I 
114TH CONGRESS 
1ST SESSION H. R. 2948 
To amend title XVIII of the Social Security Act to provide for an incremental 
expansion of telehealth coverage under the Medicare program. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 7, 2015 
Mr. THOMPSON of California (for himself, Mr. HARPER, Mrs. BLACK, and Mr. 
WELCH) introduced the following bill; which was referred to the Com-
mittee 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 amend title XVIII of the Social Security Act to provide 
for an incremental 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 2015’’. 
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 2015, 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 2015, 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)— 
(i) by striking ‘‘or a practitioner (de-
scribed in section 1842(b)(18)(C))’’ and 
inserting ‘‘or a professional described in 
paragraph (4)(E))’’; and 
(ii) by striking ‘‘individual physician 
or practitioner’’ and inserting ‘‘individual 
physician or professional’’; and 
(B) in paragraph (4), by— 
(i) striking subparagraph (E); and 
(ii) inserting after subparagraph (D) 
the following new subparagraph: 
‘‘(E) 
PROFESSIONAL
DESCRIBED.—For 
purposes of paragraph (1), a professional de-
scribed in this subparagraph is— 
‘‘(i) a practitioner described in section 
1842(b)(18)(C); or 
‘‘(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 2015, a certified 
diabetes educator or licensed— 
‘‘(I) respiratory therapist; 
‘‘(II) audiologist; 
‘‘(III) occupational therapist; 
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‘‘(IV) physical therapist; or 
‘‘(V) speech language patholo-
gist.’’. 
(4) ADDITIONAL COVERED TELEHEALTH SERV-
ICES.—Section 1834(m)(4)(F)(i) of the Social Secu-
rity Act (42 U.S.C. 1395m(m)(4)(F)(i)) is amended 
by adding at the end the following new sentence: 
‘‘Such term shall include respiratory services, audi-
ology services (as defined in section 1861(ll)), and 
outpatient therapy services, including physical ther-
apy, occupational therapy, and speech-language pa-
thology services.’’. 
(5) EXPANSION OF TELECOMMUNICATIONS SYS-
TEM.—The second sentence of section 1834(m)(1) of 
the Social Security Act (42 U.S.C. 1395m(m)(1)) is 
amended by striking ‘‘in the case of any Federal 
telemedicine demonstration program conducted in 
Alaska or Hawaii,’’. 
(6) RURAL HEALTH CLINICS AND FEDERALLY 
QUALIFIED HEALTH CENTERS AUTHORIZED TO BE 
DISTANT SITES.—Section 1834(m)(4)(A) of the So-
cial Security Act (42 U.S.C. 1395m(m)(4)(A)) is 
amended— 
(A) by striking ‘‘SITE.—The term’’ and in-
serting ‘‘SITE.— 
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‘‘(i) IN GENERAL.—The term’’; and 
(B) by adding at the end the following new 
clause: 
‘‘(ii) TREATMENT OF RURAL HEALTH 
CLINICS
AND
FEDERALLY
QUALIFIED 
HEALTH
CENTERS.—A site described in 
clause (i) includes a rural health clinic (as 
defined in section 1861(aa)(2)) and a Fed-
erally qualified health center (as defined in 
section 1861(aa)(4)). In any case in which 
such a clinic or center is treated as a dis-
tant site with respect to the provision of a 
telehealth service to an eligible telehealth 
individual for which payment is made 
under this subsection, such service shall 
not be treated as a rural health clinic serv-
ice or Federally qualified health center 
service, respectively, and payment may not 
otherwise be made under this title with re-
spect to such service provided to such indi-
vidual.’’. 
(b) SECOND PHASE.— 
(1) IN GENERAL.—Section 1834(m)(4) of the 
Social Security Act (42 U.S.C. 1395m(m)(4)) is 
amended— 
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(A) in clause (iii) of subparagraph (C), as 
added by subsection (a)(1), by adding at the 
end the following new subclauses: 
‘‘(III) 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-
ity Act of 2015, 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. 
‘‘(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-
ity Act of 2015, a home telehealth 
site, as defined in subparagraph (G). 
‘‘(V) In the case of such a service 
that is related to the evaluation or 
treatment of an acute stroke and that 
is furnished on or after the date de-
scribed in subclause (IV) during the 
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evidence-based window of treatment, 
any site at which the eligible tele-
health individual is located at the time 
the service is furnished via a tele-
communications system, regardless of 
where the site is located.’’; 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 
service described in clause (ii) furnished to 
an individual, a place of residence used as 
the home of such individual. 
‘‘(ii) SERVICES DESCRIBED.—A serv-
ice described in this clause is— 
‘‘(I) a telehealth service that is 
related to the provision of outpatient 
mental or behavioral health and shall 
include the use of video conferencing; 
and 
‘‘(II) a service described in sub-
paragraph (F)(iii) that is treated as a 
telehealth service under such subpara-
graph.’’. 
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(2) HOME
TELEHEALTH
SERVICES.—Section 
1834(m)(4)(F) of the Social Security Act (42 U.S.C. 
1395m(m)(4)(F)) is amended by adding at the end 
the following new clause: 
‘‘(iii) TREATMENT
OF
HOME
TELE-
HEALTH SERVICES.—For purposes of sub-
paragraph (G)(ii)(II), beginning 2 years 
after the date of the enactment of the 
Medicare Telehealth Parity Act of 2015, 
services (including the use of video confer-
encing) furnished at an originating site 
that is a home telehealth site to an indi-
vidual that is related to the provision of 
hospice care, home dialysis, or home health 
services shall be treated as a telehealth 
service under this subparagraph.’’. 
(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— 
(A) by redesignating subclause (V) as sub-
clause (VI); and 
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(B) by inserting after clause (IV) the fol-
lowing new subclause: 
‘‘(V) In the case of such a service 
furnished on or after the date that is 
4 years after the date of the enact-
ment of the Medicare Telehealth Par-
ity Act of 2015, 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 2015, 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-
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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 
involved and reduced costs for the distant 
site.’’. 
(d) INCREMENTAL COVERAGE OF REMOTE PATIENT 
MONITORING SERVICES FOR CERTAIN CHRONIC HEALTH 
CONDITIONS.— 
(1) IN
GENERAL.—Section 1861(s)(2) of the 
Social Security Act (42 U.S.C. 1395x(s)(2)) is 
amended— 
(A) in subparagraph (EE), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (FF), by inserting 
‘‘and’’ at the end; and 
(C) by inserting after subparagraph (FF) 
the following new subparagraph: 
‘‘(GG) applicable remote patient monitoring 
services (as defined in paragraph (1)(A) of sub-
section (iii));’’. 
(2) SERVICES
DESCRIBED.—Section 1861 of 
the Social Security Act (42 U.S.C. 1395x) is amend-
ed by adding at the end the following new sub-
section: 
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‘‘(iii) REMOTE PATIENT MONITORING SERVICES FOR 
CHRONIC HEALTH CONDITIONS.—(1)(A) The term ‘appli-
cable remote patient monitoring services’ means remote 
patient monitoring services (as defined in subparagraph 
(B)) furnished to provide for the monitoring, evaluation, 
and management of an individual with a covered chronic 
condition (as defined in paragraph (2)), insofar as such 
services are for the management of such chronic condition. 
‘‘(B) The term ‘remote patient monitoring services’ 
means services furnished through remote patient moni-
toring technology (as defined in subparagraph (C)). 
‘‘(C) The term ‘remote patient monitoring tech-
nology’ means a coordinated system that uses one or more 
home-based or mobile monitoring devices that automati-
cally transmit vital sign data or information on activities 
of daily living and may include responses to assessment 
questions collected on the devices wirelessly or through a 
telecommunications connection to a server that complies 
with the Federal regulations (concerning the privacy of in-
dividually identifiable health information) promulgated 
under section 264(c) of the Health Insurance Portability 
and Accountability Act of 1996, as part of an established 
plan of care for that patient that includes the review and 
interpretation of that data by a health care professional. 
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‘‘(2) For purposes of paragraph (1), the term ‘cov-
ered chronic health condition’ means— 
‘‘(A) in the case of applicable remote patient 
monitoring services furnished on or after the date 
that is 6 months after the date of the enactment of 
the Medicare Telehealth Parity Act of 2015, applica-
ble conditions (as defined in and applied under sec-
tion 1886(q)(5)), relating to heart failure and chron-
ic obstructive pulmonary disease and related chronic 
comorbidities when under chronic care management 
(identified as of July 1, 2015, by HCPCS code 
99490 (and as subsequently modified by the Sec-
retary)); 
‘‘(B) in the case of applicable remote patient 
monitoring services furnished on or after the date 
that is 2 years after the date of the enactment of 
the Medicare Telehealth Parity Act of 2015, in addi-
tion to the conditions described in subparagraph (A), 
diabetes and related chronic comorbidities when 
under chronic care management (identified as of 
July 1, 2015, by HCPCS code 99490 (and as subse-
quently modified by the Secretary)); and 
‘‘(C) in the case of applicable remote patient 
monitoring services furnished on or after the date 
that is 4 years after the date of the enactment of 
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the Medicare Telehealth Parity Act of 2015, in addi-
tion to the conditions described in subparagraph (A) 
and (B), such other conditions that could be speci-
fied by the Secretary that qualify for chronic care 
management and related chronic comorbidities when 
under chronic care management (identified as of 
July 1, 2015, by HCPCS code 99490 (and as subse-
quently modified by the Secretary)). 
‘‘(3)(A) Payment may be made under this part for 
applicable remote patient monitoring services provided to 
an individual during a period of up to 90 days and such 
additional period as provided for under subparagraph (B). 
‘‘(B) The 90-day period described in subparagraph 
(A), with respect to an individual, may be renewed by the 
physician who provides chronic care management to such 
individual if the individual continues to qualify for such 
management.’’. 
(3) PAYMENT
UNDER
THE
PHYSICIAN
FEE 
SCHEDULE.—Section 1848 of the Social Security 
Act (42 U.S.C. 1395w–4) is amended— 
(A) in subsection (c)— 
(i) in paragraph (2)(B)— 
(I) in clause (ii)(II), by striking 
‘‘and (v)’’ and inserting ‘‘(v), and 
(vii)’’; and 
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(II) by adding at the end the fol-
lowing new clause: 
‘‘(vii) BUDGETARY
TREATMENT
OF 
CERTAIN
SERVICES.—The additional ex-
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 following 
new paragraph: 
‘‘(7) TREATMENT OF APPLICABLE REMOTE PA-
TIENT MONITORING SERVICES.— 
‘‘(A) In determining relative value units 
for applicable remote patient monitoring serv-
ices (as defined in section 1861(iii)(1)(A)), the 
Secretary, in consultation with appropriate phy-
sician 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; 
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‘‘(II) the complexity of the eval-
uation, including the information that 
must be obtained, reviewed, and ana-
lyzed; and 
‘‘(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 
monitoring 
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 
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have been determined to include such separately 
paid remote patient monitoring services.’’; and 
(B) in subsection (j)(3), by inserting 
‘‘(2)(GG),’’ after ‘‘health risk assessment),’’. 
(4) EFFECTIVE DATE.— 
(A) IN GENERAL.—The amendments made 
by this subsection shall apply to services fur-
nished on or after the date that is 6 months 
after the date of the enactment of this Act, 
without regard to whether the guidelines under 
paragraph (3)(A) or the standards under para-
graph (3)(B) of section 1861(iii) of the Social 
Security Act, as added by paragraph (2), have 
been developed. 
(B) 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 applicable re-
mote patient monitoring services (as de-
fined in paragraph (1)(A) 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 ensure accurate 
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reporting and billing of such services under 
such title, issue such codes so that they are 
available for use as of the date of the en-
actment of this Act. 
(e) HOME DIALYSIS SERVICE.— 
(1) IN GENERAL.—Section 1881(b)(3) of the 
Social Security Act (42 U.S.C. 1395rr(b)(3)) is 
amended— 
(A) by redesignating subparagraphs (A) 
and (B) as clauses (i) and (ii), respectively; 
(B) in clause (ii), as redesignated by sub-
paragraph (A), strike ‘‘on a comprehensive’’ 
and insert ‘‘subject to subparagraph (B), on a 
comprehensive’’; 
(C) by striking ‘‘With respect to’’ and in-
serting ‘‘(A) With respect to’’; and 
(D) by adding at the end the following new 
subparagraph: 
‘‘(B) For purposes of subparagraph (A)(ii), the 
following shall apply: 
‘‘(i) The monthly fee or other basis of pay-
ment described in such subparagraph shall 
allow for a patient-specific waiver process to 
allow a physician, clinical nurse specialist, nurse 
practitioner, or physician’s assistant to request 
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a waiver under this title of face-to-face visit re-
quirements for home dialysis furnished to indi-
viduals determined to have end stage renal dis-
ease. 
‘‘(ii) Any request under clause (i) shall in-
clude documentation by the physician or practi-
tioner involved that supports active and ade-
quate care of such individual receiving home di-
alysis. 
‘‘(iii) Any patient-specific waiver under 
clause (i) that is granted shall remain effective 
until such date that the Secretary, including 
through contractor under this title, requests 
that additional information or a new waiver ap-
plication be filed. 
‘‘(iv) All individuals determined to have 
end stage renal disease receiving home dialysis 
shall receive a face-to-face examination at least 
once every three consecutive months and, in the 
intervening months, shall receive a monthly 
clinical assessment which may be furnished, if 
the patient so chooses, via remote monitoring 
by a physician, clinical nurse specialist, nurse 
practitioner, or physician’s assistant.’’. 
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(2) 
CONFORMING
AMENDMENT.—Section 
1881(b)(1) of such Act (42 U.S.C. 1395rr(b)(1)) is 
amended by striking ‘‘paragraph (3)(A)’’ and insert-
ing ‘‘paragraph (3)(A)(i)’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply with respect to the 
monthly fee or other basis of payment for home di-
alysis services furnished on or after January 1, 
2016. 
(f) APPROPRIATE VALUATION
OF REMOTE DIAG-
NOSTIC TEST SERVICES.—Section 1848(c)(2) of the So-
cial Security Act (42 U.S.C. 1395w–4(c)(2)) is amended 
by adding at the end the following new subparagraph: 
‘‘(P) ADJUSTMENTS
FOR
REMOTE
DIAG-
NOSTIC
TESTS.—In determining practice ex-
pense relative value units for diagnostic tests 
described in section 1861(s)(3) that are pro-
vided remotely, the Secretary shall, in consulta-
tion with suppliers of remote diagnostic testing 
services, include in direct costs of supplies and 
equipment, the costs of the diagnostic device, 
clinical systems (including hardware and soft-
ware), information transmission, and device de-
livery and installation. For purposes of this 
subsection, diagnostic tests described in section 
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1861(s)(3) that are provided remotely are such 
tests that are provided through the utilization 
of a system of technology that allows a remote 
interface to collect and transmit clinical data 
between the individual and a supplier. This sub-
section shall be implemented in a budget neu-
tral manner.’’. 
(g) STUDY AND REPORT; SENSE OF CONGRESS.— 
(1) STUDY AND REPORT.— 
(A) STUDY.—The Comptroller General of 
the United States shall conduct a study that in-
cludes, at a minimum, the following: 
(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 sub-
section (a)(4), between practitioners de-
scribed in subparagraph (E)(ii) of section 
1834(m)(4) of the Social Security Act (42 
U.S.C. 1395m(m)(4)), as inserted by sub-
section (a)(3)(B)(ii), and patients, includ-
ing with respect to patient satisfaction, 
provider responsiveness to patient needs 
and concerns, and the extent to which such 
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Sfmt 6201
E:\BILLS\H2948.IH
H2948
srobinson on DSK5SPTVN1PROD with BILLS