II 

113TH CONGRESS 

2D SESSION S. 2662 

To promote and expand the application of telehealth under Medicare and 

other Federal health care programs, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JULY 24, 2014 

Mr. COCHRAN (for himself and Mr. WICKER) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To promote and expand the application of telehealth under 

Medicare and other Federal health care programs, and 

for other purposes. 

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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Telehealth Enhancement Act of 2014’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—STRENGTHENING MEDICARE THROUGH TELEHEALTH 

Sec. 101. Positive incentive for Medicare’s hospital readmissions reduction program. 


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Sec. 102. Health homes and medical homes. 

Sec. 103. Flexibility in accountable care organizations coverage of telehealth. 

Sec. 104. Recognizing telehealth services and remote patient monitoring in national pilot program on payment bundling. 

Sec. 105. Additional sites to be considered originating sites for purposes of payments for telehealth services under Medicare. 

TITLE II—ENHANCING MEDICAID THROUGH TELEHEALTH 

Sec. 201. Medicaid option for high-risk pregnancies and births. 

TITLE III—IMPROVING TELECOMMUNICATIONS FOR MEDICAL 

DELIVERY 

Sec. 301. Additional providers considered health care providers for purposes of 

universal service support. 

Sec. 302. No consideration of provider location in rules enhancing health care 

provider access to advanced telecommunications and information services. 

1 TITLE I—STRENGTHENING 

2 MEDICARE THROUGH TELE3 HEALTH 

4 SEC. 101. POSITIVE INCENTIVE FOR MEDICARE’S HOSPITAL 

5 READMISSIONS REDUCTION PROGRAM. 

6 Section 1886(q) of the Social Security Act (42 U.S.C. 

7 1395ww(q)) is amended by adding at the end the following 

8 new paragraph: 

9 ‘‘(9) POSITIVE INCENTIVE FOR REDUCED RE10 ADMISSIONS.— 

11 ‘‘(A) IN GENERAL.—With respect to pay12 ment for discharges occurring during a fiscal 

13 year beginning on or after October 1, 2014, in 

14 order to provide a positive incentive for hos15 pitals described in subparagraph (B) to lower 

16 their excess readmission ratios, the Secretary 

17 shall make an additional payment to a hospital 


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1 in such proportion as provides for a sharing of 

2 the savings from such better-than-expected per3 formance between the hospital and the program 

4 under this title. 

5 ‘‘(B) HOSPITAL DESCRIBED.—A hospital 

6 described in this subparagraph is an applicable 

7 hospital (as defined in paragraph (5)(C)) not 

8 subject to a payment change under paragraph 

9 (1) and for which the positive readmission ratio 

10 (described in subparagraph (C)) is greater than 

11 1. 

12 ‘‘(C) POSITIVE READMISSION RATIO.—The 

13 positive readmission ratio described in this sub14 paragraph for a hospital is the ratio of— 

15 ‘‘(i) the risk adjusted expected re16 admissions (described in subclause (II) of 

17 paragraph (4)(C)(i)); to 

18 ‘‘(ii) the risk adjusted readmissions 

19 based on actual readmissions (described in 

20 subclause (I) of such paragraph).’’. 

21 SEC. 102. HEALTH HOMES AND MEDICAL HOMES. 

22 (a) MEDICARE CHRONIC CARE COUNTERPART TO

23 MEDICAID ‘‘HEALTH HOME’’.— 


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1 (1) IN GENERAL.—Title XVIII of the Social Se2 curity Act is amended by adding at the end the fol3 lowing new section: 

4 ‘‘SEC. 1899B. MEDICARE HEALTH HOME FOR INDIVIDUALS 

5 WITH CHRONIC CONDITIONS. 

6 ‘‘(a) IN GENERAL.—In the case of a State that has 

7 amended its State plan under title XIX in accordance with 

8 the option described in section 1945, the Secretary may 

9 contract with the State medical assistance agency with a 

10 program under such section to serve eligible individuals 

11 with chronic conditions who select a designated provider, 

12 a team of health care professionals operating with such 

13 a provider, or a health team as the individual’s health 

14 home for purposes of providing the individual with health 

15 home services in the same manner as provided under its 

16 State plan amendment. 

17 ‘‘(b) HEALTH HOME QUALIFICATION STANDARDS.— 

18 The standards established by the Secretary under section 

19 1945(b) for qualification as a designated provider shall 

20 apply under this section for the purpose of being eligible 

21 to be a health home for purposes of section 1945. 

22 ‘‘(c) PAYMENTS.—Payments shall be made under this 

23 section in the same manner to a provider or team as pay24 ments are made under subsection (c) of section 1945, inVerDate Mar 15 2010 00:58 Jul 30, 2014 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S2662.IS S2662

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1 cluding the use of the payment methodology described in 

2 paragraph (2) of such subsection. 

3 ‘‘(d) HOSPITAL REFERRALS.—Hospitals that are 

4 participating providers under this section shall establish 

5 procedures for referring any eligible individuals with 

6 chronic conditions who seek or need treatment in a hos7 pital emergency department to designated providers in the 

8 same manner as required under section 1945(d). 

9 ‘‘(e) MONITORING AND REPORT ON QUALITY.—The 

10 methodology and proposal required under subsection (f) 

11 of section 1945 and the report on quality measures under 

12 subsection (f) of such section shall also apply under this 

13 section. 

14 ‘‘(f) REPORT ON QUALITY MEASURES.—As a condi15 tion for receiving payment for health home services pro16 vided to an eligible individual with chronic conditions, a 

17 designated provider shall report, in accordance with such 

18 requirements as the Secretary shall specify, including a 

19 plan for the use of remote patient monitoring, on all appli20 cable measures for determining the quality of such serv21 ices. When appropriate and feasible, a designated provider 

22 shall use health information technology in providing the 

23 Secretary with such information. 

24 ‘‘(g) DEFINITIONS.—In this section, the provisions 

25 and definitions contained in subsection (h) of section 1945 


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1 shall also apply for purposes of this section except that, 

2 instead of the requirement specified in clause (i) of sub3 section (h)(1)(A) of such section, an individual must be 

4 eligible for services under parts A and B and covered for 

5 medical assistance for health home services under section 

6 1945 in order to be an eligible individual with chronic con7 ditions. 

8 ‘‘(h) EVIDENCE-BASED AND REPORTING.—In con9 tracting with a State under this section, the State— 

10 ‘‘(1) shall follow evidence-based guidelines for 

11 chronic care; and 

12 ‘‘(2) shall report at least by the end of every 

13 month data specified by the Secretary, including an 

14 assessment of the use of remote patient monitoring 

15 and quality measures of process, outcome, and struc16 ture. 

17 ‘‘(i) WAIVER AUTHORITY.— 

18 ‘‘(1) IN GENERAL.—The limitations on tele19 health under section 1834(m) shall not apply for 

20 purposes of this section. 

21 ‘‘(2) SECRETARY AUTHORITY.—The Secretary 

22 may waive such other requirements of this title and 

23 title XIX as may be necessary to carry out the pro24 visions of this section.’’. 

25 (2) REPORTING.— 


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1 (A) IN GENERAL.—Not later than 2 years 

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

3 Secretary of Health and Human Services shall 

4 survey States contracting under section 1899B 

5 of the Social Security Act, as added by para6 graph (1), on the nature, extent, and use of the 

7 option under such section particularly as it per8 tains to— 

9 (i) hospital admission rates; 

10 (ii) chronic disease management; 

11 (iii) coordination of care for individ12 uals with chronic conditions; 

13 (iv) assessment of program implemen14 tation; 

15 (v) processes and lessons learned (as 

16 described in subparagraph (B)); 

17 (vi) assessment of quality improve18 ments and clinical outcomes under such 

19 option; and 

20 (vii) estimates of cost savings. 

21 (B) IMPLEMENTATION REPORTING.—Such 

22 a State shall report to the Secretary, as nec23 essary, on processes that have been developed 

24 and lessons learned regarding provision of co25 ordinated care through a health home for beneVerDate Mar 15 2010 00:58 Jul 30, 2014 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S2662.IS S2662

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1 ficiaries with chronic conditions under such op2 tion. 

3 (b) SPECIALTY MEDICAL HOMES.—Title XVIII of 

4 the Social Security Act, as amended by subsection (a), is 

5 further amended by adding at the end the following new 

6 section: 

7 ‘‘SEC. 1899C. SPECIALTY MEDICAL HOMES. 

8 ‘‘(a) IN GENERAL.—Beginning not later than 30 

9 days after the date of the enactment of this section, the 

10 Secretary may contract with a national or multi-state re11 gional center of excellence with a network of affiliated 

12 local providers to provide through one or more medical 

13 homes for targeted, accessible, continuous, and coordi14 nated care to individuals under this title and title XIX 

15 with a long-term illness or medical condition that requires 

16 regular medical treatment, advising, and monitoring. 

17 ‘‘(b) MEDICAL HOME DEFINED.—In this section, the 

18 term ‘medical home’ means a medical entity that— 

19 ‘‘(1) specializes in the care for a specific long20 term illness or medical condition, including related 

21 comorbidities; 

22 ‘‘(2) leads the development of related evidence23 based clinical standards and research; 

24 ‘‘(3) has a network of affiliated personal physi25 cians and patient treatment facilities; 


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1 ‘‘(4) maintains an online Web site for patient 

2 and provider communication and collaboration and 

3 patient access to the patient’s health information; 

4 ‘‘(5) has a plan for use of health information 

5 technology in providing services under this section 

6 and improving service delivery and coordination 

7 across the care continuum (including the use of 

8 wireless patient technology to improve coordination 

9 and remote patient monitoring management of care 

10 and patient adherence to recommendations made by 

11 their provider); 

12 ‘‘(6) provides deidentified demographic data 

13 sets for clinical, statistical, and social science re14 search to develop culturally competent best practices 

15 and clinical decision support mechanisms for the 

16 long-term illness or medical condition; 

17 ‘‘(7) uses a health assessment tool for the indi18 viduals targeted, including a means for identifying 

19 those most likely to benefit from remote patient 

20 monitoring; and 

21 ‘‘(8) provides training programs for personnel 

22 involved in the coordination of care. 

23 ‘‘(c) PERSONAL PHYSICIAN DEFINED.— 

24 ‘‘(1) IN GENERAL.—In this section, the term 

25 ‘personal physician’ means a physician (as defined in 


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1 section 1861(r)(1)) who meets the requirements de2 scribed in paragraphs (2) and (3). Nothing in this 

3 paragraph shall be construed as preventing a per4 sonal physician from being a specialist or sub5 specialist for an individual requiring ongoing care 

6 for a specific chronic condition or multiple chronic 

7 conditions or for an individual with a long-term ill8 ness or medical condition. 

9 ‘‘(2) GENERAL REQUIREMENTS.—The require10 ments described in this paragraph for a personal 

11 physician for care of an individual are as follows: 

12 ‘‘(A) The physician is board certified for 

13 care of the specific illness or condition of the in14 dividual and manages continuous care for the 

15 individual. 

16 ‘‘(B) The physician has the staff and re17 sources to manage the comprehensive and co18 ordinated health care of such individual. 

19 ‘‘(3) SERVICE-RELATED REQUIREMENTS.—The 

20 requirements described in this paragraph for a per21 sonal physician are as follows: 

22 ‘‘(A) The personal physician advocates for 

23 and provides ongoing support, oversight, and 

24 guidance to implement a plan of care that pro25 vides an integrated, coherent, cross-discipline 


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1 plan for ongoing medical care developed in part2 nership with patients and including all other 

3 physicians furnishing care to the patient in4 volved and other appropriate medical personnel 

5 or agencies (such as home health agencies). 

6 ‘‘(B) The personal physician uses evidence7 based medicine and clinical decision support 

8 tools to guide decisionmaking at the point-of9 care based on patient-specific factors. 

10 ‘‘(C) The personal physician is in compli11 ance with the standards for meaningful use of 

12 electronic health records under this title. 

13 ‘‘(D) The personal physician participates 

14 with the State’s health information exchange, 

15 as available, or the federally sponsored Direct 

16 Project. 

17 ‘‘(E) The personal physician uses health 

18 information technology, including appropriate 

19 remote monitoring, to monitor and track the 

20 health status of patients and to provide patients 

21 with enhanced and convenient access to health 

22 care services. 

23 ‘‘(F) The personal physician uses elec24 tronic prescribing and provides medication man25 agement. 


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1 ‘‘(G) The personal physician encourages 

2 patients to engage in the management of their 

3 own health through education and support sys4 tems. 

5 ‘‘(H) The personal physician utilizes the 

6 services of related health professionals, includ7 ing nurse practitioners and physician assistants. 

8 ‘‘(d) LONG-TERM ILLNESS OR MEDICAL CONDITION

9 DEFINED.—In this section, the term ‘long-term illness or 

10 medical condition’— 

11 ‘‘(1) includes a chronic condition which meets 

12 criteria specified by the Secretary for a specialized 

13 MA plan for special needs individuals; and 

14 ‘‘(2) also includes another condition that the 

15 Secretary determines would provide a beneficial 

16 focus for an effective and efficient medical home. 

17 ‘‘(e) PAYMENT MECHANISMS.— 

18 ‘‘(1) MEDICAL HOME CARE MANAGEMENT FEE

19 AND MEDICAL HOME SHARING IN SAVINGS.—Except 

20 as provided in paragraph (2)— 

21 ‘‘(A) MEDICAL HOME CARE MANAGEMENT

22 FEE.—Under this section the Secretary shall 

23 provide for payment under section 1848 of a 

24 care management fee to the medical home and 

25 may include performance incentives. The medVerDate Mar 15 2010 00:58 Jul 30, 2014 Jkt 039200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S2662.IS S2662

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1 ical home shall arrange for payment for the 

2 services of affiliated physicians and facilities. 

3 ‘‘(B) MEDICAL HOME SHARING IN SAV4 INGS.—The Secretary shall provide for payment 

5 under this section of a medical home based on 

6 the payment methodology applied to health 

7 group practices under section 1866A. Under 

8 such methodology, 80 percent of the reductions 

9 in expenditures under this title and title XIX 

10 resulting fro 

11 ‘‘(C) m participation of individuals that 

12 are attributable to the medical home (as re13 duced by the total care management fees paid 

14 to the medical home under this section) shall be 

15 paid to the medical home. The amount of such 

16 reductions in expenditures shall be determined 

17 by using assumptions with respect to reductions 

18 in the occurrence of health complications, hos19 pitalization rates, medical errors, and adverse 

20 drug reactions. 

21 ‘‘(2) ALTERNATIVE PAYMENT MODEL.— 

22 ‘‘(A) IN GENERAL.—The Secretary may 

23 provide for payment under this paragraph in24 stead of the amounts otherwise payable under 

25 paragraph (1). 


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1 ‘‘(B) ESTABLISHMENT OF TARGET SPEND2 ING LEVEL.—For purposes of this paragraph, 

3 the Secretary shall compute an estimated an4 nual spending target based on the amount the 

5 Secretary estimates would have been spent in 

6 the absence of this section, for items and serv7 ices covered under parts A and B furnished to 

8 applicable beneficiaries for each qualifying med9 ical home under this section. Such spending 

10 targets shall be determined on a per capita 

11 basis. Such spending targets shall include a risk 

12 corridor that takes into account normal vari13 ation in expenditures for items and services cov14 ered under parts A and B furnished to such 

15 beneficiaries with the size of the corridor being 

16 related to the number of applicable beneficiaries 

17 furnished services by each medical home. The 

18 spending targets may also be adjusted for such 

19 other factors as the Secretary determines ap20 propriate. 

21 ‘‘(C) INCENTIVE PAYMENTS.—Subject to 

22 performance on quality measures, a qualifying 

23 medical home is eligible to receive an incentive 

24 payment under this section if actual expendi25 tures for a year for the applicable beneficiaries 


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1 it enrolls are less than the estimated spending 

2 target established under subparagraph (B) for 

3 such year. An incentive payment for such year 

4 shall be equal to a portion (as determined by 

5 the Secretary) of the amount by which actual 

6 expenditures (including incentive payments 

7 under this paragraph) for applicable bene8 ficiaries under parts A and B for such year are 

9 estimated to be less than 95 percent of the esti10 mated spending target for such year, as deter11 mined under subparagraph (B). 

12 ‘‘(3) SOURCE.—Payments paid under this sec13 tion shall be made in appropriate proportions (as 

14 specified by the Secretary) from the Hospital Insur15 ance Trust Fund, the Federal Supplementary Med16 ical Insurance Trust Fund, and funds appropriated 

17 to carry out title XIX. 

18 ‘‘(f) EVIDENCE-BASED.—The contracting entity shall 

19 follow evidence-based guidelines for care of the long-term 

20 illness or medical condition under this section. 

21 ‘‘(g) PATIENT SERVICES QUALITY AND PERFORM22 ANCE REPORTING.—The contracting entity shall report at 

23 least by the end of every month data specified by the Sec24 retary on the operation of this section, including quality 

25 measures of process, outcome, and structure. 


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1 ‘‘(h) WAIVER AUTHORITY.— 

2 ‘‘(1) IN GENERAL.—The limitations on tele3 health under section 1834(m) shall not apply for 

4 purposes of this section. 

5 ‘‘(2) SECRETARY AUTHORITY.—The Secretary 

6 may waive such other requirements of this title and 

7 title XIX as may be necessary to carry out the pro8 visions of this section.’’. 

9 SEC. 103. FLEXIBILITY IN ACCOUNTABLE CARE ORGANIZA10 TIONS COVERAGE OF TELEHEALTH. 

11 Section 1899 of the Social Security Act (42 U.S.C. 

12 1395jjj) is amended by adding at the end the following 

13 new subsection: 

14 ‘‘(l) FLEXIBILITY FOR TELEHEALTH.— 

15 ‘‘(1) PROVISION AS SUPPLEMENTAL BENE16 FITS.—Notwithstanding any other provision of this 

17 section, an ACO may include coverage of telehealth 

18 and remote patient monitoring services as supple19 mental health care benefits to the same extent as a 

20 Medicare Advantage plan is permitted to provide 

21 coverage of such services as supplemental health 

22 care benefits under section 1852(a)(3)(A). 

23 ‘‘(2) PROVISION IN CONNECTION WITH HOME

24 HEALTH SERVICES.—Nothing in this section shall be 

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1 ments for remote patient monitoring and home2 based video conferencing services in connection with 

3 the provision of home health services (under condi4 tions for which payment for such services would not 

5 be made under section 1895 for such services) in a 

6 manner that is financially equivalent to the fur7 nishing of a home health visit.’’. 

8 SEC. 104. RECOGNIZING TELEHEALTH SERVICES AND RE9 MOTE PATIENT MONITORING IN NATIONAL 

10 PILOT PROGRAM ON PAYMENT BUNDLING. 

11 Section 1866D(a)(2) of the Social Security Act (42 

12 U.S.C. 1395cc–4(a)(2)) is amended— 

13 (1) in subparagraph (B), by striking ‘‘10 condi14 tions’’ and inserting ‘‘the conditions’’; 

15 (2) in subparagraph (C)— 

16 (A) by redesignating clause (v) as clause 

17 (vi); and 

18 (B) by inserting after clause (iv) the fol19 lowing new clause: 

20 ‘‘(v) Telehealth and remote patient 

21 monitoring services.’’; and 

22 (3) in subparagraph (D)(i)(III), by inserting 

23 before the period at the end the following: ‘‘(and 

24 such longer period in the case of the use of teleVerDate Mar 15 2010 00:58 Jul 30, 2014 Jkt 039200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\S2662.IS S2662

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1 health and remote patient monitoring services as the 

2 Secretary may specify)’’. 

3 SEC. 105. ADDITIONAL SITES TO BE CONSIDERED ORIGI4 NATING SITES FOR PURPOSES OF PAYMENTS 

5 FOR TELEHEALTH SERVICES UNDER MEDI6 CARE. 

7 (a) IN GENERAL.—Section 1834(m)(4) of the Social 

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

9 (1) in subparagraph (C)— 

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

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

12 term’’; and 

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

14 clause: 

15 ‘‘(iii) ADDITIONAL ORIGINATING

16 SITES.—The term ‘originating site’ also in17 cludes the following sites, whether or not 

18 they are located in an area described in 

19 clause (i), insofar as such sites are not oth20 erwise included in the definition of origi21 nating site under such clause: 

22 ‘‘(I) A critical access hospital (as 

23 described in clause (ii)(II)). 


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1 ‘‘(II) A sole community hospital 

2 (as defined in section 

3 1886(d)(5)(D)(iii)). 

4 ‘‘(III) A home telehealth site (as 

5 defined in subparagraph (G)(i)). 

6 ‘‘(IV) A site described in clause 

7 (ii) that is located in a county with a 

8 population of less than 25,000, ac9 cording to the most recent decennial 

10 census or in an area that was not in11 cluded in a Metropolitan Statistical 

12 Area on any date in 2000. 

13 ‘‘(V) A site described in clause 

14 (ii) with respect to services related to 

15 the evaluation or treatment of an 

16 acute stroke.’’; and 

17 (2) by adding at the end the following new sub18 paragraph: 

19 ‘‘(G) HOME TELEHEALTH SITE.— 

20 ‘‘(i) HOME TELEHEALTH SITE.—The 

21 term ‘home telehealth site’ means, with re22 spect to a telehealth service described in 

23 clause (ii) furnished to an individual, in a 

24 place of residence used as the home of 

25 such individual. 


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

3 in this clause is a telehealth service that 

4 is— 

5 ‘‘(I) related to the provision of 

6 hospice care or home dialysis; or 

7 ‘‘(II) furnished to an individual 

8 who is determined to be homebound 

9 (as defined for purposes of sections 

10 1814(a)(2)(C) and 1835(a)(2)(A)(i)), 

11 including such an individual for whom 

12 a certification or recertification de13 scribed in such section is in effect 

14 with respect to home health services.’’. 

15 (b) NO ORIGINATING SITE FACILITY FEE FOR NEW

16 SITES.—Section 1834(m)(2)(B) of the Social Security Act 

17 (42 U.S.C. 1395m(m)(2)(B)) is amended by inserting 

18 after ‘‘the originating site’’ the following: ‘‘(other than an 

19 additional originating site described in paragraph 

20 (4)(C)(iii))’’. 

21 (c) APPLICATION OF TELECOMMUNICATION SYSTEMS

22 DEFINITION TO CRITICAL ACCESS HOSPITALS AND SOLE

23 COMMUNITY HOSPITALS.—The second sentence of section 

24 1834(m)(1) of the Social Security Act (42 U.S.C. 

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1 ices furnished or received at a critical access hospital (as 

2 described in paragraph (4)(C)(ii)(II)) or a sole community 

3 hospital (as defined in section 1886(d)(5)(D)(iii)) or of’’ 

4 after ‘‘in the case of’’. 

5 (d) SITE OF CARE FOR PURPOSES OF DETERMINING

6 HEALTH CARE LIABILITY.—Section 1834(m) of the So7 cial Security Act (42 U.S.C. 1395m(m)) is amended by 

8 adding at the end the following new paragraph: 

9 ‘‘(5) SITE OF CARE FOR PURPOSES OF HEALTH

10 CARE LIABILITY.—For purposes of determining 

11 health care liability with respect to telehealth serv12 ices for which payment is made under this sub13 section, such service shall be considered to be fur14 nished at the distant site.’’. 

15 (e) EFFECTIVE DATE.— 

16 (1) IN GENERAL.—Except as provided in para17 graph (2), the amendments made by this section 

18 shall apply to services furnished on or after January 

19 1, 2014. 

20 (2) CHANGE IN MSA RULE.—The amendment 

21 made by subsection (a)(1)(B)(ii) shall apply with re22 spect to telehealth services furnished on or after 

23 February 28, 2013. 


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1 TITLE II—ENHANCING MED2 ICAID THROUGH TELE3 HEALTH 

4 SEC. 201. MEDICAID OPTION FOR HIGH-RISK PREGNANCIES 

5 AND BIRTHS. 

6 (a) IN GENERAL.—Title XIX of the Social Security 

7 Act is amended by adding at the end the following new 

8 section: 

9 ‘‘SEC. 1947. STATE OPTION TO PROVIDE COORDINATED 

10 CARE FOR ENROLLEES WITH HIGH-RISK 

11 PREGNANCIES AND BIRTHS. 

12 ‘‘(a) IN GENERAL.—Notwithstanding section 

13 1902(a)(1) (relating to statewideness), section 

14 1902(a)(10)(B) (relating to comparability), and any other 

15 provision of this title for which the Secretary determines 

16 it is necessary to waive in order to implement this section, 

17 beginning 6 months after the date of the enactment of 

18 this section, a State, at its option as a State plan amend19 ment, may provide for medical assistance under this title 

20 to eligible individuals for maternal-fetal and neonatal care 

21 who select a designated provider (as described under sub22 section (h)(5)), a team of health care professionals (as de23 scribed under subsection (h)(6)) operating with such a 

24 provider, or a health team (as described under subsection 

25 (h)(7)) as the individual’s birthing network for purposes 


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1 of providing the individual with pregnancy-related serv2 ices. 

3 ‘‘(b) QUALIFICATION STANDARDS.—The Secretary 

4 shall establish standards for qualification as a designated 

5 provider for the purpose of being eligible to be a birthing 

6 network for purposes of this section. 

7 ‘‘(c) PAYMENTS.— 

8 ‘‘(1) IN GENERAL.—A State shall provide a des9 ignated provider, a team of health care professionals 

10 operating with such a provider, or a health team 

11 with payments for the provision of birthing network 

12 services to each eligible individual for maternal-fetal 

13 and neonatal care that selects such provider, team of 

14 health care professionals, or health team as the indi15 vidual’s birthing network. Payments made to a des16 ignated provider, a team of health care professionals 

17 operating with such a provider, or a health team for 

18 such services shall be treated as medical assistance 

19 for purposes of section 1903(a), except that, during 

20 the first 8 fiscal year quarters that the State plan 

21 amendment is in effect, the Federal medical assist22 ance percentage applicable to such payments shall be 

23 equal to 90 percent. 

24 ‘‘(2) SAVINGS TARGET.—As a condition for ap25 proval of a State plan amendment and payment 


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1 methodology under this section, the State shall pro2 vide the Secretary with assurances that the amend3 ment and methodology shall be projected to reduce 

4 the amount of expenditures for pregnancy-related 

5 services otherwise made under this title by one per6 cent for each 4-calendar-quarter period during the 

7 first 40 calendar quarters in which the amendment 

8 is in effect. 

9 ‘‘(3) METHODOLOGY.— 

10 ‘‘(A) IN GENERAL.—The State shall speci11 fy in the State plan amendment the method12 ology the State will use for determining pay13 ment for the provision of birthing network serv14 ices. Such methodology for determining pay15 ment shall be established consistent with section 

16 1902(a)(30)(A). 

17 ‘‘(B) INNOVATIVE MODELS OF PAYMENT.— 

18 The methodology for determining payment for 

19 provision of birthing network services under 

20 this section shall not be limited to a per-mem21 ber per-month basis and may provide (as pro22 posed by the State and subject to approval by 

23 the Secretary) for alternate models of payment, 

24 including bundled per episode, performance in25 centives, and shared savings. 


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1 ‘‘(4) PLANNING GRANTS.— 

2 ‘‘(A) IN GENERAL.—Beginning 30 days 

3 after the date of the enactment of this section, 

4 the Secretary may award planning grants to 

5 States for purposes of developing a State plan 

6 amendment under this section. A planning 

7 grant awarded to a State or a multi-state col8 laborative under this paragraph shall remain 

9 available until expended. 

10 ‘‘(B) LIMITATION.—The total amount of 

11 payments made to States under this paragraph 

12 shall not exceed $25,000,000. 

13 ‘‘(d) REPORT ON QUALITY MEASURES.—As a condi14 tion for receiving payment for birthing network services 

15 provided to an eligible individual for maternal-fetal and 

16 neonatal care, a designated provider shall report monthly 

17 to the State, in accordance with such requirements as the 

18 Secretary shall specify, on all applicable measures for de19 termining the quality of such services. When appropriate 

20 and feasible, a designated provider shall use health infor21 mation technology in providing the State with such infor22 mation. 

23 ‘‘(e) EVIDENCE-BASED.—The birthing network shall 

24 adapt, update, and follow evidence-based guidelines for 

25 maternal-fetal and neonatal care. 


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1 ‘‘(f) DEFINITIONS.—In this section: 

2 ‘‘(1) ELIGIBLE INDIVIDUAL FOR MATERNAL3 FETAL AND NEONATAL CARE.— 

4 ‘‘(A) IN GENERAL.—Subject to subpara5 graph (B), the term ‘eligible individual’ means 

6 an individual who— 

7 ‘‘(i) is eligible for medical assistance 

8 under the State plan or under a waiver of 

9 such plan; and 

10 ‘‘(ii)(I) is pregnant (or was pregnant 

11 during the immediately preceding 30 day 

12 period); or 

13 ‘‘(II) is the child of an individual de14 scribed in clause (i) and under 30 days old. 

15 ‘‘(B) RULE OF CONSTRUCTION.—Nothing 

16 in this paragraph shall prevent the Secretary 

17 from establishing other requirements for pur18 poses of determining eligibility for receipt of 

19 birthing network services under this section. 

20 ‘‘(2) BIRTHING NETWORK.—The term ‘birthing 

21 network’ means a designated provider (including a 

22 provider that operates in coordination with a team 

23 of health care professionals) or a health team se24 lected by an eligible individual to provide birthing 

25 network services. 


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1 ‘‘(3) BIRTHING NETWORK SERVICES.— 

2 ‘‘(A) IN GENERAL.—The term ‘birthing 

3 network services’ means comprehensive and 

4 timely high-quality services described in sub5 paragraph (B) that are provided by a des6 ignated provider, a team of health care profes7 sionals operating with such a provider, or a 

8 health team and are identified in a provider 

9 registry. 

10 ‘‘(B) SERVICES DESCRIBED.—The services 

11 described in this subparagraph are— 

12 ‘‘(i) comprehensive care coordination; 

13 ‘‘(ii) health promotion; 

14 ‘‘(iii) a call center to offer 24-hour 

15 physician support for consultations with 

16 maternal-fetal medicine specialists, when 

17 requested, regarding patient management 

18 issues; 

19 ‘‘(iv) newborn screening, including for 

20 heart defects and to reduce newborn hos21 pital readmissions; 

22 ‘‘(v) patient and family support (in23 cluding authorized representatives); 

24 ‘‘(vi) referral to community and social 

25 support services, if relevant; and 


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1 ‘‘(vii) use of health information tech2 nology to link services and provide moni3 toring, as feasible and appropriate. 

4 ‘‘(4) DESIGNATED PROVIDER.—The term ‘des5 ignated provider’ means a physician, clinical practice 

6 or clinical group practice, rural clinic, community 

7 health center, public health agency, home health 

8 agency, or any other entity or provider (including 

9 pediatricians, gynecologists, and obstetricians) that 

10 is determined by the State and approved by the Sec11 retary to be qualified to be a birthing network for 

12 eligible individuals on the basis of documentation ev13 idencing that the physician, practice, or clinic— 

14 ‘‘(A) has the systems and infrastructure in 

15 place to provide birthing network services; and 

16 ‘‘(B) satisfies the qualification standards 

17 established by the Secretary under subsection 

18 (b) and paragraph (7)(B). 

19 ‘‘(5) TEAM OF HEALTH CARE PROFES20 SIONALS.—The term ‘team of health care profes21 sionals’ means a team of health professionals (as de22 scribed in the State plan amendment) that may— 

23 ‘‘(A) include physicians and other profes24 sionals, such as a nurse care coordinator, mid25 wife, nutritionist, social worker, behavioral 


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1 health professional, or any professionals deemed 

2 appropriate by the State; and 

3 ‘‘(B) be free standing, virtual, or based at 

4 a hospital, community health center, rural clin5 ic, clinical practice or clinical group practice, 

6 academic health center, or any entity deemed 

7 appropriate by the State and approved by the 

8 Secretary. 

9 ‘‘(6) HEALTH TEAM.—The term ‘health team’ 

10 has the meaning given such term for purposes of 

11 section 3502 of the Patient Protection and Afford12 able Care Act. 

13 ‘‘(7) BIRTHING DATA AND EXCHANGE.— 

14 ‘‘(A) PROPOSAL FOR USE OF HEALTH IN15 FORMATION TECHNOLOGY.—A State shall in16 clude in the State plan amendment a proposal 

17 for use of health information technology in pro18 viding birthing network services under this sec19 tion and improving service delivery and coordi20 nation across the care continuum (including the 

21 use of wireless patient technology to improve 

22 coordination and management of care and pa23 tient adherence to recommendations made by 

24 their provider). 


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1 ‘‘(B) INFORMATION REQUIREMENTS FOR

2 BIRTHING NETWORKS.—The birthing network 

3 shall— 

4 ‘‘(i) be in compliance with the Med5 icaid standards for meaningful use of elec6 tronic health records; 

7 ‘‘(ii) participate with the State’s 

8 health information exchange, as available, 

9 or operate an exchange among the birthing 

10 network; 

11 ‘‘(iii) collect demographic information 

12 on participating newborns and mothers; 

13 ‘‘(iv) use demographic and event14 based data to identify patients that are 

15 likely going to need short or long-term fol16 low-up; and 

17 ‘‘(v) providing de-identified demo18 graphic data sets for statistical and social 

19 science research to develop culturally com20 petent best practices and clinical decision 

21 support mechanisms for maternal-fetal and 

22 neonatal care.’’. 

23 (b) PATIENT SERVICES QUALITY AND PERFORMANCE

24 REPORTING.— 


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1 (1) IN GENERAL.—Not later than 3 years after 

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

3 of Health and Human Services shall survey States 

4 that have elected the option under section 1947 of 

5 the Social Security Act, as added by section (a), on 

6 the nature, extent, and use of such option, particu7 larly as it pertains to— 

8 (A) terms of pregnancies; 

9 (B) use of prenatal fetal monitoring; 

10 (C) use of Caesarean section procedures; 

11 (D) use of neonatal intensive care services; 

12 (E) incidence of birthing complications; 

13 (F) incidence of infant and maternal mor14 tality; 

15 (G) coordination of maternal-fetal and neo16 natal care for individuals; 

17 (H) assessment of program implementa18 tion; 

19 (I) processes and lessons learned (as de20 scribed in subparagraph (B)); 

21 (J) assessment of quality improvements 

22 and clinical outcomes under such option; and 

23 (K) participating mothers’ assessment of 

24 performance, quality, convenience, and satisfac25 tion. 


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1 (2) IMPLEMENTATION REPORTING.—A State 

2 that has elected the option under such section shall 

3 report to the Secretary, as necessary, on processes 

4 that have been developed and lessons learned regard5 ing provision of coordinated care through a birthing 

6 network for Medicaid beneficiaries for maternal-fetal 

7 and neonatal care under such option. 

8 TITLE III—IMPROVING TELE9 COMMUNICATIONS FOR MED10 ICAL DELIVERY 

11 SEC. 301. ADDITIONAL PROVIDERS CONSIDERED HEALTH 

12 CARE PROVIDERS FOR PURPOSES OF UNI13 VERSAL SERVICE SUPPORT. 

14 Subparagraph (B) of section 254(h)(7) of the Com15 munications Act of 1934 (47 U.S.C. 254(h)(7)) is amend16 ed— 

17 (1) in clause (vi), by striking ‘‘and’’; 

18 (2) in clause (vii), by striking ‘‘clauses (i) 

19 through (vi)’’ and inserting ‘‘clauses (i) through 

20 (ix)’’; 

21 (3) by redesignating clause (vii) as clause (x); 

22 and 

23 (4) by inserting after clause (vi) the following 

24 new clauses: 


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1 ‘‘(vii) ambulance providers and other 

2 emergency medical transport providers; 

3 ‘‘(viii) health clinics of elementary and 

4 secondary schools and post-secondary edu5 cational institutions; 

6 ‘‘(ix) sites where telehealth services 

7 are provided under section 1834(m) of the 

8 Social Security Act (42 U.S.C. 1395m(m)) 

9 or under a State plan under title XIX of 

10 such Act (42 U.S.C. 1396 et seq.); and’’. 

11 SEC. 302. NO CONSIDERATION OF PROVIDER LOCATION IN 

12 RULES ENHANCING HEALTH CARE PROVIDER 

13 ACCESS TO ADVANCED TELECOMMUNI14 CATIONS AND INFORMATION SERVICES. 

15 Section 254(h)(2)(A) of the Communications Act of 

16 1934 (47 U.S.C. 254(h)(2)(A)) is amended by inserting 

17 ‘‘(regardless of the location of such providers)’’ after 

18 ‘‘health care providers’’. 

Æ 


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