,,ii #aahth ,,congress #ast ,session ,s4 #afcf ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #ag1 #bjbc,mr4 ,manchin 7for himself1 ,ms4 ,ernst1 ,mrs4 ,shaheen1 and ,mr4 ,moran7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to protect access to telehealth services under the ,medicare program4 #a4 ,short title ,this ,act may be cited as the ,protecting ,rural ,telehealth ,access ,act4 #b4 ,elimination of restrictions relating to telehealth services 7a7 ,elimination of geographic requirements for originating sites ,section #ahcd7m77#d77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,c77 is amended-- 7#a7 in clause 7i71 in the matter preceding subclause 7,i71 by striking clause 7iii7 and inserting clauses 7iii7 and 7iv72 and 7#b7 by adding at the end the following new clause3 7iv7 ,elimination of geographic requirements for originating sites ,the geographic requirements described in clause 7i7 shall not apply with respect to telehealth services furnished on or after ,january #a1 #bjbe4 4 7b7 ,elimination of restrictions in which telehealth services may be furnished in the home ,section #ahcd7m77#d77;,c77ii77,x7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,c77i77,x7 is amended to read as follows34 7,x7 7aa7 ,for the period beginning on the date of the enactment of this subclause and ending on ,december #ca1 #bjbd1 the home of an individual but only for purposes of section #ahha7;b77#c77;,b7 or telehealth services described in paragraph 7#g74 7bb7 ,for the period beginning on or after ,january #a1 #bjbe1 the home of an individual4 4 7c7 ,elimination of restrictions on store-and-,forward technologies ,the second sentence of section #ahcd7m77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#a77 is amended by striking in the case of any ,federal telemedicine demonstration program conducted in ,alaska or ,hawaii14 #c4 ,telehealth flexibilities for critical access hospitals ,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 and 7#i7 and inserting 7#i71 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 and 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 ,on or after the date of the enactment of this paragraph-- 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 appropriate2 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,c72 and 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 and 7,,ii7 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 ,definition of qualified provider ,for purposes of this subsection1 the term qualified provider means1 with respect to a telehealth service described in subparagraph 7,a77i7 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 located4 7,c7 ,payment ,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,d7 ,implementation ,notwithstanding any other provision of law1 the ,secretary may implement this paragraph through program instruction1 interim final rule1 or otherwise4 4 #d4 ,extending ,medicare telehealth flexibilities for ,federally qualified health centers and rural health clinics ,section #ahcd7m77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#h771 as amended by section #daac7;c7 of division ,,ff of the ,consolidated ,appropriations ,act1 #bjbc 7,public ,law #aag-cbh7 is amended-- 7#a7 in subparagraph 7,a71 in the matter preceding clause 7i71 by inserting 1 and on or after ,january #a1 #bjbe after ,december #ca1 #bjbd2 7#b7 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 eligible telehealth individual pursuant to this paragraph or after the date of the enactment of this subparagraph shall be reimbursed under this title at a separate telehealth payment rate as determined under the methodology established by the ,secretary pursuant to clause 7ii74 7ii7 ,payment methodology ,the ,secretary shall establish a methodology for determining the appropriate payment rate for telehealth services described in clause 7i74 ,such methodology shall consider-- 7,i7 the geography of ,federally qualified health centers and rural health clinics2 7,,ii7 costs associated with the delivery of such telehealth services as allowable costs for the center or clinic2 and 7,,iii7 the full cost of providing the services via telehealth4 7iii7 ,implementation 7,i7 ,coding system ,the ,secretary shall establish an effective coding system for telehealth services described in clause 7i7 that is reflective of the services provided at a center or clinic4 7,,ii7 ,implementation ,notwithstanding any other provision of law1 the ,secretary may implement this subparagraph through program instruction1 interim final rule1 or otherwise4 2 and 7#c7 by adding at the end the following new subparagraph3 7,c7 ,requirement during additional period 7i7 ,in general ,beginning on ,january #a1 #bjbe1 payment may only be made under this paragraph for a telehealth service described in subparagraph 7,a77i7 that is furnished to an eligible telehealth individual if such service is furnished by a qualified provider 7as defined in clause 7ii774 7ii7 ,definition of qualified provider ,for purposes of this subparagraph1 the term qualified provider means1 with respect to a telehealth service described in subparagraph 7,a77i7 that is furnished to an eligible telehealth individual1 a ,federally qualified health center or rural health clinic that has an established patient relationship with such individual as defined by the ,state in which the individual is located4 4 #e4 ,allowance of certain telehealth services furnished using audio-only technology ,section #ahcd7m77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77 is amended by adding at the end the following new subparagraph3 7,g7 ,telecommunications system 7i7 ,in general ,notwithstanding paragraph 7#a7 and section #daj4gh7;a77#c7 of title #db1 ,code of ,federal ,regulations 7or any successor regulation71 subject to clause 7v71 on or after ,january1 #bjbe1 the term telecommunications system includes1 in the case of the furnishing of a specified telehealth service 7as defined in clause 7ii77 a communications system that uses audio-only technology4 7ii7 ,specified telehealth service ,in this subparagraph1 the term specified telehealth service means a telehealth service described in clause 7iii7 that is furnished by a qualified provider 7as defined in clause 7iv774 7iii7 ,telehealth service described ,subject to clause 7vi71 a telehealth service described in this clause is a telehealth service consisting of-- 7,i7 evaluation and management services2 7,,ii7 behavioral health counseling and educational services2 and 7,,iii7 other services determined appropriate by the ,secretary4 7iv7 ,qualified provider defined 7,i7 ,in general ,for purposes of clause 7ii71 the term qualified provider means1 with respect to a specified telehealth service that is furnished to an eligible telehealth individual-- 7aa7 a physician or practitioner who has an established patient relationship with such individual as defined by the ,state in which the individual is located2 or 7bb7 a critical access hospital 7as defined in section #ahfa7mm77#a771 a rural health clinic 7as defined in section #ahfa7;aa77#b771 a ,federally qualified health center 7as defined in section #ahfa7;aa77#d771 a hospital 7as defined in section #ahfa7;e771 a hospital-based or critical access hospital-based renal dialysis center 7including satellites71 a skilled nursing facility 7as defined in section #ahai7;a771 a community mental health center 7as defined in section #ahfa7;ff77#c77;,b771 or a rural emergency hospital 7as defined in section #ahfa7kkk77#b774 7v7 ,authority ,for purposes of this subparagraph1 the ,secretary may determine whether it is clinically appropriate to furnish a specified telehealth service via a communications system that uses audio-only technology and whether an in-person initial visit 7in addition to any requirement with respect to the furnishing of an item or service in person pursuant to clause 7iv77,i77 is required prior to the furnishing of such service using such technology4 7vi7 ,review 7,i7 ,in general ,not later than #e years after the date of the enactment of this subparagraph1 the ,secretary shall conduct a review of the furnishing of specified telehealth services through audio-only technology pursuant to this paragraph4 ,such review shall include an analysis of the impact of the roll out of broadband technology and whether the use of audio-only technology is necessary to ensure access to such telehealth services4 7,,ii7 ,redetermination of specified telehealth services ,the ,secretary may1 based on the review conducted under subclause 7,i71 provide for the addition or deletion of services 7and ,,hcpcs codes71 as appropriate1 to those specified in clause 7ii7 that may be furnished using audio-only technology and authorized for payment pursuant to this subparagraph4 7vii7 ,clarification regarding payment ,the amount of payment for a specified telehealth service that is furnished using audio-only technology shall be equal to the amount that would have been paid for such service under this subsection had such service been furnished via any other telecommunications system authorized under this subsection4 4 #f4 ,sense of ,congress regarding expansion of eligible practitioners that may furnish telehealth services ,it is the sense of ,congress that the expansion of eligible practitioners that may furnish telehealth services 7as defined in section #ahcd7m77#d77;,f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,f777 during the emergency period described in section #aace7;g77#a77;,b7 of such ,act 7#db ,u4,s4,c4 #acbj;b-#e7;g77#a77;,b77 should be extended on a permanent basis4