,i #aafth ,,congress #ast ,session ,h4 ,r4 #dicb ,,in ,,the ,,house ,,of ,,representatives ,october #cj1 #bjai,mr4 ,thompson of ,california 7for himself1 ,mr4 ,welch1 ,mr4 ,johnson of ,ohio1 ,mr4 ,schweikert1 and ,ms4 ,matsui7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 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 expand access to telehealth services1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,creating ,opportunities ,now for ,necessary and ,effective ,care ,technologies for ,health ,act of #bjai or the ,,connect for ,health ,act of #bjai4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,sec4 #b4 ,findings and sense of ,congress4 ,sec4 #c4 ,expanding the use of telehealth through the waiver of certain requirements4 ,sec4 #d4 ,expanding the use of telehealth for mental health services4 ,sec4 #e4 ,use of telehealth in emergency medical care4 ,sec4 #f4 ,improvements to the process for adding telehealth services4 ,sec4 #g4 ,rural health clinics and ,federally qualified health centers4 ,sec4 #h4 ,native ,american health facilities4 ,sec4 #i4 ,waiver of telehealth restrictions during national emergencies4 ,sec4 #aj4 ,use of telehealth in recertification for hospice care4 ,sec4 #aa4 ,clarification for fraud and abuse laws regarding technologies provided to beneficiaries4 ,sec4 #ab4 ,study and report on increasing access to telehealth services in the home4 ,sec4 #ac4 ,analysis of telehealth waivers in alternative payment models4 ,sec4 #ad4 ,model to allow additional health professionals to furnish telehealth services4 ,sec4 #ae4 ,testing of models to examine the use of telehealth under the ,medicare program4 #b4 ,findings and sense of ,congress 7a7 ,findings ,congress finds the following3 7#a7 ,the use of technology in health care and coverage of telehealth services are rapidly evolving4 7#b7 ,research has found that telehealth services can expand access to care1 improve the quality of care1 and reduce spending1 and that patients receiving telehealth services are satisfied with their experiences4 7#c7 ,health care workforce shortages are a significant problem in many areas and for many types of health care clinicians4 7#d7 ,telehealth increases access to care in areas with workforce shortages and for individuals who live far away from health care facilities1 have limited mobility or transportation1 or have other barriers to accessing care4 7#e7 ,the use of health technologies can strengthen the expertise of the health care workforce1 including by connecting clinicians to specialty consultations4 7#f7 ,utilization of telehealth services in ,medicare remains low1 with only #j4be percent of ,medicare fee-for-service beneficiaries utilizing telehealth services in #bjaf4 7b7 ,sense of ,congress ,it is the sense of ,congress that-- 7#a7 health care providers can furnish safe1 effective1 and high-quality health care services through telehealth2 and 7#b7 barriers to the use of telehealth should be removed4 #c4 ,expanding the use of telehealth through the waiver of certain requirements 7a7 ,in general ,section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77 is amended-- 7#a7 in paragraph 7#d77;,c77i71 by striking and 7#g7 and inserting 7#g71 and 7#h72 and 7#b7 by adding at the end the following3 7#h7 ,authority to waive requirements and limitations if certain conditions met 7,a7 ,in general ,notwithstanding the preceding provisions of this subsection1 in the case of telehealth services furnished on or after ,january #a1 #bjba1 the ,secretary may waive any restriction applicable to payment for telehealth services under this subsection that is described in subparagraph 7,b71 but only if the ,secretary determines that such waiver would not deny or limit the coverage or provision of benefits under this title1 and-- 7i7 the ,secretary determines that the waiver is expected to reduce spending under this title without reducing the quality of care or improve the quality of patient care without increasing spending2 or 7ii7 the waiver would apply to telehealth services furnished in originating sites located in a high-need health professional shortage area 7as designated pursuant to section #ccb7;a77#a77;,a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e7a77#a77;,a7774 7,b7 ,restrictions described ,for purposes of this paragraph1 restrictions applicable to payment for telehealth services under paragraph 7#a7 are-- 7i7 requirements relating to qualifications for an originating site under paragraph 7#d77;,c77ii72 7ii7 any geographic limitations under paragraph 7#d77;,c77i7 7other than applicable ,state law requirements1 including ,state licensure requirements72 7iii7 any limitation on the type of technology used to furnish telehealth services2 7iv7 any limitation on the type of provider of services or supplier who may furnish telehealth services 7other than the requirement that the provider of services or supplier is enrolled under this title72 7v7 any limitation on specific services designated as telehealth services pursuant to this subsection 7provided the ,secretary determines that such services are clinically appropriate to furnish remotely72 or 7vi7 any other limitation relating to the furnishing of telehealth services under this title identified by the ,secretary4 7,c7 ,public comment ,the ,secretary shall establish a process by which stakeholders may 7on at least an annual basis7 provide public comment for waivers under this paragraph4 7,d7 ,periodic review of waivers ,the ,secretary shall periodically1 but not more often than every #c years1 reassess each waiver under this paragraph to determine whether the waiver continues to meet the conditions applicable under subparagraph 7,a74 4 7b7 ,posting of information ,not later than #b years after the date on which a waiver under section #ahcd7m77#h7 of the ,social ,security ,act1 as added by subsection 7a71 first becomes effective1 and at least biennially thereafter1 the ,secretary of ,health and ,human ,services shall post on the internet website of the ,centers for ,medicare ,medicaid ,services-- 7#a7 the number of ,medicare beneficiaries receiving telehealth services by reason of each waiver under such section2 7#b7 the impact of such waivers on expenditures and utilization under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq472 and 7#c7 other outcomes1 as determined appropriate by the ,secretary4 #d4 ,expanding the use of telehealth for mental health services 7a7 ,in general ,section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m771 as amended by section #c1 is amended-- 7#a7 in paragraph 7#d77;,c77i71 by striking and 7#h7 and inserting 7#h71 and 7#i72 and 7#b7 by adding at the end the following3 7#i7 ,treatment of mental health services furnished through telehealth ,the geographic requirements described in paragraph 7#d77;,c77i7 7other than applicable ,state law requirements1 including ,state licensure requirements7 shall not apply with respect to telehealth services that are mental health services 7as determined by the ,secretary7 furnished on or after ,january #a1 #bjba1 to an eligible telehealth individual at an originating site described in paragraph 7#d77;,c77ii7 7other than an originating site described in subclause 7,,ix7 of such paragraph74 4 7b7 ,inclusion of the home as an originating site ,section #ahcd7m77#d77;,c77ii77,x7 of such ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,c77ii77,x77 is amended by striking paragraph 7#g7 and inserting paragraphs 7#g7 and 7#i74 7c7 ,additional services ,as part of the implementation of the amendments made by this section1 the ,secretary of ,health and ,human ,services shall consider whether additional services should be added to the services specified in paragraph 7#d77;,f77i7 of section #ahcd7m7 of such ,act 7#db ,u4,s4,c4 #aciem7 for authorized payment under paragraph 7#a7 of such section4 #e4 ,use of telehealth in emergency medical care 7a7 ,in general ,section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m771 as amended by sections #c and #d1 is amended-- 7#a7 in paragraph 7#d77;,c77i71 by striking and 7#i7 and inserting 7#i71 and 7#aj72 and 7#b7 by adding at the end the following3 7#aj7 ,treatment of emergency medical care furnished through telehealth ,the geographic requirements described in paragraph 7#d77;,c77i7 7other than applicable ,state law requirements1 including ,state licensure requirements7 shall not apply with respect to telehealth services that are services for emergency medical care 7as determined by the ,secretary7 furnished on or after ,january #a1 #bjba1 to an eligible telehealth individual at an originating site described in subclause 7,,ii71 7,v71 or 7,,vii7 of paragraph 7#d77;,c77ii74 4 7b7 ,additional services ,as part of the implementation of the amendments made by this section1 the ,secretary of ,health and ,human ,services shall consider whether additional services should be added to the services specified in paragraph 7#d77;,f77i7 of section #ahcd7m7 of such ,act 7#db ,u4,s4,c4 #aciem7 for authorized payment under paragraph 7#a7 of such section4 #f4 ,improvements to the process for adding telehealth services ,the ,secretary shall undertake a review of the process established pursuant to section #ahcd7m77#d77;,f77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,f77ii771 and based on the results of such review-- 7#a7 implement revisions to the process so that the criteria to add services prioritizes1 as appropriate1 improved access to care through telehealth services2 and 7#b7 provide clarification on what requests to add telehealth services under such process should include4 #g4 ,rural health clinics and ,federally qualified health centers 7a7 ,expansion of originating sites ,section #ahcd7m77#d77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,c771 as amended by sections #c1 #d1 and #e1 is amended-- 7#a7 in clause 7i71 by striking and 7#aj7 and inserting and 7#aj71 and subject to clause 7iii712 and 7#b7 by adding at the end the following new clause3 7iii7 ,rural health clinics and ,federally qualified health centers ,the term originating site shall also include any ,federally qualified health center and any rural health clinic 7as such terms are defined in section #ahfa7;aa77 at which the eligible telehealth individual is located at the time the service is furnished via a telecommunications system1 whether or not the individual is located in an area described in clause 7i71 insofar as such sites are not otherwise included in the definition of originating site under such clause1 subject to applicable ,state law requirements1 including ,state licensure requirements4 4 7b7 ,expansion of distant sites ,section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77 is amended-- 7#a7 in the first sentence of paragraph 7#a7-- 7,a7 by striking or a practitioner 7described in section #ahdb7;b77#ah77;,c77 and inserting 1 a practitioner 7described in section #ahdb7;b77#ah77;,c771 a ,federally qualified health center1 or a rural health clinic2 and 7,b7 by striking or practitioner and inserting 1 practitioner1 ,federally qualified health center1 or rural health clinic2 7#b7 in paragraph 7#b77;,a7-- 7,a7 by inserting or to a ,federally qualified health center or rural health clinic that serves as a distant site after a distant site2 and 7,b7 by striking such physician or practitioner and inserting such physician1 practitioner1 ,federally qualified health center1 or rural health clinic2 and 7#c7 in paragraph 7#d7-- 7,a7 in subparagraph 7,a71 by inserting and includes a ,federally qualified health center or rural health clinic that furnishes a telehealth service to an eligible individual before the period at the end2 and 7,b7 in subparagraph 7,f71 by adding at the end the following new clause3 7iii7 ,inclusion of rural health clinic services and ,federally qualified health center services furnished using telehealth ,for purposes of this subparagraph1 the term telehealth services includes a rural health clinic service or ,federally qualified health center service that is furnished using telehealth to the extent that payment codes corresponding to services identified by the ,secretary under clause 7i7 or 7ii7 are listed on the corresponding claim for such rural health clinic service or ,federally qualified health center service4 4 7c7 ,effective date ,the amendments made by this section shall apply to services furnished on or after ,january #a1 #bjba4 #h4 ,native ,american health facilities 7a7 ,in general ,section #ahcd7m77#d77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,c771 as amended by sections #c1 #d1 #e1 and #g1 is amended-- 7#a7 in clause 7i71 by striking clause 7iii7 and inserting clauses 7iii7 and 7iv72 and 7#b7 by adding at the end the following new clause3 7iv7 ,native ,american health facilities ,the originating site requirements described in clauses 7i7 and 7ii7 shall not apply with respect to a facility of the ,indian ,health ,service1 whether operated by such ,service1 or by an ,indian tribe 7as that term is defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc77 or a tribal organization 7as that term is defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd771 or a facility of the ,native ,hawaiian health care systems authorized under the ,native ,hawaiian ,health ,care ,improvement ,act 7#db ,u4,s4,c4 #aagja et seq474 4 7b7 ,no originating site facility fee for new sites ,section #ahcd7m77#b77;,b77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#b77;,b77i77 is amended1 in the matter preceding subclause 7,i71 by inserting 7other than an originating site that is only described in clause 7iv7 of paragraph 7#d77;,c71 and does not meet the requirement for an originating site under clause 7i7 of such paragraph7 after the originating site4 7c7 ,effective date ,the amendments made by this section shall apply to services furnished on or after ,january #a1 #bjba4 #i4 ,waiver of telehealth restrictions during national emergencies ,section #aace7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#e7;b77 is amended-- 7#a7 in paragraph 7#f71 by striking and after the semicolon2 7#b7 in paragraph 7#g71 by striking the period at the end and inserting 2 and2 and 7#c7 by adding at the end the following3 7#h7 requirements for payment for telehealth services under section #ahcd7m74 4 #aj4 ,use of telehealth in recertification for hospice care 7a7 ,in general ,section #ahad7;a77#g77;,d77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7a77#g77;,d77i77 is amended by inserting 7including through use of telehealth1 notwithstanding the requirements in section #ahcd7m77#d77;,c77 after face-to-face encounter4 7b7 ,,gao report ,not later than #c years after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit a report to ,congress evaluating the impact of the amendment made by subsection 7a7 on-- 7#a7 the number and percentage of beneficiaries recertified for the ,medicare hospice benefit at #ahj days and for subsequent benefit periods2 7#b7 the appropriateness for hospice care of the patients recertified through the use of telehealth2 and 7#c7 any other factors determined appropriate by the ,comptroller ,general4 #aa4 ,clarification for fraud and abuse laws regarding technologies provided to beneficiaries ,section #aabh;,a7i77#f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;a7i77#f77 is amended-- 7#a7 in subparagraph 7,i71 by striking 2 or and inserting a semicolon2 7#b7 in subparagraph 7,j71 by striking the period at the end and inserting 2 or2 and 7#c7 by adding at the end the following new subparagraph3 7,k7 the provision of technologies 7as defined by the ,secretary7 on or after the date of the enactment of this subparagraph1 by a provider of services or supplier 7as such terms are defined for purposes of title ,,xviii7 directly to an individual who is entitled to benefits under part ,a of title ,,xviii1 enrolled under part ,b of such title1 or both1 for the purpose of furnishing telehealth services1 remote patient monitoring services1 or other services furnished through the use of technology 7as defined by the ,secretary71 if-- 7i7 the technologies are not offered as part of any advertisement or solicitation2 and 7ii7 the provision of the technologies meets any other requirements set forth in regulations promulgated by the ,secretary4 4 #ab4 ,study and report on increasing access to telehealth services in the home 7a7 ,med,p,a,c study ,the ,medicare ,payment ,advisory ,commission 7in this section referred to as the ,commission7 shall conduct a study on increasing access under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 to telehealth services in the home4 ,such study shall include an analysis of the following3 7#a7 ,how different payers allow the home to be an originating site for telehealth services4 7#b7 ,particular types of telehealth services or subgroups of beneficiaries with respect to which allowing the home to be an originating site under the ,medicare program would be suitable4 7b7 ,report ,not later than #bd months after the date of the enactment of this ,act1 the ,commission shall submit to ,congress a report containing the results of the study conducted under subsection 7a71 together with recommendations for such legislation and administrative action as the ,commission determines appropriate4 #ac4 ,analysis of telehealth waivers in alternative payment models ,the second sentence of section #aaae;,a7g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7g77 is amended by inserting an analysis of waivers under section 7d77#a7 related to telehealth and the impact on quality and spending under the applicable titles of such waivers1 after subsection 7c714 #ad4 ,model to allow additional health professionals to furnish telehealth services ,section #aaae;,a7b77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b77;,b77 is amended by adding at the end the following new clause3 7xxviii7 ,allowing health professionals1 such as those described in section #ahai7;b77#e77;,g7 or section #ahfa7ll77#d77;,b71 who are not otherwise eligible under section #ahcd7m7 to furnish telehealth services to furnish such services4 4 #ae4 ,testing of models to examine the use of telehealth under the ,medicare program ,section #aaae;,a7b77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b77 is amended by adding at the end the following new subparagraph3 7,d7 ,testing models to examine use of telehealth under ,medicare ,the ,secretary shall consider testing under this subsection models to examine the use of telehealth under title ,,xviii4 4