Protecting Rural Telehealth Access Act

I 118TH CONGRESS 1ST SESSION H. R. 3440 To amend title XVIII of the Social Security Act to protect access to telehealth services under the Medicare program. IN THE HOUSE OF REPRESENTATIVES MAY 17, 2023 Mr. PAPPAS (for himself, Mrs. MCCLAIN, Mr. LATURNER, Mr. MOLINARO, Mr. MOONEY, and Mr. NUNN of Iowa) 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 subse- quently 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 protect access to telehealth services under the Medicare program. 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 ‘‘Protecting Rural Tele- 4 health Access Act’’. 5 VerDate Sep 11 2014 01:30 Jun 06, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3440.IH H3440 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 3440 IH SEC. 2. ELIMINATION OF RESTRICTIONS RELATING TO 1 TELEHEALTH SERVICES. 2 (a) ELIMINATION OF GEOGRAPHIC REQUIREMENTS 3 FOR ORIGINATING SITES.—Section 1834(m)(4)(C) of the 4 Social Security Act (42 U.S.C. 1395m(m)(4)(C)) is 5 amended— 6 (1) in clause (i), in the matter preceding sub- 7 clause (I), by striking ‘‘clause (iii)’’ and inserting 8 ‘‘clauses (iii) and (iv)’’; and 9 (2) by adding at the end the following new 10 clause: 11 ‘‘(iv) ELIMINATION OF GEOGRAPHIC 12 REQUIREMENTS FOR ORIGINATING 13 SITES.—The geographic requirements de- 14 scribed in clause (i) shall not apply with 15 respect to telehealth services furnished on 16 or after January 1, 2025.’’. 17 (b) ELIMINATION OF RESTRICTIONS IN WHICH 18 TELEHEALTH SERVICES MAY BE FURNISHED IN THE 19 HOME.—Section 1834(m)(4)(C)(ii)(X) of the Social Secu- 20 rity Act (42 U.S.C. 1395m(m)(4)(C)(i)(X) is amended to 21 read as follows:. 22 ‘‘(X)(aa) For the period begin- 23 ning on the date of the enactment of 24 this subclause and ending on Decem- 25 ber 31, 2024, the home of an indi- 26 VerDate Sep 11 2014 01:30 Jun 06, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3440.IH H3440 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 3440 IH vidual but only for purposes of section 1 1881(b)(3)(B) or telehealth services 2 described in paragraph (7). 3 ‘‘(bb) For the period beginning 4 on or after January 1, 2025, the 5 home of an individual.’’. 6 (c) ELIMINATION OF RESTRICTIONS ON STORE-AND- 7 FORWARD TECHNOLOGIES.—The second sentence of sec- 8 tion 1834(m)(1) of the Social Security Act (42 U.S.C. 9 1395m(m)(1)) is amended by striking ‘‘in the case of any 10 Federal telemedicine demonstration program conducted in 11 Alaska or Hawaii,’’. 12 SEC. 3. TELEHEALTH FLEXIBILITIES FOR CRITICAL ACCESS 13 HOSPITALS. 14 Section 1834(m) of the Social Security Act (42 15 U.S.C. 1395m(m)) is amended— 16 (1) in the first sentence of paragraph (1), by 17 striking ‘‘and (9)’’ and inserting ‘‘(9), and (10)’’; 18 (2) in paragraph (2)(A), by striking ‘‘paragraph 19 (8)’’ and inserting ‘‘paragraphs (8) and (10)’’; 20 (3) in paragraph (4)— 21 (A) in subparagraph (A), by striking 22 ‘‘paragraph (8)’’ and inserting ‘‘paragraphs (8) 23 and (10)’’; and 24 VerDate Sep 11 2014 01:30 Jun 06, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3440.IH H3440 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 3440 IH (B) in subparagraph (F)(i), by striking 1 ‘‘paragraph (8)’’ and inserting ‘‘paragraphs (8) 2 and (10)’’; and 3 (4) by adding at the end the following new 4 paragraph: 5 ‘‘(10) TELEHEALTH FLEXIBILITIES FOR CRIT- 6 ICAL ACCESS HOSPITALS.— 7 ‘‘(A) IN GENERAL.—On or after the date 8 of the enactment of this paragraph— 9 ‘‘(i) the Secretary shall pay for tele- 10 health services that are furnished via a 11 telecommunications system by a critical ac- 12 cess hospital, including any practitioner 13 authorized to provide such services within 14 the facility, that is a qualified provider (as 15 defined in subparagraph (B)) to an eligible 16 telehealth individual enrolled under this 17 part notwithstanding that the critical ac- 18 cess hospital providing the telehealth serv- 19 ice is not at the same location as the bene- 20 ficiary, if such services complement a plan 21 of care that includes in-person care at 22 some point, as may be appropriate; 23 ‘‘(ii) the amount of payment to a crit- 24 ical access hospital that serves as a distant 25 VerDate Sep 11 2014 01:30 Jun 06, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3440.IH H3440 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 3440 IH site for such a telehealth service shall be 1 determined under subparagraph (C); and 2 ‘‘(iii) for purposes of this subsection— 3 ‘‘(I) the term ‘distant site’ in- 4 cludes a critical access hospital that 5 furnishes a telehealth service to an eli- 6 gible telehealth individual; and 7 ‘‘(II) the term ‘telehealth serv- 8 ices’ includes behavioral health serv- 9 ices and any other outpatient critical 10 access hospital service that is fur- 11 nished using telehealth to the extent 12 that payment codes corresponding to 13 services identified by the Secretary 14 under clause (i) or (ii) of paragraph 15 (4)(F) are listed on the corresponding 16 claim for such critical access hospital 17 service. 18 ‘‘(B) DEFINITION OF QUALIFIED PRO- 19 VIDER.—For purposes of this subsection, the 20 term ‘qualified provider’ means, with respect to 21 a telehealth service described in subparagraph 22 (A)(i) that is furnished to an eligible telehealth 23 individual, a critical access hospital that has an 24 established patient relationship with such indi- 25 VerDate Sep 11 2014 01:30 Jun 06, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3440.IH H3440 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 3440 IH vidual as defined by the State in which the indi- 1 vidual is located. 2 ‘‘(C) PAYMENT.—The amount of payment 3 to a critical access hospital that serves as a dis- 4 tant site that furnishes a telehealth service to 5 an eligible telehealth individual under this para- 6 graph shall be equal to 101 percent of the rea- 7 sonable costs of the hospital in providing such 8 services, unless the hospital makes an election 9 under paragraph (2) of section 1834(g) to be 10 paid for such services based on the methodology 11 described in such paragraph. Telehealth services 12 furnished by a critical access hospital shall be 13 counted for purposes of determining the pro- 14 vider productivity rate of the critical access hos- 15 pital for purposes of payment under such sec- 16 tion. 17 ‘‘(D) IMPLEMENTATION.—Notwithstanding 18 any other provision of law, the Secretary may 19 implement this paragraph through program in- 20 struction, interim final rule, or otherwise.’’. 21 VerDate Sep 11 2014 01:30 Jun 06, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3440.IH H3440 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 3440 IH SEC. 4. EXTENDING MEDICARE TELEHEALTH FLEXIBILI- 1 TIES FOR FEDERALLY QUALIFIED HEALTH 2 CENTERS AND RURAL HEALTH CLINICS. 3 Section 1834(m)(8) of the Social Security Act (42 4 U.S.C. 1395m(m)(8)), as amended by section 4113(c) of 5 division FF of the Consolidated Appropriations Act, 2023 6 (Public Law 117–328) is amended— 7 (1) in subparagraph (A), in the matter pre- 8 ceding clause (i), by inserting ‘‘, and on or after 9 January 1, 2025’’ after ‘‘December 31, 2024’’; 10 (2) by striking subparagraph (B) and inserting 11 the following: 12 ‘‘(B) PAYMENT.— 13 ‘‘(i) IN GENERAL.—A telehealth serv- 14 ice furnished by a Federally qualified 15 health center or a rural health clinic to an 16 eligible telehealth individual pursuant to 17 this paragraph or after the date of the en- 18 actment of this subparagraph shall be re- 19 imbursed under this title at a separate 20 telehealth payment rate as determined 21 under the methodology established by the 22 Secretary pursuant to clause (ii). 23 ‘‘(ii) PAYMENT METHODOLOGY.—The 24 Secretary shall establish a methodology for 25 determining the appropriate payment rate 26 VerDate Sep 11 2014 01:30 Jun 06, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3440.IH H3440 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 3440 IH for telehealth services described in clause 1 (i). Such methodology shall consider— 2 ‘‘(I) the geography of Federally 3 qualified health centers and rural 4 health clinics; 5 ‘‘(II) costs associated with the 6 delivery of such telehealth services as 7 allowable costs for the center or clinic; 8 and 9 ‘‘(III) the full cost of providing 10 the services via telehealth. 11 ‘‘(iii) IMPLEMENTATION.— 12 ‘‘(I) CODING SYSTEM.—The Sec- 13 retary shall establish an effective cod- 14 ing system for telehealth services de- 15 scribed in clause (i) that is reflective 16 of the services provided at a center or 17 clinic. 18 ‘‘(II) IMPLEMENTATION.—Not- 19 withstanding any other provision of 20 law, the Secretary may implement this 21 subparagraph through program in- 22 struction, interim final rule, or other- 23 wise.’’; and 24 VerDate Sep 11 2014 01:30 Jun 06, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3440.IH H3440 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 3440 IH (3) by adding at the end the following new sub- 1 paragraph: 2 ‘‘(C) REQUIREMENT DURING ADDITIONAL 3 PERIOD.— 4 ‘‘(i) IN GENERAL.—Beginning on Jan- 5 uary 1, 2025, payment may only be made 6 under this paragraph for a telehealth serv- 7 ice described in subparagraph (A)(i) that 8 is furnished to an eligible telehealth indi- 9 vidual if such service is furnished by a 10 qualified provider (as defined in clause 11 (ii)). 12 ‘‘(ii) DEFINITION OF QUALIFIED PRO- 13 VIDER.—For purposes of this subpara- 14 graph, the term ‘qualified provider’ means, 15 with respect to a telehealth service de- 16 scribed in subparagraph (A)(i) that is fur- 17 nished to an eligible telehealth individual, a 18 Federally qualified health center or rural 19 health clinic that has an established pa- 20 tient relationship with such individual as 21 defined by the State in which the indi- 22 vidual is located.’’. 23 VerDate Sep 11 2014 01:30 Jun 06, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3440.IH H3440 kjohnson on DSK79L0C42PROD with BILLS 10 •HR 3440 IH SEC. 5. ALLOWANCE OF CERTAIN TELEHEALTH SERVICES 1 FURNISHED USING AUDIO-ONLY TECH- 2 NOLOGY. 3 Section 1834(m)(4) of the Social Security Act (42 4 U.S.C. 1395m(m)(4)) of the Social Security Act (42 5 U.S.C. 1395m(m)(4)) is amended by adding at the end 6 the following new subparagraph: 7 ‘‘(G) TELECOMMUNICATIONS SYSTEM.— 8 ‘‘(i) IN GENERAL.—Notwithstanding 9 paragraph (1) and section 410.78(a)(3) of 10 title 42, Code of Federal Regulations (or 11 any successor regulation), subject to clause 12 (v), on or after January, 2025, the term 13 ‘telecommunications system’ includes, in 14 the case of the furnishing of a specified 15 telehealth service (as defined in clause (ii)) 16 a communications system that uses audio- 17 only technology. 18 ‘‘(ii) SPECIFIED TELEHEALTH SERV- 19 ICE.—In this subparagraph, the term 20 ‘specified telehealth service’ means a tele- 21 health service described in clause (iii) that 22 is furnished by a qualified provider (as de- 23 fined in clause (iv)). 24 ‘‘(iii) TELEHEALTH SERVICE DE- 25 SCRIBED.—Subject to clause (vi), a tele- 26 VerDate Sep 11 2014 01:30 Jun 06, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3440.IH H3440 kjohnson on DSK79L0C42PROD with BILLS 11 •HR 3440 IH health service described in this clause is a 1 telehealth service consisting of— 2 ‘‘(I) evaluation and management 3 services; 4 ‘‘(II) behavioral health counseling 5 and educational services; and 6 ‘‘(III) other services determined 7 appropriate by the Secretary. 8 ‘‘(iv) QUALIFIED PROVIDER DE- 9 FINED.—For purposes of clause (ii), the 10 term ‘qualified provider’ means, with re- 11 spect to a specified telehealth service that 12 is furnished to an eligible telehealth indi- 13 vidual— 14 ‘‘(I) a physician or practitioner 15 who has an established patient rela- 16 tionship with such individual as de- 17 fined by the State in which the indi- 18 vidual is located; or 19 ‘‘(II) a critical access hospital (as 20 defined in section 1861(mm)(1)), a 21 rural health clinic (as defined in sec- 22 tion 1861(aa)(2)), a Federally quali- 23 fied health center (as defined in sec- 24 tion 1861(aa)(4)), a hospital (as de- 25 VerDate Sep 11 2014 01:30 Jun 06, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H3440.IH H3440 kjohnson on DSK79L0C42PROD with BILLS 12 •HR 3440 IH fined in section 1861(e)), a hospital- 1 based or critical access hospital-based 2 renal dialysis center (including sat- 3 ellites), a skilled nursing facility (as 4 defined in section 1819(a)), a commu- 5 nity mental health center (as defined 6 in section 1861(ff)(3)(B)), or a rural 7 emergency hospital (as defined in sec- 8 tion 1861(kkk)(2)). 9 ‘‘(v) AUTHORITY.—For purposes of 10 this subparagraph, the Secretary may de- 11 termine whether it is clinically appropriate 12 to furnish a specified telehealth service via 13 a communications system that uses audio- 14 only technology and whether an in-person 15 initial visit (in addition to any requirement 16 with respect to the furnishing of an item 17 or service in person pursuant to clause 18 (iv)(I)) is required prior to the furnishing 19 of such service using such technology. 20 ‘‘(vi) REVIEW.— 21 ‘‘(I) IN GENERAL.—Not later 22 than 5 years after the date of the en- 23 actment of this subparagraph, the 24 Secretary shall conduct a review of 25 VerDate Sep 11 2014 01:30 Jun 06, 2023 Jkt 039200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H3440.IH H3440 kjohnson on DSK79L0C42PROD with BILLS 13 •HR 3440 IH the furnishing of specified telehealth 1 services through audio-only technology 2 pursuant to this paragraph. Such re- 3 view shall include an analysis of the 4 impact of the roll out of broadband 5 technology and whether the use of 6 audio-only technology is necessary to 7 ensure access to such telehealth serv- 8 ices. 9 ‘‘(II) REDETERMINATION OF 10 SPECIFIED TELEHEALTH SERVICES.— 11 The Secretary may, based on the re- 12 view conducted under subclause (I), 13 provide for the addition or deletion of 14 services (and HCPCS codes), as ap- 15 propriate, to those specified in clause 16 (ii) that may be furnished using 17 audio-only technology and authorized 18 for payment pursuant to this subpara- 19 graph. 20 ‘‘(vii) CLARIFICATION REGARDING 21 PAYMENT.—The amount of payment for a 22 specified telehealth service tha [Text truncated for display. Full text available on Congress.gov.]