I 

113TH CONGRESS 

2D SESSION H. R. 5380 

To amend title XVIII of the Social Security Act to provide for a phasedin expansion of telehealth coverage under the Medicare program. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 31, 2014 

Mr. THOMPSON of California (for himself, Mr. HARPER, 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 a phased-in 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 2014’’. 

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 2014, 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 2014, 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), by striking ‘‘or a 

2 practitioner (described in section 

3 1842(b)(18)(C))’’ and inserting ‘‘or a practi4 tioner (as defined in paragraph (4)(E))’’; and 

5 (B) in paragraph (4), by— 

6 (i) striking subparagraph (E); and 

7 (ii) inserting after subparagraph (D) 

8 the following new subparagraph: 

9 ‘‘(E) PRACTITIONER.—The term ‘practi10 tioner’ means— 

11 ‘‘(i) a practitioner described in section 

12 1842(b)(18)(C); and 

13 ‘‘(ii) with respect to services furnished 

14 on or after the date that is 6 months after 

15 the date of the enactment of the Medicare 

16 Telehealth Parity Act of 2014, a certified 

17 diabetes educator or licensed— 

18 ‘‘(I) respiratory therapist; 

19 ‘‘(II) audiologist; 

20 ‘‘(III) occupational therapist; 

21 ‘‘(IV) physical therapist; or 

22 ‘‘(V) speech language patholo23 gist.’’. 


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1 (4) COVERAGE OF REMOTE PATIENT MANAGE2 MENT SERVICES FOR CERTAIN CHRONIC HEALTH

3 CONDITIONS.— 

4 (A) IN GENERAL.—Section 1861(s)(2) of 

5 the Social Security Act (42 U.S.C. 1395x(s)(2)) 

6 is amended— 

7 (i) in subparagraph (EE), by striking 

8 ‘‘and’’ at the end; 

9 (ii) in subparagraph (FF), by insert10 ing ‘‘and’’ at the end; and 

11 (iii) by inserting after subparagraph 

12 (FF) the following new subparagraph: 

13 ‘‘(GG) remote patient management services (as 

14 defined in subsection (iii));’’. 

15 (B) SERVICES DESCRIBED.—Section 1861 

16 of the Social Security Act (42 U.S.C. 1395x) is 

17 amended by adding at the end the following 

18 new subsection: 

19 ‘‘(iii) REMOTE PATIENT MANAGEMENT SERVICES

20 FOR CHRONIC HEALTH CONDITIONS.—(1) The term ‘re21 mote patient management services’ means the remote 

22 monitoring, evaluation, and management of an individual 

23 with a covered chronic health condition (as defined in 

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

25 and management is with respect to such condition, 


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1 through the utilization of a system of technology that al2 lows a remote interface to collect and transmit clinical 

3 data between the individual and the responsible physician 

4 (as defined in subsection (r)) or practitioner or other sup5 plier (as defined in subsection (d)) for the purposes of clin6 ical review. Such services shall include in-home technology 

7 based professional consultations, patient monitoring, pa8 tient training services, clinical observation, assessment, 

9 treatment, and any other services that utilize technologies 

10 specified by the Secretary. Such term shall not include a 

11 telecommunication that consists solely of a telephone 

12 audio conversation, facsimile, or electronic text mail be13 tween a health care professional and patient. 

14 ‘‘(2) For purposes of paragraph (1), the term ‘cov15 ered chronic health condition’ means— 

16 ‘‘(A) congestive heart failure; 

17 ‘‘(B) chronic obstructive pulmonary disease; 

18 and 

19 ‘‘(C) in the case of services furnished at a fed20 erally qualified health center, diabetes. 

21 ‘‘(3)(A) The Secretary, in consultation with appro22 priate physician, practitioner, and supplier groups, shall 

23 develop guidelines on the frequency of billing for remote 

24 patient management services. Such guidelines shall be de25 termined based on medical necessity and shall be sufficient 


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1 to ensure appropriate and timely monitoring of individuals 

2 being furnished such services. 

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

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

5 enactment of this subsection, develop, in consulta6 tion with appropriate physician, practitioner, and 

7 supplier groups, standards (governing such matters 

8 as qualifications of personnel and the maintenance 

9 of equipment) for remote patient management serv10 ices for the covered chronic health conditions speci11 fied in paragraph (2). 

12 ‘‘(ii) Periodically review and update such stand13 ards under this subparagraph as necessary.’’. 

14 (C) PAYMENT UNDER THE PHYSICIAN FEE

15 SCHEDULE.—Section 1848 of the Social Secu16 rity Act (42 U.S.C. 1395w–4) is amended— 

17 (i) in subsection (c)— 

18 (I) in paragraph (2)((B)— 

19 (aa) in clause (ii)(II), by 

20 striking ‘‘and (v)’’ and inserting 

21 ‘‘(v), and (vii)’’; and 

22 (bb) by adding at the end 

23 the following new clause: 

24 ‘‘(vii) BUDGETARY TREATMENT OF

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1 penditures attributable to services de2 scribed in section 1861(s)(2)(GG) shall not 

3 be taken into account in applying clause 

4 (ii)(II).’’; and 

5 (II) by adding at the end the fol6 lowing new paragraph: 

7 ‘‘(7) TREATMENT OF REMOTE PATIENT MAN8 AGEMENT SERVICES.— 

9 ‘‘(A) In determining relative value units 

10 for remote patient management services (as de11 fined in section 1861(iii)), the Secretary, in 

12 consultation with appropriate physician groups, 

13 practitioner groups, and supplier groups, shall 

14 take into consideration— 

15 ‘‘(i) physician or practitioner re16 sources, including physician or practitioner 

17 time and the level of intensity of services 

18 provided, based on— 

19 ‘‘(I) the frequency of evaluation 

20 necessary to manage the individual 

21 being furnished the services; 

22 ‘‘(II) the complexity of the eval23 uation, including the information that 

24 must be obtained, reviewed, and ana25 lyzed; and 


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1 ‘‘(III) the number of possible di2 agnoses and the number of manage3 ment options that must be considered; 

4 ‘‘(ii) practice expense costs associated 

5 with such services, including the direct 

6 costs associated with installation and infor7 mation transmission, costs of remote pa8 tient management technology (including 

9 equipment and software), device delivery 

10 costs, and resource costs necessary for pa11 tient monitoring and follow-up (but not in12 cluding costs of any related item or non13 physician service otherwise reimbursed 

14 under this title); and 

15 ‘‘(iii) malpractice expense resources. 

16 ‘‘(B) Using the relative value units deter17 mined in subparagraph (A), the Secretary shall 

18 provide for separate payment for such services 

19 and shall not adjust the relative value units as20 signed to other services that might otherwise 

21 have been determined to include such separately 

22 paid remote patient management services.’’; and 

23 (ii) in subsection (j)(3), by inserting 

24 ‘‘(2)(GG),’’ after ‘‘health risk assess25 ment),’’. 


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1 (D) EFFECTIVE DATE.— 

2 (i) IN GENERAL.—The amendments 

3 made by this subsection shall apply to 

4 services furnished on or after the date that 

5 is 6 months after the date of the enact6 ment of this Act, without regard to wheth7 er the guidelines under paragraph (3)(A) 

8 or the standards under paragraph (3)(B) 

9 of section 1861(iii) of the Social Security 

10 Act, as added by subparagraph (B), have 

11 been developed. 

12 (ii) AVAILABILITY OF CODES AS OF

13 DATE OF ENACTMENT.—The Secretary of 

14 Health and Human Services shall— 

15 (I) promptly evaluate existing 

16 codes that would be used to bill for 

17 remote patient management services 

18 (as defined in paragraph (1) of such 

19 section 1861(iii), as so added) under 

20 title XVIII of the Social Security Act; 

21 and 

22 (II) if the Secretary determines 

23 that new codes are necessary to en24 sure accurate reporting and billing of 

25 such services under such title, issue 


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1 such codes so that they are available 

2 for use as of the date of the enact3 ment of this Act. 

4 (E) GAO STUDY AND REPORT.— 

5 (i) STUDY.—The Comptroller General 

6 of the United States shall conduct a study 

7 that includes, at a minimum, the following: 

8 (I) The effectiveness of remote 

9 patient monitoring on decreasing hos10 pital readmissions for the chronic con11 ditions described in subsection (iii)(2) 

12 of section 1861 of the Social Security 

13 Act (42 U.S.C. 1395x), as added by 

14 subparagraph (A). 

15 (II) The savings to the Medicare 

16 program under title XVIII of such Act 

17 associated with remote patient moni18 toring use with respect to such chron19 ic conditions. 

20 (III) The potential for greater 

21 use of remote patient monitoring for 

22 other chronic conditions. 

23 (IV) Potential implications of 

24 greater use of remote patient moni25 toring with respect to payment and 


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1 delivery system transformations under 

2 the Medicare program under such 

3 title. 

4 (ii) REPORT.—Not later than 2 years 

5 after the date of the enactment of this Act, 

6 the Comptroller General shall submit to 

7 Congress a report containing the results of 

8 the study conducted under clause (i). 

9 (5) EXPANSION OF TELECOMMUNICATIONS SYS10 TEM.—The second sentence of section 1834(m)(1) of 

11 the Social Security Act (42 U.S.C. 1835m(m)(1)) is 

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

13 telemedicine demonstration program conducted in 

14 Alaska or Hawaii,’’. 

15 (b) SECOND PHASE.— 

16 (1) FURTHER EXPANSION OF ORIGINATING

17 SITES.—Section 1834(m)(4) of the Social Security 

18 Act (42 U.S.C. 1395m(m)(4)) is amended— 

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

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

21 end the following new subclauses: 

22 ‘‘(IV) In the case of such a serv23 ice furnished on or after the date that 

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1 ity Act of 2014, any site described in 

2 clause (ii) that is located in a county 

3 within a Metropolitan Statistical Area 

4 with a population of at least 50,000 

5 individuals but fewer than 100,000 in6 dividuals, according to the most re7 cent decennial census. 

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

9 furnished on or after the date that is 

10 2 years after the date of the enact11 ment of the Medicare Telehealth Par12 ity Act of 2014, a home telehealth 

13 site, as defined in subparagraph 

14 (G).’’; and 

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

16 subparagraph: 

17 ‘‘(G) HOME TELEHEALTH SITE.— 

18 ‘‘(i) IN GENERAL.—The term ‘home 

19 telehealth site’ means, with respect to a 

20 telehealth service described in clause (ii) 

21 furnished to an individual, in a place of 

22 residence used as the home of such indi23 vidual. 


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1 ‘‘(ii) TELEHEALTH SERVICES DE2 SCRIBED.—A telehealth service described 

3 in this clause— 

4 ‘‘(I) is a telehealth service that is 

5 related to the provision of hospice 

6 care, home dialysis, home health serv7 ices, or durable medical equipment; 

8 and 

9 ‘‘(II) shall include the use of 

10 video conferencing.’’. 

11 (2) ADDITIONAL COVERED TELEHEALTH SERV12 ICES.—Section 1834(m)(4)(F)(i) of the Social Secu13 rity Act (42 U.S.C. 139m(m)(4)(F)(i)) is amended 

14 by adding at the end the following new sentence: 

15 ‘‘Beginning on the date that is 2 years after the 

16 date of the enactment of the Medicare Telehealth 

17 Parity Act of 2014, such term shall include res18 piratory services, audiology services (as defined in 

19 section 1861(ll)), and outpatient therapy services, 

20 including physical therapy, occupational therapy, 

21 and speech-language pathology services.’’ 

22 (3) GAO STUDY AND REPORT.— 

23 (A) STUDY.—The Comptroller General of 

24 the United States shall conduct a study that in25 cludes, at a minimum, the following: 


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1 (i) The effectiveness of using tele2 health services described in the second sen3 tence of section 1834(m)(4)(F)(i) of the 

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

5 1395m(m)(4)(F)(i)), as added by para6 graph (2), between therapy providers and 

7 patients. 

8 (ii) The savings to the Medicare pro9 gram under title XVIII of such Act associ10 ated with telehealth services utilization for 

11 therapy for such services described in such 

12 sentence. 

13 (iii) The potential for greater use of 

14 telehealth services for forms of therapy not 

15 described in such sentence. 

16 (c) FINAL PHASE.— 

17 (1) FURTHER EXPANSION OF ORIGINATING

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

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

20 added by subsection (a)(1) and amended by sub21 section (b)(1), is further amended by adding at the 

22 end the following new subclause: 

23 ‘‘(VI) In the case of such a serv24 ice furnished on or after the date that 

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1 ment of the Medicare Telehealth Par2 ity Act of 2014, any site described in 

3 clause (ii) that is located in a county 

4 within a Metropolitan Statistical Area 

5 with a population of at least 100,000 

6 individuals, according to the most re7 cent decennial census.’’. 

8 (2) PAYMENT METHODS FOR OTHER PATIENT

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

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

11 at the end the following new subparagraph: 

12 ‘‘(D) PAYMENT METHODS FOR OTHER PA13 TIENT SITES.—With respect to services fur14 nished on or after the date that is 4 years after 

15 the date of the enactment of the Medicare Tele16 health Parity Act of 2014, the Secretary may 

17 develop and implement payment methods that 

18 would apply under this subsection in the case of 

19 an individual who would be an eligible tele20 health individual except that the telehealth serv21 ices are furnished at a site other than an origi22 nating site. Such methods shall be designed to 

23 take into account the costs related to the site 


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1 involved and reduced costs for the distant 

2 site.’’. 

Æ 


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