HR2263-119

What This Bill Does

The Telehealth Coverage Act makes a package of Medicare telehealth changes permanent or operationally clearer. It replaces March 31, 2025 sunsets in section 1834(m) and related provisions with language tied to services furnished on or after the first day of the COVID-19 emergency period, removes expired temporary telehealth paragraphs, and directs HHS to establish claim modifiers by January 1, 2026 for telehealth services furnished through virtual platforms owned by or financially connected to practitioners and for incident-to telehealth services. It also requires modifiers or codes for hospice face-to-face recertification encounters conducted by telehealth after January 1, 2026. For the Medicare Diabetes Prevention Program, HHS must revise regulations by January 1, 2026 so entities can participate with online-only synchronous or asynchronous MDPP services, use their Diabetes Prevention Recognition Program address as the administrative location, bill across state lines based on beneficiary location, and enroll individuals without a repeat-enrollment limit. Finally, HHS must use existing communications to educate Medicare clinicians on periodic screening for medication-induced movement disorders associated with mental health treatment, including telehealth best practices and evaluation and management code selection.

Who Benefits and How

Medicare telehealth patients benefit because pandemic-era access flexibilities would continue without a March 2025 cutoff. Telehealth clinicians benefit from permanent statutory authority and clearer claim-modifier rules for virtual platform and incident-to services. Online Medicare Diabetes Prevention Program suppliers benefit because they can participate using synchronous or asynchronous virtual services beginning January 1, 2026. Hospice patients benefit because telehealth can continue for face-to-face recertification encounters when claims include the required modifier or code. Patients taking mental health medications benefit from outreach on screening for medication-induced movement disorders through telehealth.

Who Bears the Burden and How

CMS must revise telehealth, hospice, and MDPP regulations and establish claim code or modifier requirements by January 1, 2026. Hospice providers must add specified modifiers or codes when telehealth is used for recertification face-to-face encounters. Medicare clinicians using virtual platforms must identify platform-related payment arrangements on claims. Medicare program integrity staff must use the new modifiers to monitor virtual platform and incident-to telehealth billing. Federal taxpayers bear the cost of continuing broader Medicare telehealth coverage and online MDPP access.

Key Provisions

• Makes several Medicare telehealth flexibilities permanent by removing March 31, 2025 sunset language.
• Requires telehealth claim modifiers for virtual platform arrangements and incident-to telehealth services by January 1, 2026.
• Requires hospice claim modifiers or codes for telehealth face-to-face recertification encounters after January 1, 2026.
• Directs CMS to allow online-only MDPP suppliers and cross-state online MDPP claims beginning January 1, 2026.
• Requires Medicare outreach on telehealth screening for medication-induced movement disorders.