I 
114TH CONGRESS 
1ST SESSION H. R. 4155 
To require the Center for Medicare and Medicaid Innovation to test the 
effect of including telehealth services in Medicare health care delivery 
reform models. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 2, 2015 
Mrs. BLACK 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 require the Center for Medicare and Medicaid Innovation 
to test the effect of including telehealth services in Medi-
care health care delivery reform models. 
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 ‘‘Telehealth Innovation 
and Improvement Act of 2015’’. 
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SEC. 2. CMI TESTING OF COVERAGE OF EXPANDED TELE-
HEALTH SERVICES. 
(a) IN GENERAL.—Section 1115A of the Social Secu-
rity Act (42 U.S.C. 1315a) is amended— 
(1) in subsection (b)(2)— 
(A) in subparagraph (A), by adding at the 
end the following new sentence: ‘‘The models 
selected under this subparagraph shall include 
the model described in subparagraph (D), which 
shall be implemented by not later than January 
1, 2017.’’; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(D) TELEHEALTH SERVICES IN DELIVERY 
REFORM MODELS.—The model described in this 
subparagraph is a model that meets the re-
quirements of subsection (h) with respect to 
coverage of, and payment for, expanded tele-
health services, which shall include remote mon-
itoring services, furnished in conjunction with 
models that test the use of accountable care or-
ganizations under title XVIII, bundled pay-
ments under such title, and such other coordi-
nated care models under such title as the Sec-
retary determines to be appropriate.’’; 
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(2) in subsection (b)(4), by striking ‘‘EVALUA-
TION.—’’ and inserting ‘‘EVALUATION.—Subject to 
subsection (h)(6):’’; and 
(3) by adding at the end the following new sub-
section: 
‘‘(h) MEDICARE COVERAGE OF EXPANDED TELE-
HEALTH SERVICES UNDER ACCOUNTABLE CARE ORGANI-
ZATION MODELS, BUNDLED PAYMENT MODELS, AND 
OTHER APPROPRIATE MODELS TESTED BY THE SEC-
RETARY.— 
‘‘(1) ESTABLISHMENT OF TELEHEALTH SERV-
ICE MODELS.— 
‘‘(A) IN
GENERAL.—Subject to the suc-
ceeding provisions of this subsection, for the 5- 
year period that begins on January 1, 2017, the 
Secretary shall test coverage of, and payment 
for, expanded telehealth services (as defined in 
paragraph (2)) furnished to applicable individ-
uals who are Medicare beneficiaries (as defined 
in paragraph (3)(B)) in conjunction with mod-
els tested under subsection (b), and expanded 
under subsection (c) (if applicable), that test 
the use of accountable care organizations under 
title XVIII, bundled payments under such title, 
and such other coordinated care models under 
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such title as the Secretary determines to be ap-
propriate. 
‘‘(B) MODEL DESIGN CONSIDERATIONS.— 
In establishing models to be tested for enhanced 
telehealth services under subsection (b)(2)(D), 
the Secretary shall design such models in a 
manner to permit comparisons of Medicare 
beneficiaries who are participating in models 
under subsection (b) that include access to ex-
panded telehealth services with Medicare bene-
ficiaries in models under subsection (b) who do 
not have access to such services. 
‘‘(2) EXPANDED
TELEHEALTH
SERVICES
DE-
FINED.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graphs (B) and (C), in this subsection, the term 
‘expanded telehealth services’ means services 
furnished by an eligible physician or practi-
tioner to a Medicare beneficiary as part of an 
episode of care for one or more of the condi-
tions specified under paragraph (4) through one 
or more of the following: 
‘‘(i) Remote monitoring technologies, 
including remote device management for 
purposes of remotely interrogating or pro-
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gramming a medical device (such as a 
pacemaker or a cardiac resynchronization 
therapy device) outside the office of the 
physician specialist involved. 
‘‘(ii) Bi-directional audio/video tech-
nologies. 
‘‘(iii) Physiologic and behavioral moni-
toring technologies. 
‘‘(iv) 
Engagement 
prompt 
tech-
nologies. 
‘‘(v) Store and forward technologies. 
‘‘(vi) 
Point-of-care 
testing 
tech-
nologies. 
‘‘(vii) Such other technologies as the 
Secretary may specify. 
‘‘(B) INCLUSION
OF
MEDICARE
TELE-
HEALTH SERVICES; NONAPPLICATION OF CER-
TAIN RESTRICTIONS.— 
‘‘(i) INCLUSION OF MEDICARE TELE-
HEALTH SERVICES.—The term ‘expanded 
telehealth services’ shall include a tele-
health service, as defined in section 
1834(m)(4)(F), without regard to the limi-
tations specified under section 1834(m)(4). 
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‘‘(ii) 
RULE
OF
CONSTRUCTION.— 
Nothing in this section shall be construed 
as imposing a requirement on the fur-
nishing of expanded telehealth services 
that such services be furnished in real time 
through interactive audio or video tele-
communications systems between the eligi-
ble physician or practitioner and the Medi-
care beneficiary. 
‘‘(iii) NO
LIMITATIONS
ON
GEO-
GRAPHIC
AREAS
OR
LOCATION
OF
PA-
TIENT.—The term ‘expanded telehealth 
services’ shall include services furnished 
(as described in subparagraph (A)) without 
regard to the location of the Medicare ben-
eficiary at the time the telehealth service is 
furnished and without regard to the area 
in which the Medicare beneficiary resides. 
‘‘(C) 
REQUIREMENTS.—The 
term 
‘ex-
panded telehealth services’ shall not include a 
service furnished (as described in subparagraph 
(A)) unless it can be demonstrated that the 
service, when furnished as an expanded tele-
health service, is likely to do one or more of the 
following: 
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‘‘(i) The service assists eligible physi-
cians or practitioners coordinate care for 
patients. 
‘‘(ii) The service enhances collabora-
tion among providers of services and sup-
pliers, including eligible physicians and 
practitioners, in the provision of care to 
patients. 
‘‘(iii) The service improves quality of 
care furnished to patients. 
‘‘(iv) The service results in reduced 
hospital admissions and readmissions. 
‘‘(v) The service reduces or sub-
stitutes for physician office visits. 
‘‘(vi) The service results in reduced 
utilization of skilled nursing facility serv-
ices. 
‘‘(vii) The service facilitates the re-
turn of patients to the community more 
quickly than would otherwise occur in the 
absence of the service. 
‘‘(3) ADDITIONAL DEFINITIONS.—In this sub-
section: 
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‘‘(A) ELIGIBLE
PHYSICIAN
OR
PRACTI-
TIONER.—The term ‘eligible physician or prac-
titioner’ means— 
‘‘(i) a physician (as defined in section 
1861(r)); and 
‘‘(ii) a practitioner (as defined in sec-
tion 1842(b)(18)(C)). 
‘‘(B) MEDICARE BENEFICIARY.—The term 
‘Medicare beneficiary’ means an individual who 
is entitled to benefits under part A or enrolled 
under part B of title XVIII who is not enrolled 
in a Medicare Advantage plan under part C of 
such title, an eligible organization under section 
1876, or a PACE program under section 1894. 
‘‘(4) CONDITIONS.—For purposes of paragraph 
(2)(A), the conditions with respect to which a cov-
erage of an expanded telehealth service is furnished 
under this subsection shall include the following con-
ditions or diseases: chronic hypertension, ischemic 
heart diseases, chronic obstructive pulmonary dis-
ease, heart failure, heart attack, osteoarthritis, dia-
betes, chronic kidney disease, depression, atrial fi-
brillation, cancer, asthma, stroke, total hip replace-
ment procedures, total knee replacement procedures, 
Parkinson’s disease, and such other conditions or 
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diseases with respect to which the Secretary deter-
mines that expanded telehealth services would sat-
isfy one or more of the requirements of clauses (i) 
through (vii) of paragraph (2)(C). 
‘‘(5) PAYMENT.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), with respect to expanded telehealth 
services furnished under a model tested under 
subsection (b) and expanded under subsection 
(c) (if applicable), the Secretary shall establish 
payment amounts under this subsection for 
such services. The Secretary may use one or 
more of the following payment methodologies 
for expanded telehealth services: 
‘‘(i) MEDICARE FEE SCHEDULE.—Fee 
schedules established under title XVIII for 
telehealth services and remote monitoring 
services. 
‘‘(ii) NEW
FEE
SCHEDULE.—A new 
fee schedule that the Secretary establishes 
for expanded telehealth services covered by 
reason of this subsection. 
‘‘(iii) PAYMENT AMOUNTS BASED ON 
SHARED
RISK.—A payment methodology 
for shared savings and losses that is de-
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signed to ensure savings with respect to 
expanded telehealth services covered under 
the model. 
‘‘(B) 
CONSIDERATION
OF
CERTAIN 
COSTS.—In determining the amount of payment 
for an expanded telehealth service under the 
payment methodologies referred to in subpara-
graph (A), the Secretary shall take into account 
costs incurred by eligible physicians and practi-
tioners— 
‘‘(i) for the acquisition and implemen-
tation information systems necessary to 
furnish such services, including costs of 
equipment and requisite software; 
‘‘(ii) for nonphysician clinical per-
sonnel in conjunction with such service; 
and 
‘‘(iii) for physician interpretation of 
clinical data through the expanded tele-
health service as well as for the supervision 
or oversight of the system for such service. 
‘‘(6) EVALUATION OF MODELS.— 
‘‘(A) USE OF INDEPENDENT ENTITY.—In 
lieu of the evaluations conducted by the Sec-
retary under subsection (b)(4) for models tested 
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under subsection (b), the Secretary shall pro-
vide for evaluations of enhanced telehealth serv-
ice models under subsection (b)(2)(D) by an 
independent entity. Such evaluation shall be 
conducted with respect to the specific enhanced 
telehealth service and condition or conditions 
involved that are tested under such models. 
‘‘(B) TIMING OF EVALUATION.—An eval-
uation of such enhanced telehealth service and 
condition or conditions involved conducted by 
the independent entity under this paragraph 
shall begin three years after the implementation 
of the model that provides for coverage of and 
payment for the expanded telehealth service 
with respect to such condition. 
‘‘(C) CRITERIA.—An evaluation of such en-
hanced telehealth service models conducted by 
the independent entity under this paragraph 
shall include an analysis of— 
‘‘(i) the quality of care furnished 
under the model, including the measure-
ment of patient-level outcomes and patient- 
centeredness criteria determined appro-
priate by the Secretary; 
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‘‘(ii) the changes in spending under 
parts A and B of title XVIII by reason of 
the model, taking into account costs and 
savings under such parts across the con-
tinuum of care for the episode of care and 
condition or conditions involved; and 
‘‘(iii) any impediments that were en-
countered under the model, such as— 
‘‘(I) explicit telehealth restric-
tions under Federal or State laws that 
are not related to health care reim-
bursement, such as scope of practice 
limitations; 
‘‘(II) licensing or credentialing 
barriers; and 
‘‘(III) limited broadband access 
or limited health information tech-
nology capabilities. 
‘‘(D) INFORMATION.—The provisions of 
subsection (b)(4)(B) shall apply to evaluations 
conducted under this paragraph in the same 
manner as such provisions apply to evaluations 
conducted under subsection (b)(4). 
‘‘(7) APPLICATION OF EXPANDED TELEHEALTH 
SERVICES
TO
ALL
CMI
MODELS.—The Secretary 
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shall expand the application of an enhanced tele-
health service with respect to the condition or condi-
tions involved to all models tested under subsection 
(b), and expanded under subsection (c) (if applica-
ble), that apply with respect to services furnished 
under title XVIII to provide for coverage of, and 
payment for, such enhanced telehealth service or 
services with respect to such condition or conditions 
under all such models for years beginning after the 
5-year period described in paragraph (1)(A) if— 
‘‘(A) the independent evaluation conducted 
under paragraph (6) with respect to such mod-
els demonstrates that such enhanced telehealth 
service or services with respect to the condition 
or conditions involved resulted in— 
‘‘(i) reduced spending under parts A 
and B of title XVIII without reducing the 
quality of care; or 
‘‘(ii) improved quality of patient care 
without increasing such spending; and 
‘‘(B) the Chief Actuary of the Centers for 
Medicare & Medicaid Services certifies that 
such expansion would reduce net program 
spending under parts A and B of title XVIII.’’. 
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(b) COVERAGE OF AND PAYMENT FOR CERTAIN EN-
HANCED TELEHEALTH SERVICES THAT ARE CERTIFIED 
AS PROVIDING SAVINGS UNDER THE MEDICARE PRO-
GRAM.— 
(1) COVERAGE.—Section 1834 of the Social Se-
curity Act (42 U.S.C. 1395m) is amended by adding 
at the end the following new subsection: 
‘‘(s) CERTIFIED ENHANCED TELEHEALTH SERV-
ICES.— 
‘‘(1) IN GENERAL.—The Secretary shall pay for 
certified enhanced telehealth services (as defined in 
paragraph (2)(A)) furnished by a physician (as de-
fined in section 1861(r)) or a practitioner (as de-
fined in section 1842(b)(18)(C)) to a Medicare fee- 
for-service beneficiary (as defined in paragraph 
(2)(B)) for one or more of the conditions specified 
under section 1115A(h)(4) in an amount determined 
under paragraph (3) without regard to— 
‘‘(A) the location of the Medicare fee-for- 
service beneficiary at the time the certified en-
hanced telehealth service is furnished; and 
‘‘(B) the area in which the Medicare fee- 
for-service beneficiary resides. 
‘‘(2) DEFINITIONS.—In this subsection: 
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‘‘(A) CERTIFIED ENHANCED TELEHEALTH 
SERVICE.—The term ‘certified enhanced tele-
health service’ means, with respect to a condi-
tion or conditions specified under section 
115A(h)(4), an enhanced telehealth service (as 
defined in section 1115A(h)(2)) with respect to 
which— 
‘‘(i) an independent evaluation con-
ducted under section 1115A(h)(6) dem-
onstrates that the service tested under a 
model under section 1115A(b)(2)(D) with 
respect to the condition or conditions re-
sulted in— 
‘‘(I) 
reduced 
spending 
under 
parts A and B without reducing the 
quality of care; or 
‘‘(II) improved quality of patient 
care without increasing such spend-
ing; and 
‘‘(ii) the Chief Actuary of the Centers 
for Medicare & Medicaid Services certifies 
that such expansion would reduce net pro-
gram spending under such parts. 
‘‘(B) MEDICARE FEE-FOR-SERVICE BENE-
FICIARY.—The term ‘Medicare fee-for-service 
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beneficiary’ has the meaning given such term in 
section 1899(h)(3). 
‘‘(3) PAYMENT AMOUNT.—The amount of pay-
ment for certified enhanced telehealth services shall 
be determined in the same manner as payments for 
enhanced telehealth services are determined under 
section 1115A(h)(5).’’. 
(2) PAYMENT.—Section 1833(a)(1) of the So-
cial Security Act (42 U.S.C. 1395l(a)(1)) is amend-
ed by striking ‘‘and’’ before ‘‘(Z)’’ and inserting be-
fore the semicolon at the end the following: ‘‘, and 
(AA) with respect to certified enhanced telehealth 
services (as defined in section 1834(s)(2)(A)), the 
amount paid shall be an amount equal to 80 percent 
of the lesser of the actual charge for the services or 
the amount determined under section 1834(s)(3)’’. 
Æ 
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