Telehealth Modernization Act
Sponsored By: Senator Tim Scott
Introduced
Summary
Would extend and expand Medicare telehealth flexibilities to keep audio-only visits, broaden originating sites, and bring more virtual prevention and home-based care into Medicare. It also clarifies clinic payment for 2026–2027, adds oversight tools, and requires telehealth claim modifiers for certain hospice encounters.
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- Families and beneficiaries: Would keep audio-only telehealth through September 30, 2027 and let more originating sites receive telehealth. It would allow virtual Diabetes Prevention Program (MDPP) services online for 2026–2030 and let beneficiaries receive MDPP across state lines for payment.
- Providers and clinics: Federally Qualified Health Centers and Rural Health Clinics would have a payment rule for telehealth services in fiscal years 2026 and 2027 and could treat telehealth costs as allowable under their payment methods. Hospices would need a telehealth modifier on face-to-face encounters before recertification starting January 1, 2026.
- Medicare program and care models: Would extend the Acute Hospital Care at Home waiver through 2030 with required studies and reports, add a Master List and prepayment reviews for certain durable medical equipment starting January 1, 2028, and require an Inspector General fraud analysis for lab tests in 2026.
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Bill Overview
Analyzed Economic Effects
4 provisions identified: 3 benefits, 0 costs, 1 mixed.
Hospital-at-home waiver extended to 2030
If enacted, the Acute Hospital Care at Home waiver would be extended through 2030. That would keep hospital-at-home options available to Medicare patients until 2030. The bill would also require an initial study and a follow-up study on outcomes and patient experience.
Keep Medicare telehealth flexibilities
If enacted, several Medicare telehealth rules would be extended through Sept 30, 2027. Audio-only telehealth authority would continue through Sept 30, 2027. The start date for required in-person mental health visits would shift to Oct 1, 2027. Telehealth services you get from an FQHC or Rural Health Clinic between Oct 1, 2025 and before Oct 1, 2027 would be paid like regular FQHC/RHC visits and related costs would count as allowable. Home cardiopulmonary rehab could be done by live video in the home from Sept 30, 2025 until Jan 1, 2027. Telehealth use for the face-to-face hospice recertification visit would be allowed through Sept 30, 2027, but some areas or providers could be excluded. From Jan 1, 2026, hospice telehealth claims would need a special telehealth modifier or code.
Online Medicare diabetes prevention access
If enacted, an organization could offer only online Medicare Diabetes Prevention Program services from Jan 1, 2026 through Dec 31, 2030 if it meets supplier rules. The supplier must list its administrative address in the Diabetes Prevention Recognition Program. Suppliers could bill even if the beneficiary is in a different State when services are given. There would be no limit on how many times a person may enroll during this period.
Stricter checks on medical equipment claims
If enacted, starting Jan 1, 2028 Medicare could add some durable medical equipment items to a Master List and check claims before paying. An item may be flagged if many orders came from a clinician who had not billed the patient in the Secretary's look-back period of at least 24 months. If an item is added to the list and is not covered by an advance determination, the Secretary may do prepayment review. The rule would apply the same way to prosthetics and orthotics.
Sponsors & CoSponsors
Sponsor
Tim Scott
SC • R
Cosponsors
Brian Schatz
HI • D
Sponsored 9/4/2025
Cindy Hyde-Smith
MS • R
Sponsored 9/4/2025
Kirsten Gillibrand
NY • D
Sponsored 9/4/2025
Thomas Tillis
NC • R
Sponsored 9/4/2025
Angus King
ME • I
Sponsored 9/4/2025
Dan Sullivan
AK • R
Sponsored 9/9/2025
Tina Smith
MN • D
Sponsored 9/9/2025
Shelley Capito
WV • R
Sponsored 9/9/2025
Christopher Coons
DE • D
Sponsored 9/9/2025
Marsha Blackburn
TN • R
Sponsored 10/28/2025
Raphael Warnock
GA • D
Sponsored 10/28/2025
John Boozman
AR • R
Sponsored 12/17/2025
Jeanne Shaheen
NH • D
Sponsored 12/17/2025
Jon Ossoff
GA • D
Sponsored 12/18/2025
James Justice
WV • R
Sponsored 12/18/2025
Roll Call Votes
No roll call votes available for this bill.
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