Congressional Record, House, July 27, 2022 — H.R. 4040 Advancing Telehealth Beyond COVID–19 Act
Summary
This House section of the Congressional Record for July 27, 2022 (H7189 and H7190) covers the Advancing Telehealth Beyond COVID–19 Act of 2022, which Pallone calls up pursuant to House Resolution 1256 to extend telehealth flexibilities under the Medicare program. The text of the bill, as amended, includes provisions running through December 31, 2024, including audio-only telehealth services and mental health services furnished through telehealth. An amendment offered by Pallone is agreed to, the bill is ordered engrossed and read a third time, and on a motion to recommit offered by Miller-Meeks of Iowa the yeas and nays are ordered, with further proceedings postponed. Dingell speaks in support of the legislation.
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“Congressional Record, House, July 27, 2022 — H.R. 4040 Advancing Telehealth Beyond COVID–19 Act.”
Original at www.govinfo.gov. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/crec-crec-2022-07-27-crec-2022-07-27-pt1-pgh7189-b216a9aad0/
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July 27, 2022 CONGRESSIONAL RECORD — HOUSE H7189
I am just going to say, I also have ation of the ‘‘Operational Guidance for K–12 furnished during the period beginning on the
personal experience with this. After my Schools and Early Care and Education Pro- first day after the end of such emergency period
husband contracted COVID–19 from me, grams to Support Safe In-Person Learning’’; and ending on December 31, 2024’’.
and SEC. 3. EXPANDING PRACTITIONERS ELIGIBLE TO
after I got it when some colleagues on
(6) a detailed accounting of unspent Fed- FURNISH TELEHEALTH SERVICES.
the other side of the aisle did not want eral dollars directed to school districts that Section 1834(m)(4)(E) of the Social Security
to wear masks on January 6 in the safe were authorized by the American Rescue Act (42 U.S.C. 1395m(m)(4)(E)) is amended by
room, he, unfortunately had a series of Plan Act. striking ‘‘and, for the 151-day period beginning
heart attacks and had to have a series The SPEAKER pro tempore. Pursu- on the first day after the end of the emergency
of heart operations last year. ant to clause 2(b) of rule XIX, the pre- period described in section 1135(g)(1)(B)’’ and
Every single doctor said to us, we inserting ‘‘and, in the case that the emergency
vious question is ordered on the motion period described in section 1135(g)(1)(B) ends be-
need more research on exactly what to recommit.
the causal relationship is. And this is fore December 31, 2024, for the period beginning
The question is on the motion to re- on the first day after the end of such emergency
the reality of where we are today; and commit. period and ending on December 31, 2024’’.
I think that this amendment by Rep- The question was taken; and the SEC. 4. EXTENDING TELEHEALTH SERVICES FOR
resentative SHERRILL is a very good ad- Speaker pro tempore announced that FEDERALLY QUALIFIED HEALTH
dition to the bill. the noes appeared to have it. CENTERS AND RURAL HEALTH CLIN-
Mr. CARTER of Georgia. Madam ICS.
Mrs. MILLER-MEEKS. Madam Section 1834(m)(8)(A) of the Social Security
Speaker, I oppose this amendment. I Speaker, on that I demand the yeas Act (42 U.S.C. 1395m(m)(8)(A)) is amended by
think it is duplicative, and I think it is and nays. striking ‘‘during the 151-day period beginning
a waste of taxpayers’ money. The yeas and nays were ordered. on the first day after the end of such emergency
Madam Speaker, I yield back the bal- The SPEAKER pro tempore. Pursu- period’’ and inserting ‘‘in the case that such
ance of my time. ant to section 8 of rule XX, further pro- emergency period ends before December 31, 2024,
Mr. PALLONE. Madam Speaker, I during the period beginning on the first day
ceedings on this question will be post-
would urge support for the amendment, after the end of such emergency period and end-
poned. ing on December 31, 2024’’.
as well as the underlying bill, and I
yield back the balance of my time. f SEC. 5. DELAYING THE IN-PERSON REQUIRE-
MENTS UNDER MEDICARE FOR MEN-
The SPEAKER pro tempore. Pursu- ADVANCING TELEHEALTH BEYOND TAL HEALTH SERVICES FURNISHED
ant to the rule, the previous question COVID–19 ACT OF 2021 THROUGH TELEHEALTH AND TELE-
is ordered on the amendment offered by COMMUNICATIONS TECHNOLOGY.
Mr. PALLONE. Madam Speaker, pur-
the gentleman from New Jersey (Mr. (a) DELAY IN REQUIREMENTS FOR MENTAL
suant to House Resolution 1256, I call HEALTH SERVICES FURNISHED THROUGH TELE-
PALLONE).
up the bill (H.R. 4040) to amend title HEALTH.—Section 1834(m)(7)(B)(i) of the Social
The question is on the amendment.
XVIII of the Social Security Act to ex- Security Act (42 U.S.C. 1395m(m)(7)(B)(i)) is
The amendment was agreed to.
tend telehealth flexibilities under the amended, in the matter preceding subclause (I),
The SPEAKER pro tempore. The
Medicare program, and for other pur- by striking ‘‘on or after the day that is the
question is on the engrossment and 152nd day after the end of the period at the end
poses, and ask for its immediate con-
third reading of the bill. of the emergency sentence described in section
The bill was ordered to be engrossed sideration in the House.
1135(g)(1)(B))’’ and inserting ‘‘on or after Janu-
and read a third time, and was read the The Clerk read the title of the bill.
ary 1, 2025 (or, if later, the first day after the
third time. The SPEAKER pro tempore. Pursu- end of the emergency period described in section
ant to House Resolution 1256, an 1135(g)(1)(B))’’.
MOTION TO RECOMMIT
amendment in the nature of a sub- (b) MENTAL HEALTH VISITS FURNISHED BY
Mrs. MILLER-MEEKS. Madam stitute consisting of the text of Rules RURAL HEALTH CLINICS.—Section 1834(y) of the
Speaker, I have a motion to recommit Committee Print 117–59, modified by Social Security Act (42 U.S.C. 1395m(y)) is
at the desk. the amendment printed in part B of amended—
The SPEAKER pro tempore. The House Report 117–444, is adopted. The (1) in the heading, by striking ‘‘TO HOSPICE
Clerk will report the motion to recom- bill, as amended, is considered read.
PATIENTS’’; and
mit. (2) in paragraph (2), by striking ‘‘prior to the
The text of the bill, as amended, is as day that is the 152nd day after the end of the
The Clerk read as follows: follows:
Mrs. MILLER-MEEKS of Iowa moves to re- emergency period described in section
commit the bill H.R. 3771 to the Committee H.R. 4040 1135(g)(1)(B))’’ and inserting ‘‘prior to January
on Energy and Commerce. 1, 2025 (or, if later, the first day after the end of
Be it enacted by the Senate and House of Rep- the emergency period described in section
The material previously referred to resentatives of the United states of America in 1135(g)(1)(B))’’.
by Mrs. MILLER-MEEKS is as follows: Congress assembled, (c) MENTAL HEALTH VISITS FURNISHED BY
At the end of the bill, add the following SECTION 1. SHORT TITLE. FEDERALLY QUALIFIED HEALTH CENTERS.—Sec-
new section: This Act may be cited as the ‘‘Advancing Tele- tion 1834(o)(4) of the Social Security Act (42
SEC. 4. REPORT ON THE COVID–19 EDUCATION health Beyond COVID–19 Act of 2022’’. U.S.C. 1395m(o)(4) is amended—
CRISIS IN PUBLIC SCHOOLS. SEC. 2. REMOVING GEOGRAPHIC REQUIREMENTS (1) in the heading, by striking ‘‘TO HOSPICE
Not later than 6 months after the date of AND EXPANDING ORIGINATING PATIENTS’’; and
enactment of this Act, the Secretary of SITES FOR TELEHEALTH SERVICES. (2) in subparagraph (B), by striking ‘‘prior to
Health and Human Services shall provide to Section 1834(m) of the Social Security Act (42 the day that is the 152nd day after the end of
Congress a report on the COVID–19 education U.S.C. 1395m(m)) is amended— the emergency period described in section
crisis in public schools during the period be- (1) in paragraph (2)(B)(iii)— 1135(g)(1)(B))’’ and inserting ‘‘prior to January
tween March 1, 2020, and March 1, 2022. Such (A) by striking ‘‘With’’ and inserting ‘‘In the 1, 2025 (or, if later, the first day after the end of
report shall include— case that the emergency period described in sec- the emergency period described in section
(1) the average number of days elementary tion 1135(g)(1)(B) ends before December 31, 2024, 1135(g)(1)(B))’’.
and secondary education schools were closed with’’; and SEC. 6. ALLOWING FOR THE FURNISHING OF
to in-person classroom instruction; (B) by striking ‘‘that are furnished during the AUDIO-ONLY TELEHEALTH SERV-
(2) the average amount of time intended 151-day period beginning on the first day after ICES.
for in-person classroom instruction that was the end of the emergency period described in Section 1834(m)(9) of the Social Security Act
lost; section 1135(g)(1)(B)’’ and inserting ‘‘that are (42 U.S.C. 1395m(m)(9)) is amended by striking
(3) the participation rates in remote-learn- furnished during the period beginning on the ‘‘The Secretary shall continue to provide cov-
ing programs; first day after the end of such emergency period erage and payment under this part for tele-
(4) the impact of school closures on chil- and ending December 31, 2024’’; and health services identified in paragraph (4)(F)(i)
dren, including the disproportionate impact (2) in paragraph (4)(C)(iii)— as of the date of the enactment of this para-
on children in low-income, disadvantaged, or (A) by striking ‘‘With’’ and inserting ‘‘In the graph that are furnished via an audio-only tele-
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vulnerable communities, with regard to— case that the emergency period described in sec- communications system during the 151-day pe-
(A) academic achievement; tion 1135(g)(1)(B) ends before December 31, 2024, riod beginning on the first day after the end of
(B) mental health and well-being; and with’’; and the emergency period described in section
(C) social development; (B) by striking ‘‘that are furnished during the 1135(g)(1)(B)’’ and inserting ‘‘In the case that
(5) a detailed accounting of the Centers for 151-day period beginning on the first day after the emergency period described in section
Disease Control and Prevention’s decision- the end of the emergency period described in 1135(g)(1)(B) ends before December 31, 2024, the
making process and data used for the cre- section 1135(g)(1)(B)’’ and inserting ‘‘that are Secretary shall continue to provide coverage
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H7190 CONGRESSIONAL RECORD — HOUSE July 27, 2022
and payment under this part for telehealth serv- When the pandemic was beginning to Madam Speaker, one of my top prior-
ices identified in paragraph (4)(F)(i) that are take hold in America, Congress moved ities since I have been a Member of
furnished via an audio-only communications quickly to significantly expand access Congress has been to make sure that
system during the period beginning on the first
to telehealth for Medicaid bene- healthcare is accessible and available
day after the end of such emergency period and
ending on December 31, 2024’’. ficiaries. And this was critically impor- for all Americans. Telehealth has
SEC. 7. USE OF TELEHEALTH TO CONDUCT FACE- tant because Medicare beneficiaries are played a critical role for patients to ac-
TO-FACE ENCOUNTER PRIOR TO RE- some of the most vulnerable to COVID– cess the care they desperately need.
CERTIFICATION OF ELIGIBILITY FOR 19.
HOSPICE CARE DURING EMERGENCY b 1245
PERIOD.
The waiver of Medicare’s originating
site and geographic restrictions during On the Energy and Commerce Com-
Section 1814(a)(7)(D)(i)(II) of the Social Secu- mittee, we have been discussing the
rity Act (42 U.S.C. 1395f(a)(7)(D)(i)(II)) is the public health emergency has al-
lowed millions of Medicare bene- importance of telehealth flexibilities
amended by striking ‘‘and during the 151-day
period beginning on the first day after the end ficiaries nationwide to receive tele- for years. It is bringing doctors right
of such emergency period’’ and inserting ‘‘and, into families’ living rooms and is an
health services, including audio-only
in the case that such emergency period ends be- example of how innovation can im-
services, without ever having to leave
fore December 31, 2024, during the period begin- prove and save people’s lives.
their homes. As the coronavirus spread and pro-
ning on the first day after the end of such emer-
Now, the Energy and Commerce Com-
gency period described in such section viders closed their doors, patients and
1135(g)(1)(B) and ending on December 31, 2024’’. mittee has a long history of working to
providers were forced to adapt and uti-
SEC. 8. FUNDING FROM MEDICARE IMPROVE- expand access to telehealth services in
lize telehealth services. Just months
MENT FUND. the Medicare program. For example, into the public health emergency,
Section 1898(b)(1) of the Social Security Act the SUPPORT Act expanded access to Medicare was receiving over a million
(42 U.S.C. 1395jjj(b)(1)) is amended by striking substance use disorder services deliv-
‘‘$7,500,000,000’’ and inserting ‘‘$5,153,000,000’’. telehealth visits a week, an almost
ered via telehealth. 3,000 percent increase. Those without
SEC. 9. PROGRAM INSTRUCTION AUTHORITY. The Consolidated Appropriations Act
Notwithstanding any other provision of law, adequate transportation or in rural
of 2021 permanently expanded access to
the Secretary of Health and Human Services areas were still able to visit with their
telemental health services and Medi-
may implement the provisions of, including doctor.
amendments made by, sections 2 through 7 care. And most recently, the Consoli- While we have made great strides in
through program instruction or otherwise. dated Appropriations Act of 2020 ex- making telehealth more broadly avail-
SEC. 10. DETERMINATION OF BUDGETARY EF- tended key telehealth flexibilities for able, we know that Congress can do
FECTS. an additional 5 months after the end of more. Increasing access to telehealth
The budgetary effects of this Act, for the pur- the public health emergency.
pose of complying with the Statutory Pay-As- means increasing access to quality care
So H.R. 4040 builds on the bipartisan for all patients.
You-Go Act of 2010, shall be determined by ref- telehealth extension included in the
erence to the latest statement titled ‘‘Budgetary I often discuss how, before the pan-
Consolidated Appropriations Act of demic, we had a lot of regulations and
Effects of PAYGO Legislation’’ for this Act, sub-
mitted for printing in the Congressional Record 2022. The bill extends the same key red tape that piled up over the years.
by the Chairman of the House Budget Com- telehealth flexibilities as the previous So while I will support this legislation,
mittee, provided that such statement has been legislation, but now would extend them it is a shame that we did not take
submitted prior to the vote on passage. until December 31, 2024, essentially 2 something as important as this
The SPEAKER pro tempore. The bill, more years. And this longer-term ex- through committee to make sure it
as amended, shall be debatable for 1 tension will provide beneficiaries and could be the best possible product.
hour equally divided and controlled by stakeholders with more certainty. Madam Speaker, I reserve the bal-
the chair and ranking minority mem- It will also give policymakers time ance of my time.
ber of the Committee on Energy and to assess the impact expanded tele- Mr. PALLONE. Madam Speaker, I
Commerce or their respective des- health services have had on the Medi- yield 3 minutes to the gentlewoman
ignees. care program and on beneficiaries’ from Michigan (Mrs. DINGELL).
The gentleman from New Jersey (Mr. health and well-being, and the quality Mrs. DINGELL. Madam Speaker, I
PALLONE) and the gentleman from of care that they are receiving. rise in support of this legislation,
Georgia (Mr. CARTER) each will control So I thank the many Energy and which would provide critical extensions
30 minutes. Commerce Committee members who of existing telehealth flexibilities that
The Chair recognizes the gentleman have been leaders on this issue over the have been in place during the COVID–19
from New Jersey (Mr. PALLONE). years, such as Representatives DIN- pandemic.
GENERAL LEAVE GELL, ESHOO, MATSUI, WELCH, BLUNT- The Advancing Telehealth Beyond
Mr. PALLONE. Madam Speaker, I ROCHESTER, KELLY, and many more. COVID–19 Act of 2021, which I co-led
ask unanimous consent that all Mem- And I also commend Representative with my colleague, Congresswoman
bers may have 5 legislative days in CHENEY and DINGELL for their bipar- CHENEY, will do just that. It will ex-
which to revise and extend their re- tisan leadership on this legislation tend a broad range of telehealth flexi-
marks and add extraneous material on today. bilities that are central to enabling ac-
H.R. 4040. I look forward to working with all cess to care via telehealth from any lo-
The SPEAKER pro tempore. Is there Members on a permanent solution to cation through December 31, 2024.
objection to the request of the gen- address telehealth coverage under This includes allowing any site in the
tleman from New Jersey? Medicare but, in the meantime, this United States, including a patient’s
There was no objection. multi-year extension is critical for pre- home, to be considered an eligible orig-
Mr. PALLONE. Madam, I yield my- serving access to telehealth services. inating site for the delivery of tele-
self such time as I may consume. The language included in the bill is health services. It also extends other
I rise in support of H.R. 4040, the Ad- the same bipartisan language pre- vital services, including coverage of
vancing Telehealth Beyond COVID–19 viously negotiated by the House and certain telehealth services delivered
Act, bipartisan legislation, introduced Senate committees and the bill—and I via audio-only format.
by Representatives CHENEY and DIN- stress, Madam Speaker, that the bill is Collectively, these changes will build
GELL. fully paid for. on what has worked during the pan-
Over the course of this pandemic, So I hope we can, once again, extend demic. It will expand access to quality,
telehealth has served as an important these flexibilities with strong bipar- affordable healthcare across the coun-
tool for staying connected to care tisan support. try, particularly in rural and under-
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without increasing the risk of exposure I urge all my colleagues to support served communities.
to COVID–19. And in the Medicare pro- this bill, and I reserve the balance of It will also, Madam Speaker, allow
gram, millions have utilized telehealth my time. those who have been afraid to go to the
for the first time during the pandemic, Mr. CARTER of Georgia. Madam doctor, who haven’t been able to get in,
thanks to actions taken early on by Speaker, I yield myself such time as I to be able to consult with medical pro-
Congress and the administration. may consume. fessionals as they need it.
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July 27, 2022 CONGRESSIONAL RECORD — HOUSE H7191
I thank my colleague, Congress- from California (Ms. MATSUI), a mem- that give Utahns control over their
woman CHENEY, for partnering with me ber of the Energy and Commerce Com- healthcare decisions.
on this effort, as well as Chairman mittee. I support this bill and am pleased the
PALLONE for his thoughtful leadership Ms. MATSUI. Madam Speaker, I rise Protecting Mental Health Services Act
and input on the legislation before us today in support of H.R. 4040, the Ad- was included. Madam Speaker, I urge
today. vancing Telehealth Beyond COVID–19 my colleagues to support its passage.
It is also important to recognize Act, legislation to further extend tele- Mr. PALLONE. Madam Speaker, I
other leading voices on the telehealth health policies that have been critical yield such time as she may consume to
issue in the Congress, including Con- to providing care during the pandemic the gentlewoman from Wyoming (Ms.
gressman MIKE THOMPSON for his pio- through the end of 2024. CHENEY).
neering efforts on this issue. Since long before the COVID pan- Ms. CHENEY. Madam Speaker, I
This legislation is a bipartisan win demic, I worked closely with my En- thank the chairman for yielding. I ap-
for the American people. Madam ergy and Commerce Committee col- preciate it.
Speaker, I urge my colleagues to sup- I am very pleased, Madam Speaker,
league, Representative BILL JOHNSON,
port it. that today the House will have the op-
in crafting legislation to remove bar-
Mr. CARTER of Georgia. Madam portunity to vote on this important bi-
riers to telehealth and advancing poli-
Speaker, I yield 2 minutes to the gen- partisan legislation. It is an unusual
cies that expand access and improve circumstance to have a bill that has
tlewoman from Washington (Mrs. ROD- the quality of care for Medicare bene-
GERS), the ranking member of the En- such broad bipartisan support.
ficiaries. I know many of my colleagues have
ergy and Commerce Committee. As a cosponsor of this bill, I am
Mrs. RODGERS of Washington. worked on many different aspects of
pleased to see some of that important the bill that we are going to consider
Madam Speaker, I appreciate the gen- work make progress today. This legis-
tleman yielding. and vote on today. I am honored to be
lation builds on Congress’ efforts to an original cosponsor of this bill, along
I grew up in a small town, Kettle
give patients and providers the cer- with my good friend from Michigan,
Falls, and I have lived through the
tainty they need that telehealth is Congresswoman DINGELL, who spoke
challenges that people face in rural
here to stay. earlier.
communities.
I have also visited hospitals and While this bipartisan telehealth bill All of us, I think, around the coun-
healthcare facilities all throughout my meets many of our shared objectives, try, especially in rural America, saw
district. During the pandemic, Provi- we also must recognize that our work the impact of COVID on the ability of
dence Health System scaled up their on telehealth is not done. There are our constituents to get the treatment
telehealth services with a 1,000 percent vital telehealth priorities still demand- that they need. We first began working
increase in volume. ing our attention that will truly shape on legislation to expand telehealth ca-
Telehealth visits by seniors on Medi- care delivery for the future, including pabilities more than 2 years ago, fol-
care increased from 840,000 in 2019 to the need to extend the DEA in-person lowing the onset of the pandemic.
52.7 million in 2020 nationwide. Many of waiver for remote prescribing of con- In Wyoming, we have long known
these visits were from seniors’ homes, trolled substances after the public how important it is for citizens to be
which were not paid for by Medicare health emergency ends. able to take advantage of the tech-
prior to the pandemic. Likewise, while this bill continues a nology that exists today, how crucial
Congress and the Trump administra- crucial delay of the in-person tele- telehealth services are in allowing all
tion, by action, required Medicare to mental health requirement, we cannot of our citizens to interact with their
pay for more telehealth services, re- allow an arbitrary and clinically un- doctors and their other healthcare pro-
ducing out-of-pocket costs and expand- supported in-person requirement to act viders, and we saw this, in particular,
ing the availability of telehealth serv- as a barrier to mental health care when during the pandemic.
the pandemic extensions run out. We know it is vital that Medicare
ices and long-term care where people
I look forward to continuing this adapt to the ever-changing innovation
are especially vulnerable to COVID–19. in medical technology that allows tele-
This bill today makes some of those ac- work with my colleagues. This is a
really good bill, but we want to ensure health services, and this legislation
tions last beyond the public health really will expand freedom for patients
emergency through 2024. that permanent Medicare policy sup-
ports telehealth in ways that ensure by giving them more flexibility and
While I support this legislation, I do more capability to use telehealth serv-
think this is a missed opportunity to beneficiaries can continue to get the
right care in the right place at the ices.
do more. Republicans on the Energy Specifically, the legislation removes
and Commerce Committee have many right time.
geographic requirements, and it ex-
solutions to not just look at telehealth Mr. CARTER of Georgia. Madam
pands originating sites so that Medi-
and Medicare for a couple of years but Speaker, I yield 2 minutes to the gen-
care beneficiaries can receive care at
to look also at how we incentivize em- tleman from Utah (Mr. CURTIS), an im-
any site. It can expand the practi-
ployers to provide access to telehealth portant member of the Energy and tioners who are able to furnish tele-
for an estimated 156 million people Commerce Committee. health services, and it also provides for
with employer health insurance. Mr. CURTIS. Madam Speaker, I audio-only telehealth.
We have examined and worked on so- thank Mr. CARTER for his support. I am very pleased that this extension
lutions to address both where tele- I rise today in support of the Advanc- through 2024 was fully paid for using
health may not be appropriate and ing Telehealth Beyond COVID–19 Act. the Medicare Improvement Fund, and
where it drives better outcomes for pa- There is no putting the genie back in the CBO has shown that it will not in-
tients. the bottle. COVID–19 highlighted the crease direct spending.
Healthcare providers and patients importance of telehealth, especially in Madam Speaker, in Wyoming, espe-
need certainty. The pandemic has made providing quality care for rural com- cially, we know how important this is,
it clear that telehealth can and should munities. This bill would extend tele- how important telehealth access is.
be a part of modernizing healthcare. health offered through Medicare Many of our citizens live hours away,
I plan to support this legislation and through the end of 2024. hundreds of miles away, from their
hope to continue to work to unwind Like many of my colleagues, I would closest medical provider. I am very
the public health emergency in a way like to see that go longer. This bill in- proud that this bill has the support of
that provides patients and our cludes a provision I have supported in the Wyoming Hospital Association, in
healthcare providers the certainty that my bill, the Protecting Mental Health addition to the American Medical As-
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they need. I do think that we could Services Act, which extends mental sociation and a number of other crucial
have done more on this and hope that health services delivered through tele- groups whose mission is to serve pa-
this process won’t be a model for the health. tients and provide quality care.
rest. While Utah has, for the most part, re- While I know we in this body will
Mr. PALLONE. Madam Speaker, I turned to regular life, it is important continue to have legitimate and impor-
yield 3 minutes to the gentlewoman that we keep in place those flexibilities tant ongoing policy debates about
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H7192 CONGRESSIONAL RECORD — HOUSE July 27, 2022
healthcare, there is, as I said, broad bi- throughout this pandemic, we should merce Committee, Ways and Means,
partisan agreement for expanding ac- certainly continue its benefits, as I and are all longtime champions for
cess so that all of our citizens can re- proposed in bipartisan legislation last telehealth reforms, we have been com-
ceive high-quality care. That needs to year, and for which I secured the sup- pletely left out of the process.
continue to be a top priority. This bill port of 22 health-related stakeholders. The product we have before us today
does just that by allowing more Ameri- But we don’t have to accept billions of is a small step in the right direction,
cans to utilize telehealth services. dollars of fraud, of theft of taxpayer but the American people deserve bet-
Madam Speaker, I thank my col- funds as the price for maintaining tele- ter. This legislation, conceived in a
leagues from both sides of the aisle for health. last-minute deal, is, sadly, a missed op-
joining me in advancing our bill to this Here is what has been happening: In- portunity.
point, and I urge all Members to vote formation for some patients who want- This legislation, well, frankly, it
in favor of this legislation so more citi- ed a COVID–19 test was used fraudu- looks familiar. It removes geographic
zens can connect and receive care from lently to bill Medicare for expensive restrictions, enables telehealth access
the medical professionals of their cancer genetic tests and allergy tests in the home, protects telemental
choice. without any medical necessity or any health services—reforms we have been
Mr. CARTER of Georgia. Madam knowledge of the patient. In other seeking for years now.
Speaker, I yield 2 minutes to the gen- cases, expensive medical equipment in But it is time to decouple important
tleman from Texas (Mr. BURGESS). no way needed by the patient was or- telehealth reforms from this never-end-
Mr. BURGESS. Madam Speaker, I dered. ing public health emergency. Kicking
thank the gentleman for yielding. The wrongdoing has been exposed by the can down the road another year-
One of the many lessons we learned the General Accountability Office, the and-a-half, as this legislation does, just
during the pandemic is the ability to Health and Human Services inspector isn’t sufficient.
take care of patients who are safely in general, and is the subject of Justice During COVID–19, temporary tele-
their own homes. It was truly a high- Department prosecutions for literally health expansion was a real bright
light. billions of taxpayer dollars. Through spot. It eased burdens on a strained
Understanding that we will not be no fault of the gentlewoman from Wyo- medical system, protected at-risk pa-
going back to the status quo of 2019, we ming (Ms. CHENEY) or Chairman PAL- tients, and in rural Appalachian dis-
must recognize how telehealth has al- LONE, this bill fails to address this tricts like mine, I heard from countless
lowed our country to take a monu- theft. I offered an amendment to the constituents who were very relieved
mental step forward toward digitally bill that was recommended by an inde- that they could access care from their
enabled care. pendent, nonpartisan commission home instead of the common half hour
Telehealth has allowed Americans to called MedPAC, mandating reasonable or even longer to drive to the appoint-
take care of immediate and necessary steps to prevent or at least signifi- ments they needed.
health needs from their homes without cantly reduce this telehealth fraud. Now, Madam Speaker, it is time for
the costs and health risks that are Outrageous interference with the con- permanent reforms. I am proud to have
often associated with an in-person sideration of this bill is denying the introduced H.R. 8493 with my col-
visit. They don’t incur costs for park- House today any opportunity to con- leagues VERN BUCHANAN and MICHELLE
ing. They don’t have to take time off sider this antifraud amendment. STEEL to make real long-term reforms
from work. They don’t have to hire a My amendment would have required to telehealth. This, coupled with the
babysitter. in-person visits within 6 months prior additional alternative proposals my
While I am in support of this legisla- to ordering this high-cost lab testing colleagues have offered today, would do
tion, it does not go far enough. We do or DME—medical equipment—as well just that.
need to provide a permanent solution as an audit of outlier clinicians whose Clearly, as you can see, Madam
for Medicare providers and, most im- orders for these very high-cost services Speaker, the Speaker of the House has
portantly, their patients. and devices are largely made through a the will to take on this challenge. But
It is important that providers are telehealth appointment. This has to this bill on the floor today? Well, I am
given long-term certainty when taking stop, and we need to prevent the fraud, going to support it, but I am afraid it
care of their Medicare patients and are not just prosecute it and get back a few is just a start. We have more to do.
technologically capable of delivering pennies for the taxpayer per dollar Mr. PALLONE. Madam Speaker, I
the best care possible. after it has occurred. have no additional speakers at this
Yesterday, I introduced, along with The SPEAKER pro tempore. The time. We may have one more, but not
Representatives GREG MURPHY and time of the gentleman has expired. at this time. I reserve the balance of
YVETTE HERRELL, H.R. 8506 to perma- Mr. PALLONE. Madam Speaker, I my time.
nently extend Medicare coverage of yield the gentleman an additional 1 Mr. CARTER of Georgia. Madam
telehealth services for federally quali- minute. Speaker, I yield 1 minute to the gen-
fied health centers and rural health Mr. DOGGETT. Madam Speaker, this tleman from California (Mr. VALADAO).
clinics. bill costs $132 million per month. With- Mr. VALADAO. Madam Speaker, I
This important permanent extension out these targeted provisions to pre- appreciate the opportunity to speak on
would ensure that following the pan- vent Medicare from being looted, I this. Telehealth is critical for rural and
demic, providers and patients continue must vote against it. low-income communities like many in
to have access to telehealth flexibili- Mr. CARTER of Georgia. Madam my district, and I absolutely support
ties, especially in rural and under- Speaker, I yield 21⁄2 minutes to the gen- this bill.
served areas. These are arguably com- tleman from Ohio (Mr. JOHNSON), an- Throughout the COVID–19 pandemic,
munities that have benefited the most other valuable member of the Energy telehealth was widely used since we
from an increase in telehealth access. and Commerce Committee. were not able to see our healthcare
We will continue to see innovation Mr. JOHNSON of Ohio. Madam providers in person. Even before the
and technology that will further influ- Speaker, this should be a happy occa- pandemic, many of my constituents
ence how we deliver care to American sion because major telehealth legisla- were not able to go to their health ap-
patients. We need to keep up with the tion is being brought to the floor on its pointments because oftentimes the of-
times. This bill is an important step, own. Finally. fice was way too far, or they did not
but it is not the end of the discussion. As a co-chair of the bipartisan Con- have the transportation to get to their
gressional Telehealth Caucus, my fel- provider.
b 1300
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low caucus members and I have been Through this legislation, the Advanc-
Mr. PALLONE. Madam Speaker, I pushing for telehealth to be recognized ing Telehealth Beyond COVID–19 Act,
yield 2 minutes to the gentleman from for its true value for years. Years. some of the healthcare flexibilities we
Texas (Mr. DOGGETT). So here we are, and those of us who have seen since 2020 would be extended
Mr. DOGGETT. Madam Speaker, are leaders on the Congressional Tele- for another 2 years. This action is very
with telehealth helping so many health Caucus, the Energy and Com- necessary, but I also believe it is in the
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July 27, 2022 CONGRESSIONAL RECORD — HOUSE H7193
best interests of our constituents to tlewoman from Iowa (Mrs. MILLER- Mr. PALLONE. Madam Speaker, I
take these flexibilities and make them MEEKS). continue to reserve the balance of my
permanent. Mrs. MILLER-MEEKS. Madam time.
I introduced a companion bill with Speaker, I rise today in support of H.R. Mr. SMITH of Nebraska. Madam
my colleagues that would make perma- 4040. This bill would extend telehealth Speaker, I yield myself such time as I
nent the expanded list of practitioners flexibilities under Medicare until 2024. may consume. I will be brief in my re-
eligible to provide telehealth services. These flexibilities allow physicians to marks here.
Congresswoman CHENEY’s bill is a be more widely available to patients I know that you have heard several
great starting point, but I encourage who no longer need to wait weeks for a concerns expressed about this entire
my colleagues to make these flexibili- visit or take hours off work to sit in a process, and I would certainly share
ties permanent so our constituents can doctor’s office. those concerns.
have access to the care even after the While I support this bill, I am dis- I do think that this is a great oppor-
public health emergency declaration appointed that the majority did not tunity to address a bipartisan issue
has ended. follow the regular committee process, that is important across America. But
Mr. PALLONE. Madam Speaker, I am which could have further improved the it appears this bill was negotiated
prepared to close, but I think Repub- bill in a bipartisan way. quickly, in secret, and outside the com-
licans may have additional speakers. For example, the committee could mittees of jurisdiction. Neither outside
Mr. CARTER of Georgia. Madam have incorporated elements of the stakeholders nor Members who have
Speaker, I yield myself such time as I Greater Access to Telehealth Act, worked extensively on telehealth pol-
may consume. which I am proud to co-lead with the icy were consulted, as far as I can tell,
Again, let me be clear about my gentleman from Arizona (Mr. and the closed rule under which this is
standing on this bill. I support this SCHWEIKERT) and the gentleman from being considered has precluded any op-
bill. We support telehealth. We are all Georgia (Mr. CARTER). This bill would portunity to improve or amend the bill.
in favor of telehealth, but we also sup- extend the telehealth flexibility until An issue this important deserves an
port the fact that we have committees 2026 and includes policies to support open and transparent process that fol-
that this type of legislation needs to go health savings accounts. But the ma- lows regular order, allowing Members
through, and we missed an opportunity jority did not follow regular order, and to offer input and highlight important
here to make this a better bill. That is that is a great disservice to a common- needs which might otherwise have been
simply what we are saying. sense bill like H.R. 4040. overlooked. We call this legislating.
No one is saying they are not in favor Regardless, and despite the proce- If we had worked together on the
dural irregularities, I support the bill, Ways and Means Committee with our
of telehealth. Telehealth has become
and I encourage my colleagues to vote Energy and Commerce friends and had
an integral part of our healthcare sys-
for H.R. 4040. included the various ideas and innova-
tem during this pandemic. There is no Mr. PALLONE. Madam Speaker, I
question about that. All of us agree on tions, this would have been a true and
continue to reserve the balance of my real bipartisan bill. I am confident that
that. It needs to be extended. time.
But, again, the committee process is the telehealth extension we are consid-
Mr. SMITH of Nebraska. Madam
exceptionally important, and we need ering today would be even better, as
Speaker, I yield 2 minutes to the gen-
to make sure that we follow that, par- has been mentioned by my colleagues.
tleman from North Carolina (Mr. MUR-
ticularly when we are talking about In fact, back in May, I introduced a
PHY).
subject matter as important as this be- Mr. MURPHY of North Carolina. bipartisan bill almost identical to this
cause it is important. Madam Speaker, I rise today in support one called the Connecting Rural Tele-
Again, since I have been a Member of of H.R. 4040. There have been a few sil- health to the Future Act. That bill ex-
Congress, I have been working to make ver linings that we have seen in the tended all the provisions included in
healthcare accessible and available, pandemic, and definitely telehealth has the FY22 omnibus through at least 2024
and telehealth does just that. This is been one of them. and also included provisions to ensure
exactly what we want, but there are I will submit, I am personally thank- critical access hospitals can continue
ways that we could have made this bet- ful for this bill because I will say, to provide telehealth services to their
ter. maybe, perhaps I am the only sitting patients. It also corrects a flaw in the
One example is that we need to make Member of Congress who, as a physi- CARES Act which shortchanges feder-
sure there is no waste, fraud, and cian, has actually used telehealth. ally qualified health centers and rural
abuse. That is one thing that could In my surgical practice, I see pa- health clinics which offer telehealth
have been tightened up in this legisla- tients from 2 hours north, 2 hours services.
tion. south, and sometimes 5 hours east out Madam Speaker, I include in the
Another example is to make sure on the eastern North Carolina coast. RECORD two letters from the National
that we are not having any informa- So many of my patients who come Rural Health Association and the Na-
tion that is inadvertently or inten- from rural eastern North Carolina tional Association of Rural Health
tionally being released. That is ex- can’t even afford gas in the infla- Clinics expressing their support for
tremely important as well. tionary environment we have to even both the aims of H.R. 4040 as well as
So again, there are ways that we travel these distances, much less some- the need to extend critical rural health
could have made this legislation better times across town. provisions from the Connecting Rural
if we had gone through the committee While this bill is a good start, it is a Telehealth to the Future bill.
process, which is a process that is ex- very, very good start, it does not go far NATIONAL RURAL
tremely important. enough, and that is why I, with Dr. HEALTH ASSOCIATION,
Madam Speaker, I reserve the bal- BURGESS and Congresswoman HERRELL, July 26, 2022.
ance of my time. introduced a bill to permanently ex- Hon. NANCY PELOSI,
Speaker, House of Representatives.
Mr. PALLONE. Madam Speaker, I tend telehealth for federally qualified Hon. KEVIN MCCARTHY,
continue to reserve the balance of my health centers and rural health cen- Minority Leader, House of Representatives.
time. ters. These are the medical practices DEAR SPEAKER PELOSI AND MINORITY LEAD-
The SPEAKER pro tempore. The gen- that take care of our poorest and the ER MCCARTHY: The National Rural Health
tleman from Nebraska is recognized most at-risk patients. These individ- Association (NRHA) applauds the House of
and controls the time. uals need to be able to access tele- Representatives for prioritizing telehealth
Mr. SMITH of Nebraska. Madam health because they have to travel long flexibilities by scheduling a vote on H.R.
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Speaker, may I inquire how much time 4040, the Advancing Telehealth Beyond
distances and don’t have the resources
COVID–19 Act of 2022. This legislation will
is remaining? that they need to be able to access phy- extend important telehealth flexibilities en-
The SPEAKER pro tempore. The gen- sician care. acted in the Coronavirus Aid, Relief, and
tleman has 19 minutes remaining. I subsequently urge my colleagues to Economic Security (CARES) Act, and ex-
Mr. SMITH of Nebraska. Madam support this initiative and urge them tended for 151 days post-public health emer-
Speaker, I yield 2 minutes to the gen- that we can do much more. gency in the Consolidated Appropriations
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H7194 CONGRESSIONAL RECORD — HOUSE July 27, 2022
Act (CAA), 2022, until December 31, 2024. We are concerned with this ‘‘special pay- tually from the comfort of their homes.
NRHA supports the extension of telehealth ment rule’’ methodology for a whole host of As a result, 52 million seniors sought
flexibilities to show providers that tele- reasons. First and foremost, the payment is their medical care virtually in 2020.
health is here to stay but urges rural friend- significantly less than what most RHCs and I am proud to see my bill, the Pro-
ly tweaks to the legislation. FQHCs would receive for providing the same
NRHA is a non-profit membership organi- tecting Mental Health Services Act, in-
service in person, disincentivizing safety-net
zation with more than 21,000 members na- providers from offering the service via tele-
cluded in this legislation to ensure sen-
tionwide that provides leadership on rural health. Second, the current rules require iors have virtual access to mental
health issues. Our membership includes RHCs and FQHCs to ‘‘carve-out’’ all tele- health and substance abuse treatment.
every component of rural America’s health health costs from their cost report, which My bill ensures all Oklahomans can ac-
care, including rural community hospitals, adds significant administrative burden to cess high-quality care, regardless of
critical access hospitals, doctors, nurses, and the cost-reporting process. Third, the use of their physical location.
patients. We provide leadership on rural a single telehealth code, G2025, has prevented While this legislation is a step for-
health issues through advocacy, communica- RHCs from tracking annual wellness visits
tions, education, and research. ward, it is unfortunate that it excludes
and other services provided via telehealth se- employer-sponsored healthcare from
As the text is currently written, H.R. 4040
verely hindering their ability to properly the same low-cost access to telehealth.
includes the extension of distant-site status
participate in ACOs and other quality pro-
for Federally Qualified Health Centers It is critical to provide folks on the job
grams.
(FQHC) and Rural Health Clinics (RHC) at with the ability to seek flexible treat-
their current reimbursement level. While Complicating matters is the fact that for
mental health services provided via tele- ment, and I look forward to working
continuation of this flexibility is necessary, with my colleagues on both sides of the
the reimbursement level for virtual services health, RHCs and FQHCs do use their normal
coding and reimbursement mechanisms. This aisle to pass this provision at a later
is significantly lower than in-person services
under current statute. Should reimburse- policy is working well, and we believe that is date.
ment remain as it is currently written, by should work this way for all services, not Mr. PALLONE. Madam Speaker, I re-
2028 there will be nearly a $100 discrepancy just mental health services. serve the balance of my time.
between services provided in-person and vir- NARHC strongly believes that the best way Mr. SMITH of Nebraska. Madam
tually at RHCs. NRHA believes this will to encourage telehealth usage in underserved Speaker, I yield 1 minute to the gentle-
cause rural communities to utilize these im- communities is to create parity between in- woman from New Mexico (Ms.
portant services less often than their urban person and telehealth policies. We strongly HERRELL).
and suburban counterparts moving forward encourage Congress to amend H.R. 4040 to in-
Ms. HERRELL. Madam Speaker, I
and will cause harm to an already fragile clude the payment policy enumerated in Sec-
tion 9 of H.R. 7876, the Connecting Rural
rise in support of the Advancing Tele-
rural safety net. health Beyond COVID–19 Act, which
To remedy this discrepancy, NRHA urges Telehealth to the Future Act introduced by
this text be amended to incorporate reim- Representative Adrian Smith and Represent- would extend vital telehealth flexibili-
bursement updates as reflected in Section 9 ative Terri Sewell. ties through 2024. Expanding telehealth
of H.R. 7876, the Connecting Rural Tele- Please feel free to contact me if you would during the pandemic was a resounding
health into the Future Act, introduced by like to discuss this issue further. success and has been recognized by
Representatives Adrian Smith (R–NE) and Sincerely, many New Mexicans and rural Ameri-
Terri Sewell (D–AL). Incorporating this leg- NATHAN BAUGH, cans as a lifesaver.
islative text will bring payment parity be- Executive Director, Telehealth provided Americans con-
tween in-person and virtual care at RHCs National Association of Rural Health Clinics. tinued access to healthcare services
and FQHCs and ensure that rural commu- Mr. SMITH of Nebraska. Madam without being physically present and
nities have access to the same health care
Speaker, these organizations fully un- also allowed healthcare providers to re-
delivery methods as their urban and subur-
ban counterparts. derstand the vital role that rural main in practice.
NRHA applauds the House of Representa- health clinics and FQHCs and critical While this bill is an important step
tives for acting on telehealth to show pro- access hospitals play in ensuring access in the right direction, my Republican
viders long-term stability. However, to en- to care for those in rural and under- colleagues and I wish to go one step
sure that rural providers, and their patients, served areas. further by offering another bill, which
can properly utilize these services tweaks Even with the passage of this bill, would make permanent the extension
are needed. of telehealth services for federally
Sincerely,
the future of telehealth after the gov-
ernment-designated public health qualified health clinics and rural
ALAN MORGAN,
Chief Executive Officer. emergency is uncertain. More work health clinics.
-- needs to be done to assess what has Madam Speaker, I urge my col-
NATIONAL ASSOCIATION OF worked well over the last 2 years, what leagues to support the bill on the floor,
RURAL HEALTH CLINICS, can be improved, and what can safely as well as our subsequent bill to perma-
July 26, 2022. be left behind. nently expand telehealth services to all
Hon. NANCY PELOSI, While I do encourage Members to Americans, regardless of ZIP Code. Ac-
Speaker, House of Representatives, cess to the care they deserve is crucial.
Washington, DC.
vote ‘‘yes’’ on this bill, I hope in the fu-
Mr. PALLONE. Madam Speaker, I re-
Hon. KEVIN MCCARTHY, ture we can work in a true bipartisan
serve the balance of my time.
Republican Leader, House of Representatives, fashion under regular order to address Mr. SMITH of Nebraska. Madam
Washington, DC. the gaps that we know exist in policy Speaker, I yield 1 minute to the gentle-
DEAR SPEAKER PELOSI AND LEADER MCCAR- and set a long-term, sustainable course
THY: The National Association of Rural woman from California (Mrs. STEEL).
for telehealth well beyond 2024. Mrs. STEEL. Madam Speaker, I rise
Health Clinics (NARHC) is grateful that the Madam Speaker, I reserve the bal-
House of Representatives is considering ex- in support of the Advancing Telehealth
tending Medicare coverage of telehealth ance of my time. Beyond COVID–19 Act.
through 2024 but we are concerned that the b 1315 Telehealth has been life changing for
current language in H.R. 4040 will perpetuate so many, especially during the COVID–
inequitable payment policies for safety-net Mr. PALLONE. Madam Speaker, I re- 19 pandemic. Increased access to tele-
providers. serve the balance of my time. health has benefited a wide range of
Presently, our peers in traditional office Mr. SMITH of Nebraska. Madam
settings are able to bill for telehealth serv- Americans, from seniors to high-risk
Speaker, I yield 1 minute to the gen- patients.
ices as if the service was provided physically
in the office. In other words, they have cod-
tleman from Oklahoma (Mr. HERN), a We must ensure that the millions of
ing and reimbursement parity between tele- member of the Ways and Means Com- Americans who have utilized flexibility
health services and in-person services. mittee. provisions authorized during the pan-
On the other hand, Rural Health Clinics Mr. HERN. Madam Speaker, I rise in demic do not lose their access to tele-
(RHCs) and Federally Qualified Health Cen- support of H.R. 4040, which will main- medicine.
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ters (FQHCs) do not use their normal coding tain seniors’ access to telehealth, or Right now, regardless of where you
and reimbursement rules for telehealth. what should be more appropriately live, you have access to telehealth and
RHCs and FQHCs instead have a ‘‘special
payment rule’’ that requires them to bill a called virtual health. virtual care. This bill ensures that this
single code, G2025, for all telehealth services In 2020, the Trump administration can continue for millions of Ameri-
which is then reimbursed at a single nation- eliminated bureaucratic red tape so cans, but we should ensure that this
wide rate (currently $97.24). seniors could access healthcare vir- flexibility is permanent.
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July 27, 2022 CONGRESSIONAL RECORD — HOUSE H7195
That is why I introduced legislation Madam Speaker, there is just a frus- Since I heard every Republican who
with Mr. BUCHANAN and Mr. JOHNSON to tration here because we all talk pretty spoke say that they support the bill, I
permanently remove any geographic about this, and then we are unwilling was certainly reluctant to suggest that
restrictions on telehealth services. to do the things that could potentially we would have any kind of significant
Madam Speaker, I urge my col- help us all by disrupting the price of debate about the bill. I generally feel
leagues to support our legislation and healthcare and increasing access, that if I have both sides of the aisle
to vote ‘‘yes’’ on today’s bill so that we maybe making people’s lives better. In- saying it is a good bill, I should leave
can continue to expand access to qual- stead, it just became more political well enough alone.
ity, affordable healthcare solutions. theater. We should be ashamed of our- But I do want to say this in response
Mr. PALLONE. Madam Speaker, I re- selves. to some of the comments that were
serve the balance of my time. Madam Speaker, I ask unanimous made by the Republican Members. We
Mr. SMITH of Nebraska. Madam consent to insert the text of the were reluctant in the committee to
Speaker, I yield 1 minute to the gen- amendment in the RECORD imme- move to have permanent authorization
tleman from California (Mr. diately prior to the vote on the motion of the telehealth flexibility expansion
OBERNOLTE). to recommit. for several reasons.
Mr. OBERNOLTE. Madam Speaker, I The SPEAKER pro tempore. Is there First of all, it is expensive. In other
represent one of the largest geographic objection to the request of the gen- words, the Congressional Budget Office
districts in the country. Access to tleman from Arizona? scored this bill. As I said, the bill for
healthcare is a very real problem for There was no objection. the 2 years is paid for. If you wanted to
the people I represent because many of Mr. SCHWEIKERT. Madam Speaker, go permanent, I think they would have
them live hours away and hundreds of if I came to the body and said the bill said that we needed another $20 billion.
miles away from specialized we had all been working on, H.R. 8489— I feel very strongly that the bill should
healthcare. when you have someone like LLOYD be paid for. That is part of what we be-
For my constituents, one of the few DOGGETT and someone like me, and we lieve as Democrats. We were able to get
positive developments that came out of are actually working together, we are agreement with the Republicans on a
COVID–19 was the expansion of the way working on some of the antifraud pro- pay-for for the 2 years, so that was a
that telehealth can be used to provide visions, program integrity provisions, factor as to why it is for 2 years in-
quality healthcare in districts like you actually had something this body stead of permanent.
mine. was doing where we weren’t beating Beyond that, and more importantly,
This bill, H.R. 4040, would take a very the crap out of each other. It was really, is the fact that a permanent ex-
meaningful step in making permanent something that actually might be good pansion is a major change. I think it
the changes to law that enable the pro- for people in the country. Instead, we needs a lot of study, a lot of oversight
vision of that telehealth, and I strong- turned it back into another oppor- and investigation. One of the things
ly urge its adoption. tunity for political gamesmanship. that I mentioned in Rules is that both
Mr. PALLONE. Madam Speaker, I re- It is my intense disappointment be- HHS and the inspector general have
serve the balance of my time. cause it is our language, substantially been tasked to report back to us this
Mr. SMITH of Nebraska. Madam something I have worked on for years, spring with a report on a lot of the
Speaker, I yield 3 minutes to the gen- that was grabbed for the pandemic. We things that were mentioned here today,
tleman from Arizona (Mr. all know it expires the day the pan- integrity issues, in terms of fraud and
SCHWEIKERT). demic is declared over. It is time to abuse, that were mentioned by both
Mr. SCHWEIKERT. Madam Speaker, take this opportunity—I know there is sides of the aisle.
you hear everyone here all say some- an army of lobbyists out there that de- I think the feeling of the committee
thing nice. We all like telehealth. I am spise telehealth because it changes the was that this was something that need-
frustrated because I can’t get my head populations that walk in the threshold. ed more study before we went ahead
around why we are not going further. To hell with them. Let’s finally do and made this permanent. That is what
Outside the internal political the- what is right. we do. In other words, right now, the
ater, those of us who have worked on Mr. PALLONE. Madam Speaker, I re- concern is that because the omnibus
this legislation since the day we got serve the balance of my time. appropriations bill basically expanded
here and then all of a sudden wake up Mr. SMITH of Nebraska. Madam the telehealth program until 5 months
one day and it is a different bill with Speaker, I yield myself the balance of after the public health emergency for
someone who I have never even heard my time. COVID ends, that would take us to the
of working on it, God bless. The major- I think we have had a good discussion end of this year. But we don’t have a
ity gets to do things like that. here today. I think we have laid out lot of legislative days left. We figured
We want a change in the price of that we are acting in good faith, sup- the best thing was to at least extend it
healthcare. Can we come together and porting an issue, moving it forward, for another 2 years. We can pay for it,
unleash technology? Telehealth is but also posing the scenario that there as was mentioned by Ms. CHENEY.
more than just looking at the phone are so many other things we can do to This, I think, is the best way to re-
and doing FaceTime or now talking. It address the very matter that we are solve this: Do a 2-year extend, pay for
is the wearable. It is the thing. It is the taking up here today. it, and let’s spend the time between
thing you lick. The surrounding details about how now and next spring having some more
There is technology with which we this bill came up and everything, I hearings and opportunities to talk
could be crushing the price of think it is problematic for the institu- about a further extension or possibly
healthcare, and instead, we are doing tion. But the fact of the matter is, we making it permanent.
little incremental steps here. have an issue here that we need to ad- Again, I appreciate the fact that ev-
There are a couple of problems with dress. I hope that we can work to con- eryone on the Republican side supports
the bill the Democrats decided to bring tinue to make it permanent in the fu- the bill, but I do want to address some
to the floor. It is for 2 years. We com- ture so that we can encourage invest- of the things that you mentioned.
promised to 4. If you want capital in- ment, as was outlined previously, and Madam Speaker, I yield back the bal-
vestments in the technology, you have encourage bending of the cost curve, ance of my time.
to give us at least 4. It should be per- ultimately, on healthcare, which is Ms. JACKSON LEE. Madam Speaker, I rise
manent. lacking at this point in time. in support of H.R. 4040 the Advancing Tele-
There is also something in here that Madam Speaker, I urge a ‘‘yes’’ vote health Beyond COVID–19 Act of 2021, which
ctelli on DSK11ZRN23PROD with HOUSE
is just frustrating. You missed the lan- on this bill, and I urge a different kind would make permanent several telehealth
guage on health savings accounts. You of cooperation moving forward. flexibilities under Medicare that were initially
have 32 million people now who func- Madam Speaker, I yield back the bal- authorized during the COVID–19 public health
tionally are not going to have access to ance of my time. emergency.
be able to use those accounts for their Mr. PALLONE. Madam Speaker, I This bill would extend the life-saving meas-
telehealth. yield myself the balance of my time. ures put in place by Congress during the
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H7196 CONGRESSIONAL RECORD — HOUSE July 27, 2022
COVID–19 pandemic that allowed millions of It also means psychiatrists can observe chil- Now that beneficiaries have received this
American people to access telehealth-care. dren in their natural setting at home or in important benefit, they fully appreciate what
Specifically, H.R. 4040 would: school, rather than in an inorganic hospital en- telehealth does for them. We must find a way
permanently remove originating site and vironment. to continue telehealth access for seniors and
geographical restrictions that limited telehealth Telehealth allows children to be where they all Americans. That’s why I’m proud to support
services to designated clinics in the event of ought to be—in the classroom getting an edu- Representatives LIZ CHENEY and DEBBIE DIN-
a physician shortage, cation. GELL’s bipartisan H.R. 4040, the ‘‘Advancing
give rural providers the ability to serve pa- These are just some of the many examples Telehealth Beyond COVID–19 Act of 2022.’’
tients remotely while being properly com- of how telehealth has aided our healthcare The bill will allow Medicare beneficiaries to
pensated for their work, system in providing the quality medical serv- use telehealth services after the public health
empower providers to provide access to ices that our constituents deserve. emergency ends by eliminating geographical
smart devices and innovative digital tech- The passage of H.R. 4040, the Advancing restrictions on Medicare coverage for tele-
nology to their patients for monitoring pur- Telehealth Beyond COVID–19 Act of 2021, health services and expand Medicare cov-
poses, and would ensure that these positive develop- erage to include audio-only telehealth. I urge
provide coverage for audio-only evaluation, ments continue to benefit communities across my colleagues to support this important, bipar-
management, and behavioral health services. the country. tisan bill.
H.R. 4040 would codify critical telehealth It is important to note, however, that tele- Mr. THOMPSON of California. Madam
policies implemented during the pandemic for health has not always served all people equal- Speaker, I rise in strong support of this legisla-
the continued benefit of all, but especially ly. tion.
those in isolated communities, people with dis- Historical data shows that People of Color I have been working on telehealth and tele-
abilities, and seniors. have long faced obstacles to getting the crit- medicine for nearly three decades, since my
Telehealth has dramatically improved the ical health care services they need. time in the California State Senate.
medical industry by making healthcare more Unfortunately, the rapid implementation of As founder and Co-Chair of the Congres-
accessible to people in rural areas, those with telemedicine hasn’t bridged the equality divide sional Telehealth Caucus, I have repeatedly
mobility concerns, and individuals whose work as much as one would have hoped. introduced multiple bipartisan bills expanding
or family schedules may not accommodate an A study led by the University of Houston access to telehealth, and have worked with
appointment at a physical location. College of Medicine found that African Ameri- my colleagues on the caucus—including Ms.
During the height of the pandemic, while cans were 35 percent less likely to use tele- Matsui, Mr. Welch, Mr. Schweikert, and Mr.
more than 3,000 people were dying per day of medicine compared to White Americans, and Johnson of Ohio—to ensure that access to
the virus, telehealth served as an invaluable those in Hispanic communities were 51 per- telehealth services does not disappear at the
weapon against the spread of infectious dis- cent less likely to use it. conclusion of the COVID–19 Public Health
ease. Only 66 percent of African American and 61 Emergency.
Remote screening and care prevented percent of Hispanic households have access I was proud to author legislation two years
undue burden on our already exhausted med- to broadband internet compared to 79 percent ago expanding telehealth in Medicare for the
ical professionals and allowed patients to get of white households. duration of the COVID–19 pandemic. That leg-
the care they needed without putting them- Additionally, only a quarter of families earn- islation—which was included in the very first
selves or their families at risk. ing $30,000 or less have smart devices, such COVID–19 relief measure advanced by Con-
What began as emergency protocol then, as a phone, tablet, or laptop at home, limiting gress—has allowed millions of seniors on
has now emerged as best practice. their access to telehealth services.
Currently, 76 percent of hospitals in the U.S. Medicare to see their doctors over the past
So, while telehealth has reduced many bar- two years without leaving their homes.
connect doctors and patients remotely via tele- riers to adequate healthcare, we must stay
health. By allowing these patients to receive the
vigilant to the needs of our most disadvan- care they need remotely, we’ve been able to
This is up from 35 percent a decade ago.
Remote healthcare allows for greater flexi- taged community members. minimize transmission risk while maximizing
We are a long way from full medical equality safety for both patients and providers.
bility for patients, enables certain physicians
in this country, however, I believe that the Ad- In my view, the expansion and widespread
like allergists or occupational therapists to ac-
vancing Telehealth Beyond COVID–19 Act of adoption of telehealth services is one of the
cess an individual’s environmental needs, and
2021 is an important step in bringing us closer few silver linings of COVID–19.
streamlines the scheduling process to prevent
to that goal. Americans across our country now know
long wait times and wasted time.
Telehealth has allowed doctors to monitor H.R. 4040 is an opportunity to connect our firsthand that by integrating technology with
their patients’ chronic conditions more closely, healthcare providers with patients who might health care, we can bring care to underserved
like heart or lung disease. otherwise go without the medical care they so areas, reduce burdens on parents and care-
Better monitoring can improve patients’ desperately need. givers, increase the efficiency of our health
quality-of life and reduce hospital admissions It is an opportunity to lift our nation’s care system and, in many cases, save money:
and deaths from chronic diseases. healthcare into the 21st century and to utilize by ensuring that patients receive care swiftly,
Additionally, telehealth is a good way to de- technology as a medical equalizer. we can treat medical conditions early on—
liver care quickly in an emergency, such as a I urge all my colleagues to support H.R. thereby warding off worse (and more expen-
stroke or heart attack. 4040 the Advancing Telehealth Beyond sive) complications down the road.
Telehealth has also played a significant role COVID–19 Act of 2021. However, while the value of telehealth is
in expanding pediatric mental healthcare ac- Ms. ESHOO. Madam Speaker, as the Chair- particularly evident amidst a pandemic, its util-
cess. woman of the Health Subcommittee and a ity is not limited to the present circumstances.
As of April 2019, there were only 8,300 senior member of the Communications and It is critical that Congress extend telehealth
practicing child and adolescent psychiatrists in Technology Subcommittee, I’ve advanced the flexibilities in Medicare beyond the COVID–19
the U.S. importance of telehealth for years. public health emergency.
This number is dwarfed by the more than 15 Over the last several months, as I’ve talked And that’s what this bill does.
million kids and teens in need of a psychiatric to health care professionals and providers in This bill includes numerous provisions of
provider. my district, I’ve heard how the wide adoption mine ensuring that seniors can continue to
For over a decade, The University of Texas of telehealth has been the bright spot during visit providers remotely, regardless of zip
Medical Branch has offered telehealth services the pandemic. code, for two more years. It allows us to con-
for rural patients. One reason for that bright spot is that HHS tinue amassing and analyzing data, and sets
After initially partnering with community waived many rules and payment policies sur- the stage for telehealth to become a perma-
mental health clinics in fringe counties, the rounding telehealth coverage in traditional nent part of the Medicare program—a goal
program has since been able to expand ado- Medicare during the public health emergency. I’ve long sought.
ctelli on DSK11ZRN23PROD with HOUSE
lescent mental health services directly to A recent HHS Office of the Inspector General I want to thank the many, many colleagues
school districts. report found that over 28 million Medicare of mine who have worked with me on this crit-
This means children without access to a beneficiaries used telehealth during the first ical issue.
local psychiatrist can receive the care they year of the pandemic, demonstrating the long- I urge my colleagues to vote yes.
need without being pulled from school or trav- term potential of telehealth to increase access The SPEAKER pro tempore. All time
eling long distances. to health care for beneficiaries. for debate has expired.
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July 27, 2022 CONGRESSIONAL RECORD — HOUSE H7197
Pursuant to House Resolution 1256, SEC. 5. DELAYING THE IN-PERSON REQUIRE- fore January 1, 2023,’’ and inserting ‘‘and be-
MENTS UNDER MEDICARE FOR MEN- fore January 1, 2027,’’.
the previous question is ordered on the TAL HEALTH SERVICES FURNISHED
bill, as amended. SEC. 9. FUNDING FROM MEDICARE IMPROVE-
THROUGH TELEHEALTH AND TELE-
MENT FUND.
The question is on engrossment and COMMUNICATIONS TECHNOLOGY.
(a) DELAY IN REQUIREMENTS FOR MENTAL Section 1898(b)(1) of the Social Security
third reading of the bill.
HEALTH SERVICES FURNISHED THROUGH TELE- Act (42 U.S.C. 1395jjj(b)(1)) is amended by
The bill was ordered to be engrossed
HEALTH.—Section 1834(m)(7)(B)(i) of the So- striking ‘‘$7,500,000,000’’ and inserting ‘‘$0’’.
and read a third time, and was read the
cial Security Act (42 U.S.C. The SPEAKER pro tempore. Pursu-
third time. 1395m(m)(7)(B)(i)) is amended, in the matter
MOTION TO RECOMMIT
ant to clause 2(b) of rule XIX, the pre-
preceding subclause (I), by striking ‘‘on or vious question is ordered on the motion
Mr. SCHWEIKERT. Madam Speaker, after the day that is the 152nd day after the
to recommit.
I have a motion to recommit at the end of the period at the end of the emergency
sentence described in section 1135(g)(1)(B))’’ The question is on the motion to re-
desk.
The SPEAKER pro tempore. The and inserting ‘‘on or after January 1, 2027 commit.
Clerk will report the motion to recom- (or, if later, the first day after the end of the The question was taken; and the
mit.
emergency period described in section Speaker pro tempore announced that
1135(g)(1)(B))’’. the noes appeared to have it.
The Clerk read as follows: (b) MENTAL HEALTH VISITS FURNISHED BY
Mr. Schweikert of Arizona moves to re- Mr. SCHWEIKERT. Madam Speaker,
RURAL HEALTH CLINICS.—Section 1834(y) of
commit the bill H.R. 4040 to the Committee the Social Security Act (42 U.S.C. 1395m(y))
on that I demand the yeas and nays.
on Energy and Commerce. is amended— The yeas and nays were ordered.
The material previously referred to (1) in the heading, by striking ‘‘TO HOSPICE The SPEAKER pro tempore. Pursu-
by Mr. SCHWEIKERT is as follows: PATIENTS’’; and ant to section 8 of rule XX, further pro-
Strike all after the enactment clause and (2) in paragraph (2), by striking ‘‘prior to ceedings on this question are post-
insert the following: the day that is the 152nd day after the end of poned.
the emergency period described in section
SECTION 1. SHORT TITLE.
1135(g)(1)(B))’’ and inserting ‘‘prior to Janu- f
This Act may be cited as the ‘‘Greater Ac-
ary 1, 2027 (or, if later, the first day after the RECESS
cess to Telehealth Act’’.
end of the emergency period described in sec-
SEC. 2. REMOVING GEOGRAPHIC REQUIREMENTS The SPEAKER pro tempore. Pursu-
AND EXPANDING ORIGINATING
tion 1135(g)(1)(B))’’.
SITES FOR TELEHEALTH SERVICES.
(c) MENTAL HEALTH VISITS FURNISHED BY ant to clause 12(a) of rule I, the Chair
FEDERALLY QUALIFIED HEALTH CENTERS.— declares the House in recess subject to
Section 1834(m) of the Social Security Act
Section 1834(o)(4) of the Social Security Act the call of the Chair.
(42 U.S.C. 1395m(m)) is amended—
(42 U.S.C. 1395m(o)(4) is amended— Accordingly (at 1 o’clock and 28 min-
(1) in paragraph (2)(B)(iii)—
(1) in the heading, by striking ‘‘TO HOSPICE
(A) by striking ‘‘With’’ and inserting ‘‘In
PATIENTS’’; and
utes p.m.), the House stood in recess.
the case that the emergency period described
(2) in subparagraph (B), by striking ‘‘prior f
in section 1135(g)(1)(B) ends before December
to the day that is the 152nd day after the end
31, 2026, with’’; and
of the emergency period described in section b 1534
(B) by striking ‘‘that are furnished during
1135(g)(1)(B))’’ and inserting ‘‘prior to Janu- AFTER RECESS
the 151-day period beginning on the first day
ary 1, 2027 (or, if later, the first day after the
after the end of the emergency period de- The recess having expired, the House
end of the emergency period described in sec-
scribed in section 1135(g)(1)(B)’’ and inserting was called to order by the Speaker pro
tion 1135(g)(1)(B))’’.
‘‘that are furnished during the period begin-
ning on the first day after the end of such
SEC. 6. ALLOWING FOR THE FURNISHING OF tempore (Ms. KAPTUR) at 3 o’clock and
AUDIO-ONLY TELEHEALTH SERV- 34 minutes p.m.
emergency period and ending December 31, ICES.
2026’’; and Section 1834(m)(9) of the Social Security f
(2) in paragraph (4)(C)(iii)— Act (42 U.S.C. 1395m(m)(9)) is amended by
(A) by striking ‘‘With’’ and inserting ‘‘In COMMUNICATION FROM THE
striking ‘‘The Secretary shall continue to
the case that the emergency period described provide coverage and payment under this CLERK OF THE HOUSE
in section 1135(g)(1)(B) ends before December part for telehealth services identified in The SPEAKER pro tempore laid be-
31, 2026, with’’; and paragraph (4)(F)(i) as of the date of the en-
(B) by striking ‘‘that are furnished during
fore the House the following commu-
actment of this paragraph that are furnished nication from the Clerk of the House of
the 151-day period beginning on the first day via an audio-only telecommunications sys-
after the end of the emergency period de- Representatives:
tem during the 151-day period beginning on
scribed in section 1135(g)(1)(B)’’ and inserting the first day after the end of the emergency OFFICE OF THE CLERK,
‘‘that are furnished during the period begin- period described in section 1135(g)(1)(B)’’ and HOUSE OF REPRESENTATIVES,
ning on the first day after the end of such inserting ‘‘In the case that the emergency Washington, DC, July 27, 2022.
emergency period and ending on December period described in section 1135(g)(1)(B) ends Hon. NANCY PELOSI,
31, 2026’’. before December 31, 2026, the Secretary shall Speaker, House of Representatives,
SEC. 3. EXPANDING PRACTITIONERS ELIGIBLE continue to provide coverage and payment Washington, DC.
TO FURNISH TELEHEALTH SERV- DEAR MADAM SPEAKER: Pursuant to the
under this part for telehealth services identi-
ICES. permission granted in Clause 2(h) of Rule II
fied in paragraph (4)(F)(i) that are furnished
Section 1834(m)(4)(E) of the Social Security via an audio-only communications system of the Rules of the U.S. House of Representa-
Act (42 U.S.C. 1395m(m)(4)(E)) is amended by during the period beginning on the first day tives, the Clerk received the following mes-
striking ‘‘and, for the 151-day period begin- after the end of such emergency period and sage from the Secretary of the Senate on
ning on the first day after the end of the ending on December 31, 2026’’. July 27, 2022, at 2:09 p.m.
emergency period described in section That the Senate agrees to the House
SEC. 7. USE OF TELEHEALTH TO CONDUCT FACE-
1135(g)(1)(B)’’ and inserting ‘‘and, in the case TO-FACE ENCOUNTER PRIOR TO RE- amendment to the Senate amendment with
that the emergency period described in sec- CERTIFICATION OF ELIGIBILITY FOR an amendment H.R. 4346.
tion 1135(g)(1)(B) ends before December 31, HOSPICE CARE DURING EMER- With best wishes, I am,
2026, for the period beginning on the first day GENCY PERIOD. Sincerely,
after the end of such emergency period and Section 1814(a)(7)(D)(i)(II) of the Social Se- CHERYL L. JOHNSON,
ending on December 31, 2026’’. curity Act (42 U.S.C. 1395f(a)(7)(D)(i)(II)) is Clerk.
SEC. 4. EXTENDING TELEHEALTH SERVICES FOR amended by striking ‘‘and during the 151-day
FEDERALLY QUALIFIED HEALTH period beginning on the first day after the f
CENTERS AND RURAL HEALTH CLIN- end of such emergency period’’ and inserting
ICS.
MOTION TO SUSPEND THE RULES
‘‘and, in the case that such emergency period AND PASS CERTAIN BILLS
Section 1834(m)(8)(A) of the Social Secu- ends before December 31, 2026, during the pe-
rity Act (42 U.S.C. 1395m(m)(8)(A)) is amend- riod beginning on the first day after the end Mr. KILDEE. Madam Speaker, pursu-
ed by striking ‘‘during the 151-day period be- of such emergency period described in such ant to section 5 of House Resolution
ctelli on DSK11ZRN23PROD with HOUSE
ginning on the first day after the end of such section 1135(g)(1)(B) and ending on December 1254, I move to suspend the rules and
emergency period’’ and inserting ‘‘in the 31, 2026’’. pass the bills: H.R. 623, H.R. 3952, H.R.
case that such emergency period ends before SEC. 8. EXTENSION OF SAFE HARBOR FOR AB-
December 31, 2026, during the period begin- SENCE OF DEDUCTIBLE FOR TELE-
3962, H.R. 4551, H.R. 5313, H.R. 6933, H.R.
ning on the first day after the end of such HEALTH. 7132, H.R. 7361, H.R. 7569, H.R. 7624, H.R.
emergency period and ending on December Section 223(c)(2)(E) of the Internal Revenue 7733, and H.R. 7981.
31, 2026’’. Code of 1986 is amended by striking ‘‘and be- The Clerk read the titles of the bills.
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