110TH CONGRESS 
2D SESSION 
H. R. 5765 
To amend title XVIII of the Social Security Act to cover remote patient 
management services for certain chronic health conditions under the 
Medicare Program. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 10, 2008 
Ms. ESHOO (for herself, Mr. PICKERING, Mr. TANNER, Mr. HULSHOF, Mr. 
STUPAK, Mr. RAMSTAD, Mr. CAMP of Michigan, and Mr. LINDER) intro-
duced the following bill; which was referred to the Committee 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 cover 
remote patient management services for certain chronic 
health conditions 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 Remote Mon-
itoring Access Act of 2008’’. 
VerDate Aug 31 2005 
03:38 Apr 12, 2008
Jkt 069200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H5765.IH
H5765
smartinez on PRODPC60 with BILLS
SEC. 2. REMOTE PATIENT MANAGEMENT SERVICES FOR 
CHRONIC HEALTH CONDITIONS UNDER THE 
MEDICARE PROGRAM. 
(a) COVERAGE OF REMOTE PATIENT MANAGEMENT 
SERVICES
FOR
CERTAIN
CHRONIC
HEALTH
CONDI-
TIONS.— 
(1) IN
GENERAL.—Section 1861(s)(2) of the 
Social Security Act (42 U.S.C. 1395x(s)(2)) is 
amended— 
(A) in subparagraph (Z), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (AA), by inserting 
‘‘and’’ at the end; and 
(C) by inserting after subparagraph (AA) 
the following new subparagraph: 
‘‘(BB) remote patient management services (as 
defined in subsection (ccc));’’. 
(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: 
‘‘(ccc) REMOTE PATIENT MANAGEMENT SERVICES 
FOR CHRONIC HEALTH CONDITIONS.—(1) The term ‘re-
mote patient management services’ means the remote 
monitoring, evaluation, and management of an individual 
with a covered chronic health condition (as defined in 
VerDate Aug 31 2005 
03:38 Apr 12, 2008
Jkt 069200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H5765.IH
H5765
smartinez on PRODPC60 with BILLS
paragraph (2)), insofar as such monitoring, evaluation, 
and management is with respect to such condition, 
through the utilization of a system of technology that al-
lows a remote interface to collect and transmit clinical 
data between the individual and the responsible physician 
(as defined in subsection (r)) or supplier (as defined in 
subsection (d)) for the purposes of clinical review or re-
sponse by the physician or supplier. 
‘‘(2) For purposes of paragraph (1), the term ‘cov-
ered chronic health condition’ means— 
‘‘(A) heart failure; and 
‘‘(B) cardiac arrhythmia. 
‘‘(3)(A) Not later than January 1, 2010, the Sec-
retary, in consultation with appropriate physician and sup-
plier groups, shall develop guidelines on the frequency of 
billing for remote patient management services. Such 
guidelines shall be determined based on medical necessity 
and shall be sufficient to ensure appropriate and timely 
monitoring of individuals being furnished such services. 
‘‘(B) The Secretary shall do the following: 
‘‘(i) Not later than 2 years after the date of the 
enactment of this subsection, develop, in consulta-
tion with appropriate physician and supplier groups, 
standards (governing such matters as qualifications 
of personnel and the maintenance of equipment) for 
VerDate Aug 31 2005 
03:38 Apr 12, 2008
Jkt 069200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H5765.IH
H5765
smartinez on PRODPC60 with BILLS
remote patient management services for the covered 
chronic health conditions specified in subparagraphs 
(A) and (B) of paragraph (2). 
‘‘(ii) Periodically review and update such stand-
ards under this subparagraph as necessary.’’. 
(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 
(vi)’’; and 
(II) by adding at the end the fol-
lowing new clause: 
‘‘(vi) BUDGETARY
TREATMENT
OF 
CERTAIN
SERVICES.—The additional ex-
penditures attributable to services de-
scribed in section 1861(s)(2)(BB) shall not 
be taken into account in applying clause 
(ii)(II) for 2010.’’; and 
(ii) by adding at the end the following 
new paragraph: 
‘‘(7) TREATMENT OF REMOTE PATIENT MAN-
AGEMENT SERVICES.— 
VerDate Aug 31 2005 
03:38 Apr 12, 2008
Jkt 069200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H5765.IH
H5765
smartinez on PRODPC60 with BILLS
‘‘(A) In determining relative value units 
for remote patient management services (as de-
fined in section 1861(ccc)), the Secretary, in 
consultation with appropriate physician groups, 
shall take into consideration— 
‘‘(i) physician resources, including 
physician time and the level of intensity of 
services provided, based on— 
‘‘(I) the frequency of evaluation 
necessary to manage the individual 
being furnished the services; 
‘‘(II) the complexity of the eval-
uation, including the information that 
must be obtained, reviewed, and ana-
lyzed; and 
‘‘(III) the number of possible di-
agnoses and the number of manage-
ment options that must be considered; 
and 
‘‘(ii) practice expense costs associated 
with such services, including installation 
and information transmittal costs, costs of 
remote patient management technology 
(including equipment and software), and 
resource costs necessary for patient moni-
VerDate Aug 31 2005 
03:38 Apr 12, 2008
Jkt 069200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H5765.IH
H5765
smartinez on PRODPC60 with BILLS
toring and follow-up (but not including 
costs of any related item or non-physician 
service otherwise reimbursed under this 
title). 
‘‘(iii) malpractice expense resources. 
‘‘(B) Using the relative value units deter-
mined in subparagraph (A), the Secretary shall 
provide for separate payment for such services 
and shall not adjust the relative value units as-
signed to other services that might otherwise 
have been determined to include such separately 
paid remote patient management services.’’; and 
(B) in subsection (j)(3), by inserting 
‘‘(2)(BB)’’ after ‘‘(2)(AA),’’. 
(4) EFFECTIVE DATE.— 
(A) IN GENERAL.—The amendments made 
by this section shall apply to services furnished 
on or after January 1, 2010 without regard to 
whether the guidelines under paragraph (3)(A) 
or the standards under paragraph (3)(B) of 
section 1861(ccc) of the Social Security Act (as 
added by paragraph (2)) have been developed. 
(B) AVAILABILITY OF CODES AS OF JANU-
ARY
1, 2010.—The Secretary of Health and 
Human Services shall— 
VerDate Aug 31 2005 
03:38 Apr 12, 2008
Jkt 069200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H5765.IH
H5765
smartinez on PRODPC60 with BILLS
(i) promptly evaluate existing codes 
that would be used to bill for remote pa-
tient management services (as defined in 
paragraph (1) of such section 1861(ccc), 
as so added) under title XVIII of the So-
cial Security Act; and 
(ii) if the Secretary determines that 
new codes are necessary to ensure accurate 
reporting and billing of such services under 
such title, issue such codes so that they are 
available for use as of January 1, 2010. 
(b) DEMONSTRATION PROJECT FOR THE COVERAGE 
OF REMOTE PATIENT MANAGEMENT SERVICES FOR AD-
DITIONAL CHRONIC HEALTH CONDITIONS UNDER THE 
MEDICARE PROGRAM.— 
(1) ESTABLISHMENT.— 
(A) IN GENERAL.—The Secretary shall es-
tablish a demonstration project for the purpose 
of evaluating the impact and benefits of cov-
ering under the Medicare program remote pa-
tient management services for certain chronic 
health conditions. 
(B) CONSULTATION.—In establishing the 
demonstration project, the Secretary shall con-
sult with appropriate physician and supplier 
VerDate Aug 31 2005 
04:58 Apr 12, 2008
Jkt 069200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H5765.IH
H5765
smartinez on PRODPC60 with BILLS
groups, eligible beneficiaries, and organizations 
representing eligible beneficiaries. 
(C) PARTICIPATION.—Any eligible bene-
ficiary may participate in the demonstration 
project on a voluntary basis. 
(2) 
CONDUCT
OF
THE
DEMONSTRATION 
PROJECT.— 
(A) SITES.— 
(i) SELECTION
OF
DEMONSTRATION 
SITES.—The Secretary shall conduct the 
demonstration project at 3 sites. 
(ii) GEOGRAPHIC DIVERSITY.—In se-
lecting the sites under clause (i), the Sec-
retary shall ensure that at least 1 of the 
sites is in a rural area. 
(B) IMPLEMENTATION; DURATION.— 
(i) IMPLEMENTATION.—The Secretary 
shall implement the demonstration project 
not later than January 1, 2010. 
(ii) DURATION.—The Secretary shall 
complete the demonstration project by the 
date that is 2 years after the date on 
which the demonstration project is imple-
mented. 
(3) EVALUATION AND REPORT.— 
VerDate Aug 31 2005 
03:38 Apr 12, 2008
Jkt 069200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H5765.IH
H5765
smartinez on PRODPC60 with BILLS
(A) EVALUATION.—The Secretary shall 
conduct an evaluation of the demonstration 
project— 
(i) to determine improvements in the 
quality of care and utilization of services 
received by eligible beneficiaries partici-
pating in the demonstration project; 
(ii) to determine the cost of providing 
payment for remote monitoring services 
under the Medicare program; 
(iii) to determine the satisfaction of 
eligible beneficiaries participating in the 
demonstration projects; and 
(iv) to evaluate such other matters as 
the Secretary determines is appropriate. 
(4) WAIVER AUTHORITY.—The Secretary may 
waive such provisions of titles XI and XVIII of the 
Social Security Act as the Secretary determines to 
be appropriate for the conduct of the demonstration 
project. 
(5) FUNDING.— 
(A) DEMONSTRATION.— 
(i) IN
GENERAL.—Subject to clause 
(ii), the Secretary shall provide for the 
transfer from the Federal Supplementary 
VerDate Aug 31 2005 
03:38 Apr 12, 2008
Jkt 069200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H5765.IH
H5765
smartinez on PRODPC60 with BILLS
Medical Trust Fund under section 1841 of 
the Social Security Act (42 U.S.C. 1395t) 
of such funds as are necessary for the 
costs of carrying out the demonstration 
project. 
(ii) CAP
ON
EXPENDITURES.—The 
amount transferred under clause (i) for the 
period during which the demonstration 
project is conducted may not exceed an 
amount equal to the lesser of— 
(I) $9,000,000; or 
(II) an amount equal to the costs 
of providing remote monitoring serv-
ices to 7,500 individuals during such 
period. 
(B) EVALUATION
AND
REPORT.—There 
are authorized to be appropriated such sums as 
are necessary for the purpose of conducting the 
evaluation and developing and submitting the 
report to Congress under paragraph (3). 
(6) DEFINITIONS.—In this section: 
(A) REMOTE PATIENT MANAGEMENT SERV-
ICES.—The term ‘‘remote patient management 
services’’ means the remote monitoring, evalua-
tion, and management of an individual with a 
VerDate Aug 31 2005 
03:38 Apr 12, 2008
Jkt 069200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H5765.IH
H5765
smartinez on PRODPC60 with BILLS
covered chronic health condition (as defined in 
paragraph (B)), insofar as such monitoring, 
evaluation, and management is with respect to 
such condition, through the utilization of a sys-
tem of technology that allows a remote interface 
to collect and transmit clinical data between the 
individual and the responsible physician (as de-
fined in subsection (r) of section 1861 of the 
Social Security Act (42 U.S.C. 1395X))) or 
supplier (as defined in subsection (d) of such 
section) for the purposes of clinical review or 
response by the physician or supplier. 
(B) COVERED
CHRONIC
HEALTH
CONDI-
TION.—The term ‘‘covered chronic health condi-
tion’’ means diabetes, sleep apnea, or epilepsy. 
(C) DEMONSTRATION PROJECT.—The term 
‘‘demonstration project’’ means a demonstra-
tion project conducted under this subsection. 
(D) ELIGIBLE
BENEFICIARY.—The term 
‘‘eligible beneficiary’’ means an individual who 
is enrolled under part B of the Medicare pro-
gram and has a covered chronic health condi-
tion. 
(E) 
MEDICARE
PROGRAM.—The 
term 
‘‘Medicare program’’ means the health benefits 
VerDate Aug 31 2005 
03:38 Apr 12, 2008
Jkt 069200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H5765.IH
H5765
smartinez on PRODPC60 with BILLS
program under title XVIII of the Social Secu-
rity Act (42 U.S.C. 1395 et seq.). 
(F) SECRETARY.—The term ‘‘Secretary’’ 
means the Secretary of Health and Human 
Services. 
Æ 
VerDate Aug 31 2005 
03:38 Apr 12, 2008
Jkt 069200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6301
E:\BILLS\H5765.IH
H5765
smartinez on PRODPC60 with BILLS