Telehealth Extension Act of 2021
This bill expands and otherwise modifies coverage of telehealth services under Medicare.
Specifically, the bill permanently (1) removes geographic restrictions on originating sites (i.e., the location of the beneficiary), (2) allows the home of the beneficiary to serve as the originating site for all services, and (3) allows federally qualified health centers and rural health clinics to serve as the distant site (i.e., the location of the health care practitioner).
The bill also extends any Medicare telehealth flexibilities that were granted during the COVID-19 public health emergency until two years after the emergency ends and generally allows such flexibilities to be granted during any public health emergency.
In addition, the bill (1) allows for Medicare payment of outpatient critical access hospital services consisting of telehealth behavioral therapy until two years after the COVID-19 public health emergency ends; and (2) after the emergency ends, conditions payment for certain high-cost laboratory tests and durable medical equipment that are ordered via telehealth on at least one in-person visit during the preceding six-month period.
To amend titles XI and XVIII of the Social Security Act to establish 
  requirements for the provision of certain high-cost durable medical 
   equipment and laboratory testing; to extend and 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.

    This Act may be cited as the ``Telehealth Extension Act of 2021''.

SEC. 2. REQUIREMENT FOR PROVISION OF HIGH-COST DURABLE MEDICAL 
              EQUIPMENT AND LABORATORY TESTS.

    (a) High-Cost Durable Medical Equipment.--Section 1834(a)(1)(E) of 
the Social Security Act (42 U.S.C. 1395m(a)(1)(E)) is amended by adding 
at the end the following new clause:
                            ``(vi) Standards for high-cost durable 
                        medical equipment.--
                                    ``(I) Limitation on payment for 
                                high-cost durable medical equipment.--
                                Payment may not be made under this 
                                subsection for a high-cost durable 
                                medical equipment ordered by a 
                                physician or other practitioner 
                                described in clause (ii) via telehealth 
                                for an individual, unless such 
                                physician or practitioner furnished to 
                                such individual a service in-person at 
                                least once during the 6-month period 
                                prior to ordering such high-cost 
                                durable medical equipment.
                                    ``(II) High-cost durable medical 
                                equipment determination.--For purposes 
                                of this clause, the Administrator of 
                                the Centers for Medicare & Medicaid 
                                Services shall define the term `high-
                                cost durable medical equipment' and 
                                specify the durable medical equipment 
                                for which such definition shall apply.
                            ``(vii) Audit of providers and 
                        practitioners furnishing a high volume of 
                        durable medical equipment via telehealth.--
                                    ``(I) Identification of 
                                providers.--Beginning 6 months after 
                                the effective date of this clause, 
                                Medicare administrative contractors 
                                shall conduct reviews on a schedule 
                                determined by the Secretary, of claims 
                                for durable medical equipment 
                                prescribed by a physician or other 
                                practitioner described in clause (ii) 
                                during the 12-month period preceding 
                                such review to identify physicians or 
                                other practitioners with respect to 
                                whom at least 90 percent of all durable 
                                medical equipment prescribed by such 
                                physician or practitioner during such 
                                period was prescribed pursuant to a 
                                telehealth visit.
                                    ``(II) Audit.--In the case of a 
                                physician or practitioner identified 
                                under subclause (I), with respect to a 
                                period described in such subclause, the 
                                Medicare administrative contractors 
                                shall conduct audits of all claims for 
                                durable medical equipment prescribed by 
                                such physicians or practitioners to 
                                determine whether such claims comply 
                                with the requirements for coverage 
                                under this title.''.
    (b) High-Cost Laboratory Tests.--Section 1834A(b) of the Social 
Security Act (42 U.S.C. 1395m-1(b)) is amended by adding at the end the 
following new paragraph:
            ``(6) Requirement for high-cost laboratory tests.--
                    ``(A) Limitation on payment for high-cost 
                laboratory tests.--Payment may not be made under this 
                subsection for a high-cost laboratory test ordered by a 
                physician or practitioner via telehealth for an 
                individual, unless such physician or practitioner 
                furnished to such individual a service in-person at 
                least once during the 6-month period prior to ordering 
                such high-cost laboratory test.
                    ``(B) High-cost laboratory test defined.--For 
                purposes of this paragraph, the Administrator for the 
                Centers for Medicare & Medicaid Services shall define 
                the term `high-cost laboratory test' and specify which 
                laboratory tests such definition shall apply to.
            ``(7) Audit of laboratory testing ordered pursuant to 
        telehealth visit.--
                    ``(A) Identification of providers.--Beginning 6 
                months after the effective date of this paragraph, 
                Medicare administrative contractors shall conduct 
                periodic reviews on a schedule determined by the 
                Secretary, of claims for laboratory tests prescribed by 
                a physician or practitioner during the 12-month period 
                preceding such review to identify physicians or other 
                practitioners with respect to whom at least 90 percent 
                of all laboratory tests prescribed by such physician or 
                practitioner during such period was prescribed pursuant 
                to a telehealth visit.
                    ``(B) Audit.--In the case of a physician or 
                practitioner identified under subparagraph (A), with 
                respect to a period described in such subparagraph, the 
                Medicare administrative contractors shall conduct 
                audits of all claims for laboratory tests prescribed by 
                such physicians or practitioners during such period 
                beginning to determine whether such claims comply with 
                the requirements for coverage under this title.''.
    (c) Effective Date.--The amendments made by this section shall take 
effect upon the termination of the emergency period described in 
section 1135(g)(1)(B) of the Social Security Act (42 U.S.C. 1320b-
5(g)(1)(B)).

SEC. 3. REQUIREMENT TO SUBMIT NPI NUMBER FOR SEPARATELY BILLABLE 
              TELEHEALTH SERVICES.

    (a) Requirement To Submit NPI Number for Separately Billable 
Telehealth Services.--Section 1834(m) of the Social Security Act (42 
U.S.C. 1395m(m)) is amended by adding at the end the following new 
paragraph:
            ``(9) Requirement to submit npi number for separately 
        billable telehealth services.--Payment may not be made under 
        this subsection for separately billable telehealth services 
        furnished by a physician or practitioner unless such physician 
        or practitioner submits a claim for payment under the national 
        provider identification number assigned to such physician or 
        practitioner.''.
    (b) Effective Date.--The amendment made by this section shall take 
effect upon the termination of the emergency period described in 
section 1135(g)(1)(B) of the Social Security Act (42 U.S.C. 1320b-
5(g)(1)(B)).

SEC. 4. REMOVING GEOGRAPHIC REQUIREMENTS FOR TELEHEALTH SERVICES.

    Section 1834(m)(4)(C) of the Social Security Act (42 U.S.C. 
1395m(m)(4)(C)) is amended by adding at the end the following new 
clause:
                            ``(iii) Removal of geographic 
                        requirements.--The geographic requirements 
                        described in clause (i) shall not apply with 
                        respect to telehealth services furnished on or 
                        after the date of the enactment of this 
                        clause.''.

SEC. 5. EXPANDING ORIGINATING SITES.

    (a) Expanding the Home as an Originating Site.--Section 
1834(m)(4)(C)(ii)(X) of the Social Security Act (42 U.S.C. 
1395m(m)(4)(C)(ii)(X)) is amended to read as follows:
                                    ``(X) The home of an individual, 
                                but, with respect to services furnished 
                                before the date of the enactment of the 
                                `Telehealth Extension and Evaluation 
                                Act', only for purposes of section 
                                1881(b)(3)(B) or telehealth services 
                                described in paragraph (7).''.
    (b) Allowing Additional Originating Sites.--Section 
1834(m)(4)(C)(ii) of the Social Security Act (42 U.S.C. 
1395m(m)(4)(C)(ii)) is amended by adding at the end the following new 
subclause:
                                    ``(XII) Any other site determined 
                                appropriate by the Secretary at which 
                                an eligible telehealth individual is 
                                located at the time a telehealth 
                                service is furnished via a 
                                telecommunications system.''.
    (c) Parameters for New Originating Sites.--Section 1834(m)(4)(C) of 
the Social Security Act (42 U.S.C. 1395m(m)(4)(C)), as amended by 
section 4, is amended by adding at the end the following new clause:
                            ``(iv) Requirements for new sites.--
                                    ``(I) In general.--The Secretary 
                                may establish requirements for the 
                                furnishing of telehealth services at 
                                sites described in clause (ii)(XII) to 
                                provide for beneficiary and program 
                                integrity protections.
                                    ``(II) Clarification.--Nothing in 
                                this clause shall be construed to 
                                preclude the Secretary from 
                                establishing requirements for other 
                                originating sites described in clause 
                                (ii).''.
    (d) No Originating Site Facility Fee for New Sites.--Section 
1834(m)(2)(B)(ii) of the Social Security Act (42 U.S.C. 
1395m(m)(2)(B)(ii)) is amended--
            (1) in the heading, by striking ``if originating site is 
        the home'' and inserting ``for certain sites''; and
            (2) by striking ``paragraph (4)(C)(ii)(X)'' and inserting 
        ``subclause (X) or (XII) of paragraph (4)(C)''.

SEC. 6. FEDERALLY QUALIFIED HEALTH CENTERS AND RURAL HEALTH CLINICS.

    Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is 
amended--
            (1) in paragraph (4)(C)(i), in the matter preceding 
        subclause (I), by striking ``(5), (6), and (7)'' and inserting 
        ``(5) through (8)''; and
            (2) in paragraph (8)--
                    (A) in the paragraph heading by inserting ``and 
                after'' after ``during'';
                    (B) in subparagraph (A)--
                            (i) in the matter preceding clause (i), by 
                        inserting ``and after such emergency period'' 
                        after ``1135(g)(1)(B)'';
                            (ii) in clause (ii), by striking ``and'' at 
                        the end;
                            (iii) by redesignating clause (iii) as 
                        clause (iv); and
                            (iv) by inserting after clause (ii) the 
                        following new clause:
                            ``(iii) the geographic requirements 
                        described in paragraph (4)(C)(i) shall not 
                        apply with respect to such a telehealth 
                        service; and''; and
                    (C) by striking subparagraph (B) and inserting the 
                following:
                    ``(B) Payment.--
                            ``(i) In general.--A telehealth service 
                        furnished by a Federally qualified health 
                        center or a rural health clinic to an 
                        individual pursuant to this paragraph on or 
                        after the date of the enactment of this 
                        subparagraph shall be deemed to be so furnished 
                        to such individual as an outpatient of such 
                        clinic or facility (as applicable) for purposes 
                        of paragraph (1) or (3), respectively, of 
                        section 1861(aa) and payable as a Federally 
                        qualified health center service or rural health 
                        clinic service (as applicable) under the 
                        prospective payment system established under 
                        section 1834(o) or under section 1833(a)(3), 
                        respectively.
                            ``(ii) Treatment of costs for fqhc pps 
                        calculations and rhc air calculations.--Costs 
                        associated with the delivery of telehealth 
                        services by a Federally qualified health center 
                        or rural health clinic serving as a distant 
                        site pursuant to this paragraph shall be 
                        considered allowable costs for purposes of the 
                        prospective payment system established under 
                        section 1834(o) and any payment methodologies 
                        developed under section 1833(a)(3), as 
                        applicable.''.

SEC. 7. 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 4 and 5(c), is 
amended--
            (1) in clause (i), by striking ``clause (ii)'' and 
        inserting ``clauses (ii) and (v)''; and
            (2) by adding at the end the following new clause:
                            ``(v) Native american health facilities.--
                        With respect to telehealth services furnished 
                        on or after January 1, 2022, 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 Certain Native American 
Facilities.--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 (v) of paragraph (4)(C), and does not meet the 
requirement for an originating site under clauses (i) and (ii) of such 
paragraph)'' after ``the originating site''.

SEC. 8. WAIVER OF TELEHEALTH REQUIREMENTS DURING PUBLIC HEALTH 
              EMERGENCIES.

    Section 1135(g)(1) of the Social Security Act (42 U.S.C. 1320b-
5(g)(1)) is amended--
            (1) in subparagraph (A), in the matter preceding clause 
        (i), by striking ``subparagraph (B)'' and inserting 
        ``subparagraphs (B) and (C)''; and
            (2) by adding at the end the following new subparagraph:
                    ``(C) Exception for waiver of telehealth 
                requirements during public health emergencies.--For 
                purposes of subsection (b)(8), in addition to the 
                emergency period described in subparagraph (B), an 
                `emergency area' is a geographical area in which, and 
                an `emergency period' is the period during which, there 
                exists a public health emergency declared by the 
                Secretary pursuant to section 319 of the Public Health 
                Service Act.''.

SEC. 9. TWO-YEAR EXTENSION OF TELEHEALTH SERVICES FOLLOWING THE COVID-
              19 EMERGENCY PERIOD.

    Section 1135(e) of the Social Security Act (42 U.S.C. 1320b-5(e)) 
is amended by adding at the end the following new paragraph:
            ``(3) Two-year extension of telehealth services following 
        the covid-19 emergency period.--Notwithstanding any other 
        provision of this section, a waiver or modification of 
        requirements pursuant to subsection (b)(8) shall terminate on 
        the date that is two years after the last day of the emergency 
        period described in subsection (g)(1)(B).''.

SEC. 10. OUTPATIENT CRITICAL ACCESS HOSPITALS.

    (a) In General.--Notwithstanding section 1834(m) of the Social 
Security Act (42 U.S.C. 1395m(m)) and subject to subsection (b), the 
Secretary of Health and Human Services shall provide payment under 
section 1834(g) of such Act (42 U.S.C. 1395m(g)) for outpatient 
critical access hospital services consisting of behavioral therapy 
services furnished by a critical access hospital to an individual 
during the period beginning on January 1, 2021, and ending on the date 
that is two years after the last day of the emergency period described 
in section 1135(g)(1)(B) of the Social Security Act (42 U.S.C. 1320b-
5(g)(1)(B)), via telecommunications technology, notwithstanding the 
fact that such individual is not located at such hospital.
    (b) Initiation of Services Via Telehealth.--In the case of an 
individual receiving services described in subsection (a) from a 
critical access hospital during the period described in subsection (a), 
if such individual has not, prior to receiving such services, received 
in-person care at such hospital, payment shall be made to such hospital 
in accordance with such subsection only if such services complement a 
plan of care that includes in-person care to be furnished at such 
hospital not later than 1 year after the date such services are 
furnished.
    (c) Definitions.--For purposes of this section:
            (1) Critical access hospital.--The term ``critical access 
        hospital'' has the meaning given such term in section 
        1861(mm)(1) of the Social Security Act (42 U.S.C. 
        1395x(mm)(1)).
            (2) Outpatient critical access hospital services.--The term 
        ``outpatient critical access hospital services'' has the 
        meaning given such term in section 1861(mm)(3) of such Act (42 
        U.S.C. 1395x(mm)(3)).
            (3) Telecommunications technology.--The term 
        ``telecommunications technology'' means a communications system 
        permitting two-way, real-time interactive communication between 
        the individuals and health care professional and includes a 
        communications system consisting of only audio capabilities, 
        but only if such individual does not have access to a 
        communications system with audio-visual capabilities.
                                 <all>
Telehealth Extension Act of 2021
To amend titles XI and XVIII of the Social Security Act to establish requirements for the provision of certain high-cost durable medical equipment and laboratory testing; to extend and expand access to telehealth services; and for other purposes.
Telehealth Extension Act of 2021
Rep. Doggett, Lloyd