Safe Testing at Residence Telehealth Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 318 To amend title XVIII to provide coverage and payment for certain tests and assistive telehealth consultations during the COVID–19 emergency period, and for other purposes. IN THE HOUSE OF REPRESENTATIVES JANUARY 13, 2021 Mr. SCHWEIKERT (for himself, Mr. RUSH, and Mr. KELLY of Pennsylvania) introduced the following bill; which was referred to the Committee on En- ergy 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 jurisdic- tion of the committee concerned A BILL To amend title XVIII to provide coverage and payment for certain tests and assistive telehealth consultations during the COVID–19 emergency period, and for other pur- poses. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Safe Testing at Resi- 4 dence Telehealth Act of 2021’’. 5 VerDate Sep 11 2014 03:40 Feb 08, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H318.IH H318 pbinns on DSKJLVW7X2PROD with BILLS 2 •HR 318 IH SEC. 2. COVERAGE AND PAYMENT FOR CERTAIN TESTS 1 AND ASSISTIVE TELEHEALTH CONSULTA- 2 TIONS DURING THE COVID–19 EMERGENCY 3 PERIOD. 4 (a) COVERAGE AND PAYMENT RULE.— 5 (1) IN GENERAL.—Section 1834(m) of the So- 6 cial Security Act (42 U.S.C. 1395m(m)) is amended 7 by adding at the end of the following new para- 8 graph: 9 ‘‘(9) COVERAGE AND PAYMENT FOR CERTAIN 10 TESTS AND ASSISTIVE TELEHEALTH CONSULTA- 11 TIONS DURING COVID–19 EMERGENCY PERIOD.— 12 ‘‘(A) IN GENERAL.—During the emergency 13 period described in section 1135(g)(1)(B), the 14 Secretary shall pay for a test described in sub- 15 paragraph (C) that is ordered and an assistive 16 telehealth consultation that is furnished via a 17 telecommunications system by a physician or 18 practitioner to an eligible telehealth individual 19 enrolled under this part notwithstanding that 20 the individual physician or practitioner ordering 21 the test did not furnish the test or that the in- 22 dividual physician or practitioner providing the 23 assistive telehealth consultation is not at the 24 same location as the beneficiary. 25 VerDate Sep 11 2014 03:40 Feb 08, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H318.IH H318 pbinns on DSKJLVW7X2PROD with BILLS 3 •HR 318 IH ‘‘(B) PAYMENT AMOUNT.—During the 1 emergency period described in section 2 1135(g)(1)(B), the Secretary shall pay to a 3 physician or practitioner located at a distant 4 site that— 5 ‘‘(i) orders a test described in sub- 6 paragraph (C) to an eligible telehealth in- 7 dividual an amount equal to the amount 8 that such physician or practitioner would 9 have been paid for a diagnostic laboratory 10 test under section 1833(h); and 11 ‘‘(ii) furnishes an assistive telehealth 12 consultation to an eligible telehealth indi- 13 vidual an amount equal to the amount that 14 a physician or practitioner would have been 15 paid for such telehealth service under para- 16 graph (2). 17 ‘‘(C) TESTS DESCRIBED.—For purposes of 18 subparagraphs (A) and (B), a test described in 19 this subparagraph is a medical device (as de- 20 fined in section 201(h) of the Federal Food, 21 Drug, and Cosmetic Act) or is a test approved 22 under an emergency use authorization under 23 section 564 of such Act and is either— 24 VerDate Sep 11 2014 03:40 Feb 08, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H318.IH H318 pbinns on DSKJLVW7X2PROD with BILLS 4 •HR 318 IH ‘‘(i) a diagnostic laboratory test for 1 the diagnosis of influenza or a similar res- 2 piratory condition that is required to ob- 3 tain a final diagnosis of COVID–19 for an 4 individual when such test is ordered by a 5 physician or practitioner in conjunction 6 with a COVID–19 diagnostic laboratory 7 test for purposes of discounting a diagnosis 8 of influenza or a related diagnosis for such 9 individual; or 10 ‘‘(ii) a serology test for COVID–19. 11 ‘‘(D) OTHER MATTERS RELATING TO DOC- 12 UMENTATION AND CLAIMS REVIEW.—The re- 13 quirements of paragraphs (2) and (3) of section 14 410.32(d) of title 42, Code of Federal Regula- 15 tions (as in effect on the date of the enactment 16 of this paragraph), relating to documentation 17 and claims review, respectively, shall apply to a 18 test described in subparagraph (C) and an as- 19 sistive telehealth consultation. 20 ‘‘(E) DEMOGRAPHIC DATA.—To be eligible 21 for reimbursement under this paragraph, each 22 claim for reimbursement shall include, with re- 23 spect to such an eligible telehealth individual, 24 the following demographic data: 25 VerDate Sep 11 2014 03:40 Feb 08, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H318.IH H318 pbinns on DSKJLVW7X2PROD with BILLS 5 •HR 318 IH ‘‘(i) Age. 1 ‘‘(ii) Race and ethnicity. 2 ‘‘(iii) Gender. 3 ‘‘(iv) An affirmative or negative state- 4 ment of the existence of any chronic condi- 5 tion. 6 ‘‘(v) Any other information the Sec- 7 retary determines appropriate. 8 ‘‘(F) ASSISTIVE TELEHEALTH CONSULTA- 9 TION.—In this paragraph, the term ‘assistive 10 telehealth consultation’ means a telehealth serv- 11 ice (as defined in paragraph (4)(F)) that is— 12 ‘‘(i) an evaluation and management 13 service; 14 ‘‘(ii) an assessment of any evidence of 15 systems which would make a diagnostic 16 laboratory test necessary to be furnished in 17 the home of an eligible telehealth indi- 18 vidual; 19 ‘‘(iii) the ordering of a diagnostic lab- 20 oratory test; 21 ‘‘(iv) an assessment of an individual 22 succeeding the delivery of a diagnostic lab- 23 oratory test; 24 VerDate Sep 11 2014 03:40 Feb 08, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H318.IH H318 pbinns on DSKJLVW7X2PROD with BILLS 6 •HR 318 IH ‘‘(v) any assistance in the collection of 1 a sample necessary for a diagnostic labora- 2 tory test and securing the sample for ship- 3 ping; 4 ‘‘(vi) the referral of an eligible tele- 5 health individual to a physician or practi- 6 tioner for in-person treatment; or 7 ‘‘(vii) the review of a diagnostic lab- 8 oratory test by a physician or practi- 9 tioner.’’. 10 (2) REPORT.— 11 (A) IN GENERAL.—During the period be- 12 ginning 20 days after the date of the enactment 13 of this Act and ending on the last day of the 14 emergency period, each physician and practi- 15 tioner, who furnishes a test or an assistive tele- 16 health consultation during such period, shall, on 17 a monthly basis during such period, submit to 18 the Administrator of the Centers for Medicare 19 & Medicaid Services and the appropriate State 20 health agency demographic data specified under 21 section 1834(m)(9)(E) of the Social Security 22 Act (42 U.S.C. 1395m(m)(9)(E)) with respect 23 to individuals to whom such test or consultation 24 VerDate Sep 11 2014 03:40 Feb 08, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H318.IH H318 pbinns on DSKJLVW7X2PROD with BILLS 7 •HR 318 IH was so furnished (in accordance with the 1 HIPAA privacy regulation). 2 (B) DEFINITIONS.—In this paragraph: 3 (i) ASSISTIVE TELEHEALTH CON- 4 SULTATION.—The term ‘‘assistive tele- 5 health consultation’’ has the meaning given 6 such term in section 1834(m)(9)(E) of the 7 Social Security Act (42 U.S.C. 8 1395m(m)(9)(F)). 9 (ii) EMERGENCY PERIOD.—The term 10 ‘‘emergency period’’ has the meaning as 11 such term is described in section 12 1135(g)(1)(B) of the Social Security Act 13 (42 U.S.C. 1320b–5(g)(1)(B)). 14 (iii) HIPAA PRIVACY REGULATION.— 15 The term ‘‘HIPAA privacy regulation’’ has 16 the meaning given such term in section 17 1180(b)(3) of the Social Security Act (42 18 U.S.C. 1320d–9(b)(3)). 19 (iv) TEST.—The term ‘‘test’’ has the 20 meaning as such term is described in sec- 21 tion 1834(m)(9)(C) of the Social Security 22 Act (42 U.S.C. 1395m(m)(9)(C)). 23 VerDate Sep 11 2014 03:40 Feb 08, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H318.IH H318 pbinns on DSKJLVW7X2PROD with BILLS 8 •HR 318 IH .(b) NO PAYMENT FOR CERTAIN IN-PERSON TEST 1 AFTER TELEHEALTH TEST DURING THE COVID–19 2 EMERGENCY PERIOD.— 3 (1) IN GENERAL.—Section 1833(h) of the So- 4 cial Security Act (42 U.S.C. 1395l(h)) is amended— 5 (A) in paragraph (1)(A), by striking ‘‘Sub- 6 ject to section 1834(d)(1)’’ and inserting ‘‘Sub- 7 ject to section 1834(a)(1) and paragraph (10)’’; 8 and 9 (B) by adding at the end the following new 10 paragraph: 11 ‘‘(10) During the emergency period described in sec- 12 tion 1135(g)(1)(B), the Secretary may not make payment 13 for a test described in section 1834(m)(9)(C) that is fur- 14 nished in-person by a physician or practitioner to an indi- 15 vidual if a physician or practitioner has previously ordered 16 such a test via a telecommunications system pursuant to 17 section 1834(m)(9)(A), unless the physician or practi- 18 tioner determines such a test is medically necessary and 19 appropriate (as determined by the Secretary).’’. 20 (2) REPORT.—Not later than 1 year after the 21 termination of the emergency period described in 22 section 1135(g)(1)(B) of the Social Security Act (42 23 U.S.C. 1320b–5(g)(1)(B)), the Inspector General of 24 the Department of Health and Human Services shall 25 VerDate Sep 11 2014 03:40 Feb 08, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H318.IH H318 pbinns on DSKJLVW7X2PROD with BILLS 9 •HR 318 IH review claims for payment for tests described in sec- 1 tion 1834(m)(9)(C) of such Act (42 U.S.C. 2 1395m(m)(9)(C)) furnished during such emergency 3 period and submit to Congress a report on any in- 4 stances of waste, fraud, or abuse identified through 5 such review. 6 (c) CONFORMING AMENDMENTS.—Section 1834(m) 7 of the Social Security Act (42 U.S.C. 8 1395m(m)(4)(C)(ii)(X)), as amended by subsection (a), is 9 further amended— 10 (1) in paragraph (1), by striking ‘‘Subject to 11 paragraph (8)’’ and inserting ‘‘Subject to para- 12 graphs (8) and (9)’’; 13 (2) in paragraph (2), by striking ‘‘Subject to 14 paragraph (8)’’ and inserting ‘‘Subject to para- 15 graphs (8) and (9)’’; and 16 (3) in paragraph (4)(C)(ii)(X), by striking 17 ‘‘telehealth services described in paragraph (7)’’ and 18 inserting ‘‘telehealth services described in paragraph 19 (7) or (9)’’. 20 Æ VerDate Sep 11 2014 03:40 Feb 08, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6301 E:\BILLS\H318.IH H318 pbinns on DSKJLVW7X2PROD with BILLS