What does Preamble of Telehealth Modernization Act do?

This bill, formally titled 'To amend title XVIII of the Social Security Act to extend certain telehealth flexibilities under the Medicare program,' aims to modify the Social Security Act. The bill seeks to extend certain telehealth flexibilities within the Medicare program.

What does SHORT TITLE. of Telehealth Modernization Act do?

This bill is formally titled the Telehealth Modernization Act.

What does EXTENSION OF CERTAIN TELEHEALTH FLEXIBILITIES. of Telehealth Modernization Act do?

This section extends certain telehealth flexibilities, primarily by extending expiration dates from September 30, 2025, to September 30, 2027. The extension applies to geographic requirements and originating sites for telehealth services. It expands the types of practitioners eligible to furnish telehealth services. Telehealth services provided by Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) will be paid as FQHC or RHC services under existing payment systems. Costs associated with telehealth services furnished by FQHCs and RHCs are considered allowable costs for payment purposes. In-person requirements for mental health services furnished through telehealth are delayed until October 1, 2027. The use of audio-only telehealth services is also extended. The use of telehealth to conduct face-to-face encounters prior to hospice recertification is extended, with certain exceptions related to moratoriums, enhanced oversight, and unenrolled providers.

What does REQUIRING MODIFIER FOR USE OF TELEHEALTH TO CONDUCT FACE-TO- of Telehealth Modernization Act do?

This section amends Section 1814(a)(7)(D)(i)(II) of the Social Security Act. The amendment requires hospice claims to include modifiers or codes, as specified by the Secretary, to indicate telehealth use for face-to-face encounters. This requirement applies to encounters occurring on or after January 1, 2026.

What does EXTENDING ACUTE HOSPITAL CARE AT HOME WAIVER FLEXIBILITIES. of Telehealth Modernization Act do?

This section amends Section 1866G(a)(1) of the Social Security Act to extend the Acute Hospital Care at Home Waiver flexibilities through 2030. It redesignates subsections (c) and (d) of Section 1866G as (d) and (e), respectively. A new subsection (c) is added, requiring the Secretary to conduct a study by September 30, 2028, analyzing the Acute Hospital Care at Home initiative. The study will analyze criteria used by hospitals to select participants, and compare quality of care, clinical conditions, costs, services, socioeconomic information, and outcomes between those receiving care through the initiative and those receiving inpatient care. The Secretary must also analyze and compare individuals who participate and do not participate in the initiative, controlling for selection bias. The Secretary is required to submit a report on the study to the House Committee on Ways and Means and the Senate Committee on Finance by September 30, 2028.

What does ENHANCING CERTAIN PROGRAM INTEGRITY REQUIREMENTS FOR DME UNDER of Telehealth Modernization Act do?

This section amends Section 1834(a) of the Social Security Act to establish new requirements related to durable medical equipment (DME) inclusion on a Master List and claim review. Beginning January 1, 2028, DME items may be treated as having aberrant billing patterns if the Secretary determines a substantial number of claims are ordered by physicians without a prior 24-month relationship with the patient. For DME items included on the Master List due to aberrant billing patterns, the Secretary may conduct prepayment review of claims if coverage was not determined in advance. Section 1834(h)(3) of the Social Security Act is amended to apply these provisions to prosthetic devices, orthotics, and prosthetics. The Inspector General of the Department of Health and Human Services must submit a report to Congress by January 1, 2026, assessing fraud risks related to clinical diagnostic laboratory tests under Section 1834A of the Social Security Act. The report should identify high-risk tests, analyze contributing factors, and suggest strategies for reducing fraudulent claims, including analyzing CMS's ability to detect aberrant billing patterns.

What does GUIDANCE ON FURNISHING SERVICES VIA TELEHEALTH TO INDIVIDUALS of Telehealth Modernization Act do?

This section requires the Secretary of Health and Human Services to issue or update guidance within one year of enactment. The guidance is intended for entities providing telehealth services and focuses on improving access for individuals with limited English proficiency (LEP). The guidance will cover best practices for interpreter use, accessible instructions for telecommunications systems, digital patient portal access, video platform integration for interpretation, and multilingual patient materials. The Secretary must consult with entities including health information technology providers, healthcare providers, health insurers, language service companies, interpreter associations, certification organizations, and patient advocates.

What does IN-HOME CARDIOPULMONARY REHABILITATION FLEXIBILITIES. of Telehealth Modernization Act do?

This section amends Section 1861(eee)(2) of the Social Security Act. The amendment allows for in-home cardiopulmonary rehabilitation services, including those provided through audio and video real-time communications technology, to be covered under the program. This coverage applies to services furnished in the home of an outpatient between September 30, 2025, and January 1, 2027. The amendment also allows for the virtual presence of certain healthcare professionals (physician, physician assistant, nurse practitioner, or clinical nurse specialist) to be considered for coverage during this period. The Secretary of Health and Human Services has the authority to implement these amendments through program instructions or other means.

What does INCLUSION OF VIRTUAL DIABETES PREVENTION PROGRAM SUPPLIERS IN of Telehealth Modernization Act do?

This section requires the Secretary to revise regulations under parts 410 and 424 of title 42, Code of Federal Regulations, by January 1, 2026. The revised regulations will allow entities to participate in the Medicare Diabetes Prevention Program (MDPP) by offering only online services via synchronous or asynchronous technology or telecommunications. Entities participating in the MDPP through online services will have their administrative location defined as the address on file under the Diabetes Prevention Recognition Program. Entities will not be prohibited from submitting claims for payment for online MDPP services furnished to beneficiaries located in a different state. There will be no limit on the number of times an individual may enroll in the MDPP.

Back to bills

Telehealth Modernization Act

Last updated: 9/2/2025 · Introduced: 9/2/2025

Author: Earl Carter (R-GA)

TL;DR (AI)

The bill extends existing telehealth flexibilities, such as geographic requirements and audio-only services, through September 30, 2027, to maintain access to care.
Hospice providers will be required to use specific modifiers on claims to indicate when telehealth is used for face-to-face encounters, starting January 1, 2026.
The Acute Hospital Care at Home Waiver program, which allows hospitals to provide inpatient-level care in patients' homes, is extended through 2030 and will be subject to a study analyzing its effectiveness.
To combat fraud, the bill establishes new requirements for durable medical equipment (DME) billing, potentially leading to prepayment claim reviews if aberrant billing patterns are detected.
The bill mandates guidance from the Department of Health and Human Services to improve telehealth access for individuals with limited English proficiency, focusing on interpreter services and accessible materials.

119th Congressin committeeS. 891(In Committee)Official page

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Includes provisions on preamble, short title., and 7 more.

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