I 
117TH CONGRESS 
1ST SESSION H. R. 4437 
To amend title XVIII of the Social Security Act to provide for permanent 
payments for telehealth services furnished by Federally qualified health 
centers and rural health clinics under the Medicare program. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 16, 2021 
Mr. THOMPSON of Pennsylvania (for himself and Mr. BUTTERFIELD) intro-
duced 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 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 provide 
for permanent payments for telehealth services furnished 
by Federally qualified health centers and rural health 
clinics 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 ‘‘Helping Ensure Access 
to Local TeleHealth Act of 2021’’ or the ‘‘HEALTH Act 
of 2021’’. 
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SEC. 2. PROVIDING FOR PERMANENT COST-RELATED PAY-
MENTS FOR TELEHEALTH SERVICES FUR-
NISHED BY FEDERALLY QUALIFIED HEALTH 
CENTERS 
AND 
RURAL 
HEALTH 
CLINICS 
UNDER THE MEDICARE PROGRAM AND PER-
MANENTLY REMOVING ORIGINATING SITE 
FACILITY AND LOCATION REQUIREMENTS 
FOR DISTANT SITE TELEHEALTH SERVICES 
FURNISHED BY SUCH CENTERS AND SUCH 
CLINICS. 
(a) COVERAGE OF AUDIO-ONLY TELEHEALTH SERV-
ICES.— 
(1) IN GENERAL.—Section 1834(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.— 
Except as provided in paragraph (1), the term 
‘telecommunications system’ means a two-way, 
real-time interactive communications system, 
whether by audiovisual or audio-only commu-
nications.’’. 
(2) REQUIRED IMPLEMENTATION STEPS.—Not 
later than 60 days after the date of the enactment 
of this Act, the Secretary of Health and Human 
Services shall— 
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(A) revise section 410.78(a)(3) of title 42, 
Code of Federal Regulations (or a successor 
regulation) to define the term ‘‘interactive tele-
communications system’’ in accordance with the 
amendment made by paragraph (1); and 
(B) revise section 405.2463 of such title 
(or a successor regulation) to provide that, for 
purposes of distant site telehealth services fur-
nished by Federally qualified health centers and 
rural health clinics under section 1834(m)(8) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395m(m)(8)), a visit includes any two-way, 
real-time interactive communication between an 
individual and the distant site Federally quali-
fied health center provider or rural health clin-
ic, whether by audiovisual or audio-only com-
munication. 
(b) PERMANENT TELEHEALTH PAYMENTS.—Section 
1834(m)(8) of the Social Security Act (42 U.S.C. 
1395m(m)(8)) is amended— 
(1) in the header, by striking ‘‘DURING EMER-
GENCY PERIOD’’; 
(2) in subparagraph (A), in the matter pre-
ceding clause (i), by striking ‘‘During the emergency 
period described in section 1135(g)(1)(B)’’ and in-
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serting ‘‘With respect to telehealth services furnished 
on or after the date of the beginning of the emer-
gency period described in section 1135(g)(1)(B)’’; 
and 
(3) by striking subparagraph (B) and inserting 
the following new subparagraph: 
‘‘(B) PAYMENT.— 
‘‘(i) IN GENERAL.—A telehealth serv-
ice furnished by a rural health clinic or a 
Federally qualified health center serving as 
a distant site to an individual shall be 
deemed to be so furnished to such indi-
vidual as an outpatient of such clinic or fa-
cility (as applicable) for purposes of para-
graph (1) or (3), respectively, of section 
1861(aa) and payable as a rural health 
clinic service or Federally-qualified health 
center service (as applicable) under section 
1833(a)(3) or under the prospective pay-
ment system established under section 
1834(o), respectively. 
‘‘(ii) TREATMENT
OF
COSTS
FOR 
FQHC
PPS
CALCULATIONS
AND
RHC
AIR 
CALCULATIONS.—Costs associated with the 
delivery of telehealth services by a Feder-
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ally qualified health center or rural health 
clinic serving as a distant site pursuant to 
this paragraph shall be considered allow-
able costs for purposes of the prospective 
payment system established under section 
1834(o) and any payment methodologies 
developed under section 1833(a)(3), as ap-
plicable.’’. 
(c) ELIMINATION OF ORIGINATING SITE REQUIRE-
MENTS
FOR TELEHEALTH SERVICES FURNISHED
BY 
FQHCS OR RHCS.— 
(1) IN GENERAL.—Section 1834(m) of the So-
cial Security Act (42 U.S.C. 1395m(m)), as amend-
ed by subsection (b), is further amended— 
(A) in paragraph (4)(C)(i), by striking 
‘‘and (7)’’ and inserting ‘‘(7), and (8)’’; and 
(B) in paragraph (8), by adding at the end 
the following new subparagraph: 
‘‘(C) NONAPPLICATION
OF
ORIGINATING 
SITE REQUIREMENTS.—The geographic and site 
requirements described in paragraph (4)(C) 
shall not apply with respect to telehealth serv-
ices furnished by a Federally qualified health 
center or a rural health clinic serving as a dis-
tant site.’’. 
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(2) SPECIAL PAYMENT RULE FOR ORIGINATING 
SITES
WITH
RESPECT
TO
TELEHEALTH
SERVICES 
FURNISHED
BY
AN
FQHC
OR
RHC.—Section 
1834(m)(2)(B) of the Social Security Act (42 U.S.C. 
1395m(m)(2)(B)) is amended— 
(A) in clause (i), by striking ‘‘clause (ii)’’ 
and inserting ‘‘clauses (ii) and (iii)’’; and 
(B) by adding at the end the following new 
clause: 
‘‘(iii) SPECIAL
RULE
FOR
TELE-
HEALTH SERVICES FURNISHED BY FQHCS 
AND RHCS.—No facility fee shall be paid 
under this subparagraph to an originating 
site with respect to telehealth services fur-
nished by a Federally qualified health cen-
ter or rural health clinic serving as a dis-
tant site unless such originating site is a 
site described in any of subclauses (I) 
through (IX) or (XI) of paragraph 
(4)(C)(ii).’’. 
Æ 
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