health individual is located at the time the 
service is furnished via a telecommuni-
cations system, regardless of where the hos-
pital, critical access hospital, or mobile 
stroke unit is located.’’; 
(2) in subparagraph (F)(i) by inserting ‘‘tele-
health-eligible stroke services,’’ after ‘‘Secretary)),’’; 
and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(G) TELEHEALTH-ELIGIBLE STROKE SERV-
ICES.—The term ‘telehealth-eligible stroke serv-
ices’ means services that are— 
‘‘(i) related to the diagnosis, evalua-
tion, or treatment of symptoms of an acute 
stroke in an individual; and 
‘‘(ii) furnished to such individual not 
later than four and a half hours (or such 
other clinically appropriate amount of time 
as is determined by the Secretary) after the 
onset of such symptoms with respect to such 
individual.’’. 
(b) NO ORIGINATING SITE FACILITY FEE FOR NEW 
SITES.—Section 1834(m)(2)(B) of the Social Security Act 
(42 U.S.C. 1395m(m)(2)(B)) is amended— 
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(1) by redesignating clauses (i) and (ii) as sub-
clauses (I) and (II), respectively (and adjusting the 
margins accordingly); 
(2) in subclause (II), as redesignated by para-
graph (1), by striking ‘‘clause (i) or this clause’’ and 
inserting ‘‘subclause (I) or this subclause’’; 
(3) by striking ‘‘SITE.—With respect to’’ and in-
serting ‘‘SITE.— 
‘‘(i) IN GENERAL.—With respect to’’; 
(4) by striking ‘‘subject to section 1833(a)(1)(U)’’ 
and inserting ‘‘subject to clause (ii) and section 
1833(a)(1)(U)’’; and 
(5) by adding at the end the following new 
clause: 
‘‘(ii) NO ORIGINATING SITE FACILITY 
FEE
FOR
CERTAIN
TELESTROKE
SERV-
ICES.—No facility fee shall be paid under 
this subparagraph to an originating site 
that is described in clause (iii) of para-
graph (4)(C) and that would not otherwise 
meet the requirements for an originating 
site under paragraph (4)(C) without appli-
cation of the amendments made by the 
FAST Act of 2017.’’. 
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(c) EFFECTIVE DATE.—The amendments made by this 
section shall apply to services furnished on or after January 
1, 2021. 
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Union Calendar No. 328 
115TH CONGRESS 
1ST SESSION 
H. R. 1148 
[Report No. 115–444, Part I] 
A BILL 
To amend title XVIII of the Social Security Act to 
expand access to telehealth-eligible stroke serv-
ices under the Medicare program. 
DECEMBER 6, 2017 
Reported from the Committee on Energy and Commerce 
with an amendment 
DECEMBER 6, 2017 
The Committee on Ways and Means discharged; com-
mitted to the Committee of the Whole House on the 
State of the Union and ordered to be printed 
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