Expanding Remote Monitoring Access Act

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3032 Introduced in House (IH)]

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119th CONGRESS
  1st Session
                                H. R. 3032

 To ensure appropriate access to remote monitoring services furnished
                      under the Medicare program.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             April 28, 2025

   Mr. Balderson (for himself, Mr. Dunn of Florida, and Mr. Murphy)
 introduced the following bill; which was referred to the Committee on
   Energy and Commerce, and in addition to the Committee on Ways and
 Means, 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 ensure appropriate access to remote monitoring services furnished
                      under the Medicare program.

    Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Expanding Remote Monitoring Access
Act''.

SEC. 2. FINDINGS.

    The Congress finds the following:
            (1) Remote monitoring is an option that can help patients
        manage their health conditions from their homes with oversight
        from their health care providers, which can improve patient
        health outcomes, reduce long-term health costs, and increase
        care options for patients.
            (2) The Department of Veterans Affairs (VA) saw such
        results in a 2019 report. Veterans enrolled in remote patient
        monitoring had a 53 percent decrease in VA bed days of care and
        a 33 percent decrease in VA hospital admissions.
            (3) Providers are currently required by Medicare to collect
        16 days of patient data over a 30-day period in order to bill
        Medicare for remote monitoring services, even in cases where
        this full duration is not medically necessary to ensure the
        health and safety of the patient. This can limit the use of
        remote monitoring in instances where it can promote patient
        health and safety and where it can reduce the overall cost on
        the health system.
            (4) In the 2021 Physician Fee Schedule, the Centers for
        Medicare and Medicaid Services (CMS) issued an interim policy
        to lower the duration required by Medicare to bill for remote
        monitoring services from 16 days to 2 days within a 30-day
        period, but only for individuals who had been diagnosed with,
        or were suspected of having, COVID-19. This short-term
        flexibility called attention to the long-term need to reassess
        the minimum duration required for providers to bill for remote
        monitoring.
            (5) As part of issuing the 2021 Physician Fee Schedule, CMS
        studied comments in support of permanently lowering the minimum
        required duration of remote monitoring for all patients, not
        just those with COVID-19.
            (6) CMS concluded that ``we agree that a full 16 days of
        monitoring may not always be reasonable and necessary'' but did
        not revise the 16 day per 30-day period minimum duration for
        all patients because CMS did not believe they had received
        ``specific clinical examples'' to allow for ``understanding
        under what clinical circumstances fewer days of monitoring
        would be medically reasonable and necessary and allow a
        practitioner to establish clinically meaningful care''.
            (7) Clinical evidence shows numerous instances in which
        fewer than sixteen days of monitoring within a 30-day period
        establishes clinically meaningful care. These include:
                    (A) Sixteen days of monitoring per 30-day period
                may not be required to establish that a patient has
                sleep apnea.
                    (B) A patient prescribed a narcotic for pain may
                require their breathing to be monitored only while on
                the medication.
                    (C) A patient with a chronic condition like
                diabetes, congestive heart failure, or obesity may have
                their weight monitored over a longer period of time,
                but it is not clinically appropriate to have such
                patient step on a scale 16 or more times in each 30-day
                period.
                    (D) A patient whose blood pressure or oxygen levels
                are monitored during physical therapy may not
                necessitate 16 days of monitoring in each 30-day period
                given physical therapy is often ordered twice weekly.
                    (E) A patient who wears a heart monitor to measure
                palpitations may wear the monitor continuously, but the
                data only needs to be collected when the individual is
                experiencing symptoms.
                    (F) A patient with hypertension is often monitored
                for long-term management of this condition on more of a
                weekly basis, only needing more frequent data
                collection for active monitoring with changes in
                medication or dosages.
                    (G) A patient who suffers from Muscular Sclerosis
                or Muscular Dystrophy may benefit from a provider
                tracking the patient's exercise between visits to
                monitor certain physiologic parameters such as muscle
                movement but may not produce 16 days of data in a 30-
                day period.
                    (H) A patient who needs a total joint replacement
                may simply need pre-testing for surgery baselines,
                including to establish gait, force, activity, heart
                rate and other factors and then compare pre-surgery and
                post-surgery function.
                    (I) For a patient with urologic dysfunction, male
                urine flow data obtained from the patient can be
                collected in two to four consecutive days.
                    (J) Remote monitoring may allow a provider to
                assess a patient's adherence, range of motion, and
                response to physical therapy and occupational therapy
                regimens even though many such regimens are less than
                16 days per month.
                    (K) Monitoring cognitive behavioral therapy for
                less than 16 days in a 30-day period may provide
                clinically meaningful care while moderating a patient's
                anxiety and other symptoms.
                    (L) A patient with respiratory issues may not
                require a full 16 days of monitoring of inhaler usage
                to get clinical benefits from remote monitoring.
            (8) A two-day minimum duration would permit Medicare
        coverage of the full range of remote monitoring services that
        can be beneficial to a patient without precluding the
        differential reimbursement of individual remote monitoring
        services based on patient acuity and cost.

SEC. 3. ENSURING APPROPRIATE ACCESS TO REMOTE MONITORING SERVICES
              FURNISHED UNDER THE MEDICARE PROGRAM.

    (a) In General.--Notwithstanding any other provision of law, the
Secretary of Health and Human Services (in this section referred to as
the ``Secretary'') shall ensure that remote monitoring services
furnished under title XVIII of the Social Security Act (42 U.S.C. 1395
et seq.) during the period beginning on the date of the enactment of
this Act and ending on the date that is 2 years after such date of
enactment are payable for a minimum of 2 days of data collection over a
30-day period, regardless of whether the individual receiving such
services has been diagnosed with, or is suspected of having, COVID-19.
    (b) Report.--
            (1) In general.--Not later than 1 year after the date of
        the enactment of this Act, the Secretary shall, after
        consulting with entities specified in paragraph (2), submit to
        Congress a report that includes the following:
                    (A) A summary and analysis of previous experience
                with such remote monitoring services being payable
                under such title for a minimum of 2 days of data
                collection over a 30-day period.
                    (B) Recommendations for implementing a
                reimbursement model that takes into account patient
                acuity and cost of providing remote monitoring
                services, including potentially creating differential
                reimbursements for periods with different durations,
                such as fewer than and more than 16 days.
                    (C) An analysis and justification for the
                appropriate place of service and supervision
                requirements for non-clinical staff reviewing and
                escalating patient data and provide recommendations.
                    (D) An analysis of the estimated savings resulting
                from earlier interventions and fewer days of
                hospitalizations among patients furnished remote
                monitoring services.
            (2) Specified entities.--For purposes of paragraph (1), the
        entities specified in this paragraph are the following:
                    (A) Relevant agencies within the Department of
                Health and Human Services (including, with respect to
                issues relating to waste, fraud, or abuse, the
                Inspector General of such Department).
                    (B) The Department of Veterans Affairs (including
                the Office of Connected Care of such Department).
                    (C) Licensed and practicing osteopathic and
                allopathic physicians, anesthesiologists, physician
                assistants, and nurse practitioners.
                    (D) Hospitals, health systems, academic medical
                centers, and other medical facilities, such as acute
                care hospitals, cancer hospitals, psychiatric
                hospitals, hospital emergency departments, facilities
                furnishing urgent care services, ambulatory surgical
                centers, Federally qualified health centers, rural
                health clinics, and post-acute care and long-term care
                facilities.
                    (E) Medical professional organizations and medical
                specialty organizations.
                    (F) Organizations with expertise in the development
                of or operation of innovative remote physiologic
                monitoring services technologies.
                    (G) Beneficiary advocacy organizations.
                    (H) The American Medical Association Current
                Procedural Terminology Editorial Panel.
                    (I) Commercial payers.
                    (J) Any other entity determined appropriate by the
                Secretary.
    (c) Definitions.--In this section:
            (1) Remote monitoring.--The term ``remote monitoring''
        means remote physiologic monitoring and remote therapeutic
        monitoring.
            (2) Remote physiologic monitoring.--The term ``remote
        physiologic monitoring'' means non-face-to-face monitoring and
        analysis of physiologic factors used to understand a patient's
        health status, including the collection and analysis of patient
        physiologic data that are used to develop and manage a
        treatment plan related to chronic or acute conditions.
            (3) Remote therapeutic monitoring.--The term ``remote
        therapeutic monitoring'' means the use of medical devices to
        monitor a patient's health or response to treatment using non-
        physiological data.
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