Preserving Telehealth, Hospital, and Ambulance Access Act

This bill extends various Medicare flexibilities and payment adjustments, including telehealth, hospital, and ambulance services, through 2026 or 2029, and includes offsets and program integrity measures.

Title I, Preserving Patients' Access to Care in the Home: Extends telehealth flexibilities, such as removing geographic requirements and expanding originating sites, through December 31, 2026. It delays in-person requirements for mental health services via telehealth until January 1, 2027, and extends audio-only telehealth services through 2026. It also extends the use of telehealth for hospice care recertification through 2026, with exceptions for certain areas. The Secretary of Health and Human Services must issue guidance on telehealth for individuals with limited English proficiency within one year. A modifier for hospice care recertifications via telehealth is established. The Acute Hospital Care at Home waiver is extended through 2029, with additional studies and reports required. A report on wearable medical devices is due within 18 months. Program integrity requirements for durable medical equipment are enhanced, including a master list for items with aberrant billing patterns and prepayment review. A report on fraudulent clinical diagnostic lab tests is due by January 1, 2026.

Title II, Sustaining Access to Hospital and Emergency Services: Extends the increased inpatient hospital payment adjustment for certain low-volume hospitals through fiscal year 2025. The Medicare-dependent hospital program is extended through October 1, 2025. Add-on payments for ambulance services are extended through October 1, 2025.

Title III, Offsets: Revises the phase-in of Medicare clinical laboratory test payment changes, delaying the full implementation of private payor rate reductions to 2028 and adjusting reporting periods. Requires pharmacy benefit managers for prescription drug plans to have written agreements with PDP sponsors, prohibiting remuneration other than bona fide service fees, ensuring transparency in guarantees and cost performance evaluations, and requiring annual reports to sponsors and the Secretary. Extends the adjustment to the calculation of hospice cap amounts under Medicare through 2034.