; and (3) by adding at the end the following new subparagraph: (J) the provision of telehealth technologies on or after January 1, 2019, to individuals with end stage renal disease under title XVIII by a health care provider for the purpose of furnishing of telehealth. . (d) Study and report on further expansion (1) Study The Comptroller General of the United States shall conduct a study to examine the feasibility, benefits, and drawbacks of expanding the use of telehealth and store-and-forward technologies under the Medicare program under title XVIII of the Social Security Act for items and services included in renal dialysis services, as such term is defined in section 1881(b)(14)(B) of such Act ( 42 U.S.C. 1395rr(b)(14)(B) ). (2) Report Not later than 2 years after the date of the enactment of this Act, the Comptroller General shall submit to Congress a report on the results of the study conducted under paragraph (1). III Improvements in Application of Stark Rule 301. Modernizing the application of the Stark rule under Medicare (a) Clarification of the writing requirement and signature requirement for arrangements pursuant to the Stark rule (1) Writing requirement Section 1877(h)(1) of the Social Security Act ( 42 U.S.C. 1395nn(h)(1) ) is amended by adding at the end the following new subparagraph: (D) Written requirement clarified In the case of any requirement pursuant to this section for a compensation arrangement to be in writing, such requirement shall be satisfied by such means as determined by the Secretary, including by a collection of documents, including contemporaneous documents evidencing the course of conduct between the parties involved. . (2) Signature requirement Section 1877(h)(1) of the Social Security Act ( 42 U.S.C. 1395nn(h)(1) ), as amended by paragraph (1), is further amended by adding at the end the following new subparagraph: (E) Special rule for signature requirements In the case of any requirement pursuant to this section for a compensation arrangement to be in writing and signed by