Telehealth Extension Act of 2021

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. 1. Short title This Act may be cited as the Telehealth Extension Act of 2021 2. Requirement for provision of high-cost durable medical equipment and laboratory tests (a) High-Cost durable medical equipment Section 1834(a)(1)(E) of the Social Security Act ( 42 U.S.C. 1395m(a)(1)(E) (vi) Standards for high-cost durable medical equipment (I) Limitation on payment for high-cost durable medical equipment Payment may not be made under this subsection for a high-cost durable medical equipment ordered by a physician or other practitioner described in clause (ii) via telehealth for an individual, unless such physician or practitioner furnished to such individual a service in-person at least once during the 6-month period prior to ordering such high-cost durable medical equipment. (II) High-Cost durable medical equipment determination For purposes of this clause, the Administrator of the Centers for Medicare & Medicaid Services shall define the term high-cost durable medical equipment (vii) Audit of providers and practitioners furnishing a high volume of durable medical equipment via telehealth (I) Identification of providers Beginning 6 months after the effective date of this clause, Medicare administrative contractors shall conduct reviews on a schedule determined by the Secretary, of claims for durable medical equipment prescribed by a physician or other practitioner described in clause (ii) during the 12-month period preceding such review to identify physicians or other practitioners with respect to whom at least 90 percent of all durable medical equipment prescribed by such physician or practitioner during such period was prescribed pursuant to a telehealth visit. (II) Audit In the case of a physician or practitioner identified under subclause (I), with respect to a period described in such subclause, the Medicare administrative contractors shall conduct audits of all claims for durable medical equipment prescribed by such physicians or practitioners to determine whether such claims comply with the requirements for coverage under this title. . (b) High-Cost laboratory tests Section 1834A(b) of the Social Security Act ( 42 U.S.C. 1395m–1(b) (6) Requirement for high-cost laboratory tests (A) Limitation on payment for high-cost laboratory tests Payment may not be made under this subsection for a high-cost laboratory test ordered by a physician or practitioner via telehealth for an individual, unless such physician or practitioner furnished to such individual a service in-person at least once during the 6-month period prior to ordering such high-cost laboratory test. (B) High-cost laboratory test defined For purposes of this paragraph, the Administrator for the Centers for Medicare & Medicaid Services shall define the term high-cost laboratory test (7) Audit of laboratory testing ordered pursuant to telehealth visit (A) Identification of providers Beginning 6 months after the effective date of this paragraph, Medicare administrative contractors shall conduct periodic reviews on a schedule determined by the Secretary, of claims for laboratory tests prescribed by a physician or practitioner during the 12-month period preceding such review to identify physicians or other practitioners with respect to whom at least 90 percent of all laboratory tests prescribed by such physician or practitioner during such period was prescribed pursuant to a telehealth visit. (B) Audit In the case of a physician or practitioner identified under subparagraph (A), with respect to a period described in such subparagraph, the Medicare administrative contractors shall conduct audits of all claims for laboratory tests prescribed by such physicians or practitioners during such period beginning to determine whether such claims comply with the requirements for coverage under this title. . (c) Effective date The amendments made by this section shall take effect upon the termination of the emergency period described in section 1135(g)(1)(B) of the Social Security Act ( 42 U.S.C. 1320b–5(g)(1)(B) 3. Requirement to submit NPI number for separately billable telehealth services (a) Requirement To submit NPI number for separately billable telehealth services Section 1834(m) of the Social Security Act ( 42 U.S.C. 1395m(m) (9) Requirement to submit NPI number for separately billable telehealth services Payment may not be made under this subsection for separately billable telehealth services furnished by a physician or practitioner unless such physician or practitioner submits a claim for payment under the national provider identification number assigned to such physician or practitioner. . (b) Effective date The amendment made by this section shall take effect upon the termination of the emergency period described in section 1135(g)(1)(B) of the Social Security Act ( 42 U.S.C. 1320b–5(g)(1)(B) 4. Removing geographic requirements for telehealth services Section 1834(m)(4)(C) of the Social Security Act ( 42 U.S.C. 1395m(m)(4)(C) (iii) Removal of geographic requirements The geographic requirements described in clause (i) shall not apply with respect to telehealth services furnished on or after the date of the enactment of this clause. . 5. Expanding originating sites (a) Expanding the home as an originating site Section 1834(m)(4)(C)(ii)(X) of the Social Security Act ( 42 U.S.C. 1395m(m)(4)(C)(ii)(X) (X) The home of an individual, but, with respect to services furnished before the date of the enactment of the Telehealth Extension and Evaluation Act . (b) Allowing additional originating sites Section 1834(m)(4)(C)(ii) of the Social Security Act ( 42 U.S.C. 1395m(m)(4)(C)(ii) (XII) Any other site determined appropriate by the Secretary at which an eligible telehealth individual is located at the time a telehealth service is furnished via a telecommunications system. . (c) Parameters for new originating sites Section 1834(m)(4)(C) of the Social Security Act ( 42 U.S.C. 1395m(m)(4)(C) (iv) Requirements for new sites (I) In general The Secretary may establish requirements for the furnishing of telehealth services at sites described in clause (ii)(XII) to provide for beneficiary and program integrity protections. (II) Clarification Nothing in this clause shall be construed to preclude the Secretary from establishing requirements for other originating sites described in clause (ii). . (d) No originating site facility fee for new sites Section 1834(m)(2)(B)(ii) of the Social Security Act ( 42 U.S.C. 1395m(m)(2)(B)(ii) (1) in the heading, by striking if originating site is the home for certain sites (2) by striking paragraph (4)(C)(ii)(X) subclause (X) or (XII) of paragraph (4)(C) 6. Federally qualified health centers and rural health clinics Section 1834(m) of the Social Security Act ( 42 U.S.C. 1395m(m) (1) in paragraph (4)(C)(i), in the matter preceding subclause (I), by striking (5), (6), and (7) (5) through (8) (2) in paragraph (8)— (A) in the paragraph heading by inserting and after during (B) in subparagraph (A)— (i) in the matter preceding clause (i), by inserting and after such emergency period 1135(g)(1)(B) (ii) in clause (ii), by striking and (iii) by redesignating clause (iii) as clause (iv); and (iv) by inserting after clause (ii) the following new clause: (iii) the geographic requirements described in paragraph (4)(C)(i) shall not apply with respect to such a telehealth service; and ; and (C) by striking subparagraph (B) and inserting the following: (B) Payment (i) In general A telehealth service furnished by a Federally qualified health center or a rural health clinic to an individual pursuant to this paragraph on or after the date of the enactment of this subparagraph shall be deemed to be so furnished to such individual as an outpatient of such clinic or facility (as applicable) for purposes of paragraph (1) or (3), respectively, of section 1861(aa) and payable as a Federally qualified health center service or rural health clinic service (as applicable) under the prospective payment system established under section 1834(o) or under section 1833(a)(3), respectively. (ii) Treatment of costs for FQHC PPS calculations and RHC AIR calculations Costs associated with the delivery of telehealth services by a Federally qualified health center or rural health clinic serving as a distant site pursuant to this paragraph shall be considered allowable costs for purposes of the prospective payment system established under section 1834(o) and any payment methodologies developed under section 1833(a)(3), as applicable. . 7. Native American health facilities (a) In general Section 1834(m)(4)(C) of the Social Security Act ( 42 U.S.C. 1395m(m)(4)(C) (1) in clause (i), by striking clause (ii) clauses (ii) and (v) (2) by adding at the end the following new clause: (v) Native American health facilities With respect to telehealth services furnished on or after January 1, 2022, the originating site requirements described in clauses (i) and (ii) shall not apply with respect to a facility of the Indian Health Service, whether operated by such Service, or by an Indian tribe (as that term is defined in section 4 of the Indian Health Care Improvement Act ( 25 U.S.C. 1603 25 U.S.C. 5304 42 U.S.C. 11701 et seq. . (b) No originating site facility fee for Certain Native American facilities Section 1834(m)(2)(B)(i) of the Social Security Act ( 42 U.S.C. 1395m(m)(2)(B)(i) (other than an originating site that is only described in clause (v) of paragraph (4)(C), and does not meet the requirement for an originating site under clauses (i) and (ii) of such paragraph) the originating site 8. Waiver of telehealth requirements during public health emergencies Section 1135(g)(1) of the Social Security Act ( 42 U.S.C. 1320b–5(g)(1) (1) in subparagraph (A), in the matter preceding clause (i), by striking subparagraph (B) subparagraphs (B) and (C) (2) by adding at the end the following new subparagraph: (C) Exception for waiver of telehealth requirements during public health emergencies For purposes of subsection (b)(8), in addition to the emergency period described in subparagraph (B), an emergency area emergency period . 9. Two-year extension of telehealth services following the COVID-19 emergency period Section 1135(e) of the Social Security Act ( 42 U.S.C. 1320b–5(e) (3) Two-year extension of telehealth services following the COVID-19 emergency period Notwithstanding any other provision of this section, a waiver or modification of requirements pursuant to subsection (b)(8) shall terminate on the date that is two years after the last day of the emergency period described in subsection (g)(1)(B). . 10. Outpatient critical access hospitals (a) In general Notwithstanding section 1834(m) of the Social Security Act ( 42 U.S.C. 1395m(m) 42 U.S.C. 1395m(g) 42 U.S.C. 1320b–5(g)(1)(B) (b) Initiation of services via telehealth In the case of an individual receiving services described in subsection (a) from a critical access hospital during the period described in subsection (a), if such individual has not, prior to receiving such services, received in-person care at such hospital, payment shall be made to such hospital in accordance with such subsection only if such services complement a plan of care that includes in-person care to be furnished at such hospital not later than 1 year after the date such services are furnished. (c) Definitions For purposes of this section: (1) Critical access hospital The term “critical access hospital” has the meaning given such term in section 1861(mm)(1) of the Social Security Act ( 42 U.S.C. 1395x(mm)(1) (2) Outpatient critical access hospital services The term “outpatient critical access hospital services” has the meaning given such term in section 1861(mm)(3) of such Act ( 42 U.S.C. 1395x(mm)(3) (3) Telecommunications technology The term “telecommunications technology” means a communications system permitting two-way, real-time interactive communication between the individuals and health care professional and includes a communications system consisting of only audio capabilities, but only if such individual does not have access to a communications system with audio-visual capabilities.

Summary: Telehealth Extension Act of 2021 This bill expands and otherwise modifies coverage of telehealth services under Medicare. Specifically, the bill permanently (1) removes geographic restrictions on originating sites (i.e., the location of the beneficiary), (2) allows the home of the beneficiary to serve as the originating site for all services, and (3) allows federally qualified health centers and rural health clinics to serve as the distant site (i.e., the location of the health care practitioner). The bill also extends any Medicare telehealth flexibilities that were granted during the COVID-19 public health emergency until two years after the emergency ends and generally allows such flexibilities to be granted during any public health emergency. In addition, the bill (1) allows for Medicare payment of outpatient critical access hospital services consisting of telehealth behavioral therapy until two years after the COVID-19 public health emergency ends; and (2) after the emergency ends, conditions payment for certain high-cost laboratory tests and durable medical equipment that are ordered via telehealth on at least one in-person visit during the preceding six-month period.