‘‘(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.’’. 
SEC. 103. 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 section 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-
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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.’’. 
SEC. 104. 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-
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health and remote patient monitoring services as the 
Secretary may specify)’’. 
SEC. 105. ADDITIONAL SITES TO BE CONSIDERED ORIGI-
NATING SITES FOR PURPOSES OF PAYMENTS 
FOR TELEHEALTH SERVICES UNDER MEDI-
CARE. 
(a) IN GENERAL.—Section 1834(m)(4) of the Social 
Security Act (42 U.S.C. 1395m(m)(4)) is amended— 
(1) in subparagraph (C)— 
(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
ORIGINATING 
SITES.—The term ‘originating site’ also in-
cludes the following sites, whether or not 
they are located in an area described in 
clause (i), insofar as such sites are not oth-
erwise included in the definition of origi-
nating site under such clause: 
‘‘(I) A critical access hospital (as 
described in clause (ii)(II)). 
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‘‘(II) A sole community hospital 
(as 
defined 
in 
section 
1886(d)(5)(D)(iii)). 
‘‘(III) A home telehealth site (as 
defined in subparagraph (G)(i)). 
‘‘(IV) A site described in clause 
(ii) that is located in a county with a 
population of less than 25,000, ac-
cording to the most recent decennial 
census or in an area that was not in-
cluded in a Metropolitan Statistical 
Area on any date in 2000. 
‘‘(V) A site described in clause 
(ii) with respect to services related to 
the evaluation or treatment of an 
acute stroke.’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(G) HOME TELEHEALTH SITE.— 
‘‘(i) HOME TELEHEALTH SITE.—The 
term ‘home telehealth site’ means, with re-
spect to a telehealth service described in 
clause (ii) furnished to an individual, the 
in a place of residence used as the home of 
such individual. 
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‘‘(ii) TELEHEALTH
SERVICES
DE-
SCRIBED.—A telehealth service described 
in this clause is a telehealth service that 
is— 
‘‘(I) related to the provision of 
hospice care or home dialysis; or 
‘‘(II) furnished to an individual 
who is determined to be homebound 
(as defined for purposes of sections 
1814(a)(2)(C) and 1835(a)(2)(A)(i)), 
including such an individual for whom 
a certification or recertification de-
scribed in such section is in effect 
with respect to home health services.’’. 
(b) NO ORIGINATING SITE FACILITY FEE FOR NEW 
SITES.—Section 1834(m)(2)(B) of the Social Security Act 
(42 U.S.C. 1395m(m)(2)(B)) is amended by inserting 
after ‘‘the originating site’’ the following: ‘‘(other than an 
additional originating site described in paragraph 
(4)(C)(iii))’’. 
(c) APPLICATION OF TELECOMMUNICATION SYSTEMS 
DEFINITION TO CRITICAL ACCESS HOSPITALS AND SOLE 
COMMUNITY HOSPITALS.—The second sentence of section 
1834(m)(1) of the Social Security Act (42 U.S.C. 
1395m(m)) is amended by inserting ‘‘any telehealth serv-
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ices furnished or received at a critical access hospital (as 
described in paragraph (4)(C)(ii)(II)) or a sole community 
hospital (as defined in section 1886(d)(5)(D)(iii)) or of’’ 
after ‘‘in the case of’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on or after 
January 1, 2016. 
TITLE 
II—ENHANCING 
MED-
ICAID 
THROUGH 
TELE-
HEALTH 
SEC. 201. 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-
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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. 
‘‘(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 
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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, 
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-
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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. 
‘‘(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-
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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 
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 
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requested, regarding patient management 
issues; 
‘‘(iv) newborn screening, including for 
heart defects and to reduce newborn hos-
pital readmissions; 
‘‘(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 
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‘‘(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-
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-
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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 
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 
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‘‘(v) providing de-identified demo-
graphic data sets for statistical and social 
science research to develop culturally com-
petent best practices and clinical decision 
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; 
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(H) assessment of program implementa-
tion; 
(I) processes and lessons learned (as de-
scribed in subparagraph (B)); 
(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. 
TITLE 
III—IMPROVING 
TELE-
COMMUNICATIONS FOR MED-
ICAL DELIVERY 
SEC. 301. ADDITIONAL PROVIDERS CONSIDERED HEALTH 
CARE PROVIDERS FOR PURPOSES OF UNI-
VERSAL SERVICE SUPPORT. 
Subparagraph (B) of section 254(h)(7) of the Com-
munications Act of 1934 (47 U.S.C. 254(h)(7)) is amend-
ed— 
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(1) in clause (vi), by striking ‘‘and’’; 
(2) in clause (vii), by striking ‘‘clauses (i) 
through (vi)’’ and inserting ‘‘clauses (i) through 
(ix)’’; 
(3) by redesignating clause (vii) as clause (x); 
and 
(4) by inserting after clause (vi) the following 
new clauses: 
‘‘(vii) ambulance providers and other 
emergency medical transport providers; 
‘‘(viii) health clinics of elementary and 
secondary schools and post-secondary edu-
cational institutions; 
‘‘(ix) sites where telehealth services 
are provided under section 1834(m) of the 
Social Security Act (42 U.S.C. 1395m(m)) 
or under a State plan under title XIX of 
such Act (42 U.S.C. 1396 et seq.); and’’. 
SEC. 302. NO CONSIDERATION OF PROVIDER LOCATION IN 
RULES ENHANCING HEALTH CARE PROVIDER 
ACCESS 
TO 
ADVANCED 
TELECOMMUNI-
CATIONS AND INFORMATION SERVICES. 
Section 254(h)(2)(A) of the Communications Act of 
1934 (47 U.S.C. 254(h)(2)(A)) is amended by inserting 
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‘‘(regardless of the location of such providers)’’ after 
‘‘health care providers’’. 
Æ 
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