‘‘(B) ESTABLISHMENT OF TARGET SPEND-
ING LEVEL.—For purposes of this paragraph, 
the Secretary shall compute an estimated an-
nual spending target based on the amount the 
Secretary estimates would have been spent in 
the absence of this section, for items and serv-
ices covered under parts A and B furnished to 
applicable beneficiaries for each qualifying med-
ical home under this section. Such spending 
targets shall be determined on a per capita 
basis. Such spending targets shall include a risk 
corridor that takes into account normal vari-
ation in expenditures for items and services cov-
ered under parts A and B furnished to such 
beneficiaries with the size of the corridor being 
related to the number of applicable beneficiaries 
furnished services by each medical home. The 
spending targets may also be adjusted for such 
other factors as the Secretary determines ap-
propriate. 
‘‘(C) INCENTIVE
PAYMENTS.—Subject to 
performance on quality measures, a qualifying 
medical home is eligible to receive an incentive 
payment under this section if actual expendi-
tures for a year for the applicable beneficiaries 
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it enrolls are less than the estimated spending 
target established under subparagraph (B) for 
such year. An incentive payment for such year 
shall be equal to a portion (as determined by 
the Secretary) of the amount by which actual 
expenditures 
(including 
incentive 
payments 
under this paragraph) for applicable bene-
ficiaries under parts A and B for such year are 
estimated to be less than 95 percent of the esti-
mated spending target for such year, as deter-
mined under subparagraph (B). 
‘‘(3) SOURCE.—Payments paid under this sec-
tion shall be made in appropriate proportions (as 
specified by the Secretary) from the Hospital Insur-
ance Trust Fund, the Federal Supplementary Med-
ical Insurance Trust Fund, and funds appropriated 
to carry out title XIX. 
‘‘(f) EVIDENCE-BASED.—The contracting entity shall 
follow evidence-based guidelines for care of the long-term 
illness or medical condition under this section. 
‘‘(g) PATIENT SERVICES QUALITY AND PERFORM-
ANCE REPORTING.—The contracting entity shall report at 
least by the end of every month data specified by the Sec-
retary on the operation of this section, including quality 
measures of process, outcome, and structure. 
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‘‘(h) WAIVER AUTHORITY.— 
‘‘(1) IN
GENERAL.—The limitations on tele-
health under section 1834(m) shall not apply for 
purposes of this section. 
‘‘(2) SECRETARY
AUTHORITY.—The Secretary 
may waive such other requirements of this title and 
title XIX as may be necessary to carry out the pro-
visions of this section.’’. 
SEC. 103. FLEXIBILITY IN ACCOUNTABLE CARE ORGANIZA-
TIONS COVERAGE OF TELEHEALTH. 
Section 1899 of the Social Security Act (42 U.S.C. 
1395jjj) is amended by adding at the end the following 
new subsection: 
‘‘(l) FLEXIBILITY FOR TELEHEALTH.— 
‘‘(1) PROVISION
AS
SUPPLEMENTAL
BENE-
FITS.—Notwithstanding any other provision of this 
section, an ACO may include coverage of telehealth 
and remote patient monitoring services as supple-
mental health care benefits to the same extent as a 
Medicare Advantage plan is permitted to provide 
coverage of such services as supplemental health 
care benefits under section 1852(a)(3)(A). 
‘‘(2) PROVISION IN CONNECTION WITH HOME 
HEALTH SERVICES.—Nothing in this section shall be 
construed as preventing an ACO from including pay-
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ments for remote patient monitoring and home- 
based video conferencing services in connection with 
the provision of home health services (under condi-
tions for which payment for such services would not 
be made under section 1895 for such services) in a 
manner that is financially equivalent to the fur-
nishing of a home health visit.’’. 
SEC. 104. RECOGNIZING TELEHEALTH SERVICES AND RE-
MOTE PATIENT MONITORING IN NATIONAL 
PILOT PROGRAM ON PAYMENT BUNDLING. 
Section 1866D(a)(2) of the Social Security Act (42 
U.S.C. 1395cc–4(a)(2)) is amended— 
(1) in subparagraph (B), by striking ‘‘10 condi-
tions’’ and inserting ‘‘the conditions’’; 
(2) in subparagraph (C)— 
(A) by redesignating clause (v) as clause 
(vi); and 
(B) by inserting after clause (iv) the fol-
lowing new clause: 
‘‘(v) Telehealth and remote patient 
monitoring services.’’; and 
(3) in subparagraph (D)(i)(III), by inserting 
before the period at the end the following: ‘‘(and 
such longer period in the case of the use of tele-
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health and remote patient monitoring services as the 
Secretary may specify)’’. 
SEC. 105. ADDITIONAL SITES TO BE CONSIDERED ORIGI-
NATING SITES FOR PURPOSES OF PAYMENTS 
FOR TELEHEALTH SERVICES UNDER MEDI-
CARE. 
(a) IN GENERAL.—Section 1834(m)(4) of the Social 
Security Act (42 U.S.C. 1395m(m)(4)) is amended— 
(1) in subparagraph (C)— 
(A) in clause (i), by striking ‘‘The term’’ 
and inserting ‘‘Subject to clause (iii), the 
term’’; and 
(B) by adding at the end the following new 
clause: 
‘‘(iii) 
ADDITIONAL
ORIGINATING 
SITES.—The term ‘originating site’ also in-
cludes the following sites, whether or not 
they are located in an area described in 
clause (i), insofar as such sites are not oth-
erwise included in the definition of origi-
nating site under such clause: 
‘‘(I) A critical access hospital (as 
described in clause (ii)(II)). 
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