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 outlined in the Social Security Act. It extends the expiration dates for various telehealth provisions, including those related to geographic requirements, originating sites, eligible practitioners, and Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), from September 30, 2025, to September 30, 2027. The section modifies payment rules for telehealth services furnished by FQHCs and RHCs, specifying that these services should be paid under existing prospective payment systems or all-inclusive rates. It delays in-person requirements for mental health services furnished through telehealth, extending the delay from October 1, 2025, to October 1, 2027. The bill allows for the continued furnishing of audio-only telehealth services through September 30, 2027. It extends the use of telehealth to conduct face-to-face encounters prior to hospice care recertification, with exceptions for certain circumstances like moratoriums on hospice program enrollment or enhanced oversight of 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 the inclusion of modifiers or codes on hospice claims for telehealth encounters. This requirement applies to encounters occurring on or after January 1, 2026. The Secretary specifies the modifiers or codes to be used.

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 patients for the initiative. The study will compare quality of care, clinical conditions, costs, services, socioeconomic information, and outcomes between patients receiving care through the initiative and those receiving inpatient care. The Secretary must analyze and compare individuals participating and not participating 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 the item was not previously determined to be covered. 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. The guidance will cover best practices for facilitating interpreter use during telemedicine appointments. It will also address accessible instructions for telecommunications systems, digital patient portal access, and multi-person video calls for interpretation. The guidance must include best practices for providing patient materials and communications in multiple languages. Consultation will occur with entities including health IT providers, healthcare providers, health insurers, language service companies, interpreter associations, quality 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 expands the definition of 'outpatient basis' to include items and services furnished through audio and video real-time communications technology in the home of an individual. The amendment allows for the virtual presence of certain healthcare professionals (physician, physician assistant, nurse practitioner, or clinical nurse specialist) under the program when using audio and video real-time communications technology. These changes apply to services provided on or after September 30, 2025, and before January 1, 2027. 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 directs the Secretary to revise regulations to 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 online must meet enrollment conditions specified in 42 CFR 424.205(b). For online MDPP services, the administrative location of the entity is considered the entity's address on file under the Diabetes Prevention Recognition Program. Entities providing online services are not prohibited from submitting claims solely due to the beneficiary's location. There is no limit on the number of times an individual may enroll in the MDPP. The changes outlined in this section are effective from January 1, 2026, to December 31, 2030.

Back to bills

Telehealth Modernization Act

Last updated: 9/4/2025 · Introduced: 9/4/2025

Author: Tim Scott (R-SC)

TL;DR (AI)

The bill extends temporary telehealth flexibilities, including those related to geographic restrictions and originating sites, through September 30, 2027, to ensure continued access to telehealth services.
It allows for the continued provision of audio-only telehealth services and delays in-person requirements for mental health services through September 30, 2027.
The bill extends the Acute Hospital Care at Home Waiver program through 2030 and mandates a study analyzing the program's impact on patient care, costs, and outcomes.
To combat fraud, the bill establishes new requirements for durable medical equipment (DME) billing, including potential claim review for items ordered by physicians without a prior patient relationship.
The bill requires the Department of Health and Human Services to provide updated guidance on best practices for telehealth, including interpreter use and accessible communication methods for patients.

119th Congressin committeeHR. 5081(In Committee)Official page

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

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