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Adds a new paragraph (3) to subsection (b) requiring mandatory deactivation and reactivation rules for standard unique health identifiers for entities excluded under sections 1128 or 1128A, including an annual review requirement and a nonapplication clause for certain waivers.
Adds a new subsection (j) to require Medicare Advantage encounter data for designated items/services furnished on or after enactment to include the applicable standard unique health identifier of the provider or supplier that ordered or referred the item or service, and authorizes rejection of encounter data that fail to include a valid active identifier.
Adds a new paragraph (10) to subsection (m) requiring that claims for telehealth services furnished by a 'specified entity' include a claims modifier (to be established by the Secretary within 180 days), and prohibits payment for such services unless the claim includes that modifier; defines 'specified entity' and 'telehealth company.'
Tightens program integrity for federal health care payments by shutting off billing identifiers for entities that are excluded, requiring fuller provider identification in Medicare Advantage encounter data, and adding a claims modifier to show when a telehealth company arranged a service and which practitioner delivered it. The Secretary of Health and Human Services must update rules by set deadlines and run annual checks of the exclusion list.
Providers, telehealth companies, and Medicare Advantage plans will need to update systems and workflows to capture and report the new identifiers and relationships. The goal is to reduce improper payments and improve transparency and tracking in telehealth and other claims data.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced March 3, 2025 by Lloyd Alton Doggett · Last progress March 3, 2025