CONNECT for Health Act of 2019

II 116TH CONGRESS 1ST SESSION S. 2741 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 OCTOBER 30, 2019 Mr. SCHATZ (for himself, Mr. WICKER, Mr. CARDIN, Mr. THUNE, Mr. WAR- NER, and Mrs. HYDE-SMITH) introduced the following bill; which was read twice and referred to the Committee on Finance 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 2019’’ 6 or the ‘‘CONNECT for Health Act of 2019’’. 7 (b) TABLE OF CONTENTS.—The table of contents of 8 this Act is as follows: 9 Sec. 1. Short title; table of contents. Sec. 2. Findings and sense of Congress. VerDate Sep 11 2014 17:58 Nov 02, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6211 E:\BILLS\S2741.IS S2741 pamtmann on DSKBC07HB2PROD with BILLS 2 •S 2741 IS Sec. 3. Expanding the use of telehealth through the waiver of certain require- ments. Sec. 4. Expanding the use of telehealth for mental health services. Sec. 5. Use of telehealth in emergency medical care. Sec. 6. Improvements to the process for adding telehealth services. Sec. 7. Rural health clinics and federally qualified health centers. Sec. 8. Native American health facilities. Sec. 9. Waiver of telehealth restrictions during national emergencies. Sec. 10. Use of telehealth in recertification for hospice care. Sec. 11. Clarification for fraud and abuse laws regarding technologies provided to beneficiaries. Sec. 12. Study and report on increasing access to telehealth services in the home. Sec. 13. Analysis of telehealth waivers in alternative payment models. Sec. 14. Model to allow additional health professionals to furnish telehealth services. Sec. 15. Testing of models to examine the use of telehealth under the Medicare program. SEC. 2. FINDINGS AND SENSE OF CONGRESS. 1 (a) FINDINGS.—Congress finds the following: 2 (1) The use of technology in health care and 3 coverage of telehealth services are rapidly evolving. 4 (2) Research has found that telehealth services 5 can expand access to care, improve the quality of 6 care, and reduce spending, and that patients receiv- 7 ing telehealth services are satisfied with their experi- 8 ences. 9 (3) Health care workforce shortages are a sig- 10 nificant problem in many areas and for many types 11 of health care clinicians. 12 (4) Telehealth increases access to care in areas 13 with workforce shortages and for individuals who 14 live far away from health care facilities, have limited 15 mobility or transportation, or have other barriers to 16 accessing care. 17 VerDate Sep 11 2014 17:58 Nov 02, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2741.IS S2741 pamtmann on DSKBC07HB2PROD with BILLS 3 •S 2741 IS (5) The use of health technologies can strength- 1 en the expertise of the health care workforce, includ- 2 ing by connecting clinicians to specialty consulta- 3 tions. 4 (6) Utilization of telehealth services in Medicare 5 remains low, with only 0.25 percent of Medicare fee- 6 for-service beneficiaries utilizing telehealth services 7 in 2016. 8 (b) SENSE OF CONGRESS.—It is the sense of Con- 9 gress that— 10 (1) health care providers can furnish safe, effec- 11 tive, and high-quality health care services through 12 telehealth; and 13 (2) barriers to the use of telehealth should be 14 removed. 15 SEC. 3. EXPANDING THE USE OF TELEHEALTH THROUGH 16 THE WAIVER OF CERTAIN REQUIREMENTS. 17 (a) IN GENERAL.—Section 1834(m) of the Social Se- 18 curity Act (42 U.S.C. 1395m(m)) is amended— 19 (1) in paragraph (4)(C)(i), by striking ‘‘and 20 (7)’’ and inserting ‘‘(7), and (8)’’; and 21 (2) by adding at the end the following: 22 ‘‘(8) AUTHORITY TO WAIVE REQUIREMENTS 23 AND LIMITATIONS IF CERTAIN CONDITIONS MET.— 24 VerDate Sep 11 2014 17:58 Nov 02, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S2741.IS S2741 pamtmann on DSKBC07HB2PROD with BILLS 4 •S 2741 IS ‘‘(A) IN GENERAL.—Notwithstanding the 1 preceding provisions of this subsection, in the 2 case of telehealth services furnished on or after 3 January 1, 2021, the Secretary may waive any 4 restriction applicable to payment for telehealth 5 services under this subsection that is described 6 in subparagraph (B), but only if the Secretary 7 determines that such waiver would not deny or 8 limit the coverage or provision of benefits under 9 this title, and— 10 ‘‘(i) the Secretary determines that the 11 waiver is expected to reduce spending 12 under this title without reducing the qual- 13 ity of care or improve the quality of pa- 14 tient care without increasing spending; or 15 ‘‘(ii) the waiver would apply to tele- 16 health services furnished in originating 17 sites located in a high-need health profes- 18 sional shortage area (as designated pursu- 19 ant to section 332(a)(1)(A) of the Public 20 Health Service Act (42 U.S.C. 21 254e(a)(1)(A))). 22 ‘‘(B) RESTRICTIONS DESCRIBED.—For 23 purposes of this paragraph, restrictions applica- 24 VerDate Sep 11 2014 17:58 Nov 02, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S2741.IS S2741 pamtmann on DSKBC07HB2PROD with BILLS 5 •S 2741 IS ble to payment for telehealth services under 1 paragraph (1) are— 2 ‘‘(i) requirements relating to qualifica- 3 tions for an originating site under para- 4 graph (4)(C)(ii); 5 ‘‘(ii) any geographic limitations under 6 paragraph (4)(C)(i) (other than applicable 7 State law requirements, including State li- 8 censure requirements); 9 ‘‘(iii) any limitation on the type of 10 technology used to furnish telehealth serv- 11 ices; 12 ‘‘(iv) any limitation on the type of 13 provider of services or supplier who may 14 furnish telehealth services (other than the 15 requirement that the provider of services 16 or supplier is enrolled 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 17:58 Nov 02, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S2741.IS S2741 pamtmann on DSKBC07HB2PROD with BILLS 6 •S 2741 IS ‘‘(C) PUBLIC COMMENT.—The Secretary 1 shall establish a process by which stakeholders 2 may (on at least an annual basis) provide public 3 comment for waivers under this paragraph. 4 ‘‘(D) PERIODIC REVIEW OF WAIVERS.— 5 The Secretary shall periodically, but not more 6 often than every 3 years, reassess each waiver 7 under this paragraph to determine whether the 8 waiver continues to meet the conditions applica- 9 ble under subparagraph (A).’’. 10 (b) POSTING OF INFORMATION.—Not later than 2 11 years after the date on which a waiver under section 12 1834(m)(8) of the Social Security Act, as added by sub- 13 section (a), first becomes effective, and at least biennially 14 thereafter, the Secretary of Health and Human Services 15 shall post on the internet website of the Centers for Medi- 16 care & Medicaid Services— 17 (1) the number of Medicare beneficiaries receiv- 18 ing telehealth services by reason of each waiver 19 under such section; 20 (2) the impact of such waivers on expenditures 21 and utilization under title XVIII of the Social Secu- 22 rity Act (42 U.S.C. 1395 et seq.); and 23 (3) other outcomes, as determined appropriate 24 by the Secretary. 25 VerDate Sep 11 2014 17:58 Nov 02, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S2741.IS S2741 pamtmann on DSKBC07HB2PROD with BILLS 7 •S 2741 IS SEC. 4. EXPANDING THE USE OF TELEHEALTH FOR MEN- 1 TAL HEALTH SERVICES. 2 (a) IN GENERAL.—Section 1834(m) of the Social Se- 3 curity Act (42 U.S.C. 1395m(m)), as amended by section 4 3, is amended— 5 (1) in paragraph (4)(C)(i), by striking ‘‘and 6 (8)’’ and inserting ‘‘(8), and (9)’’; and 7 (2) by adding at the end the following: 8 ‘‘(9) TREATMENT OF MENTAL HEALTH SERV- 9 ICES FURNISHED THROUGH TELEHEALTH.—The ge- 10 ographic 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 mental health services (as determined by the Sec- 15 retary) furnished on or after January 1, 2021, to an 16 eligible telehealth individual at an originating site 17 described in paragraph (4)(C)(ii) (other than an 18 originating site described in subclause (IX) of such 19 paragraph).’’. 20 (b) INCLUSION OF THE HOME AS AN ORIGINATING 21 SITE.—Section 1834(m)(4)(C)(ii)(X) of such Act (42 22 U.S.C. 1395m(m)(4)(C)(ii)(X)) is amended by striking 23 ‘‘paragraph (7)’’ and inserting ‘‘paragraphs (7) and (9)’’. 24 (c) ADDITIONAL SERVICES.—As part of the imple- 25 mentation of the amendments made by this section, the 26 VerDate Sep 11 2014 17:58 Nov 02, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S2741.IS S2741 pamtmann on DSKBC07HB2PROD with BILLS 8 •S 2741 IS Secretary of Health and Human Services shall consider 1 whether additional services should be added to the services 2 specified in paragraph (4)(F)(i) of section 1834(m) of 3 such Act (42 U.S.C. 1395m) for authorized payment 4 under paragraph (1) of such section. 5 SEC. 5. USE OF TELEHEALTH IN EMERGENCY MEDICAL 6 CARE. 7 (a) IN GENERAL.—Section 1834(m) of the Social Se- 8 curity Act (42 U.S.C. 1395m(m)), as amended by sections 9 3 and 4, is amended— 10 (1) in paragraph (4)(C)(i), by striking ‘‘and 11 (9)’’ and inserting ‘‘(9), and (10)’’; and 12 (2) by adding at the end the following: 13 ‘‘(10) TREATMENT OF EMERGENCY MEDICAL 14 CARE FURNISHED THROUGH TELEHEALTH.—The 15 geographic requirements described in paragraph 16 (4)(C)(i) (other than applicable State law require- 17 ments, including State licensure requirements) shall 18 not apply with respect to telehealth services that are 19 services for emergency medical care (as determined 20 by the Secretary) furnished on or after January 1, 21 2021, to an eligible telehealth individual at an origi- 22 nating site described in subclause (II), (V), or (VII) 23 of paragraph (4)(C)(ii).’’. 24 VerDate Sep 11 2014 17:58 Nov 02, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S2741.IS S2741 pamtmann on DSKBC07HB2PROD with BILLS 9 •S 2741 IS (b) ADDITIONAL SERVICES.—As part of the imple- 1 mentation of the amendments made by this section, the 2 Secretary of Health and Human Services shall consider 3 whether additional services should be added to the services 4 specified in paragraph (4)(F)(i) of section 1834(m) of 5 such Act (42 U.S.C. 1395m) for authorized payment 6 under paragraph (1) of such section. 7 SEC. 6. IMPROVEMENTS TO THE PROCESS FOR ADDING 8 TELEHEALTH SERVICES. 9 The Secretary shall undertake a review of the process 10 established pursuant to section 1834(m)(4)(F)(ii) of the 11 Social Security Act (42 U.S.C. 1395m(m)(4)(F)(ii)), and 12 based on the results of such review— 13 (1) implement revisions to the process so that 14 the criteria to add services prioritizes, as appro- 15 priate, improved access to care through telehealth 16 services; and 17 (2) provide clarification on what requests to 18 add telehealth services under such process should in- 19 clude. 20 SEC. 7. RURAL HEALTH CLINICS AND FEDERALLY QUALI- 21 FIED HEALTH CENTERS. 22 (a) EXPANSION OF ORIGINATING SITES.—Section 23 1834(m)(4)(C) of the Social Security Act (42 U.S.C. 24 VerDate Sep 11 2014 17:58 Nov 02, 2019 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S2741.IS S2741 pamtmann on DSKBC07HB2PROD with BILLS 10 •S 2741 IS 1395m(m)(4)(C)), as amended by sections 3, 4, and 5, 1 is amended— 2 (1) in clause (i), by striking ‘‘and (10)’’ and in- 3 serting ‘‘and (10), and subject to clause (iii),’’; and 4 (2) by adding at the end the following new 5 clause: 6 ‘‘(iii) RURAL HEALTH CLINICS AND 7 FEDERALLY QUALIFIED HEALTH CEN- 8 TERS.—The term ‘originating site’ shall 9 also include any Federally qualified health 10 center and any rural health clinic (as such 11 terms are defined in section 1861(aa)) at 12 which the eligible telehealth individual is 13 located at the time the service is furnished 14 via a telecommunications system, whether 15 or not the individual is located in an area 16 described in clause (i), insofar as such 17 sites are not otherwise included in the defi- 18 nition of originating site under such 19 clause, subject to applicable State law re- 20 quirements, including State licensure re- 21 quirements.’’. 22 (b) EXPANSION OF DISTANT SITES.—Section 23 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) 24 is amended— 25 VerDate Sep 11 2014 17:58 Nov 02, 2019 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S2741.IS S2741 pamtmann on DSKBC07HB2PROD with BILLS 11 •S 2741 IS (1) in the first sentence of paragraph (1)— 1 (A) by striking ‘‘or a practitioner (de- 2 scribed in section 1842(b)(18)(C))’’ and insert- 3 ing ‘‘, a practitioner (described in section 4 1842(b)(18)(C)), a Federally qualified health 5 center, or a rural health clinic’’; and 6 (B) by striking ‘‘or practitioner’’ and in- 7 serting ‘‘, practitioner, Federally qualified 8 health center, or rural health clinic’’; and 9 (2) in paragraph (2)(A)— 10 (A) by inserting ‘‘or to a Federally quali- 11 fied health center or rural health clinic that 12 serves as a distant site’’ after ‘‘a distant site’’; 13 and 14 (B) by striking ‘‘such physician or practi- 15 tioner’’ and inserting ‘‘such physician, practi- 16 tioner, Federally qualified health center, or 17 rural health clinic’’; and 18 (3) in paragraph (4)— 19 (A) in subparagraph (A), by inserting 20 ‘‘and includes a Federally qualified health cen- 21 ter or rural health clinic that furnishes a tele- 22 health service to an eligible individual’’ before 23 the period at the end; and 24 VerDate Sep 11 2014 17:58 Nov 02, 2019 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S2741.IS S2741 pamtmann on DSKBC07HB2PROD with BILLS 12 •S 2741 IS (B) in subparagraph (F), by adding at the 1 end the following new clause: 2 ‘‘(iii) INCLUSION OF RURAL HEALTH 3 CLINIC SERVICES AND FEDERALLY QUALI- 4 FIED HEALTH CENTER SERVICES FUR- 5 NISHED USING TELEHEALTH.—For pur- 6 poses of this subparagraph, the term ‘tele- 7 health services’ includes a rural h [Text truncated for display. 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