H.R. 7444

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7444 Introduced in House (IH)]

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119th CONGRESS
2d Session
H. R. 7444

To amend title XVIII of the Social Security Act to protect access to 
telehealth services under the Medicare program.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

February 9, 2026

Mr. Pappas (for himself and Mr. Nunn of Iowa) introduced the following 
bill; which was referred to the Committee on Energy and Commerce, and 
in addition to the Committee on Ways and Means, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
of such provisions as fall within the jurisdiction of the committee 
concerned

_______________________________________________________________________

A BILL

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 ``Protecting Rural Telehealth Access 
Act''.

SEC. 2. ELIMINATION OF RESTRICTIONS RELATING TO TELEHEALTH SERVICES.

(a) Elimination of Geographic Requirements for Originating Sites.--
Section 1834(m)(4)(C) of the Social Security Act (42 U.S.C. 
1395m(m)(4)(C)) is amended--
(1) in clause (i), in the matter preceding subclause (I), 
by striking ``clause (iii)'' and inserting ``clauses (iii) and 
(iv)''; and
(2) by adding at the end the following new clause:
``(iv) Elimination of geographic 
requirements for originating sites.--The 
geographic requirements described in clause (i) 
shall not apply with respect to telehealth 
services furnished on or after January 1, 
2027.''.
(b) Elimination of Restrictions in Which Telehealth Services May Be 
Furnished in the Home.--Section 1834(m)(4)(C)(ii)(X) of the Social 
Security Act (42 U.S.C. 1395m(m)(4)(C)(i)(X)) is amended to read as 
follows:
``(X)(aa) For the period beginning 
on the date of the enactment of this 
subclause and ending on December 31, 
2026, the home of an individual but 
only for purposes of section 
1881(b)(3)(B) or telehealth services 
described in paragraph (7).
``(bb) For the period beginning on 
or after January 1, 2027, the home of 
an individual.''.
(c) Elimination of Restrictions on Store-and-Forward 
Technologies.--The second sentence of section 1834(m)(1) of the Social 
Security Act (42 U.S.C. 1395m(m)(1)) is amended by striking ``in the 
case of any Federal telemedicine demonstration program conducted in 
Alaska or Hawaii,''.

SEC. 3. 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 
``and (9)'' and inserting ``(9), and (10)'';
(2) in paragraph (2)(A), by striking ``paragraph (8)'' and 
inserting ``paragraphs (8) and (10)'';
(3) in paragraph (4)--
(A) in subparagraph (A), by striking ``paragraph 
(8)'' and inserting ``paragraphs (8) and (10)''; and
(B) in subparagraph (F)(i), by striking ``paragraph 
(8)'' and inserting ``paragraphs (8) and (10)''; and
(4) by adding at the end the following new paragraph:
``(10) 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 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. 4. EXTENDING MEDICARE TELEHEALTH FLEXIBILITIES 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)), as amended by section 4113(c) of division FF of the 
Consolidated Appropriations Act, 2023 (Public Law 117-328), is 
amended--
(1) in subparagraph (A), in the matter preceding clause 
(i), by inserting ``, and on or after January 1, 2027'' after 
``December 31, 2024'';
(2) 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 eligible 
telehealth individual pursuant to this 
paragraph or after the date of the enactment of 
this subparagraph shall be reimbursed under 
this title at a separate telehealth payment 
rate as determined under the methodology 
established by the Secretary pursuant to clause 
(ii).
``(ii) Payment methodology.--The Secretary 
shall establish a methodology for determining 
the appropriate payment rate for telehealth 
services described in clause (i). Such 
methodology shall consider--
``(I) the geography of Federally 
qualified health centers and rural 
health clinics;
``(II) costs associated with the 
delivery of such telehealth services as 
allowable costs for the center or 
clinic; and
``(III) the full cost of providing 
the services via telehealth.
``(iii) Implementation.--
``(I) Coding system.--The Secretary 
shall establish an effective coding 
system for telehealth services 
described in clause (i) that is 
reflective of the services provided at 
a center or clinic.
``(II) Implementation.--
Notwithstanding any other provision of 
law, the Secretary may implement this 
subparagraph through program 
instruction, interim final rule, or 
otherwise.''; and
(3) by adding at the end the following new subparagraph:
``(C) Requirement during additional period.--
``(i) In general.--Beginning on January 1, 
2027, payment may only be made under this 
paragraph for a telehealth service described in 
subparagraph (A)(i) that is furnished to an 
eligible telehealth individual if such service 
is furnished by a qualified provider (as 
defined in clause (ii)).
``(ii) Definition of qualified provider.--
For purposes of this subparagraph, 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 Federally qualified 
health center or rural health clinic that has 
an established patient relationship with such 
individual as defined by the State in which the 
individual is located.''.

SEC. 5. ALLOWANCE OF CERTAIN TELEHEALTH SERVICES FURNISHED USING AUDIO-
ONLY TECHNOLOGY.

Section 1834(m)(4) of the Social Security Act (42 U.S.C. 
1395m(m)(4)) is amended 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), 
on or after January 1, 2027, 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.--
Subject to clause (vi), a telehealth service 
described in this clause is a telehealth 
service consisting of--
``(I) evaluation and management 
services;
``(II) behavioral health counseling 
and educational services; and
``(III) other services determined 
appropriate by the Secretary.
``(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) Review.--
``(I) In general.--Not later than 5 
years after the date of the enactment 
of this subparagraph, the Secretary 
shall conduct a review of the 
furnishing of specified telehealth 
services through audio-only technology 
pursuant to this paragraph. Such review 
shall include an analysis of the impact 
of the roll out of broadband technology 
and whether the use of audio-only 
technology is necessary to ensure 
access to such telehealth services.
``(II) Redetermination of specified 
telehealth services.--The Secretary 
may, based on the review conducted 
under subclause (I), provide for the 
addition or deletion of services (and 
HCPCS codes), as appropriate, to those 
specified in clause (ii) that may be 
furnished using audio-only technology 
and authorized for payment pursuant to 
this subparagraph.
``(vii) 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. 6. SENSE OF CONGRESS REGARDING EXPANSION OF ELIGIBLE PRACTITIONERS 
THAT MAY FURNISH TELEHEALTH SERVICES.

It is the sense of Congress that the expansion of eligible 
practitioners that may furnish telehealth services (as defined in 
section 1834(m)(4)(F) of the Social Security Act (42 U.S.C. 
1395m(m)(4)(F))) during the emergency period described in section 
1135(g)(1)(B) of such Act (42 U.S.C. 1320b-5(g)(1)(B)) should be 
extended on a permanent basis.
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