II 

110TH CONGRESS 

1ST SESSION S. 631 

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

of remote patient management services for chronic health care conditions 

under the Medicare Program. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 15, 2007 

Mr. COLEMAN 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 coverage of remote patient management services for 

chronic health care 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 ‘‘Remote Monitoring 

5 Access Act of 2007’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) Remote patient monitoring can make chron2 ic disease management more effective and efficient 

3 for patients and the health care system. 

4 (2) By collecting, analyzing, and transmitting 

5 clinical health information to a health care practi6 tioner, remote monitoring technologies allow patients 

7 and physicians to manage the patient’s condition in 

8 a consistent and real-time fashion. 

9 (3) Utilization of these technologies not only 

10 improves the quality of care given to patients, it also 

11 reduces the need for frequent physician office ap12 pointments, costly emergency room visits, and un13 necessary hospitalizations. 

14 (4) Monitoring a patient’s disease from the 

15 home reduces the need for face-to-face physician 

16 interactions, thereby minimizing unnecessary travel 

17 and missed work and providing particular value to 

18 individuals residing in rural or underserved commu19 nities who would otherwise face potentially signifi20 cant access barriers to receiving needed care. 

21 (5) Four major areas in which remote manage22 ment technologies are emerging in health care are 

23 the treatment of congestive heart failure, diabetes, 

24 cardiac arrhythmia, and sleep apnea (sleep dis25 ordered breathing). Prompt transmission of clinical 


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1 data on each of these conditions, to the physician or 

2 the patient as appropriate, are essential to providing 

3 timely and appropriate therapeutic interventions 

4 which can then reduce expensive hospitalizations. 

5 (6) Despite these innovations, remote manage6 ment technologies have failed to diffuse rapidly. A 

7 significant barrier to wider adoption is the relative 

8 lack of payment mechanisms in fee-for-service Medi9 care to reimburse for remote, non-face-to-face man10 agement. 

11 (7) This Act will eliminate this barrier to new 

12 technologies by requiring Medicare to reimburse doc13 tors for time spent analyzing data transmitted to 

14 them by remote patient management technologies. 

15 (8) This Act also promotes high quality care by 

16 requiring the Secretary of Health and Human Serv17 ices to consult with physician groups to create a 

18 standard of care and a quality standard for remote 

19 patient management services for the covered chronic 

20 conditions. 

21 (9) This Act provides physicians with a finan22 cial incentive to meet or exceed the standard of care 

23 and quality standards. 


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1 SEC. 3. COVERAGE OF REMOTE PATIENT MANAGEMENT 

2 SERVICES FOR CHRONIC HEALTH CARE CON3 DITIONS. 

4 (a) IN GENERAL.—Section 1861(s)(2) of the Social 

5 Security Act (42 U.S.C. 1395x(s)(2)) is amended— 

6 (1) in subparagraph (Z), by striking ‘‘and’’ at 

7 the end; 

8 (2) in subparagraph (AA), by inserting ‘‘and’’ 

9 at the end; and 

10 (3) by inserting after subparagraph (AA) the 

11 following new subparagraph: 

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

13 defined in subsection (ccc));’’. 

14 (b) SERVICES DESCRIBED.—Section 1861 of the So15 cial Security Act (42 U.S.C. 1395x) is amended by adding 

16 at the end the following new subsection: 

17 ‘‘Remote Patient Management Services 

18 ‘‘(ccc)(1) The term ‘remote patient management serv19 ices’ means the remote monitoring and management of an 

20 individual with a covered chronic health condition (as de21 fined in paragraph (2)) through the utilization of a system 

22 of technology that allows a remote interface to collect and 

23 transmit clinical data between the individual and the re24 sponsible physician or supplier for the purposes of clinical 

25 review or response by the physician or supplier. 


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

3 ‘‘(A) heart failure; 

4 ‘‘(B) diabetes; 

5 ‘‘(C) cardiac arrhythmia; 

6 ‘‘(D) sleep apnea; and 

7 ‘‘(E) any other chronic condition determined by 

8 the Secretary to be appropriate for treatment 

9 through remote patient management services. 

10 ‘‘(3)(A) The Secretary, in consultation with appro11 priate physician groups, shall develop guidelines on the 

12 frequency of billing for remote patient management serv13 ices. Such guidelines shall be determined based on medical 

14 necessity and shall be sufficient to ensure appropriate and 

15 timely monitoring of individuals being furnished such serv16 ices. 

17 ‘‘(B) The Secretary, acting through the Agency for 

18 Health Care Research and Quality, shall do the following: 

19 ‘‘(i) Not later than 1 year after the date of en20 actment of the Remote Monitoring Access Act of 

21 2007, develop, in consultation with appropriate phy22 sician groups, a standard of care and quality stand23 ards for remote patient management services for the 

24 covered chronic health conditions specified in sub25 paragraphs (A), (B), (C), and (D) of paragraph (2). 


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1 ‘‘(ii) If the Secretary makes a determination 

2 under paragraph (2)(E) with respect to a chronic 

3 condition, develop, in consultation with appropriate 

4 physician groups, a standard of care and quality 

5 standards for remote patient management services 

6 for such condition within 1 year of such determina7 tion. 

8 ‘‘(iii) Periodically review and update such 

9 standards of care and quality standards under this 

10 subparagraph as necessary.’’. 

11 (c) PAYMENT UNDER THE PHYSICIAN FEE SCHED12 ULE.—Section 1848 of the Social Security Act (42 U.S.C. 

13 1395w–4) is amended— 

14 (1) in subsection (c)— 

15 (A) in paragraph (2)(B)— 

16 (i) in clause (ii)(II), by striking ‘‘and 

17 (v)’’ and inserting ‘‘, (v), and (vi)’’; and 

18 (ii) by adding at the end the following 

19 new clause: 

20 ‘‘(vi) BUDGETARY TREATMENT OF

21 CERTAIN SERVICES.—The additional ex22 penditures attributable to services de23 scribed in section 1861(s)(2)(BB) shall not 

24 be taken into account in applying clause 

25 (ii)(II) for 2008.’’; and 


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

2 paragraph: 

3 ‘‘(7) TREATMENT OF REMOTE PATIENT MAN4 AGEMENT SERVICES.—In determining relative value 

5 units for remote patient management services (as 

6 defined in section 1861(ccc)), the Secretary, in con7 sultation with appropriate physician groups, shall 

8 take into consideration— 

9 ‘‘(A) costs associated with such services, 

10 including physician time involved, installation 

11 and information transmittal costs, costs of re12 mote patient management technology (including 

13 devices and software), and resource costs nec14 essary for patient monitoring and follow-up 

15 (but not including costs of any related item or 

16 non-physician service otherwise reimbursed 

17 under this title); and 

18 ‘‘(B) the level of intensity of services pro19 vided, based on— 

20 ‘‘(i) the frequency of evaluation nec21 essary to manage the individual being fur22 nished the services; 

23 ‘‘(ii) the amount of time necessary 

24 for, and the complexity of the evaluation, 


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1 including the information that must be ob2 tained, reviewed, and analyzed; and 

3 ‘‘(iii) the number of possible diagnoses 

4 and the number of management options 

5 that must be considered.’’; and 

6 (2) in subsection (j)(3), by inserting ‘‘(2)(BB),’’ 

7 after ‘‘(2)(AA),’’. 

8 (d) INCENTIVE PAYMENTS.—Section 1833 of the So9 cial Security Act (42 U.S.C. 1395l) is amended by adding 

10 at the end the following new subsection: 

11 ‘‘(v) INCENTIVE FOR MEETING CERTAIN STANDARDS

12 OF CARE AND QUALITY STANDARDS IN THE FURNISHING

13 OF REMOTE PATIENT MANAGEMENT SERVICES.—In the 

14 case of remote patient management services (as defined 

15 in section 1861(ccc)) that are furnished by a physician 

16 who the Secretary determines meets or exceeds the stand17 ards of care and quality standards developed by the Sec18 retary under paragraph (3)(B) of such section for such 

19 services, in addition to the amount of payment that would 

20 otherwise be made for such services under this part, there 

21 shall also be paid to the physician (or to an employer or 

22 facility in cases described in subclause (A) of section 

23 1842(b)(6)) (on a monthly or quarterly basis) from the 

24 Federal Supplementary Medical Insurance Trust Fund an 


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1 amount equal to 10 percent of the payment amount for 

2 the service under this part.’’. 

3 (e) EFFECTIVE DATE.—The amendments made by 

4 this section shall apply to services furnished on or after 

5 January 1, 2008. 

Æ 


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