HR7444-119

What This Bill Does

The bill amends Social Security Act section 1834(m). Beginning January 1, 2027, Medicare telehealth geographic originating-site requirements no longer apply, the patient's home becomes an originating site for all Medicare telehealth services, and the Alaska/Hawaii federal demonstration limitation is removed. Critical access hospitals may serve as distant-site telehealth providers for eligible Medicare beneficiaries when they have an established patient relationship defined by state law and the service complements a care plan with in-person care when appropriate; payment is 101 percent of reasonable costs unless the hospital elects the section 1834(g) method. FQHCs and rural health clinics can keep furnishing telehealth after January 1, 2027, under a separate telehealth payment rate based on geography, allowable delivery costs, and full telehealth costs, with a coding system and established-patient requirement. For specified telehealth services, Medicare treats audio-only technology as a telecommunications system beginning January 1, 2027 for evaluation and management, behavioral health counseling, education, and other Secretary-approved services furnished by qualified providers. The Secretary may decide clinical appropriateness, initial in-person requirements, and service additions or deletions after a five-year broadband-impact review. Congress also states that the pandemic-era expansion of eligible telehealth practitioners should be made permanent.

Who Benefits and How

Rural Medicare beneficiaries, homebound Medicare beneficiaries, critical access hospitals, Federally qualified health centers, rural health clinics, physicians, practitioners, community mental health centers, rural emergency hospitals, and renal dialysis centers benefit from permanent Medicare telehealth coverage, home-originating-site access, cost-based CAH payment, separate FQHC/RHC rates, and audio-only options when broadband access is limited.

Who Bears the Burden and How

CMS and HHS must implement new payment rules, coding systems, established-patient requirements, clinical-appropriateness decisions, possible in-person visit requirements, and a five-year review of audio-only telehealth and broadband rollout. Providers must document established patient relationships, fit services into qualifying categories, use new codes, and comply with any Secretary-imposed in-person or clinical appropriateness conditions.

Key Provisions

• Eliminates Medicare telehealth geographic originating-site restrictions and makes the patient's home an originating site for services furnished on or after January 1, 2027.
• Pays critical access hospitals as distant-site telehealth providers at 101 percent of reasonable costs, subject to established-patient and plan-of-care requirements.
• Extends FQHC and rural health clinic telehealth payment after January 1, 2027 with a separate payment methodology, coding system, and established-patient requirement.
• Authorizes audio-only Medicare telehealth for specified services beginning January 1, 2027, including evaluation and management, behavioral health counseling, education, and Secretary-approved services.
• Requires a five-year review of audio-only telehealth, broadband rollout, continued access needs, and possible service-code additions or deletions.