Sponsors (8)
Introduced September 2, 2025 by Buddy Carter · Last progress September 2, 2025
The bill expands and clarifies telehealth, preventive program access, and program integrity measures that can improve access and produce savings, but it raises fiscal costs, administrative burdens, access trade-offs for digitally underserved patients, and governance/transparency risks.
Medicare beneficiaries retain broad telehealth access (including audio-only), with expanded practitioner eligibility, hospice recertification allowed via telehealth, and clearer billing for telehealth encounters—preserving remote care options and stabilizing clinic revenue (including FQHCs/RHCs) through Sept. 30, 2027 (and related billing clarity).
Medicare beneficiaries gain easier access to Diabetes Prevention Program (MDPP) online—online-only suppliers may bill across States and beneficiaries can re-enroll repeatedly from 2026–2030—increasing preventive care reach, especially for rural patients.
Targeted monitoring and prepayment review for certain DME, prosthetics, and lab tests aims to reduce improper Medicare payments and fraud, potentially saving taxpayers and improving program integrity.
Millions of Americans (Medicare beneficiaries and taxpayers) face higher Medicare program costs from multiple expansions (telehealth extensions, MDPP expansion, and potential statutory benefit expansions), which could increase fiscal pressure on premiums, taxes, or other benefits.
Prepayment review and targeted monitoring for DME, prosthetics, and labs could delay patients' access to needed equipment and diagnostic tests and disrupt cash flow for legitimate providers, harming patients with chronic conditions and small providers.
Providers and HHS will face substantial administrative and technical burdens—updating billing systems for new modifiers/instructions, collecting detailed Hospital-at-Home data, adopting multilingual portals and interpreter tech, and responding to sudden program instructions—which could raise provider costs and divert agency resources.
Based on analysis of 8 sections of legislative text.
Extends Medicare telehealth flexibilities to Sept 30, 2027; updates telehealth payment and hospice rules, adds DME fraud controls and studies, requires LEP telehealth guidance, and allows online-only MDPP through 2030.
Extends many temporary Medicare telehealth flexibilities for two more years (moving several sunsets from Sept 30, 2025 to Sept 30, 2027), sets payment rules for telehealth furnished by Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) in FY2026–FY2027, and makes several related Medicare changes. It also adds a new hospice recertification telehealth modifier requirement, orders a major comparative study of Hospital-at-Home care, creates new DME/prosthetics billing-risk rules with authority for prepayment review, requires HHS guidance on telehealth for people with limited English proficiency, authorizes administrative implementation of a Medicare definition change, and allows online-only participation in the Medicare Diabetes Prevention Program from 2026 through 2030.