‘‘(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) SITE OF CARE FOR PURPOSES OF DETERMINING 
HEALTH CARE LIABILITY.—Section 1834(m) of the So-
cial Security Act (42 U.S.C. 1395m(m)) is amended by 
adding at the end the following new paragraph: 
‘‘(5) SITE OF CARE FOR PURPOSES OF HEALTH 
CARE
LIABILITY.—For purposes of determining 
health care liability with respect to telehealth serv-
ices for which payment is made under this sub-
section, such service shall be considered to be fur-
nished at the distant site.’’. 
(e) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), the amendments made by this section 
shall apply to services furnished on or after January 
1, 2014. 
(2) CHANGE IN MSA RULE.—The amendment 
made by subsection (a)(1)(B)(ii) shall apply with re-
spect to telehealth services furnished on or after 
February 28, 2013. 
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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-
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 
provider, or a health team (as described under subsection 
(h)(7)) as the individual’s birthing network for purposes 
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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. 
‘‘(2) SAVINGS TARGET.—As a condition for ap-
proval of a State plan amendment and payment 
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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, 
including bundled per episode, performance in-
centives, and shared savings. 
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‘‘(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. 
‘‘(e) EVIDENCE-BASED.—The birthing network shall 
adapt, update, and follow evidence-based guidelines for 
maternal-fetal and neonatal care. 
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‘‘(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 
of health care professionals) or a health team se-
lected by an eligible individual to provide birthing 
network services. 
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