[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 2741 Introduced in Senate (IS)]

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116th CONGRESS
  1st Session
                                S. 2741

  To amend title XVIII of the Social Security Act to expand access to 
              telehealth services, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            October 30, 2019

Mr. Schatz (for himself, Mr. Wicker, Mr. Cardin, Mr. Thune, Mr. Warner, 
  and Mrs. Hyde-Smith) introduced the following bill; which was read 
             twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
  To amend title XVIII of the Social Security Act to expand access to 
              telehealth services, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Creating 
Opportunities Now for Necessary and Effective Care Technologies 
(CONNECT) for Health Act of 2019'' or the ``CONNECT for Health Act of 
2019''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings and sense of Congress.
Sec. 3. Expanding the use of telehealth through the waiver of certain 
                            requirements.
Sec. 4. Expanding the use of telehealth for mental health services.
Sec. 5. Use of telehealth in emergency medical care.
Sec. 6. Improvements to the process for adding telehealth services.
Sec. 7. Rural health clinics and federally qualified health centers.
Sec. 8. Native American health facilities.
Sec. 9. Waiver of telehealth restrictions during national emergencies.
Sec. 10. Use of telehealth in recertification for hospice care.
Sec. 11. Clarification for fraud and abuse laws regarding technologies 
                            provided to beneficiaries.
Sec. 12. Study and report on increasing access to telehealth services 
                            in the home.
Sec. 13. Analysis of telehealth waivers in alternative payment models.
Sec. 14. Model to allow additional health professionals to furnish 
                            telehealth services.
Sec. 15. Testing of models to examine the use of telehealth under the 
                            Medicare program.

SEC. 2. FINDINGS AND SENSE OF CONGRESS.

    (a) Findings.--Congress finds the following:
            (1) The use of technology in health care and coverage of 
        telehealth services are rapidly evolving.
            (2) Research has found that telehealth services can expand 
        access to care, improve the quality of care, and reduce 
        spending, and that patients receiving telehealth services are 
        satisfied with their experiences.
            (3) Health care workforce shortages are a significant 
        problem in many areas and for many types of health care 
        clinicians.
            (4) Telehealth increases access to care in areas with 
        workforce shortages and for individuals who live far away from 
        health care facilities, have limited mobility or 
        transportation, or have other barriers to accessing care.
            (5) The use of health technologies can strengthen the 
        expertise of the health care workforce, including by connecting 
        clinicians to specialty consultations.
            (6) Utilization of telehealth services in Medicare remains 
        low, with only 0.25 percent of Medicare fee-for-service 
        beneficiaries utilizing telehealth services in 2016.
    (b) Sense of Congress.--It is the sense of Congress that--
            (1) health care providers can furnish safe, effective, and 
        high-quality health care services through telehealth; and
            (2) barriers to the use of telehealth should be removed.

SEC. 3. EXPANDING THE USE OF TELEHEALTH THROUGH THE WAIVER OF CERTAIN 
              REQUIREMENTS.

    (a) In General.--Section 1834(m) of the Social Security Act (42 
U.S.C. 1395m(m)) is amended--
            (1) in paragraph (4)(C)(i), by striking ``and (7)'' and 
        inserting ``(7), and (8)''; and
            (2) by adding at the end the following:
            ``(8) Authority to waive requirements and limitations if 
        certain conditions met.--
                    ``(A) In general.--Notwithstanding the preceding 
                provisions of this subsection, in the case of 
                telehealth services furnished on or after January 1, 
                2021, the Secretary may waive any restriction 
                applicable to payment for telehealth services under 
                this subsection that is described in subparagraph (B), 
                but only if the Secretary determines that such waiver 
                would not deny or limit the coverage or provision of 
                benefits under this title, and--
                            ``(i) the Secretary determines that the 
                        waiver is expected to reduce spending under 
                        this title without reducing the quality of care 
                        or improve the quality of patient care without 
                        increasing spending; or
                            ``(ii) the waiver would apply to telehealth 
                        services furnished in originating sites located 
                        in a high-need health professional shortage 
                        area (as designated pursuant to section 
                        332(a)(1)(A) of the Public Health Service Act 
                        (42 U.S.C. 254e(a)(1)(A))).
                    ``(B) Restrictions described.--For purposes of this 
                paragraph, restrictions applicable to payment for 
                telehealth services under paragraph (1) are--
                            ``(i) requirements relating to 
                        qualifications for an originating site under 
                        paragraph (4)(C)(ii);
                            ``(ii) any geographic limitations under 
                        paragraph (4)(C)(i) (other than applicable 
                        State law requirements, including State 
                        licensure requirements);
                            ``(iii) any limitation on the type of 
                        technology used to furnish telehealth services;
                            ``(iv) any limitation on the type of 
                        provider of services or supplier who may 
                        furnish telehealth services (other than the 
                        requirement that the provider of services or 
                        supplier is enrolled under this title);
                            ``(v) any limitation on specific services 
                        designated as telehealth services pursuant to 
                        this subsection (provided the Secretary 
                        determines that such services are clinically 
                        appropriate to furnish remotely); or
                            ``(vi) any other limitation relating to the 
                        furnishing of telehealth services under this 
                        title identified by the Secretary.
                    ``(C) Public comment.--The Secretary shall 
                establish a process by which stakeholders may (on at 
                least an annual basis) provide public comment for 
                waivers under this paragraph.
                    ``(D) Periodic review of waivers.--The Secretary 
                shall periodically, but not more often than every 3 
                years, reassess each waiver under this paragraph to 
                determine whether the waiver continues to meet the 
                conditions applicable under subparagraph (A).''.
    (b) Posting of Information.--Not later than 2 years after the date 
on which a waiver under section 1834(m)(8) of the Social Security Act, 
as added by subsection (a), first becomes effective, and at least 
biennially thereafter, the Secretary of Health and Human Services shall 
post on the internet website of the Centers for Medicare & Medicaid 
Services--
            (1) the number of Medicare beneficiaries receiving 
        telehealth services by reason of each waiver under such 
        section;
            (2) the impact of such waivers on expenditures and 
        utilization under title XVIII of the Social Security Act (42 
        U.S.C. 1395 et seq.); and
            (3) other outcomes, as determined appropriate by the 
        Secretary.

SEC. 4. EXPANDING THE USE OF TELEHEALTH FOR MENTAL HEALTH SERVICES.

    (a) In General.--Section 1834(m) of the Social Security Act (42 
U.S.C. 1395m(m)), as amended by section 3, is amended--
            (1) in paragraph (4)(C)(i), by striking ``and (8)'' and 
        inserting ``(8), and (9)''; and
            (2) by adding at the end the following:
            ``(9) Treatment of mental health services furnished through 
        telehealth.--The geographic requirements described in paragraph 
        (4)(C)(i) (other than applicable State law requirements, 
        including State licensure requirements) shall not apply with 
        respect to telehealth services that are mental health services 
        (as determined by the Secretary) furnished on or after January 
        1, 2021, to an eligible telehealth individual at an originating 
        site described in paragraph (4)(C)(ii) (other than an 
        originating site described in subclause (IX) of such 
        paragraph).''.
    (b) Inclusion of the Home as an Originating Site.--Section 
1834(m)(4)(C)(ii)(X) of such Act (42 U.S.C. 1395m(m)(4)(C)(ii)(X)) is 
amended by striking ``paragraph (7)'' and inserting ``paragraphs (7) 
and (9)''.
    (c) Additional Services.--As part of the implementation of the 
amendments made by this section, the Secretary of Health and Human 
Services shall consider whether additional services should be added to 
the services specified in paragraph (4)(F)(i) of section 1834(m) of 
such Act (42 U.S.C. 1395m) for authorized payment under paragraph (1) 
of such section.

SEC. 5. USE OF TELEHEALTH IN EMERGENCY MEDICAL CARE.

    (a) In General.--Section 1834(m) of the Social Security Act (42 
U.S.C. 1395m(m)), as amended by sections 3 and 4, is amended--
            (1) in paragraph (4)(C)(i), by striking ``and (9)'' and 
        inserting ``(9), and (10)''; and
            (2) by adding at the end the following:
            ``(10) Treatment of emergency medical care furnished 
        through telehealth.--The geographic requirements described in 
        paragraph (4)(C)(i) (other than applicable State law 
        requirements, including State licensure requirements) shall not 
        apply with respect to telehealth services that are services for 
        emergency medical care (as determined by the Secretary) 
        furnished on or after January 1, 2021, to an eligible 
        telehealth individual at an originating site described in 
        subclause (II), (V), or (VII) of paragraph (4)(C)(ii).''.
    (b) Additional Services.--As part of the implementation of the 
amendments made by this section, the Secretary of Health and Human 
Services shall consider whether additional services should be added to 
the services specified in paragraph (4)(F)(i) of section 1834(m) of 
such Act (42 U.S.C. 1395m) for authorized payment under paragraph (1) 
of such section.

SEC. 6. IMPROVEMENTS TO THE PROCESS FOR ADDING TELEHEALTH SERVICES.

    The Secretary shall undertake a review of the process established 
pursuant to section 1834(m)(4)(F)(ii) of the Social Security Act (42 
U.S.C. 1395m(m)(4)(F)(ii)), and based on the results of such review--
            (1) implement revisions to the process so that the criteria 
        to add services prioritizes, as appropriate, improved access to 
        care through telehealth services; and
            (2) provide clarification on what requests to add 
        telehealth services under such process should include.

SEC. 7. RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS.

    (a) Expansion of Originating Sites.--Section 1834(m)(4)(C) of the 
Social Security Act (42 U.S.C. 1395m(m)(4)(C)), as amended by sections 
3, 4, and 5, is amended--
            (1) in clause (i), by striking ``and (10)'' and inserting 
        ``and (10), and subject to clause (iii),''; and
            (2) by adding at the end the following new clause:
                            ``(iii) Rural health clinics and federally 
                        qualified health centers.--The term 
                        `originating site' shall also include any 
                        Federally qualified health center and any rural 
                        health clinic (as such terms are defined in 
                        section 1861(aa)) at which the eligible 
                        telehealth individual is located at the time 
                        the service is furnished via a 
                        telecommunications system, whether or not the 
                        individual is located in an area described in 
                        clause (i), insofar as such sites are not 
                        otherwise included in the definition of 
                        originating site under such clause, subject to 
                        applicable State law requirements, including 
                        State licensure requirements.''.
    (b) Expansion of Distant Sites.--Section 1834(m) of the Social 
Security Act (42 U.S.C. 1395m(m)) is amended--
            (1) in the first sentence of paragraph (1)--
                    (A) by striking ``or a practitioner (described in 
                section 1842(b)(18)(C))'' and inserting ``, a 
                practitioner (described in section 1842(b)(18)(C)), a 
                Federally qualified health center, or a rural health 
                clinic''; and
                    (B) by striking ``or practitioner'' and inserting 
                ``, practitioner, Federally qualified health center, or 
                rural health clinic''; and
            (2) in paragraph (2)(A)--
                    (A) by inserting ``or to a Federally qualified 
                health center or rural health clinic that serves as a 
                distant site'' after ``a distant site''; and
                    (B) by striking ``such physician or practitioner'' 
                and inserting ``such physician, practitioner, Federally 
                qualified health center, or rural health clinic''; and
            (3) in paragraph (4)--
                    (A) in subparagraph (A), by inserting ``and 
                includes a Federally qualified health center or rural 
                health clinic that furnishes a telehealth service to an 
                eligible individual'' before the period at the end; and
                    (B) in subparagraph (F), by adding at the end the 
                following new clause:
                            ``(iii) Inclusion of rural health clinic 
                        services and federally qualified health center 
                        services furnished using telehealth.--For 
                        purposes of this subparagraph, the term 
                        `telehealth services' includes a rural health 
                        clinic service or Federally qualified health 
                        center service that is furnished using 
                        telehealth to the extent that payment codes 
                        corresponding to services identified by the 
                        Secretary under clause (i) or (ii) are listed 
                        on the corresponding claim for such rural 
                        health clinic service or Federally qualified 
                        health center service.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 2021.

SEC. 8. NATIVE AMERICAN HEALTH FACILITIES.

    (a) In General.--Section 1834(m)(4)(C) of the Social Security Act 
(42 U.S.C. 1395m(m)(4)(C)), as amended by sections 3, 4, 5, and 7, is 
amended--
            (1) in clause (i), by striking ``clause (iii)'' and 
        inserting ``clauses (iii) and (iv)''; and
            (2) by adding at the end the following new clause:
                            ``(iv) Native american health facilities.--
                        The originating site requirements described in 
                        clauses (i) and (ii) shall not apply with 
                        respect to a facility of the Indian Health 
                        Service, whether operated by such Service, or 
                        by an Indian tribe (as that term is defined in 
                        section 4 of the Indian Health Care Improvement 
                        Act (25 U.S.C. 1603)) or a tribal organization 
                        (as that term is defined in section 4 of the 
                        Indian Self-Determination and Education 
                        Assistance Act (25 U.S.C. 5304)), or a facility 
                        of the Native Hawaiian health care systems 
                        authorized under the Native Hawaiian Health 
                        Care Improvement Act (42 U.S.C. 11701 et 
                        seq.).''.
    (b) No Originating Site Facility Fee for New Sites.--Section 
1834(m)(2)(B)(i) of the Social Security Act (42 U.S.C. 
1395m(m)(2)(B)(i)) is amended, in the matter preceding subclause (I), 
by inserting ``(other than an originating site that is only described 
in clause (iv) of paragraph (4)(C), and does not meet the requirement 
for an originating site under clause (i) of such paragraph)'' after 
``the originating site''.
    (c) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 2021.

SEC. 9. WAIVER OF TELEHEALTH RESTRICTIONS DURING NATIONAL EMERGENCIES.

    Section 1135(b) of the Social Security Act (42 U.S.C. 1320b-5(b)) 
is amended--
            (1) in paragraph (6), by striking ``and'' after the 
        semicolon;
            (2) in paragraph (7), by striking the period at the end and 
        inserting ``; and''; and
            (3) by adding at the end the following:
            ``(8) requirements for payment for telehealth services 
        under section 1834(m).''.

SEC. 10. USE OF TELEHEALTH IN RECERTIFICATION FOR HOSPICE CARE.

    (a) In General.--Section 1814(a)(7)(D)(i) of the Social Security 
Act (42 U.S.C. 1395f(a)(7)(D)(i)) is amended by inserting ``(including 
through use of telehealth, notwithstanding the requirements in section 
1834(m)(4)(C))'' after ``face-to-face encounter''.
    (b) GAO Report.--Not later than 3 years after the date of enactment 
of this Act, the Comptroller General of the United States shall submit 
a report to Congress evaluating the impact of the amendment made by 
subsection (a) on--
            (1) the number and percentage of beneficiaries recertified 
        for the Medicare hospice benefit at 180 days and for subsequent 
        benefit periods;
            (2) the appropriateness for hospice care of the patients 
        recertified through the use of telehealth; and
            (3) any other factors determined appropriate by the 
        Comptroller General.

SEC. 11. CLARIFICATION FOR FRAUD AND ABUSE LAWS REGARDING TECHNOLOGIES 
              PROVIDED TO BENEFICIARIES.

    Section 1128A(i)(6) of the Social Security Act (42 U.S.C. 1320a-
7a(i)(6)) is amended--
            (1) in subparagraph (I), by striking ``; or'' and inserting 
        a semicolon;
            (2) in subparagraph (J), by striking the period at the end 
        and inserting ``; or''; and
            (3) by adding at the end the following new subparagraph:
                    ``(K) the provision of technologies (as defined by 
                the Secretary) on or after the date of the enactment of 
                this subparagraph, by a provider of services or 
                supplier (as such terms are defined for purposes of 
                title XVIII) directly to an individual who is entitled 
                to benefits under part A of title XVIII, enrolled under 
                part B of such title, or both, for the purpose of 
                furnishing telehealth services, remote patient 
                monitoring services, or other services furnished 
                through the use of technology (as defined by the 
                Secretary), if--
                            ``(i) the technologies are not offered as 
                        part of any advertisement or solicitation; and
                            ``(ii) the provision of the technologies 
                        meets any other requirements set forth in 
                        regulations promulgated by the Secretary.''.

SEC. 12. STUDY AND REPORT ON INCREASING ACCESS TO TELEHEALTH SERVICES 
              IN THE HOME.

    (a) MedPAC Study.--The Medicare Payment Advisory Commission (in 
this section referred to as the ``Commission'') shall conduct a study 
on increasing access under the Medicare program under title XVIII of 
the Social Security Act (42 U.S.C. 1395 et seq.) to telehealth services 
in the home. Such study shall include an analysis of the following:
            (1) How different payers allow the home to be an 
        originating site for telehealth services.
            (2) Particular types of telehealth services or subgroups of 
        beneficiaries with respect to which allowing the home to be an 
        originating site under the Medicare program would be suitable.
    (b) Report.--Not later than 24 months after the date of the 
enactment of this Act, the Commission shall submit to Congress a report 
containing the results of the study conducted under subsection (a), 
together with recommendations for such legislation and administrative 
action as the Commission determines appropriate.

SEC. 13. ANALYSIS OF TELEHEALTH WAIVERS IN ALTERNATIVE PAYMENT MODELS.

    The second sentence of section 1115A(g) of the Social Security Act 
(42 U.S.C. 1315a(g)) is amended by inserting ``an analysis of waivers 
under section (d)(1) related to telehealth and the impact on quality 
and spending under the applicable titles of such waivers,'' after 
``subsection (c),''.

SEC. 14. MODEL TO ALLOW ADDITIONAL HEALTH PROFESSIONALS TO FURNISH 
              TELEHEALTH SERVICES.

    Section 1115A(b)(2)(B) of the Social Security Act (42 U.S.C. 
1315a(b)(2)(B)) is amended by adding at the end the following new 
clause:
                            ``(xxviii) Allowing health professionals, 
                        such as those described in section 
                        1819(b)(5)(G) or section 1861(ll)(4)(B), who 
                        are not otherwise eligible under section 
                        1834(m) to furnish telehealth services to 
                        furnish such services.''.

SEC. 15. TESTING OF MODELS TO EXAMINE THE USE OF TELEHEALTH UNDER THE 
              MEDICARE PROGRAM.

    Section 1115A(b)(2) of the Social Security Act (42 U.S.C. 
1315a(b)(2)) is amended by adding at the end the following new 
subparagraph:
                    ``(D) Testing models to examine use of telehealth 
                under medicare.--The Secretary shall consider testing 
                under this subsection models to examine the use of 
                telehealth under title XVIII.''.
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