Sec. 6. Coverage of remote patient monitoring services furnished to certain individuals

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Section 1848(b) of the Social Security Act ( 42 U.S.C. 1395w–4(b) ) is amended by adding at the end the following new paragraph: The Secretary shall, subject to subparagraph (B), make payment (as the Secretary determines to be appropriate) under this section for remote patient monitoring services (as defined in subparagraph (C)(iii)) furnished on or after January 1, 2018, to an applicable individual (as defined in subparagraph (C)(i)) by an eligible provider (as defined in subparagraph (C)(ii)).

The following shall apply with respect to remote patient monitoring services under this paragraph: Coverage of such remote patient monitoring services shall be in addition to coverage for chronic care management services or transitional care management services furnished to an applicable individual under this section. The Secretary shall consult with public and private stakeholders in determining the amount of payment for remote patient monitoring services under this section.

Payment, pricing, and coverage for such remote patient monitoring services may occur through the unbundling, modification, or establishment of certain codes. Such remote patient monitoring services (other than those services that are physicians' services) shall be furnished under the general supervision of an eligible provider. In this paragraph: The term applicable individual means an individual— receiving chronic care management services or transitional care management services under this section; who is in the top five percent of Medicare cost utilization and has two or more chronic diseases, as determined on a yearly basis by the Secretary; or who has any other condition or with respect to an episode of care that the Secretary may specify, so long as the Chief Actuary of the Centers for Medicare & Medicaid Services certifies that providing coverage for remote patient monitoring services with respect to such individuals would— reduce spending under this title without reducing the quality of care; or improve the quality of patient care without increasing spending.

The term eligible provider means a physician (as defined in section 1861(r)) or a practitioner described in section 1842(b)(18)(C). The term remote patient monitoring services means clinical data transmitted from an applicable individual in one location via electronic communications technologies that are devices as defined in section 201(h) of the Federal Food, Drug, and Cosmetic Act to an eligible provider in a different location and used by the eligible provider in furnishing such 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 the applicable 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. Such term shall not include a communication that consists solely of a telephone audio conversation, facsimile, or electronic text message between an eligible provider and the applicable individual. . Section 1848(b)(12) of the Social Security Act ( 42 U.S.C. 1395w–4(b)(12) ), as added by subsection (a), is amended by adding at the end the following new subparagraph: For purposes of applying this paragraph with respect to remote patient monitoring services furnished by an eligible provider participating in an alternative payment model (as defined in section 1833(z)(3)(C)), the term applicable individual shall mean any beneficiary assigned to the alternative payment model. .

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42 USC 1395w–4(b)
42 USC 1395w–4(b)(12)

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Sec. 6

Coverage of remote patient monitoring services furnished to certain individuals

Cite42 USC 1395w–4(b)

Cite42 USC 1395w–4(b)(12)

Cites 2Cited by 0 across 0 sources