S. 1261 — CONNECT for Health Act of 2025

This section removes the geographic requirements for Medicare telehealth services (i.e., certain Part B physician, practitioner, and other services furnished via telecommunications technology to beneficiaries located in rural health professional shortage areas, rural census tracts, or non-metropolitan statistical areas) furnished on or after October 1, 2025. (Thus, such telehealth services will be available nationwide beginning in FY2026.)

This section expands eligible originating sites for Medicare telehealth services by striking the September 30, 2025, expiration date in two provisions and inserting language making the sites eligible beginning on the date of enactment of the CONNECT for Health Act of 2025, and by removing a purpose limitation on one site. (As background, Medicare Part B pays originating sites—i.e., patient locations such as physician offices and rural health clinics—a facility fee for telehealth services furnished by distant-site practitioners; certain sites were temporarily expanded during the COVID-19 public health emergency.)

This section expands the definition of practitioner eligible to furnish Medicare telehealth services under Part B by authorizing the Secretary, for services furnished on or after October 1, 2025, to waive any limitations on practitioner types if determined clinically appropriate. (Thus, the Secretary may impose related requirements for practitioners, including beneficiary and program integrity protections; must establish an annual process for stakeholder public comment on such waivers; and must periodically reassess each waiver, not more frequently than every three years, terminating any waiver no longer clinically appropriate.)

This section modifies Medicare telehealth payment flexibilities for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs)—which serve underserved populations under prospective payment systems (PPS for FQHCs) and all-inclusive rate (AIR) methodologies (for RHCs)—as follows: (1) updates a cross-reference in paragraph (4)(C)(i) to include the new paragraph (8); (2) revises paragraph (8)(A) to apply telehealth services beginning on the first day of the COVID-19 public health emergency period under section 1135(g)(1)(B) (previously, during a period ending September 30, 2025) and adds a waiver of geographic requirements under paragraph (4)(C)(i); (3) limits the special originating site payment rule under paragraph (8)(B) to the period from the start of the emergency period through September 30, 2025; and (4) adds paragraph (8)(C) to provide that, on or after October 1, 2025, such telehealth services are deemed FQHC or RHC outpatient services payable under the FQHC PPS (section 1834(o)) or RHC payment methodology (section 1833(a)(3)), with associated distant-site costs treated as allowable for PPS and AIR calculations.

This section expands Medicare telehealth originating sites, effective for services furnished on or after January 1, 2026, to include facilities of the Indian Health Service (whether operated by the Service, an Indian tribe, or a tribal organization), and Native Hawaiian health care systems, waiving standard geographic and facility requirements otherwise applicable to originating sites (i.e., patient locations). It further prohibits payment of the originating site facility fee for such Native American and Native Hawaiian facilities.

This section repeals the Medicare requirement in SSA section 1834(m)(7)(B) for an in-person visit within six months prior to subsequent telemental health services (i.e., mental health telehealth services) furnished by physicians, nurse practitioners, physician assistants, or clinical nurse specialists. It also makes permanent the provisions waiving that requirement for rural health clinics under section 1834(y)(2) and federally qualified health centers under section 1834(o)(4)(B) (previously applicable prior to October 1, 2025). (Thus, Medicare beneficiaries may receive ongoing telemental health services without an in-person visit.)

This section expands the definition of emergency area and emergency period under SSA section 1135(g)(1) for telehealth waiver purposes (subsection (b)(8)) to include, in addition to the period described in subparagraph (B), any public health emergency declared by the HHS Secretary pursuant to section 319 of the Public Health Service Act on or after the date of enactment. (As background, SSA section 1135 authorizes the Secretary to waive or modify certain Medicare, Medicaid, and CHIP requirements during an emergency area and period to ensure the availability of health care services. Thus, this change enables telehealth flexibilities during future public health emergencies.)

This section permanently authorizes the use of telehealth for physician recertification of Medicare hospice benefit eligibility during and after the COVID-19 public health emergency under section 1135(g)(1)(B) of the Social Security Act (previously authorized only during the emergency through September 30, 2025). (The Medicare hospice benefit covers hospice care for terminally ill beneficiaries.) It also requires the Government Accountability Office, not later than three years after enactment, to report to Congress on the impact of this change, including (1) the number and percentage of beneficiaries recertified at 180 days and subsequent periods using telehealth; (2) federal oversight of hospice care appropriateness for such patients; and (3) other relevant factors.

This section adds an exception to civil monetary penalties for beneficiary inducements (under SSA §1128A(i)(6)) for a provider of services or supplier providing technologies (as defined by the Secretary of HHS) directly to Medicare beneficiaries entitled to Part A benefits, enrolled under Part B, or both, for telehealth services, remote patient monitoring services, or other technology-based services (as defined by the Secretary), if the technologies are not offered as part of any advertisement or solicitation and the provision meets other Secretary regulations.

This section authorizes appropriations of $3 million for each of FY2026 through FY2030 to the Inspector General of the Department of Health and Human Services, in addition to amounts otherwise available, for audits, investigations, and other oversight and enforcement activities related to telehealth services, remote patient monitoring services, and other services furnished through technology. Funds remain available until expended.

This section directs the Secretary of Health and Human Services to identify Medicare physicians and practitioners with significant outlier billing patterns for telehealth services furnished under section 1834(m) of the Social Security Act (e.g., coding for inappropriate length of time or inaccurate complexity, or inappropriate/duplicate billing for such services or concurrently ordered/prescribed items or services), using standard unique health identifiers reported on claims and thresholds relative to peers in the same specialty and geographic area. The Secretary must notify such providers of their comparative billing data, Medicare telehealth guidelines, and related information (without mandating additional audits beyond existing authorities); post aggregate, anonymized outlier data on the CMS website; and permit other comparative feedback activities. The section also amends telehealth resource centers under section 330I(j)(2) of the Public Health Service Act to require education for identified outliers on proper telehealth coding, billing prevention, annually-updated payable services under section 1834(m)(4)(F), and referrals to Medicare administrative contractors.

This section amends the Medicare telehealth provisions (42 U.S.C. 1395m(m)) by adding a new paragraph (10) to direct the Secretary of Health and Human Services (HHS), not later than six months after enactment and in consultation with stakeholders, to issue resources, guidance, and training sessions for beneficiaries, physicians, practitioners, and health information technology vendors on best practices ensuring telehealth services are accessible for (1) individuals with limited English proficiency, including access to platforms, interpreter services, and integration of telehealth and virtual interpreters; and (2) individuals with disabilities, including telecommunications system accessibility, beneficiary engagement, and captioning/transcript training. The resources must account for age and sociodemographic, geographic, literacy, cultural, cognitive, and linguistic differences. The section further requires HHS to conduct a study on clinician, payer, and health care organization strategies to improve beneficiary engagement in Medicare telehealth services (with emphasis on underserved communities, digital navigators, pre-visit information, caregiver engagement, training, and technology investments) and submit a report to Congress with legislative and administrative recommendations not later than two years after enactment. The section authorizes appropriations as necessary to implement these requirements.

This section directs the Secretary of Health and Human Services, not later than 6 months after the date of enactment, to develop and make available to health care professionals educational resources and training sessions on requirements for furnishing Medicare telehealth services under section 1834(m) (42 U.S.C. 1395m(m)), including payment requirements, telehealth-specific privacy and security, utilizing telehealth to engage underserved, high-risk, and vulnerable patient populations, and other topics determined appropriate by the Secretary. It authorizes appropriations of such sums as necessary to carry out this section.

This section requires the Secretary of Health and Human Services (HHS), not later than 180 days after enactment, to review quality measures—developed through HHS's contract with a consensus-based entity such as the National Quality Forum for Medicare, Medicaid, and CHIP—to ensure inclusion of measures relating to telehealth services in areas including care, prevention, diagnosis, patient experience, health outcomes, and treatment. In conducting the review, HHS must consult external technical experts (including patient organizations, providers, and telehealth specialists); assess existing and developing measures for telehealth inclusion or gaps; and evaluate streamlining, implementation, and accountability for such measures across settings and providers. The section further directs HHS to issue technical guidance for providers and stakeholders on stratifying measures by care modality and population, uniform data elements, best practices in telehealth quality measurement and improvement, and other appropriate areas; and, not later than two years after enactment, to submit a report on the review to Congress and post it on the CMS website.

This section directs the Secretary of Health and Human Services, not later than 180 days after enactment and quarterly thereafter, to post on the Centers for Medicare & Medicaid Services (CMS) website information on Medicare telehealth services, including (1) data on the furnishing of such services by patient population, type of service, geography, place of service, and provider type; (2) impacts on expenditures and utilization for the most recent four quarters for which Medicare claims data is available; and (3) other outcomes as determined appropriate by the Secretary.