Telehealth Modernization Act

This bill extends several temporary telehealth flexibilities under the Medicare program through September 30, 2027, and makes other changes to Medicare telehealth, hospice, and program integrity rules. It also extends the Acute Hospital Care at Home waiver through 2030, requires a new study on that program, and mandates guidance on telehealth for individuals with limited English proficiency.

Sec. 2, Extension of certain telehealth flexibilities: This section extends through September 30, 2027, the removal of geographic requirements for telehealth, the expansion of originating sites, the list of eligible practitioners, telehealth services for Federally Qualified Health Centers and Rural Health Clinics, audio-only telehealth services, and the use of telehealth for hospice face-to-face recertification encounters. It also delays in-person requirements for mental health services via telehealth until October 1, 2027, and establishes a payment rule for FQHCs and RHCs for fiscal years 2026 and 2027.

Sec. 3, Requiring modifier for use of telehealth for hospice face-to-face encounter: For hospice claims on or after January 1, 2026, a modifier or code must be included to indicate the encounter was conducted via telehealth.

Sec. 4, Extending Acute Hospital Care at Home waiver flexibilities: The waiver authority is extended through 2030. The Secretary must conduct a subsequent study by September 30, 2028, analyzing criteria, quality, costs, and other metrics of the initiative, and submit a report to Congress.

Sec. 5, Enhancing program integrity requirements for DME: Beginning January 1, 2028, items with aberrant billing patterns on the DME Master List include those ordered by a physician or practitioner with no prior relationship to the patient. The Secretary may conduct prepayment review for such items. The Inspector General must report to Congress by January 1, 2026, on fraud risks for clinical diagnostic lab tests.

Sec. 6, Guidance on telehealth for individuals with limited English proficiency: Within one year, the Secretary must issue guidance on best practices for integrating interpreters, providing accessible instructions, improving digital patient portals, using multi-person video calls for interpretation, and providing materials in multiple languages.

Sec. 7, In-home cardiopulmonary rehabilitation flexibilities: For items and services furnished via audio and video real-time communications technology from September 30, 2025, through December 31, 2026, such services may be provided in the patient's home, and the supervising physician may be virtually present.

Sec. 8, Inclusion of virtual diabetes prevention program suppliers in MDPP: From January 1, 2026, through December 31, 2030, entities may participate in the Medicare Diabetes Prevention Program by offering only online services, with specific rules on administrative location, cross-state claims, and no limit on individual enrollments.