HR 5765 IHCommentsClose CommentsPermalink

To amend title XVIII of the Social Security Act to cover remote patient management services for certain chronic health conditions under the Medicare Program.CommentsClose CommentsPermalink

April 10, 2008

Ms. ESHOO (for herself, Mr. PICKERING, Mr. TANNER, Mr. HULSHOF, Mr. STUPAK, Mr. RAMSTAD, Mr. CAMP of Michigan, and Mr. LINDER) introduced the following bill; which was referred to the Committee 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 concernedCommentsClose CommentsPermalink

To amend title XVIII of the Social Security Act to cover remote patient management services for certain chronic health conditions under the Medicare Program.CommentsClose CommentsPermalink

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

SECTION 1. SHORT TITLE.

This Act may be cited as the `Medicare Remote Monitoring Access Act of 2008'.CommentsClose CommentsPermalink

SEC. 2. REMOTE PATIENT MANAGEMENT SERVICES FOR CHRONIC HEALTH CONDITIONS UNDER THE MEDICARE PROGRAM.

(a) Coverage of Remote Patient Management Services for Certain Chronic Health Conditions-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)) is amended--CommentsClose CommentsPermalink





(A) in subparagraph (Z), by striking `and' at the end;CommentsClose CommentsPermalink





(B) in subparagraph (AA), by inserting `and' at the end; andCommentsClose CommentsPermalink





(C) by inserting after subparagraph (AA) the following new subparagraph:CommentsClose CommentsPermalink





`(BB) remote patient management services (as defined in subsection (ccc));'.CommentsClose CommentsPermalink





(2) SERVICES DESCRIBED- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





`(ccc) Remote Patient Management Services for Chronic Health Conditions- (1) The term `remote 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 allows 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 response by the physician or supplier.CommentsClose CommentsPermalink





`(2) For purposes of paragraph (1), the term `covered chronic health condition' means--CommentsClose CommentsPermalink





`(A) heart failure; andCommentsClose CommentsPermalink





`(B) cardiac arrhythmia.CommentsClose CommentsPermalink





`(3)(A) Not later than January 1, 2010, the Secretary, in consultation with appropriate physician and supplier 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.CommentsClose CommentsPermalink





`(B) The Secretary shall do the following:CommentsClose CommentsPermalink





`(i) Not later than 2 years after the date of the enactment of this subsection, develop, in consultation 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).CommentsClose CommentsPermalink





`(ii) Periodically review and update such standards under this subparagraph as necessary.'.CommentsClose CommentsPermalink





(3) PAYMENT UNDER THE PHYSICIAN FEE SCHEDULE- Section 1848 of the Social Security Act (42 U.S.C. 1395w-4) is amended--CommentsClose CommentsPermalink





(A) in subsection (c)--CommentsClose CommentsPermalink





(i) in paragraph (2)((B)--CommentsClose CommentsPermalink





(I) in clause (ii)(II), by striking `and (v)' and inserting `(v), (and (vi)'; andCommentsClose CommentsPermalink





(II) by adding at the end the following new clause:CommentsClose CommentsPermalink





`(vi) BUDGETARY TREATMENT OF CERTAIN SERVICES- The additional expenditures attributable to services described in section 1861(s)(2)(BB) shall not be taken into account in applying clause (ii)(II) for 2010.'; andCommentsClose CommentsPermalink





(ii) by adding at the end the following new paragraph:CommentsClose CommentsPermalink





`(7) TREATMENT OF REMOTE PATIENT MANAGEMENT SERVICES-CommentsClose CommentsPermalink





`(A) In determining relative value units for remote patient management services (as defined in section 1861(ccc)), the Secretary, in consultation with appropriate physician groups, shall take into consideration--CommentsClose CommentsPermalink





`(i) physician resources, including physician time and the level of intensity of services provided, based on--CommentsClose CommentsPermalink





`(I) the frequency of evaluation necessary to manage the individual being furnished the services;CommentsClose CommentsPermalink





`(II) the complexity of the evaluation, including the information that must be obtained, reviewed, and analyzed; andCommentsClose CommentsPermalink





`(III) the number of possible diagnoses and the number of management options that must be considered; andCommentsClose CommentsPermalink





`(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 monitoring and follow-up (but not including costs of any related item or non-physician service otherwise reimbursed under this title).CommentsClose CommentsPermalink





`(iii) malpractice expense resources.CommentsClose CommentsPermalink





`(B) Using the relative value units determined in subparagraph (A), the Secretary shall provide for separate payment for such services and shall not adjust the relative value units assigned to other services that might otherwise have been determined to include such separately paid remote patient management services.'; andCommentsClose CommentsPermalink





(B) in subsection (j)(3), by inserting `(2)(BB)' after `(2)(AA),'.CommentsClose CommentsPermalink





(4) EFFECTIVE DATE-CommentsClose CommentsPermalink





(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(ccc) of the Social Security Act (as added by paragraph (2)) have been developed.CommentsClose CommentsPermalink





(B) AVAILABILITY OF CODES AS OF JANUARY 1, 2010- The Secretary of Health and Human Services shall--CommentsClose CommentsPermalink





(i) promptly evaluate existing codes that would be used to bill for remote patient management services (as defined in paragraph (1) of such section 1861(ccc), as so added) under title XVIII of the Social Security Act; andCommentsClose CommentsPermalink





(ii) if the Secretary determines that new codes are necessary to ensure accurate reporting and billing of such services under such title, issue such codes so that they are available for use as of January 1, 2010.CommentsClose CommentsPermalink





(b) Demonstration Project for the Coverage of Remote Patient Management Services for Additional Chronic Health Conditions Under the Medicare Program-CommentsClose CommentsPermalink





(1) ESTABLISHMENT-CommentsClose CommentsPermalink





(A) IN GENERAL- The Secretary shall establish a demonstration project for the purpose of evaluating the impact and benefits of covering under the Medicare program remote patient management services for certain chronic health conditions.CommentsClose CommentsPermalink





(B) CONSULTATION- In establishing the demonstration project, the Secretary shall consult with appropriate physician and supplier groups, eligible beneficiaries, and organizations representing eligible beneficiaries.CommentsClose CommentsPermalink





(C) PARTICIPATION- Any eligible beneficiary may participate in the demonstration project on a voluntary basis.CommentsClose CommentsPermalink





(2) CONDUCT OF THE DEMONSTRATION PROJECT-CommentsClose CommentsPermalink





(A) SITES-CommentsClose CommentsPermalink





(i) SELECTION OF DEMONSTRATION SITES- The Secretary shall conduct the demonstration project at 3 sites.CommentsClose CommentsPermalink





(ii) GEOGRAPHIC DIVERSITY- In selecting the sites under clause (i), the Secretary shall ensure that at least 1 of the sites is in a rural area.CommentsClose CommentsPermalink





(B) IMPLEMENTATION; DURATION-CommentsClose CommentsPermalink





(i) IMPLEMENTATION- The Secretary shall implement the demonstration project not later than January 1, 2010.CommentsClose CommentsPermalink





(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 implemented.CommentsClose CommentsPermalink





(3) EVALUATION AND REPORT-CommentsClose CommentsPermalink





(A) EVALUATION- The Secretary shall conduct an evaluation of the demonstration project--CommentsClose CommentsPermalink





(i) to determine improvements in the quality of care and utilization of services received by eligible beneficiaries participating in the demonstration project;CommentsClose CommentsPermalink





(ii) to determine the cost of providing payment for remote monitoring services under the Medicare program;CommentsClose CommentsPermalink





(iii) to determine the satisfaction of eligible beneficiaries participating in the demonstration projects; andCommentsClose CommentsPermalink





(iv) to evaluate such other matters as the Secretary determines is appropriate.CommentsClose CommentsPermalink





(4) WAIVER AUTHORITY- The Secretary may waive such provisions of titles XI and XVIII of the Social Security Act as the Secretary determines to be appropriate for the conduct of the demonstration project.CommentsClose CommentsPermalink





(5) FUNDING-CommentsClose CommentsPermalink





(A) DEMONSTRATION-CommentsClose CommentsPermalink





(i) IN GENERAL- Subject to clause (ii), the Secretary shall provide for the transfer from the Federal Supplementary Medical Trust Fund under section 1841 of the Social Security Act (42 U.S.C. 1395t) of such funds as are necessary for the costs of carrying out the demonstration project.CommentsClose CommentsPermalink





(ii) CAP ON EXPENDITURES- The amount transferred under clause (i) for the period during which the demonstration project is conducted may not exceed an amount equal to the lesser of--CommentsClose CommentsPermalink





(I) $9,000,000; orCommentsClose CommentsPermalink





(II) an amount equal to the costs of providing remote monitoring services to 7,500 individuals during such period.CommentsClose CommentsPermalink





(B) EVALUATION AND REPORT- There are authorized to be appropriated such sums as are necessary for the purpose of conducting the evaluation and developing and submitting the report to Congress under paragraph (3).CommentsClose CommentsPermalink





(6) DEFINITIONS- In this section:CommentsClose CommentsPermalink





(A) REMOTE PATIENT MANAGEMENT SERVICES- The term `remote patient management services' means the remote monitoring, evaluation, and management of an individual with a covered chronic health condition (as defined in paragraph (B)), insofar as such monitoring, evaluation, and management is with respect to such condition, through the utilization of a system of technology that allows a remote interface to collect and transmit clinical data between the individual and the responsible physician (as defined in subsection (r) of section 1861 of the Social Security Act (42 U.S.C. 1395X))) or supplier (as defined in subsection (d) of such section) for the purposes of clinical review or response by the physician or supplier.CommentsClose CommentsPermalink





(B) COVERED CHRONIC HEALTH CONDITION- The term `covered chronic health condition' means diabetes, sleep apnea, or epilepsy.CommentsClose CommentsPermalink





(C) DEMONSTRATION PROJECT- The term `demonstration project' means a demonstration project conducted under this subsection.CommentsClose CommentsPermalink





(D) ELIGIBLE BENEFICIARY- The term `eligible beneficiary' means an individual who is enrolled under part B of the Medicare program and has a covered chronic health condition.CommentsClose CommentsPermalink





(E) MEDICARE PROGRAM- The term `Medicare program' means the health benefits program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).CommentsClose CommentsPermalink





(F) SECRETARY- The term `Secretary' means the Secretary of Health and Human Services.CommentsClose CommentsPermalink