II 

118TH CONGRESS 

1ST SESSION S. 3021 

To amend title XVIII of the Social Security Act to permanently extend 

certain in-home cardiopulmonary rehabilitation flexibilities established in 

response to COVID–19, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

OCTOBER 4, 2023 

Ms. SINEMA (for herself, Mrs. BLACKBURN, and Ms. KLOBUCHAR) 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 permanently extend certain in-home cardiopulmonary rehabilitation flexibilities established in response to COVID– 

19, 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. 

4 This Act may be cited as the ‘‘Sustainable 

5 Cardiopulmonary Rehabilitation Services in the Home 

6 Act’’. 


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•S 3021 IS

1 SEC. 2. CODIFYING VIRTUAL CARDIOPULMONARY REHA2 BILITATION FLEXIBILITIES ESTABLISHED IN 

3 RESPONSE TO COVID–19. 

4 (a) IN GENERAL.—Section 1861(eee)(2) of the Social 

5 Security Act (42 U.S.C. 1395x(eee)(2)) is amended— 

6 (1) in subparagraph (A)(ii), by inserting ‘‘, in7 cluding in the home of an individual when furnished 

8 as a telehealth service through audio-visual real-time 

9 communications technology, or when such home is 

10 designated as a provider-based location of a hospital 

11 outpatient department’’ after ‘‘outpatient basis’’; 

12 and 

13 (2) in subparagraph (B), by inserting ‘‘, includ14 ing through the virtual presence of such physician, 

15 physician assistant, nurse practitioner, or clinical 

16 nurse specialist, through audio-visual real-time com17 munications technology’’ after ‘‘under the program’’. 

18 (b) EXPANDING ORIGINATING SITES.—Section 

19 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) 

20 is amended— 

21 (1) in paragraph (1), by striking ‘‘and (9)’’ and 

22 all that follows through ‘‘(as defined in paragraph 

23 (4)(E))’’ and inserting ‘‘, (9), and (10), the Sec24 retary shall pay for telehealth services that are fur25 nished via a telecommunications system by a physi26 cian (as defined in section 1861(r)) or a practitioner 


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•S 3021 IS

1 (as defined in paragraph (4)(E)), or by a hospital 

2 (as defined in section 1861(e))’’; 

3 (2) in paragraph (2)(A), by striking ‘‘or practi4 tioner’’ each place that it appears and inserting ‘‘, 

5 practitioner, or hospital’’; 

6 (3) in paragraph (4)(A), by striking ‘‘or practi7 tioner’’ and inserting ‘‘, practitioner, or hospital’’; 

8 (4) in paragraph (4)(C)— 

9 (A) in clause (i), by striking ‘‘and (7)’’ and 

10 inserting ‘‘(7), and (10)’’; and 

11 (B) in clause (ii)(X), by striking ‘‘para12 graph (7)’’ and inserting ‘‘paragraphs (7) and 

13 (10)’’; 

14 (5) in paragraph (4)(F)(i), by striking ‘‘para15 graph (8)’’ and inserting ‘‘paragraphs (8) and (10)’’; 

16 and 

17 (6) by adding at the end the following new 

18 paragraph: 

19 ‘‘(10) TREATMENT OF CARDIAC REHABILITA20 TION PROGRAM, INTENSIVE CARDIAC REHABILITA21 TION PROGRAM, AND PULMONARY REHABILITATION

22 PROGRAM VISITS FURNISHED THROUGH TELE23 HEALTH.—In the case of items and services fur24 nished on or after January 1, 2024, the geographic 

25 requirements described in paragraph (4)(C)(i) shall 


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•S 3021 IS

1 not apply with respect to telehealth services for car2 diac rehabilitation programs and intensive cardiac 

3 rehabilitation programs (as such terms are defined 

4 in section 1861(eee)) and pulmonary rehabilitation 

5 programs (as defined in section 1861(fff)) at an 

6 originating site described in subclauses (V) and (X) 

7 of paragraph (4)(C)(ii).’’. 

8 (c) AUTHORITY TO ESTABLISH STANDARDS AND

9 ALLOW FOR CERTAIN PROGRAMS TO UTILIZE TELE10 HEALTH SERVICES.— 

11 (1) IN GENERAL.—Not later than 30 days after 

12 the date of enactment of this section, the Secretary 

13 of Health and Human Services shall— 

14 (A) establish standards for the designation 

15 of the home of an individual with status as a 

16 provider-based organization of a hospital con17 sistent with waivers issued through the Hospital 

18 Without Walls program for cardiac rehabilita19 tion, pulmonary rehabilitation, and intensive 

20 cardiac rehabilitation; and 

21 (B) include items and services furnished 

22 under cardiac rehabilitation program or under 

23 an intensive cardiac rehabilitation program (as 

24 such terms are defined in section 1861(eee) of 

25 the Social Security Act (42 U.S.C. 1395x(eee)), 


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•S 3021 IS

1 or under a pulmonary rehabilitation program 

2 (as defined in section 1861(fff) of such Act (42 

3 U.S.C. 1395x(fff)) among telehealth services to 

4 be specified under section 1834(m)(4)(F) of 

5 such Act (42 U.S.C. 1395m(m)(4)(F)). 

6 (2) EFFECTIVE DATE.—The standards estab7 lished under paragraph (1) shall apply to items and 

8 services furnished on or after January 1, 2024. 

9 (d) IMPLEMENTATION.—Notwithstanding any other 

10 provision of the law, the Secretary of Health and Human 

11 Services may implement the provisions of, and the amend12 ments made by, this section by program instruction or oth13 erwise. 

14 (e) EFFECTIVE DATE.—The amendments made by 

15 subsections (a) and (b) shall apply to items and services 

16 furnished on or after January 1, 2024. 

Æ 


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