119-HR2263

Bill is currently in: House
Path to Law
House Senate President

119th CONGRESS

1st Session

H. R. 2263

1. Short title
2. Making permanent certain telehealth flexibilities under Medicare
3. Requiring modifier for use of telehealth to conduct face-to-face encounter prior to recertification of eligibility for hospice care
4. Extending acute hospital care at home waiver flexibilities
5. Guidance on furnishing services via telehealth to individuals with limited English proficiency
6. In-home cardiopulmonary rehabilitation flexibilities
7. Inclusion of virtual diabetes prevention program suppliers in MDPP Expanded Model
8. Medication-induced movement disorder outreach and education

1. Short title

This Act may be cited as the "Telehealth Coverage Act of 2025".

2. Making permanent certain telehealth flexibilities under Medicare

(a) Expanded access to 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 "In the case that" and all that follows through "ending March 31, 2025," and inserting "With respect to telehealth services that are furnished on or after the first day of the emergency period described in section 1135(g)(1)(B),"; and

(2) - in paragraph (4)(C)(iii), by striking "In the case that" and all that follows through "ending on March 31, 2025," and inserting "With respect to telehealth services that are furnished on or after the first day of the emergency period described in section 1135(g)(1)(B),".

(b) Expansion of 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 "in the case that" and all that follows through "ending on March 31, 2025," and inserting "beginning on the first day of the emergency period described in section 1135(g)(1)(B),".

(c) Extension of telehealth services furnished by Federally qualified health centers and rural health clinics - Section 1834(m)(8)(A) of the Social Security Act (42 U.S.C. 1395m(m)(8)(A)) is amended by striking "During the emergency" and all that follows through "ending on March 31, 2025" and inserting "Beginning on the first day of the emergency period described in section 1135(g)(1)(B)".

(d) Treatment of telehealth services furnished using audio-Only telecommunications technology - Section 1834(m)(9) of the Social Security Act (42 U.S.C. 1395m(m)(9)) is amended—

(1) - by striking "In the case that" and all that follows through "the Secretary shall continue to" and inserting "The Secretary shall";

(2) - by striking "identified in paragraph (4)(F)(i) as of the date of the enactment of this paragraph"; and

(3) - by striking "during the period" and all that follows through the period at the end and inserting "on or after the first day of the emergency period described in section 1135(g)(1)(B).".

(e) Elimination of in-Person requirements under Medicare for certain services furnished through telehealth

(1) Home dialysis monthly ESRD-related visit; stroke telehealth services; substance use disorder services and mental health services

(A) In general - Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is amended by striking paragraphs (5) through (7) and redesignating paragraphs (8) and (9) as paragraphs (5) and (6), accordingly.

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

(i) - in paragraph (1), by striking "Subject to paragraphs (8) and (9)" and inserting "Subject to paragraphs (5) and (6)";

(ii) - in paragraph (2)—

(I) - in subparagraph (A), by striking "Subject to paragraph (8)" and inserting "Subject to paragraph (5)"; and

(II) - in subparagraph (B), by striking "and paragraph (6)(C)"; and

(iii) - in paragraph (4)—

(I) - in subparagraph (A), by striking "Subject to paragraph (8)" and inserting "Subject to paragraph (5)";

(II) - in subparagraph (C)—

(aa) - in clause (i), by striking "and paragraphs (5), (6), and (7)"; and

(bb) - in clause (ii)(X), by striking "or telehealth services described in paragraph (7)"; and

(III) - in subparagraph (F), by striking "Subject to paragraph (8)" and inserting "Subject to paragraph (5)".

(2) 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 "prior to April 1, 2025".

(3) 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 "prior to April 1, 2025".

(f) 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 "during the emergency period" and all that follows through "and ending on March 31, 2025" and inserting "beginning on the first day of the emergency period described in section 1135(g)(1)(B)"; 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 March 31, 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.

(g) Requiring modifiers for telehealth services in certain instances - 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) Required use of modifiers in certain instances - Not later than January 1, 2026, the Secretary shall establish requirements to include 1 or more codes or modifiers, as determined appropriate by the Secretary, in the case of—

(A) - claims for telehealth services under this subsection that are furnished through a telehealth virtual platform—

(i) - by a physician or practitioner that contracts with an entity that owns such virtual platform; or

(ii) - for which a physician or practitioner has a payment arrangement with an entity for use of such virtual platform; and

(B) - claims for telehealth services under this subsection that are furnished incident to a physician’s or practitioner’s professional service.

(h) Program instruction authority - The Secretary of Health and Human Services may implement the amendments made by this section through program instruction or otherwise.

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".

4. Extending acute hospital care at home waiver flexibilities

Section 1866G(a)(1) of the Social Security Act (42 U.S.C. 1395cc–7(a)(1)) is amended by striking "during the period" and all that follows through "March 31, 2025" and inserting "on or after the first day after the end of the emergency period described in section 1135(g)(1)(B)".

5. 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 , 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 , 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.

6. 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 March 31, 2025, 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 March 31, 2025, 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.

7. 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, beginning January 1, 2026—

(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 —

(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, full CDC DPRP recognition, 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.

8. Medication-induced movement disorder outreach and education

Not later than January 1, 2026, the Secretary shall use existing communications mechanisms to provide education and outreach to physicians and appropriate non-physician practitioners participating under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) with respect to periodic screening for medication-induced movement disorders that are associated with the treatment of mental health disorders in at-risk patients, as well as resources related to clinical guidelines and best practices for furnishing such screening services through telehealth. Such education and outreach shall include information on how to account for such screening services in evaluation and management code selection. The Secretary shall, to the extent practicable, seek input from relevant stakeholders to inform such education and outreach. Such education and outreach may also address other relevant screening services furnished through telehealth, as the Secretary determines appropriate.