I 
109TH CONGRESS 
1ST SESSION H. R. 3588 
To amend title XVIII of the Social Security Act to provide for access to 
telehealth services in the home. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 28, 2005 
Mr. RAMSTAD introduced the following bill; which was referred to the Com-
mittee on Ways and Means, and in addition to the Committee on Energy 
and Commerce, for a period to be subsequently determined by the Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
for access to telehealth services in the home. 
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 Home Health 
Telehealth Access Act of 2005’’. 
SEC. 2. ACCESS TO TELEHEALTH SERVICES IN THE HOME. 
(a) IN GENERAL.—Section 1895(e) of the Social Se-
curity Act (42 U.S.C. 1395fff(e)) is amended to read as 
follows:
‘‘(e) COVERAGE OF TELEHEALTH SERVICES.— 
‘‘(1) IN GENERAL.—The Secretary shall include 
telehealth services that are furnished via a tele-
communication system by a home health agency to 
an individual receiving home health services under 
section 1814(a)(2)(C) or 1835(a)(2)(A) as a home 
health visit for purposes of eligibility and payment 
under this title if the telehealth services— 
‘‘(A) are ordered as part of a plan of care 
certified by a physician pursuant to section 
1814(a)(2)(C) or 1835(a)(2)(A); 
‘‘(B) do not substitute for in-person home 
health services ordered as part of a plan of care 
certified by a physician pursuant to such re-
spective section; and 
‘‘(C) are considered the equivalent of a 
visit under criteria developed by the Secretary 
under paragraph (3). 
‘‘(2) PHYSICIAN
CERTIFICATION.—Nothing in 
this section shall be construed as waiving the re-
quirement for a physician certification under section 
1814(a)(2)(C) or 1835(a)(2)(A) for the payment for 
home health services, whether or not furnished via 
a telecommunication system. 
‘‘(3) CRITERIA FOR VISIT EQUIVALENCY.—
‘‘(A) STANDARDS.—The Secretary shall es-
tablish standards and qualifications for catego-
rizing and coding under HCPCS codes tele-
health services under this subsection as equiva-
lent to an in-person visit for purposes of eligi-
bility and payment for home health services 
under this title. In establishing the standards 
and qualifications, the Secretary may distin-
guish between varying modes and modalities of 
telehealth services and shall consider— 
‘‘(i) the nature and amount of service 
time involved; and 
‘‘(ii) the functions of the telecommuni-
cations. 
‘‘(B) LIMITATION.—A telecommunication 
that consists solely of a telephone audio con-
versation, facsimile, electronic text mail, or con-
sultation between two health care practitioners 
is not considered a visit under this subsection. 
‘‘(4) TELEHEALTH SERVICE.— 
‘‘(A) DEFINITION.—For purposes of this 
section, the term ‘telehealth service’ means 
technology-based professional consultations, pa-
tient monitoring, patient training services, clin-
ical observation, assessment, or treatment, and
any additional services that utilize technologies 
specified by the Secretary as HCPCS codes de-
veloped under paragraph (3). 
‘‘(B) UPDATE
OF
HCPCS
CODES.—The 
Secretary shall establish a process for the up-
dating, not less frequently than annually, of 
HCPCS codes for telehealth services. 
‘‘(5) CONDITIONS
FOR
PAYMENT
AND
COV-
ERAGE.—Nothing in this subsection shall be con-
strued as waiving any condition of payment under 
sections 1814(a)(2)(C) or 1835(a)(2)(A) or exclu-
sion of coverage under section 1862(a)(1). 
‘‘(6) COST REPORTING.—Notwithstanding any 
provision to the contrary, the Secretary shall provide 
that the costs of telehealth services under this sub-
section shall be reported as a reimbursable cost cen-
ter on any cost report submitted by a home health 
agency to the Secretary.’’. 
(b) EFFECTIVE DATE.— 
(1) The amendment made by subsection (a) 
shall apply to telehealth services furnished on or 
after October 1, 2006. The Secretary of Health and 
Human Services shall develop and implement cri-
teria and standards under section 1895(e)(3) of the
Social Security Act, as amended by subsection (a), 
by no later than July 1, 2006. 
(2) In the event that the Secretary has not 
complied with these deadlines, beginning October 1, 
2006, a home health visit for purpose of eligibility 
and payment under title XVIII of the Social Secu-
rity Act shall include telehealth services under sec-
tion 1895(e) of such Act with the aggregate of tele-
communication encounters in a 24-hour period con-
sidered the equivalent of one in-person visit. 
SEC. 3. REMOTE MONITORING PILOT PROJECTS. 
(a) PILOT PROGRAM AUTHORIZED.—The Secretary 
of Health and Human Services (in this section referred 
to as the ‘‘Secretary’’) shall initiate and carry out pilot 
projects (each in this section referred to as a ‘‘pilot 
project’’) in a variety of geographic locations that provide 
incentives to home health agencies to utilize home moni-
toring and communications technologies that will— 
(1) enhance health outcomes for individuals en-
rolled under parts A and B of title XVIII of the So-
cial Security Act; and 
(2) reduce part A and B program expenditures 
for institutional and other providers, practitioners, 
and suppliers of health care items and services. 
(b) INDIVIDUALS WITHIN THE SCOPE OF PILOT.—
(1) IN GENERAL.—The Secretary shall specify, 
in accordance with this subsection, the criteria for 
identifying those individuals who shall be considered 
within the scope of the pilot projects under this sec-
tion for purposes of the incentive payments under 
subsection (c) and for assessment of the effective-
ness of the home health agency in achieving the ob-
jectives of the section. 
(2) PARTICIPATION OF INDIVIDUALS NOT RE-
CEIVING HOME HEALTH SERVICES.—Participation in 
these pilot projects shall not be limited to individuals 
receiving home health services under part A or part 
B of title XVIII of the Social Security Act. 
(c) INCENTIVE PAYMENTS.— 
(1) IN GENERAL.—Subject to paragraph (2), 
the Secretary shall pay to each home health agency 
participating in a pilot project an amount for each 
year under the pilot project equal to at least 50 per-
cent of the reduction in expenditures under such 
parts realized for such year due to the agency’s par-
ticipation in the project. The computation of such 
reduction shall be based on the Secretary’s estimate 
of the amount by which the amount of expenditures 
under such parts for the individuals under the pilot 
project is less than the amount that would have been
expended under such parts for such individuals if 
the project were not implemented. In determining 
the estimate, the Secretary may use estimates for 
expenditures for individuals who are not partici-
pating in the project and who are comparable to in-
dividuals participating in the project. 
(2) LIMITATION ON EXPENDITURES.—The Sec-
retary shall limit incentive payments under this sub-
section as necessary to ensure that the aggregate ex-
penditures under title XVIII of the Social Security 
Act (inclusive of such incentive payments) with re-
spect to patients within the scope of the pilot 
projects do not exceed the amount that the Sec-
retary estimates would be expended under such title 
if the pilot projects under this section were not im-
plemented. 
(d) CONSTRUCTION.—Nothing in this section shall 
limit the amount of payment (other than under subsection 
(c)) a home health agency may receive for home health 
services provided to eligible individuals under part A or 
part B of title XVIII of the Social Security Act. 
(e) IMPLEMENTATION DATE.—The Secretary shall 
implement the pilot projects authorized by this section no 
later than nine months after the date of the enactment 
of this Act.
(f) EXPANSION OF THE PILOT PROJECT.—If the Sec-
retary determines that any of the pilot projects— 
(1) result in a decrease in Federal expenditures 
under title XVIII of the Social Security Act; and 
(2) maintain or enhance health outcomes for 
the participating beneficiaries, 
the Secretary may initiate or extend comparable projects 
in additional areas. 
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