[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 2325 Introduced in Senate (IS)]







108th CONGRESS
  2d Session
                                S. 2325

                   To strengthen telehealth programs.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 21, 2004

  Mr. Edwards introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
                   To strengthen telehealth programs.

    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 
2004''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) 36,000,000 people of the United States lack access to 
        doctors who are willing or able to care for them.
            (2) Many individuals lack access to treatment because 
        appropriate transportation is too expensive or limited by 
        weather factors, or because the patient involved is too sick to 
        use the options that are available.
            (3) Telehealth services can improve access to quality 
        health care and can help control skyrocketing medical costs.
            (4) Sophisticated audio and video telehealth services link 
        physicians and nurses with patients for checkups and diagnoses. 
        Those services give patients access to quality health care 
        without having to travel to a hospital or doctor's office, 
        which is critical for patients in rural and underserved urban 
        areas and for patients who have difficulty leaving their homes.
            (5) Telehealth services have also been pivotal in 
        protecting lives during emergency situations, including large-
        scale natural disasters.
            (6) The Department of Commerce found that the United States 
        maintains a ``competitive advantage for exporting telehealth 
        technologies and services'', yet the ``international market for 
        telehealth technologies and major projects has been largely 
        overlooked by U.S. industry''. A 2003 report by the Department 
        of Commerce stated that ``with effective marketing and 
        responsiveness to sales opportunities, American firms can also 
        lead in world market share''.

SEC. 3. INCREASING TYPES OF ORIGINATING TELEHEALTH SITES AND 
              FACILITATING THE PROVISION OF TELEHEALTH SERVICES ACROSS 
              STATE LINES.

    (a) Increasing Types of Originating Sites.--Section 
1834(m)(4)(C)(ii) of the Social Security Act (42 U.S.C. 
1395m(m)(4)(C)(ii)) is amended by adding at the end the following:
                                    ``(VI) A skilled nursing facility 
                                (as defined in section 1819(a)).
                                    ``(VII) An assisted-living facility 
                                (as defined by the Secretary).
                                    ``(VIII) A board-and-care home (as 
                                defined by the Secretary).
                                    ``(IX) A county or community health 
                                clinic (as defined by the Secretary).
                                    ``(X) A community mental health 
                                center (as described in section 
                                1861(ff)(2)(B)).
                                    ``(XI) A facility operated by the 
                                Indian Health Service or by an Indian 
                                tribe, tribal organization, or an urban 
                                Indian organization (as such terms are 
                                defined in section 4 of the Indian 
                                Health Care Improvement Act (25 U.S.C. 
                                1603)) directly, or under contract or 
                                other arrangement.
                                    ``(XII) A site in a State in which 
                                the respective State medical board has 
                                adopted a formal policy regarding 
                                licensing or certification requirements 
                                for providers at distant sites who do 
                                not have a license to practice medicine 
                                at the originating site.''.
    (b) Expanding Eligibility for Reimbursement.--Section 
1834(m)(4)(C)(i)(I) of the Social Security Act (42 U.S.C. 
1395m(m)(4)(C)(i)(I)) is amended by striking ``rural''.

SEC. 4. STRENGTHENING TELEHEALTH SERVICES IN RURAL AND UNDERSERVED 
              URBAN AMERICA.

    Subpart I of part D of title III of the Public Health Service Act 
(42 U.S.C. 254b et seq.) is amended--
            (1) in section 330L--
                    (A) by redesignating subsection (b) as subsection 
                (c); and
                    (B) by inserting after subsection (a) the 
                following:
    ``(b) Conference.--Within 1 year of the date of enactment of the 
Telehealth Improvement Act of 2004, the Secretary shall convene a 
conference of State licensing boards, local telehealth projects, health 
care practitioners, and patient advocates to promote interstate 
licensure for telehealth projects.''; and
            (2) by adding at the end the following:

``SEC. 330M. INTEGRATIVE ELDERCARE TELEHEALTH DEMONSTRATION PROJECT.

    ``(a) Purposes.--The purposes of this section are to encourage the 
creation of programs to--
            ``(1) evaluate the use of telehealth services in an 
        integrative eldercare setting;
            ``(2) eliminate fragmented service delivery while promoting 
        enhanced continuity of care and more simplified access to 
        services;
            ``(3) develop community-based options that promote patient 
        independence and leverage telehealth services and equipment to 
        enable the use of the most cost-effective, least restrictive 
        care settings; and
            ``(4) promote access for elderly patients in rural and 
        underserved urban areas to improvements in medical technology 
        and training across an integrated spectrum of care; and to make 
health care services more flexible and responsive to the diverse and 
changing needs of elderly patients in rural areas.
    ``(b) Grants Authorized--
            ``(1) In general.--The Director may award grants to 
        eligible providers for projects to demonstrate how telehealth 
        technologies can be used through telehealth networks in rural 
        areas, frontier communities, and medically underserved areas, 
        and for medically underserved populations, to--
                    ``(A) expand access to, coordinate, and improve the 
                quality of health care services;
                    ``(B) improve and expand the training of health 
                care providers; and
                    ``(C) expand and improve the quality of health 
                information available to health care providers, and 
                patients and their families, for decisionmaking.
            ``(2) Grant period.--The Director shall award grants under 
        this subsection for a period of up to 4 years.
            ``(3) Number of grants.--Not to exceed 20 grants shall be 
        awarded under this subsection, of which at least \1/2\ shall be 
        dedicated to providing services in rural communities.
    ``(c) Use of Funds.--Grants awarded pursuant to subsection (b) may 
be used for activities including--
            ``(1) improving access to coordinated health care services 
        at the lowest intensity and resource level of care consistent 
        with quality health care services and optimal patient outcomes, 
        improving the quality of such care, increasing patient 
        satisfaction with such care, and reducing the cost of such care 
        through advanced telecommunication technologies;
            ``(2) developing effective care management practices and 
        educational curricula to train health care professionals, 
        paraprofessionals, and caregivers, including family members, 
        and to increase the general level of competency of such 
        individuals through such training; and
            ``(3) developing curricula to train health care 
        professionals, paraprofessionals, and caregivers, including 
        family members, serving integrative eldercare patients in the 
        use of telecommunications.
    ``(d) Applications.--To be eligible to receive a grant under 
subsection (b), an eligible provider, in consultation with the 
appropriate State office of rural health or another appropriate State 
entity, shall prepare and submit to the Director an application, at 
such time, in such manner, and containing such information as the 
Director may require, including--
            ``(1) a description of the project that the eligible entity 
        will carry out using the funds provided under the grant;
            ``(2) a description of the manner in which the project 
        funded under the grant will meet the health care needs of rural 
        or other populations to be served through the project, or 
        improve the access to services of, and the quality of the 
        services received by, those populations;
            ``(3) evidence of local support for the project, and a 
        description of how the areas, communities, or populations to be 
        served will be involved in the development and ongoing 
        operations of the project;
            ``(4) a plan for sustaining the project after Federal 
        support for the project has ended;
            ``(5) information on the source and amount of non-Federal 
        funds that the entity will provide for the project;
            ``(6) information demonstrating the long-term viability of 
        the project, and other evidence of institutional commitment of 
        the entity to the project;
            ``(7) in the case of an application for a project involving 
        a telehealth network, information demonstrating how the project 
        will promote the integration of telehealth technologies into 
        the operations of health care providers, to avoid redundancy, 
        and improve access to and the quality of care; and
            ``(8) other such information as the Director determines to 
        be appropriate.
    ``(e) Report.--
            ``(1) Final report.--Not later than 9 months after the date 
        of termination of the last grant to be awarded under this 
        section, the Director shall submit to Congress a final report--
                    ``(A) describing the results of the programs funded 
                by grants awarded pursuant to this section; and
                    ``(B) evaluating the impact of the use of 
                telehealth services in an integrative eldercare setting 
                on--
                            ``(i) access to care for patients served by 
                        integrative eldercare programs; and
                            ``(ii) the quality of, patient satisfaction 
                        with, and the cost of, such care.
            ``(2) Ensuring access to quality care.--In conducting the 
        evaluation under paragraph (1)(B), the Director shall--
                    ``(A) give special consideration to the impact of 
                programs funded under this section on face-to-face 
                access to medical providers; and
                    ``(B) develop specific measures to evaluate the 
                quality of care provided to those participating in such 
                programs to ensure that telehealth augments the plan of 
                care.
    ``(f) Eligible Provider.--The term `eligible provider' means a 
consortia of home and facility-based care providers that includes 
providers from no less than 2 of the following:
            ``(1) An adult congregate care facility.
            ``(2) A continuing care retirement community.
            ``(3) An assisted living facility.
            ``(4) An Alzheimer's facility.
            ``(5) An institutional hospice facility.
            ``(6) A residential care facility.
            ``(7) An adult foster home.
            ``(8) A State-licensed nursing home, including a skilled 
        nursing facility, an intermediate care facility, licensed home 
        health provider or other health care provider that the Director 
        deems appropriate and consistent with the purposes of this 
        section.
    ``(g) Definitions.--In this section:
            ``(1) Director; office.--The terms `Director' and `Office' 
        mean the Director of the Office for the Advancement of 
        Telehealth and the Office for the Advancement of Telehealth.
            ``(2) Integrative eldercare.--The term `integrative 
        eldercare' includes case management and coordination of care 
        for elderly patients recovering from acute illness or coping 
        with chronic disease at the lowest intensity and resource level 
        of care consistent with quality health care services and 
        optimal patient outcomes.
            ``(3) Telehealth services.--The term `telehealth services' 
        means services provided through telehealth technologies.
            ``(4) Telehealth technologies.--The term `telehealth 
        technologies' means technologies relating to the use of 
        electronic information, and telecommunications technologies, to 
        support and promote, at a distance, health care, patient and 
        professional health-related education, health administration, 
        and public health.
    ``(h) Authorization of Appropriations.--There are authorized to be 
appropriated to the Office for the Advancement of Telehealth to carry 
out this section $30,000,000 for fiscal year 2005 and such sums as may 
be necessary for each of fiscal years 2006 through 2008.

``SEC. 330N. AMERICAN INDIAN AND ALASKA NATIVE TELEHEALTH DEMONSTRATION 
              PROJECT.

    ``(a) Purpose.--The purpose of this section is to evaluate the use 
of telehealth services in areas under the jurisdiction of Indian tribes 
or tribal organizations, including efforts to develop more effective 
case management for chronic and acute disease and preventive health 
care programs.
    ``(b) Grants Authorized.--
            ``(1) In general.--The Director may award grants to 
        eligible providers, individually or as part of a network of 
        eligible providers, for the provision of telehealth services to 
        improve patient care, prevent health care complications, 
        improve patient outcomes, and achieve efficiencies in the 
        delivery of care to patients who reside in areas under the 
        jurisdiction of Indian tribes or tribal organizations.
            ``(2) Grant period.--The Director shall award grants under 
        this section for a period of up to 4 years.
            ``(3) Number of grants.--Not to exceed 20 grants shall be 
        awarded under this section, of which at least \1/2\ shall be 
        dedicated to providing services in rural communities.
    ``(c) Use of Funds.--Grants awarded under this section may be used 
for activities including--
            ``(1) improving access to care for home care patients 
        served by eligible providers, improving the quality of such 
        care, increasing patient satisfaction with such care, and 
        reducing the cost of such care through advanced 
        telecommunication technologies;
            ``(2) developing effective telehealth management practices 
        and educational curricula to train health professionals and 
        paraprofessionals and increase their general level of 
        competency through such training; and
            ``(3) developing curricula to train health care 
        professionals and paraprofessionals serving patients of 
        eligible providers in the use of telecommunications.
    ``(d) Collaboration.--The Director shall ensure that eligible 
providers receiving grants under this section collaborate to enable 
comparisons across programs and to share relevant, de-identified 
information to better facilitate program performance evaluation.
    ``(e) Applications.--To be eligible to receive a grant under 
subsection (b), an eligible entity, in consultation with the 
appropriate State office of rural health or another appropriate State 
entity, shall prepare and submit to the Director an application, at 
such time, in such manner, and containing such information as the 
Director may require, including--
            ``(1) a description of the project that the eligible entity 
        will carry out using the funds provided under the grant;
            ``(2) a description of the manner in which the project 
        funded under the grant will meet the health care needs of rural 
        or other populations to be served through the project, or 
        improve the access to services of, and the quality of the 
        services received by, those populations;
            ``(3) evidence of local support for the project, and a 
        description of how the areas, communities, or populations to be 
        served will be involved in the development and ongoing 
        operations of the project;
            ``(4) a plan for sustaining the project after Federal 
        support for the project has ended;
            ``(5) information on the source and amount of non-Federal 
        funds that the entity will provide for the project;
            ``(6) information demonstrating the long-term viability of 
        the project, and other evidence of institutional commitment of 
        the entity to the project;
            ``(7) in the case of an application for a project involving 
        a telehealth network, information demonstrating how the project 
        will promote the integration of telehealth technologies into 
        the operations of health care providers, to avoid redundancy, 
        and improve access to and the quality of care; and
            ``(8) other such information as the Director determines to 
        be appropriate.
    ``(f) Report.--
            ``(1) Final report.--Not later than 9 months after the date 
        of termination of the last grant to be awarded under this 
        section, the Director shall submit to Congress a final report--
                    ``(A) describing the results of the programs funded 
                by grants awarded pursuant to this section; and
                    ``(B) evaluating the impact of telehealth services 
                in an institutional long-term care setting on--
                            ``(i) access to care for patients of 
                        eligible providers; and
                            ``(ii) the quality of, patient satisfaction 
                        with, and the cost of, such care.
            ``(2) Ensuring access to quality care.--In conducting the 
        evaluation under paragraph (1)(B), the Director shall--
                    ``(A) give special consideration to the impact of 
                programs funded under this section on face-to-face 
                access to medical providers; and
                    ``(B) develop specific measures to evaluate the 
                quality of care provided to those participating in such 
                programs to ensure that telemedicine augments the plan 
                of care.
    ``(g) Definitions.--In this section:
            ``(1) Director; office.--The terms `Director' and `Office' 
        mean the Director of the Office for the Advancement of 
        Telehealth and the Office for the Advancement of Telehealth.
            ``(2) Eligible provider.--The term `eligible provider' 
        includes any public or private nonprofit health care provider a 
        majority of whose patient practice is Native American or any 
        Indian tribe or tribal organization that provides health care 
        services for its members.
            ``(3) Indian tribe.--The term `Indian tribe' has the 
        meaning given such term in section 4 of the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 450b).
            ``(4) Native american.--The term `Native American' means a 
        member of an Indian tribe, a Native Hawaiian (as defined in 
        section 338K(c)), or a Native American Pacific Islander.
            ``(5) Native american pacific islander.--The term `Native 
        American Pacific Islander' means an individual who is 
        indigenous to a United States territory or possession located 
        in the Pacific Ocean.
            ``(6) Tribal organization.--The term ``tribal 
        organization'' has the meaning given such term in section 4 of 
        the Indian Self-Determination and Education Assistance Act (25 
        U.S.C. 450b).
    ``(h) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $30,000,000 for fiscal year 2005 
and such sums as may be necessary for each of fiscal years 2006 through 
2008.

``SEC. 330O. ORAL HEALTH TELEHEALTH DEMONSTRATION PROJECT.

    ``(a) Purpose.--The purpose of this section is to evaluate the use 
of telehealth services to expand access to oral health services and 
improve oral health outcomes among rural and underserved urban 
patients.
    ``(b) Grants Authorized.--
            ``(1) In general.--The Director is authorized to award 
        competitive grants to eligible providers, individually or as 
        part of a network of eligible providers, for the provision of 
        oral health services to improve patient care, prevent health 
        care complications, improve patient outcomes, and achieve 
        efficiencies in the delivery of oral health care to patients 
        who reside in rural areas.
            ``(2) Grant period.--The Director shall award grants under 
        this section for a period of up to 4 years.
            ``(3) Number of grants.--The number of grants awarded under 
        this section shall not exceed 10 grants.
    ``(c) Use of Funds.--Grants awarded pursuant to subsection (b) may 
be used for activities including--
            ``(1) improving access to care for rural and underserved 
        urban patients served by eligible providers, improving the 
        quality of that care, increasing patient satisfaction with that 
        care, and reducing the cost of that care through advanced 
        telecommunication technologies;
            ``(2) developing effective oral telehealth care management 
        practices and educational curricula to train oral health 
        professionals and paraprofessionals and increase their general 
        level of competency through that training; and
            ``(3) developing curricula to train health care 
        professionals and paraprofessionals, serving rural and 
        underserved urban patients in the use of telecommunications.
    ``(d) Applications.--To be eligible to receive a grant under 
subsection (b), an eligible entity, in consultation with the 
appropriate State office of rural health or another appropriate State 
entity, shall prepare and submit to the Director an application, at 
such time, in such manner, and containing such information as the 
Director may require, including--
            ``(1) a description of the project that the eligible entity 
        will carry out using the funds provided under the grant;
            ``(2) a description of the manner in which the project 
        funded under the grant will meet the health care needs of rural 
        or other populations to be served through the project, or 
        improve the access to services of, and the quality of the 
        services received by, those populations;
            ``(3) evidence of local support for the project, and a 
        description of how the areas, communities, or populations to be 
        served will be involved in the development and ongoing 
        operations of the project;
            ``(4) a plan for sustaining the project after Federal 
        support for the project has ended;
            ``(5) information on the source and amount of non-Federal 
        funds that the entity will provide for the project;
            ``(6) information demonstrating the long-term viability of 
        the project, and other evidence of institutional commitment of 
        the entity to the project;
            ``(7) in the case of an application for a project involving 
        a telehealth network, information demonstrating how the project 
        will promote the integration of telehealth technologies into 
        the operations of health care providers, to avoid redundancy, 
        and improve access to and the quality of care; and
            ``(8) other such information as the Director determines to 
        be appropriate.
    ``(e) Report.--
            ``(1) Final report.--Not later than 9 months after the date 
        of termination of the last grant to be awarded under this 
        section, the Director shall submit to Congress a final report--
                    ``(A) describing the results of the programs funded 
                by grants awarded pursuant to this section; and
                    ``(B) including an evaluation of the impact of the 
                use of oral telehealth services on--
                            ``(i) access to oral health care for rural 
                        patients; and
                            ``(ii) the quality of, patient satisfaction 
                        with, and the cost of, that care.
            ``(2) Ensuring access to quality care.--In conducting the 
        evaluation under paragraph (1)(B), the Director shall--
                    ``(A) give special consideration to the impact of 
                programs funded under this section on face-to-face 
                access to medical providers; and
                    ``(B) develop specific measures to evaluate the 
                quality of care provided to those participating in such 
                programs to ensure that telemedicine augments the plan 
                of care.
    ``(f) Definition of Eligible Provider.--In this section the term 
`eligible provider' includes dentists, periodontists, orthodontists, 
dental and oral health clinics, and schools of dentistry and oral 
health, where a majority of the patient population resides in a rural 
area, and may include other rural oral health providers that the 
Director deems appropriate.
    ``(g) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $30,000,000 for fiscal year 2005 
and such sums as may be necessary for each of fiscal years 2006 through 
2008.''.

SEC. 5. JOINT WORKING GROUP ON TELEHEALTH.

    (a) In General.--
            (1) Representation of rural areas.--The Secretary of Health 
        and Human Services shall establish, within the Health Resources 
        and Services Administration Office for the Advancement of 
        Telehealth, and under the leadership of the Director of the 
        Office for the Advancement of Telehealth, a Joint Working Group 
        on Telehealth. In establishing such Group, the Secretary shall 
        ensure that all relevant Federal agencies are represented and 
        that input from relevant industry groups, including 
        representatives of rural areas and medically underserved areas, 
        is fully considered.
            (2) Mission.--The mission of the Joint Working Group on 
        Telehealth 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 2 years after the date 
        of enactment of this Act, and each January 1 thereafter, the 
        Joint Working Group on Telehealth 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)(2)(B);
                    (B) Federal activities with respect to telehealth; 
                and
                    (C) the process of the Joint Working Group on 
                Telehealth'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 may be necessary to enable the Joint Working 
Group on Telehealth to carry out this section.
                                 <all>