I 

118TH CONGRESS 

1ST SESSION H. R. 5611 

To amend title XVIII of the Social Security Act to provide for permanent 

payments for telehealth services furnished by Federally qualified health 

centers and rural health clinics under the Medicare program. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 20, 2023 

Mr. THOMPSON of Pennsylvania (for himself and Ms. KUSTER) 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 provide 

for permanent payments for telehealth services furnished 

by Federally qualified health centers and rural health 

clinics under the Medicare program. 

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 ‘‘Helping Ensure Access 

5 to Local TeleHealth Act of 2023’’ or the ‘‘HEALTH Act 

6 of 2023’’. 


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1 SEC. 2. PROVIDING FOR PERMANENT COST-RELATED PAY2 MENTS FOR TELEHEALTH SERVICES FUR3 NISHED BY FEDERALLY QUALIFIED HEALTH 

4 CENTERS AND RURAL HEALTH CLINICS 

5 UNDER THE MEDICARE PROGRAM AND PER6 MANENTLY REMOVING ORIGINATING SITE 

7 FACILITY AND LOCATION REQUIREMENTS 

8 FOR DISTANT SITE TELEHEALTH SERVICES 

9 FURNISHED BY SUCH CENTERS AND SUCH 

10 CLINICS. 

11 (a) COVERAGE OF AUDIO-ONLY TELEHEALTH SERV12 ICES.— 

13 (1) IN GENERAL.—Section 1834(m)(4) of the 

14 Social Security Act (42 U.S.C. 1395m(m)(4)) is 

15 amended by adding at the end the following new 

16 subparagraph: 

17 ‘‘(G) TELECOMMUNICATIONS SYSTEM.— 

18 Except as provided in paragraph (1), the term 

19 ‘telecommunications system’ means a two-way, 

20 real-time interactive communications system, 

21 whether by audiovisual or audio-only commu22 nications.’’. 

23 (2) REQUIRED IMPLEMENTATION STEPS.—Not 

24 later than 60 days after the date of the enactment 

25 of this Act, the Secretary of Health and Human 

26 Services shall— 


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1 (A) revise section 410.78(a)(3) of title 42, 

2 Code of Federal Regulations (or a successor 

3 regulation) to define the term ‘‘interactive tele4 communications system’’ in accordance with the 

5 amendment made by paragraph (1); and 

6 (B) revise section 405.2463 of such title 

7 (or a successor regulation) to provide that, for 

8 purposes of distant site telehealth services fur9 nished by Federally qualified health centers and 

10 rural health clinics under section 1834(m)(8) of 

11 the Social Security Act (42 U.S.C. 

12 1395m(m)(8)), a visit includes any two-way, 

13 real-time interactive communication between an 

14 individual and the distant site Federally quali15 fied health center provider or rural health clin16 ic, whether by audiovisual or audio-only com17 munication. 

18 (b) PERMANENT TELEHEALTH PAYMENTS.—Section 

19 1834(m)(8) of the Social Security Act (42 U.S.C. 

20 1395m(m)(8)) is amended— 

21 (1) in subparagraph (A), in the matter pre22 ceding clause (i), by striking ‘‘During the emergency 

23 period’’ and all that follows through ‘‘2024—’’ and 

24 inserting ‘‘With respect to telehealth services fur25 nished on or after the date of the beginning of the 


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1 emergency period described in section 

2 1135(g)(1)(B)—’’; and 

3 (2) by striking subparagraph (B) and inserting 

4 the following new subparagraph: 

5 ‘‘(B) PAYMENT.— 

6 ‘‘(i) IN GENERAL.—A telehealth serv7 ice furnished by a rural health clinic or a 

8 Federally qualified health center serving as 

9 a distant site to an individual shall be 

10 deemed to be so furnished to such indi11 vidual as an outpatient of such clinic or fa12 cility (as applicable) for purposes of para13 graph (1) or (3), respectively, of section 

14 1861(aa) and payable as a rural health 

15 clinic service or Federally qualified health 

16 center service (as applicable) under section 

17 1833(a)(3) or under the prospective pay18 ment system established under section 

19 1834(o), respectively. 

20 ‘‘(ii) TREATMENT OF COSTS FOR

21 FQHC PPS CALCULATIONS AND RHC AIR

22 CALCULATIONS.—Costs associated with the 

23 delivery of telehealth services by a Feder24 ally qualified health center or rural health 

25 clinic serving as a distant site pursuant to 


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1 this paragraph shall be considered allow2 able costs for purposes of the prospective 

3 payment system established under section 

4 1834(o) and any payment methodologies 

5 developed under section 1833(a)(3), as ap6 plicable.’’. 

7 (c) ELIMINATION OF ORIGINATING SITE REQUIRE8 MENTS FOR TELEHEALTH SERVICES FURNISHED BY

9 FQHCS OR RHCS.— 

10 (1) IN GENERAL.—Section 1834(m) of the So11 cial Security Act (42 U.S.C. 1395m(m)), as amend12 ed by subsection (b), is further amended— 

13 (A) in paragraph (4)(C)(i), by striking 

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

15 (B) in paragraph (8), by adding at the end 

16 the following new subparagraph: 

17 ‘‘(C) NONAPPLICATION OF ORIGINATING

18 SITE REQUIREMENTS.—The geographic and site 

19 requirements described in paragraph (4)(C) 

20 shall not apply with respect to telehealth serv21 ices furnished by a Federally qualified health 

22 center or a rural health clinic serving as a dis23 tant site.’’. 

24 (2) SPECIAL PAYMENT RULE FOR ORIGINATING

25 SITES WITH RESPECT TO TELEHEALTH SERVICES


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1 FURNISHED BY AN FQHC OR RHC.—Section 

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

3 1395m(m)(2)(B)) is amended— 

4 (A) in clause (i), by striking ‘‘clause (ii)’’ 

5 and inserting ‘‘clauses (ii) and (iii)’’; and 

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

7 clause: 

8 ‘‘(iii) SPECIAL RULE FOR TELE9 HEALTH SERVICES FURNISHED BY FQHCS

10 AND RHCS.—No facility fee shall be paid 

11 under this subparagraph to an originating 

12 site with respect to telehealth services fur13 nished by a Federally qualified health cen14 ter or rural health clinic serving as a dis15 tant site unless such originating site is a 

16 site described in any of subclauses (I) 

17 through (IX) or (XI) of paragraph 

18 (4)(C)(ii).’’. 

Æ 


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