42 U.S.C. 1395m(m)(2)(B)(iii)changedby H.R. 5081 Sec. 2(a)
The bill says: in paragraph (2)(B)(iii), by striking "ending September 30, 2025" and inserting "ending September 30, 2027"; and
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395m(m)(4)(C)(iii)changedby H.R. 5081 Sec. 2(a)
The bill says: in paragraph (4)(C)(iii), by striking "ending on September 30, 2025" and inserting "ending on September 30, 2027".
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395m(m)(4)(E)changedby H.R. 5081 Sec. 2(b)
The bill says: Section 1834(m)(4)(E) of the Social Security Act (42 U.S.C. 1395m(m)(4)(E)) is amended by striking "ending on September 30, 2025" and inserting "ending on September 30, 2027".
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395m(m)(8)(A)changedby H.R. 5081 Sec. 2(c)
The bill says: in subparagraph (A), by striking "ending on September 30, 2025" and inserting "ending on September 30, 2027";
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395m(m)(8)(B)changedby H.R. 5081 Sec. 2(c)
The bill says: in the subparagraph heading, by inserting "before fiscal year 2026" after "rule";
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395m(m)(8)(B)(i)changedby H.R. 5081 Sec. 2(c)
The bill says: in clause (i), by striking "during the periods for which subparagraph (A) applies" and inserting "before October 1, 2025"; and
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395m(m)(8)(B)(ii)changedby H.R. 5081 Sec. 2(c)
The bill says: in clause (ii), by inserting "furnished to an eligible telehealth individual before October 1, 2025" after "telehealth services"; and
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395m(m)(8)added (C)by H.R. 5081 Sec. 2(c)
(C) Payment rule for fiscal years 2026 and 2027.—(i) In general.— A telehealth service furnished to an eligible telehealth individual by a Federally qualified health center or rural health clinic on or after October 1, 2025, and before October 1, 2027, shall be paid as a Federally qualified health center service or rural health clinic service (as applicable) under the prospective payment system established under section 1834(o) or the methodology for all-inclusive rates established under section 1833(a)(3), respectively.(ii) Treatment of costs.— Costs associated with the furnishing of telehealth services by a Federally qualified health center or rural health clinic on or after October 1, 2025, and before October 1, 2027, shall be considered allowable costs for purposes of the prospective payment system established under section 1834(o) and the methodology for all-inclusive rates established under section 1833(a)(3), as applicable.
The bill says: by adding at the end the following new subparagraph:
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395m(m)(7)(B)(i)changedby H.R. 5081 Sec. 2(d)
The bill says: Section 1834(m)(7)(B)(i) of the Social Security Act (42 U.S.C. 1395m(m)(7)(B)(i)) is amended, in the matter preceding subclause (I), by striking "on or after October 1, 2025" and inserting "on or after October 1, 2027".
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395m(y)(2)changedby H.R. 5081 Sec. 2(d)
The bill says: Section 1834(y)(2) of the Social Security Act (42 U.S.C. 1395m(y)(2)) is amended by striking "October 1, 2025" and inserting "October 1, 2027".
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395m(o)(4)(B)changedby H.R. 5081 Sec. 2(d)
The bill says: Section 1834(o)(4)(B) of the Social Security Act (42 U.S.C. 1395m(o)(4)(B)) is amended by striking "October 1, 2025" and inserting "October 1, 2027".
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395m(m)(9)changedby H.R. 5081 Sec. 2(e)
The bill says: Section 1834(m)(9) of the Social Security Act (42 U.S.C. 1395m(m)(9)) is amended by striking "ending on September 30, 2025" and inserting "ending on September 30, 2027".
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395f(a)(7)(D)(i)(II)a new sectionchangedby H.R. 5081 Sec. 2(f)
The bill says: by striking "ending on September 30, 2025" and inserting "ending on September 30, 2027"; and
Bill text
42 U.S.C. 1395f(a)(7)(D)(i)(II)a new sectionchangedby H.R. 5081 Sec. 2(f)
The bill says: by inserting ", except that this subclause shall not apply in the case of such an encounter with an individual occurring on or after September 30, 2025, if such individual is located in an area that is subject to a moratorium on the enrollment of hospice programs under this title pursuant to section 1866(j)(7), if such individual is receiving hospice care from a provider that is subject to enhanced oversight under this title pursuant to section 1866(j)(3), or if such encounter is performed by a hospice physician or nurse practitioner who is not enrolled under section 1866(j) and is not an opt-out physician or practitioner (as defined in section 1802(b)(6)(D))" before the semicolon.
Bill text
42 U.S.C. 1395cc-7(a)(1)changedby H.R. 5081 Sec. 4(a)
(1) Extension. With respect to inpatient hospital admissions occurring during the period beginning on the first day after the end of the emergency period described in section 1320b–5(g)(1)(B) of this title and ending on March 31, 20252030, the Secretary of Health and Human Services shall grant waivers and flexibilities (as described in paragraph (2)) to an individual hospital that submits a request for such waivers and flexibilities and meets specified criteria (as described in paragraph (3)) in order to participate in the Acute Hospital Care at Home initiative of the Secretary.
The bill says: Section 1866G(a)(1) of the Social Security Act (42 U.S.C. 1395cc–7(a)(1)) is amended by striking "2025" and inserting "2030".
Bill text · Current law (42 U.S.C. 1395cc-7)
42 U.S.C. 1395m(a)added (23)by H.R. 5081 Sec. 5(a)
(23) Master List inclusion and claim review for certain items.—(A) Master List inclusion.— Beginning January 1, 2028, for purposes of the Master List described in section 414.234(b) of title 42, Code of Federal Regulations (or any successor regulation), an item for which payment may be made under this subsection shall be treated as having aberrant billing patterns (as such term is used for purposes of such section) if the Secretary determines that, without explanatory contributing factors (such as furnishing emergent care services), a substantial number of claims for such items under this subsection are for such items ordered by a physician or practitioner who has not previously (during a period of not less than 24 months, as established by the Secretary) furnished to the individual involved any item or service for which payment may be made under this title.(B) Claim review.— With respect to items furnished on or after January 1, 2028, that are included on the Master List pursuant to subparagraph (A), if such an item is not subject to a determination of coverage in advance pursuant to paragraph (15)(C), the Secretary may conduct prepayment review of claims for payment for such item.
The bill says: Section 1834(a) of the Social Security Act (42 U.S.C. 1395m(a)) is amended by adding at the end the following new paragraph:
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395m(h)(3)changedby H.R. 5081 Sec. 5(a)
The bill says: Section 1834(h)(3) of the Social Security Act (42 U.S.C. 1395m(h)(3)) is amended by inserting ", and paragraph (23) of subsection (a) shall apply to prosthetic devices, orthotics, and prosthetics in the same manner as such provision applies to items for which payment may be made under such subsection" before the period at the end.
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395x(eee)(2)(A)(ii)changedby H.R. 5081 Sec. 7(a)
The bill says: in subparagraph (A)(ii), by inserting "(including, with respect to items and services furnished through audio and video real-time communications technology (excluding audio-only) on or after September 30, 2025, and before January 1, 2027, in the home of an individual who is an outpatient of the hospital)" after "outpatient basis"; and
Bill text · Current law (42 U.S.C. 1395x)
42 U.S.C. 1395x(eee)(2)(B)changedby H.R. 5081 Sec. 7(a)
The bill says: in subparagraph (B), by inserting "(including, with respect to items and services furnished through audio and video real-time communications technology on or after September 30, 2025, and before January 1, 2027, the virtual presence of such physician, physician assistant, nurse practitioner, or clinical nurse specialist)" after "under the program".
Bill text · Current law (42 U.S.C. 1395x)