Title: Telehealth Innovation and Improvement Act of 2019
Policy area: Health

Summary:
Telehealth Innovation and Improvement Act of 2019
This bill establishes (1) a telehealth service model, and (2) Medicare payment rules with respect to certain services tested under the model.
The Centers for Medicare & Medicaid Services (CMS) shall test Medicare coverage of expanded telehealth services, as defined by the bill, in conjunction with existing models that test the use of accountable care organizations, bundled payments, and other coordinated care models under Medicare. The CMS must (1) establish a methodology for determining the amounts of payment for such services, and (2) provide for evaluations of the service model by an independent entity.
The CMS shall expand the application of a service tested under the model if (1) the required evaluation demonstrates that the service either reduced Medicare spending without reducing the quality of care or improved the quality of care without increasing spending, and (2) the Chief Actuary of the CMS certifies that such expansion would reduce net program spending. A service that meets these requirements is defined by the bill as a certified enhanced telehealth service.
Medicare payment for a certified enhanced telehealth service shall equal 80% of the lesser of (1) the actual charge for the service, or (2) the amount determined using the payment methodology established under the test model.
The CMS shall pay for such services without regard to a Medicare beneficiary's location or area of residence.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 773 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  1st Session
                                 S. 773

To require the Center for Medicare and Medicaid Innovation to test the 
    effect of including telehealth services in Medicare health care 
                        delivery reform models.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 13, 2019

Mr. Gardner (for himself and Mr. Peters) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To require the Center for Medicare and Medicaid Innovation to test the 
    effect of including telehealth services in Medicare health care 
                        delivery reform models.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Telehealth Innovation and 
Improvement Act of 2019''.

SEC. 2. CMI TESTING OF COVERAGE OF EXPANDED TELEHEALTH SERVICES.

    (a) In General.--Section 1115A of the Social Security Act (42 
U.S.C. 1315a) is amended--
            (1) in subsection (b)(2)--
                    (A) in subparagraph (A), by adding at the end the 
                following new sentence: ``The models selected under 
                this subparagraph shall include the model described in 
                subparagraph (D), which shall be implemented by not 
                later than January 1, 2020.''; and
                    (B) by adding at the end the following new 
                subparagraph:
                    ``(D) Telehealth services in delivery reform 
                models.--The model described in this subparagraph is a 
                model that meets the requirements of subsection (h) 
                with respect to coverage of, and payment for, expanded 
                telehealth services, which shall include remote 
                monitoring services, furnished in conjunction with 
                models that test the use of accountable care 
                organizations under title XVIII, bundled payments under 
                such title, and such other coordinated care models 
                under such title as the Secretary determines to be 
                appropriate.'';
            (2) in subsection (b)(4), by striking ``Evaluation.--'' and 
        inserting ``Evaluation.--Subject to subsection (h)(6):''; and
            (3) by adding at the end the following new subsection:
    ``(h) Medicare Coverage of Expanded Telehealth Services Under 
Accountable Care Organization Models, Bundled Payment Models, and Other 
Appropriate Models Tested by the Secretary.--
            ``(1) Establishment of telehealth service models.--
                    ``(A) In general.--Subject to the succeeding 
                provisions of this subsection, for the 5-year period 
                that begins on January 1, 2020, the Secretary shall 
                test coverage of, and payment for, expanded telehealth 
                services (as defined in paragraph (2)) furnished to 
                applicable individuals who are Medicare beneficiaries 
                (as defined in paragraph (3)(B)) in conjunction with 
                models tested under subsection (b), and expanded under 
                subsection (c) (if applicable), that test the use of 
                accountable care organizations under title XVIII, 
                bundled payments under such title, and such other 
                coordinated care models under such title as the 
                Secretary determines to be appropriate.
                    ``(B) Model design considerations.--In establishing 
                models to be tested for enhanced telehealth services 
                under subsection (b)(2)(D), the Secretary shall design 
                such models in a manner to permit comparisons of 
                Medicare beneficiaries who are participating in models 
                under subsection (b) that include access to expanded 
                telehealth services with Medicare beneficiaries in 
                models under subsection (b) who do not have access to 
                such services.
            ``(2) Expanded telehealth services defined.--
                    ``(A) In general.--Subject to subparagraphs (B) and 
                (C), in this subsection, the term `expanded telehealth 
                services' means services furnished by an eligible 
                physician or practitioner to a Medicare beneficiary as 
                part of an episode of care for one or more of the 
                conditions specified under paragraph (4) through one or 
                more of the following:
                            ``(i) Remote monitoring technologies, 
                        including remote device management for purposes 
                        of remotely interrogating or programming a 
                        medical device (such as a pacemaker or a 
                        cardiac resynchronization therapy device) 
                        outside the office of the physician specialist 
                        involved.
                            ``(ii) Bi-directional audio/video 
                        technologies.
                            ``(iii) Physiologic and behavioral 
                        monitoring technologies.
                            ``(iv) Engagement prompt technologies.
                            ``(v) Store and forward technologies.
                            ``(vi) Point-of-care testing technologies.
                            ``(vii) Such other technologies as the 
                        Secretary may specify.
                    ``(B) Inclusion of medicare telehealth services; 
                non-application of certain restrictions.--
                            ``(i) Inclusion of medicare telehealth 
                        services.--The term `expanded telehealth 
                        services' shall include a telehealth service, 
                        as defined in section 1834(m)(4)(F), without 
                        regard to the limitations specified under 
                        section 1834(m)(4).
                            ``(ii) Rule of construction.--Nothing in 
                        this section shall be construed as imposing a 
                        requirement on the furnishing of expanded 
                        telehealth services that such services be 
                        furnished in real time through interactive 
                        audio or video telecommunications systems 
                        between the eligible physician or practitioner 
                        and the Medicare beneficiary.
                            ``(iii) No limitations on geographic areas 
                        or location of patient.--The term `expanded 
                        telehealth services' shall include services 
                        furnished (as described in subparagraph (A)) 
                        without regard to the location of the Medicare 
                        beneficiary at the time the telehealth service 
                        is furnished and without regard to the area in 
                        which the Medicare beneficiary resides.
                    ``(C) Requirements.--The term `expanded telehealth 
                services' shall not include a service furnished (as 
                described in subparagraph (A)) unless it can be 
                demonstrated that the service, when furnished as an 
                expanded telehealth service, is likely to do one or 
                more of the following:
                            ``(i) The service assists eligible 
                        physicians or practitioners to coordinate care 
                        for patients.
                            ``(ii) The service enhances collaboration 
                        among providers of services and suppliers, 
                        including eligible physicians and 
                        practitioners, in the provision of care to 
                        patients.
                            ``(iii) The service improves quality of 
                        care furnished to patients.
                            ``(iv) The service results in reduced 
                        hospital admissions and readmissions.
                            ``(v) The service reduces or substitutes 
                        for physician office visits.
                            ``(vi) The service results in reduced 
                        utilization of skilled nursing facility 
                        services.
                            ``(vii) The service facilitates the return 
                        of patients to the community more quickly than 
                        would otherwise occur in the absence of the 
                        service.
            ``(3) Additional definitions.--In this subsection:
                    ``(A) Eligible physician or practitioner.--The term 
                `eligible physician or practitioner' means--
                            ``(i) a physician (as defined in section 
                        1861(r)); and
                            ``(ii) a practitioner (as defined in 
                        section 1842(b)(18)(C)).
                    ``(B) Medicare beneficiary.--The term `Medicare 
                beneficiary' means an individual who is entitled to 
                benefits under part A or enrolled under part B of title 
                XVIII who is not enrolled in a Medicare Advantage plan 
                under part C of such title, an eligible organization 
                under section 1876, or a PACE program under section 
                1894.
            ``(4) Conditions.--For purposes of paragraph (2)(A), the 
        conditions with respect to which a coverage of an expanded 
        telehealth service is furnished under this subsection shall 
        include the following conditions or diseases: chronic 
        hypertension, ischemic heart diseases, chronic obstructive 
        pulmonary disease, heart failure, heart attack, osteoarthritis, 
        diabetes, chronic kidney disease, depression, atrial 
        fibrillation, cancer, asthma, stroke, total hip replacement 
        procedures, total knee replacement procedures, Parkinson's 
        disease, and such other conditions or diseases with respect to 
        which the Secretary determines that expanded telehealth 
        services would satisfy one or more of the requirements of 
        clauses (i) through (vii) of paragraph (2)(C).
            ``(5) Payment.--
                    ``(A) In general.--Subject to subparagraph (B), 
                with respect to expanded telehealth services furnished 
                under a model tested under subsection (b) and expanded 
                under subsection (c) (if applicable), the Secretary 
                shall establish payment amounts under this subsection 
                for such services. The Secretary may use one or more of 
                the following payment methodologies for expanded 
                telehealth services:
                            ``(i) Medicare fee schedule.--Fee schedules 
                        established under title XVIII for telehealth 
                        services and remote monitoring services.
                            ``(ii) New fee schedule.--A new fee 
                        schedule that the Secretary establishes for 
                        expanded telehealth services covered by reason 
                        of this subsection.
                            ``(iii) Payment amounts based on shared 
                        risk.--A payment methodology for shared savings 
                        and losses that is designed to ensure savings 
                        with respect to expanded telehealth services 
                        covered under the model.
                    ``(B) Consideration of certain costs.--In 
                determining the amount of payment for an expanded 
                telehealth service under the payment methodologies 
                referred to in subparagraph (A), the Secretary shall 
                take into account costs incurred by eligible physicians 
                and practitioners--
                            ``(i) for the acquisition and 
                        implementation of information systems necessary 
                        to furnish such services, including costs of 
                        equipment and requisite software;
                            ``(ii) for non-physician clinical personnel 
                        in conjunction with such service; and
                            ``(iii) for physician interpretation of 
                        clinical data through the expanded telehealth 
                        service as well as for the supervision or 
                        oversight of the system for such service.
            ``(6) Evaluation of models.--
                    ``(A) Use of independent entity.--In lieu of the 
                evaluations conducted by the Secretary under subsection 
                (b)(4) for models tested under subsection (b), the 
                Secretary shall provide for evaluations of enhanced 
                telehealth service models under subsection (b)(2)(D) by 
                an independent entity. Such evaluation shall be 
                conducted with respect to the specific enhanced 
                telehealth service and condition or conditions involved 
                that are tested under such models.
                    ``(B) Timing of evaluation.--An evaluation of such 
                enhanced telehealth service and condition or conditions 
                involved conducted by the independent entity under this 
                paragraph shall begin three years after the 
                implementation of the model that provides for coverage 
                of and payment for the expanded telehealth service with 
                respect to such condition.
                    ``(C) Criteria.--An evaluation of such enhanced 
                telehealth service models conducted by the independent 
                entity under this paragraph shall include an analysis 
                of--
                            ``(i) the quality of care furnished under 
                        the model, including the measurement of 
                        patient-level outcomes and patient-centeredness 
                        criteria determined appropriate by the 
                        Secretary;
                            ``(ii) the changes in spending under parts 
                        A and B of title XVIII by reason of the model, 
                        taking into account costs and savings under 
                        such parts across the continuum of care for the 
                        episode of care and condition or conditions 
                        involved; and
                            ``(iii) any impediments that were 
                        encountered under the model, such as--
                                    ``(I) explicit telehealth 
                                restrictions under Federal or State 
                                laws that are not related to health 
                                care reimbursement, such as scope of 
                                practice limitations;
                                    ``(II) licensing or credentialing 
                                barriers; and
                                    ``(III) limited broadband access or 
                                limited health information technology 
                                capabilities.
                    ``(D) Information.--The provisions of subsection 
                (b)(4)(B) shall apply to evaluations conducted under 
                this paragraph in the same manner as such provisions 
                apply to evaluations conducted under subsection (b)(4).
            ``(7) Application of expanded telehealth services to all 
        cmi models.--The Secretary shall expand the application of an 
        enhanced telehealth service with respect to the condition or 
        conditions involved to all models tested under subsection (b), 
        and expanded under subsection (c) (if applicable), that apply 
        with respect to services furnished under title XVIII to provide 
        for coverage of, and payment for, such enhanced telehealth 
        service or services with respect to such condition or 
        conditions under all such models for years beginning after the 
        5-year period described in paragraph (1)(A) if--
                    ``(A) the independent evaluation conducted under 
                paragraph (6) with respect to such models demonstrates 
                that such enhanced telehealth service or services with 
                respect to the condition or conditions involved 
                resulted in--
                            ``(i) reduced spending under parts A and B 
                        of title XVIII without reducing the quality of 
                        care; or
                            ``(ii) improved quality of patient care 
                        without increasing such spending; and
                    ``(B) the Chief Actuary of the Centers for Medicare 
                & Medicaid Services certifies that such expansion would 
                reduce net program spending under parts A and B of 
                title XVIII.''.
    (b) Coverage of and Payment for Certain Enhanced Telehealth 
Services That Are Certified as Providing Savings Under the Medicare 
Program.--
            (1) Coverage.--Section 1834 of the Social Security Act (42 
        U.S.C. 1395m) is amended by adding at the end the following new 
        subsection:
    ``(x) Certified Enhanced Telehealth Services.--
            ``(1) In general.--The Secretary shall pay for certified 
        enhanced telehealth services (as defined in paragraph (2)(A)) 
        furnished by a physician (as defined in section 1861(r)) or a 
        practitioner (as defined in section 1842(b)(18)(C)) to a 
        Medicare fee-for-service beneficiary (as defined in paragraph 
        (2)(B)) for one or more of the conditions specified under 
        section 1115A(h)(4) in an amount determined under paragraph (3) 
        without regard to--
                    ``(A) the location of the Medicare fee-for-service 
                beneficiary at the time the certified enhanced 
                telehealth service is furnished; and
                    ``(B) the area in which the Medicare fee-for-
                service beneficiary resides.
            ``(2) Definitions.--In this subsection:
                    ``(A) Certified enhanced telehealth service.--The 
                term `certified enhanced telehealth service' means, 
                with respect to a condition or conditions specified 
                under section 115A(h)(4), an enhanced telehealth 
                service (as defined in section 1115A(h)(2)) with 
                respect to which--
                            ``(i) an independent evaluation conducted 
                        under section 1115A(h)(6) demonstrates that the 
                        service tested under a model under section 
                        1115A(b)(2)(D) with respect to the condition or 
                        conditions resulted in--
                                    ``(I) reduced spending under parts 
                                A and B without reducing the quality of 
                                care; or
                                    ``(II) improved quality of patient 
                                care without increasing such spending; 
                                and
                            ``(ii) the Chief Actuary of the Centers for 
                        Medicare & Medicaid Services certifies that 
                        such expansion would reduce net program 
                        spending under such parts.
                    ``(B) Medicare fee-for-service beneficiary.--The 
                term `Medicare fee-for-service beneficiary' has the 
                meaning given such term in section 1899(h)(3).
            ``(3) Payment amount.--The amount of payment for certified 
        enhanced telehealth services shall be determined in the same 
        manner as payments for enhanced telehealth services are 
        determined under section 1115A(h)(5).''.
            (2) Payment.--Section 1833(a)(1) of the Social Security Act 
        (42 U.S.C. 1395l(a)(1)) is amended by striking ``and'' before 
        ``(CC)'' and inserting before the semicolon at the end the 
        following: ``, and (CC) with respect to certified enhanced 
        telehealth services (as defined in section 1834(x)(2)(A)), the 
        amount paid shall be an amount equal to 80 percent of the 
        lesser of the actual charge for the services or the amount 
        determined under section 1834(x)(3)''.
                                 <all>