,,ii  #aah? ,,congress  #a/ ,session    
,s4 #bjaf  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,june #ae1 #bjbc ,mr4  
,s*atz 7= himself1 ,mr4 ,wick]1 ,mr4    
,c>d91 ,mr4 ,?une1 ,mr4 ,w>n]1 ,mrs4    
,hyde-,smi?1 ,mr4 ,k+1 ,mrs4 ,capito1   
,mr4 ,m]kley1 ,mr4 ,r\nds1 ,mr4 ,casey1 
,ms4 ,coll9s1 ,mr4 ,kelly1 ,mr4 ,scott (
 ,s\? ,c>ol9a1 ,ms4 ,w>r51 ,mr4 ,lank=d1
 ,mrs4 ,%ahe51 ,mr4 ,cram]1 ,mrs4       
,gillibr&1 ,mr4 ,tub]ville1 ,mr4 ,wel*1 
,mr4 ,tillis1 ,ms4 ,duckwor?1 ,mrs4     
,fis*]1 ,mr4 ,blum5?al1 ,ms4 ,murk[ski1 
,ms4 ,ros51 ,mr4 ,sullivan1 ,mr4 ,van   
,holl51 ,mr4 ,da9es1 ,ms4 ,cantwell1    
,ms4 ,lummis1 ,ms4 ,s9ema1 ,mr4 ,hoev51 
,mr4 ,hick5loop]1 ,mr4 ,boozman1 ,mr4   
,te/]1 ,mr4 ,vance1 ,mr4 ,:iteh\se1 ,mr4
 ,cassidy1 ,mr4 ,s&]s1 ,mr4 ,graham1    
,mr4 ,b5net1 ,mrs4 ,britt1 ,ms4 ,smi?1  
,mr4 ,b>rasso1 ,ms4 ,klobu*>1 ,mr4      
,grassley1 ,mr4 ,padilla1 ,mr4 ,moran1  
,mr4 ,ka9e1 ,mr4 ,"y1 ,mr4 ,w>nock1 ,mr4
 ,rubio1 ,mr4 ,he9ri*1 ,mr4 ,cotton1    
,mr4 ,c>p]1 ,mr4 ,mull91 ,mr4 ,book]1 & 

,mr4 ,m>%all7 introduc$ ! foll[+ bill2  
:i* 0 read twice & ref]r$ to !          
,committee on ,f9ance  ,a ,,bill  ,to   
am5d title ,,xviii ( ! ,social ,security
 ,act to exp& access to teleheal?       
s]vices1 & = o!r purposes4  #a4 ,%ort   
title2 table ( cont5ts  7a7 ,%ort title 
,?is ,act may be cit$ z ! ,creat+       
,opportunities ,n[ = ,necess>y &        
,effective ,c>e ,te*nologies 7,,connect7
 = ,heal? ,act ( #bjbc or ! ,,connect = 
,heal? ,act ( #bjbc4  7b7 ,table (      
cont5ts ,! table ( cont5ts ( ?is ,act is
 z foll[s3  ,sec4 #a4 ,%ort title2 table
 ( cont5ts4 ,sec4 #b4 ,f9d+s & s5se (   
,congress4 ,,title ,i--,remov+ b>ri]s to
 teleheal? cov]age ,sec4 #aja4 ,remov+  
geographic requirem5ts = teleheal?      
s]vices4 ,sec4 #ajb4 ,exp&+ orig9at+    
sites4 ,sec4 #ajc4 ,exp&+ au?ority =    
practition]s eligible to furni%         
teleheal? s]vices4 ,sec4 #ajd4          
,improvem5ts to ! process = add+        
teleheal? s]vices4 ,sec4 #aje4 ,f$]ally 
qualifi$ heal? c5t]s & rural heal?      

cl9ics4 ,sec4 #ajf4 ,native ,am]ican    
heal? facilities4 ,sec4 #ajg4 ,repeal ( 
six-mon? 9-p]son visit requirem5t =     
telem5tal heal? s]vices4 ,sec4 #ajh4    
,waiv] ( teleheal? requirem5ts dur+     
public heal? em]g5cies4 ,sec4 #aji4 ,use
 ( teleheal? 9 rec]tification = hospice 
c>e4 ,,title ,,ii--,program integrity   
,sec4 #bja4 ,cl>ification = fraud &     
abuse laws reg>d+ te*nologies provid$ to
 b5efici>ies4 ,sec4 #bjb4 ,additional   
res\rces = teleheal? ov]sight4 ,sec4    
#bjc4 ,address+ significant outli] bill+
 patt]ns = teleheal? s]vices4 ,,title   
,,iii--,b5efici>y & provid] supports1   
quality ( c>e1 & data ,sec4 #cja4       
,b5efici>y engagem5t on teleheal?4 ,sec4
 #cjb4 ,provid] supports on teleheal?4  
,sec4 #cjc4 ,ensur+ ! inclusion (       
teleheal? 9 measur+ quality ( c>e4 ,sec4
 #cjd4 ,po/+ ( in=mation on teleheal?   
s]vices4  #b4 ,f9d+s & s5se ( ,congress 
7a7 ,f9d+s ,congress f9ds ! foll[+3 7#a7
 ,! use ( te*nology 9 heal? c>e &       
cov]age ( teleheal? s]vices are rapidly 

evolv+4  7#b7 ,rese>* has f\nd t        
teleheal? s]vices c exp& access to c>e1 
improve ! quality ( c>e1 & r$uce sp5d+4 
7#c7 ,9 #bjba1 #ia p]c5t ( pati5ts      
receiv+ teleheal? s]vices 7 satisfi$ )  
_! exp]i5ces4  7#d7 ,heal? c>e work=ce  
%ortages are a significant problem 9 _m 
areas & = _m types ( heal? c>e          
cl9icians4  7#e7 ,teleheal? increases   
access to c>e 9 areas ) work=ce %ortages
 & = individuals :o live f> away f heal?
 c>e facilities1 h limit$ mobility or   
transportation1 or h o!r b>ri]s to      
access+ c>e4  7#f7 ,! use ( heal?       
te*nologies c /r5g!n ! exp]tise ( !     
heal? c>e work=ce1 includ+ by connect+  
cl9icians to specialty consultations4   
7#g7 ,prior to ! ,,covid-#ai p&emic1 !  
utilization ( teleheal? s]vices 9 !     
,m$ic>e program "u title ,,xviii ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acie et seq47 0 l[1 acc\nt+ = #j4a     
p]c5t ( ,m$ic>e ,"p ,b visits 9 #bjai4  
7#h7 ,teleheal? n[ repres5ts a critical 
compon5t ( c>e deliv]y4 ,z ( ,febru>y   

#bjbc1 #ae p]c5t ( ,m$ic>e fee-=-s]vice 
b5efici>ies h _h a teleheal? s]vice 9 ! 
pa/ qu>t]4  7#i7 ,long-t]m c]ta9ty ab\t 
cov]age ( teleheal? s]vices "u ! ,m$ic>e
 program is necess>y to fully realize ! 
b5efits ( teleheal?4  7b7 ,s5se (       
,congress ,x is ! s5se ( ,congress t--  
7#a7 heal? c>e provid]s c furni% safe1  
effective1 & high-quality heal? c>e     
s]vices ?r\gh teleheal?2  7#b7 !        
,secret>y ( ,heal? & ,human ,s]vices    
%\ld promptly take all necess>y measures
 to ensure t provid]s & b5efici>ies c   
cont9ue to furni% & utilize1            
respectively1 teleheal? s]vices 9 !     
,m$ic>e program1 includ+ modify+1 z     
appropriate1 ! def9ition ( int]active   
telecommunications sy/em 9 regulations &
 program in/ruction "u ! ,m$ic>e program
 to ensure t provid]s c utilize all     
appropriate means & types ( te*nology1  
includ+ audio-visual1 audio-only1 & o!r 
types ( te*nologies1 to furni% teleheal?
 s]vices2 &  7#c7 b>ri]s to ! use (     
teleheal? %\ld be remov$4  ,i ,remov+   

b>ri]s to teleheal? cov]age  #aja4      
,remov+ geographic requirem5ts =        
teleheal? s]vices ,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 ,removal ( geographic     
requirem5ts ,! geographic requirem5ts   
describ$ 9 clause 7i7 %all n apply )    
respect to teleheal? s]vices furni%$ on 
or aft] ,janu>y #a1 #bjbe4  4  #ajb4    
,exp&+ orig9at+ sites  7a7 ,exp&+ ! home
 z an orig9at+ site ,section            
#ahcd7m77#d77;,c77ii77,x7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4           
#aciem7m77#d77;,c77ii77,x77 is am5d$ to 
read z foll[s3  7,x7 7aa7 ,prior to     
,janu>y #a1 #bjbe1 ! home ( an          
individual b only = purposes ( section  
#ahha7;b77#c77;,b7 or teleheal? s]vices 
describ$ 9 p>agraph 7#g74  7bb7 ,on or  
aft] ,janu>y #a1 #bjbe1 ! home ( an     

individual4 ,= purposes ( ! prec$+      
s5t5ce1 ! home ( an individual includes 
tempor>y lodg+ &1 9 ! case :]e1 =       
privacy or o!r p]sonal reasons1 an      
individual *ooses to travel a %ort      
di/ance f ! home = ! furni%+ ( a        
teleheal? s]vice1 includes su* location1
 z describ$ 9 ! f9al rule entitl$       
,m$ic>e ,program2 ,,cy #bjbb ,paym5t    
,policies ,"u ! ,physician ,fee ,s*$ule 
& ,o!r ,*anges to ,"p ,b ,paym5t        
,policies2 ,m$ic>e ,%>$ ,sav+s ,program 
,requirem5ts2 ,provid] ,enrollm5t       
,regulation ,updates2 & ,provid] &      
,suppli] ,prepaym5t & ,po/-,paym5t      
,m$ical ,review ,requirem5ts publi%$ 9 !
 ,f$]al ,regi/] on ,novemb] #ai1 #bjba  
7#hf ,f$4 ,reg4 #fdiif71 or a successor 
regulation4  4  7b7 ,all[+ additional   
orig9at+ sites ,section                 
#ahcd7m77#d77;,c77ii7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#aciem7m77#d77;,c77ii77 is am5d$ by add+
 at ! end ! foll[+ new subclause3       
7,,xii7 ,any o!r cl9ically appropriate  

site at :i* an eligible teleheal?       
individual is locat$ at ! "t a teleheal?
 s]vice is furni%$ via a                
telecommunications sy/em4 ,n lat] ?an   
,janu>y #a1 #bjbe1 ! ,secret>y %all     
issue regulations t e/abli% p>amet]s = !
 det]m9ation ( :e!r a site is cl9ically 
appropriate = purposes ( ! prec$+       
s5t5ce4  4  7c7 ,p>amet]s = new orig9at+
 sites ,section #ahcd7m77#d77;,c7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7m77#d77;,c771 z am5d$ by section 
#aja1 is am5d$ by add+ at ! end ! foll[+
 new clause3  7v7 ,requirem5ts = new    
sites  7,i7 ,9 g5]al ,! ,secret>y may   
e/abli% requirem5ts = ! furni%+ (       
teleheal? s]vices at sites describ$ 9   
clause 7ii77,,xii7 to provide =         
b5efici>y & program integrity           
protections4  7,,ii7 ,rule ( con/ruction
 ,no?+ 9 ?is clause %all be con/ru$ to  
preclude ! ,secret>y f e/abli%+         
requirem5ts = o!r orig9at+ sites        
describ$ 9 clause 7ii7  4  7d7 ,no      
orig9at+ site facility fee = new sites  

,section #ahcd7m77#b77;,b77ii7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7m77#b77;,b77ii77 is am5d$-- 7#a7 
9 ! head+1 by /rik+ if orig9at+ site is 
! home & ins]t+ = c]ta9 sites2 &  7#b7  
by /rik+ p>agraph 7#d77;,c77ii77,x7 &   
ins]t+ subclause 7,x7 or 7,,xii7 (      
p>agraph 7#d77;,c77ii74  #ajc4 ,exp&+   
au?ority = practition]s eligible to     
furni% teleheal? s]vices ,section       
#ahcd7m77#d77;,e7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciem7m77#d77;,e77 
is am5d$--  7#a7 by /rik+               
,practition]4--,! t]m & ins]t+          
8,practition]4--  7i7 ,9 g5]al ,subject 
to clause 7ii71 ! t]m  2 &  7#b7 by add+
 at ! end ! foll[+ new clause3  7ii7    
,exp&+ practition]s eligible to furni%  
teleheal? s]vices  7,i7 ,9 g5]al        
,not)/&+ any o!r provision ( ?is        
subsection1 9 ! case ( teleheal? s]vices
 furni%$ on or aft] ,janu>y #a1 #bjbd1 !
 ,secret>y may waive any limitation on !
 types ( practition]s :o are eligible to
 furni% teleheal? s]vices 7o!r ?an !    

requirem5t t ! practition] is enroll$ "u
 section #ahff7;j77 if ! ,secret>y      
det]m9es t su* waiv] is cl9ically       
appropriate4  7,,ii7 ,implem5tation ,9  
implem5t+ a waiv] "u ?is clause1 !      
,secret>y may e/abli% p>amet]s1 z       
appropriate1 = teleheal? s]vices "u su* 
waiv]1 includ+ ) respect to b5efici>y & 
program integrity protections4  7,,iii7 
,public comm5t ,! ,secret>y %all e/abli%
 a process by :i* /akehold]s may 7on at 
lea/ an annual basis7 provide public    
comm5t on su* waiv] "u ?is clause4      
7,,iv7 ,p]iodic review ,! ,secret>y %all
 p]iodically1 b n m frequ5tly ?an e #c  
ye>s1 reassess ! waiv] "u ?is clause to 
det]m9e :e!r su* waiv] cont9ues to be   
cl9ically appropriate4 ,! ,secret>y %all
 t]m9ate any waiv] t ! ,secret>y        
det]m9es is no long] cl9ically          
appropriate4  4  #ajd4 ,improvem5ts to !
 process = add+ teleheal? s]vices  7a7  
,review ,! ,secret>y %all und]take a    
review ( ! process e/abli%$ pursuant to 
section #ahcd7m77#d77;,f77ii7 ( !       

,social ,security ,act 7#db ,u4,s4,c4   
#aciem7m77#d77;,f77ii771 & bas$ on !    
results ( su* review--  7#a7 implem5t   
revisions to ! process s t ! crit]ia to 
add s]vices prioritizes1 z appropriate1 
improv$ access to c>e ?r\gh cl9ically   
appropriate teleheal? s]vices2 &  7#b7  
provide cl>ification on :at reque/s to  
add teleheal? s]vices "u su* process    
%\ld include4  7b7 ,tempor>y cov]age (  
c]ta9 teleheal? s]vices ,section        
#ahcd7m77#d77;,f7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciem7m77#d77;,f77 
is am5d$ by add+ at ! end ! foll[+ new  
clause3  7iii7 ,tempor>y cov]age ( c]ta9
 teleheal? s]vices ,! ,secret>y may add 
s]vices ) a reasonable pot5tial         
likelihood ( cl9ical b5efit & improv$   
access to c>e :5 furni%$ via a          
telecommunications sy/em 7z det]m9$ by !
 ,secret>y7 on a tempor>y basis to ^?   
specifi$ 9 clause 7i7 = au?oriz$ paym5t 
"u p>agraph 7#a74  4  #aje4 ,f$]ally    
qualifi$ heal? c5t]s & rural heal?      
cl9ics ,section #ahcd7m7 ( ! ,social    

,security ,act 7#db ,u4,s4,c4 #aciem7m77
 is am5d$-- 7#a7 9 p>agraph             
7#d77;,c77i71 9 ! matt] prec$+ subclause
 7,i71 by /rik+ & 7#g7 & ins]t+ 7#g71 & 
7#h72 &  7#b7 9 p>agraph 7#h7-- 7,a7 9  
subp>agraph 7,a7--  7i7 9 ! matt] prec$+
 clause 7i71 by /rik+ ,dur+ & all t     
foll[s ?r\gh ,decemb] #ca1 #bjbd-- &    
ins]t+ ! foll[+3 ,dur+ & aft] ! em]g5cy 
p]iod describ$ 9 section                
#aace7;g77#a77;,b7--2  7ii7 9 clause    
7ii71 by /rik+ & at ! end2  7iii7 by    
r$esignat+ clause 7iii7 z clause 7iv72 &
  7iv7 by ins]t+ aft] clause 7ii7 !     
foll[+ new clause3  7iii7 ! geographic  
requirem5ts describ$ 9 p>agraph         
7#d77;,c77i7 %all n apply ) respect to  
su* a teleheal? s]vice2 &  2 &  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 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  #ajf4  
,native ,am]ican heal? facilities  7a7  
,9 g5]al ,section #ahcd7m77#d77;,c7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7m77#d77;,c771 z am5d$ by sections
 #aja & #ajb1 is am5d$-- 7#a7 9 clause  

7i71 by /rik+ & 7iv7 & ins]t+ 1 7iv71 & 
7vi72 &  7#b7 by add+ at ! end ! foll[+ 
new clause3  7vi7 ,native ,am]ican heal?
 facilities ,) respect to teleheal?     
s]vices furni%$ on or aft] ,janu>y #a1  
#bjbd1 ! orig9at+ site requirem5ts      
describ$ 9 clauses 7i7 & 7ii7 %all n    
apply ) respect to a facility ( !       
,indian ,heal? ,s]vice1 :e!r op]at$ by  
su* ,s]vice1 or by an ,indian tribe 7z t
 t]m is def9$ 9 section #d ( ! ,indian  
,heal? ,c>e ,improvem5t ,act 7#be       
,u4,s4,c4 #afjc77 or a tribal           
organization 7z t t]m is def9$ 9 section
 #d ( ! ,indian ,self-,det]m9ation &    
,education ,assi/ance ,act 7#be         
,u4,s4,c4 #ecjd771 or a facility ( !    
,native ,hawaiian heal? c>e sy/ems      
au?oriz$ "u ! ,native ,hawaiian ,heal?  
,c>e ,improvem5t ,act 7#db ,u4,s4,c4    
#aagja et seq474  4  7b7 ,no orig9at+   
site facility fee = ,c]ta9 ,native      
,am]ican facilities ,section            
#ahcd7m77#b77;,b77i7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           

#aciem7m77#b77;,b77i77 is am5d$1 9 !    
matt] prec$+ subclause 7,i71 by ins]t+  
7o!r ?an an orig9at+ site t is only     
describ$ 9 clause 7v7 ( p>agraph        
7#d77;,c71 & does n meet ! requirem5t = 
an orig9at+ site "u clauses 7i7 & 7ii7 (
 su* p>agraph7 aft] ! orig9at+ site4    
#ajg4 ,repeal ( six-mon? 9-p]son visit  
requirem5t = telem5tal heal? s]vices    
,section #ahcd7m77#g7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#aciem7m77#g77;,b77 is am5d$--  7#a7 9  
subp>agraph 7,a71 by /rik+ 1 subject to 
subp>agraph 7,b712  7#b7 by /rik+ 7,a7  
,9 g5]al4--,! geographic & ins]t+ ,!    
geographic2 &  7#c7 by /rik+ subp>agraph
 7,b74  #ajh4 ,waiv] ( teleheal?        
requirem5ts dur+ public heal? em]g5cies 
,section #aace7;g77#a7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acbj;b-#e7;g77#a77 is am5d$--  7#a7 9  
subp>agraph 7,a71 9 ! matt] prec$+      
clause 7i71 by /rik+ subp>agraph 7,b7 & 
ins]t+ subp>agraphs 7,b7 & 7,c72 &  7#b7
 by add+ at ! end ! foll[+ new          

subp>agraph3  7,c7 ,exception = waiv] ( 
teleheal? requirem5ts dur+ public heal? 
em]g5cies ,= purposes ( subsection      
7b77#h71 9 addition to ! em]g5cy p]iod  
describ$ 9 subp>agraph 7,b71 an em]g5cy 
area is a geographical area 9 :i*1 & an 
em]g5cy p]iod is ! p]iod dur+ :i*1 !re  
exi/s a public heal? em]g5cy decl>$ by !
 ,secret>y pursuant to section #cai ( ! 
,public ,heal? ,s]vice ,act4  4  #aji4  
,use ( teleheal? 9 rec]tification =     
hospice c>e  7a7 ,9 g5]al ,section      
#ahad7;a77#g77;,d77i77,,ii7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acie;f7a77#g77;,d77i77,,ii77 is am5d$  
by /rik+ dur+ ! em]g5cy p]iod & all t   
foll[s ?r\gh end+ on ,decemb] #ca1 #bjbd
 & ins]t+ ! foll[+3 dur+ & aft] !       
em]g5cy p]iod describ$ 9 section        
#aace7;g77#a77;,b74  7b7 ,national      
,academy ( ,m$ic9e report ,! ,secret>y (
 ,heal? & ,human ,s]vices %all reque/ ! 
,national ,academy ( ,m$ic9e to submit a
 report to ,congress1 n lat] ?an #c ye>s
 aft] ! date ( enactm5t ( ?is ,act1     

evaluat+ ! impact ( section             
#ahad7;a77#g77;,d77i77,,ii7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acie;f7a77#g77;,d77i77,,ii771 z am5d$  
by subsection 7a71 on-- 7#a7 ! numb] &  
p]c5tage ( b5efici>ies rec]tifi$ = !    
,m$ic>e hospice b5efit at #ahj days & = 
subsequ5t b5efit p]iods2  7#b7 !        
appropriat5ess = hospice c>e ( ! pati5ts
 rec]tifi$ ?r\gh ! use ( teleheal?2 &   
7#c7 any o!r factors det]m9$ appropriate
 by ! ,national ,academy ( ,m$ic9e4     
,,ii ,program integrity  #bja4          
,cl>ification = fraud & abuse laws      
reg>d+ te*nologies provid$ to           
b5efici>ies ,section #aabh;,a7i77#f7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acbj;a-#g;a7i77#f77 is am5d$-- 7#a7 9  
subp>agraph 7,i71 by /rik+ 2 or & ins]t+
 a semicolon2  7#b7 9 subp>agraph 7,j71 
by /rik+ ! p]iod at ! end & ins]t+ 2 or2
 &  7#c7 by add+ at ! end ! foll[+ new  
subp>agraph3  7,k7 ! provision (        
te*nologies 7z def9$ by ! ,secret>y7 on 
or aft] ! date ( ! enactm5t ( ?is       

subp>agraph1 by a provid] ( s]vices or  
suppli] 7z su* t]ms are def9$ = purposes
 ( title ,,xviii7 directly to an        
individual :o is entitl$ to b5efits "u  
"p ,a ( title ,,xviii1 enroll$ "u "p ,b 
( su* title1 or bo?1 = ! purpose (      
furni%+ teleheal? s]vices1 remote pati5t
 monitor+ s]vices1 or o!r s]vices       
furni%$ ?r\gh ! use ( te*nology 7z def9$
 by ! ,secret>y71 if-- 7i7 ! te*nologies
 are n (f]$ z "p ( any adv]tisem5t or   
solicitation2 &  7ii7 ! provision ( !   
te*nologies meets any o!r requirem5ts   
set =? 9 regulations promulgat$ by !    
,secret>y4  4  #bjb4 ,additional        
res\rces = teleheal? ov]sight ,9        
addition to am\nts o!rwise available1   
!re are au?oriz$ to be appropriat$ to ! 
,inspector ,g5]al ( ! ,dep>tm5t ( ,heal?
 & ,human ,s]vices = ea* ( fiscal ye>s  
#bjbd ?r\gh #bjbh1 out ( any money 9 !  
,treasury n o!rwise appropriat$1        
#c1jjj1jjj1 to rema9 available until    
exp5d$1 = purposes ( conduct+ audits1   
inve/igations1 & o!r ov]sight & en=cem5t

 activities ) respect to teleheal?      
s]vices1 remote pati5t monitor+ s]vices1
 or o!r s]vices furni%$ ?r\gh ! use (   
te*nology 7z def9$ by ! ,secret>y74     
#bjc4 ,address+ significant outli] bill+
 patt]ns = teleheal? s]vices  7a7       
,id5tification & notification ( outli]  
bill]s ( teleheal?  7#a7 ,9 g5]al ,!    
,secret>y %all1 us+ national provid]    
id5tifi]s on claims = teleheal? s]vices 
furni%$ to individuals "u section       
#ahcd7m7 ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #aciem7m771 id5tify          
physicians & practition]s t demon/rate  
significant outli] bill+ patt]ns 7su* z 
cod+ ( teleheal? s]vices = inappropriate
 l5g? ( "t & inaccurate complexity &    
inappropriate or duplicate bill+7 =     
teleheal? s]vices or items or s]vices   
ord]$ or prescrib$ concurr5t to a       
teleheal? s]vice ov] a p]iod ( "t       
specifi$ by ! ,secret>y4  7#b7          
,e/abli%m5t ( ?re%olds ,= purposes ( ?is
 subsection1 ! ,secret>y %all e/abli%   
?re%olds = outli] bill+ patt]ns to      

id5tify :e!r a physician or practition] 
is a significant outli] bill] =         
teleheal? s]vices or items or s]vices   
ord]$ or prescrib$ concurr5t to a       
teleheal? s]vice z comp>$ to o!r        
physicians or practition]s )9 ! same    
specialty & geographic area4  7b7       
,notification  7#a7 ,9 g5]al ,!         
,secret>y %all notify any physician or  
practition] id5tifi$ z a significant    
outli] bill] = teleheal? s]vices or     
items or s]vices ord]$ or prescrib$     
concurr5t to a teleheal? s]vice "u      
subsection 7a74 ,ea* notification "u !  
prec$+ s5t5ce %all include ! foll[+3    
7,a7 ,in=mation on h[ ! physician or    
practition] comp>es to physicians or    
practition]s )9 ! same specialty &      
geographic area ) respect to bill+ =    
teleheal? s]vices or items or s]vices   
ord]$ or prescrib$ concurr5t to a       
teleheal? s]vice "u ! ,m$ic>e program "u
 title ,,xviii ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acie et seq474     
7,b7 ,in=mation on teleheal? bill+      

guidel9es "u ! ,m$ic>e program4  7,c7   
,o!r in=mation det]m9$ appropriate by ! 
,secret>y4  7#b7 ,cl>ification ,no?+ 9  
?is subsection or subsection 7a7 %all be
 con/ru$ z direct+ ! ,c5t]s = ,m$ic>e   
,m$icaid ,s]vices to pursue fur!r audits
 ( provid]s ( s]vices & suppli]s outside
 ( ^? p]mitt$ or requir$ "u titles ,,xi 
or ,,xviii ( ! ,social ,security ,act1  
or o!rwise "u applicable ,f$]al law4    
7c7 ,public ,availability ( ,in=mation  
,! ,secret>y %all make aggregate        
in=mation on outli] bill+ patt]ns       
id5tifi$ "u subsection 7a7 available on 
! int]net website ( ! ,c5t]s = ,m$ic>e  
,m$icaid ,s]vices4 ,su* in=mation %all  
be 9 a =m & mann] det]m9$ appropriate by
 ! ,secret>y & %all n id5tify any       
specific physician or practition]4  7d7 
,o!r activities ,no?+ 9 ?is section %all
 preclude ! ,secret>y f conduct+        
activities t provide physicians &       
practition]s ) in=mation z to h[ !y     
comp>e to o!r physicians & practition]s 
t are 9 addition to ! activities "u ?is 

section4  7e7 ,teleheal? res\rce c5t]s  
education activities ,section           
#ccj;,i7j77#b7 ( ! ,public ,heal?       
,s]vice ,act 7#db ,u4,s4,c4             
#bed;c-#ad7;j77#b77 is am5d$--  7#a7 9  
subp>agraph 7,f71 by /rik+ & at ! end2  
7#b7 9 subp>agraph 7,g71 by /rik+ !     
p]iod at ! end & ins]t+ 2 &2 &  7#c7 by 
add+ at ! end ! foll[+ new subp>agraph3 
7,h7 provid+ te*nical assi/ance &       
education to physicians & practition]s t
 ! ,secret>y id5tifies pursuant to      
section #bjc7;a7 ( ! ,,connect = ,heal? 
,act ( #bjbc z hav+ significant levels (
 outli] bill+ patt]ns ) respect to      
teleheal? s]vices or items or s]vices   
ord]$ or prescrib$ concurr5t to a       
teleheal? s]vice "u ! ,m$ic>e program "u
 title ,,xviii ( ! ,social ,security    
,act1 includ+--  7i7 education on       
practices to ensure cod+ ( teleheal?    
s]vices = appropriate l5g? ( "t &       
accurate complexity2  7ii7 education on 
prev5tion ( inappropriate or duplicate  
bill+2 &  7iii7 in=mation on-- 7,i7     

s]vices specifi$ 9 p>agraph 7#d77;,f77i7
 ( section #ahcd7m7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4 #aciem7m77
 = au?oriz$ paym5t "u p>agraph 7#a7 (   
su* section2 &  7,,ii7 ! process us$ to 
update su* s]vices "u clauses 7ii7 &    
7iii7 7z add$ by section #ajd7 (        
p>agraph 7#d77;,f7 ( su* section        
#ahcd7m72 &  7iv7 ref]ral to !          
appropriate m$ic>e adm9i/rative         
contractor = specific que/ions t fall   
outside ( ! scope ( broad be/ practices4
  4  7f7 ,def9itions ,9 ?is section3    
7#a7 ,secret>y ,! t]m ,secret>y means ! 
,secret>y ( ,heal? & ,human ,s]vices4   
7#b7 ,teleheal? s]vice ,! t]m teleheal? 
s]vice has ! mean+ giv5 t t]m 9 section 
#ahcd7m77#d77;,f7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciem7m77#d77;,f774
  7#c7 ,physician2 practition] ,! t]ms  
physician & practition] h ! mean+ giv5  
^? t]ms = purposes ( section #ahcd7m7 ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#aciem7m774  ,,iii ,b5efici>y & provid] 
supports1 quality ( c>e1 & data  #cja4  

,b5efici>y engagem5t on teleheal?  7a7  
,res\rces1 guidance1 & tra9+ sessions   
,section #ahcd7m7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciem7m77 is am5d$ 
by add+ at ! end ! foll[+ new p>agraph3 
7#aj7 ,res\rces1 guidance1 & tra9+      
sessions  7,a7 ,9 g5]al ,n lat] ?an #f  
mon?s aft] ! date ( ! enactm5t ( ?is    
p>agraph1 ! ,secret>y1 9 consultation ) 
/akehold]s1 %all issue res\rces1        
guidance1 & tra9+ sessions =            
b5efici>ies1 physicians1 practition]s1 &
 heal? in=mation te*nology s(tw>e v5dors
 on be/ practices = ensur+ teleheal?    
s]vices are accessible =--  7i7         
individuals ) limit$ ,engli% pr(ici5cy1 
includ+ in/ructions on h[ to-- 7,i7     
access teleheal? plat=ms2  7,,ii7       
utilize int]pret] s]vices2 &  7,,iii7   
integrate teleheal? & virtual int]pret] 
s]vices2 &  7ii7 individuals )          
,disabilities1 includ+ in/ructions on   
accessibility ( ! telecommunications    
sy/em be+ us$ = teleheal? s]vices1      
engagem5t ) b5efici>ies ) disabilities  

prior to1 dur+1 & aft] ! furni%+ ( !    
teleheal? s]vice1 & tra9+ on caption+ & 
transcripts4  7,b7 ,acc\nt+ = age & o!r 
diff]5ces ,res\rces1 guidance1 & tra9+  
sessions issu$ "u ?is p>agraph %all     
acc\nt = age & sociodemographic1        
geographic1 lit]acy1 cultural1          
cognitive1 & l+ui/ic diff]5ces 9 h[     
individuals int]act ) te*nology4  4  7b7
 ,/udy & report on tactics ,to improve  
b5efici>y engagem5t on teleheal?  7#a7  
,/udy ,! ,secret>y ( ,heal? & ,human    
,s]vices %all collect & analyze         
qualitative & quantitative data on      
/rategies t cl9icians1 pay]s1 & o!r     
heal? c>e organizations use to improve  
b5efici>y engagem5t on teleheal? s]vices
 7z def9$ 9 section #ahcd7m77#d77;,f7 ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#aciem7m77#d77;,f7771 ) an emphasis on  
und]s]v$ communities1 su* z ! use (     
digital navigators1 provid+ pati5ts )   
pre-visit in=mation on teleheal?1       
c>egiv] engagem5t1 & tra9+ on           
telecommunications sy/ems1 & ! inve/m5ts

 necess>y = heal? c>e pr(essionals to   
effectively furni% teleheal? s]vices1   
includ+ ! co/s ( necess>y te*nology & ( 
tra9+ /aff4  7#b7 ,report ,n lat] ?an #a
 ye> aft] ! date ( ! enactm5t ( ?is     
,act1 ! ,secret>y %all submit to        
,congress & make available on ! int]net 
website ( ! ,c5t]s = ,m$ic>e  ,m$icaid  
,s]vices a report conta9+ ! results ( ! 
/udy "u p>agraph 7#a71 toge!r )         
recomm5dations = su* legislation &      
adm9i/rative action z ! ,secret>y       
det]m9es appropriate4  7c7 ,fund+ ,!re  
are au?oriz$ to be appropriat$ su* sums 
z necess>y to c>ry out ! provisions (1  
includ+ ! am5dm5ts made by1 ?is section4
  #cjb4 ,provid] supports on teleheal?  
7a7 ,educational res\rces & tra9+       
sessions ,n lat] ?an #f mon?s aft] !    
date ( enactm5t ( ?is ,act1 ! ,secret>y 
( ,heal? & ,human ,s]vices %all develop 
& make available to heal? c>e           
pr(essionals educational res\rces &     
tra9+ sessions on requirem5ts relat+ to 
! furni%+ ( teleheal? s]vices "u section

 #ahcd7m7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #aciem7m77 & topics      
includ+--  7#a7 requirem5ts = paym5t =  
teleheal? s]vices2  7#b7                
teleheal?-specific heal? c>e privacy &  
security tra9+2  7#c7 utiliz+ teleheal? 
s]vices to engage & support und]s]v$1   
high-risk1 & vuln]able pati5t           
populations2 &  7#d7 o!r topics z       
det]m9$ appropriate by ! ,secret>y4  7b7
 ,teleheal? res\rce c5t]s ,! ,secret>y  
%all consid] includ+ te*nical assi/ance1
 education1 & tra9+ on teleheal? s]vices
 z a requir$ activity = teleheal?       
res\rce c5t]s "u section #ccj;,i ( !    
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #bed;c-#ad74  7c7 ,fund+ ,!re 
are au?oriz$ to be appropriat$ su* sums 
z necess>y to c>ry out ?is section4     
#cjc4 ,ensur+ ! inclusion ( teleheal? 9 
measur+ quality ( c>e ,section #ahij;,a 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acie;aaa-#a7 is am5d$ by add+
 at ! end ! foll[+ new subsection3  7h7 
,measur+ quality ( teleheal? s]vices    

7#a7 ,9 g5]al ,n lat] ?an #ahj days aft]
 ! date ( ! enactm5t ( ?is subsection1 !
 ,secret>y %all review quality measures 
to ensure inclusion ( measures relat+ to
 teleheal? s]vices1 includ+ c>e1        
prev5tion1 diagnosis1 pati5t exp]i5ce1  
heal? outcomes1 & treatm5t4  7#b7       
,consultation ,9 conduct+ ! review &    
assessm5t "u p>agraph 7#a71 ! ,secret>y 
%all consult ext]nal te*nical exp]ts 9  
quality measurem5t1 includ+ pati5t      
organizations1 provid]s1 & exp]ts 9     
teleheal?4  7#c7 ,review & assessm5t ,! 
review & assessm5t "u ?is subsection    
%all--  7,a7 include review ( exi/+ & "u
 developm5t quality measures to id5tify 
measures t are curr5tly inclusive (1 &  
measures t fail to acc\nt =1 teleheal?  
s]vices2 &  7,b7 id5tify gaps 9 areas ( 
quality measurem5t t relate to teleheal?
 s]vices1 includ+ heal? outcomes &      
pati5t exp]i5ce ( c>e4  7#d7 ,te*nical  
guidance ,! ,secret>y %all issue        
te*nical guidance on-- 7,a7 h[ to       
effectively /reaml9e1 implem5t1 & assign

 acc\ntability = heal? outcomes =       
quality measures = teleheal? s]vices    
across heal? c>e sett+s & provid]s2     
7,b7 h[ to /ratify measures by c>e      
modality & population to id5tify        
diff]5ces 9 heal? outcomes2  7,c7 ! use 
( uni=m data elem5ts2  7,d7 h[ to       
id5tify & catalogue be/ practices relat$
 to ! use ( quality measurem5t & quality
 improvem5t = teleheal? s]vices2 &  7,e7
 o!r areas det]m9$ appropriate by !     
,secret>y4  7#e7 ,report ,n lat] ?an #b 
ye>s aft] ! date ( ! enactm5t ( ?is     
subsection1 ! ,secret>y %all submit to  
,congress & po/ on ! int]net website ( !
 ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices a  
report on ! review & assessm5t conduct$ 
"u ?is subsection4  4  #cjd4 ,po/+ (    
in=mation on teleheal? s]vices ,n lat]  
?an #ahj days aft] ! date ( enactm5t1 & 
qu>t]ly !reaft]1 ! ,secret>y ( ,heal? & 
,human ,s]vices %all po/ on ! int]net   
website ( ! ,c5t]s = ,m$ic>e  ,m$icaid  
,s]vices in=mation on--  7#a7 ! furni%+ 
( teleheal? s]vices "u ! ,m$ic>e program

 "u title ,,xviii ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acie et seq471     
describ$ by pati5t population1 type (   
s]vice1 geography1 place ( s]vice1 &    
provid] type2  7#b7 ! impact ( teleheal?
 s]vices on exp5ditures & utilization "u
 ! ,m$ic>e program2 &  7#c7 o!r outcomes
 relat$ to ! furni%+ ( teleheal? s]vices
 "u ! ,m$ic>e program1 z det]m9$        
appropriate by ! ,secret>y4