[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 1636 Introduced in Senate (IS)]

<DOC>






118th CONGRESS
  1st Session
                                S. 1636

 To amend title XVIII of the Social Security Act to protect access to 
            telehealth services under the Medicare program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 17, 2023

   Mr. Manchin (for himself, Ms. Ernst, Mrs. Shaheen, and Mr. Moran) 
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 protect access to 
            telehealth services under the Medicare program.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Protecting Rural Telehealth Access 
Act''.

SEC. 2. ELIMINATION OF RESTRICTIONS RELATING TO TELEHEALTH SERVICES.

    (a) Elimination of Geographic Requirements for Originating Sites.--
Section 1834(m)(4)(C) of the Social Security Act (42 U.S.C. 
1395m(m)(4)(C)) is amended--
            (1) in clause (i), in the matter preceding subclause (I), 
        by striking ``clause (iii)'' and inserting ``clauses (iii) and 
        (iv)''; and
            (2) by adding at the end the following new clause:
                            ``(iv) Elimination of geographic 
                        requirements for originating sites.--The 
                        geographic requirements described in clause (i) 
                        shall not apply with respect to telehealth 
                        services furnished on or after January 1, 
                        2025.''.
    (b) Elimination of Restrictions in Which Telehealth Services May Be 
Furnished in the Home.--Section 1834(m)(4)(C)(ii)(X) of the Social 
Security Act (42 U.S.C. 1395m(m)(4)(C)(i)(X) is amended to read as 
follows:.
                                    ``(X)(aa) For the period beginning 
                                on the date of the enactment of this 
                                subclause and ending on December 31, 
                                2024, the home of an individual but 
                                only for purposes of section 
                                1881(b)(3)(B) or telehealth services 
                                described in paragraph (7).
                                    ``(bb) For the period beginning on 
                                or after January 1, 2025, the home of 
                                an individual.''.
    (c) Elimination of Restrictions on Store-and-Forward 
Technologies.--The second sentence of section 1834(m)(1) of the Social 
Security Act (42 U.S.C. 1395m(m)(1)) is amended by striking ``in the 
case of any Federal telemedicine demonstration program conducted in 
Alaska or Hawaii,''.

SEC. 3. TELEHEALTH FLEXIBILITIES FOR CRITICAL ACCESS HOSPITALS.

    Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is 
amended--
            (1) in the first sentence of paragraph (1), by striking 
        ``and (9)'' and inserting ``(9), and (10)'';
            (2) in paragraph (2)(A), by striking ``paragraph (8)'' and 
        inserting ``paragraphs (8) and (10)'';
            (3) in paragraph (4)--
                    (A) in subparagraph (A), by striking ``paragraph 
                (8)'' and inserting ``paragraphs (8) and (10)''; and
                    (B) in subparagraph (F)(i), by striking ``paragraph 
                (8)'' and inserting ``paragraphs (8) and (10)''; and
            (4) by adding at the end the following new paragraph:
            ``(10) Telehealth flexibilities for critical access 
        hospitals.--
                    ``(A) In general.--On or after the date of the 
                enactment of this paragraph--
                            ``(i) the Secretary shall pay for 
                        telehealth services that are furnished via a 
                        telecommunications system by a critical access 
                        hospital, including any practitioner authorized 
                        to provide such services within the facility, 
                        that is a qualified provider (as defined in 
                        subparagraph (B)) to an eligible telehealth 
                        individual enrolled under this part 
                        notwithstanding that the critical access 
                        hospital providing the telehealth service is 
                        not at the same location as the beneficiary, if 
                        such services complement a plan of care that 
                        includes in-person care at some point, as may 
                        be appropriate;
                            ``(ii) the amount of payment to a critical 
                        access hospital that serves as a distant site 
                        for such a telehealth service shall be 
                        determined under subparagraph (C); and
                            ``(iii) for purposes of this subsection--
                                    ``(I) the term `distant site' 
                                includes a critical access hospital 
                                that furnishes a telehealth service to 
                                an eligible telehealth individual; and
                                    ``(II) the term `telehealth 
                                services' includes behavioral health 
                                services and any other outpatient 
                                critical access hospital service that 
                                is furnished using telehealth to the 
                                extent that payment codes corresponding 
                                to services identified by the Secretary 
                                under clause (i) or (ii) of paragraph 
                                (4)(F) are listed on the corresponding 
                                claim for such critical access hospital 
                                service.
                    ``(B) Definition of qualified provider.--For 
                purposes of this subsection, the term `qualified 
                provider' means, with respect to a telehealth service 
                described in subparagraph (A)(i) that is furnished to 
                an eligible telehealth individual, a critical access 
                hospital that has an established patient relationship 
                with such individual as defined by the State in which 
                the individual is located.
                    ``(C) Payment.--The amount of payment to a critical 
                access hospital that serves as a distant site that 
                furnishes a telehealth service to an eligible 
                telehealth individual under this paragraph shall be 
                equal to 101 percent of the reasonable costs of the 
                hospital in providing such services, unless the 
                hospital makes an election under paragraph (2) of 
                section 1834(g) to be paid for such services based on 
                the methodology described in such paragraph. Telehealth 
                services furnished by a critical access hospital shall 
                be counted for purposes of determining the provider 
                productivity rate of the critical access hospital for 
                purposes of payment under such section.
                    ``(D) Implementation.--Notwithstanding any other 
                provision of law, the Secretary may implement this 
                paragraph through program instruction, interim final 
                rule, or otherwise.''.

SEC. 4. EXTENDING MEDICARE TELEHEALTH FLEXIBILITIES FOR FEDERALLY 
              QUALIFIED HEALTH CENTERS AND RURAL HEALTH CLINICS.

    Section 1834(m)(8) of the Social Security Act (42 U.S.C. 
1395m(m)(8)), as amended by section 4113(c) of division FF of the 
Consolidated Appropriations Act, 2023 (Public Law 117-328) is amended--
            (1) in subparagraph (A), in the matter preceding clause 
        (i), by inserting ``, and on or after January 1, 2025'' after 
        ``December 31, 2024'';
            (2) by striking subparagraph (B) and inserting the 
        following:
                    ``(B) Payment.--
                            ``(i) In general.--A telehealth service 
                        furnished by a Federally qualified health 
                        center or a rural health clinic to an eligible 
                        telehealth individual pursuant to this 
                        paragraph or after the date of the enactment of 
                        this subparagraph shall be reimbursed under 
                        this title at a separate telehealth payment 
                        rate as determined under the methodology 
                        established by the Secretary pursuant to clause 
                        (ii).
                            ``(ii) Payment methodology.--The Secretary 
                        shall establish a methodology for determining 
                        the appropriate payment rate for telehealth 
                        services described in clause (i). Such 
                        methodology shall consider--
                                    ``(I) the geography of Federally 
                                qualified health centers and rural 
                                health clinics;
                                    ``(II) costs associated with the 
                                delivery of such telehealth services as 
                                allowable costs for the center or 
                                clinic; and
                                    ``(III) the full cost of providing 
                                the services via telehealth.
                            ``(iii) Implementation.--
                                    ``(I) Coding system.--The Secretary 
                                shall establish an effective coding 
                                system for telehealth services 
                                described in clause (i) that is 
                                reflective of the services provided at 
                                a center or clinic.
                                    ``(II) Implementation.--
                                Notwithstanding any other provision of 
                                law, the Secretary may implement this 
                                subparagraph through program 
                                instruction, interim final rule, or 
                                otherwise.''; and
            (3) by adding at the end the following new subparagraph:
                    ``(C) Requirement during additional period.--
                            ``(i) In general.--Beginning on January 1, 
                        2025, payment may only be made under this 
                        paragraph for a telehealth service described in 
                        subparagraph (A)(i) that is furnished to an 
                        eligible telehealth individual if such service 
                        is furnished by a qualified provider (as 
                        defined in clause (ii)).
                            ``(ii) Definition of qualified provider.--
                        For purposes of this subparagraph, the term 
                        `qualified provider' means, with respect to a 
                        telehealth service described in subparagraph 
                        (A)(i) that is furnished to an eligible 
                        telehealth individual, a Federally qualified 
                        health center or rural health clinic that has 
                        an established patient relationship with such 
                        individual as defined by the State in which the 
                        individual is located.''.

SEC. 5. ALLOWANCE OF CERTAIN TELEHEALTH SERVICES FURNISHED USING AUDIO-
              ONLY TECHNOLOGY.

    Section 1834(m)(4) of the Social Security Act (42 U.S.C. 
1395m(m)(4)) of the Social Security Act (42 U.S.C. 1395m(m)(4)) is 
amended by adding at the end the following new subparagraph:
                    ``(G) Telecommunications system.--
                            ``(i) In general.--Notwithstanding 
                        paragraph (1) and section 410.78(a)(3) of title 
                        42, Code of Federal Regulations (or any 
                        successor regulation), subject to clause (v), 
                        on or after January, 2025, the term 
                        `telecommunications system' includes, in the 
                        case of the furnishing of a specified 
                        telehealth service (as defined in clause (ii)) 
                        a communications system that uses audio-only 
                        technology.
                            ``(ii) Specified telehealth service.--In 
                        this subparagraph, the term `specified 
                        telehealth service' means a telehealth service 
                        described in clause (iii) that is furnished by 
                        a qualified provider (as defined in clause 
                        (iv)).
                            ``(iii) Telehealth service described.--
                        Subject to clause (vi), a telehealth service 
                        described in this clause is a telehealth 
                        service consisting of--
                                    ``(I) evaluation and management 
                                services;
                                    ``(II) behavioral health counseling 
                                and educational services; and
                                    ``(III) other services determined 
                                appropriate by the Secretary.
                            ``(iv) Qualified provider defined.--
                                    ``(I) In general.--For purposes of 
                                clause (ii), the term `qualified 
                                provider' means, with respect to a 
                                specified telehealth service that is 
                                furnished to an eligible telehealth 
                                individual--
                                            ``(aa) a physician or 
                                        practitioner who has an 
                                        established patient 
                                        relationship with such 
                                        individual as defined by the 
                                        State in which the individual 
                                        is located; or
                                            ``(bb) a critical access 
                                        hospital (as defined in section 
                                        1861(mm)(1)), a rural health 
                                        clinic (as defined in section 
                                        1861(aa)(2)), a Federally 
                                        qualified health center (as 
                                        defined in section 
                                        1861(aa)(4)), a hospital (as 
                                        defined in section 1861(e)), a 
                                        hospital-based or critical 
                                        access hospital-based renal 
                                        dialysis center (including 
                                        satellites), a skilled nursing 
                                        facility (as defined in section 
                                        1819(a)), a community mental 
                                        health center (as defined in 
                                        section 1861(ff)(3)(B)), or a 
                                        rural emergency hospital (as 
                                        defined in section 
                                        1861(kkk)(2)).
                            ``(v) Authority.--For purposes of this 
                        subparagraph, the Secretary may determine 
                        whether it is clinically appropriate to furnish 
                        a specified telehealth service via a 
                        communications system that uses audio-only 
                        technology and whether an in-person initial 
                        visit (in addition to any requirement with 
                        respect to the furnishing of an item or service 
                        in person pursuant to clause (iv)(I)) is 
                        required prior to the furnishing of such 
                        service using such technology.
                            ``(vi) Review.--
                                    ``(I) In general.--Not later than 5 
                                years after the date of the enactment 
                                of this subparagraph, the Secretary 
                                shall conduct a review of the 
                                furnishing of specified telehealth 
                                services through audio-only technology 
                                pursuant to this paragraph. Such review 
                                shall include an analysis of the impact 
                                of the roll out of broadband technology 
                                and whether the use of audio-only 
                                technology is necessary to ensure 
                                access to such telehealth services.
                                    ``(II) Redetermination of specified 
                                telehealth services.--The Secretary 
                                may, based on the review conducted 
                                under subclause (I), provide for the 
                                addition or deletion of services (and 
                                HCPCS codes), as appropriate, to those 
                                specified in clause (ii) that may be 
                                furnished using audio-only technology 
                                and authorized for payment pursuant to 
                                this subparagraph.
                            ``(vii) Clarification regarding payment.--
                        The amount of payment for a specified 
                        telehealth service that is furnished using 
                        audio-only technology shall be equal to the 
                        amount that would have been paid for such 
                        service under this subsection had such service 
                        been furnished via any other telecommunications 
                        system authorized under this subsection.''.

SEC. 6. SENSE OF CONGRESS REGARDING EXPANSION OF ELIGIBLE PRACTITIONERS 
              THAT MAY FURNISH TELEHEALTH SERVICES.

    It is the sense of Congress that the expansion of eligible 
practitioners that may furnish telehealth services (as defined in 
section 1834(m)(4)(F) of the Social Security Act (42 U.S.C. 
1395m(m)(4)(F))) during the emergency period described in section 
1135(g)(1)(B) of such Act (42 U.S.C. 1320b-5(g)(1)(B)) should be 
extended on a permanent basis.
                                 <all>