I 

118TH CONGRESS 

1ST SESSION H. R. 5394 

To ensure appropriate access to remote monitoring services furnished under 

the Medicare program. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 12, 2023 

Mr. BALDERSON (for himself, Ms. PORTER, Mr. DUNN of Florida, and Mr. 

MURPHY) 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 ensure appropriate access to remote monitoring services 

furnished 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 ‘‘Expanding Remote 

5 Monitoring Access Act’’. 

6 SEC. 2. FINDINGS. 

7 The Congress finds the following: 


pbinns on DSKJLVW7X2PROD with $$_JOB
2 

•HR 5394 IH

1 (1) Remote monitoring is an option that can 

2 help patients manage their health conditions from 

3 their homes with oversight from their health care 

4 providers, which can improve patient health out5 comes, reduce long-term health costs, and increase 

6 care options for patients. 

7 (2) The Department of Veterans Affairs (VA) 

8 saw such results in a 2019 report. Veterans enrolled 

9 in remote patient monitoring had a 53 percent de10 crease in VA bed days of care and a 33 percent de11 crease in VA hospital admissions. 

12 (3) Providers are currently required by Medi13 care to collect 16 days of patient data over a 30-day 

14 period in order to bill Medicare for remote moni15 toring services, even in cases where this full duration 

16 is not medically necessary to ensure the health and 

17 safety of the patient. This can limit the use of re18 mote monitoring in instances where it can promote 

19 patient health and safety and where it can reduce 

20 the overall cost on the health system. 

21 (4) In the 2021 Physician Fee Schedule, the 

22 Centers for Medicare and Medicaid Services (CMS) 

23 issued an interim policy to lower the duration re24 quired by Medicare to bill for remote monitoring 

25 services from 16 days to 2 days within a 30-day peVerDate Sep 11 2014 18:41 Sep 13, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5394.IH H5394

pbinns on DSKJLVW7X2PROD with $$_JOB
3 

•HR 5394 IH

1 riod, but only for individuals who had been diag2 nosed with, or were suspected of having, COVID–19. 

3 This short-term flexibility called attention to the 

4 long-term need to reassess the minimum duration 

5 required for providers to bill for remote monitoring. 

6 (5) As part of issuing the 2021 Physician Fee 

7 Schedule, CMS studied comments in support of per8 manently lowering the minimum required duration 

9 of remote monitoring for all patients, not just those 

10 with COVID–19. 

11 (6) CMS concluded that ‘‘we agree that a full 

12 16 days of monitoring may not always be reasonable 

13 and necessary’’ but did not revise the 16 day per 30- 

14 day period minimum duration for all patients be15 cause CMS did not believe they had received ‘‘spe16 cific clinical examples’’ to allow for ‘‘understanding 

17 under what clinical circumstances fewer days of 

18 monitoring would be medically reasonable and nec19 essary and allow a practitioner to establish clinically 

20 meaningful care’’. 

21 (7) Clinical evidence shows numerous instances 

22 in which fewer than sixteen days of monitoring with23 in a 30-day period establishes clinically meaningful 

24 care. These include: 


pbinns on DSKJLVW7X2PROD with $$_JOB
4 

•HR 5394 IH

1 (A) Sixteen days of monitoring per 30-day 

2 period may not be required to establish that a 

3 patient has sleep apnea. 

4 (B) A patient prescribed a narcotic for 

5 pain may require their breathing to be mon6 itored only while on the medication. 

7 (C) A patient with a chronic condition like 

8 diabetes, congestive heart failure, or obesity 

9 may have their weight monitored over a longer 

10 period of time, but it is not clinically appro11 priate to have such patient step on a scale 16 

12 or more times in each 30-day period. 

13 (D) A patient whose blood pressure or oxy14 gen levels are monitored during physical ther15 apy may not necessitate 16 days of monitoring 

16 in each 30-day period given physical therapy is 

17 often ordered twice weekly. 

18 (E) A patient who wears a heart monitor 

19 to measure palpitations may wear the monitor 

20 continuously, but the data only needs to be col21 lected when the individual is experiencing symp22 toms. 

23 (F) A patient with hypertension is often 

24 monitored for long-term management of this 

25 condition on more of a weekly basis, only needVerDate Sep 11 2014 02:48 Sep 13, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5394.IH H5394

pbinns on DSKJLVW7X2PROD with $$_JOB
5 

•HR 5394 IH

1 ing more frequent data collection for active 

2 monitoring with changes in medication or dos3 ages. 

4 (G) A patient who suffers from Muscular 

5 Sclerosis or Muscular Dystrophy may benefit 

6 from a provider tracking the patient’s exercise 

7 between visits to monitor certain physiologic pa8 rameters such as muscle movement but may not 

9 produce 16 days of data in a 30-day period. 

10 (H) A patient who needs a total joint re11 placement may simply need pre-testing for sur12 gery baselines, including to establish gait, force, 

13 activity, heart rate and other factors and then 

14 compare pre-surgery and post-surgery function. 

15 (I) For a patient with urologic dysfunction, 

16 male urine flow data obtained from the patient 

17 can be collected in two to four consecutive days. 

18 (J) Remote monitoring may allow a pro19 vider to assess a patient’s adherence, range of 

20 motion, and response to physical therapy and 

21 occupational therapy regimens even though 

22 many such regimens are less than 16 days per 

23 month. 

24 (K) Monitoring cognitive behavioral ther25 apy for less than 16 days in a 30-day period 


pbinns on DSKJLVW7X2PROD with $$_JOB
6 

•HR 5394 IH

1 may provide clinically meaningful care while 

2 moderating a patient’s anxiety and other symp3 toms. 

4 (L) A patient with respiratory issues may 

5 not require a full 16 days of monitoring of in6 haler usage to get clinical benefits from remote 

7 monitoring. 

8 (8) A two-day minimum duration would permit 

9 Medicare coverage of the full range of remote moni10 toring services that can be beneficial to a patient 

11 without precluding the differential reimbursement of 

12 individual remote monitoring services based on pa13 tient acuity and cost. 

14 SEC. 3. ENSURING APPROPRIATE ACCESS TO REMOTE 

15 MONITORING SERVICES FURNISHED UNDER 

16 THE MEDICARE PROGRAM. 

17 (a) IN GENERAL.—Notwithstanding any other provi18 sion of law, the Secretary of Health and Human Services 

19 (in this section referred to as the ‘‘Secretary’’) shall en20 sure that remote monitoring services furnished under title 

21 XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) 

22 during the period beginning on the date of the enactment 

23 of this Act and ending on the date that is 2 years after 

24 such date of enactment are payable for a minimum of 2 

25 days of data collection over a 30-day period, regardless 


pbinns on DSKJLVW7X2PROD with $$_JOB
7 

•HR 5394 IH

1 of whether the individual receiving such services has been 

2 diagnosed with, or is suspected of having, COVID–19. 

3 (b) REPORT.— 

4 (1) IN GENERAL.—Not later than 1 year after 

5 the date of the enactment of this Act, the Secretary 

6 shall, after consulting with entities specified in para7 graph (2), submit to Congress a report that includes 

8 the following: 

9 (A) A summary and analysis of previous 

10 experience with such remote monitoring services 

11 being payable under such title for a minimum 

12 of 2 days of data collection over a 30-day pe13 riod. 

14 (B) Recommendations for implementing a 

15 reimbursement model that takes into account 

16 patient acuity and cost of providing remote 

17 monitoring services, including potentially cre18 ating differential reimbursements for periods 

19 with different durations, such as fewer than 

20 and more than 16 days. 

21 (C) An analysis and justification for the 

22 appropriate place of service and supervision re23 quirements for non-clinical staff reviewing and 

24 escalating patient data and provide rec25 ommendations. 


pbinns on DSKJLVW7X2PROD with $$_JOB
8 

•HR 5394 IH

1 (D) An analysis of the estimated savings 

2 resulting from earlier interventions and fewer 

3 days of hospitalizations among patients fur4 nished remote monitoring services. 

5 (2) SPECIFIED ENTITIES.—For purposes of 

6 paragraph (1), the entities specified in this para7 graph are the following: 

8 (A) Relevant agencies within the Depart9 ment of Health and Human Services (including, 

10 with respect to issues relating to waste, fraud, 

11 or abuse, the Inspector General of such Depart12 ment). 

13 (B) The Department of Veterans Affairs 

14 (including the Office of Connected Care of such 

15 Department). 

16 (C) Licensed and practicing osteopathic 

17 and allopathic physicians, anesthesiologists, 

18 physician assistants, and nurse practitioners. 

19 (D) Hospitals, health systems, academic 

20 medical centers, and other medical facilities, 

21 such as acute care hospitals, cancer hospitals, 

22 psychiatric hospitals, hospital emergency de23 partments, facilities furnishing urgent care 

24 services, ambulatory surgical centers, Federally 

25 qualified health centers, rural health clinics, 


pbinns on DSKJLVW7X2PROD with $$_JOB
9 

•HR 5394 IH

1 and post-acute care and long-term care facili2 ties. 

3 (E) Medical professional organizations and 

4 medical specialty organizations. 

5 (F) Organizations with expertise in the de6 velopment of or operation of innovative remote 

7 physiologic monitoring services technologies. 

8 (G) Beneficiary advocacy organizations. 

9 (H) The American Medical Association 

10 Current Procedural Terminology Editorial 

11 Panel. 

12 (I) Commercial payers. 

13 (J) Any other entity determined appro14 priate by the Secretary. 

15 (c) DEFINITIONS.—In this section: 

16 (1) REMOTE MONITORING.—The term ‘‘remote 

17 monitoring’’ means remote physiologic monitoring 

18 and remote therapeutic monitoring. 

19 (2) REMOTE PHYSIOLOGIC MONITORING.—The 

20 term ‘‘remote physiologic monitoring’’ means non21 face-to-face monitoring and analysis of physiologic 

22 factors used to understand a patient’s health status, 

23 including the collection and analysis of patient phys24 iologic data that are used to develop and manage a 


pbinns on DSKJLVW7X2PROD with $$_JOB
10 

•HR 5394 IH

1 treatment plan related to chronic or acute condi2 tions. 

3 (3) REMOTE THERAPEUTIC MONITORING.—The 

4 term ‘‘remote therapeutic monitoring’’ means the 

5 use of medical devices to monitor a patient’s health 

6 or response to treatment using non-physiological 

7 data. 

Æ 


pbinns on DSKJLVW7X2PROD with $$_JOB