I 
110TH CONGRESS 
2D SESSION 
H. R. 6163 
To improve the provision of telehealth services under the Medicare Program, 
to provide grants for the development of telehealth networks, and for 
other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 22, 2008 
Mr. THOMPSON of California (for himself, Mr. STUPAK, Mr. HULSHOF, and 
Ms. ESHOO) 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 improve the provision of telehealth services under the 
Medicare Program, to provide grants for the development 
of telehealth networks, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Medicare Telehealth Enhancement Act of 2008’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
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Sec. 1. Short title; table of contents. 
TITLE I—MEDICARE PROGRAM 
Sec. 101. Expansion and improvement of telehealth services. 
Sec. 102. Increase in number of types of originating sites; clarification. 
Sec. 103. Facilitating the provision of telehealth services across State lines. 
Sec. 104. Access to telehealth services in the home. 
Sec. 105. Coverage of home health remote patient management services for cer-
tain chronic health conditions. 
Sec. 106. Remote patient management services for chronic health conditions. 
Sec. 107. Definition of Medicare program. 
TITLE II—HRSA GRANT PROGRAM 
Sec. 201. Grant program for the development of telehealth networks. 
Sec. 202. Reauthorization of telehealth network and telehealth resource centers 
grant programs. 
TITLE I—MEDICARE PROGRAM 
SEC. 101. EXPANSION AND IMPROVEMENT OF TELEHEALTH 
SERVICES. 
(a) EXPANDING ACCESS TO TELEHEALTH SERVICES 
TO ALL AREAS.—Section 1834(m) of the Social Security 
Act (42 U.S.C. 1395m(m)) is amended in paragraph 
(4)(C)(i) by striking ‘‘and only if such site is located’’ and 
all that follows and inserting ‘‘without regard to the geo-
graphic area where the site is located.’’. 
(b) REPORT TO CONGRESS ON STORE AND FORWARD 
TECHNOLOGY.— 
(1) STUDY.—The Secretary of Health and 
Human Services, acting through the Director of the 
Office for the Advancement of Telehealth, shall con-
duct a study on the use of store and forward tech-
nologies (that provide for the asynchronous trans-
mission of health care information in single or multi-
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media formats) in the provision of telehealth services 
for which payment may be made under the Medicare 
program in Alaska and Hawaii and in other States. 
Such study shall include an assessment of the feasi-
bility, advisability, and the costs of expanding the 
use of such technologies to other areas for use in the 
diagnosis and treatment of certain conditions. 
(2) REPORT.—Not later than 18 months after 
the date of the enactment of this Act, the Secretary 
shall submit to Congress a report on the study con-
ducted under subparagraph (A) and shall include in 
such report such recommendations for legislation or 
administration action as the Secretary determines 
appropriate. 
SEC. 102. INCREASE IN NUMBER OF TYPES OF ORIGI-
NATING SITES; CLARIFICATION. 
(a) INCREASE.—Paragraph (4)(C)(ii) of section 
1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) 
is amended by adding at the end the following new sub-
clauses: 
‘‘(VI) A skilled nursing facility 
(as defined in section 1819(a)). 
‘‘(VII) A renal dialysis facility. 
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‘‘(VIII) A county mental health 
clinic or other publicly funded mental 
health facility.’’. 
(b) CLARIFICATION OF INTENT OF THE TERM ORIGI-
NATING SITE.—Such section is further amended by add-
ing at the end the following new paragraph: 
‘‘(5) CONSTRUCTION.—In applying the term 
‘originating site’ under this subsection, the Secretary 
shall apply the term only for the purpose of deter-
mining whether a site is eligible to receive a facility 
fee. Nothing in the application of that term under 
this subsection shall be construed as affecting the 
ability of an eligible practitioner to submit claims for 
telehealth services that are provided to other sites 
that have telehealth systems and capabilities.’’. 
SEC. 103. FACILITATING THE PROVISION OF TELEHEALTH 
SERVICES ACROSS STATE LINES. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall, in coordination with physicians, 
health care practitioners, patient advocates, and rep-
resentatives of States, encourage and facilitate the adop-
tion of State reciprocity agreements for practitioner licen-
sure in order to expedite the provision across State lines 
of telehealth services. 
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(b) REPORT.—Not later than 18 months after the 
date of the enactment of this Act, the Secretary of Health 
and Human Services shall submit to Congress a report 
on the actions taken to carry out subsection (a). 
(c) DEFINITIONS.—In subsection (a): 
(1) TELEHEALTH
SERVICE.—The term ‘‘tele-
health service’’ has the meaning given that term in 
subparagraph (F) of section 1834(m)(4) of the So-
cial Security Act (42 U.S.C. 1395m(m)(4)). 
(2) STATE.—The term ‘‘State’’ has the mean-
ing given that term for purposes of title XVIII of 
such Act. 
SEC. 104. 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: 
‘‘(f) 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— 
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‘‘(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-
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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. 
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‘‘(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, 2009. The Secretary of Health and 
Human Services shall develop and implement cri-
teria and standards under section 1895(f)(3) of the 
Social Security Act, as amended by subsection (a), 
by no later than July 1, 2009. 
(2) In the event that the Secretary has not 
complied with these deadlines, beginning October 1, 
2009, 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(f) of such Act with the aggregate of tele-
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communication encounters in a 24-hour period con-
sidered the equivalent of one in-person visit. 
SEC. 105. COVERAGE OF HOME HEALTH REMOTE PATIENT 
MANAGEMENT 
SERVICES 
FOR 
CERTAIN 
CHRONIC HEALTH CONDITIONS. 
(a) IN GENERAL.—Section 1861(s)(2) of the Social 
Security Act (42 U.S.C. 1395x(s)(2)), as amended by sec-
tion 4(a)(1), is further amended— 
(1) in subparagraph (AA), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (BB), by inserting ‘‘and’’ 
at the end; and 
(3) by inserting after subparagraph (BB) the 
following new subparagraph: 
‘‘(CC) home health remote patient man-
agement services (as defined in subsection 
(eee));’’. 
(b) SERVICES DESCRIBED.—Section 1861 of the So-
cial Security Act (42 U.S.C. 1395x), as amended by sec-
tion 4(a)(2), is further amended by adding at the end the 
following new subsection: 
‘‘Home Health Remote Patient Management Services for 
Certain Chronic Conditions 
‘‘(eee)(1) The term ‘home health remote patient man-
agement services’ means the remote monitoring, evalua-
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tion, and management of an individual with a covered 
chronic health condition (as defined in paragraph (2)) 
through the utilization of a system of technology that al-
lows a remote interface to collect and transmit clinical 
data between the individual and a home health agency, 
in accordance with a plan of care established by a physi-
cian, for purposes of clinical review or response by the 
home health agency. Such term, with respect to an indi-
vidual, does not include any remote monitoring, evalua-
tion, or management of the individual if such remote mon-
itoring, evaluation, or management, respectively, is in-
cluded as a home health visit under section 1895(e) for 
purposes of payment under this title. 
‘‘(2) For purposes of paragraph (1), the term ‘cov-
ered chronic health condition’ means— 
‘‘(A) a covered chronic health condition, as de-
fined under section 1861(ddd)(2); and 
‘‘(B) any other chronic health condition speci-
fied by the Secretary.’’. 
(c) PAYMENT.— 
(1) IN GENERAL.—Section 1834 of the Social 
Security Act (42 U.S.C. 1395l) is amended by add-
ing at the end the following new subsection: 
‘‘(n) HOME HEALTH REMOTE PATIENT MANAGE-
MENT SERVICES.— 
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‘‘(1) IN GENERAL.—The Secretary shall estab-
lish a fee schedule for home health remote patient 
management 
services 
(as 
defined 
in 
section 
1861(eee)) for which payment is made under this 
part. The fee schedule shall be designed in a manner 
so that, on an annual basis, the aggregate payment 
amounts under this title for such services approxi-
mates 50 percent of the savings amount described in 
paragraph (2) for such year. 
‘‘(2) SAVINGS DESCRIBED.— 
‘‘(A) IN GENERAL.—For purposes of para-
graph (1), the savings amount described in this 
paragraph for a year is the amount (if any), as 
estimated by the Secretary before the beginning 
of the year, by which— 
‘‘(i) the product described in subpara-
graph (B) for the year, exceeds 
‘‘(ii) the total payments under this 
part and part A for items and services fur-
nished to individuals receiving home health 
remote patient management services at any 
time during the year. 
‘‘(B) PRODUCT DESCRIBED.—The product 
described in this subparagraph for a year is the 
product of— 
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‘‘(i) the average per capita total pay-
ments under this part and part A for items 
and services furnished during the year to 
individuals not described in subparagraph 
(A)(ii), adjusted to remove case mix dif-
ferences between such individuals not de-
scribed in such subparagraph and the indi-
viduals described in such subparagraph; 
and 
‘‘(ii) the number of individuals under 
subparagraph (A)(ii) for the year. 
‘‘(3) LIMITATION.—In no case may payments 
under this subsection result in the aggregate expend-
itures under this title (including payments under 
this subsection) exceeding the amount that the Sec-
retary estimates would have been expended if cov-
erage under this title for home health patient man-
agement services was not provided. 
‘‘(4) CLARIFICATION.—Payments under the fee 
schedule under this subsection, with respect to an 
individual, shall be in addition to any other pay-
ments that a home health agency would otherwise 
receive under this title for items and services fur-
nished to such individual and shall have no effect on 
the amount of such other payments. 
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‘‘(5) PAYMENT
TRANSFER.—There shall be 
transferred from the Federal Hospital Insurance 
Trust Fund under section 1817 to the Federal Sup-
plementary Medical Insurance Trust Fund under 
section 1841 each year an amount equivalent to the 
product of— 
‘‘(A) expenditures under this subsection 
for the year, and 
‘‘(B) the ratio of the portion of the savings 
described in paragraph (2) for the year that are 
attributable to part A, to the total savings de-
scribed in such paragraph for the year.’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
1833(a)(1) of such Act (42 U.S.C. 1395l(1)) is 
amended— 
(A) by striking ‘‘and (V)’’ and inserting 
‘‘(V)’’; and 
(B) by inserting before the semicolon at 
the end the following: ‘‘, and (W) with respect 
to home health remote patient management 
services (as defined in section 1861(eee)), the 
amounts paid shall be the amount determined 
under the fee schedule established under section 
1834(n)’’. 
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(d) EXPANSION OF HOME HEALTH REMOTE PA-
TIENT MANAGEMENT SERVICES COVERAGE
TO ADDI-
TIONAL CHRONIC HEALTH CONDITIONS.—The Secretary 
of Health and Human Services is authorized to carry out 
pilot projects for purposes of determining the extent to 
which the coverage under title XVIII of the Social Security 
Act of home health remote patient management services 
(as defined in paragraph (1) of section 1861(eee) of such 
Act, as added by subsection (b)) should be extended to 
individuals with chronic health conditions other than those 
described in paragraph (2)(A) of such section. 
(e) EFFECTIVE DATE.—The amendments made by 
subsections (a), (b), and (c) shall apply to services fur-
nished on or after January 1, 2010. 
SEC. 106. REMOTE PATIENT MANAGEMENT SERVICES FOR 
CHRONIC HEALTH CONDITIONS. 
(a) COVERAGE OF REMOTE PATIENT MANAGEMENT 
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 (Z), by striking 
‘‘and’’ at the end; 
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(B) in subparagraph (AA), by inserting 
‘‘and’’ at the end; and 
(C) by inserting after subparagraph (AA) 
the following new subparagraph: 
‘‘(BB) remote patient management services (as 
defined in subsection (ddd));’’. 
(2) SERVICES
DESCRIBED.—Section 1861 of 
the Social Security Act (42 U.S.C. 1395x), as 
amended by section 114(a) of the Medicare, Med-
icaid, and SCHIP Extension Act of 2007 (Public 
Law 110–173), is amended by adding at the end the 
following new subsection: 
‘‘(ddd) REMOTE PATIENT MANAGEMENT SERVICES 
FOR CHRONIC HEALTH CONDITIONS.—(1) The term ‘re-
mote patient management services’ means the remote 
monitoring, evaluation, and management of an individual 
with a covered chronic health condition (as defined in 
paragraph (2)), insofar as such monitoring, evaluation, 
and management is with respect to such condition, 
through the utilization of a system of technology that al-
lows a remote interface to collect and transmit clinical 
data between the individual and the responsible physician 
(as defined in subsection (r)) or supplier (as defined in 
subsection (d)) for the purposes of clinical review or re-
sponse by the physician or supplier. 
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‘‘(2) For purposes of paragraph (1), the term ‘cov-
ered chronic health condition’ means— 
‘‘(A) heart failure; and 
‘‘(B) cardiac arrhythmia. 
‘‘(3)(A) Not later than January 1, 2010, the Sec-
retary, in consultation with appropriate physician and sup-
plier groups, shall develop guidelines on the frequency of 
billing for remote patient management services. Such 
guidelines shall be determined based on medical necessity 
and shall be sufficient to ensure appropriate and timely 
monitoring of individuals being furnished such services. 
‘‘(B) The Secretary shall do the following: 
‘‘(i) Not later than 2 years after the date of the 
enactment of this subsection, develop, in consulta-
tion with appropriate physician and supplier groups, 
standards (governing such matters as qualifications 
of personnel and the maintenance of equipment) for 
remote patient management services for the covered 
chronic health conditions specified in subparagraphs 
(A) and (B) of paragraph (2). 
‘‘(ii) Periodically review and update such stand-
ards under this subparagraph as necessary.’’. 
(3) PAYMENT
UNDER
THE
PHYSICIAN
FEE 
SCHEDULE.—Section 1848 of the Social Security 
Act (42 U.S.C. 1395w–4) is amended— 
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(A) in subsection (c)— 
(i) in paragraph (2)((B)— 
(I) in clause (ii)(II), by striking 
‘‘and (v)’’ and inserting ‘‘(v), (and 
(vi)’’; and 
(II) by adding at the end the fol-
lowing new clause: 
‘‘(vi) BUDGETARY
TREATMENT
OF 
CERTAIN
SERVICES.—The additional ex-
penditures attributable to services de-
scribed in section 1861(s)(2)(BB) shall not 
be taken into account in applying clause 
(ii)(II) for 2010.’’; and 
(ii) by adding at the end the following 
new paragraph: 
‘‘(7) TREATMENT OF REMOTE PATIENT MAN-
AGEMENT SERVICES.— 
‘‘(A) In determining relative value units 
for remote patient management services (as de-
fined in section 1861(ddd)), the Secretary, in 
consultation with appropriate physician groups, 
shall take into consideration— 
‘‘(i) physician resources, including 
physician time and the level of intensity of 
services provided, based on— 
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‘‘(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 
‘‘(III) the number of possible di-
agnoses and the number of manage-
ment options that must be considered; 
and 
‘‘(ii) practice expense costs associated 
with such services, including installation 
and information transmittal costs, costs of 
remote patient management technology 
(including equipment and software), and 
resource costs necessary for patient moni-
toring and follow-up (but not including 
costs of any related item or non-physician 
service otherwise reimbursed under this 
title). 
‘‘(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 
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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 management services.’’; and 
(B) in subsection (j)(3), by inserting 
‘‘(2)(BB)’’ after ‘‘(2)(AA),’’. 
(4) EFFECTIVE DATE.— 
(A) IN GENERAL.—The amendments made 
by this section shall apply to services furnished 
on or after January 1, 2010 without regard to 
whether the guidelines under paragraph (3)(A) 
or the standards under paragraph (3)(B) of 
section 1861(ddd) of the Social Security Act (as 
added by paragraph (2)) have been developed. 
(B) AVAILABILITY OF CODES AS OF JANU-
ARY
1, 2010.—The Secretary of Health and 
Human Services shall— 
(i) promptly evaluate existing codes 
that would be used to bill for remote pa-
tient management services (as defined in 
paragraph (1) of such section 1861(ddd), 
as so added) under title XVIII of the So-
cial Security Act; and 
(ii) if the Secretary determines that 
new codes are necessary to ensure accurate 
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reporting and billing of such services under 
such title, issue such codes so that they are 
available for use as of January 1, 2010. 
(b) DEMONSTRATION PROJECT FOR THE COVERAGE 
OF REMOTE PATIENT MANAGEMENT SERVICES FOR AD-
DITIONAL CHRONIC HEALTH CONDITIONS UNDER THE 
MEDICARE PROGRAM.— 
(1) ESTABLISHMENT.— 
(A) IN GENERAL.—The Secretary shall es-
tablish a demonstration project for the purpose 
of evaluating the impact and benefits of cov-
ering under the Medicare program remote pa-
tient management services for certain chronic 
health conditions. 
(B) CONSULTATION.—In establishing the 
demonstration project, the Secretary shall con-
sult with appropriate physician and supplier 
groups, eligible beneficiaries, and organizations 
representing eligible beneficiaries. 
(C) PARTICIPATION.—Any eligible bene-
ficiary may participate in the demonstration 
project on a voluntary basis. 
(2) 
CONDUCT
OF
THE
DEMONSTRATION 
PROJECT.— 
(A) SITES.— 
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(i) SELECTION
OF
DEMONSTRATION 
SITES.—The Secretary shall conduct the 
demonstration project at 3 sites. 
(ii) GEOGRAPHIC DIVERSITY.—In se-
lecting the sites under clause (i), the Sec-
retary shall ensure that at least 1 of the 
sites is in a rural area. 
(B) IMPLEMENTATION; DURATION.— 
(i) IMPLEMENTATION.—The Secretary 
shall implement the demonstration project 
not later than January 1, 2010. 
(ii) DURATION.—The Secretary shall 
complete the demonstration project by the 
date that is 2 years after the date on 
which the demonstration project is imple-
mented. 
(3) EVALUATION AND REPORT.— 
(A) EVALUATION.—The Secretary shall 
conduct an evaluation of the demonstration 
project— 
(i) to determine improvements in the 
quality of care and utilization of services 
received by eligible beneficiaries partici-
pating in the demonstration project; 
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E:\BILLS\H6163.IH
H6163
smartinez on PROD1PC64 with BILLS