House Ways and Means Committee advances 2-year telehealth extension bill

Editor's Note: This story has been updated following the committee's markup.

The House Ways and Means Committee passed the Preserving Telehealth, Hospital, and Ambulance Access Act by a vote of 41-0 after lawmakers raised concerns about the need for more guardrails and hospice recertification. 

The move sets up the legislation for passage by the full House later this year.

The Wednesday markup included objections by Democrats and Republicans to the high cost durable medical equipment and clinical diagnostics guardrails proposed in the bill, saying the provisions merely restate existing authorities of the Center for Medicare and Medicaid Services. The bill requires reports on DME and clinical diagnostics fraud which some lawmakers think have already been established and don’t need further study. 

Many lawmakers likewise expressed concern about the extension of hospice recertification via telehealth. Some lawmakers raised concern about fraud in the hospice program, which they say the telehealth requirement could let fester.

"I've long recognized the value of telehealth and I will not oppose this bill, but I do oppose its failure to address waste, fraud and abuse," said Rep. Lloyd Doggett (D-Texas) during the markup hearing. "It's difficult to view this bill as progress with regard to fraud since it gives CMS no new authority and no new enforcement tools."

Other lawmakers opposed the hospice telehealth recertification because they want sick hospice patients to meet face-to-face with a physician.

ATA Action, an affiliated trade organization of the American Telemedicine Association (ATA), applauded the House Ways and Means Committee for advancing a two-year telehealth extension.

This extension will maintain many of the current Medicare telehealth flexibilities through the end of calendar year 2026.

"While we prefer Medicare telehealth flexibilities be made permanent, we understand the dynamics and applaud the Committee for a two-year extension of many of the critical flexibilities without arbitrary and unnecessary guardrails such as in-person requirements,” said Kyle Zebley, senior vice president, public policy, at the ATA and executive director of ATA Action. “This is a clear sign that our bipartisan telehealth supporters are at work, determined not to leave the American people without access to safe, effective, quality healthcare where and when they need it. But this is not over yet. There will be additional markups and other committees need to weigh in, as we continue to push for telehealth permanency.”

The legislation, if passed by Congress, will provide certainty for patients and providers across the country and "allow U.S. healthcare systems enough time to implement appropriate virtual tools, technologies, programs, and processes moving forward,” Zebley said.

The ATA also supports additional telehealth priorities that have not yet been acted upon, including the remote prescribing of controlled substances, which were not included in the legislative proposal.

"We believe, if left omitted, this would lead to a tremendous gap in care," Zebley said.

Federation of American Hospitals also cheered the committee's passage of the bill for its impact on rural hospitals.

“Patients in rural communities are facing a dire health care access crisis. We appreciate the Ways & Means Committee’s efforts to support rural hospitals and other providers through the extension of telehealth flexibilities and Medicare payment adjustments for rural hospitals," Charlene MacDonald, executive vice president of public affairs for the Federation of American Hospitals, said in a statement after the Ways and Means Committee marked up several rural health care bills on Wednesday. " As the Committee develops its rural health agenda, we welcome a dialogue to ensure that policy solutions promote innovation while also protecting facilities already struggling to stay afloat."

The Ways and Means Committee also passed several other bills on Wednesday, including:

•  The Preserving Emergency Access in Key Sites Act of 2024 (PEAKS Act), which expands emergency services for patients served by Critical Access Hospitals.

• The Rural Hospital Stabilization Act, which provides resources to help struggling hospitals continue to serve patients in rural and underserved communities.

• The Ensuring Seniors' Access to Quality Care Act that allows more nursing homes to continue training nurses and serving patients.

• The Rural Physician Workforce Preservation Act, which aims to address rural America's doctor shortage by shutting a loophole that has resulted in residency slots meant for truly rural training programs being taken up by urban hospitals.

• The Second Chances for Rural Hospitals Act to expand the designation for Rural Emergency Hospitals to give rural communities a second chance at access to emergency and outpatient services.

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Telehealth lobbyists told Fierce Healthcare on the sidelines of the American Telemedicine Association annual conference in Phoenix this week that they are happy with the extension, though they prefer telehealth permanency. 

The House Energy and Commerce Committee will likely follow suit in the next week, a source said, further entrenching the battle between the two committees to get a telehealth extension through the House. 

The Ways and Means legislation introduced by Rep. David Schweikert, R-Arizona, the Preserving Telehealth, Hospital and Ambulance Access Act, extends Medicare telehealth flexibilities such as allowing telehealth visits to be conducted from anywhere, delaying the in-person requirement for the provision of telemental health services and extending audio-only telehealth. The flexibilities are currently set to expire at the end of the year if Congress doesn’t act. 

The bill also ropes in a longer, five-year extension for the Centers for Medicare & Medicaid Services’ Hospital at Home waiver program, which allows enrolled hospitals to receive payment for acute-level hospital care provided at home. The bill also touches on wearable medical devices, the integration of AI and how Congress should create policies to maximize their benefit and minimize their harm. 

Schwiekert’s bill includes several guardrails for the two-year telehealth extension, which some members of Congress have called for during recent telehealth hearings. One major concern is the fraudulent ordering of high-cost durable medical equipment and clinical diagnostic tests through telehealth. 

The House Energy and Commerce Committee told stakeholders Monday it will hold a health subcommittee markup next week. Though the committee hasn’t disclosed what legislation will be included in the markup, a source close to the issue told Fierce Healthcare that it has been working on a telehealth extension bill. 

The source predicts the hearing will include the telehealth extension legislation because the Energy and Commerce Committee has been committed to following regular order, and its last legislative health subcommittee hearing in April was on telehealth and other at-home healthcare services. 

The offsets for the bill include pharmacy benefit manager reforms one source said were included in Senate Finance Committee PBM transparency legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act introduced in 2023.

Two sources told Fierce Healthcare it’s likely the House will move on telehealth before the lame-duck session, possibly by August. It’s unclear where telehealth falls on the Senate’s list of priorities. 

In July, the Senate Finance Committee overwhelmingly passed MEPA 26-1. The bill said PBMs could only receive payment through service fees, not through payment for Part D-covered drugs based on a manufacturer's price.

PBM reform, despite broad support, has faced obstacles in getting over the finish line. But MEPA enjoyed support by the Alliance for Transparent & Affordable Prescriptions, the Alliance of Community Health Plans, the National Community Pharmacists Association, and others. Elements of MEPA were included in the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act in November.

MEPA originally called for banning spread pricing, a practice PBMs and other entities in the pharma supply chain rely on to earn profits. It doesn't appear a provision banning spread pricing has made it into the proposed extension. The bill does outline enforcement mechanisms for potential violations as well as certain transparency standards.

The following is a list of the provisions in the Preserving Telehealth, Hospital and Ambulance Access Act that apply to the Medicare program: 

• Removes originating and geographic site restrictions for Medicare telehealth services through December 2026.

• Expands the types of providers able to furnish telehealth through December 2026.  

• Extends telehealth for federally qualified health centers (FQHCs) and rural health clinics (RHCs) through December 2026.

• Delays the in-person visit requirement for telemental health services until January 2027. 

• Allows rural health clinics to continue offering telemental health services through January 2027.

• Extends the ability to bill for audio-only telehealth through December 2026.

• Extends the use of telehealth encounters prior to recertification of eligibility for hospice care through December 2026.

Hospital at home, wearable devices: 

• Extends Medicare hospital at home for five years and requires additional reports to Congress on the program.  

• Requires a report on wearable medical devices 18 months after passage, including the capabilities and limitations of wearable medical devices used to support clinical decision-making and prescribe treatments, the benefits and challenges of AI to support such capabilities and policy options for devices. 

Program integrity requirements:

• The bill notes that ordering a disproportionate amount of durable medical equipment without a prior patient relationship through telehealth could be suspect. The Department of Health and Human Services (HHS) Secretary may conduct a prepayment review of claims starting in January 2026.

• The bill also requires the inspector general of HHS to submit a report to Congress on clinical diagnostic tests and the risk for fraudulent billing through telehealth.

Best telehealth practices for patients with limited English proficiency:

• The bill says within one year, HHS must provide best practices and updated guidance for all actors in the healthcare system to provide services and materials to individuals with limited English proficiency. This includes access to translators, interacting with patient portals and the use of video platforms for multiperson calls. 

Staff writer Noah Tong contributed to this story.