I 
115TH CONGRESS 
1ST SESSION H. R. 2291 
To amend title XVIII of the Social Security Act to expand the coverage 
of telehealth services under the Medicare program, to provide coverage 
for home-based monitoring for congestive heart failure and chronic ob-
structive pulmonary disease under such program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 2, 2017 
Mr. DUFFY introduced 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 juris-
diction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to expand 
the coverage of telehealth services under the Medicare 
program, to provide coverage for home-based monitoring 
for congestive heart failure and chronic obstructive pul-
monary disease under such program, and for other pur-
poses. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Helping Expand Ac-
cess to Rural Telemedicine Act of 2017’’ or as the 
‘‘HEART Act of 2017’’. 
SEC. 2. EXPANSIONS OF COVERAGE OF TELEHEALTH SERV-
ICES. 
(a) COUNTIES IN MSAS WITH POPULATIONS LESS 
THAN 70,000 INDIVIDUALS.—Section 1834(m)(4)(C) of 
the Social Security Act (42 U.S.C. 1395m(m)(4)(C)(i)) is 
amended in clause (i)(II) by inserting ‘‘both a county that 
has a population of greater than 70,000 individuals, ac-
cording to the most recent decennial census, and a county 
that is’’ before ‘‘included in a Metropolitan Statistical 
Area’’. 
(b) CRITICAL ACCESS AND SOLE COMMUNITY HOS-
PITALS.—Section 1834(m)(4)(C) of the Social Security 
Act (42 U.S.C. 1395m(m)(4)(C)), as amended by sub-
section (a), is further amended— 
(1) in clause (i), by inserting ‘‘, in the case that 
such site is not a site described in subclause (II) or 
(IX) of such clause,’’ after ‘‘via a telecommuni-
cations system and’’; and 
(2) in clause (ii), by adding at the end the fol-
lowing new subclause: 
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‘‘(IX) A sole community hospital 
(as 
defined 
in 
section 
1886(d)(5)(D)(iii)).’’. 
(c) STORE-AND-FORWARD TECHNOLOGIES.—Section 
1834(m)(1) of the Social Security Act (42 U.S.C. 
1395m(m)(1)) is amended by inserting ‘‘any telehealth 
services that are furnished from a distant site, or to an 
originating site, that is a critical access hospital (as de-
scribed in paragraph subclause (II) of paragraph 
(4)(C)(ii)), a rural health clinic (as described in subclause 
(III) of such paragraph), or a sole community hospital (as 
described in subclause (IX) of such paragraph), or of’’ 
after ‘‘in the case of’’. 
(d) RURAL HEALTH CLINICS AS DISTANT SITES.— 
Section 1834(m)(4)(A) of the Social Security Act (42 
U.S.C. 1395m(m)(4)(A)) is amended— 
(1) by striking ‘‘SITE.—The term’’ and insert-
ing: 
‘‘SITE.— 
‘‘(i) IN GENERAL.—The term’’; and 
(2) by adding at the end the following new 
clause: 
‘‘(ii) TREATMENT OF RURAL HEALTH 
CLINICS.—A site described in clause (i) in-
cludes a rural health clinic (as defined in 
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section 1861(aa)(2)). In any case in which 
such a clinic is treated as a distant site 
with respect to the provision of a telehealth 
service to an eligible telehealth individual 
for which payment is made under this sub-
section, such service shall not be treated as 
a rural health clinic service, and payment 
may not otherwise be made under this title 
with respect to such service provided to 
such individual.’’. 
(e) COVERED SERVICES.—Section 1834(m)(4)(F)(i) 
of the Social Security Act (42 U.S.C. 1395m(m)(4)(F)(i)) 
is amended— 
(1) by striking ‘‘and office’’ and inserting ‘‘of-
fice’’; and 
(2) by inserting by adding at the end the fol-
lowing new sentence: ‘‘respiratory services, audiology 
services (as defined in section 1861(ll)), outpatient 
therapy services (including physical therapy, occupa-
tional therapy, and speech-language pathology serv-
ices)’’ after ‘‘the Secretary)),’’. 
(f) PROVIDERS.—Subsection (m) of section 1834 of 
such Act (42 U.S.C. 1395m) is amended— 
(1) in paragraph (1), by striking ‘‘or a practi-
tioner (described in section 1842(b)(18)(C))’’ and 
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inserting ‘‘, a practitioner (described in section 
1842(b)(18)(C)), or an applicable professional (as 
defined in paragraph (4)(G))’’; 
(2) by striking ‘‘physician or practitioner’’ each 
time it appears in such subsection and inserting 
‘‘physician, practitioner, or applicable professional’’; 
(3) in paragraph (3)(A)— 
(A) in the heading, by striking ‘‘PHYSI-
CIAN AND PRACTITIONER’’ and inserting ‘‘PHY-
SICIAN, PRACTITIONER, AND APPLICABLE PRO-
FESSIONAL’’; and 
(B) by striking ‘‘physicians or practi-
tioners’’ and inserting ‘‘physicians, suppliers, or 
practitioners’’; and 
(4) in paragraph (4), by adding at the end the 
following new subparagraph: 
‘‘(G) APPLICABLE
PROFESSIONAL.—The 
term ‘applicable professional’ means, with re-
spect to services furnished on or after the date 
that is 6 months after the date of the enact-
ment of this subparagraph, a certified diabetes 
educator or licensed— 
‘‘(i) respiratory therapist; 
‘‘(ii) audiologist; 
‘‘(iii) occupational therapist; 
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‘‘(iv) physical therapist; or 
‘‘(v) speech language pathologist.’’. 
SEC. 3. HOME-BASED MONITORING SERVICES FOR CONGES-
TIVE HEART FAILURE AND CHRONIC OB-
STRUCTIVE PULMONARY DISEASE. 
(a) COVERAGE OF REMOTE PATIENT MONITORING 
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 (EE), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (FF), by inserting 
‘‘and’’ at the end; and 
(C) by inserting after subparagraph (FF) 
the following new subparagraph: 
‘‘(GG) applicable remote patient moni-
toring services (as defined in paragraph (1)(A) 
of subsection (iii));’’. 
(b) SERVICES DESCRIBED.—Section 1861 of the So-
cial Security Act (42 U.S.C. 1395x) is amended by adding 
at the end the following new subsection: 
‘‘(iii) REMOTE PATIENT MONITORING SERVICES FOR 
CHRONIC HEALTH CONDITIONS.—(1)(A) The term ‘appli-
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cable remote patient monitoring services’ means remote 
patient monitoring services (as defined in subparagraph 
(B)) furnished to provide for the monitoring, evaluation, 
and management of an individual with a covered chronic 
condition (as defined in paragraph (2)), insofar as such 
services are for the management of such chronic condition. 
‘‘(B) The term ‘remote patient monitoring services’ 
means services furnished through remote patient moni-
toring technology (as defined in subparagraph (C)). 
‘‘(C) The term ‘remote patient monitoring tech-
nology’ means a coordinated system that uses one or more 
home-based or mobile monitoring devices that automati-
cally transmit vital sign data or information on activities 
of daily living and may include responses to assessment 
questions collected on the devices wirelessly or through a 
telecommunications connection to a server that complies 
with the Federal regulations (concerning the privacy of in-
dividually identifiable health information) promulgated 
under section 264(c) of the Health Insurance Portability 
and Accountability Act of 1996, as part of an established 
plan of care for that patient that includes the review and 
interpretation of that data by a health care professional. 
‘‘(2) For purposes of paragraph (1), the term ‘cov-
ered chronic health condition’ means applicable conditions 
(as defined in and applied under section 1886(q)(5)) when 
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under chronic care management (identified as of July 1, 
2015, by HCPCS code 99490 (and as subsequently modi-
fied by the Secretary)). 
‘‘(3)(A) Payment may be made under this part for 
applicable remote patient monitoring services provided to 
an individual during a period of up to 90 days and such 
additional period as provided for under subparagraph (B). 
‘‘(B) The 90-day period described in subparagraph 
(A), with respect to an individual, may be renewed by the 
physician who provides chronic care management to such 
individual if the individual continues to qualify for such 
management.’’. 
(c) PAYMENT UNDER THE PHYSICIAN FEE SCHED-
ULE.—Section 1848 of the Social Security Act (42 U.S.C. 
1395w–4) is amended— 
(1) in subsection (c)— 
(A) in paragraph (2)(B)— 
(i) in clause (ii)(II), by striking ‘‘and 
(v)’’ and inserting ‘‘(v), and (vii)’’; and 
(ii) by adding at the end the following 
new clause: 
‘‘(vii) BUDGETARY
TREATMENT
OF 
CERTAIN
SERVICES.—The additional ex-
penditures attributable to services de-
scribed in section 1861(s)(2)(GG) shall not 
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be taken into account in applying clause 
(ii)(II).’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(7) TREATMENT OF APPLICABLE REMOTE PA-
TIENT MONITORING SERVICES.— 
‘‘(A) In determining relative value units 
for applicable remote patient monitoring serv-
ices (as defined in section 1861(iii)(1)(A)), the 
Secretary, in consultation with appropriate phy-
sician groups, practitioner groups, and supplier 
groups, shall take into consideration— 
‘‘(i) physician or practitioner re-
sources, including physician or practitioner 
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 
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‘‘(III) the number of possible di-
agnoses and the number of manage-
ment options that must be considered; 
‘‘(ii) practice expense costs associated 
with such services, including the direct 
costs associated with installation and infor-
mation transmission, costs of remote pa-
tient 
monitoring 
technology 
(including 
equipment and software), device delivery 
costs, and resource costs necessary for pa-
tient monitoring and follow-up (but not in-
cluding costs of any related item or non- 
physician service otherwise reimbursed 
under this title); and 
‘‘(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 monitoring services.’’; and 
(2) in subsection (j)(3), by inserting ‘‘(2)(GG),’’ 
after ‘‘health risk assessment),’’. 
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SEC. 4. EFFECTIVE DATE. 
The amendments made by this Act shall apply to 
items or services furnished on or after the date that is 
6 months after the date of the enactment of the this Act. 
Æ 
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