Connecting Rural Telehealth to the Future Act
This bill modifies requirements relating to coverage of telehealth services under Medicare.
Specifically, the bill extends through 2024 certain flexibilities that were initially authorized during the public health emergency relating to COVID-19. Among other things, the bill allows (1) rural health clinics and federally qualified health centers to serve as the distant site (i.e., the location of the health care practitioner), (2) the home of a beneficiary to serve as the originating site (i.e., the location of the beneficiary) for all services (rather than for only certain services), and (3) other types of practitioners to furnish telehealth services.
To amend title XVIII of the Social Security Act to protect access to 
            telehealth services under the Medicare program.

    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 ``Connecting Rural Telehealth to the 
Future Act''.

SEC. 2. REMOVING GEOGRAPHIC REQUIREMENTS AND EXPANDING ORIGINATING 
              SITES FOR TELEHEALTH SERVICES.

    Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is 
amended--
            (1) in paragraph (4)(C)(iii), by striking ``during the 151-
        day period beginning on the first day after the end of the 
        emergency period described in section 1135(g)(1)(B)'' and 
        inserting ``before January 1, 2025''; and
            (2) in paragraph (2)(B)(iii), by striking ``during the 151-
        day period beginning on the first day after the end of the 
        emergency period described in section 1135(g)(1)(B)'' and 
        inserting ``before January 1, 2025''.

SEC. 3. EXPANDING PRACTITIONERS ELIGIBLE TO FURNISH TELEHEALTH 
              SERVICES.

    Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is 
amended in paragraph (4)(E), by striking ``151-day'' and inserting 
``and ending on December 31, 2024'' after ``described in section 
1135(g)(1)(B)''.

SEC. 4. EXTENDING TELEHEALTH SERVICES FOR FEDERALLY QUALIFIED HEALTH 
              CENTERS AND RURAL HEALTH CLINICS.

    Section 1834(m)(8) of the Social Security Act (42 U.S.C. 
1395m(m)(8)) is amended in subparagraph (A), by striking ``151-day'' 
and inserting ``and ending on December 31, 2024'' after ``described in 
section 1135(g)(1)(B)''.

SEC. 5. DELAYING THE IN-PERSON REQUIREMENTS UNDER MEDICARE FOR MENTAL 
              HEALTH SERVICES FURNISHED THROUGH TELEHEALTH AND 
              TELECOMMUNICATIONS TECHNOLOGY.

    (a) In General.--Section 1834(m)(7)(B)(i) of the Social Security 
Act (42 U.S.C. 1395m(m)(7)(B)(i)) is amended in the matter preceding 
subclause (I), by striking ``the day that is the 152nd day after the 
end of the emergency period'' and inserting ``January 1, 2025''.
    (b) Payment.--Section 1834(y) of the Social Security Act (42 U.S.C. 
1395m(y)) is amended in paragraph (2), by striking ``the day that is 
the 152nd day after the end of the emergency period'' and inserting 
``January 1, 2025''.
    (c) Conforming Amendment.--Section 1834(o)(4) of the Social 
Security Act (42 U.S.C. 1395m(o)(4)) is amended in subparagraph (B), by 
striking ``the day that is the 152nd day after the end of the emergency 
period described in section 1135(g)(1)(B)'' and inserting ``January 1, 
2025''.

SEC. 6. ALLOWING FOR THE FURNISHING OF AUDIO-ONLY TELEHEALTH SERVICES.

    Section 1834(m) of Social Security Act (42 U.S.C. 1395m(m)) is 
amended--
            (1) in paragraph (1), by striking ``paragraphs (8) and 
        (9)'' and inserting ``paragraph (8)'';
            (2) by striking paragraph (9); and
            (3) in paragraph (4), by adding at the end the following 
        new subparagraph:
                    ``(G) Telecommunications system.--
                            ``(i) In general.--Notwithstanding 
                        paragraph (1) and section 410.78(a)(3) of title 
                        42, Code of Federal Regulations (or any 
                        successor regulation), subject to clause (v), 
                        the term `telecommunications system' includes, 
                        in the case of the furnishing of a specified 
                        telehealth service (as defined in clause (ii)) 
                        a communications system that uses audio-only 
                        technology.
                            ``(ii) Specified telehealth service.--In 
                        this subparagraph, the term `specified 
                        telehealth service' means a telehealth service 
                        described in clause (iii) that is furnished by 
                        a qualified provider (as defined in clause 
                        (iv)).
                            ``(iii) Telehealth service described.--A 
                        telehealth service as defined in subparagraph 
                        (F)(i).
                            ``(iv) Qualified provider defined.--For 
                        purposes of clause (ii), the term `qualified 
                        provider' means, with respect to a specified 
                        telehealth service that is furnished to an 
                        eligible telehealth individual--
                                    ``(I) a physician or practitioner 
                                who has an established patient 
                                relationship with such individual as 
                                defined by the State in which the 
                                individual is located; or
                                    ``(II) a critical access hospital 
                                (as defined in section 1861(mm)(1)), a 
                                rural health clinic (as defined in 
                                section 1861(aa)(2)), a federally 
                                qualified health center (as defined in 
                                section 1861(aa)(4)), a hospital (as 
                                defined in section 1861(e)), a 
                                hospital-based or critical access 
                                hospital-based renal dialysis center 
                                (including satellites), a skilled 
                                nursing facility (as defined in section 
                                1819(a)), a community mental health 
                                center (as defined in section 
                                1861(ff)(3)(B)), or a rural emergency 
                                hospital (as defined in section 
                                1861(kkk)(2)).
                            ``(v) Authority.--For purposes of this 
                        subparagraph, the Secretary may determine 
                        whether it is clinically appropriate to furnish 
                        a specified telehealth service via a 
                        communications system that uses audio-only 
                        technology and whether an in-person initial 
                        visit (in addition to any requirement with 
                        respect to the furnishing of an item or service 
                        in person pursuant to clause (iv)(I)) is 
                        required prior to the furnishing of such 
                        service using such technology.
                            ``(vi) Clarification regarding payment.--
                        The amount of payment for a specified 
                        telehealth service that is furnished using 
                        audio-only technology shall be equal to the 
                        amount that would have been paid for such 
                        service under this subsection had such service 
                        been furnished via any other telecommunications 
                        system authorized under this subsection.''.

SEC. 7. USE OF TELEHEALTH TO CONDUCT FACE-TO-FACE ENCOUNTER PRIOR TO 
              RECERTIFICATION OF ELIGIBILITY FOR HOSPICE CARE DURING 
              EMERGENCY PERIOD.

    Section 1814(a)(7)(D)(i)(II) of the Social Security Act (42 U.S.C. 
1395f(a)(7)(D)(i)(II)) is amended by striking ``151-day'' and inserting 
``and ending on December 31, 2024'' after ``described in section 
1135(g)(1)(B)''.

SEC. 8. EXTENSION OF EXEMPTION FOR TELEHEALTH SERVICES.

    (a) In General.--Subparagraph (E) of section 223(c)(2) of the 
Internal Revenue Code of 1986 is amended by striking ``2023''and 
inserting ``2025''.
    (b) Certain Coverage Disregarded.--Clause (ii) of section 
223(c)(1)(B) of the Internal Revenue Code of 1986 is amended by 
striking ``2023'' and inserting ``2025''.

SEC. 9. FEDERALLY QUALIFIED HEALTH CENTERS AND RURAL HEALTH CLINICS.

    Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is 
amended in paragraph (8), 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. 10. TELEHEALTH FLEXIBILITIES FOR CRITICAL ACCESS HOSPITALS.

    Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is 
amended--
            (1) in the first sentence of paragraph (1), by striking 
        ``paragraph (8)'' and inserting ``paragraphs (8) and (9)'';
            (2) in paragraph (2)(A), by striking ``paragraph (8)'' and 
        inserting ``paragraphs (8) and (9)'';
            (3) in paragraph (4)--
                    (A) in subparagraph (A), by striking ``paragraph 
                (8)'' and inserting ``paragraphs (8) and (9)''; and
                    (B) in subparagraph (F)(i), by striking ``paragraph 
                (8)'' and inserting ``paragraphs (8) and (9)''; and
            (4) by adding at the end the following new paragraph:
            ``(9) Telehealth flexibilities for critical access 
        hospitals.--
                    ``(A) In general.--On or after the date of the 
                enactment of this paragraph--
                            ``(i) the Secretary shall pay for 
                        telehealth services that are furnished between 
                        the end of the emergency period described in 
                        section 1135(g)(1)(B) and January 1, 2025, via 
                        a telecommunications system by a critical 
                        access hospital, including any practitioner 
                        authorized to provide such services within the 
                        facility, that is a qualified provider (as 
                        defined in subparagraph (B)) to an eligible 
                        telehealth individual enrolled under this part 
                        notwithstanding that the critical access 
                        hospital providing the telehealth service is 
                        not at the same location as the beneficiary, if 
                        such services complement a plan of care that 
                        includes in-person care at some point, as may 
                        be appropriate;
                            ``(ii) the amount of payment to a critical 
                        access hospital that serves as a distant site 
                        for such a telehealth service shall be 
                        determined under subparagraph (C); and
                            ``(iii) for purposes of this subsection--
                                    ``(I) the term `distant site' 
                                includes a critical access hospital 
                                that furnishes a telehealth service to 
                                an eligible telehealth individual; and
                                    ``(II) the term `telehealth 
                                services' includes behavioral health 
                                services and any other outpatient 
                                critical access hospital service that 
                                is furnished using telehealth to the 
                                extent that payment codes corresponding 
                                to services identified by the Secretary 
                                under clause (i) or (ii) of paragraph 
                                (4)(F) are listed on the corresponding 
                                claim for such critical access hospital 
                                service.
                    ``(B) Definition of qualified provider.--For 
                purposes of this subsection, the term `qualified 
                provider' means, with respect to a telehealth service 
                described in subparagraph (A)(i) that is furnished to 
                an eligible telehealth individual, a critical access 
                hospital that has an established patient relationship 
                with such individual as defined by the State in which 
                the individual is located.
                    ``(C) Payment.--The amount of payment to a critical 
                access hospital that serves as a distant site that 
                furnishes a telehealth service to an eligible 
                telehealth individual under this paragraph shall be 
                equal to 101 percent of the reasonable costs of the 
                hospital in providing such services, unless the 
                hospital makes an election under paragraph (2) of 
                section 1834(g) to be paid for such services based on 
                the methodology described in such paragraph. Telehealth 
                services furnished by a critical access hospital shall 
                be counted for purposes of determining the provider 
                productivity rate of the critical access hospital for 
                purposes of payment under such section.
                    ``(D) Implementation.--Notwithstanding any other 
                provision of law, the Secretary may implement this 
                paragraph through program instruction, interim final 
                rule, or otherwise.''.

SEC. 11. EFFECTIVE DATE.

    The amendments made by this Act shall take effect on the date of 
the enactment of this Act.
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Connecting Rural Telehealth to the Future Act
To amend title XVIII of the Social Security Act to protect access to telehealth services under the Medicare program.
Connecting Rural Telehealth to the Future Act
Rep. Smith, Adrian