H.R. 5081: Telehealth Modernization Act

This bill, titled the Telehealth Modernization Act, proposes several changes to the use and regulation of telehealth services, particularly focusing on Medicare. Here’s a summary of the main provisions:

Extension of Telehealth Flexibilities

The bill extends certain telehealth flexibilities under Medicare until September 30, 2027. This includes:

• Removing Geographic Restrictions: The requirement for patients to be in specific geographic areas to access telehealth services is removed.
• Expanding Eligible Practitioners: More types of healthcare professionals will be able to provide telehealth services.
• Support for Health Centers: Federally qualified health centers and rural health clinics will be able to offer and receive payment for telehealth services for an additional two years.

Changes to Mental Health Services

The in-person requirements for receiving mental health services through telehealth are delayed until October 1, 2027. This applies to services provided through telehealth and telecommunications technology.

Audio-Only Telehealth Services

The bill allows for audio-only telehealth services, which can now be provided until September 30, 2027, broadening access for those who might not have video capabilities.

Hospice Care Criteria

The bill enables telehealth to be used for face-to-face visits prior to recertifying eligibility for hospice care until September 30, 2027. Modified claims must indicate that these encounters were conducted through telehealth.

Acute Hospital Care at Home

Flexibilities regarding acute hospital care at home are extended to 2030, along with a requirement for an additional study on the impact of this care method by September 30, 2028. The study will assess quality of care, costs, and outcomes compared to inpatient settings.

Durable Medical Equipment Oversight

The bill introduces new requirements for oversight of claims related to durable medical equipment to prevent fraud. Effective January 1, 2028, certain items will be subject to increased scrutiny if claimed by practitioners who have not treated the patient for a significant prior period.

Guidance for Limited English Proficiency

New guidance will be developed for delivering telehealth services to individuals with limited English proficiency. This guidance will include best practices for interpreter integration, accessibility instructions, and multi-language patient materials.

In-Home Cardiac Rehabilitation

The bill allows for in-home cardiopulmonary rehabilitation services to include virtual participation on a patient’s behalf beginning September 30, 2025, until January 1, 2027, thus enhancing rehabilitation programs through telecommunication technology.

Online Diabetes Prevention Program

Starting January 1, 2026, organizations may provide online services as part of the Medicare Diabetes Prevention Program (MDPP), including synchronous or asynchronous technology delivery methods.

Reporting Requirements

Various reporting requirements are included in the bill, such as a study on the fraud risks related to clinical diagnostic laboratory tests, due by January 1, 2026, and a report following a comprehensive examination of in-home care under the acute hospital care initiative.

Relevant Companies

• AMGN (Amgen Inc.): A biotechnology company that may see increased demand for telehealth consultations related to chronic disease management.
• CSCO (Cisco Systems, Inc.): A technology company that provides teleconferencing solutions, which may see increased use in telehealth applications.
• UPST (Upstart Holdings, Inc.): A financial technology platform that may facilitate payment solutions for telehealth services.