Us Congress 2025-2026 Regular Session

Us Congress House Bill HB1785 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	I
2	2	119THCONGRESS
3	3	1
4	4	STSESSION H. R. 1785
5	5	To amend title XVIII of the Social Security Act to establish requirements
6	6	for the provision of certain high-cost durable medical equipment and
7	7	laboratory testing, and for other purposes.
8	8	IN THE HOUSE OF REPRESENTATIVES
9	9	MARCH3, 2025
10	10	Mr. D
11	11	OGGETTintroduced the following bill; which was referred to the Com-
12	12	mittee on Energy and Commerce, and in addition to the Committee on
13	13	Ways and Means, for a period to be subsequently determined by the
14	14	Speaker, in each case for consideration of such provisions as fall within
15	15	the jurisdiction of the committee concerned
16	16	A BILL
17	17	To amend title XVIII of the Social Security Act to establish
18	18	requirements for the provision of certain high-cost dura-
19	19	ble medical equipment and laboratory testing, and for
20	20	other purposes.
21	21	Be it enacted by the Senate and House of Representa-1
22	22	tives of the United States of America in Congress assembled, 2
23	23	SECTION 1. SHORT TITLE. 3
24	24	This Act may be cited as the ‘‘Preventing Medicare 4
25	25	Telefraud Act’’. 5
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28	28	•HR 1785 IH
29	29	SEC. 2. REQUIREMENT FOR PROVISION OF HIGH-COST DU-1
30	30	RABLE MEDICAL EQUIPMENT AND LABORA-2
31	31	TORY TESTS. 3
32	32	(a) H
33	33	IGH-COSTDURABLEMEDICALEQUIPMENT.— 4
34	34	Section 1834(a)(1)(E) of the Social Security Act (42 5
35	35	U.S.C. 1395m(a)(1)(E)) is amended by adding at the end 6
36	36	the following new clause: 7
37	37	‘‘(vi) S
38	38	TANDARDS FOR HIGH -COST DU-8
39	39	RABLE MEDICAL EQUIPMENT .— 9
40	40	‘‘(I) L
41	41	IMITATION ON PAYMENT 10
42	42	FOR HIGH-COST DURABLE MEDICAL 11
43	43	EQUIPMENT.—Payment may not be 12
44	44	made under this subsection for a 13
45	45	high-cost durable medical equipment 14
46	46	ordered by a physician or other practi-15
47	47	tioner described in clause (ii) via tele-16
48	48	health for an individual on or after 17
49	49	the date that is 180 days after the 18
50	50	date of the enactment of this clause, 19
51	51	unless such physician or practitioner 20
52	52	furnished to such individual a service 21
53	53	in-person at least once during the 6 22
54	54	month period prior to ordering such 23
55	55	high-cost durable medical equipment. 24
56	56	‘‘(II) H
57	57	IGH-COST DURABLE MED -25
58	58	ICAL EQUIPMENT DETERMINATION .— 26
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61	61	•HR 1785 IH
62	62	For purposes of this clause, the Ad-1
63	63	ministrator of the Centers for Medi-2
64	64	care & Medicaid Services shall define 3
65	65	the term ‘high-cost durable medical 4
66	66	equipment’ and specify the durable 5
67	67	medical equipment for which such def-6
68	68	inition shall apply. 7
69	69	‘‘(vii) A
70	70	UDIT OF PROVIDERS AND 8
71	71	PRACTITIONERS FURNISHING A HIGH VOL -9
72	72	UME OF DURABLE MEDICAL EQUIPMENT 10
73	73	VIA TELEHEALTH.— 11
74	74	‘‘(I) I
75	75	DENTIFICATION OF PRO -12
76	76	VIDERS.—Beginning 6 months after 13
77	77	the date of the enactment of this 14
78	78	clause, Medicare administrative con-15
79	79	tractors shall conduct reviews on a 16
80	80	schedule determined by the Secretary, 17
81	81	of claims for durable medical equip-18
82	82	ment prescribed by a physician or 19
83	83	other practitioner described in clause 20
84	84	(ii) during the 12 month period pre-21
85	85	ceding such review to identify physi-22
86	86	cians or other practitioners with re-23
87	87	spect to whom at least 90 percent of 24
88	88	all durable medical equipment pre-25
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91	91	•HR 1785 IH
92	92	scribed by such physician or practi-1
93	93	tioner during such period was pre-2
94	94	scribed pursuant to a telehealth visit. 3
95	95	‘‘(II) A
96	96	UDIT.—In the case of a 4
97	97	physician or practitioner identified 5
98	98	under subclause (I), with respect to a 6
99	99	period described in such subclause, 7
100	100	the Medicare administrative contrac-8
101	101	tors shall conduct audits of all claims 9
102	102	for durable medical equipment pre-10
103	103	scribed by such physicians or practi-11
104	104	tioners to determine whether such 12
105	105	claims comply with the requirements 13
106	106	for coverage under this title.’’. 14
107	107	(b) H
108	108	IGH-COSTLABORATORY TESTS.—Section 15
109	109	1834A(b) of the Social Security Act (42 U.S.C. 1395m– 16
110	110	1(b)) is amended by adding at the end the following new 17
111	111	paragraph: 18
112	112	‘‘(6) R
113	113	EQUIREMENT FOR HIGH -COST LABORA-19
114	114	TORY TESTS.— 20
115	115	‘‘(A) L
116	116	IMITATION ON PAYMENT FOR HIGH - 21
117	117	COST LABORATORY TESTS .—Payment may not 22
118	118	be made under this subsection for a high-cost 23
119	119	laboratory test ordered by a physician or practi-24
120	120	tioner via telehealth for an individual on or 25
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123	123	•HR 1785 IH
124	124	after the date that is 180 days after the date 1
125	125	of the enactment of this paragraph, unless such 2
126	126	physician or practitioner furnished to such indi-3
127	127	vidual a service in-person at least once during 4
128	128	the 6 month period prior to ordering such high- 5
129	129	cost laboratory test. 6
130	130	‘‘(B) H
131	131	IGH-COST LABORATORY TEST DE -7
132	132	FINED.—For purposes of this paragraph, the 8
133	133	Administrator for the Centers for Medicare & 9
134	134	Medicaid Services shall define the term ‘high- 10
135	135	cost laboratory test’ and specify which labora-11
136	136	tory tests such definition shall apply to. 12
137	137	‘‘(7) A
138	138	UDIT OF LABORATORY TESTING OR -13
139	139	DERED PURSUANT TO TELEHEALTH VISIT .— 14
140	140	‘‘(A) I
141	141	DENTIFICATION OF PROVIDERS .— 15
142	142	Beginning 6 months after the date of the enact-16
143	143	ment of this paragraph, Medicare administra-17
144	144	tive contractors shall conduct periodic reviews 18
145	145	on a schedule determined by the Secretary, of 19
146	146	claims for laboratory tests prescribed by a phy-20
147	147	sician or practitioner during the 12 month pe-21
148	148	riod preceding such review to identify physi-22
149	149	cians or other practitioners with respect to 23
150	150	whom at least 90 percent of all laboratory tests 24
151	151	prescribed by such physician or practitioner 25
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154	154	•HR 1785 IH
155	155	during such period was prescribed pursuant to 1
156	156	a telehealth visit. 2
157	157	‘‘(B) A
158	158	UDIT.—In the case of a physician 3
159	159	or practitioner identified under subparagraph 4
160	160	(A), with respect to a period described in such 5
161	161	subparagraph, the Medicare administrative con-6
162	162	tractors shall conduct audits of all claims for 7
163	163	laboratory tests prescribed by such physicians 8
164	164	or practitioners during such period beginning to 9
165	165	determine whether such claims comply with the 10
166	166	requirements for coverage under this title.’’. 11
167	167	SEC. 3. REQUIREMENT TO SUBMIT NPI NUMBER FOR SEPA-12
168	168	RATELY BILLABLE TELEHEALTH SERVICES. 13
169	169	Section 1834(m) of the Social Security Act (42 14
170	170	U.S.C. 1395m(m)) is amended by adding at the end the 15
171	171	following new paragraph: 16
172	172	‘‘(10) R
173	173	EQUIREMENT TO SUBMIT NPI NUMBER 17
174	174	FOR SEPARATELY BILLABLE TELEHEALTH SERV -18
175	175	ICES.—Payment may not be made under this sub-19
176	176	section for separately billable telehealth services fur-20
177	177	nished on or after the date that is 180 days after 21
178	178	the date of the enactment of this paragraph by a 22
179	179	physician or practitioner unless such physician or 23
180	180	practitioner submits a claim for payment under the 24
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183	183	•HR 1785 IH
184	184	national provider identification number assigned to 1
185	185	such physician or practitioner.’’. 2
186	186	Æ
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