,,ii  #aah? ,,congress  #a/ ,session    
,s4 #afcf  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,may #ag1 #bjbc,mr4    
,man*9 7= himself1 ,ms4 ,ern/1 ,mrs4    
,%ahe51 & ,mr4 ,moran7 introduc$ !      
foll[+ bill2 :i* 0 read twice & ref]r$  
to ! ,committee on ,f9ance  ,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 
! ,protect+ ,rural ,teleheal? ,access   
,act4  #b4 ,elim9ation ( re/rictions    
relat+ to teleheal? s]vices  7a7        
,elim9ation ( geographic requirem5ts =  
orig9at+ sites ,section                 
#ahcd7m77#d77;,c7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciem7m77#d77;,c77 
is am5d$-- 7#a7 9 clause 7i71 9 ! matt] 
prec$+ subclause 7,i71 by /rik+ clause  
7iii7 & ins]t+ clauses 7iii7 & 7iv72 &  
7#b7 by add+ at ! end ! foll[+ new      
clause3  7iv7 ,elim9ation ( geographic  
requirem5ts = orig9at+ sites ,!         
geographic requirem5ts describ$ 9 clause

 7i7 %all n apply ) respect to teleheal?
 s]vices furni%$ on or aft] ,janu>y #a1 
#bjbe4  4  7b7 ,elim9ation ( re/rictions
 9 :i* teleheal? s]vices may be furni%$ 
9 ! home ,section                       
#ahcd7m77#d77;,c77ii77,x7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4           
#aciem7m77#d77;,c77i77,x7 is am5d$ to   
read z foll[s34  7,x7 7aa7 ,= ! p]iod   
beg9n+ on ! date ( ! enactm5t ( ?is     
subclause & end+ on ,decemb] #ca1 #bjbd1
 ! home ( an individual b only =        
purposes ( section #ahha7;b77#c77;,b7 or
 teleheal? s]vices describ$ 9 p>agraph  
7#g74  7bb7 ,= ! p]iod beg9n+ on or aft]
 ,janu>y #a1 #bjbe1 ! home ( an         
individual4  4  7c7 ,elim9ation (       
re/rictions on /ore-&-,=w>d te*nologies 
,! second s5t5ce ( section #ahcd7m77#a7 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #aciem7m77#a77 is am5d$ by    
/rik+ 9 ! case ( any ,f$]al telem$ic9e  
demon/ration program conduct$ 9 ,alaska 
or ,hawaii14  #c4 ,teleheal?            
flexibilities = critical access         

hospitals ,section #ahcd7m7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4 #aciem7m77
 is am5d$-- 7#a7 9 ! fir/ s5t5ce (      
p>agraph 7#a71 by /rik+ & 7#i7 & ins]t+ 
7#i71 & 7#aj72  7#b7 9 p>agraph         
7#b77;,a71 by /rik+ p>agraph 7#h7 &     
ins]t+ p>agraphs 7#h7 & 7#aj72  7#c7 9  
p>agraph 7#d7-- 7,a7 9 subp>agraph 7,a71
 by /rik+ p>agraph 7#h7 & ins]t+        
p>agraphs 7#h7 & 7#aj72 &  7,b7 9       
subp>agraph 7,f77i71 by /rik+ p>agraph  
7#h7 & ins]t+ p>agraphs 7#h7 & 7#aj72 & 
7#d7 by add+ at ! end ! foll[+ new      
p>agraph3  7#aj7 ,teleheal?             
flexibilities = critical access         
hospitals  7,a7 ,9 g5]al ,on or aft] !  
date ( ! enactm5t ( ?is p>agraph-- 7i7 !
 ,secret>y %all pay = teleheal? s]vices 
t are furni%$ 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  #d4 ,ext5d+ ,m$ic>e        
teleheal? flexibilities = ,f$]ally      
qualifi$ heal? c5t]s & rural heal?      
cl9ics ,section #ahcd7m77#h7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#aciem7m77#h771 z am5d$ by section      
#daac7;c7 ( division ,,ff ( !           
,consolidat$ ,appropriations ,act1 #bjbc
 7,public ,law #aag-cbh7 is am5d$-- 7#a7
 9 subp>agraph 7,a71 9 ! matt] prec$+   
clause 7i71 by ins]t+ 1 & on or aft]    
,janu>y #a1 #bjbe aft] ,decemb] #ca1    
#bjbd2  7#b7 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 eligible teleheal?    
individual pursuant to ?is p>agraph or  
aft] ! date ( ! enactm5t ( ?is          
subp>agraph %all be reimburs$ "u ?is    
title at a sep>ate teleheal? paym5t rate
 z det]m9$ "u ! me?odology e/abli%$ by !
 ,secret>y pursuant to clause 7ii74     
7ii7 ,paym5t me?odology ,! ,secret>y    

%all e/abli% a me?odology = det]m9+ !   
appropriate paym5t rate = teleheal?     
s]vices describ$ 9 clause 7i74 ,su*     
me?odology %all consid]-- 7,i7 !        
geography ( ,f$]ally qualifi$ heal?     
c5t]s & rural heal? cl9ics2  7,,ii7 co/s
 associat$ ) ! deliv]y ( su* teleheal?  
s]vices z all[able co/s = ! c5t] or     
cl9ic2 &  7,,iii7 ! full co/ ( provid+ !
 s]vices via teleheal?4  7iii7          
,implem5tation  7,i7 ,cod+ sy/em ,!     
,secret>y %all e/abli% an effective cod+
 sy/em = teleheal? s]vices describ$ 9   
clause 7i7 t is reflective ( ! s]vices  
provid$ at a c5t] or cl9ic4  7,,ii7     
,implem5tation ,not)/&+ any o!r         
provision ( law1 ! ,secret>y may        
implem5t ?is subp>agraph ?r\gh program  
in/ruction1 int]im f9al rule1 or        
o!rwise4  2 &  7#c7 by add+ at ! end !  
foll[+ new subp>agraph3  7,c7           
,requirem5t dur+ additional p]iod  7i7  
,9 g5]al ,beg9n+ on ,janu>y #a1 #bjbe1  
paym5t may only be made "u ?is p>agraph 
= a teleheal? s]vice describ$ 9         

subp>agraph 7,a77i7 t is furni%$ to an  
eligible teleheal? individual if su*    
s]vice is furni%$ by a qualifi$ provid] 
7z def9$ 9 clause 7ii774  7ii7          
,def9ition ( qualifi$ provid] ,=        
purposes ( ?is subp>agraph1 ! 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 ,f$]ally        
qualifi$ heal? c5t] or rural heal? cl9ic
 t has an e/abli%$ pati5t relation%ip ) 
su* individual z def9$ by ! ,/ate 9 :i* 
! individual is locat$4  4  #e4         
,all[ance ( c]ta9 teleheal? s]vices     
furni%$ us+ audio-only te*nology        
,section #ahcd7m77#d7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#aciem7m77#d77 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #aciem7m77#d77 is   
am5d$ 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 on or aft] ,janu>y1 #bjbe1 !
 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$ ,subject to clause 7vi71
 a teleheal? s]vice describ$ 9 ?is      
clause is a teleheal? s]vice consi/+ (--
 7,i7 evaluation & managem5t s]vices2   
7,,ii7 behavioral heal? c\nsel+ &       
educational s]vices2 &  7,,iii7 o!r     
s]vices det]m9$ appropriate by !        
,secret>y4  7iv7 ,qualifi$ provid] def9$
  7,i7 ,9 g5]al ,= purposes ( clause    
7ii71 ! t]m qualifi$ provid] means1 )   
respect to a specifi$ teleheal? s]vice t
 is furni%$ to an eligible teleheal?    
individual-- 7aa7 a physician or        

practition] :o has an e/abli%$ pati5t   
relation%ip ) su* individual z def9$ by 
! ,/ate 9 :i* ! individual is locat$2 or
  7bb7 a critical access hospital 7z    
def9$ 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 ,review  7,i7 ,9 g5]al ,n lat] ?an 
#e ye>s aft] ! date ( ! enactm5t ( ?is  
subp>agraph1 ! ,secret>y %all conduct a 
review ( ! furni%+ ( specifi$ teleheal? 
s]vices ?r\gh audio-only te*nology      
pursuant to ?is p>agraph4 ,su* review   
%all include an analysis ( ! impact ( ! 
roll out ( broadb& te*nology & :e!r !   
use ( audio-only te*nology is necess>y  
to ensure access to su* teleheal?       
s]vices4  7,,ii7 ,r$et]m9ation (        
specifi$ teleheal? s]vices ,! ,secret>y 
may1 bas$ on ! review conduct$ "u       
subclause 7,i71 provide = ! addition or 
deletion ( s]vices 7& ,,hcpcs codes71 z 
appropriate1 to ^? specifi$ 9 clause    
7ii7 t may be furni%$ us+ audio-only    
te*nology & au?oriz$ = paym5t pursuant  
to ?is subp>agraph4  7vii7 ,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  #f4 ,s5se ( ,congress  
reg>d+ expansion ( eligible practition]s
 t may furni% teleheal? s]vices ,x is ! 
s5se ( ,congress t ! expansion (        
eligible practition]s t may furni%      
teleheal? s]vices 7z def9$ 9 section    
#ahcd7m77#d77;,f7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciem7m77#d77;,f777
 dur+ ! em]g5cy p]iod describ$ 9 section
 #aace7;g77#a77;,b7 ( su* ,act 7#db     
,u4,s4,c4 #acbj;b-#e7;g77#a77;,b77 %\ld 
be ext5d$ on a p]man5t basis4