CONNECT for Health Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 4932 To amend title XVIII of the Social Security Act to expand access to telehealth services, and for other purposes. IN THE HOUSE OF REPRESENTATIVES OCTOBER 30, 2019 Mr. THOMPSON of California (for himself, Mr. WELCH, Mr. JOHNSON of Ohio, Mr. SCHWEIKERT, and Ms. MATSUI) 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 subsequently determined by the Speaker, in each case for consideration of such provi- sions 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 for Health Act of 2019’’ or the ‘‘CON- 6 NECT for Health Act of 2019’’. 7 VerDate Sep 11 2014 16:51 Nov 09, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4932.IH H4932 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 4932 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. 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. 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 (3) Health care workforce shortages are a sig- 12 nificant problem in many areas and for many types 13 of health care clinicians. 14 (4) Telehealth increases access to care in areas 15 with workforce shortages and for individuals who 16 VerDate Sep 11 2014 16:51 Nov 09, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4932.IH H4932 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 4932 IH live far away from health care facilities, have limited 1 mobility or transportation, or have other barriers to 2 accessing care. 3 (5) The use of health technologies can strength- 4 en the expertise of the health care workforce, includ- 5 ing by connecting clinicians to specialty consulta- 6 tions. 7 (6) Utilization of telehealth services in Medicare 8 remains low, with only 0.25 percent of Medicare fee- 9 for-service beneficiaries utilizing telehealth services 10 in 2016. 11 (b) SENSE OF CONGRESS.—It is the sense of Con- 12 gress that— 13 (1) health care providers can furnish safe, effec- 14 tive, and high-quality health care services through 15 telehealth; and 16 (2) barriers to the use of telehealth should be 17 removed. 18 SEC. 3. EXPANDING THE USE OF TELEHEALTH THROUGH 19 THE WAIVER OF CERTAIN REQUIREMENTS. 20 (a) IN GENERAL.—Section 1834(m) of the Social Se- 21 curity Act (42 U.S.C. 1395m(m)) is amended— 22 (1) in paragraph (4)(C)(i), by striking ‘‘and 23 (7)’’ and inserting ‘‘(7), and (8)’’; and 24 (2) by adding at the end the following: 25 VerDate Sep 11 2014 16:51 Nov 09, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4932.IH H4932 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 4932 IH ‘‘(8) AUTHORITY TO WAIVE REQUIREMENTS 1 AND LIMITATIONS IF CERTAIN CONDITIONS MET.— 2 ‘‘(A) IN GENERAL.—Notwithstanding the 3 preceding provisions of this subsection, in the 4 case of telehealth services furnished on or after 5 January 1, 2021, the Secretary may waive any 6 restriction applicable to payment for telehealth 7 services under this subsection that is described 8 in subparagraph (B), but only if the Secretary 9 determines that such waiver would not deny or 10 limit the coverage or provision of benefits under 11 this title, and— 12 ‘‘(i) the Secretary determines that the 13 waiver is expected to reduce spending 14 under this title without reducing the qual- 15 ity of care or improve the quality of pa- 16 tient care without increasing spending; or 17 ‘‘(ii) the waiver would apply to tele- 18 health services furnished in originating 19 sites located in a high-need health profes- 20 sional shortage area (as designated pursu- 21 ant to section 332(a)(1)(A) of the Public 22 Health Service Act (42 U.S.C. 23 254e(a)(1)(A))). 24 VerDate Sep 11 2014 16:51 Nov 09, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4932.IH H4932 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 4932 IH ‘‘(B) RESTRICTIONS DESCRIBED.—For 1 purposes of this paragraph, restrictions applica- 2 ble to payment for telehealth services under 3 paragraph (1) are— 4 ‘‘(i) requirements relating to qualifica- 5 tions for an originating site under para- 6 graph (4)(C)(ii); 7 ‘‘(ii) any geographic limitations under 8 paragraph (4)(C)(i) (other than applicable 9 State law requirements, including State li- 10 censure requirements); 11 ‘‘(iii) any limitation on the type of 12 technology used to furnish telehealth serv- 13 ices; 14 ‘‘(iv) any limitation on the type of 15 provider of services or supplier who may 16 furnish telehealth services (other than the 17 requirement that the provider of services 18 or supplier is enrolled under this title); 19 ‘‘(v) any limitation on specific services 20 designated as telehealth services pursuant 21 to this subsection (provided the Secretary 22 determines that such services are clinically 23 appropriate to furnish remotely); or 24 VerDate Sep 11 2014 16:51 Nov 09, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4932.IH H4932 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 4932 IH ‘‘(vi) any other limitation relating to 1 the furnishing of telehealth services under 2 this title identified by the Secretary. 3 ‘‘(C) PUBLIC COMMENT.—The Secretary 4 shall establish a process by which stakeholders 5 may (on at least an annual basis) provide public 6 comment for waivers under this paragraph. 7 ‘‘(D) PERIODIC REVIEW OF WAIVERS.— 8 The Secretary shall periodically, but not more 9 often than every 3 years, reassess each waiver 10 under this paragraph to determine whether the 11 waiver continues to meet the conditions applica- 12 ble under subparagraph (A).’’. 13 (b) POSTING OF INFORMATION.—Not later than 2 14 years after the date on which a waiver under section 15 1834(m)(8) of the Social Security Act, as added by sub- 16 section (a), first becomes effective, and at least biennially 17 thereafter, the Secretary of Health and Human Services 18 shall post on the internet website of the Centers for Medi- 19 care & Medicaid Services— 20 (1) the number of Medicare beneficiaries receiv- 21 ing telehealth services by reason of each waiver 22 under such section; 23 VerDate Sep 11 2014 16:51 Nov 09, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4932.IH H4932 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 4932 IH (2) the impact of such waivers on expenditures 1 and utilization under title XVIII of the Social Secu- 2 rity Act (42 U.S.C. 1395 et seq.); and 3 (3) other outcomes, as determined appropriate 4 by the Secretary. 5 SEC. 4. EXPANDING THE USE OF TELEHEALTH FOR MEN- 6 TAL HEALTH SERVICES. 7 (a) IN GENERAL.—Section 1834(m) of the Social Se- 8 curity Act (42 U.S.C. 1395m(m)), as amended by section 9 3, is amended— 10 (1) in paragraph (4)(C)(i), by striking ‘‘and 11 (8)’’ and inserting ‘‘(8), and (9)’’; and 12 (2) by adding at the end the following: 13 ‘‘(9) TREATMENT OF MENTAL HEALTH SERV- 14 ICES FURNISHED THROUGH TELEHEALTH.—The ge- 15 ographic 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 mental health services (as determined by the Sec- 20 retary) furnished on or after January 1, 2021, to an 21 eligible telehealth individual at an originating site 22 described in paragraph (4)(C)(ii) (other than an 23 originating site described in subclause (IX) of such 24 paragraph).’’. 25 VerDate Sep 11 2014 16:51 Nov 09, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4932.IH H4932 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 4932 IH (b) INCLUSION OF THE HOME AS AN ORIGINATING 1 SITE.—Section 1834(m)(4)(C)(ii)(X) of such Act (42 2 U.S.C. 1395m(m)(4)(C)(ii)(X)) is amended by striking 3 ‘‘paragraph (7)’’ and inserting ‘‘paragraphs (7) and (9)’’. 4 (c) ADDITIONAL SERVICES.—As part of the imple- 5 mentation of the amendments made by this section, the 6 Secretary of Health and Human Services shall consider 7 whether additional services should be added to the services 8 specified in paragraph (4)(F)(i) of section 1834(m) of 9 such Act (42 U.S.C. 1395m) for authorized payment 10 under paragraph (1) of such section. 11 SEC. 5. USE OF TELEHEALTH IN EMERGENCY MEDICAL 12 CARE. 13 (a) IN GENERAL.—Section 1834(m) of the Social Se- 14 curity Act (42 U.S.C. 1395m(m)), as amended by sections 15 3 and 4, is amended— 16 (1) in paragraph (4)(C)(i), by striking ‘‘and 17 (9)’’ and inserting ‘‘(9), and (10)’’; and 18 (2) by adding at the end the following: 19 ‘‘(10) TREATMENT OF EMERGENCY MEDICAL 20 CARE FURNISHED THROUGH TELEHEALTH.—The 21 geographic requirements described in paragraph 22 (4)(C)(i) (other than applicable State law require- 23 ments, including State licensure requirements) shall 24 not apply with respect to telehealth services that are 25 VerDate Sep 11 2014 16:51 Nov 09, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H4932.IH H4932 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 4932 IH services for emergency medical care (as determined 1 by the Secretary) furnished on or after January 1, 2 2021, to an eligible telehealth individual at an origi- 3 nating site described in subclause (II), (V), or (VII) 4 of paragraph (4)(C)(ii).’’. 5 (b) ADDITIONAL SERVICES.—As part of the imple- 6 mentation of the amendments made by this section, the 7 Secretary of Health and Human Services shall consider 8 whether additional services should be added to the services 9 specified in paragraph (4)(F)(i) of section 1834(m) of 10 such Act (42 U.S.C. 1395m) for authorized payment 11 under paragraph (1) of such section. 12 SEC. 6. IMPROVEMENTS TO THE PROCESS FOR ADDING 13 TELEHEALTH SERVICES. 14 The Secretary shall undertake a review of the process 15 established pursuant to section 1834(m)(4)(F)(ii) of the 16 Social Security Act (42 U.S.C. 1395m(m)(4)(F)(ii)), and 17 based on the results of such review— 18 (1) implement revisions to the process so that 19 the criteria to add services prioritizes, as appro- 20 priate, improved access to care through telehealth 21 services; and 22 (2) provide clarification on what requests to 23 add telehealth services under such process should in- 24 clude. 25 VerDate Sep 11 2014 16:51 Nov 09, 2019 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H4932.IH H4932 pamtmann on DSKBC07HB2PROD with BILLS 10 •HR 4932 IH SEC. 7. RURAL HEALTH CLINICS AND FEDERALLY QUALI- 1 FIED HEALTH CENTERS. 2 (a) EXPANSION OF ORIGINATING SITES.—Section 3 1834(m)(4)(C) of the Social Security Act (42 U.S.C. 4 1395m(m)(4)(C)), as amended by sections 3, 4, and 5, 5 is amended— 6 (1) in clause (i), by striking ‘‘and (10)’’ and in- 7 serting ‘‘and (10), and subject to clause (iii),’’; and 8 (2) by adding at the end the following new 9 clause: 10 ‘‘(iii) RURAL HEALTH CLINICS AND 11 FEDERALLY QUALIFIED HEALTH CEN- 12 TERS.—The term ‘originating site’ shall 13 also include any Federally qualified health 14 center and any rural health clinic (as such 15 terms are defined in section 1861(aa)) at 16 which the eligible telehealth individual is 17 located at the time the service is furnished 18 via a telecommunications system, whether 19 or not the individual is located in an area 20 described in clause (i), insofar as such 21 sites are not otherwise included in the defi- 22 nition of originating site under such 23 clause, subject to applicable State law re- 24 quirements, including State licensure re- 25 quirements.’’. 26 VerDate Sep 11 2014 16:51 Nov 09, 2019 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H4932.IH H4932 pamtmann on DSKBC07HB2PROD with BILLS 11 •HR 4932 IH (b) EXPANSION OF DISTANT SITES.—Section 1 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) 2 is amended— 3 (1) in the first sentence of paragraph (1)— 4 (A) by striking ‘‘or a practitioner (de- 5 scribed in section 1842(b)(18)(C))’’ and insert- 6 ing ‘‘, a practitioner (described in section 7 1842(b)(18)(C)), a Federally qualified health 8 center, or a rural health clinic’’; and 9 (B) by striking ‘‘or practitioner’’ and in- 10 serting ‘‘, practitioner, Federally qualified 11 health center, or rural health clinic’’; 12 (2) in paragraph (2)(A)— 13 (A) by inserting ‘‘or to a Federally quali- 14 fied health center or rural health clinic that 15 serves as a distant site’’ after ‘‘a distant site’’; 16 and 17 (B) by striking ‘‘such physician or practi- 18 tioner’’ and inserting ‘‘such physician, practi- 19 tioner, Federally qualified health center, or 20 rural health clinic’’; and 21 (3) in paragraph (4)— 22 (A) in subparagraph (A), by inserting 23 ‘‘and includes a Federally qualified health cen- 24 ter or rural health clinic that furnishes a tele- 25 VerDate Sep 11 2014 16:51 Nov 09, 2019 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H4932.IH H4932 pamtmann on DSKBC07HB2PROD with BILLS 12 •HR 4932 IH health service to an eligible individual’’ before 1 the period at the end; and 2 (B) in subparagraph (F), by adding at the 3 end the following new clause: 4 [Text truncated for display. 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