[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 2741 Introduced in Senate (IS)]
<DOC>
116th CONGRESS
1st Session
S. 2741
To amend title XVIII of the Social Security Act to expand access to
telehealth services, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
October 30, 2019
Mr. Schatz (for himself, Mr. Wicker, Mr. Cardin, Mr. Thune, Mr. Warner,
and Mrs. Hyde-Smith) introduced the following bill; which was read
twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to expand access to
telehealth services, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Creating
Opportunities Now for Necessary and Effective Care Technologies
(CONNECT) for Health Act of 2019'' or the ``CONNECT for Health Act of
2019''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings and sense of Congress.
Sec. 3. Expanding the use of telehealth through the waiver of certain
requirements.
Sec. 4. Expanding the use of telehealth for mental health services.
Sec. 5. Use of telehealth in emergency medical care.
Sec. 6. Improvements to the process for adding telehealth services.
Sec. 7. Rural health clinics and federally qualified health centers.
Sec. 8. Native American health facilities.
Sec. 9. Waiver of telehealth restrictions during national emergencies.
Sec. 10. Use of telehealth in recertification for hospice care.
Sec. 11. Clarification for fraud and abuse laws regarding technologies
provided to beneficiaries.
Sec. 12. Study and report on increasing access to telehealth services
in the home.
Sec. 13. Analysis of telehealth waivers in alternative payment models.
Sec. 14. Model to allow additional health professionals to furnish
telehealth services.
Sec. 15. Testing of models to examine the use of telehealth under the
Medicare program.
SEC. 2. FINDINGS AND SENSE OF CONGRESS.
(a) Findings.--Congress finds the following:
(1) The use of technology in health care and coverage of
telehealth services are rapidly evolving.
(2) Research has found that telehealth services can expand
access to care, improve the quality of care, and reduce
spending, and that patients receiving telehealth services are
satisfied with their experiences.
(3) Health care workforce shortages are a significant
problem in many areas and for many types of health care
clinicians.
(4) Telehealth increases access to care in areas with
workforce shortages and for individuals who live far away from
health care facilities, have limited mobility or
transportation, or have other barriers to accessing care.
(5) The use of health technologies can strengthen the
expertise of the health care workforce, including by connecting
clinicians to specialty consultations.
(6) Utilization of telehealth services in Medicare remains
low, with only 0.25 percent of Medicare fee-for-service
beneficiaries utilizing telehealth services in 2016.
(b) Sense of Congress.--It is the sense of Congress that--
(1) health care providers can furnish safe, effective, and
high-quality health care services through telehealth; and
(2) barriers to the use of telehealth should be removed.
SEC. 3. EXPANDING THE USE OF TELEHEALTH THROUGH THE WAIVER OF CERTAIN
REQUIREMENTS.
(a) In General.--Section 1834(m) of the Social Security Act (42
U.S.C. 1395m(m)) is amended--
(1) in paragraph (4)(C)(i), by striking ``and (7)'' and
inserting ``(7), and (8)''; and
(2) by adding at the end the following:
``(8) Authority to waive requirements and limitations if
certain conditions met.--
``(A) In general.--Notwithstanding the preceding
provisions of this subsection, in the case of
telehealth services furnished on or after January 1,
2021, the Secretary may waive any restriction
applicable to payment for telehealth services under
this subsection that is described in subparagraph (B),
but only if the Secretary determines that such waiver
would not deny or limit the coverage or provision of
benefits under this title, and--
``(i) the Secretary determines that the
waiver is expected to reduce spending under
this title without reducing the quality of care
or improve the quality of patient care without
increasing spending; or
``(ii) the waiver would apply to telehealth
services furnished in originating sites located
in a high-need health professional shortage
area (as designated pursuant to section
332(a)(1)(A) of the Public Health Service Act
(42 U.S.C. 254e(a)(1)(A))).
``(B) Restrictions described.--For purposes of this
paragraph, restrictions applicable to payment for
telehealth services under paragraph (1) are--
``(i) requirements relating to
qualifications for an originating site under
paragraph (4)(C)(ii);
``(ii) any geographic limitations under
paragraph (4)(C)(i) (other than applicable
State law requirements, including State
licensure requirements);
``(iii) any limitation on the type of
technology used to furnish telehealth services;
``(iv) any limitation on the type of
provider of services or supplier who may
furnish telehealth services (other than the
requirement that the provider of services or
supplier is enrolled under this title);
``(v) any limitation on specific services
designated as telehealth services pursuant to
this subsection (provided the Secretary
determines that such services are clinically
appropriate to furnish remotely); or
``(vi) any other limitation relating to the
furnishing of telehealth services under this
title identified by the Secretary.
``(C) Public comment.--The Secretary shall
establish a process by which stakeholders may (on at
least an annual basis) provide public comment for
waivers under this paragraph.
``(D) Periodic review of waivers.--The Secretary
shall periodically, but not more often than every 3
years, reassess each waiver under this paragraph to
determine whether the waiver continues to meet the
conditions applicable under subparagraph (A).''.
(b) Posting of Information.--Not later than 2 years after the date
on which a waiver under section 1834(m)(8) of the Social Security Act,
as added by subsection (a), first becomes effective, and at least
biennially thereafter, the Secretary of Health and Human Services shall
post on the internet website of the Centers for Medicare & Medicaid
Services--
(1) the number of Medicare beneficiaries receiving
telehealth services by reason of each waiver under such
section;
(2) the impact of such waivers on expenditures and
utilization under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.); and
(3) other outcomes, as determined appropriate by the
Secretary.
SEC. 4. EXPANDING THE USE OF TELEHEALTH FOR MENTAL HEALTH SERVICES.
(a) In General.--Section 1834(m) of the Social Security Act (42
U.S.C. 1395m(m)), as amended by section 3, is amended--
(1) in paragraph (4)(C)(i), by striking ``and (8)'' and
inserting ``(8), and (9)''; and
(2) by adding at the end the following:
``(9) Treatment of mental health services furnished through
telehealth.--The geographic requirements described in paragraph
(4)(C)(i) (other than applicable State law requirements,
including State licensure requirements) shall not apply with
respect to telehealth services that are mental health services
(as determined by the Secretary) furnished on or after January
1, 2021, to an eligible telehealth individual at an originating
site described in paragraph (4)(C)(ii) (other than an
originating site described in subclause (IX) of such
paragraph).''.
(b) Inclusion of the Home as an Originating Site.--Section
1834(m)(4)(C)(ii)(X) of such Act (42 U.S.C. 1395m(m)(4)(C)(ii)(X)) is
amended by striking ``paragraph (7)'' and inserting ``paragraphs (7)
and (9)''.
(c) Additional Services.--As part of the implementation of the
amendments made by this section, the Secretary of Health and Human
Services shall consider whether additional services should be added to
the services specified in paragraph (4)(F)(i) of section 1834(m) of
such Act (42 U.S.C. 1395m) for authorized payment under paragraph (1)
of such section.
SEC. 5. USE OF TELEHEALTH IN EMERGENCY MEDICAL CARE.
(a) In General.--Section 1834(m) of the Social Security Act (42
U.S.C. 1395m(m)), as amended by sections 3 and 4, is amended--
(1) in paragraph (4)(C)(i), by striking ``and (9)'' and
inserting ``(9), and (10)''; and
(2) by adding at the end the following:
``(10) Treatment of emergency medical care furnished
through telehealth.--The geographic requirements described in
paragraph (4)(C)(i) (other than applicable State law
requirements, including State licensure requirements) shall not
apply with respect to telehealth services that are services for
emergency medical care (as determined by the Secretary)
furnished on or after January 1, 2021, to an eligible
telehealth individual at an originating site described in
subclause (II), (V), or (VII) of paragraph (4)(C)(ii).''.
(b) Additional Services.--As part of the implementation of the
amendments made by this section, the Secretary of Health and Human
Services shall consider whether additional services should be added to
the services specified in paragraph (4)(F)(i) of section 1834(m) of
such Act (42 U.S.C. 1395m) for authorized payment under paragraph (1)
of such section.
SEC. 6. IMPROVEMENTS TO THE PROCESS FOR ADDING TELEHEALTH SERVICES.
The Secretary shall undertake a review of the process established
pursuant to section 1834(m)(4)(F)(ii) of the Social Security Act (42
U.S.C. 1395m(m)(4)(F)(ii)), and based on the results of such review--
(1) implement revisions to the process so that the criteria
to add services prioritizes, as appropriate, improved access to
care through telehealth services; and
(2) provide clarification on what requests to add
telehealth services under such process should include.
SEC. 7. RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS.
(a) Expansion of Originating Sites.--Section 1834(m)(4)(C) of the
Social Security Act (42 U.S.C. 1395m(m)(4)(C)), as amended by sections
3, 4, and 5, is amended--
(1) in clause (i), by striking ``and (10)'' and inserting
``and (10), and subject to clause (iii),''; and
(2) by adding at the end the following new clause:
``(iii) Rural health clinics and federally
qualified health centers.--The term
`originating site' shall also include any
Federally qualified health center and any rural
health clinic (as such terms are defined in
section 1861(aa)) at which the eligible
telehealth individual is located at the time
the service is furnished via a
telecommunications system, whether or not the
individual is located in an area described in
clause (i), insofar as such sites are not
otherwise included in the definition of
originating site under such clause, subject to
applicable State law requirements, including
State licensure requirements.''.
(b) Expansion of Distant Sites.--Section 1834(m) of the Social
Security Act (42 U.S.C. 1395m(m)) is amended--
(1) in the first sentence of paragraph (1)--
(A) by striking ``or a practitioner (described in
section 1842(b)(18)(C))'' and inserting ``, a
practitioner (described in section 1842(b)(18)(C)), a
Federally qualified health center, or a rural health
clinic''; and
(B) by striking ``or practitioner'' and inserting
``, practitioner, Federally qualified health center, or
rural health clinic''; and
(2) in paragraph (2)(A)--
(A) by inserting ``or to a Federally qualified
health center or rural health clinic that serves as a
distant site'' after ``a distant site''; and
(B) by striking ``such physician or practitioner''
and inserting ``such physician, practitioner, Federally
qualified health center, or rural health clinic''; and
(3) in paragraph (4)--
(A) in subparagraph (A), by inserting ``and
includes a Federally qualified health center or rural
health clinic that furnishes a telehealth service to an
eligible individual'' before the period at the end; and
(B) in subparagraph (F), by adding at the end the
following new clause:
``(iii) Inclusion of rural health clinic
services and federally qualified health center
services furnished using telehealth.--For
purposes of this subparagraph, the term
`telehealth services' includes a rural health
clinic service or Federally qualified health
center service that is furnished using
telehealth to the extent that payment codes
corresponding to services identified by the
Secretary under clause (i) or (ii) are listed
on the corresponding claim for such rural
health clinic service or Federally qualified
health center service.''.
(c) Effective Date.--The amendments made by this section shall
apply to services furnished on or after January 1, 2021.
SEC. 8. NATIVE AMERICAN HEALTH FACILITIES.
(a) In General.--Section 1834(m)(4)(C) of the Social Security Act
(42 U.S.C. 1395m(m)(4)(C)), as amended by sections 3, 4, 5, and 7, is
amended--
(1) in clause (i), by striking ``clause (iii)'' and
inserting ``clauses (iii) and (iv)''; and
(2) by adding at the end the following new clause:
``(iv) Native american health facilities.--
The originating site requirements described in
clauses (i) and (ii) shall not apply with
respect to a facility of the Indian Health
Service, whether operated by such Service, or
by an Indian tribe (as that term is defined in
section 4 of the Indian Health Care Improvement
Act (25 U.S.C. 1603)) or a tribal organization
(as that term is defined in section 4 of the
Indian Self-Determination and Education
Assistance Act (25 U.S.C. 5304)), or a facility
of the Native Hawaiian health care systems
authorized under the Native Hawaiian Health
Care Improvement Act (42 U.S.C. 11701 et
seq.).''.
(b) No Originating Site Facility Fee for New Sites.--Section
1834(m)(2)(B)(i) of the Social Security Act (42 U.S.C.
1395m(m)(2)(B)(i)) is amended, in the matter preceding subclause (I),
by inserting ``(other than an originating site that is only described
in clause (iv) of paragraph (4)(C), and does not meet the requirement
for an originating site under clause (i) of such paragraph)'' after
``the originating site''.
(c) Effective Date.--The amendments made by this section shall
apply to services furnished on or after January 1, 2021.
SEC. 9. WAIVER OF TELEHEALTH RESTRICTIONS DURING NATIONAL EMERGENCIES.
Section 1135(b) of the Social Security Act (42 U.S.C. 1320b-5(b))
is amended--
(1) in paragraph (6), by striking ``and'' after the
semicolon;
(2) in paragraph (7), by striking the period at the end and
inserting ``; and''; and
(3) by adding at the end the following:
``(8) requirements for payment for telehealth services
under section 1834(m).''.
SEC. 10. USE OF TELEHEALTH IN RECERTIFICATION FOR HOSPICE CARE.
(a) In General.--Section 1814(a)(7)(D)(i) of the Social Security
Act (42 U.S.C. 1395f(a)(7)(D)(i)) is amended by inserting ``(including
through use of telehealth, notwithstanding the requirements in section
1834(m)(4)(C))'' after ``face-to-face encounter''.
(b) GAO Report.--Not later than 3 years after the date of enactment
of this Act, the Comptroller General of the United States shall submit
a report to Congress evaluating the impact of the amendment made by
subsection (a) on--
(1) the number and percentage of beneficiaries recertified
for the Medicare hospice benefit at 180 days and for subsequent
benefit periods;
(2) the appropriateness for hospice care of the patients
recertified through the use of telehealth; and
(3) any other factors determined appropriate by the
Comptroller General.
SEC. 11. CLARIFICATION FOR FRAUD AND ABUSE LAWS REGARDING TECHNOLOGIES
PROVIDED TO BENEFICIARIES.
Section 1128A(i)(6) of the Social Security Act (42 U.S.C. 1320a-
7a(i)(6)) is amended--
(1) in subparagraph (I), by striking ``; or'' and inserting
a semicolon;
(2) in subparagraph (J), by striking the period at the end
and inserting ``; or''; and
(3) by adding at the end the following new subparagraph:
``(K) the provision of technologies (as defined by
the Secretary) on or after the date of the enactment of
this subparagraph, by a provider of services or
supplier (as such terms are defined for purposes of
title XVIII) directly to an individual who is entitled
to benefits under part A of title XVIII, enrolled under
part B of such title, or both, for the purpose of
furnishing telehealth services, remote patient
monitoring services, or other services furnished
through the use of technology (as defined by the
Secretary), if--
``(i) the technologies are not offered as
part of any advertisement or solicitation; and
``(ii) the provision of the technologies
meets any other requirements set forth in
regulations promulgated by the Secretary.''.
SEC. 12. STUDY AND REPORT ON INCREASING ACCESS TO TELEHEALTH SERVICES
IN THE HOME.
(a) MedPAC Study.--The Medicare Payment Advisory Commission (in
this section referred to as the ``Commission'') shall conduct a study
on increasing access under the Medicare program under title XVIII of
the Social Security Act (42 U.S.C. 1395 et seq.) to telehealth services
in the home. Such study shall include an analysis of the following:
(1) How different payers allow the home to be an
originating site for telehealth services.
(2) Particular types of telehealth services or subgroups of
beneficiaries with respect to which allowing the home to be an
originating site under the Medicare program would be suitable.
(b) Report.--Not later than 24 months after the date of the
enactment of this Act, the Commission shall submit to Congress a report
containing the results of the study conducted under subsection (a),
together with recommendations for such legislation and administrative
action as the Commission determines appropriate.
SEC. 13. ANALYSIS OF TELEHEALTH WAIVERS IN ALTERNATIVE PAYMENT MODELS.
The second sentence of section 1115A(g) of the Social Security Act
(42 U.S.C. 1315a(g)) is amended by inserting ``an analysis of waivers
under section (d)(1) related to telehealth and the impact on quality
and spending under the applicable titles of such waivers,'' after
``subsection (c),''.
SEC. 14. MODEL TO ALLOW ADDITIONAL HEALTH PROFESSIONALS TO FURNISH
TELEHEALTH SERVICES.
Section 1115A(b)(2)(B) of the Social Security Act (42 U.S.C.
1315a(b)(2)(B)) is amended by adding at the end the following new
clause:
``(xxviii) Allowing health professionals,
such as those described in section
1819(b)(5)(G) or section 1861(ll)(4)(B), who
are not otherwise eligible under section
1834(m) to furnish telehealth services to
furnish such services.''.
SEC. 15. TESTING OF MODELS TO EXAMINE THE USE OF TELEHEALTH UNDER THE
MEDICARE PROGRAM.
Section 1115A(b)(2) of the Social Security Act (42 U.S.C.
1315a(b)(2)) is amended by adding at the end the following new
subparagraph:
``(D) Testing models to examine use of telehealth
under medicare.--The Secretary shall consider testing
under this subsection models to examine the use of
telehealth under title XVIII.''.
<all>
CONNECT for Health Act of 2019
#2741 | S Congress #116
Policy Area: Health
Subjects: Advisory bodiesCongressional oversightEmergency medical services and trauma careGovernment information and archivesGovernment studies and investigationsHealth care costs and insuranceHealth care coverage and accessHealth care qualityHealth facilities and institutionsHealth personnelHealth programs administration and fundingHealth technology, devices, suppliesLong-term, rehabilitative, and terminal careMedicareMental healthMinority healthRural conditions and developmentTelephone and wireless communication
Last Action: Read twice and referred to the Committee on Finance. (10/30/2019)
Bill Text Source: Congress.gov
Summary and Impacts
Original Text