Telehealth Modernization Act
Summary
What This Bill Does
The Telehealth Modernization Act extends multiple Medicare telehealth flexibilities from September 30, 2025, to September 30, 2027. It continues broader originating-site and practitioner flexibilities, delays certain in-person requirements, and creates payment rules for telehealth services furnished by Federally qualified health centers and rural health clinics from October 1, 2025, through September 30, 2027. Those services are paid as FQHC or rural health clinic services, and related telehealth costs are treated as allowable costs.
The bill extends hospice face-to-face encounter telehealth authority through September 30, 2027, but excludes certain encounters involving areas with hospice enrollment moratoria, providers subject to enhanced oversight, or non-enrolled hospice physicians and nurse practitioners. It then requires hospice claims for telehealth recertification encounters on or after January 1, 2026, to include modifiers or codes specified by the Secretary.
The bill extends the Acute Hospital Care at Home waiver authority through 2030 and requires HHS to study quality, readmissions, mortality, length of stay, infection rates, staffing, transfers, costs, service intensity, caregiver involvement, socioeconomic data, and direct emergency-department admissions compared with inpatient care, with a report due September 30, 2028. It also adds durable medical equipment and prosthetics program-integrity rules for aberrant billing patterns and prepayment review beginning in 2028, requires an HHS Inspector General report on clinical diagnostic laboratory test fraud risks by January 1, 2026, and permits virtual-only Medicare Diabetes Prevention Program suppliers from 2026 through 2030.
Who Benefits and How
Medicare beneficiaries using telehealth, FQHC patients, rural health clinic patients, hospice patients needing recertification encounters, hospitals participating in Acute Hospital Care at Home, and virtual Diabetes Prevention Program suppliers benefit from extended or expanded remote-care authority. FQHCs and rural health clinics benefit from payment and allowable-cost rules for telehealth services. Medicare beneficiaries seeking online diabetes prevention services benefit from expanded virtual supplier participation and removal of repeat-enrollment limits.
Who Bears the Burden and How
CMS Medicare payment staff must administer the telehealth extensions, FQHC and rural health clinic payment rules, hospice modifiers, hospital-at-home study, DME prepayment review authority, and MDPP regulation revisions. Hospice providers must code telehealth recertification encounters. DME suppliers, prosthetics providers, orthotics providers, and clinical laboratories with aberrant billing patterns face more scrutiny and potential prepayment review. HHS Inspector General staff must report on laboratory fraud risks.
Key Provisions
- Extends specified Medicare telehealth flexibilities from September 30, 2025, to September 30, 2027.
- Provides FQHC and rural health clinic telehealth payment and allowable-cost treatment for fiscal years 2026 and 2027.
- Requires hospice telehealth recertification claims to include Secretary-specified modifiers or codes beginning January 1, 2026.
- Extends Acute Hospital Care at Home waiver authority through 2030 and requires a detailed HHS study and 2028 report.
- Adds DME, prosthetic, and orthotic aberrant-billing criteria and prepayment review authority beginning January 1, 2028.
- Requires an HHS Inspector General report on clinical diagnostic laboratory test fraud risks by January 1, 2026.
- Expands Medicare Diabetes Prevention Program participation to virtual-only suppliers from 2026 through 2030 and removes repeat-enrollment limits.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
Extends Medicare telehealth and hospital-at-home flexibilities, sets FQHC and rural health clinic telehealth payment rules, adds hospice telehealth modifier requirements, strengthens DME and lab-fraud program integrity, and permits virtual-only Medicare Diabetes Prevention Program suppliers for 2026 through 2030.
Key Policy Areas
Medicare, Telehealth, Hospitals, Program Integrity, Diabetes Prevention
Primary Purpose
Extends Medicare telehealth and hospital-at-home flexibilities, sets FQHC and rural health clinic telehealth payment rules, adds hospice telehealth modifier requirements, strengthens DME and lab-fraud program integrity, and permits virtual-only Medicare Diabetes Prevention Program suppliers for 2026 through 2030.
Policy Domains
Sections 2 and 3 Medicare telehealth and hospice modifier extensions
Identified Gains
- Medicare telehealth beneficiaries
- Federally qualified health centers
- Rural health clinics
- Hospice patients needing recertification encounters
Identified Costs
- CMS Medicare telehealth payment staff
- Hospice providers submitting telehealth modifier claims
- Hospice providers under enhanced Medicare oversight
Sections 4, 5, and 8 hospital-at-home, Medicare program integrity, and virtual MDPP rules
Identified Gains
- Acute Hospital Care at Home hospitals
- Virtual Medicare Diabetes Prevention Program suppliers
- Medicare diabetes prevention beneficiaries
Identified Costs
- CMS hospital-at-home study staff
- DME suppliers with aberrant billing patterns
- Clinical laboratories with fraud-risk billing patterns
- HHS Inspector General audit staff
Sponsors
Legislative Progress
In CommitteeMr. Carter of Georgia (for himself and Mrs. Dingell) introduced …
Referred to the Committee on Energy and Commerce, and in …
Introduced in House
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
CMS MDPP enrollment staff, CMS Medicare prepayment review staff, CMS Medicare telehealth payment staff
Positive-direction: Federal Medicare trust funds
Negative-direction: CMS MDPP enrollment staff, CMS Medicare prepayment review staff, CMS Medicare telehealth payment staff, CMS hospice claims processing staff, CMS hospital-at-home study staff, HHS Inspector General audit staff
Federally qualified health centers, Medicare diabetes prevention beneficiaries, Medicare patients eligible for hospital-at-home care
Acute Hospital Care at Home hospitals, DME suppliers with aberrant billing patterns, Hospitals submitting hospital-at-home study data
Positive-direction: Acute Hospital Care at Home hospitals
Negative-direction: DME suppliers with aberrant billing patterns, Hospitals submitting hospital-at-home study data, Prosthetics and orthotics suppliers
Hospice providers submitting telehealth modifier claims, Hospice providers under enhanced Medicare oversight
Clinical laboratories with fraud-risk billing patterns
Virtual Medicare Diabetes Prevention Program suppliers
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "fqhcs"
- → Federally qualified health centers
- "hospice"
- → Hospice providers
- "secretary"
- → Secretary of Health and Human Services
- "beneficiaries"
- → Medicare telehealth beneficiaries
- "rural_clinics"
- → Rural health clinics
- "hospital"
- → Hospital participating in Acute Hospital Care at Home
- "secretary"
- → Secretary of Health and Human Services
- "dme_supplier"
- → Durable medical equipment supplier
- "mdpp_supplier"
- → Medicare Diabetes Prevention Program supplier
- "inspector_general"
- → HHS Inspector General
Key Definitions
Terms defined in this bill
Telehealth services furnished from October 1, 2025, through September 30, 2027, are paid as FQHC or rural health clinic services and related costs are allowable costs.
The Medicare hospital-at-home waiver initiative extended through 2030 and subject to a 2028 HHS comparative study.
An MDPP supplier offering only online MDPP services through synchronous or asynchronous technology or telecommunications during 2026 through 2030.
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology