HR-7444-119
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sponsored by Chris Pappas (D-NH)
What it does
This bill would permanently expand Medicare coverage of telehealth services in four ways: it would remove geographic restrictions that currently limit which locations qualify as originating sites (where the patient is); allow patients' homes to serve as originating sites for all services; allow federally qualified health centers and rural health clinics to serve as the distant site (where the provider is); and add audio-only services — phone calls without video — to covered evaluation, management, and behavioral health visits.
Who benefits
Rural Medicare beneficiaries who currently lack access to in-person specialists or behavioral health providers. Elderly and disabled patients with transportation barriers. Patients in areas with provider shortages. Federally qualified health centers (FQHCs) and rural health clinics (RHCs), which would gain new billing authority as distant sites. Telehealth technology companies and platforms. Patients without reliable internet or video-capable devices who would gain access through audio-only coverage. Behavioral health patients in rural areas, who face some of the most acute provider shortages.
Who is hurt
In-person rural healthcare providers who may see reduced patient volume as telehealth expands. Medicare's Hospital Insurance and Supplementary Medical Insurance trust funds, which would bear increased costs. Taxpayers who fund Medicare, to the extent costs rise. Urban telehealth providers who previously faced fewer geographic restrictions and may face increased competition. Patients who receive lower-quality care through audio-only visits compared to in-person or video visits, if audio-only becomes a default rather than a last resort.
Supporters argue
Supporters argue that geographic restrictions on Medicare telehealth were designed for a pre-broadband era and leave rural beneficiaries with systematically worse access to care than their urban counterparts. They contend that during the COVID-19 public health emergency, temporary telehealth waivers demonstrated strong utilization and patient satisfaction in rural areas, and that allowing those flexibilities to expire would reverse documented gains in access. They further argue that audio-only coverage is essential for the roughly 14 million rural Americans who lack reliable broadband, ensuring that the least-connected patients are not excluded from telehealth's benefits.
Opponents argue
Opponents argue that permanently removing geographic and site restrictions without corresponding quality safeguards could accelerate Medicare fraud, waste, and abuse — the HHS Office of Inspector General has repeatedly flagged telehealth as a high-risk area for billing irregularities. They contend that audio-only visits in particular lack the clinical information available in video or in-person encounters, potentially leading to misdiagnoses or inappropriate prescribing, especially for behavioral health conditions. They further argue that making temporary pandemic-era flexibilities permanent forecloses future reassessment of whether expanded telehealth actually improves health outcomes, citing mixed evidence in peer-reviewed literature on telehealth's long-term effectiveness compared to in-person care.
Constitutional context
Congress has broad authority to structure Medicare benefits under the Taxing and Spending Clause (Art. I, §8, cl. 1). NFIB v. Sebelius (2012) affirmed Congress's wide latitude to set conditions on federal spending programs like Medicare. No significant constitutional tension is present here, as this bill modifies an existing voluntary federal benefit program rather than compelling any activity or imposing conditions on states.
Checks and balances
Congress gains authority by permanently locking in expanded coverage terms, reducing CMS and HHS administrative flexibility to adjust telehealth rules; CMS retains rulemaking authority over implementation details, and courts could review specific coverage determinations.
Historical precedent
Congress temporarily expanded Medicare telehealth access during the COVID-19 public health emergency (2020–2023) under similar provisions, and has repeatedly extended those flexibilities through short-term legislation rather than making them permanent.