S 787 — Telehealth Innovation and Improvement Act of 2017

Summary

Telehealth Innovation and Improvement Act of 2017 This bill amends titles XI (General Provisions) and XVIII (Medicare) of the Social Security Act to establish: (1) a telehealth service model, and (2) Medicare payment rules with respect to certain services tested under the model. The Centers for Medicare & Medicaid Services (CMS) shall test Medicare coverage of expanded telehealth services, as defined by the bill, in conjunction with existing models that test the use of accountable care organizations, bundled payments, and other coordinated care models under Medicare. CMS must: (1) establish a methodology for determining the amounts of payment for such services, and (2) provide for evaluations of the service model by an independent entity. CMS shall expand the application of a service tested under the model if: (1) the required evaluation demonstrates that the service either reduced Medicare spending without reducing the quality of care or improved the quality of care without increasing spending, and (2) the Chief Actuary of CMS certifies that such expansion would reduce net program spending. A service that meets these requirements is defined by the bill as a "certified enhanced telehealth service." Medicare payment for a certified enhanced telehealth service shall equal 80% of the lesser of: (1) the actual charge for the service, or (2) the amount determined using the payment methodology established under the test model. CMS shall pay for such services without regard to a Medicare beneficiary's location or area of residence.

Bill Text

• Introduced Introduced in Senate Current html March 30, 2017

Compared against current U.S. Code AI-generated reading aid — verify against the official bill.

The bill requires the Center for Medicare and Medicaid Innovation to test expanded telehealth services as part of various Medicare delivery reform models.

• 42 U.S.C. 1315a

  The models selected under this subparagraph shall include the model described in subparagraph (D), which shall be implemented by not later than January 1, 2018.

  This establishes a requirement for including telehealth services in the models tested for Medicare delivery reform.

• 42 U.S.C. 1315a

  Evaluation.-- → Evaluation.--Subject to subsection (h)(6):

  This adds a reference to new evaluation requirements that will apply specifically to telehealth models.

• 42 U.S.C. 1315a

  The model described in this subparagraph is a model that meets the requirements of subsection (h) with respect to coverage of, and payment for, expanded telehealth services, which shall include remote monitoring services, furnished in conjunction with models that test the use of accountable care organizations under title XVIII, bundled payments under such title, and such other coordinated care models under such title as the Secretary determines to be appropriate.

  This defines a new telehealth service delivery model that must be tested within existing Medicare reform frameworks.

• 42 U.S.C. 1315a

  Subject to the succeeding provisions of this subsection, for the 5-year period that begins on January 1, 2018, the Secretary shall test coverage of, and payment for, expanded telehealth services (as defined in paragraph (2)) furnished to applicable individuals who are Medicare beneficiaries...

  This mandates the testing of expanded telehealth services for a defined period, specifically for Medicare beneficiaries.

• 42 U.S.C. 1315a

  The term 'expanded telehealth services' means services furnished by an eligible physician or practitioner to a Medicare beneficiary as part of an episode of care...

  This establishes a formal definition of expanded telehealth services to be included in the reform models.

• 42 U.S.C. 1315a

  The term 'expanded telehealth services' shall include a telehealth service, as defined in section 1834(m)(4)(F), without regard to the limitations specified under section 1834(m)(4).

  This ensures that telehealth services are included even if they do not meet existing limitations.

• 42 U.S.C. 1315a

  The term 'expanded telehealth services' shall include services furnished (as described in subparagraph (A)) without regard to the location of the Medicare beneficiary at the time the telehealth service is furnished...

  This removes geographical restrictions on where Medicare beneficiaries can receive telehealth services.

• 42 U.S.C. 1315a

  In lieu of the evaluations conducted by the Secretary under subsection (b)(4) for models tested under subsection (b), the Secretary shall provide for evaluations of enhanced telehealth service models under subsection (b)(2)(D) by an independent entity.

  This changes the evaluation process for telehealth service models to involve independent assessments, rather than those conducted solely by the Secretary.

Action History

1. March 30, 2017

   Introduced in Senate

2. March 30, 2017

   Read twice and referred to the Committee on Finance.

Sponsors

• Cory Gardner · Primary

Subjects