[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8261 Reported in House (RH)]
<DOC>
Union Calendar No. 786
118th CONGRESS
2d Session
H. R. 8261
[Report No. 118-891, Part I]
To amend title XVIII of the Social Security Act to extend certain
flexibilities and payment adjustments under the Medicare program, and
for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 7, 2024
Mr. Schweikert (for himself and Mr. Thompson of California) introduced
the following bill; which was referred to the Committee on Ways and
Means, and in addition to the Committee on Energy and Commerce, 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
December 17, 2024
Reported from the Committee on Ways and Means with an amendment
[Strike out all after the enacting clause and insert the part printed
in italic]
December 17, 2024
Referral to the Committee on Energy and Commerce extended for a period
ending not later than December 19, 2024
December 19, 2024
Committee on Energy and Commerce discharged; committed to the Committee
of the Whole House on the State of the Union and ordered to be printed
[For text of introduced bill, see copy of bill as introduced on May 7,
2024]
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to extend certain
flexibilities and payment adjustments under the Medicare program, 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 ``Preserving Telehealth, Hospital, and
Ambulance Access Act''.
TITLE I--PRESERVING PATIENTS' ACCESS TO CARE IN THE HOME
SEC. 101. 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 December
31, 2024'' and inserting ``ending December 31, 2026''; and
(2) in paragraph (4)(C)(iii), by striking ``ending on
December 31, 2024'' and inserting ``ending on December 31,
2026''.
(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 December 31, 2024''
and inserting ``ending on December 31, 2026''.
(c) Extending Telehealth Services for 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 ``ending
on December 31, 2024'' and inserting ``ending on December 31, 2026''.
(d) Delaying the 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'' and all that follows through ``described in section
1135(g)(1)(B))'' and inserting ``on or after January 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 ``January 1, 2025''
and all that follows through the period at the end and
inserting ``January 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 ``January
1, 2025'' and all that follows through the period at the end
and inserting ``January 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 December 31, 2024'' and
inserting ``ending on December 31, 2026''.
(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 December 31, 2024'' and
inserting ``ending on December 31, 2026''; 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 January 1, 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) Program Instruction Authority.--The Secretary of Health and
Human Services may implement the amendments made by this section
through program instruction or otherwise.
SEC. 102. 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. 103. ESTABLISHMENT OF MODIFIER FOR RECERTIFICATIONS OF HOSPICE
CARE ELIGIBILITY CONDUCTED THROUGH TELEHEALTH.
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 101(f), is further
amended by inserting ``, provided that, in the case of such an
encounter occurring on or after the date that is 2 years after the date
of the enactment of the `Preserving Telehealth, Hospital, and Ambulance
Access Act', such physician or nurse practitioner includes in any claim
for such encounter one or more modifiers or codes specified by the
Secretary to indicate that such encounter was furnished through
telehealth'' after ``as determined appropriate by the Secretary''.
SEC. 104. EXTENDING ACUTE HOSPITAL CARE AT HOME WAIVER FLEXIBILITIES.
Section 1866G of the Social Security Act (42 U.S.C. 1395cc-7) is
amended--
(1) in subsection (a)(1), by striking ``2024'' and
inserting ``2029''; and
(2) in subsection (b)--
(A) in the header, by striking ``Study and Report''
and inserting ``Studies and Reports'';
(B) in paragraph (1)--
(i) in the matter preceding subparagraph
(A), by striking ``The Secretary'' and
inserting ``Not later than September 30, 2024,
and again not later than September 30, 2028,
the Secretary'';
(ii) in clause (iv), by striking ``and'' at
the end;
(iii) in clause (v), by striking the period
and inserting ``; and''; and
(iv) by adding at the end the following new
clause:
``(vi) in the case of the second study
conducted under this paragraph, 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.''; and
(C) in paragraph (2)--
(i) in the header, by striking ``Report''
and inserting ``Reports''; and
(ii) by inserting ``and again not later
than September 30, 2028,'' after ``2024,''; and
(iii) by striking ``on the study conducted
under paragraph (1).'' and inserting the
following: ``on--
``(A) with respect to the first report submitted
under this paragraph, the first study conducted under
paragraph (1); and
``(B) with respect to the second report submitted
under this paragraph, the second study conducted under
paragraph (1).''.
SEC. 105. REPORT ON WEARABLE MEDICAL DEVICES.
Not later than 18 months after the date of the enactment of this
Act, the Comptroller General of the United States shall conduct a
technology assessment of, and submit to Congress a report on, the
capabilities and limitations of wearable medical devices used to
support clinical decision-making. Such report shall include a
description of--
(1) the potential for such devices to accurately prescribe
treatments;
(2) an examination of the benefits and challenges of
artificial intelligence to augment such capabilities; and
(3) policy options to enhance the benefits and mitigate
potential challenges of developing or using such devices.
SEC. 106. ENHANCING CERTAIN PROGRAM INTEGRITY REQUIREMENTS FOR DME
UNDER MEDICARE.
(a) Durable Medical Equipment.--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,
2027, 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 from an ordering
physician or practitioner with whom the individual
involved does not have a prior relationship, as
determined on the basis of claims.
``(B) Claim review.--With respect to items
furnished on or after January 1, 2027 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.''.
(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 fraudulent
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 shall include--
(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 subparagraph (A) 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; and
(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.
TITLE II--SUSTAINING ACCESS TO HOSPITAL AND EMERGENCY SERVICES
SEC. 201. EXTENSION OF INCREASED INPATIENT HOSPITAL PAYMENT ADJUSTMENT
FOR CERTAIN LOW-VOLUME HOSPITALS.
(a) In General.--Section 1886(d)(12) of the Social Security Act (42
U.S.C. 1395ww(d)(12)) is amended--
(1) in subparagraph (B), by striking ``during the portion
of fiscal year 2025 beginning on January 1, 2025, and ending on
September 30, 2025, and'';
(2) in subparagraph (C)(i)--
(A) in the matter preceding subclause (I)--
(i) by striking ``or portion of a fiscal
year''; and
(ii) by striking ``2024 and the portion of
fiscal year 2025 beginning on October 1, 2024,
and ending on December 31, 2024'' and inserting
``2025'';
(B) in subclause (III), by striking ``2024 and the
portion of fiscal year 2025 beginning on October 1,
2024, and ending on December 31, 2024'' and inserting
``2025''; and
(C) in subclause (IV), by striking ``the portion of
fiscal year 2025 beginning on January 1, 2025, and
ending on September 30, 2025, and''; and
(3) in subparagraph (D)--
(A) in the matter preceding clause (i), by striking
``2024 or during the portion of fiscal year 2025
beginning on October 1, 2024, and ending on December
31, 2024'' and inserting ``2025''; and
(B) in clause (ii), by striking `` 2024 and the
portion of fiscal year 2025 beginning on October 1,
2024, and ending on December 31, 2024'' and inserting
``2025''.
(b) Implementation.--Notwithstanding any other provision of law,
the Secretary of Health and Human Services may implement the provisions
of, including the amendments made by, this section by program
instruction or otherwise.
SEC. 202. EXTENSION OF THE MEDICARE-DEPENDENT HOSPITAL PROGRAM.
(a) In General.--Section 1886(d)(5)(G) of the Social Security Act
(42 U.S.C. 1395ww(d)(5)(G)) is amended--
(1) in clause (i), by striking ``January 1, 2025'' and
inserting ``October 1, 2025''; and
(2) in clause (ii)(II), by striking ``January 1, 2025'' and
inserting ``October 1, 2025''.
(b) Conforming Amendments.--
(1) Extension of target amount.--Section 1886(b)(3)(D) of
the Social Security Act (42 U.S.C. 1395ww(b)(3)(D)) is
amended--
(A) in the matter preceding clause (i),