[Congressional Record Volume 168, Number 125 (Wednesday, July 27, 2022)]
[House]
[Pages H7189-H7197]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




            ADVANCING TELEHEALTH BEYOND COVID-19 ACT OF 2021

  Mr. PALLONE. Madam Speaker, pursuant to House Resolution 1256, I call 
up the bill (H.R. 4040) to amend title XVIII of the Social Security Act 
to extend telehealth flexibilities under the Medicare program, and for 
other purposes, and ask for its immediate consideration in the House.
  The Clerk read the title of the bill.
  The SPEAKER pro tempore. Pursuant to House Resolution 1256, an 
amendment in the nature of a substitute consisting of the text of Rules 
Committee Print 117-59, modified by the amendment printed in part B of 
House Report 117-444, is adopted. The bill, as amended, is considered 
read.
  The text of the bill, as amended, is as follows:

                               H.R. 4040

       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 ``Advancing Telehealth Beyond 
     COVID-19 Act of 2022''.

     SEC. 2. REMOVING GEOGRAPHIC REQUIREMENTS AND EXPANDING 
                   ORIGINATING SITES FOR TELEHEALTH SERVICES.

       Section 1834(m) of the Social Security Act (42 U.S.C. 
     1395m(m)) is amended--
       (1) in paragraph (2)(B)(iii)--
       (A) by striking ``With'' and inserting ``In the case that 
     the emergency period described in section 1135(g)(1)(B) ends 
     before December 31, 2024, with''; and
       (B) by striking ``that are furnished during the 151-day 
     period beginning on the first day after the end of the 
     emergency period described in section 1135(g)(1)(B)'' and 
     inserting ``that are furnished during the period beginning on 
     the first day after the end of such emergency period and 
     ending December 31, 2024''; and
       (2) in paragraph (4)(C)(iii)--
       (A) by striking ``With'' and inserting ``In the case that 
     the emergency period described in section 1135(g)(1)(B) ends 
     before December 31, 2024, with''; and
       (B) by striking ``that are furnished during the 151-day 
     period beginning on the first day after the end of the 
     emergency period described in section 1135(g)(1)(B)'' and 
     inserting ``that are furnished during the period beginning on 
     the first day after the end of such emergency period and 
     ending on December 31, 2024''.

     SEC. 3. EXPANDING PRACTITIONERS ELIGIBLE TO FURNISH 
                   TELEHEALTH SERVICES.

       Section 1834(m)(4)(E) of the Social Security Act (42 U.S.C. 
     1395m(m)(4)(E)) is amended by striking ``and, for the 151-day 
     period beginning on the first day after the end of the 
     emergency period described in section 1135(g)(1)(B)'' and 
     inserting ``and, in the case that the emergency period 
     described in section 1135(g)(1)(B) ends before December 31, 
     2024, for the period beginning on the first day after the end 
     of such emergency period and ending on December 31, 2024''.

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

       Section 1834(m)(8)(A) of the Social Security Act (42 U.S.C. 
     1395m(m)(8)(A)) is amended by striking ``during the 151-day 
     period beginning on the first day after the end of such 
     emergency period'' and inserting ``in the case that such 
     emergency period ends before December 31, 2024, during the 
     period beginning on the first day after the end of such 
     emergency period and ending on December 31, 2024''.

     SEC. 5. DELAYING THE IN-PERSON REQUIREMENTS UNDER MEDICARE 
                   FOR MENTAL HEALTH SERVICES FURNISHED THROUGH 
                   TELEHEALTH AND TELECOMMUNICATIONS TECHNOLOGY.

       (a) Delay in Requirements for Mental Health Services 
     Furnished Through Telehealth.--Section 1834(m)(7)(B)(i) of 
     the Social Security Act (42 U.S.C. 1395m(m)(7)(B)(i)) is 
     amended, in the matter preceding subclause (I), by striking 
     ``on or after the day that is the 152nd day after the end of 
     the period at the end of the emergency sentence described in 
     section 1135(g)(1)(B))'' and inserting ``on or after January 
     1, 2025 (or, if later, the first day after the end of the 
     emergency period described in section 1135(g)(1)(B))''.
       (b) Mental Health Visits Furnished by Rural Health 
     Clinics.--Section 1834(y) of the Social Security Act (42 
     U.S.C. 1395m(y)) is amended--
       (1) in the heading, by striking ``to hospice patients''; 
     and
       (2) in paragraph (2), by striking ``prior to the day that 
     is the 152nd day after the end of the emergency period 
     described in section 1135(g)(1)(B))'' and inserting ``prior 
     to January 1, 2025 (or, if later, the first day after the end 
     of the emergency period described in section 
     1135(g)(1)(B))''.
       (c) Mental Health Visits Furnished by Federally Qualified 
     Health Centers.--Section 1834(o)(4) of the Social Security 
     Act (42 U.S.C. 1395m(o)(4) is amended--
       (1) in the heading, by striking ``to hospice patients''; 
     and
       (2) in subparagraph (B), by striking ``prior to the day 
     that is the 152nd day after the end of the emergency period 
     described in section 1135(g)(1)(B))'' and inserting ``prior 
     to January 1, 2025 (or, if later, the first day after the end 
     of the emergency period described in section 
     1135(g)(1)(B))''.

     SEC. 6. ALLOWING FOR THE FURNISHING OF AUDIO-ONLY TELEHEALTH 
                   SERVICES.

       Section 1834(m)(9) of the Social Security Act (42 U.S.C. 
     1395m(m)(9)) is amended by striking ``The Secretary shall 
     continue to provide coverage and payment under this part for 
     telehealth services identified in paragraph (4)(F)(i) as of 
     the date of the enactment of this paragraph that are 
     furnished via an audio-only telecommunications system during 
     the 151-day period beginning on the first day after the end 
     of the emergency period described in section 1135(g)(1)(B)'' 
     and inserting ``In the case that the emergency period 
     described in section 1135(g)(1)(B) ends before December 31, 
     2024, the Secretary shall continue to provide coverage

[[Page H7190]]

     and payment under this part for telehealth services 
     identified in paragraph (4)(F)(i) that are furnished via an 
     audio-only communications system during the period beginning 
     on the first day after the end of such emergency period and 
     ending on December 31, 2024''.

     SEC. 7. USE OF TELEHEALTH TO CONDUCT FACE-TO-FACE ENCOUNTER 
                   PRIOR TO RECERTIFICATION OF ELIGIBILITY FOR 
                   HOSPICE CARE DURING EMERGENCY PERIOD.

       Section 1814(a)(7)(D)(i)(II) of the Social Security Act (42 
     U.S.C. 1395f(a)(7)(D)(i)(II)) is amended by striking ``and 
     during the 151-day period beginning on the first day after 
     the end of such emergency period'' and inserting ``and, in 
     the case that such emergency period ends before December 31, 
     2024, during the period beginning on the first day after the 
     end of such emergency period described in such section 
     1135(g)(1)(B) and ending on December 31, 2024''.

     SEC. 8. FUNDING FROM MEDICARE IMPROVEMENT FUND.

       Section 1898(b)(1) of the Social Security Act (42 U.S.C. 
     1395jjj(b)(1)) is amended by striking ``$7,500,000,000'' and 
     inserting ``$5,153,000,000''.

     SEC. 9. PROGRAM INSTRUCTION AUTHORITY.

       Notwithstanding any other provision of law, the Secretary 
     of Health and Human Services may implement the provisions of, 
     including amendments made by, sections 2 through 7 through 
     program instruction or otherwise.

     SEC. 10. DETERMINATION OF BUDGETARY EFFECTS.

       The budgetary effects of this Act, for the purpose of 
     complying with the Statutory Pay-As-You-Go Act of 2010, shall 
     be determined by reference to the latest statement titled 
     ``Budgetary Effects of PAYGO Legislation'' for this Act, 
     submitted for printing in the Congressional Record by the 
     Chairman of the House Budget Committee, provided that such 
     statement has been submitted prior to the vote on passage.

  The SPEAKER pro tempore. The bill, as amended, shall be debatable for 
1 hour equally divided and controlled by the chair and ranking minority 
member of the Committee on Energy and Commerce or their respective 
designees.
  The gentleman from New Jersey (Mr. Pallone) and the gentleman from 
Georgia (Mr. Carter) each will control 30 minutes.
  The Chair recognizes the gentleman from New Jersey (Mr. Pallone).


                             General Leave

  Mr. PALLONE. Madam Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and add extraneous material on H.R. 4040.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. PALLONE. Madam, I yield myself such time as I may consume.
  I rise in support of H.R. 4040, the Advancing Telehealth Beyond 
COVID-19 Act, bipartisan legislation, introduced by Representatives 
Cheney and Dingell.
  Over the course of this pandemic, telehealth has served as an 
important tool for staying connected to care without increasing the 
risk of exposure to COVID-19. And in the Medicare program, millions 
have utilized telehealth for the first time during the pandemic, thanks 
to actions taken early on by Congress and the administration.
  When the pandemic was beginning to take hold in America, Congress 
moved quickly to significantly expand access to telehealth for Medicaid 
beneficiaries. And this was critically important because Medicare 
beneficiaries are some of the most vulnerable to COVID-19.
  The waiver of Medicare's originating site and geographic restrictions 
during the public health emergency has allowed millions of Medicare 
beneficiaries nationwide to receive telehealth services, including 
audio-only services, without ever having to leave their homes.
  Now, the Energy and Commerce Committee has a long history of working 
to expand access to telehealth services in the Medicare program. For 
example, the SUPPORT Act expanded access to substance use disorder 
services delivered via telehealth.
  The Consolidated Appropriations Act of 2021 permanently expanded 
access to telemental health services and Medicare. And most recently, 
the Consolidated Appropriations Act of 2020 extended key telehealth 
flexibilities for an additional 5 months after the end of the public 
health emergency.
  So H.R. 4040 builds on the bipartisan telehealth extension included 
in the Consolidated Appropriations Act of 2022. The bill extends the 
same key telehealth flexibilities as the previous legislation, but now 
would extend them until December 31, 2024, essentially 2 more years. 
And this longer-term extension will provide beneficiaries and 
stakeholders with more certainty.
  It will also give policymakers time to assess the impact expanded 
telehealth services have had on the Medicare program and on 
beneficiaries' health and well-being, and the quality of care that they 
are receiving.
  So I thank the many Energy and Commerce Committee members who have 
been leaders on this issue over the years, such as Representatives 
Dingell, Eshoo, Matsui, Welch, Blunt-Rochester, Kelly, and many more.
  And I also commend Representative Cheney and Dingell for their 
bipartisan leadership on this legislation today.
  I look forward to working with all Members on a permanent solution to 
address telehealth coverage under Medicare but, in the meantime, this 
multi-year extension is critical for preserving access to telehealth 
services.
  The language included in the bill is the same bipartisan language 
previously negotiated by the House and Senate committees and the bill--
and I stress, Madam Speaker, that the bill is fully paid for.
  So I hope we can, once again, extend these flexibilities with strong 
bipartisan support.
  I urge all my colleagues to support this bill, and I reserve the 
balance of my time.
  Mr. CARTER of Georgia. Madam Speaker, I yield myself such time as I 
may consume.
  Madam Speaker, one of my top priorities since I have been a Member of 
Congress has been to make sure that healthcare is accessible and 
available for all Americans. Telehealth has played a critical role for 
patients to access the care they desperately need.

                              {time}  1245

  On the Energy and Commerce Committee, we have been discussing the 
importance of telehealth flexibilities for years. It is bringing 
doctors right into families' living rooms and is an example of how 
innovation can improve and save people's lives.
  As the coronavirus spread and providers closed their doors, patients 
and providers were forced to adapt and utilize telehealth services. 
Just months into the public health emergency, Medicare was receiving 
over a million telehealth visits a week, an almost 3,000 percent 
increase. Those without adequate transportation or in rural areas were 
still able to visit with their doctor.
  While we have made great strides in making telehealth more broadly 
available, we know that Congress can do more. Increasing access to 
telehealth means increasing access to quality care for all patients.
  I often discuss how, before the pandemic, we had a lot of regulations 
and red tape that piled up over the years. So while I will support this 
legislation, it is a shame that we did not take something as important 
as this through committee to make sure it could be the best possible 
product.
  Madam Speaker, I reserve the balance of my time.
  Mr. PALLONE. Madam Speaker, I yield 3 minutes to the gentlewoman from 
Michigan (Mrs. Dingell).
  Mrs. DINGELL. Madam Speaker, I rise in support of this legislation, 
which would provide critical extensions of existing telehealth 
flexibilities that have been in place during the COVID-19 pandemic.
  The Advancing Telehealth Beyond COVID-19 Act of 2021, which I co-led 
with my colleague, Congresswoman Cheney, will do just that. It will 
extend a broad range of telehealth flexibilities that are central to 
enabling access to care via telehealth from any location through 
December 31, 2024.
  This includes allowing any site in the United States, including a 
patient's home, to be considered an eligible originating site for the 
delivery of telehealth services. It also extends other vital services, 
including coverage of certain telehealth services delivered via audio-
only format.
  Collectively, these changes will build on what has worked during the 
pandemic. It will expand access to quality, affordable healthcare 
across the country, particularly in rural and underserved communities.
  It will also, Madam Speaker, allow those who have been afraid to go 
to the doctor, who haven't been able to get in, to be able to consult 
with medical professionals as they need it.

[[Page H7191]]

  I thank my colleague, Congresswoman Cheney, for partnering with me on 
this effort, as well as Chairman Pallone for his thoughtful leadership 
and input on the legislation before us today.
  It is also important to recognize other leading voices on the 
telehealth issue in the Congress, including Congressman   Mike Thompson 
for his pioneering efforts on this issue.
  This legislation is a bipartisan win for the American people. Madam 
Speaker, I urge my colleagues to support it.
  Mr. CARTER of Georgia. Madam Speaker, I yield 2 minutes to the 
gentlewoman from Washington (Mrs. Rodgers), the ranking member of the 
Energy and Commerce Committee.
  Mrs. RODGERS of Washington. Madam Speaker, I appreciate the gentleman 
yielding.
  I grew up in a small town, Kettle Falls, and I have lived through the 
challenges that people face in rural communities.
  I have also visited hospitals and healthcare facilities all 
throughout my district. During the pandemic, Providence Health System 
scaled up their telehealth services with a 1,000 percent increase in 
volume.
  Telehealth visits by seniors on Medicare increased from 840,000 in 
2019 to 52.7 million in 2020 nationwide. Many of these visits were from 
seniors' homes, which were not paid for by Medicare prior to the 
pandemic.
  Congress and the Trump administration, by action, required Medicare 
to pay for more telehealth services, reducing out-of-pocket costs and 
expanding the availability of telehealth services and long-term care 
where people are especially vulnerable to COVID-19. This bill today 
makes some of those actions last beyond the public health emergency 
through 2024.
  While I support this legislation, I do think this is a missed 
opportunity to do more. Republicans on the Energy and Commerce 
Committee have many solutions to not just look at telehealth and 
Medicare for a couple of years but to look also at how we incentivize 
employers to provide access to telehealth for an estimated 156 million 
people with employer health insurance.
  We have examined and worked on solutions to address both where 
telehealth may not be appropriate and where it drives better outcomes 
for patients.
  Healthcare providers and patients need certainty. The pandemic has 
made it clear that telehealth can and should be a part of modernizing 
healthcare.
  I plan to support this legislation and hope to continue to work to 
unwind the public health emergency in a way that provides patients and 
our healthcare providers the certainty that they need. I do think that 
we could have done more on this and hope that this process won't be a 
model for the rest.
  Mr. PALLONE. Madam Speaker, I yield 3 minutes to the gentlewoman from 
California (Ms. Matsui), a member of the Energy and Commerce Committee.
  Ms. MATSUI. Madam Speaker, I rise today in support of H.R. 4040, the 
Advancing Telehealth Beyond COVID-19 Act, legislation to further extend 
telehealth policies that have been critical to providing care during 
the pandemic through the end of 2024.
  Since long before the COVID pandemic, I worked closely with my Energy 
and Commerce Committee colleague, Representative Bill Johnson, in 
crafting legislation to remove barriers to telehealth and advancing 
policies that expand access and improve the quality of care for 
Medicare beneficiaries.
  As a cosponsor of this bill, I am pleased to see some of that 
important work make progress today. This legislation builds on 
Congress' efforts to give patients and providers the certainty they 
need that telehealth is here to stay.

  While this bipartisan telehealth bill meets many of our shared 
objectives, we also must recognize that our work on telehealth is not 
done. There are vital telehealth priorities still demanding our 
attention that will truly shape care delivery for the future, including 
the need to extend the DEA in-person waiver for remote prescribing of 
controlled substances after the public health emergency ends.
  Likewise, while this bill continues a crucial delay of the in-person 
telemental health requirement, we cannot allow an arbitrary and 
clinically unsupported in-person requirement to act as a barrier to 
mental health care when the pandemic extensions run out.
  I look forward to continuing this work with my colleagues. This is a 
really good bill, but we want to ensure that permanent Medicare policy 
supports telehealth in ways that ensure beneficiaries can continue to 
get the right care in the right place at the right time.
  Mr. CARTER of Georgia. Madam Speaker, I yield 2 minutes to the 
gentleman from Utah (Mr. Curtis), an important member of the Energy and 
Commerce Committee.
  Mr. CURTIS. Madam Speaker, I thank Mr. Carter for his support.
  I rise today in support of the Advancing Telehealth Beyond COVID-19 
Act. There is no putting the genie back in the bottle. COVID-19 
highlighted the importance of telehealth, especially in providing 
quality care for rural communities. This bill would extend telehealth 
offered through Medicare through the end of 2024.
  Like many of my colleagues, I would like to see that go longer. This 
bill includes a provision I have supported in my bill, the Protecting 
Mental Health Services Act, which extends mental health services 
delivered through telehealth.
  While Utah has, for the most part, returned to regular life, it is 
important that we keep in place those flexibilities that give Utahns 
control over their healthcare decisions.
  I support this bill and am pleased the Protecting Mental Health 
Services Act was included. Madam Speaker, I urge my colleagues to 
support its passage.
  Mr. PALLONE. Madam Speaker, I yield such time as she may consume to 
the gentlewoman from Wyoming (Ms. Cheney).
  Ms. CHENEY. Madam Speaker, I thank the chairman for yielding. I 
appreciate it.
  I am very pleased, Madam Speaker, that today the House will have the 
opportunity to vote on this important bipartisan legislation. It is an 
unusual circumstance to have a bill that has such broad bipartisan 
support.
  I know many of my colleagues have worked on many different aspects of 
the bill that we are going to consider and vote on today. I am honored 
to be an original cosponsor of this bill, along with my good friend 
from Michigan, Congresswoman Dingell, who spoke earlier.
  All of us, I think, around the country, especially in rural America, 
saw the impact of COVID on the ability of our constituents to get the 
treatment that they need. We first began working on legislation to 
expand telehealth capabilities more than 2 years ago, following the 
onset of the pandemic.
  In Wyoming, we have long known how important it is for citizens to be 
able to take advantage of the technology that exists today, how crucial 
telehealth services are in allowing all of our citizens to interact 
with their doctors and their other healthcare providers, and we saw 
this, in particular, during the pandemic.
  We know it is vital that Medicare adapt to the ever-changing 
innovation in medical technology that allows telehealth services, and 
this legislation really will expand freedom for patients by giving them 
more flexibility and more capability to use telehealth services.
  Specifically, the legislation removes geographic requirements, and it 
expands originating sites so that Medicare beneficiaries can receive 
care at any site. It can expand the practitioners who are able to 
furnish telehealth services, and it also provides for audio-only 
telehealth.
  I am very pleased that this extension through 2024 was fully paid for 
using the Medicare Improvement Fund, and the CBO has shown that it will 
not increase direct spending.
  Madam Speaker, in Wyoming, especially, we know how important this is, 
how important telehealth access is. Many of our citizens live hours 
away, hundreds of miles away, from their closest medical provider. I am 
very proud that this bill has the support of the Wyoming Hospital 
Association, in addition to the American Medical Association and a 
number of other crucial groups whose mission is to serve patients and 
provide quality care.
  While I know we in this body will continue to have legitimate and 
important ongoing policy debates about

[[Page H7192]]

healthcare, there is, as I said, broad bipartisan agreement for 
expanding access so that all of our citizens can receive high-quality 
care. That needs to continue to be a top priority. This bill does just 
that by allowing more Americans to utilize telehealth services.
  Madam Speaker, I thank my colleagues from both sides of the aisle for 
joining me in advancing our bill to this point, and I urge all Members 
to vote in favor of this legislation so more citizens can connect and 
receive care from the medical professionals of their choice.
  Mr. CARTER of Georgia. Madam Speaker, I yield 2 minutes to the 
gentleman from Texas (Mr. Burgess).
  Mr. BURGESS. Madam Speaker, I thank the gentleman for yielding.
  One of the many lessons we learned during the pandemic is the ability 
to take care of patients who are safely in their own homes. It was 
truly a highlight.
  Understanding that we will not be going back to the status quo of 
2019, we must recognize how telehealth has allowed our country to take 
a monumental step forward toward digitally enabled care.
  Telehealth has allowed Americans to take care of immediate and 
necessary health needs from their homes without the costs and health 
risks that are often associated with an in-person visit. They don't 
incur costs for parking. They don't have to take time off from work. 
They don't have to hire a babysitter.
  While I am in support of this legislation, it does not go far enough. 
We do need to provide a permanent solution for Medicare providers and, 
most importantly, their patients.
  It is important that providers are given long-term certainty when 
taking care of their Medicare patients and are technologically capable 
of delivering the best care possible.
  Yesterday, I introduced, along with Representatives Greg Murphy and 
Yvette Herrell, H.R. 8506 to permanently extend Medicare coverage of 
telehealth services for federally qualified health centers and rural 
health clinics.
  This important permanent extension would ensure that following the 
pandemic, providers and patients continue to have access to telehealth 
flexibilities, especially in rural and underserved areas. These are 
arguably communities that have benefited the most from an increase in 
telehealth access.
  We will continue to see innovation and technology that will further 
influence how we deliver care to American patients. We need to keep up 
with the times. This bill is an important step, but it is not the end 
of the discussion.

                              {time}  1300

  Mr. PALLONE. Madam Speaker, I yield 2 minutes to the gentleman from 
Texas (Mr. Doggett).
  Mr. DOGGETT. Madam Speaker, with telehealth helping so many 
throughout this pandemic, we should certainly continue its benefits, as 
I proposed in bipartisan legislation last year, and for which I secured 
the support of 22 health-related stakeholders. But we don't have to 
accept billions of dollars of fraud, of theft of taxpayer funds as the 
price for maintaining telehealth.
  Here is what has been happening: Information for some patients who 
wanted a COVID-19 test was used fraudulently to bill Medicare for 
expensive cancer genetic tests and allergy tests without any medical 
necessity or any knowledge of the patient. In other cases, expensive 
medical equipment in no way needed by the patient was ordered.
  The wrongdoing has been exposed by the General Accountability Office, 
the Health and Human Services inspector general, and is the subject of 
Justice Department prosecutions for literally billions of taxpayer 
dollars. Through no fault of the gentlewoman from Wyoming (Ms. Cheney) 
or Chairman Pallone, this bill fails to address this theft. I offered 
an amendment to the bill that was recommended by an independent, 
nonpartisan commission called MedPAC, mandating reasonable steps to 
prevent or at least significantly reduce this telehealth fraud. 
Outrageous interference with the consideration of this bill is denying 
the House today any opportunity to consider this antifraud amendment.
  My amendment would have required in-person visits within 6 months 
prior to ordering this high-cost lab testing or DME--medical 
equipment--as well as an audit of outlier clinicians whose orders for 
these very high-cost services and devices are largely made through a 
telehealth appointment. This has to stop, and we need to prevent the 
fraud, not just prosecute it and get back a few pennies for the 
taxpayer per dollar after it has occurred.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. PALLONE. Madam Speaker, I yield the gentleman an additional 1 
minute.
  Mr. DOGGETT. Madam Speaker, this bill costs $132 million per month. 
Without these targeted provisions to prevent Medicare from being 
looted, I must vote against it.
  Mr. CARTER of Georgia. Madam Speaker, I yield 2\1/2\ minutes to the 
gentleman from Ohio (Mr. Johnson), another valuable member of the 
Energy and Commerce Committee.
  Mr. JOHNSON of Ohio. Madam Speaker, this should be a happy occasion 
because major telehealth legislation is being brought to the floor on 
its own. Finally.
  As a co-chair of the bipartisan Congressional Telehealth Caucus, my 
fellow caucus members and I have been pushing for telehealth to be 
recognized for its true value for years. Years.
  So here we are, and those of us who are leaders on the Congressional 
Telehealth Caucus, the Energy and Commerce Committee, Ways and Means, 
and are all longtime champions for telehealth reforms, we have been 
completely left out of the process.
  The product we have before us today is a small step in the right 
direction, but the American people deserve better. This legislation, 
conceived in a last-minute deal, is, sadly, a missed opportunity.
  This legislation, well, frankly, it looks familiar. It removes 
geographic restrictions, enables telehealth access in the home, 
protects telemental health services--reforms we have been seeking for 
years now.
  But it is time to decouple important telehealth reforms from this 
never-ending public health emergency. Kicking the can down the road 
another year-and-a-half, as this legislation does, just isn't 
sufficient.
  During COVID-19, temporary telehealth expansion was a real bright 
spot. It eased burdens on a strained medical system, protected at-risk 
patients, and in rural Appalachian districts like mine, I heard from 
countless constituents who were very relieved that they could access 
care from their home instead of the common half hour or even longer to 
drive to the appointments they needed.
  Now, Madam Speaker, it is time for permanent reforms. I am proud to 
have introduced H.R. 8493 with my colleagues Vern Buchanan and Michelle 
Steel to make real long-term reforms to telehealth. This, coupled with 
the additional alternative proposals my colleagues have offered today, 
would do just that.
  Clearly, as you can see, Madam Speaker, the Speaker of the House has 
the will to take on this challenge. But this bill on the floor today? 
Well, I am going to support it, but I am afraid it is just a start. We 
have more to do.
  Mr. PALLONE. Madam Speaker, I have no additional speakers at this 
time. We may have one more, but not at this time. I reserve the balance 
of my time.

  Mr. CARTER of Georgia. Madam Speaker, I yield 1 minute to the 
gentleman from California (Mr. Valadao).
  Mr. VALADAO. Madam Speaker, I appreciate the opportunity to speak on 
this. Telehealth is critical for rural and low-income communities like 
many in my district, and I absolutely support this bill.
  Throughout the COVID-19 pandemic, telehealth was widely used since we 
were not able to see our healthcare providers in person. Even before 
the pandemic, many of my constituents were not able to go to their 
health appointments because oftentimes the office was way too far, or 
they did not have the transportation to get to their provider.
  Through this legislation, the Advancing Telehealth Beyond COVID-19 
Act, some of the healthcare flexibilities we have seen since 2020 would 
be extended for another 2 years. This action is very necessary, but I 
also believe it is in the

[[Page H7193]]

best interests of our constituents to take these flexibilities and make 
them permanent.
  I introduced a companion bill with my colleagues that would make 
permanent the expanded list of practitioners eligible to provide 
telehealth services.
  Congresswoman Cheney's bill is a great starting point, but I 
encourage my colleagues to make these flexibilities permanent so our 
constituents can have access to the care even after the public health 
emergency declaration has ended.
  Mr. PALLONE. Madam Speaker, I am prepared to close, but I think 
Republicans may have additional speakers.
  Mr. CARTER of Georgia. Madam Speaker, I yield myself such time as I 
may consume.
  Again, let me be clear about my standing on this bill. I support this 
bill. We support telehealth. We are all in favor of telehealth, but we 
also support the fact that we have committees that this type of 
legislation needs to go through, and we missed an opportunity here to 
make this a better bill. That is simply what we are saying.
  No one is saying they are not in favor of telehealth. Telehealth has 
become an integral part of our healthcare system during this pandemic. 
There is no question about that. All of us agree on that. It needs to 
be extended.
  But, again, the committee process is exceptionally important, and we 
need to make sure that we follow that, particularly when we are talking 
about subject matter as important as this because it is important.
  Again, since I have been a Member of Congress, I have been working to 
make healthcare accessible and available, and telehealth does just 
that. This is exactly what we want, but there are ways that we could 
have made this better.
  One example is that we need to make sure there is no waste, fraud, 
and abuse. That is one thing that could have been tightened up in this 
legislation.
  Another example is to make sure that we are not having any 
information that is inadvertently or intentionally being released. That 
is extremely important as well.
  So again, there are ways that we could have made this legislation 
better if we had gone through the committee process, which is a process 
that is extremely important.
  Madam Speaker, I reserve the balance of my time.
  Mr. PALLONE. Madam Speaker, I continue to reserve the balance of my 
time.
  The SPEAKER pro tempore. The gentleman from Nebraska is recognized 
and controls the time.
  Mr. SMITH of Nebraska. Madam Speaker, may I inquire how much time is 
remaining?
  The SPEAKER pro tempore. The gentleman has 19 minutes remaining.
  Mr. SMITH of Nebraska. Madam Speaker, I yield 2 minutes to the 
gentlewoman from Iowa (Mrs. Miller-Meeks).
  Mrs. MILLER-MEEKS. Madam Speaker, I rise today in support of H.R. 
4040. This bill would extend telehealth flexibilities under Medicare 
until 2024. These flexibilities allow physicians to be more widely 
available to patients who no longer need to wait weeks for a visit or 
take hours off work to sit in a doctor's office.
  While I support this bill, I am disappointed that the majority did 
not follow the regular committee process, which could have further 
improved the bill in a bipartisan way.
  For example, the committee could have incorporated elements of the 
Greater Access to Telehealth Act, which I am proud to co-lead with the 
gentleman from Arizona (Mr. Schweikert) and the gentleman from Georgia 
(Mr. Carter). This bill would extend the telehealth flexibility until 
2026 and includes policies to support health savings accounts. But the 
majority did not follow regular order, and that is a great disservice 
to a commonsense bill like H.R. 4040.
  Regardless, and despite the procedural irregularities, I support the 
bill, and I encourage my colleagues to vote for H.R. 4040.
  Mr. PALLONE. Madam Speaker, I continue to reserve the balance of my 
time.
  Mr. SMITH of Nebraska. Madam Speaker, I yield 2 minutes to the 
gentleman from North Carolina (Mr. Murphy).
  Mr. MURPHY of North Carolina. Madam Speaker, I rise today in support 
of H.R. 4040. There have been a few silver linings that we have seen in 
the pandemic, and definitely telehealth has been one of them.
  I will submit, I am personally thankful for this bill because I will 
say, maybe, perhaps I am the only sitting Member of Congress who, as a 
physician, has actually used telehealth.
  In my surgical practice, I see patients from 2 hours north, 2 hours 
south, and sometimes 5 hours east out on the eastern North Carolina 
coast. So many of my patients who come from rural eastern North 
Carolina can't even afford gas in the inflationary environment we have 
to even travel these distances, much less sometimes across town.
  While this bill is a good start, it is a very, very good start, it 
does not go far enough, and that is why I, with Dr. Burgess and 
Congresswoman Herrell, introduced a bill to permanently extend 
telehealth for federally qualified health centers and rural health 
centers. These are the medical practices that take care of our poorest 
and the most at-risk patients. These individuals need to be able to 
access telehealth because they have to travel long distances and don't 
have the resources that they need to be able to access physician care.

  I subsequently urge my colleagues to support this initiative and urge 
them that we can do much more.
  Mr. PALLONE. Madam Speaker, I continue to reserve the balance of my 
time.
  Mr. SMITH of Nebraska. Madam Speaker, I yield myself such time as I 
may consume. I will be brief in my remarks here.
  I know that you have heard several concerns expressed about this 
entire process, and I would certainly share those concerns.
  I do think that this is a great opportunity to address a bipartisan 
issue that is important across America. But it appears this bill was 
negotiated quickly, in secret, and outside the committees of 
jurisdiction. Neither outside stakeholders nor Members who have worked 
extensively on telehealth policy were consulted, as far as I can tell, 
and the closed rule under which this is being considered has precluded 
any opportunity to improve or amend the bill.
  An issue this important deserves an open and transparent process that 
follows regular order, allowing Members to offer input and highlight 
important needs which might otherwise have been overlooked. We call 
this legislating.
  If we had worked together on the Ways and Means Committee with our 
Energy and Commerce friends and had included the various ideas and 
innovations, this would have been a true and real bipartisan bill. I am 
confident that the telehealth extension we are considering today would 
be even better, as has been mentioned by my colleagues.
  In fact, back in May, I introduced a bipartisan bill almost identical 
to this one called the Connecting Rural Telehealth to the Future Act. 
That bill extended all the provisions included in the FY22 omnibus 
through at least 2024 and also included provisions to ensure critical 
access hospitals can continue to provide telehealth services to their 
patients. It also corrects a flaw in the CARES Act which shortchanges 
federally qualified health centers and rural health clinics which offer 
telehealth services.
  Madam Speaker, I include in the Record two letters from the National 
Rural Health Association and the National Association of Rural Health 
Clinics expressing their support for both the aims of H.R. 4040 as well 
as the need to extend critical rural health provisions from the 
Connecting Rural Telehealth to the Future bill.

                                                    National Rural


                                           Health Association,

                                                    July 26, 2022.
     Hon. Nancy Pelosi,
     Speaker, House of Representatives.
     Hon. Kevin McCarthy,
     Minority Leader, House of Representatives.
       Dear Speaker Pelosi and Minority Leader McCarthy: The 
     National Rural Health Association (NRHA) applauds the House 
     of Representatives for prioritizing telehealth flexibilities 
     by scheduling a vote on H.R. 4040, the Advancing Telehealth 
     Beyond COVID-19 Act of 2022. This legislation will extend 
     important telehealth flexibilities enacted in the Coronavirus 
     Aid, Relief, and Economic Security (CARES) Act, and extended 
     for 151 days post-public health emergency in the Consolidated 
     Appropriations

[[Page H7194]]

     Act (CAA), 2022, until December 31, 2024. NRHA supports the 
     extension of telehealth flexibilities to show providers that 
     telehealth is here to stay but urges rural friendly tweaks to 
     the legislation.
       NRHA is a non-profit membership organization with more than 
     21,000 members nationwide that provides leadership on rural 
     health issues. Our membership includes every component of 
     rural America's health care, including rural community 
     hospitals, critical access hospitals, doctors, nurses, and 
     patients. We provide leadership on rural health issues 
     through advocacy, communications, education, and research.
       As the text is currently written, H.R. 4040 includes the 
     extension of distant-site status for Federally Qualified 
     Health Centers (FQHC) and Rural Health Clinics (RHC) at their 
     current reimbursement level. While continuation of this 
     flexibility is necessary, the reimbursement level for virtual 
     services is significantly lower than in-person services under 
     current statute. Should reimbursement remain as it is 
     currently written, by 2028 there will be nearly a $100 
     discrepancy between services provided in-person and virtually 
     at RHCs. NRHA believes this will cause rural communities to 
     utilize these important services less often than their urban 
     and suburban counterparts moving forward and will cause harm 
     to an already fragile rural safety net.
       To remedy this discrepancy, NRHA urges this text be amended 
     to incorporate reimbursement updates as reflected in Section 
     9 of H.R. 7876, the Connecting Rural Telehealth into the 
     Future Act, introduced by Representatives Adrian Smith (R-NE) 
     and Terri Sewell (D-AL). Incorporating this legislative text 
     will bring payment parity between in-person and virtual care 
     at RHCs and FQHCs and ensure that rural communities have 
     access to the same health care delivery methods as their 
     urban and suburban counterparts.
       NRHA applauds the House of Representatives for acting on 
     telehealth to show providers long-term stability. However, to 
     ensure that rural providers, and their patients, can properly 
     utilize these services tweaks are needed.
           Sincerely,
                                                      Alan Morgan,
     Chief Executive Officer.
                                  ____

                                           National Association of


                                         Rural Health Clinics,

                                                    July 26, 2022.
     Hon. Nancy Pelosi,
     Speaker, House of Representatives,
     Washington, DC.
     Hon. Kevin McCarthy,
     Republican Leader, House of Representatives,
     Washington, DC.
       Dear Speaker Pelosi and Leader McCarthy: The National 
     Association of Rural Health Clinics (NARHC) is grateful that 
     the House of Representatives is considering extending 
     Medicare coverage of telehealth through 2024 but we are 
     concerned that the current language in H.R. 4040 will 
     perpetuate inequitable payment policies for safety-net 
     providers.
       Presently, our peers in traditional office settings are 
     able to bill for telehealth services as if the service was 
     provided physically in the office. In other words, they have 
     coding and reimbursement parity between telehealth services 
     and in-person services.
       On the other hand, Rural Health Clinics (RHCs) and 
     Federally Qualified Health Centers (FQHCs) do not use their 
     normal coding and reimbursement rules for telehealth. RHCs 
     and FQHCs instead have a ``special payment rule'' that 
     requires them to bill a single code, G2025, for all 
     telehealth services which is then reimbursed at a single 
     nationwide rate (currently $97.24).
       We are concerned with this ``special payment rule'' 
     methodology for a whole host of reasons. First and foremost, 
     the payment is significantly less than what most RHCs and 
     FQHCs would receive for providing the same service in person, 
     disincentivizing safety-net providers from offering the 
     service via telehealth. Second, the current rules require 
     RHCs and FQHCs to ``carve-out'' all telehealth costs from 
     their cost report, which adds significant administrative 
     burden to the cost-reporting process. Third, the use of a 
     single telehealth code, G2025, has prevented RHCs from 
     tracking annual wellness visits and other services provided 
     via telehealth severely hindering their ability to properly 
     participate in ACOs and other quality programs.
       Complicating matters is the fact that for mental health 
     services provided via telehealth, RHCs and FQHCs do use their 
     normal coding and reimbursement mechanisms. This policy is 
     working well, and we believe that is should work this way for 
     all services, not just mental health services.
       NARHC strongly believes that the best way to encourage 
     telehealth usage in underserved communities is to create 
     parity between in-person and telehealth policies. We strongly 
     encourage Congress to amend H.R. 4040 to include the payment 
     policy enumerated in Section 9 of H.R. 7876, the Connecting 
     Rural Telehealth to the Future Act introduced by 
     Representative Adrian Smith and Representative Terri Sewell.
       Please feel free to contact me if you would like to discuss 
     this issue further.
           Sincerely,

                                                 Nathan Baugh,

                                               Executive Director,
                     National Association of Rural Health Clinics.

  Mr. SMITH of Nebraska. Madam Speaker, these organizations fully 
understand the vital role that rural health clinics and FQHCs and 
critical access hospitals play in ensuring access to care for those in 
rural and underserved areas.
  Even with the passage of this bill, the future of telehealth after 
the government-designated public health emergency is uncertain. More 
work needs to be done to assess what has worked well over the last 2 
years, what can be improved, and what can safely be left behind.
  While I do encourage Members to vote ``yes'' on this bill, I hope in 
the future we can work in a true bipartisan fashion under regular order 
to address the gaps that we know exist in policy and set a long-term, 
sustainable course for telehealth well beyond 2024.
  Madam Speaker, I reserve the balance of my time.

                              {time}  1315

  Mr. PALLONE. Madam Speaker, I reserve the balance of my time.
  Mr. SMITH of Nebraska. Madam Speaker, I yield 1 minute to the 
gentleman from Oklahoma (Mr. Hern), a member of the Ways and Means 
Committee.
  Mr. HERN. Madam Speaker, I rise in support of H.R. 4040, which will 
maintain seniors' access to telehealth, or what should be more 
appropriately called virtual health.
  In 2020, the Trump administration eliminated bureaucratic red tape so 
seniors could access healthcare virtually from the comfort of their 
homes. As a result, 52 million seniors sought their medical care 
virtually in 2020.
  I am proud to see my bill, the Protecting Mental Health Services Act, 
included in this legislation to ensure seniors have virtual access to 
mental health and substance abuse treatment. My bill ensures all 
Oklahomans can access high-quality care, regardless of their physical 
location.
  While this legislation is a step forward, it is unfortunate that it 
excludes employer-sponsored healthcare from the same low-cost access to 
telehealth. It is critical to provide folks on the job with the ability 
to seek flexible treatment, and I look forward to working with my 
colleagues on both sides of the aisle to pass this provision at a later 
date.
  Mr. PALLONE. Madam Speaker, I reserve the balance of my time.
  Mr. SMITH of Nebraska. Madam Speaker, I yield 1 minute to the 
gentlewoman from New Mexico (Ms. Herrell).
  Ms. HERRELL. Madam Speaker, I rise in support of the Advancing 
Telehealth Beyond COVID-19 Act, which would extend vital telehealth 
flexibilities through 2024. Expanding telehealth during the pandemic 
was a resounding success and has been recognized by many New Mexicans 
and rural Americans as a lifesaver.
  Telehealth provided Americans continued access to healthcare services 
without being physically present and also allowed healthcare providers 
to remain in practice.
  While this bill is an important step in the right direction, my 
Republican colleagues and I wish to go one step further by offering 
another bill, which would make permanent the extension of telehealth 
services for federally qualified health clinics and rural health 
clinics.
  Madam Speaker, I urge my colleagues to support the bill on the floor, 
as well as our subsequent bill to permanently expand telehealth 
services to all Americans, regardless of ZIP Code. Access to the care 
they deserve is crucial.
  Mr. PALLONE. Madam Speaker, I reserve the balance of my time.
  Mr. SMITH of Nebraska. Madam Speaker, I yield 1 minute to the 
gentlewoman from California (Mrs. Steel).
  Mrs. STEEL. Madam Speaker, I rise in support of the Advancing 
Telehealth Beyond COVID-19 Act.
  Telehealth has been life changing for so many, especially during the 
COVID-19 pandemic. Increased access to telehealth has benefited a wide 
range of Americans, from seniors to high-risk patients.
  We must ensure that the millions of Americans who have utilized 
flexibility provisions authorized during the pandemic do not lose their 
access to telemedicine.
  Right now, regardless of where you live, you have access to 
telehealth and virtual care. This bill ensures that this can continue 
for millions of Americans, but we should ensure that this flexibility 
is permanent.

[[Page H7195]]

  That is why I introduced legislation with Mr. Buchanan and Mr. 
Johnson to permanently remove any geographic restrictions on telehealth 
services.
  Madam Speaker, I urge my colleagues to support our legislation and to 
vote ``yes'' on today's bill so that we can continue to expand access 
to quality, affordable healthcare solutions.
  Mr. PALLONE. Madam Speaker, I reserve the balance of my time.
  Mr. SMITH of Nebraska. Madam Speaker, I yield 1 minute to the 
gentleman from California (Mr. Obernolte).
  Mr. OBERNOLTE. Madam Speaker, I represent one of the largest 
geographic districts in the country. Access to healthcare is a very 
real problem for the people I represent because many of them live hours 
away and hundreds of miles away from specialized healthcare.
  For my constituents, one of the few positive developments that came 
out of COVID-19 was the expansion of the way that telehealth can be 
used to provide quality healthcare in districts like mine.
  This bill, H.R. 4040, would take a very meaningful step in making 
permanent the changes to law that enable the provision of that 
telehealth, and I strongly urge its adoption.
  Mr. PALLONE. Madam Speaker, I reserve the balance of my time.
  Mr. SMITH of Nebraska. Madam Speaker, I yield 3 minutes to the 
gentleman from Arizona (Mr. Schweikert).
  Mr. SCHWEIKERT. Madam Speaker, you hear everyone here all say 
something nice. We all like telehealth. I am frustrated because I can't 
get my head around why we are not going further.
  Outside the internal political theater, those of us who have worked 
on this legislation since the day we got here and then all of a sudden 
wake up one day and it is a different bill with someone who I have 
never even heard of working on it, God bless. The majority gets to do 
things like that.
  We want a change in the price of healthcare. Can we come together and 
unleash technology? Telehealth is more than just looking at the phone 
and doing FaceTime or now talking. It is the wearable. It is the thing. 
It is the thing you lick.
  There is technology with which we could be crushing the price of 
healthcare, and instead, we are doing little incremental steps here.
  There are a couple of problems with the bill the Democrats decided to 
bring to the floor. It is for 2 years. We compromised to 4. If you want 
capital investments in the technology, you have to give us at least 4. 
It should be permanent.

  There is also something in here that is just frustrating. You missed 
the language on health savings accounts. You have 32 million people now 
who functionally are not going to have access to be able to use those 
accounts for their telehealth.
  Madam Speaker, there is just a frustration here because we all talk 
pretty about this, and then we are unwilling to do the things that 
could potentially help us all by disrupting the price of healthcare and 
increasing access, maybe making people's lives better. Instead, it just 
became more political theater. We should be ashamed of ourselves.
  Madam Speaker, I ask unanimous consent to insert the text of the 
amendment in the Record immediately prior to the vote on the motion to 
recommit.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Arizona?
  There was no objection.
  Mr. SCHWEIKERT. Madam Speaker, if I came to the body and said the 
bill we had all been working on, H.R. 8489--when you have someone like 
Lloyd Doggett and someone like me, and we are actually working 
together, we are working on some of the antifraud provisions, program 
integrity provisions, you actually had something this body was doing 
where we weren't beating the crap out of each other. It was something 
that actually might be good for people in the country. Instead, we 
turned it back into another opportunity for political gamesmanship.
  It is my intense disappointment because it is our language, 
substantially something I have worked on for years, that was grabbed 
for the pandemic. We all know it expires the day the pandemic is 
declared over. It is time to take this opportunity--I know there is an 
army of lobbyists out there that despise telehealth because it changes 
the populations that walk in the threshold. To hell with them. Let's 
finally do what is right.
  Mr. PALLONE. Madam Speaker, I reserve the balance of my time.
  Mr. SMITH of Nebraska. Madam Speaker, I yield myself the balance of 
my time.
  I think we have had a good discussion here today. I think we have 
laid out that we are acting in good faith, supporting an issue, moving 
it forward, but also posing the scenario that there are so many other 
things we can do to address the very matter that we are taking up here 
today.
  The surrounding details about how this bill came up and everything, I 
think it is problematic for the institution. But the fact of the matter 
is, we have an issue here that we need to address. I hope that we can 
work to continue to make it permanent in the future so that we can 
encourage investment, as was outlined previously, and encourage bending 
of the cost curve, ultimately, on healthcare, which is lacking at this 
point in time.
  Madam Speaker, I urge a ``yes'' vote on this bill, and I urge a 
different kind of cooperation moving forward.
  Madam Speaker, I yield back the balance of my time.
  Mr. PALLONE. Madam Speaker, I yield myself the balance of my time.
  Since I heard every Republican who spoke say that they support the 
bill, I was certainly reluctant to suggest that we would have any kind 
of significant debate about the bill. I generally feel that if I have 
both sides of the aisle saying it is a good bill, I should leave well 
enough alone.
  But I do want to say this in response to some of the comments that 
were made by the Republican Members. We were reluctant in the committee 
to move to have permanent authorization of the telehealth flexibility 
expansion for several reasons.
  First of all, it is expensive. In other words, the Congressional 
Budget Office scored this bill. As I said, the bill for the 2 years is 
paid for. If you wanted to go permanent, I think they would have said 
that we needed another $20 billion. I feel very strongly that the bill 
should be paid for. That is part of what we believe as Democrats. We 
were able to get agreement with the Republicans on a pay-for for the 2 
years, so that was a factor as to why it is for 2 years instead of 
permanent.
  Beyond that, and more importantly, really, is the fact that a 
permanent expansion is a major change. I think it needs a lot of study, 
a lot of oversight and investigation. One of the things that I 
mentioned in Rules is that both HHS and the inspector general have been 
tasked to report back to us this spring with a report on a lot of the 
things that were mentioned here today, integrity issues, in terms of 
fraud and abuse, that were mentioned by both sides of the aisle.
  I think the feeling of the committee was that this was something that 
needed more study before we went ahead and made this permanent. That is 
what we do. In other words, right now, the concern is that because the 
omnibus appropriations bill basically expanded the telehealth program 
until 5 months after the public health emergency for COVID ends, that 
would take us to the end of this year. But we don't have a lot of 
legislative days left. We figured the best thing was to at least extend 
it for another 2 years. We can pay for it, as was mentioned by Ms. 
Cheney.
  This, I think, is the best way to resolve this: Do a 2-year extend, 
pay for it, and let's spend the time between now and next spring having 
some more hearings and opportunities to talk about a further extension 
or possibly making it permanent.
  Again, I appreciate the fact that everyone on the Republican side 
supports the bill, but I do want to address some of the things that you 
mentioned.
  Madam Speaker, I yield back the balance of my time.
  Ms. JACKSON LEE. Madam Speaker, I rise in support of H.R. 4040 the 
Advancing Telehealth Beyond COVID-19 Act of 2021, which would make 
permanent several telehealth flexibilities under Medicare that were 
initially authorized during the COVID-19 public health emergency.
  This bill would extend the life-saving measures put in place by 
Congress during the

[[Page H7196]]

COVID-19 pandemic that allowed millions of American people to access 
telehealth-care.
  Specifically, H.R. 4040 would:
  permanently remove originating site and geographical restrictions 
that limited telehealth services to designated clinics in the event of 
a physician shortage,
  give rural providers the ability to serve patients remotely while 
being properly compensated for their work,
  empower providers to provide access to smart devices and innovative 
digital technology to their patients for monitoring purposes, and
  provide coverage for audio-only evaluation, management, and 
behavioral health services.
  H.R. 4040 would codify critical telehealth policies implemented 
during the pandemic for the continued benefit of all, but especially 
those in isolated communities, people with disabilities, and seniors.
  Telehealth has dramatically improved the medical industry by making 
healthcare more accessible to people in rural areas, those with 
mobility concerns, and individuals whose work or family schedules may 
not accommodate an appointment at a physical location.
  During the height of the pandemic, while more than 3,000 people were 
dying per day of the virus, telehealth served as an invaluable weapon 
against the spread of infectious disease.
  Remote screening and care prevented undue burden on our already 
exhausted medical professionals and allowed patients to get the care 
they needed without putting themselves or their families at risk.
  What began as emergency protocol then, has now emerged as best 
practice.
  Currently, 76 percent of hospitals in the U.S. connect doctors and 
patients remotely via telehealth.
  This is up from 35 percent a decade ago.
  Remote healthcare allows for greater flexibility for patients, 
enables certain physicians like allergists or occupational therapists 
to access an individual's environmental needs, and streamlines the 
scheduling process to prevent long wait times and wasted time.
  Telehealth has allowed doctors to monitor their patients' chronic 
conditions more closely, like heart or lung disease.
  Better monitoring can improve patients' quality-of life and reduce 
hospital admissions and deaths from chronic diseases.
  Additionally, telehealth is a good way to deliver care quickly in an 
emergency, such as a stroke or heart attack.
  Telehealth has also played a significant role in expanding pediatric 
mental healthcare access.
  As of April 2019, there were only 8,300 practicing child and 
adolescent psychiatrists in the U.S.
  This number is dwarfed by the more than 15 million kids and teens in 
need of a psychiatric provider.
  For over a decade, The University of Texas Medical Branch has offered 
telehealth services for rural patients.
  After initially partnering with community mental health clinics in 
fringe counties, the program has since been able to expand adolescent 
mental health services directly to school districts.
  This means children without access to a local psychiatrist can 
receive the care they need without being pulled from school or 
traveling long distances.
  It also means psychiatrists can observe children in their natural 
setting at home or in school, rather than in an inorganic hospital 
environment.
  Telehealth allows children to be where they ought to be--in the 
classroom getting an education.
  These are just some of the many examples of how telehealth has aided 
our healthcare system in providing the quality medical services that 
our constituents deserve.
  The passage of H.R. 4040, the Advancing Telehealth Beyond COVID-19 
Act of 2021, would ensure that these positive developments continue to 
benefit communities across the country.
  It is important to note, however, that telehealth has not always 
served all people equally.
  Historical data shows that People of Color have long faced obstacles 
to getting the critical health care services they need.
  Unfortunately, the rapid implementation of telemedicine hasn't 
bridged the equality divide as much as one would have hoped.
  A study led by the University of Houston College of Medicine found 
that African Americans were 35 percent less likely to use telemedicine 
compared to White Americans, and those in Hispanic communities were 51 
percent less likely to use it.
  Only 66 percent of African American and 61 percent of Hispanic 
households have access to broadband internet compared to 79 percent of 
white households.
  Additionally, only a quarter of families earning $30,000 or less have 
smart devices, such as a phone, tablet, or laptop at home, limiting 
their access to telehealth services.
  So, while telehealth has reduced many barriers to adequate 
healthcare, we must stay vigilant to the needs of our most 
disadvantaged community members.
  We are a long way from full medical equality in this country, 
however, I believe that the Advancing Telehealth Beyond COVID-19 Act of 
2021 is an important step in bringing us closer to that goal.
  H.R. 4040 is an opportunity to connect our healthcare providers with 
patients who might otherwise go without the medical care they so 
desperately need.
  It is an opportunity to lift our nation's healthcare into the 21st 
century and to utilize technology as a medical equalizer.
  I urge all my colleagues to support H.R. 4040 the Advancing 
Telehealth Beyond COVID-19 Act of 2021.
  Ms. ESHOO. Madam Speaker, as the Chairwoman of the Health 
Subcommittee and a senior member of the Communications and Technology 
Subcommittee, I've advanced the importance of telehealth for years.
  Over the last several months, as I've talked to health care 
professionals and providers in my district, I've heard how the wide 
adoption of telehealth has been the bright spot during the pandemic.
  One reason for that bright spot is that HHS waived many rules and 
payment policies surrounding telehealth coverage in traditional 
Medicare during the public health emergency. A recent HHS Office of the 
Inspector General report found that over 28 million Medicare 
beneficiaries used telehealth during the first year of the pandemic, 
demonstrating the long-term potential of telehealth to increase access 
to health care for beneficiaries.
  Now that beneficiaries have received this important benefit, they 
fully appreciate what telehealth does for them. We must find a way to 
continue telehealth access for seniors and all Americans. That's why 
I'm proud to support Representatives Liz Cheney and Debbie Dingell's 
bipartisan H.R. 4040, the ``Advancing Telehealth Beyond COVID-19 Act of 
2022.'' The bill will allow Medicare beneficiaries to use telehealth 
services after the public health emergency ends by eliminating 
geographical restrictions on Medicare coverage for telehealth services 
and expand Medicare coverage to include audio-only telehealth. I urge 
my colleagues to support this important, bipartisan bill.
  Mr. THOMPSON of California. Madam Speaker, I rise in strong support 
of this legislation.
  I have been working on telehealth and telemedicine for nearly three 
decades, since my time in the California State Senate.
  As founder and Co-Chair of the Congressional Telehealth Caucus, I 
have repeatedly introduced multiple bipartisan bills expanding access 
to telehealth, and have worked with my colleagues on the caucus--
including Ms. Matsui, Mr. Welch, Mr. Schweikert, and Mr. Johnson of 
Ohio--to ensure that access to telehealth services does not disappear 
at the conclusion of the COVID-19 Public Health Emergency.
  I was proud to author legislation two years ago expanding telehealth 
in Medicare for the duration of the COVID-19 pandemic. That 
legislation--which was included in the very first COVID-19 relief 
measure advanced by Congress--has allowed millions of seniors on 
Medicare to see their doctors over the past two years without leaving 
their homes.
  By allowing these patients to receive the care they need remotely, 
we've been able to minimize transmission risk while maximizing safety 
for both patients and providers.
  In my view, the expansion and widespread adoption of telehealth 
services is one of the few silver linings of COVID-19.
  Americans across our country now know firsthand that by integrating 
technology with health care, we can bring care to underserved areas, 
reduce burdens on parents and caregivers, increase the efficiency of 
our health care system and, in many cases, save money: by ensuring that 
patients receive care swiftly, we can treat medical conditions early 
on--thereby warding off worse (and more expensive) complications down 
the road.
  However, while the value of telehealth is particularly evident amidst 
a pandemic, its utility is not limited to the present circumstances.
  It is critical that Congress extend telehealth flexibilities in 
Medicare beyond the COVID-19 public health emergency.
  And that's what this bill does.
  This bill includes numerous provisions of mine ensuring that seniors 
can continue to visit providers remotely, regardless of zip code, for 
two more years. It allows us to continue amassing and analyzing data, 
and sets the stage for telehealth to become a permanent part of the 
Medicare program--a goal I've long sought.
  I want to thank the many, many colleagues of mine who have worked 
with me on this critical issue.
  I urge my colleagues to vote yes.
  The SPEAKER pro tempore. All time for debate has expired.

[[Page H7197]]

  Pursuant to House Resolution 1256, the previous question is ordered 
on the bill, as amended.
  The question is on engrossment and third reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.


                           Motion to Recommit

  Mr. SCHWEIKERT. Madam Speaker, I have a motion to recommit at the 
desk.
  The SPEAKER pro tempore. The Clerk will report the motion to 
recommit.
  The Clerk read as follows:
       Mr. Schweikert of Arizona moves to recommit the bill H.R. 
     4040 to the Committee on Energy and Commerce.

  The material previously referred to by Mr. Schweikert is as follows:

       Strike all after the enactment clause and insert the 
     following:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Greater Access to Telehealth 
     Act''.

     SEC. 2. REMOVING GEOGRAPHIC REQUIREMENTS AND EXPANDING 
                   ORIGINATING SITES FOR TELEHEALTH SERVICES.

       Section 1834(m) of the Social Security Act (42 U.S.C. 
     1395m(m)) is amended--
       (1) in paragraph (2)(B)(iii)--
       (A) by striking ``With'' and inserting ``In the case that 
     the emergency period described in section 1135(g)(1)(B) ends 
     before December 31, 2026, with''; and
       (B) by striking ``that are furnished during the 151-day 
     period beginning on the first day after the end of the 
     emergency period described in section 1135(g)(1)(B)'' and 
     inserting ``that are furnished during the period beginning on 
     the first day after the end of such emergency period and 
     ending December 31, 2026''; and
       (2) in paragraph (4)(C)(iii)--
       (A) by striking ``With'' and inserting ``In the case that 
     the emergency period described in section 1135(g)(1)(B) ends 
     before December 31, 2026, with''; and
       (B) by striking ``that are furnished during the 151-day 
     period beginning on the first day after the end of the 
     emergency period described in section 1135(g)(1)(B)'' and 
     inserting ``that are furnished during the period beginning on 
     the first day after the end of such emergency period and 
     ending on December 31, 2026''.

     SEC. 3. EXPANDING PRACTITIONERS ELIGIBLE TO FURNISH 
                   TELEHEALTH SERVICES.

       Section 1834(m)(4)(E) of the Social Security Act (42 U.S.C. 
     1395m(m)(4)(E)) is amended by striking ``and, for the 151-day 
     period beginning on the first day after the end of the 
     emergency period described in section 1135(g)(1)(B)'' and 
     inserting ``and, in the case that the emergency period 
     described in section 1135(g)(1)(B) ends before December 31, 
     2026, for the period beginning on the first day after the end 
     of such emergency period and ending on December 31, 2026''.

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

       Section 1834(m)(8)(A) of the Social Security Act (42 U.S.C. 
     1395m(m)(8)(A)) is amended by striking ``during the 151-day 
     period beginning on the first day after the end of such 
     emergency period'' and inserting ``in the case that such 
     emergency period ends before December 31, 2026, during the 
     period beginning on the first day after the end of such 
     emergency period and ending on December 31, 2026''.

     SEC. 5. DELAYING THE IN-PERSON REQUIREMENTS UNDER MEDICARE 
                   FOR MENTAL HEALTH SERVICES FURNISHED THROUGH 
                   TELEHEALTH AND TELECOMMUNICATIONS TECHNOLOGY.

       (a) Delay in Requirements for Mental Health Services 
     Furnished Through Telehealth.--Section 1834(m)(7)(B)(i) of 
     the Social Security Act (42 U.S.C. 1395m(m)(7)(B)(i)) is 
     amended, in the matter preceding subclause (I), by striking 
     ``on or after the day that is the 152nd day after the end of 
     the period at the end of the emergency sentence described in 
     section 1135(g)(1)(B))'' and inserting ``on or after January 
     1, 2027 (or, if later, the first day after the end of the 
     emergency period described in section 1135(g)(1)(B))''.
       (b) Mental Health Visits Furnished by Rural Health 
     Clinics.--Section 1834(y) of the Social Security Act (42 
     U.S.C. 1395m(y)) is amended--
       (1) in the heading, by striking ``to hospice patients''; 
     and
       (2) in paragraph (2), by striking ``prior to the day that 
     is the 152nd day after the end of the emergency period 
     described in section 1135(g)(1)(B))'' and inserting ``prior 
     to January 1, 2027 (or, if later, the first day after the end 
     of the emergency period described in section 
     1135(g)(1)(B))''.
       (c) Mental Health Visits Furnished by Federally Qualified 
     Health Centers.--Section 1834(o)(4) of the Social Security 
     Act (42 U.S.C. 1395m(o)(4) is amended--
       (1) in the heading, by striking ``to hospice patients''; 
     and
       (2) in subparagraph (B), by striking ``prior to the day 
     that is the 152nd day after the end of the emergency period 
     described in section 1135(g)(1)(B))'' and inserting ``prior 
     to January 1, 2027 (or, if later, the first day after the end 
     of the emergency period described in section 
     1135(g)(1)(B))''.

     SEC. 6. ALLOWING FOR THE FURNISHING OF AUDIO-ONLY TELEHEALTH 
                   SERVICES.

       Section 1834(m)(9) of the Social Security Act (42 U.S.C. 
     1395m(m)(9)) is amended by striking ``The Secretary shall 
     continue to provide coverage and payment under this part for 
     telehealth services identified in paragraph (4)(F)(i) as of 
     the date of the enactment of this paragraph that are 
     furnished via an audio-only telecommunications system during 
     the 151-day period beginning on the first day after the end 
     of the emergency period described in section 1135(g)(1)(B)'' 
     and inserting ``In the case that the emergency period 
     described in section 1135(g)(1)(B) ends before December 31, 
     2026, the Secretary shall continue to provide coverage and 
     payment under this part for telehealth services identified in 
     paragraph (4)(F)(i) that are furnished via an audio-only 
     communications system during the period beginning on the 
     first day after the end of such emergency period and ending 
     on December 31, 2026''.

     SEC. 7. USE OF TELEHEALTH TO CONDUCT FACE-TO-FACE ENCOUNTER 
                   PRIOR TO RECERTIFICATION OF ELIGIBILITY FOR 
                   HOSPICE CARE DURING EMERGENCY PERIOD.

       Section 1814(a)(7)(D)(i)(II) of the Social Security Act (42 
     U.S.C. 1395f(a)(7)(D)(i)(II)) is amended by striking ``and 
     during the 151-day period beginning on the first day after 
     the end of such emergency period'' and inserting ``and, in 
     the case that such emergency period ends before December 31, 
     2026, during the period beginning on the first day after the 
     end of such emergency period described in such section 
     1135(g)(1)(B) and ending on December 31, 2026''.

     SEC. 8. EXTENSION OF SAFE HARBOR FOR ABSENCE OF DEDUCTIBLE 
                   FOR TELEHEALTH.

       Section 223(c)(2)(E) of the Internal Revenue Code of 1986 
     is amended by striking ``and before January 1, 2023,'' and 
     inserting ``and before January 1, 2027,''.

     SEC. 9. FUNDING FROM MEDICARE IMPROVEMENT FUND.

       Section 1898(b)(1) of the Social Security Act (42 U.S.C. 
     1395jjj(b)(1)) is amended by striking ``$7,500,000,000'' and 
     inserting ``$0''.

  The SPEAKER pro tempore. Pursuant to clause 2(b) of rule XIX, the 
previous question is ordered on the motion to recommit.
  The question is on the motion to recommit.
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.
  Mr. SCHWEIKERT. Madam Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to section 8 of rule XX, further 
proceedings on this question are postponed.

                          ____________________