Extending Medicare telehealth flexibilities for Federally qualified health centers and rural health clinics

Section 1834(m)(8) of the Social Security Act (42 U.S.C. 1395m(m)(8)), as amended by section 4113(c) of division FF of the Consolidated Appropriations Act, 2023 (Public Law 117–328), is amended— (1) in subparagraph (A), in the matter preceding clause (i), by inserting, and on or after January 1, 2027 after December 31, 2024; (2) by striking subparagraph (B) and inserting the following: (B) Payment (i) In general A telehealth service furnished by a Federally qualified health center or a rural health clinic to an eligible telehealth individual pursuant to this paragraph or after the date of the enactment of this subparagraph shall be reimbursed under this title at a separate telehealth payment rate as determined under the methodology established by the Secretary pursuant to clause (ii). (ii) Payment methodology The Secretary shall establish a methodology for determining the appropriate payment rate for telehealth services described in clause (i). Such methodology shall consider— (I) the geography of Federally qualified health centers and rural health clinics; (II) costs associated with the delivery of such telehealth services as allowable costs for the center or clinic; and (III) the full cost of providing the services via telehealth. (iii) Implementation (I) Coding system The Secretary shall establish an effective coding system for telehealth services described in clause (i) that is reflective of the services provided at a center or clinic. (II) Implementation Notwithstanding any other provision of law, the Secretary may implement this subparagraph through program instruction, interim final rule, or otherwise.; and (3) by adding at the end the following new subparagraph: (C) Requirement during additional period (i) In general Beginning on January 1, 2027, payment may only be made under this paragraph for a telehealth service described in subparagraph (A)(i) that is furnished to an eligible telehealth individual if such service is furnished by a qualified provider (as defined in clause (ii)). (ii) Definition of qualified provider For purposes of this subparagraph, the term qualified provider means, with respect to a telehealth service described in subparagraph (A)(i) that is furnished to an eligible telehealth individual, a Federally qualified health center or rural health clinic that has an established patient relationship with such individual as defined by the State in which the individual is located..