Telehealth Modernization Act
The Telehealth Modernization Act would extend and expand a wide set of Medicare telehealth flexibilities that were initially enacted during the public health emergency and subsequent years. The bill stretches key telehealth authorities through 2027 (and some programs through 2030), broadens who can furnish telehealth, expands where telehealth can originate and be used (including for FQHCs and rural health clinics), and allows audio-only services in more circumstances. It also adds new safeguards and oversight aims, such as stronger program integrity rules for durable medical equipment (DME), a fraud risk review for certain laboratory tests, and required telehealth usage labeling for hospice encounters starting in 2026. Additional provisions support telehealth expansion in home-based care, cardiopulmonary rehabilitation, language access, and the inclusion of virtual options in the Medicare Diabetes Prevention Program (MDPP). Overall, the bill aims to normalize and broaden telehealth access across more settings and populations while increasing oversight to prevent misuse.
Key Points
- 1Extends telehealth flexibilities through 2027, including removing certain geographic requirements and expanding originating sites; continues telehealth use across more provider types and settings, including for rural clinics and federally qualified health centers (FQHCs/RHCs).
- 2Maintains and clarifies payment and billing rules for telehealth services during 2026-2027, with specific pay rules for FQHCs/RHCs under prospective payment or all-inclusive rate methodologies; extends in-person visit requirements pause for mental health services furnished via telehealth to 2027; allows audio-only telehealth for broader use through 2027.
- 3Expands hospice-related telehealth use (face-to-face encounters prior to eligibility recertification) through 2027, and adds a new requirement that encounters occurring from 2026 onward include a telehealth modifier on hospice claims.
- 4Extends the Acute Hospital Care at Home waiver through 2030 and requires a comprehensive study and report by 2028 on its quality, cost, and operational metrics, including comparisons to inpatient care.
- 5Strengthens program integrity for DME by creating a master list-based prepayment review mechanism starting in 2028, increases scrutiny of aberrant billing patterns, and requires an inspector general report (by 2026) on fraud risks for clinical diagnostic laboratory tests under 1834A.
- 6Provides guidance on telehealth use for individuals with limited English proficiency, outlining best practices for interpreters, access to telecommunication systems, multilingual materials, and multi-person video interpretation.
- 7Adds in-home cardiopulmonary rehabilitation flexibilities (via real-time audiovisual telehealth) for a defined period and allows program instruction to implement these changes by directive.
- 8Enables virtual MDPP suppliers to participate in the MDPP expansion model from 2026-2030, allowing online MDPP services with adherence to MDPP enrollment rules and ensuring cross-state participation and no enrollment limits.