Sec. 5. Increasing access to digital tools for Medicare Advantage enrollees through telehealth and remote patient monitoring

633 words·~3 min read·/bill/115/hr/2556/ih/section-5

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

Section 1852 of the Social Security Act ( 42 U.S.C. 1395w–22 ) is amended— in subsection (a)(1)(B)(i), by inserting , subject to subsection (m), after means ; and by adding at the end the following new subsection: For plan year 2018 and subsequent plan years, subject to the requirements of paragraph (3), an MA plan may provide additional telehealth benefits (as defined in paragraph (2)) to individuals enrolled under this part. For purposes of this subsection and section 1854:

The term additional telehealth benefits means services for which benefits are available under part B, notwithstanding the restrictions applicable to the coverage of telehealth services under section 1834(m) described in subparagraph (B). The term additional telehealth benefits does not include capital and infrastructure costs and investments relating to such benefits. For purposes of this subsection, restrictions applicable to the coverage of telehealth services under section 1834(m) shall include requirements relating to qualifications for an originating site under paragraph (4)(C)(ii) of such section, any geographic limitations under paragraph (4)(C)(i) of such section (other than applicable State law requirements, including State licensure requirements), any limitation on the use of store-and-forward technologies described in paragraph

(1)of such section, any limitation on the type of health care provider who may furnish such services (other than the requirement that the provider is a Medicare-enrolled provider), or any limitation on specific codes designated as telehealth services that are covered under this title pursuant to such section (provided such codes are clinically appropriate to furnish remotely). Not later than November 30, 2017, the Secretary shall solicit comments on what types of telehealth services should be considered to meet the definition of additional telehealth benefits under this paragraph. The Secretary shall specify requirements for the provision or furnishing of additional telehealth benefits, including with respect to the following: Physician, practitioner, or other health care provider licensure consistent with State law and other requirements such as specific training. Factors necessary to ensure the coordination of such benefits with items and services furnished in person. Such other areas as determined by the Secretary. If an MA plan provides a service as an additional telehealth benefit (as defined in paragraph (2)), an individual enrollee shall have discretion as to whether to receive such service as an additional telehealth benefit. The provision of additional telehealth benefits under this subsection shall not be construed as making such benefits available and accessible for purposes of compliance with subsection (d). For purposes of this subsection and section 1854, additional telehealth benefits shall be treated as if they were benefits under the original Medicare fee-for-service program option. Nothing in this subsection shall be construed as affecting the requirement under subsection (a)(1) that MA plans provide enrollees with items and services (other than hospice care) for which benefits are available under parts A and B, including benefits available under section 1834(m). For purposes of this subsection and section 1854, remote patient monitoring services shall be treated as if they were benefits under the original Medicare fee-for-service program option so long as such treatment does not increase the bid amount attributable to such benefits from the amount it would otherwise be, as determined by the Secretary. An MA plan that provides additional telehealth benefits or remote patient monitoring services with respect to a plan year shall provide to the Secretary (at such time and in such manner as the Secretary may specify) data on expenditures and utilization for telehealth or remote patient monitoring services under the plan for enrollees during that plan year. . Section 1854(a)(6)(A)(ii)(I) of the Social Security Act ( 42 U.S.C. 1395w–24(a)(6)(A)(ii)(I) ) is amended by inserting , including, for plan year 2019 and subsequent plan years, the provision of additional telehealth benefits and remote patient monitoring as described in section 1852(m) before the semicolon at the end.

Connections2 off-index

2 references not yet in our index

42 USC 1395w–22
42 USC 1395w–24(a)(6)(A)(ii)(I)

Citation graph

cites case law

Sec. 5

Increasing access to digital tools for Medicare Advantage enrollees through telehealth and remote patient monitoring

Cite42 USC 1395w–22

Cite42 USC 1395w–24(a)(6)(A)(ii)(I)

Cites 2Cited by 0 across 0 sources