I 
117TH CONGRESS 
1ST SESSION H. R. 6202 
To amend titles XI and XVIII of the Social Security Act to establish require-
ments for the provision of certain high-cost durable medical equipment 
and laboratory testing; to extend and expand access to telehealth services; 
and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 9, 2021 
Mr. DOGGETT (for himself, Mr. NUNES, Mr. THOMPSON of California, Mr. 
KELLY of Pennsylvania, Mr. SCHWEIKERT, Mrs. AXNE, Mr. BLU-
MENAUER, Mr. BRENDAN F. BOYLE of Pennsylvania, Mr. BUTTERFIELD, 
Mr. CARSON, Ms. CRAIG, Mr. DANNY
K. DAVIS
of Illinois, Mr. 
FITZPATRICK, Mrs. FLETCHER, Mr. HIGGINS of New York, Mr. KILDEE, 
Mr. LAHOOD, Mrs. LESKO, Mrs. MILLER
of West Virginia, Mr. 
O’HALLERAN, Mr. RASKIN, Mr. RICE of South Carolina, Ms. SCHA-
KOWSKY, Ms. SEWELL, Mr. SMITH of Nebraska, Mr. SMUCKER, Mr. 
VEASEY, Mrs. WALORSKI, Ms. WILD, Mr. GREEN of Texas, and Mr. 
BUCHANAN) introduced the following bill; which was referred to the Com-
mittee 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 titles XI and XVIII of the Social Security Act 
to establish requirements for the provision of certain 
high-cost durable medical equipment and laboratory test-
ing; to extend and expand access to telehealth services; 
and for other purposes. 
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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 ‘‘Telehealth Extension 
Act of 2021’’. 
SEC. 2. REQUIREMENT FOR PROVISION OF HIGH-COST DU-
RABLE MEDICAL EQUIPMENT AND LABORA-
TORY TESTS. 
(a) HIGH-COST DURABLE MEDICAL EQUIPMENT.— 
Section 1834(a)(1)(E) of the Social Security Act (42 
U.S.C. 1395m(a)(1)(E)) is amended by adding at the end 
the following new clause: 
‘‘(vi) STANDARDS FOR HIGH-COST DU-
RABLE MEDICAL EQUIPMENT.— 
‘‘(I) LIMITATION
ON
PAYMENT 
FOR
HIGH-COST
DURABLE
MEDICAL 
EQUIPMENT.—Payment may not be 
made under this subsection for a 
high-cost durable medical equipment 
ordered by a physician or other practi-
tioner described in clause (ii) via tele-
health for an individual, unless such 
physician or practitioner furnished to 
such individual a service in-person at 
least once during the 6-month period 
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prior to ordering such high-cost dura-
ble medical equipment. 
‘‘(II) HIGH-COST DURABLE MED-
ICAL EQUIPMENT DETERMINATION.— 
For purposes of this clause, the Ad-
ministrator of the Centers for Medi-
care & Medicaid Services shall define 
the term ‘high-cost durable medical 
equipment’ and specify the durable 
medical equipment for which such def-
inition shall apply. 
‘‘(vii) AUDIT
OF
PROVIDERS
AND 
PRACTITIONERS FURNISHING A HIGH VOL-
UME
OF
DURABLE
MEDICAL
EQUIPMENT 
VIA TELEHEALTH.— 
‘‘(I) IDENTIFICATION
OF
PRO-
VIDERS.—Beginning 6 months after 
the effective date of this clause, Medi-
care administrative contractors shall 
conduct reviews on a schedule deter-
mined by the Secretary, of claims for 
durable medical equipment prescribed 
by a physician or other practitioner 
described in clause (ii) during the 12- 
month period preceding such review to 
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identify physicians or other practi-
tioners with respect to whom at least 
90 percent of all durable medical 
equipment prescribed by such physi-
cian or practitioner during such pe-
riod was prescribed pursuant to a 
telehealth visit. 
‘‘(II) AUDIT.—In the case of a 
physician or practitioner identified 
under subclause (I), with respect to a 
period described in such subclause, 
the Medicare administrative contrac-
tors shall conduct audits of all claims 
for durable medical equipment pre-
scribed by such physicians or practi-
tioners to determine whether such 
claims comply with the requirements 
for coverage under this title.’’. 
(b) 
HIGH-COST
LABORATORY
TESTS.—Section 
1834A(b) of the Social Security Act (42 U.S.C. 1395m– 
1(b)) is amended by adding at the end the following new 
paragraph: 
‘‘(6) REQUIREMENT FOR HIGH-COST LABORA-
TORY TESTS.— 
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‘‘(A) LIMITATION ON PAYMENT FOR HIGH- 
COST LABORATORY TESTS.—Payment may not 
be made under this subsection for a high-cost 
laboratory test ordered by a physician or practi-
tioner via telehealth for an individual, unless 
such physician or practitioner furnished to such 
individual a service in-person at least once dur-
ing the 6-month period prior to ordering such 
high-cost laboratory test. 
‘‘(B) HIGH-COST LABORATORY TEST DE-
FINED.—For purposes of this paragraph, the 
Administrator for the Centers for Medicare & 
Medicaid Services shall define the term ‘high- 
cost laboratory test’ and specify which labora-
tory tests such definition shall apply to. 
‘‘(7) AUDIT
OF
LABORATORY
TESTING
OR-
DERED PURSUANT TO TELEHEALTH VISIT.— 
‘‘(A) IDENTIFICATION
OF
PROVIDERS.— 
Beginning 6 months after the effective date of 
this paragraph, Medicare administrative con-
tractors shall conduct periodic reviews on a 
schedule determined by the Secretary, of claims 
for laboratory tests prescribed by a physician or 
practitioner during the 12-month period pre-
ceding such review to identify physicians or 
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other practitioners with respect to whom at 
least 90 percent of all laboratory tests pre-
scribed by such physician or practitioner during 
such period was prescribed pursuant to a tele-
health visit. 
‘‘(B) AUDIT.—In the case of a physician 
or practitioner identified under subparagraph 
(A), with respect to a period described in such 
subparagraph, the Medicare administrative con-
tractors shall conduct audits of all claims for 
laboratory tests prescribed by such physicians 
or practitioners during such period beginning to 
determine whether such claims comply with the 
requirements for coverage under this title.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect upon the termination of the 
emergency period described in section 1135(g)(1)(B) of 
the Social Security Act (42 U.S.C. 1320b–5(g)(1)(B)). 
SEC. 3. REQUIREMENT TO SUBMIT NPI NUMBER FOR SEPA-
RATELY BILLABLE TELEHEALTH SERVICES. 
(a) REQUIREMENT TO SUBMIT NPI NUMBER FOR 
SEPARATELY BILLABLE TELEHEALTH SERVICES.—Sec-
tion 1834(m) of the Social Security Act (42 U.S.C. 
1395m(m)) is amended by adding at the end the following 
new paragraph: 
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‘‘(9) REQUIREMENT TO SUBMIT NPI NUMBER 
FOR
SEPARATELY
BILLABLE
TELEHEALTH
SERV-
ICES.—Payment may not be made under this sub-
section for separately billable telehealth services fur-
nished by a physician or practitioner unless such 
physician or practitioner submits a claim for pay-
ment under the national provider identification num-
ber assigned to such physician or practitioner.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall take effect upon the termination of the 
emergency period described in section 1135(g)(1)(B) of 
the Social Security Act (42 U.S.C. 1320b–5(g)(1)(B)). 
SEC. 4. REMOVING GEOGRAPHIC REQUIREMENTS FOR 
TELEHEALTH SERVICES. 
Section 1834(m)(4)(C) of the Social Security Act (42 
U.S.C. 1395m(m)(4)(C)) is amended by adding at the end 
the following new clause: 
‘‘(iii) REMOVAL OF GEOGRAPHIC RE-
QUIREMENTS.—The 
geographic 
require-
ments described in clause (i) shall not 
apply with respect to telehealth services 
furnished on or after the date of the enact-
ment of this clause.’’. 
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SEC. 5. EXPANDING ORIGINATING SITES. 
(a) EXPANDING
THE HOME
AS
AN ORIGINATING 
SITE.—Section 1834(m)(4)(C)(ii)(X) of the Social Secu-
rity Act (42 U.S.C. 1395m(m)(4)(C)(ii)(X)) is amended 
to read as follows: 
‘‘(X) The home of an individual, 
but, with respect to services furnished 
before the date of the enactment of 
the ‘Telehealth Extension and Evalua-
tion Act’, only for purposes of section 
1881(b)(3)(B) or telehealth services 
described in paragraph (7).’’. 
(b) ALLOWING ADDITIONAL ORIGINATING SITES.— 
Section 1834(m)(4)(C)(ii) of the Social Security Act (42 
U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding at the 
end the following new subclause: 
‘‘(XII) Any other site determined 
appropriate by the Secretary at which 
an eligible telehealth individual is lo-
cated at the time a telehealth service 
is furnished via a telecommunications 
system.’’. 
(c) PARAMETERS FOR NEW ORIGINATING SITES.— 
Section 1834(m)(4)(C) of the Social Security Act (42 
U.S.C. 1395m(m)(4)(C)), as amended by section 4, is 
amended by adding at the end the following new clause: 
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‘‘(iv) 
REQUIREMENTS
FOR
NEW 
SITES.— 
‘‘(I) IN
GENERAL.—The Sec-
retary may establish requirements for 
the furnishing of telehealth services at 
sites described in clause (ii)(XII) to 
provide for beneficiary and program 
integrity protections. 
‘‘(II) CLARIFICATION.—Nothing 
in this clause shall be construed to 
preclude the Secretary from estab-
lishing requirements for other origi-
nating sites described in clause (ii).’’. 
(d) NO ORIGINATING SITE FACILITY FEE FOR NEW 
SITES.—Section 1834(m)(2)(B)(ii) of the Social Security 
Act (42 U.S.C. 1395m(m)(2)(B)(ii)) is amended— 
(1) in the heading, by striking ‘‘IF ORIGINATING 
SITE IS THE HOME’’ and inserting ‘‘FOR CERTAIN 
SITES’’; and 
(2) by striking ‘‘paragraph (4)(C)(ii)(X)’’ and 
inserting ‘‘subclause (X) or (XII) of paragraph 
(4)(C)’’. 
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SEC. 6. FEDERALLY QUALIFIED HEALTH CENTERS AND 
RURAL HEALTH CLINICS. 
Section 1834(m) of the Social Security Act (42 
U.S.C. 1395m(m)) is amended— 
(1) in paragraph (4)(C)(i), in the matter pre-
ceding subclause (I), by striking ‘‘(5), (6), and (7)’’ 
and inserting ‘‘(5) through (8)’’; and 
(2) in paragraph (8)— 
(A) in the paragraph heading by inserting 
‘‘AND AFTER’’ after ‘‘DURING’’; 
(B) in subparagraph (A)— 
(i) in the matter preceding clause (i), 
by inserting ‘‘and after such emergency pe-
riod’’ after ‘‘1135(g)(1)(B)’’; 
(ii) in clause (ii), by striking ‘‘and’’ at 
the end; 
(iii) by redesignating clause (iii) as 
clause (iv); and 
(iv) by inserting after clause (ii) the 
following new clause: 
‘‘(iii) the geographic requirements de-
scribed in paragraph (4)(C)(i) shall not 
apply with respect to such a telehealth 
service; and’’; and 
(C) by striking subparagraph (B) and in-
serting the following: 
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‘‘(B) PAYMENT.— 
‘‘(i) IN GENERAL.—A telehealth serv-
ice furnished by a Federally qualified 
health center or a rural health clinic to an 
individual pursuant to this paragraph on 
or after the date of the enactment of this 
subparagraph shall be deemed to be so fur-
nished to such individual as an outpatient 
of such clinic or facility (as applicable) for 
purposes of paragraph (1) or (3), respec-
tively, of section 1861(aa) and payable as 
a Federally qualified health center service 
or rural health clinic service (as applicable) 
under the prospective payment system es-
tablished under section 1834(o) or under 
section 1833(a)(3), respectively. 
‘‘(ii) TREATMENT
OF
COSTS
FOR 
FQHC
PPS
CALCULATIONS
AND
RHC
AIR 
CALCULATIONS.—Costs associated with the 
delivery of telehealth services by a Feder-
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 
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1834(o) and any payment methodologies 
developed under section 1833(a)(3), as ap-
plicable.’’. 
SEC. 7. NATIVE AMERICAN HEALTH FACILITIES. 
(a) IN GENERAL.—Section 1834(m)(4)(C) of the So-
cial Security Act (42 U.S.C. 1395m(m)(4)(C)), as amend-
ed by sections 4 and 5(c), is amended— 
(1) in clause (i), by striking ‘‘clause (ii)’’ and 
inserting ‘‘clauses (ii) and (v)’’; and 
(2) by adding at the end the following new 
clause: 
‘‘(v) NATIVE AMERICAN HEALTH FA-
CILITIES.—With respect to telehealth serv-
ices furnished on or after January 1, 2022, 
the originating site requirements described 
in clauses (i) and (ii) shall not apply with 
respect to a facility of the Indian Health 
Service, whether operated by such Service, 
or by an Indian tribe (as that term is de-
fined in section 4 of the Indian Health 
Care Improvement Act (25 U.S.C. 1603)) 
or a tribal organization (as that term is 
defined in section 4 of the Indian Self-De-
termination and Education Assistance Act 
(25 U.S.C. 5304)), or a facility of the Na-
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tive Hawaiian health care systems author-
ized under the Native Hawaiian Health 
Care Improvement Act (42 U.S.C. 11701 
et seq.).’’. 
(b) NO ORIGINATING SITE FACILITY FEE FOR CER-
TAIN
NATIVE
AMERICAN
FACILITIES.—Section 
1834(m)(2)(B)(i) of the Social Security Act (42 U.S.C. 
1395m(m)(2)(B)(i)) is amended, in the matter preceding 
subclause (I), by inserting ‘‘(other than an originating site 
that is only described in clause (v) of paragraph (4)(C), 
and does not meet the requirement for an originating site 
under clauses (i) and (ii) of such paragraph)’’ after ‘‘the 
originating site’’. 
SEC. 8. WAIVER OF TELEHEALTH REQUIREMENTS DURING 
PUBLIC HEALTH EMERGENCIES. 
Section 1135(g)(1) of the Social Security Act (42 
U.S.C. 1320b–5(g)(1)) is amended— 
(1) in subparagraph (A), in the matter pre-
ceding clause (i), by striking ‘‘subparagraph (B)’’ 
and inserting ‘‘subparagraphs (B) and (C)’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(C) EXCEPTION FOR WAIVER OF TELE-
HEALTH
REQUIREMENTS
DURING
PUBLIC 
HEALTH EMERGENCIES.—For purposes of sub-
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section (b)(8), in addition to the emergency pe-
riod described in subparagraph (B), an ‘emer-
gency area’ is a geographical area in which, and 
an ‘emergency period’ is the period during 
which, there exists a public health emergency 
declared by the Secretary pursuant to section 
319 of the Public Health Service Act.’’. 
SEC. 9. TWO-YEAR EXTENSION OF TELEHEALTH SERVICES 
FOLLOWING THE COVID-19 EMERGENCY PE-
RIOD. 
Section 1135(e) of the Social Security Act (42 U.S.C. 
1320b–5(e)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(3) TWO-YEAR EXTENSION OF TELEHEALTH 
SERVICES
FOLLOWING
THE
COVID-19
EMERGENCY 
PERIOD.—Notwithstanding any other provision of 
this section, a waiver or modification of require-
ments pursuant to subsection (b)(8) shall terminate 
on the date that is two years after the last day of 
the emergency period described in subsection 
(g)(1)(B).’’. 
SEC. 10. OUTPATIENT CRITICAL ACCESS HOSPITALS. 
(a) IN GENERAL.—Notwithstanding section 1834(m) 
of the Social Security Act (42 U.S.C. 1395m(m)) and sub-
ject to subsection (b), the Secretary of Health and Human 
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Services shall provide payment under section 1834(g) of 
such Act (42 U.S.C. 1395m(g)) for outpatient critical ac-
cess hospital services consisting of behavioral therapy serv-
ices furnished by a critical access hospital to an individual 
during the period beginning on January 1, 2021, and end-
ing on the date that is two years after the last day of 
the emergency period described in section 1135(g)(1)(B) 
of the Social Security Act (42 U.S.C. 1320b–5(g)(1)(B)), 
via telecommunications technology, notwithstanding the 
fact that such individual is not located at such hospital. 
(b) INITIATION OF SERVICES VIA TELEHEALTH.—In 
the case of an individual receiving services described in 
subsection (a) from a critical access hospital during the 
period described in subsection (a), if such individual has 
not, prior to receiving such services, received in-person 
care at such hospital, payment shall be made to such hos-
pital in accordance with such subsection only if such serv-
ices complement a plan of care that includes in-person 
care to be furnished at such hospital not later than 1 year 
after the date such services are furnished. 
(c) DEFINITIONS.—For purposes of this section: 
(1) CRITICAL
ACCESS
HOSPITAL.—The term 
‘‘critical access hospital’’ has the meaning given 
such term in section 1861(mm)(1) of the Social Se-
curity Act (42 U.S.C. 1395x(mm)(1)). 
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(2) OUTPATIENT
CRITICAL
ACCESS
HOSPITAL 
SERVICES.—The term ‘‘outpatient critical access 
hospital services’’ has the meaning given such term 
in section 1861(mm)(3) of such Act (42 U.S.C. 
1395x(mm)(3)). 
(3) TELECOMMUNICATIONS TECHNOLOGY.—The 
term ‘‘telecommunications technology’’ means a com-
munications system permitting two-way, real-time 
interactive communication between the individuals 
and health care professional and includes a commu-
nications system consisting of only audio capabili-
ties, but only if such individual does not have access 
to a communications system with audio-visual capa-
bilities. 
Æ 
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