H.R. 7444 — Protecting Rural Telehealth Access Act

This section eliminates certain Medicare telehealth restrictions under section 1834(m) of the Social Security Act (i.e., services furnished via interactive telecommunications systems by distant physicians or practitioners to Medicare beneficiaries at originating sites). Specifically, it (1) removes geographic requirements (i.e., rural health professional shortage areas) for originating sites for telehealth services furnished on or after January 1, 2027; (2) allows telehealth services in a beneficiary's home for all purposes on or after January 1, 2027 (from limitation to certain purposes through December 31, 2026); and (3) permits store-and-forward telehealth technologies for all telehealth services (from limitation to Federal telemedicine demonstration programs in Alaska and Hawaii).

This section establishes telehealth payment flexibilities for critical access hospitals (CAHs) under Medicare Part B by adding a new paragraph (10) to section 1834(m) of the Social Security Act and making conforming amendments to paragraphs (1), (2)(A), and (4)(A) and (F)(i) to include such services. (CAHs are small rural hospitals eligible for cost-based reimbursement of outpatient services at 101% of reasonable costs.) The new provision directs the Secretary, on or after enactment, to pay CAHs serving as distant sites for telehealth services—provided via telecommunications to eligible telehealth individuals with an established patient relationship (as defined by the relevant state) that complement a plan of care including appropriate in-person care—at 101% of the CAH's reasonable costs (or, if elected by the CAH under section 1834(g)(2), under that methodology); such services include behavioral health and other outpatient CAH services with corresponding payment codes identified by the Secretary. (Thus, these telehealth services count toward the CAH's provider productivity adjustment for cost-based payments.) The Secretary may implement via program instruction or otherwise.

This section extends Medicare telehealth flexibilities for Federally qualified health centers (FQHCs) and rural health clinics (RHCs)—which provide primary care in underserved urban and rural areas—through December 31, 2024, and on or after January 1, 2027 (previously through December 31, 2024); (2) replaces the prior payment provision with a requirement to reimburse telehealth services furnished by FQHCs or RHCs to eligible telehealth individuals at a separate payment rate, as determined by a methodology considering provider geography, telehealth delivery costs, and full service costs, with implementation via a reflective coding system and program instructions or interim final rules; and (3) requires, beginning January 1, 2027, that such payments be limited to services furnished by an FQHC or RHC with an established patient relationship for the individual, as defined by the state where the individual is located.

This section allows Medicare payment, on or after January 1, 2027, for specified telehealth services (i.e., evaluation and management services; behavioral health counseling and educational services; and other services determined appropriate by the Secretary) furnished using audio-only technology by qualified providers (i.e., physicians or practitioners with an established patient relationship or specified facilities such as critical access hospitals, rural health clinics, and federally qualified health centers), notwithstanding prior requirements for interactive audio-video telecommunications. The Secretary may impose clinical appropriateness standards, including any required in-person initial visit, and must review the policy no later than five years after enactment—including analysis of broadband impacts—with authority to add or delete covered services; payment equals the amount payable if furnished via other authorized telecommunications systems.

This section states the sense of Congress that the expansion of eligible practitioners authorized to furnish Medicare telehealth services during the COVID-19 public health emergency period—defined in section 1135(g)(1)(B) of the Social Security Act (42 U.S.C. 1320b-5(g)(1)(B))—should be extended permanently. (As background, the expansion added practitioners such as physical therapists, occupational therapists, and speech-language pathologists to those eligible to bill Medicare for telehealth services otherwise limited primarily to physicians and certain other professionals.)