[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7573 Introduced in House (IH)]
<DOC>
117th CONGRESS
2d Session
H. R. 7573
To amend titles XI and XVIII of the Social Security Act to extend
certain telehealth services covered by Medicare and to evaluate the
impact of telehealth services on Medicare beneficiaries, and for other
purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 26, 2022
Mrs. Axne (for herself and Mr. Hudson) introduced the following bill;
which was referred to the Committee on Energy and Commerce, and in
addition to the Committees on Ways and Means, and the Judiciary, 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 titles XI and XVIII of the Social Security Act to extend
certain telehealth services covered by Medicare and to evaluate the
impact of telehealth services on Medicare beneficiaries, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) In General.--This Act may be cited as the ``Telehealth
Extension and Evaluation Act''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Extension of telehealth services.
Sec. 3. Temporary requirements for provision of high-cost durable
medical equipment and laboratory tests.
Sec. 4. Requirement to submit NPI number for telehealth billing.
Sec. 5. Federally qualified health centers and rural health clinics.
Sec. 6. Telehealth flexibilities for critical access hospitals.
Sec. 7. Use of telehealth for the dispensing of controlled substances
by means of the internet.
Sec. 8. Study on the effects of changes to telehealth under the
Medicare and Medicaid programs during the
COVID-19 emergency.
Sec. 9. Extension of authority for audio-only telehealth services under
the Medicare program.
SEC. 2. EXTENSION OF TELEHEALTH SERVICES.
Section 1135(e) of the Social Security Act (42 U.S.C. 1320b-5(e))
is amended by adding at the end the following new paragraph:
``(3) Two-year extension of telehealth services following
the covid-19 emergency period.--Notwithstanding any other
provision of this section, a waiver or modification of
requirements pursuant to subsection (b)(8) shall terminate on
the date that is 2 years after the last day of the emergency
period described in subsection (g)(1)(B).''.
SEC. 3. TEMPORARY REQUIREMENTS FOR PROVISION OF HIGH-COST DURABLE
MEDICAL EQUIPMENT AND LABORATORY TESTS.
(a) High-Cost Durable Medical Equipment.--Section 1834(a)(1)(E) of
the Social Security Act (42 U.S.C. 1395m(a)(1)(E)) is amended by adding
at the end the following new clauses:
``(vi) Standards for high-cost durable
medical equipment.--
``(I) Limitation on payment for
high-cost durable medical equipment.--
During the 2-year period beginning on
the day after the last day of the
emergency period described in section
1135(g)(1)(B), payment may not be made
under this subsection for high-cost
durable medical equipment ordered by a
physician or other practitioner
described in clause (ii) via telehealth
for an individual, unless such
physician or practitioner furnished to
such individual a service in person at
least once during the 12-month period
prior to ordering such high-cost
durable medical equipment.
``(II) High-cost durable medical
equipment defined.--For purposes of
this clause, the term `high-cost
durable medical equipment' means, with
respect to a year, durable medical
equipment for which payment may be made
under paragraphs (2) through (8), the
price under the clinical lab fee
schedule which for such year is in the
highest quartile of national purchase
prices of durable medical equipment
payable for such year.
``(vii) Audit of providers and
practitioners furnishing a high volume of
durable medical equipment via telehealth.--
``(I) Identification of
providers.--During the 2-year period
beginning on the day after the last day
of the emergency period described in
section 1135(g)(1)(B), Medicare
administrative contractors shall
conduct reviews, on a schedule
determined by the Secretary, of claims
for durable medical equipment
prescribed by a physician or other
practitioner described in clause (ii)
during the 12-month period preceding
such review to identify physicians or
other practitioners with respect to
whom at least 90 percent of all durable
medical equipment prescribed by such
physician or practitioner during such
period was prescribed pursuant to a
telehealth visit.
``(II) Audit.--In the case of a
physician or practitioner identified
under subclause (I), with respect to a
12-month period described in such
subclause, the Medicare administrative
contractors shall conduct audits of all
claims for durable medical equipment
prescribed by such physicians or
practitioners to determine whether such
claims comply with the requirements for
coverage under this title.''.
(b) High-Cost Laboratory Tests.--Section 1834A(b) of the Social
Security Act (42 U.S.C. 1395m-1(b)) is amended by adding at the end the
following new paragraphs:
``(6) Requirement for high-cost laboratory tests.--
``(A) Limitation on payment for high-cost
laboratory tests.--During the 2-year period beginning
on the day after the last day of the emergency period
described in section 1135(g)(1)(B), payment may not be
made under this subsection for a high-cost laboratory
test ordered by a physician or practitioner via
telehealth for an individual, unless such physician or
practitioner furnished to such individual a service in
person at least once during the 12-month period prior
to ordering such high-cost laboratory test.
``(B) High-cost laboratory test defined.--For
purposes of this paragraph, the term `high-cost
laboratory test' means, with respect to a year, a
laboratory test for which payment may be made under
this section, and the purchase price of which for such
year is in the highest quartile of purchase prices of
laboratory tests for such year.
``(7) Audit of laboratory testing ordered pursuant to
telehealth visit.--
``(A) Identification of providers.--During the 2-
year period beginning on the day after the last day of
the emergency period described in section
1135(g)(1)(B), Medicare administrative contractors
shall conduct periodic reviews, on a schedule
determined by the Secretary, of claims for laboratory
tests prescribed by a physician or practitioner during
the 12-month period preceding such review to identify
physicians or other practitioners with respect to whom
at least 90 percent of all laboratory tests prescribed
by such physician or practitioner during such period
were prescribed pursuant to a telehealth visit.
``(B) Audit.--In the case of a physician or
practitioner identified under subparagraph (A), with
respect to a 12-month period described in such
subparagraph, the Medicare administrative contractors
shall conduct audits of all claims for laboratory tests
prescribed by such physicians or practitioners during
such period to determine whether such claims comply
with the requirements for coverage under this title.''.
SEC. 4. REQUIREMENT TO SUBMIT NPI NUMBER FOR TELEHEALTH BILLING.
Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is
amended--
(1) in the first sentence of paragraph (1), by striking
``paragraphs (8) and (9)'' and inserting ``paragraphs (8), (9),
and (10)''; and
(2) by adding at the end the following new paragraph:
``(10) Requirement to submit npi number for telehealth
billing.--During the 2-year period beginning on the day after
the last day of the emergency period described in section
1135(g)(1)(B), payment may not be made under this subsection
for telehealth services furnished by a health care professional
eligible to bill Medicare for their professional services
unless such health care professional submits a claim for
payment--
``(A) under the national provider identification
number assigned to such health care professional;
``(B) in the case of services provided under
section 1833(a)(8), under the facility identification
number; or
``(C) in the case of occupational therapy
assistants or physical therapy assistants in private
practice, under the national provider identification of
the supervising therapist.''.
SEC. 5. FEDERALLY QUALIFIED HEALTH CENTERS AND RURAL HEALTH CLINICS.
Section 1834(m)(8) of the Social Security Act (42 U.S.C.
1395m(m)(8)) is amended--
(1) in subparagraph (A), in the matter preceding clause
(i), by striking ``the 151-day period'' and inserting ``the 2-
year period''; and
(2) by striking subparagraph (B) and inserting the
following:
``(B) Payment.--
``(i) In general.--A telehealth service
furnished by a Federally qualified health
center or a rural health clinic to an
individual pursuant to this paragraph on or
after the date of the enactment of this
subparagraph shall be deemed to be so furnished
to such individual as an outpatient of such
clinic or facility (as applicable) for purposes
of paragraph (1) or (3), respectively, of
section 1861(aa) and payable as a Federally
qualified health center service or rural health
clinic service (as applicable) under the
prospective payment system established under
section 1834(o) or under section 1833(a)(3),
respectively.
``(ii) Treatment of costs for fqhc pps
calculations and rhc air calculations.--Costs
associated with the delivery of telehealth
services by a Federally qualified health center
or rural health clinic serving as a distant
site pursuant to this paragraph shall be
considered allowable costs for purposes of the
prospective payment system established under
section 1834(o) and any payment methodologies
developed under section 1833(a)(3), as
applicable.''.
SEC. 6. TELEHEALTH FLEXIBILITIES FOR CRITICAL ACCESS HOSPITALS.
Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)), as
amended by section 4, is amended--
(1) in the first sentence of paragraph (1), by striking
``and (10)'' and inserting ``, (10), and (11)'';
(2) in paragraph (2)(A), by striking ``paragraph (8)'' and
inserting ``paragraphs (8) and (11)'';
(3) in paragraph (4)--
(A) in subparagraph (A), by striking ``paragraph
(8)'' and inserting ``paragraphs (8) and (11)'';
(B) in subparagraph (F)(i), by striking ``paragraph
(8)'' and inserting ``paragraphs (8) and (11)''; and
(4) by adding at the end the following new paragraph:
``(11) Telehealth flexibilities for critical access
hospitals.--
``(A) In general.--During the period beginning on
the date of the enactment of this paragraph and ending
on the date that is 2 years after the end of the
emergency period described in section 1135(g)(1)(B),
the following shall apply:
``(i) The Secretary shall pay for
telehealth services that are furnished via a
telecommunications system by a critical access
hospital, including any practitioner authorized
to provide such services within the facility,
that is a qualified provider (as defined in
subparagraph (B)) to an eligible telehealth
individual enrolled under this part
notwithstanding that the critical access
hospital providing the telehealth service is
not at the same location as the beneficiary, if
such services complement a plan of care that
includes in-person care at some point, as may
be appropriate.
``(ii) The amount of payment to a critical
access hospital that serves as a distant site
for such a telehealth service shall be
determined under subparagraph (B).
``(iii) For purposes of this subsection--
``(I) the term `distant site'
includes a critical access hospital
that furnishes a telehealth service to
an eligible telehealth individual;
``(II) the term `qualified
provider' means, with respect to a
telehealth service described in clause
(i) that is furnished to an eligible
telehealth individual, a critical
access hospital that has an established
patient relationship with such
individual as defined by the State in
which the individual is located; and
``(III) the term `telehealth
services' includes behavioral health
services and any other outpatient
critical access hospital service that
is furnished using telehealth to the
extent that payment codes corresponding
to services identified by the Secretary
under clause (i) or (ii) of paragraph
(4)(F) are listed on the corresponding
claim for such critical access hospital
service.
``(B) Payment.--For purposes of subparagraph
(A)(ii), the amount of payment to a critical access
hospital that serves as a distant site that furnishes a
telehealth service to an eligible telehealth individual
under this paragraph shall be equal to 101 percent of
the reasonable costs of the hospital in providing such
services, unless the hospital makes an election under
paragraph (2) of section 1834(g) to be paid for such
services based on the methodology described in such
paragraph. Telehealth services furnished by a critical
access hospital shall be counted for purposes of
determining the provider productivity rate of the
critical access hospital for purposes of payment under
such section.
``(C) Implementation.--Notwithstanding any other
provision of law, the Secretary may implement this
paragraph through program instruction, interim final
rule, or otherwise.''.
SEC. 7. USE OF TELEHEALTH FOR THE DISPENSING OF CONTROLLED SUBSTANCES
BY MEANS OF THE INTERNET.
Section 309(e)(2) of the Controlled Substances Act (21 U.S.C.
829(e)(2)) is amended--
(1) in subparagraph (A)(i)--
(A) by striking ``at least 1 in-person medical
evaluation'' and inserting the following: ``at least--
``(I) 1 in-person medical
evaluation''; and
(B) by adding at the end the following:
``(II) during the period beginning
on the date of the enactment of this
subclause and ending on the date that
is 2 years after the end of the
emergency period described in section
1135(g)(1)(B) of the Social Security
Act (42 U.S.C. 1320b-5(g)(1)(B)), for
purposes of prescribing a controlled
substance in schedules II through V, 1
telehealth evaluation; or''; and
(2) by adding at the end the following:
``(D)(i) The term `telehealth evaluation' means a
medical evaluation that is conducted in accordance with
applicable Federal and State laws by a practitioner
(other than a pharmacist) who is at a location remote
from the patient and is communicating with the patient
using a telecommunications system referred to in
section 1834(m) of the Social Security Act (42 U.S.C.
1395m(m)) that includes, at a minimum, audio and video
equipment permitting two-way, real-time interactive
communication between the patient and distant site
practitioner.
``(ii) Nothing in clause (i) shall be construed to
imply that 1 telehealth evaluation demonstrates that a
prescription has been issued for a legitimate medical
purpose within the usual course of professional
practice.
``(iii) A practitioner who prescribes the drugs or
combination of drugs that are covered under section
303(g)(2)(C) using the authority under subparagraph
(A)(i)(II) of this paragraph shall adhere to nationally
recognized evidence-based guidelines for the treatment
of patients with opioid use disorders and a diversion
control plan, as those terms are defined in section 8.2
of title 42, Code of Federal Regulations, as in effect
on the date of enactment of this subparagraph.''.
SEC. 8. STUDY ON THE EFFECTS OF CHANGES TO TELEHEALTH UNDER THE
MEDICARE AND MEDICAID PROGRAMS DURING THE COVID-19
EMERGENCY.
(a) In General.--Not later than 1 year after the date of the
enactment of this Act, the Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall conduct a study
and submit to the Committee on Energy and Commerce and the Committee on
Ways and Means of the House of Representatives and the Committee on
Finance of the Senate an interim report on any changes made to the
provision or availability of telehealth services under part A or B of
title XVIII of the Social Security Act (including by reason of the
amendments made to the Controlled Substances Act under section 7) since
the start of the emergency period described in section 1135(g)(1)(B) of
the Social Security Act (42 U.S.C. 1320b-5(g)(1)(B)). Such report shall
include the following:
(1) A summary of utilization of all health care services
furnished under such part A or B during such emergency period,
including the number of telehealth visits (broken down by
service type, the number of such visits furnished via audio-
visual technology, the number of such visits furnished via
audio-only technology, and the number of such visits furnished
by a Federally qualified health center, rural health clinic, or
community health center, respectively, if practicable), in-
person outpatient visits, inpatient admissions, and emergency
department visits.
(2) A description of any changes in utilization patterns
for the care settings described in paragraph (1) over the
course of such emergency period compared to such patterns prior
to such emergency period.
(3) An analysis of utilization of telehealth services under
such part A or B during such emergency period, broken down by
race and ethnicity, geographic region, and income level (as
measured directly or indirectly, such as by patient's zip code
tabulation area median income as publicly reported by the
United States Census Bureau), and of any trends in such
utilization during such emergency period, so broken down. Such
analysis may not include any personally identifiable
information or protected health information.
(4) A description of expenditures and any savings under
such part A or B attributable to use of such telehealth
services during such emergency period.
(5) A description of any instances of fraud identified by
the Secretary, acting through the Office of the Inspector
General or other relevant agencies and departments, with
respect to such telehealth services furnished under such part A
or B during such emergency period and a comparison of the
number of such instances with the number of instances of fraud
so identified with respect to in-person services so furnished
during such emergency period.
(6) A description of any privacy concerns with respect to
the furnishing of such telehealth services (such as
cybersecurity or ransomware concerns), including a description
of any actions taken by the Secretary, acting through the
Health Sector Cybersecurity Coordination Center or other
relevant agencies and departments, during such emergency period
to assist health care providers secure telecommunications
systems.
(7) Identification of common ICD-10 codes billed via
telehealth, comparing measures of quality and outcomes between
telehealth care and in-person care for the same category of
service.
(8) Recommendations regarding the permanency of the waivers
and authorities under the provisions of, and amendments made
by, this Act.
(b) Consultation.--In conducting the study and submitting the
report under subsection (a), the Secretary--
(1) shall consult with--
(A) the Medicaid and CHIP Payment and Access
Commission;
(B) the Medicare Payment Advisory Commission;
(C) the Office of Inspector General of the
Department of Health and Human Services; and
(D) other stakeholders determined appropriate by
the Secretary, such as patients, tribal communities,
medical professionals, health facilities, State medical
boards, State nursing boards, telehealth providers,
health professional liability providers, public and
private payers, and State leaders; and
(2) shall endeavor to include as many racially, ethnically,
geographically, and professionally diverse perspectives as
possible.
(c) Final Report.--Not later than 18 months after the end of the
emergency period described in section 1135(g)(1)(B) of the Social
Security Act (42 U.S.C. 1320b-5(g)(1)(B)), the Secretary shall--
(1) update and finalize the interim report under subsection
(a); and
(2) submit such updated and finalized report to the
committees specified in such subsection.
(d) Grants for Medicaid Reports.--
(1) In general.--Not later than January 1, 2023, the
Secretary shall award grants to States with a State plan (or
waiver of such plan) in effect under title XIX of the Social
Security Act (42 U.S.C. 1396r) that submit an application under
this subsection for purposes of enabling such States to study
and submit reports to the Secretary on any changes made to the
provision or availability of telehealth services under such
plans (or such waivers) during such period.
(2) Eligibility.--To be eligible to receive a grant under
paragraph (1), a State shall--
(A) provide benefits for telehealth services under
the State plan (or waiver of such plan) in effect under
title XIX of the Social Security Act (42 U.S.C. 1396r);
(B) be able to differentiate telehealth from in-
person visits within claims data submitted under such
plan (or such waiver) during such period; and
(C) submit to the Secretary an application at such
time, in such manner, and containing such information
(including the amount of the grant requested) as the
Secretary may require.
(3) Use of funds.--A State shall use amounts received under
a grant under this subsection to conduct a study and report
findings regarding the effects of changes to telehealth
services offered under the State plan (or waiver of such plan)
of such State under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) during such period in accordance with
paragraph (4).
(4) Reports.--
(A) Interim report.--Not later 1 year after the
date a State receives a grant under this subsection,
the State shall submit to the Secretary an interim
report that--
(i) details any changes made to the
provision or availability of telehealth
benefits (such as eligibility, coverage, or
payment changes) under the State plan (or
waiver of such plan) of the State under title
XIX of the Social Security Act (42 U.S.C. 1396
et seq.) during the emergency period described
in paragraph (1); and
(ii) contains--
(I) a summary and description of
the type described in paragraphs (1)
and (2), respectively, of subsection
(a); and
(II) to the extent practicable, an
analysis of the type described in
paragraph (3) of subsection (a),
except that any reference in such subsection to
``such part A or B'' shall, for purposes of
subclauses (I) and (II), be treated as a
reference to such State plan (or waiver).
(B) Final report.--Not later than 3 years after the
date a State receives a grant under this subsection,
the State shall update and finalize the interim report
and submit such final report to the Secretary.
(C) Report by secretary.--Not later than the
earlier of the date that is 1 year after the submission
of all final reports under subparagraph (B) and
December 31, 2027, the Secretary shall submit to
Congress a report on the grant program, including a
summary of the reports received from States under this
paragraph.
(5) Modification authority.--The Secretary may modify any
deadline described in paragraph (4) or any information required
to be included in a report made under this subsection to
provide flexibility for States to modify the scope of the study
and timeline for such reports.
(6) Technical assistance.--The Secretary shall provide such
technical assistance as may be necessary to a State receiving a
grant under this subsection in order to assist such State in
conducting studies and submitting reports under this
subsection.
(7) State.--For purposes of this subsection, the term
``State'' means each of the several States, the District of
Columbia, and each territory of the United States.
(e) Authorization of Appropriations.--
(1) Medicare.--For the purpose of carrying out subsections
(a) through (c), there are authorized to be appropriated such
sums as may be necessary for each of fiscal years 2022 through
2026.
(2) Medicaid.--For the purpose of carrying out subsection
(d), there are authorized to be appropriated such sums as may
be necessary for each of fiscal years 2023 through 2027.
SEC. 9. EXTENSION OF AUTHORITY FOR AUDIO-ONLY TELEHEALTH SERVICES UNDER
THE MEDICARE PROGRAM.
Paragraph (9) of section 1834(m) of the Social Security Act (42
U.S.C. 1395m(m)) is amended by striking ``151-day period'' and
inserting ``2-year period''.
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