[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4841 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 4841

To amend the Balanced Budget Act of 1997 to provide increased access to 
  health care for Medicare beneficiaries through telehealth services.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 12, 2000

Mr. Thune (for himself, Mrs. Emerson, Mr. Moran of Kansas, Mr. Nussle, 
Mr. Pomeroy, and Mrs. Clayton) 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 the Balanced Budget Act of 1997 to provide increased access to 
  health care for Medicare beneficiaries through telehealth services.

    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 ``Medicare Access to Telehealth 
Services Act of 2000''.

SEC. 2. REVISION OF MEDICARE REIMBURSEMENT FOR TELEHEALTH SERVICES.

    Section 4206 of the Balanced Budget Act of 1997 (42 U.S.C. 1395l 
note) is amended to read as follows:
    ``(a) Telehealth Services Reimbursed.--
            ``(1) In general.--Not later than October 1, 2000, the 
        Secretary of Health and Human Services shall make payments from 
        the Federal Supplementary Medical Insurance Trust Fund in 
        accordance with the methodology described in subsection (b) for 
        services for which payment may be made under part B of title 
        XVIII of the Social Security Act (42 U.S.C. 1395j et seq.) that 
        are furnished via a telecommunications system by a physician or 
        practitioner to an eligible telehealth beneficiary.
            ``(2) 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.
    ``(b) Methodology for Determining Amount of Payments.--
            ``(1) In general.--The Secretary shall make payment under 
        this section as follows:
                    ``(A) Subject to subparagraph (B), with respect to 
                a physician or practitioner located at a distant site 
                that furnishes a service to an eligible medicare 
                beneficiary under subsection (a), an amount equal to 
                the amount that such physician or practitioner would 
                have been paid had the service been furnished without 
                the use of a telecommunications system.
                    ``(B) In the case of a referring physician or 
                practitioner located at the originating site with 
                respect to the service furnished the eligible medicare 
                beneficiary for which payment is made under 
                subparagraph (A), the amount of the payment under 
                subparagraph (A) shall be shared between the physician 
                or practitioner located at the distant site and such 
                referring physician or practitioner.
                    ``(C) With respect to an originating site, a 
                facility fee 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.
            ``(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).
    ``(c) Telepresenter Not Required.--Nothing in this section shall be 
construed as requiring an eligible telehealth beneficiary to be 
presented by a physician or practitioner at the originating site for 
the furnishing of a service via a telecommunications system.
    ``(d) Coverage of Additional Services.--
            ``(1) Study and report on additional services.--
                    ``(A) Study.--The Secretary of Health and Human 
                Services shall conduct a study to identify services in 
                addition to those described in subsection (a)(1) that 
                are appropriate for payment under this section.
                    ``(B) Report.--Not later than 2 years after the 
                date of enactment of this Act, the Secretary shall 
                submit to Congress a report on the study conducted 
                under subparagraph (A) together with such 
                recommendations for legislation that the Secretary 
                determines are appropriate.
            ``(2) In general.--The Secretary shall provide for payment 
        under this section for services identified in paragraph (1).
    ``(e) Construction Relating to Home Health Services.--
            ``(1) 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 furnishing a home 
        health unit of service for which payment is made under the 
        prospective payment system established in such section for such 
        units of service from furnishing the service via a 
        telecommunications system.
            ``(2) Limitation.--The Secretary shall not consider a home 
        health service provided in the manner described in paragraph 
        (1) to be a home health visit for purposes of--
                    ``(A) determining the amount of payment to be made 
                under such prospective payment system; or
                    ``(B) 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)).
    ``(f) Definitions.--In this section:
            ``(1) Eligible telehealth beneficiary.--The term `eligible 
        telehealth beneficiary' means an individual enrolled under part 
        B of title XVIII of the Social Security Act (42 U.S.C. 1395j 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 a Federal telemedicine 
                demonstration program is carried out.
            ``(2) Physician.--The term `physician' has the meaning 
        given that term in section 1861(r) of the Social Security Act 
        (42 U.S.C. 1395x(r))
            ``(3) Practitioner.--The term `practitioner' means--
                    ``(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.
            ``(4) Distant site.--The term `distant site' means the site 
        at which the physician or practitioner is located at the time 
        the service is provided via a telecommunications system.
            ``(5) Originating site.--
                    ``(A) In general.--The term `originating site' 
                means any site described in subparagraph (B) at which 
                the eligible telehealth beneficiary is located at the 
                time the service is furnished via a telecommunications 
                system.
                    ``(B) Sites described.--The sites described in this 
                subparagraph are as follows:
                            ``(i) On or after October 1, 2000--
                                    ``(I) the office of a physician or 
                                a practitioner,
                                    ``(II) a critical access hospital 
                                (as defined in section 1861(mm)(1) of 
                                the Social Security Act (42 U.S.C. 
                                1395x(mm)(1))),
                                    ``(III) a rural health clinic (as 
                                defined in section 1861(aa)(2) of such 
                                Act (42 U.S.C. 1395x(aa)(2))), and
                                    ``(IV) a Federally qualified health 
                                center (as defined in section 
                                1861(aa)(4) of such Act (42 U.S.C. 
                                1395x(aa)(4))).
                            ``(ii) On or after October 1, 2001--
                                    ``(I) a hospital (as defined in 
                                section 1861(e) of such Act (42 U.S.C. 
                                1395x(e))),
                                    ``(II) a skilled nursing facility 
                                (as defined in section 1861(j) of such 
                                Act (42 U.S.C. 1395x(j))),
                                    ``(III) a comprehensive outpatient 
                                rehabilitation facility (as defined in 
                                section 1861(cc)(2) of such Act (42 
                                U.S.C. 1395x(cc)(2))),
                                    ``(IV) a renal dialysis facility 
                                (described in section 1881(b)(1) of 
                                such Act (42 U.S.C. 1395rr(b)(1))),
                                    ``(V) an ambulatory surgical center 
                                (described in section 1833(i)(1)(A) of 
                                such Act (42 U.S.C. 1395l(i)(1)(A))),
                                    ``(VI) a hospital or skilled 
                                nursing facility of the Indian Health 
                                Service (under section 1880 of such Act 
                                (42 U.S.C. 1395qq)), and
                                    ``(VII) a community mental health 
                                center (as defined in section 
                                1861(ff)(3)(B) of such Act (42 U.S.C. 
                                1395x(ff)(3)(B))).
            ``(6) Federal supplementary medical insurance trust fund.--
        The term `Federal Supplementary Medical Insurance Trust Fund' 
        means the trust fund established under section 1841 of the 
        Social Security Act (42 U.S.C. 1395t).''.
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