109th CONGRESS
2d Session
S. 2282
To amend title XVIII of the Social Security Act to provide for
access to telehealth services in the home.
IN THE SENATE OF THE UNITED STATES
February 14, 2006
Mr. SANTORUM 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 provide for
access to telehealth services in the home.
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 `Medicare Home Health Telehealth Access Act
of 2006'.
SEC. 2. ACCESS TO TELEHEALTH SERVICES IN THE HOME.
(a) In General- Section 1895(e) of the Social Security Act (42 U.S.C. 1395fff(e))
is amended to read as follows:
`(e) Coverage of Telehealth Services-
`(1) IN GENERAL- The Secretary shall include telehealth services that
are furnished via a telecommunication system by a home health agency to
an individual receiving home health services under section 1814(a)(2)(C)
or 1835(a)(2)(A) as a home health visit for purposes of eligibility and
payment under this title if the telehealth services--
`(A) are ordered as part of a plan of care certified by a physician
pursuant to section 1814(a)(2)(C) or 1835(a)(2)(A);
`(B) do not substitute for in-person home health services ordered as
part of a plan of care certified by a physician pursuant to such respective
section; and
`(C) are considered the equivalent of a visit under criteria developed
by the Secretary under paragraph (3).
`(2) PHYSICIAN CERTIFICATION- Nothing in this section shall be construed
as waiving the requirement for a physician certification under section
1814(a)(2)(C) or 1835(a)(2)(A) for the payment for home health services,
whether or not furnished via a telecommunication system.
`(3) CRITERIA FOR VISIT EQUIVALENCY-
`(A) STANDARDS- The Secretary shall establish standards and qualifications
for categorizing and coding under HCPCS codes telehealth services under
this subsection as equivalent to an in-person visit for purposes of
eligibility and payment for home health services under this title. In
establishing the standards and qualifications, the Secretary may distinguish
between varying modes and modalities of telehealth services and shall
consider--
`(i) the nature and amount of service time involved; and
`(ii) the functions of the telecommunications.
`(B) LIMITATION- A telecommunication that consists solely of a telephone
audio conversation, facsimile, electronic text mail, or consultation
between two health care practitioners is not considered a visit under
this subsection.
`(A) DEFINITION- For purposes of this section, the term `telehealth
service' means technology-based professional consultations, patient
monitoring, patient training services, clinical observation, assessment,
or treatment, and any additional services that utilize technologies
specified by the Secretary as HCPCS codes developed under paragraph
(3).
`(B) UPDATE OF HCPCS CODES- The Secretary shall establish a process
for the updating, not less frequently than annually, of HCPCS codes
for telehealth services.
`(5) CONDITIONS FOR PAYMENT AND COVERAGE- Nothing in this subsection shall
be construed as waiving any condition of payment under sections 1814(a)(2)(C)
or 1835(a)(2)(A) or exclusion of coverage under section 1862(a)(1).
`(6) COST REPORTING- Notwithstanding any provision to the contrary, the
Secretary shall provide that the costs of telehealth services under this
subsection shall be reported as a reimbursable cost center on any cost
report submitted by a home health agency to the Secretary.'.
(1) The amendment made by subsection (a) shall apply to telehealth services
furnished on or after October 1, 2006. The Secretary of Health and Human
Services shall develop and implement criteria and standards under section
1895(e)(3) of the Social Security Act, as amended by subsection (a), by
no later than July 1, 2006.
(2) In the event that the Secretary has not complied with these deadlines,
beginning October 1, 2006, a home health visit for purpose of eligibility
and payment under title XVIII of the Social Security Act shall include
telehealth services under section 1895(e) of such Act with the aggregate
of telecommunication encounters in a 24-hour period considered the equivalent
of one in-person visit.
SEC. 3. REMOTE MONITORING PILOT PROJECTS.
(a) Pilot Program Authorized- The Secretary of Health and Human Services
(in this section referred to as the `Secretary') shall initiate and carry
out pilot projects (each in this section referred to as a `pilot project')
in a variety of geographic locations that provide incentives to home health
agencies to utilize home monitoring and communications technologies that
will--
(1) enhance health outcomes for individuals enrolled under parts A and
B of title XVIII of the Social Security Act; and
(2) reduce part A and B program expenditures for institutional and other
providers, practitioners, and suppliers of health care items and services.
(b) Individuals Within the Scope of Pilot-
(1) IN GENERAL- The Secretary shall specify, in accordance with this subsection,
the criteria for identifying those individuals who shall be considered
within the scope of the pilot projects under this section for purposes
of the incentive payments under subsection (c) and for assessment of the
effectiveness of the home health agency in achieving the objectives of
the section.
(2) PARTICIPATION OF INDIVIDUALS NOT RECEIVING HOME HEALTH SERVICES- Participation
in these pilot projects shall not be limited to individuals receiving
home health services under part A or part B of title XVIII of the Social
Security Act.
(1) IN GENERAL- Subject to paragraph (2), the Secretary shall pay to each
home health agency participating in a pilot project an amount for each
year under the pilot project equal to at least 50 percent of the reduction
in expenditures under such parts realized for such year due to the agency's
participation in the project. The computation of such reduction shall
be based on the Secretary's estimate of the amount by which the amount
of expenditures under such parts for the individuals under the pilot project
is less than the amount that would have been expended under such parts
for such individuals if the project were not implemented. In determining
the estimate, the Secretary may use estimates for expenditures for individuals
who are not participating in the project and who are comparable to individuals
participating in the project.
(2) LIMITATION ON EXPENDITURES- The Secretary shall limit incentive payments
under this subsection as necessary to ensure that the aggregate expenditures
under title XVIII of the Social Security Act (inclusive of such incentive
payments) with respect to patients within the scope of the pilot projects
do not exceed the amount that the Secretary estimates would be expended
under such title if the pilot projects under this section were not implemented.
(d) Construction- Nothing in this section shall limit the amount of payment
(other than under subsection (c)) a home health agency may receive for home
health services provided to eligible individuals under part A or part B
of title XVIII of the Social Security Act.
(e) Implementation Date- The Secretary shall implement the pilot projects
authorized by this section no later than nine months after the date of the
enactment of this Act.
(f) Expansion of the Pilot Project- If the Secretary determines that any
of the pilot projects--
(1) result in a decrease in Federal expenditures under title XVIII of
the Social Security Act; and
(2) maintain or enhance health outcomes for the participating beneficiaries,
the Secretary may initiate or extend comparable projects in additional areas.
END
