I 
118TH CONGRESS 
1ST SESSION H. R. 3440 
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 17, 2023 
Mr. PAPPAS (for himself, Mrs. MCCLAIN, Mr. LATURNER, Mr. MOLINARO, 
Mr. MOONEY, and Mr. NUNN of Iowa) 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 subse-
quently 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 striking ‘‘clause (iii)’’ and inserting 
‘‘clauses (iii) and (iv)’’; and 
(2) by adding at the end the following new 
clause: 
‘‘(iv) 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, 2025.’’. 
(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, 2024, 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, 2025, the 
home of an individual.’’. 
(c) ELIMINATION OF RESTRICTIONS ON STORE-AND- 
FORWARD TECHNOLOGIES.—The second sentence of sec-
tion 1834(m)(1) of the Social Security Act (42 U.S.C. 
1395m(m)(1)) is amended by striking ‘‘in the case of any 
Federal telemedicine demonstration program conducted in 
Alaska or Hawaii,’’. 
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 ‘‘and (9)’’ and inserting ‘‘(9), and (10)’’; 
(2) in paragraph (2)(A), by striking ‘‘paragraph 
(8)’’ and inserting ‘‘paragraphs (8) and (10)’’; 
(3) in paragraph (4)— 
(A) in subparagraph (A), by striking 
‘‘paragraph (8)’’ and inserting ‘‘paragraphs (8) 
and (10)’’; and 
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(B) in subparagraph (F)(i), by striking 
‘‘paragraph (8)’’ and inserting ‘‘paragraphs (8) 
and (10)’’; and 
(4) by adding at the end the following new 
paragraph: 
‘‘(10) 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 
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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 
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-
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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 
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.’’. 
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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)), as amended by section 4113(c) of 
division FF of the Consolidated Appropriations Act, 2023 
(Public Law 117–328) is amended— 
(1) in subparagraph (A), in the matter pre-
ceding clause (i), by inserting ‘‘, and on or after 
January 1, 2025’’ after ‘‘December 31, 2024’’; 
(2) 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 
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for telehealth services described in clause 
(i). Such methodology shall consider— 
‘‘(I) the geography of Federally 
qualified health centers and rural 
health clinics; 
‘‘(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 
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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: 
‘‘(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), on or after January, 2025, 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)). 
‘‘(iii) 
TELEHEALTH
SERVICE
DE-
SCRIBED.—Subject to clause (vi), a tele-
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health service described in this clause is a 
telehealth service consisting of— 
‘‘(I) evaluation and management 
services; 
‘‘(II) behavioral health counseling 
and educational services; and 
‘‘(III) other services determined 
appropriate by the Secretary. 
‘‘(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-
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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-
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) REVIEW.— 
‘‘(I) IN
GENERAL.—Not later 
than 5 years after the date of the en-
actment of this subparagraph, the 
Secretary shall conduct a review of 
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the furnishing of specified telehealth 
services through audio-only technology 
pursuant to this paragraph. Such re-
view shall include an analysis of the 
impact of the roll out of broadband 
technology and whether the use of 
audio-only technology is necessary to 
ensure access to such telehealth serv-
ices. 
‘‘(II) 
REDETERMINATION
OF 
SPECIFIED TELEHEALTH SERVICES.— 
The Secretary may, based on the re-
view conducted under subclause (I), 
provide for the addition or deletion of 
services (and HCPCS codes), as ap-
propriate, to those specified in clause 
(ii) that may be furnished using 
audio-only technology and authorized 
for payment pursuant to this subpara-
graph. 
‘‘(vii) 
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 
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paid for such service under this subsection 
had such service been furnished via any 
other telecommunications system author-
ized under this subsection.’’. 
SEC. 6. SENSE OF CONGRESS REGARDING EXPANSION OF 
ELIGIBLE PRACTITIONERS THAT MAY FUR-
NISH TELEHEALTH SERVICES. 
It is the sense of Congress that the expansion of eligi-
ble practitioners that may furnish telehealth services (as 
defined in section 1834(m)(4)(F) of the Social Security 
Act (42 U.S.C. 1395m(m)(4)(F))) during the emergency 
period described in section 1135(g)(1)(B) of such Act (42 
U.S.C. 1320b–5(g)(1)(B)) should be extended on a perma-
nent basis. 
Æ 
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