I 
116TH CONGRESS 
1ST SESSION H. R. 4932 
To amend title XVIII of the Social Security Act to expand access to telehealth 
services, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 30, 2019 
Mr. THOMPSON of California (for himself, Mr. WELCH, Mr. JOHNSON of Ohio, 
Mr. SCHWEIKERT, and Ms. MATSUI) 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 subsequently 
determined by the Speaker, in each case for consideration of such provi-
sions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to expand 
access to telehealth services, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Creating Opportunities Now for Necessary and Effective 
Care Technologies for Health Act of 2019’’ or the ‘‘CON-
NECT for Health Act of 2019’’. 
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(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Findings and sense of Congress. 
Sec. 3. Expanding the use of telehealth through the waiver of certain require-
ments. 
Sec. 4. Expanding the use of telehealth for mental health services. 
Sec. 5. Use of telehealth in emergency medical care. 
Sec. 6. Improvements to the process for adding telehealth services. 
Sec. 7. Rural health clinics and Federally qualified health centers. 
Sec. 8. Native American health facilities. 
Sec. 9. Waiver of telehealth restrictions during national emergencies. 
Sec. 10. Use of telehealth in recertification for hospice care. 
Sec. 11. Clarification for fraud and abuse laws regarding technologies provided 
to beneficiaries. 
Sec. 12. Study and report on increasing access to telehealth services in the 
home. 
Sec. 13. Analysis of telehealth waivers in alternative payment models. 
Sec. 14. Model to allow additional health professionals to furnish telehealth 
services. 
Sec. 15. Testing of models to examine the use of telehealth under the Medicare 
program. 
SEC. 2. FINDINGS AND SENSE OF CONGRESS. 
(a) FINDINGS.—Congress finds the following: 
(1) The use of technology in health care and 
coverage of telehealth services are rapidly evolving. 
(2) Research has found that telehealth services 
can expand access to care, improve the quality of 
care, and reduce spending, and that patients receiv-
ing telehealth services are satisfied with their experi-
ences. 
(3) Health care workforce shortages are a sig-
nificant problem in many areas and for many types 
of health care clinicians. 
(4) Telehealth increases access to care in areas 
with workforce shortages and for individuals who 
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live far away from health care facilities, have limited 
mobility or transportation, or have other barriers to 
accessing care. 
(5) The use of health technologies can strength-
en the expertise of the health care workforce, includ-
ing by connecting clinicians to specialty consulta-
tions. 
(6) Utilization of telehealth services in Medicare 
remains low, with only 0.25 percent of Medicare fee- 
for-service beneficiaries utilizing telehealth services 
in 2016. 
(b) SENSE OF CONGRESS.—It is the sense of Con-
gress that— 
(1) health care providers can furnish safe, effec-
tive, and high-quality health care services through 
telehealth; and 
(2) barriers to the use of telehealth should be 
removed. 
SEC. 3. EXPANDING THE USE OF TELEHEALTH THROUGH 
THE WAIVER OF CERTAIN REQUIREMENTS. 
(a) IN GENERAL.—Section 1834(m) of the Social Se-
curity Act (42 U.S.C. 1395m(m)) is amended— 
(1) in paragraph (4)(C)(i), by striking ‘‘and 
(7)’’ and inserting ‘‘(7), and (8)’’; and 
(2) by adding at the end the following: 
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‘‘(8) AUTHORITY
TO
WAIVE
REQUIREMENTS 
AND LIMITATIONS IF CERTAIN CONDITIONS MET.— 
‘‘(A) IN
GENERAL.—Notwithstanding the 
preceding provisions of this subsection, in the 
case of telehealth services furnished on or after 
January 1, 2021, the Secretary may waive any 
restriction applicable to payment for telehealth 
services under this subsection that is described 
in subparagraph (B), but only if the Secretary 
determines that such waiver would not deny or 
limit the coverage or provision of benefits under 
this title, and— 
‘‘(i) the Secretary determines that the 
waiver is expected to reduce spending 
under this title without reducing the qual-
ity of care or improve the quality of pa-
tient care without increasing spending; or 
‘‘(ii) the waiver would apply to tele-
health services furnished in originating 
sites located in a high-need health profes-
sional shortage area (as designated pursu-
ant to section 332(a)(1)(A) of the Public 
Health 
Service 
Act 
(42 
U.S.C. 
254e(a)(1)(A))). 
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‘‘(vi) any other limitation relating to 
the furnishing of telehealth services under 
this title identified by the Secretary. 
‘‘(C) PUBLIC
COMMENT.—The Secretary 
shall establish a process by which stakeholders 
may (on at least an annual basis) provide public 
comment for waivers under this paragraph. 
‘‘(D) PERIODIC
REVIEW
OF
WAIVERS.— 
The Secretary shall periodically, but not more 
often than every 3 years, reassess each waiver 
under this paragraph to determine whether the 
waiver continues to meet the conditions applica-
ble under subparagraph (A).’’. 
(b) POSTING OF INFORMATION.—Not later than 2 
years after the date on which a waiver under section 
1834(m)(8) of the Social Security Act, as added by sub-
section (a), first becomes effective, and at least biennially 
thereafter, the Secretary of Health and Human Services 
shall post on the internet website of the Centers for Medi-
care & Medicaid Services— 
(1) the number of Medicare beneficiaries receiv-
ing telehealth services by reason of each waiver 
under such section; 
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(2) the impact of such waivers on expenditures 
and utilization under title XVIII of the Social Secu-
rity Act (42 U.S.C. 1395 et seq.); and 
(3) other outcomes, as determined appropriate 
by the Secretary. 
SEC. 4. EXPANDING THE USE OF TELEHEALTH FOR MEN-
TAL HEALTH SERVICES. 
(a) IN GENERAL.—Section 1834(m) of the Social Se-
curity Act (42 U.S.C. 1395m(m)), as amended by section 
3, is amended— 
(1) in paragraph (4)(C)(i), by striking ‘‘and 
(8)’’ and inserting ‘‘(8), and (9)’’; and 
(2) by adding at the end the following: 
‘‘(9) TREATMENT OF MENTAL HEALTH SERV-
ICES FURNISHED THROUGH TELEHEALTH.—The ge-
ographic 
requirements 
described 
in 
paragraph 
(4)(C)(i) (other than applicable State law require-
ments, including State licensure requirements) shall 
not apply with respect to telehealth services that are 
mental health services (as determined by the Sec-
retary) furnished on or after January 1, 2021, to an 
eligible telehealth individual at an originating site 
described in paragraph (4)(C)(ii) (other than an 
originating site described in subclause (IX) of such 
paragraph).’’. 
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(b) INCLUSION OF THE HOME AS AN ORIGINATING 
SITE.—Section 1834(m)(4)(C)(ii)(X) of such Act (42 
U.S.C. 1395m(m)(4)(C)(ii)(X)) is amended by striking 
‘‘paragraph (7)’’ and inserting ‘‘paragraphs (7) and (9)’’. 
(c) ADDITIONAL SERVICES.—As part of the imple-
mentation of the amendments made by this section, the 
Secretary of Health and Human Services shall consider 
whether additional services should be added to the services 
specified in paragraph (4)(F)(i) of section 1834(m) of 
such Act (42 U.S.C. 1395m) for authorized payment 
under paragraph (1) of such section. 
SEC. 5. USE OF TELEHEALTH IN EMERGENCY MEDICAL 
CARE. 
(a) IN GENERAL.—Section 1834(m) of the Social Se-
curity Act (42 U.S.C. 1395m(m)), as amended by sections 
3 and 4, is amended— 
(1) in paragraph (4)(C)(i), by striking ‘‘and 
(9)’’ and inserting ‘‘(9), and (10)’’; and 
(2) by adding at the end the following: 
‘‘(10) TREATMENT
OF
EMERGENCY
MEDICAL 
CARE
FURNISHED
THROUGH
TELEHEALTH.—The 
geographic requirements described in paragraph 
(4)(C)(i) (other than applicable State law require-
ments, including State licensure requirements) shall 
not apply with respect to telehealth services that are 
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services for emergency medical care (as determined 
by the Secretary) furnished on or after January 1, 
2021, to an eligible telehealth individual at an origi-
nating site described in subclause (II), (V), or (VII) 
of paragraph (4)(C)(ii).’’. 
(b) ADDITIONAL SERVICES.—As part of the imple-
mentation of the amendments made by this section, the 
Secretary of Health and Human Services shall consider 
whether additional services should be added to the services 
specified in paragraph (4)(F)(i) of section 1834(m) of 
such Act (42 U.S.C. 1395m) for authorized payment 
under paragraph (1) of such section. 
SEC. 6. IMPROVEMENTS TO THE PROCESS FOR ADDING 
TELEHEALTH SERVICES. 
The Secretary shall undertake a review of the process 
established pursuant to section 1834(m)(4)(F)(ii) of the 
Social Security Act (42 U.S.C. 1395m(m)(4)(F)(ii)), and 
based on the results of such review— 
(1) implement revisions to the process so that 
the criteria to add services prioritizes, as appro-
priate, improved access to care through telehealth 
services; and 
(2) provide clarification on what requests to 
add telehealth services under such process should in-
clude. 
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SEC. 7. RURAL HEALTH CLINICS AND FEDERALLY QUALI-
FIED HEALTH CENTERS. 
(a) EXPANSION
OF ORIGINATING SITES.—Section 
1834(m)(4)(C) of the Social Security Act (42 U.S.C. 
1395m(m)(4)(C)), as amended by sections 3, 4, and 5, 
is amended— 
(1) in clause (i), by striking ‘‘and (10)’’ and in-
serting ‘‘and (10), and subject to clause (iii),’’; and 
(2) by adding at the end the following new 
clause: 
‘‘(iii) RURAL
HEALTH
CLINICS
AND 
FEDERALLY
QUALIFIED
HEALTH
CEN-
TERS.—The term ‘originating site’ shall 
also include any Federally qualified health 
center and any rural health clinic (as such 
terms are defined in section 1861(aa)) at 
which the eligible telehealth individual is 
located at the time the service is furnished 
via a telecommunications system, whether 
or not the individual is located in an area 
described in clause (i), insofar as such 
sites are not otherwise included in the defi-
nition of originating site under such 
clause, subject to applicable State law re-
quirements, including State licensure re-
quirements.’’. 
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