H.R. 2263 — Telehealth Coverage Act of 2025

This section makes permanent certain Medicare telehealth flexibilities established during the COVID-19 public health emergency (PHE, under SSA §1135(g)(1)(B)), which were previously authorized only through March 31, 2025, by (1) removing geographic (i.e., rural-only) and originating site restrictions on telehealth services; (2) expanding the types of practitioners eligible to furnish telehealth services; (3) allowing telehealth services furnished by Federally qualified health centers (FQHCs) and rural health clinics (RHCs); and (4) permitting audio-only telecommunications for mental health services identified in SSA §1834(m)(4)(F)(i). It further eliminates in-person requirements previously applicable to (1) monthly home dialysis end-stage renal disease (ESRD)-related visits; (2) stroke telehealth services; (3) substance use disorder (SUD) and mental health telehealth services; and (4) mental health telehealth visits furnished by FQHCs or RHCs. The section also permits use of telehealth for the face-to-face encounter prior to hospice eligibility recertification beginning on the first day of the PHE (previously limited through March 31, 2025), except for encounters on or after April 1, 2025, involving individuals in moratorium areas for hospice enrollment, care from providers under enhanced oversight, or non-enrolled/opt-out physicians or nurse practitioners; requires the Secretary to establish modifiers or codes for certain telehealth claims (e.g., those using virtual platforms under contract or incident to professional services) by January 1, 2026; and authorizes program instruction for implementation.

This section requires that, for face-to-face encounters conducted via telehealth on or after January 1, 2026, prior to recertification of Medicare hospice care eligibility, any associated hospice claim include one or more modifiers or codes (as specified by the Secretary) indicating the encounter was conducted via telehealth.

This section extends Acute Hospital Care at Home waiver flexibilities to on or after the first day after the end of the emergency period described in section 1135(g)(1)(B) of the Social Security Act (from March 31, 2025). (As background, the waiver allows Medicare-participating hospitals to furnish acute-level inpatient services in beneficiaries' homes, subject to certain conditions.)

This section directs the Secretary of Health and Human Services, not later than one year after the date of enactment and in consultation with entities from seven specified categories (i.e., health information technology service providers, health care providers, health insurers, language service companies, interpreter or translator professional associations, health and language services quality certification organizations, and patient and consumer advocates), to issue or update guidance on best practices for telehealth services (as defined in section 1834(m) of the Social Security Act) for individuals with limited English proficiency, including: (1) facilitating and integrating use of interpreters during telemedicine appointments; (2) providing accessible instructions on accessing telecommunications systems; (3) improving access to digital patient portals; (4) integrating video platforms that enable multi-person video calls for interpretation during telemedicine appointments; and (5) providing patient materials, communications, and instructions in multiple languages (e.g., text message appointment reminders and prescription information).

This section expands the scope of Medicare Part B cardiopulmonary rehabilitation program services—structured outpatient programs of exercise or training, education, and counseling for beneficiaries with cardiopulmonary conditions—to include items and services furnished in the home of a hospital outpatient via audio and video real-time communications technology (excluding audio-only) on or after March 31, 2025. It also permits supervision of such services by the virtual presence of a physician, physician assistant, nurse practitioner, or clinical nurse specialist via telehealth on or after that date. Additionally, it authorizes the Secretary of Health and Human Services to implement these changes by program instruction or otherwise.

This section directs the Secretary of Health and Human Services to revise Medicare regulations by January 1, 2026, to permit, beginning on that date, entities enrolled as Medicare Diabetes Prevention Program (MDPP) suppliers—under the Center for Medicare and Medicaid Innovation—to participate in MDPP by offering only online services via synchronous or asynchronous technology or telecommunications. For such entities, (1) the administrative location is the entity's address on file under the Diabetes Prevention Recognition Program; (2) there is no prohibition on submitting claims for online MDPP services furnished to beneficiaries located in other states at the time of furnishing; and (3) no limit applies to the number of times an individual may enroll in MDPP. (Thus, the changes expand beneficiary access to this lifestyle intervention program for prediabetic Medicare enrollees.)

This section directs the Secretary of Health and Human Services, not later than January 1, 2026, to provide education and outreach—using existing communications mechanisms—to physicians and non-physician practitioners participating in Medicare on periodic screening for medication-induced movement disorders (i.e., side effects such as tardive dyskinesia from mental health medications) in at-risk patients, including clinical guidelines and best practices for telehealth delivery and evaluation and management code selection. The Secretary must, to the extent practicable, seek input from stakeholders and may address other relevant telehealth screening services.