The "Protecting Rural Telehealth Access Act" seeks to make permanent and expand access to telehealth services under Medicare, particularly benefiting rural areas. Beginning January 1, 2027, it eliminates geographic requirements for originating sites and allows an individual's home to serve as an originating site for telehealth services. The bill also removes existing restrictions on the use of store-and-forward technologies for telehealth. Furthermore, the legislation introduces new telehealth flexibilities for Critical Access Hospitals (CAHs) , enabling them to serve as distant sites for telehealth services and receive payment at 101 percent of reasonable costs. It also extends and refines Medicare telehealth flexibilities for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) beyond 2024, requiring the Secretary to establish a separate payment methodology. For these services, both CAHs and FQHCs/RHCs must have an established patient relationship to be considered a "qualified provider." Significantly, the bill permits the use of audio-only technology for specified telehealth services, including evaluation and management and behavioral health counseling, starting January 1, 2027. These services can be furnished by qualified providers, and payment will be equivalent to other telehealth services. The Secretary is mandated to review the impact of audio-only technology within five years and can adjust the list of eligible services based on this review.