Title: CONNECT for Health Act of 2017
Policy area: Health

Summary:
Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2017 or the CONNECT for Health Act of 2017
This bill makes a series of changes to expand coverage of telehealth services under Medicare, including by exempting certain telehealth services (e.g., specified renal dialysis and stroke evaluation services) from originating site requirements.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 1016 Introduced in Senate (IS)]

<DOC>






115th CONGRESS
  1st Session
                                S. 1016

  To amend title XVIII of the Social Security Act to expand access to 
              telehealth services, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 3, 2017

   Mr. Schatz (for himself, Mr. Wicker, Mr. Cochran, Mr. Cardin, Mr. 
 Thune, and Mr. Warner) introduced the following bill; which was read 
             twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
  To amend title XVIII of the Social Security Act to expand access to 
              telehealth services, and for other purposes.

    Be it enacted by the Senate and House of Representatives 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 ``Creating 
Opportunities Now for Necessary and Effective Care Technologies 
(CONNECT) for Health Act of 2017'' or the ``CONNECT for Health Act of 
2017''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Providing accountable care organizations the ability to expand 
                            the use of telehealth.
Sec. 3. Expanding access to home dialysis therapy.
Sec. 4. Expanding the use of telehealth for individuals with stroke.
Sec. 5. Increasing access to digital tools for Medicare Advantage 
                            enrollees through telehealth and remote 
                            patient monitoring.
Sec. 6. Coverage of remote patient monitoring services furnished to 
                            certain individuals.
Sec. 7. Rural health clinics and Federally qualified health centers.
Sec. 8. Allowing Native American health service facilities as sites 
                            eligible for telehealth payment.
Sec. 9. Clarification regarding telehealth and remote patient 
                            monitoring technologies provided to 
                            beneficiaries.
Sec. 10. Allowing telehealth and remote patient monitoring services to 
                            be included in bundled or global payments.
Sec. 11. Expanding the use of telehealth through the waiver of certain 
                            requirements.
Sec. 12. Expanding the use of telehealth for mental health services.
Sec. 13. HHS evaluation and report on the use of telehealth and remote 
                            patient monitoring under all demonstration 
                            programs and pilots with a telehealth 
                            waiver.
Sec. 14. Testing of models to examine the use of telehealth and remote 
                            patient monitoring under the Medicare 
                            program.
Sec. 15. Sense of Congress regarding the remote practice of medicine.

SEC. 2. PROVIDING ACCOUNTABLE CARE ORGANIZATIONS THE ABILITY TO EXPAND 
              THE USE OF TELEHEALTH.

    (a) In General.--Section 1899 of the Social Security Act (42 U.S.C. 
1395jjj) is amended by adding at the end the following new subsection:
    ``(l) Providing ACOs the Ability To Expand the Use of Telehealth 
Services.--
            ``(1) In general.--
                    ``(A) Expanding use of telehealth services.--In the 
                case of telehealth services for which payment would 
                otherwise be made under this title furnished on or 
                after January 1, 2018, for purposes of this subsection 
                only, the restrictions applicable to the coverage of 
                telehealth services under section 1834(m) described in 
                subparagraph (B) shall not apply with respect to such 
                services furnished to a Medicare fee-for-service 
                beneficiary assigned to an applicable ACO (as defined 
                in paragraph (2)).
                    ``(B) Restrictions described.--For purposes of this 
                subsection, restrictions applicable to the coverage of 
                telehealth services under section 1834(m) shall include 
                requirements relating to qualifications for an 
                originating site under paragraph (4)(C)(ii) of such 
                section, any geographic limitations under paragraph 
                (4)(C)(i) of such section (other than applicable State 
                law requirements, including State licensure 
                requirements), any limitation on the use of store-and-
                forward technologies described in paragraph (1) of such 
                section, any limitation on the type of health care 
                provider who may furnish such services (other than the 
                requirement that the provider is a Medicare-enrolled 
                provider), or any limitation on specific codes 
                designated as telehealth services that are covered 
                under this title pursuant to such section (provided 
                such codes are clinically appropriate to furnish 
                remotely).
            ``(2) Definition of applicable aco.--In this subsection, 
        the term `applicable ACO' means an ACO participating in a model 
        tested or expanded under section 1115A or under this section--
                    ``(A) that operates under a two-sided model--
                            ``(i) described in section 425.600(a) of 
                        title 42, Code of Federal Regulations; or
                            ``(ii) tested or expanded under section 
                        1115A; and
                    ``(B) for which Medicare fee-for-service 
                beneficiaries are assigned to the ACO using a 
                prospective assignment method, as determined 
                appropriate by the Secretary.
            ``(3) No originating site facility fee for new sites.--The 
        Secretary shall not pay an originating site facility fee (as 
        described in paragraph (2)(B) of section 1834(m)) with respect 
        to telehealth services described in paragraph (1) if such 
        services would not have been covered under this title as of the 
        date of enactment of this subsection.
            ``(4) Annual submission of data.--An applicable ACO that 
        furnishes telehealth services described in paragraph (1) shall, 
        on an annual basis, submit to the Secretary information 
        requested by the Secretary for evaluation of the implementation 
        of this subsection, including information on utilization and 
        expenditures for telehealth under this subsection during the 
        preceding year and data on any applicable quality measures, 
        consistent with sections 1848 and 1833(z).''.
    (b) Evaluation and Report.--
            (1) Evaluation.--
                    (A) In general.--The Secretary of Health and Human 
                Services (in this subsection referred to as the 
                ``Secretary'') shall conduct an evaluation on the 
                implementation of section 1899(l) of the Social 
                Security Act, as added by subsection (a). Such 
                evaluation shall include an analysis of the utilization 
                of, and expenditures for, telehealth services under 
                such section, including a comparison of the utilization 
                of, and expenditures for, the same services provided in 
                the office setting.
                    (B) Collection of data.--The Secretary may collect 
                such data as the Secretary determines necessary to 
                carry out the evaluation under this paragraph.
            (2) Report.--Not later than January 1, 2025, the Secretary 
        shall submit to Congress a report containing the results of the 
        evaluation conducted under paragraph (1), together with 
        recommendations for such legislation and administrative action 
        as the Secretary determines appropriate.

SEC. 3. EXPANDING ACCESS TO HOME DIALYSIS THERAPY.

    (a) In General.--Section 1881(b)(3) of the Social Security Act (42 
U.S.C. 1395rr(b)(3)) is amended--
            (1) by redesignating subparagraphs (A) and (B) as clauses 
        (i) and (ii), respectively;
            (2) in clause (ii), as redesignated by subparagraph (A), 
        strike ``on a comprehensive'' and insert ``subject to 
        subparagraph (B), on a comprehensive'';
            (3) by striking ``With respect to'' and inserting ``(A) 
        With respect to''; and
            (4) by adding at the end the following new subparagraph:
    ``(B) For purposes of subparagraph (A)(ii), an individual 
determined to have end stage renal disease receiving home dialysis may 
choose to receive the monthly end stage renal disease-related visits 
furnished on or after January 1, 2018, via telehealth, if the 
individual receives a face-to-face visit, without the use of 
telehealth, at least once every three consecutive months.''.
    (b) Originating Site Requirements.--
            (1) In general.--Section 1834(m) of the Social Security Act 
        (42 U.S.C. 1395m(m)) is amended--
                    (A) in paragraph (4)(C)(ii), by adding at the end 
                the following new subclauses:
                                    ``(IX) A renal dialysis facility, 
                                but only for purposes of section 
                                1881(b)(3)(B).
                                    ``(X) The home of an individual, 
                                but only for purposes of section 
                                1881(b)(3)(B).''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(5) Treatment of home dialysis monthly esrd-related 
        visit.--The geographic requirements described in paragraph 
        (4)(C)(i) shall not apply with respect to telehealth services 
        furnished on or after January 1, 2018, for purposes of section 
        1881(b)(3)(B), at an originating site described in subclause 
        (VI), (IX), or (X) of paragraph (4)(C)(ii)), subject to 
        applicable State law requirements, including State licensure 
        requirements.''.
            (2) No facility fee if originating site for home dialysis 
        therapy is the home.--Section 1834(m)(2)(B) of the Social 
        Security (42 U.S.C. 1395m(m)(2)(B)) is amended--
                    (A) by redesignating clauses (i) and (ii) as 
                subclauses (I) and (II), and indenting appropriately;
                    (B) in subclause (II), as redesignated by 
                subparagraph (A), by striking ``clause (i) or this 
                clause'' and inserting ``subclause (I) or this 
                subclause'';
                    (C) by striking ``site.--With respect to'' and 
                inserting ``site.--
                            ``(i) In general.--Subject to clause (ii), 
                        with respect to''; and
                    (D) by adding at the end the following new clause:
                            ``(ii) No facility fee if originating site 
                        for home dialysis therapy is the home.--No 
                        facility fee shall be paid under this 
                        subparagraph to an originating site described 
                        in paragraph (4)(C)(ii)(X).''.
    (c) Conforming Amendment.--Section 1881(b)(1) of the Social 
Security Act (42 U.S.C. 1395rr(b)(1)) is amended by striking 
``paragraph (3)(A)'' and inserting ``paragraph (3)(A)(i)''.

SEC. 4. EXPANDING THE USE OF TELEHEALTH FOR INDIVIDUALS WITH STROKE.

    Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)), as 
amended by section 3(b), is amended by adding at the end the following 
new paragraph:
            ``(6) Treatment of stroke telehealth services.--
                    ``(A) Nonapplication of originating site 
                requirements.--The requirements described in paragraph 
                (4)(C) shall not apply with respect to telehealth 
                services furnished on or after January 1, 2018, for 
                purposes of evaluation of an acute stroke, as 
                determined by the Secretary, subject to applicable 
                State law requirements, including State licensure 
                requirements.
                    ``(B) No originating site facility fee for new 
                sites.--The Secretary shall not pay an originating site 
                facility fee (as described in paragraph (2)(B)) with 
                respect to telehealth services described in 
                subparagraph (A) if the services would not have been 
                covered under this title as of the date of enactment of 
                this paragraph.''.

SEC. 5. INCREASING ACCESS TO DIGITAL TOOLS FOR MEDICARE ADVANTAGE 
              ENROLLEES THROUGH TELEHEALTH AND REMOTE PATIENT 
              MONITORING.

    (a) In General.--Section 1852 of the Social Security Act (42 U.S.C. 
1395w-22) is amended--
            (1) in subsection (a)(1)(B)(i), by inserting ``, subject to 
        subsection (m),'' after ``means''; and
            (2) by adding at the end the following new subsection:
    ``(m) Provision of Additional Telehealth Benefits and Treatment of 
Remote Patient Monitoring.--
            ``(1) MA plan option.--For plan year 2018 and subsequent 
        plan years, subject to the requirements of paragraph (3), an MA 
        plan may provide additional telehealth benefits (as defined in 
        paragraph (2)) to individuals enrolled under this part.
            ``(2) Additional telehealth benefits defined.--
                    ``(A) In general.--For purposes of this subsection 
                and section 1854:
                            ``(i) Definition.--The term `additional 
                        telehealth benefits' means services for which 
                        benefits are available under part B, 
                        notwithstanding the restrictions applicable to 
                        the coverage of telehealth services under 
                        section 1834(m) described in subparagraph (B).
                            ``(ii) Exclusion of capital and 
                        infrastructure costs and investments.--The term 
                        `additional telehealth benefits' does not 
                        include capital and infrastructure costs and 
                        investments relating to such benefits.
                    ``(B) Restrictions described.--For purposes of this 
                subsection, restrictions applicable to the coverage of 
                telehealth services under section 1834(m) shall include 
                requirements relating to qualifications for an 
                originating site under paragraph (4)(C)(ii) of such 
                section, any geographic limitations under paragraph 
                (4)(C)(i) of such section (other than applicable State 
                law requirements, including State licensure 
                requirements), any limitation on the use of store-and-
                forward technologies described in paragraph (1) of such 
                section, any limitation on the type of health care 
                provider who may furnish such services (other than the 
                requirement that the provider is a Medicare-enrolled 
                provider), or any limitation on specific codes 
                designated as telehealth services that are covered 
                under this title pursuant to such section (provided 
                such codes are clinically appropriate to furnish 
                remotely).
                    ``(C) Public comment.--Not later than November 30, 
                2017, the Secretary shall solicit comments on what 
                types of telehealth services should be considered to 
                meet the definition of additional telehealth benefits 
                under this paragraph.
            ``(3) Requirements for additional telehealth benefits.--The 
        Secretary shall specify requirements for the provision or 
        furnishing of additional telehealth benefits, including with 
        respect to the following:
                    ``(A) Physician, practitioner, or other health care 
                provider licensure consistent with State law and other 
                requirements such as specific training.
                    ``(B) Factors necessary to ensure the coordination 
                of such benefits with items and services furnished in-
                person.
                    ``(C) Such other areas as determined by the 
                Secretary.
            ``(4) Enrollee choice.--If an MA plan provides a service as 
        an additional telehealth benefit (as defined in paragraph (2)), 
        an individual enrollee shall have discretion as to whether to 
        receive such service as an additional telehealth benefit.
            ``(5) Construction regarding network access adequacy.--
        Provision of additional telehealth benefits under this 
        subsection shall not be construed as making such benefits 
        available and accessible for purposes of compliance with 
        subsection (d).
            ``(6) Treatment under ma.--For purposes of this subsection 
        and section 1854, additional telehealth benefits shall be 
        treated as if they were benefits under the original Medicare 
        fee-for-service program option.
            ``(7) Construction.--Nothing in this subsection shall be 
        construed as affecting the requirement under subsection (a)(1) 
        that MA plans provide enrollees with items and services (other 
        than hospice care) for which benefits are available under parts 
        A and B, including benefits available under section 1834(m).
            ``(8) Clarification regarding remote patient monitoring 
        services.--For purposes of this subsection and section 1854, 
        remote patient monitoring services shall be treated as if they 
        were benefits under the original Medicare fee-for-service 
        program option so long as such treatment does not increase the 
        bid amount attributable to such benefits from the amount it 
        would otherwise be, as determined by the Secretary.
            ``(9) Provision of data.--An MA plan that provides 
        additional telehealth benefits or remote patient monitoring 
        services with respect to a plan year shall provide to the 
        Secretary (at such time and in such manner as the Secretary may 
        specify) data on expenditures and utilization for telehealth or 
        remote patient monitoring services under the plan for enrollees 
        during that plan year.''.
    (b) Clarification Regarding Inclusion in Bid Amount.--Section 
1854(a)(6)(A)(ii)(I) of the Social Security Act (42 U.S.C. 1395w-
24(a)(6)(A)(ii)(I)) is amended by inserting ``, including, for plan 
year 2019 and subsequent plan years, the provision of additional 
telehealth benefits and remote patient monitoring as described in 
section 1852(m)'' before the semicolon at the end.

SEC. 6. COVERAGE OF REMOTE PATIENT MONITORING SERVICES FURNISHED TO 
              CERTAIN INDIVIDUALS.

    (a) In General.--Section 1848(b) of the Social Security Act (42 
U.S.C. 1395w-4(b)) is amended by adding at the end the following new 
paragraph:
            ``(12) Coverage of remote patient monitoring services 
        furnished to certain individuals.--
                    ``(A) In general.--The Secretary shall, subject to 
                subparagraph (B), make payment (as the Secretary 
                determines to be appropriate) under this section for 
                remote patient monitoring services (as defined in 
                subparagraph (C)(iii)) furnished on or after January 1, 
                2018, to an applicable individual (as defined in 
                subparagraph (C)(i)) by an eligible provider (as 
                defined in subparagraph (C)(ii)).
                    ``(B) Requirements.--The following shall apply with 
                respect to remote patient monitoring services under 
                this paragraph:
                            ``(i) Coverage of such remote patient 
                        monitoring services shall be in addition to 
                        coverage for chronic care management services 
                        or transitional care management services 
                        furnished to an applicable individual under 
                        this section.
                            ``(ii) The Secretary shall consult with 
                        public and private stakeholders in determining 
                        the amount of payment for remote patient 
                        monitoring services under this section.
                            ``(iii) Payment, pricing, and coverage for 
                        such remote patient monitoring services may 
                        occur through the unbundling, modification, or 
                        establishment of certain codes.
                            ``(iv) Such remote patient monitoring 
                        services (other than those services that are 
                        physicians' services) shall be furnished under 
                        the general supervision of an eligible 
                        provider.
                    ``(C) Definitions.--In this paragraph:
                            ``(i) Applicable individual.--The term 
                        `applicable individual' means an individual--
                                    ``(I) receiving chronic care 
                                management services or transitional 
                                care management services under this 
                                section;
                                    ``(II) who is in the top five 
                                percent of Medicare cost utilization 
                                and has two or more chronic diseases, 
                                as determined on a yearly basis by the 
                                Secretary; or
                                    ``(III) who has any other condition 
                                or with respect to an episode of care 
                                that the Secretary may specify, so long 
                                as the Chief Actuary of the Centers for 
                                Medicare & Medicaid Services certifies 
                                that providing coverage for remote 
                                patient monitoring services with 
                                respect to such individuals would--
                                            ``(aa) reduce spending 
                                        under this title without 
                                        reducing the quality of care; 
                                        or
                                            ``(bb) improve the quality 
                                        of patient care without 
                                        increasing spending.
                            ``(ii) Eligible provider.--The term 
                        `eligible provider' means a physician (as 
                        defined in section 1861(r)) or a practitioner 
                        described in section 1842(b)(18)(C).
                            ``(iii) Remote patient monitoring 
                        services.--The term `remote patient monitoring 
                        services' means clinical data transmitted from 
                        an applicable individual in one location via 
                        electronic communications technologies that are 
                        devices as defined in section 201(h) of the 
                        Federal Food, Drug, and Cosmetic Act to an 
                        eligible provider in a different location and 
                        used by the eligible provider in furnishing 
                        such services to such individual that complies 
                        with the Federal regulations (concerning the 
                        privacy and security of individually 
                        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 the 
                        applicable individual that includes the review 
                        and interpretation of that data by an eligible 
                        provider. Such term includes those services 
                        furnished in a Federally qualified health 
                        center or a rural health clinic. Such term 
                        shall not include a communication that consists 
                        solely of a telephone audio conversation, 
                        facsimile, or electronic text message between 
                        an eligible provider and the applicable 
                        individual.''.
    (b) Expanding the Use of Remote Patient Monitoring Services Under 
Alternative Payment Models.--Section 1848(b)(12) of the Social Security 
Act (42 U.S.C. 1395w-4(b)(12)), as added by subsection (a), is amended 
by adding at the end the following new subparagraph:
                    ``(D) Application to alternative payment models.--
                For purposes of applying this paragraph with respect to 
                remote patient monitoring services furnished by an 
                eligible provider participating in an alternative 
                payment model (as defined in section 1833(z)(3)(C)), 
                the term `applicable individual' shall mean any 
                beneficiary assigned to the alternative payment 
                model.''.

SEC. 7. RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS.

    (a) Expansion of Originating Sites.--Section 1834(m)(4)(C) of the 
Social Security Act (42 U.S.C. 1395m(m)(4)(C)) is amended--
            (1) in clause (i), by striking ``The term'' and inserting 
        ``Subject to clause (iii), the term''; and
            (2) by adding at the end the following new clause:
                            ``(iii) Rural health clinics and federally 
                        qualified health centers.--In the case of a 
                        service furnished on or after the date that is 
                        6 months after the date of the enactment of the 
                        CONNECT for Health Act of 2017, the term 
                        `originating site' shall also include any 
                        Federally qualified health center and any rural 
                        health clinic (as such terms are defined in 
                        section 1861(aa)) at which the eligible 
                        telehealth individual is located at the time 
                        the service is furnished via a 
                        telecommunications system, whether or not they 
                        are located in an area described in clause (i), 
                        insofar as such sites are not otherwise 
                        included in the definition of originating site 
                        under such clause, subject to applicable State 
                        law requirements, including State licensure 
                        requirements.''.
    (b) Expansion of Distant Sites.--Section 1834(m) of the Social 
Security Act (42 U.S.C. 1395m(m)) is amended--
            (1) in the first sentence of paragraph (1)--
                    (A) by striking ``or a practitioner (described in 
                section 1842(b)(18)(C))'' and inserting ``, a 
                practitioner (described in section 1842(b)(18)(C)), a 
                Federally qualified health center, or a rural health 
                clinic''; and
                    (B) by striking ``or practitioner'' and inserting 
                ``, practitioner, Federally qualified health center, or 
                rural health clinic'';
            (2) in paragraph (2)(A)--
                    (A) by inserting the following after ``eligible 
                telehealth individual'': ``or to a Federally qualified 
                health center or rural health clinic that serves as a 
                distant site and furnishes a telehealth service to an 
                eligible telehealth individual''; and
                    (B) by striking ``such physician or practitioner'' 
                and inserting ``such physician, practitioner, Federally 
                qualified health center, or rural health clinic''; and
            (3) in paragraph (4)(A), by inserting the following before 
        the period at the end: ``and includes a Federally qualified 
        health center or rural health clinic that furnishes a 
        telehealth service to an eligible individual''.
    (c) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 2018.

SEC. 8. ALLOWING NATIVE AMERICAN HEALTH SERVICE FACILITIES AS SITES 
              ELIGIBLE FOR TELEHEALTH PAYMENT.

    (a) In General.--Section 1834(m)(4)(C) of the Social Security Act 
(42 U.S.C. 1395m(m)(4)(C)), as amended by section 7, is amended--
            (1) in clause (i), by striking ``clause (iii)'' and 
        inserting ``clauses (iii) and (iv)''; and
            (2) by adding at the end the following new clause:
                            ``(iv) Native american health service 
                        facilities.--The originating site requirements 
                        described in clauses (i) and (ii) shall not 
                        apply with respect to a facility of the Indian 
                        Health Service, whether operated by such 
                        Service, or by an Indian tribe (as that term is 
                        defined in section 4 of the Indian Health Care 
                        Improvement Act (25 U.S.C. 1603)) or a tribal 
                        organization (as that term is defined in 
                        section 4 of the Indian Self-Determination and 
                        Education Assistance Act (25 U.S.C. 450b)), or 
                        a facility of the Native Hawaiian health care 
                        systems authorized under the Native Hawaiian 
                        Health Care Improvement Act (42 U.S.C. 11701 et 
                        seq.).''.
    (b) No Originating Site Facility Fee for New Sites.--Section 
1834(m)(2)(B) of the Social Security Act (42 U.S.C. 1395m(m)(2)(B)) is 
amended, in the matter preceding clause (i), by inserting ``(other than 
an originating site that is only described in clause (iv) of paragraph 
(4)(C), and does not meet the requirement for an originating site under 
clause (i) of such paragraph)'' after ``the originating site''.
    (c) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 2018.

SEC. 9. CLARIFICATION REGARDING TELEHEALTH AND REMOTE PATIENT 
              MONITORING TECHNOLOGIES PROVIDED TO BENEFICIARIES.

    Section 1128A(i)(6) of the Social Security Act (42 U.S.C. 1320a-
7a(i)(6)) is amended--
            (1) in subparagraph (H), by striking ``; or'' and inserting 
        a semicolon;
            (2) in subparagraph (I), by striking the period at the end 
        and inserting ``; or''; and
            (3) by adding at the end the following new subparagraph:
                    ``(J) the provision of telehealth or remote patient 
                monitoring technologies to individuals under title 
                XVIII by a health care provider for the purpose of 
                furnishing telehealth or remote patient monitoring 
                services.''.

SEC. 10. ALLOWING TELEHEALTH AND REMOTE PATIENT MONITORING SERVICES TO 
              BE INCLUDED IN BUNDLED OR GLOBAL PAYMENTS.

    Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is 
amended by adding at the end the following new section:

``SEC. 1899C. ALLOWING TELEHEALTH AND REMOTE PATIENT MONITORING 
              SERVICES TO BE INCLUDED IN BUNDLED OR GLOBAL PAYMENTS.

    ``Notwithstanding any other provision of this title, the Secretary 
may include under any bundled or global payment under this title the 
following:
            ``(1) Telehealth services.--Notwithstanding requirements 
        otherwise applicable under section 1834(m), including any 
        requirements relating to qualifications for an originating site 
        under paragraph (4)(C)(ii) of such section, any geographic 
        limitations under paragraph (4)(C)(i) of such section (other 
        than applicable State law requirements, including State 
        licensure requirements), any limitation on the use of store-
        and-forward technologies described in paragraph (1) of such 
        section, any limitation on the type of health care provider who 
        may furnish such services (other than the requirement that the 
        provider is a Medicare-enrolled provider), any items and 
        services for which payment would otherwise be made under this 
        title that are furnished using telehealth, or any limitation on 
        specific codes designated as telehealth services that are 
        covered under this title pursuant to section 1834(m) (provided 
        such codes are clinically appropriate to furnish remotely).
            ``(2) Remote patient monitoring services.--Notwithstanding 
        section 1848(b)(12), remote patient monitoring services (as 
        defined in such section) furnished to any individual under this 
        title.''.

SEC. 11. EXPANDING THE USE OF TELEHEALTH THROUGH THE WAIVER OF CERTAIN 
              REQUIREMENTS.

    Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)), as 
amended by sections 3(b) and 4, is amended by adding at the end the 
following new paragraph:
            ``(7) Authority to waive requirements and limitations if 
        certain conditions met.--
                    ``(A) In general.--In the case of telehealth 
                services furnished on or after January 1, 2018, the 
                Secretary may waive any restriction applicable to the 
                coverage of telehealth services under this subsection 
                described in subparagraph (B) with respect to certain 
                providers of services, suppliers, provider groups, 
                sites of care, services, conditions, individuals 
                receiving the services, or States, as determined by the 
                Secretary, if each of the requirements described in 
                subparagraph (C) is met with respect to the waiver.
                    ``(B) Restrictions described.--For purposes of this 
                paragraph, restrictions applicable to the coverage of 
                telehealth services under this subsection shall include 
                requirements relating to qualifications for an 
                originating site under paragraph (4)(C)(ii), any 
                geographic limitations under paragraph (4)(C)(i) (other 
                than applicable State law requirements, including State 
                licensure requirements), any limitation on the use of 
                store-and-forward technologies described in paragraph 
                (1), any limitation on the type of health care provider 
                who may furnish such services (other than the 
                requirement that the provider is a Medicare-enrolled 
                provider), or any limitation on specific codes 
                designated as telehealth services that are covered 
                under this title pursuant to this subsection (provided 
                such codes are clinically appropriate to furnish 
                remotely).
                    ``(C) Requirements for waiver.--The requirements 
                described in this subparagraph are, with respect to the 
                waiver of a restriction described in subparagraph (B), 
                the following:
                            ``(i) The Secretary determines that the 
                        waiver is expected to--
                                    ``(I) reduce spending under this 
                                title without reducing the quality of 
                                care; or
                                    ``(II) improve the quality of 
                                patient care without increasing 
                                spending.
                            ``(ii) The Chief Actuary of the Centers for 
                        Medicare & Medicaid Services certifies that 
                        such waiver would reduce (or would not result 
                        in any increase in) net program spending under 
                        this title.
                            ``(iii) The Secretary determines that such 
                        waiver would not deny or limit the coverage or 
                        provision of benefits under this title for 
                        individuals.
                    ``(D) Public comment.--The Secretary shall 
                establish a process by which stakeholders may (on at 
                least an annual basis) submit requests for a waiver 
                under this paragraph.''.

SEC. 12. EXPANDING THE USE OF TELEHEALTH FOR MENTAL HEALTH SERVICES.

    Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)), as 
amended by sections 3(b), 4, and 11, is amended by adding at the end 
the following new paragraph:
            ``(8) Treatment of mental health services delivered via 
        telehealth.--
                    ``(A) In general.--Restrictions applicable to the 
                coverage of telehealth services under this subsection 
                described in subparagraph (B) shall not apply with 
                respect to telehealth services that are mental health 
                services (as determined by the Secretary) and are 
                furnished on or after January 1, 2018.
                    ``(B) Restrictions described.--For purposes of this 
                paragraph, restrictions applicable to the coverage of 
                telehealth services under this subsection shall include 
                requirements relating to qualifications for an 
                originating site under paragraph (4)(C)(ii), any 
                geographic limitations under paragraph (4)(C)(i) (other 
                than applicable State law requirements, including State 
                licensure requirements), any limitation on the use of 
                store-and-forward technologies described in paragraph 
                (1), any limitation on the type of health care provider 
                who may furnish such services (other than the 
                requirement that the provider is a Medicare-enrolled 
                provider), or any limitation on specific codes 
                designated as telehealth services that are covered 
                under this title pursuant to this subsection (provided 
                such codes are clinically appropriate to furnish 
                remotely).''.

SEC. 13. HHS EVALUATION AND REPORT ON THE USE OF TELEHEALTH AND REMOTE 
              PATIENT MONITORING UNDER ALL DEMONSTRATION PROGRAMS AND 
              PILOTS WITH A TELEHEALTH WAIVER.

    (a) Study.--The Secretary of Health and Human Services (in this 
subsection referred to as the ``Secretary'') shall conduct an 
evaluation on the use of telehealth and remote patient monitoring under 
all programs and pilots under the Medicare program under title XVIII of 
the Social Security Act and the Medicaid program under title XIX of 
such Act with a waiver of telehealth restrictions otherwise applicable 
under such titles of the Social Security Act (42 U.S.C. 1395m(m)). Such 
evaluation shall include an analysis of the following:
            (1) The number of providers and payers using telehealth and 
        remote patient monitoring under such programs and pilots.
            (2) The cost impact among the beneficiaries receiving 
        telehealth and remote patient monitoring under such programs 
        and pilots, including with respect to preventable 
        hospitalizations, hospital readmissions, and emergency room 
        visits, and the total cost of items and services under the 
        Medicare and Medicaid programs.
            (3) Beneficiary and family caregiver satisfaction with the 
        use of telehealth and remote patient monitoring under such 
        programs and pilots.
            (4) A comparison of the utilization of, and expenditures 
        for, the same services furnished under the Medicare and 
        Medicaid programs in the office setting.
    (b) Report.--Not later than 2 years after the date of the enactment 
of this Act, the Secretary shall submit to Congress a report containing 
the results of the evaluation conducted under subsection (a), together 
with recommendations for such legislation and administrative action as 
the Secretary determines appropriate.

SEC. 14. TESTING OF MODELS TO EXAMINE THE USE OF TELEHEALTH AND REMOTE 
              PATIENT MONITORING UNDER THE MEDICARE PROGRAM.

    Section 1115A(b)(2) of the Social Security Act (42 U.S.C. 
1315a(b)(2)) is amended by adding at the end the following new 
subparagraph:
                    ``(D) Testing models to examine use of telehealth 
                and remote patient monitoring under medicare.--The 
                Secretary shall consider testing under this subsection 
                models to examine the use of telehealth and remote 
                patient monitoring under title XVIII.''.

SEC. 15. SENSE OF CONGRESS REGARDING THE REMOTE PRACTICE OF MEDICINE.

    (a) Findings.--Congress finds that the laws of all 50 States and 
the District of Columbia--
            (1) consider the practice of medicine to include remote 
        visits; and
            (2) recognize that any remote practice of medicine is 
        governed by the same medical practice statutes as in-person 
        care.
    (b) Sense of Congress.--It is the sense of Congress that--
            (1) telemedicine is the delivery of safe, effective, 
        quality health care services, by a health care provider, using 
        technology-based modalities to deliver medical care;
            (2) States have recognized this by treating telemedicine as 
        the practice of medicine; and
            (3) the Medicare program under title XVIII of the Social 
        Security Act should cover the delivery of remote patient 
        services.
                                 <all>