II 

109TH CONGRESS 

2D SESSION S. 2282 

To amend title XVIII of the Social Security Act to provide for access to 

telehealth services in the home. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 14, 2006 

Mr. SANTORUM introduced the following bill; which was read twice and 

referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to provide 

for access to telehealth services in the home. 

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 ‘‘Medicare Home Health 

5 Telehealth Access Act of 2006’’. 

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

7 (a) IN GENERAL.—Section 1895(e) of the Social Se8 curity Act (42 U.S.C. 1395fff(e)) is amended to read as 

9 follows: 

10 ‘‘(e) COVERAGE OF TELEHEALTH SERVICES.— 
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1 ‘‘(1) IN GENERAL.—The Secretary shall include 

2 telehealth services that are furnished via a tele3 communication system by a home health agency to 

4 an individual receiving home health services under 

5 section 1814(a)(2)(C) or 1835(a)(2)(A) as a home 

6 health visit for purposes of eligibility and payment 

7 under this title if the telehealth services— 

8 ‘‘(A) are ordered as part of a plan of care 

9 certified by a physician pursuant to section 

10 1814(a)(2)(C) or 1835(a)(2)(A); 

11 ‘‘(B) do not substitute for in-person home 

12 health services ordered as part of a plan of care 

13 certified by a physician pursuant to such re14 spective section; and 

15 ‘‘(C) are considered the equivalent of a 

16 visit under criteria developed by the Secretary 

17 under paragraph (3). 

18 ‘‘(2) PHYSICIAN CERTIFICATION.—Nothing in 

19 this section shall be construed as waiving the re20 quirement for a physician certification under section 

21 1814(a)(2)(C) or 1835(a)(2)(A) for the payment for 

22 home health services, whether or not furnished via 

23 a telecommunication system. 

24 ‘‘(3) CRITERIA FOR VISIT EQUIVALENCY.— 
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1 ‘‘(A) STANDARDS.—The Secretary shall es2 tablish standards and qualifications for catego3 rizing and coding under HCPCS codes tele4 health services under this subsection as equiva5 lent to an in-person visit for purposes of eligi6 bility and payment for home health services 

7 under this title. In establishing the standards 

8 and qualifications, the Secretary may distin9 guish between varying modes and modalities of 

10 telehealth services and shall consider— 

11 ‘‘(i) the nature and amount of service 

12 time involved; and 

13 ‘‘(ii) the functions of the telecommuni14 cations. 

15 ‘‘(B) LIMITATION.—A telecommunication 

16 that consists solely of a telephone audio con17 versation, facsimile, electronic text mail, or con18 sultation between two health care practitioners 

19 is not considered a visit under this subsection. 

20 ‘‘(4) TELEHEALTH SERVICE.— 

21 ‘‘(A) DEFINITION.—For purposes of this 

22 section, the term ‘telehealth service’ means 

23 technology-based professional consultations, pa24 tient monitoring, patient training services, clin25 ical observation, assessment, or treatment, and 
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1 any additional services that utilize technologies 

2 specified by the Secretary as HCPCS codes de3 veloped under paragraph (3). 

4 ‘‘(B) UPDATE OF HCPCS CODES.—The 

5 Secretary shall establish a process for the up6 dating, not less frequently than annually, of 

7 HCPCS codes for telehealth services. 

8 ‘‘(5) CONDITIONS FOR PAYMENT AND COV9 ERAGE.—Nothing in this subsection shall be con10 strued as waiving any condition of payment under 

11 sections 1814(a)(2)(C) or 1835(a)(2)(A) or exclu12 sion of coverage under section 1862(a)(1). 

13 ‘‘(6) COST REPORTING.—Notwithstanding any 

14 provision to the contrary, the Secretary shall provide 

15 that the costs of telehealth services under this sub16 section shall be reported as a reimbursable cost cen17 ter on any cost report submitted by a home health 

18 agency to the Secretary.’’. 

19 (b) EFFECTIVE DATE.— 

20 (1) The amendment made by subsection (a) 

21 shall apply to telehealth services furnished on or 

22 after October 1, 2006. The Secretary of Health and 

23 Human Services shall develop and implement cri24 teria and standards under section 1895(e)(3) of the 
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1 Social Security Act, as amended by subsection (a), 

2 by no later than July 1, 2006. 

3 (2) In the event that the Secretary has not 

4 complied with these deadlines, beginning October 1, 

5 2006, a home health visit for purpose of eligibility 

6 and payment under title XVIII of the Social Secu7 rity Act shall include telehealth services under sec8 tion 1895(e) of such Act with the aggregate of tele9 communication encounters in a 24-hour period con10 sidered the equivalent of one in-person visit. 

11 SEC. 3. REMOTE MONITORING PILOT PROJECTS. 

12 (a) PILOT PROGRAM AUTHORIZED.—The Secretary 

13 of Health and Human Services (in this section referred 

14 to as the ‘‘Secretary’’) shall initiate and carry out pilot 

15 projects (each in this section referred to as a ‘‘pilot 

16 project’’) in a variety of geographic locations that provide 

17 incentives to home health agencies to utilize home moni18 toring and communications technologies that will— 

19 (1) enhance health outcomes for individuals en20 rolled under parts A and B of title XVIII of the So21 cial Security Act; and 

22 (2) reduce part A and B program expenditures 

23 for institutional and other providers, practitioners, 

24 and suppliers of health care items and services. 

25 (b) INDIVIDUALS WITHIN THE SCOPE OF PILOT.— 
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1 (1) IN GENERAL.—The Secretary shall specify, 

2 in accordance with this subsection, the criteria for 

3 identifying those individuals who shall be considered 

4 within the scope of the pilot projects under this sec5 tion for purposes of the incentive payments under 

6 subsection (c) and for assessment of the effective7 ness of the home health agency in achieving the ob8 jectives of the section. 

9 (2) PARTICIPATION OF INDIVIDUALS NOT RE10 CEIVING HOME HEALTH SERVICES.—Participation in 

11 these pilot projects shall not be limited to individuals 

12 receiving home health services under part A or part 

13 B of title XVIII of the Social Security Act. 

14 (c) INCENTIVE PAYMENTS.— 

15 (1) IN GENERAL.—Subject to paragraph (2), 

16 the Secretary shall pay to each home health agency 

17 participating in a pilot project an amount for each 

18 year under the pilot project equal to at least 50 per19 cent of the reduction in expenditures under such 

20 parts realized for such year due to the agency’s par21 ticipation in the project. The computation of such 

22 reduction shall be based on the Secretary’s estimate 

23 of the amount by which the amount of expenditures 

24 under such parts for the individuals under the pilot 

25 project is less than the amount that would have been 
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1 expended under such parts for such individuals if 

2 the project were not implemented. In determining 

3 the estimate, the Secretary may use estimates for 

4 expenditures for individuals who are not partici5 pating in the project and who are comparable to in6 dividuals participating in the project. 

7 (2) LIMITATION ON EXPENDITURES.—The Sec8 retary shall limit incentive payments under this sub9 section as necessary to ensure that the aggregate ex10 penditures under title XVIII of the Social Security 

11 Act (inclusive of such incentive payments) with re12 spect to patients within the scope of the pilot 

13 projects do not exceed the amount that the Sec14 retary estimates would be expended under such title 

15 if the pilot projects under this section were not im16 plemented. 

17 (d) CONSTRUCTION.—Nothing in this section shall 

18 limit the amount of payment (other than under subsection 

19 (c)) a home health agency may receive for home health 

20 services provided to eligible individuals under part A or 

21 part B of title XVIII of the Social Security Act. 

22 (e) IMPLEMENTATION DATE.—The Secretary shall 

23 implement the pilot projects authorized by this section no 

24 later than nine months after the date of the enactment 

25 of this Act. 
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1 (f) EXPANSION OF THE PILOT PROJECT.—If the Sec2 retary determines that any of the pilot projects— 

3 (1) result in a decrease in Federal expenditures 

4 under title XVIII of the Social Security Act; and 

5 (2) maintain or enhance health outcomes for 

6 the participating beneficiaries, 

7 the Secretary may initiate or extend comparable projects 

8 in additional areas. 

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