Telehealth Extension Act of 2021
This bill expands and otherwise modifies coverage of telehealth services under Medicare.
Specifically, the bill permanently (1) removes geographic restrictions on originating sites (i.e., the location of the beneficiary), (2) allows the home of the beneficiary to serve as the originating site for all services, and (3) allows federally qualified health centers and rural health clinics to serve as the distant site (i.e., the location of the health care practitioner).
The bill also extends any Medicare telehealth flexibilities that were granted during the COVID-19 public health emergency until two years after the emergency ends and generally allows such flexibilities to be granted during any public health emergency.
In addition, the bill (1) allows for Medicare payment of outpatient critical access hospital services consisting of telehealth behavioral therapy until two years after the COVID-19 public health emergency ends; and (2) after the emergency ends, conditions payment for certain high-cost laboratory tests and durable medical equipment that are ordered via telehealth on at least one in-person visit during the preceding six-month period.
[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6202 Introduced in House (IH)]
<DOC>
117th CONGRESS
1st Session
H. R. 6202
To amend titles XI and XVIII of the Social Security Act to establish
requirements for the provision of certain high-cost durable medical
equipment and laboratory testing; to extend and expand access to
telehealth services; and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
December 9, 2021
Mr. Doggett (for himself, Mr. Nunes, Mr. Thompson of California, Mr.
Kelly of Pennsylvania, Mr. Schweikert, Mrs. Axne, Mr. Blumenauer, Mr.
Brendan F. Boyle of Pennsylvania, Mr. Butterfield, Mr. Carson, Ms.
Craig, Mr. Danny K. Davis of Illinois, Mr. Fitzpatrick, Mrs. Fletcher,
Mr. Higgins of New York, Mr. Kildee, Mr. LaHood, Mrs. Lesko, Mrs.
Miller of West Virginia, Mr. O'Halleran, Mr. Raskin, Mr. Rice of South
Carolina, Ms. Schakowsky, Ms. Sewell, Mr. Smith of Nebraska, Mr.
Smucker, Mr. Veasey, Mrs. Walorski, Ms. Wild, Mr. Green of Texas, and
Mr. Buchanan) introduced the following bill; which was referred to the
Committee 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 titles XI and XVIII of the Social Security Act to establish
requirements for the provision of certain high-cost durable medical
equipment and laboratory testing; to extend and expand access to
telehealth services; 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.
This Act may be cited as the ``Telehealth Extension Act of 2021''.
SEC. 2. REQUIREMENT 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 clause:
``(vi) Standards for high-cost durable
medical equipment.--
``(I) Limitation on payment for
high-cost durable medical equipment.--
Payment may not be made under this
subsection for a 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 6-month period
prior to ordering such high-cost
durable medical equipment.
``(II) High-cost durable medical
equipment determination.--For purposes
of this clause, the Administrator of
the Centers for Medicare & Medicaid
Services shall define the term `high-
cost durable medical equipment' and
specify the durable medical equipment
for which such definition shall apply.
``(vii) Audit of providers and
practitioners furnishing a high volume of
durable medical equipment via telehealth.--
``(I) Identification of
providers.--Beginning 6 months after
the effective date of this clause,
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
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 paragraph:
``(6) Requirement for high-cost laboratory tests.--
``(A) Limitation on payment for high-cost
laboratory tests.--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 6-month period prior to ordering
such high-cost laboratory test.
``(B) High-cost laboratory test defined.--For
purposes of this paragraph, the Administrator for the
Centers for Medicare & Medicaid Services shall define
the term `high-cost laboratory test' and specify which
laboratory tests such definition shall apply to.
``(7) Audit of laboratory testing ordered pursuant to
telehealth visit.--
``(A) Identification of providers.--Beginning 6
months after the effective date of this paragraph,
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 was prescribed pursuant
to a telehealth visit.
``(B) Audit.--In the case of a physician or
practitioner identified under subparagraph (A), with
respect to a 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
beginning to determine whether such claims comply with
the requirements for coverage under this title.''.
(c) Effective Date.--The amendments made by this section shall take
effect upon the termination 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)).
SEC. 3. REQUIREMENT TO SUBMIT NPI NUMBER FOR SEPARATELY BILLABLE
TELEHEALTH SERVICES.
(a) Requirement To Submit NPI Number for Separately Billable
Telehealth Services.--Section 1834(m) of the Social Security Act (42
U.S.C. 1395m(m)) is amended by adding at the end the following new
paragraph:
``(9) Requirement to submit npi number for separately
billable telehealth services.--Payment may not be made under
this subsection for separately billable telehealth services
furnished by a physician or practitioner unless such physician
or practitioner submits a claim for payment under the national
provider identification number assigned to such physician or
practitioner.''.
(b) Effective Date.--The amendment made by this section shall take
effect upon the termination 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)).
SEC. 4. REMOVING GEOGRAPHIC REQUIREMENTS FOR TELEHEALTH SERVICES.
Section 1834(m)(4)(C) of the Social Security Act (42 U.S.C.
1395m(m)(4)(C)) is amended by adding at the end the following new
clause:
``(iii) Removal of geographic
requirements.--The geographic requirements
described in clause (i) shall not apply with
respect to telehealth services furnished on or
after the date of the enactment of this
clause.''.
SEC. 5. EXPANDING ORIGINATING SITES.
(a) Expanding the Home as an Originating Site.--Section
1834(m)(4)(C)(ii)(X) of the Social Security Act (42 U.S.C.
1395m(m)(4)(C)(ii)(X)) is amended to read as follows:
``(X) The home of an individual,
but, with respect to services furnished
before the date of the enactment of the
`Telehealth Extension and Evaluation
Act', only for purposes of section
1881(b)(3)(B) or telehealth services
described in paragraph (7).''.
(b) Allowing Additional Originating Sites.--Section
1834(m)(4)(C)(ii) of the Social Security Act (42 U.S.C.
1395m(m)(4)(C)(ii)) is amended by adding at the end the following new
subclause:
``(XII) Any other site determined
appropriate by the Secretary at which
an eligible telehealth individual is
located at the time a telehealth
service is furnished via a
telecommunications system.''.
(c) Parameters for New Originating Sites.--Section 1834(m)(4)(C) of
the Social Security Act (42 U.S.C. 1395m(m)(4)(C)), as amended by
section 4, is amended by adding at the end the following new clause:
``(iv) Requirements for new sites.--
``(I) In general.--The Secretary
may establish requirements for the
furnishing of telehealth services at
sites described in clause (ii)(XII) to
provide for beneficiary and program
integrity protections.
``(II) Clarification.--Nothing in
this clause shall be construed to
preclude the Secretary from
establishing requirements for other
originating sites described in clause
(ii).''.
(d) No Originating Site Facility Fee for New Sites.--Section
1834(m)(2)(B)(ii) of the Social Security Act (42 U.S.C.
1395m(m)(2)(B)(ii)) is amended--
(1) in the heading, by striking ``if originating site is
the home'' and inserting ``for certain sites''; and
(2) by striking ``paragraph (4)(C)(ii)(X)'' and inserting
``subclause (X) or (XII) of paragraph (4)(C)''.
SEC. 6. FEDERALLY QUALIFIED HEALTH CENTERS AND RURAL HEALTH CLINICS.
Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is
amended--
(1) in paragraph (4)(C)(i), in the matter preceding
subclause (I), by striking ``(5), (6), and (7)'' and inserting
``(5) through (8)''; and
(2) in paragraph (8)--
(A) in the paragraph heading by inserting ``and
after'' after ``during'';
(B) in subparagraph (A)--
(i) in the matter preceding clause (i), by
inserting ``and after such emergency period''
after ``1135(g)(1)(B)'';
(ii) in clause (ii), by striking ``and'' at
the end;
(iii) by redesignating clause (iii) as
clause (iv); and
(iv) by inserting after clause (ii) the
following new clause:
``(iii) the geographic requirements
described in paragraph (4)(C)(i) shall not
apply with respect to such a telehealth
service; and''; and
(C) 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. 7. NATIVE AMERICAN HEALTH FACILITIES.
(a) In General.--Section 1834(m)(4)(C) of the Social Security Act
(42 U.S.C. 1395m(m)(4)(C)), as amended by sections 4 and 5(c), is
amended--
(1) in clause (i), by striking ``clause (ii)'' and
inserting ``clauses (ii) and (v)''; and
(2) by adding at the end the following new clause:
``(v) Native american health facilities.--
With respect to telehealth services furnished
on or after January 1, 2022, the originating
site requirements described in clauses (i) and
(ii) shall not apply with respect to a facility
of the Indian Health Service, whether operated
by such Service, or by an Indian tribe (as that
term is defined in section 4 of the Indian
Health Care Improvement Act (25 U.S.C. 1603))
or a tribal organization (as that term is
defined in section 4 of the Indian Self-
Determination and Education Assistance Act (25
U.S.C. 5304)), or a facility of the Native
Hawaiian health care systems authorized under
the Native Hawaiian Health Care Improvement Act
(42 U.S.C. 11701 et seq.).''.
(b) No Originating Site Facility Fee for Certain Native American
Facilities.--Section 1834(m)(2)(B)(i) of the Social Security Act (42
U.S.C. 1395m(m)(2)(B)(i)) is amended, in the matter preceding subclause
(I), by inserting ``(other than an originating site that is only
described in clause (v) of paragraph (4)(C), and does not meet the
requirement for an originating site under clauses (i) and (ii) of such
paragraph)'' after ``the originating site''.
SEC. 8. WAIVER OF TELEHEALTH REQUIREMENTS DURING PUBLIC HEALTH
EMERGENCIES.
Section 1135(g)(1) of the Social Security Act (42 U.S.C. 1320b-
5(g)(1)) is amended--
(1) in subparagraph (A), in the matter preceding clause
(i), by striking ``subparagraph (B)'' and inserting
``subparagraphs (B) and (C)''; and
(2) by adding at the end the following new subparagraph:
``(C) Exception for waiver of telehealth
requirements during public health emergencies.--For
purposes of subsection (b)(8), in addition to the
emergency period described in subparagraph (B), an
`emergency area' is a geographical area in which, and
an `emergency period' is the period during which, there
exists a public health emergency declared by the
Secretary pursuant to section 319 of the Public Health
Service Act.''.
SEC. 9. TWO-YEAR EXTENSION OF TELEHEALTH SERVICES FOLLOWING THE COVID-
19 EMERGENCY PERIOD.
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 two years after the last day of the emergency
period described in subsection (g)(1)(B).''.
SEC. 10. OUTPATIENT CRITICAL ACCESS HOSPITALS.
(a) In General.--Notwithstanding section 1834(m) of the Social
Security Act (42 U.S.C. 1395m(m)) and subject to subsection (b), the
Secretary of Health and Human Services shall provide payment under
section 1834(g) of such Act (42 U.S.C. 1395m(g)) for outpatient
critical access hospital services consisting of behavioral therapy
services furnished by a critical access hospital to an individual
during the period beginning on January 1, 2021, and ending on the date
that is two years after the last day 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)), via telecommunications technology, notwithstanding the
fact that such individual is not located at such hospital.
(b) Initiation of Services Via Telehealth.--In the case of an
individual receiving services described in subsection (a) from a
critical access hospital during the period described in subsection (a),
if such individual has not, prior to receiving such services, received
in-person care at such hospital, payment shall be made to such hospital
in accordance with such subsection only if such services complement a
plan of care that includes in-person care to be furnished at such
hospital not later than 1 year after the date such services are
furnished.
(c) Definitions.--For purposes of this section:
(1) Critical access hospital.--The term ``critical access
hospital'' has the meaning given such term in section
1861(mm)(1) of the Social Security Act (42 U.S.C.
1395x(mm)(1)).
(2) Outpatient critical access hospital services.--The term
``outpatient critical access hospital services'' has the
meaning given such term in section 1861(mm)(3) of such Act (42
U.S.C. 1395x(mm)(3)).
(3) Telecommunications technology.--The term
``telecommunications technology'' means a communications system
permitting two-way, real-time interactive communication between
the individuals and health care professional and includes a
communications system consisting of only audio capabilities,
but only if such individual does not have access to a
communications system with audio-visual capabilities.
<all>
Introduced in House
Introduced in House
Referred to the Committee 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.
Referred to the Committee 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.
Referred to the Subcommittee on Health.
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