472 
if such individual is located in an area that is sub-
ject to a moratorium on the enrollment of hospice 
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. 
(g) REQUIRING MODIFIERS FOR TELEHEALTH SERV-
ICES IN CERTAIN INSTANCES.—Section 1834(m) of the 
Social Security Act (42 U.S.C. 1395m(m)) is amended by 
adding at the end the following new paragraph: 
‘‘(10) REQUIRED USE OF MODIFIERS IN CER-
TAIN INSTANCES.—Not later than January 1, 2026, 
the Secretary shall establish requirements to include 
1 or more codes or modifiers, as determined appro-
priate by the Secretary, in the case of— 
‘‘(A) claims for telehealth services under 
this subsection that are furnished through a 
telehealth virtual platform— 
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‘‘(i) by a physician or practitioner 
that contracts with an entity that owns 
such virtual platform; or 
‘‘(ii) for which a physician or practi-
tioner has a payment arrangement with an 
entity for use of such virtual platform; and 
‘‘(B) claims for telehealth services under 
this subsection that are furnished incident to a 
physician’s or practitioner’s professional serv-
ice.’’. 
(h) PROGRAM INSTRUCTION AUTHORITY.—The Sec-
retary of Health and Human Services may implement the 
amendments made by this section through program in-
struction or otherwise. 
SEC. 210. 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 209(f) of the Health Improvements, Extenders, and 
Reauthorizations Act, 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 Sec-
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474 
retary) to indicate that such encounter was conducted via 
telehealth’’ after ‘‘as determined appropriate by the Sec-
retary’’. 
SEC. 211. EXTENDING ACUTE HOSPITAL CARE AT HOME 
WAIVER FLEXIBILITIES. 
Section 1866G of the Social Security Act (42 U.S.C. 
1395cc–7) is amended— 
(1) in the section heading, by inserting ‘‘THE 
THOMAS
R. CARPER, TIM
SCOTT, BRAD
R. 
WENSTRUP, D.P.M., AND EARL BLUMENAUER’’ 
after ‘‘EXTENSION OF’’; 
(2) in subsection (a)— 
(A) in paragraph (1)— 
(i) by striking ‘‘2024’’ and inserting 
‘‘2029’’; and 
(ii) by striking ‘‘in the Acute Hospital 
Care at Home initiative of the Secretary’’ 
and inserting ‘‘in the Thomas R. Carper, 
Tim Scott, Brad R. Wenstrup, D.P.M., 
and Earl Blumenauer Acute Hospital Care 
at Home initiative of the Secretary (in this 
section referred to as the ‘Acute Hospital 
Care at Home initiative’)’’; 
(B) in paragraph (2), by striking ‘‘of the 
Secretary’’; and 
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(C) in paragraph (3)(E), by adding at the 
end the following new flush sentence: 
‘‘The Secretary may require that such data and 
information be submitted through a hospital’s 
cost report, through such survey instruments as 
the Secretary may develop, through medical 
record information, or through such other 
means as the Secretary determines appro-
priate.’’; 
(3) in subsection (b)— 
(A) in the subsection heading, by striking 
‘‘STUDY’’ and inserting ‘‘INITIAL STUDY’’; 
(B) in paragraph (1)(A), by striking ‘‘of 
the Secretary’’; and 
(C) in paragraph (3), by inserting ‘‘or sub-
section (c)’’ before the period at the end; 
(4) by redesignating subsections (c) and (d) as 
subsections (d) and (e), respectively; and 
(5) 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 
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Hospital Care at Home initiative to determine 
which individuals may be furnished services 
under such initiative; and 
‘‘(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 
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477 
settings (including the timing, frequency, 
and causes of such transfers and dis-
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; 
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478 
‘‘(v) socioeconomic information on in-
dividuals treated in comparable inpatient 
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 
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479 
shall post on a website of the Centers for Medicare 
& Medicaid Services a report on the study conducted 
under paragraph (1). 
‘‘(4) FUNDING.—In addition to amounts other-
wise available, there is appropriated to the Centers 
for Medicare & Medicaid Services Program Manage-
ment Account for fiscal year 2025, out of any 
amounts in the Treasury not otherwise appropriated, 
$6,000,000, respectively, to remain available until 
expended, for purposes of carrying out this section.’’. 
SEC. 212. 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 
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480 
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 
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 
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481 
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 
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 
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482 
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 
(D) the frequency with which a claim for 
payment under such section 1834A included the 
payment modifier identified by code 59 or 91; 
and 
(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 
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