[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3420 Introduced in House (IH)]







106th CONGRESS
  1st Session
                                H. R. 3420

To improve the Medicare telemedicine program, to provide grants for the 
      development of telehealth networks, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 17, 1999

Mr. Bilbray (for himself, Mr. Norwood, Mr. Thompson of California, and 
 Mr. Bryant) introduced the following bill; which was referred to the 
  Committee on 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

_______________________________________________________________________

                                 A BILL


 
To improve the Medicare telemedicine program, to provide grants for the 
      development of telehealth networks, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Telehealth Improvement Act of 
1999''.

SEC. 2. IMPROVEMENT OF TELEHEALTH SERVICES.

    (a) Medicare Coverage of Telehealth Services.--
            (1) All services furnished under medicare.--Section 4206(a) 
        of the Balanced Budget Act of 1997 (42 U.S.C. 1395l note) is 
        amended by striking ``furnishing a service for which payment 
        may be made under such part'' and inserting ``furnishing a 
        service for which payment may be made under such title''.
            (2) Physical, occupational, and speech therapy.--
        Subsections (a) and (d)(1) of section 4206 of the Balanced 
        Budget Act of 1997 (42 U.S.C. 1395l note) are each amended by 
        adding at the end the following new sentence: ``For purposes of 
        the preceding sentence, the term `practitioner' shall include 
        physical, occupational, and speech therapists.''.
            (3) Telehealth consultation using store and forward 
        technology.--Section 4206(a) of the Balanced Budget Act of 1997 
        (42 U.S.C. 1395l note), as amended by paragraph (2), is further 
        amended by adding at the end the following new sentence: 
        ``Payment shall also be made under this section for 
        professional consultations utilizing technology that provides 
        for the asynchronous transmission of health care information, 
        in single or multimedia formats, for the objective of any or 
        all of the following:
            ``(1) Medical diagnosis.
            ``(2) Medical treatment.
            ``(3) Medical education.''.
    (b) Medicare Reimbursement for Telehealth Services in All Rural 
Areas.--Section 4206 of the Balanced Budget Act of 1997 (42 U.S.C. 
1395l note) is amended--
            (1) in subsection (a), by inserting ``and in any area'' 
        before ``that is designated as a health professional shortage 
        area under section 332(a)(1)(A) of the Public Health Service 
        Act (42 U.S.C. 254e(a)(1)(A))''; and
            (2) in subsection (d), by striking ``who does not reside in 
        a rural area (as so defined) that is designated as a health 
        professional shortage area under section 332(a)(1)(A) of the 
        Public Health Service Act (42 U.S.C. 254e(a)(1)(A))'' and 
        inserting ``who resides in a county in a rural area (as so 
        defined) or a county that is not otherwise included in a 
        Metropolitan Statistical Area''.
    (c) Permitting Presentation of Patient by Health Care Providers.--
Section 4206(a) of the Balanced Budget Act of 1997 (42 U.S.C. 1395l 
note), as amended by subsection (a), is further amended--
            (1) by inserting ``(1)'' after ``(a) In General.--''; and
            (2) by adding at the end the following new paragraph:
    ``(2)(A) In the case of telehomecare (as described in subparagraph 
(D)) a registered nurse, acting under the directions of a physician or 
practitioner, may present the beneficiary for the professional 
consultation. In the case of such a presentation the presence of a 
referring or consulting physician or practitioner is not required.
    ``(B) Telehomecare may be furnished in areas other than in rural 
areas.
    ``(C) In this section, the term ``registered nurse'' means a 
registered nurse who is licensed to practice nursing and is operating 
within the scope of that license.
    ``(D) For purposes of subparagraph (A), telehomecare consists of 
home health services furnished using a electronic device capable of 
two-way audio and video transmissions, and capable of monitoring and 
transmitting vital statistics of a patient, including measuring blood 
pressure and temperature of a patient.''.
    (d) Revision of Payment Methodology.--Section 4206(b) of the 
Balanced Budget Act of 1997 (42 U.S.C. 1395l note) is amended--
            (1) by redesignating paragraphs (1), (2), (3), and (4) as 
        subparagraphs (A), (B), (C), and (D), respectively;
            (2) by inserting ``(1)'' before ``Taking into account'';
            (3) in subparagraph (A), as so redesignated, to read as 
        follows:
            ``(A) The payment shall be made under a fee schedule 
        established by the Secretary that provides for payment for the 
        referring physician or practitioner and for the consulting 
        physician or practitioner. If the referring physician or 
        practitioner determines it appropriate, such referring 
        physician or practitioner may be present during the 
        professional consultation. The amount of the payment to the 
        physicians or practitioners shall not be greater than the 
        current fee schedule of such consulting physician or 
        practitioner for the health care services provided.'';
            (2) in subparagraph (B), to read as follows:
            ``(B) The payment shall include payment to a provider of 
        services for the costs associated with professional 
        consultation via telecommunications systems. Such costs shall 
        include facility fees, costs of maintenance of telehealth 
        equipment and of telecommunications facilities, and costs of 
        staff incurred in furnishing such professional consultations. 
        In no case may a beneficiary be billed for any such charges or 
        fees.''; and
            (3) by adding at the end the following new paragraph:
    ``(2) The Secretary shall establish a separate code (or codes) for 
purposes of claims for payment for items and services furnished under 
this section.''.
    (e) Reports to Congress.--Section 4206 of the Balanced Budget Act 
of 1997 (42 U.S.C. 1395l note) is amended by adding at the end the 
following new subsection:
    ``(e) Additional Reports to Congress.--
            ``(1) Initial report.--Not later than August 1, 2003, the 
        Secretary of Health and Human Services shall prepare and submit 
        to Congress a report concerning--
                    ``(A) the number, percentage, and types of health 
                care providers who are--
                            ``(i) currently providing telehealth 
                        services across State lines;
                            ``(ii) currently licensed to provide 
                        telehealth services across State lines, 
                        including the number and types of health care 
                        providers licensed to provide such services in 
                        more than three States; and
                            ``(iii) expressing an interest in providing 
                        such services across State lines;
                    ``(B) the status of any reciprocal, mutual 
                recognition, fast-track, or other licensure agreements 
                between or among various States;
                    ``(C) the status of any efforts to develop uniform 
                national sets of standards for--
                            ``(i) the licensure of health care 
                        providers to provide telehealth services across 
                        State lines;
                            ``(ii) the exclusion from full State 
                        medical licensure requirements for licensed 
                        providers of other States when called in 
                        consultation by a licensed provider of the 
                        State in which the patient consultation occurs: 
                        and
                            ``(iii) the incorporation of telehealth 
                        licensure into existing State medical licensure 
                        processes when the provider of telehealth 
                        services is providing medical services via 
                        telehealth that are identical to medical 
                        services that fall within the scope of existing 
                        State medical licensure when provided directly 
                        to the patient by the provider;
                    ``(D) a projection of future utilization of 
                telehealth consultations across State lines;
                    ``(E) State efforts to increase or reduce licensure 
                as a burden to interstate telehealth practice; and
                    ``(F) any State licensure requirements that appear 
                to constitute unnecessary barriers to the provision of 
                telehealth services across State lines.
            ``(2) Annual report.--
                    ``(A) In general.--Not later than August 1, 2004, 
                and each July 1 thereafter, the Secretary of Health and 
                Human Services shall prepare and submit to Congress, an 
                annual report on relevant developments concerning the 
                matters referred to in subparagraphs (A) through (F) of 
                paragraph (1).
                    ``(B) Recommendations.--If, with respect to a 
                report submitted under subparagraph (A), the Secretary 
                of Health and Human Services determines that States are 
                not making progress in facilitating the provision of 
                telehealth services across State lines by eliminating 
                unnecessary requirements, adopting reciprocal licensing 
                arrangements for telehealth services, implementing 
                uniform requirements for telehealth licensure, or other 
                means, the Secretary shall include in the report 
                recommendations concerning the scope and nature of 
                Federal actions required to reduce licensure as a 
                barrier to the interstate provision of telehealth 
                services.
    (f) Interim, Final Rule.--The Secretary shall publish a rule under 
this section in the Federal Register by not later than 180 days after 
the date of the enactment of this section to carry out the provisions 
of this section. Such rule shall be effective and final immediately on 
an interim basis, but is subject to change and revision after public 
notice and opportunity for a period (of not less than 60 days) for 
public comment. In connection with such rule, the Secretary shall 
specify the process for the timely review and approval of applications 
of entities to be eligible telehealth networks pursuant to such rules 
and consistent with this section.

SEC. 3. GRANT PROGRAM FOR THE DEVELOPMENT OF TELEHEALTH NETWORKS.

    (a) In General.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary''), acting through the 
Director of the Office for the Advancement of Telehealth (of the Health 
Resources and Services Administration), shall make grants to eligible 
recipients (as described in subsection (b)(1)) for the purpose of 
expanding access to health care services for individuals in rural 
areas, frontier areas, and medically underserved areas through the use 
of telehealth.
    (b) Eligible Recipients.--
            (1) Application.--To be eligible to receive a grant under 
        this section, an eligible entity described in paragraph (2) 
        shall, in consultation with the State office of rural health or 
        other appropriate State entity, prepare and submit to the 
        Secretary an application, at such time, in such manner, and 
        containing such information as the Secretary may require, 
        including the following:
                    (A) A description of the anticipated need for the 
                grant.
                    (B) A description of the activities which the 
                entity intends to carry out using amounts provided 
                under the grant.
                    (C) A plan for continuing the project after Federal 
                support under this section is ended.
                    (D) A description of the manner in which the 
                activities funded under the grant will meet health care 
                needs of underserved rural populations within the 
                State.
                    (E) A description of how the local community or 
                region to be served by the network or proposed network 
                will be involved in the development and ongoing 
                operations of the network.
                    (F) The source and amount of non-Federal funds the 
                entity would pledge for the project.
                    (G) A showing of the long-term viability of the 
                project and evidence of health care provider commitment 
                to the network.
        The application should demonstrate the manner in which the 
        project will promote the integration of telehealth in the 
        community so as to avoid redundancy of technology and achieve 
        economies of scale.
            (2) Eligible entities.--An eligible entity described in 
        this paragraph is a hospital or other health care provider in a 
        health care network of community-based health care providers 
        that includes at least two of the organizations described in 
        subparagraph (A) and one of the institutions and entities 
        described in subparagraph (B) if the institution or entity is 
        able to demonstrate use of the network for purposes of 
        education and economic development (as required by the 
        Secretary).
                    (A) The organizations described in this 
                subparagraph are the following:
                            (i) Community or migrant health centers.
                            (ii) Local health departments.
                            (iii) Nonprofit hospitals.
                            (iv) Private practice health professionals, 
                        including community and rural health clinics.
                            (v) Other publicly funded health or social 
                        services agencies.
                            (vi) Skilled nursing facilities.
                            (vii) County mental health and other 
                        publicly funded mental health facilities.
                            (viii) Providers of home health services.
                    (B) The institutions and entities described in this 
                subparagraph are the following:
                            (i) A public school.
                            (ii) A public library.
                            (iii) A university or college.
                            (iv) A local government entity.
                            (v) A local nonhealth-related business 
                        entity.
        An eligible entity may include for-profit entities so long as 
        the recipient of the grant is a not-for-profit entity.
    (d) Priority.--The Secretary shall establish procedures to 
prioritize financial assistance under this section based upon the 
following considerations:
            (1) The applicant is a health care provider in a health 
        care network or a health care provider that proposes to form 
        such a network that furnishes or proposes to furnish services 
        in a medically underserved area, health professional shortage 
        area, or mental health professional shortage area.
            (2) The applicant is able to demonstrate broad geographic 
        coverage in the rural or medically underserved areas of the 
        State, or States in which the applicant is located.
            (3) The applicant proposes to use Federal funds to develop 
        plans for, or to establish, telehealth systems that will link 
        rural hospitals and rural health care providers to other 
        hospitals, health care providers, and patients.
            (4) The applicant will use the amounts provided for a range 
        of health care applications and to promote greater efficiency 
        in the use of health care resources.
            (5) The applicant is able to demonstrate the long-term 
        viability of projects through cost participation (cash or in-
        kind).
            (6) The applicant is able to demonstrate financial, 
        institutional, and community support for the long-term 
        viability of the network.
            (7) The applicant is able to provide a detailed plan for 
        coordinating system use by eligible entities so that health 
        care services are given a priority over non-clinical uses.
    (e) Maximum Amount of Assistance to Individual Recipients.--The 
Secretary shall establish, by regulation, the terms and conditions of 
the grant and the maximum amount of a grant award to be made available 
to an individual recipient for each fiscal year under this section. The 
Secretary shall publish in the Federal Register notice of the terms and 
conditions of a grant under this section and the maximum amount of such 
a grant for a fiscal year.
    (f) Use of Amounts.--The recipient of a grant under this section 
may use sums received under such grant for the acquisition of 
telehealth equipment and modifications or improvements of 
telecommunications facilities including the following:
            (1) The development and acquisition through lease or 
        purchase of computer hardware and software, audio and video 
        equipment, computer network equipment, interactive equipment, 
        data terminal equipment, and other facilities and equipment 
        that would further the purposes of this section.
            (2) The provision of technical assistance and instruction 
        for the development and use of such programming equipment or 
        facilities.
            (3) The development and acquisition of instructional 
        programming.
            (4) Demonstration projects for teaching or training medical 
        students, residents, and other health profession students in 
        rural or medically underserved training sites about the 
        application of telehealth.
            (5) Transmission costs, maintenance of equipment, and 
        compensation of specialists and referring health care 
        providers.
            (6) Development of projects to use telehealth to facilitate 
        collaboration between health care providers.
            (7) Electronic archival of patient records.
            (8) Collection and analysis of usage statistics and data 
        that can be used to document the cost-effectiveness of the 
        telehealth services.
            (9) Such other uses that are consistent with achieving the 
        purposes of this section as approved by the Secretary.
    (g) Prohibited Uses.--Sums received under a grant under this 
section may not be used for any of the following:
            (1) To acquire real property.
            (2) Expenditures to purchase or lease equipment to the 
        extent the expenditures would exceed more than 40 percent of 
        the total grant funds.
            (3) To purchase or install transmission equipment (such as 
        laying cable or telephone lines, microwave towers, satellite 
        dishes, amplifiers, and digital switching equipment).
            (4) For construction, except that such funds may be 
        expended for minor renovations relating to the installation of 
        equipment.
            (5) Expenditures for indirect costs (as determined by the 
        Secretary) to the extent the expenditures would exceed more 
        than 20 percent of the total grant.
    (h) Administration.--
            (1) Nonduplication.--The Secretary shall ensure that 
        facilities constructed using grants provided under this section 
        do not duplicate adequately established telehealth networks.
            (2) Coordination with other agencies.--The Secretary shall 
        coordinate, to the extent practicable, with other Federal and 
        State agencies and not-for-profit organizations, operating 
        similar grant programs to pool resources for funding 
        meritorious proposals.
            (3) Informational efforts.--The Secretary shall establish 
        and implement procedures to carry out outreach activities to 
        advise potential end users located in rural and medically 
        underserved areas of each State about the program authorized by 
        this section.
    (i) Interim, Final Rule.--The Secretary shall publish a rule under 
this section in the Federal Register by not later than 180 days after 
the date of the enactment of this Act. Such rule shall be effective and 
final immediately on an interim basis, but is subject to change and 
revision after public notice and opportunity for a period (of not less 
than 60 days) for public comment. In connection with such rule, the 
Secretary shall specify the process for the timely review and approval 
of applications of entities to be eligible telehealth networks pursuant 
to such rules and consistent with this section.
    (j) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $40,000,000 for fiscal year 
2001, and such sums as may be necessary for each of the fiscal years 
2002 through 2007.

SEC. 4. JOINT WORKING GROUP ON TELEMEDICINE.

    (a) In General.--
            (1) Representation of rural areas.--The Joint Working Group 
        on Telemedicine shall ensure that individuals that represent 
        the interests of rural areas and medically underserved areas 
        are members of the Group.
            (2) Mission.--The mission of the Joint Working Group on 
        Telemedicine is--
                    (A) to identify, monitor, and coordinate Federal 
                telehealth projects, data sets, and programs;
                    (B) to analyze--
                            (i) how telehealth systems are expanding 
                        access to health care services, education, and 
                        information;
                            (ii) the clinical, educational, or 
                        administrative efficacy and cost-effectiveness 
                        of telehealth applications; and
                            (iii) the quality of the telehealth 
                        services delivered; and
                    (C) to make further recommendations for 
                coordinating Federal and State efforts to increase 
                access to health services, education, and information 
                in rural and medically underserved areas.
            (3) Annual reports.--Not later than two years after the 
        date of enactment of this Act and each January 1 thereafter the 
        Joint Working Group on Telemedicine shall submit to Congress a 
        report on the status of the Group's mission and the state of 
        the telehealth field generally.
    (b) Report Specifics.--The annual report required under subsection 
(a)(3) shall provide--
            (1) an analysis of--
                    (A) the matters described in subsection (a)(3)(B);
                    (B) the Federal activities with respect to 
                telehealth; and
                    (C) the progress of the Joint Working Group on 
                Telemedicine's efforts to coordinate Federal telehealth 
                programs; and
            (2) recommendations for a coordinated Federal strategy to 
        increase health care access through telehealth.
    (c) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as are necessary for the Joint Working Group on 
Telemedicine to carry out this section.
                                 <all>