I 
113TH CONGRESS 
2D SESSION 
H. R. 5380 
To amend title XVIII of the Social Security Act to provide for a phased- 
in 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) in-
troduced the following bill; which was referred to the Committee on En-
ergy 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 jurisdic-
tion 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Telehealth 
Parity Act of 2014’’. 
SEC. 2. PHASED-IN EXPANSION OF TELEHEALTH COV-
ERAGE UNDER MEDICARE. 
(a) INITIAL PHASE.— 
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(1) EXPANSION OF ORIGINATING SITES.—Sec-
tion 1834(m)(4)(C) of the Social Security Act (42 
U.S.C. 1395m(m)(4)(C)) is amended— 
(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 SITES.—The term 
‘originating site’ shall also include the fol-
lowing sites at which the eligible telehealth 
individual is located at the time the service 
is furnished via a telecommunications sys-
tem, whether or not they are located in an 
area described in clause (i), insofar as such 
sites are not otherwise included in the defi-
nition of originating site under such 
clause: 
‘‘(I) In the case of such a service 
furnished on or after the date that is 
6 months after the date of the enact-
ment of the Medicare Telehealth Par-
ity Act of 2014, any Federally quali-
fied health center and any rural 
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health clinic (as such terms are de-
fined in section 1861(aa)). 
‘‘(II) In the case of such a serv-
ice furnished on or after the date that 
is 6 months after the date of the en-
actment of the Medicare Telehealth 
Parity Act of 2014, any site described 
in clause (ii) that is located in a coun-
ty within a Metropolitan Statistical 
Area with a population of fewer than 
50,000 individuals, according to the 
most recent decennial census.’’. 
(2) ORIGINATING SITE FEE NOT TO APPLY TO 
ADDITIONAL SITES.—Section 1834(m)(2)(B) of such 
Act (42 U.S.C. 1395m(m)(4)(C)) is amended by in-
serting after and below clause (ii) the following: 
‘‘The facility fee under this subparagraph shall 
not apply to any site included as an originating 
site pursuant to clause (iii) of paragraph (4)(C) 
that would not otherwise be included as an orig-
inating 
site 
without 
application 
of 
such 
clause.’’. 
(3) ADDITIONAL
TELEHEALTH
PROVIDERS.— 
Section 1834(m) of such Act (42 U.S.C. 1395m(m)) 
is amended— 
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(A) in paragraph (1), by striking ‘‘or a 
practitioner 
(described 
in 
section 
1842(b)(18)(C))’’ and inserting ‘‘or a practi-
tioner (as defined in paragraph (4)(E))’’; and 
(B) in paragraph (4), by— 
(i) striking subparagraph (E); and 
(ii) inserting after subparagraph (D) 
the following new subparagraph: 
‘‘(E) PRACTITIONER.—The term ‘practi-
tioner’ means— 
‘‘(i) a practitioner described in section 
1842(b)(18)(C); and 
‘‘(ii) with respect to services furnished 
on or after the date that is 6 months after 
the date of the enactment of the Medicare 
Telehealth Parity Act of 2014, a certified 
diabetes educator or licensed— 
‘‘(I) respiratory therapist; 
‘‘(II) audiologist; 
‘‘(III) occupational therapist; 
‘‘(IV) physical therapist; or 
‘‘(V) speech language patholo-
gist.’’. 
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(4) COVERAGE OF REMOTE PATIENT MANAGE-
MENT
SERVICES
FOR
CERTAIN
CHRONIC
HEALTH 
CONDITIONS.— 
(A) IN GENERAL.—Section 1861(s)(2) of 
the Social Security Act (42 U.S.C. 1395x(s)(2)) 
is amended— 
(i) in subparagraph (EE), by striking 
‘‘and’’ at the end; 
(ii) in subparagraph (FF), by insert-
ing ‘‘and’’ at the end; and 
(iii) by inserting after subparagraph 
(FF) the following new subparagraph: 
‘‘(GG) remote patient management services (as 
defined in subsection (iii));’’. 
(B) SERVICES DESCRIBED.—Section 1861 
of the Social Security Act (42 U.S.C. 1395x) is 
amended by adding at the end the following 
new subsection: 
‘‘(iii) REMOTE PATIENT MANAGEMENT SERVICES 
FOR CHRONIC HEALTH CONDITIONS.—(1) The term ‘re-
mote patient management services’ means the remote 
monitoring, evaluation, and management of an individual 
with a covered chronic health condition (as defined in 
paragraph (2)), insofar as such monitoring, evaluation, 
and management is with respect to such condition, 
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through the utilization of a system of technology that al-
lows a remote interface to collect and transmit clinical 
data between the individual and the responsible physician 
(as defined in subsection (r)) or practitioner or other sup-
plier (as defined in subsection (d)) for the purposes of clin-
ical review. Such services shall include in-home technology 
based professional consultations, patient monitoring, pa-
tient training services, clinical observation, assessment, 
treatment, and any other services that utilize technologies 
specified by the Secretary. Such term shall not include a 
telecommunication that consists solely of a telephone 
audio conversation, facsimile, or electronic text mail be-
tween a health care professional and patient. 
‘‘(2) For purposes of paragraph (1), the term ‘cov-
ered chronic health condition’ means— 
‘‘(A) congestive heart failure; 
‘‘(B) chronic obstructive pulmonary disease; 
and 
‘‘(C) in the case of services furnished at a fed-
erally qualified health center, diabetes. 
‘‘(3)(A) The Secretary, in consultation with appro-
priate physician, practitioner, and supplier groups, shall 
develop guidelines on the frequency of billing for remote 
patient management services. Such guidelines shall be de-
termined based on medical necessity and shall be sufficient 
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to ensure appropriate and timely monitoring of individuals 
being furnished such services. 
‘‘(B) The Secretary shall do the following: 
‘‘(i) Not later than 2 years after the date of the 
enactment of this subsection, develop, in consulta-
tion with appropriate physician, practitioner, and 
supplier groups, standards (governing such matters 
as qualifications of personnel and the maintenance 
of equipment) for remote patient management serv-
ices for the covered chronic health conditions speci-
fied in paragraph (2). 
‘‘(ii) Periodically review and update such stand-
ards under this subparagraph as necessary.’’. 
(C) PAYMENT UNDER THE PHYSICIAN FEE 
SCHEDULE.—Section 1848 of the Social Secu-
rity Act (42 U.S.C. 1395w–4) is amended— 
(i) in subsection (c)— 
(I) in paragraph (2)((B)— 
(aa) in clause (ii)(II), by 
striking ‘‘and (v)’’ and inserting 
‘‘(v), and (vii)’’; and 
(bb) by adding at the end 
the following new clause: 
‘‘(vii) BUDGETARY
TREATMENT
OF 
CERTAIN
SERVICES.—The additional ex-
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penditures attributable to services de-
scribed in section 1861(s)(2)(GG) shall not 
be taken into account in applying clause 
(ii)(II).’’; and 
(II) by adding at the end the fol-
lowing new paragraph: 
‘‘(7) TREATMENT OF REMOTE PATIENT MAN-
AGEMENT SERVICES.— 
‘‘(A) In determining relative value units 
for remote patient management services (as de-
fined in section 1861(iii)), the Secretary, in 
consultation with appropriate physician groups, 
practitioner groups, and supplier groups, shall 
take into consideration— 
‘‘(i) physician or practitioner re-
sources, including physician or practitioner 
time and the level of intensity of services 
provided, based on— 
‘‘(I) the frequency of evaluation 
necessary to manage the individual 
being furnished the services; 
‘‘(II) the complexity of the eval-
uation, including the information that 
must be obtained, reviewed, and ana-
lyzed; and 
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‘‘(III) the number of possible di-
agnoses and the number of manage-
ment options that must be considered; 
‘‘(ii) practice expense costs associated 
with such services, including the direct 
costs associated with installation and infor-
mation transmission, costs of remote pa-
tient management technology (including 
equipment and software), device delivery 
costs, and resource costs necessary for pa-
tient monitoring and follow-up (but not in-
cluding costs of any related item or non- 
physician service otherwise reimbursed 
under this title); and 
‘‘(iii) malpractice expense resources. 
‘‘(B) Using the relative value units deter-
mined in subparagraph (A), the Secretary shall 
provide for separate payment for such services 
and shall not adjust the relative value units as-
signed to other services that might otherwise 
have been determined to include such separately 
paid remote patient management services.’’; and 
(ii) in subsection (j)(3), by inserting 
‘‘(2)(GG),’’ after ‘‘health risk assess-
ment),’’. 
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(D) EFFECTIVE DATE.— 
(i) IN
GENERAL.—The amendments 
made by this subsection shall apply to 
services furnished on or after the date that 
is 6 months after the date of the enact-
ment of this Act, without regard to wheth-
er the guidelines under paragraph (3)(A) 
or the standards under paragraph (3)(B) 
of section 1861(iii) of the Social Security 
Act, as added by subparagraph (B), have 
been developed. 
(ii) AVAILABILITY OF CODES AS OF 
DATE OF ENACTMENT.—The Secretary of 
Health and Human Services shall— 
(I) promptly evaluate existing 
codes that would be used to bill for 
remote patient management services 
(as defined in paragraph (1) of such 
section 1861(iii), as so added) under 
title XVIII of the Social Security Act; 
and 
(II) if the Secretary determines 
that new codes are necessary to en-
sure accurate reporting and billing of 
such services under such title, issue 
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such codes so that they are available 
for use as of the date of the enact-
ment of this Act. 
(E) GAO STUDY AND REPORT.— 
(i) STUDY.—The Comptroller General 
of the United States shall conduct a study 
that includes, at a minimum, the following: 
(I) The effectiveness of remote 
patient monitoring on decreasing hos-
pital readmissions for the chronic con-
ditions described in subsection (iii)(2) 
of section 1861 of the Social Security 
Act (42 U.S.C. 1395x), as added by 
subparagraph (A). 
(II) The savings to the Medicare 
program under title XVIII of such Act 
associated with remote patient moni-
toring use with respect to such chron-
ic conditions. 
(III) The potential for greater 
use of remote patient monitoring for 
other chronic conditions. 
(IV) Potential implications of 
greater use of remote patient moni-
toring with respect to payment and 
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delivery system transformations under 
the Medicare program under such 
title. 
(ii) REPORT.—Not later than 2 years 
after the date of the enactment of this Act, 
the Comptroller General shall submit to 
Congress a report containing the results of 
the study conducted under clause (i). 
(5) EXPANSION OF TELECOMMUNICATIONS SYS-
TEM.—The second sentence of section 1834(m)(1) of 
the Social Security Act (42 U.S.C. 1835m(m)(1)) is 
amended by striking ‘‘in the case of any Federal 
telemedicine demonstration program conducted in 
Alaska or Hawaii,’’. 
(b) SECOND PHASE.— 
(1) FURTHER
EXPANSION
OF
ORIGINATING 
SITES.—Section 1834(m)(4) of the Social Security 
Act (42 U.S.C. 1395m(m)(4)) is amended— 
(A) in clause (iii) of subparagraph (C), as 
added by subsection (a)(1), by adding at the 
end the following new subclauses: 
‘‘(IV) In the case of such a serv-
ice furnished on or after the date that 
is 2 years after the date of the enact-
ment of the Medicare Telehealth Par-
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ity Act of 2014, any site described in 
clause (ii) that is located in a county 
within a Metropolitan Statistical Area 
with a population of at least 50,000 
individuals but fewer than 100,000 in-
dividuals, according to the most re-
cent decennial census. 
‘‘(V) In the case of such a service 
furnished on or after the date that is 
2 years after the date of the enact-
ment of the Medicare Telehealth Par-
ity Act of 2014, a home telehealth 
site, as defined in subparagraph 
(G).’’; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(G) HOME TELEHEALTH SITE.— 
‘‘(i) IN GENERAL.—The term ‘home 
telehealth site’ means, with respect to a 
telehealth service described in clause (ii) 
furnished to an individual, in a place of 
residence used as the home of such indi-
vidual. 
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‘‘(ii) TELEHEALTH
SERVICES
DE-
SCRIBED.—A telehealth service described 
in this clause— 
‘‘(I) is a telehealth service that is 
related to the provision of hospice 
care, home dialysis, home health serv-
ices, or durable medical equipment; 
and 
‘‘(II) shall include the use of 
video conferencing.’’. 
(2) ADDITIONAL COVERED TELEHEALTH SERV-
ICES.—Section 1834(m)(4)(F)(i) of the Social Secu-
rity Act (42 U.S.C. 139m(m)(4)(F)(i)) is amended 
by adding at the end the following new sentence: 
‘‘Beginning on the date that is 2 years after the 
date of the enactment of the Medicare Telehealth 
Parity Act of 2014, such term shall include res-
piratory services, audiology services (as defined in 
section 1861(ll)), and outpatient therapy services, 
including physical therapy, occupational therapy, 
and speech-language pathology services.’’ 
(3) GAO STUDY AND REPORT.— 
(A) STUDY.—The Comptroller General of 
the United States shall conduct a study that in-
cludes, at a minimum, the following: 
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(i) The effectiveness of using tele-
health services described in the second sen-
tence of section 1834(m)(4)(F)(i) of the 
Social 
Security 
Act 
(42 
U.S.C. 
1395m(m)(4)(F)(i)), as added by para-
graph (2), between therapy providers and 
patients. 
(ii) The savings to the Medicare pro-
gram under title XVIII of such Act associ-
ated with telehealth services utilization for 
therapy for such services described in such 
sentence. 
(iii) The potential for greater use of 
telehealth services for forms of therapy not 
described in such sentence. 
(c) FINAL PHASE.— 
(1) FURTHER
EXPANSION
OF
ORIGINATING 
SITES.—Clause (iii) of section 1834(m)(4)(C) of the 
Social Security Act (42 U.S.C. 1395m(m)(4)), as 
added by subsection (a)(1) and amended by sub-
section (b)(1), is further amended by adding at the 
end the following new subclause: 
‘‘(VI) In the case of such a serv-
ice furnished on or after the date that 
is 4 years after the date of the enact-
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ment of the Medicare Telehealth Par-
ity Act of 2014, any site described in 
clause (ii) that is located in a county 
within a Metropolitan Statistical Area 
with a population of at least 100,000 
individuals, according to the most re-
cent decennial census.’’. 
(2) PAYMENT METHODS FOR OTHER PATIENT 
SITES.—Section 1834(m)(2) of the Social Security 
Act (42 U.S.C. 1395m(m)(2)) is amended by adding 
at the end the following new subparagraph: 
‘‘(D) PAYMENT METHODS FOR OTHER PA-
TIENT
SITES.—With respect to services fur-
nished on or after the date that is 4 years after 
the date of the enactment of the Medicare Tele-
health Parity Act of 2014, the Secretary may 
develop and implement payment methods that 
would apply under this subsection in the case of 
an individual who would be an eligible tele-
health individual except that the telehealth serv-
ices are furnished at a site other than an origi-
nating site. Such methods shall be designed to 
take into account the costs related to the site 
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involved and reduced costs for the distant 
site.’’. 
Æ 
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