110TH CONGRESS 

2D SESSION H. R. 5765 

To amend title XVIII of the Social Security Act to cover remote patient 

management services for certain chronic health conditions under the 

Medicare Program. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 10, 2008 

Ms. ESHOO (for herself, Mr. PICKERING, Mr. TANNER, Mr. HULSHOF, Mr. 

STUPAK, Mr. RAMSTAD, Mr. CAMP of Michigan, and Mr. LINDER) 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 cover 

remote patient management services for certain chronic 

health conditions 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 Remote Mon5 itoring Access Act of 2008’’. 


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1 SEC. 2. REMOTE PATIENT MANAGEMENT SERVICES FOR 

2 CHRONIC HEALTH CONDITIONS UNDER THE 

3 MEDICARE PROGRAM. 

4 (a) COVERAGE OF REMOTE PATIENT MANAGEMENT

5 SERVICES FOR CERTAIN CHRONIC HEALTH CONDI6 TIONS.— 

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

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

9 amended— 

10 (A) in subparagraph (Z), by striking 

11 ‘‘and’’ at the end; 

12 (B) in subparagraph (AA), by inserting 

13 ‘‘and’’ at the end; and 

14 (C) by inserting after subparagraph (AA) 

15 the following new subparagraph: 

16 ‘‘(BB) remote patient management services (as 

17 defined in subsection (ccc));’’. 

18 (2) SERVICES DESCRIBED.—Section 1861 of 

19 the Social Security Act (42 U.S.C. 1395x) is amend20 ed by adding at the end the following new sub21 section: 

22 ‘‘(ccc) REMOTE PATIENT MANAGEMENT SERVICES

23 FOR CHRONIC HEALTH CONDITIONS.—(1) The term ‘re24 mote patient management services’ means the remote 

25 monitoring, evaluation, and management of an individual 

26 with a covered chronic health condition (as defined in 


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1 paragraph (2)), insofar as such monitoring, evaluation, 

2 and management is with respect to such condition, 

3 through the utilization of a system of technology that al4 lows a remote interface to collect and transmit clinical 

5 data between the individual and the responsible physician 

6 (as defined in subsection (r)) or supplier (as defined in 

7 subsection (d)) for the purposes of clinical review or re8 sponse by the physician or supplier. 

9 ‘‘(2) For purposes of paragraph (1), the term ‘cov10 ered chronic health condition’ means— 

11 ‘‘(A) heart failure; and 

12 ‘‘(B) cardiac arrhythmia. 

13 ‘‘(3)(A) Not later than January 1, 2010, the Sec14 retary, in consultation with appropriate physician and sup15 plier groups, shall develop guidelines on the frequency of 

16 billing for remote patient management services. Such 

17 guidelines shall be determined based on medical necessity 

18 and shall be sufficient to ensure appropriate and timely 

19 monitoring of individuals being furnished such services. 

20 ‘‘(B) The Secretary shall do the following: 

21 ‘‘(i) Not later than 2 years after the date of the 

22 enactment of this subsection, develop, in consulta23 tion with appropriate physician and supplier groups, 

24 standards (governing such matters as qualifications 

25 of personnel and the maintenance of equipment) for 


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1 remote patient management services for the covered 

2 chronic health conditions specified in subparagraphs 

3 (A) and (B) of paragraph (2). 

4 ‘‘(ii) Periodically review and update such stand5 ards under this subparagraph as necessary.’’. 

6 (3) PAYMENT UNDER THE PHYSICIAN FEE

7 SCHEDULE.—Section 1848 of the Social Security 

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

9 (A) in subsection (c)— 

10 (i) in paragraph (2)((B)— 

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

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

13 (vi)’’; and 

14 (II) by adding at the end the fol15 lowing new clause: 

16 ‘‘(vi) BUDGETARY TREATMENT OF

17 CERTAIN SERVICES.—The additional ex18 penditures attributable to services de19 scribed in section 1861(s)(2)(BB) shall not 

20 be taken into account in applying clause 

21 (ii)(II) for 2010.’’; and 

22 (ii) by adding at the end the following 

23 new paragraph: 

24 ‘‘(7) TREATMENT OF REMOTE PATIENT MAN25 AGEMENT SERVICES.— 


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1 ‘‘(A) In determining relative value units 

2 for remote patient management services (as de3 fined in section 1861(ccc)), the Secretary, in 

4 consultation with appropriate physician groups, 

5 shall take into consideration— 

6 ‘‘(i) physician resources, including 

7 physician time and the level of intensity of 

8 services provided, based on— 

9 ‘‘(I) the frequency of evaluation 

10 necessary to manage the individual 

11 being furnished the services; 

12 ‘‘(II) the complexity of the eval13 uation, including the information that 

14 must be obtained, reviewed, and ana15 lyzed; and 

16 ‘‘(III) the number of possible di17 agnoses and the number of manage18 ment options that must be considered; 

19 and 

20 ‘‘(ii) practice expense costs associated 

21 with such services, including installation 

22 and information transmittal costs, costs of 

23 remote patient management technology 

24 (including equipment and software), and 

25 resource costs necessary for patient moniVerDate Aug 31 2005 03:38 Apr 12, 2008 Jkt 069200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H5765.IH H5765

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1 toring and follow-up (but not including 

2 costs of any related item or non-physician 

3 service otherwise reimbursed under this 

4 title). 

5 ‘‘(iii) malpractice expense resources. 

6 ‘‘(B) Using the relative value units deter7 mined in subparagraph (A), the Secretary shall 

8 provide for separate payment for such services 

9 and shall not adjust the relative value units as10 signed to other services that might otherwise 

11 have been determined to include such separately 

12 paid remote patient management services.’’; and 

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

14 ‘‘(2)(BB)’’ after ‘‘(2)(AA),’’. 

15 (4) EFFECTIVE DATE.— 

16 (A) IN GENERAL.—The amendments made 

17 by this section shall apply to services furnished 

18 on or after January 1, 2010 without regard to 

19 whether the guidelines under paragraph (3)(A) 

20 or the standards under paragraph (3)(B) of 

21 section 1861(ccc) of the Social Security Act (as 

22 added by paragraph (2)) have been developed. 

23 (B) AVAILABILITY OF CODES AS OF JANU24 ARY 1, 2010.—The Secretary of Health and 

25 Human Services shall— 


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1 (i) promptly evaluate existing codes 

2 that would be used to bill for remote pa3 tient management services (as defined in 

4 paragraph (1) of such section 1861(ccc), 

5 as so added) under title XVIII of the So6 cial Security Act; and 

7 (ii) if the Secretary determines that 

8 new codes are necessary to ensure accurate 

9 reporting and billing of such services under 

10 such title, issue such codes so that they are 

11 available for use as of January 1, 2010. 

12 (b) DEMONSTRATION PROJECT FOR THE COVERAGE

13 OF REMOTE PATIENT MANAGEMENT SERVICES FOR AD14 DITIONAL CHRONIC HEALTH CONDITIONS UNDER THE

15 MEDICARE PROGRAM.— 

16 (1) ESTABLISHMENT.— 

17 (A) IN GENERAL.—The Secretary shall es18 tablish a demonstration project for the purpose 

19 of evaluating the impact and benefits of cov20 ering under the Medicare program remote pa21 tient management services for certain chronic 

22 health conditions. 

23 (B) CONSULTATION.—In establishing the 

24 demonstration project, the Secretary shall con25 sult with appropriate physician and supplier 


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1 groups, eligible beneficiaries, and organizations 

2 representing eligible beneficiaries. 

3 (C) PARTICIPATION.—Any eligible bene4 ficiary may participate in the demonstration 

5 project on a voluntary basis. 

6 (2) CONDUCT OF THE DEMONSTRATION

7 PROJECT.— 

8 (A) SITES.— 

9 (i) SELECTION OF DEMONSTRATION

10 SITES.—The Secretary shall conduct the 

11 demonstration project at 3 sites. 

12 (ii) GEOGRAPHIC DIVERSITY.—In se13 lecting the sites under clause (i), the Sec14 retary shall ensure that at least 1 of the 

15 sites is in a rural area. 

16 (B) IMPLEMENTATION; DURATION.— 

17 (i) IMPLEMENTATION.—The Secretary 

18 shall implement the demonstration project 

19 not later than January 1, 2010. 

20 (ii) DURATION.—The Secretary shall 

21 complete the demonstration project by the 

22 date that is 2 years after the date on 

23 which the demonstration project is imple24 mented. 

25 (3) EVALUATION AND REPORT.— 


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1 (A) EVALUATION.—The Secretary shall 

2 conduct an evaluation of the demonstration 

3 project— 

4 (i) to determine improvements in the 

5 quality of care and utilization of services 

6 received by eligible beneficiaries partici7 pating in the demonstration project; 

8 (ii) to determine the cost of providing 

9 payment for remote monitoring services 

10 under the Medicare program; 

11 (iii) to determine the satisfaction of 

12 eligible beneficiaries participating in the 

13 demonstration projects; and 

14 (iv) to evaluate such other matters as 

15 the Secretary determines is appropriate. 

16 (4) WAIVER AUTHORITY.—The Secretary may 

17 waive such provisions of titles XI and XVIII of the 

18 Social Security Act as the Secretary determines to 

19 be appropriate for the conduct of the demonstration 

20 project. 

21 (5) FUNDING.— 

22 (A) DEMONSTRATION.— 

23 (i) IN GENERAL.—Subject to clause 

24 (ii), the Secretary shall provide for the 

25 transfer from the Federal Supplementary 


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1 Medical Trust Fund under section 1841 of 

2 the Social Security Act (42 U.S.C. 1395t) 

3 of such funds as are necessary for the 

4 costs of carrying out the demonstration 

5 project. 

6 (ii) CAP ON EXPENDITURES.—The 

7 amount transferred under clause (i) for the 

8 period during which the demonstration 

9 project is conducted may not exceed an 

10 amount equal to the lesser of— 

11 (I) $9,000,000; or 

12 (II) an amount equal to the costs 

13 of providing remote monitoring serv14 ices to 7,500 individuals during such 

15 period. 

16 (B) EVALUATION AND REPORT.—There 

17 are authorized to be appropriated such sums as 

18 are necessary for the purpose of conducting the 

19 evaluation and developing and submitting the 

20 report to Congress under paragraph (3). 

21 (6) DEFINITIONS.—In this section: 

22 (A) REMOTE PATIENT MANAGEMENT SERV23 ICES.—The term ‘‘remote patient management 

24 services’’ means the remote monitoring, evalua25 tion, and management of an individual with a 


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1 covered chronic health condition (as defined in 

2 paragraph (B)), insofar as such monitoring, 

3 evaluation, and management is with respect to 

4 such condition, through the utilization of a sys5 tem of technology that allows a remote interface 

6 to collect and transmit clinical data between the 

7 individual and the responsible physician (as de8 fined in subsection (r) of section 1861 of the 

9 Social Security Act (42 U.S.C. 1395X))) or 

10 supplier (as defined in subsection (d) of such 

11 section) for the purposes of clinical review or 

12 response by the physician or supplier. 

13 (B) COVERED CHRONIC HEALTH CONDI14 TION.—The term ‘‘covered chronic health condi15 tion’’ means diabetes, sleep apnea, or epilepsy. 

16 (C) DEMONSTRATION PROJECT.—The term 

17 ‘‘demonstration project’’ means a demonstra18 tion project conducted under this subsection. 

19 (D) ELIGIBLE BENEFICIARY.—The term 

20 ‘‘eligible beneficiary’’ means an individual who 

21 is enrolled under part B of the Medicare pro22 gram and has a covered chronic health condi23 tion. 

24 (E) MEDICARE PROGRAM.—The term 

25 ‘‘Medicare program’’ means the health benefits 


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1 program under title XVIII of the Social Secu2 rity Act (42 U.S.C. 1395 et seq.). 

3 (F) SECRETARY.—The term ‘‘Secretary’’ 

4 means the Secretary of Health and Human 

5 Services. 

Æ 


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