Sponsors (9)
The bill expands and clarifies telehealth and preventive service access for many Medicare beneficiaries and seeks to curb improper payments, but does so at the cost of higher federal spending, added provider administrative burdens, and potential access, oversight, and transparency risks for some populations.
Medicare beneficiaries — including rural, homebound, and LEP individuals — retain and gain telehealth options: audio-only and practitioner-eligibility flexibilities extended through Sept. 30, 2027; hospice recertification can be done by telehealth; and MDPP is allowed online 2026–2030, improving access and convenience for remote or mobility-limited patients.
Targeted monitoring and a new prepayment review regime for selected DME, prosthetics, and certain lab tests aim to reduce improper Medicare payments, protecting taxpayer dollars and stabilizing program spending long-term.
A comprehensive Hospital-at-Home study will produce comparative evidence on outcomes, costs, and disparities (including race, income, housing, distance, dual-eligibility), helping hospitals and policymakers identify safer, more efficient care pathways and potential cost-savings.
Extending telehealth flexibilities, allowing online MDPP with unlimited re-enrollment, and potential benefit expansions increase Medicare program spending and could put upward pressure on premiums, taxes, or other federal fiscal resources.
The bill imposes substantial administrative and operational burdens on providers and CMS — from new billing modifiers and IT changes to data collection for studies, prepayment review processes, and tech upgrades for interpretation — which could raise provider costs and disrupt operations, especially for smaller and rural providers.
Prepayment review for DME, prosthetics, and certain lab tests risks delaying patient access to necessary equipment and diagnostics when orders trigger reviews, harming timely care for beneficiaries with urgent or chronic needs.
Based on analysis of 8 sections of legislative text.
Extends Medicare telehealth flexibilities to Sept 30, 2027, adds hospice telehealth recertification rules, mandates studies and fraud controls, issues LEP telehealth guidance, and allows online MDPP (2026–2030).
Official title: To amend title XVIII of the Social Security Act to extend certain telehealth flexibilities under the Medicare program.
Introduced September 2, 2025 by Buddy Carter · Last progress September 2, 2025
Extends and makes permanent-like changes to several Medicare telehealth flexibilities by pushing multiple temporary expirations from September 30, 2025 to September 30, 2027, sets payment rules for telehealth furnished by FQHCs and RHCs for FY2026–FY2027, and permits administrative implementation. It also: adds a new requirement for telehealth face-to-face hospice recertification encounters; requires a comparative study of hospital-at-home care vs inpatient care with a report due by September 30, 2028; directs new DMEPOS aberrant-billing rules and prepayment review authorities beginning January 1, 2028 and an OIG report on high-risk lab tests by January 1, 2026; issues guidance on telehealth for people with limited English proficiency; and allows online-only Medicare Diabetes Prevention Program suppliers to operate Jan 1, 2026–Dec 31, 2030 with modified billing/enrollment rules. The bill makes multiple technical and substantive changes to Medicare statutory and regulatory provisions, gives the HHS Secretary implementation authority by program instruction when specified, and sets several distinct effective dates across sections rather than a single uniform effective date.