SB248 amends the Social Security Act to permanently allow cardiopulmonary rehabilitation services to be furnished to Medicare beneficiaries in their homes when delivered as telehealth using audio‑visual real‑time communications or when the home is designated a provider‑based location of a hospital outpatient department. The bill also updates Medicare’s telehealth originating/distant site rules to explicitly include hospitals and to remove certain geographic restrictions for cardiac and pulmonary rehab telehealth visits.
This is a targeted, rules‑level change: it preserves COVID‑era flexibilities that shifted supervised rehab services out of facilities and into patients’ homes, requires the Department of Health and Human Services (HHS) to set standards for hospital designation of homes, and applies to services furnished on or after January 1, 2026. For hospitals, rehab providers, compliance officers, and Medicare program analysts, the bill changes billing, supervision, and site‑of‑service rules that govern who may be a distant site, what counts as an acceptable telehealth connection, and how a home can be treated administratively for Medicare payment purposes.
At a Glance
What It Does
Amends sections 1861(eee)(2) and 1834(m) of the Social Security Act to permit cardiac and pulmonary rehab visits to be furnished to a patient’s home as telehealth via audio‑visual real‑time communications and to allow the home to be designated as a hospital provider‑based location. It also expands telehealth payment rules to expressly include hospitals and removes certain geographic originating‑site restrictions for these rehab services.
Who It Affects
Medicare fee‑for‑service beneficiaries receiving cardiac or pulmonary rehabilitation, hospitals with outpatient rehab programs, rehabilitation clinicians (physicians, PAs, NPs, clinical nurse specialists), and Medicare program operations and auditors charged with implementing telehealth payment and provider‑based designations.
Why It Matters
The bill entrenches a COVID‑era delivery model that shifts some supervised rehab into patients’ homes; that affects billing (originating/distant site payments), supervision and clinician presence rules, program integrity risks, and access for beneficiaries without broadband—changing how hospitals and rehab providers organize services and document compliance.
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What This Bill Actually Does
SB248 takes the temporary telehealth flexibilities Congress and CMS allowed during the COVID‑19 emergency for cardiac and pulmonary rehabilitation and writes them into the Social Security Act. It modifies the statutory definitions in section 1861 so that cardiac rehabilitation, intensive cardiac rehabilitation, and pulmonary rehabilitation visits may be furnished in a beneficiary’s home when delivered as telehealth using audio‑visual, real‑time communications, or when the home is designated as a provider‑based location of a hospital outpatient department.
The amendment also clarifies that clinicians may participate through a virtual presence via real‑time audio‑visual communications.
On the Medicare payment side, the bill revises section 1834(m) to expand who may be paid for telehealth services (explicitly adding hospitals) and to carve out cardiac and pulmonary rehab telehealth visits from the usual geographic restrictions that limit originating sites. Practically, that means hospitals can be distant site billers for tele‑rehab, and certain originating site requirements won’t block payment for rehab delivered to specified originating sites referenced in the statute.The Secretary of HHS must move quickly: within 30 days of enactment the agency must issue standards for designating a patient’s home as a provider‑based organization of a hospital for the purposes of these programs, aligned with the earlier Hospital Without Walls waivers.
HHS must also list cardiac and pulmonary rehab among the telehealth services specified under the Medicare telehealth payment rules. The bill allows HHS to implement these changes by program instruction if needed, and the statutory amendments take effect for services furnished on or after January 1, 2026.Taken together, these changes alter the operational and compliance landscape: hospitals and outpatient rehab programs will have a new pathway to deliver and bill for supervised rehab to homes, clinicians will rely on audio‑visual telehealth modalities to meet supervision requirements, and Medicare administrators will need to adapt payment, coverage, and oversight procedures to this more distributed model of care.
The Five Things You Need to Know
The bill amends 42 U.S.C. 1395x(eee)(2) to permit cardiac and intensive cardiac rehabilitation visits, and 42 U.S.C. 1395x(fff) for pulmonary rehabilitation, to be furnished in the home when delivered via audio‑visual real‑time telehealth or when the home is designated as a hospital provider‑based location.
Section 1834(m) is revised to explicitly allow hospitals to be distant‑site billers for telehealth and to remove certain geographic originating‑site restrictions for cardiac and pulmonary rehab telehealth visits (targets originating‑site subclauses (V) and (X) in existing law).
The Secretary of HHS must establish standards for designating a patient’s home as a provider‑based location of a hospital consistent with Hospital Without Walls waivers, and must list cardiac/pulmonary rehab among telehealth services specified under section 1834(m)(4)(F).
The bill sets January 1, 2026 as the effective date for the payment and originating‑site rule changes and requires HHS to issue standards within 30 days of enactment; it also permits HHS to implement the changes by program instruction.
All telehealth delivery authorized by the bill must use audio‑visual real‑time communications technology and explicitly permits the virtual presence of physicians, physician assistants, nurse practitioners, and clinical nurse specialists to satisfy supervision/participation requirements.
Section-by-Section Breakdown
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Allows in‑home cardiopulmonary rehab and virtual clinician presence
This subsection changes the statutory definition of cardiac rehabilitation to cover services ‘‘in the home of an individual when furnished as a telehealth service through audio‑visual real‑time communications technology’’ and to permit clinicians to meet participation or supervision requirements via their ‘‘virtual presence’’ using the same real‑time audiovisual standard. For providers, the practical implication is that supervision or physician involvement may be satisfied remotely provided the interaction meets the bill’s telehealth modality requirement; compliance teams will need to document the technology, timestamps, and clinician engagement to support medical necessity and supervision claims.
Expands who can bill telehealth and limits geographic restrictions for rehab
This amendment retools Medicare’s telehealth payment paragraph to explicitly include hospitals as entities that may furnish telehealth services and be paid for them, bringing hospitals into the distant‑site billing framework. It also adds a new paragraph (10) that says the usual geographic restrictions in paragraph (4)(C)(i) do not apply to cardiac and pulmonary rehab telehealth visits at certain originating sites. Billing and coding policies will need updates so hospital outpatient departments can bill appropriately and so claims from excluded originating sites are paid rather than denied for geography.
HHS must issue standards to treat a home as a hospital provider‑based location
The Secretary must, within 30 days of enactment, issue standards to designate a patient’s home as a provider‑based organization of a hospital for cardiac and pulmonary rehab services—drawing on Hospital Without Walls waivers. This creates an administrative pathway for hospitals to treat homes similarly to hospital outpatient departments, but it also requires HHS to define what documentation, clinical protocols, and infrastructure (e.g., emergency protocols, technology requirements) are required to support that designation.
Permits HHS to implement by program instruction
The bill explicitly authorizes HHS to implement the changes through program instruction or similar administrative guidance rather than waiting for a formal regulation. That accelerates operational rollout but also raises questions about the longevity and procedural protections of the resulting policies; auditors and compliance officers will want to track CMS transmittals and program memoranda closely.
Applies amendments to services on or after January 1, 2026
All of the statutory amendments in subsections (a) and (b), and the telehealth payment changes, apply to items and services furnished on or after January 1, 2026. Organizations should plan technical, clinical, and billing changes with that target in mind so documentation, privileging, and IT readiness are aligned by the effective date.
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Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Medicare beneficiaries with cardiac or pulmonary conditions — they gain continued access to supervised rehab in their homes, which may reduce travel burden and increase adherence for people with mobility or transportation barriers.
- Hospitals with outpatient rehab programs — hospitals can bill as distant sites and may designate patient homes as provider‑based locations, opening a revenue pathway for hospital‑led home rehab services.
- Community and rural beneficiaries — relaxing geographic originating‑site restrictions removes a barrier for beneficiaries outside urban hub areas to receive billed tele‑rehab services.
- Telehealth platform vendors and remote monitoring companies — higher demand for secure audio‑visual, real‑time tech and documentation tools to meet supervision and compliance requirements.
- Rehabilitation clinicians and clinics seeking to expand service models — the statute enables hybrid and home‑based program models that can broaden caseloads and care delivery settings.
Who Bears the Cost
- The Medicare program — broader tele‑enabled access and removal of geographic restrictions may increase utilization and Medicare spending for supervised rehab unless constrained by medical necessity and utilization management.
- Hospitals and outpatient departments — hospitals must develop policies, documentation systems, emergency protocols, and credentialing to designate homes as provider‑based locations and to demonstrate compliance with HHS standards.
- Compliance and billing departments — increased audit risk and the need to demonstrate telehealth modality, clinician virtual presence, and home designation will drive staffing and process costs.
- Beneficiaries without reliable broadband or devices — patients lacking access to audio‑visual real‑time connections effectively cannot benefit from the change and may face lower quality alternatives.
- State licensing and scope‑of‑practice regulators — states may see increased cross‑jurisdictional practice issues as clinicians render virtual services into patients’ homes located in other states.
Key Issues
The Core Tension
The central dilemma is access versus accountability: the bill increases access and convenience by enabling supervised cardiopulmonary rehab in patients’ homes, but doing so expands Medicare payment exposure, relies on real‑time audiovisual connectivity that not all patients have, and requires new oversight and clinical standards to ensure safety—tradeoffs that do not have a single, risk‑free resolution.
The bill resolves a short‑term emergency policy by codifying telehealth routes for cardiopulmonary rehab but leaves several operational levers unspecified. HHS must define the standards for treating a home as a provider‑based location, yet the statute does not set content for those standards beyond saying they should be ‘‘consistent with Hospital Without Walls’’ waivers.
That leaves open questions about required clinical oversight, emergency response expectations when patients exercise or have adverse events at home, equipment and monitoring requirements, and documentation standards auditors will later use to evaluate claims. Compliance teams should not assume Hospital Without Walls standards will map exactly to permanent rules; the Secretary has discretion and tight timing to issue guidance quickly.
The requirement that telehealth use ‘‘audio‑visual real‑time communications technology’’ clarifies that audio‑only contacts won’t satisfy the statutory standard, which advantages beneficiaries with broadband and devices and disadvantages others. The bill permits HHS to implement changes by program instruction—speeding deployment—but program instructions are administratively weaker than formal regulations and may change with subsequent administrations, creating uncertainty for long‑term program design.
Finally, expanding hospitals into the distant‑site billing role and permitting homes to be provider‑based locations creates potential payment shifts (e.g., site‑of‑service differentials, hospital overhead capture) that could change incentives for where and by whom rehab is delivered; Congress or HHS may later need to address payment parity, medical necessity guardrails, or utilization controls.
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