I 
118TH CONGRESS 
1ST SESSION H. R. 5394 
To ensure appropriate access to remote monitoring services furnished under 
the Medicare program. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 12, 2023 
Mr. BALDERSON (for himself, Ms. PORTER, Mr. DUNN of Florida, and Mr. 
MURPHY) 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 ensure appropriate access to remote monitoring services 
furnished 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 ‘‘Expanding Remote 
Monitoring Access Act’’. 
SEC. 2. FINDINGS. 
The Congress finds the following: 
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(1) Remote monitoring is an option that can 
help patients manage their health conditions from 
their homes with oversight from their health care 
providers, which can improve patient health out-
comes, reduce long-term health costs, and increase 
care options for patients. 
(2) The Department of Veterans Affairs (VA) 
saw such results in a 2019 report. Veterans enrolled 
in remote patient monitoring had a 53 percent de-
crease in VA bed days of care and a 33 percent de-
crease in VA hospital admissions. 
(3) Providers are currently required by Medi-
care to collect 16 days of patient data over a 30-day 
period in order to bill Medicare for remote moni-
toring services, even in cases where this full duration 
is not medically necessary to ensure the health and 
safety of the patient. This can limit the use of re-
mote monitoring in instances where it can promote 
patient health and safety and where it can reduce 
the overall cost on the health system. 
(4) In the 2021 Physician Fee Schedule, the 
Centers for Medicare and Medicaid Services (CMS) 
issued an interim policy to lower the duration re-
quired by Medicare to bill for remote monitoring 
services from 16 days to 2 days within a 30-day pe-
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riod, but only for individuals who had been diag-
nosed with, or were suspected of having, COVID–19. 
This short-term flexibility called attention to the 
long-term need to reassess the minimum duration 
required for providers to bill for remote monitoring. 
(5) As part of issuing the 2021 Physician Fee 
Schedule, CMS studied comments in support of per-
manently lowering the minimum required duration 
of remote monitoring for all patients, not just those 
with COVID–19. 
(6) CMS concluded that ‘‘we agree that a full 
16 days of monitoring may not always be reasonable 
and necessary’’ but did not revise the 16 day per 30- 
day period minimum duration for all patients be-
cause CMS did not believe they had received ‘‘spe-
cific clinical examples’’ to allow for ‘‘understanding 
under what clinical circumstances fewer days of 
monitoring would be medically reasonable and nec-
essary and allow a practitioner to establish clinically 
meaningful care’’. 
(7) Clinical evidence shows numerous instances 
in which fewer than sixteen days of monitoring with-
in a 30-day period establishes clinically meaningful 
care. These include: 
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(A) Sixteen days of monitoring per 30-day 
period may not be required to establish that a 
patient has sleep apnea. 
(B) A patient prescribed a narcotic for 
pain may require their breathing to be mon-
itored only while on the medication. 
(C) A patient with a chronic condition like 
diabetes, congestive heart failure, or obesity 
may have their weight monitored over a longer 
period of time, but it is not clinically appro-
priate to have such patient step on a scale 16 
or more times in each 30-day period. 
(D) A patient whose blood pressure or oxy-
gen levels are monitored during physical ther-
apy may not necessitate 16 days of monitoring 
in each 30-day period given physical therapy is 
often ordered twice weekly. 
(E) A patient who wears a heart monitor 
to measure palpitations may wear the monitor 
continuously, but the data only needs to be col-
lected when the individual is experiencing symp-
toms. 
(F) A patient with hypertension is often 
monitored for long-term management of this 
condition on more of a weekly basis, only need-
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ing more frequent data collection for active 
monitoring with changes in medication or dos-
ages. 
(G) A patient who suffers from Muscular 
Sclerosis or Muscular Dystrophy may benefit 
from a provider tracking the patient’s exercise 
between visits to monitor certain physiologic pa-
rameters such as muscle movement but may not 
produce 16 days of data in a 30-day period. 
(H) A patient who needs a total joint re-
placement may simply need pre-testing for sur-
gery baselines, including to establish gait, force, 
activity, heart rate and other factors and then 
compare pre-surgery and post-surgery function. 
(I) For a patient with urologic dysfunction, 
male urine flow data obtained from the patient 
can be collected in two to four consecutive days. 
(J) Remote monitoring may allow a pro-
vider to assess a patient’s adherence, range of 
motion, and response to physical therapy and 
occupational therapy regimens even though 
many such regimens are less than 16 days per 
month. 
(K) Monitoring cognitive behavioral ther-
apy for less than 16 days in a 30-day period 
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may provide clinically meaningful care while 
moderating a patient’s anxiety and other symp-
toms. 
(L) A patient with respiratory issues may 
not require a full 16 days of monitoring of in-
haler usage to get clinical benefits from remote 
monitoring. 
(8) A two-day minimum duration would permit 
Medicare coverage of the full range of remote moni-
toring services that can be beneficial to a patient 
without precluding the differential reimbursement of 
individual remote monitoring services based on pa-
tient acuity and cost. 
SEC. 3. ENSURING APPROPRIATE ACCESS TO REMOTE 
MONITORING SERVICES FURNISHED UNDER 
THE MEDICARE PROGRAM. 
(a) IN GENERAL.—Notwithstanding any other provi-
sion of law, the Secretary of Health and Human Services 
(in this section referred to as the ‘‘Secretary’’) shall en-
sure that remote monitoring services furnished under title 
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) 
during the period beginning on the date of the enactment 
of this Act and ending on the date that is 2 years after 
such date of enactment are payable for a minimum of 2 
days of data collection over a 30-day period, regardless 
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of whether the individual receiving such services has been 
diagnosed with, or is suspected of having, COVID–19. 
(b) REPORT.— 
(1) IN GENERAL.—Not later than 1 year after 
the date of the enactment of this Act, the Secretary 
shall, after consulting with entities specified in para-
graph (2), submit to Congress a report that includes 
the following: 
(A) A summary and analysis of previous 
experience with such remote monitoring services 
being payable under such title for a minimum 
of 2 days of data collection over a 30-day pe-
riod. 
(B) Recommendations for implementing a 
reimbursement model that takes into account 
patient acuity and cost of providing remote 
monitoring services, including potentially cre-
ating differential reimbursements for periods 
with different durations, such as fewer than 
and more than 16 days. 
(C) An analysis and justification for the 
appropriate place of service and supervision re-
quirements for non-clinical staff reviewing and 
escalating patient data and provide rec-
ommendations. 
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(D) An analysis of the estimated savings 
resulting from earlier interventions and fewer 
days of hospitalizations among patients fur-
nished remote monitoring services. 
(2) SPECIFIED
ENTITIES.—For purposes of 
paragraph (1), the entities specified in this para-
graph are the following: 
(A) Relevant agencies within the Depart-
ment of Health and Human Services (including, 
with respect to issues relating to waste, fraud, 
or abuse, the Inspector General of such Depart-
ment). 
(B) The Department of Veterans Affairs 
(including the Office of Connected Care of such 
Department). 
(C) Licensed and practicing osteopathic 
and allopathic physicians, anesthesiologists, 
physician assistants, and nurse practitioners. 
(D) Hospitals, health systems, academic 
medical centers, and other medical facilities, 
such as acute care hospitals, cancer hospitals, 
psychiatric hospitals, hospital emergency de-
partments, facilities furnishing urgent care 
services, ambulatory surgical centers, Federally 
qualified health centers, rural health clinics, 
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and post-acute care and long-term care facili-
ties. 
(E) Medical professional organizations and 
medical specialty organizations. 
(F) Organizations with expertise in the de-
velopment of or operation of innovative remote 
physiologic monitoring services technologies. 
(G) Beneficiary advocacy organizations. 
(H) The American Medical Association 
Current 
Procedural 
Terminology 
Editorial 
Panel. 
(I) Commercial payers. 
(J) Any other entity determined appro-
priate by the Secretary. 
(c) DEFINITIONS.—In this section: 
(1) REMOTE MONITORING.—The term ‘‘remote 
monitoring’’ means remote physiologic monitoring 
and remote therapeutic monitoring. 
(2) REMOTE PHYSIOLOGIC MONITORING.—The 
term ‘‘remote physiologic monitoring’’ means non- 
face-to-face monitoring and analysis of physiologic 
factors used to understand a patient’s health status, 
including the collection and analysis of patient phys-
iologic data that are used to develop and manage a 
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treatment plan related to chronic or acute condi-
tions. 
(3) REMOTE THERAPEUTIC MONITORING.—The 
term ‘‘remote therapeutic monitoring’’ means the 
use of medical devices to monitor a patient’s health 
or response to treatment using non-physiological 
data. 
Æ 
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