Prohibiting increased payments under a group health plan or group health insurance coverage for telehealth services furnished by a provider located at a facility

(a)

In general

Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.) is amended by adding at the end the following new section:

726.

Prohibition on increased payments for telehealth services furnished by a provider located at a facility

(a)

In general

In the case of a telehealth service furnished to a participant or beneficiary of a group health plan or group health insurance coverage by a health care provider located at a health care facility, the total amount recognized by such plan or coverage as payment for such service (including any facility fee or other amount that may be billed separately by such facility in relation to such provider’s furnishing of such service) may not exceed the total amount that would have been recognized by such plan or coverage as payment for such service had such provider not been located at such a facility. (b)

Telehealth service defined

For purposes of this section, the term telehealth service means a service furnished by a health care provider via a telecommunications system where such provider is not at the same location as the individual receiving such service.

(b)

Clerical amendment

The table of contents in section 1 of such Act is amended by inserting after the item relating to section 725 the following new item:

Sec. 726. Prohibition on increased payments for telehealth services furnished by a provider located at a facility.

(c)

Report

Not later than 18 months after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on what is known about the use of telehealth under group health plans and group or individual health insurance coverage (as such terms are defined in section 2791 of the Public Health Service Act (42 U.S.C. 1395x)). Such report shall include the following: (1)Trends and statistics regarding the use of telehealth for specific types of care, including primary care, mental health care, and specialty care. (2)Trends and statistics regarding the availability, access, and utilization of telehealth services by individuals residing in rural areas and urban areas. (3)Trends and statistics regarding the application of hospital facility fees in the context of telehealth services. (4)Trends and statistics regarding how individuals access telehealth services, including with respect to the devices used and tools offered by such plans and issuers of such coverage to facilitate access to such services and with respect to the utilization of audio-only telehealth services. (5)Trends and statistics with respect to individuals accessing telehealth services provided from physicians or other medical professionals residing in a State other than the State that the individual is located in while receiving such services and with respect to applicable State laws or State-to-State compacts that impact cross-State provision of telehealth services. (6)Trends and statistics regarding payment and reimbursement for telehealth services. (7)Trends and statistics regarding premiums for such plans and coverage offering telehealth services. (d)

Effective date

The amendment made by subsection (a) shall apply to plan years beginning on or after January 1, 2026.

Prohibiting health care providers and facilities from imposing certain facility fees for telehealth

(a)

In general

Subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1021 et seq.) is amended by adding at the end the following new part:

Billing Requirements for Health Care Facilities and Providers

901.

Limitation on telehealth facility fees

A health care facility may not bill a separate facility fee when a health care provider who provided telehealth services is authorized to bill independently for the professional services rendered.

(b)

Enforcement

Section 502 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1132) is amended— (1)in subsection (a)(6), by striking or (9) and inserting (9), or (13); and (2)in subsection (c), by adding at the end the following new paragraph:

(13)If a health care provider or facility is found by the Secretary to be in violation of section 901, the Secretary may assess a civil monetary penalty against such provider or facility in an amount not to exceed $10,000 per violation.

(c)

Clerical amendment

The table of contents of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 note) is amended by inserting after the item relating to section 804 the following new item:

Part 9—Billing Requirements for Health Care Facilities and Providers

901. Limitation on telehealth facility fees.