II 

115TH CONGRESS 

1ST SESSION S. 1016 

To amend title XVIII of the Social Security Act to expand access to telehealth 

services, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MAY 3, 2017 

Mr. SCHATZ (for himself, Mr. WICKER, Mr. COCHRAN, Mr. CARDIN, Mr. 

THUNE, and Mr. WARNER) 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 expand 

access to telehealth services, and for other purposes. 

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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Creating Opportunities Now for Necessary and Effective 

6 Care Technologies (CONNECT) for Health Act of 2017’’ 

7 or the ‘‘CONNECT for Health Act of 2017’’. 

8 (b) TABLE OF CONTENTS.—The table of contents of 

9 this Act is as follows: 

Sec. 1. Short title; table of contents. 


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Sec. 2. Providing accountable care organizations the ability to expand the use 

of telehealth. 

Sec. 3. Expanding access to home dialysis therapy. 

Sec. 4. Expanding the use of telehealth for individuals with stroke. 

Sec. 5. Increasing access to digital tools for Medicare Advantage enrollees 

through telehealth and remote patient monitoring. 

Sec. 6. Coverage of remote patient monitoring services furnished to certain individuals. 

Sec. 7. Rural health clinics and Federally qualified health centers. 

Sec. 8. Allowing Native American health service facilities as sites eligible for 

telehealth payment. 

Sec. 9. Clarification regarding telehealth and remote patient monitoring technologies provided to beneficiaries. 

Sec. 10. Allowing telehealth and remote patient monitoring services to be included in bundled or global payments. 

Sec. 11. Expanding the use of telehealth through the waiver of certain requirements. 

Sec. 12. Expanding the use of telehealth for mental health services. 

Sec. 13. HHS evaluation and report on the use of telehealth and remote patient 

monitoring under all demonstration programs and pilots with 

a telehealth waiver. 

Sec. 14. Testing of models to examine the use of telehealth and remote patient 

monitoring under the Medicare program. 

Sec. 15. Sense of Congress regarding the remote practice of medicine. 

1 SEC. 2. PROVIDING ACCOUNTABLE CARE ORGANIZATIONS 

2 THE ABILITY TO EXPAND THE USE OF TELE3 HEALTH. 

4 (a) IN GENERAL.—Section 1899 of the Social Secu5 rity Act (42 U.S.C. 1395jjj) is amended by adding at the 

6 end the following new subsection: 

7 ‘‘(l) PROVIDING ACOS THE ABILITY TO EXPAND

8 THE USE OF TELEHEALTH SERVICES.— 

9 ‘‘(1) IN GENERAL.— 

10 ‘‘(A) EXPANDING USE OF TELEHEALTH

11 SERVICES.—In the case of telehealth services 

12 for which payment would otherwise be made 

13 under this title furnished on or after January 

14 1, 2018, for purposes of this subsection only, 


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1 the restrictions applicable to the coverage of 

2 telehealth services under section 1834(m) de3 scribed in subparagraph (B) shall not apply 

4 with respect to such services furnished to a 

5 Medicare fee-for-service beneficiary assigned to 

6 an applicable ACO (as defined in paragraph 

7 (2)). 

8 ‘‘(B) RESTRICTIONS DESCRIBED.—For 

9 purposes of this subsection, restrictions applica10 ble to the coverage of telehealth services under 

11 section 1834(m) shall include requirements re12 lating to qualifications for an originating site 

13 under paragraph (4)(C)(ii) of such section, any 

14 geographic limitations under paragraph 

15 (4)(C)(i) of such section (other than applicable 

16 State law requirements, including State licen17 sure requirements), any limitation on the use of 

18 store-and-forward technologies described in 

19 paragraph (1) of such section, any limitation on 

20 the type of health care provider who may fur21 nish such services (other than the requirement 

22 that the provider is a Medicare-enrolled pro23 vider), or any limitation on specific codes des24 ignated as telehealth services that are covered 

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1 vided such codes are clinically appropriate to 

2 furnish remotely). 

3 ‘‘(2) DEFINITION OF APPLICABLE ACO.—In this 

4 subsection, the term ‘applicable ACO’ means an 

5 ACO participating in a model tested or expanded 

6 under section 1115A or under this section— 

7 ‘‘(A) that operates under a two-sided 

8 model— 

9 ‘‘(i) described in section 425.600(a) of 

10 title 42, Code of Federal Regulations; or 

11 ‘‘(ii) tested or expanded under section 

12 1115A; and 

13 ‘‘(B) for which Medicare fee-for-service 

14 beneficiaries are assigned to the ACO using a 

15 prospective assignment method, as determined 

16 appropriate by the Secretary. 

17 ‘‘(3) NO ORIGINATING SITE FACILITY FEE FOR

18 NEW SITES.—The Secretary shall not pay an origi19 nating site facility fee (as described in paragraph 

20 (2)(B) of section 1834(m)) with respect to telehealth 

21 services described in paragraph (1) if such services 

22 would not have been covered under this title as of 

23 the date of enactment of this subsection. 

24 ‘‘(4) ANNUAL SUBMISSION OF DATA.—An appli25 cable ACO that furnishes telehealth services deVerDate Sep 11 2014 00:34 May 10, 2017 Jkt 069200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1016.IS S1016

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1 scribed in paragraph (1) shall, on an annual basis, 

2 submit to the Secretary information requested by 

3 the Secretary for evaluation of the implementation 

4 of this subsection, including information on utiliza5 tion and expenditures for telehealth under this sub6 section during the preceding year and data on any 

7 applicable quality measures, consistent with sections 

8 1848 and 1833(z).’’. 

9 (b) EVALUATION AND REPORT.— 

10 (1) EVALUATION.— 

11 (A) IN GENERAL.—The Secretary of 

12 Health and Human Services (in this subsection 

13 referred to as the ‘‘Secretary’’) shall conduct an 

14 evaluation on the implementation of section 

15 1899(l) of the Social Security Act, as added by 

16 subsection (a). Such evaluation shall include an 

17 analysis of the utilization of, and expenditures 

18 for, telehealth services under such section, in19 cluding a comparison of the utilization of, and 

20 expenditures for, the same services provided in 

21 the office setting. 

22 (B) COLLECTION OF DATA.—The Sec23 retary may collect such data as the Secretary 

24 determines necessary to carry out the evalua25 tion under this paragraph. 


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1 (2) REPORT.—Not later than January 1, 2025, 

2 the Secretary shall submit to Congress a report con3 taining the results of the evaluation conducted under 

4 paragraph (1), together with recommendations for 

5 such legislation and administrative action as the 

6 Secretary determines appropriate. 

7 SEC. 3. EXPANDING ACCESS TO HOME DIALYSIS THERAPY. 

8 (a) IN GENERAL.—Section 1881(b)(3) of the Social 

9 Security Act (42 U.S.C. 1395rr(b)(3)) is amended— 

10 (1) by redesignating subparagraphs (A) and 

11 (B) as clauses (i) and (ii), respectively; 

12 (2) in clause (ii), as redesignated by subpara13 graph (A), strike ‘‘on a comprehensive’’ and insert 

14 ‘‘subject to subparagraph (B), on a comprehensive’’; 

15 (3) by striking ‘‘With respect to’’ and inserting 

16 ‘‘(A) With respect to’’; and 

17 (4) by adding at the end the following new sub18 paragraph: 

19 ‘‘(B) For purposes of subparagraph (A)(ii), an indi20 vidual determined to have end stage renal disease receiv21 ing home dialysis may choose to receive the monthly end 

22 stage renal disease-related visits furnished on or after 

23 January 1, 2018, via telehealth, if the individual receives 

24 a face-to-face visit, without the use of telehealth, at least 

25 once every three consecutive months.’’. 


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1 (b) ORIGINATING SITE REQUIREMENTS.— 

2 (1) IN GENERAL.—Section 1834(m) of the So3 cial Security Act (42 U.S.C. 1395m(m)) is amend4 ed— 

5 (A) in paragraph (4)(C)(ii), by adding at 

6 the end the following new subclauses: 

7 ‘‘(IX) A renal dialysis facility, 

8 but only for purposes of section 

9 1881(b)(3)(B). 

10 ‘‘(X) The home of an individual, 

11 but only for purposes of section 

12 1881(b)(3)(B).’’; and 

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

14 paragraph: 

15 ‘‘(5) TREATMENT OF HOME DIALYSIS MONTHLY

16 ESRD-RELATED VISIT.—The geographic require17 ments described in paragraph (4)(C)(i) shall not 

18 apply with respect to telehealth services furnished on 

19 or after January 1, 2018, for purposes of section 

20 1881(b)(3)(B), at an originating site described in 

21 subclause (VI), (IX), or (X) of paragraph 

22 (4)(C)(ii)), subject to applicable State law require23 ments, including State licensure requirements.’’. 

24 (2) NO FACILITY FEE IF ORIGINATING SITE

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1 tion 1834(m)(2)(B) of the Social Security (42 

2 U.S.C. 1395m(m)(2)(B)) is amended— 

3 (A) by redesignating clauses (i) and (ii) as 

4 subclauses (I) and (II), and indenting appro5 priately; 

6 (B) in subclause (II), as redesignated by 

7 subparagraph (A), by striking ‘‘clause (i) or 

8 this clause’’ and inserting ‘‘subclause (I) or this 

9 subclause’’; 

10 (C) by striking ‘‘SITE.—With respect to’’ 

11 and inserting ‘‘SITE.— 

12 ‘‘(i) IN GENERAL.—Subject to clause 

13 (ii), with respect to’’; and 

14 (D) by adding at the end the following new 

15 clause: 

16 ‘‘(ii) NO FACILITY FEE IF ORIGI17 NATING SITE FOR HOME DIALYSIS THER18 APY IS THE HOME.—No facility fee shall 

19 be paid under this subparagraph to an 

20 originating site described in paragraph 

21 (4)(C)(ii)(X).’’. 

22 (c) CONFORMING AMENDMENT.—Section 1881(b)(1) 

23 of the Social Security Act (42 U.S.C. 1395rr(b)(1)) is 

24 amended by striking ‘‘paragraph (3)(A)’’ and inserting 

25 ‘‘paragraph (3)(A)(i)’’. 


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1 SEC. 4. EXPANDING THE USE OF TELEHEALTH FOR INDI2 VIDUALS WITH STROKE. 

3 Section 1834(m) of the Social Security Act (42 

4 U.S.C. 1395m(m)), as amended by section 3(b), is amend5 ed by adding at the end the following new paragraph: 

6 ‘‘(6) TREATMENT OF STROKE TELEHEALTH

7 SERVICES.— 

8 ‘‘(A) NONAPPLICATION OF ORIGINATING

9 SITE REQUIREMENTS.—The requirements de10 scribed in paragraph (4)(C) shall not apply with 

11 respect to telehealth services furnished on or 

12 after January 1, 2018, for purposes of evalua13 tion of an acute stroke, as determined by the 

14 Secretary, subject to applicable State law re15 quirements, including State licensure require16 ments. 

17 ‘‘(B) NO ORIGINATING SITE FACILITY FEE

18 FOR NEW SITES.—The Secretary shall not pay 

19 an originating site facility fee (as described in 

20 paragraph (2)(B)) with respect to telehealth 

21 services described in subparagraph (A) if the 

22 services would not have been covered under this 

23 title as of the date of enactment of this para24 graph.’’. 


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1 SEC. 5. INCREASING ACCESS TO DIGITAL TOOLS FOR MEDI2 CARE ADVANTAGE ENROLLEES THROUGH 

3 TELEHEALTH AND REMOTE PATIENT MONI4 TORING. 

5 (a) IN GENERAL.—Section 1852 of the Social Secu6 rity Act (42 U.S.C. 1395w–22) is amended— 

7 (1) in subsection (a)(1)(B)(i), by inserting ‘‘, 

8 subject to subsection (m),’’ after ‘‘means’’; and 

9 (2) by adding at the end the following new sub10 section: 

11 ‘‘(m) PROVISION OF ADDITIONAL TELEHEALTH

12 BENEFITS AND TREATMENT OF REMOTE PATIENT MONI13 TORING.— 

14 ‘‘(1) MA PLAN OPTION.—For plan year 2018 

15 and subsequent plan years, subject to the require16 ments of paragraph (3), an MA plan may provide 

17 additional telehealth benefits (as defined in para18 graph (2)) to individuals enrolled under this part. 

19 ‘‘(2) ADDITIONAL TELEHEALTH BENEFITS DE20 FINED.— 

21 ‘‘(A) IN GENERAL.—For purposes of this 

22 subsection and section 1854: 

23 ‘‘(i) DEFINITION.—The term ‘addi24 tional telehealth benefits’ means services 

25 for which benefits are available under part 

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1 ble to the coverage of telehealth services 

2 under section 1834(m) described in sub3 paragraph (B). 

4 ‘‘(ii) EXCLUSION OF CAPITAL AND IN5 FRASTRUCTURE COSTS AND INVEST6 MENTS.—The term ‘additional telehealth 

7 benefits’ does not include capital and infra8 structure costs and investments relating to 

9 such benefits. 

10 ‘‘(B) RESTRICTIONS DESCRIBED.—For 

11 purposes of this subsection, restrictions applica12 ble to the coverage of telehealth services under 

13 section 1834(m) shall include requirements re14 lating to qualifications for an originating site 

15 under paragraph (4)(C)(ii) of such section, any 

16 geographic limitations under paragraph 

17 (4)(C)(i) of such section (other than applicable 

18 State law requirements, including State licen19 sure requirements), any limitation on the use of 

20 store-and-forward technologies described in 

21 paragraph (1) of such section, any limitation on 

22 the type of health care provider who may fur23 nish such services (other than the requirement 

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1 ignated as telehealth services that are covered 

2 under this title pursuant to such section (pro3 vided such codes are clinically appropriate to 

4 furnish remotely). 

5 ‘‘(C) PUBLIC COMMENT.—Not later than 

6 November 30, 2017, the Secretary shall solicit 

7 comments on what types of telehealth services 

8 should be considered to meet the definition of 

9 additional telehealth benefits under this para10 graph. 

11 ‘‘(3) REQUIREMENTS FOR ADDITIONAL TELE12 HEALTH BENEFITS.—The Secretary shall specify re13 quirements for the provision or furnishing of addi14 tional telehealth benefits, including with respect to 

15 the following: 

16 ‘‘(A) Physician, practitioner, or other 

17 health care provider licensure consistent with 

18 State law and other requirements such as spe19 cific training. 

20 ‘‘(B) Factors necessary to ensure the co21 ordination of such benefits with items and serv22 ices furnished in-person. 

23 ‘‘(C) Such other areas as determined by 

24 the Secretary. 


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1 ‘‘(4) ENROLLEE CHOICE.—If an MA plan pro2 vides a service as an additional telehealth benefit (as 

3 defined in paragraph (2)), an individual enrollee 

4 shall have discretion as to whether to receive such 

5 service as an additional telehealth benefit. 

6 ‘‘(5) CONSTRUCTION REGARDING NETWORK AC7 CESS ADEQUACY.—Provision of additional telehealth 

8 benefits under this subsection shall not be construed 

9 as making such benefits available and accessible for 

10 purposes of compliance with subsection (d). 

11 ‘‘(6) TREATMENT UNDER MA.—For purposes of 

12 this subsection and section 1854, additional tele13 health benefits shall be treated as if they were bene14 fits under the original Medicare fee-for-service pro15 gram option. 

16 ‘‘(7) CONSTRUCTION.—Nothing in this sub17 section shall be construed as affecting the require18 ment under subsection (a)(1) that MA plans provide 

19 enrollees with items and services (other than hospice 

20 care) for which benefits are available under parts A 

21 and B, including benefits available under section 

22 1834(m). 

23 ‘‘(8) CLARIFICATION REGARDING REMOTE PA24 TIENT MONITORING SERVICES.—For purposes of 

25 this subsection and section 1854, remote patient 


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1 monitoring services shall be treated as if they were 

2 benefits under the original Medicare fee-for-service 

3 program option so long as such treatment does not 

4 increase the bid amount attributable to such benefits 

5 from the amount it would otherwise be, as deter6 mined by the Secretary. 

7 ‘‘(9) PROVISION OF DATA.—An MA plan that 

8 provides additional telehealth benefits or remote pa9 tient monitoring services with respect to a plan year 

10 shall provide to the Secretary (at such time and in 

11 such manner as the Secretary may specify) data on 

12 expenditures and utilization for telehealth or remote 

13 patient monitoring services under the plan for enroll14 ees during that plan year.’’. 

15 (b) CLARIFICATION REGARDING INCLUSION IN BID

16 AMOUNT.—Section 1854(a)(6)(A)(ii)(I) of the Social Se17 curity Act (42 U.S.C. 1395w–24(a)(6)(A)(ii)(I)) is 

18 amended by inserting ‘‘, including, for plan year 2019 and 

19 subsequent plan years, the provision of additional tele20 health benefits and remote patient monitoring as described 

21 in section 1852(m)’’ before the semicolon at the end. 


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1 SEC. 6. COVERAGE OF REMOTE PATIENT MONITORING 

2 SERVICES FURNISHED TO CERTAIN INDIVID3 UALS. 

4 (a) IN GENERAL.—Section 1848(b) of the Social Se5 curity Act (42 U.S.C. 1395w–4(b)) is amended by adding 

6 at the end the following new paragraph: 

7 ‘‘(12) COVERAGE OF REMOTE PATIENT MONI8 TORING SERVICES FURNISHED TO CERTAIN INDIVID9 UALS.— 

10 ‘‘(A) IN GENERAL.—The Secretary shall, 

11 subject to subparagraph (B), make payment (as 

12 the Secretary determines to be appropriate) 

13 under this section for remote patient moni14 toring services (as defined in subparagraph 

15 (C)(iii)) furnished on or after January 1, 2018, 

16 to an applicable individual (as defined in sub17 paragraph (C)(i)) by an eligible provider (as de18 fined in subparagraph (C)(ii)). 

19 ‘‘(B) REQUIREMENTS.—The following shall 

20 apply with respect to remote patient monitoring 

21 services under this paragraph: 

22 ‘‘(i) Coverage of such remote patient 

23 monitoring services shall be in addition to 

24 coverage for chronic care management 

25 services or transitional care management 


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1 services furnished to an applicable indi2 vidual under this section. 

3 ‘‘(ii) The Secretary shall consult with 

4 public and private stakeholders in deter5 mining the amount of payment for remote 

6 patient monitoring services under this sec7 tion. 

8 ‘‘(iii) Payment, pricing, and coverage 

9 for such remote patient monitoring services 

10 may occur through the unbundling, modi11 fication, or establishment of certain codes. 

12 ‘‘(iv) Such remote patient monitoring 

13 services (other than those services that are 

14 physicians’ services) shall be furnished 

15 under the general supervision of an eligible 

16 provider. 

17 ‘‘(C) DEFINITIONS.—In this paragraph: 

18 ‘‘(i) APPLICABLE INDIVIDUAL.—The 

19 term ‘applicable individual’ means an indi20 vidual— 

21 ‘‘(I) receiving chronic care man22 agement services or transitional care 

23 management services under this sec24 tion; 


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1 ‘‘(II) who is in the top five per2 cent of Medicare cost utilization and 

3 has two or more chronic diseases, as 

4 determined on a yearly basis by the 

5 Secretary; or 

6 ‘‘(III) who has any other condi7 tion or with respect to an episode of 

8 care that the Secretary may specify, 

9 so long as the Chief Actuary of the 

10 Centers for Medicare & Medicaid 

11 Services certifies that providing cov12 erage for remote patient monitoring 

13 services with respect to such individ14 uals would— 

15 ‘‘(aa) reduce spending under 

16 this title without reducing the 

17 quality of care; or 

18 ‘‘(bb) improve the quality of 

19 patient care without increasing 

20 spending. 

21 ‘‘(ii) ELIGIBLE PROVIDER.—The term 

22 ‘eligible provider’ means a physician (as 

23 defined in section 1861(r)) or a practi24 tioner described in section 1842(b)(18)(C). 


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1 ‘‘(iii) REMOTE PATIENT MONITORING

2 SERVICES.—The term ‘remote patient 

3 monitoring services’ means clinical data 

4 transmitted from an applicable individual 

5 in one location via electronic communica6 tions technologies that are devices as de7 fined in section 201(h) of the Federal 

8 Food, Drug, and Cosmetic Act to an eligi9 ble provider in a different location and 

10 used by the eligible provider in furnishing 

11 such services to such individual that com12 plies with the Federal regulations (con13 cerning the privacy and security of individ14 ually identifiable health information) pro15 mulgated under section 264(c) of the 

16 Health Insurance Portability and Account17 ability Act of 1996, as part of an estab18 lished plan of care for the applicable indi19 vidual that includes the review and inter20 pretation of that data by an eligible pro21 vider. Such term includes those services 

22 furnished in a Federally qualified health 

23 center or a rural health clinic. Such term 

24 shall not include a communication that 

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1 versation, facsimile, or electronic text mes2 sage between an eligible provider and the 

3 applicable individual.’’. 

4 (b) EXPANDING THE USE OF REMOTE PATIENT

5 MONITORING SERVICES UNDER ALTERNATIVE PAYMENT

6 MODELS.—Section 1848(b)(12) of the Social Security Act 

7 (42 U.S.C. 1395w–4(b)(12)), as added by subsection (a), 

8 is amended by adding at the end the following new sub9 paragraph: 

10 ‘‘(D) APPLICATION TO ALTERNATIVE PAY11 MENT MODELS.—For purposes of applying this 

12 paragraph with respect to remote patient moni13 toring services furnished by an eligible provider 

14 participating in an alternative payment model 

15 (as defined in section 1833(z)(3)(C)), the term 

16 ‘applicable individual’ shall mean any bene17 ficiary assigned to the alternative payment 

18 model.’’. 

19 SEC. 7. RURAL HEALTH CLINICS AND FEDERALLY QUALI20 FIED HEALTH CENTERS. 

21 (a) EXPANSION OF ORIGINATING SITES.—Section 

22 1834(m)(4)(C) of the Social Security Act (42 U.S.C. 

23 1395m(m)(4)(C)) is amended— 

24 (1) in clause (i), by striking ‘‘The term’’ and 

25 inserting ‘‘Subject to clause (iii), the term’’; and 


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1 (2) by adding at the end the following new 

2 clause: 

3 ‘‘(iii) RURAL HEALTH CLINICS AND

4 FEDERALLY QUALIFIED HEALTH CEN5 TERS.—In the case of a service furnished 

6 on or after the date that is 6 months after 

7 the date of the enactment of the CON8 NECT for Health Act of 2017, the term 

9 ‘originating site’ shall also include any 

10 Federally qualified health center and any 

11 rural health clinic (as such terms are de12 fined in section 1861(aa)) at which the eli13 gible telehealth individual is located at the 

14 time the service is furnished via a tele15 communications system, whether or not 

16 they are located in an area described in 

17 clause (i), insofar as such sites are not oth18 erwise included in the definition of origi19 nating site under such clause, subject to 

20 applicable State law requirements, includ21 ing State licensure requirements.’’. 

22 (b) EXPANSION OF DISTANT SITES.—Section 

23 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) 

24 is amended— 

25 (1) in the first sentence of paragraph (1)— 


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1 (A) by striking ‘‘or a practitioner (de2 scribed in section 1842(b)(18)(C))’’ and insert3 ing ‘‘, a practitioner (described in section 

4 1842(b)(18)(C)), a Federally qualified health 

5 center, or a rural health clinic’’; and 

6 (B) by striking ‘‘or practitioner’’ and in7 serting ‘‘, practitioner, Federally qualified 

8 health center, or rural health clinic’’; 

9 (2) in paragraph (2)(A)— 

10 (A) by inserting the following after ‘‘eligi11 ble telehealth individual’’: ‘‘or to a Federally 

12 qualified health center or rural health clinic 

13 that serves as a distant site and furnishes a 

14 telehealth service to an eligible telehealth indi15 vidual’’; and 

16 (B) by striking ‘‘such physician or practi17 tioner’’ and inserting ‘‘such physician, practi18 tioner, Federally qualified health center, or 

19 rural health clinic’’; and 

20 (3) in paragraph (4)(A), by inserting the fol21 lowing before the period at the end: ‘‘and includes 

22 a Federally qualified health center or rural health 

23 clinic that furnishes a telehealth service to an eligi24 ble individual’’. 


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1 (c) EFFECTIVE DATE.—The amendments made by 

2 this section shall apply to services furnished on or after 

3 January 1, 2018. 

4 SEC. 8. ALLOWING NATIVE AMERICAN HEALTH SERVICE 

5 FACILITIES AS SITES ELIGIBLE FOR TELE6 HEALTH PAYMENT. 

7 (a) IN GENERAL.—Section 1834(m)(4)(C) of the So8 cial Security Act (42 U.S.C. 1395m(m)(4)(C)), as amend9 ed by section 7, is amended— 

10 (1) in clause (i), by striking ‘‘clause (iii)’’ and 

11 inserting ‘‘clauses (iii) and (iv)’’; and 

12 (2) by adding at the end the following new 

13 clause: 

14 ‘‘(iv) NATIVE AMERICAN HEALTH

15 SERVICE FACILITIES.—The originating site 

16 requirements described in clauses (i) and 

17 (ii) shall not apply with respect to a facil18 ity of the Indian Health Service, whether 

19 operated by such Service, or by an Indian 

20 tribe (as that term is defined in section 4 

21 of the Indian Health Care Improvement 

22 Act (25 U.S.C. 1603)) or a tribal organiza23 tion (as that term is defined in section 4 

24 of the Indian Self-Determination and Edu25 cation Assistance Act (25 U.S.C. 450b)), 


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1 or a facility of the Native Hawaiian health 

2 care systems authorized under the Native 

3 Hawaiian Health Care Improvement Act 

4 (42 U.S.C. 11701 et seq.).’’. 

5 (b) NO ORIGINATING SITE FACILITY FEE FOR NEW

6 SITES.—Section 1834(m)(2)(B) of the Social Security Act 

7 (42 U.S.C. 1395m(m)(2)(B)) is amended, in the matter 

8 preceding clause (i), by inserting ‘‘(other than an origi9 nating site that is only described in clause (iv) of para10 graph (4)(C), and does not meet the requirement for an 

11 originating site under clause (i) of such paragraph)’’ after 

12 ‘‘the originating site’’. 

13 (c) EFFECTIVE DATE.—The amendments made by 

14 this section shall apply to services furnished on or after 

15 January 1, 2018. 

16 SEC. 9. CLARIFICATION REGARDING TELEHEALTH AND RE17 MOTE PATIENT MONITORING TECHNOLOGIES 

18 PROVIDED TO BENEFICIARIES. 

19 Section 1128A(i)(6) of the Social Security Act (42 

20 U.S.C. 1320a–7a(i)(6)) is amended— 

21 (1) in subparagraph (H), by striking ‘‘; or’’ and 

22 inserting a semicolon; 

23 (2) in subparagraph (I), by striking the period 

24 at the end and inserting ‘‘; or’’; and 


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

3 ‘‘(J) the provision of telehealth or remote 

4 patient monitoring technologies to individuals 

5 under title XVIII by a health care provider for 

6 the purpose of furnishing telehealth or remote 

7 patient monitoring services.’’. 

8 SEC. 10. ALLOWING TELEHEALTH AND REMOTE PATIENT 

9 MONITORING SERVICES TO BE INCLUDED IN 

10 BUNDLED OR GLOBAL PAYMENTS. 

11 Title XVIII of the Social Security Act (42 U.S.C. 

12 1395 et seq.) is amended by adding at the end the fol13 lowing new section: 

14 ‘‘SEC. 1899C. ALLOWING TELEHEALTH AND REMOTE PA15 TIENT MONITORING SERVICES TO BE IN16 CLUDED IN BUNDLED OR GLOBAL PAY17 MENTS. 

18 ‘‘Notwithstanding any other provision of this title, 

19 the Secretary may include under any bundled or global 

20 payment under this title the following: 

21 ‘‘(1) TELEHEALTH SERVICES.—Notwith22 standing requirements otherwise applicable under 

23 section 1834(m), including any requirements relat24 ing to qualifications for an originating site under 

25 paragraph (4)(C)(ii) of such section, any geographic 


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1 limitations under paragraph (4)(C)(i) of such section 

2 (other than applicable State law requirements, in3 cluding State licensure requirements), any limitation 

4 on the use of store-and-forward technologies de5 scribed in paragraph (1) of such section, any limita6 tion on the type of health care provider who may 

7 furnish such services (other than the requirement 

8 that the provider is a Medicare-enrolled provider), 

9 any items and services for which payment would oth10 erwise be made under this title that are furnished 

11 using telehealth, or any limitation on specific codes 

12 designated as telehealth services that are covered 

13 under this title pursuant to section 1834(m) (pro14 vided such codes are clinically appropriate to furnish 

15 remotely). 

16 ‘‘(2) REMOTE PATIENT MONITORING SERV17 ICES.—Notwithstanding section 1848(b)(12), remote 

18 patient monitoring services (as defined in such sec19 tion) furnished to any individual under this title.’’. 

20 SEC. 11. EXPANDING THE USE OF TELEHEALTH THROUGH 

21 THE WAIVER OF CERTAIN REQUIREMENTS. 

22 Section 1834(m) of the Social Security Act (42 

23 U.S.C. 1395m(m)), as amended by sections 3(b) and 4, 

24 is amended by adding at the end the following new para25 graph: 


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1 ‘‘(7) AUTHORITY TO WAIVE REQUIREMENTS

2 AND LIMITATIONS IF CERTAIN CONDITIONS MET.— 

3 ‘‘(A) IN GENERAL.—In the case of tele4 health services furnished on or after January 1, 

5 2018, the Secretary may waive any restriction 

6 applicable to the coverage of telehealth services 

7 under this subsection described in subpara8 graph (B) with respect to certain providers of 

9 services, suppliers, provider groups, sites of 

10 care, services, conditions, individuals receiving 

11 the services, or States, as determined by the 

12 Secretary, if each of the requirements described 

13 in subparagraph (C) is met with respect to the 

14 waiver. 

15 ‘‘(B) RESTRICTIONS DESCRIBED.—For 

16 purposes of this paragraph, restrictions applica17 ble to the coverage of telehealth services under 

18 this subsection shall include requirements relat19 ing to qualifications for an originating site 

20 under paragraph (4)(C)(ii), any geographic lim21 itations under paragraph (4)(C)(i) (other than 

22 applicable State law requirements, including 

23 State licensure requirements), any limitation on 

24 the use of store-and-forward technologies de25 scribed in paragraph (1), any limitation on the 


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1 type of health care provider who may furnish 

2 such services (other than the requirement that 

3 the provider is a Medicare-enrolled provider), or 

4 any limitation on specific codes designated as 

5 telehealth services that are covered under this 

6 title pursuant to this subsection (provided such 

7 codes are clinically appropriate to furnish re8 motely). 

9 ‘‘(C) REQUIREMENTS FOR WAIVER.—The 

10 requirements described in this subparagraph 

11 are, with respect to the waiver of a restriction 

12 described in subparagraph (B), the following: 

13 ‘‘(i) The Secretary determines that 

14 the waiver is expected to— 

15 ‘‘(I) reduce spending under this 

16 title without reducing the quality of 

17 care; or 

18 ‘‘(II) improve the quality of pa19 tient care without increasing spend20 ing. 

21 ‘‘(ii) The Chief Actuary of the Centers 

22 for Medicare & Medicaid Services certifies 

23 that such waiver would reduce (or would 

24 not result in any increase in) net program 

25 spending under this title. 


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1 ‘‘(iii) The Secretary determines that 

2 such waiver would not deny or limit the 

3 coverage or provision of benefits under this 

4 title for individuals. 

5 ‘‘(D) PUBLIC COMMENT.—The Secretary 

6 shall establish a process by which stakeholders 

7 may (on at least an annual basis) submit re8 quests for a waiver under this paragraph.’’. 

9 SEC. 12. EXPANDING THE USE OF TELEHEALTH FOR MEN10 TAL HEALTH SERVICES. 

11 Section 1834(m) of the Social Security Act (42 

12 U.S.C. 1395m(m)), as amended by sections 3(b), 4, and 

13 11, is amended by adding at the end the following new 

14 paragraph: 

15 ‘‘(8) TREATMENT OF MENTAL HEALTH SERV16 ICES DELIVERED VIA TELEHEALTH.— 

17 ‘‘(A) IN GENERAL.—Restrictions applicable 

18 to the coverage of telehealth services under this 

19 subsection described in subparagraph (B) shall 

20 not apply with respect to telehealth services 

21 that are mental health services (as determined 

22 by the Secretary) and are furnished on or after 

23 January 1, 2018. 

24 ‘‘(B) RESTRICTIONS DESCRIBED.—For 

25 purposes of this paragraph, restrictions applicaVerDate Sep 11 2014 00:13 May 09, 2017 Jkt 069200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\S1016.IS S1016

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1 ble to the coverage of telehealth services under 

2 this subsection shall include requirements relat3 ing to qualifications for an originating site 

4 under paragraph (4)(C)(ii), any geographic lim5 itations under paragraph (4)(C)(i) (other than 

6 applicable State law requirements, including 

7 State licensure requirements), any limitation on 

8 the use of store-and-forward technologies de9 scribed in paragraph (1), any limitation on the 

10 type of health care provider who may furnish 

11 such services (other than the requirement that 

12 the provider is a Medicare-enrolled provider), or 

13 any limitation on specific codes designated as 

14 telehealth services that are covered under this 

15 title pursuant to this subsection (provided such 

16 codes are clinically appropriate to furnish re17 motely).’’. 

18 SEC. 13. HHS EVALUATION AND REPORT ON THE USE OF 

19 TELEHEALTH AND REMOTE PATIENT MONI20 TORING UNDER ALL DEMONSTRATION PRO21 GRAMS AND PILOTS WITH A TELEHEALTH 

22 WAIVER. 

23 (a) STUDY.—The Secretary of Health and Human 

24 Services (in this subsection referred to as the ‘‘Secretary’’) 

25 shall conduct an evaluation on the use of telehealth and 


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1 remote patient monitoring under all programs and pilots 

2 under the Medicare program under title XVIII of the So3 cial Security Act and the Medicaid program under title 

4 XIX of such Act with a waiver of telehealth restrictions 

5 otherwise applicable under such titles of the Social Secu6 rity Act (42 U.S.C. 1395m(m)). Such evaluation shall in7 clude an analysis of the following: 

8 (1) The number of providers and payers using 

9 telehealth and remote patient monitoring under such 

10 programs and pilots. 

11 (2) The cost impact among the beneficiaries re12 ceiving telehealth and remote patient monitoring 

13 under such programs and pilots, including with re14 spect to preventable hospitalizations, hospital re15 admissions, and emergency room visits, and the total 

16 cost of items and services under the Medicare and 

17 Medicaid programs. 

18 (3) Beneficiary and family caregiver satisfaction 

19 with the use of telehealth and remote patient moni20 toring under such programs and pilots. 

21 (4) A comparison of the utilization of, and ex22 penditures for, the same services furnished under 

23 the Medicare and Medicaid programs in the office 

24 setting. 


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1 (b) REPORT.—Not later than 2 years after the date 

2 of the enactment of this Act, the Secretary shall submit 

3 to Congress a report containing the results of the evalua4 tion conducted under subsection (a), together with rec5 ommendations for such legislation and administrative ac6 tion as the Secretary determines appropriate. 

7 SEC. 14. TESTING OF MODELS TO EXAMINE THE USE OF 

8 TELEHEALTH AND REMOTE PATIENT MONI9 TORING UNDER THE MEDICARE PROGRAM. 

10 Section 1115A(b)(2) of the Social Security Act (42 

11 U.S.C. 1315a(b)(2)) is amended by adding at the end the 

12 following new subparagraph: 

13 ‘‘(D) TESTING MODELS TO EXAMINE USE

14 OF TELEHEALTH AND REMOTE PATIENT MONI15 TORING UNDER MEDICARE.—The Secretary 

16 shall consider testing under this subsection 

17 models to examine the use of telehealth and re18 mote patient monitoring under title XVIII.’’. 

19 SEC. 15. SENSE OF CONGRESS REGARDING THE REMOTE 

20 PRACTICE OF MEDICINE. 

21 (a) FINDINGS.—Congress finds that the laws of all 

22 50 States and the District of Columbia— 

23 (1) consider the practice of medicine to include 

24 remote visits; and 


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1 (2) recognize that any remote practice of medi2 cine is governed by the same medical practice stat3 utes as in-person care. 

4 (b) SENSE OF CONGRESS.—It is the sense of Con5 gress that— 

6 (1) telemedicine is the delivery of safe, effective, 

7 quality health care services, by a health care pro8 vider, using technology-based modalities to deliver 

9 medical care; 

10 (2) States have recognized this by treating tele11 medicine as the practice of medicine; and 

12 (3) the Medicare program under title XVIII of 

13 the Social Security Act should cover the delivery of 

14 remote patient services. 

Æ 


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