CONNECT for Health Act of 2023

I 118TH CONGRESS 1ST SESSION H. R. 4189 To amend title XVIII of the Social Security Act to expand access to telehealth services, and for other purposes. IN THE HOUSE OF REPRESENTATIVES JUNE 15, 2023 Mr. THOMPSON of California (for himself, Ms. MATSUI, Mr. SCHWEIKERT, and Mr. JOHNSON of Ohio) introduced the following bill; which was re- ferred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently de- termined 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 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 2023’’ or the ‘‘CON- 6 NECT for Health Act of 2023’’. 7 VerDate Sep 11 2014 22:41 Jul 09, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4189.IH H4189 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HR 4189 IH (b) TABLE OF CONTENTS.—The table of contents of 1 this Act is as follows: 2 Sec. 1. Short title; table of contents. Sec. 2. Findings and sense of Congress. TITLE I—REMOVING BARRIERS TO TELEHEALTH COVERAGE Sec. 101. Removing geographic requirements for telehealth services. Sec. 102. Expanding originating sites. Sec. 103. Expanding authority for practitioners eligible to furnish telehealth services. Sec. 104. Improvements to the process for adding telehealth services. Sec. 105. Federally qualified health centers and rural health clinics. Sec. 106. Native American health facilities. Sec. 107. Repeal of six-month in-person visit requirement for telemental health services. Sec. 108. Waiver of telehealth requirements during public health emergencies. Sec. 109. Use of telehealth in recertification for hospice care. TITLE II—PROGRAM INTEGRITY Sec. 201. Clarification for fraud and abuse laws regarding technologies pro- vided to beneficiaries. Sec. 202. Additional resources for telehealth oversight. Sec. 203. Addressing significant outlier billing patterns for telehealth services. TITLE III—BENEFICIARY AND PROVIDER SUPPORTS, QUALITY OF CARE, AND DATA Sec. 301. Beneficiary engagement on telehealth. Sec. 302. Provider supports on telehealth. Sec. 303. Ensuring the inclusion of telehealth in measuring quality of care. Sec. 304. Posting of information on telehealth services. SEC. 2. FINDINGS AND SENSE OF CONGRESS. 3 (a) FINDINGS.—Congress finds the following: 4 (1) The use of technology in health care and 5 coverage of telehealth services are rapidly evolving. 6 (2) Research has found that telehealth services 7 can expand access to care, improve the quality of 8 care, and reduce spending. 9 VerDate Sep 11 2014 22:41 Jul 09, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4189.IH H4189 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HR 4189 IH (3) In 2021, 91 percent of patients receiving 1 telehealth services were satisfied with their experi- 2 ences. 3 (4) Health care workforce shortages are a sig- 4 nificant problem in many areas and for many types 5 of health care clinicians. 6 (5) Telehealth increases access to care in areas 7 with workforce shortages and for individuals who 8 live far away from health care facilities, have limited 9 mobility or transportation, or have other barriers to 10 accessing care. 11 (6) The use of health technologies can strength- 12 en the expertise of the health care workforce, includ- 13 ing by connecting clinicians to specialty consulta- 14 tions. 15 (7) Prior to the COVID–19 pandemic, the utili- 16 zation of telehealth services in the Medicare program 17 under title XVIII of the Social Security Act (42 18 U.S.C. 1395 et seq.) was low, accounting for 0.1 19 percent of Medicare Part B visits in 2019. 20 (8) Telehealth now represents a critical compo- 21 nent of care delivery. As of February 2023, 15 per- 22 cent of Medicare fee-for-service beneficiaries have 23 had a telehealth service in the past quarter. 24 VerDate Sep 11 2014 22:41 Jul 09, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4189.IH H4189 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •HR 4189 IH (9) Long-term certainty about coverage of tele- 1 health services under the Medicare program is nec- 2 essary to fully realize the benefits of telehealth. 3 (b) SENSE OF CONGRESS.—It is the sense of Con- 4 gress that— 5 (1) health care providers can furnish safe, effec- 6 tive, and high-quality health care services through 7 telehealth; 8 (2) the Secretary of Health and Human Serv- 9 ices should promptly take all necessary measures to 10 ensure that providers and beneficiaries can continue 11 to furnish and utilize, respectively, telehealth serv- 12 ices in the Medicare program, including modifying, 13 as appropriate, the definition of ‘‘interactive tele- 14 communications system’’ in regulations and program 15 instruction under the Medicare program to ensure 16 that providers can utilize all appropriate means and 17 types of technology, including audio-visual, audio- 18 only, and other types of technologies, to furnish tele- 19 health services; and 20 (3) barriers to the use of telehealth should be 21 removed. 22 VerDate Sep 11 2014 22:41 Jul 09, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4189.IH H4189 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •HR 4189 IH TITLE I—REMOVING BARRIERS 1 TO TELEHEALTH COVERAGE 2 SEC. 101. REMOVING GEOGRAPHIC REQUIREMENTS FOR 3 TELEHEALTH SERVICES. 4 Section 1834(m)(4)(C) of the Social Security Act (42 5 U.S.C. 1395m(m)(4)(C)) is 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) REMOVAL OF GEOGRAPHIC RE- 12 QUIREMENTS.—The geographic require- 13 ments described in clause (i) shall not 14 apply with respect to telehealth services 15 furnished on or after January 1, 2025.’’. 16 SEC. 102. EXPANDING ORIGINATING SITES. 17 (a) EXPANDING THE HOME AS AN ORIGINATING 18 SITE.—Section 1834(m)(4)(C)(ii)(X) of the Social Secu- 19 rity Act (42 U.S.C. 1395m(m)(4)(C)(ii)(X)) is amended 20 to read as follows: 21 ‘‘(X)(aa) Prior to January 1, 22 2025, the home of an individual but 23 only for purposes of section 24 VerDate Sep 11 2014 22:41 Jul 09, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4189.IH H4189 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •HR 4189 IH 1881(b)(3)(B) or telehealth services 1 described in paragraph (7). 2 ‘‘(bb) On or after January 1, 3 2025, the home of an individual. For 4 purposes of the preceding sentence, 5 the home of an individual includes 6 temporary lodging and, in the case 7 where, for privacy or other personal 8 reasons, an individual chooses to trav- 9 el a short distance from the home for 10 the furnishing of a telehealth service, 11 includes such location, as described in 12 the final rule entitled ‘Medicare Pro- 13 gram; CY 2022 Payment Policies 14 Under the Physician Fee Schedule 15 and Other Changes to Part B Pay- 16 ment Policies; Medicare Shared Sav- 17 ings Program Requirements; Provider 18 Enrollment Regulation Updates; and 19 Provider and Supplier Prepayment 20 and Post-Payment Medical Review 21 Requirements’ published in the Fed- 22 eral Register on November 19, 2021 23 (86 Fed. Reg. 64996), or a successor 24 regulation.’’. 25 VerDate Sep 11 2014 22:41 Jul 09, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4189.IH H4189 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •HR 4189 IH (b) ALLOWING ADDITIONAL ORIGINATING SITES.— 1 Section 1834(m)(4)(C)(ii) of the Social Security Act (42 2 U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding at the 3 end the following new subclause: 4 ‘‘(XII) Any other clinically ap- 5 propriate site at which an eligible tele- 6 health individual is located at the time 7 a telehealth service is furnished via a 8 telecommunications system. Not later 9 than January 1, 2025, the Secretary 10 shall issue regulations that establish 11 parameters for the determination of 12 whether a site is clinically appropriate 13 for purposes of the preceding sen- 14 tence.’’. 15 (c) PARAMETERS FOR NEW ORIGINATING SITES.— 16 Section 1834(m)(4)(C) of the Social Security Act (42 17 U.S.C. 1395m(m)(4)(C)), as amended by section 101, is 18 amended by adding at the end the following new clause: 19 ‘‘(v) REQUIREMENTS FOR NEW 20 SITES.— 21 ‘‘(I) IN GENERAL.—The Sec- 22 retary may establish requirements for 23 the furnishing of telehealth services at 24 sites described in clause (ii)(XII) to 25 VerDate Sep 11 2014 22:41 Jul 09, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4189.IH H4189 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •HR 4189 IH provide for beneficiary and program 1 integrity protections. 2 ‘‘(II) RULE OF CONSTRUC- 3 TION.—Nothing in this clause shall be 4 construed to preclude the Secretary 5 from establishing requirements for 6 other originating sites described in 7 clause (ii)’’. 8 (d) NO ORIGINATING SITE FACILITY FEE FOR NEW 9 SITES.—Section 1834(m)(2)(B)(ii) of the Social Security 10 Act (42 U.S.C. 1395m(m)(2)(B)(ii)) is amended— 11 (1) in the heading, by striking ‘‘IF ORIGINATING 12 SITE IS THE HOME’’ and inserting ‘‘FOR CERTAIN 13 SITES’’; and 14 (2) by striking ‘‘paragraph (4)(C)(ii)(X)’’ and 15 inserting ‘‘subclause (X) or (XII) of paragraph 16 (4)(C)(ii)’’. 17 SEC. 103. EXPANDING AUTHORITY FOR PRACTITIONERS EL- 18 IGIBLE TO FURNISH TELEHEALTH SERVICES. 19 Section 1834(m)(4)(E) of the Social Security Act (42 20 U.S.C. 1395m(m)(4)(E)) is amended— 21 (1) by striking ‘‘PRACTITIONER.—The term’’ 22 and inserting ‘‘PRACTITIONER.— 23 ‘‘(i) IN GENERAL.—Subject to clause 24 (ii), the term’’; and 25 VerDate Sep 11 2014 22:41 Jul 09, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H4189.IH H4189 pbinns on DSKJLVW7X2PROD with $$_JOB 9 •HR 4189 IH (2) by adding at the end the following new 1 clause: 2 ‘‘(ii) EXPANDING PRACTITIONERS ELI- 3 GIBLE TO FURNISH TELEHEALTH SERV- 4 ICES.— 5 ‘‘(I) IN GENERAL.—Notwith- 6 standing any other provision of this 7 subsection, in the case of telehealth 8 services furnished on or after January 9 1, 2024, the Secretary may waive any 10 limitation on the types of practitioners 11 who are eligible to furnish telehealth 12 services (other than the requirement 13 that the practitioner is enrolled under 14 section 1866(j)) if the Secretary de- 15 termines that such waiver is clinically 16 appropriate. 17 ‘‘(II) IMPLEMENTATION.—In im- 18 plementing a waiver under this clause, 19 the Secretary may establish param- 20 eters, as appropriate, for telehealth 21 services under such waiver, including 22 with respect to beneficiary and pro- 23 gram integrity protections. 24 VerDate Sep 11 2014 22:41 Jul 09, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H4189.IH H4189 pbinns on DSKJLVW7X2PROD with $$_JOB 10 •HR 4189 IH ‘‘(III) PUBLIC COMMENT.—The 1 Secretary shall establish a process by 2 which stakeholders may (on at least 3 an annual basis) provide public com- 4 ment on such waiver under this 5 clause. 6 ‘‘(IV) PERIODIC REVIEW.—The 7 Secretary shall periodically, but not 8 more frequently than every 3 years, 9 reassess the waiver under this clause 10 to determine whether such waiver con- 11 tinues to be clinically appropriate. The 12 Secretary shall terminate any waiver 13 that the Secretary determines is no 14 longer clinically appropriate.’’. 15 SEC. 104. IMPROVEMENTS TO THE PROCESS FOR ADDING 16 TELEHEALTH SERVICES. 17 (a) REVIEW.—The Secretary shall undertake a review 18 of the process established pursuant to section 19 1834(m)(4)(F)(ii) of the Social Security Act (42 U.S.C. 20 1395m(m)(4)(F)(ii)), and based on the results of such re- 21 view— 22 (1) implement revisions to the process so that 23 the criteria to add services prioritizes, as appro- 24 VerDate Sep 11 2014 22:41 Jul 09, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H4189.IH H4189 pbinns on DSKJLVW7X2PROD with $$_JOB 11 •HR 4189 IH priate, improved access to care through clinically ap- 1 propriate telehealth services; and 2 (2) provide clarification on what requests to 3 add telehealth services under such process should in- 4 clude. 5 (b) TEMPORARY COVERAGE OF CERTAIN TELE- 6 HEALTH SERVICES.—Section 1834(m)(4)(F) of the Social 7 Security Act (42 U.S.C. 1395m(m)(4)(F)) is amended by 8 adding at the end the following new clause: 9 ‘‘(iii) TEMPORARY COVERAGE OF CER- 10 TAIN TELEHEALTH SERVICES.—The Sec- 11 retary may add services with a reasonable 12 potential likelihood of clinical benefit and 13 improved access to care when furnished via 14 a telecommunications system (as deter- 15 mined by the Secretary) on a temporary 16 basis to those specified in clause (i) for au- 17 thorized payment under paragraph (1).’’. 18 SEC. 105. FEDERALLY QUALIFIED HEALTH CENTERS AND 19 RURAL HEALTH CLINICS. 20 Section 1834(m) of the Social Security Act (42 21 U.S.C. 1395m(m)) is amended— 22 (1) in paragraph (4)(C)(i), in the matter pre- 23 ceding subclause (I), by striking ‘‘and (7)’’ and in- 24 serting ‘‘(7), and (8)’’; and 25 VerDate Sep 11 2014 22:41 Jul 09, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H4189.IH H4189 pbinns on DSKJLVW7X2PROD with $$_JOB 12 •HR 4189 IH (2) in paragraph (8)— 1 (A) in subparagraph (A)— 2 (i) in the matter preceding clause (i), 3 by striking ‘‘During’’ and all that follows 4 through ‘‘December 31, 2024—’’ and in- 5 serting the following: ‘‘During and after 6 the emergency period described in section 7 1135(g)(1)(B)—’’; 8 (ii) in clause (ii), by striking ‘‘and’’ at 9 the end; 10 (iii) by redesignating clause (iii) as 11 clause (iv); and 12 (iv) by inserting after clause (ii) the 13 following new clause: 14 ‘‘(iii) the geographic requirements de- 15 scribed in paragraph (4)(C)(i) shall not 16 apply with respect to such a telehealth 17 service; and’’; and 18 (B) by striking subparagraph (B) and in- 19 serting the following: 20 ‘‘(B) PAYMENT.— 21 ‘‘(i) IN GENERAL.—A telehealth serv- 22 ice furnished by a Federally qualified 23 health center or a rural health clinic to an 24 individual pursuant to this paragraph on 25 VerDate Sep 11 2014 22:41 Jul 09, 2023 Jkt 039200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H4189.IH H4189 pbinns on DSKJLVW7X2PROD with $$_JOB 13 •HR 4189 IH or after the date of the enactment of this 1 subparagraph shall be deemed to be so fur- 2 nished to such i [Text truncated for display. 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