[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 1988 Introduced in Senate (IS)]
<DOC>
117th CONGRESS
1st Session
S. 1988
To amend title XVIII of the Social Security Act to protect access to
telehealth services under the Medicare program.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 9, 2021
Mr. Manchin (for himself, Ms. Ernst, Mrs. Shaheen, and Mr. Moran)
introduced the following bill; which was read twice and referred to the
Committee on Finance
_______________________________________________________________________
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 ``Protecting Rural Telehealth Access
Act''.
SEC. 2. ELIMINATION OF RESTRICTIONS RELATING TO TELEHEALTH SERVICES.
(a) Elimination of Geographic Requirements for Originating Sites.--
Section 1834(m)(4)(C) of the Social Security Act (42 U.S.C.
1395m(m)(4)(C)) is amended--
(1) in clause (i), in the matter preceding subclause (I),
by inserting ``and clause (iii)'' after ``and (7)''; and
(2) by adding at the end the following new clause:
``(iii) Elimination of geographic
requirements for originating sites.--The
geographic requirements described in clause (i)
shall not apply with respect to telehealth
services furnished on or after January 1,
2021.''.
(b) Elimination of Restrictions in Which Telehealth Services May Be
Furnished in the Home.--Section 1834(m)(4)(C)(ii)(X) of the Social
Security Act (42 U.S.C. 1395m(m)(4)(C)(i)(X) is amended to read as
follows:.
``(X)(aa) For the period beginning
on the date of the enactment of this
subclause and ending on December 31,
2020, the home of an individual but
only for purposes of section
1881(b)(3)(B) or telehealth services
described in paragraph (7).
``(bb) For the period beginning on
or after January 1, 2021, the home of
an individual.''.
(c) Elimination of Restrictions on Store-and-Forward
Technologies.--The second sentence of section 1834(m)(1) of the Social
Security Act (42 U.S.C. 1395m(m)(1)) is amended by striking ``in the
case of any Federal telemedicine demonstration program conducted in
Alaska or Hawaii,''.
SEC. 3. 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)'';
(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 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. 4. EXTENDING MEDICARE TELEHEALTH FLEXIBILITIES 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--
(1) in the paragraph heading by striking ``during emergency
period'';
(2) in subparagraph (A), in the matter preceding clause
(i), by inserting ``and after such emergency period'' after
``1135(g)(1)(B)'';
(3) 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 eligible
telehealth individual pursuant to this
paragraph or after the date of the enactment of
this subparagraph shall be reimbursed under
this title at a separate telehealth payment
rate as determined under the methodology
established by the Secretary pursuant to clause
(ii).
``(ii) Payment methodology.--The Secretary
shall establish a methodology for determining
the appropriate payment rate for telehealth
services described in clause (i). Such
methodology shall consider--
``(I) the geography of Federally
qualified health centers and rural
health clinics;
``(II) costs associated with the
delivery of such telehealth services as
allowable costs for the center or
clinic; and
``(III) the full cost of providing
the services via telehealth.
``(iii) Implementation.--
``(I) Coding system.--The Secretary
shall establish an effective coding
system for telehealth services
described in clause (i) that is
reflective of the services provided at
a center or clinic.
``(II) Implementation.--
Notwithstanding any other provision of
law, the Secretary may implement this
subparagraph through program
instruction, interim final rule, or
otherwise.''; and
(4) by adding at the end the following new subparagraph:
``(C) Requirement during additional period.--
``(i) In general.--Beginning on the first
day after the end of the emergency period
described in section 1135(g)(1)(B), payment may
only be made under this paragraph for a
telehealth service described in subparagraph
(A)(i) that is furnished to an eligible
telehealth individual if such service is
furnished by a qualified provider (as defined
in clause (ii)).
``(ii) Definition of qualified provider.--
For purposes of this subparagraph, 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 Federally qualified
health center or rural health clinic that has
an established patient relationship with such
individual as defined by the State in which the
individual is located.''.
SEC. 5. ALLOWANCE OF CERTAIN TELEHEALTH SERVICES FURNISHED USING AUDIO-
ONLY TECHNOLOGY.
Section 1834(m)(4) of the Social Security Act (42 U.S.C.
1395m(m)(4)) of the Social Security Act (42 U.S.C. 1395m(m)(4)) is
amended 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 described in this clause is
a telehealth service consisting of--
``(I) evaluation and management
services;
``(II) behavioral health counseling
and educational services; and
``(III) other services determined
appropriate by the Secretary.
``(iv) Qualified provider defined.--
``(I) In general.--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--
``(aa) 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
``(bb) 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. 6. SENSE OF CONGRESS REGARDING EXPANSION OF ELIGIBLE PRACTITIONERS
THAT MAY FURNISH TELEHEALTH SERVICES.
It is the sense of Congress that the expansion of eligible
practitioners that may furnish telehealth services (as defined in
section 1834(m)(4)(F) of the Social Security Act (42 U.S.C.
1395m(m)(4)(F))) during the emergency period described in section
1135(g)(1)(B) of such Act (42 U.S.C. 1320b-5(g)(1)(B)) should be
extended on a permanent basis.
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