H.R. 5496: Helping Ensure Access to Local TeleHealth Act of 2025

This bill, titled the Helping Ensure Access to Local TeleHealth Act of 2025, aims to amend the Social Security Act to expand and make permanent certain telehealth services provided under Medicare. Here are the key provisions of the bill:

Permanent Payments for Telehealth Services

The bill establishes permanent cost-related payments for telehealth services delivered by federally qualified health centers (FQHCs) and rural health clinics (RHCs). This means that Medicare will consistently reimburse these clinics for telehealth services, not just during specific emergency periods.

Inclusion of Audio-Only Telehealth Services

The bill broadens the definition of telehealth to include audio-only communications. Specifically, it defines telehealth services as two-way, real-time communications that can be either audiovisual or audio-only. This change acknowledges the value of audio-only interactions, which can be crucial for patients without access to video capabilities.

Implementation Timeline

Within 60 days of the bill's enactment, the Secretary of Health and Human Services is required to update regulations to reflect the new definitions and ensure that telehealth services provided by FQHCs and RHCs are recognized as outpatient services for payment purposes.

Removal of Originating Site Requirements

The legislation removes the geographic and site requirements for telehealth services delivered by FQHCs and RHCs. Previously, telehealth services could only be reimbursed if the patient was located at specific originating sites. With this bill, patients can access telehealth services regardless of their location, making it more accessible to rural and underserved populations.

Cost Consideration for Reimbursement

The bill specifies that costs incurred during the delivery of telehealth services by FQHCs and RHCs will be considered allowable costs under various payment systems. This framework is expected to facilitate more consistent funding for these clinics, enabling them to provide telehealth services without financial barriers.

Special Payment Rules

The bill introduces special payment rules that specify no facility fee will be paid to originating sites for telehealth services provided by FQHCs and RHCs, unless those sites meet certain criteria listed in the legislation. This provision appears to aim at controlling costs and ensuring that payments are appropriately allocated.

Conclusion

The bill aims to enhance access to telehealth services for Medicare recipients, particularly in rural and underserved areas, by making payments for telehealth permanent and removing previous restrictions on service delivery locations.

Relevant Companies

• TDOC - Teladoc Health: As a major telehealth provider, Teladoc could benefit from increased utilization of telehealth services due to expanded Medicare reimbursements.
• CMD - Caremedix: This company provides telehealthcare services and could see growth in demand as telehealth coverage expands under Medicare.
• AMED - Amedisys: Provides home health care and telehealth services that may qualify for new Medicare payments, potentially increasing their revenue.