I 

116TH CONGRESS 

1ST SESSION H. R. 4932 

To amend title XVIII of the Social Security Act to expand access to telehealth 

services, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 30, 2019 

Mr. THOMPSON of California (for himself, Mr. WELCH, Mr. JOHNSON of Ohio, 

Mr. SCHWEIKERT, and Ms. MATSUI) 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 expand 

access to telehealth services, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Creating Opportunities Now for Necessary and Effective 

6 Care Technologies for Health Act of 2019’’ or the ‘‘CON7 NECT for Health Act of 2019’’. 


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1 (b) TABLE OF CONTENTS.—The table of contents of 

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings and sense of Congress. 

Sec. 3. Expanding the use of telehealth through the waiver of certain requirements. 

Sec. 4. Expanding the use of telehealth for mental health services. 

Sec. 5. Use of telehealth in emergency medical care. 

Sec. 6. Improvements to the process for adding telehealth services. 

Sec. 7. Rural health clinics and Federally qualified health centers. 

Sec. 8. Native American health facilities. 

Sec. 9. Waiver of telehealth restrictions during national emergencies. 

Sec. 10. Use of telehealth in recertification for hospice care. 

Sec. 11. Clarification for fraud and abuse laws regarding technologies provided 

to beneficiaries. 

Sec. 12. Study and report on increasing access to telehealth services in the 

home. 

Sec. 13. Analysis of telehealth waivers in alternative payment models. 

Sec. 14. Model to allow additional health professionals to furnish telehealth 

services. 

Sec. 15. Testing of models to examine the use of telehealth under the Medicare 

program. 

3 SEC. 2. FINDINGS AND SENSE OF CONGRESS. 

4 (a) FINDINGS.—Congress finds the following: 

5 (1) The use of technology in health care and 

6 coverage of telehealth services are rapidly evolving. 

7 (2) Research has found that telehealth services 

8 can expand access to care, improve the quality of 

9 care, and reduce spending, and that patients receiv10 ing telehealth services are satisfied with their experi11 ences. 

12 (3) Health care workforce shortages are a sig13 nificant problem in many areas and for many types 

14 of health care clinicians. 

15 (4) Telehealth increases access to care in areas 

16 with workforce shortages and for individuals who 


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1 live far away from health care facilities, have limited 

2 mobility or transportation, or have other barriers to 

3 accessing care. 

4 (5) The use of health technologies can strength5 en the expertise of the health care workforce, includ6 ing by connecting clinicians to specialty consulta7 tions. 

8 (6) Utilization of telehealth services in Medicare 

9 remains low, with only 0.25 percent of Medicare fee10 for-service beneficiaries utilizing telehealth services 

11 in 2016. 

12 (b) SENSE OF CONGRESS.—It is the sense of Con13 gress that— 

14 (1) health care providers can furnish safe, effec15 tive, and high-quality health care services through 

16 telehealth; and 

17 (2) barriers to the use of telehealth should be 

18 removed. 

19 SEC. 3. EXPANDING THE USE OF TELEHEALTH THROUGH 

20 THE WAIVER OF CERTAIN REQUIREMENTS. 

21 (a) IN GENERAL.—Section 1834(m) of the Social Se22 curity Act (42 U.S.C. 1395m(m)) is amended— 

23 (1) in paragraph (4)(C)(i), by striking ‘‘and 

24 (7)’’ and inserting ‘‘(7), and (8)’’; and 

25 (2) by adding at the end the following: 


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1 ‘‘(8) AUTHORITY TO WAIVE REQUIREMENTS

2 AND LIMITATIONS IF CERTAIN CONDITIONS MET.— 

3 ‘‘(A) IN GENERAL.—Notwithstanding the 

4 preceding provisions of this subsection, in the 

5 case of telehealth services furnished on or after 

6 January 1, 2021, the Secretary may waive any 

7 restriction applicable to payment for telehealth 

8 services under this subsection that is described 

9 in subparagraph (B), but only if the Secretary 

10 determines that such waiver would not deny or 

11 limit the coverage or provision of benefits under 

12 this title, and— 

13 ‘‘(i) the Secretary determines that the 

14 waiver is expected to reduce spending 

15 under this title without reducing the qual16 ity of care or improve the quality of pa17 tient care without increasing spending; or 

18 ‘‘(ii) the waiver would apply to tele19 health services furnished in originating 

20 sites located in a high-need health profes21 sional shortage area (as designated pursu22 ant to section 332(a)(1)(A) of the Public 

23 Health Service Act (42 U.S.C. 

24 254e(a)(1)(A))). 


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1 ‘‘(B) RESTRICTIONS DESCRIBED.—For 

2 purposes of this paragraph, restrictions applica3 ble to payment for telehealth services under 

4 paragraph (1) are— 

5 ‘‘(i) requirements relating to qualifica6 tions for an originating site under para7 graph (4)(C)(ii); 

8 ‘‘(ii) any geographic limitations under 

9 paragraph (4)(C)(i) (other than applicable 

10 State law requirements, including State li11 censure requirements); 

12 ‘‘(iii) any limitation on the type of 

13 technology used to furnish telehealth serv14 ices; 

15 ‘‘(iv) any limitation on the type of 

16 provider of services or supplier who may 

17 furnish telehealth services (other than the 

18 requirement that the provider of services 

19 or supplier is enrolled under this title); 

20 ‘‘(v) any limitation on specific services 

21 designated as telehealth services pursuant 

22 to this subsection (provided the Secretary 

23 determines that such services are clinically 

24 appropriate to furnish remotely); or 


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1 ‘‘(vi) any other limitation relating to 

2 the furnishing of telehealth services under 

3 this title identified by the Secretary. 

4 ‘‘(C) PUBLIC COMMENT.—The Secretary 

5 shall establish a process by which stakeholders 

6 may (on at least an annual basis) provide public 

7 comment for waivers under this paragraph. 

8 ‘‘(D) PERIODIC REVIEW OF WAIVERS.— 

9 The Secretary shall periodically, but not more 

10 often than every 3 years, reassess each waiver 

11 under this paragraph to determine whether the 

12 waiver continues to meet the conditions applica13 ble under subparagraph (A).’’. 

14 (b) POSTING OF INFORMATION.—Not later than 2 

15 years after the date on which a waiver under section 

16 1834(m)(8) of the Social Security Act, as added by sub17 section (a), first becomes effective, and at least biennially 

18 thereafter, the Secretary of Health and Human Services 

19 shall post on the internet website of the Centers for Medi20 care & Medicaid Services— 

21 (1) the number of Medicare beneficiaries receiv22 ing telehealth services by reason of each waiver 

23 under such section; 


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1 (2) the impact of such waivers on expenditures 

2 and utilization under title XVIII of the Social Secu3 rity Act (42 U.S.C. 1395 et seq.); and 

4 (3) other outcomes, as determined appropriate 

5 by the Secretary. 

6 SEC. 4. EXPANDING THE USE OF TELEHEALTH FOR MEN7 TAL HEALTH SERVICES. 

8 (a) IN GENERAL.—Section 1834(m) of the Social Se9 curity Act (42 U.S.C. 1395m(m)), as amended by section 

10 3, is amended— 

11 (1) in paragraph (4)(C)(i), by striking ‘‘and 

12 (8)’’ and inserting ‘‘(8), and (9)’’; and 

13 (2) by adding at the end the following: 

14 ‘‘(9) TREATMENT OF MENTAL HEALTH SERV15 ICES FURNISHED THROUGH TELEHEALTH.—The ge16 ographic requirements described in paragraph 

17 (4)(C)(i) (other than applicable State law require18 ments, including State licensure requirements) shall 

19 not apply with respect to telehealth services that are 

20 mental health services (as determined by the Sec21 retary) furnished on or after January 1, 2021, to an 

22 eligible telehealth individual at an originating site 

23 described in paragraph (4)(C)(ii) (other than an 

24 originating site described in subclause (IX) of such 

25 paragraph).’’. 


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1 (b) INCLUSION OF THE HOME AS AN ORIGINATING

2 SITE.—Section 1834(m)(4)(C)(ii)(X) of such Act (42 

3 U.S.C. 1395m(m)(4)(C)(ii)(X)) is amended by striking 

4 ‘‘paragraph (7)’’ and inserting ‘‘paragraphs (7) and (9)’’. 

5 (c) ADDITIONAL SERVICES.—As part of the imple6 mentation of the amendments made by this section, the 

7 Secretary of Health and Human Services shall consider 

8 whether additional services should be added to the services 

9 specified in paragraph (4)(F)(i) of section 1834(m) of 

10 such Act (42 U.S.C. 1395m) for authorized payment 

11 under paragraph (1) of such section. 

12 SEC. 5. USE OF TELEHEALTH IN EMERGENCY MEDICAL 

13 CARE. 

14 (a) IN GENERAL.—Section 1834(m) of the Social Se15 curity Act (42 U.S.C. 1395m(m)), as amended by sections 

16 3 and 4, is amended— 

17 (1) in paragraph (4)(C)(i), by striking ‘‘and 

18 (9)’’ and inserting ‘‘(9), and (10)’’; and 

19 (2) by adding at the end the following: 

20 ‘‘(10) TREATMENT OF EMERGENCY MEDICAL

21 CARE FURNISHED THROUGH TELEHEALTH.—The 

22 geographic requirements described in paragraph 

23 (4)(C)(i) (other than applicable State law require24 ments, including State licensure requirements) shall 

25 not apply with respect to telehealth services that are 


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1 services for emergency medical care (as determined 

2 by the Secretary) furnished on or after January 1, 

3 2021, to an eligible telehealth individual at an origi4 nating site described in subclause (II), (V), or (VII) 

5 of paragraph (4)(C)(ii).’’. 

6 (b) ADDITIONAL SERVICES.—As part of the imple7 mentation of the amendments made by this section, the 

8 Secretary of Health and Human Services shall consider 

9 whether additional services should be added to the services 

10 specified in paragraph (4)(F)(i) of section 1834(m) of 

11 such Act (42 U.S.C. 1395m) for authorized payment 

12 under paragraph (1) of such section. 

13 SEC. 6. IMPROVEMENTS TO THE PROCESS FOR ADDING 

14 TELEHEALTH SERVICES. 

15 The Secretary shall undertake a review of the process 

16 established pursuant to section 1834(m)(4)(F)(ii) of the 

17 Social Security Act (42 U.S.C. 1395m(m)(4)(F)(ii)), and 

18 based on the results of such review— 

19 (1) implement revisions to the process so that 

20 the criteria to add services prioritizes, as appro21 priate, improved access to care through telehealth 

22 services; and 

23 (2) provide clarification on what requests to 

24 add telehealth services under such process should in25 clude. 


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1 SEC. 7. RURAL HEALTH CLINICS AND FEDERALLY QUALI2 FIED HEALTH CENTERS. 

3 (a) EXPANSION OF ORIGINATING SITES.—Section 

4 1834(m)(4)(C) of the Social Security Act (42 U.S.C. 

5 1395m(m)(4)(C)), as amended by sections 3, 4, and 5, 

6 is amended— 

7 (1) in clause (i), by striking ‘‘and (10)’’ and in8 serting ‘‘and (10), and subject to clause (iii),’’; and 

9 (2) by adding at the end the following new 

10 clause: 

11 ‘‘(iii) RURAL HEALTH CLINICS AND

12 FEDERALLY QUALIFIED HEALTH CEN13 TERS.—The term ‘originating site’ shall 

14 also include any Federally qualified health 

15 center and any rural health clinic (as such 

16 terms are defined in section 1861(aa)) at 

17 which the eligible telehealth individual is 

18 located at the time the service is furnished 

19 via a telecommunications system, whether 

20 or not the individual is located in an area 

21 described in clause (i), insofar as such 

22 sites are not otherwise included in the defi23 nition of originating site under such 

24 clause, subject to applicable State law re25 quirements, including State licensure re26 quirements.’’. 


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1 (b) EXPANSION OF DISTANT SITES.—Section 

2 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) 

3 is amended— 

4 (1) in the first sentence of paragraph (1)— 

5 (A) by striking ‘‘or a practitioner (de6 scribed in section 1842(b)(18)(C))’’ and insert7 ing ‘‘, a practitioner (described in section 

8 1842(b)(18)(C)), a Federally qualified health 

9 center, or a rural health clinic’’; and 

10 (B) by striking ‘‘or practitioner’’ and in11 serting ‘‘, practitioner, Federally qualified 

12 health center, or rural health clinic’’; 

13 (2) in paragraph (2)(A)— 

14 (A) by inserting ‘‘or to a Federally quali15 fied health center or rural health clinic that 

16 serves as a distant site’’ after ‘‘a distant site’’; 

17 and 

18 (B) by striking ‘‘such physician or practi19 tioner’’ and inserting ‘‘such physician, practi20 tioner, Federally qualified health center, or 

21 rural health clinic’’; and 

22 (3) in paragraph (4)— 

23 (A) in subparagraph (A), by inserting 

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1 health service to an eligible individual’’ before 

2 the period at the end; and 

3 (B) in subparagraph (F), by adding at the 

4 end the following new clause: 

5 ‘‘(iii) INCLUSION OF RURAL HEALTH

6 CLINIC SERVICES AND FEDERALLY QUALI7 FIED HEALTH CENTER SERVICES FUR8 NISHED USING TELEHEALTH.—For pur9 poses of this subparagraph, the term ‘tele10 health services’ includes a rural health 

11 clinic service or Federally qualified health 

12 center service that is furnished using tele13 health to the extent that payment codes 

14 corresponding to services identified by the 

15 Secretary under clause (i) or (ii) are listed 

16 on the corresponding claim for such rural 

17 health clinic service or Federally qualified 

18 health center service.’’. 

19 (c) EFFECTIVE DATE.—The amendments made by 

20 this section shall apply to services furnished on or after 

21 January 1, 2021. 

22 SEC. 8. NATIVE AMERICAN HEALTH FACILITIES. 

23 (a) IN GENERAL.—Section 1834(m)(4)(C) of the So24 cial Security Act (42 U.S.C. 1395m(m)(4)(C)), as amend25 ed by sections 3, 4, 5, and 7, is amended— 


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1 (1) in clause (i), by striking ‘‘clause (iii)’’ and 

2 inserting ‘‘clauses (iii) and (iv)’’; and 

3 (2) by adding at the end the following new 

4 clause: 

5 ‘‘(iv) NATIVE AMERICAN HEALTH FA6 CILITIES.—The originating site require7 ments described in clauses (i) and (ii) shall 

8 not apply with respect to a facility of the 

9 Indian Health Service, whether operated 

10 by such Service, or by an Indian tribe (as 

11 that term is defined in section 4 of the In12 dian Health Care Improvement Act (25 

13 U.S.C. 1603)) or a tribal organization (as 

14 that term is defined in section 4 of the In15 dian Self-Determination and Education 

16 Assistance Act (25 U.S.C. 5304)), or a fa17 cility of the Native Hawaiian health care 

18 systems authorized under the Native Ha19 waiian Health Care Improvement Act (42 

20 U.S.C. 11701 et seq.).’’. 

21 (b) NO ORIGINATING SITE FACILITY FEE FOR NEW

22 SITES.—Section 1834(m)(2)(B)(i) of the Social Security 

23 Act (42 U.S.C. 1395m(m)(2)(B)(i)) is amended, in the 

24 matter preceding subclause (I), by inserting ‘‘(other than 

25 an originating site that is only described in clause (iv) of 


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1 paragraph (4)(C), and does not meet the requirement for 

2 an originating site under clause (i) of such paragraph)’’ 

3 after ‘‘the originating site’’. 

4 (c) EFFECTIVE DATE.—The amendments made by 

5 this section shall apply to services furnished on or after 

6 January 1, 2021. 

7 SEC. 9. WAIVER OF TELEHEALTH RESTRICTIONS DURING 

8 NATIONAL EMERGENCIES. 

9 Section 1135(b) of the Social Security Act (42 U.S.C. 

10 1320b–5(b)) is amended— 

11 (1) in paragraph (6), by striking ‘‘and’’ after 

12 the semicolon; 

13 (2) in paragraph (7), by striking the period at 

14 the end and inserting ‘‘; and’’; and 

15 (3) by adding at the end the following: 

16 ‘‘(8) requirements for payment for telehealth 

17 services under section 1834(m).’’. 

18 SEC. 10. USE OF TELEHEALTH IN RECERTIFICATION FOR 

19 HOSPICE CARE. 

20 (a) IN GENERAL.—Section 1814(a)(7)(D)(i) of the 

21 Social Security Act (42 U.S.C. 1395f(a)(7)(D)(i)) is 

22 amended by inserting ‘‘(including through use of tele23 health, notwithstanding the requirements in section 

24 1834(m)(4)(C))’’ after ‘‘face-to-face encounter’’. 


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1 (b) GAO REPORT.—Not later than 3 years after the 

2 date of enactment of this Act, the Comptroller General 

3 of the United States shall submit a report to Congress 

4 evaluating the impact of the amendment made by sub5 section (a) on— 

6 (1) the number and percentage of beneficiaries 

7 recertified for the Medicare hospice benefit at 180 

8 days and for subsequent benefit periods; 

9 (2) the appropriateness for hospice care of the 

10 patients recertified through the use of telehealth; 

11 and 

12 (3) any other factors determined appropriate by 

13 the Comptroller General. 

14 SEC. 11. CLARIFICATION FOR FRAUD AND ABUSE LAWS RE15 GARDING TECHNOLOGIES PROVIDED TO 

16 BENEFICIARIES. 

17 Section 1128A(i)(6) of the Social Security Act (42 

18 U.S.C. 1320a–7a(i)(6)) is amended— 

19 (1) in subparagraph (I), by striking ‘‘; or’’ and 

20 inserting a semicolon; 

21 (2) in subparagraph (J), by striking the period 

22 at the end and inserting ‘‘; or’’; and 

23 (3) by adding at the end the following new sub24 paragraph: 


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1 ‘‘(K) the provision of technologies (as de2 fined by the Secretary) on or after the date of 

3 the enactment of this subparagraph, by a pro4 vider of services or supplier (as such terms are 

5 defined for purposes of title XVIII) directly to 

6 an individual who is entitled to benefits under 

7 part A of title XVIII, enrolled under part B of 

8 such title, or both, for the purpose of furnishing 

9 telehealth services, remote patient monitoring 

10 services, or other services furnished through the 

11 use of technology (as defined by the Secretary), 

12 if— 

13 ‘‘(i) the technologies are not offered 

14 as part of any advertisement or solicita15 tion; and 

16 ‘‘(ii) the provision of the technologies 

17 meets any other requirements set forth in 

18 regulations promulgated by the Sec19 retary.’’. 

20 SEC. 12. STUDY AND REPORT ON INCREASING ACCESS TO 

21 TELEHEALTH SERVICES IN THE HOME. 

22 (a) MEDPAC STUDY.—The Medicare Payment Advi23 sory Commission (in this section referred to as the ‘‘Com24 mission’’) shall conduct a study on increasing access under 

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1 curity Act (42 U.S.C. 1395 et seq.) to telehealth services 

2 in the home. Such study shall include an analysis of the 

3 following: 

4 (1) How different payers allow the home to be 

5 an originating site for telehealth services. 

6 (2) Particular types of telehealth services or 

7 subgroups of beneficiaries with respect to which al8 lowing the home to be an originating site under the 

9 Medicare program would be suitable. 

10 (b) REPORT.—Not later than 24 months after the 

11 date of the enactment of this Act, the Commission shall 

12 submit to Congress a report containing the results of the 

13 study conducted under subsection (a), together with rec14 ommendations for such legislation and administrative ac15 tion as the Commission determines appropriate. 

16 SEC. 13. ANALYSIS OF TELEHEALTH WAIVERS IN ALTER17 NATIVE PAYMENT MODELS. 

18 The second sentence of section 1115A(g) of the So19 cial Security Act (42 U.S.C. 1315a(g)) is amended by in20 serting ‘‘an analysis of waivers under section (d)(1) re21 lated to telehealth and the impact on quality and spending 

22 under the applicable titles of such waivers,’’ after ‘‘sub23 section (c),’’. 


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1 SEC. 14. MODEL TO ALLOW ADDITIONAL HEALTH PROFES2 SIONALS TO FURNISH TELEHEALTH SERV3 ICES. 

4 Section 1115A(b)(2)(B) of the Social Security Act 

5 (42 U.S.C. 1315a(b)(2)(B)) is amended by adding at the 

6 end the following new clause: 

7 ‘‘(xxviii) Allowing health professionals, 

8 such as those described in section 

9 1819(b)(5)(G) or section 1861(ll)(4)(B), 

10 who are not otherwise eligible under sec11 tion 1834(m) to furnish telehealth services 

12 to furnish such services.’’. 

13 SEC. 15. TESTING OF MODELS TO EXAMINE THE USE OF 

14 TELEHEALTH UNDER THE MEDICARE PRO15 GRAM. 

16 Section 1115A(b)(2) of the Social Security Act (42 

17 U.S.C. 1315a(b)(2)) is amended by adding at the end the 

18 following new subparagraph: 

19 ‘‘(D) TESTING MODELS TO EXAMINE USE

20 OF TELEHEALTH UNDER MEDICARE.—The Sec21 retary shall consider testing under this sub22 section models to examine the use of telehealth 

23 under title XVIII.’’. 

Æ 


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