“A bill to amend title XVIII of the Social Security Act to extend certain telehealth flexibilities under the Medicare program.”
No CRS summary available for this bill.
This section extends multiple Medicare telehealth flexibilities through September 30, 2027 (from September 30, 2025), including (1) waiver of geographic restrictions and expanded originating sites under SSA section 1834(m)(2)(B)(iii) and (4)(C)(iii); (2) eligibility of additional practitioners to furnish telehealth services under section 1834(m)(4)(E); (3) audio-only telehealth services under section 1834(m)(9); and (4) use of telehealth for face-to-face encounters prior to hospice eligibility recertification under section 1814(a)(7)(D)(i)(II), with new post-September 30, 2025 exceptions if the beneficiary is in a hospice enrollment moratorium area, receiving care from a provider under enhanced oversight, or the encounter is by a non-enrolled hospice physician or nurse practitioner. It also (1) delays in-person requirements for mental health telehealth services to on or after October 1, 2027 (from October 1, 2025) under section 1834(m)(7)(B)(i), with conforming changes for rural health clinics under section 1834(y)(2) and federally qualified health centers under section 1834(o)(4)(B); and (2) extends and specifies payment for telehealth services by federally qualified health centers and rural health clinics under section 1834(m)(8), including a new payment rule for fiscal years 2026 and 2027 treating such services (and associated costs) as allowable under the applicable prospective payment system or all-inclusive rates. (As background, these flexibilities—originally expanded during the COVID-19 public health emergency—remove rural-only and originating site limits on Medicare Part B telehealth services, which reimburse physicians and practitioners for distant evaluation and management via telecommunications technology.)
This section requires that, for face-to-face encounters conducted via telehealth on or after January 1, 2026, prior to recertification of Medicare eligibility for hospice care, any associated hospice claim include one or more modifiers or codes (as specified by the Secretary) indicating telehealth use. (Thus, telehealth is permitted for such encounters only if the claim properly identifies it as telehealth.)
This section extends the Acute Hospital Care at Home waiver flexibilities—which allow Medicare-participating hospitals to furnish acute-level hospital care in patients' homes under a waiver of certain inpatient hospital requirements—through 2030 (from 2025). It further amends the waiver statute (1) to rename the existing study of the initiative as the "initial study," (2) to redesignate existing subsections (c) and (d) as (d) and (e), and (3) to require a subsequent study by September 30, 2028, analyzing hospital eligibility criteria, quality metrics (e.g., readmissions, mortality, length of stay, infection rates), costs, service intensity and mix, patient demographics (including dual eligibles), and outcomes between initiative participants and comparable nonparticipants or inpatient care—controlling for selection bias—and a report on the study to the House Ways and Means Committee and Senate Finance Committee by that date.
This section establishes program integrity requirements for durable medical equipment (DME) under Medicare Part B. Beginning January 1, 2028, the Secretary must include certain DME items on the Master List (i.e., the list under 42 CFR 414.234(b) of items with aberrant billing patterns subject to prior authorization) if a substantial number of claims lack explanatory factors (such as emergent care) and are for items ordered by a physician or practitioner without prior furnishing of any Medicare-covered item or service to the beneficiary during at least the prior 24 months; the Secretary may also conduct prepayment claim review for such listed items (if not subject to prior coverage determination under paragraph (15)(C)). The same requirements apply to prosthetic devices, orthotics, and prosthetics. Separately, this section requires the HHS Inspector General to report to Congress by January 1, 2026, on fraud risks for clinical diagnostic laboratory tests under Medicare Part B (i.e., paid under SSA section 1834A), including identification of high-risk tests, billing patterns (such as orders from providers without prior beneficiary relationships or use of certain payment modifiers), and mitigation strategies (e.g., outlier monitoring and targeted education).
This section directs the Secretary of Health and Human Services, not later than one year after enactment and in consultation with one or more entities from each of seven specified categories (i.e., health information technology providers, health care providers, health insurers, language service companies, interpreter or translator professional associations, health and language services quality certification organizations, and patient advocates for individuals with limited English proficiency), to issue or update guidance on best practices for telehealth furnished via telecommunications systems under Medicare (42 U.S.C. 1395m(m)). The guidance addresses (1) facilitating interpreter use during telemedicine appointments, (2) accessible instructions for such systems for individuals with limited English proficiency, (3) access to digital patient portals for such individuals, (4) video platforms enabling multi-person calls for interpretation during such appointments, and (5) multilingual patient materials, communications, and instructions (e.g., text message reminders and prescription information).
This section temporarily expands Medicare Part B coverage for cardiac rehabilitation programs and pulmonary rehabilitation programs—structured outpatient exercise, education, and risk-factor modification services for beneficiaries with qualifying heart or chronic obstructive pulmonary disease conditions—to include items and services furnished in the home of a hospital outpatient via real-time audio and video communications technology (excluding audio-only) during the period beginning September 30, 2025, and ending December 31, 2026. Specifically, it (1) permits such items and services on an outpatient basis in the home, and (2) allows virtual presence of a physician, physician assistant, nurse practitioner, or clinical nurse specialist. It further authorizes the Secretary of Health and Human Services to implement these changes by program instruction or otherwise, notwithstanding other provisions of law.
This section directs the Secretary of Health and Human Services to revise regulations by January 1, 2026, to expand the Medicare Diabetes Prevention Program (MDPP)—a Center for Medicare and Medicaid Innovation model providing lifestyle change services to prevent type 2 diabetes in prediabetic Medicare beneficiaries—for the period January 1, 2026, through December 31, 2030, as follows: (1) permitting entities to participate by offering only online MDPP services via synchronous or asynchronous technology or telecommunications, if enrolled as an MDPP supplier; (2) for such entities, designating the administrative location as the entity's address on file under the Diabetes Prevention Recognition Program and removing prohibitions on billing for online services furnished to out-of-state beneficiaries; and (3) eliminating limits on the number of times an individual may enroll in MDPP.