I 
112TH CONGRESS 
2D SESSION 
H. R. 6719 
To promote and expand the application of telehealth under Medicare and 
other Federal health care programs, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 30, 2012 
Mr. THOMPSON of California introduced the following bill; which was referred 
to the Committee on Energy and Commerce, and in addition to the Com-
mittees on Ways and Means, Oversight and Government Reform, Armed 
Services, and Veterans’ Affairs, for a period to be subsequently deter-
mined by the Speaker, in each case for consideration of such provisions 
as fall within the jurisdiction of the committee concerned 
A BILL 
To promote and expand the application of telehealth under 
Medicare and other Federal health care programs, 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 
‘‘Telehealth Promotion Act of 2012’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
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TITLE I—REMOVING ARBITRARY COVERAGE RESTRICTIONS ON 
TELEHEALTH FROM FEDERAL HEALTH CARE PROGRAMS 
Sec. 101. Medicare; Medicaid; CHIP. 
Sec. 102. Federal employees health, dental, and vision benefits programs. 
Sec. 103. TRICARE. 
Sec. 104. Health care provided by the Department of Veterans Affairs. 
Sec. 105. Effective date. 
TITLE II—ADDITIONAL IMPROVEMENTS TO MEDICARE 
Sec. 201. Positive incentive for Medicare’s hospital readmissions reduction pro-
gram. 
Sec. 202. Health homes and medical homes. 
Sec. 203. Flexibility in accountable care organizations coverage of telehealth. 
Sec. 204. Recognizing telehealth services and remote patient monitoring in na-
tional pilot program on payment bundling. 
Sec. 205. Adjustment in Medicare home health payments to account for use of 
remote patient monitoring. 
Sec. 206. Including telehealth and remote patient monitoring services as part 
of an intervention proposal under the Medicare Community- 
Based Care Transitions Program. 
TITLE III—ADDITIONAL IMPROVEMENT TO MEDICAID 
Sec. 301. Medicaid option for high-risk pregnancies and births. 
TITLE I—REMOVING ARBITRARY 
COVERAGE 
RESTRICTIONS 
ON TELEHEALTH FROM FED-
ERAL 
HEALTH 
CARE 
PRO-
GRAMS 
SEC. 101. MEDICARE; MEDICAID; CHIP. 
(a) IN GENERAL.—Title XI of the Social Security Act 
is amended by inserting after section 1150B the following 
new section: 
‘‘REMOVAL OF LIMITATION ON COVERAGE OF SERVICES 
PROVIDED
VIA
A
TELECOMMUNICATIONS
SYSTEM 
UNDER MEDICARE, MEDICAID, AND CHIP 
‘‘SEC. 1150C. (a) MEDICARE.—An item or service 
under part A or part B of title XVIII furnished to a Medi-
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care beneficiary by an individual or entity via a tele-
communications system shall be covered to the same ex-
tent the item or service would be covered if furnished in 
the same location of the beneficiary, and benefits shall not 
be denied under either such part solely on the basis that 
the item or service is being furnished via a telecommuni-
cations system. 
‘‘(b) MEDICAID.—Medical assistance under a State 
plan under title XIX for an item or service furnished to 
a Medicaid beneficiary by an individual or entity via a tele-
communications system shall be available to the same ex-
tent as such assistance would be available if furnished in 
the same location as the beneficiary, and medical assist-
ance shall not be denied under such plan solely on the 
basis that the item or service is being furnished via a tele-
communications system, except as a State may otherwise 
provide in its State plan under this title. For the purposes 
of reimbursement, licensure, professional liability, and 
other purposes under such title with respect to the provi-
sion of telehealth services, practitioners, suppliers, and 
providers of such services are considered to be furnishing 
such services at their location and not at the originating 
site. 
‘‘(c) CHIP.—Child health assistance under a State 
child health plan under title XXI for an item or service 
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furnished to a CHIP beneficiary by an individual or entity 
via a telecommunications system shall be available to the 
same extent as such assistance would be available if fur-
nished in the same location as the beneficiary, and child 
health assistance shall not be denied under such plan sole-
ly on the basis that the item or service is being furnished 
via a telecommunications system, except as a State may 
otherwise provide in its State child health plan under this 
title. The previous sentence applies with respect to items 
and services furnished through coverage provided in the 
form described in section 2101(a)(1). For the purposes of 
reimbursement, licensure, professional liability, and other 
purposes under such title with respect to the provision of 
telehealth services, practitioners, suppliers, and providers 
of such services are considered to be furnishing such serv-
ices at their location and not at the originating site.’’. 
(b) CONFORMING MEDICARE PART B COVERAGE 
PROVISIONS.— 
(1) REMOVAL OF LIMITATION ON TELEHEALTH 
SERVICES.—Section 1834(m)(4) of the Social Secu-
rity Act (42 U.S.C. 1395m(m)(4)) is amended by 
striking subparagraph (F). 
(2) 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 
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amended by striking ‘‘in the case of any Federal 
telemedicine demonstration program conducted in 
Alaska or Hawaii,’’. 
(3) EXPANSION
OF
TELEHEALTH
PROVIDERS 
TO
ALL
HEALTH
CARE
PROFESSIONALS.—Section 
1834(m) of such Act (42 U.S.C. 1395m(m)) is 
amended— 
(A) in paragraph (1)— 
(i) by inserting ‘‘or other health care 
professional’’ after ‘‘(described in section 
1842(b)(18)(C))’’; and 
(ii) by inserting ‘‘or other health care 
professional’’ after ‘‘individual physician or 
practitioner’’; and 
(B) in paragraphs (2)(A), (2)(C), (3)(A), 
and (4)(A) by inserting ‘‘or other health care 
professional’’ after ‘‘physician or practitioner’’ 
each place it appears. 
(4) REMOVAL OF LIMITATIONS ON ORIGINATING 
SITES.—Section 1834(m)(4)(C) of such Act (42 
U.S.C. 1395m(m)(4)(C)) is amended— 
(A) by inserting ‘‘The term ‘originating 
site’ means one of the following sites:’’ after 
‘‘ORIGINATING SITE.—’’; 
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(B) by striking clause (i) and all that fol-
lows up to subclause (I) of clause (ii); and 
(C) 
by 
redesignating 
subclauses 
(I) 
through (VIII) of clause (ii) as clauses (i) 
through (viii), respectively. 
(5) LOCATION
OF
FURNISHING
TELEHEALTH 
SERVICES.—Section 1834(m) of such Act is further 
amended by adding at the end the following new 
paragraph: 
‘‘(5) TREATMENT OF LOCATION IN FURNISHING 
TELEHEALTH
SERVICES.—For purposes of reim-
bursement, licensure, professional liability, and other 
purposes under this title with respect to the provi-
sion of telehealth services, physicians, practitioners, 
suppliers, and providers of such services are consid-
ered to be furnishing such services at their location 
and not at the originating site.’’. 
(6) PAYMENT METHODS FOR OTHER PATIENT 
SITES.—Section 1834(m)(2) of such Act is further 
amended by adding at the end the following new 
subparagraph: 
‘‘(D) PAYMENT METHODS FOR OTHER PA-
TIENT SITES.—The Secretary may develop and 
implement payment methods that would apply 
under this subsection in the case of an indi-
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vidual who would be an eligible telehealth indi-
vidual except that the telehealth services are 
furnished the individual at a site other than an 
originating site. Such methods shall be designed 
to take into account the costs related to the site 
involved and reduced costs for the distant 
site.’’. 
SEC. 102. FEDERAL EMPLOYEES HEALTH, DENTAL, AND VI-
SION BENEFITS PROGRAMS. 
(a) HEALTH BENEFITS (FEHBP).—Section 8904 of 
title 5, United States Code, is amended by adding at the 
end the following: 
‘‘(c) Benefits for an item or service furnished by an 
individual or entity via a telecommunications system shall 
be covered under a health benefits plan under this chapter 
as if it were furnished in person at the location of the 
beneficiary, and benefits shall not be denied under such 
a plan solely on the basis that the item or service is being 
furnished via a telecommunications system. For the pur-
poses of reimbursement, licensure, professional liability, 
and other purposes under this chapter with respect to the 
provision of telehealth services, practitioners, suppliers, 
and providers of such services are considered to be fur-
nishing such services at their location and not at the origi-
nating site.’’. 
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(b) DENTAL BENEFITS.—Section 8954 of title 5, 
United States Code, is amended by adding at the end the 
following: 
‘‘(f) Benefits for an item or service furnished by an 
individual or entity via a telecommunications system shall 
be covered under an enhanced dental benefits plan under 
this chapter as if it were furnished in person at the loca-
tion of the beneficiary, and benefits shall not be denied 
under such a plan solely on the basis that the item or 
service is being furnished via a telecommunications sys-
tem. For the purposes of reimbursement, licensure, profes-
sional liability, and other purposes under this chapter with 
respect to the provision of telehealth services, practi-
tioners, suppliers, and providers of such services are con-
sidered to be furnishing such services at their location and 
not at the originating site.’’. 
(c) VISION BENEFITS.—Section 8984 of title 5, 
United States Code, is amended by adding at the end the 
following: 
‘‘(f) Benefits for an item or service furnished by an 
individual or entity via a telecommunications system shall 
be covered under an enhanced vision benefits plan under 
this chapter as if it were furnished in person at the loca-
tion of the beneficiary, and benefits shall not be denied 
under such a plan solely on the basis that the item or 
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service is being furnished via a telecommunications sys-
tem. For the purposes of reimbursement, licensure, profes-
sional liability, and other purposes under this chapter with 
respect to the provision of telehealth services, practi-
tioners, suppliers, and providers of such services are con-
sidered to be furnishing such services at their location and 
not at the originating site.’’. 
SEC. 103. TRICARE. 
(a) CARE PROVIDED AT MILITARY MEDICAL TREAT-
MENT FACILITIES.—Section 1077 of title 10, United 
States Code, is amended by adding at the end the fol-
lowing new subsection: 
‘‘(g) In providing health care to a covered beneficiary 
under section 1076 of this title at a military medical treat-
ment facility, the Secretary may furnish an item or service 
to the covered beneficiary via a telecommunications sys-
tem.’’. 
(b) CARE PROVIDED AT PRIVATE FACILITIES.— 
(1) CERTAIN DEPENDENTS.—Section 1079 of 
title 10, United States Code, is amended by adding 
at the end the following new subsection: 
‘‘(r)(1) An item or service furnished to a covered ben-
eficiary via a telecommunications system shall be covered 
by a plan described in paragraph (2) to the same extent 
the item or service would be covered if furnished in the 
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same location of the covered beneficiary, and benefits shall 
not be denied under such a plan solely on the basis that 
the item or service is being furnished via a telecommuni-
cations system. For the purposes of reimbursement, licen-
sure, professional liability, and other purposes under this 
section with respect to the provision of telehealth services, 
practitioners, suppliers, and providers of such services are 
considered to be furnishing such services at their location 
and not at the originating site. 
‘‘(2) A plan described in this paragraph is a plan for 
which the Secretary enters into a contract under sub-
section (a) to provide dependents with medical care.’’. 
(2) CERTAIN
MEMBERS
AND
FORMER
MEM-
BERS.—Section 1086 of title 10, United States 
Code, is amended by adding at the end the following 
new subsection: 
‘‘(i)(1) An item or service furnished to a covered ben-
eficiary via a telecommunications system shall be covered 
by a plan described in paragraph (2) to the same extent 
the item or service would be covered if furnished in the 
same location of the covered beneficiary, and benefits shall 
not be denied under such a plan solely on the basis that 
the item or service is being furnished via a telecommuni-
cations system. For the purposes of reimbursement, licen-
sure, professional liability, and other purposes under this 
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section with respect to the provision of telehealth services, 
practitioners, suppliers, and providers of such services are 
considered to be furnishing such services at their location 
and not at the originating site. 
‘‘(2) A plan described in this paragraph is a plan for 
which the Secretary enters into a contract under sub-
section (a) to provide persons covered by subsection (c) 
with health benefits.’’. 
SEC. 104. HEALTH CARE PROVIDED BY THE DEPARTMENT 
OF VETERANS AFFAIRS. 
(a) IN GENERAL.—Subchapter I of chapter 17 of title 
38, United States Code, is amended by inserting after sec-
tion 1709A the following new section: 
‘‘§ 1709B. Provision of health care via telecommuni-
cations system 
‘‘(a) DIRECT CARE.—In providing health care di-
rectly to an individual under this chapter or chapter 18 
of this title, the Secretary may furnish an item or service 
to the individual via a telecommunications system. 
‘‘(b) CONTRACTED CARE.—(1) An item or service 
furnished to an individual covered by a plan described in 
paragraph (2) via a telecommunications system shall be 
covered by such a plan to the same extent the item or 
service would be covered if furnished in the same location 
of the individual, and benefits shall not be denied under 
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such a plan solely on the basis that the item or service 
is being furnished via a telecommunications system. For 
the purposes of reimbursement, licensure, professional li-
ability, and other purposes under this chapter and chapter 
18 with respect to the provision of telehealth services, 
practitioners, suppliers, and providers of such services are 
considered to be furnishing such services at their location 
and not at the originating site. 
‘‘(2) A plan described in this paragraph is a plan for 
which the Secretary enters into a contract or agreement 
under this chapter or chapter 18 of this title to furnish 
health care to an individual.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of such chapter is amended by inserting 
after the item relating to section 1709A the following new 
item: 
‘‘1709B. Provision of health care via telecommunications system.’’. 
SEC. 105. EFFECTIVE DATE. 
The amendments made by this title shall take effect 
on January 1, 2013, and shall apply to items and services 
furnished on or after such date and contracts for health 
plans entered into on or after such date, except that such 
amendments shall not apply to health plans for plan years 
for which bids were submitted before the date of the enact-
ment of this Act. 
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TITLE II—ADDITIONAL 
IMPROVEMENTS TO MEDICARE 
SEC. 201. POSITIVE INCENTIVE FOR MEDICARE’S HOSPITAL 
READMISSIONS REDUCTION PROGRAM. 
Section 1886(q) of the Social Security Act (42 U.S.C. 
1395ww(q)) is amended by adding at the end the following 
new paragraph: 
‘‘(9) POSITIVE INCENTIVE FOR REDUCED RE-
ADMISSIONS.— 
‘‘(A) IN GENERAL.—With respect to pay-
ment for discharges occurring during a fiscal 
year beginning on or after October 1, 2013, in 
order to provide a positive incentive for hos-
pitals described in subparagraph (B) to lower 
their excess readmission ratios, the Secretary 
shall make an additional payment to a hospital 
in such proportion as provides for a sharing of 
the savings from such better-than-expected per-
formance between the hospital and the program 
under this title. 
‘‘(B) HOSPITAL
DESCRIBED.—A hospital 
described in this subparagraph is an applicable 
hospital (as defined in paragraph (5)(C)) not 
subject to a payment change under paragraph 
(1) and for which the positive readmission ratio 
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(described in subparagraph (C)) is greater than 
1. 
‘‘(C) POSITIVE READMISSION RATIO.—The 
positive readmission ratio described in this sub-
paragraph for a hospital is the ratio of— 
‘‘(i) the risk adjusted expected re-
admissions (described in subclause (II) of 
paragraph (4)(C)(i)); to 
‘‘(ii) the risk adjusted readmissions 
based on actual readmissions (described in 
subclause (I) of such paragraph).’’. 
SEC. 202. HEALTH HOMES AND MEDICAL HOMES. 
(a) MEDICARE CHRONIC CARE COUNTERPART TO 
MEDICAID ‘‘HEALTH HOME’’.— 
(1) IN GENERAL.—Title XVIII of the Social Se-
curity Act is amended by adding at the end the fol-
lowing new section: 
‘‘SEC. 1899B. MEDICARE HEALTH HOME FOR INDIVIDUALS 
WITH CHRONIC CONDITIONS. 
‘‘(a) IN GENERAL.—In the case of a State that has 
amended its State plan under title XIX in accordance with 
the option described in section 1945, the Secretary may 
contract with the State medical assistance agency with a 
program under such section to serve eligible individuals 
with chronic conditions who select a designated provider, 
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a team of health care professionals operating with such 
a provider, or a health team as the individual’s health 
home for purposes of providing the individual with health 
home services in the same manner as provided under its 
State plan amendment. 
‘‘(b) HEALTH HOME QUALIFICATION STANDARDS.— 
The standards established by the Secretary under section 
1945(b) for qualification as a designated provider shall 
apply under this section for the purpose of being eligible 
to be a health home for purposes of section 1945. 
‘‘(c) PAYMENTS.—Payments shall be made under this 
section in the same manner to a provider or team as pay-
ments are made under subsection (c) of section 1945, in-
cluding the use of the payment methodology described in 
paragraph (2) of such subsection. 
‘‘(d) HOSPITAL REFERRALS.—Hospitals that are 
participating providers under this section shall establish 
procedures for referring any eligible individuals with 
chronic conditions who seek or need treatment in a hos-
pital emergency department to designated providers in the 
same manner as required under section 1945(d). 
‘‘(e) MONITORING AND REPORT ON QUALITY.—The 
methodology and proposal required under subsection (f) 
of section 1945 and the report on quality measures under 
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subsection (f) of such section shall also apply under this 
section. 
‘‘(f) REPORT ON QUALITY MEASURES.—As a condi-
tion for receiving payment for health home services pro-
vided to an eligible individual with chronic conditions, a 
designated provider shall report, in accordance with such 
requirements as the Secretary shall specify, including a 
plan for the use of remote patient monitoring, on all appli-
cable measures for determining the quality of such serv-
ices. When appropriate and feasible, a designated provider 
shall use health information technology in providing the 
Secretary with such information. 
‘‘(g) DEFINITIONS.—In this section, the provisions 
and definitions contained in subsection (h) of section 1945 
shall also apply for purposes of this section except that, 
instead of the requirement specified in clause (i) of sub-
section (h)(1)(A) of such section, an individual must be 
eligible for services under parts A and B and covered for 
medical assistance for health home services under section 
1945 in order to be an eligible individual with chronic con-
ditions. 
‘‘(h) EVIDENCE-BASED AND REPORTING.—In con-
tracting with a State under this section, the State— 
‘‘(1) shall follow evidence-based guidelines for 
chronic care; and 
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‘‘(2) shall report at least by the end of every 
month data specified by the Secretary, including an 
assessment of the use of remote patient monitoring 
and quality measures of process, outcome, and struc-
ture. 
‘‘(i) 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.’’. 
(2) REPORTING.— 
(A) IN GENERAL.—Not later than 2 years 
after the date of the enactment of this Act, the 
Secretary of Health and Human Services shall 
survey States contracting under section 1899B 
of the Social Security Act, as added by para-
graph (1), on the nature, extent, and use of the 
option under such section particularly as it per-
tains to— 
(i) hospital admission rates; 
(ii) chronic disease management; 
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(iii) coordination of care for individ-
uals with chronic conditions; 
(iv) assessment of program implemen-
tation; 
(v) processes and lessons learned (as 
described in subparagraph (B)); 
(vi) assessment of quality improve-
ments and clinical outcomes under such 
option; and 
(vii) estimates of cost savings. 
(B) IMPLEMENTATION REPORTING.—Such 
a State shall report to the Secretary, as nec-
essary, on processes that have been developed 
and lessons learned regarding provision of co-
ordinated care through a health home for bene-
ficiaries with chronic conditions under such op-
tion. 
(b) SPECIALTY MEDICAL HOMES.—Title XVIII of 
the Social Security Act, as amended by subsection (a), is 
further amended by adding at the end the following new 
section: 
‘‘SEC. 1899C. SPECIALTY MEDICAL HOMES. 
‘‘(a) IN GENERAL.—Beginning not later than 30 
days after the date of the enactment of this section, the 
Secretary may contract with a national or multi-state re-
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gional center of excellence with a network of affiliated 
local providers to provide through one or more medical 
homes for targeted, accessible, continuous, and coordi-
nated care to individuals under this title and title XIX 
with a long-term illness or medical condition that requires 
regular medical treatment, advising, and monitoring. 
‘‘(b) MEDICAL HOME DEFINED.—In this section, the 
term ‘medical home’ means a medical entity that— 
‘‘(1) specializes in the care for a specific long- 
term illness or medical condition, including related 
comorbidities; 
‘‘(2) leads the development of related evidence- 
based clinical standards and research; 
‘‘(3) has a network of affiliated personal physi-
cians and patient treatment facilities; 
‘‘(4) maintains an online Web Site for patient 
and provider communication and collaboration and 
patient access to the patient’s health information; 
‘‘(5) has a plan for use of health information 
technology in providing services under this section 
and improving service delivery and coordination 
across the care continuum (including the use of 
wireless patient technology to improve coordination 
and remote patient monitoring management of care 
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and patient adherence to recommendations made by 
their provider); 
‘‘(6) provides deidentified demographic data 
sets for clinical, statistical, and social science re-
search to develop culturally-competent best practices 
and clinical decision support mechanisms for the 
long-term illness or medical condition; 
‘‘(7) uses a health assessment tool for the indi-
viduals targeted, including a means for identifying 
those most likely to benefit from remote patient 
monitoring; and 
‘‘(8) provides training programs for personnel 
involved in the coordination of care. 
‘‘(c) PERSONAL PHYSICIAN DEFINED.— 
‘‘(1) IN GENERAL.—In this section, the term 
‘personal physician’ means a physician (as defined in 
section 1861(r)(1)) who meets the requirements de-
scribed in paragraphs (2) and (3). Nothing in this 
paragraph shall be construed as preventing a per-
sonal physician from being a specialist or sub-
specialist for an individual requiring ongoing care 
for a specific chronic condition or multiple chronic 
conditions or for an individual with a long-term ill-
ness or medical condition. 
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‘‘(2) GENERAL REQUIREMENTS.—The require-
ments described in this paragraph for a personal 
physician for care of an individual are as follows: 
‘‘(A) The physician is board certified for 
care of the specific illness or condition of the in-
dividual and manages continuous care for the 
individual. 
‘‘(B) The physician has the staff and re-
sources to manage the comprehensive and co-
ordinated health care of such individual. 
‘‘(3) SERVICE-RELATED REQUIREMENTS.—The 
requirements described in this paragraph for a per-
sonal physician are as follows: 
‘‘(A) The personal physician advocates for 
and provides ongoing support, oversight, and 
guidance to implement a plan of care that pro-
vides an integrated, coherent, cross-discipline 
plan for ongoing medical care developed in part-
nership with patients and including all other 
physicians furnishing care to the patient in-
volved and other appropriate medical personnel 
or agencies (such as home health agencies). 
‘‘(B) The personal physician uses evidence- 
based medicine and clinical decision support 
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tools to guide decisionmaking at the point-of- 
care based on patient-specific factors. 
‘‘(C) The personal physician is in compli-
ance with the standards for meaningful use of 
electronic health records under this title. 
‘‘(D) The personal physician participates 
with the State’s health information exchange, 
as available, or the federally-sponsored Direct 
Project. 
‘‘(E) The personal physician uses health 
information technology, including appropriate 
remote monitoring, to monitor and track the 
health status of patients and to provide patients 
with enhanced and convenient access to health 
care services. 
‘‘(F) The personal physician uses elec-
tronic prescribing and provides medication man-
agement. 
‘‘(G) The personal physician encourages 
patients to engage in the management of their 
own health through education and support sys-
tems. 
‘‘(H) The personal physician utilizes the 
services of related health professionals, includ-
ing nurse practitioners and physician assistants. 
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‘‘(d) LONG-TERM ILLNESS OR MEDICAL CONDITION 
DEFINED.—In this section, the term ‘long-term illness or 
medical condition’— 
‘‘(1) includes a chronic condition which meets 
criteria specified by the Secretary for a specialized 
MA plan for special needs individuals; and 
‘‘(2) also includes another condition that the 
Secretary determines would provide a beneficial 
focus for an effective and efficient medical home. 
‘‘(e) PAYMENT MECHANISMS.— 
‘‘(1) MEDICAL HOME CARE MANAGEMENT FEE 
AND MEDICAL HOME SHARING IN SAVINGS.—Except 
as provided in paragraph (2)— 
‘‘(A) MEDICAL HOME CARE MANAGEMENT 
FEE.—Under this section the Secretary shall 
provide for payment under section 1848 of a 
care management fee to the medical home and 
may include performance incentives. The med-
ical home shall arrange for payment for the 
services of affiliated physicians and facilities. 
‘‘(B) MEDICAL
HOME
SHARING
IN
SAV-
INGS.—The Secretary shall provide for payment 
under this section of a medical home based on 
the payment methodology applied to health 
group practices under section 1866A. Under 
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such methodology, 80 percent of the reductions 
in expenditures under this title and title XIX 
resulting from participation of individuals that 
are attributable to the medical home (as re-
duced by the total care management fees paid 
to the medical home under this section) shall be 
paid to the medical home. The amount of such 
reductions in expenditures shall be determined 
by using assumptions with respect to reductions 
in the occurrence of health complications, hos-
pitalization rates, medical errors, and adverse 
drug reactions. 
‘‘(2) ALTERNATIVE PAYMENT MODEL.— 
‘‘(A) IN
GENERAL.—The Secretary may 
provide for payment under this paragraph in-
stead of the amounts otherwise payable under 
paragraph (1). 
‘‘(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-
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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 
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 
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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. 
‘‘(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.’’. 
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SEC. 203. 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 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-
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.’’. 
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SEC. 204. 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-
health and remote patient monitoring services as the 
Secretary may specify)’’. 
SEC. 205. ADJUSTMENT IN MEDICARE HOME HEALTH PAY-
MENTS TO ACCOUNT FOR USE OF REMOTE 
PATIENT MONITORING. 
(a) IN GENERAL.—Section 1895(b) of the Social Se-
curity Act (42 U.S.C. 1395fff(b)) is amended by adding 
at the end the following new paragraph: 
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‘‘(7) INCREASE FOR THE USE OF REMOTE PA-
TIENT MONITORING.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
provide for an increase in the standard prospec-
tive payment amount (or amounts) under para-
graph (3) applicable to home health services 
furnished using remote patient monitoring. No 
such increase shall be provided unless the agen-
cy furnishing the services provides the Sec-
retary with such additional information on out-
comes from the use of such monitoring as the 
Secretary may require. 
‘‘(B) LIMITATION.—The increase under 
this paragraph shall be— 
‘‘(i) applied only in 2014, 2015, and 
2016; and 
‘‘(ii) reduced in the case of 2016. 
‘‘(C) USING
REMOTE
PATIENT
MONI-
TORING DEFINED.—In this paragraph, the term 
‘using remote patient monitoring’ means using 
devices and communications networks to re-
motely collect and send diagnostic data to a 
monitoring station for interpretation.’’. 
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(b) APPLICATION ON A BUDGET NEUTRAL BASIS.— 
Paragraph (3) of such section is amended by adding at 
the end the following new subparagraph: 
‘‘(D) BUDGET-NEUTRALITY
ADJUSTMENT 
TO OFFSET COST OF INCREASED PAYMENT FOR 
USING
REMOTE
PATIENT
MONITORING.—The 
Secretary shall reduce the standard prospective 
payment amount (or amounts) under this para-
graph applicable to home health services fur-
nished during a period by such proportion as 
the Secretary estimates will result in an aggre-
gate reduction in payments for the period equal 
to the total increase in payments estimated to 
be made based on the application of paragraph 
(7) for the period.’’. 
SEC. 206. INCLUDING TELEHEALTH AND REMOTE PATIENT 
MONITORING SERVICES AS PART OF AN 
INTERVENTION PROPOSAL UNDER THE MEDI-
CARE 
COMMUNITY-BASED 
CARE 
TRANSI-
TIONS PROGRAM. 
Section 3026(c)(2)(B) of the Patient Protection and 
Affordable Care Act of 2010 (Public Law 111–148; 42 
U.S.C. 1395b–1 note) is amended by adding at the end 
the following new clause: 
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‘‘(vi) Monitoring a high-risk Medicare 
beneficiary through the use of telehealth or 
remote patient monitoring services.’’. 
TITLE III—ADDITIONAL 
IMPROVEMENT TO MEDICAID 
SEC. 301. MEDICAID OPTION FOR HIGH-RISK PREGNANCIES 
AND BIRTHS. 
(a) IN GENERAL.—Title XIX of the Social Security 
Act is amended by adding at the end the following new 
section: 
‘‘SEC. 1947. STATE OPTION TO PROVIDE COORDINATED 
CARE 
FOR 
ENROLLEES 
WITH 
HIGH-RISK 
PREGNANCIES AND BIRTHS. 
‘‘(a) 
IN
GENERAL.—Notwithstanding 
section 
1902(a)(1) 
(relating 
to 
statewideness), 
section 
1902(a)(10)(B) (relating to comparability), and any other 
provision of this title for which the Secretary determines 
it is necessary to waive in order to implement this section, 
beginning 6 months after the date of the enactment of 
this section, a State, at its option as a State plan amend-
ment, may provide for medical assistance under this title 
to eligible individuals for maternal-fetal and neonatal care 
who select a designated provider (as described under sub-
section (h)(5)), a team of health care professionals (as de-
scribed under subsection (h)(6)) operating with such a 
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provider, or a health team (as described under subsection 
(h)(7)) as the individual’s birthing network for purposes 
of providing the individual with pregnancy-related serv-
ices. 
‘‘(b) QUALIFICATION STANDARDS.—The Secretary 
shall establish standards for qualification as a designated 
provider for the purpose of being eligible to be a birthing 
network for purposes of this section. 
‘‘(c) PAYMENTS.— 
‘‘(1) IN GENERAL.—A State shall provide a des-
ignated provider, a team of health care professionals 
operating with such a provider, or a health team 
with payments for the provision of birthing network 
services to each eligible individual for maternal-fetal 
and neonatal care that selects such provider, team of 
health care professionals, or health team as the indi-
vidual’s birthing network. Payments made to a des-
ignated provider, a team of health care professionals 
operating with such a provider, or a health team for 
such services shall be treated as medical assistance 
for purposes of section 1903(a), except that, during 
the first 8 fiscal year quarters that the State plan 
amendment is in effect, the Federal medical assist-
ance percentage applicable to such payments shall be 
equal to 90 percent. 
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‘‘(2) SAVINGS TARGET.—As a condition for ap-
proval of a State plan amendment and payment 
methodology under this section, the State shall pro-
vide the Secretary with assurances that the amend-
ment and methodology shall be projected to reduce 
the amount of expenditures for pregnancy-related 
services otherwise made under this title by one per-
cent for each 4-calendar-quarter period during the 
first 40 calendar quarters in which the amendment 
is in effect. 
‘‘(3) METHODOLOGY.— 
‘‘(A) IN GENERAL.—The State shall speci-
fy in the State plan amendment the method-
ology the State will use for determining pay-
ment for the provision of birthing network serv-
ices. Such methodology for determining pay-
ment shall be established consistent with section 
1902(a)(30)(A). 
‘‘(B) INNOVATIVE MODELS OF PAYMENT.— 
The methodology for determining payment for 
provision of birthing network services under 
this section shall not be limited to a per-mem-
ber per-month basis and may provide (as pro-
posed by the State and subject to approval by 
the Secretary) for alternate models of payment, 
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including bundled per episode, performance in-
centives, and shared savings. 
‘‘(4) PLANNING GRANTS.— 
‘‘(A) IN
GENERAL.—Beginning 30 days 
after the date of the enactment of this section, 
the Secretary may award planning grants to 
States for purposes of developing a State plan 
amendment under this section. A planning 
grant awarded to a State or a multi-state col-
laborative under this paragraph shall remain 
available until expended. 
‘‘(B) LIMITATION.—The total amount of 
payments made to States under this paragraph 
shall not exceed $25,000,000. 
‘‘(d) REPORT ON QUALITY MEASURES.—As a condi-
tion for receiving payment for birthing network services 
provided to an eligible individual for maternal-fetal and 
neonatal care, a designated provider shall report monthly 
to the State, in accordance with such requirements as the 
Secretary shall specify, on all applicable measures for de-
termining the quality of such services. When appropriate 
and feasible, a designated provider shall use health infor-
mation technology in providing the State with such infor-
mation. 
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‘‘(e) EVIDENCE-BASED.—The birthing network shall 
adapt, update, and follow evidence-based guidelines for 
maternal-fetal and neonatal care. 
‘‘(f) DEFINITIONS.—In this section: 
‘‘(1) ELIGIBLE
INDIVIDUAL
FOR
MATERNAL- 
FETAL AND NEONATAL CARE.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the term ‘eligible individual’ means 
an individual who— 
‘‘(i) is eligible for medical assistance 
under the State plan or under a waiver of 
such plan; and 
‘‘(ii)(I) is pregnant (or was pregnant 
during the immediately preceding 30 day 
period); or 
‘‘(II) is the child of an individual de-
scribed in clause (i) and under 30 days old. 
‘‘(B) RULE OF CONSTRUCTION.—Nothing 
in this paragraph shall prevent the Secretary 
from establishing other requirements for pur-
poses of determining eligibility for receipt of 
birthing network services under this section. 
‘‘(2) BIRTHING NETWORK.—The term ‘birthing 
network’ means a designated provider (including a 
provider that operates in coordination with a team 
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of health care professionals) or a health team se-
lected by an eligible individual to provide birthing 
network services. 
‘‘(3) BIRTHING NETWORK SERVICES.— 
‘‘(A) IN
GENERAL.—The term ‘birthing 
network services’ means comprehensive and 
timely high-quality services described in sub-
paragraph (B) that are provided by a des-
ignated provider, a team of health care profes-
sionals operating with such a provider, or a 
health team and are identified in a provider 
registry. 
‘‘(B) SERVICES DESCRIBED.—The services 
described in this subparagraph are— 
‘‘(i) comprehensive care coordination; 
‘‘(ii) health promotion; 
‘‘(iii) a call center to offer 24-hour 
physician support for consultations with 
maternal-fetal medicine specialists, when 
requested, regarding patient management 
issues; 
‘‘(iv) newborn screening, including for 
heart defects and to reduce newborn hos-
pital readmissions; 
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‘‘(v) patient and family support (in-
cluding authorized representatives); 
‘‘(vi) referral to community and social 
support services, if relevant; and 
‘‘(vii) use of health information tech-
nology to link services and provide moni-
toring, as feasible and appropriate. 
‘‘(4) DESIGNATED PROVIDER.—The term ‘des-
ignated provider’ means a physician, clinical practice 
or clinical group practice, rural clinic, community 
health center, public health agency, home health 
agency, or any other entity or provider (including 
pediatricians, gynecologists, and obstetricians) that 
is determined by the State and approved by the Sec-
retary to be qualified to be a birthing network for 
eligible individuals on the basis of documentation ev-
idencing that the physician, practice, or clinic— 
‘‘(A) has the systems and infrastructure in 
place to provide birthing network services; and 
‘‘(B) satisfies the qualification standards 
established by the Secretary under subsection 
(b) and paragraph (7)(B). 
‘‘(5) 
TEAM
OF
HEALTH
CARE
PROFES-
SIONALS.—The term ‘team of health care profes-
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sionals’ means a team of health professionals (as de-
scribed in the State plan amendment) that may— 
‘‘(A) include physicians and other profes-
sionals, such as a nurse care coordinator, mid-
wife, nutritionist, social worker, behavioral 
health professional, or any professionals deemed 
appropriate by the State; and 
‘‘(B) be free standing, virtual, or based at 
a hospital, community health center, rural clin-
ic, clinical practice or clinical group practice, 
academic health center, or any entity deemed 
appropriate by the State and approved by the 
Secretary. 
‘‘(6) HEALTH TEAM.—The term ‘health team’ 
has the meaning given such term for purposes of 
section 3502 of the Patient Protection and Afford-
able Care Act. 
‘‘(7) BIRTHING DATA AND EXCHANGE.— 
‘‘(A) PROPOSAL FOR USE OF HEALTH IN-
FORMATION
TECHNOLOGY.—A State shall in-
clude in the State plan amendment a proposal 
for use of health information technology in pro-
viding birthing network services under this sec-
tion and improving service delivery and coordi-
nation across the care continuum (including the 
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use of wireless patient technology to improve 
coordination and management of care and pa-
tient adherence to recommendations made by 
their provider). 
‘‘(B) INFORMATION
REQUIREMENTS
FOR 
BIRTHING
NETWORKS.—The birthing network 
shall— 
‘‘(i) be in compliance with the Med-
icaid standards for meaningful use of elec-
tronic health records; 
‘‘(ii) participate with the State’s 
health information exchange, as available, 
or operate an exchange among the birthing 
network; 
‘‘(iii) collect demographic information 
on participating newborns and mothers; 
‘‘(iv) use demographic and event- 
based data to identify patients that are 
likely going to need short or long-term fol-
low-up; and 
‘‘(v) providing de-identified demo-
graphic data sets for statistical and social 
science research to develop culturally-com-
petent best practices and clinical decision 
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support mechanisms for maternal-fetal and 
neonatal care.’’. 
(b) PATIENT SERVICES QUALITY AND PERFORMANCE 
REPORTING.— 
(1) IN GENERAL.—Not later than 3 years after 
the date of the enactment of this Act, the Secretary 
of Health and Human Services shall survey States 
that have elected the option under section 1947 of 
the Social Security Act, as added by section (a), on 
the nature, extent, and use of such option, particu-
larly as it pertains to— 
(A) terms of pregnancies; 
(B) use of prenatal fetal monitoring; 
(C) use of Caesarean section procedures; 
(D) use of neonatal intensive care services; 
(E) incidence of birthing complications; 
(F) incidence of infant and maternal mor-
tality; 
(G) coordination of maternal-fetal and neo-
natal care for individuals; 
(H) assessment of program implementa-
tion; 
(I) processes and lessons learned (as de-
scribed in subparagraph (B)); 
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(J) assessment of quality improvements 
and clinical outcomes under such option; and 
(K) participating mothers’ assessment of 
performance, quality, convenience, and satisfac-
tion. 
(2) IMPLEMENTATION
REPORTING.—A State 
that has elected the option under such section shall 
report to the Secretary, as necessary, on processes 
that have been developed and lessons learned regard-
ing provision of coordinated care through a birthing 
network for Medicaid beneficiaries for maternal-fetal 
and neonatal care under such option. 
Æ 
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