I 

114TH CONGRESS 

1ST SESSION H. R. 2948 

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

expansion of telehealth coverage under the Medicare program. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 7, 2015 

Mr. THOMPSON of California (for himself, Mr. HARPER, Mrs. BLACK, and Mr. 

WELCH) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on 

Ways and Means, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to provide 

for an incremental expansion of telehealth coverage under 

the Medicare 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. 

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

5 Parity Act of 2015’’. 

6 SEC. 2. PHASED-IN EXPANSION OF TELEHEALTH COV7 ERAGE UNDER MEDICARE. 

8 (a) INITIAL PHASE.— 


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1 (1) EXPANSION OF ORIGINATING SITES.—Sec2 tion 1834(m)(4)(C) of the Social Security Act (42 

3 U.S.C. 1395m(m)(4)(C)) is amended— 

4 (A) in clause (i), by striking ‘‘The term’’ 

5 and inserting ‘‘Subject to clause (iii), the 

6 term’’; and 

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

8 clause: 

9 ‘‘(iii) ADDITIONAL SITES.—The term 

10 ‘originating site’ shall also include the fol11 lowing sites at which the eligible telehealth 

12 individual is located at the time the service 

13 is furnished via a telecommunications sys14 tem, whether or not they are located in an 

15 area described in clause (i), insofar as such 

16 sites are not otherwise included in the defi17 nition of originating site under such 

18 clause: 

19 ‘‘(I) In the case of such a service 

20 furnished on or after the date that is 

21 6 months after the date of the enact22 ment of the Medicare Telehealth Par23 ity Act of 2015, any Federally quali24 fied health center and any rural 


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1 health clinic (as such terms are de2 fined in section 1861(aa)). 

3 ‘‘(II) In the case of such a serv4 ice furnished on or after the date that 

5 is 6 months after the date of the en6 actment of the Medicare Telehealth 

7 Parity Act of 2015, any site described 

8 in clause (ii) that is located in a coun9 ty within a Metropolitan Statistical 

10 Area with a population of fewer than 

11 50,000 individuals, according to the 

12 most recent decennial census.’’. 

13 (2) ORIGINATING SITE FEE NOT TO APPLY TO

14 ADDITIONAL SITES.—Section 1834(m)(2)(B) of such 

15 Act (42 U.S.C. 1395m(m)(4)(C)) is amended by in16 serting after and below clause (ii) the following: 

17 ‘‘The facility fee under this subparagraph shall 

18 not apply to any site included as an originating 

19 site pursuant to clause (iii) of paragraph (4)(C) 

20 that would not otherwise be included as an orig21 inating site without application of such 

22 clause.’’. 

23 (3) ADDITIONAL TELEHEALTH PROVIDERS.— 

24 Section 1834(m) of such Act (42 U.S.C. 1395m(m)) 

25 is amended— 


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1 (A) in paragraph (1)— 

2 (i) by striking ‘‘or a practitioner (de3 scribed in section 1842(b)(18)(C))’’ and 

4 inserting ‘‘or a professional described in 

5 paragraph (4)(E))’’; and 

6 (ii) by striking ‘‘individual physician 

7 or practitioner’’ and inserting ‘‘individual 

8 physician or professional’’; and 

9 (B) in paragraph (4), by— 

10 (i) striking subparagraph (E); and 

11 (ii) inserting after subparagraph (D) 

12 the following new subparagraph: 

13 ‘‘(E) PROFESSIONAL DESCRIBED.—For 

14 purposes of paragraph (1), a professional de15 scribed in this subparagraph is— 

16 ‘‘(i) a practitioner described in section 

17 1842(b)(18)(C); or 

18 ‘‘(ii) with respect to services furnished 

19 on or after the date that is 6 months after 

20 the date of the enactment of the Medicare 

21 Telehealth Parity Act of 2015, a certified 

22 diabetes educator or licensed— 

23 ‘‘(I) respiratory therapist; 

24 ‘‘(II) audiologist; 

25 ‘‘(III) occupational therapist; 


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1 ‘‘(IV) physical therapist; or 

2 ‘‘(V) speech language patholo3 gist.’’. 

4 (4) ADDITIONAL COVERED TELEHEALTH SERV5 ICES.—Section 1834(m)(4)(F)(i) of the Social Secu6 rity Act (42 U.S.C. 1395m(m)(4)(F)(i)) is amended 

7 by adding at the end the following new sentence: 

8 ‘‘Such term shall include respiratory services, audi9 ology services (as defined in section 1861(ll)), and 

10 outpatient therapy services, including physical ther11 apy, occupational therapy, and speech-language pa12 thology services.’’. 

13 (5) EXPANSION OF TELECOMMUNICATIONS SYS14 TEM.—The second sentence of section 1834(m)(1) of 

15 the Social Security Act (42 U.S.C. 1395m(m)(1)) is 

16 amended by striking ‘‘in the case of any Federal 

17 telemedicine demonstration program conducted in 

18 Alaska or Hawaii,’’. 

19 (6) RURAL HEALTH CLINICS AND FEDERALLY

20 QUALIFIED HEALTH CENTERS AUTHORIZED TO BE

21 DISTANT SITES.—Section 1834(m)(4)(A) of the So22 cial Security Act (42 U.S.C. 1395m(m)(4)(A)) is 

23 amended— 

24 (A) by striking ‘‘SITE.—The term’’ and in25 serting ‘‘SITE.— 


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1 ‘‘(i) IN GENERAL.—The term’’; and 

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

3 clause: 

4 ‘‘(ii) TREATMENT OF RURAL HEALTH

5 CLINICS AND FEDERALLY QUALIFIED

6 HEALTH CENTERS.—A site described in 

7 clause (i) includes a rural health clinic (as 

8 defined in section 1861(aa)(2)) and a Fed9 erally qualified health center (as defined in 

10 section 1861(aa)(4)). In any case in which 

11 such a clinic or center is treated as a dis12 tant site with respect to the provision of a 

13 telehealth service to an eligible telehealth 

14 individual for which payment is made 

15 under this subsection, such service shall 

16 not be treated as a rural health clinic serv17 ice or Federally qualified health center 

18 service, respectively, and payment may not 

19 otherwise be made under this title with re20 spect to such service provided to such indi21 vidual.’’. 

22 (b) SECOND PHASE.— 

23 (1) IN GENERAL.—Section 1834(m)(4) of the 

24 Social Security Act (42 U.S.C. 1395m(m)(4)) is 

25 amended— 


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1 (A) in clause (iii) of subparagraph (C), as 

2 added by subsection (a)(1), by adding at the 

3 end the following new subclauses: 

4 ‘‘(III) In the case of such a serv5 ice furnished on or after the date that 

6 is 2 years after the date of the enact7 ment of the Medicare Telehealth Par8 ity Act of 2015, any site described in 

9 clause (ii) that is located in a county 

10 within a Metropolitan Statistical Area 

11 with a population of at least 50,000 

12 individuals but fewer than 100,000 in13 dividuals, according to the most re14 cent decennial census. 

15 ‘‘(IV) In the case of such a serv16 ice furnished on or after the date that 

17 is 2 years after the date of the enact18 ment of the Medicare Telehealth Par19 ity Act of 2015, a home telehealth 

20 site, as defined in subparagraph (G). 

21 ‘‘(V) In the case of such a service 

22 that is related to the evaluation or 

23 treatment of an acute stroke and that 

24 is furnished on or after the date de25 scribed in subclause (IV) during the 


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1 evidence-based window of treatment, 

2 any site at which the eligible tele3 health individual is located at the time 

4 the service is furnished via a tele5 communications system, regardless of 

6 where the site is located.’’; and 

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

8 subparagraph: 

9 ‘‘(G) HOME TELEHEALTH SITE.— 

10 ‘‘(i) IN GENERAL.—The term ‘home 

11 telehealth site’ means, with respect to a 

12 service described in clause (ii) furnished to 

13 an individual, a place of residence used as 

14 the home of such individual. 

15 ‘‘(ii) SERVICES DESCRIBED.—A serv16 ice described in this clause is— 

17 ‘‘(I) a telehealth service that is 

18 related to the provision of outpatient 

19 mental or behavioral health and shall 

20 include the use of video conferencing; 

21 and 

22 ‘‘(II) a service described in sub23 paragraph (F)(iii) that is treated as a 

24 telehealth service under such subpara25 graph.’’. 


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1 (2) HOME TELEHEALTH SERVICES.—Section 

2 1834(m)(4)(F) of the Social Security Act (42 U.S.C. 

3 1395m(m)(4)(F)) is amended by adding at the end 

4 the following new clause: 

5 ‘‘(iii) TREATMENT OF HOME TELE6 HEALTH SERVICES.—For purposes of sub7 paragraph (G)(ii)(II), beginning 2 years 

8 after the date of the enactment of the 

9 Medicare Telehealth Parity Act of 2015, 

10 services (including the use of video confer11 encing) furnished at an originating site 

12 that is a home telehealth site to an indi13 vidual that is related to the provision of 

14 hospice care, home dialysis, or home health 

15 services shall be treated as a telehealth 

16 service under this subparagraph.’’. 

17 (c) FINAL PHASE.— 

18 (1) FURTHER EXPANSION OF ORIGINATING

19 SITES.—Clause (iii) of section 1834(m)(4)(C) of the 

20 Social Security Act (42 U.S.C. 1395m(m)(4)), as 

21 added by subsection (a)(1) and amended by sub22 section (b)(1), is further amended— 

23 (A) by redesignating subclause (V) as sub24 clause (VI); and 


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1 (B) by inserting after clause (IV) the fol2 lowing new subclause: 

3 ‘‘(V) In the case of such a service 

4 furnished on or after the date that is 

5 4 years after the date of the enact6 ment of the Medicare Telehealth Par7 ity Act of 2015, any site described in 

8 clause (ii) that is located in a county 

9 within a Metropolitan Statistical Area 

10 with a population of at least 100,000 

11 individuals, according to the most re12 cent decennial census.’’. 

13 (2) PAYMENT METHODS FOR OTHER PATIENT

14 SITES.—Section 1834(m)(2) of the Social Security 

15 Act (42 U.S.C. 1395m(m)(2)) is amended by adding 

16 at the end the following new subparagraph: 

17 ‘‘(D) PAYMENT METHODS FOR OTHER PA18 TIENT SITES.—With respect to services fur19 nished on or after the date that is 4 years after 

20 the date of the enactment of the Medicare Tele21 health Parity Act of 2015, the Secretary may 

22 develop and implement payment methods that 

23 would apply under this subsection in the case of 

24 an individual who would be an eligible tele25 health individual except that the telehealth servVerDate Sep 11 2014 21:43 Jul 08, 2015 Jkt 049200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2948.IH H2948

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1 ices are furnished at a site other than an origi2 nating site. Such methods shall be designed to 

3 take into account the costs related to the site 

4 involved and reduced costs for the distant 

5 site.’’. 

6 (d) INCREMENTAL COVERAGE OF REMOTE PATIENT

7 MONITORING SERVICES FOR CERTAIN CHRONIC HEALTH

8 CONDITIONS.— 

9 (1) IN GENERAL.—Section 1861(s)(2) of the 

10 Social Security Act (42 U.S.C. 1395x(s)(2)) is 

11 amended— 

12 (A) in subparagraph (EE), by striking 

13 ‘‘and’’ at the end; 

14 (B) in subparagraph (FF), by inserting 

15 ‘‘and’’ at the end; and 

16 (C) by inserting after subparagraph (FF) 

17 the following new subparagraph: 

18 ‘‘(GG) applicable remote patient monitoring 

19 services (as defined in paragraph (1)(A) of sub20 section (iii));’’. 

21 (2) SERVICES DESCRIBED.—Section 1861 of 

22 the Social Security Act (42 U.S.C. 1395x) is amend23 ed by adding at the end the following new sub24 section: 


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1 ‘‘(iii) REMOTE PATIENT MONITORING SERVICES FOR

2 CHRONIC HEALTH CONDITIONS.—(1)(A) The term ‘appli3 cable remote patient monitoring services’ means remote 

4 patient monitoring services (as defined in subparagraph 

5 (B)) furnished to provide for the monitoring, evaluation, 

6 and management of an individual with a covered chronic 

7 condition (as defined in paragraph (2)), insofar as such 

8 services are for the management of such chronic condition. 

9 ‘‘(B) The term ‘remote patient monitoring services’ 

10 means services furnished through remote patient moni11 toring technology (as defined in subparagraph (C)). 

12 ‘‘(C) The term ‘remote patient monitoring tech13 nology’ means a coordinated system that uses one or more 

14 home-based or mobile monitoring devices that automati15 cally transmit vital sign data or information on activities 

16 of daily living and may include responses to assessment 

17 questions collected on the devices wirelessly or through a 

18 telecommunications connection to a server that complies 

19 with the Federal regulations (concerning the privacy of in20 dividually identifiable health information) promulgated 

21 under section 264(c) of the Health Insurance Portability 

22 and Accountability Act of 1996, as part of an established 

23 plan of care for that patient that includes the review and 

24 interpretation of that data by a health care professional. 


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1 ‘‘(2) For purposes of paragraph (1), the term ‘cov2 ered chronic health condition’ means— 

3 ‘‘(A) in the case of applicable remote patient 

4 monitoring services furnished on or after the date 

5 that is 6 months after the date of the enactment of 

6 the Medicare Telehealth Parity Act of 2015, applica7 ble conditions (as defined in and applied under sec8 tion 1886(q)(5)), relating to heart failure and chron9 ic obstructive pulmonary disease and related chronic 

10 comorbidities when under chronic care management 

11 (identified as of July 1, 2015, by HCPCS code 

12 99490 (and as subsequently modified by the Sec13 retary)); 

14 ‘‘(B) in the case of applicable remote patient 

15 monitoring services furnished on or after the date 

16 that is 2 years after the date of the enactment of 

17 the Medicare Telehealth Parity Act of 2015, in addi18 tion to the conditions described in subparagraph (A), 

19 diabetes and related chronic comorbidities when 

20 under chronic care management (identified as of 

21 July 1, 2015, by HCPCS code 99490 (and as subse22 quently modified by the Secretary)); and 

23 ‘‘(C) in the case of applicable remote patient 

24 monitoring services furnished on or after the date 

25 that is 4 years after the date of the enactment of 


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1 the Medicare Telehealth Parity Act of 2015, in addi2 tion to the conditions described in subparagraph (A) 

3 and (B), such other conditions that could be speci4 fied by the Secretary that qualify for chronic care 

5 management and related chronic comorbidities when 

6 under chronic care management (identified as of 

7 July 1, 2015, by HCPCS code 99490 (and as subse8 quently modified by the Secretary)). 

9 ‘‘(3)(A) Payment may be made under this part for 

10 applicable remote patient monitoring services provided to 

11 an individual during a period of up to 90 days and such 

12 additional period as provided for under subparagraph (B). 

13 ‘‘(B) The 90-day period described in subparagraph 

14 (A), with respect to an individual, may be renewed by the 

15 physician who provides chronic care management to such 

16 individual if the individual continues to qualify for such 

17 management.’’. 

18 (3) PAYMENT UNDER THE PHYSICIAN FEE

19 SCHEDULE.—Section 1848 of the Social Security 

20 Act (42 U.S.C. 1395w–4) is amended— 

21 (A) in subsection (c)— 

22 (i) in paragraph (2)(B)— 

23 (I) in clause (ii)(II), by striking 

24 ‘‘and (v)’’ and inserting ‘‘(v), and 

25 (vii)’’; and 


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1 (II) by adding at the end the fol2 lowing new clause: 

3 ‘‘(vii) BUDGETARY TREATMENT OF

4 CERTAIN SERVICES.—The additional ex5 penditures attributable to services de6 scribed in section 1861(s)(2)(GG) shall not 

7 be taken into account in applying clause 

8 (ii)(II).’’; and 

9 (ii) by adding at the end the following 

10 new paragraph: 

11 ‘‘(7) TREATMENT OF APPLICABLE REMOTE PA12 TIENT MONITORING SERVICES.— 

13 ‘‘(A) In determining relative value units 

14 for applicable remote patient monitoring serv15 ices (as defined in section 1861(iii)(1)(A)), the 

16 Secretary, in consultation with appropriate phy17 sician groups, practitioner groups, and supplier 

18 groups, shall take into consideration— 

19 ‘‘(i) physician or practitioner re20 sources, including physician or practitioner 

21 time and the level of intensity of services 

22 provided, based on— 

23 ‘‘(I) the frequency of evaluation 

24 necessary to manage the individual 

25 being furnished the services; 


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1 ‘‘(II) the complexity of the eval2 uation, including the information that 

3 must be obtained, reviewed, and ana4 lyzed; and 

5 ‘‘(III) the number of possible di6 agnoses and the number of manage7 ment options that must be considered; 

8 ‘‘(ii) practice expense costs associated 

9 with such services, including the direct 

10 costs associated with installation and infor11 mation transmission, costs of remote pa12 tient monitoring technology (including 

13 equipment and software), device delivery 

14 costs, and resource costs necessary for pa15 tient monitoring and follow-up (but not in16 cluding costs of any related item or non17 physician service otherwise reimbursed 

18 under this title); and 

19 ‘‘(iii) malpractice expense resources. 

20 ‘‘(B) Using the relative value units deter21 mined in subparagraph (A), the Secretary shall 

22 provide for separate payment for such services 

23 and shall not adjust the relative value units as24 signed to other services that might otherwise 


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1 have been determined to include such separately 

2 paid remote patient monitoring services.’’; and 

3 (B) in subsection (j)(3), by inserting 

4 ‘‘(2)(GG),’’ after ‘‘health risk assessment),’’. 

5 (4) EFFECTIVE DATE.— 

6 (A) IN GENERAL.—The amendments made 

7 by this subsection shall apply to services fur8 nished on or after the date that is 6 months 

9 after the date of the enactment of this Act, 

10 without regard to whether the guidelines under 

11 paragraph (3)(A) or the standards under para12 graph (3)(B) of section 1861(iii) of the Social 

13 Security Act, as added by paragraph (2), have 

14 been developed. 

15 (B) AVAILABILITY OF CODES AS OF DATE

16 OF ENACTMENT.—The Secretary of Health and 

17 Human Services shall— 

18 (i) promptly evaluate existing codes 

19 that would be used to bill for applicable re20 mote patient monitoring services (as de21 fined in paragraph (1)(A) of such section 

22 1861(iii), as so added) under title XVIII of 

23 the Social Security Act; and 

24 (ii) if the Secretary determines that 

25 new codes are necessary to ensure accurate 


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1 reporting and billing of such services under 

2 such title, issue such codes so that they are 

3 available for use as of the date of the en4 actment of this Act. 

5 (e) HOME DIALYSIS SERVICE.— 

6 (1) IN GENERAL.—Section 1881(b)(3) of the 

7 Social Security Act (42 U.S.C. 1395rr(b)(3)) is 

8 amended— 

9 (A) by redesignating subparagraphs (A) 

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

11 (B) in clause (ii), as redesignated by sub12 paragraph (A), strike ‘‘on a comprehensive’’ 

13 and insert ‘‘subject to subparagraph (B), on a 

14 comprehensive’’; 

15 (C) by striking ‘‘With respect to’’ and in16 serting ‘‘(A) With respect to’’; and 

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

18 subparagraph: 

19 ‘‘(B) For purposes of subparagraph (A)(ii), the 

20 following shall apply: 

21 ‘‘(i) The monthly fee or other basis of pay22 ment described in such subparagraph shall 

23 allow for a patient-specific waiver process to 

24 allow a physician, clinical nurse specialist, nurse 

25 practitioner, or physician’s assistant to request 


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1 a waiver under this title of face-to-face visit re2 quirements for home dialysis furnished to indi3 viduals determined to have end stage renal dis4 ease. 

5 ‘‘(ii) Any request under clause (i) shall in6 clude documentation by the physician or practi7 tioner involved that supports active and ade8 quate care of such individual receiving home di9 alysis. 

10 ‘‘(iii) Any patient-specific waiver under 

11 clause (i) that is granted shall remain effective 

12 until such date that the Secretary, including 

13 through contractor under this title, requests 

14 that additional information or a new waiver ap15 plication be filed. 

16 ‘‘(iv) All individuals determined to have 

17 end stage renal disease receiving home dialysis 

18 shall receive a face-to-face examination at least 

19 once every three consecutive months and, in the 

20 intervening months, shall receive a monthly 

21 clinical assessment which may be furnished, if 

22 the patient so chooses, via remote monitoring 

23 by a physician, clinical nurse specialist, nurse 

24 practitioner, or physician’s assistant.’’. 


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1 (2) CONFORMING AMENDMENT.—Section 

2 1881(b)(1) of such Act (42 U.S.C. 1395rr(b)(1)) is 

3 amended by striking ‘‘paragraph (3)(A)’’ and insert4 ing ‘‘paragraph (3)(A)(i)’’. 

5 (3) EFFECTIVE DATE.—The amendments made 

6 by this subsection shall apply with respect to the 

7 monthly fee or other basis of payment for home di8 alysis services furnished on or after January 1, 

9 2016. 

10 (f) APPROPRIATE VALUATION OF REMOTE DIAG11 NOSTIC TEST SERVICES.—Section 1848(c)(2) of the So12 cial Security Act (42 U.S.C. 1395w–4(c)(2)) is amended 

13 by adding at the end the following new subparagraph: 

14 ‘‘(P) ADJUSTMENTS FOR REMOTE DIAG15 NOSTIC TESTS.—In determining practice ex16 pense relative value units for diagnostic tests 

17 described in section 1861(s)(3) that are pro18 vided remotely, the Secretary shall, in consulta19 tion with suppliers of remote diagnostic testing 

20 services, include in direct costs of supplies and 

21 equipment, the costs of the diagnostic device, 

22 clinical systems (including hardware and soft23 ware), information transmission, and device de24 livery and installation. For purposes of this 

25 subsection, diagnostic tests described in section 


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1 1861(s)(3) that are provided remotely are such 

2 tests that are provided through the utilization 

3 of a system of technology that allows a remote 

4 interface to collect and transmit clinical data 

5 between the individual and a supplier. This sub6 section shall be implemented in a budget neu7 tral manner.’’. 

8 (g) STUDY AND REPORT; SENSE OF CONGRESS.— 

9 (1) STUDY AND REPORT.— 

10 (A) STUDY.—The Comptroller General of 

11 the United States shall conduct a study that in12 cludes, at a minimum, the following: 

13 (i) The effectiveness of using tele14 health services described in the second sen15 tence of section 1834(m)(4)(F)(i) of the 

16 Social Security Act (42 U.S.C. 

17 1395m(m)(4)(F)(i)), as added by sub18 section (a)(4), between practitioners de19 scribed in subparagraph (E)(ii) of section 

20 1834(m)(4) of the Social Security Act (42 

21 U.S.C. 1395m(m)(4)), as inserted by sub22 section (a)(3)(B)(ii), and patients, includ23 ing with respect to patient satisfaction, 

24 provider responsiveness to patient needs 

25 and concerns, and the extent to which such 


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1 telehealth services are at least comparable 

2 to face-to-face encounters. 

3 (ii) The savings to the Medicare pro4 gram under title XVIII of such Act associ5 ated with telehealth services utilization for 

6 therapy for the additional telehealth serv7 ices described in such sentence. 

8 (iii) The potential for greater use of 

9 telehealth services for forms of additional 

10 telehealth services not described in such 

11 sentence. 

12 (B) REPORT.—Not later than two years 

13 after the date of the enactment of this Act, the 

14 Comptroller General shall submit to Congress a 

15 report on the findings of the study conducted 

16 under subparagraph (A). 

17 (2) SENSE OF CONGRESS.—It is the sense of 

18 Congress that the telehealth expansion efforts initi19 ated by the studies and reports on the use of tele20 health and remote patient monitoring services under 

21 the Medicare Access and CHIP Reauthorization Act 

22 of 2015 are continued and furthered through the in23 cremental expansion of telehealth and remote patient 

24 monitoring services under this Act. 

Æ 


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