Telehealth Modernization Act
The Telehealth Modernization Act would extend and expand Medicare telehealth flexibilities and related care delivery programs through key dates (generally extending many current waivers to 2027, with some provisions extended to 2030). It broadens who can provide telehealth services, where telehealth can occur, and how certain telehealth services are paid. It also adds new reporting, oversight, and guidance measures—affecting providers, patients, and suppliers across settings such as federally qualified health centers, rural health clinics, hospices, home-based hospital care, and Medicare programs like the Diabetes Prevention Program. Overall, the bill seeks to solidify and broaden telehealth use in Medicare, while also addressing potential fraud, language access, and quality-improvement considerations. Key features include: extending telehealth access beyond current geographic/originating-site limits; expanding the pool of eligible clinicians; extending Medicaid-style home-based hospital care flexibilities; delaying certain in-person requirements for mental health and hospice telehealth; enabling audio-only telehealth; creating tighter program integrity rules for durable medical equipment; and permitting virtual formats for the Diabetes Prevention Program under Medicare (MDPP) from 2026 through 2030.
Key Points
- 1Extend and broaden telehealth flexibilities through 2027 (and keep certain home-care waivers through 2030), including removing geographic restrictions, expanding originating sites, and allowing more providers to furnish telehealth services (with additional allowances for mental health and audio-only visits).
- 2Extend use of telehealth for hospice care, including a face-to-face encounter prior to recertification of eligibility, with a new requirement that hospice claims for such encounters include a telehealth modifier beginning January 1, 2026 (plus specified exceptions).
- 3Extend the Acute Hospital Care at Home waiver through 2030 and require a two-stage study (initial and subsequent) with a detailed report by September 30, 2028 evaluating care quality, costs, staffing, patient experience, and other performance metrics.
- 4Strengthen program integrity around durable medical equipment (DME) and certain medical items, including a master list starting January 1, 2028 to flag aberrant billing patterns and authorize prepayment claim review for items on that list; extend similar treatment to prosthetics and related devices.
- 5Expand the Medicare Diabetes Prevention Program (MDPP) to include virtual/online and remote MDPP suppliers from 2026 through 2030, allowing online MDPP services under certain enrollment rules and allowing out-of-state beneficiaries to receive online MDPP services without geographic denial; no limit on enrollments.