Sec. 301. Remote patient monitoring services for individuals with certain chronic health conditions
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Section 1861(s)(2) of the Social Security Act ( 42 U.S.C. 1395x(s)(2) ) is amended— in subparagraph (EE), by striking and at the end; in subparagraph (FF), by inserting and at the end; and by inserting after subparagraph
(FF)the following new subparagraph: applicable remote patient monitoring services for individuals with certain chronic health conditions (as defined in subsection (iii)); . Section 1861(aa) of the Social Security Act ( 42 U.S.C. 1395x(aa) ) is amended— in paragraph (1)— in subparagraph (B), by striking , and and inserting a comma; in subparagraph (C), by inserting and after the comma at the end; and by inserting after subparagraph
(C)the following new subparagraph: applicable remote patient monitoring services for individuals with certain chronic health conditions (as defined in subsection (iii)), ; and in paragraph (3)— in subparagraph (A), by striking ; and and inserting a semicolon; in subparagraph (B), by striking the comma and inserting ; and ; and by inserting after subparagraph
(B)the following new subparagraph: applicable remote patient monitoring services for individuals with certain chronic health conditions (as defined in subsection (iii)), . Section 1861 of the Social Security Act ( 42 U.S.C. 1395x ) is amended by adding at the end the following new subsection: The term applicable remote patient monitoring services for individuals with certain chronic health conditions means remote patient monitoring services (as defined in subparagraph (B)) furnished to an applicable individual (as defined in subparagraph (C)) under general supervision of the provider, with the exception of those services covered under subsection (s)(1). The term remote patient monitoring services means personal medical data transmitted from an applicable individual in one location via electronic communications technologies to an eligible provider (as defined in subparagraph (D)) in a different location and used by the eligible provider in furnishing remote patient monitoring services to such individual that complies with the Federal regulations (concerning the privacy and security of individually identifiable health information) promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996, as part of an established plan of care for that individual that includes the review and interpretation of that data by an eligible provider. Such term includes those services furnished in a Federally qualified health center or a rural health clinic The term applicable individual means an individual— with 2 or more covered chronic conditions (as defined in paragraph (2)); and who has a history of 2 or more hospitalizations or emergency room visits related to such covered chronic conditions of the individual in the preceding 12 months. The term eligible provider means a physician (as defined in section 1861(r)) or a practitioner described in section 1842(b)(18)(C). The Secretary shall establish procedures under which eligible providers who furnish remote patient monitoring services are required to annually submit data on applicable quality measures under sections 1848 and 1833(z). For purposes of paragraph (1)(C), subject to subparagraph (B), the term covered chronic condition means— a condition that qualifies an individual for chronic care management services under section 1848(b)(8); and any other condition the Secretary may specify. If the Chief Actuary of the Centers for Medicare & Medicaid Services determines that the inclusion of a condition described in subparagraph
(A)in the definition of the term covered chronic condition under such subparagraph will result in increased expenditures under this title, the Secretary shall make adjustments to such definition to eliminate such increased expenditures. Payment may be made under this part for applicable remote patient monitoring services for individuals with certain chronic health conditions furnished to an applicable individual during a period of up to 90 days (beginning with the commencement of such services) and such additional period as provided for under subparagraph (B). The 90-day period described in subparagraph (A), with respect to an applicable individual, may be renewed by the eligible provider who provides chronic care management services to such individual if the individual has had one or more hospitalizations, not including emergency room visits, related to the covered chronic conditions of the individual described in paragraph (1)(C) since the beginning of such period. . Section 1848(j)(3) of the Social Security Act ( 42 U.S.C. 1395w–4(j)(3) ) is amended by inserting (2)(GG), after health risk assessment), . Section 1833 of the Social Security Act ( 42 U.S.C. 1395l ) is amended by adding at the end the following new subsection: Notwithstanding any other provision of law, in the case of applicable remote patient monitoring services for individuals with certain chronic health conditions (as defined in section 1861(iii)) furnished by a rural health clinic or a Federally qualified health center under paragraphs
(1)and (3), respectively, of section 1861(aa), payment shall be made in an amount equal to the national average payment amount for such service, as determined by the Secretary, in accordance with section 1848 (without regard to any adjustment under subsections (a)(5), (a)(7), (a)(8), (p), or
(q)of such section). . The amendments made by this section shall apply to services furnished on or after January 1, 2017.
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- 42 USC 1395w–4(j)(3)
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Sec. 301
Remote patient monitoring services for individuals with certain chronic health conditions
Cite42 USC 1395w–4(j)(3)
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