Telehealth Modernization Act

This bill extends certain telehealth flexibilities under the Medicare program, modifies program integrity requirements for durable medical equipment, and requires studies and guidance on various healthcare topics. It amends the Social Security Act to extend waivers and flexibilities related to telehealth, acute hospital care at home, and other Medicare provisions through specified dates.

Sec. 2, Extension of certain telehealth flexibilities: This section extends several telehealth flexibilities from September 30, 2025, to September 30, 2027. These include removing geographic requirements and expanding originating sites for telehealth services, expanding the list of practitioners eligible to furnish telehealth services, extending telehealth services for Federally Qualified Health Centers and Rural Health Clinics, delaying in-person requirements for mental health services furnished through telehealth, allowing audio-only telehealth services, and extending the use of telehealth for face-to-face encounters prior to recertification of eligibility for hospice care. It also adds a new payment rule for Federally Qualified Health Centers and Rural Health Clinics for fiscal years 2026 and 2027.

Sec. 3, Requiring modifier for use of telehealth to conduct face-to-face encounter prior to recertification of eligibility for hospice care: This section requires that, for hospice claims on or after January 1, 2026, a modifier or code must be included to indicate that the face-to-face encounter was conducted via telehealth.

Sec. 4, Extending acute hospital care at home waiver flexibilities: This section extends the Acute Hospital Care at Home waiver from 2025 to 2030. It also requires the Secretary to conduct a subsequent study and report by September 30, 2028, analyzing criteria, quality of care, costs, and other metrics related to the initiative, and to submit a report to Congress.

Sec. 5, Enhancing certain program integrity requirements for DME under Medicare: This section adds new requirements for durable medical equipment, including treating items with aberrant billing patterns on a master list and allowing prepayment review of claims. It also requires a report by January 1, 2026, from the Inspector General on fraud risks related to clinical diagnostic laboratory tests.

Sec. 6, Guidance on furnishing services via telehealth to individuals with limited English proficiency: This section requires the Secretary to issue guidance within one year on best practices for integrating interpreters, providing accessible instructions, improving access to digital patient portals, using multi-person video platforms, and providing materials in multiple languages for individuals with limited English proficiency.

Sec. 7, In-home cardiopulmonary rehabilitation flexibilities: This section allows cardiopulmonary rehabilitation services to be furnished through audio and video real-time communications technology in the patient's home from September 30, 2025, to January 1, 2027. It also allows the virtual presence of a physician or practitioner during such services.

Sec. 8, Inclusion of virtual diabetes prevention program suppliers in MDPP expanded model: This section requires the Secretary to revise regulations by January 1, 2026, to allow entities to participate in the Medicare Diabetes Prevention Program by offering only online services from January 1, 2026, to December 31, 2030. It specifies conditions for enrollment, administrative location, and removes limits on the number of times an individual may enroll.