190 
can inform the use of telehealth in the Medicare 
program under title XVIII of the Social Secu-
rity Act (42 U.S.C. 1395 et seq.). 
(B) Issues that can facilitate or inhibit the 
use of telehealth under the Medicare program 
under such title, including oversight and profes-
sional licensure, changing technology, privacy 
and security, infrastructure requirements, and 
varying needs across urban and rural areas. 
(C) Potential implications of greater use of 
telehealth with respect to payment and delivery 
system transformations under the Medicare 
program under such title XVIII and the Med-
icaid program under title XIX of such Act (42 
U.S.C. 1396 et seq.). 
(D) How the Centers for Medicare & Med-
icaid Services conducts oversight of payments 
made under the Medicare program under such 
title XVIII to providers for telehealth services. 
(2) STUDY ON REMOTE PATIENT MONITORING 
SERVICES.— 
(A) IN GENERAL.—The Comptroller Gen-
eral of the United States shall conduct a 
study—
191 
(i) of the dissemination of remote pa-
tient monitoring technology in the private 
health insurance market; 
(ii) of the financial incentives in the 
private health insurance market relating to 
adoption of such technology; 
(iii) of the barriers to adoption of 
such services under the Medicare program 
under title XVIII of the Social Security 
Act; 
(iv) that evaluates the patients, condi-
tions, and clinical circumstances that could 
most benefit from remote patient moni-
toring services; and 
(v) that evaluates the challenges re-
lated to establishing appropriate valuation 
for remote patient monitoring services 
under the Medicare physician fee schedule 
under section 1848 of the Social Security 
Act (42 U.S.C. 1395w–4) in order to accu-
rately reflect the resources involved in fur-
nishing such services. 
(B) DEFINITIONS.—For purposes of this 
paragraph:
192 
(i) REMOTE
PATIENT
MONITORING 
SERVICES.—The term ‘‘remote patient 
monitoring services’’ means services fur-
nished through remote patient monitoring 
technology. 
(ii) REMOTE
PATIENT
MONITORING 
TECHNOLOGY.—The term ‘‘remote patient 
monitoring technology’’ means a coordi-
nated system that uses one or more home- 
based or mobile monitoring devices that 
automatically transmit vital sign data or 
information on activities of daily living and 
may include responses to assessment ques-
tions collected on the devices wirelessly or 
through a telecommunications connection 
to a server that complies with the Federal 
regulations (concerning the privacy of indi-
vidually identifiable health information) 
promulgated under section 264(c) of the 
Health Insurance Portability and Account-
ability Act of 1996, as part of an estab-
lished plan of care for that patient that in-
cludes the review and interpretation of that 
data by a health care professional.
193 
(3) REPORTS.—Not later than 24 months after 
the date of the enactment of this Act, the Comp-
troller General shall submit to Congress— 
(A) a report containing the results of the 
study conducted under paragraph (1); and 
(B) a report containing the results of the 
study conducted under paragraph (2). 
A report required under this paragraph shall be sub-
mitted together with recommendations for such leg-
islation and administrative action as the Comptroller 
General determines appropriate. The Comptroller 
General may submit one report containing the re-
sults described in subparagraphs (A) and (B) and 
the recommendations described in the previous sen-
tence. 
(e) 
RULE
OF
CONSTRUCTION
REGARDING 
HEALTHCARE PROVIDER STANDARDS OF CARE.— 
(1) MAINTENANCE
OF
STATE
STANDARDS.— 
The development, recognition, or implementation of 
any guideline or other standard under any Federal 
health care provision shall not be construed— 
(A) to establish the standard of care or 
duty of care owed by a health care provider to 
a patient in any medical malpractice or medical 
product liability action or claim; or
194 
(B) to preempt any standard of care or 
duty of care, owed by a health care provider to 
a patient, duly established under State or com-
mon law. 
(2) DEFINITIONS.—For purposes of this sub-
section: 
(A) FEDERAL HEALTH CARE PROVISION.— 
The term ‘‘Federal health care provision’’ 
means any provision of the Patient Protection 
and Affordable Care Act (Public Law 111– 
148), title I or subtitle B of title II of the 
Health Care and Education Reconciliation Act 
of 2010 (Public Law 111–152), or title XVIII 
or XIX of the Social Security Act. 
(B) HEALTH CARE PROVIDER.—The term 
‘‘health care provider’’ means any individual or 
entity— 
(i) licensed, registered, or certified 
under Federal or State laws or regulations 
to provide health care services; or 
(ii) required to be so licensed, reg-
istered, or certified but that is exempted 
by other statute or regulation. 
(C) MEDICAL MALPRACTICE OR MEDICAL 
PRODUCT
LIABILITY
ACTION
OR
CLAIM.—The
195 
term ‘‘medical malpractice or medical product 
liability action or claim’’ means a medical mal-
practice action or claim (as defined in section 
431(7) of the Health Care Quality Improve-
ment Act of 1986 (42 U.S.C. 11151(7))) and 
includes a liability action or claim relating to a 
health care provider’s prescription or provision 
of a drug, device, or biological product (as such 
terms are defined in section 201 of the Federal 
Food, Drug, and Cosmetic Act or section 351 
of the Public Health Service Act). 
(D) STATE.—The term ‘‘State’’ includes 
the District of Columbia, Puerto Rico, and any 
other commonwealth, possession, or territory of 
the United States. 
(3) PRESERVATION OF STATE LAW.—No provi-
sion of the Patient Protection and Affordable Care 
Act (Public Law 111–148), title I or subtitle B of 
title II of the Health Care and Education Reconcili-
ation Act of 2010 (Public Law 111–152), or title 
XVIII or XIX of the Social Security Act shall be 
construed to preempt any State or common law gov-
erning medical professional or medical product liabil-
ity actions or claims.
196 
SEC. 10. DELAY IN IMPLEMENTATION OF PENALTY FOR 
FAILURE 
TO 
COMPLY 
WITH 
INDIVIDUAL 
HEALTH INSURANCE MANDATE. 
(a) IN GENERAL.—Section 5000A(c) of the Internal 
Revenue Code of 1986 is amended by adding at the end 
the following new paragraph: 
‘‘(5) DELAY
IN
IMPLEMENTATION
OF
PEN-
ALTY.—Notwithstanding any other provision of this 
subsection, the monthly penalty amount with respect 
to any taxpayer for any month beginning before 
January 1, 2019, shall be zero.’’. 
(b) DELAY OF CERTAIN PHASE INS AND INDEX-
ING.— 
(1) PHASE IN OF PERCENTAGE OF INCOME LIM-
ITATION.—Section 5000A(c)(2)(B) of such Code is 
amended— 
(A) by striking ‘‘2014’’ in clause (i) and 
inserting ‘‘2019’’, and 
(B) by striking ‘‘2015’’ in clauses (ii) and 
(iii) and inserting ‘‘2020’’. 
(2) 
PHASE
IN
OF
APPLICABLE
DOLLAR 
AMOUNT.—Section 5000A(c)(3)(B) of such Code is 
amended— 
(A) by striking ‘‘2014’’ and inserting 
‘‘2019’’, and
197 
(B) by striking ‘‘2015’’ (before amendment 
by subparagraph (A)) and inserting ‘‘2020’’. 
(3) 
INDEXING
OF
APPLICABLE
DOLLAR 
AMOUNT.—Section 5000A(c)(3)(D) of such Code is 
amended— 
(A) by striking ‘‘2016’’ in the matter pre-
ceding clause (i) and inserting ‘‘2021’’, and 
(B) by striking ‘‘2015’’ in clause (ii) and 
inserting ‘‘2020’’. 
(4) INDEXING
OF
EXEMPTION
BASED
ON 
HOUSEHOLD
INCOME.—Section 5000A(e)(1)(D) of 
such Code is amended— 
(A) by striking ‘‘2014’’ (before amendment 
by subparagraph (B)) and inserting ‘‘2019’’, 
and 
(B) by striking ‘‘2013’’ and inserting 
‘‘2018’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to months beginning after Decem-
ber 31, 2013. 
Passed the House of Representatives March 14, 
2014. 
Attest: 
Clerk.
113TH CONGRESS 
2D SESSION 
H. R. 4015 
AN ACT 
To amend title XVIII of the Social Security Act to 
repeal the Medicare sustainable growth rate and 
improve Medicare payments for physicians and 
other professionals, and for other purposes.