119-s2709

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 2709 Introduced in Senate

    (IS) ]

<DOC>

119th CONGRESS
 1st Session
 S. 2709

 To amend title XVIII of the Social Security Act to extend certain 
 telehealth flexibilities under the Medicare program.

_______________________________________________________________________

 IN THE SENATE OF THE UNITED STATES

 September 4, 2025

Mr. Scott of South Carolina (for himself, Mr. Schatz, Mrs. Hyde-Smith, 
 Mrs. Gillibrand, Mr. Tillis, and Mr. King) introduced the following 
 bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

 A BILL

 To amend title XVIII of the Social Security Act to extend certain 
 telehealth flexibilities under the Medicare program.

 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 ``Telehealth Modernization Act''.

SEC. 2. EXTENSION OF CERTAIN TELEHEALTH FLEXIBILITIES.

    (a) Removing Geographic Requirements and Expanding Originating 
Sites for Telehealth Services.--

Section 1834
            (m) of the Social Security 
Act (42 U.S.C. 1395m
            (m) ) is amended--

    (1) in paragraph

    (2)
        (B)
            (iii) , by striking ``ending 
 September 30, 2025'' and inserting ``ending September 30, 
 2027''; and

    (2) in paragraph

    (4)
            (C) 
            (iii) , by striking ``ending on 
 September 30, 2025'' and inserting ``ending on September 30, 
 2027''.

    (b) Expanding Practitioners Eligible To Furnish Telehealth 
Services.--

Section 1834
            (m) (4)
        (E) of the Social Security Act (42 U.S.C. 
1395m
            (m) (4)
        (E) ) is amended by striking ``ending on September 30, 2025'' 
and inserting ``ending on September 30, 2027''.
            (c) Extending Telehealth Services for Federally Qualified Health 
Centers and Rural Health Clinics.--

Section 1834
            (m) (8) of the Social 
Security Act (42 U.S.C. 1395m
            (m) (8) ) is amended--

    (1) in subparagraph
        (A) , by striking ``ending on September 
 30, 2025'' and inserting ``ending on September 30, 2027'';

    (2) in subparagraph
        (B) --
        (A) in the subparagraph heading, by inserting 
 ``before fiscal year 2026'' after ``rule'';
        (B) in clause
            (i) , by striking ``during the periods 
 for which subparagraph
        (A) applies'' and inserting 
 ``before October 1, 2025''; and
            (C) in clause
            (ii) , by inserting ``furnished to an 
 eligible telehealth individual before October 1, 2025'' 
 after ``telehealth services''; and

    (3) by adding at the end the following new subparagraph:
 ``
            (C) Payment rule for fiscal years 2026 and 
 2027.--
 ``
            (i) In general.--A telehealth service 
 furnished to an eligible telehealth individual 
 by a Federally qualified health center or rural 
 health clinic on or after October 1, 2025, and 
 before October 1, 2027, shall be paid as a 
 Federally qualified health center service or 
 rural health clinic service (as applicable) 
 under the prospective payment system 
 established under 

section 1834

    (o) or the 
 methodology for all-inclusive rates established 
 under 

section 1833

    (a)

    (3) , respectively.
 ``
            (ii) Treatment of costs.--Costs 
 associated with the furnishing of telehealth 
 services by a Federally qualified health center 
 or rural health clinic on or after October 1, 
 2025, and before October 1, 2027, shall be 
 considered allowable costs for purposes of the 
 prospective payment system established under 
 

section 1834

    (o) and the methodology for all-
 inclusive rates established under 

section 1833

    (a)

    (3) , as applicable.''.
            (d) Delaying In-Person Requirements Under Medicare for Mental 
Health Services Furnished Through Telehealth and Telecommunications 
Technology.--

    (1) Delay in requirements for mental health services 
 furnished through telehealth.--

Section 1834
            (m) (7)
        (B)
            (i) of the 
 Social Security Act (42 U.S.C. 1395m
            (m) (7)
        (B)
            (i) ) is amended, 
 in the matter preceding subclause
            (I) , by striking ``on or 
 after October 1, 2025'' and inserting ``on or after October 1, 
 2027''.

    (2) Mental health visits furnished by rural health 
 clinics.--

Section 1834

    (y)

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

    (y)

    (2) ) is amended by striking ``October 1, 2025'' 
 and inserting ``October 1, 2027''.

    (3) Mental health visits furnished by federally qualified 
 health centers.--

Section 1834

    (o)

    (4)
        (B) of the Social Security 
 Act (42 U.S.C. 1395m

    (o)

    (4)
        (B) ) is amended by striking ``October 
 1, 2025'' and inserting ``October 1, 2027''.

    (e) Allowing for the Furnishing of Audio-Only Telehealth 
Services.--

Section 1834
            (m) (9) of the Social Security Act (42 U.S.C. 
1395m
            (m) (9) ) is amended by striking ``ending on September 30, 2025'' 
and inserting ``ending on September 30, 2027''.

    (f) Extending Use of Telehealth To Conduct Face-to-Face Encounter 
Prior to Recertification of Eligibility for Hospice Care.--

Section 1814

    (a)

    (7)
            (D) 
            (i) 
            (II) of the Social Security Act (42 U.S.C. 
1395f

    (a)

    (7)
            (D) 
            (i) 
            (II) ) is amended--

    (1) by striking ``ending on September 30, 2025'' and 
 inserting ``ending on September 30, 2027''; and

    (2) by inserting ``, except that this subclause shall not 
 apply in the case of such an encounter with an individual 
 occurring on or after September 30, 2025, if such individual is 
 located in an area that is subject to a moratorium on the 
 enrollment of hospice programs under this title pursuant to 
 

section 1866

    (j)

    (7) , if such individual is receiving hospice 
 care from a provider that is subject to enhanced oversight 
 under this title pursuant to 

section 1866

    (j)

    (3) , or if such 
 encounter is performed by a hospice physician or nurse 
 practitioner who is not enrolled under 

section 1866

    (j) and is 
 not an opt-out physician or practitioner (as defined in 

section 1802

    (b)

    (6)
            (D) )'' before the semicolon.

SEC. 3. REQUIRING MODIFIER FOR USE OF TELEHEALTH TO CONDUCT FACE-TO-
 FACE ENCOUNTER PRIOR TO RECERTIFICATION OF ELIGIBILITY 
 FOR HOSPICE CARE.

 

Section 1814

    (a)

    (7)
            (D) 
            (i) 
            (II) of the Social Security Act (42 U.S.C. 
1395f

    (a)

    (7)
            (D) 
            (i) 
            (II) ), as amended by 

section 2

    (f) , is further amended 
by inserting ``, but only if, in the case of such an encounter 
occurring on or after January 1, 2026, any hospice claim includes 1 or 
more modifiers or codes (as specified by the Secretary) to indicate 
that such encounter was conducted via telehealth'' after ``as 
determined appropriate by the Secretary''.

SEC. 4. EXTENDING ACUTE HOSPITAL CARE AT HOME WAIVER FLEXIBILITIES.

    (a) In General.--

Section 1866G

    (a)

    (1) of the Social Security Act (42 
U.S.C. 1395cc-7

    (a)

    (1) ) is amended by striking ``2025'' and inserting 
``2030''.

    (b) Requiring Additional Study and Report on Acute Hospital Care at 
Home Waiver Flexibilities.--

Section 1866G of the Social Security Act 
(42 U.S.C. 1395cc-7), as amended by subsection

    (a) , is further 
amended--

    (1) in subsection

    (b) , in the subsection heading, by 
 striking ``Study'' and inserting ``Initial Study'';

    (2) by redesignating subsections
            (c) and
            (d) as subsections
            (d) and

    (e) , respectively; and

    (3) by inserting after subsection

    (b) the following new 
 subsection:
 ``
            (c) Subsequent Study and Report.--
 ``

    (1) In general.--Not later than September 30, 2028, the 
 Secretary shall conduct a study to--
 ``
        (A) analyze, to the extent practicable, the 
 criteria established by hospitals under the Acute 
 Hospital Care at Home initiative to determine which 
 individuals may be furnished services under such 
 initiative; and
 ``
        (B) analyze and compare (both within and between 
 hospitals participating in the initiative, and relative 
 to comparable hospitals that do not participate in the 
 initiative, for relevant parameters such as diagnosis-
 related groups)--
 ``
            (i) quality of care furnished to 
 individuals with similar conditions and 
 characteristics in the inpatient setting and 
 through the Acute Hospital Care at Home 
 initiative, including health outcomes, hospital 
 readmission rates (including readmissions both 
 within and beyond 30 days post-discharge), 
 hospital mortality rates, length of stay, 
 infection rates, composition of care team 
 (including the types of labor used, such as 
 contracted labor), the ratio of nursing staff, 
 transfers from the hospital to the home, 
 transfers from the home to the hospital 
 (including the timing, frequency, and causes of 
 such transfers), transfers and discharges to 
 post-acute care settings (including the timing, 
 frequency, and causes of such transfers and 
 discharges), and patient and caregiver 
 experience of care;
 ``
            (ii) clinical conditions treated and 
 diagnosis-related groups of discharges from 
 inpatient settings relative to discharges from 
 the Acute Hospital Care at Home initiative;
 ``
            (iii) costs incurred by the hospital for 
 furnishing care in inpatient settings relative 
 to costs incurred by the hospital for 
 furnishing care through the Acute Hospital Care 
 at Home initiative, including costs relating to 
 staffing, equipment, food, prescriptions, and 
 other services, as determined by the Secretary;
 ``
            (iv) the quantity, mix, and intensity of 
 services (such as in-person visits and virtual 
 contacts with patients and the intensity of 
 such services) furnished in inpatient settings 
 relative to the Acute Hospital Care at Home 
 initiative, and, to the extent practicable, the 
 nature and extent of family or caregiver 
 involvement;
 ``
            (v) socioeconomic information on 
 individuals treated in comparable inpatient 
 settings relative to the initiative, including 
 racial and ethnic data, income, housing, 
 geographic proximity to the brick-and-mortar 
 facility and whether such individuals are 
 dually eligible for benefits under this title 
 and title XIX; and
 ``
            (vi) the quality of care, outcomes, 
 costs, quantity and intensity of services, and 
 other relevant metrics between individuals who 
 entered into the Acute Hospital Care at Home 
 initiative directly from an emergency 
 department compared with individuals who 
 entered into the Acute Hospital Care at Home 
 initiative directly from an existing inpatient 
 stay in a hospital.
 ``

    (2) Selection bias.--In conducting the study under 
 paragraph

    (1) , the Secretary shall, to the extent practicable, 
 analyze and compare individuals who participate and do not 
 participate in the initiative controlling for selection bias or 
 other factors that may impact the reliability of data.
 ``

    (3) Report.--Not later than September 30, 2028, the 
 Secretary of Health and Human Services shall submit to the 
 Committee on Ways and Means of the House of Representatives and 
 the Committee on Finance of the Senate a report on the study 
 conducted under paragraph

    (1) .''.

SEC. 5. ENHANCING CERTAIN PROGRAM INTEGRITY REQUIREMENTS FOR DME UNDER 
 MEDICARE.

    (a) Durable Medical Equipment.--

    (1) In general.--

Section 1834

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

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

    (23) Master list inclusion and claim review for certain 
 items.--
 ``
        (A) Master list inclusion.--Beginning January 1, 
 2028, for purposes of the Master List described in 
 

section 414.234

    (b) of title 42, Code of Federal 
 Regulations (or any successor regulation), an item for 
 which payment may be made under this subsection shall 
 be treated as having aberrant billing patterns (as such 
 term is used for purposes of such section) if the 
 Secretary determines that, without explanatory 
 contributing factors (such as furnishing emergent care 
 services), a substantial number of claims for such 
 items under this subsection are for such items ordered 
 by a physician or practitioner who has not previously 
 (during a period of not less than 24 months, as 
 established by the Secretary) furnished to the 
 individual involved any item or service for which 
 payment may be made under this title.
 ``
        (B) Claim review.--With respect to items 
 furnished on or after January 1, 2028, that are 
 included on the Master List pursuant to subparagraph
        (A) , if such an item is not subject to a determination 
 of coverage in advance pursuant to paragraph

    (15)
            (C) , 
 the Secretary may conduct prepayment review of claims 
 for payment for such item.''.

    (2) Conforming amendment for prosthetic devices, orthotics, 
 and prosthetics.--

Section 1834

    (h)

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

    (h)

    (3) ) is amended by inserting ``, and 
 paragraph

    (23) of subsection

    (a) shall apply to prosthetic 
 devices, orthotics, and prosthetics in the same manner as such 
 provision applies to items for which payment may be made under 
 such subsection'' before the period at the end.

    (b) Report on Identifying Clinical Diagnostic Laboratory Tests at 
High Risk for Fraud and Effective Mitigation Measures.--Not later than 
January 1, 2026, the Inspector General of the Department of Health and 
Human Services shall submit to Congress a report assessing fraud risks 
relating to claims for clinical diagnostic laboratory tests for which 
payment may be made under 

section 1834A of the Social Security Act (42 
U.S.C. 1395m-1) and effective tools for reducing such fraudulent 
claims. The report may include information regarding--

    (1) which, if any, clinical diagnostic laboratory tests are 
 identified as being at high risk of fraudulent claims, and an 
 analysis of the factors that contribute to such risk;

    (2) with respect to a clinical diagnostic laboratory test 
 identified under paragraph

    (1) as being at high risk of 
 fraudulent claims--
        (A) the amount payable under such 

section 1834A 
 with respect to such test;
        (B) the number of such tests furnished to 
 individuals enrolled under part B of title XVIII of the 
 Social Security Act (42 U.S.C. 1395j et seq.);
            (C) whether an order for such a test was more 
 likely to come from a provider with whom the individual 
 involved did not have a prior relationship, as 
 determined on the basis of prior payment experience; 
 and
            (D) the frequency with which a claim for payment 
 under such 

section 1834A included the payment modifier 
 identified by code 59 or 91;

    (3) suggested strategies for reducing the number of 
 fraudulent claims made with respect to tests so identified as 
 being at high risk, including--
        (A) an analysis of whether the Centers for Medicare 
 & Medicaid Services can detect aberrant billing 
 patterns with respect to such tests in a timely manner;
        (B) any strategies for identifying and monitoring 
 the providers who are outliers with respect to the 
 number of such tests that such providers order; and
            (C) targeted education efforts to mitigate improper 
 billing for such tests; and

    (4) such other information as the Inspector General 
 determines appropriate.

SEC. 6. GUIDANCE ON FURNISHING SERVICES VIA TELEHEALTH TO INDIVIDUALS 
 WITH LIMITED ENGLISH PROFICIENCY.

    (a) In General.--Not later than 1 year after the date of the 
enactment of this section, the Secretary of Health and Human Services, 
in consultation with 1 or more entities from each of the categories 
described in paragraphs

    (1) through

    (7) of subsection

    (b) , shall issue 
and disseminate, or update and revise as applicable, guidance for the 
entities described in such subsection on the following:

    (1) Best practices on facilitating and integrating use of 
 interpreters during a telemedicine appointment.

    (2) Best practices on providing accessible instructions on 
 how to access telecommunications systems (as such term is used 
 for purposes of 

section 1834
            (m) of the Social Security Act (42 
 U.S.C. 1395m
            (m) )) for individuals with limited English 
 proficiency.

    (3) Best practices on improving access to digital patient 
 portals for individuals with limited English proficiency.

    (4) Best practices on integrating the use of video 
 platforms that enable multi-person video calls furnished via a 
 telecommunications system for purposes of providing 
 interpretation during a telemedicine appointment for an 
 individual with limited English proficiency.

    (5) Best practices for providing patient materials, 
 communications, and instructions in multiple languages, 
 including text message appointment reminders and prescription 
 information.

    (b) Entities Described.--For purposes of subsection

    (a) , an entity 
described in this subsection is an entity in 1 or more of the following 
categories:

    (1) Health information technology service providers, 
 including--
        (A) electronic medical record companies;
        (B) remote patient monitoring companies; and
            (C) telehealth or mobile health vendors and 
 companies.

    (2) Health care providers, including--
        (A) physicians; and
        (B) hospitals.

    (3) Health insurers.

    (4) Language service companies.

    (5) Interpreter or translator professional associations.

    (6) Health and language services quality certification 
 organizations.

    (7) Patient and consumer advocates, including such 
 advocates that work with individuals with limited English 
 proficiency.

SEC. 7. IN-HOME CARDIOPULMONARY REHABILITATION FLEXIBILITIES.

    (a) In General.--

Section 1861

    (eee)

    (2) of the Social Security Act 
(42 U.S.C. 1395x

    (eee)

    (2) ) is amended--

    (1) in subparagraph
        (A)
            (ii) , by inserting ``(including, 
 with respect to items and services furnished through audio and 
 video real-time communications technology (excluding audio-
 only) on or after September 30, 2025, and before January 1, 
 2027, in the home of an individual who is an outpatient of the 
 hospital)'' after ``outpatient basis''; and

    (2) in subparagraph
        (B) , by inserting ``(including, with 
 respect to items and services furnished through audio and video 
 real-time communications technology on or after September 30, 
 2025, and before January 1, 2027, the virtual presence of such 
 physician, physician assistant, nurse practitioner, or clinical 
 nurse specialist)'' after ``under the program''.

    (b) Program Instruction Authority.--Notwithstanding any other 
provision of law, the Secretary of Health and Human Services may 
implement the amendments made by this section by program instruction or 
otherwise.

SEC. 8. INCLUSION OF VIRTUAL DIABETES PREVENTION PROGRAM SUPPLIERS IN 
 MDPP EXPANDED MODEL.

    (a) In General.--Not later than January 1, 2026, the Secretary 
shall revise the regulations under parts 410 and 424 of title 42, Code 
of Federal Regulations, to provide that, for the period beginning 
January 1, 2026, and ending December 31, 2030--

    (1) an entity may participate in the MDPP by offering only 
 online MDPP services via synchronous or asynchronous technology 
 or telecommunications if such entity meets the conditions for 
 enrollment as an MDPP supplier (as specified in 

section 424.205

    (b) of title 42, Code of Federal Regulations (or a 
 successor regulation));

    (2) if an entity participates in the MDPP in the manner 
 described in paragraph

    (1) --
        (A) the administrative location of such entity 
 shall be the address of the entity on file under the 
 Diabetes Prevention Recognition Program; and
        (B) in the case of online MDPP services furnished 
 by such entity to an MDPP beneficiary who was not 
 located in the same State as the entity at the time 
 such services were furnished, the entity shall not be 
 prohibited from submitting a claim for payment for such 
 services solely by reason of the location of such 
 beneficiary at such time; and

    (3) no limit is applied on the number of times an 
 individual may enroll in the MDPP.

    (b) 

=== Definitions. ===
-In this section:

    (1) MDPP.--The term ``MDPP'' means the Medicare Diabetes 
 Prevention Program conducted under 

section 1115A of the Social 
 Security Act (42 U.S.C. 1315a), as described in the final rule 
 published in the Federal Register entitled ``Medicare and 
 Medicaid Programs; CY 2024 Payment Policies Under the Physician 
 Fee Schedule and Other Changes to Part B Payment and Coverage 
 Policies; Medicare Shared Savings Program Requirements; 
 Medicare Advantage; Medicare and Medicaid Provider and Supplier 
 Enrollment Policies; and Basic Health Program'' (88 Fed. Reg. 
 78818 (November 16, 2023)) (or a successor regulation).

    (2) Regulatory terms.--The terms ``Diabetes Prevention 
 Recognition Program'', ``MDPP beneficiary'', ``MDPP services'', 
 and ``MDPP supplier'' have the meanings given each such term in 
 

section 410.79

    (b) of title 42, Code of Federal Regulations.

    (3) Secretary.--The term ``Secretary'' means the Secretary 
 of Health and Human Services.
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