What This Bill Does
This bill changes Medicare rules to permanently allow certain medical service codes to be delivered through telehealth (remote healthcare using technology). It specifically allows some of these services to be provided using audio-only technology (like phone calls) instead of requiring video.
Who It Affects
Medicare patients receiving telehealth services and healthcare providers who deliver those services through Medicare.
Key Provisions
• Certain HCPCS codes (medical billing codes that identify specific healthcare services) become permanent telehealth services under Medicare, starting April 1, 2023. These codes are: 90875, 96125, 96170, 96171, 97151, 97152, 97153, 97154, 97155, 97156, 97157, and 97158. (Sec. 2)
• An additional set of HCPCS codes becomes permanent telehealth services: 96127, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, and 96158. (Sec. 2)
• For the second set of codes, the Secretary of Health and Human Services can waive rules that require video technology, allowing qualified providers to deliver evaluation and management services (doctor assessments), behavioral health counseling, and educational services using audio-only technology if it is clinically appropriate and an in-person visit isn't required first. (Sec. 2)
What Changes
If this becomes law, Medicare will permanently cover these specific medical services delivered remotely instead of requiring temporary approval periods. Patients can receive certain mental health and behavioral health services by phone call instead of video call.
Important Definitions
HCPCS codes: Medical identification numbers used to bill for specific healthcare services. Telehealth: Healthcare services delivered remotely using technology.
Effective Date
April 1, 2023 (Sec. 2)
I
118TH CONGRESS
1ST SESSION
H. R. 635
To amend title XVIII of the Social Security Act to permanently include
certain HCPCS codes as telehealth services under such title, and for
other purposes.
IN THE HOUSE OF REPRESENTATIVES
JANUARY 30, 2023
Mr. ROSENDALE 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 perma-
nently include certain HCPCS codes as telehealth serv-
ices under such title, and for other purposes.
Be it enacted by the Senate and House of Representa-
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tives of the United States of America in Congress assembled,
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SECTION 1. SHORT TITLE.
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This Act may be cited as the ‘‘Expanding Access to
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Mental Health Services Act’’.
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•HR 635 IH
SEC. 2. PERMANENT INCLUSION OF CERTAIN HCPCS
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CODES AS TELEHEALTH SERVICES UNDER
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MEDICARE.
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Section 1834(m)(4)(F) of the Social Security Act (42
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U.S.C. 1395m(m)(4)(F)) is amended—
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(1) in clause (i), by inserting ‘‘the HCPCS
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codes specified in clause (iii),’’ before ‘‘, and’’; and
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(2) by adding at the end the following new
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clause:
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‘‘(iii) SPECIFIED HCPCS CODE.—For
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purposes of clause (i), beginning April 1,
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2023, an HCPCS code specified in this
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clause is—
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‘‘(I)
90875,
96125,
96170,
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96171, 97151, 97152, 97153, 97154,
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97155, 97156, 97157, and 97158;
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and
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‘‘(II)
96127,
96130,
96131,
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96132, 96133, 96136, 96137, 96138,
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96139, and 96158.
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With respect to telehealth services identi-
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fied by HCPCS codes in subclause (II), the
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Secretary shall waive the requirements of
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paragraph (1) and section 410.78(a)(3) of
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title 42, Code of Federal Regulations (or
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any successor regulation), relating to the
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•HR 635 IH
use of interactive telecommunications sys-
1
tems to furnish telehealth services, to the
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extent such provisions require the use of
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video technology, to allow for the fur-
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nishing of evaluation and management
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services, behavioral health counseling and
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educational services, and other services de-
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termined appropriate by the Secretary by a
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qualified provider using audio-only tech-
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nology, as determined by the Secretary
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based on whether it is clinically appro-
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priate to furnish such services using audio-
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only technology and whether an in-person
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initial visit is required prior to the fur-
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nishing of such service using such tech-
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nology.’’.
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Æ
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