Safe Testing at Residence Telehealth Act of 2020

I 116TH CONGRESS 2D SESSION H. R. 8642 To amend title XVIII to provide coverage and payment for certain tests and assistive telehealth consultations during the COVID–19 emergency period, and for other purposes. IN THE HOUSE OF REPRESENTATIVES OCTOBER 20, 2020 Mr. SCHWEIKERT (for himself, Mr. RUSH, and Mr. KELLY of Pennsylvania) introduced the following bill; which was referred to the Committee on En- ergy 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 jurisdic- tion of the committee concerned A BILL To amend title XVIII to provide coverage and payment for certain tests and assistive telehealth consultations during the COVID–19 emergency period, and for other pur- poses. 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 ‘‘Safe Testing at Resi- 4 dence Telehealth Act of 2020’’. 5 VerDate Sep 11 2014 01:52 Nov 07, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H8642.IH H8642 dlhill on DSK120RN23PROD with BILLS 2 •HR 8642 IH SEC. 2. COVERAGE AND PAYMENT FOR CERTAIN TESTS 1 AND ASSISTIVE TELEHEALTH CONSULTA- 2 TIONS DURING THE COVID–19 EMERGENCY 3 PERIOD. 4 (a) COVERAGE AND PAYMENT RULE.— 5 (1) IN GENERAL.—Section 1834(m) of the So- 6 cial Security Act (42 U.S.C. 1395m(m)) is amended 7 by adding at the end the following new paragraph: 8 ‘‘(9) COVERAGE AND PAYMENT FOR CERTAIN 9 TESTS AND ASSISTIVE TELEHEALTH CONSULTA- 10 TIONS DURING COVID–19 EMERGENCY PERIOD.— 11 ‘‘(A) IN GENERAL.—During the emergency 12 period described in section 1135(g)(1)(B), the 13 Secretary shall pay for a test described in sub- 14 paragraph (C) that is ordered and an assistive 15 telehealth consultation that is furnished via a 16 telecommunications system by a physician or 17 practitioner to an eligible telehealth individual 18 enrolled under this part notwithstanding that 19 the individual physician or practitioner ordering 20 the test did not furnish the test or that the in- 21 dividual physician or practitioner providing the 22 assistive telehealth consultation is not at the 23 same location as the beneficiary. 24 ‘‘(B) PAYMENT AMOUNT.—During the 25 emergency period described in section 26 VerDate Sep 11 2014 01:52 Nov 07, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H8642.IH H8642 dlhill on DSK120RN23PROD with BILLS 3 •HR 8642 IH 1135(g)(1)(B), the Secretary shall pay to a 1 physician or practitioner located at a distant 2 site that— 3 ‘‘(i) orders a test described in sub- 4 paragraph (C) to an eligible telehealth in- 5 dividual an amount equal to the amount 6 that such physician or practitioner would 7 have been paid for a diagnostic laboratory 8 test under section 1833(h); and 9 ‘‘(ii) furnishes an assistive telehealth 10 consultation to an eligible telehealth indi- 11 vidual an amount equal to the amount that 12 a physician or practitioner would have been 13 paid for such telehealth service under para- 14 graph (2). 15 ‘‘(C) TESTS DESCRIBED.—For purposes of 16 subparagraphs (A) and (B), a test described in 17 this subparagraph is a medical device (as de- 18 fined in section 201(h) of the Federal Food, 19 Drug, and Cosmetic Act) or is a test approved 20 under an emergency use authorization under 21 section 564 of such Act and is either— 22 ‘‘(i) a diagnostic laboratory test for 23 the diagnosis of influenza or a similar res- 24 piratory condition that is required to ob- 25 VerDate Sep 11 2014 01:52 Nov 07, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H8642.IH H8642 dlhill on DSK120RN23PROD with BILLS 4 •HR 8642 IH tain a final diagnosis of COVID–19 for an 1 individual when such test is ordered by a 2 physician or practitioner in conjunction 3 with a COVID–19 diagnostic laboratory 4 test for purposes of discounting a diagnosis 5 of influenza or a related diagnosis for such 6 individual; or 7 ‘‘(ii) a serology test for COVID–19. 8 ‘‘(D) OTHER MATTERS RELATING TO DOC- 9 UMENTATION AND CLAIMS REVIEW.—The re- 10 quirements of paragraphs (2) and (3) of section 11 410.32(d) of title 42, Code of Federal Regula- 12 tions (as in effect on the date of the enactment 13 of this paragraph), relating to documentation 14 and claims review, respectively, shall apply to a 15 test described in subparagraph (C) and an as- 16 sistive telehealth consultation. 17 ‘‘(E) DEMOGRAPHIC DATA.—To be eligible 18 for reimbursement under this paragraph, each 19 claim for reimbursement shall include, with re- 20 spect to such an eligible telehealth individual, 21 the following demographic data: 22 ‘‘(i) Age. 23 ‘‘(ii) Race and ethnicity. 24 ‘‘(iii) Gender. 25 VerDate Sep 11 2014 01:52 Nov 07, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H8642.IH H8642 dlhill on DSK120RN23PROD with BILLS 5 •HR 8642 IH ‘‘(iv) An affirmative or negative state- 1 ment of the existence of any chronic condi- 2 tion. 3 ‘‘(v) Any other information the Sec- 4 retary determines appropriate. 5 ‘‘(F) ASSISTIVE TELEHEALTH CONSULTA- 6 TION.—In this paragraph, the term ‘assistive 7 telehealth consultation’ means a telehealth serv- 8 ice (as defined in paragraph (4)(F)) that is— 9 ‘‘(i) an evaluation and management 10 service; 11 ‘‘(ii) an assessment of any evidence of 12 systems which would make a diagnostic 13 laboratory test necessary to be furnished in 14 the home of an eligible telehealth indi- 15 vidual; 16 ‘‘(iii) the ordering of a diagnostic lab- 17 oratory test; 18 ‘‘(iv) an assessment of an individual 19 succeeding the delivery of a diagnostic lab- 20 oratory test; 21 ‘‘(v) any assistance in the collection of 22 a sample necessary for a diagnostic labora- 23 tory test and securing the sample for ship- 24 ping; 25 VerDate Sep 11 2014 01:52 Nov 07, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H8642.IH H8642 dlhill on DSK120RN23PROD with BILLS 6 •HR 8642 IH ‘‘(vi) the referral of an eligible tele- 1 health individual to a physician or practi- 2 tioner for in-person treatment; or 3 ‘‘(vii) the review of a diagnostic lab- 4 oratory test by a physician or practi- 5 tioner.’’. 6 (2) REPORT.— 7 (A) IN GENERAL.—During the period be- 8 ginning 20 days after the date of the enactment 9 of this Act and ending on the last day of the 10 emergency period, each physician and practi- 11 tioner, who furnishes a test or an assistive tele- 12 health consultation during such period, shall, on 13 a monthly basis during such period, submit to 14 the Administrator of the Centers for Medicare 15 & Medicaid Services and the appropriate State 16 health agency demographic data specified under 17 section 1834(m)(9)(E) of the Social Security 18 Act (42 U.S.C. 1395m(m)(9)(E)) with respect 19 to individuals to whom such test or consultation 20 was so furnished (in accordance with the 21 HIPAA privacy regulation). 22 (B) DEFINITIONS.—In this paragraph: 23 (i) ASSISTIVE TELEHEALTH CON- 24 SULTATION.—The term ‘‘assistive tele- 25 VerDate Sep 11 2014 01:52 Nov 07, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H8642.IH H8642 dlhill on DSK120RN23PROD with BILLS 7 •HR 8642 IH health consultation’’ has the meaning given 1 such term in section 1834(m)(9)(E) of the 2 Social Security Act (42 U.S.C. 3 1395m(m)(9)(F)). 4 (ii) EMERGENCY PERIOD.—The term 5 ‘‘emergency period’’ has the meaning as 6 such term is described in section 7 1135(g)(1)(B) of the Social Security Act 8 (42 U.S.C. 1320b–5(g)(1)(B)). 9 (iii) HIPAA PRIVACY REGULATION.— 10 The term ‘‘HIPAA privacy regulation’’ has 11 the meaning given such term in section 12 1180(b)(3) of the Social Security Act (42 13 U.S.C. 1320d–9(b)(3)). 14 (iv) TEST.—The term ‘‘test’’ has the 15 meaning as such term is described in sec- 16 tion 1834(m)(9)(C) of the Social Security 17 Act (42 U.S.C. 1395m(m)(9)(C)). 18 (b) NO PAYMENT FOR CERTAIN IN-PERSON TEST 19 AFTER TELEHEALTH TEST DURING THE COVID–19 20 EMERGENCY PERIOD.— 21 (1) IN GENERAL.—Section 1833(h) of the So- 22 cial Security Act (42 U.S.C. 1395l(h)) is amended— 23 (A) in paragraph (1)(A), by striking ‘‘Sub- 24 ject to section 1834(d)(1)’’ and inserting ‘‘Sub- 25 VerDate Sep 11 2014 01:52 Nov 07, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H8642.IH H8642 dlhill on DSK120RN23PROD with BILLS 8 •HR 8642 IH ject to section 1834(a)(1) and paragraph (10)’’; 1 and 2 (B) by adding at the end the following new 3 paragraph: 4 ‘‘(10) During the emergency period described in sec- 5 tion 1135(g)(1)(B), the Secretary may not make payment 6 for a test described in section 1834(m)(9)(C) that is fur- 7 nished in-person by a physician or practitioner to an indi- 8 vidual if a physician or practitioner has previously ordered 9 such a test via a telecommunications system pursuant to 10 section 1834(m)(9)(A), unless the physician or practi- 11 tioner determines such a test is medically necessary and 12 appropriate (as determined by the Secretary).’’. 13 (2) REPORT.—Not later than 1 year after the 14 termination of the emergency period described in 15 section 1135(g)(1)(B) of the Social Security Act (42 16 U.S.C. 1320b–5(g)(1)(B)), the Inspector General of 17 the Department of Health and Human Services shall 18 review claims for payment for tests described in sec- 19 tion 1834(m)(9)(C) of such Act (42 U.S.C. 20 1395m(m)(9)(C)) furnished during such emergency 21 period and submit to Congress a report on any in- 22 stances of waste, fraud, or abuse identified through 23 such review. 24 VerDate Sep 11 2014 01:52 Nov 07, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H8642.IH H8642 dlhill on DSK120RN23PROD with BILLS 9 •HR 8642 IH (c) CONFORMING AMENDMENTS.—Section 1834(m) 1 of the Social Security Act (42 U.S.C. 2 1395m(m)(4)(C)(ii)(X)), as amended by subsection (a), is 3 further amended— 4 (1) in paragraph (1), by striking ‘‘Subject to 5 paragraph (8)’’ and inserting ‘‘Subject to para- 6 graphs (8) and (9)’’; 7 (2) in paragraph (2), by striking ‘‘Subject to 8 paragraph (8)’’ and inserting ‘‘Subject to para- 9 graphs (8) and (9)’’; and 10 (3) in paragraph (4)(C)(ii)(X), by striking 11 ‘‘telehealth services described in paragraph (7)’’ and 12 inserting ‘‘telehealth services described in paragraph 13 (7) or (9)’’. 14 Æ VerDate Sep 11 2014 01:52 Nov 07, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6301 E:\BILLS\H8642.IH H8642 dlhill on DSK120RN23PROD with BILLS