,,ii #aaith ,,congress #ast ,session ,s4 #bgji ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,september #d1 #bjbe ,mr4 ,scott of ,south ,carolina 7for himself1 ,mr4 ,schatz1 ,mrs4 ,hyde-,smith1 ,mrs4 ,gillibrand1 ,mr4 ,tillis1 and ,mr4 ,king7 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 extend certain telehealth flexibilities under the ,medicare program4 #a4 ,short title ,this ,act may be cited as the ,telehealth ,modernization ,act4 #b4 ,extension of certain telehealth flexibilities 7a7 ,removing geographic requirements and expanding originating sites for telehealth services ,section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77 is amended-- 7#a7 in paragraph 7#b77;,b77iii71 by striking ending ,september #cj1 #bjbe and inserting ending ,september #cj1 #bjbg2 and 7#b7 in paragraph 7#d77;,c77iii71 by striking ending on ,september #cj1 #bjbe and inserting ending on ,september #cj1 #bjbg4 7b7 ,expanding practitioners eligible ,to furnish telehealth services ,section #ahcd7m77#d77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,e77 is amended by striking ending on ,september #cj1 #bjbe and inserting ending on ,september #cj1 #bjbg4 7c7 ,extending telehealth services for 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 subparagraph 7,a71 by striking ending on ,september #cj1 #bjbe and inserting ending on ,september #cj1 #bjbg2 7#b7 in subparagraph 7,b7-- 7,a7 in the subparagraph heading1 by inserting before fiscal year #bjbf after rule2 7,b7 in clause 7i71 by striking during the periods for which subparagraph 7,a7 applies and inserting before ,october #a1 #bjbe2 and 7,c7 in clause 7ii71 by inserting furnished to an eligible telehealth individual before ,october #a1 #bjbe after telehealth services2 and 7#c7 by adding at the end the following new subparagraph3 7,c7 ,payment rule for fiscal years #bjbf and #bjbg 7i7 ,in general ,a telehealth service furnished to an eligible telehealth individual by a ,federally qualified health center or rural health clinic on or after ,october #a1 #bjbe1 and before ,october #a1 #bjbg1 shall be paid as a ,federally qualified health center service or rural health clinic service 7as applicable7 under the prospective payment system established under section #ahcd7o7 or the methodology for all-inclusive rates established under section #ahcc7;a77#c71 respectively4 7ii7 ,treatment of costs ,costs associated with the furnishing of telehealth services by a ,federally qualified health center or rural health clinic on or after ,october #a1 #bjbe1 and before ,october #a1 #bjbg1 shall be considered allowable costs for purposes of the prospective payment system established under section #ahcd7o7 and the methodology for all-inclusive rates established under section #ahcc7;a77#c71 as applicable4 4 7d7 ,delaying in-,person requirements under ,medicare for mental health services furnished through telehealth and telecommunications technology 7#a7 ,delay in requirements for mental health services furnished through telehealth ,section #ahcd7m77#g77;,b77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#g77;,b77i77 is amended1 in the matter preceding subclause 7,i71 by striking on or after ,october #a1 #bjbe and inserting on or after ,october #a1 #bjbg4 7#b7 ,mental health visits furnished by rural health clinics ,section #ahcd7y77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7y77#b77 is amended by striking ,october #a1 #bjbe and inserting ,october #a1 #bjbg4 7#c7 ,mental health visits furnished by ,federally qualified health centers ,section #ahcd7o77#d77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7o77#d77;,b77 is amended by striking ,october #a1 #bjbe and inserting ,october #a1 #bjbg4 7e7 ,allowing for the furnishing of audio-,only telehealth services ,section #ahcd7m77#i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#i77 is amended by striking ending on ,september #cj1 #bjbe and inserting ending on ,september #cj1 #bjbg4 7f7 ,extending use of telehealth ,to conduct face-to-,face encounter prior to recertification of eligibility for hospice care ,section #ahad7;a77#g77;,d77i77,,ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7a77#g77;,d77i77,,ii77 is amended-- 7#a7 by striking ending on ,september #cj1 #bjbe and inserting ending on ,september #cj1 #bjbg2 and 7#b7 by inserting 1 except that this subclause shall not apply in the case of such an encounter with an individual occurring on or after ,september #cj1 #bjbe1 if such individual is located in an area that is subject to a moratorium on the enrollment of hospice programs under this title pursuant to section #ahff7;j77#g71 if such individual is receiving hospice care from a provider that is subject to enhanced oversight under this title pursuant to section #ahff7;j77#c71 or if such encounter is performed by a hospice physician or nurse practitioner who is not enrolled under section #ahff7;j7 and is not an opt-out physician or practitioner 7as defined in section #ahjb7;b77#f77;,d77 before the semicolon4 #c4 ,requiring modifier for use of telehealth to conduct face-to-face encounter prior to recertification of eligibility for hospice care ,section #ahad7;a77#g77;,d77i77,,ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7a77#g77;,d77i77,,ii771 as amended by section #b7;f71 is further amended by inserting 1 but only if1 in the case of such an encounter occurring on or after ,january #a1 #bjbf1 any hospice claim includes #a or more modifiers or codes 7as specified by the ,secretary7 to indicate that such encounter was conducted via telehealth after as determined appropriate by the ,secretary4 #d4 ,extending acute hospital care at home waiver flexibilities 7a7 ,in general ,section #ahff;,g7a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc-#g7;a77#a77 is amended by striking #bjbe and inserting #bjcj4 7b7 ,requiring additional study and report on acute hospital care at home waiver flexibilities ,section #ahff;,g of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc-#g71 as amended by subsection 7a71 is further amended-- 7#a7 in subsection 7b71 in the subsection heading1 by striking ,study and inserting ,initial study2 7#b7 by redesignating subsections 7c7 and 7d7 as subsections 7d7 and 7e71 respectively2 and 7#c7 by inserting after subsection 7b7 the following new subsection3 7c7 ,subsequent study and report 7#a7 ,in general ,not later than ,september #cj1 #bjbh1 the ,secretary shall conduct a study to-- 7,a7 analyze1 to the extent practicable1 the criteria established by hospitals under the ,acute ,hospital ,care at ,home initiative to determine which individuals may be furnished services under such initiative2 and 7,b7 analyze and compare 7both within and between hospitals participating in the initiative1 and relative to comparable hospitals that do not participate in the initiative1 for relevant parameters such as diagnosis-related groups7-- 7i7 quality of care furnished to individuals with similar conditions and characteristics in the inpatient setting and through the ,acute ,hospital ,care at ,home initiative1 including health outcomes1 hospital readmission rates 7including readmissions both within and beyond #cj days post-discharge71 hospital mortality rates1 length of stay1 infection rates1 composition of care team 7including the types of labor used1 such as contracted labor71 the ratio of nursing staff1 transfers from the hospital to the home1 transfers from the home to the hospital 7including the timing1 frequency1 and causes of such transfers71 transfers and discharges to post-acute care settings 7including the timing1 frequency1 and causes of such transfers and discharges71 and patient and caregiver experience of care2 7ii7 clinical conditions treated and diagnosis-related groups of discharges from inpatient settings relative to discharges from the ,acute ,hospital ,care at ,home initiative2 7iii7 costs incurred by the hospital for furnishing care in inpatient settings relative to costs incurred by the hospital for furnishing care through the ,acute ,hospital ,care at ,home initiative1 including costs relating to staffing1 equipment1 food1 prescriptions1 and other services1 as determined by the ,secretary2 7iv7 the quantity1 mix1 and intensity of services 7such as in-person visits and virtual contacts with patients and the intensity of such services7 furnished in inpatient settings relative to the ,acute ,hospital ,care at ,home initiative1 and1 to the extent practicable1 the nature and extent of family or caregiver involvement2 7v7 socioeconomic information on individuals treated in comparable inpatient settings relative to the initiative1 including racial and ethnic data1 income1 housing1 geographic proximity to the brick-and-mortar facility and whether such individuals are dually eligible for benefits under this title and title ,,xix2 and 7vi7 the quality of care1 outcomes1 costs1 quantity and intensity of services1 and other relevant metrics between individuals who entered into the ,acute ,hospital ,care at ,home initiative directly from an emergency department compared with individuals who entered into the ,acute ,hospital ,care at ,home initiative directly from an existing inpatient stay in a hospital4 7#b7 ,selection bias ,in conducting the study under paragraph 7#a71 the ,secretary shall1 to the extent practicable1 analyze and compare individuals who participate and do not participate in the initiative controlling for selection bias or other factors that may impact the reliability of data4 7#c7 ,report ,not later than ,september #cj1 #bjbh1 the ,secretary of ,health and ,human ,services shall submit to the ,committee on ,ways and ,means of the ,house of ,representatives and the ,committee on ,finance of the ,senate a report on the study conducted under paragraph 7#a74 4 #e4 ,enhancing certain program integrity requirements for ,,dme under ,medicare 7a7 ,durable medical equipment 7#a7 ,in general ,section #ahcd7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7a77 is amended by adding at the end the following new paragraph3 7#bc7 ,master ,list inclusion and claim review for certain items 7,a7 ,master ,list inclusion ,beginning ,january #a1 #bjbh1 for purposes of the ,master ,list described in section #dad4bcd7;b7 of title #db1 ,code of ,federal ,regulations 7or any successor regulation71 an item for which payment may be made under this subsection shall be treated as having aberrant billing patterns 7as such term is used for purposes of such section7 if the ,secretary determines that1 without explanatory contributing factors 7such as furnishing emergent care services71 a substantial number of claims for such items under this subsection are for such items ordered by a physician or practitioner who has not previously 7during a period of not less than #bd months1 as established by the ,secretary7 furnished to the individual involved any item or service for which payment may be made under this title4 7,b7 ,claim review ,with respect to items furnished on or after ,january #a1 #bjbh1 that are included on the ,master ,list pursuant to subparagraph 7,a71 if such an item is not subject to a determination of coverage in advance pursuant to paragraph 7#ae77;,c71 the ,secretary may conduct prepayment review of claims for payment for such item4 4 7#b7 ,conforming amendment for prosthetic devices1 orthotics1 and prosthetics ,section #ahcd7;h77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7h77#c77 is amended by inserting 1 and paragraph 7#bc7 of subsection 7a7 shall apply to prosthetic devices1 orthotics1 and prosthetics in the same manner as such provision applies to items for which payment may be made under such subsection before the period at the end4 7b7 ,report on identifying clinical diagnostic laboratory tests at high risk for fraud and effective mitigation measures ,not later than ,january #a1 #bjbf1 the ,inspector ,general of the ,department of ,health and ,human ,services shall submit to ,congress a report assessing fraud risks relating to claims for clinical diagnostic laboratory tests for which payment may be made under section #ahcd;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem-#a7 and effective tools for reducing such fraudulent claims4 ,the report may include information regarding-- 7#a7 which1 if any1 clinical diagnostic laboratory tests are identified as being at high risk of fraudulent claims1 and an analysis of the factors that contribute to such risk2 7#b7 with respect to a clinical diagnostic laboratory test identified under paragraph 7#a7 as being at high risk of fraudulent claims-- 7,a7 the amount payable under such section #ahcd;,a with respect to such test2 7,b7 the number of such tests furnished to individuals enrolled under part ,b of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;j et seq472 7,c7 whether an order for such a test was more likely to come from a provider with whom the individual involved did not have a prior relationship1 as determined on the basis of prior payment experience2 and 7,d7 the frequency with which a claim for payment under such section #ahcd;,a included the payment modifier identified by code #ei or #ia2 7#c7 suggested strategies for reducing the number of fraudulent claims made with respect to tests so identified as being at high risk1 including-- 7,a7 an analysis of whether the ,centers for ,medicare ,medicaid ,services can detect aberrant billing patterns with respect to such tests in a timely manner2 7,b7 any strategies for identifying and monitoring the providers who are outliers with respect to the number of such tests that such providers order2 and 7,c7 targeted education efforts to mitigate improper billing for such tests2 and 7#d7 such other information as the ,inspector ,general determines appropriate4 #f4 ,guidance on furnishing services via telehealth to individuals with limited ,english proficiency 7a7 ,in general ,not later than #a year after the date of the enactment of this section1 the ,secretary of ,health and ,human ,services1 in consultation with #a or more entities from each of the categories described in paragraphs 7#a7 through 7#g7 of subsection 7b71 shall issue and disseminate1 or update and revise as applicable1 guidance for the entities described in such subsection on the following3 7#a7 ,best practices on facilitating and integrating use of interpreters during a telemedicine appointment4 7#b7 ,best practices on providing accessible instructions on how to access telecommunications systems 7as such term is used for purposes of section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m777 for individuals with limited ,english proficiency4 7#c7 ,best practices on improving access to digital patient portals for individuals with limited ,english proficiency4 7#d7 ,best practices on integrating the use of video platforms that enable multi-person video calls furnished via a telecommunications system for purposes of providing interpretation during a telemedicine appointment for an individual with limited ,english proficiency4 7#e7 ,best practices for providing patient materials1 communications1 and instructions in multiple languages1 including text message appointment reminders and prescription information4 7b7 ,entities described ,for purposes of subsection 7a71 an entity described in this subsection is an entity in #a or more of the following categories3 7#a7 ,health information technology service providers1 including-- 7,a7 electronic medical record companies2 7,b7 remote patient monitoring companies2 and 7,c7 telehealth or mobile health vendors and companies4 7#b7 ,health care providers1 including-- 7,a7 physicians2 and 7,b7 hospitals4 7#c7 ,health insurers4 7#d7 ,language service companies4 7#e7 ,interpreter or translator professional associations4 7#f7 ,health and language services quality certification organizations4 7#g7 ,patient and consumer advocates1 including such advocates that work with individuals with limited ,english proficiency4 #g4 ,in-home cardiopulmonary rehabilitation flexibilities 7a7 ,in general ,section #ahfa7;eee77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7eee77#b77 is amended-- 7#a7 in subparagraph 7,a77ii71 by inserting 7including1 with respect to items and services furnished through audio and video real-time communications technology 7excluding audio-only7 on or after ,september #cj1 #bjbe1 and before ,january #a1 #bjbg1 in the home of an individual who is an outpatient of the hospital7 after outpatient basis2 and 7#b7 in subparagraph 7,b71 by inserting 7including1 with respect to items and services furnished through audio and video real-time communications technology on or after ,september #cj1 #bjbe1 and before ,january #a1 #bjbg1 the virtual presence of such physician1 physician assistant1 nurse practitioner1 or clinical nurse specialist7 after under the program4 7b7 ,program instruction authority ,notwithstanding any other provision of law1 the ,secretary of ,health and ,human ,services may implement the amendments made by this section by program instruction or otherwise4 #h4 ,inclusion of virtual diabetes prevention program suppliers in ,,mdpp ,expanded ,model 7a7 ,in general ,not later than ,january #a1 #bjbf1 the ,secretary shall revise the regulations under parts #daj and #dbd of title #db1 ,code of ,federal ,regulations1 to provide that1 for the period beginning ,january #a1 #bjbf1 and ending ,december #ca1 #bjcj-- 7#a7 an entity may participate in the ,,mdpp by offering only online ,,mdpp services via synchronous or asynchronous technology or telecommunications if such entity meets the conditions for enrollment as an ,,mdpp supplier 7as specified in section #dbd4bje7;b7 of title #db1 ,code of ,federal ,regulations 7or a successor regulation772 7#b7 if an entity participates in the ,,mdpp in the manner described in paragraph 7#a7-- 7,a7 the administrative location of such entity shall be the address of the entity on file under the ,diabetes ,prevention ,recognition ,program2 and 7,b7 in the case of online ,,mdpp services furnished by such entity to an ,,mdpp beneficiary who was not located in the same ,state as the entity at the time such services were furnished1 the entity shall not be prohibited from submitting a claim for payment for such services solely by reason of the location of such beneficiary at such time2 and 7#c7 no limit is applied on the number of times an individual may enroll in the ,,mdpp4 7b7 ,definitions ,in this section3 7#a7 ,,mdpp ,the term ,,mdpp means the ,medicare ,diabetes ,prevention ,program conducted under section #aaae;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a71 as described in the final rule published in the ,federal ,register entitled ,medicare and ,medicaid ,programs2 ,,cy #bjbd ,payment ,policies ,under the ,physician ,fee ,schedule and ,other ,changes to ,part ,b ,payment and ,coverage ,policies2 ,medicare ,shared ,savings ,program ,requirements2 ,medicare ,advantage2 ,medicare and ,medicaid ,provider and ,supplier ,enrollment ,policies2 and ,basic ,health ,program 7#hh ,fed4 ,reg4 #ghhah 7,november #af1 #bjbc77 7or a successor regulation74 7#b7 ,regulatory terms ,the terms ,diabetes ,prevention ,recognition ,program1 ,,mdpp beneficiary1 ,,mdpp services1 and ,,mdpp supplier have the meanings given each such term in section #daj4gi7;b7 of title #db1 ,code of ,federal ,regulations4 7#c7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4