,i #aafth ,,congress #b;d ,session ,h4 ,r4 #giib ,,in ,,the ,,house ,,of ,,representatives ,august #g1 #bjbj,mrs4 ,wagner introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on ,ways and ,means1 the ,judiciary1 and ,veterans' ,affairs1 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 expand access to telehealth services1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,telehealth ,act4 ,i ,,va ,mission ,telehealth ,clarification #aja4 ,licensure of health care professionals providing treatment via telemedicine ,section #agcj;,c7b7 of title #ch1 ,united ,states ,code1 is amended to read as follows3 7b7 ,covered health care professionals ,for purposes of this section1 a covered health care professional is any of the following individuals3 7#a7 ,a health care professional who-- 7,a7 is an employee of the ,department appointed under the authority under section #gcjf1 #gdja1 #gdje1 #gdjf1 or #gdjh of this title or title #e2 7,b7 is authorized by the ,secretary to provide health care under this chapter2 7,c7 is required to adhere to all standards for quality relating to the provision of medicine in accordance with applicable policies of the ,department2 and 7,d7 has an active1 current1 full1 and unrestricted license1 registration1 or certification in a ,state to practice the health care profession of the health care professional4 7#b7 ,a health professional trainee who-- 7,a7 is appointed under section #gdje or #gdjf of this title2 and 7,b7 is under the clinical supervision of a health care professional described in paragraph 7#a74 4 ,,ii ,advancing ,telehealth ,beyond ,,covid-#ai #bja4 ,permitting the ,secretary of ,health and ,human ,services to waive requirements relating to the furnishing of telehealth services under the ,medicare program ,section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77 is amended by adding at the end the following new paragraph3 7#i7 ,authority to waive telehealth requirements ,notwithstanding any other provision of this subsection1 the ,secretary may waive any such provision for any area and time period specified by the ,secretary4 4 #bjb4 ,making permanent the ability of federally qualified health centers and rural health clinics to furnish telehealth services under the ,medicare program ,section #ahcd7m77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#h77 is amended-- 7#a7 in the header1 by striking during emergency period2 7#b7 in subparagraph 7,a71 in the matter preceding clause 7i71 by striking ,during and inserting ,beginning on the first day of2 and 7#c7 in subparagraph 7,b77i71 by striking during such emergency period4 #bjc4 ,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 ,,iii ,enhance ,access to ,support ,essential ,behavioral ,health ,services #cja4 ,findings ,congress finds as follows3 7#a7 ,nearly #ah percent of adults in the ,united ,states reported a mental1 behavioral1 or emotional disorder in #bjae4 7#b7 ,children are also significantly impacted4 ,according to the ,centers for ,disease ,control and ,prevention1 #a in #f children ages #b years through #h years have a diagnosed mental1 behavioral1 or developmental disorder1 indicating that disorders begin in early childhood and affect lifelong health4 7#c7 ,moreover1 #a in #g children and adolescents have at least one treatable mental health disorder4 7#d7 ,there is a critical link between mental health and substance use disorders4 ,according to the ,substance ,abuse and ,mental ,health ,services ,administration1 #a in #d adults with severe mental illness had a substance use disorder in #bjag4 7#e7 ,moreover1 children who have had a major depressive episode are more than twice as likely to use illicit drugs4 7#f7 ,in #bjag1 approximately #ai4g million people aged #ab years or older had a substance use disorder related to their use of alcohol or illicit drugs in the past year4 7#g7 ,despite this overwhelming need1 access to behavioral health services remains among the most pressing health care challenges in our country4 7#h7 ,an estimated #ef percent of ,americans with a mental health disorder did not receive treatment in #bjag4 7#i7 ,similarly1 half of children and adolescents did not receive treatment for their mental health disorder in #bjaf4 7#aj7 ,further complicating access to care1 as demand for behavioral health services increases in communities across the ,united ,states1 the number of psychiatrists available to treat them continues to decline4 7#aa7 ,the population of practicing psychiatrists declined by more than #aj percent between the period of #bjjc through #bjac1 while the population of primary care physicians and neurologists grew during the same period4 7#ab7 ,technology has evolved to connect individuals to health care services in new ways1 including via telehealth4 7#ac7 ,moreover1 studies show that video visits are an effective strategy to provide mental health treatment to children and1 in fact1 may be preferable in some cases4 7#ad7 ,during the #aaeth ,congress1 ,congress recognized the potential of telehealth to ensure that those in urgent need of substance use disorder treatment receive the care they require4 7#ae7 ,as passed and signed into law1 sections #bjja and #ajji of the ,,support for ,patients and ,communities ,act 7,public ,law #aae-bga7 expands the use of telehealth services for the treatment of opioid use disorder and other substance use disorders4 7#af7 ,it is widely recognized that there is a close relationship between mental health and substance use disorders4 #cjb4 ,medicare treatment of behavioral health services furnished through telehealth ,section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m771 as amended by title ,,ii1 is further amended-- 7#a7 in paragraph 7#d77;,c7-- 7,a7 in clause 7i71 by striking and 7#g7 and inserting 7#g71 and 7#aj72 and 7,b7 in clause 7ii77,x7-- 7i7 by striking or telehealth services and inserting 1 telehealth services2 and 7ii7 by inserting 1 or telehealth services described in paragraph 7#aj7 before the period at the end2 and 7#b7 by adding at the end the following new paragraph3 7#aj7 ,treatment of behavioral health services furnished through telehealth ,the geographic requirements described in paragraph 7#d77;,c77i7 shall not apply with respect to telehealth services that are behavioral health services furnished on or after ,july #a1 #bjbj1 to eligible telehealth individuals1 including initial patient evaluations1 follow-up medical management1 and other behavioral health services1 as determined by the ,secretary1 at an originating site described in paragraph 7#d77;,c77ii7 7other than an originating site described in subclause 7,,ix7 of such paragraph74 4 #cjc4 ,medicaid mental and behavioral health treatment through telehealth ,section #ajji of the ,,support for ,patients and ,communities ,act 7,public ,law #aae-bga7 is amended-- 7#a7 in subsection 7b7-- 7,a7 in the header1 by striking treatment for substance use disorders and inserting treatment for substance use disorders and mental health disorders and behavioral health disorders2 7,b7 in the matter preceding paragraph 7#a71 by striking ,not later than #a year after the date of enactment of this ,act1 the ,secretary and inserting ,the ,secretary2 7,c7 in paragraph 7#a7-- 7i7 by striking treatment for substance use disorders and inserting treatment for substance use disorders and mental health disorders and behavioral health disorders2 and 7ii7 by inserting psychotherapy1 after counseling12 7,d7 in paragraph 7#b71 by inserting or mental health disorders and behavioral health disorders after substance use disorders2 7,e7 in paragraph 7#c71 by inserting and mental health disorders and behavioral health disorders after substance use disorders2 and 7,f7 by adding at the end1 below and after paragraph 7#c71 the following flush left text3 ,the ,secretary shall issue the guidance under this subsection not later than #a year after the date of the enactment of this ,act1 with respect to the matters described in the previous provisions of this subsection relating to substance use disorders1 and not later than #b years after the date of the enactment of this ,act1 with respect to the matters described in such previous provisions relating to mental health disorders and behavioral health disorders4 2 7#b7 in subsection 7c7-- 7,a7 in the header1 by striking treatment for substance use disorders and inserting treatment for substance use disorders and mental health disorders and behavioral health disorders2 7,b7 in paragraph 7#a71 by striking treatment for substance use disorders and inserting treatment for substance use disorders and mental health disorders and behavioral health disorders each place it appears2 and 7,c7 in paragraph 7#b7-- 7i7 by inserting with respect to substance use disorders1 after paragraph 7#a712 and 7ii7 by adding at the end the following new sentence3 ,not later than #b years after the date of enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report containing the results of the evaluation conducted under paragraph 7#a71 with respect to mental health disorders and behavioral health disorders1 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate42 and 7#c7 in subsection 7d77#a7-- 7,a7 in the matter preceding subparagraph 7,a71 by inserting and mental health disorders and behavioral health disorders after substance use disorders2 7,b7 in subparagraph 7,a71 by inserting 1 and mental health disorders and behavioral health disorders after opioid use disorder2 and 7,c7 in subparagraph 7,b71 by inserting and mental health disorders and behavioral health disorders after substance use disorders4 #cjd4 ,effective date ,the amendments made by this title shall take effect as if included in the enactment of the ,,support for ,patients and ,communities ,act4 ,,iv ,helping ,ensure ,access to ,local ,tele,health #dja4 ,providing for permanent cost-related payments for telehealth services furnished by ,federally qualified health centers and rural health clinics under the ,medicare program and permanently removing originating site facility and location requirements for distant site telehealth services furnished by such centers and such clinics 7a7 ,permanent telehealth payments ,section #ahcd7m77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#h77 is amended-- 7#a7 in the header1 by striking during emergency period2 7#b7 in subparagraph 7,a71 in the matter preceding clause 7i71 by striking ,during the emergency period described in section #aace7;g77#a77;,b7 and inserting ,with respect to telehealth services furnished on or after the date of the beginning of the emergency period described in section #aace7;g77#a77;,b72 and 7#c7 by striking subparagraph 7,b7 and inserting the following new subparagraph3 7,b7 ,payment 7i7 ,in general ,a telehealth service furnished by a rural health clinic or a ,federally qualified health center serving as a distant site to an individual shall be deemed to be so furnished to such individual as an outpatient of such clinic or facility 7as applicable7 for purposes of paragraph 7#a7 or 7#c71 respectively1 of section #ahfa7;aa7 and payable as a rural health clinic service or ,federally qualified health center service 7as applicable7 under section #ahcc7;a77#c7 or under the prospective payment system established under section #ahcd7o71 respectively4 7ii7 ,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 #ahcd7o7 and any payment methodologies developed under section #ahcc7;a77#c71 as applicable4 4 7b7 ,elimination of originating site requirements for telehealth services furnished by ,f,q,h,cs or ,r,h,cs 7#a7 ,in general ,section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m771 as amended by subsection 7a7 and titles ,,ii and ,,iii1 is further amended-- 7,a7 in paragraph 7#d77;,c77i71 by striking 7#g71 and 7#aj7 and inserting 7#g71 7#h71 and 7#aj72 and 7,b7 by adding at the end the following new subparagraph3 7,c7 ,nonapplication of originating site requirements ,the geographic and site requirements described in paragraph 7#d77;,c7 shall not apply with respect to telehealth services furnished by a ,federally qualified health center or a rural health clinic serving as a distant site4 4 7#b7 ,special payment rule for originating sites with respect to telehealth services furnished by an ,,fqhc or ,,rhc ,section #ahcd7m77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#b77;,b77 is amended-- 7,a7 in clause 7i71 by striking clause 7ii7 and inserting clauses 7ii7 and 7iii72 and 7,b7 by adding at the end the following new clause3 7iii7 ,special rule for telehealth services furnished by ,f,q,h,cs and ,r,h,cs ,no facility fee shall be paid under this subparagraph to an originating site with respect to telehealth services furnished by a ,federally qualified health center or rural health clinic serving as a distant site unless such originating site is a site described in any of subclauses 7,i7 through 7,,ix7 of paragraph 7#d77;,c77ii74 4 7c7 ,treatment of ,,fqhc and ,,rhc telehealth services as a visit ,the ,secretary of ,health and ,human ,services shall revise section #dje4bdfc of title #db1 ,code of ,federal ,regulations 7or a successor regulation7 to provide that1 in the case of a ,federally qualified health center or a rural health clinic serving as a distant site furnishing telehealth services to an individual in accordance with section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m771 such services so furnished are considered to constitute a visit to such center or such clinic 7as applicable7 by such individual4 ,v ,telehealth ,across ,state ,lines #eja4 ,national telehealth program ,subpart ,i of part ,d of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b et seq47 is amended by adding at the end the following3 #ccj,n4 ,national telehealth program 7a7 ,uniform national best practices 7#a7 ,in general ,the ,secretary shall1 in consultation with a range of stakeholders including the entities listed in paragraph 7#c71 issue guidance on uniform best practices for the provision of telehealth across ,state lines4 7#b7 ,objective ,the objective of the best practices issued under paragraph 7#a7 shall be to1 not later than #e years after the date of enactment of this section1 provide high-quality telehealth in rural areas across the ,united ,states4 7#c7 ,consultation ,the entities listed in this paragraph include-- 7,a7 technology experts2 7,b7 data security experts2 7,c7 primary care providers2 7,d7 specialist providers2 7,e7 mental health providers2 7,f7 academic medical centers2 7,g7 ,federally qualified health centers1 as defined in section #ahfa7;aa7 of the ,social ,security ,act2 7,h7 ,state1 local1 or tribal health departments2 7,i7 critical access hospitals2 7,j7 any ,federal agency with expertise in the provision of telecommunications or telehealth2 and 7,k7 consumers of telehealth4 7#d7 ,reports ,the ,secretary shall1 not less than once every year beginning #a year after the date of enactment of this section and ending on the date on which the guidance under paragraph 7#a7 is issued1 report to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives on the progress of such guidance4 7b7 ,grant program 7#a7 ,in general ,the ,secretary shall for each of fiscal years #bjbj through #bjbd award grants to eligible entities described in paragraph 7#b7 for the expansion of telehealth programs to rural areas4 7#b7 ,eligible entity ,to be eligible to receive a grant under this subsection1 an entity shall-- 7,a7 demonstrate that it is operating1 on the date on which the entity submits an application under subparagraph 7,b71 an effective telehealth program 7as determined in accordance with criteria established by the ,secretary72 and 7,b7 submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may reasonably require1 including a plan to expand the telehealth program operated by the entity to rural areas4 7#c7 ,study ,not later than #c years after the date of enactment of this section1 the ,secretary shall-- 7,a7 complete a study on the grant program under this subsection1 including the successes and challenges of the program1 lessons the ,secretary has learned with respect to the program1 and best practices for telehealth programs2 and 7,b7 submit a report on such study to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives4 7#d7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this subsection1 #bj1jjj1jjj for each of fiscal years #bjbj through #bjbd4 7c7 ,definition of rural area ,in this section1 the term rural area has the meaning given the term in section #ccj;,j7e74 4 #ejb4 ,center for ,medicare and ,medicaid ,innovation 7,,cmmi7 model to incentivize the adoption of telehealth in order to increase access to care in rural areas ,section #aaae;,a7b77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;a7b77#b77;,b77 is amended by adding at the end the following new clause3 7xxviii7 ,providing incentives under title ,,xviii to encourage the adoption of telehealth in order to increase access to care in rural areas4 4 ,,vi ,enhancing ,preparedness through ,telehealth #fja4 ,telehealth enhancements for emergency response ,subsection 7e7 of section #cai;,d of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;d-#d7 is amended to read as follows3 7e7 ,telehealth enhancements for emergency response 7#a7 ,evaluation ,the ,secretary1 in consultation with the ,federal ,communications ,commission and other relevant ,federal agencies1 shall1 every #e years-- 7,a7 conduct an inventory of telehealth initiatives in existence on the date of enactment of the ,enhancing ,preparedness through ,telehealth ,act1 including the-- 7i7 specific location of networks and health information technology infrastructure that support such initiatives2 7ii7 medical1 technological1 and communications capabilities of such initiatives2 7iii7 functionality of such initiatives2 and 7iv7 capacity and ability of such initiatives to handle increased volume during the response to a public health emergency2 7,b7 identify methods to expand and interconnect the ,state and regional health information networks funded by the ,secretary1 the ,state and regional broadband networks funded by the ,federal ,communications ,commission1 including such networks supported by the rural health care support mechanism pilot program1 and other telehealth networks2 7,c7 evaluate ways to prepare for1 monitor1 respond rapidly to1 or manage the events of1 a public health emergency through the enhanced use of telehealth technologies1 including-- 7i7 mechanisms for payment or reimbursement for use of such technologies and personnel during public health emergencies2 7ii7 the use of telehealth technologies and services by health care providers in recent public health emergencies2 7iii7 ways in which ,states used telehealth technologies and services in ,state responses to public health emergencies2 and 7iv7 infrastructure and resource needs to ensure providers have the necessary tools1 training1 and technical assistance to provide telehealth services2 7,d7 identify methods for reducing legal barriers that deter health care professionals from providing telehealth services1 such as by utilizing ,state emergency health care professional credentialing verification systems1 encouraging ,states to establish and implement mechanisms to improve interstate medical licensure cooperation1 facilitating the exchange of information among ,states regarding investigations and adverse actions1 and encouraging ,states to waive the application of licensing requirements during a public health emergency2 7,e7 evaluate ways to integrate the practice of telehealth within the ,national ,disaster ,medical ,system or any recent actions taken related to such integration2 7,f7 promote greater coordination among existing ,federal interagency telehealth and health information technology initiatives2 and 7,g7 make recommendations related to updates on the use of telehealth in public health emergencies in ,federal and ,state public health preparedness plans and any actions taken to implement such recommendations4 7#b7 ,report 7,a7 ,in general 7i7 ,initial report ,not later than #a year after the date of enactment of the ,enhancing ,preparedness through ,telehealth ,act1 the ,secretary shall prepare and submit a report to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives regarding the findings and recommendations pursuant to paragraph 7#a74 7ii7 ,subsequent reports ,the ,secretary shall submit updated reports described in clause 7i7 to the committees described in such clause not later than ,january #a1 #bjbc1 and every #e years thereafter4 7,b7 ,considerations ,in preparing the reports under subparagraph 7,a71 the ,secretary shall take into consideration potential barriers to the adoption of telehealth by patients and providers during a public health emergency1 including-- 7i7 provider reimbursement2 7ii7 insurance coverage2 7iii7 provider licensure2 7iv7 accessibility of telehealth and remote technologies2 and 7v7 concerns around violating relevant privacy1 security1 and patient safety regulations4 4 ,,vii ,knowing the ,efficiency and ,efficacy of ,permanent ,telehealth ,options #gja4 ,findings ,congress finds the following3 7#a7 ,on ,january #ba1 #bjbj1 the ,united ,states confirmed the ,nation's first case of the #bjai novel coronavirus 7which presents as the disease ,,covid-#ai74 7#b7 ,on ,january #ca1 #bjbj1 the ,secretary of ,health and ,human ,services 7in this title referred to as the ,secretary7 declared a public health emergency in response to ,,covid-#ai4 7#c7 ,by ,march1 the disease reached the pandemic level according to the ,world ,health ,organization1 and the ,president proclaimed the ,,covid-#ai outbreak in the ,united ,states to constitute a national emergency4 7#d7 ,this emergency declaration authorizes the ,secretary to temporarily waive or modify certain requirements of the ,medicare1 ,medicaid1 and ,state ,children's ,health ,insurance programs and of the ,health ,insurance ,portability and ,accountability ,act ,privacy ,rule throughout the duration of the public health emergency declared in response to the ,,covid-#ai outbreak4 7#e7 ,under this authority1 the ,secretary1 and the ,administrator of the ,centers for ,medicare ,medicaid ,services 7in this title referred to as the ,administrator7 acting under the ,secretary's authority1 issued numerous rules1 regulations1 and waivers enabling the expansion of telehealth services during the public health emergency4 7#f7 ,telehealth services play a critical role in enhancing access to care for patients while simultaneously reducing the risk of exposure to the coronavirus for both patients and providers4 7#g7 ,the ,administrator expanded access to telehealth services under the public health emergency to all ,medicare beneficiaries 7including clinician-provided services to new and established patients74 7#h7 ,on ,april #bc1 #bjbj1 the ,administrator released a telehealth toolkit to assist ,states in expanding the use of telehealth through ,medicaid and ,,chip4 7#i7 ,expanded telehealth options are valuable for all ,americans during this public health crisis1 but especially for high-risk patients and rural ,americans who already have difficulty accessing care4 #gjb4 ,studies and reports on the expansion of access to telehealth services during the ,,covid-#ai emergency 7a7 ,,hhs 7#a7 ,in general ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary1 in consultation with the ,administrator1 shall conduct a study and submit to ,congress a report on actions taken by the ,secretary during the emergency period described in section #aace7;g77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#e7;g77#a77;,b77 to expand access to telehealth services under the ,medicare program1 the ,medicaid program1 and the ,children's ,health ,insurance program4 ,such report shall include the following3 7,a7 ,a comprehensive list of telehealth services available under the programs described in paragraph 7#a7 and an explanation of all actions undertaken by the ,secretary during the emergency period described in such paragraph to expand access to such services4 7,b7 ,a comprehensive list of types of providers that may be reimbursed for such services furnished under such programs during such period1 including a list of services which may only be reimbursed under such programs during such period if furnished by such providers in-person4 7,c7 ,a quantitative analysis of the use of such telehealth services under such programs during such period1 including data points on use by rural1 minority1 low-income1 and elderly populations4 7,d7 ,a quantitative analysis of the use of such services under such programs during such period for mental and behavioral health treatments4 7,e7 ,an analysis of the public health impacts of the actions described in subparagraph 7,a74 7#b7 ,publication of report ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary shall publish on the public website of the ,department of ,health and ,human ,services the report described in paragraph 7#a74 7b7 ,,gao 7#a7 ,in general ,not later than #baj days after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall conduct a study and submit to ,congress a report on-- 7,a7 the efficiency1 management1 and success and failures of the expansion of access to telehealth services under the ,medicare1 ,medicaid1 and ,children's ,health ,insurance programs during the emergency period described in subsection 7a77#a72 and 7,b7 any risk in increased fraudulent activity1 and types of fraudulent activity1 associated with such expansion4 7#b7 ,recommendations ,the report submitted under paragraph 7#a7 shall include recommendations on-- 7,a7 potential improvements to telehealth services1 and expansions of such services1 under the programs described in paragraph 7#a77;,a72 and 7,b7 ways to address any fraudulent activity described in paragraph 7#a77;,b74 ,,viii ,telemedicine ,everywhere ,lifting ,everyone's ,healthcare ,experience ,and ,long ,term ,health ,,hsa #hja4 ,permanent exemption for telehealth services 7a7 ,in general ,subparagraph 7,e7 of section #bbc7;c77#b7 of the ,internal ,revenue ,code of #aihf is amended by striking ,in the case of plan years beginning on or before ,december #ca1 #bjba1 a plan and inserting ,a plan4 7b7 ,conforming amendment ,clause 7ii7 of section #bbc7;c77#a77;,b7 of the ,internal ,revenue ,code of #aihf is amended by striking 7in the case of plan years beginning on or before ,december #ca1 #bjba74 7c7 ,effective date ,the amendments made by this section shall apply to plan years beginning after ,december #ca1 #bjba4 ,,ix ,telehealth ,response for ,e-prescribing ,addiction ,therapy ,services #ija4 ,telehealth for substance use disorder treatment 7a7 ,substance use disorder services furnished through telehealth under ,medicare ,section #ahcd7m77#g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#g77 is amended by adding at the end the following3 ,with respect to telehealth services described in the preceding sentence that are furnished on or after ,january #a1 #bjbj1 nothing shall preclude the furnishing of such services through audio or telephone only technologies in the case where a physician or practitioner has already conducted an in-person medical evaluation or a telehealth evaluation that utilizes both audio and visual capabilities with the eligible telehealth individual44 7b7 ,controlled substances dispensed by means of the internet ,section #cji7;e77#b7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbi7;e77#b77 is amended-- 7#a7 in subparagraph 7,a77i7-- 7,a7 by striking at least #a in-person medical evaluation and inserting the following3 at least-- 7,i7 #a in-person medical evaluation 2 and 7,b7 by adding at the end the following3 7,,ii7 for purposes of prescribing a controlled substance in schedule ,,iii or ,,iv1 #a telehealth evaluation2 or 2 and 7#b7 by adding at the end the following3 7,d7 7i7 ,the term telehealth evaluation means a medical evaluation that is conducted in accordance with applicable ,federal and ,state laws by a practitioner 7other than a pharmacist7 who is at a location remote from the patient and is communicating with the patient using a telecommunications system referred to in section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77 that includes1 at a minimum1 audio and video equipment permitting two-way1 real-time interactive communication between the patient and distant site practitioner4 7ii7 ,nothing in clause 7i7 shall be construed to imply that #a telehealth evaluation demonstrates that a prescription has been issued for a legitimate medical purpose within the usual course of professional practice4 7iii7 ,a practitioner who prescribes the drugs or combination of drugs that are covered under section #cjc7;g77#b77;,c7 using the authority under subparagraph 7,a77i77,,ii7 of this paragraph shall adhere to nationally recognized evidence-based guidelines for the treatment of patients with opioid use disorders and a diversion control plan1 as those terms are defined in section #h4b of title #db1 ,code of ,federal ,regulations1 as in effect on the date of enactment of this subparagraph4 4