CONNECT for Health Act of 2021

II 117TH CONGRESS 1ST SESSION S. 1512 To amend title XVIII of the Social Security Act to expand access to telehealth services, and for other purposes. IN THE SENATE OF THE UNITED STATES APRIL 29, 2021 Mr. SCHATZ (for himself, Mr. WICKER, Mr. CARDIN, Mr. THUNE, Mr. WAR- NER, Mrs. HYDE-SMITH, Mr. TESTER, Mr. PORTMAN, Mr. HEINRICH, Ms. MURKOWSKI, Mr. WHITEHOUSE, Mr. DAINES, Mr. MURPHY, Mr. SCOTT of South Carolina, Mr. KING, Mr. TILLIS, Mr. CARPER, Mr. CRAMER, Ms. SMITH, Mr. SASSE, Mr. VAN HOLLEN, Ms. COLLINS, Ms. HASSAN, Mr. BARRASSO, Mrs. SHAHEEN, Mr. BOOZMAN, Ms. KLO- BUCHAR, Mrs. CAPITO, Mr. BLUMENTHAL, Mr. INHOFE, Mr. KAINE, Mr. COTTON, Mr. LEAHY, Ms. ERNST, Ms. SINEMA, Mr. MORAN, Mr. SAND- ERS, Mr. SULLIVAN, Mr. COONS, Mr. HOEVEN, Mr. WARNOCK, Mr. BLUNT, Mr. BENNET, Mr. RUBIO, Mr. KELLY, Mr. LANKFORD, Mr. BOOKER, Mr. GRAHAM, Ms. ROSEN, and Mr. CASSIDY) introduced the following bill; which was read twice and referred to the Committee on Fi- nance 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 VerDate Sep 11 2014 04:09 May 28, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1512.IS S1512 pbinns on DSKJLVW7X2PROD with BILLS 2 •S 1512 IS Care Technologies (CONNECT) for Health Act of 2021’’ 1 or the ‘‘CONNECT for Health Act of 2021’’. 2 (b) TABLE OF CONTENTS.—The table of contents of 3 this Act is as follows: 4 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. 5 (a) FINDINGS.—Congress finds the following: 6 (1) The use of technology in health care and 7 coverage of telehealth services are rapidly evolving. 8 (2) Research has found that telehealth services 9 can expand access to care, improve the quality of 10 care, and reduce spending, and that patients receiv- 11 VerDate Sep 11 2014 04:09 May 28, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1512.IS S1512 pbinns on DSKJLVW7X2PROD with BILLS 3 •S 1512 IS ing telehealth services are satisfied with their experi- 1 ences. 2 (3) Health care workforce shortages are a sig- 3 nificant problem in many areas and for many types 4 of health care clinicians. 5 (4) Telehealth increases access to care in areas 6 with workforce shortages and for individuals who 7 live far away from health care facilities, have limited 8 mobility or transportation, or have other barriers to 9 accessing care. 10 (5) The use of health technologies can strength- 11 en the expertise of the health care workforce, includ- 12 ing by connecting clinicians to specialty consulta- 13 tions. 14 (6) Prior to the COVID–19 pandemic, the utili- 15 zation of telehealth services in the Medicare program 16 under title XVIII of the Social Security Act (42 17 U.S.C. 1395 et seq.) was low, with only 0.25 percent 18 of Medicare fee-for-service beneficiaries utilizing tele- 19 health services in 2016. 20 (7) The COVID–19 pandemic demonstrated ad- 21 ditional benefits of telehealth, including reducing in- 22 fection risk of patients and health care professionals 23 and conserving space in health care facilities, and 24 the Centers for Disease Control and Prevention rec- 25 VerDate Sep 11 2014 04:09 May 28, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1512.IS S1512 pbinns on DSKJLVW7X2PROD with BILLS 4 •S 1512 IS ommended that telehealth services should be opti- 1 mized, when available and appropriate, during the 2 pandemic. 3 (8) Long-term certainty about coverage of tele- 4 health services under the Medicare program is nec- 5 essary to fully realize the benefits of telehealth. 6 (b) SENSE OF CONGRESS.—It is the sense of Con- 7 gress that— 8 (1) health care providers can furnish safe, effec- 9 tive, and high-quality health care services through 10 telehealth; 11 (2) the Secretary of Health and Human Serv- 12 ices should promptly take all necessary measures to 13 ensure that providers and beneficiaries can continue 14 to furnish and utilize, respectively, telehealth serv- 15 ices in the Medicare program during and after the 16 conclusion of the COVID–19 pandemic, including 17 modifying, as appropriate, the definition of ‘‘inter- 18 active telecommunications system’’ in regulations 19 and program instruction under the Medicare pro- 20 gram to ensure that providers can utilize all appro- 21 priate means and types of technology, including 22 audio-visual, audio-only, and other types of tech- 23 nologies, to furnish telehealth services; and 24 VerDate Sep 11 2014 04:09 May 28, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1512.IS S1512 pbinns on DSKJLVW7X2PROD with BILLS 5 •S 1512 IS (3) barriers to the use of telehealth should be 1 removed. 2 TITLE I—REMOVING BARRIERS 3 TO TELEHEALTH COVERAGE 4 SEC. 101. EXPANDING THE USE OF TELEHEALTH THROUGH 5 THE WAIVER OF REQUIREMENTS. 6 (a) IN GENERAL.—Section 1834(m) of the Social Se- 7 curity Act (42 U.S.C. 1395m(m)) is amended— 8 (1) in paragraph (4)(C)(i), by striking ‘‘and 9 (7)’’ and inserting ‘‘(7), and (9)’’; and 10 (2) by adding at the end the following: 11 ‘‘(9) AUTHORITY TO WAIVE REQUIREMENTS 12 AND LIMITATIONS.— 13 ‘‘(A) IN GENERAL.—Notwithstanding the 14 preceding provisions of this subsection, in the 15 case of telehealth services furnished on or after 16 January 1, 2022, the Secretary may waive any 17 requirement described in subparagraph (B) that 18 is applicable to payment for telehealth services 19 under this subsection, but only if the Secretary 20 determines that such waiver would not ad- 21 versely impact quality of care. 22 ‘‘(B) REQUIREMENTS DESCRIBED.—For 23 purposes of this paragraph, requirements appli- 24 VerDate Sep 11 2014 04:09 May 28, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1512.IS S1512 pbinns on DSKJLVW7X2PROD with BILLS 6 •S 1512 IS cable to payment for telehealth services under 1 this subsection are— 2 ‘‘(i) requirements relating to qualifica- 3 tions for an originating site under para- 4 graph (4)(C)(ii); 5 ‘‘(ii) any geographic requirement 6 under paragraph (4)(C)(i) (other than ap- 7 plicable State law requirements, including 8 State licensure requirements); 9 ‘‘(iii) any limitation on the type of 10 technology used to furnish telehealth serv- 11 ices; 12 ‘‘(iv) any limitation on the types of 13 practitioners who are eligible to furnish 14 telehealth services (other than the require- 15 ment that the practitioner is enrolled 16 under this title); 17 ‘‘(v) any limitation on specific services 18 designated as telehealth services pursuant 19 to this subsection (provided the Secretary 20 determines that such services are clinically 21 appropriate to furnish remotely); or 22 ‘‘(vi) any other limitation relating to 23 the furnishing of telehealth services under 24 this title identified by the Secretary. 25 VerDate Sep 11 2014 04:09 May 28, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1512.IS S1512 pbinns on DSKJLVW7X2PROD with BILLS 7 •S 1512 IS ‘‘(C) WAIVER IMPLEMENTATION.—In im- 1 plementing a waiver under this paragraph, the 2 Secretary may establish parameters, as appro- 3 priate, for telehealth services under such waiv- 4 er, including with respect to payment of a facil- 5 ity fee for originating sites and beneficiary and 6 program integrity protections. 7 ‘‘(D) PUBLIC COMMENT.—The Secretary 8 shall establish a process by which stakeholders 9 may (on at least an annual basis) provide public 10 comment on waivers under this paragraph. 11 ‘‘(E) PERIODIC REVIEW OF WAIVERS.— 12 The Secretary shall periodically, but not more 13 often than every 3 years, reassess each waiver 14 under this paragraph to determine whether the 15 waiver continues to meet the quality of care 16 condition applicable under subparagraph (A). 17 The Secretary shall terminate any waiver that 18 does not continue to meet such condition.’’. 19 (b) POSTING OF INFORMATION.—Not later than 2 20 years after the date on which a waiver under section 21 1834(m)(9) of the Social Security Act, as added by sub- 22 section (a), first becomes effective, and at least every 2 23 years thereafter, the Secretary of Health and Human 24 VerDate Sep 11 2014 04:09 May 28, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1512.IS S1512 pbinns on DSKJLVW7X2PROD with BILLS 8 •S 1512 IS Services shall post on the Internet website of the Centers 1 for Medicare & Medicaid Services— 2 (1) the number of Medicare beneficiaries receiv- 3 ing telehealth services by reason of each waiver 4 under such section; 5 (2) the impact of such waivers on expenditures 6 and utilization under title XVIII of the Social Secu- 7 rity Act (42 U.S.C. 1395 et seq.); and 8 (3) other outcomes, as determined appropriate 9 by the Secretary. 10 SEC. 102. REMOVING GEOGRAPHIC REQUIREMENTS FOR 11 TELEHEALTH SERVICES. 12 Section 1834(m)(4)(C) of the Social Security Act (42 13 U.S.C. 1395m(m)(4)(C)), as amended by section 101, is 14 amended— 15 (1) in clause (i), in the matter preceding sub- 16 clause (I), by inserting ‘‘and clause (iii)’’ after ‘‘and 17 (9)’’; and 18 (2) by adding at the end the following new 19 clause: 20 ‘‘(iii) REMOVAL OF GEOGRAPHIC RE- 21 QUIREMENTS.—The geographic require- 22 ments described in clause (i) shall not 23 apply with respect to telehealth services 24 VerDate Sep 11 2014 04:09 May 28, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1512.IS S1512 pbinns on DSKJLVW7X2PROD with BILLS 9 •S 1512 IS furnished on or after the date of the enact- 1 ment of this clause.’’. 2 SEC. 103. EXPANDING ORIGINATING SITES. 3 (a) EXPANDING THE HOME AS AN ORIGINATING 4 SITE.—Section 1834(m)(4)(C)(ii)(X) of the Social Secu- 5 rity Act (42 U.S.C. 1395m(m)(4)(C)(ii)(X)) is amended 6 to read as follows: 7 ‘‘(X)(aa) Prior to the date of en- 8 actment of the CONNECT for Health 9 Act of 2021, the home of an indi- 10 vidual but only for purposes of section 11 1881(b)(3)(B) or telehealth services 12 described in paragraph (7). 13 ‘‘(bb) On or after such date of 14 enactment, the home of an indi- 15 vidual.’’. 16 (b) ALLOWING ADDITIONAL ORIGINATING SITES.— 17 Section 1834(m)(4)(C)(ii) of the Social Security Act (42 18 U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding at the 19 end the following new subclause: 20 ‘‘(XII) Any other site determined 21 appropriate by the Secretary at which 22 an eligible telehealth individual is lo- 23 cated at the time a telehealth service 24 VerDate Sep 11 2014 04:09 May 28, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1512.IS S1512 pbinns on DSKJLVW7X2PROD with BILLS 10 •S 1512 IS is furnished via a telecommunications 1 system.’’. 2 (c) PARAMETERS FOR NEW ORIGINATING SITES.— 3 Section 1834(m)(4)(C) of the Social Security Act (42 4 U.S.C. 1395m(m)(4)(C)), as amended by section 102, is 5 amended by adding at the end the following new clause: 6 ‘‘(iv) REQUIREMENTS FOR NEW 7 SITES.— 8 ‘‘(I) IN GENERAL.—The Sec- 9 retary may establish requirements for 10 the furnishing of telehealth services at 11 sites described in clause (ii)(XII) to 12 provide for beneficiary and program 13 integrity protections. 14 ‘‘(II) CLARIFICATION.—Nothing 15 in this clause shall be construed to 16 preclude the Secretary from estab- 17 lishing requirements for other origi- 18 nating sites described in clause (ii)’’. 19 (d) NO ORIGINATING SITE FACILITY FEE FOR NEW 20 SITES.—Section 1834(m)(2)(B)(ii) of the Social Security 21 Act (42 U.S.C. 1395m(m)(2)(B)(ii)) is amended— 22 (1) in the heading, by striking ‘‘IF ORIGINATING 23 SITE IS THE HOME’’ and inserting ‘‘FOR CERTAIN 24 SITES’’; and 25 VerDate Sep 11 2014 04:09 May 28, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1512.IS S1512 pbinns on DSKJLVW7X2PROD with BILLS 11 •S 1512 IS (2) by striking ‘‘paragraph (4)(C)(ii)(X)’’ and 1 inserting ‘‘subclause (X) or (XII) of paragraph 2 (4)(C)’’. 3 SEC. 104. USE OF TELEHEALTH IN EMERGENCY MEDICAL 4 CARE. 5 (a) IN GENERAL.—Section 1834(m) of the Social Se- 6 curity Act (42 U.S.C. 1395m(m)), as amended by sections 7 101 and 102, is amended— 8 (1) in paragraph (4)(C)(i), by striking ‘‘and 9 (9)’’ and inserting ‘‘(9), and (10)’’; and 10 (2) by adding at the end the following: 11 ‘‘(10) TREATMENT OF EMERGENCY MEDICAL 12 CARE FURNISHED THROUGH TELEHEALTH.—The 13 geographic requirements described in paragraph 14 (4)(C)(i) (other than applicable State law require- 15 ments, including State licensure requirements) shall 16 not apply with respect to telehealth services that are 17 services for emergency medical care (as determined 18 by the Secretary) furnished on or after January 1, 19 2022, to an eligible telehealth individual.’’. 20 (b) ADDITIONAL SERVICES.—As part of the imple- 21 mentation of the amendments made by this section, the 22 Secretary of Health and Human Services shall consider 23 whether additional services should be added to the services 24 specified in paragraph (4)(F)(i) of section 1834(m) of 25 VerDate Sep 11 2014 04:09 May 28, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1512.IS S1512 pbinns on DSKJLVW7X2PROD with BILLS 12 •S 1512 IS such Act (42 U.S.C. 1395m)) for authorized payment 1 under paragraph (1) of such section. 2 SEC. 105. IMPROVEMENTS TO THE PROCESS FOR ADDING 3 TELEHEALTH S [Text truncated for display. Full text available on Congress.gov.]