[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7876 Introduced in House (IH)]
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117th CONGRESS
2d Session
H. R. 7876
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 24, 2022
Mr. Smith of Nebraska (for himself, Mr. O'Halleran, and Mr. Armstrong)
introduced the following bill; which was referred to the Committee on
Ways and Means, and in addition to the Committee on Energy and
Commerce, 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 protect access to
telehealth services under the Medicare program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Connecting Rural Telehealth to the
Future Act''.
SEC. 2. REMOVING GEOGRAPHIC REQUIREMENTS AND EXPANDING ORIGINATING
SITES FOR TELEHEALTH SERVICES.
Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is
amended--
(1) in paragraph (4)(C)(iii), by striking ``during the 151-
day period beginning on the first day after the end of the
emergency period described in section 1135(g)(1)(B)'' and
inserting ``before January 1, 2025''; and
(2) in paragraph (2)(B)(iii), by striking ``during the 151-
day period beginning on the first day after the end of the
emergency period described in section 1135(g)(1)(B)'' and
inserting ``before January 1, 2025''.
SEC. 3. EXPANDING PRACTITIONERS ELIGIBLE TO FURNISH TELEHEALTH
SERVICES.
Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is
amended in paragraph (4)(E), by striking ``151-day'' and inserting
``and ending on December 31, 2024'' after ``described in section
1135(g)(1)(B)''.
SEC. 4. EXTENDING TELEHEALTH SERVICES FOR 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 in subparagraph (A), by striking ``151-day''
and inserting ``and ending on December 31, 2024'' after ``described in
section 1135(g)(1)(B)''.
SEC. 5. DELAYING THE IN-PERSON REQUIREMENTS UNDER MEDICARE FOR MENTAL
HEALTH SERVICES FURNISHED THROUGH TELEHEALTH AND
TELECOMMUNICATIONS TECHNOLOGY.
(a) In General.--Section 1834(m)(7)(B)(i) of the Social Security
Act (42 U.S.C. 1395m(m)(7)(B)(i)) is amended in the matter preceding
subclause (I), by striking ``the day that is the 152nd day after the
end of the emergency period'' and inserting ``January 1, 2025''.
(b) Payment.--Section 1834(y) of the Social Security Act (42 U.S.C.
1395m(y)) is amended in paragraph (2), by striking ``the day that is
the 152nd day after the end of the emergency period'' and inserting
``January 1, 2025''.
(c) Conforming Amendment.--Section 1834(o)(4) of the Social
Security Act (42 U.S.C. 1395m(o)(4)) is amended in subparagraph (B), by
striking ``the day that is the 152nd day after the end of the emergency
period described in section 1135(g)(1)(B)'' and inserting ``January 1,
2025''.
SEC. 6. ALLOWING FOR THE FURNISHING OF AUDIO-ONLY TELEHEALTH SERVICES.
Section 1834(m) of Social Security Act (42 U.S.C. 1395m(m)) is
amended--
(1) in paragraph (1), by striking ``paragraphs (8) and
(9)'' and inserting ``paragraph (8)'';
(2) by striking paragraph (9); and
(3) in paragraph (4), by adding at the end the following
new subparagraph:
``(G) Telecommunications system.--
``(i) In general.--Notwithstanding
paragraph (1) and section 410.78(a)(3) of title
42, Code of Federal Regulations (or any
successor regulation), subject to clause (v),
the term `telecommunications system' includes,
in the case of the furnishing of a specified
telehealth service (as defined in clause (ii))
a communications system that uses audio-only
technology.
``(ii) Specified telehealth service.--In
this subparagraph, the term `specified
telehealth service' means a telehealth service
described in clause (iii) that is furnished by
a qualified provider (as defined in clause
(iv)).
``(iii) Telehealth service described.--A
telehealth service as defined in subparagraph
(F)(i).
``(iv) Qualified provider defined.--For
purposes of clause (ii), the term `qualified
provider' means, with respect to a specified
telehealth service that is furnished to an
eligible telehealth individual--
``(I) a physician or practitioner
who has an established patient
relationship with such individual as
defined by the State in which the
individual is located; or
``(II) a critical access hospital
(as defined in section 1861(mm)(1)), a
rural health clinic (as defined in
section 1861(aa)(2)), a federally
qualified health center (as defined in
section 1861(aa)(4)), a hospital (as
defined in section 1861(e)), a
hospital-based or critical access
hospital-based renal dialysis center
(including satellites), a skilled
nursing facility (as defined in section
1819(a)), a community mental health
center (as defined in section
1861(ff)(3)(B)), or a rural emergency
hospital (as defined in section
1861(kkk)(2)).
``(v) Authority.--For purposes of this
subparagraph, the Secretary may determine
whether it is clinically appropriate to furnish
a specified telehealth service via a
communications system that uses audio-only
technology and whether an in-person initial
visit (in addition to any requirement with
respect to the furnishing of an item or service
in person pursuant to clause (iv)(I)) is
required prior to the furnishing of such
service using such technology.
``(vi) Clarification regarding payment.--
The amount of payment for a specified
telehealth service that is furnished using
audio-only technology shall be equal to the
amount that would have been paid for such
service under this subsection had such service
been furnished via any other telecommunications
system authorized under this subsection.''.
SEC. 7. USE OF TELEHEALTH TO CONDUCT FACE-TO-FACE ENCOUNTER PRIOR TO
RECERTIFICATION OF ELIGIBILITY FOR HOSPICE CARE DURING
EMERGENCY PERIOD.
Section 1814(a)(7)(D)(i)(II) of the Social Security Act (42 U.S.C.
1395f(a)(7)(D)(i)(II)) is amended by striking ``151-day'' and inserting
``and ending on December 31, 2024'' after ``described in section
1135(g)(1)(B)''.
SEC. 8. EXTENSION OF EXEMPTION FOR TELEHEALTH SERVICES.
(a) In General.--Subparagraph (E) of section 223(c)(2) of the
Internal Revenue Code of 1986 is amended by striking ``2023''and
inserting ``2025''.
(b) Certain Coverage Disregarded.--Clause (ii) of section
223(c)(1)(B) of the Internal Revenue Code of 1986 is amended by
striking ``2023'' and inserting ``2025''.
SEC. 9. FEDERALLY QUALIFIED HEALTH CENTERS AND RURAL HEALTH CLINICS.
Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is
amended in paragraph (8), 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. 10. TELEHEALTH FLEXIBILITIES FOR CRITICAL ACCESS HOSPITALS.
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
``paragraph (8)'' and inserting ``paragraphs (8) and (9)'';
(2) in paragraph (2)(A), by striking ``paragraph (8)'' and
inserting ``paragraphs (8) and (9)'';
(3) in paragraph (4)--
(A) in subparagraph (A), by striking ``paragraph
(8)'' and inserting ``paragraphs (8) and (9)''; and
(B) in subparagraph (F)(i), by striking ``paragraph
(8)'' and inserting ``paragraphs (8) and (9)''; and
(4) by adding at the end the following new paragraph:
``(9) Telehealth flexibilities for critical access
hospitals.--
``(A) In general.--On or after the date of the
enactment of this paragraph--
``(i) the Secretary shall pay for
telehealth services that are furnished between
the end of the emergency period described in
section 1135(g)(1)(B) and January 1, 2025, 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 (C); and
``(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; and
``(II) 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) Definition of qualified provider.--For
purposes of this subsection, the term `qualified
provider' means, with respect to a telehealth service
described in subparagraph (A)(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.
``(C) Payment.--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.
``(D) Implementation.--Notwithstanding any other
provision of law, the Secretary may implement this
paragraph through program instruction, interim final
rule, or otherwise.''.
SEC. 11. EFFECTIVE DATE.
The amendments made by this Act shall take effect on the date of
the enactment of this Act.
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