[Congressional Bills 112th Congress]
[From the U.S. Government Printing Office]
[H.R. 6719 Introduced in House (IH)]

112th CONGRESS
  2d Session
                                H. R. 6719

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

                           December 30, 2012

  Mr. Thompson of California introduced the following bill; which was 
 referred to the Committee on Energy and Commerce, and in addition to 
  the Committees on Ways and Means, Oversight and Government Reform, 
Armed Services, and Veterans' Affairs, 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 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 ``Telehealth 
Promotion Act of 2012''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
 TITLE I--REMOVING ARBITRARY COVERAGE RESTRICTIONS ON TELEHEALTH FROM 
                      FEDERAL HEALTH CARE PROGRAMS

Sec. 101. Medicare; Medicaid; CHIP.
Sec. 102. Federal employees health, dental, and vision benefits 
                            programs.
Sec. 103. TRICARE.
Sec. 104. Health care provided by the Department of Veterans Affairs.
Sec. 105. Effective date.
             TITLE II--ADDITIONAL IMPROVEMENTS TO MEDICARE

Sec. 201. Positive incentive for Medicare's hospital readmissions 
                            reduction program.
Sec. 202. Health homes and medical homes.
Sec. 203. Flexibility in accountable care organizations coverage of 
                            telehealth.
Sec. 204. Recognizing telehealth services and remote patient monitoring 
                            in national pilot program on payment 
                            bundling.
Sec. 205. Adjustment in Medicare home health payments to account for 
                            use of remote patient monitoring.
Sec. 206. Including telehealth and remote patient monitoring services 
                            as part of an intervention proposal under 
                            the Medicare Community-Based Care 
                            Transitions Program.
             TITLE III--ADDITIONAL IMPROVEMENT TO MEDICAID

Sec. 301. Medicaid option for high-risk pregnancies and births.

 TITLE I--REMOVING ARBITRARY COVERAGE RESTRICTIONS ON TELEHEALTH FROM 
                      FEDERAL HEALTH CARE PROGRAMS

SEC. 101. MEDICARE; MEDICAID; CHIP.

    (a) In General.--Title XI of the Social Security Act is amended by 
inserting after section 1150B the following new section:

    ``removal of limitation on coverage of services provided via a 
      telecommunications system under medicare, medicaid, and chip

    ``Sec. 1150C.  (a) Medicare.--An item or service under part A or 
part B of title XVIII furnished to a Medicare beneficiary by an 
individual or entity via a telecommunications system shall be covered 
to the same extent the item or service would be covered if furnished in 
the same location of the beneficiary, and benefits shall not be denied 
under either such part solely on the basis that the item or service is 
being furnished via a telecommunications system.
    ``(b) Medicaid.--Medical assistance under a State plan under title 
XIX for an item or service furnished to a Medicaid beneficiary by an 
individual or entity via a telecommunications system shall be available 
to the same extent as such assistance would be available if furnished 
in the same location as the beneficiary, and medical assistance shall 
not be denied under such plan solely on the basis that the item or 
service is being furnished via a telecommunications system, except as a 
State may otherwise provide in its State plan under this title. For the 
purposes of reimbursement, licensure, professional liability, and other 
purposes under such title with respect to the provision of telehealth 
services, practitioners, suppliers, and providers of such services are 
considered to be furnishing such services at their location and not at 
the originating site.
    ``(c) CHIP.--Child health assistance under a State child health 
plan under title XXI for an item or service furnished to a CHIP 
beneficiary by an individual or entity via a telecommunications system 
shall be available to the same extent as such assistance would be 
available if furnished in the same location as the beneficiary, and 
child health assistance shall not be denied under such plan solely on 
the basis that the item or service is being furnished via a 
telecommunications system, except as a State may otherwise provide in 
its State child health plan under this title. The previous sentence 
applies with respect to items and services furnished through coverage 
provided in the form described in section 2101(a)(1). For the purposes 
of reimbursement, licensure, professional liability, and other purposes 
under such title with respect to the provision of telehealth services, 
practitioners, suppliers, and providers of such services are considered 
to be furnishing such services at their location and not at the 
originating site.''.
    (b) Conforming Medicare Part B Coverage Provisions.--
            (1) Removal of limitation on telehealth services.--Section 
        1834(m)(4) of the Social Security Act (42 U.S.C. 1395m(m)(4)) 
        is amended by striking subparagraph (F).
            (2) Expansion of telecommunications system.--The second 
        sentence of section 1834(m)(1) of the Social Security Act (42 
        U.S.C. 1835m(m)(1)) is amended by striking ``in the case of any 
        Federal telemedicine demonstration program conducted in Alaska 
        or Hawaii,''.
            (3) Expansion of telehealth providers to all health care 
        professionals.--Section 1834(m) of such Act (42 U.S.C. 
        1395m(m)) is amended--
                    (A) in paragraph (1)--
                            (i) by inserting ``or other health care 
                        professional'' after ``(described in section 
                        1842(b)(18)(C))''; and
                            (ii) by inserting ``or other health care 
                        professional'' after ``individual physician or 
                        practitioner''; and
                    (B) in paragraphs (2)(A), (2)(C), (3)(A), and 
                (4)(A) by inserting ``or other health care 
                professional'' after ``physician or practitioner'' each 
                place it appears.
            (4) Removal of limitations on originating sites.--Section 
        1834(m)(4)(C) of such Act (42 U.S.C. 1395m(m)(4)(C)) is 
        amended--
                    (A) by inserting ``The term `originating site' 
                means one of the following sites:'' after ``Originating 
                site.--'';
                    (B) by striking clause (i) and all that follows up 
                to subclause (I) of clause (ii); and
                    (C) by redesignating subclauses (I) through (VIII) 
                of clause (ii) as clauses (i) through (viii), 
                respectively.
            (5) Location of furnishing telehealth services.--Section 
        1834(m) of such Act is further amended by adding at the end the 
        following new paragraph:
            ``(5) Treatment of location in furnishing telehealth 
        services.--For purposes of reimbursement, licensure, 
        professional liability, and other purposes under this title 
        with respect to the provision of telehealth services, 
        physicians, practitioners, suppliers, and providers of such 
        services are considered to be furnishing such services at their 
        location and not at the originating site.''.
            (6) Payment methods for other patient sites.--Section 
        1834(m)(2) of such Act is further amended by adding at the end 
        the following new subparagraph:
                    ``(D) Payment methods for other patient sites.--The 
                Secretary may develop and implement payment methods 
                that would apply under this subsection in the case of 
                an individual who would be an eligible telehealth 
                individual except that the telehealth services are 
                furnished the individual at a site other than an 
                originating site. Such methods shall be designed to 
                take into account the costs related to the site 
                involved and reduced costs for the distant site.''.

SEC. 102. FEDERAL EMPLOYEES HEALTH, DENTAL, AND VISION BENEFITS 
              PROGRAMS.

    (a) Health Benefits (FEHBP).--Section 8904 of title 5, United 
States Code, is amended by adding at the end the following:
    ``(c) Benefits for an item or service furnished by an individual or 
entity via a telecommunications system shall be covered under a health 
benefits plan under this chapter as if it were furnished in person at 
the location of the beneficiary, and benefits shall not be denied under 
such a plan solely on the basis that the item or service is being 
furnished via a telecommunications system. For the purposes of 
reimbursement, licensure, professional liability, and other purposes 
under this chapter with respect to the provision of telehealth 
services, practitioners, suppliers, and providers of such services are 
considered to be furnishing such services at their location and not at 
the originating site.''.
    (b) Dental Benefits.--Section 8954 of title 5, United States Code, 
is amended by adding at the end the following:
    ``(f) Benefits for an item or service furnished by an individual or 
entity via a telecommunications system shall be covered under an 
enhanced dental benefits plan under this chapter as if it were 
furnished in person at the location of the beneficiary, and benefits 
shall not be denied under such a plan solely on the basis that the item 
or service is being furnished via a telecommunications system. For the 
purposes of reimbursement, licensure, professional liability, and other 
purposes under this chapter with respect to the provision of telehealth 
services, practitioners, suppliers, and providers of such services are 
considered to be furnishing such services at their location and not at 
the originating site.''.
    (c) Vision Benefits.--Section 8984 of title 5, United States Code, 
is amended by adding at the end the following:
    ``(f) Benefits for an item or service furnished by an individual or 
entity via a telecommunications system shall be covered under an 
enhanced vision benefits plan under this chapter as if it were 
furnished in person at the location of the beneficiary, and benefits 
shall not be denied under such a plan solely on the basis that the item 
or service is being furnished via a telecommunications system. For the 
purposes of reimbursement, licensure, professional liability, and other 
purposes under this chapter with respect to the provision of telehealth 
services, practitioners, suppliers, and providers of such services are 
considered to be furnishing such services at their location and not at 
the originating site.''.

SEC. 103. TRICARE.

    (a) Care Provided at Military Medical Treatment Facilities.--
Section 1077 of title 10, United States Code, is amended by adding at 
the end the following new subsection:
    ``(g) In providing health care to a covered beneficiary under 
section 1076 of this title at a military medical treatment facility, 
the Secretary may furnish an item or service to the covered beneficiary 
via a telecommunications system.''.
    (b) Care Provided at Private Facilities.--
            (1) Certain dependents.--Section 1079 of title 10, United 
        States Code, is amended by adding at the end the following new 
        subsection:
    ``(r)(1) An item or service furnished to a covered beneficiary via 
a telecommunications system shall be covered by a plan described in 
paragraph (2) to the same extent the item or service would be covered 
if furnished in the same location of the covered beneficiary, and 
benefits shall not be denied under such a plan solely on the basis that 
the item or service is being furnished via a telecommunications system. 
For the purposes of reimbursement, licensure, professional liability, 
and other purposes under this section with respect to the provision of 
telehealth services, practitioners, suppliers, and providers of such 
services are considered to be furnishing such services at their 
location and not at the originating site.
    ``(2) A plan described in this paragraph is a plan for which the 
Secretary enters into a contract under subsection (a) to provide 
dependents with medical care.''.
            (2) Certain members and former members.--Section 1086 of 
        title 10, United States Code, is amended by adding at the end 
        the following new subsection:
    ``(i)(1) An item or service furnished to a covered beneficiary via 
a telecommunications system shall be covered by a plan described in 
paragraph (2) to the same extent the item or service would be covered 
if furnished in the same location of the covered beneficiary, and 
benefits shall not be denied under such a plan solely on the basis that 
the item or service is being furnished via a telecommunications system. 
For the purposes of reimbursement, licensure, professional liability, 
and other purposes under this section with respect to the provision of 
telehealth services, practitioners, suppliers, and providers of such 
services are considered to be furnishing such services at their 
location and not at the originating site.
    ``(2) A plan described in this paragraph is a plan for which the 
Secretary enters into a contract under subsection (a) to provide 
persons covered by subsection (c) with health benefits.''.

SEC. 104. HEALTH CARE PROVIDED BY THE DEPARTMENT OF VETERANS AFFAIRS.

    (a) In General.--Subchapter I of chapter 17 of title 38, United 
States Code, is amended by inserting after section 1709A the following 
new section:
``Sec. 1709B. Provision of health care via telecommunications system
    ``(a) Direct Care.--In providing health care directly to an 
individual under this chapter or chapter 18 of this title, the 
Secretary may furnish an item or service to the individual via a 
telecommunications system.
    ``(b) Contracted Care.--(1) An item or service furnished to an 
individual covered by a plan described in paragraph (2) via a 
telecommunications system shall be covered by such a plan to the same 
extent the item or service would be covered if furnished in the same 
location of the individual, and benefits shall not be denied under such 
a plan solely on the basis that the item or service is being furnished 
via a telecommunications system. For the purposes of reimbursement, 
licensure, professional liability, and other purposes under this 
chapter and chapter 18 with respect to the provision of telehealth 
services, practitioners, suppliers, and providers of such services are 
considered to be furnishing such services at their location and not at 
the originating site.
    ``(2) A plan described in this paragraph is a plan for which the 
Secretary enters into a contract or agreement under this chapter or 
chapter 18 of this title to furnish health care to an individual.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
1709A the following new item:

``1709B. Provision of health care via telecommunications system.''.

SEC. 105. EFFECTIVE DATE.

    The amendments made by this title shall take effect on January 1, 
2013, and shall apply to items and services furnished on or after such 
date and contracts for health plans entered into on or after such date, 
except that such amendments shall not apply to health plans for plan 
years for which bids were submitted before the date of the enactment of 
this Act.

             TITLE II--ADDITIONAL IMPROVEMENTS TO MEDICARE

SEC. 201. 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 readmissions.--
                    ``(A) In general.--With respect to payment for 
                discharges occurring during a fiscal year beginning on 
                or after October 1, 2013, in order to provide a 
                positive incentive for hospitals described in 
                subparagraph (B) to lower 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 
                performance 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 subparagraph for a 
                hospital is the ratio of--
                            ``(i) the risk adjusted expected 
                        readmissions (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. 202. HEALTH HOMES AND MEDICAL HOMES.

    (a) Medicare Chronic Care Counterpart to Medicaid ``Health 
Home''.--
            (1) In general.--Title XVIII of the Social Security Act is 
        amended by adding at the end the following 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 payments are made under subsection 
(c) of section 1945, including 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 hospital 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 condition for receiving 
payment for health home services provided 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 
applicable measures for determining the quality of such services. 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 shall also apply for 
purposes of this section except that, instead of the requirement 
specified in clause (i) of subsection (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 conditions.
    ``(h) Evidence-Based and Reporting.--In contracting 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 structure.
    ``(i) Waiver Authority.--
            ``(1) In general.--The limitations on telehealth 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 provisions of this section.''.
            (2) Reporting.--
                    (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 paragraph (1), on the nature, extent, 
                and use of the option under such section particularly 
                as it pertains to--
                            (i) hospital admission rates;
                            (ii) chronic disease management;
                            (iii) coordination of care for individuals 
                        with chronic conditions;
                            (iv) assessment of program implementation;
                            (v) processes and lessons learned (as 
                        described in subparagraph (B));
                            (vi) assessment of quality improvements and 
                        clinical outcomes under such option; and
                            (vii) estimates of cost savings.
                    (B) Implementation reporting.--Such a State shall 
                report to the Secretary, as necessary, on processes 
                that have been developed and lessons learned regarding 
                provision of coordinated care through a health home for 
                beneficiaries with chronic conditions under such 
                option.
    (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 regional center of excellence with a network of 
affiliated local providers to provide through one or more medical homes 
for targeted, accessible, continuous, and coordinated 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 physicians and 
        patient treatment facilities;
            ``(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 research 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 individuals 
        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 section 1861(r)(1)) 
        who meets the requirements described in paragraphs (2) and (3). 
        Nothing in this paragraph shall be construed as preventing a 
        personal physician from being a specialist or subspecialist for 
        an individual requiring ongoing care for a specific chronic 
        condition or multiple chronic conditions or for an individual 
        with a long-term illness or medical condition.
            ``(2) General requirements.--The requirements 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 individual and 
                manages continuous care for the individual.
                    ``(B) The physician has the staff and resources to 
                manage the comprehensive and coordinated health care of 
                such individual.
            ``(3) Service-related requirements.--The requirements 
        described in this paragraph for a personal physician are as 
        follows:
                    ``(A) The personal physician advocates for and 
                provides ongoing support, oversight, and guidance to 
                implement a plan of care that provides an integrated, 
                coherent, cross-discipline plan for ongoing medical 
                care developed in partnership with patients and 
                including all other physicians furnishing care to the 
                patient involved and other appropriate medical 
                personnel or agencies (such as home health agencies).
                    ``(B) The personal physician uses evidence-based 
                medicine and clinical decision support tools to guide 
                decisionmaking at the point-of-care based on patient-
                specific factors.
                    ``(C) The personal physician is in compliance with 
                the standards for meaningful use of electronic health 
                records under this title.
                    ``(D) The personal physician participates with the 
                State's health information exchange, as available, or 
                the federally-sponsored Direct Project.
                    ``(E) The personal physician uses health 
                information technology, including appropriate remote 
                monitoring, to monitor and track the health status of 
                patients and to provide patients with enhanced and 
                convenient access to health care services.
                    ``(F) The personal physician uses electronic 
                prescribing and provides medication management.
                    ``(G) The personal physician encourages patients to 
                engage in the management of their own health through 
                education and support systems.
                    ``(H) The personal physician utilizes the services 
                of related health professionals, including nurse 
                practitioners and physician assistants.
    ``(d) Long-Term Illness or Medical Condition Defined.--In this 
section, the term `long-term illness or medical condition'--
            ``(1) includes a chronic condition which meets criteria 
        specified by the Secretary for a specialized MA plan for 
        special needs individuals; and
            ``(2) also includes another condition that the Secretary 
        determines would provide a beneficial focus for an effective 
        and efficient medical home.
    ``(e) Payment Mechanisms.--
            ``(1) Medical home care management fee and medical home 
        sharing in savings.--Except as provided in paragraph (2)--
                    ``(A) Medical home care management fee.--Under this 
                section the Secretary shall provide for payment under 
                section 1848 of a care management fee to the medical 
                home and may include performance incentives. The 
                medical home shall arrange for payment for the services 
                of affiliated physicians and facilities.
                    ``(B) Medical home sharing in savings.--The 
                Secretary shall provide for payment under this section 
                of a medical home based on the payment methodology 
                applied to health group practices under section 1866A. 
                Under such methodology, 80 percent of the reductions in 
                expenditures under this title and title XIX resulting 
                from participation of individuals that are attributable 
                to the medical home (as reduced by the total care 
                management fees paid to the medical home under this 
                section) shall be paid to the medical home. The amount 
                of such reductions in expenditures shall be determined 
                by using assumptions with respect to reductions in the 
                occurrence of health complications, hospitalization 
                rates, medical errors, and adverse drug reactions.
            ``(2) Alternative payment model.--
                    ``(A) In general.--The Secretary may provide for 
                payment under this paragraph instead of the amounts 
                otherwise payable under paragraph (1).
                    ``(B) Establishment of target spending level.--For 
                purposes of this paragraph, the Secretary shall compute 
                an estimated annual spending target based on the amount 
                the Secretary estimates would have been spent in the 
                absence of this section, for items and services covered 
                under parts A and B furnished to applicable 
                beneficiaries for each qualifying medical home under 
                this section. Such spending targets shall be determined 
                on a per capita basis. Such spending targets shall 
                include a risk corridor that takes into account normal 
                variation in expenditures for items and services 
                covered under parts A and B furnished to such 
                beneficiaries with the size of the corridor being 
                related to the number of applicable beneficiaries 
                furnished services by each medical home. The spending 
                targets may also be adjusted for such other factors as 
                the Secretary determines appropriate.
                    ``(C) Incentive payments.--Subject to performance 
                on quality measures, a qualifying medical home is 
                eligible to receive an incentive payment under this 
                section if actual expenditures for a year for the 
                applicable beneficiaries it enrolls are less than the 
                estimated spending target established under 
                subparagraph (B) for such year. An incentive payment 
                for such year shall be equal to a portion (as 
                determined by the Secretary) of the amount by which 
                actual expenditures (including incentive payments under 
                this paragraph) for applicable beneficiaries under 
                parts A and B for such year are estimated to be less 
                than 95 percent of the estimated spending target for 
                such year, as determined under subparagraph (B).
            ``(3) Source.--Payments paid under this section shall be 
        made in appropriate proportions (as specified by the Secretary) 
        from the Hospital Insurance Trust Fund, the Federal 
        Supplementary Medical Insurance Trust Fund, and funds 
        appropriated to carry out title XIX.
    ``(f) Evidence-Based.--The contracting entity shall follow 
evidence-based guidelines for care of the long-term illness or medical 
condition under this section.
    ``(g) Patient Services Quality and Performance Reporting.--The 
contracting entity shall report at least by the end of every month data 
specified by the Secretary on the operation of this section, including 
quality measures of process, outcome, and structure.
    ``(h) Waiver Authority.--
            ``(1) In general.--The limitations on telehealth 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 provisions of this section.''.

SEC. 203. FLEXIBILITY IN ACCOUNTABLE CARE ORGANIZATIONS COVERAGE OF 
              TELEHEALTH.

    Section 1899 of the Social Security Act (42 U.S.C. 1395jjj) is 
amended by adding at the end the following new subsection:
    ``(l) Flexibility for Telehealth.--
            ``(1) Provision as supplemental benefits.--Notwithstanding 
        any other provision of this section, an ACO may include 
        coverage of telehealth and remote patient monitoring services 
        as supplemental health care benefits to the same extent as a 
        Medicare Advantage plan is permitted to provide coverage of 
        such services as supplemental health care benefits under 
        1852(a)(3)(A).
            ``(2) Provision in connection with home health services.--
        Nothing in this section shall be construed as preventing an ACO 
        from including payments for remote patient monitoring and home-
        based video conferencing services in connection with the 
        provision of home health services (under conditions for which 
        payment for such services would not be made under section 1895 
        for such services) in a manner that is financially equivalent 
        to the furnishing of a home health visit.''.

SEC. 204. RECOGNIZING TELEHEALTH SERVICES AND REMOTE PATIENT MONITORING 
              IN NATIONAL PILOT PROGRAM ON PAYMENT BUNDLING.

    Section 1866D(a)(2) of the Social Security Act (42 U.S.C. 1395cc-
4(a)(2)) is amended--
            (1) in subparagraph (B), by striking ``10 conditions'' and 
        inserting ``the conditions'';
            (2) in subparagraph (C)--
                    (A) by redesignating clause (v) as clause (vi); and
                    (B) by inserting after clause (iv) the following 
                new clause:
                            ``(v) Telehealth and remote patient 
                        monitoring services.''; and
            (3) in subparagraph (D)(i)(III), by inserting before the 
        period at the end the following: ``(and such longer period in 
        the case of the use of telehealth and remote patient monitoring 
        services as the Secretary may specify)''.

SEC. 205. ADJUSTMENT IN MEDICARE HOME HEALTH PAYMENTS TO ACCOUNT FOR 
              USE OF REMOTE PATIENT MONITORING.

    (a) In General.--Section 1895(b) of the Social Security Act (42 
U.S.C. 1395fff(b)) is amended by adding at the end the following new 
paragraph:
            ``(7) Increase for the use of remote patient monitoring.--
                    ``(A) In general.--The Secretary shall provide for 
                an increase in the standard prospective payment amount 
                (or amounts) under paragraph (3) applicable to home 
                health services furnished using remote patient 
                monitoring. No such increase shall be provided unless 
                the agency furnishing the services provides the 
                Secretary with such additional information on outcomes 
                from the use of such monitoring as the Secretary may 
                require.
                    ``(B) Limitation.--The increase under this 
                paragraph shall be--
                            ``(i) applied only in 2014, 2015, and 2016; 
                        and
                            ``(ii) reduced in the case of 2016.
                    ``(C) Using remote patient monitoring defined.--In 
                this paragraph, the term `using remote patient 
                monitoring' means using devices and communications 
                networks to remotely collect and send diagnostic data 
                to a monitoring station for interpretation.''.
    (b) Application on a Budget Neutral Basis.--Paragraph (3) of such 
section is amended by adding at the end the following new subparagraph:
                    ``(D) Budget-neutrality adjustment to offset cost 
                of increased payment for using remote patient 
                monitoring.--The Secretary shall reduce the standard 
                prospective payment amount (or amounts) under this 
                paragraph applicable to home health services furnished 
                during a period by such proportion as the Secretary 
                estimates will result in an aggregate reduction in 
                payments for the period equal to the total increase in 
                payments estimated to be made based on the application 
                of paragraph (7) for the period.''.

SEC. 206. INCLUDING TELEHEALTH AND REMOTE PATIENT MONITORING SERVICES 
              AS PART OF AN INTERVENTION PROPOSAL UNDER THE MEDICARE 
              COMMUNITY-BASED CARE TRANSITIONS PROGRAM.

    Section 3026(c)(2)(B) of the Patient Protection and Affordable Care 
Act of 2010 (Public Law 111-148; 42 U.S.C. 1395b-1 note) is amended by 
adding at the end the following new clause:
                            ``(vi) Monitoring a high-risk Medicare 
                        beneficiary through the use of telehealth or 
                        remote patient monitoring services.''.

             TITLE III--ADDITIONAL IMPROVEMENT TO MEDICAID

SEC. 301. MEDICAID OPTION FOR HIGH-RISK PREGNANCIES AND BIRTHS.

    (a) In General.--Title XIX of the Social Security Act is amended by 
adding at the end the following new section:

``SEC. 1947. STATE OPTION TO PROVIDE COORDINATED CARE FOR ENROLLEES 
              WITH HIGH-RISK PREGNANCIES AND BIRTHS.

    ``(a) In General.--Notwithstanding section 1902(a)(1) (relating to 
statewideness), section 1902(a)(10)(B) (relating to comparability), and 
any other provision of this title for which the Secretary determines it 
is necessary to waive in order to implement this section, beginning 6 
months after the date of the enactment of this section, a State, at its 
option as a State plan amendment, may provide for medical assistance 
under this title to eligible individuals for maternal-fetal and 
neonatal care who select a designated provider (as described under 
subsection (h)(5)), a team of health care professionals (as described 
under subsection (h)(6)) operating with such a provider, or a health 
team (as described under subsection (h)(7)) as the individual's 
birthing network for purposes of providing the individual with 
pregnancy-related services.
    ``(b) Qualification Standards.--The Secretary shall establish 
standards for qualification as a designated provider for the purpose of 
being eligible to be a birthing network for purposes of this section.
    ``(c) Payments.--
            ``(1) In general.--A State shall provide a designated 
        provider, a team of health care professionals operating with 
        such a provider, or a health team with payments for the 
        provision of birthing network services to each eligible 
        individual for maternal-fetal and neonatal care that selects 
        such provider, team of health care professionals, or health 
        team as the individual's birthing network. Payments made to a 
        designated provider, a team of health care professionals 
        operating with such a provider, or a health team for such 
        services shall be treated as medical assistance for purposes of 
        section 1903(a), except that, during the first 8 fiscal year 
        quarters that the State plan amendment is in effect, the 
        Federal medical assistance percentage applicable to such 
        payments shall be equal to 90 percent.
            ``(2) Savings target.--As a condition for approval of a 
        State plan amendment and payment methodology under this 
        section, the State shall provide the Secretary with assurances 
        that the amendment and methodology shall be projected to reduce 
        the amount of expenditures for pregnancy-related services 
        otherwise made under this title by one percent for each 4-
        calendar-quarter period during the first 40 calendar quarters 
        in which the amendment is in effect.
            ``(3) Methodology.--
                    ``(A) In general.--The State shall specify in the 
                State plan amendment the methodology the State will use 
                for determining payment for the provision of birthing 
                network services. Such methodology for determining 
                payment shall be established consistent with section 
                1902(a)(30)(A).
                    ``(B) Innovative models of payment.--The 
                methodology for determining payment for provision of 
                birthing network services under this section shall not 
                be limited to a per-member per-month basis and may 
                provide (as proposed by the State and subject to 
                approval by the Secretary) for alternate models of 
                payment, including bundled per episode, performance 
                incentives, and shared savings.
            ``(4) Planning grants.--
                    ``(A) In general.--Beginning 30 days after the date 
                of the enactment of this section, the Secretary may 
                award planning grants to States for purposes of 
                developing a State plan amendment under this section. A 
                planning grant awarded to a State or a multi-state 
                collaborative under this paragraph shall remain 
                available until expended.
                    ``(B) Limitation.--The total amount of payments 
                made to States under this paragraph shall not exceed 
                $25,000,000.
    ``(d) Report on Quality Measures.--As a condition for receiving 
payment for birthing network services provided to an eligible 
individual for maternal-fetal and neonatal care, a designated provider 
shall report monthly to the State, in accordance with such requirements 
as the Secretary shall specify, on all applicable measures for 
determining the quality of such services. When appropriate and 
feasible, a designated provider shall use health information technology 
in providing the State with such information.
    ``(e) Evidence-Based.--The birthing network shall adapt, update, 
and follow evidence-based guidelines for maternal-fetal and neonatal 
care.
    ``(f) Definitions.--In this section:
            ``(1) Eligible individual for maternal-fetal and neonatal 
        care.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                term `eligible individual' means an individual who--
                            ``(i) is eligible for medical assistance 
                        under the State plan or under a waiver of such 
                        plan; and
                            ``(ii)(I) is pregnant (or was pregnant 
                        during the immediately preceding 30 day 
                        period); or
                            ``(II) is the child of an individual 
                        described in clause (i) and under 30 days old.
                    ``(B) Rule of construction.--Nothing in this 
                paragraph shall prevent the Secretary from establishing 
                other requirements for purposes of determining 
                eligibility for receipt of birthing network services 
                under this section.
            ``(2) Birthing network.--The term `birthing network' means 
        a designated provider (including a provider that operates in 
        coordination with a team of health care professionals) or a 
        health team selected by an eligible individual to provide 
        birthing network services.
            ``(3) Birthing network services.--
                    ``(A) In general.--The term `birthing network 
                services' means comprehensive and timely high-quality 
                services described in subparagraph (B) that are 
                provided by a designated provider, a team of health 
                care professionals 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 hospital 
                        readmissions;
                            ``(v) patient and family support (including 
                        authorized representatives);
                            ``(vi) referral to community and social 
                        support services, if relevant; and
                            ``(vii) use of health information 
                        technology to link services and provide 
                        monitoring, as feasible and appropriate.
            ``(4) Designated provider.--The term `designated provider' 
        means a physician, clinical practice or clinical group 
        practice, rural clinic, community health center, public health 
        agency, home health agency, or any other entity or provider 
        (including pediatricians, gynecologists, and obstetricians) 
        that is determined by the State and approved by the Secretary 
        to be qualified to be a birthing network for eligible 
        individuals on the basis of documentation evidencing that the 
        physician, practice, or clinic--
                    ``(A) has the systems and infrastructure in place 
                to provide birthing network services; and
                    ``(B) satisfies the qualification standards 
                established by the Secretary under subsection (b) and 
                paragraph (7)(B).
            ``(5) Team of health care professionals.--The term `team of 
        health care professionals' means a team of health professionals 
        (as described in the State plan amendment) that may--
                    ``(A) include physicians and other professionals, 
                such as a nurse care coordinator, midwife, 
                nutritionist, social worker, behavioral health 
                professional, or any professionals deemed appropriate 
                by the State; and
                    ``(B) be free standing, virtual, or based at a 
                hospital, community health center, rural clinic, 
                clinical practice or clinical group practice, academic 
                health center, or any entity deemed appropriate by the 
                State and approved by the Secretary.
            ``(6) Health team.--The term `health team' has the meaning 
        given such term for purposes of section 3502 of the Patient 
        Protection and Affordable Care Act.
            ``(7) Birthing data and exchange.--
                    ``(A) Proposal for use of health information 
                technology.--A State shall include in the State plan 
                amendment a proposal for use of health information 
                technology in providing birthing network 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 management of care and patient 
                adherence to recommendations made by their provider).
                    ``(B) Information requirements for birthing 
                networks.--The birthing network shall--
                            ``(i) be in compliance with the Medicaid 
                        standards for meaningful use of electronic 
                        health records;
                            ``(ii) participate with the State's health 
                        information exchange, as available, or operate 
                        an exchange among the birthing network;
                            ``(iii) collect demographic information on 
                        participating newborns and mothers;
                            ``(iv) use demographic and event-based data 
                        to identify patients that are likely going to 
                        need short or long-term follow-up; and
                            ``(v) providing de-identified demographic 
                        data sets for statistical and social science 
                        research to develop culturally-competent best 
                        practices and clinical decision support 
                        mechanisms for maternal-fetal and neonatal 
                        care.''.
    (b) Patient Services Quality and Performance Reporting.--
            (1) In general.--Not later than 3 years after the date of 
        the enactment of this Act, the Secretary of Health and Human 
        Services shall survey States that have elected the option under 
        section 1947 of the Social Security Act, as added by section 
        (a), on the nature, extent, and use of such option, 
        particularly as it pertains to--
                    (A) terms of pregnancies;
                    (B) use of prenatal fetal monitoring;
                    (C) use of Caesarean section procedures;
                    (D) use of neonatal intensive care services;
                    (E) incidence of birthing complications;
                    (F) incidence of infant and maternal mortality;
                    (G) coordination of maternal-fetal and neonatal 
                care for individuals;
                    (H) assessment of program implementation;
                    (I) processes and lessons learned (as described in 
                subparagraph (B));
                    (J) assessment of quality improvements and clinical 
                outcomes under such option; and
                    (K) participating mothers' assessment of 
                performance, quality, convenience, and satisfaction.
            (2) Implementation reporting.--A State that has elected the 
        option under such section shall report to the Secretary, as 
        necessary, on processes that have been developed and lessons 
        learned regarding provision of coordinated care through a 
        birthing network for Medicaid beneficiaries for maternal-fetal 
        and neonatal care under such option.
                                 <all>