I 
117TH CONGRESS 
1ST SESSION H. R. 5425 
To amend title XVIII of the Social Security Act to protect access to telehealth 
services under the Medicare program. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 29, 2021 
Mr. O’HALLERAN (for himself, Mr. MCKINLEY, Mr. KIND, and Mr. SMITH of 
Nebraska) introduced the following bill; which was referred to the Com-
mittee 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 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 ‘‘Protecting Rural Tele-
health Access Act’’. 
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SEC. 2. ELIMINATION OF RESTRICTIONS RELATING TO 
TELEHEALTH SERVICES. 
(a) ELIMINATION OF GEOGRAPHIC REQUIREMENTS 
FOR ORIGINATING SITES.—Section 1834(m)(4)(C) of the 
Social Security Act (42 U.S.C. 1395m(m)(4)(C)) is 
amended— 
(1) in clause (i), in the matter preceding sub-
clause (I), by inserting ‘‘and clause (iii)’’ after ‘‘and 
(7)’’; and 
(2) by adding at the end the following new 
clause: 
‘‘(iii) ELIMINATION
OF
GEOGRAPHIC 
REQUIREMENTS
FOR
ORIGINATING 
SITES.—The geographic requirements de-
scribed in clause (i) shall not apply with 
respect to telehealth services furnished on 
or after January 1, 2021.’’. 
(b) ELIMINATION
OF
RESTRICTIONS
IN
WHICH 
TELEHEALTH SERVICES MAY BE FURNISHED IN THE 
HOME.—Section 1834(m)(4)(C)(ii)(X) of the Social Secu-
rity Act (42 U.S.C. 1395m(m)(4)(C)(i)(X)) is amended to 
read as follows:. 
‘‘(X)(aa) For the period begin-
ning on the date of the enactment of 
this subclause and ending on Decem-
ber 31, 2020, the home of an indi-
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vidual but only for purposes of section 
1881(b)(3)(B) or telehealth services 
described in paragraph (7). 
‘‘(bb) For the period beginning 
on or after January 1, 2021, the 
home of an individual.’’. 
SEC. 3. TELEHEALTH FLEXIBILITIES FOR CRITICAL ACCESS 
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: 
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‘‘(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 via a 
telecommunications system by a critical ac-
cess hospital, including any practitioner 
authorized to provide such services within 
the facility, that is a qualified provider (as 
defined in subparagraph (B)) to an eligible 
telehealth individual enrolled under this 
part notwithstanding that the critical ac-
cess hospital providing the telehealth serv-
ice is not at the same location as the bene-
ficiary, if such services complement a plan 
of care that includes in-person care at 
some point, as may be appropriate; 
‘‘(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 
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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 
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 
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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 
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. 4. EXTENDING MEDICARE TELEHEALTH FLEXIBILI-
TIES FOR FEDERALLY 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— 
(1) in the paragraph heading by striking ‘‘DUR-
ING EMERGENCY PERIOD’’; 
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(2) in subparagraph (A), in the matter pre-
ceding clause (i), by inserting ‘‘and after such emer-
gency period’’ after ‘‘1135(g)(1)(B)’’; 
(3) by striking 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 
eligible telehealth individual pursuant to 
this paragraph or after the date of the en-
actment of this subparagraph shall be re-
imbursed under this title at a separate 
telehealth payment rate as determined 
under the methodology established by the 
Secretary pursuant to clause (ii). 
‘‘(ii) PAYMENT METHODOLOGY.—The 
Secretary shall establish a methodology for 
determining the appropriate payment rate 
for telehealth services described in clause 
(i). Such methodology shall consider— 
‘‘(I) the geography of Federally 
qualified health centers and rural 
health clinics; 
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‘‘(II) costs associated with the 
delivery of such telehealth services as 
allowable costs for the center or clinic; 
and 
‘‘(III) the full cost of providing 
the services via telehealth. 
‘‘(iii) IMPLEMENTATION.— 
‘‘(I) CODING SYSTEM.—The Sec-
retary shall establish an effective cod-
ing system for telehealth services de-
scribed in clause (i) that is reflective 
of the services provided at a center or 
clinic. 
‘‘(II) 
IMPLEMENTATION.—Not-
withstanding any other provision of 
law, the Secretary may implement this 
subparagraph through program in-
struction, interim final rule, or other-
wise.’’; and 
(4) by adding at the end the following new sub-
paragraph: 
‘‘(C) REQUIREMENT DURING ADDITIONAL 
PERIOD.— 
‘‘(i) IN GENERAL.—Beginning on the 
first day after the end of the emergency 
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period described in section 1135(g)(1)(B), 
payment may only be made under this 
paragraph for a telehealth service de-
scribed in subparagraph (A)(i) that is fur-
nished to an eligible telehealth individual if 
such service is furnished by a qualified 
provider (as defined in clause (ii)). 
‘‘(ii) DEFINITION OF QUALIFIED PRO-
VIDER.—For purposes of this subpara-
graph, the term ‘qualified provider’ means, 
with respect to a telehealth service de-
scribed in subparagraph (A)(i) that is fur-
nished to an eligible telehealth individual, a 
Federally qualified health center or rural 
health clinic that has an established pa-
tient relationship with such individual as 
defined by the State in which the indi-
vidual is located.’’. 
SEC. 5. ALLOWANCE OF CERTAIN TELEHEALTH SERVICES 
FURNISHED 
USING 
AUDIO-ONLY 
TECH-
NOLOGY. 
Section 1834(m)(4) of the Social Security Act (42 
U.S.C. 1395m(m)(4)) of the Social Security Act (42 
U.S.C. 1395m(m)(4)) is amended by adding at the end 
the following new subparagraph: 
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‘‘(III) other services determined 
appropriate by the Secretary. 
‘‘(iv) 
QUALIFIED
PROVIDER
DE-
FINED.— 
‘‘(I) IN GENERAL.—For purposes 
of clause (ii), the term ‘qualified pro-
vider’ means, with respect to a speci-
fied telehealth service that is fur-
nished to an eligible telehealth indi-
vidual— 
‘‘(aa) a physician or practi-
tioner who has an established pa-
tient relationship with such indi-
vidual as defined by the State in 
which the individual is located; or 
‘‘(bb) a critical access hos-
pital 
(as 
defined 
in 
section 
1861(mm)(1)), a rural health 
clinic (as defined in section 
1861(aa)(2)), a Federally quali-
fied health center (as defined in 
section 1861(aa)(4)), a hospital 
(as defined in section 1861(e)), a 
hospital-based or critical access 
hospital-based renal dialysis cen-
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ter (including satellites), a skilled 
nursing facility (as defined in 
section 1819(a)), a community 
mental health center (as defined 
in section 1861(ff)(3)(B)), or a 
rural emergency hospital (as de-
fined in section 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 
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other telecommunications system author-
ized under this subsection.’’. 
Æ 
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