119-hr1785

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1785 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 1785

 To amend title XVIII of the Social Security Act to establish 
 requirements for the provision of certain high-cost durable medical 
 equipment and laboratory testing, and for other purposes.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 March 3, 2025

 Mr. Doggett introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
 Ways and Means, for a period to be subsequently determined by the 
 Speaker, in each case for consideration of such provisions as fall 
 within the jurisdiction of the committee concerned

_______________________________________________________________________

 A BILL

 To amend title XVIII of the Social Security Act to establish 
 requirements for the provision of certain high-cost durable medical 
 equipment and laboratory testing, and for other purposes.

 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 ``Preventing Medicare Telefraud Act''.

SEC. 2. REQUIREMENT FOR PROVISION OF HIGH-COST DURABLE MEDICAL 
 EQUIPMENT AND LABORATORY TESTS.

    (a) High-Cost Durable Medical Equipment.--

Section 1834

    (a)

    (1)
        (E) of 
the Social Security Act (42 U.S.C. 1395m

    (a)

    (1)
        (E) ) is amended by adding 
at the end the following new clause:
 ``
            (vi) Standards for high-cost durable 
 medical equipment.--
 ``
            (I) Limitation on payment for 
 high-cost durable medical equipment.--
 Payment may not be made under this 
 subsection for a high-cost durable 
 medical equipment ordered by a 
 physician or other practitioner 
 described in clause
            (ii) via telehealth 
 for an individual on or after the date 
 that is 180 days after the date of the 
 enactment of this clause, unless such 
 physician or practitioner furnished to 
 such individual a service in-person at 
 least once during the 6 month period 
 prior to ordering such high-cost 
 durable medical equipment.
 ``
            (II) High-cost durable medical 
 equipment determination.--For purposes 
 of this clause, the Administrator of 
 the Centers for Medicare & Medicaid 
 Services shall define the term `high-
 cost durable medical equipment' and 
 specify the durable medical equipment 
 for which such definition shall apply.
 ``
            (vii) Audit of providers and 
 practitioners furnishing a high volume of 
 durable medical equipment via telehealth.--
 ``
            (I) Identification of 
 providers.--Beginning 6 months after 
 the date of the enactment of this 
 clause, Medicare administrative 
 contractors shall conduct reviews on a 
 schedule determined by the Secretary, 
 of claims for durable medical equipment 
 prescribed by a physician or other 
 practitioner described in clause
            (ii) during the 12 month period preceding 
 such review to identify physicians or 
 other practitioners with respect to 
 whom at least 90 percent of all durable 
 medical equipment prescribed by such 
 physician or practitioner during such 
 period was prescribed pursuant to a 
 telehealth visit.
 ``
            (II) Audit.--In the case of a 
 physician or practitioner identified 
 under subclause
            (I) , with respect to a 
 period described in such subclause, the 
 Medicare administrative contractors 
 shall conduct audits of all claims for 
 durable medical equipment prescribed by 
 such physicians or practitioners to 
 determine whether such claims comply 
 with the requirements for coverage 
 under this title.''.

    (b) High-Cost Laboratory Tests.--

Section 1834A

    (b) of the Social 
Security Act (42 U.S.C. 1395m-1

    (b) ) is amended by adding at the end the 
following new paragraph:
 ``

    (6) Requirement for high-cost laboratory tests.--
 ``
        (A) Limitation on payment for high-cost 
 laboratory tests.--Payment may not be made under this 
 subsection for a high-cost laboratory test ordered by a 
 physician or practitioner via telehealth for an 
 individual on or after the date that is 180 days after 
 the date of the enactment of this paragraph, unless 
 such physician or practitioner furnished to such 
 individual a service in-person at least once during the 
 6 month period prior to ordering such high-cost 
 laboratory test.
 ``
        (B) High-cost laboratory test defined.--For 
 purposes of this paragraph, the Administrator for the 
 Centers for Medicare & Medicaid Services shall define 
 the term `high-cost laboratory test' and specify which 
 laboratory tests such definition shall apply to.
 ``

    (7) Audit of laboratory testing ordered pursuant to 
 telehealth visit.--
 ``
        (A) Identification of providers.--Beginning 6 
 months after the date of the enactment of this 
 paragraph, Medicare administrative contractors shall 
 conduct periodic reviews on a schedule determined by 
 the Secretary, of claims for laboratory tests 
 prescribed by a physician or practitioner during the 12 
 month period preceding such review to identify 
 physicians or other practitioners with respect to whom 
 at least 90 percent of all laboratory tests prescribed 
 by such physician or practitioner during such period 
 was prescribed pursuant to a telehealth visit.
 ``
        (B) Audit.--In the case of a physician or 
 practitioner identified under subparagraph
        (A) , with 
 respect to a period described in such subparagraph, the 
 Medicare administrative contractors shall conduct 
 audits of all claims for laboratory tests prescribed by 
 such physicians or practitioners during such period 
 beginning to determine whether such claims comply with 
 the requirements for coverage under this title.''.

SEC. 3. REQUIREMENT TO SUBMIT NPI NUMBER FOR SEPARATELY BILLABLE 
 TELEHEALTH SERVICES.

 

Section 1834
            (m) of the Social Security Act (42 U.S.C. 1395m
            (m) ) is 
amended by adding at the end the following new paragraph:
 ``

    (10) Requirement to submit npi number for separately 
 billable telehealth services.--Payment may not be made under 
 this subsection for separately billable telehealth services 
 furnished on or after the date that is 180 days after the date 
 of the enactment of this paragraph by a physician or 
 practitioner unless such physician or practitioner submits a 
 claim for payment under the national provider identification 
 number assigned to such physician or practitioner.''.
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