I 
113TH CONGRESS 
1ST SESSION H. R. 3306 
To promote and expand the application of telehealth under Medicare and 
other Federal health care programs, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 22, 2013 
Mr. HARPER (for himself, Mr. THOMPSON of California, Mr. NUNES, and Mr. 
WELCH) 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 promote and expand the application of telehealth under 
Medicare and other Federal health care programs, 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 
‘‘Telehealth Enhancement Act of 2013’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
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TITLE I—STRENGTHENING MEDICARE THROUGH TELEHEALTH 
Sec. 101. Positive incentive for Medicare’s hospital readmissions reduction pro-
gram. 
Sec. 102. Health homes and medical homes. 
Sec. 103. Flexibility in accountable care organizations coverage of telehealth. 
Sec. 104. Recognizing telehealth services and remote patient monitoring in na-
tional pilot program on payment bundling. 
Sec. 105. Additional sites to be considered originating sites for purposes of pay-
ments for telehealth services under Medicare. 
TITLE II—ENHANCING MEDICAID THROUGH TELEHEALTH 
Sec. 201. Medicaid option for high-risk pregnancies and births. 
TITLE III—IMPROVING TELECOMMUNICATIONS FOR MEDICAL 
DELIVERY 
Sec. 301. Additional providers considered health care providers for purposes of 
universal service support. 
Sec. 302. No consideration of provider location in rules enhancing health care 
provider access to advanced telecommunications and informa-
tion services. 
TITLE 
I—STRENGTHENING 
MEDICARE THROUGH TELE-
HEALTH 
SEC. 101. POSITIVE INCENTIVE FOR MEDICARE’S HOSPITAL 
READMISSIONS REDUCTION PROGRAM. 
Section 1886(q) of the Social Security Act (42 U.S.C. 
1395ww(q)) is amended by adding at the end the following 
new paragraph: 
‘‘(9) POSITIVE INCENTIVE FOR REDUCED RE-
ADMISSIONS.— 
‘‘(A) IN GENERAL.—With respect to pay-
ment for discharges occurring during a fiscal 
year beginning on or after October 1, 2014, in 
order to provide a positive incentive for hos-
pitals described in subparagraph (B) to lower 
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their excess readmission ratios, the Secretary 
shall make an additional payment to a hospital 
in such proportion as provides for a sharing of 
the savings from such better-than-expected per-
formance between the hospital and the program 
under this title. 
‘‘(B) HOSPITAL
DESCRIBED.—A hospital 
described in this subparagraph is an applicable 
hospital (as defined in paragraph (5)(C)) not 
subject to a payment change under paragraph 
(1) and for which the positive readmission ratio 
(described in subparagraph (C)) is greater than 
1. 
‘‘(C) POSITIVE READMISSION RATIO.—The 
positive readmission ratio described in this sub-
paragraph for a hospital is the ratio of— 
‘‘(i) the risk adjusted expected re-
admissions (described in subclause (II) of 
paragraph (4)(C)(i)); to 
‘‘(ii) the risk adjusted readmissions 
based on actual readmissions (described in 
subclause (I) of such paragraph).’’. 
SEC. 102. HEALTH HOMES AND MEDICAL HOMES. 
(a) MEDICARE CHRONIC CARE COUNTERPART TO 
MEDICAID ‘‘HEALTH HOME’’.— 
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(1) IN GENERAL.—Title XVIII of the Social Se-
curity Act is amended by adding at the end the fol-
lowing new section: 
‘‘SEC. 1899B. MEDICARE HEALTH HOME FOR INDIVIDUALS 
WITH CHRONIC CONDITIONS. 
‘‘(a) IN GENERAL.—In the case of a State that has 
amended its State plan under title XIX in accordance with 
the option described in section 1945, the Secretary may 
contract with the State medical assistance agency with a 
program under such section to serve eligible individuals 
with chronic conditions who select a designated provider, 
a team of health care professionals operating with such 
a provider, or a health team as the individual’s health 
home for purposes of providing the individual with health 
home services in the same manner as provided under its 
State plan amendment. 
‘‘(b) HEALTH HOME QUALIFICATION STANDARDS.— 
The standards established by the Secretary under section 
1945(b) for qualification as a designated provider shall 
apply under this section for the purpose of being eligible 
to be a health home for purposes of section 1945. 
‘‘(c) PAYMENTS.—Payments shall be made under this 
section in the same manner to a provider or team as pay-
ments are made under subsection (c) of section 1945, in-
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cluding the use of the payment methodology described in 
paragraph (2) of such subsection. 
‘‘(d) HOSPITAL REFERRALS.—Hospitals that are 
participating providers under this section shall establish 
procedures for referring any eligible individuals with 
chronic conditions who seek or need treatment in a hos-
pital emergency department to designated providers in the 
same manner as required under section 1945(d). 
‘‘(e) MONITORING AND REPORT ON QUALITY.—The 
methodology and proposal required under subsection (f) 
of section 1945 and the report on quality measures under 
subsection (f) of such section shall also apply under this 
section. 
‘‘(f) REPORT ON QUALITY MEASURES.—As a condi-
tion for receiving payment for health home services pro-
vided to an eligible individual with chronic conditions, a 
designated provider shall report, in accordance with such 
requirements as the Secretary shall specify, including a 
plan for the use of remote patient monitoring, on all appli-
cable measures for determining the quality of such serv-
ices. When appropriate and feasible, a designated provider 
shall use health information technology in providing the 
Secretary with such information. 
‘‘(g) DEFINITIONS.—In this section, the provisions 
and definitions contained in subsection (h) of section 1945 
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shall also apply for purposes of this section except that, 
instead of the requirement specified in clause (i) of sub-
section (h)(1)(A) of such section, an individual must be 
eligible for services under parts A and B and covered for 
medical assistance for health home services under section 
1945 in order to be an eligible individual with chronic con-
ditions. 
‘‘(h) EVIDENCE-BASED AND REPORTING.—In con-
tracting with a State under this section, the State— 
‘‘(1) shall follow evidence-based guidelines for 
chronic care; and 
‘‘(2) shall report at least by the end of every 
month data specified by the Secretary, including an 
assessment of the use of remote patient monitoring 
and quality measures of process, outcome, and struc-
ture. 
‘‘(i) 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.’’. 
(2) REPORTING.— 
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(A) IN GENERAL.—Not later than 2 years 
after the date of the enactment of this Act, the 
Secretary of Health and Human Services shall 
survey States contracting under section 1899B 
of the Social Security Act, as added by para-
graph (1), on the nature, extent, and use of the 
option under such section particularly as it per-
tains to— 
(i) hospital admission rates; 
(ii) chronic disease management; 
(iii) coordination of care for individ-
uals with chronic conditions; 
(iv) assessment of program implemen-
tation; 
(v) processes and lessons learned (as 
described in subparagraph (B)); 
(vi) assessment of quality improve-
ments and clinical outcomes under such 
option; and 
(vii) estimates of cost savings. 
(B) IMPLEMENTATION REPORTING.—Such 
a State shall report to the Secretary, as nec-
essary, on processes that have been developed 
and lessons learned regarding provision of co-
ordinated care through a health home for bene-
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ficiaries with chronic conditions under such op-
tion. 
(b) SPECIALTY MEDICAL HOMES.—Title XVIII of 
the Social Security Act, as amended by subsection (a), is 
further amended by adding at the end the following new 
section: 
‘‘SEC. 1899C. SPECIALTY MEDICAL HOMES. 
‘‘(a) IN GENERAL.—Beginning not later than 30 
days after the date of the enactment of this section, the 
Secretary may contract with a national or multi-state re-
gional center of excellence with a network of affiliated 
local providers to provide through one or more medical 
homes for targeted, accessible, continuous, and coordi-
nated care to individuals under this title and title XIX 
with a long-term illness or medical condition that requires 
regular medical treatment, advising, and monitoring. 
‘‘(b) MEDICAL HOME DEFINED.—In this section, the 
term ‘medical home’ means a medical entity that— 
‘‘(1) specializes in the care for a specific long- 
term illness or medical condition, including related 
comorbidities; 
‘‘(2) leads the development of related evidence- 
based clinical standards and research; 
‘‘(3) has a network of affiliated personal physi-
cians and patient treatment facilities; 
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‘‘(4) maintains an online Web site for patient 
and provider communication and collaboration and 
patient access to the patient’s health information; 
‘‘(5) has a plan for use of health information 
technology in providing services under this section 
and improving service delivery and coordination 
across the care continuum (including the use of 
wireless patient technology to improve coordination 
and remote patient monitoring management of care 
and patient adherence to recommendations made by 
their provider); 
‘‘(6) provides deidentified demographic data 
sets for clinical, statistical, and social science re-
search to develop culturally competent best practices 
and clinical decision support mechanisms for the 
long-term illness or medical condition; 
‘‘(7) uses a health assessment tool for the indi-
viduals targeted, including a means for identifying 
those most likely to benefit from remote patient 
monitoring; and 
‘‘(8) provides training programs for personnel 
involved in the coordination of care. 
‘‘(c) PERSONAL PHYSICIAN DEFINED.— 
‘‘(1) IN GENERAL.—In this section, the term 
‘personal physician’ means a physician (as defined in 
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section 1861(r)(1)) who meets the requirements de-
scribed in paragraphs (2) and (3). Nothing in this 
paragraph shall be construed as preventing a per-
sonal physician from being a specialist or sub-
specialist for an individual requiring ongoing care 
for a specific chronic condition or multiple chronic 
conditions or for an individual with a long-term ill-
ness or medical condition. 
‘‘(2) GENERAL REQUIREMENTS.—The require-
ments described in this paragraph for a personal 
physician for care of an individual are as follows: 
‘‘(A) The physician is board certified for 
care of the specific illness or condition of the in-
dividual and manages continuous care for the 
individual. 
‘‘(B) The physician has the staff and re-
sources to manage the comprehensive and co-
ordinated health care of such individual. 
‘‘(3) SERVICE-RELATED REQUIREMENTS.—The 
requirements described in this paragraph for a per-
sonal physician are as follows: 
‘‘(A) The personal physician advocates for 
and provides ongoing support, oversight, and 
guidance to implement a plan of care that pro-
vides an integrated, coherent, cross-discipline 
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‘‘(3) BIRTHING NETWORK SERVICES.— 
‘‘(A) IN
GENERAL.—The term ‘birthing 
network services’ means comprehensive and 
timely high-quality services described in sub-
paragraph (B) that are provided by a des-
ignated provider, a team of health care profes-
sionals operating with such a provider, or a 
health team and are identified in a provider 
registry. 
‘‘(B) SERVICES DESCRIBED.—The services 
described in this subparagraph are— 
‘‘(i) comprehensive care coordination; 
‘‘(ii) health promotion; 
‘‘(iii) a call center to offer 24-hour 
physician support for consultations with 
maternal-fetal medicine specialists, when 
requested, regarding patient management 
issues; 
‘‘(iv) newborn screening, including for 
heart defects and to reduce newborn hos-
pital readmissions; 
‘‘(v) patient and family support (in-
cluding authorized representatives); 
‘‘(vi) referral to community and social 
support services, if relevant; and 
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