[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 207 Introduced in House (IH)]
<DOC>
118th CONGRESS
1st Session
H. R. 207
To amend title XVIII of the Social Security Act to provide coverage and
payment for certain tests and assistive telehealth consultations, and
for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
January 9, 2023
Mr. Schweikert introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Ways and Means, 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 amend title XVIII of the Social Security Act to provide coverage and
payment for certain tests and assistive telehealth consultations, 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 ``Advanced Safe
Testing at Residence Telehealth Act of 2023''.
(b) Table of Contents.--The table of contents is as follows:
Sec. 1. Short title.
Sec. 2. Coverage and payment for certain tests and assistive telehealth
consultations; demonstration program under
certain State Medicaid programs.
``Sec. 1859A. Tests and assistive telehealth consultations
demonstration.
Sec. 3. Pilot program on improved access to certain tests and assistive
telehealth consultations for veterans.
SEC. 2. COVERAGE AND PAYMENT FOR CERTAIN TESTS AND ASSISTIVE TELEHEALTH
CONSULTATIONS; DEMONSTRATION PROGRAM UNDER CERTAIN STATE
MEDICAID PROGRAMS.
(a) Tests and Assistive Telehealth Consultations Demonstration.--
Part C of title XVIII of the Social Security Act is amended by
inserting after section 1859 (42 U.S.C. 1395w-28) the following new
subsection:
``SEC. 1859A. TESTS AND ASSISTIVE TELEHEALTH CONSULTATIONS
DEMONSTRATION.
``(a) Establishment.--
``(1) In general.--The Secretary shall establish a Value-
Based Insurance Design Model demonstration program (in this
section referred to as the `VBID demonstration program') to
provide to eligible Medicare beneficiaries--
``(A) an assistive telehealth consultation that is
furnished via a telecommunications system by a
physician or practitioner to an eligible telehealth
individual enrolled under part B notwithstanding that
the individual physician or practitioner ordering the
test did not furnish the test or that the individual
physician or practitioner providing the assistive
telehealth consultation is not at the same location as
the beneficiary; and
``(B) home and community-based care.
``(2) Agreements.--The Secretary shall enter into
agreements with eligible MA organizations under which such
organizations shall offer eligible MA plans under the VBID
demonstration program to eligible Medicare beneficiaries.
``(3) Limitations on number of plans for vbid demonstration
program.--The VBID demonstration program shall be carried out
with respect to not greater than 25 MA plans, with a minimum of
10 MA plans that serve rural or underserved areas.
``(4) Eligible ma plans defined.--For purposes of this
section, the term `eligible MA plan' means a plan that, in
addition to items and services for which coverage is otherwise
provided under this part (including benefits under section
1852(a)(3) and notwithstanding any waivers under section
1915(c)), provides for coverage of--
``(A) tests that are medical devices (as defined in
section 201(h) of the Federal Food, Drug, and Cosmetic
Act or wearable patient monitoring device, including
adaptive artificial intelligence, machine learning, and
software as a medical device (SaMD) technologies that
operate to the full scope of medical purpose defined by
the Administrator of the Food and Drug Administration)
and are identified by the Secretary as having
appropriate at home use that is approved under section
505 of the Federal Food, Drug, and Cosmetic Act, and
are either--
``(i) a diagnostic test or screening for
the diagnosis of influenza or a similar
respiratory condition that is required to
obtain a final diagnosis of COVID-19 for an
individual when such test is ordered by a
physician or practitioner in conjunction with a
COVID-19 diagnostic test or screening for
purposes of discounting a diagnosis of
influenza or a related diagnosis for such
individual;
``(ii) a serology test for COVID-19;
``(iii) a diagnostic test or screening for
the diagnosis of prostate cancer, ovarian
cancer, breast cancer, hypothyroidism,
rheumatoid arthritis, celiac disease, vascular
inflammation, cardiovascular health, strep
throat, or lipoprotein (A);
``(iv) a haptoglobin genetic test;
``(v) a prediabetes and diabetes screening;
``(vi) an IgE allergy test;
``(vii) a screening or diagnostic capsule
endoscopy; or
``(viii) any other test identified by the
Secretary, including those proposed by the MA
organization, as having appropriate for at-home
use that is approved under section 505 of the
Federal Food, Drug, and Cosmetic Act;
``(B) assistive telehealth consultations;
``(C) telehealth services;
``(D) fitness benefits;
``(E) meal benefits (beyond limited basis);
``(F) transportation services;
``(G) safety and other equipment not otherwise
covered under this title; and
``(H) care in rural or highly rural areas (as
determined in consultation with the Secretary of
Agriculture using the Rural-Urban Commuting Areas
coding system).
``(5) Other matters relating to documentation and claims
review.--The requirements of paragraphs (2) and (3) of section
410.32(d) of title 42, Code of Federal Regulations (as in
effect on the date of the enactment of this paragraph),
relating to documentation and claims review, respectively,
shall apply to a test described in paragraph (4)(A) and an
assistive telehealth consultation.
``(6) Demographic data.--To be eligible for reimbursement
under this paragraph, each claim for reimbursement shall
include, with respect to each eligible Medicare beneficiary,
the following demographic data:
``(A) Age.
``(B) Race and ethnicity.
``(C) Gender.
``(D) An affirmative or negative statement of the
existence of any chronic condition.
``(E) Any other information the Secretary
determines appropriate.
``(7) Assistive telehealth consultation.--In this
subsection, the term `assistive telehealth consultation' means
a telehealth service (as defined in section 1834(m)(4)(F)) that
is--
``(A) an evaluation and management service;
``(B) an assessment of any evidence of systems
which would make a diagnostic test or screening
necessary to be furnished in the home of an eligible
telehealth individual;
``(C) the ordering of a diagnostic test or
screening;
``(D) an assessment of an individual succeeding the
delivery of a diagnostic test or screening;
``(E) any assistance in the collection (or
transmission) of images or data necessary for a
diagnostic test or screening and securing the sample
for shipping;
``(F) the referral of an eligible telehealth
individual to a physician or practitioner for in-person
treatment; or
``(G) the review of a diagnostic test or screening
by a physician or practitioner.
``(b) Eligible MA Organizations.--For purposes of this section, the
term `eligible MA organization' means an MA organization that--
``(1) is located in a State that the Secretary has
determined is able to participate in the VBID demonstration
program by agreeing to make available data necessary for
purposes of conducting the independent evaluation required
under subsection (h); and
``(2) meets such other criteria as the Secretary may
require.
``(c) Eligible Medicare Beneficiary Defined.--In this section, the
term `eligible Medicare beneficiary' means a Medicare beneficiary who--
``(1) is eligible for benefits under this title and--
``(A) is eligible to enroll in an eligible MA plan
under the VBID demonstration program;
``(B) is a subsidy-eligible individual (as defined
in section 1860D-14(a)(3)(A)); and
``(C) is age 65 or older; or
``(2) is a dual eligible individual (as defined in section
1915(h)(2)(B)) or qualified medicare beneficiary (as defined in
section 1905(p)(1)) who is eligible for medical assistance
under a State plan under title XIX.
``(d) Payments.--The Secretary shall establish payment rates for
eligible MA organizations offering eligible MA plans under the VBID
demonstration program for benefits covered under such program (and not
otherwise covered under part C) and provided to eligible Medicare
beneficiaries under such plans. Such payment rates shall--
``(1) be based upon payment rates established for purposes
of payment under section 1853;
``(2) be in addition to payments otherwise made to such
organization with respect to such plans under part C;
``(3) be adjusted to reflect the costs of treating eligible
Medicare beneficiaries under this section; and
``(4) not be made for a test via a telecommunications
system described in subsection (a)(4), unless the physician or
practitioner determines such a test is medically necessary and
appropriate (as determined by the Secretary).
``(e) Special Election Period.--Notwithstanding sections
1852(e)(2)(C) and 1860D-1(b)(1)(B)(iii), an eligible Medicare
beneficiary may, other than during the annual, coordinated election
periods under such sections discontinue enrollment in an MA plan not
participating in the VBID demonstration program and enroll in an MA
plan participating in such program.
``(f) Beneficiary Education.--The Secretary shall help to educate,
through State Health Insurance Assistance Programs and other
organizations that assist seniors with respect to benefits and
enrollment under this title, eligible Medicare beneficiaries on the
availability of the VBID demonstration program.
``(g) Implementation.--
``(1) Deadline.--The VBID demonstration program shall be
implemented not later than January 1 of the second year
beginning after the date of the enactment of this section.
``(2) Duration.--Subject to paragraph (3), the VBID
demonstration program shall be conducted for a period of five
years.
``(3) Extension or expansion.--Taking into account the
report under subsection (h)(2), the Secretary may, through
notice and comment rulemaking, expand the duration, scope, or
both the duration and scope of the VBID demonstration program
(including implementation on a nationwide or permanent basis or
both), other than under the original Medicare fee-for-service
program under parts A and B of such title, to the extent
determined appropriate by the Secretary, unless the Secretary
determines that such expansion is expected to--
``(A) increase aggregate expenditures under this
title and title XIX with respect to eligible Medicare
beneficiaries participating in the VBID demonstration
program; or
``(B) decrease the quality of health care services
furnished to eligible Medicare beneficiaries
participating in the VBID demonstration program.
``(h) Independent Evaluation and Reports.--
``(1) Independent evaluation.--
``(A) In general.--The Secretary shall provide for
the evaluation of the VBID demonstration program by an
independent third party.
``(B) Evaluation objectives.--Such evaluation shall
determine the extent to which the VBID demonstration
program has resulted in--
``(i) improved patient care;
``(ii) reduced hospitalizations or
rehospitalizations;
``(iii) reduced or delayed nursing facility
admissions and lengths of stay under title XIX;
``(iv) reduced spend down of income and
assets for purposes of becoming eligible for
medical assistance under a State plan under
title XIX;
``(v) improved quality of life for the
eligible Medicare beneficiaries enrolled in an
eligible MA plan participating in the VBID
demonstration program;
``(vi) improved caregiver satisfaction; and
``(vii) addressing disparities and access
for underserved populations.
``(C) Evaluation process.--Such evaluation shall be
completed in accordance with the following process:
``(i) The Secretary shall, prior to the
implementation of such program, establish goals
for such program with respect to the evaluation
objectives described in subparagraph (B) and
criteria for measuring the extent to which an
eligible MA plan participating in the VBID
demonstration program meets such goals.
``(ii) The Secretary shall implement clear
data collection and reporting requirements for
such eligible MA plans in order to carry out
such evaluation.
In carrying out such process, the Secretary shall
recognize that definitions, benefits, and program
requirements for long-term care services and supports
vary across States.
``(2) Reports.--Not later than four years after the
implementation of the VBID demonstration program, the Secretary
shall submit to Congress a report containing the results of the
evaluation conducted under paragraph (1), together with such
recommendations for legislative or administrative action as the
Secretary determines appropriate. In preparing such report, the
Secretary shall use at least three years worth of data under
the VBID demonstration program.
``(i) Budget Neutrality.--For any year after the third year of the
VBID demonstration program, the Secretary shall ensure that the
aggregate payments made under this title and title XIX, including under
the VBID demonstration program, do not exceed the amount which the
Secretary estimates would have been expended under such titles during
such year if the VBID demonstration program had not been implemented.
``(j) Paperwork Reduction Act.--Chapter 35 of title 44, United
States Code, shall not apply to the testing and evaluation of the VBID
demonstration program.''.
(b) Demonstration Program Under Certain State Medicaid Programs.--
(1) In general.--Not later than 1 year after the date of
the enactment of this Act, subject to paragraph (3), the
Secretary of Health and Human Services, acting through the
Deputy Administrator and Director of the Center for Medicare
and Medicaid Innovation of the Centers for Medicare & Medicaid
Services, shall administer a program that awards grants to at
least 5, but not more than 10 States or territories for
purposes of the State Medicaid program to provide coverage to
individuals entitled to benefits under the State plan under
title XIX of the Social Security Act (42 U.S.C. 1396 et seq.)
for tests described in section 1859A(a)(4) of such Act that are
ordered and assistive telehealth consultations that are
furnished via a telecommunications system by a physician or
practitioner to such individuals notwithstanding that the
individual physician or practitioner ordering the test did not
furnish the test or that the individual physician or
practitioner providing the assistive telehealth consultation is
not at the same location as the individuals.
(2) Applications.--To be eligible to receive a grant under
this subsection, a State shall submit an application to the
Secretary in such manner, and containing such information as
the Secretary may require.
(3) Duration; amount.--
(A) Duration.--A grant under this subsection shall
be for a 4-year period.
(B) Amount.--A State that is awarded a grant under
this subsection shall be for an amount not to exceed
$12,000,000.
(4) Funding.--The Secretary, acting through the Deputy
Administrator and Director, shall provide for not more than
$100,000,000 to carry out the program described in paragraph
(1) from amounts otherwise appropriated pursuant to section
1115A(f) of the Social Security Act (42 U.S.C. 1315a(f)).
SEC. 3. PILOT PROGRAM ON IMPROVED ACCESS TO CERTAIN TESTS AND ASSISTIVE
TELEHEALTH CONSULTATIONS FOR VETERANS.
(a) Pilot Program.--
(1) Establishment.--Not later than 180 days after the date
of the enactment of this Act, the Secretary of Veterans shall
establish a pilot program on improved access to certain
telehealth services for veterans (in this section referred to
as the ``pilot program''). Under the pilot program, the
Secretary shall furnish covered services to participants, at no
cost to the participants, in accordance with this section.
(2) Provision of covered services.--
(A) Health care providers.--The Secretary shall
select not fewer than five facilities of the Department
of Veterans Affairs through which to carry out the
program, of which not fewer than three shall serve
veterans in rural or highly rural areas (as determined
through the use of the Rural-Urban Commuting Areas
coding system of the Department of Agriculture).
(B) Covered services.--Under the pilot program, and
notwithstanding that the provider ordering or providing
the service is not at the same location as the
participant receiving the service, health care
providers at each facility selected under subparagraph
(A) shall furnish to program participants the following
services:
(i) Tests described in subparagraph (C)
that are ordered by the health care provider
via a telecommunications system.
(ii) Assistive telehealth consultations
that are provided by the health care provider
via a telecommunications system.
(C) Tests described.--A test described in this
subparagraph is a test that--
(i) is a medical device (as defined in
section 201(h) of the Federal Food, Drug, and
Cosmetic Act) or wearable patient monitoring
device, and
(ii) is for a condition determined relevant
by the Secretary for purposes of the pilot
program.
(3) Participation in program.--
(A) Application.--To participate in the pilot
program, veterans eligible to apply under subparagraph
(B) shall submit an application for such participation
in such form, at such time, and containing such
information as the Secretary determines appropriate.
(B) Eligibility.--A veteran is eligible to submit
an application for participation in the pilot program
if the veteran--
(i) is enrolled in the system of patient
enrollment of the Department under section
1705(a) of title 38, United States Code; and
(ii) has received health care under the
laws administered by the Secretary during the
two-year period preceding the date on which the
veteran is first selected by the Secretary for
participation in the pilot program.
(4) No payment.--
(A) Pilot program.--The Secretary may not charge a
program participant for any cost of services furnished
under the pilot program.
(B) Effect on certain in person tests.--While a
veteran is a program participant in the pilot program,
the Secretary may not make payment for a test described
in paragraph (2)(C) that is furnished in-person by a
physician or practitioner to the veteran if a physician
or practitioner has previously ordered such a test for
the veteran under the pilot program via a
telecommunications system, unless the physician or
practitioner determines such a test is medically
necessary and appropriate (as determined by the
Secretary).
(5) Termination.--
(A) In general.--Subject to subparagraph (B), the
pilot program shall terminate on the date that is three
years after the date on which the pilot program
commences.
(B) Extension.--If the Secretary determines, based
on the results of the interim report under subsection
(b)(1), that it is appropriate to extend the pilot
program, the Secretary may extend the termination of
such program for a period of not more than two years.
(b) Reports.--
(1) Interim report.--Not later than one year after the date
on which the pilot program commences, the Secretary shall
submit to the appropriate congressional committees an interim
report. Such report shall include the following information:
(A) The number of veterans who have participated in
the pilot program.
(B) The types of at-home diagnostics furnished
under the pilot program.
(C) An assessment of whether participation in the
pilot program resulted in any changes in clinically
relevant endpoints for the participant with respect to
the conditions identified during an assistive
telehealth consultation or through a covered test under
the pilot program.
(D) An assessment of the quality of life of
veterans who have participated in the pilot program,
including the results of a satisfaction survey provided
to each such veteran.
(2) Final report.--Not later than 90 days after the date of
termination of the pilot program under subsection (a)(4)(A)
(or, if the pilot program is extended under subsection
(a)(4)(B), the date on which such extension terminates), the
Secretary shall submit to the appropriate congressional
committees a final report on the pilot program that contains
any relevant updates to the information specified in paragraph
(1).
(c) Definitions.--In this section:
(1) The term ``appropriate congressional committees''
means--
(A) the Committee on Energy and Commerce, the
Committee on Veterans' Affairs, and the Committee on
Ways and Means of the House of Representatives; and
(B) the Committee on Health, Education, Labor, and
Pensions and the Committee on Veterans' Affairs of the
Senate.
(2) The term ``assistive telehealth consultation'' has the
meaning given such term in section 1859A(a)(7) of the Social
Security Act, as added by section 1 of this Act.
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