,i  #aag? ,,congress  #b;d ,session  ,h4
 ,r4 #ghgf  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,may #bd1 #bjbb,mr4   
,smi? ( ,nebraska 7= himself1 ,mr4      
,o',hall]an1 & ,mr4 ,arm/rong7 introduc$
 ! foll[+ bill2 :i* 0 ref]r$ to !       
,committee on ,ways & ,means1 & 9       
addition to ! ,committee on ,en]gy &    
,comm]ce1 = a p]iod to be subsequ5tly   
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d title ,,xviii ( !     
,social ,security ,act to protect access
 to teleheal? s]vices "u ! ,m$ic>e      
program4  #a4 ,%ort title ,?is ,act may 
be cit$ z ! ,connect+ ,rural ,teleheal? 
to ! ,future ,act4  #b4 ,remov+         
geographic requirem5ts & exp&+ orig9at+ 
sites = teleheal? s]vices ,section      
#ahcd7m7 ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #aciem7m77 is am5d$-- 7#a7 9 
p>agraph 7#d77;,c77iii71 by /rik+ dur+ !
 #aea-;day p]iod beg9n+ on ! fir/ day   
aft] ! end ( ! em]g5cy p]iod describ$ 9 

section #aace7;g77#a77;,b7 & ins]t+ be=e
 ,janu>y #a1 #bjbe2 &  7#b7 9 p>agraph  
7#b77;,b77iii71 by /rik+ dur+ !         
#aea-;day p]iod beg9n+ on ! fir/ day    
aft] ! end ( ! em]g5cy p]iod describ$ 9 
section #aace7;g77#a77;,b7 & ins]t+ be=e
 ,janu>y #a1 #bjbe4  #c4 ,exp&+         
practition]s eligible to furni%         
teleheal? s]vices ,section #ahcd7m7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7m77 is am5d$ 9 p>agraph          
7#d77;,e71 by /rik+ #aea-;day & ins]t+ &
 end+ on ,decemb] #ca1 #bjbd aft]       
describ$ 9 section #aace7;g77#a77;,b74  
#d4 ,ext5d+ teleheal? s]vices = f$]ally 
qualifi$ heal? c5t]s & rural heal?      
cl9ics ,section #ahcd7m77#h7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#aciem7m77#h77 is am5d$ 9 subp>agraph   
7,a71 by /rik+ #aea-;day & ins]t+ & end+
 on ,decemb] #ca1 #bjbd aft] describ$ 9 
section #aace7;g77#a77;,b74  #e4 ,delay+
 ! 9-p]son requirem5ts "u m$ic>e = m5tal
 heal? s]vices furni%$ ?r\gh teleheal? &
 telecommunications te*nology  7a7 ,9   

g5]al ,section #ahcd7m77#g77;,b77i7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7m77#g77;,b77i77 is am5d$ 9 !     
matt] prec$+ subclause 7,i71 by /rik+ ! 
day t is ! #aebnd day aft] ! end ( !    
em]g5cy p]iod & ins]t+ ,janu>y #a1      
#bjbe4  7b7 ,paym5t ,section #ahcd7y7 ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#aciem7y77 is am5d$ 9 p>agraph 7#b71 by 
/rik+ ! day t is ! #aebnd day aft] ! end
 ( ! em]g5cy p]iod & ins]t+ ,janu>y #a1 
#bjbe4  7c7 ,con=m+ am5dm5t ,section    
#ahcd7o77#d7 ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #aciem7o77#d77 is am5d$ 9
 subp>agraph 7,b71 by /rik+ ! day t is !
 #aebnd day aft] ! end ( ! em]g5cy p]iod
 describ$ 9 section #aace7;g77#a77;,b7 &
 ins]t+ ,janu>y #a1 #bjbe4  #f4 ,all[+ =
 ! furni%+ ( audio-only teleheal?       
s]vices ,section #ahcd7m7 ( ,social     
,security ,act 7#db ,u4,s4,c4 #aciem7m77
 is am5d$-- 7#a7 9 p>agraph 7#a71 by    
/rik+ p>agraphs 7#h7 & 7#i7 & ins]t+    
p>agraph 7#h72  7#b7 by /rik+ p>agraph  
7#i72 &  7#c7 9 p>agraph 7#d71 by add+  

at ! end ! foll[+ new subp>agraph3  7,g7
 ,telecommunications sy/em  7i7 ,9 g5]al
 ,not)/&+ p>agraph 7#a7 & section       
#daj4gh7;a77#c7 ( title #db1 ,code (    
,f$]al ,regulations 7or any successor   
regulation71 subject to clause 7v71 !   
t]m telecommunications sy/em includes1 9
 ! case ( ! furni%+ ( a specifi$        
teleheal? s]vice 7z def9$ 9 clause 7ii77
 a communications sy/em t uses          
audio-only te*nology4  7ii7 ,specifi$   
teleheal? s]vice ,9 ?is subp>agraph1 !  
t]m specifi$ teleheal? s]vice means a   
teleheal? s]vice describ$ 9 clause 7iii7
 t is furni%$ by a qualifi$ provid] 7z  
def9$ 9 clause 7iv774  7iii7 ,teleheal? 
s]vice describ$ ,a teleheal? s]vice z   
def9$ 9 subp>agraph 7,f77i74  7iv7      
,qualifi$ provid] def9$ ,= purposes (   
clause 7ii71 ! t]m qualifi$ provid]     
means1 ) respect to a specifi$ teleheal?
 s]vice t is furni%$ to an eligible     
teleheal? individual-- 7,i7 a physician 
or practition] :o has an e/abli%$ pati5t
 relation%ip ) su* individual z def9$ by

 ! ,/ate 9 :i* ! individual is locat$2  
or  7,,ii7 a critical access hospital 7z
 def9$ 9 section #ahfa7mm77#a771 a rural
 heal? cl9ic 7z def9$ 9 section         
#ahfa7;aa77#b771 a f$]ally qualifi$     
heal? c5t] 7z def9$ 9 section           
#ahfa7;aa77#d771 a hospital 7z def9$ 9  
section #ahfa7;e771 a hospital-bas$ or  
critical access hospital-bas$ r5al      
dialysis c5t] 7includ+ satellites71 a   
skill$ nurs+ facility 7z def9$ 9 section
 #ahai7;a771 a community m5tal heal?    
c5t] 7z def9$ 9 section                 
#ahfa7;ff77#c77;,b771 or a rural em]g5cy
 hospital 7z def9$ 9 section            
#ahfa7kkk77#b774  7v7 ,au?ority ,=      
purposes ( ?is subp>agraph1 ! ,secret>y 
may det]m9e :e!r x is cl9ically         
appropriate to furni% a specifi$        
teleheal? s]vice via a communications   
sy/em t uses audio-only te*nology & :e!r
 an 9-p]son initial visit 79 addition to
 any requirem5t ) respect to ! furni%+ (
 an item or s]vice 9 p]son pursuant to  
clause 7iv77,i77 is requir$ prior to !  

furni%+ ( su* s]vice us+ su* te*nology4 
7vi7 ,cl>ification reg>d+ paym5t ,!     
am\nt ( paym5t = a specifi$ teleheal?   
s]vice t is furni%$ us+ audio-only      
te*nology %all be equal to ! am\nt t    
w\ld h be5 paid = su* s]vice "u ?is     
subsection _h su* s]vice be5 furni%$ via
 any o!r telecommunications sy/em       
au?oriz$ "u ?is subsection4  4  #g4 ,use
 ( teleheal? to conduct face-to-face    
enc\nt] prior to rec]tification (       
eligibility = hospice c>e dur+ em]g5cy  
p]iod ,section                          
#ahad7;a77#g77;,d77i77,,ii7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acie;f7a77#g77;,d77i77,,ii77 is am5d$  
by /rik+ #aea-;day & ins]t+ & end+ on   
,decemb] #ca1 #bjbd aft] describ$ 9     
section #aace7;g77#a77;,b74  #h4        
,ext5sion ( exemption = teleheal?       
s]vices  7a7 ,9 g5]al ,subp>agraph 7,e7 
( section #bbc7;c77#b7 ( ! ,int]nal     
,rev5ue ,code ( #aihf is am5d$ by /rik+ 
#bjbc;& ins]t+ #bjbe4  7b7 ,c]ta9       
cov]age disreg>d$ ,clause 7ii7 ( section

 #bbc7;c77#a77;,b7 ( ! ,int]nal ,rev5ue 
,code ( #aihf is am5d$ by /rik+ #bjbc & 
ins]t+ #bjbe4  #i4 ,f$]ally qualifi$    
heal? c5t]s & rural heal? cl9ics        
,section #ahcd7m7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciem7m77 is am5d$ 
9 p>agraph 7#h71 by /rik+ subp>agraph   
7,b7 & ins]t+ ! foll[+3  7,b7 ,paym5t   
7i7 ,9 g5]al ,a teleheal? s]vice furni%$
 by a f$]ally qualifi$ heal? c5t] or a  
rural heal? cl9ic to an individual      
pursuant to ?is p>agraph on or aft] !   
date ( ! enactm5t ( ?is subp>agraph %all
 be deem$ to be s furni%$ to su*        
individual z an outpati5t ( su* cl9ic or
 facility 7z applicable7 = purposes (   
p>agraph 7#a7 or 7#c71 respectively1 (  
section #ahfa7;aa7 & payable z a f$]ally
 qualifi$ heal? c5t] s]vice or rural    
heal? cl9ic s]vice 7z applicable7 "u !  
prospective paym5t sy/em e/abli%$ "u    
section #ahcd7o7 or "u section          
#ahcc7;a77#c71 respectively4  7ii7      
,treatm5t ( co/s = fqhc pps calculations
 & rhc air calculations ,co/s associat$ 

) ! deliv]y ( teleheal? s]vices by a    
f$]ally qualifi$ heal? c5t] or rural    
heal? cl9ic s]v+ z a di/ant site        
pursuant to ?is p>agraph %all be        
consid]$ all[able co/s = purposes ( !   
prospective paym5t sy/em e/abli%$ "u    
section #ahcd7o7 & any paym5t           
me?odologies develop$ "u section        
#ahcc7;a77#c71 z applicable4  4  #aj4   
,teleheal? flexibilities = critical     
access hospitals ,section #ahcd7m7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7m77 is am5d$-- 7#a7 9 ! fir/     
s5t5ce ( p>agraph 7#a71 by /rik+        
p>agraph 7#h7 & ins]t+ p>agraphs 7#h7 & 
7#i72  7#b7 9 p>agraph 7#b77;,a71 by    
/rik+ p>agraph 7#h7 & ins]t+ p>agraphs  
7#h7 & 7#i72  7#c7 9 p>agraph 7#d7--    
7,a7 9 subp>agraph 7,a71 by /rik+       
p>agraph 7#h7 & ins]t+ p>agraphs 7#h7 & 
7#i72 &  7,b7 9 subp>agraph 7,f77i71 by 
/rik+ p>agraph 7#h7 & ins]t+ p>agraphs  
7#h7 & 7#i72 &  7#d7 by add+ at ! end ! 
foll[+ new p>agraph3  7#i7 ,teleheal?   
flexibilities = critical access         

hospitals  7,a7 ,9 g5]al ,on or aft] !  
date ( ! enactm5t ( ?is p>agraph-- 7i7 !
 ,secret>y %all pay = teleheal? s]vices 
t are furni%$ betwe5 ! end ( ! em]g5cy  
p]iod describ$ 9 section                
#aace7;g77#a77;,b7 & ,janu>y #a1 #bjbe1 
via a telecommunications sy/em by a     
critical access hospital1 includ+ any   
practition] au?oriz$ to provide su*     
s]vices )9 ! facility1 t is a qualifi$  
provid] 7z def9$ 9 subp>agraph 7,b77 to 
an eligible teleheal? individual enroll$
 "u ?is "p not)/&+ t ! critical access  
hospital provid+ ! teleheal? s]vice is n
 at ! same location z ! b5efici>y1 if   
su* s]vices complem5t a plan ( c>e t    
includes 9-p]son c>e at "s po9t1 z may  
be appropriate2  7ii7 ! am\nt ( paym5t  
to a critical access hospital t s]ves z 
a di/ant site = su* a teleheal? s]vice  
%all be det]m9$ "u subp>agraph 7,c72 &  
7iii7 = purposes ( ?is subsection-- 7,i7
 ! t]m di/ant site includes a critical  
access hospital t furni%es a teleheal?  
s]vice to an eligible teleheal?         

individual2 &  7,,ii7 ! t]m teleheal?   
s]vices includes behavioral heal?       
s]vices & any o!r outpati5t critical    
access hospital s]vice t is furni%$ us+ 
teleheal? to ! ext5t t paym5t codes     
correspond+ to s]vices id5tifi$ by !    
,secret>y "u clause 7i7 or 7ii7 (       
p>agraph 7#d77;,f7 are li/$ on !        
correspond+ claim = su* critical access 
hospital s]vice4  7,b7 ,def9ition (     
qualifi$ provid] ,= purposes ( ?is      
subsection1 ! t]m qualifi$ provid]      
means1 ) respect to a teleheal? s]vice  
describ$ 9 subp>agraph 7,a77i7 t is     
furni%$ to an eligible teleheal?        
individual1 a critical access hospital t
 has an e/abli%$ pati5t relation%ip )   
su* individual z def9$ by ! ,/ate 9 :i* 
! individual is locat$4  7,c7 ,paym5t ,!
 am\nt ( paym5t to a critical access    
hospital t s]ves z a di/ant site t      
furni%es a teleheal? s]vice to an       
eligible teleheal? individual "u ?is    
p>agraph %all be equal to #aja p]c5t ( !
 reasonable co/s ( ! hospital 9 provid+ 

su* s]vices1 unless ! hospital makes an 
election "u p>agraph 7#b7 ( section     
#ahcd7;g7 to be paid = su* s]vices bas$ 
on ! me?odology describ$ 9 su* p>agraph4
 ,teleheal? s]vices furni%$ by a        
critical access hospital %all be c\nt$ =
 purposes ( det]m9+ ! provid]           
productivity rate ( ! critical access   
hospital = purposes ( paym5t "u su*     
section4  7,d7 ,implem5tation ,not)/&+  
any o!r provision ( law1 ! ,secret>y may
 implem5t ?is p>agraph ?r\gh program    
in/ruction1 int]im f9al rule1 or        
o!rwise4  4  #aa4 ,effective date ,!    
am5dm5ts made by ?is ,act %all take     
effect on ! date ( ! enactm5t ( ?is     
,act4