,,ii #aagth ,,congress #b;d ,session ,s4 #ceic ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,february #h 7legislative day1 ,february #c71 #bjbb,ms4 ,cortez ,masto 7for herself and ,mr4 ,young7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend titles ,,xi and ,,xviii of the ,social ,security ,act to extend certain telehealth services covered by ,medicare and to evaluate the impact of telehealth services on ,medicare beneficiaries1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,in general ,this ,act may be cited as the ,telehealth ,extension and ,evaluation ,act4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4,sec4 #b4 ,extension of telehealth services4,sec4 #c4 ,temporary requirements for provision of high-cost durable medical equipment and laboratory tests4,sec4 #d4 ,requirement to submit ,,npi number for telehealth billing4,sec4 #e4 ,federally qualified health centers and rural health clinics4,sec4 #f4 ,telehealth flexibilities for critical access hospitals4,sec4 #g4 ,use of telehealth for the dispensing of controlled substances by means of the internet4,sec4 #h4 ,study on the effects of changes to telehealth under the ,medicare and ,medicaid programs during the ,,covid-#ai emergency4 #b4 ,extension of telehealth services ,section #aace7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#e7;e77 is amended by adding at the end the following new paragraph3 7#c7 ,two-year extension of telehealth services following the ,,covid-#ai emergency period ,notwithstanding any other provision of this section1 a waiver or modification of requirements pursuant to subsection 7b77#h7 shall terminate on the date that is #b years after the last day of the emergency period described in subsection 7g77#a77;,b74 4 #c4 ,temporary requirements for provision of high-cost durable medical equipment and laboratory tests 7a7 ,high-,cost durable medical equipment ,section #ahcd7;a77#a77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7a77#a77;,e77 is amended by adding at the end the following new clauses3 7vi7 ,standards for high-cost durable medical equipment 7,i7 ,limitation on payment for high-cost durable medical equipment ,during the #b-year period beginning on the day after the last day of the emergency period described in section #aace7;g77#a77;,b71 payment may not be made under this subsection for high-cost durable medical equipment ordered by a physician or other practitioner described in clause 7ii7 via telehealth for an individual1 unless such physician or practitioner furnished to such individual a service in person at least once during the #ab-month period prior to ordering such high-cost durable medical equipment4 7,,ii7 ,high-cost durable medical equipment defined ,for purposes of this clause1 the term high-cost durable medical equipment means1 with respect to a year1 durable medical equipment for which payment may be made under paragraphs 7#b7 through 7#h71 the price under the clinical lab fee schedule which for such year is in the highest quartile of national purchase prices of durable medical equipment payable for such year4 7vii7 ,audit of providers and practitioners furnishing a high volume of durable medical equipment via telehealth 7,i7 ,identification of providers ,during the #b-year period beginning on the day after the last day of the emergency period described in section #aace7;g77#a77;,b71 ,medicare administrative contractors shall conduct reviews1 on a schedule determined by the ,secretary1 of claims for durable medical equipment prescribed by a physician or other practitioner described in clause 7ii7 during the #ab-month period preceding such review to identify physicians or other practitioners with respect to whom at least #ij percent of all durable medical equipment prescribed by such physician or practitioner during such period was prescribed pursuant to a telehealth visit4 7,,ii7 ,audit ,in the case of a physician or practitioner identified under subclause 7,i71 with respect to a #ab-month period described in such subclause1 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 title4 4 7b7 ,high-,cost laboratory tests ,section #ahcd;,a7b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem-#a7;b77 is amended by adding at the end the following new paragraphs3 7#f7 ,requirement for high-cost laboratory tests 7,a7 ,limitation on payment for high-cost laboratory tests ,during the #b-year period beginning on the day after the last day of the emergency period described in section #aace7;g77#a77;,b71 payment may not be made under this subsection for a high-cost laboratory test ordered by a physician or practitioner via telehealth for an individual1 unless such physician or practitioner furnished to such individual a service in person at least once during the #ab-month period prior to ordering such high-cost laboratory test4 7,b7 ,high-cost laboratory test defined ,for purposes of this paragraph1 the term high-cost laboratory test means1 with respect to a year1 a laboratory test for which payment may be made under this section1 and the purchase price of which for such year is in the highest quartile of purchase prices of laboratory tests for such year4 7#g7 ,audit of laboratory testing ordered pursuant to telehealth visit 7,a7 ,identification of providers ,during the #b-year period beginning on the day after the last day of the emergency period described in section #aace7;g77#a77;,b71 ,medicare administrative contractors shall conduct periodic reviews1 on a schedule determined by the ,secretary1 of claims for laboratory tests prescribed by a physician or practitioner during the #ab-month period preceding such review to identify physicians or other practitioners with respect to whom at least #ij percent of all laboratory tests prescribed by such physician or practitioner during such period were prescribed pursuant to a telehealth visit4 7,b7 ,audit ,in the case of a physician or practitioner identified under subparagraph 7,a71 with respect to a #ab-month period described in such subparagraph1 the ,medicare administrative contractors shall conduct audits of all claims for laboratory tests prescribed by such physicians or practitioners during such period to determine whether such claims comply with the requirements for coverage under this title4 4 #d4 ,requirement to submit ,,npi number for telehealth billing ,section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77 is amended-- 7#a7 in the first sentence of paragraph 7#a71 by striking paragraph 7#h7 and inserting paragraphs 7#h7 and 7#i72 and 7#b7 by adding at the end the following new paragraph3 7#i7 ,requirement to submit ,,npi number for telehealth billing ,during the #b-year period beginning on the day after the last day of the emergency period described in section #aace7;g77#a77;,b71 payment may not be made under this subsection for 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 practitioner4 4 #e4 ,federally qualified health centers and rural health clinics ,section #ahcd7m77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#h77 is amended-- 7#a7 in the paragraph heading by inserting and the #b-year period after such emergency period after period2 7#b7 in subparagraph 7,a71 in the matter preceding clause 7i71 by inserting and the #b-year period immediately following such emergency period after #aace7;g77#a77;,b72 and 7#c7 by striking subparagraph 7,b7 and inserting the following3 7,b7 ,payment 7i7 ,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 7as applicable7 for purposes of paragraph 7#a7 or 7#c71 respectively1 of section #ahfa7;aa7 and payable as a ,federally qualified health center service or rural health clinic service 7as applicable7 under the prospective payment system established under section #ahcd7o7 or under section #ahcc7;a77#c71 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 #f4 ,telehealth flexibilities for critical access hospitals ,section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m771 as amended by section #d1 is amended-- 7#a7 in the first sentence of paragraph 7#a71 by striking and 7#i7 and inserting 1 7#i7 and 7#aj72 7#b7 in paragraph 7#b77;,a71 by striking paragraph 7#h7 and inserting paragraphs 7#h7 and 7#aj72 7#c7 in paragraph 7#d7-- 7,a7 in subparagraph 7,a71 by striking paragraph 7#h7 and inserting paragraphs 7#h7 and 7#aj72 7,b7 in subparagraph 7,f77i71 by striking paragraph 7#h7 and inserting paragraphs 7#h7 and 7#aj72 and 7#d7 by adding at the end the following new paragraph3 7#aj7 ,telehealth flexibilities for critical access hospitals 7,a7 ,in general ,during the period beginning on the date of the enactment of this paragraph and ending on the date that is #b years after the end of the emergency period described in section #aace7;g77#a77;,b71 the following shall apply3 7i7 ,the ,secretary shall pay for telehealth services that are furnished via a telecommunications system by a critical access hospital1 including any practitioner authorized to provide such services within the facility1 that is a qualified provider 7as defined in subparagraph 7,b77 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 beneficiary1 if such services complement a plan of care that includes in-person care at some point1 as may be appropriate4 7ii7 ,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 7,b74 7iii7 ,for purposes of this subsection-- 7,i7 the term distant site includes a critical access hospital that furnishes a telehealth service to an eligible telehealth individual2 7,,ii7 the term qualified provider means1 with respect to a telehealth service described in clause 7i7 that is furnished to an eligible telehealth individual1 a critical access hospital that has an established patient relationship with such individual as defined by the ,state in which the individual is located2 and 7,,iii7 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 7i7 or 7ii7 of paragraph 7#d77;,f7 are listed on the corresponding claim for such critical access hospital service4 7,b7 ,payment ,for purposes of subparagraph 7,a77ii71 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 #aja percent of the reasonable costs of the hospital in providing such services1 unless the hospital makes an election under paragraph 7#b7 of section #ahcd7;g7 to be paid for such services based on the methodology described in such paragraph4 ,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 section4 7,c7 ,implementation ,notwithstanding any other provision of law1 the ,secretary may implement this paragraph through program instruction1 interim final rule1 or otherwise4 4 #g4 ,use of telehealth for the dispensing of controlled substances 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 during the period beginning on the date of the enactment of this subclause and ending on the date that is #b years after the end of 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;,b771 for purposes of prescribing a controlled substance in schedules ,,ii through ,v1 #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 #h4 ,study on the effects of changes to telehealth under the ,medicare and ,medicaid programs during the ,,covid-#ai emergency 7a7 ,in general ,not later than #a year after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall conduct a study and submit to the ,committee on ,energy and ,commerce and the ,committee on ,ways and ,means of the ,house of ,representatives and the ,committee on ,finance of the ,senate an interim report on any changes made to the provision or availability of telehealth services under part ,a or ,b of title ,,xviii of the ,social ,security ,act 7including by reason of the amendments made to the ,controlled ,substances ,act under section #g7 since the start of 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;,b774 ,such report shall include the following3 7#a7 ,a summary of utilization of all health care services furnished under such part ,a or ,b during such emergency period1 including the number of telehealth visits 7broken down by service type1 the number of such visits furnished via audio-visual technology1 the number of such visits furnished via audio-only technology1 and the number of such visits furnished by a ,federally qualified health center1 rural health clinic1 or community health center1 respectively1 if practicable71 in-person outpatient visits1 inpatient admissions1 and emergency department visits4 7#b7 ,a description of any changes in utilization patterns for the care settings described in paragraph 7#a7 over the course of such emergency period compared to such patterns prior to such emergency period4 7#c7 ,an analysis of utilization of telehealth services under such part ,a or ,b during such emergency period1 broken down by race and ethnicity1 geographic region1 and income level 7as measured directly or indirectly1 such as by patient's zip code tabulation area median income as publicly reported by the ,united ,states ,census ,bureau71 and of any trends in such utilization during such emergency period1 so broken down4 ,such analysis may not include any personally identifiable information or protected health information4 7#d7 ,a description of expenditures and any savings under such part ,a or ,b attributable to use of such telehealth services during such emergency period4 7#e7 ,a description of any instances of fraud identified by the ,secretary1 acting through the ,office of the ,inspector ,general or other relevant agencies and departments1 with respect to such telehealth services furnished under such part ,a or ,b during such emergency period and a comparison of the number of such instances with the number of instances of fraud so identified with respect to in-person services so furnished during such emergency period4 7#f7 ,a description of any privacy concerns with respect to the furnishing of such telehealth services 7such as cybersecurity or ransomware concerns71 including a description of any actions taken by the ,secretary1 acting through the ,health ,sector ,cybersecurity ,coordination ,center or other relevant agencies and departments1 during such emergency period to assist health care providers secure telecommunications systems4 7#g7 ,identification of common ,,icd-#aj codes billed via telehealth1 comparing measures of quality and outcomes between telehealth care and in-person care for the same category of service4 7#h7 ,recommendations regarding the permanency of the waivers and authorities under the provisions of1 and amendments made by1 this ,act4 7b7 ,consultation ,in conducting the study and submitting the report under subsection 7a71 the ,secretary-- 7#a7 shall consult with-- 7,a7 the ,medicaid and ,,chip ,payment and ,access ,commission2 7,b7 the ,medicare ,payment ,advisory ,commission2 7,c7 the ,office of ,inspector ,general of the ,department of ,health and ,human ,services2 and 7,d7 other stakeholders determined appropriate by the ,secretary1 such as patients1 tribal communities1 medical professionals1 health facilities1 ,state medical boards1 ,state nursing boards1 telehealth providers1 health professional liability providers1 public and private payers1 and ,state leaders2 and 7#b7 shall endeavor to include as many racially1 ethnically1 geographically1 and professionally diverse perspectives as possible4 7c7 ,final report ,not later than #ah months after the end of 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;,b771 the ,secretary shall-- 7#a7 update and finalize the interim report under subsection 7a72 and 7#b7 submit such updated and finalized report to the committees specified in such subsection4 7d7 ,grants for ,medicaid reports 7#a7 ,in general ,not later than ,january #a1 #bjbc1 the ,secretary shall award grants to ,states with a ,state plan 7or waiver of such plan7 in effect under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr7 that submit an application under this subsection for purposes of enabling such ,states to study and submit reports to the ,secretary on any changes made to the provision or availability of telehealth services under such plans 7or such waivers7 during such period4 7#b7 ,eligibility ,to be eligible to receive a grant under paragraph 7#a71 a ,state shall-- 7,a7 provide benefits for telehealth services under the ,state plan 7or waiver of such plan7 in effect under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr72 7,b7 be able to differentiate telehealth from in-person visits within claims data submitted under such plan 7or such waiver7 during such period2 and 7,c7 submit to the ,secretary an application at such time1 in such manner1 and containing such information 7including the amount of the grant requested7 as the ,secretary may require4 7#c7 ,use of funds ,a ,state shall use amounts received under a grant under this subsection to conduct a study and report findings regarding the effects of changes to telehealth services offered under the ,state plan 7or waiver of such plan7 of such ,state under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 during such period in accordance with paragraph 7#d74 7#d7 ,reports 7,a7 ,interim report ,not later #a year after the date a ,state receives a grant under this subsection1 the ,state shall submit to the ,secretary an interim report that-- 7i7 details any changes made to the provision or availability of telehealth benefits 7such as eligibility1 coverage1 or payment changes7 under the ,state plan 7or waiver of such plan7 of the ,state under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 during the emergency period described in paragraph 7#a72 and 7ii7 contains-- 7,i7 a summary and description of the type described in paragraphs 7#a7 and 7#b71 respectively1 of subsection 7a72 and 7,,ii7 to the extent practicable1 an analysis of the type described in paragraph 7#c7 of subsection 7a71 except that any reference in such subsection to such part ,a or ,b shall1 for purposes of subclauses 7,i7 and 7,,ii71 be treated as a reference to such ,state plan 7or waiver74 7,b7 ,final report ,not later than #c years after the date a ,state receives a grant under this subsection1 the ,state shall update and finalize the interim report and submit such final report to the ,secretary4 7,c7 ,report by ,secretary ,not later than the earlier of the date that is #a year after the submission of all final reports under subparagraph 7,b7 and ,december #ca1 #bjbg1 the ,secretary shall submit to ,congress a report on the grant program1 including a summary of the reports received from ,states under this paragraph4 7#e7 ,modification authority ,the ,secretary may modify any deadline described in paragraph 7#d7 or any information required to be included in a report made under this subsection to provide flexibility for ,states to modify the scope of the study and timeline for such reports4 7#f7 ,technical assistance ,the ,secretary shall provide such technical assistance as may be necessary to a ,state receiving a grant under this subsection in order to assist such ,state in conducting studies and submitting reports under this subsection4 7#g7 ,state ,for purposes of this subsection1 the term ,state means each of the several ,states1 the ,district of ,columbia1 and each territory of the ,united ,states4 7e7 ,authorization of appropriations 7#a7 ,medicare ,for the purpose of carrying out subsections 7a7 through 7c71 there are authorized to be appropriated such sums as may be necessary for each of fiscal years #bjbb through #bjbf4 7#b7 ,medicaid ,for the purpose of carrying out subsection 7d71 there are authorized to be appropriated such sums as may be necessary for each of fiscal years #bjbc through #bjbg4