[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 1909 Introduced in Senate (IS)]








109th CONGRESS
  1st Session
                                S. 1909

  To improve the provision of telehealth services under the Medicare 
Program, to provide grants for the development of telehealth networks, 
                        and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            October 24, 2005

   Mr. Burns introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
  To improve the provision of telehealth services under the Medicare 
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; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Medicare 
Telehealth Enhancement Act of 2005''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
                       TITLE I--MEDICARE PROGRAM

Sec. 101. Expanding access to telehealth services to all areas.
Sec. 102. Increase in number of types of originating sites; 
                            clarification.
Sec. 103. Expansion of use of store-and-forward technology.
Sec. 104. Expansion of practitioners eligible to furnish telehealth 
                            services.
Sec. 105. Expansion of covered telehealth services.
Sec. 106. Facilitating the provision of telehealth services across 
                            State lines.
Sec. 107. Effective Date.
                      TITLE II--HRSA GRANT PROGRAM

Sec. 201. Grant program for the development of telehealth networks.
Sec. 202. Reauthorization of telehealth network and telehealth resource 
                            centers grant programs.

                       TITLE I--MEDICARE PROGRAM

SEC. 101. EXPANDING ACCESS TO TELEHEALTH SERVICES TO ALL AREAS.

    Section 1834(m)(4)(C)(i) of the Social Security Act (42 U.S.C. 
1395m(m)(4)(C)(i)) is amended by striking ``and only if such site is 
located'' and all that follows and inserting ``without regard to the 
geographic area where the site is located.''.

SEC. 102. INCREASE IN NUMBER OF TYPES OF ORIGINATING SITES; 
              CLARIFICATION.

    (a) Increase.--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 new subclauses:
                                    ``(VI) A skilled nursing facility 
                                (as defined in section 1819(a)).
                                    ``(VII) A renal dialysis facility.
                                    ``(VIII) A county mental health 
                                clinic or other publicly funded mental 
                                health facility.''.
    (b) Clarification of Intent of the Term Originating Site.--Such 
section is further amended by adding at the end the following new 
paragraph:
            ``(5) Construction.--In applying the term `originating 
        site' under this subsection, the Secretary shall apply the term 
        only for the purpose of determining whether a site is eligible 
        to receive a facility fee. Nothing in the application of that 
        term under this subsection shall be construed as affecting the 
        ability of an eligible practitioner to submit claims for 
        telehealth services that are provided to other sites that have 
        telehealth systems and capabilities.''.

SEC. 103. EXPANSION OF USE OF STORE-AND-FORWARD TECHNOLOGY.

    The second sentence of section 1834(m)(1) of the Social Security 
Act (42 U.S.C. 1395m(m)(1)) is amended to read as follows: ``For 
purposes of the preceding sentence, in the case of any medicare 
demonstration program conducted by the Secretary, any disease 
management program under this title, or any site determined appropriate 
by the Secretary, 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. 104. EXPANSION OF PRACTITIONERS ELIGIBLE TO FURNISH TELEHEALTH 
              SERVICES.

    Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is 
amended--
            (1) in paragraph (1), by striking ``(as defined in section 
        1861(r)) or a practitioner (described in section 
        1842(b)(18)(C))'' and inserting ``or a practitioner''; and
            (2) by striking paragraph (4)(E) and inserting the 
        following new subparagraph:
                    ``(E) Practitioner.--The term `practitioner' 
                means--
                            ``(i) a practitioner described in section 
                        1842(b)(18)(C);
                            ``(ii) a physical therapist (as described 
                        in section 1861(p));
                            ``(iii) an occupational therapist (as so 
                        described);
                            ``(iv) a qualified speech-language 
                        pathologist (as defined in section 
                        1861(ll)(3)(A));
                            ``(v) a certified provider (as described in 
                        section 1861(qq)(2)(A)); and
                            ``(vi) any other individual or entity 
                        determined appropriate by the Secretary.''.

SEC. 105. EXPANSION OF COVERED TELEHEALTH SERVICES.

    Section 1834(m)(4)(F)(i) of the Social Security Act (42 U.S.C. 
1395m(m)(4)(F)(i)) is amended to read as follows:
                            ``(i) In general.--The term `telehealth 
                        service' means--
                                    ``(I) any professional service 
                                (identified as of July 1, 2000, by 
                                HCPCS codes approved for face-to-face 
                                care, and as subsequently modified by 
                                the Secretary); and
                                    ``(II) any additional service 
                                specified by the Secretary.''.

SEC. 106. FACILITATING THE PROVISION OF TELEHEALTH SERVICES ACROSS 
              STATE LINES.

    (a) In General.--For purposes of expediting the provision of 
telehealth services, for which payment is made under the medicare 
program, across State lines, the Secretary of Health and Human Services 
shall, in consultation with representatives of States, physicians, 
health care practitioners, and patient advocates, encourage and 
facilitate the adoption of provisions allowing for multistate 
practitioner licensure across State lines.
    (b) Definitions.--In subsection (a):
            (1) Telehealth service.--The term ``telehealth service'' 
        has the meaning given that term in subparagraph (F) of section 
        1834(m)(4) of the Social Security Act (42 U.S.C. 1395m(m)(4)), 
        as amended by this title.
            (2) Physician, practitioner.--The terms ``physician'' and 
        ``practitioner'' have the meaning given those terms in 
        subparagraphs (D) and (E), respectively, of such section, as so 
        amended.
            (3) Medicare program.--The term ``medicare program'' means 
        the program of health insurance administered by the Secretary 
        of Health and Human Services under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.).

SEC. 107. EFFECTIVE DATE.

    The amendments made by sections 101 through 105 shall apply to 
services furnished on or after the date that is 90 days after the date 
of enactment of this Act.

                      TITLE II--HRSA GRANT PROGRAM

SEC. 201. 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 
entities (as described in subsection (b)(2)) for the purpose of 
expanding access to health care services for individuals in rural 
areas, frontier areas, and urban medically underserved areas through 
the use of telehealth.
    (b) Eligible Entities.--
            (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 or 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.
                            (ix) Renal dialysis facilities.
                    (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 health entity.
                            (vi) A health-related nonprofit foundation.
                            (vii) An academic health center.
        An eligible entity may include for-profit entities so long as 
        the recipient of the grant is a not-for-profit entity.
    (c) Preference.--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.
    (d) 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 cause to have published in the Federal Register or the 
``HRSA Preview'' notice of the terms and conditions of a grant under 
this section and the maximum amount of such a grant for a fiscal year.
    (e) 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) The provision of telenursing services designed to 
        enhance care coordination and promote patient self-management 
        skills.
            (6) The provision of services designed to promote patient 
        understanding and adherence to national guidelines for common 
        chronic diseases, such as congestive heart failure or diabetes.
            (7) Transmission costs, maintenance of equipment, and 
        compensation of specialists and referring health care 
        providers, when no other form of reimbursement is available.
            (8) Development of projects to use telehealth to facilitate 
        collaboration between health care providers.
            (9) Electronic archival of patient records.
            (10) Collection and analysis of usage statistics and data 
        that can be used to document the cost-effectiveness of the 
        telehealth services.
            (11) Such other uses that are consistent with achieving the 
        purposes of this section as approved by the Secretary.
    (f) 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) 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 off the 
        premises of the telehealth site and any transmission costs not 
        directly related to the grant.
            (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 15 percent of the total grant.
    (g) 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.
    (h) Prompt Implementation.--The Secretary shall take such actions 
as are necessary to carry out the grant program as expeditiously as 
possible.
    (i) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $10,000,000 for fiscal year 
2006, and such sums as may be necessary for each of the fiscal years 
2007 through 2012.

SEC. 202. REAUTHORIZATION OF TELEHEALTH NETWORK AND TELEHEALTH RESOURCE 
              CENTERS GRANT PROGRAMS.

    Subsection (s) of section 330I of the Public Health Service Act (42 
U.S.C. 254c-14) is amended--
            (1) in paragraph (1)--
                    (A) by striking ``and'' before ``such sums''; and
                    (B) by inserting ``, $10,000,000 for fiscal year 
                2007, and such sums as may be necessary for each of 
                fiscal years 2008 through 2012'' before the semicolon 
                at the end; and
            (2) in paragraph (2)--
                    (A) by striking ``and'' before ``such sums''; and
                    (B) by inserting ``, $10,000,000 for fiscal year 
                2007, and such sums as may be necessary for each of 
                fiscal years 2008 through 2012'' before the period at 
                the end.
                                 <all>