‘‘(ii) TREATMENT
OF
COSTS.—Costs 
associated with the furnishing of telehealth 
services by a Federally qualified health 
center or rural health clinic on or after Oc-
tober 1, 2025, and before October 1, 2027, 
shall be considered allowable costs for pur-
poses of the prospective payment system 
established under section 1834(o) and the 
methodology for all-inclusive rates estab-
lished under section 1833(a)(3), as appli-
cable.’’. 
(d) DELAYING IN-PERSON REQUIREMENTS UNDER 
MEDICARE FOR MENTAL HEALTH SERVICES FURNISHED 
THROUGH
TELEHEALTH
AND
TELECOMMUNICATIONS 
TECHNOLOGY.— 
(1) DELAY
IN
REQUIREMENTS
FOR
MENTAL 
HEALTH
SERVICES
FURNISHED
THROUGH
TELE-
HEALTH.—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 ‘‘on or after October 1, 2025’’ and inserting 
‘‘on or after October 1, 2027’’. 
(2) MENTAL
HEALTH
VISITS
FURNISHED
BY 
RURAL HEALTH CLINICS.—Section 1834(y)(2) of the 
Social Security Act (42 U.S.C. 1395m(y)(2)) is 
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amended by striking ‘‘October 1, 2025’’ and insert-
ing ‘‘October 1, 2027’’. 
(3) MENTAL
HEALTH
VISITS
FURNISHED
BY 
FEDERALLY QUALIFIED HEALTH CENTERS.—Section 
1834(o)(4)(B) of the Social Security Act (42 U.S.C. 
1395m(o)(4)(B)) is amended by striking ‘‘October 1, 
2025’’ and inserting ‘‘October 1, 2027’’. 
(e) ALLOWING FOR THE FURNISHING OF AUDIO- 
ONLY TELEHEALTH SERVICES.—Section 1834(m)(9) of 
the Social Security Act (42 U.S.C. 1395m(m)(9)) is 
amended by striking ‘‘ending on September 30, 2025’’ and 
inserting ‘‘ending on September 30, 2027’’. 
(f) EXTENDING USE OF TELEHEALTH TO CONDUCT 
FACE-TO-FACE ENCOUNTER PRIOR TO RECERTIFICATION 
OF
ELIGIBILITY
FOR
HOSPICE
CARE.—Section 
1814(a)(7)(D)(i)(II) of the Social Security Act (42 U.S.C. 
1395f(a)(7)(D)(i)(II)) is amended— 
(1) by striking ‘‘ending on September 30, 
2025’’ and inserting ‘‘ending on September 30, 
2027’’; and 
(2) by inserting ‘‘, except that this subclause 
shall not apply in the case of such an encounter with 
an individual occurring on or after September 30, 
2025, if such individual is located in an area that 
is subject to a moratorium on the enrollment of hos-
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pice programs under this title pursuant to section 
1866(j)(7), if such individual is receiving hospice 
care from a provider that is subject to enhanced 
oversight under this title pursuant to section 
1866(j)(3), or if such encounter is performed by a 
hospice physician or nurse practitioner who is not 
enrolled under section 1866(j) and is not an opt-out 
physician or practitioner (as defined in section 
1802(b)(6)(D))’’ before the semicolon. 
SEC. 3. REQUIRING MODIFIER FOR USE OF TELEHEALTH 
TO 
CONDUCT 
FACE-TO-FACE 
ENCOUNTER 
PRIOR TO RECERTIFICATION OF ELIGIBILITY 
FOR HOSPICE CARE. 
Section 1814(a)(7)(D)(i)(II) of the Social Security 
Act (42 U.S.C. 1395f(a)(7)(D)(i)(II)), as amended by sec-
tion 2(f), is further amended by inserting ‘‘, but only if, 
in the case of such an encounter occurring on or after 
January 1, 2026, any hospice claim includes 1 or more 
modifiers or codes (as specified by the Secretary) to indi-
cate that such encounter was conducted via telehealth’’ 
after ‘‘as determined appropriate by the Secretary’’. 
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SEC. 4. EXTENDING ACUTE HOSPITAL CARE AT HOME 
WAIVER FLEXIBILITIES. 
(a) IN GENERAL.—Section 1866G(a)(1) of the Social 
Security Act (42 U.S.C. 1395cc–7(a)(1)) is amended by 
striking ‘‘2025’’ and inserting ‘‘2030’’. 
(b) REQUIRING ADDITIONAL STUDY AND REPORT ON 
ACUTE HOSPITAL CARE AT HOME WAIVER FLEXIBILI-
TIES.—Section 1866G of the Social Security Act (42 
U.S.C. 1395cc–7), as amended by subsection (a), is fur-
ther amended— 
(1) in subsection (b), in the subsection heading, 
by striking ‘‘STUDY’’ and inserting ‘‘INITIAL 
STUDY’’; 
(2) by redesignating subsections (c) and (d) as 
subsections (d) and (e), respectively; and 
(3) by inserting after subsection (b) the fol-
lowing new subsection: 
‘‘(c) SUBSEQUENT STUDY AND REPORT.— 
‘‘(1) IN GENERAL.—Not later than September 
30, 2028, the Secretary shall conduct a study to— 
‘‘(A) analyze, to the extent practicable, the 
criteria established by hospitals under the Acute 
Hospital Care at Home initiative to determine 
which individuals may be furnished services 
under such initiative; and 
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‘‘(B) analyze and compare (both within 
and between hospitals participating in the ini-
tiative, and relative to comparable hospitals 
that do not participate in the initiative, for rel-
evant parameters such as diagnosis-related 
groups)— 
‘‘(i) quality of care furnished to indi-
viduals with similar conditions and charac-
teristics in the inpatient setting and 
through the Acute Hospital Care at Home 
initiative, including health outcomes, hos-
pital readmission rates (including readmis-
sions both within and beyond 30 days post- 
discharge), hospital mortality rates, length 
of stay, infection rates, composition of care 
team (including the types of labor used, 
such as contracted labor), the ratio of 
nursing staff, transfers from the hospital 
to the home, transfers from the home to 
the hospital (including the timing, fre-
quency, and causes of such transfers), 
transfers and discharges to post-acute care 
settings (including the timing, frequency, 
and causes of such transfers and dis-
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charges), and patient and caregiver experi-
ence of care; 
‘‘(ii) clinical conditions treated and di-
agnosis-related groups of discharges from 
inpatient settings relative to discharges 
from the Acute Hospital Care at Home ini-
tiative; 
‘‘(iii) costs incurred by the hospital 
for furnishing care in inpatient settings 
relative to costs incurred by the hospital 
for furnishing care through the Acute Hos-
pital Care at Home initiative, including 
costs relating to staffing, equipment, food, 
prescriptions, and other services, as deter-
mined by the Secretary; 
‘‘(iv) the quantity, mix, and intensity 
of services (such as in-person visits and 
virtual contacts with patients and the in-
tensity of such services) furnished in inpa-
tient settings relative to the Acute Hospital 
Care at Home initiative, and, to the extent 
practicable, the nature and extent of family 
or caregiver involvement; 
‘‘(v) socioeconomic information on in-
dividuals treated in comparable inpatient 
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settings relative to the initiative, including 
racial and ethnic data, income, housing, 
geographic proximity to the brick-and-mor-
tar facility and whether such individuals 
are dually eligible for benefits under this 
title and title XIX; and 
‘‘(vi) the quality of care, outcomes, 
costs, quantity and intensity of services, 
and other relevant metrics between individ-
uals who entered into the Acute Hospital 
Care at Home initiative directly from an 
emergency department compared with indi-
viduals who entered into the Acute Hos-
pital Care at Home initiative directly from 
an existing inpatient stay in a hospital. 
‘‘(2) SELECTION
BIAS.—In conducting the 
study under paragraph (1), the Secretary shall, to 
the extent practicable, analyze and compare individ-
uals who participate and do not participate in the 
initiative controlling for selection bias or other fac-
tors that may impact the reliability of data. 
‘‘(3) REPORT.—Not later than September 30, 
2028, the Secretary of Health and Human Services 
shall submit to the Committee on Ways and Means 
of the House of Representatives and the Committee 
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on Finance of the Senate a report on the study con-
ducted under paragraph (1).’’. 
SEC. 5. ENHANCING CERTAIN PROGRAM INTEGRITY RE-
QUIREMENTS FOR DME UNDER MEDICARE. 
(a) DURABLE MEDICAL EQUIPMENT.— 
(1) IN GENERAL.—Section 1834(a) of the So-
cial Security Act (42 U.S.C. 1395m(a)) is amended 
by adding at the end the following new paragraph: 
‘‘(23) MASTER LIST INCLUSION AND CLAIM RE-
VIEW FOR CERTAIN ITEMS.— 
‘‘(A) MASTER
LIST
INCLUSION.—Begin-
ning January 1, 2028, for purposes of the Mas-
ter List described in section 414.234(b) of title 
42, Code of Federal Regulations (or any suc-
cessor regulation), an item for which payment 
may be made under this subsection shall be 
treated as having aberrant billing patterns (as 
such term is used for purposes of such section) 
if the Secretary determines that, without ex-
planatory contributing factors (such as fur-
nishing emergent care services), a substantial 
number of claims for such items under this sub-
section are for such items ordered by a physi-
cian or practitioner who has not previously 
(during a period of not less than 24 months, as 
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established by the Secretary) furnished to the 
individual involved any item or service for which 
payment may be made under this title. 
‘‘(B) CLAIM
REVIEW.—With respect to 
items furnished on or after January 1, 2028, 
that are included on the Master List pursuant 
to subparagraph (A), if such an item is not sub-
ject to a determination of coverage in advance 
pursuant to paragraph (15)(C), the Secretary 
may conduct prepayment review of claims for 
payment for such item.’’. 
(2) CONFORMING
AMENDMENT
FOR
PROS-
THETIC DEVICES, ORTHOTICS, AND PROSTHETICS.— 
Section 1834(h)(3) of the Social Security Act (42 
U.S.C. 1395m(h)(3)) is amended by inserting ‘‘, and 
paragraph (23) of subsection (a) shall apply to pros-
thetic devices, orthotics, and prosthetics in the same 
manner as such provision applies to items for which 
payment may be made under such subsection’’ be-
fore the period at the end. 
(b) REPORT ON IDENTIFYING CLINICAL DIAGNOSTIC 
LABORATORY TESTS AT HIGH RISK FOR FRAUD AND EF-
FECTIVE MITIGATION MEASURES.—Not later than Janu-
ary 1, 2026, the Inspector General of the Department of 
Health and Human Services shall submit to Congress a 
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report assessing fraud risks relating to claims for clinical 
diagnostic laboratory tests for which payment may be 
made under section 1834A of the Social Security Act (42 
U.S.C. 1395m–1) and effective tools for reducing such 
fraudulent claims. The report may include information re-
garding— 
(1) which, if any, clinical diagnostic laboratory 
tests are identified as being at high risk of fraudu-
lent claims, and an analysis of the factors that con-
tribute to such risk; 
(2) with respect to a clinical diagnostic labora-
tory test identified under paragraph (1) as being at 
high risk of fraudulent claims— 
(A) the amount payable under such section 
1834A with respect to such test; 
(B) the number of such tests furnished to 
individuals enrolled under part B of title XVIII 
of the Social Security Act (42 U.S.C. 1395j et 
seq.); 
(C) whether an order for such a test was 
more likely to come from a provider with whom 
the individual involved did not have a prior re-
lationship, as determined on the basis of prior 
payment experience; and 
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(D) the frequency with which a claim for 
payment under such section 1834A included the 
payment modifier identified by code 59 or 91; 
(3) suggested strategies for reducing the num-
ber of fraudulent claims made with respect to tests 
so identified as being at high risk, including— 
(A) an analysis of whether the Centers for 
Medicare & Medicaid Services can detect aber-
rant billing patterns with respect to such tests 
in a timely manner; 
(B) any strategies for identifying and mon-
itoring the providers who are outliers with re-
spect to the number of such tests that such pro-
viders order; and 
(C) targeted education efforts to mitigate 
improper billing for such tests; and 
(4) such other information as the Inspector 
General determines appropriate. 
SEC. 6. GUIDANCE ON FURNISHING SERVICES VIA TELE-
HEALTH TO INDIVIDUALS WITH LIMITED 
ENGLISH PROFICIENCY. 
(a) IN GENERAL.—Not later than 1 year after the 
date of the enactment of this section, the Secretary of 
Health and Human Services, in consultation with 1 or 
more entities from each of the categories described in 
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