term ‘Medicare fee-for-service 

19 beneficiary’ has the meaning given such term in 

20 section 1899(h)(3). 

21 ‘‘(3) PAYMENT AMOUNT.—The amount of pay22 ment for certified enhanced telehealth services shall 

23 be determined in the same manner as payments for 

24 enhanced telehealth services are determined under 

25 section 1115A(h)(5).’’. 


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1 (2) PAYMENT.—Section 1833(a)(1) of the So2 cial Security Act (42 U.S.C. 1395l(a)(1)) is amend3 ed by striking ‘‘and’’ before ‘‘(CC)’’ and inserting 

4 before the semicolon at the end the following: ‘‘, and 

5 (CC) with respect to certified enhanced telehealth 

6 services (as defined in section 1834(x)(2)(A)), the 

7 amount paid shall be an amount equal to 80 percent 

8 of the lesser of the actual charge for the services or 

9 the amount determined under section 1834(x)(3)’’. 

Æ 


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