Telehealth Modernization Act
- Sponsor
- Rep. Carter, Earl L. "Buddy" [R-GA-1]
- Committees
- Ways and Means Committee (primary)
- Last action
- Sep 2, 2025
Bottom line
The bill aims to preserve and expand access to telehealth and home-based care under Medicare for several more years, while also addressing program integrity and equitable access for specific populations.
What it actually does
This bill extends various Medicare telehealth flexibilities, including the waiver of geographic and originating site requirements, expansion of eligible practitioners, and coverage for audio-only services, generally until September 30, 2027. It also delays in-person requirements for mental health telehealth services until October 1, 2027. Furthermore, the bill extends the Acute Hospital Care at Home waiver program until 2030 and mandates a comprehensive study on its effectiveness. It enhances program integrity for durable medical equipment (DME) by identifying aberrant billing patterns, requires guidance on telehealth for individuals with Limited English Proficiency (LEP), and introduces flexibilities for in-home cardiopulmonary rehabilitation and virtual diabetes prevention programs.
Proponents argue
Supporters argue that extending these flexibilities ensures continued access to critical healthcare services, particularly for rural and underserved populations, improves patient convenience, and leverages technological advancements in healthcare delivery. They emphasize the benefits of home-based acute care, virtual chronic disease management, and the importance of addressing health equity through tailored telehealth guidance.
Opponents contend
Opponents might raise concerns about the long-term cost implications for Medicare of extending these flexibilities without corresponding offsets. They could also express reservations about potential for fraud and abuse, particularly with extended audio-only services or in the DME sector, and advocate for more robust data collection and oversight before making permanent policy changes.
The bill is moderately complex due to its amendments to the Social Security Act, but its concise nature allows for a reasonable review within typical legislative timelines.
Section 2(a)
Extending Telehealth Geographic and Originating Site Flexibilities
This provision amends Section 1834(m) of the Social Security Act to extend the waiver of geographic requirements and the expansion of originating sites for telehealth services under Medicare. This flexibility, which allows Medicare beneficiaries to receive telehealth services from any location, including their homes, and from a wider range of healthcare facilities, is extended from September 30, 2025, to September 30, 2027.
Supporters argue
Supporters argue that this extension is crucial for maintaining access to care, particularly for vulnerable populations, and for allowing healthcare systems to continue leveraging telehealth's efficiency and convenience.
Critics contend
While generally popular, some might express concerns about the long-term fiscal impact of these extensions without a clear plan for permanent integration or cost offsets.
Tradeoffs
Balancing the benefits of broad access and convenience against potential concerns regarding overutilization or the need for more structured, permanent policy.
Section 2(b)
Expanding Eligible Telehealth Practitioners
This section amends Section 1834(m)(4)(E) of the Social Security Act to extend the period during which a broader range of healthcare practitioners are eligible to furnish telehealth services under Medicare. The extension moves the expiration date from September 30, 2025, to September 30, 2027, allowing more types of healthcare professionals, beyond physicians, to provide telehealth services and be reimbursed by Medicare.
Section 2(c)
Extending Telehealth Services for Federally Qualified Health Centers and Rural Health Clinics
This provision amends Section 1834(m)(8) of the Social Security Act to extend the ability of Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to furnish telehealth services and receive appropriate payment. The extension is from September 30, 2025, to September 30, 2027. It also establishes a specific payment rule for fiscal years 2026 and 2027, ensuring these services are paid as FQHC/RHC services under their respective prospective payment systems or all-inclusive rates.
Section 2(d)
Delaying In-Person Requirements for Mental Health Telehealth Services
This section amends various parts of the Social Security Act to delay the requirement for an in-person visit prior to receiving mental health services via telehealth under Medicare. The delay shifts the effective date of this requirement from October 1, 2025, to October 1, 2027. This applies broadly to mental health services furnished through telehealth, as well as those provided by rural health clinics and federally qualified health centers.
Section 2(e)
Extending Coverage for Audio-Only Telehealth Services
This provision amends Section 1834(m)(9) of the Social Security Act to extend the period during which audio-only telecommunications technology can be used to furnish telehealth services under Medicare. The extension moves the expiration date from September 30, 2025, to September 30, 2027, ensuring that beneficiaries without access to video technology can continue to receive certain telehealth services.
Section 4(a)
Extending Acute Hospital Care at Home Waiver Flexibilities
This provision amends Section 1866G(a)(1) of the Social Security Act to extend the Acute Hospital Care at Home waiver flexibilities under Medicare. The extension moves the expiration date from 2025 to 2030, allowing hospitals to continue providing acute-level care to eligible patients in their homes under a waiver from standard inpatient regulations.
Section 4(b)
Mandating Comprehensive Study on Acute Hospital Care at Home
This section requires the Secretary of Health and Human Services to conduct a comprehensive study by September 30, 2028, on the Acute Hospital Care at Home initiative. The study must analyze patient selection criteria, compare quality of care, outcomes, costs, and service intensity between home-based and inpatient settings, and examine socioeconomic information of treated individuals. It also mandates analysis to control for selection bias, with a report to Congress on its findings.
Section 5(a)
Strengthening Program Integrity for Durable Medical Equipment
This provision amends Section 1834(a) of the Social Security Act to enhance program integrity for Durable Medical Equipment (DME), prosthetics, and orthotics. Beginning January 1, 2028, an item will be deemed to have "aberrant billing patterns" if a substantial number of claims for it are ordered by a physician or practitioner who has not previously furnished any item or service to the individual in the prior 24 months. The Secretary may then conduct prepayment review of claims for such items, aiming to reduce fraud and abuse.
Section 6
Guidance for Telehealth Services to Individuals with Limited English Proficiency
This section requires the Secretary of Health and Human Services, within one year of enactment, to issue or update guidance on best practices for furnishing telehealth services to individuals with Limited English Proficiency (LEP). The guidance will cover integrating interpreters, providing accessible instructions for telecommunications systems, improving digital patient portal access, using multi-person video calls for interpretation, and offering patient materials in multiple languages.
Section 7
Allowing In-Home Cardiopulmonary Rehabilitation
This provision amends Section 1861(eee)(2) of the Social Security Act to allow for in-home cardiopulmonary rehabilitation services furnished through audio and video real-time communications technology (excluding audio-only) for outpatients. This flexibility is provided for services furnished from September 30, 2025, to January 1, 2027. It also clarifies that the virtual presence of a physician or other specified practitioner is sufficient for supervision of these services.
This provision limits the extension of telehealth for hospice face-to-face encounters by disallowing its use if the individual is located in an area subject to a hospice enrollment moratorium, if the provider is subject to enhanced oversight, or if the encounter is performed by a hospice physician or nurse practitioner who is not enrolled under section 1866(j) or is an opt-out practitioner.
Section 2(f)(2)
Why it matters:This is a standard legislative technique to add specific program integrity guardrails to a broader flexibility, often to address known vulnerabilities or prevent abuse in a particular sector (hospice care has faced fraud concerns). It's not necessarily evasive but requires careful reading.
Case for: Supporters argue this is a crucial safeguard to prevent fraud and abuse in hospice care, an area historically susceptible to such issues, while still allowing telehealth flexibility where appropriate and for legitimate providers.
Case against: Some might argue it adds complexity and could inadvertently limit access to hospice care in certain situations, even for legitimate providers, if the criteria are too broad or difficult to navigate.
Estimated impact: Reduces potential for fraudulent claims in high-risk hospice scenarios, protecting Medicare funds and ensuring appropriate care.
This section mandates that any hospice claim for a face-to-face encounter conducted via telehealth on or after January 1, 2026, must include one or more modifiers or codes (as specified by the Secretary) to indicate that such encounter was conducted via telehealth.
Section 3
Why it matters:This is a technical requirement for claims processing, often separated for clarity or to highlight its importance as a new administrative step for data collection and oversight. It's a common legislative practice for implementing new billing rules.
Case for: Supporters argue this modifier is essential for data collection, monitoring, and identifying potential fraud or inappropriate use of telehealth in hospice, allowing CMS to track and analyze these encounters effectively.
Case against: Hospice providers might view this as an additional administrative burden, requiring updates to billing systems and processes, which could incur compliance costs.
Estimated impact: Improves data transparency and oversight for hospice telehealth services, aiding in program integrity efforts and future policy development.
This provision requires the Inspector General of the Department of Health and Human Services to submit a report to Congress by January 1, 2026, assessing fraud risks relating to claims for clinical diagnostic laboratory tests under Medicare and identifying effective tools for reducing such fraudulent claims. The report should include information on high-risk tests, payment amounts, provider relationships, and billing patterns.
Section 5(b)
Why it matters:Reporting requirements are common legislative tools to gather information and inform future policy, rather than directly amending the Social Security Act's core provisions. It's a mechanism for oversight and future legislative action.
Case for: Supporters argue this report is vital for proactively identifying and addressing fraud in a rapidly evolving and high-cost area of Medicare, protecting taxpayer dollars and ensuring the integrity of laboratory testing services.
Case against: No direct opposition is typically raised, but some might argue that resources could be better spent on immediate enforcement actions rather than studies, or that the scope of the report is too broad.
Estimated impact: Provides data and recommendations that could lead to significant savings and improved program integrity in the future by targeting fraud in clinical diagnostic laboratory tests.