I 
117TH CONGRESS 
2D SESSION 
H. R. 7876 
To amend title XVIII of the Social Security Act to protect access to telehealth 
services under the Medicare program. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 24, 2022 
Mr. SMITH of Nebraska (for himself, Mr. O’HALLERAN, and Mr. ARMSTRONG) 
introduced the following bill; which was referred to the Committee on 
Ways and Means, and in addition to the Committee on Energy and Com-
merce, for a period to be subsequently determined by the Speaker, in 
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to protect 
access to telehealth services under the Medicare program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Connecting Rural Tele-
health to the Future Act’’. 
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SEC. 2. REMOVING GEOGRAPHIC REQUIREMENTS AND EX-
PANDING ORIGINATING SITES FOR TELE-
HEALTH SERVICES. 
Section 1834(m) of the Social Security Act (42 
U.S.C. 1395m(m)) is amended— 
(1) in paragraph (4)(C)(iii), by striking ‘‘during 
the 151-day period beginning on the first day after 
the end of the emergency period described in section 
1135(g)(1)(B)’’ and inserting ‘‘before January 1, 
2025’’; and 
(2) in paragraph (2)(B)(iii), by striking ‘‘during 
the 151-day period beginning on the first day after 
the end of the emergency period described in section 
1135(g)(1)(B)’’ and inserting ‘‘before January 1, 
2025’’. 
SEC. 3. EXPANDING PRACTITIONERS ELIGIBLE TO FUR-
NISH TELEHEALTH SERVICES. 
Section 1834(m) of the Social Security Act (42 
U.S.C. 1395m(m)) is amended in paragraph (4)(E), by 
striking ‘‘151-day’’ and inserting ‘‘and ending on Decem-
ber 31, 2024’’ after ‘‘described in section 1135(g)(1)(B)’’. 
SEC. 4. EXTENDING TELEHEALTH SERVICES FOR FEDER-
ALLY QUALIFIED HEALTH CENTERS AND 
RURAL HEALTH CLINICS. 
Section 1834(m)(8) of the Social Security Act (42 
U.S.C. 1395m(m)(8)) is amended in subparagraph (A), by 
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striking ‘‘151-day’’ and inserting ‘‘and ending on Decem-
ber 31, 2024’’ after ‘‘described in section 1135(g)(1)(B)’’. 
SEC. 5. DELAYING THE IN-PERSON REQUIREMENTS UNDER 
MEDICARE FOR MENTAL HEALTH SERVICES 
FURNISHED 
THROUGH 
TELEHEALTH 
AND 
TELECOMMUNICATIONS TECHNOLOGY. 
(a) IN GENERAL.—Section 1834(m)(7)(B)(i) of the 
Social Security Act (42 U.S.C. 1395m(m)(7)(B)(i)) is 
amended in the matter preceding subclause (I), by striking 
‘‘the day that is the 152nd day after the end of the emer-
gency period’’ and inserting ‘‘January 1, 2025’’. 
(b) PAYMENT.—Section 1834(y) of the Social Secu-
rity Act (42 U.S.C. 1395m(y)) is amended in paragraph 
(2), by striking ‘‘the day that is the 152nd day after the 
end of the emergency period’’ and inserting ‘‘January 1, 
2025’’. 
(c) CONFORMING AMENDMENT.—Section 1834(o)(4) 
of the Social Security Act (42 U.S.C. 1395m(o)(4)) is 
amended in subparagraph (B), by striking ‘‘the day that 
is the 152nd day after the end of the emergency period 
described in section 1135(g)(1)(B)’’ and inserting ‘‘Janu-
ary 1, 2025’’. 
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SEC. 6. ALLOWING FOR THE FURNISHING OF AUDIO-ONLY 
TELEHEALTH SERVICES. 
Section 1834(m) of Social Security Act (42 U.S.C. 
1395m(m)) is amended— 
(1) in paragraph (1), by striking ‘‘paragraphs 
(8) and (9)’’ and inserting ‘‘paragraph (8)’’; 
(2) by striking paragraph (9); and 
(3) in paragraph (4), by adding at the end the 
following new subparagraph: 
‘‘(G) TELECOMMUNICATIONS SYSTEM.— 
‘‘(i) IN
GENERAL.—Notwithstanding 
paragraph (1) and section 410.78(a)(3) of 
title 42, Code of Federal Regulations (or 
any successor regulation), subject to clause 
(v), the term ‘telecommunications system’ 
includes, in the case of the furnishing of a 
specified telehealth service (as defined in 
clause (ii)) a communications system that 
uses audio-only technology. 
‘‘(ii) SPECIFIED TELEHEALTH SERV-
ICE.—In this subparagraph, the term 
‘specified telehealth service’ means a tele-
health service described in clause (iii) that 
is furnished by a qualified provider (as de-
fined in clause (iv)). 
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‘‘(iii) 
TELEHEALTH
SERVICE
DE-
SCRIBED.—A telehealth service as defined 
in subparagraph (F)(i). 
‘‘(iv) 
QUALIFIED
PROVIDER
DE-
FINED.—For purposes of clause (ii), the 
term ‘qualified provider’ means, with re-
spect to a specified telehealth service that 
is furnished to an eligible telehealth indi-
vidual— 
‘‘(I) a physician or practitioner 
who has an established patient rela-
tionship with such individual as de-
fined by the State in which the indi-
vidual is located; or 
‘‘(II) a critical access hospital (as 
defined in section 1861(mm)(1)), a 
rural health clinic (as defined in sec-
tion 1861(aa)(2)), a federally quali-
fied health center (as defined in sec-
tion 1861(aa)(4)), a hospital (as de-
fined in section 1861(e)), a hospital- 
based or critical access hospital-based 
renal dialysis center (including sat-
ellites), a skilled nursing facility (as 
defined in section 1819(a)), a commu-
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nity mental health center (as defined 
in section 1861(ff)(3)(B)), or a rural 
emergency hospital (as defined in sec-
tion 1861(kkk)(2)). 
‘‘(v) AUTHORITY.—For purposes of 
this subparagraph, the Secretary may de-
termine whether it is clinically appropriate 
to furnish a specified telehealth service via 
a communications system that uses audio- 
only technology and whether an in-person 
initial visit (in addition to any requirement 
with respect to the furnishing of an item 
or service in person pursuant to clause 
(iv)(I)) is required prior to the furnishing 
of such service using such technology. 
‘‘(vi) 
CLARIFICATION
REGARDING 
PAYMENT.—The amount of payment for a 
specified telehealth service that is fur-
nished using audio-only technology shall be 
equal to the amount that would have been 
paid for such service under this subsection 
had such service been furnished via any 
other telecommunications system author-
ized under this subsection.’’. 
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SEC. 7. USE OF TELEHEALTH TO CONDUCT FACE-TO-FACE 
ENCOUNTER PRIOR TO RECERTIFICATION OF 
ELIGIBILITY FOR HOSPICE CARE DURING 
EMERGENCY PERIOD. 
Section 1814(a)(7)(D)(i)(II) of the Social Security 
Act (42 U.S.C. 1395f(a)(7)(D)(i)(II)) is amended by 
striking ‘‘151-day’’ and inserting ‘‘and ending on Decem-
ber 31, 2024’’ after ‘‘described in section 1135(g)(1)(B)’’. 
SEC. 8. EXTENSION OF EXEMPTION FOR TELEHEALTH 
SERVICES. 
(a) IN GENERAL.—Subparagraph (E) of section 
223(c)(2) of the Internal Revenue Code of 1986 is amend-
ed by striking ‘‘2023’’and inserting ‘‘2025’’. 
(b) CERTAIN COVERAGE DISREGARDED.—Clause (ii) 
of section 223(c)(1)(B) of the Internal Revenue Code of 
1986 is amended by striking ‘‘2023’’ and inserting 
‘‘2025’’. 
SEC. 9. FEDERALLY QUALIFIED HEALTH CENTERS AND 
RURAL HEALTH CLINICS. 
Section 1834(m) of the Social Security Act (42 
U.S.C. 1395m(m)) is amended in paragraph (8), by strik-
ing subparagraph (B) and inserting the following: 
‘‘(B) PAYMENT.— 
‘‘(i) IN GENERAL.—A telehealth serv-
ice furnished by a federally qualified health 
center or a rural health clinic to an indi-
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vidual pursuant to this paragraph on or 
after the date of the enactment of this sub-
paragraph shall be deemed to be so fur-
nished to such individual as an outpatient 
of such clinic or facility (as applicable) for 
purposes of paragraph (1) or (3), respec-
tively, 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 es-
tablished 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 clin-
ic serving as a distant site pursuant to this 
paragraph shall be considered allowable 
costs for purposes of the prospective pay-
ment system established under section 
1834(o) and any payment methodologies 
developed under section 1833(a)(3), as ap-
plicable.’’. 
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SEC. 10. TELEHEALTH FLEXIBILITIES FOR CRITICAL AC-
CESS HOSPITALS. 
Section 1834(m) of the Social Security Act (42 
U.S.C. 1395m(m)) is amended— 
(1) in the first sentence of paragraph (1), by 
striking ‘‘paragraph (8)’’ and inserting ‘‘paragraphs 
(8) and (9)’’; 
(2) in paragraph (2)(A), by striking ‘‘paragraph 
(8)’’ and inserting ‘‘paragraphs (8) and (9)’’; 
(3) in paragraph (4)— 
(A) in subparagraph (A), by striking 
‘‘paragraph (8)’’ and inserting ‘‘paragraphs (8) 
and (9)’’; and 
(B) in subparagraph (F)(i), by striking 
‘‘paragraph (8)’’ and inserting ‘‘paragraphs (8) 
and (9)’’; and 
(4) by adding at the end the following new 
paragraph: 
‘‘(9) TELEHEALTH
FLEXIBILITIES
FOR
CRIT-
ICAL ACCESS HOSPITALS.— 
‘‘(A) IN GENERAL.—On or after the date 
of the enactment of this paragraph— 
‘‘(i) the Secretary shall pay for tele-
health services that are furnished between 
the end of the emergency period described 
in section 1135(g)(1)(B) and January 1, 
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2025, via a telecommunications system by 
a critical access hospital, including any 
practitioner authorized to provide such 
services within the facility, that is a quali-
fied provider (as defined in subparagraph 
(B)) to an eligible telehealth individual en-
rolled under this part notwithstanding that 
the critical access hospital providing the 
telehealth service is not at the same loca-
tion as the beneficiary, if such services 
complement a plan of care that includes in- 
person care at some point, as may be ap-
propriate; 
‘‘(ii) the amount of payment to a crit-
ical access hospital that serves as a distant 
site for such a telehealth service shall be 
determined under subparagraph (C); and 
‘‘(iii) for purposes of this subsection— 
‘‘(I) the term ‘distant site’ in-
cludes a critical access hospital that 
furnishes a telehealth service to an eli-
gible telehealth individual; and 
‘‘(II) the term ‘telehealth serv-
ices’ includes behavioral health serv-
ices and any other outpatient critical 
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access hospital service that is fur-
nished using telehealth to the extent 
that payment codes corresponding to 
services identified by the Secretary 
under clause (i) or (ii) of paragraph 
(4)(F) are listed on the corresponding 
claim for such critical access hospital 
service. 
‘‘(B) DEFINITION
OF
QUALIFIED
PRO-
VIDER.—For purposes of this subsection, the 
term ‘qualified provider’ means, with respect to 
a telehealth service described in subparagraph 
(A)(i) that is furnished to an eligible telehealth 
individual, a critical access hospital that has an 
established patient relationship with such indi-
vidual as defined by the State in which the indi-
vidual is located. 
‘‘(C) PAYMENT.—The amount of payment 
to a critical access hospital that serves as a dis-
tant site that furnishes a telehealth service to 
an eligible telehealth individual under this para-
graph shall be equal to 101 percent of the rea-
sonable costs of the hospital in providing such 
services, unless the hospital makes an election 
under paragraph (2) of section 1834(g) to be 
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paid for such services based on the methodology 
described in such paragraph. Telehealth services 
furnished by a critical access hospital shall be 
counted for purposes of determining the pro-
vider productivity rate of the critical access hos-
pital for purposes of payment under such sec-
tion. 
‘‘(D) IMPLEMENTATION.—Notwithstanding 
any other provision of law, the Secretary may 
implement this paragraph through program in-
struction, interim final rule, or otherwise.’’. 
SEC. 11. EFFECTIVE DATE. 
The amendments made by this Act shall take effect 
on the date of the enactment of this Act. 
Æ 
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