Title: Protecting Access to Post-COVID–19 Telehealth Act of 2021
Policy area: Health

Summary:
Protecting Access to Post-COVID-19 Telehealth Act of 2021
This bill makes permanent several telehealth flexibilities that were initially authorized during the public health emergency relating to COVID-19 (i.e., coronavirus disease 2019), particularly with respect to Medicare coverage of telehealth services.
For example, the bill permanently allows federally qualified health centers and rural health clinics to serve as the distant site (i.e., the location of the health care practitioner) for telehealth services under Medicare. Payment must be made in the same manner as for non-telehealth services, rather than in accordance with a separate methodology determined by the Centers for Medicare & Medicaid Services (CMS). The bill also permanently allows beneficiaries to receive Medicare telehealth services at any site, regardless of type or location, and grants the CMS general authority to waive any other requirements during any emergency period.

[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 366 Introduced in House (IH)]

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117th CONGRESS
  1st Session
                                H. R. 366

To amend title XI of the Social Security Act to authorize the Secretary 
of Health and Human Services to waive or modify application of Medicare 
 requirements with respect to telehealth services during any emergency 
                    period, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            January 19, 2021

 Mr. Thompson of California (for himself, Ms. Matsui, Mr. Schweikert, 
    Mr. Johnson of Ohio, Mr. Curtis, and Mr. Welch) 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 provisions as fall within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                                 A BILL


 
To amend title XI of the Social Security Act to authorize the Secretary 
of Health and Human Services to waive or modify application of Medicare 
 requirements with respect to telehealth services during any emergency 
                    period, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Protecting Access to Post-COVID-19 
Telehealth Act of 2021''.

SEC. 2. AUTHORIZATION FOR THE SECRETARY OF HEALTH AND HUMAN SERVICES TO 
              WAIVE OR MODIFY APPLICATION OF MEDICARE REQUIREMENTS WITH 
              RESPECT TO TELEHEALTH SERVICES.

    (a) Secretarial Authority to Temporarily Waive or Modify Medicare 
Requirements With Respect to Telehealth Services Furnished During Any 
Emergency Period.--Section 1135 of the Social Security Act (42 U.S.C. 
1320b-5) is amended by adding at the end the following new subsection:
    ``(h) Waiver or Modification of Certain Requirements With Respect 
to Telehealth Services.--
            ``(1) In general.--Notwithstanding any other provision of 
        this section, during the period described paragraph (2), the 
        Secretary may waive or modify any requirement with respect to a 
        telehealth service payable under section 1834(m)(1) for such 
        period.
            ``(2) Period described.--For purposes of paragraph (1), the 
        period described in this paragraph is the period--
                    ``(A) beginning on the first day of--
                            ``(i) an emergency or disaster declared by 
                        the President pursuant to the National 
                        Emergencies Act or the Robert T. Stafford 
                        Disaster Relief and Emergency Assistance Act; 
                        or
                            ``(ii) a public health emergency declared 
                        by the Secretary pursuant to section 319 of the 
                        Public Health Service Act; and
                    ``(B) ending on the day that is 90 days after the 
                last day of an emergency, disaster, or public health 
                emergency described in subparagraph (A).''.
    (b) Report.--
            (1) Definitions.--In this subsection:
                    (A) COVID-19 public health emergency.--The term 
                ``COVID-19 public health emergency'' means the outbreak 
                and public health response pertaining to Coronavirus 
                Disease 2019 (COVID-19), associated with the emergency 
                declared by the Secretary on January 31, 2020, under 
                section 319 of the Public Health Service Act (42 U.S.C. 
                247d), and any renewals thereof and any subsequent 
                declarations by the Secretary related to COVID-19.
                    (B) Secretary.--The term ``Secretary'' means the 
                Secretary of Health and Human Services.
            (2) Data collection and reports on the use of telehealth 
        during the covid-19 public health emergency.--
                    (A) Data collection and analysis.--
                            (i) In general.--Beginning not later than 
                        30 days after the date of enactment of this 
                        Act, the Secretary shall collect and analyze 
                        qualitative and quantitative data on the impact 
                        of telehealth services, virtual check-ins, 
                        digital health, and remote patient monitoring 
                        technologies on health care delivery permitted 
                        by the waiver or modification of certain 
                        requirements under titles XVIII of the Social 
                        Security Act (42 U.S.C. 1395 et seq.), and any 
                        regulations thereunder, pursuant to section 
                        1135 of such Act (42 U.S.C. 1320b-5) during the 
                        COVID-19 public health emergency, which may 
                        include the collection of data regarding--
                                    (I) health care utilization rates 
                                across the Medicare program under title 
                                XVIII of the Social Security Act (42 
                                U.S.C. 1395 et seq.) for individuals 
                                confirmed or suspected to have COVID-19 
                                and individuals seeking care unrelated 
                                to COVID-19, including--
                                            (aa) patient access to 
                                        telehealth services in 
                                        medically underserved 
                                        communities; or
                                            (bb) individuals receiving 
                                        telehealth services through 
                                        federally qualified health 
                                        centers (as defined in section 
                                        1861(aa)(4) of the Social 
                                        Security Act (42 U.S.C. 
                                        1395x(aa)(4)) or rural health 
                                        clinics (as defined in section 
                                        1861(aa)(2) of such Act (42 
                                        U.S.C. 1395x(aa)(2))) serving 
                                        as originating sites or distant 
                                        sites, and any challenges for 
                                        providers furnishing telehealth 
                                        services in these communities;
                                    (II) health care quality for 
                                individuals confirmed or suspected to 
                                have COVID-19 and individuals seeking 
                                care unrelated to COVID-19 as measured 
                                by--
                                            (aa) quality of care 
                                        metrics, such as hospital 
                                        readmission rates, missed 
                                        appointment rates, or wellness 
                                        visits, and
                                            (bb) engagement metrics, 
                                        such as voluntary patient 
                                        satisfaction surveys and 
                                        voluntary provider satisfaction 
                                        surveys;
                                    (III) audio-only telehealth 
                                utilization rates when other video-
                                based telehealth was not an option or 
                                any other telehealth services that were 
                                not provided in real-time (including 
                                text-messaging or through online chat 
                                platforms), the types of visits, and 
                                the types of providers treating 
                                individuals;
                                    (IV) telehealth utilization rates 
                                used to treat individuals across State 
                                lines;
                                    (V) the health outcomes of any 
                                individual who utilizes telehealth 
                                services to treat an underlying health 
                                condition such as diabetes, end-stage 
                                renal disease, chronic lung disease, 
                                obstructive pulmonary disease, coronary 
                                artery disease, or cirrhosis and the 
                                types of technology utilized to receive 
                                care, including text-messaging, online 
                                chat platforms, audio-only, or video 
                                conferencing;
                                    (VI) the health outcomes of any 
                                individual who utilizes mental health 
                                care and substance use disorder 
                                treatment services, and the types of 
                                technology utilized to receive care, 
                                including text-messaging, online chat 
                                platforms, audio-only, or video 
                                conferencing;
                                    (VII) the impact of State and 
                                Federal privacy and security 
                                protections on the delivery of care and 
                                patient safety, including the security 
                                of the various technologies utilized to 
                                deliver or receive telehealth care;
                                    (VIII) how telehealth access 
                                differs by race, ethnicity, or income 
                                levels;
                                    (IX) the types of technologies 
                                utilized to deliver or receive 
                                telehealth care, including Zoom, Skype, 
                                FaceTime, text messaging, online chat 
                                platforms, or other technologies, as 
                                observed by the Secretary, and 
                                utilization rates, disaggregated by 
                                type of technology (as applicable);
                                    (X) the investments necessary for 
                                providers to develop a platform to 
                                effectively provide telehealth services 
                                to their patients, including the costs 
                                of the necessary technology and the 
                                costs of training staff; and
                                    (XI) any additional information 
                                determined appropriate by the 
                                Secretary.
                            (ii) Broadband availability data.--Upon 
                        request by the Secretary, the Assistant 
                        Secretary of Commerce for Communications and 
                        Information and the Federal Communications 
                        Commission shall provide the Secretary any 
                        relevant data regarding the availability of 
                        broadband internet access service (as defined 
                        in section 801 of the Communications Act of 
                        1934 (47 U.S.C. 641)) for the purposes of 
                        completing the report under clause (i).
                    (B) Interim report to congress.--Not later than 90 
                days after the date of enactment of this Act, the 
                Secretary shall submit to the Committees on Finance and 
                Health, Education, Labor, and Pensions of the Senate 
                and the Committees on Ways and Means and Energy and 
                Commerce of the House of Representatives an interim 
                report on the impact of telehealth based on the data 
                collected and analyzed under subparagraph (A). For the 
                purposes of the interim report, the Secretary may 
                determine which data collected and analyzed under 
                subparagraph (A) is most appropriate to complete such 
                report.
                    (C) Final report to congress.--Not later than 180 
                days after the date of enactment of this Act, the 
                Secretary shall submit to the Committees on Finance and 
                Health, Education, Labor, and Pensions of the Senate 
                and the Committees on Ways and Means and Energy and 
                Commerce of the House of Representatives a final report 
                on the impact of telehealth based on the data collected 
                and analyzed under subparagraph (A) that includes--
                            (i) conclusions regarding the impact of 
                        telehealth services on health care delivery 
                        during the COVID-19 public health emergency; 
                        and
                            (ii) an estimation for total Medicare 
                        spending on telehealth services, including 
                        total spending for each specific type of 
                        service for which Medicare reimbursed.
                    (D) Stakeholder input.--
                            (i) In general.--For purposes of 
                        subparagraph (A), (B), and (C), the Secretary 
                        shall seek input from the Medicare Payment 
                        Advisory Commission, the Medicaid and CHIP 
                        Payment and Access Commission and 
                        nongovernmental stakeholders, including patient 
                        organizations, providers, and experts in 
                        telehealth.
                            (ii) Comment period.--For the purposes of 
                        this subsection, the Secretary shall establish 
                        a comment period not later than 14 days after 
                        the date of enactment of this Act.

SEC. 3. RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS.

    (a) Expansion of Distant Sites.--Section 1834(m) of the Social 
Security Act (42 U.S.C. 1395m(m)) is amended--
            (1) in the first sentence of paragraph (1)--
                    (A) by striking ``or a practitioner (described in 
                section 1842(b)(18)(C))'' and inserting ``, a 
                practitioner (described in section 1842(b)(18)(C)), a 
                federally qualified health center, or a rural health 
                clinic''; and
                    (B) by striking ``or practitioner'' and inserting 
                ``, practitioner, federally qualified health center, or 
                rural health clinic'';
            (2) in paragraph (2)(A)--
                    (A) by inserting ``or to a federally qualified 
                health center or rural health clinic that serves as a 
                distant site'' after ``a distant site''; and
                    (B) by striking ``such physician or practitioner'' 
                and inserting ``such physician, practitioner, federally 
                qualified health center, or rural health clinic''; and
            (3) in paragraph (4)--
                    (A) in subparagraph (A), by inserting ``and 
                includes a federally qualified health center or rural 
                health clinic that furnishes a telehealth service to an 
                eligible individual'' before the period at the end; and
                    (B) in subparagraph (F), by adding at the end the 
                following new clause:
                            ``(iii) Inclusion of rural health clinic 
                        services and federally qualified health center 
                        services furnished using telehealth.--For 
                        purposes of this subparagraph, the term 
                        `telehealth services' includes a rural health 
                        clinic service or Federally qualified health 
                        center service that is furnished using 
                        telehealth to the extent that payment codes 
                        corresponding to services identified by the 
                        Secretary under clause (i) or (ii) are listed 
                        on the corresponding claim for such rural 
                        health clinic service or Federally qualified 
                        health center service.''.
    (b) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 2022.

SEC. 4. ELIMINATION OF RESTRICTIONS RELATING TO TELEHEALTH SERVICES.

    (a) Elimination of Geographic Restrictions of Originating Sites.--
Section 1834(m)(4)(C)(i) of the Social Security Act (42 U.S.C. 
1395m(m)(4)(C)(i)) is amended--
            (1) by striking ``the service is furnished via a 
        telecommunications system and only if such site is located--'' 
        and inserting ``the service--'';
            (2) by redesignating subclauses (I) through (III) as items 
        (aa) through (cc), respectively, and moving the margins two ems 
        to the right; and
            (3) by inserting before item (aa), as redesignated by 
        paragraph (2), the following new subclauses:
                                    ``(I) is furnished via a 
                                telecommunications system; and
                                    ``(II) for the period beginning on 
                                the date of the enactment of this 
                                subclause and ending on December 31, 
                                2021, only if such site is located--''.
    (b) Elimination of Restrictions in Which Telehealth Services May Be 
Furnished in the Home.--Section 1834(m)(4)(C)(ii)(X)) of the Social 
Security Act (42 U.S.C. 1395m(m)(4)(C)(ii)(X) is amended to read as 
follows:
                                    ``(X)(aa) For the period beginning 
                                on the date of the enactment of this 
                                subclause and ending on December 31, 
                                2021, the home of an individual but 
                                only for purposes of section 
                                1881(b)(3)(B) or telehealth services 
                                described in paragraph (7).
                                    ``(bb) For the period beginning on 
                                or after January 1, 2022, the home of 
                                an individual.''.
    (c) Inclusion of Additional Originating Sites as Determined by the 
Secretary.--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:
                                    ``(XI) Any other location 
                                determined by the Secretary.''.
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