I 

117TH CONGRESS 

1ST SESSION H. R. 6202 

To amend titles XI and XVIII of the Social Security Act to establish requirements for the provision of certain high-cost durable medical equipment 

and laboratory testing; to extend and expand access to telehealth services; 

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 9, 2021 

Mr. DOGGETT (for himself, Mr. NUNES, Mr. THOMPSON of California, Mr. 

KELLY of Pennsylvania, Mr. SCHWEIKERT, Mrs. AXNE, Mr. BLUMENAUER, Mr. BRENDAN F. BOYLE of Pennsylvania, Mr. BUTTERFIELD, 

Mr. CARSON, Ms. CRAIG, Mr. DANNY K. DAVIS of Illinois, Mr. 

FITZPATRICK, Mrs. FLETCHER, Mr. HIGGINS of New York, Mr. KILDEE, 

Mr. LAHOOD, Mrs. LESKO, Mrs. MILLER of West Virginia, Mr. 

O’HALLERAN, Mr. RASKIN, Mr. RICE of South Carolina, Ms. SCHAKOWSKY, Ms. SEWELL, Mr. SMITH of Nebraska, Mr. SMUCKER, Mr. 

VEASEY, Mrs. WALORSKI, Ms. WILD, Mr. GREEN of Texas, and Mr. 

BUCHANAN) 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 titles XI and XVIII of the Social Security Act 

to establish requirements for the provision of certain 

high-cost durable medical equipment and laboratory testing; to extend and expand access to telehealth services; 

and for other purposes. 


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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 ‘‘Telehealth Extension 

5 Act of 2021’’. 

6 SEC. 2. REQUIREMENT FOR PROVISION OF HIGH-COST DU7 RABLE MEDICAL EQUIPMENT AND LABORA8 TORY TESTS. 

9 (a) HIGH-COST DURABLE MEDICAL EQUIPMENT.— 

10 Section 1834(a)(1)(E) of the Social Security Act (42 

11 U.S.C. 1395m(a)(1)(E)) is amended by adding at the end 

12 the following new clause: 

13 ‘‘(vi) STANDARDS FOR HIGH-COST DU14 RABLE MEDICAL EQUIPMENT.— 

15 ‘‘(I) LIMITATION ON PAYMENT

16 FOR HIGH-COST DURABLE MEDICAL

17 EQUIPMENT.—Payment may not be 

18 made under this subsection for a 

19 high-cost durable medical equipment 

20 ordered by a physician or other practi21 tioner described in clause (ii) via tele22 health for an individual, unless such 

23 physician or practitioner furnished to 

24 such individual a service in-person at 

25 least once during the 6-month period 


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1 prior to ordering such high-cost dura2 ble medical equipment. 

3 ‘‘(II) HIGH-COST DURABLE MED4 ICAL EQUIPMENT DETERMINATION.— 

5 For purposes of this clause, the Ad6 ministrator of the Centers for Medi7 care & Medicaid Services shall define 

8 the term ‘high-cost durable medical 

9 equipment’ and specify the durable 

10 medical equipment for which such def11 inition shall apply. 

12 ‘‘(vii) AUDIT OF PROVIDERS AND

13 PRACTITIONERS FURNISHING A HIGH VOL14 UME OF DURABLE MEDICAL EQUIPMENT

15 VIA TELEHEALTH.— 

16 ‘‘(I) IDENTIFICATION OF PRO17 VIDERS.—Beginning 6 months after 

18 the effective date of this clause, Medi19 care administrative contractors shall 

20 conduct reviews on a schedule deter21 mined by the Secretary, of claims for 

22 durable medical equipment prescribed 

23 by a physician or other practitioner 

24 described in clause (ii) during the 12- 

25 month period preceding such review to 


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1 identify physicians or other practi2 tioners with respect to whom at least 

3 90 percent of all durable medical 

4 equipment prescribed by such physi5 cian or practitioner during such pe6 riod was prescribed pursuant to a 

7 telehealth visit. 

8 ‘‘(II) AUDIT.—In the case of a 

9 physician or practitioner identified 

10 under subclause (I), with respect to a 

11 period described in such subclause, 

12 the Medicare administrative contrac13 tors shall conduct audits of all claims 

14 for durable medical equipment pre15 scribed by such physicians or practi16 tioners to determine whether such 

17 claims comply with the requirements 

18 for coverage under this title.’’. 

19 (b) HIGH-COST LABORATORY TESTS.—Section 

20 1834A(b) of the Social Security Act (42 U.S.C. 1395m– 

21 1(b)) is amended by adding at the end the following new 

22 paragraph: 

23 ‘‘(6) REQUIREMENT FOR HIGH-COST LABORA24 TORY TESTS.— 


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1 ‘‘(A) LIMITATION ON PAYMENT FOR HIGH2 COST LABORATORY TESTS.—Payment may not 

3 be made under this subsection for a high-cost 

4 laboratory test ordered by a physician or practi5 tioner via telehealth for an individual, unless 

6 such physician or practitioner furnished to such 

7 individual a service in-person at least once dur8 ing the 6-month period prior to ordering such 

9 high-cost laboratory test. 

10 ‘‘(B) HIGH-COST LABORATORY TEST DE11 FINED.—For purposes of this paragraph, the 

12 Administrator for the Centers for Medicare & 

13 Medicaid Services shall define the term ‘high14 cost laboratory test’ and specify which labora15 tory tests such definition shall apply to. 

16 ‘‘(7) AUDIT OF LABORATORY TESTING OR17 DERED PURSUANT TO TELEHEALTH VISIT.— 

18 ‘‘(A) IDENTIFICATION OF PROVIDERS.— 

19 Beginning 6 months after the effective date of 

20 this paragraph, Medicare administrative con21 tractors shall conduct periodic reviews on a 

22 schedule determined by the Secretary, of claims 

23 for laboratory tests prescribed by a physician or 

24 practitioner during the 12-month period pre25 ceding such review to identify physicians or 


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1 other practitioners with respect to whom at 

2 least 90 percent of all laboratory tests pre3 scribed by such physician or practitioner during 

4 such period was prescribed pursuant to a tele5 health visit. 

6 ‘‘(B) AUDIT.—In the case of a physician 

7 or practitioner identified under subparagraph 

8 (A), with respect to a period described in such 

9 subparagraph, the Medicare administrative con10 tractors shall conduct audits of all claims for 

11 laboratory tests prescribed by such physicians 

12 or practitioners during such period beginning to 

13 determine whether such claims comply with the 

14 requirements for coverage under this title.’’. 

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

16 this section shall take effect upon the termination of the 

17 emergency period described in section 1135(g)(1)(B) of 

18 the Social Security Act (42 U.S.C. 1320b–5(g)(1)(B)). 

19 SEC. 3. REQUIREMENT TO SUBMIT NPI NUMBER FOR SEPA20 RATELY BILLABLE TELEHEALTH SERVICES. 

21 (a) REQUIREMENT TO SUBMIT NPI NUMBER FOR

22 SEPARATELY BILLABLE TELEHEALTH SERVICES.—Sec23 tion 1834(m) of the Social Security Act (42 U.S.C. 

24 1395m(m)) is amended by adding at the end the following 

25 new paragraph: 


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1 ‘‘(9) REQUIREMENT TO SUBMIT NPI NUMBER

2 FOR SEPARATELY BILLABLE TELEHEALTH SERV3 ICES.—Payment may not be made under this sub4 section for separately billable telehealth services fur5 nished by a physician or practitioner unless such 

6 physician or practitioner submits a claim for pay7 ment under the national provider identification num8 ber assigned to such physician or practitioner.’’. 

9 (b) EFFECTIVE DATE.—The amendment made by 

10 this section shall take effect upon the termination of the 

11 emergency period described in section 1135(g)(1)(B) of 

12 the Social Security Act (42 U.S.C. 1320b–5(g)(1)(B)). 

13 SEC. 4. REMOVING GEOGRAPHIC REQUIREMENTS FOR 

14 TELEHEALTH SERVICES. 

15 Section 1834(m)(4)(C) of the Social Security Act (42 

16 U.S.C. 1395m(m)(4)(C)) is amended by adding at the end 

17 the following new clause: 

18 ‘‘(iii) REMOVAL OF GEOGRAPHIC RE19 QUIREMENTS.—The geographic require20 ments described in clause (i) shall not 

21 apply with respect to telehealth services 

22 furnished on or after the date of the enact23 ment of this clause.’’. 


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1 SEC. 5. EXPANDING ORIGINATING SITES. 

2 (a) EXPANDING THE HOME AS AN ORIGINATING

3 SITE.—Section 1834(m)(4)(C)(ii)(X) of the Social Secu4 rity Act (42 U.S.C. 1395m(m)(4)(C)(ii)(X)) is amended 

5 to read as follows: 

6 ‘‘(X) The home of an individual, 

7 but, with respect to services furnished 

8 before the date of the enactment of 

9 the ‘Telehealth Extension and Evalua10 tion Act’, only for purposes of section 

11 1881(b)(3)(B) or telehealth services 

12 described in paragraph (7).’’. 

13 (b) ALLOWING ADDITIONAL ORIGINATING SITES.— 

14 Section 1834(m)(4)(C)(ii) of the Social Security Act (42 

15 U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding at the 

16 end the following new subclause: 

17 ‘‘(XII) Any other site determined 

18 appropriate by the Secretary at which 

19 an eligible telehealth individual is lo20 cated at the time a telehealth service 

21 is furnished via a telecommunications 

22 system.’’. 

23 (c) PARAMETERS FOR NEW ORIGINATING SITES.— 

24 Section 1834(m)(4)(C) of the Social Security Act (42 

25 U.S.C. 1395m(m)(4)(C)), as amended by section 4, is 

26 amended by adding at the end the following new clause: 


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1 ‘‘(iv) REQUIREMENTS FOR NEW

2 SITES.— 

3 ‘‘(I) IN GENERAL.—The Sec4 retary may establish requirements for 

5 the furnishing of telehealth services at 

6 sites described in clause (ii)(XII) to 

7 provide for beneficiary and program 

8 integrity protections. 

9 ‘‘(II) CLARIFICATION.—Nothing 

10 in this clause shall be construed to 

11 preclude the Secretary from estab12 lishing requirements for other origi13 nating sites described in clause (ii).’’. 

14 (d) NO ORIGINATING SITE FACILITY FEE FOR NEW

15 SITES.—Section 1834(m)(2)(B)(ii) of the Social Security 

16 Act (42 U.S.C. 1395m(m)(2)(B)(ii)) is amended— 

17 (1) in the heading, by striking ‘‘IF ORIGINATING

18 SITE IS THE HOME’’ and inserting ‘‘FOR CERTAIN

19 SITES’’; and 

20 (2) by striking ‘‘paragraph (4)(C)(ii)(X)’’ and 

21 inserting ‘‘subclause (X) or (XII) of paragraph 

22 (4)(C)’’. 


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1 SEC. 6. FEDERALLY QUALIFIED HEALTH CENTERS AND 

2 RURAL HEALTH CLINICS. 

3 Section 1834(m) of the Social Security Act (42 

4 U.S.C. 1395m(m)) is amended— 

5 (1) in paragraph (4)(C)(i), in the matter pre6 ceding subclause (I), by striking ‘‘(5), (6), and (7)’’ 

7 and inserting ‘‘(5) through (8)’’; and 

8 (2) in paragraph (8)— 

9 (A) in the paragraph heading by inserting 

10 ‘‘AND AFTER’’ after ‘‘DURING’’; 

11 (B) in subparagraph (A)— 

12 (i) in the matter preceding clause (i), 

13 by inserting ‘‘and after such emergency pe14 riod’’ after ‘‘1135(g)(1)(B)’’; 

15 (ii) in clause (ii), by striking ‘‘and’’ at 

16 the end; 

17 (iii) by redesignating clause (iii) as 

18 clause (iv); and 

19 (iv) by inserting after clause (ii) the 

20 following new clause: 

21 ‘‘(iii) the geographic requirements de22 scribed in paragraph (4)(C)(i) shall not 

23 apply with respect to such a telehealth 

24 service; and’’; and 

25 (C) by striking subparagraph (B) and in26 serting the following: 


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1 ‘‘(B) PAYMENT.— 

2 ‘‘(i) IN GENERAL.—A telehealth serv3 ice furnished by a Federally qualified 

4 health center or a rural health clinic to an 

5 individual pursuant to this paragraph on 

6 or after the date of the enactment of this 

7 subparagraph shall be deemed to be so fur8 nished to such individual as an outpatient 

9 of such clinic or facility (as applicable) for 

10 purposes of paragraph (1) or (3), respec11 tively, of section 1861(aa) and payable as 

12 a Federally qualified health center service 

13 or rural health clinic service (as applicable) 

14 under the prospective payment system es15 tablished under section 1834(o) or under 

16 section 1833(a)(3), respectively. 

17 ‘‘(ii) TREATMENT OF COSTS FOR

18 FQHC PPS CALCULATIONS AND RHC AIR

19 CALCULATIONS.—Costs associated with the 

20 delivery of telehealth services by a Feder21 ally qualified health center or rural health 

22 clinic serving as a distant site pursuant to 

23 this paragraph shall be considered allow24 able costs for purposes of the prospective 

25 payment system established under section 


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1 1834(o) and any payment methodologies 

2 developed under section 1833(a)(3), as ap3 plicable.’’. 

4 SEC. 7. NATIVE AMERICAN HEALTH FACILITIES. 

5 (a) IN GENERAL.—Section 1834(m)(4)(C) of the So6 cial Security Act (42 U.S.C. 1395m(m)(4)(C)), as amend7 ed by sections 4 and 5(c), is amended— 

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

9 inserting ‘‘clauses (ii) and (v)’’; and 

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

11 clause: 

12 ‘‘(v) NATIVE AMERICAN HEALTH FA13 CILITIES.—With respect to telehealth serv14 ices furnished on or after January 1, 2022, 

15 the originating site requirements described 

16 in clauses (i) and (ii) shall not apply with 

17 respect to a facility of the Indian Health 

18 Service, whether operated by such Service, 

19 or by an Indian tribe (as that term is de20 fined in section 4 of the Indian Health 

21 Care Improvement Act (25 U.S.C. 1603)) 

22 or a tribal organization (as that term is 

23 defined in section 4 of the Indian Self-De24 termination and Education Assistance Act 

25 (25 U.S.C. 5304)), or a facility of the NaVerDate Sep 11 2014 16:10 Jan 06, 2022 Jkt 029200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H6202.IH H6202

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1 tive Hawaiian health care systems author2 ized under the Native Hawaiian Health 

3 Care Improvement Act (42 U.S.C. 11701 

4 et seq.).’’. 

5 (b) NO ORIGINATING SITE FACILITY FEE FOR CER6 TAIN NATIVE AMERICAN FACILITIES.—Section 

7 1834(m)(2)(B)(i) of the Social Security Act (42 U.S.C. 

8 1395m(m)(2)(B)(i)) is amended, in the matter preceding 

9 subclause (I), by inserting ‘‘(other than an originating site 

10 that is only described in clause (v) of paragraph (4)(C), 

11 and does not meet the requirement for an originating site 

12 under clauses (i) and (ii) of such paragraph)’’ after ‘‘the 

13 originating site’’. 

14 SEC. 8. WAIVER OF TELEHEALTH REQUIREMENTS DURING 

15 PUBLIC HEALTH EMERGENCIES. 

16 Section 1135(g)(1) of the Social Security Act (42 

17 U.S.C. 1320b–5(g)(1)) is amended— 

18 (1) in subparagraph (A), in the matter pre19 ceding clause (i), by striking ‘‘subparagraph (B)’’ 

20 and inserting ‘‘subparagraphs (B) and (C)’’; and 

21 (2) by adding at the end the following new sub22 paragraph: 

23 ‘‘(C) EXCEPTION FOR WAIVER OF TELE24 HEALTH REQUIREMENTS DURING PUBLIC

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1 section (b)(8), in addition to the emergency pe2 riod described in subparagraph (B), an ‘emer3 gency area’ is a geographical area in which, and 

4 an ‘emergency period’ is the period during 

5 which, there exists a public health emergency 

6 declared by the Secretary pursuant to section 

7 319 of the Public Health Service Act.’’. 

8 SEC. 9. TWO-YEAR EXTENSION OF TELEHEALTH SERVICES 

9 FOLLOWING THE COVID-19 EMERGENCY PE10 RIOD. 

11 Section 1135(e) of the Social Security Act (42 U.S.C. 

12 1320b–5(e)) is amended by adding at the end the fol13 lowing new paragraph: 

14 ‘‘(3) TWO-YEAR EXTENSION OF TELEHEALTH

15 SERVICES FOLLOWING THE COVID-19 EMERGENCY

16 PERIOD.—Notwithstanding any other provision of 

17 this section, a waiver or modification of require18 ments pursuant to subsection (b)(8) shall terminate 

19 on the date that is two years after the last day of 

20 the emergency period described in subsection 

21 (g)(1)(B).’’. 

22 SEC. 10. OUTPATIENT CRITICAL ACCESS HOSPITALS. 

23 (a) IN GENERAL.—Notwithstanding section 1834(m) 

24 of the Social Security Act (42 U.S.C. 1395m(m)) and sub25 ject to subsection (b), the Secretary of Health and Human 


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1 Services shall provide payment under section 1834(g) of 

2 such Act (42 U.S.C. 1395m(g)) for outpatient critical ac3 cess hospital services consisting of behavioral therapy serv4 ices furnished by a critical access hospital to an individual 

5 during the period beginning on January 1, 2021, and end6 ing on the date that is two years after the last day of 

7 the emergency period described in section 1135(g)(1)(B) 

8 of the Social Security Act (42 U.S.C. 1320b–5(g)(1)(B)), 

9 via telecommunications technology, notwithstanding the 

10 fact that such individual is not located at such hospital. 

11 (b) INITIATION OF SERVICES VIA TELEHEALTH.—In 

12 the case of an individual receiving services described in 

13 subsection (a) from a critical access hospital during the 

14 period described in subsection (a), if such individual has 

15 not, prior to receiving such services, received in-person 

16 care at such hospital, payment shall be made to such hos17 pital in accordance with such subsection only if such serv18 ices complement a plan of care that includes in-person 

19 care to be furnished at such hospital not later than 1 year 

20 after the date such services are furnished. 

21 (c) DEFINITIONS.—For purposes of this section: 

22 (1) CRITICAL ACCESS HOSPITAL.—The term 

23 ‘‘critical access hospital’’ has the meaning given 

24 such term in section 1861(mm)(1) of the Social Se25 curity Act (42 U.S.C. 1395x(mm)(1)). 


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1 (2) OUTPATIENT CRITICAL ACCESS HOSPITAL

2 SERVICES.—The term ‘‘outpatient critical access 

3 hospital services’’ has the meaning given such term 

4 in section 1861(mm)(3) of such Act (42 U.S.C. 

5 1395x(mm)(3)). 

6 (3) TELECOMMUNICATIONS TECHNOLOGY.—The 

7 term ‘‘telecommunications technology’’ means a com8 munications system permitting two-way, real-time 

9 interactive communication between the individuals 

10 and health care professional and includes a commu11 nications system consisting of only audio capabili12 ties, but only if such individual does not have access 

13 to a communications system with audio-visual capa14 bilities. 

Æ 


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