[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6394 Introduced in House (IH)]







109th CONGRESS
  2d Session
                                H. R. 6394

   To facilitate the provision of telehealth services, and for other 
                               purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            December 6, 2006

Mr. Jefferson introduced the following bill; which was referred to the 
 Committee on Energy and 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 facilitate the provision of telehealth services, 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 and Medically Underserved 
and Advancement Act of 2006''.

SEC. 2. FINDINGS.

    The Congress finds as follows:
            (1) Studies state that telehealth improves access to 
        medical care for geographically or socio-economically isolated 
        patients.
            (2) Research has consistently shown that the use of 
        telehealth is a major factor in preventing unnecessary patient 
        travel to secondary or tertiary health care centers.
            (3) Literature states that the use of telehealth can 
        augment the quality, continuity, and affordability of medical 
        care.
            (4) The practice of teleheatlh preserves the patient's 
        current provider-to-patient relationship while facilitating 
        access to specialty care.
            (5) The use of telehealth will ensure educational and 
        training support for rural-based providers and remove the 
        obstacle of professional isolation.
            (6) Telehealth allows patients to obtain medical 
        consultation in their own communities, and the expanded use of 
        telehealth technology will improve the quality of chronic 
        disease care, increase wellness initiatives, and reduce health 
        disparities for patients.

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 2 years of the date of enactment of the 
Telehealth Medically Underserved and Advancement Act of 2006, 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 inserting after section 330L 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, elimination of health disparities, 
        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
            ``(5) 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;
                    ``(C) expand and improve the quality of health 
                information available to health care providers, and 
                patients and their families, for decision making; and
                    ``(D) expand and improve efforts to eliminate 
                health care disparities.
            ``(2) Grant period.--The Director shall award grants under 
        this subsection for a period of up to 5 years.
            ``(3) Number of grants.--Not to exceed 50 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 
        and resource levels 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 culturally competent 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) information on how services will be used to eliminate 
        health care disparities;
            ``(8) 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
            ``(9) other such information as the Director determines to 
        be appropriate.
    ``(e) Report.--
            ``(1) Final report.--Not later than 1 year 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, 
        respectively.
            ``(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 $45,000,000 for fiscal year 2007 and such sums as may 
be necessary for each of fiscal years 2008 through 2012.

``SEC. 330N. 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 5 years.
            ``(3) Number of grants.--The number of grants awarded under 
        this section shall not exceed 30 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 culturally competent educational curricula to 
        train oral health professionals and paraprofessionals and 
        increase their general level of competency through that 
        training; and
            ``(3) developing culturally competent 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) information on how services will be used to eliminate 
        health care disparities;
            ``(8) 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
            ``(9) other such information as the Director determines to 
        be appropriate.
    ``(e) Report.--
            ``(1) Final report.--Not later than 1 year 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 2007 
and such sums as may be necessary for each of fiscal years 2008 through 
2010.''.

SEC. 5. JOINT WORKING GROUP ON TELEHEALTH.

    (a) In General.--
            (1) Representation of rural and urban areas.--The Secretary 
        of Health and Human Services shall establish, within the Office 
        for the Advancement of Telehealth in the Health Resources and 
        Services Administration, and under the leadership of the 
        Director of such Office, 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 in rural 
                and urban areas;
                    (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;
                            (iv) how telehealth systems can advance the 
                        improvement of health care quality and the 
                        elimination of health care disparities; and
                            (v) the level of Federal resources needed 
                        to accomplish the stated objectives of 
                        telehealth programs as established under this 
                        Act; and
                    (C) to make further recommendations for 
                coordinating Federal and State efforts to increase 
                access to health services, education, and information 
                in rural and urban 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>