I 
117TH CONGRESS 
1ST SESSION H. R. 4670 
To amend title XVIII of the Social Security Act to provide coverage and 
payment for certain tests and assistive telehealth consultations, and for 
other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 22, 2021 
Mr. SCHWEIKERT introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees 
on Ways and Means, and Veterans’ Affairs, for a period to be subse-
quently 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 
coverage and payment for certain tests and assistive 
telehealth consultations, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Advanced Safe Testing at Residence Telehealth Act of 
2021’’. 
(b) TABLE OF CONTENTS.—The table of contents is 
as follows: 
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Sec. 1. Short title. 
Sec. 2. Coverage and payment for certain tests and assistive telehealth con-
sultations; demonstration program under certain State Med-
icaid programs. 
‘‘Sec. 1859A. Tests and assistive telehealth consultations demonstration. 
Sec. 3. Pilot program on improved access to certain tests and assistive tele-
health consultations for veterans. 
SEC. 2. COVERAGE AND PAYMENT FOR CERTAIN TESTS 
AND 
ASSISTIVE 
TELEHEALTH 
CONSULTA-
TIONS; DEMONSTRATION PROGRAM UNDER 
CERTAIN STATE MEDICAID PROGRAMS. 
(a) TESTS AND ASSISTIVE TELEHEALTH CONSULTA-
TIONS DEMONSTRATION.—Part C of title XVIII of the So-
cial Security Act is amended by inserting after section 
1859 (42 U.S.C. 1395w–28) the following new subsection: 
‘‘SEC. 1859A. TESTS AND ASSISTIVE TELEHEALTH CON-
SULTATIONS DEMONSTRATION. 
‘‘(a) ESTABLISHMENT.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish a Value-Based Insurance Design Model dem-
onstration program (in this section referred to as 
the ‘VBID demonstration program’) to provide to el-
igible Medicare beneficiaries— 
‘‘(A) an assistive telehealth consultation 
that is furnished via a telecommunications sys-
tem by a physician or practitioner to an eligible 
telehealth individual enrolled under part B not-
withstanding that the individual physician or 
practitioner ordering the test did not furnish 
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the test or that the individual physician or 
practitioner providing the assistive telehealth 
consultation is not at the same location as the 
beneficiary; and 
‘‘(B) home and community-based care. 
‘‘(2) AGREEMENTS.—The Secretary shall enter 
into agreements with eligible MA organizations 
under which such organizations shall offer eligible 
MA plans under the VBID demonstration program 
to eligible Medicare beneficiaries. 
‘‘(3) LIMITATIONS ON NUMBER OF PLANS FOR 
VBID DEMONSTRATION PROGRAM.—The VBID dem-
onstration program shall be carried out with respect 
to not greater than 25 MA plans, with a minimum 
of 10 MA plans that serve rural or underserved 
areas. 
‘‘(4) ELIGIBLE MA PLANS DEFINED.—For pur-
poses of this section, the term ‘eligible MA plan’ 
means a plan that, in addition to items and services 
for which coverage is otherwise provided under this 
part (including benefits under section 1852(a)(3) 
and notwithstanding any waivers under section 
1915(c)), provides for coverage of— 
‘‘(A) tests that are medical devices (as de-
fined in section 201(h) of the Federal Food, 
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Drug, and Cosmetic Act or wearable patient 
monitoring device, including adaptive artificial 
intelligence, machine learning, and software as 
a medical device (SaMD) technologies that op-
erate to the full scope of medical purpose de-
fined by the Administrator of the Food and 
Drug Administration) and are identified by the 
Secretary as having appropriate at home use 
that is approved under section 505 of the Fed-
eral Food, Drug, and Cosmetic Act, and are ei-
ther— 
‘‘(i) a diagnostic test or screening for 
the diagnosis of influenza or a similar res-
piratory condition that is required to ob-
tain a final diagnosis of COVID–19 for an 
individual when such test is ordered by a 
physician or practitioner in conjunction 
with a COVID–19 diagnostic test or 
screening for purposes of discounting a di-
agnosis of influenza or a related diagnosis 
for such individual; 
‘‘(ii) a serology test for COVID–19; 
‘‘(iii) a diagnostic test or screening for 
the diagnosis of prostate cancer, ovarian 
cancer, breast cancer, hypothyroidism, 
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rheumatoid arthritis, celiac disease, vas-
cular inflammation, cardiovascular health, 
strep throat, or lipoprotein (A); 
‘‘(iv) a haptoglobin genetic test; 
‘‘(v) 
a 
prediabetes 
and 
diabetes 
screening; 
‘‘(vi) an IgE allergy test; 
‘‘(vii) a screening or diagnostic cap-
sule endoscopy; or 
‘‘(viii) any other test identified by the 
Secretary, including those proposed by the 
MA organization, as having appropriate for 
at-home use that is approved under section 
505 of the Federal Food, Drug, and Cos-
metic Act; 
‘‘(B) assistive telehealth consultations; 
‘‘(C) telehealth services; 
‘‘(D) fitness benefits; 
‘‘(E) meal benefits (beyond limited basis); 
‘‘(F) transportation services; 
‘‘(G) safety and other equipment not oth-
erwise covered under this title; and 
‘‘(H) care in rural or highly rural areas (as 
determined in consultation with the Secretary 
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of Agriculture using the Rural-Urban Com-
muting Areas coding system). 
‘‘(5) OTHER
MATTERS
RELATING
TO
DOCU-
MENTATION
AND
CLAIMS
REVIEW.—The require-
ments of paragraphs (2) and (3) of section 
410.32(d) of title 42, Code of Federal Regulations 
(as in effect on the date of the enactment of this 
paragraph), relating to documentation and claims 
review, respectively, shall apply to a test described in 
paragraph (4)(A) and an assistive telehealth con-
sultation. 
‘‘(6) DEMOGRAPHIC DATA.—To be eligible for 
reimbursement under this paragraph, each claim for 
reimbursement shall include, with respect to each el-
igible Medicare beneficiary, the following demo-
graphic data: 
‘‘(A) Age. 
‘‘(B) Race and ethnicity. 
‘‘(C) Gender. 
‘‘(D) An affirmative or negative statement 
of the existence of any chronic condition. 
‘‘(E) Any other information the Secretary 
determines appropriate. 
‘‘(7) 
ASSISTIVE
TELEHEALTH
CONSULTA-
TION.—In this subsection, the term ‘assistive tele-
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‘‘(1) is located in a State that the Secretary has 
determined is able to participate in the VBID dem-
onstration program by agreeing to make available 
data necessary for purposes of conducting the inde-
pendent evaluation required under subsection (h); 
and 
‘‘(2) meets such other criteria as the Secretary 
may require. 
‘‘(c) 
ELIGIBLE
MEDICARE
BENEFICIARY
DE-
FINED.—In this section, the term ‘eligible Medicare bene-
ficiary’ means a Medicare beneficiary who— 
‘‘(1) is eligible for benefits under this title 
and— 
‘‘(A) is eligible to enroll in an eligible MA 
plan under the VBID demonstration program; 
‘‘(B) is a subsidy-eligible individual (as de-
fined in section 1860D–14(a)(3)(A)); and 
‘‘(C) is age 65 or older; or 
‘‘(2) is a dual eligible individual (as defined in 
section 1915(h)(2)(B)) or qualified medicare bene-
ficiary (as defined in section 1905(p)(1)) who is eli-
gible for medical assistance under a State plan 
under title XIX. 
‘‘(d) PAYMENTS.—The Secretary shall establish pay-
ment rates for eligible MA organizations offering eligible 
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MA plans under the VBID demonstration program for 
benefits covered under such program (and not otherwise 
covered under part C) and provided to eligible Medicare 
beneficiaries under such plans. Such payment rates 
shall— 
‘‘(1) be based upon payment rates established 
for purposes of payment under section 1853; 
‘‘(2) be in addition to payments otherwise made 
to such organization with respect to such plans 
under part C; 
‘‘(3) be adjusted to reflect the costs of treating 
eligible Medicare beneficiaries under this section; 
and 
‘‘(4) not be made for a test via a telecommuni-
cations system described in subsection (a)(4), unless 
the physician or practitioner determines such a test 
is medically necessary and appropriate (as deter-
mined by the Secretary). 
‘‘(e) SPECIAL ELECTION PERIOD.—Notwithstanding 
sections 1852(e)(2)(C) and 1860D–1(b)(1)(B)(iii), an eli-
gible Medicare beneficiary may, other than during the an-
nual, coordinated election periods under such sections dis-
continue enrollment in an MA plan not participating in 
the VBID demonstration program and enroll in an MA 
plan participating in such program. 
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‘‘(f) BENEFICIARY EDUCATION.—The Secretary shall 
help to educate, through State Health Insurance Assist-
ance Programs and other organizations that assist seniors 
with respect to benefits and enrollment under this title, 
eligible Medicare beneficiaries on the availability of the 
VBID demonstration program. 
‘‘(g) IMPLEMENTATION.— 
‘‘(1) DEADLINE.—The VBID demonstration 
program shall be implemented not later than Janu-
ary 1 of the second year beginning after the date of 
the enactment of this section. 
‘‘(2) DURATION.—Subject to paragraph (3), the 
VBID demonstration program shall be conducted for 
a period of five years. 
‘‘(3) EXTENSION OR EXPANSION.—Taking into 
account the report under subsection (h)(2), the Sec-
retary may, through notice and comment rule-
making, expand the duration, scope, or both the du-
ration and scope of the VBID demonstration pro-
gram (including implementation on a nationwide or 
permanent basis or both), other than under the 
original Medicare fee-for-service program under 
parts A and B of such title, to the extent determined 
appropriate by the Secretary, unless the Secretary 
determines that such expansion is expected to— 
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‘‘(A) 
increase 
aggregate 
expenditures 
under this title and title XIX with respect to el-
igible Medicare beneficiaries participating in the 
VBID demonstration program; or 
‘‘(B) decrease the quality of health care 
services furnished to eligible Medicare bene-
ficiaries participating in the VBID demonstra-
tion program. 
‘‘(h) INDEPENDENT EVALUATION AND REPORTS.— 
‘‘(1) INDEPENDENT EVALUATION.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
provide for the evaluation of the VBID dem-
onstration program by an independent third 
party. 
‘‘(B) 
EVALUATION
OBJECTIVES.—Such 
evaluation shall determine the extent to which 
the VBID demonstration program has resulted 
in— 
‘‘(i) improved patient care; 
‘‘(ii) reduced hospitalizations or rehos-
pitalizations; 
‘‘(iii) reduced or delayed nursing facil-
ity admissions and lengths of stay under 
title XIX; 
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‘‘(iv) reduced spend down of income 
and assets for purposes of becoming eligi-
ble for medical assistance under a State 
plan under title XIX; 
‘‘(v) improved quality of life for the 
eligible Medicare beneficiaries enrolled in 
an eligible MA plan participating in the 
VBID demonstration program; 
‘‘(vi) improved caregiver satisfaction; 
and 
‘‘(vii) addressing disparities and ac-
cess for underserved populations. 
‘‘(C) EVALUATION
PROCESS.—Such eval-
uation shall be completed in accordance with 
the following process: 
‘‘(i) The Secretary shall, prior to the 
implementation of such program, establish 
goals for such program with respect to the 
evaluation objectives described in subpara-
graph (B) and criteria for measuring the 
extent to which an eligible MA plan par-
ticipating in the VBID demonstration pro-
gram meets such goals. 
‘‘(ii) The Secretary shall implement 
clear data collection and reporting require-
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