What This Bill Does
This bill creates new rules for Medicare (the federal health insurance program for people 65 and older) about telehealth visits (medical appointments by phone or video). It requires doctors to have seen patients in person before ordering expensive medical equipment or lab tests through telehealth. The bill also requires doctors to use their official identification number when billing for telehealth services.
Who It Affects
Doctors and medical practitioners who provide telehealth services to Medicare patients. Medicare patients who receive expensive durable medical equipment (wheelchairs, oxygen machines, etc.) and high-cost laboratory tests through telehealth. Medicare administrative contractors (companies that process Medicare payments).
Key Provisions
• Doctors cannot get Medicare payment for expensive durable medical equipment ordered through telehealth unless they saw the patient in person at least once during the 6 months before ordering the equipment. (Sec. 2(a))
• Doctors cannot get Medicare payment for expensive laboratory tests ordered through telehealth unless they saw the patient in person at least once during the 6 months before ordering the tests. (Sec. 2(b))
• The Centers for Medicare and Medicaid Services (the agency that runs Medicare) will decide what counts as "expensive" durable medical equipment and laboratory tests. (Sec. 2(a) and 2(b))
• Medicare payment processors must review claims every 12 months to find doctors who order expensive equipment or lab tests through telehealth at least 90 percent of the time, then audit all those doctors' claims. (Sec. 2(a) and 2(b))
• Doctors must submit claims for telehealth services using their National Provider Identification number (an official identification number assigned to healthcare providers). (Sec. 3)
What Changes
The Medicare program will no longer pay for expensive medical equipment or lab tests ordered through telehealth unless the doctor previously saw the patient in person within the past 6 months. Medicare will conduct audits of doctors who heavily rely on telehealth for ordering expensive equipment and tests. Doctors must use their official identification number when billing Medicare for telehealth services.
Important Definitions
The bill does not define "high-cost durable medical equipment" or "high-cost laboratory test" itself. Instead, the Centers for Medicare and Medicaid Services will create these definitions.
Effective Date
The law takes effect when the emergency period described in section 1135(g)(1)(B) of the Social Security Act ends. This specific date is not written in this bill text.
I
118TH CONGRESS
1ST SESSION H. R. 1746
To amend title XVIII of the Social Security Act to establish requirements
for the provision of certain high-cost durable medical equipment and
laboratory testing, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
MARCH 23, 2023
Mr. DOGGETT introduced the following bill; which was referred to the Com-
mittee 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 provisions as fall within
the jurisdiction of the committee concerned
A BILL
To amend title XVIII of the Social Security Act to establish
requirements for the provision of certain high-cost dura-
ble medical equipment and laboratory testing, 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 ‘‘Preventing Medicare
4
Telefraud Act’’.
5
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•HR 1746 IH
SEC. 2. REQUIREMENT FOR PROVISION OF HIGH-COST DU-
1
RABLE MEDICAL EQUIPMENT AND LABORA-
2
TORY TESTS.
3
(a) HIGH-COST DURABLE MEDICAL EQUIPMENT.—
4
Section 1834(a)(1)(E) of the Social Security Act (42
5
U.S.C. 1395m(a)(1)(E)) is amended by adding at the end
6
the following new clause:
7
‘‘(vi) STANDARDS FOR HIGH-COST DU-
8
RABLE MEDICAL EQUIPMENT.—
9
‘‘(I) LIMITATION
ON
PAYMENT
10
FOR
HIGH-COST
DURABLE
MEDICAL
11
EQUIPMENT.—Payment may not be
12
made under this subsection for a
13
high-cost durable medical equipment
14
ordered by a physician or other practi-
15
tioner described in clause (ii) via tele-
16
health for an individual, unless such
17
physician or practitioner furnished to
18
such individual a service in-person at
19
least once during the 6-month period
20
prior to ordering such high-cost dura-
21
ble medical equipment.
22
‘‘(II) HIGH-COST DURABLE MED-
23
ICAL EQUIPMENT DETERMINATION.—
24
For purposes of this clause, the Ad-
25
ministrator of the Centers for Medi-
26
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•HR 1746 IH
care & Medicaid Services shall define
1
the term ‘high-cost durable medical
2
equipment’ and specify the durable
3
medical equipment for which such def-
4
inition shall apply.
5
‘‘(vii) AUDIT
OF
PROVIDERS
AND
6
PRACTITIONERS FURNISHING A HIGH VOL-
7
UME
OF
DURABLE
MEDICAL
EQUIPMENT
8
VIA TELEHEALTH.—
9
‘‘(I) IDENTIFICATION
OF
PRO-
10
VIDERS.—Beginning 6 months after
11
the effective date of this clause, Medi-
12
care administrative contractors shall
13
conduct reviews on a schedule deter-
14
mined by the Secretary, of claims for
15
durable medical equipment prescribed
16
by a physician or other practitioner
17
described in clause (ii) during the 12-
18
month period preceding such review to
19
identify physicians or other practi-
20
tioners with respect to whom at least
21
90 percent of all durable medical
22
equipment prescribed by such physi-
23
cian or practitioner during such pe-
24
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•HR 1746 IH
riod was prescribed pursuant to a
1
telehealth visit.
2
‘‘(II) AUDIT.—In the case of a
3
physician or practitioner identified
4
under subclause (I), with respect to a
5
period described in such subclause,
6
the Medicare administrative contrac-
7
tors shall conduct audits of all claims
8
for durable medical equipment pre-
9
scribed by such physicians or practi-
10
tioners to determine whether such
11
claims comply with the requirements
12
for coverage under this title.’’.
13
(b)
HIGH-COST
LABORATORY
TESTS.—Section
14
1834A(b) of the Social Security Act (42 U.S.C. 1395m–
15
1(b)) is amended by adding at the end the following new
16
paragraph:
17
‘‘(6) REQUIREMENT FOR HIGH-COST LABORA-
18
TORY TESTS.—
19
‘‘(A) LIMITATION ON PAYMENT FOR HIGH-
20
COST LABORATORY TESTS.—Payment may not
21
be made under this subsection for a high-cost
22
laboratory test ordered by a physician or practi-
23
tioner via telehealth for an individual, unless
24
such physician or practitioner furnished to such
25
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•HR 1746 IH
individual a service in-person at least once dur-
1
ing the 6-month period prior to ordering such
2
high-cost laboratory test.
3
‘‘(B) HIGH-COST LABORATORY TEST DE-
4
FINED.—For purposes of this paragraph, the
5
Administrator for the Centers for Medicare &
6
Medicaid Services shall define the term ‘high-
7
cost laboratory test’ and specify which labora-
8
tory tests such definition shall apply to.
9
‘‘(7) AUDIT
OF
LABORATORY
TESTING
OR-
10
DERED PURSUANT TO TELEHEALTH VISIT.—
11
‘‘(A) IDENTIFICATION
OF
PROVIDERS.—
12
Beginning 6 months after the effective date of
13
this paragraph, Medicare administrative con-
14
tractors shall conduct periodic reviews on a
15
schedule determined by the Secretary, of claims
16
for laboratory tests prescribed by a physician or
17
practitioner during the 12-month period pre-
18
ceding such review to identify physicians or
19
other practitioners with respect to whom at
20
least 90 percent of all laboratory tests pre-
21
scribed by such physician or practitioner during
22
such period was prescribed pursuant to a tele-
23
health visit.
24
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‘‘(B) AUDIT.—In the case of a physician
1
or practitioner identified under subparagraph
2
(A), with respect to a period described in such
3
subparagraph, the Medicare administrative con-
4
tractors shall conduct audits of all claims for
5
laboratory tests prescribed by such physicians
6
or practitioners during such period beginning to
7
determine whether such claims comply with the
8
requirements for coverage under this title.’’.
9
(c) EFFECTIVE DATE.—The amendments made by
10
this section shall take effect upon the termination of the
11
emergency period described in section 1135(g)(1)(B) of
12
the Social Security Act (42 U.S.C. 1320b–5(g)(1)(B)).
13
SEC. 3. REQUIREMENT TO SUBMIT NPI NUMBER FOR SEPA-
14
RATELY BILLABLE TELEHEALTH SERVICES.
15
(a) REQUIREMENT TO SUBMIT NPI NUMBER FOR
16
SEPARATELY BILLABLE TELEHEALTH SERVICES.—Sec-
17
tion 1834(m) of the Social Security Act (42 U.S.C.
18
1395m(m)) is amended by adding at the end the following
19
new paragraph:
20
‘‘(10) REQUIREMENT TO SUBMIT NPI NUMBER
21
FOR
SEPARATELY
BILLABLE
TELEHEALTH
SERV-
22
ICES.—Payment may not be made under this sub-
23
section for separately billable telehealth services fur-
24
nished by a physician or practitioner unless such
25
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•HR 1746 IH
physician or practitioner submits a claim for pay-
1
ment under the national provider identification num-
2
ber assigned to such physician or practitioner.’’.
3
(b) EFFECTIVE DATE.—The amendment made by
4
this section shall take effect upon the termination of the
5
emergency period described in section 1135(g)(1)(B) of
6
the Social Security Act (42 U.S.C. 1320b–5(g)(1)(B)).
7
Æ
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