CONNECT for Health Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 2903 To amend title XVIII of the Social Security Act to expand access to telehealth services, and for other purposes. IN THE HOUSE OF REPRESENTATIVES APRIL 28, 2021 Mr. THOMPSON of California (for himself, Mr. SCHWEIKERT, Mr. JOHNSON of Ohio, Ms. MATSUI, and Mr. WELCH) 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 subse- quently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend title XVIII of the Social Security Act to expand access to telehealth services, 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; TABLE OF CONTENTS. 3 (a) SHORT TITLE.—This Act may be cited as the 4 ‘‘Creating Opportunities Now for Necessary and Effective 5 Care Technologies (CONNECT) for Health Act of 2021’’ 6 or the ‘‘CONNECT for Health Act of 2021’’. 7 VerDate Sep 11 2014 18:42 Jun 18, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2903.IH H2903 pbinns on DSKJLVW7X2PROD with BILLS 2 •HR 2903 IH (b) TABLE OF CONTENTS.—The table of contents of 1 this Act is as follows: 2 Sec. 1. Short title; table of contents. Sec. 2. Findings and sense of Congress. TITLE I—REMOVING BARRIERS TO TELEHEALTH COVERAGE Sec. 101. Expanding the use of telehealth through the waiver of requirements. Sec. 102. Removing geographic requirements for telehealth services. Sec. 103. Expanding originating sites. Sec. 104. Use of telehealth in emergency medical care. Sec. 105. Improvements to the process for adding telehealth services. Sec. 106. Federally qualified health centers and rural health clinics. Sec. 107. Native American health facilities. Sec. 108. Waiver of telehealth requirements during public health emergencies. Sec. 109. Use of telehealth in recertification for hospice care. TITLE II—PROGRAM INTEGRITY Sec. 201. Clarification for fraud and abuse laws regarding technologies pro- vided to beneficiaries. Sec. 202. Additional resources for telehealth oversight. Sec. 203. Provider and beneficiary education on telehealth. TITLE III—DATA AND TESTING OF MODELS Sec. 301. Study on telehealth utilization during the COVID–19 pandemic. Sec. 302. Analysis of telehealth waivers in alternative payment models. Sec. 303. Model to allow additional health professionals to furnish telehealth services. Sec. 304. Testing of models to examine the use of telehealth under the Medi- care program. SEC. 2. FINDINGS AND SENSE OF CONGRESS. 3 (a) FINDINGS.—Congress finds the following: 4 (1) The use of technology in health care and 5 coverage of telehealth services are rapidly evolving. 6 (2) Research has found that telehealth services 7 can expand access to care, improve the quality of 8 care, and reduce spending, and that patients receiv- 9 ing telehealth services are satisfied with their experi- 10 ences. 11 VerDate Sep 11 2014 18:42 Jun 18, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2903.IH H2903 pbinns on DSKJLVW7X2PROD with BILLS 3 •HR 2903 IH (3) Health care workforce shortages are a sig- 1 nificant problem in many areas and for many types 2 of health care clinicians. 3 (4) Telehealth increases access to care in areas 4 with workforce shortages and for individuals who 5 live far away from health care facilities, have limited 6 mobility or transportation, or have other barriers to 7 accessing care. 8 (5) The use of health technologies can strength- 9 en the expertise of the health care workforce, includ- 10 ing by connecting clinicians to specialty consulta- 11 tions. 12 (6) Prior to the COVID–19 pandemic, the utili- 13 zation of telehealth services in the Medicare program 14 under title XVIII of the Social Security Act (42 15 U.S.C. 1395 et seq.) was low, with only 0.25 percent 16 of Medicare fee-for-service beneficiaries utilizing tele- 17 health services in 2016. 18 (7) The COVID–19 pandemic demonstrated ad- 19 ditional benefits of telehealth, including reducing in- 20 fection risk of patients and health care professionals 21 and conserving space in health care facilities, and 22 the Centers for Disease Control and Prevention rec- 23 ommended that telehealth services should be opti- 24 VerDate Sep 11 2014 18:42 Jun 18, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2903.IH H2903 pbinns on DSKJLVW7X2PROD with BILLS 4 •HR 2903 IH mized, when available and appropriate, during the 1 pandemic. 2 (8) Long-term certainty about coverage of tele- 3 health services under the Medicare program is nec- 4 essary to fully realize the benefits of telehealth. 5 (b) SENSE OF CONGRESS.—It is the sense of Con- 6 gress that— 7 (1) health care providers can furnish safe, effec- 8 tive, and high-quality health care services through 9 telehealth; 10 (2) the Secretary of Health and Human Serv- 11 ices should promptly take all necessary measures to 12 ensure that providers and beneficiaries can continue 13 to furnish and utilize, respectively, telehealth serv- 14 ices in the Medicare program during and after the 15 conclusion of the COVID–19 pandemic, including 16 modifying, as appropriate, the definition of ‘‘inter- 17 active telecommunications system’’ in regulations 18 and program instruction under the Medicare pro- 19 gram to ensure that providers can utilize all appro- 20 priate means and types of technology, including 21 audio-visual, audio-only, and other types of tech- 22 nologies, to furnish telehealth services; and 23 (3) barriers to the use of telehealth should be 24 removed. 25 VerDate Sep 11 2014 18:42 Jun 18, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2903.IH H2903 pbinns on DSKJLVW7X2PROD with BILLS 5 •HR 2903 IH TITLE I—REMOVING BARRIERS 1 TO TELEHEALTH COVERAGE 2 SEC. 101. EXPANDING THE USE OF TELEHEALTH THROUGH 3 THE WAIVER OF REQUIREMENTS. 4 (a) IN GENERAL.—Section 1834(m) of the Social Se- 5 curity Act (42 U.S.C. 1395m(m)) is amended— 6 (1) in paragraph (4)(C)(i), by striking ‘‘and 7 (7)’’ and inserting ‘‘(7), and (9)’’; and 8 (2) by adding at the end the following: 9 ‘‘(9) AUTHORITY TO WAIVE REQUIREMENTS 10 AND LIMITATIONS.— 11 ‘‘(A) IN GENERAL.—Notwithstanding the 12 preceding provisions of this subsection, in the 13 case of telehealth services furnished on or after 14 January 1, 2022, the Secretary may waive any 15 requirement described in subparagraph (B) that 16 is applicable to payment for telehealth services 17 under this subsection, but only if the Secretary 18 determines that such waiver would not ad- 19 versely impact quality of care. 20 ‘‘(B) REQUIREMENTS DESCRIBED.—For 21 purposes of this paragraph, requirements appli- 22 cable to payment for telehealth services under 23 this subsection are— 24 VerDate Sep 11 2014 18:42 Jun 18, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2903.IH H2903 pbinns on DSKJLVW7X2PROD with BILLS 6 •HR 2903 IH ‘‘(i) requirements relating to qualifica- 1 tions for an originating site under para- 2 graph (4)(C)(ii); 3 ‘‘(ii) any geographic requirement 4 under paragraph (4)(C)(i) (other than ap- 5 plicable State law requirements, including 6 State licensure requirements); 7 ‘‘(iii) any limitation on the type of 8 technology used to furnish telehealth serv- 9 ices; 10 ‘‘(iv) any limitation on the types of 11 practitioners who are eligible to furnish 12 telehealth services (other than the require- 13 ment that the practitioner is enrolled 14 under this title); 15 ‘‘(v) any limitation on specific services 16 designated as telehealth services pursuant 17 to this subsection (provided the Secretary 18 determines that such services are clinically 19 appropriate to furnish remotely); or 20 ‘‘(vi) any other limitation relating to 21 the furnishing of telehealth services under 22 this title identified by the Secretary. 23 ‘‘(C) WAIVER IMPLEMENTATION.—In im- 24 plementing a waiver under this paragraph, the 25 VerDate Sep 11 2014 18:42 Jun 18, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2903.IH H2903 pbinns on DSKJLVW7X2PROD with BILLS 7 •HR 2903 IH Secretary may establish parameters, as appro- 1 priate, for telehealth services under such waiv- 2 er, including with respect to payment of a facil- 3 ity fee for originating sites and beneficiary and 4 program integrity protections. 5 ‘‘(D) PUBLIC COMMENT.—The Secretary 6 shall establish a process by which stakeholders 7 may (on at least an annual basis) provide public 8 comment on waivers under this paragraph. 9 ‘‘(E) PERIODIC REVIEW OF WAIVERS.— 10 The Secretary shall periodically, but not more 11 often than every 3 years, reassess each waiver 12 under this paragraph to determine whether the 13 waiver continues to meet the quality of care 14 condition applicable under subparagraph (A). 15 The Secretary shall terminate any waiver that 16 does not continue to meet such condition.’’. 17 (b) POSTING OF INFORMATION.—Not later than 2 18 years after the date on which a waiver under section 19 1834(m)(9) of the Social Security Act, as added by sub- 20 section (a), first becomes effective, and at least every 2 21 years thereafter, the Secretary of Health and Human 22 Services shall post on the internet website of the Centers 23 for Medicare & Medicaid Services— 24 VerDate Sep 11 2014 18:42 Jun 18, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2903.IH H2903 pbinns on DSKJLVW7X2PROD with BILLS 8 •HR 2903 IH (1) the number of Medicare beneficiaries receiv- 1 ing telehealth services by reason of each waiver 2 under such section; 3 (2) the impact of such waivers on expenditures 4 and utilization under title XVIII of the Social Secu- 5 rity Act (42 U.S.C. 1395 et seq.); and 6 (3) other outcomes, as determined appropriate 7 by the Secretary. 8 SEC. 102. REMOVING GEOGRAPHIC REQUIREMENTS FOR 9 TELEHEALTH SERVICES. 10 Section 1834(m)(4)(C) of the Social Security Act (42 11 U.S.C. 1395m(m)(4)(C)), as amended by section 101, is 12 amended— 13 (1) in clause (i), in the matter preceding sub- 14 clause (I), by inserting ‘‘and clause (iii)’’ after ‘‘and 15 (9)’’; and 16 (2) by adding at the end the following new 17 clause: 18 ‘‘(iii) REMOVAL OF GEOGRAPHIC RE- 19 QUIREMENTS.—The geographic require- 20 ments described in clause (i) shall not 21 apply with respect to telehealth services 22 furnished on or after the date of the enact- 23 ment of this clause.’’. 24 VerDate Sep 11 2014 18:42 Jun 18, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2903.IH H2903 pbinns on DSKJLVW7X2PROD with BILLS 9 •HR 2903 IH SEC. 103. EXPANDING ORIGINATING SITES. 1 (a) EXPANDING THE HOME AS AN ORIGINATING 2 SITE.—Section 1834(m)(4)(C)(ii)(X) of the Social Secu- 3 rity Act (42 U.S.C. 1395m(m)(4)(C)(ii)(X)) is amended 4 to read as follows: 5 ‘‘(X)(aa) Prior to the date of en- 6 actment of the CONNECT for Health 7 Act of 2021, the home of an indi- 8 vidual but only for purposes of section 9 1881(b)(3)(B) or telehealth services 10 described in paragraph (7). 11 ‘‘(bb) On or after such date of 12 enactment, the home of an indi- 13 vidual.’’. 14 (b) ALLOWING ADDITIONAL ORIGINATING SITES.— 15 Section 1834(m)(4)(C)(ii) of the Social Security Act (42 16 U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding at the 17 end the following new subclause: 18 ‘‘(XII) Any other site determined 19 appropriate by the Secretary at which 20 an eligible telehealth individual is lo- 21 cated at the time a telehealth service 22 is furnished via a telecommunications 23 system.’’. 24 (c) PARAMETERS FOR NEW ORIGINATING SITES.— 25 Section 1834(m)(4)(C) of the Social Security Act (42 26 VerDate Sep 11 2014 18:42 Jun 18, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2903.IH H2903 pbinns on DSKJLVW7X2PROD with BILLS 10 •HR 2903 IH U.S.C. 1395m(m)(4)(C)), as amended by section 102, is 1 amended by adding at the end the following new clause: 2 ‘‘(iv) REQUIREMENTS FOR NEW 3 SITES.— 4 ‘‘(I) IN GENERAL.—The Sec- 5 retary may establish requirements for 6 the furnishing of telehealth services at 7 sites described in clause (ii)(XII) to 8 provide for beneficiary and program 9 integrity protections. 10 ‘‘(II) CLARIFICATION.—Nothing 11 in this clause shall be construed to 12 preclude the Secretary from estab- 13 lishing requirements for other origi- 14 nating sites described in clause (ii)’’. 15 (d) NO ORIGINATING SITE FACILITY FEE FOR NEW 16 SITES.—Section 1834(m)(2)(B)(ii) of the Social Security 17 Act (42 U.S.C. 1395m(m)(2)(B)(ii)) is amended— 18 (1) in the heading, by striking ‘‘IF ORIGINATING 19 SITE IS THE HOME’’ and inserting ‘‘FOR CERTAIN 20 SITES’’; and 21 (2) by striking ‘‘paragraph (4)(C)(ii)(X)’’ and 22 inserting ‘‘subclause (X) or (XII) of paragraph 23 (4)(C)’’. 24 VerDate Sep 11 2014 18:42 Jun 18, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2903.IH H2903 pbinns on DSKJLVW7X2PROD with BILLS 11 •HR 2903 IH SEC. 104. USE OF TELEHEALTH IN EMERGENCY MEDICAL 1 CARE. 2 (a) IN GENERAL.—Section 1834(m) of the Social Se- 3 curity Act (42 U.S.C. 1395m(m)), as amended by sections 4 101 and 102, is amended— 5 (1) in paragraph (4)(C)(i), by striking ‘‘and 6 (9)’’ and inserting ‘‘(9), and (10)’’; and 7 (2) by adding at the end the following: 8 ‘‘(10) TREATMENT OF EMERGENCY MEDICAL 9 CARE FURNISHED THROUGH TELEHEALTH.—The 10 geographic requirements described in paragraph 11 (4)(C)(i) (other than applicable State law require- 12 ments, including State licensure requirements) shall 13 not apply with respect to telehealth services that are 14 services for emergency medical care (as determined 15 by the Secretary) furnished on or after January 1, 16 2022, to an eligible telehealth individual.’’. 17 (b) ADDITIONAL SERVICES.—As part of the imple- 18 mentation of the amendments made by this section, the 19 Secretary of Health and Human Services shall consider 20 whether additional services should be added to the services 21 specified in paragraph (4)(F)(i) of section 1834(m) of 22 such Act (42 U.S.C. 1395m)) for authorized payment 23 under paragraph (1) of such section. 24 VerDate Sep 11 2014 18:42 Jun 18, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H2903.IH H2903 pbinns on DSKJLVW7X2PROD with BILLS 12 •HR 2903 IH SEC. 105. IMPROVEMENTS TO THE PROCESS FOR ADDING 1 TELEHEALTH SERVICES. 2 (a) REVIEW.—The Secretary shall undertake a review 3 of the process established pursuant to section 4 1834(m)(4)(F)(ii) of the Social Security Act (42 U.S.C. 5 1395m(m)(4)(F)(ii)), and based on the results of such re- 6 view— 7 (1) implement revisions to the process so that 8 the criteria to add services prioritiz [Text truncated for display. Full text available on Congress.gov.]