[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4771 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 4771

 To amend title XVIII of the Social Security Act to provide increased 
 access to health care for Medicare beneficiaries through telemedicine.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 27, 2000

  Mr. McHugh 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 amend title XVIII of the Social Security Act to provide increased 
 access to health care for Medicare beneficiaries through telemedicine.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Telehealth 
Improvement and Modernization Act of 2000''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Revision of telehealth payment methodology and elimination of 
                            fee-sharing requirement.
Sec. 3. Elimination of requirement for telepresenter.
Sec. 4. Reimbursement for medicare beneficiaries who do not reside in a 
                            HPSA.
Sec. 5. Telehealth coverage for direct patient care.
Sec. 6. All physicians and practitioners eligible for telehealth 
                            reimbursement.
Sec. 7. Telehealth services provided using store-and-forward 
                            technologies.
Sec. 8. Construction relating to home health services.
Sec. 9. Effective date.

SEC. 2. REVISION OF TELEHEALTH PAYMENT METHODOLOGY AND ELIMINATION OF 
              FEE-SHARING REQUIREMENT.

    Section 4206(b) of the Balanced Budget Act of 1997 (42 U.S.C. 1395l 
note) is amended to read as follows:
    ``(b) Methodology for Determining Amount of Payments.--
            ``(1) In general.--The Secretary shall pay to--
                    ``(A) the physician or practitioner at a distant 
                site that provides an item or service under subsection 
                (a) an amount equal to the amount that such physician 
                or provider would have been paid had the item or 
                service been provided without the use of a 
                telecommunications system; and
                    ``(B) the originating site a facility fee for 
                facility services furnished in connection with such 
                item or service.
            ``(2) Application of part b coinsurance and deductible.--
        Any payment made under this section shall be subject to the 
        coinsurance and deductible requirements under subsections 
        (a)(1) and (b) of section 1833 of the Social Security Act (42 
        U.S.C. 1395l).
            ``(3) Definitions.--In this subsection:
                    ``(A) Distant site.--The term `distant site' means 
                the site at which the physician or practitioner is 
                located at the time the item or service is provided via 
                a telecommunications system.
                    ``(B) Facility fee.--The term `facility fee' means 
                an amount equal to--
                            ``(i) for 2000 and 2001, $20; and
                            ``(ii) for a subsequent year, the facility 
                        fee under this subsection for the previous year 
                        increased by the percentage increase in the MEI 
                        (as defined in section 1842(i)(3)) for such 
                        subsequent year.
                    ``(C) Originating site.--
                            ``(i) In general.--The term `originating 
                        site' means the site described in clause (ii) 
                        at which the eligible telehealth beneficiary 
                        under the medicare program is located at the 
                        time the item or service is provided via a 
                        telecommunications system.
                            ``(ii) Sites described.--The sites 
                        described in this paragraph are as follows:
                                    ``(I) On or before January 1, 2002, 
                                the office of a physician or a 
                                practitioner, a critical access 
                                hospital, a rural health clinic, and a 
                                Federally qualified health center.
                                    ``(II) On or before January 1, 
                                2003, a hospital, a skilled nursing 
                                facility, a comprehensive outpatient 
                                rehabilitation facility, a renal 
                                dialysis facility, an ambulatory 
                                surgical center, an Indian Health 
                                Service facility, and a community 
                                mental health center.''.

SEC. 3. ELIMINATION OF REQUIREMENT FOR TELEPRESENTER.

    Section 4206 of the Balanced Budget Act of 1997 (42 U.S.C. 1395l 
note) is amended--
            (1) in subsection (a), by striking ``, notwithstanding that 
        the individual physician'' and all that follows before the 
        period at the end; and
            (2) by adding at the end the following new subsection:
    ``(e) Telepresenter Not Required.--Nothing in this section shall be 
construed as requiring an eligible telehealth beneficiary to be 
presented by a physician or practitioner for the provision of an item 
or service via a telecommunications system.''.

SEC. 4. REIMBURSEMENT FOR MEDICARE BENEFICIARIES WHO DO NOT RESIDE IN A 
              HPSA.

    Section 4206(a) of the Balanced Budget Act of 1997 (42 U.S.C. 1395l 
note), as amended by section 3, is amended--
            (1) by striking ``In General.--Not later than'' and 
        inserting the following: ``Telehealth Services Reimbursed.--
            ``(1) In general.--Not later than'';
            (2) by striking ``furnishing a service for which payment'' 
        and all that follows before the period and inserting ``to an 
        eligible telehealth beneficiary''; and
            (3) by adding at the end the following new paragraph:
            ``(2) Eligible telehealth beneficiary defined.--In this 
        section, the term `eligible telehealth beneficiary' means a 
        beneficiary under the medicare program under title XVIII of the 
        Social Security Act (42 U.S.C. 1395 et seq.) that resides in--
                    ``(A) an area 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));
                    ``(B) a county that is not included in a 
                Metropolitan Statistical Area;
                    ``(C) an inner-city area that is medically 
                underserved (as defined in section 330(b)(3) of the 
                Public Health Service Act (42 U.S.C. 254b(b)(3))); or
                    ``(D) an area in which there is a Federal 
                telemedicine demonstration program.''.

SEC. 5. TELEHEALTH COVERAGE FOR DIRECT PATIENT CARE.

    (a) In General.--Section 4206 of the Balanced Budget Act of 1997 
(42 U.S.C. 1395l note), as amended by section 4, is amended--
            (1) in subsection (a)(1), by striking ``professional 
        consultation via telecommunications systems with a physician'' 
        and inserting ``items and services for which payment may be 
        made under such part that are furnished via a 
        telecommunications system by a physician''; and
            (2) by adding at the end the following new subsection:
    ``(f) Coverage of Items and Services.--Payment for items and 
services provided pursuant to subsection (a) shall include payment for 
professional consultations, office visits, office psychiatry services, 
including any service identified as of July 1, 2000, by HCPCS codes 
99241-99275, 99201-99215, 90804-90815, and 90862, and any additional 
item or service specified by the Secretary.''.
    (b) Study and Report Regarding Additional Items and Services.--
            (1) Study.--The Secretary of Health and Human Services 
        shall conduct a study to identify items and services in 
        addition to those described in section 4206(f) of the Balanced 
        Budget Act of 1997 (as added by subsection (a)) that would be 
        appropriate to provide payment under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.).
            (2) Report.--Not later than 2 years after the date of 
        enactment of this Act, the Secretary shall submit a report to 
        Congress on the study conducted under paragraph (1) together 
        with such recommendations for legislation that the Secretary 
        determines are appropriate.

SEC. 6. ALL PHYSICIANS AND PRACTITIONERS ELIGIBLE FOR TELEHEALTH 
              REIMBURSEMENT.

    Section 4206(a) of the Balanced Budget Act of 1997 (42 U.S.C. 1395l 
note), as amended by section 5, is amended--
            (1) in paragraph (1), by striking ``(described in section 
        1842(b)(18)(C) of such Act (42 U.S.C. 1395u(b)(18)(C))''; and
            (2) by adding at the end the following new paragraph:
            ``(3) Practitioner defined.--For purposes of paragraph (1), 
        the term `practitioner' includes--
                    ``(A) a practitioner described in section 
                1842(b)(18)(C) of the Social Security Act (42 U.S.C. 
                1395u(b)(18)(C)); and
                    ``(B) a physical, occupational, or speech 
                therapist.''.

SEC. 7. TELEHEALTH SERVICES PROVIDED USING STORE-AND-FORWARD 
              TECHNOLOGIES.

    Section 4206(a)(1) of the Balanced Budget Act of 1997 (42 U.S.C. 
1395l note), as amended by section 6, is amended by adding at the end 
the following new paragraph:
            ``(4) Use of store-and-forward technologies.--For purposes 
        of paragraph (1), in the case of any Federal telemedicine 
        demonstration program in Alaska or Hawaii, the term 
        `telecommunications system' includes store-and-forward 
        technologies that provide for the asynchronous transmission of 
        health care information in single or multimedia formats.''.

SEC. 8. CONSTRUCTION RELATING TO HOME HEALTH SERVICES.

    Section 4206(a) of the Balanced Budget Act of 1997 (42 U.S.C. 1395l 
note), as amended by section 7, is amended by adding at the end the 
following new paragraph:
            ``(5) Construction relating to home health services.--
                    ``(A) In general.--Nothing in this section or in 
                section 1895 of the Social Security Act (42 U.S.C. 
                1395fff) shall be construed as preventing a home health 
                agency that is receiving payment under the prospective 
                payment system described in such section from 
                furnishing a home health service via a 
                telecommunications system.
                    ``(B) Limitation.--The Secretary shall not consider 
                a home health service provided in the manner described 
                in subparagraph (A) to be a home health visit for 
                purposes of--
                            ``(i) determining the amount of payment to 
                        be made under the prospective payment system 
                        established under section 1895 of the Social 
                        Security Act (42 U.S.C. 1395fff); or
                            ``(ii) any requirement relating to the 
                        certification of a physician required under 
                        section 1814(a)(2)(C) of such Act (42 U.S.C. 
                        1395f(a)(2)(C)).''.

SEC. 9. EFFECTIVE DATE.

    The amendments made by this Act shall apply to items and services 
provided on or after the date of enactment of this Act.
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