II 

113TH CONGRESS 

1ST SESSION S. 596 

To establish pilot projects under the Medicare program to provide incentives 

for home health agencies to furnish remote patient monitoring services 

that reduce expenditures under such program. 

IN THE SENATE OF THE UNITED STATES 

MARCH 18, 2013 

Mr. THUNE (for himself and Mr. FRANKEN) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To establish pilot projects under the Medicare program to 

provide incentives for home health agencies to furnish 

remote patient monitoring services that reduce expenditures under such program. 

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; FINDINGS. 

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

5 ‘‘Fostering Independence Through Technology Act of 

6 2013’’. 

7 (b) FINDINGS.—Congress makes the following find8 ings: 


srobinson on DSK4SPTVN1PROD with BILLS
2 

•S 596 IS

1 (1) Allowing seniors to remain in their homes 

2 longer can delay unnecessary, costly transfers to 

3 higher acuity care settings. 

4 (2) Remote patient monitoring provides oppor5 tunities to control chronic conditions and research 

6 shows that approximately 66 percent of total health 

7 care spending is associated with care for the over 

8 one-in-four Americans with multiple chronic condi9 tions. 

10 (3) Current remote patient monitoring pro11 grams report patient satisfaction rates of over 90 

12 percent. 

13 (4) Due to changes enacted by Congress, hos14 pitals are facing payment penalties for patients that 

15 are readmitted to the hospital within 30 days of dis16 charge. 

17 (5) Current remote patient monitoring pro18 grams that use technology to monitor discharged pa19 tients in non-invasive ways have experienced a re20 duction in hospital readmissions. 

21 SEC. 2. REMOTE PATIENT MONITORING AND SUPPORT 

22 PILOT PROJECTS. 

23 (a) PILOT PROJECTS.— 

24 (1) IN GENERAL.—Not later than 9 months 

25 after the date of the enactment of this Act, the SecVerDate Mar 15 2010 23:07 Mar 22, 2013 Jkt 029200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S596.IS S596

srobinson on DSK4SPTVN1PROD with BILLS
3 

•S 596 IS

1 retary of Health and Human Services (in this sec2 tion referred to as the ‘‘Secretary’’) shall conduct 

3 pilot projects under title XVIII of the Social Secu4 rity Act for the purpose of providing incentives to 

5 home health agencies to furnish remote patient mon6 itoring services that reduce expenditures under such 

7 title. 

8 (2) SITE REQUIREMENTS.— 

9 (A) URBAN AND RURAL.—The Secretary 

10 shall conduct the pilot projects under this sec11 tion in both urban and rural areas. 

12 (B) SITE IN A SMALL STATE.—The Sec13 retary shall conduct at least 1 of the pilot 

14 projects in a State with a population of less 

15 than 1,000,000. 

16 (3) DEFINITIONS.—In this section: 

17 (A) HOME HEALTH AGENCY.—The term 

18 ‘‘home health agency’’ has the meaning given 

19 that term in section 1861(o) of the Social Secu20 rity Act (42 U.S.C. 1395x(o)). 

21 (B) REMOTE PATIENT MONITORING SERV22 ICES.— 

23 (i) IN GENERAL.—The term ‘‘remote 

24 patient monitoring services’’ means serv25 ices furnished in the home using remote 


srobinson on DSK4SPTVN1PROD with BILLS
4 

•S 596 IS

1 patient monitoring technology, including 

2 in-home technology based professional con3 sultations, patient monitoring, patient 

4 training services, clinical observation, as5 sessment, treatment, and any additional 

6 services that utilize technologies specified 

7 by the Secretary. 

8 (ii) LIMITATION.—The term ‘‘remote 

9 patient monitoring services’’ shall not in10 clude a telecommunication that consists 

11 solely of a telephone audio conversation, 

12 facsimile, or electronic text mail between a 

13 health care professional and a patient. 

14 (C) REMOTE PATIENT MONITORING TECH15 NOLOGY.—The term ‘‘remote patient moni16 toring technology’’ means a coordinated system 

17 that uses one or more home-based or mobile 

18 monitoring devices that are accessed by a pa19 tient and automatically transmit clinical data 

20 and responses to assessment questions collected 

21 on the devices wirelessly or through a tele22 communications connection to a server that 

23 complies with the Federal regulations (con24 cerning the privacy of individually identifiable 

25 health information) promulgated under section 


srobinson on DSK4SPTVN1PROD with BILLS
5 

•S 596 IS

1 264(c) of the Health Insurance Portability and 

2 Accountability Act of 1996, as part of an estab3 lished plan of care for that patient that includes 

4 the review and interpretation of that data by a 

5 health care professional. 

6 (b) MEDICARE BENEFICIARIES WITHIN THE SCOPE

7 OF PROJECTS.— 

8 (1) IN GENERAL.—The Secretary shall specify 

9 the criteria for identifying those Medicare bene10 ficiaries who shall be considered within the scope of 

11 the pilot projects under this section for purposes of 

12 the application of subsection (c) and for the assess13 ment of the effectiveness of the home health agency 

14 in achieving the objectives of this section. 

15 (2) The criteria specified under paragraph 

16 (1)— 

17 (A) shall include conditions and clinical 

18 circumstances, including congestive heart fail19 ure, diabetes, and chronic pulmonary obstruc20 tive disease, and other conditions determined 

21 appropriate by the Secretary; and 

22 (B) may provide for the inclusion in the 

23 projects of Medicare beneficiaries who begin re24 ceiving home health services under title XVIII 


srobinson on DSK4SPTVN1PROD with BILLS
6 

•S 596 IS

1 of the Social Security Act after the date of the 

2 implementation of the projects. 

3 (c) INCENTIVES.— 

4 (1) PERFORMANCE TARGETS.—The Secretary 

5 shall establish for each home health agency partici6 pating in a pilot project under this section a per7 formance target using one of the following meth8 odologies, as determined appropriate by the Sec9 retary: 

10 (A) ADJUSTED HISTORICAL PERFORMANCE

11 TARGET.—The Secretary shall establish for the 

12 agency— 

13 (i) a base expenditure amount equal 

14 to the average total payments made under 

15 parts A, B, and D of title XVIII of the So16 cial Security Act for Medicare beneficiaries 

17 determined to be within the scope of the 

18 pilot project in a base period determined 

19 by the Secretary; and 

20 (ii) an annual per capita expenditure 

21 target for such beneficiaries, reflecting the 

22 base expenditure amount adjusted for risk, 

23 changes in costs, and growth rates. 

24 (B) COMPARATIVE PERFORMANCE TAR25 GET.—The Secretary shall establish for the 


srobinson on DSK4SPTVN1PROD with BILLS
7 

•S 596 IS

1 agency a comparative performance target equal 

2 to the average total payments under such parts 

3 A, B, and D during the pilot project for com4 parable individuals in the same geographic area 

5 that are not determined to be within the scope 

6 of the pilot project. 

7 (2) PAYMENT.—Subject to paragraph (3), the 

8 Secretary shall pay to each participating home care 

9 agency a payment for each year under the pilot 

10 project equal to a 75 percent share of the total 

11 Medicare cost savings realized for such year relative 

12 to the performance target under paragraph (1). 

13 (3) LIMITATION ON EXPENDITURES.—The Sec14 retary shall limit payments under this section in 

15 order to ensure that the aggregate expenditures 

16 under title XVIII of the Social Security Act (includ17 ing payments under this subsection) do not exceed 

18 the amount that the Secretary estimates would have 

19 been expended if the pilot projects under this section 

20 had not been implemented, including any reasonable 

21 costs incurred by the Secretary in the administration 

22 of the pilot projects. 

23 (4) NO DUPLICATION IN PARTICIPATION IN

24 SHARED SAVINGS PROGRAMS.—A home health agen25 cy that participates in any of the following shall not 


srobinson on DSK4SPTVN1PROD with BILLS
8 

•S 596 IS

1 be eligible to participate in the pilot project under 

2 this section: 

3 (A) A model tested or expanded under sec4 tion 1115A that involves shared savings under 

5 this title or any other program or demonstra6 tion project that involves such shared savings. 

7 (B) The independence at home medical 

8 practice pilot program under section 1866E. 

9 (d) WAIVER AUTHORITY.—The Secretary may waive 

10 such provisions of titles XI and XVIII of the Social Secu11 rity Act as the Secretary determines to be appropriate for 

12 the conduct of the pilot projects under this section. 

13 (e) REPORT TO CONGRESS.—Not later than 3 years 

14 after the date that the first pilot project under this section 

15 is implemented, the Secretary shall submit to Congress a 

16 report on the projects. Such report shall contain— 

17 (1) a detailed description of the projects, in18 cluding any changes in clinical outcomes for Medi19 care beneficiaries under the projects, Medicare bene20 ficiary satisfaction under the projects, utilization of 

21 items and services under Medicare parts A, B, and 

22 D by Medicare beneficiaries under the projects, and 

23 Medicare per-beneficiary and Medicare aggregate 

24 spending under the projects; 


srobinson on DSK4SPTVN1PROD with BILLS
9 

•S 596 IS

1 (2) a detailed description of issues related to 

2 the expansion of the projects under subsection (f); 

3 (3) recommendations for such legislation and 

4 administrative actions as the Secretary considers ap5 propriate; and 

6 (4) other items considered appropriate by the 

7 Secretary. 

8 (f) EXPANSION.—If the Secretary determines that 

9 any of the pilot projects under this section enhance health 

10 outcomes for Medicare beneficiaries and reduce expendi11 tures under title XVIII of the Social Security Act, the Sec12 retary shall initiate comparable projects in additional 

13 areas. 

14 (g) PAYMENTS HAVE NO EFFECT ON OTHER MEDI15 CARE PAYMENTS TO AGENCIES.—A payment under this 

16 section shall have no effect on the amount of payments 

17 that a home health agency would otherwise receive under 

18 title XVIII of the Social Security Act for the provision 

19 of home health services. 

Æ 


srobinson on DSK4SPTVN1PROD with BILLS