H.R. 8261 — what changed
Preserving Telehealth, Hospital, and Ambulance Access Act
From Introduced in House to Reported in House. 4 sections amended between Introduced in House and Reported in House.
Sec. 101 Extension of certain telehealth flexibilities
changed
Removing geographic requirements and expanding originating sites for telehealth services— Section 1834(m) of the Social Security Act (42 U.S.C. 1395m) 1395m(m)) is amended—
in paragraph (2)(B)(iii), by striking “ending December 31, 2024” and inserting “ending December 31, 2026”; and
in paragraph (4)(C)(iii), by striking “ending on December 31, 2024” and inserting “ending on December 31, 2026”.
Expanding practitioners eligible to furnish telehealth services— Section 1834(m)(4)(E) of the Social Security Act (42 U.S.C. 1395m(m)(4)(E)) is amended by striking “ending on December 31, 2024” and inserting “ending on December 31, 2026”.
Extending telehealth services for federally qualified health centers and rural health clinics— Section 1834(m)(8)(A) of the Social Security Act (42 U.S.C. 1395m(m)(8)(A)) is amended by striking “ending on December 31, 2024” and inserting “ending on December 31, 2026”.
changed
Delaying the in-Person in-person requirements under medicare for mental health services furnished through telehealth and telecommunications technology—
Delay in requirements for mental health services furnished through telehealth— 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 “on or after” and all that follows through “described in section 1135(g)(1)(B))” and inserting “on or after January 1, 2027”.
Mental health visits furnished by rural health clinics— Section 1834(y)(2) of the Social Security Act (42 U.S.C. 1395m(y)(2)) is amended by striking “January 1, 2025” and all that follows through the period at the end and inserting “January 1, 2027.”.
Mental health visits furnished by Federally qualified health centers— Section 1834(o)(4)(B) of the Social Security Act (42 U.S.C. 1395m(o)(4)(B)) is amended by striking “January 1, 2025” and all that follows through the period at the end and inserting “January 1, 2027.”.
changed
Allowing for the furnishing of audio-Only audio-only telehealth services— Section 1834(m)(9) of the Social Security Act (42 U.S.C. 1395m(m)(9)) is amended by striking “ending on December 31, 2024” and inserting “ending on December 31, 2026”.
changed
Extending use of telehealth To to conduct face-to-Face face-to-face encounter prior to recertification of eligibility for hospice care— 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 “ending on December 31, 2024” and inserting “ending on December 31, 2026”; and
by inserting “, except that this subclause shall not apply in the case of such an encounter with an individual occurring on or after January 1, 2025, if such individual is located in an area that is subject to a moratorium on the enrollment of hospice programs under this title pursuant to section 1866(j)(7), if such individual is receiving hospice care from a provider that is subject to enhanced oversight under this title pursuant to section 1866(j)(3), or if such encounter is performed by a hospice physician or nurse practitioner who is not enrolled under section 1866(j) and is not an opt-out physician or practitioner (as defined in section 1802(b)(6)(D))” before the semicolon.
Program instruction authority— The Secretary of Health and Human Services may implement the amendments made by this section through program instruction or otherwise.
Sec. 104 Extending acute hospital care at home waiver flexibilities
Section 1866G of the Social Security Act (42 U.S.C. 1395cc–7) is amended—
in subsection (a)(1), by striking “2024” and inserting “2029”; and
in subsection (b)—
in the header, by striking “Study and report” and inserting “Studies and reports”;
in paragraph (1)—
in the matter preceding subparagraph (A), by striking “The Secretary” and inserting “Not later than September 30, 2024, and again not later than September 30, 2028, the Secretary”;
changed
in clause (vi), (iv), by striking “and” at the end;
changed
in clause (vii), (v), by striking the period and inserting “; and”; and
by adding at the end the following new clause:
changed
“(viii) “(vi) in the case of the second study conducted under this paragraph, the quality of care, outcomes, costs, quantity and intensity of services, and other relevant metrics between individuals who entered into the Acute Hospital Care at Home initiative directly from an emergency department compared with individuals who entered into the Acute Hospital Care at Home initiative directly from an existing inpatient stay in a hospital.”
in paragraph (2)—
in the header, by striking “Report” and inserting “Reports”; and
by inserting “and again not later than September 30, 2028,” after “2024,”; and
by striking “on the study conducted under paragraph (1).” and inserting the following:
“(A) with respect to the first report submitted under this paragraph, the first study conducted under paragraph (1); and
“(B) with respect to the second report submitted under this paragraph, the second study conducted under paragraph (1).”
Sec. 106 Enhancing certain program integrity requirements for DME under Medicare
Durable medical equipment— Section 1834(a) of the Social Security Act (42 U.S.C. 1395m(a)) is amended by adding at the end the following new paragraph:
“(23) Master List inclusion and claim review for certain items
changed
“(A) Master List inclusion—Beginning January 1, 2026, 2027, for purposes of the Master List described in section 414.234(b) of title 42, Code of Federal Regulations (or any successor regulation), an item for which payment may be made under this subsection shall be treated as having aberrant billing patterns (as such term is used for purposes of such section) if the Secretary determines that, without explanatory contributing factors (such as furnishing emergent care services), a substantial number of written orders claims for such items under this subsection are from an ordering physician or applicable practitioner with whom the individual involved does not have a prior relationship, as determined on the basis of prior payment experience.claims.
changed
“(B) Claim review—With respect to items furnished on or after January 1, 2026 2027 that are included on the Master List pursuant to subparagraph (A), if such an item is not subject to a determination of coverage in advance pursuant to paragraph (15)(C), the Secretary may conduct prepayment review of claims for payment for such item.”
Report on identifying clinical diagnostic laboratory tests at high risk for fraud and effective mitigation measures— Not later than January 1, 2026, the Inspector General of the Department of Health and Human Services shall submit to Congress a report assessing fraudulent claims for clinical diagnostic laboratory tests for which payment may be made under section 1834A of the Social Security Act (42 U.S.C. 1395m–1) and effective tools for reducing such fraudulent claims. The report shall include—
which, if any, clinical diagnostic laboratory tests are identified as being at high risk of fraudulent claims, and an analysis of the factors that contribute to such risk;
with respect to a clinical diagnostic laboratory test identified under subparagraph (A) as being at high risk of fraudulent claims—
the amount payable under such section 1834A with respect to such test;
the number of such tests furnished to individuals enrolled under part B of title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.);
whether an order for such a test was more likely to come from a provider with whom the individual involved did not have a prior relationship, as determined on the basis of prior payment experience; and
the frequency with which a claim for payment under such section 1834A included the payment modifier identified by code 59 or 91; and
suggested strategies for reducing the number of fraudulent claims made with respect to tests so identified as being at high risk, including—
an analysis of whether the Centers for Medicare & Medicaid Services can detect aberrant billing patterns with respect to such tests in a timely manner;
any strategies for identifying and monitoring the providers who are outliers with respect to the number of such tests that such providers order; and
targeted education efforts to mitigate improper billing for such tests.
Sec. 301 Revising phase-in of Medicare clinical laboratory test payment changes
changed
Revised phase-In phase-in of reductions from private payor rate implementation— Section 1834A(b)(3) of the Social Security Act (42 U.S.C. 1395m–1(b)(3)) is amended—
in subparagraph (A), by striking “2027” and inserting “2028”; and
in subparagraph (B)—
in clause (ii), by striking “2024” and inserting “2025”; and
in clause (iii), by striking “2025 through 2027” and inserting “2026 through 2028”.
Revised reporting period for reporting of private sector payment rates for establishment of Medicare payment rates— Section 1834A(a)(1)(B) of the Social Security Act (42 U.S.C. 1395m–1(a)(1)(B)) is amended—
in clause (i), by striking “2024” and inserting “2025”; and
in clause (ii), by striking “2025” each place it appears and inserting “2026”.
Implementation— The Secretary of Health and Human Services may implement the amendments made by this section by program instruction or otherwise.