TREAT Act

II 116TH CONGRESS 2D SESSION S. 4421 To provide temporary licensing reciprocity for telehealth and interstate health care treatment. IN THE SENATE OF THE UNITED STATES AUGUST 4, 2020 Mr. MURPHY (for himself and Mr. BLUNT) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To provide temporary licensing reciprocity for telehealth and interstate health care treatment. 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 ‘‘Temporary Reciprocity 4 to Ensure Access to Treatment Act’’ or the ‘‘TREAT 5 Act’’. 6 SEC. 2. FINDINGS. 7 Congress finds the following: 8 (1) It is necessary to regulate, on a temporary 9 and emergency basis, the provision of interstate 10 VerDate Sep 11 2014 03:46 Aug 21, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S4421.IS S4421 kjohnson on DSK79L0C42PROD with BILLS 2 •S 4421 IS commerce as it pertains to treatment by medical 1 professionals licensed in one State to patients in 2 other States. 3 (2) COVID–19, the disease caused by SARS– 4 CoV–2, has created a national public health emer- 5 gency, as declared by the Secretary of Health and 6 Human Services under section 319 of the Public 7 Health Service Act (42 U.S.C. 247d) on January 8 31, 2020, and by the President under the National 9 Emergencies Act on March 13, 2020. 10 (3) The COVID–19 pandemic has resulted in 11 closing many businesses and nonprofit organizations, 12 including colleges and universities, and large areas 13 of the country remain under full or partial stay-at- 14 home orders, precluding the ability to seek routine 15 or elective medical treatment and consultation. The 16 closing of campus-based in-person learning at insti- 17 tutions of higher education has also meant that up 18 to 1,000,000 students have returned to live with 19 their families across State lines from where they 20 may have been receiving medical care in the univer- 21 sity setting. Furthermore, in many rural areas, in- 22 person medical treatment is inaccessible. Even in 23 urban areas, the pandemic has severely disrupted ac- 24 cess to medical care, requiring medical professionals 25 VerDate Sep 11 2014 03:46 Aug 21, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4421.IS S4421 kjohnson on DSK79L0C42PROD with BILLS 3 •S 4421 IS licensed in one State to provide treatment to pa- 1 tients residing nearby but across a State line and 2 unable to visit the medical professional’s office in 3 the State of licensure. 4 (4) It is vital that hospitals, temporary surge or 5 field facilities, skilled nursing facilities, and nursing 6 homes in areas with high caseloads of COVID–19 7 patients be able to have access to qualified medical 8 professionals, including such professionals licensed 9 in other States, without the delays that would be re- 10 quired for individualized licensing during a time 11 when State agencies’ capacity to review and process 12 licensing requests are limited by the pandemic. 13 (5) The provision of services by medical profes- 14 sionals, including services provided at no cost and 15 services provided to patients in a State other than 16 the State or States in which the medical professional 17 maintains an office for professional services, affects 18 interstate commerce. When used to provide services 19 to patients located in a State other than the State 20 in which the medical professional is located, tele- 21 health services, as defined in section 3, utilize facili- 22 ties of interstate commerce. 23 (6) The inability of patients to visit in-State 24 health care providers during the current crisis sub- 25 VerDate Sep 11 2014 03:46 Aug 21, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S4421.IS S4421 kjohnson on DSK79L0C42PROD with BILLS 4 •S 4421 IS stantially affects interstate commerce. Economic ac- 1 tivity has been limited by public health authorities 2 and other government officials to ‘‘flatten the curve’’ 3 of infections and hospitalizations and thereby pre- 4 vent the health care system from becoming over- 5 whelmed. Maximizing the efficient and effective use 6 of health care resources is therefore vital to reopen- 7 ing the economy. 8 (7) Barriers to the efficient delivery of health 9 care services will lead to a shortage of those services 10 that substantially affect health care availability 11 across State lines. Shortages in health care services 12 in one State prompt interstate travel to obtain 13 health care in other States, even though discour- 14 aging such travel, particularly among the sick, is 15 vital to containing the contagion and reopening the 16 national economy. 17 SEC. 3. DEFINITIONS. 18 In this Act: 19 (1) the term ‘‘health care professional’’ means 20 an individual who— 21 (A) has a valid and unrestricted license or 22 certification from, or is otherwise authorized by, 23 a State, the District of Columbia, or a territory 24 VerDate Sep 11 2014 03:46 Aug 21, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S4421.IS S4421 kjohnson on DSK79L0C42PROD with BILLS 5 •S 4421 IS or possession of the United States, for any 1 health profession, including mental health; and 2 (B) is not affirmatively excluded from 3 practice in the licensing or certifying jurisdic- 4 tion or in any other jurisdiction; 5 (2) the term ‘‘Secretary’’ means the Secretary 6 of Health and Human Services; and 7 (3) the term ‘‘telehealth services’’ means use of 8 telecommunications and information technology (in- 9 cluding synchronous or asynchronous audio-visual, 10 audio-only, or store and forward technology) to pro- 11 vide access to physical and mental health assess- 12 ment, diagnosis, treatment, intervention, consulta- 13 tion, supervision, and information across distance. 14 SEC. 4. TEMPORARY AUTHORIZATION OF TELEHEALTH 15 AND INTERSTATE TREATMENT. 16 (a) IN GENERAL.—Notwithstanding any other provi- 17 sion of Federal or State law or regulation regarding the 18 licensure or certification of health care providers or the 19 provision of telehealth services, a health care professional 20 may practice within the scope of the individual’s license, 21 certification, or authorization described in section 3(1)(A), 22 either in-person or through telehealth, in any State, the 23 District of Columbia, or any territory or possession of the 24 United States, or any other location designated by the 25 VerDate Sep 11 2014 03:46 Aug 21, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S4421.IS S4421 kjohnson on DSK79L0C42PROD with BILLS 6 •S 4421 IS Secretary, based on the licensure, certification, or author- 1 ization such individual in any one State, the District of 2 Columbia, or territory or possession of the United States. 3 (b) SCOPE OF TELEHEALTH SERVICES.—Telehealth 4 services authorized by this section include services pro- 5 vided to any patient regardless of whether the health care 6 professional has a prior treatment relationship with the 7 patient, provided that, if the health care professional does 8 not have a prior treatment relationship with the patient, 9 a new relationship may be established only via a written 10 acknowledgment or synchronous technology. 11 (c) INITIATION OF TELEHEALTH SERVICES.—Before 12 providing telehealth services authorized by this section, the 13 health care professional shall— 14 (1) verify the identification of the patient re- 15 ceiving health services; 16 (2) obtain oral or written acknowledgment from 17 the patient (or legal representative of the patient) to 18 perform telehealth services, and if such acknowledg- 19 ment is oral, make a record of such acknowledg- 20 ment; and 21 (3) obtain or confirm an alternative method of 22 contacting the patient in case of a technological fail- 23 ure. 24 VerDate Sep 11 2014 03:46 Aug 21, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S4421.IS S4421 kjohnson on DSK79L0C42PROD with BILLS 7 •S 4421 IS (d) WRITTEN NOTICE OF PROVISION OF SERV- 1 ICES.—As soon as practicable, but not later than 30 days 2 after first providing services pursuant to this section in 3 a jurisdiction other than the jurisdiction in which a health 4 care professional is licensed, certified, or otherwise author- 5 ized, such health care professional shall provide written 6 notice to the applicable licensing, certifying, or authorizing 7 authority in the jurisdiction in which the health care pro- 8 fessional provided such services. Such notice shall include 9 the health care professional’s— 10 (1) name; 11 (2) email address; 12 (3) phone number; 13 (4) State of primary license, certification, or 14 authorization; and 15 (5) license, certification, or authorization type, 16 and applicable number or identifying information 17 with respect to such license, certification, or author- 18 ization. 19 (e) CLARIFICATION.—Nothing in this section author- 20 izes a health care professional to— 21 (1) practice beyond the scope of practice au- 22 thorized by any State, District of Columbia, terri- 23 torial, or local authority in the jurisdiction in which 24 VerDate Sep 11 2014 03:46 Aug 21, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S4421.IS S4421 kjohnson on DSK79L0C42PROD with BILLS 8 •S 4421 IS the health care professional holds a license, certifi- 1 cation, or authorization described in section 3(1)(A); 2 (2) provide any service or subset of services 3 prohibited by any such authority in the jurisdiction 4 in which the patient receiving services is located; 5 (3) provide any service or subset of services in 6 a manner prohibited by any such authority the juris- 7 diction in which the patient receiving services is lo- 8 cated; or 9 (4) provide any service or subset of services in 10 a manner other than the manner prescribed by any 11 such authority in the jurisdiction in which the pa- 12 tient receiving services is located. 13 (f) INVESTIGATIVE AND DISCIPLINARY AUTHOR- 14 ITY.—A health care professional providing services pursu- 15 ant to the authority under this section shall be subject 16 to investigation and disciplinary action by the licensing, 17 certifying, or authorizing authorities in the jurisdiction in 18 which the patient receiving services is located. The juris- 19 diction in which the patient receiving services is located 20 shall have the authority to preclude the health care pro- 21 vider from practicing further in its jurisdiction, whether 22 such practice is authorized by the laws of such jurisdiction 23 or the authority granted under this section, and shall re- 24 port any such preclusion to the licensing authority in the 25 VerDate Sep 11 2014 03:46 Aug 21, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S4421.IS S4421 kjohnson on DSK79L0C42PROD with BILLS 9 •S 4421 IS jurisdiction in which the health care provider is licensed, 1 certified, or authorized. 2 (g) MULTIPLE JURISDICTION LICENSURE.—Notwith- 3 standing any other provision of this section, a health care 4 professional shall be subject to the requirements of the 5 jurisdiction of licensure if the professional is licensed in 6 the State, the District of Columbia, or territory or posses- 7 sion where the patient is located. 8 (h) INTERSTATE LICENSURE COMPACTS.—If a 9 health care professional is licensed in multiple jurisdic- 10 tions through an interstate licensure compact, with respect 11 to services provided to a patient located in a jurisdiction 12 covered by such compact, the health care professional shall 13 be subject to the requirements of the compact and not this 14 section. 15 SEC. 5. APPLICATION. 16 This Act shall apply— 17 (1) during the period beginning on the date of 18 enactment of this Act and ending on the date that 19 is at least 180 days (as determined by the Sec- 20 retary) after the end of the public health emergency 21 declared by the Secretary of Health and Human 22 Services under section 319 of the Public Health 23 Service Act (42 U.S.C. 247d) on January 31, 2020, 24 with respect to COVID–19; and 25 VerDate Sep 11 2014 03:46 Aug 21, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S4421.IS S4421 kjohnson on DSK79L0C42PROD with BILLS 10 •S 4421 IS (2) subject to a declaration by the Secretary of 1 Health and Human Services invoking such applica- 2 tion— 3 (A) during a period in which there is in ef- 4 fect both— 5 (i)(I) a major disaster with respect to 6 not less than 12 States, declared by the 7 President pursuant to section 401 of the 8 Robert T. Stafford Disaster Relief and 9 Emergency Assistance Act (42 U.S.C. 10 5170) or emergency declared by the Presi- 11 dent under section 501 of the Robert T. 12 Stafford Disaster Relief and Emergency 13 Assistance Act (42 U.S.C. 5191); or 14 (II) a national emergency declared by 15 the President under the National Emer- 16 gencies Act (50 U.S.C. 1601 et seq.); and 17 (ii) a public health emergency de- 18 clared by the Secretary of Health and 19 Human Services under section 319 of the 20 Public Health Service Act (42 U.S.C. 21 247d); and 22 (B) for at least 180 days after the disaster 23 or emergency period under subclause (I) or (II) 24 VerDate Sep 11 2014 03:46 Aug 21, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S4421.IS S4421 kjohnson on DSK79L0C42PROD with BILLS 11 •S 4421 IS of subparagraph (a)(I) ends, as determined by 1 the Secretary of Health and Human Services. 2 Æ VerDate Sep 11 2014 03:46 Aug 21, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6301 E:\BILLS\S4421.IS S4421 kjohnson on DSK79L0C42PROD with BILLS