TIKES Act

I 117TH CONGRESS 1ST SESSION H. R. 1397 To provide for strategies to increase access to telehealth under the Medicaid program and Children’s Health Insurance Program, and for other purposes. IN THE HOUSE OF REPRESENTATIVES FEBRUARY 26, 2021 Ms. BLUNT ROCHESTER (for herself and Mr. BURGESS) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To provide for strategies to increase access to telehealth under the Medicaid program and Children’s Health In- surance Program, and for other purposes. 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 ‘‘Telehealth Improve- 4 ment for Kids’ Essential Services Act’’ or the ‘‘TIKES 5 Act’’. 6 VerDate Sep 11 2014 03:02 Apr 01, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1397.IH H1397 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 1397 IH SEC. 2. STRATEGIES TO INCREASE ACCESS TO TELE- 1 HEALTH UNDER MEDICAID AND CHILDREN’S 2 HEALTH INSURANCE PROGRAM. 3 (a) GUIDANCE.—Not later than 1 year after the date 4 of the enactment of this Act, the Secretary of Health and 5 Human Services shall issue and disseminate guidance to 6 States to clarify strategies to overcome existing barriers 7 and increase access to telehealth under the Medicaid pro- 8 gram under title XIX of the Social Security Act (42 9 U.S.C. 1396 et seq.) and the Children’s Health Insurance 10 Program under title XXI of such Act (42 U.S.C. 1397aa 11 et seq.). Such guidance shall include technical assistance 12 and best practices regarding— 13 (1) telehealth delivery of covered services; 14 (2) recommended voluntary billing codes, modi- 15 fiers, and place-of-service designations for telehealth 16 and other virtual health care services; 17 (3) the simplification or alignment (including 18 through reciprocity) of provider licensing, 19 credentialing, and enrollment protocols with respect 20 to telehealth across States, State Medicaid plans 21 under such title XIX, and Medicaid managed care 22 organizations, including during national public 23 health emergencies; 24 VerDate Sep 11 2014 03:02 Apr 01, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1397.IH H1397 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 1397 IH (4) existing strategies States can use to inte- 1 grate telehealth and other virtual health care serv- 2 ices into value-based health care models; and 3 (5) examples of States that have used waivers 4 under the Medicaid program to test expanded access 5 to telehealth, including during the emergency period 6 described in section 1135(g)(1)(B) of the Social Se- 7 curity Act (42 U.S.C. 1320b–5(g)(1)(B)). 8 (b) STUDIES.— 9 (1) TELEHEALTH IMPACT ON HEALTH CARE 10 ACCESS.—Not later than 1 year after the date of the 11 enactment of this Act, the Medicaid and CHIP Pay- 12 ment and Access Commission shall conduct a study, 13 with respect to a minimum of 10 States across geo- 14 graphic regions of the United States, and submit to 15 Congress a report, on the impact of telehealth on 16 health care access, utilization, cost, and outcomes, 17 broken down by race, ethnicity, sex, age, disability 18 status, and zip code. Such report shall— 19 (A) evaluate cost, access, utilization, out- 20 comes, and patient experience data from across 21 the health care field, including States, Medicaid 22 managed care organizations, provider organiza- 23 tions, and other organizations that provide or 24 VerDate Sep 11 2014 03:02 Apr 01, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1397.IH H1397 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 1397 IH pay for telehealth under the Medicaid program 1 and Children’s Health Insurance Program; 2 (B) identify barriers and potential solu- 3 tions to provider entry and participation in tele- 4 health that States are experiencing, as well as 5 barriers to providing telehealth across State 6 lines, including during times of public health 7 crisis or public health emergency; 8 (C) determine the frequency at which out- 9 of-State telehealth is provided to patients en- 10 rolled in the Medicaid program and the poten- 11 tial impact on access to telehealth if State Med- 12 icaid policies were more aligned; and 13 (D) identify and evaluate opportunities for 14 more alignment among such policies to promote 15 access to telehealth across all States, State 16 Medicaid plans under title XIX of the Social 17 Security Act (42 U.S.C. 1396 et seq.), State 18 child health plans under title XXI of such Act 19 (42 U.S.C. 1397aa et seq.), and Medicaid man- 20 aged care organizations, including the potential 21 for regional compacts or reciprocity agreements. 22 (2) FEDERAL AGENCY TELEHEALTH COLLABO- 23 RATION.—Not later than 1 year after the date of the 24 enactment of this Act, the Comptroller General of 25 VerDate Sep 11 2014 03:02 Apr 01, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1397.IH H1397 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 1397 IH the United States shall conduct a study and submit 1 to Congress a report evaluating collaboration be- 2 tween Federal agencies with respect to telehealth 3 services furnished under the Medicaid or CHIP pro- 4 gram to individuals under the age of 18, including 5 such services furnished to such individuals in early 6 care and education settings. Such report shall in- 7 clude recommendations on— 8 (A) opportunities for Federal agencies to 9 improve collaboration with respect to such tele- 10 health services; and 11 (B) opportunities for collaboration between 12 Federal agencies to expand telehealth access to 13 such individuals enrolled under the Medicaid or 14 CHIP program, including in early care and 15 education settings. 16 Æ VerDate Sep 11 2014 03:02 Apr 01, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\H1397.IH H1397 kjohnson on DSK79L0C42PROD with BILLS