,i #aaith ,,congress #ast ,session ,h4 ,r4 #aghe ,,in ,,the ,,house ,,of ,,representatives ,march #c1 #bjbe,mr4 ,doggett introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to establish requirements for the provision of certain high-cost durable medical equipment and laboratory testing1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,preventing ,medicare ,telefraud ,act4 #b4 ,requirement 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 clause3 7vi7 ,standards for high-cost durable medical equipment 7,i7 ,limitation on payment for high-cost durable medical equipment ,payment may not be made under this subsection for a high-cost durable medical equipment ordered by a physician or other practitioner described in clause 7ii7 via telehealth for an individual on or after the date that is #ahj days after the date of the enactment of this clause1 unless such physician or practitioner furnished to such individual a service in-person at least once during the #f month period prior to ordering such high-cost durable medical equipment4 7,,ii7 ,high-cost durable medical equipment determination ,for purposes of this clause1 the ,administrator of the ,centers for ,medicare ,medicaid ,services shall define the term high-cost durable medical equipment and specify the durable medical equipment for which such definition shall apply4 7vii7 ,audit of providers and practitioners furnishing a high volume of durable medical equipment via telehealth 7,i7 ,identification of providers ,beginning #f months after the date of the enactment of this clause1 ,medicare administrative contractors shall conduct reviews 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 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 paragraph3 7#f7 ,requirement for high-cost laboratory tests 7,a7 ,limitation on payment for high-cost laboratory tests ,payment may not be made under this subsection for a high-cost laboratory test ordered by a physician or practitioner via telehealth for an individual on or after the date that is #ahj days after the date of the enactment of this paragraph1 unless such physician or practitioner furnished to such individual a service in-person at least once during the #f month period prior to ordering such high-cost laboratory test4 7,b7 ,high-cost laboratory test defined ,for purposes of this paragraph1 the ,administrator for the ,centers for ,medicare ,medicaid ,services shall define the term high-cost laboratory test and specify which laboratory tests such definition shall apply to4 7#g7 ,audit of laboratory testing ordered pursuant to telehealth visit 7,a7 ,identification of providers ,beginning #f months after the date of the enactment of this paragraph1 ,medicare administrative contractors shall conduct periodic reviews 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 was 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 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 beginning to determine whether such claims comply with the requirements for coverage under this title4 4 #c4 ,requirement to submit ,,npi number for separately billable telehealth services ,section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77 is amended by adding at the end the following new paragraph3 7#aj7 ,requirement to submit ,,npi number for separately billable telehealth services ,payment may not be made under this subsection for separately billable telehealth services furnished on or after the date that is #ahj days after the date of the enactment of this paragraph 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