1.Short title; table of
contents
(a)This Act may be cited as the Medicare Telehealth Enhancement Act of
2005
.
(b)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.
<enum>I</enum><header>Medicare
Program</header>
<section id="ID8DCEB1F2AD304ACD9A4EB18D2A17C4E4"><enum>101.</enum><header>Expanding
access to telehealth services to all areas</header><text display-inline="no-display-inline">Section 1834(m)(4)(C)(i) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395m(m)(4)(C)(i)) is amended by striking <quote>and only if such site is
located</quote> and all that follows and inserting <quote>without regard to the
geographic area where the site is located.</quote>.</text>
</section><section id="ID3D388B4D8E3942129E55E0A9A3F366EC"><enum>102.</enum><header>Increase in
number of types of originating sites; clarification</header>
<subsection id="IDEA628769FA7D465DA6C089A5B1EA6321"><enum>(a)</enum><header>Increase</header><text>Section
1834(m)(4)(C)(ii) of the <act-name parsable-cite="SSA">Social Security
Act</act-name> (42 U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding at the end
the following new subclauses:</text>
<quoted-block act-name="Social Security Act" id="ID291B3149F7EC438D973F9CDB46099519">
<subclause id="ID85A0715972F6463A984660EA60F0A304"><enum>(VI)</enum><text>A skilled
nursing facility (as defined in section 1819(a)).</text>
</subclause><subclause id="ID4457B55E2BDF4903853ADF7E975C0285"><enum>(VII)</enum><text>A renal
dialysis facility.</text>
</subclause><subclause id="ID2C534DFE80D343B7B23D9486AB725E89"><enum>(VIII)</enum><text>A county
mental health clinic or other publicly funded mental health
facility.</text>
</subclause><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="ID6184C35A2CF1475CA91F8A53E32841A0"><enum>(b)</enum><header>Clarification
of intent of the term originating site</header><text>Such section is further
amended by adding at the end the following new paragraph:</text>
<quoted-block id="ID4768726AFB0A48AF9749513D4C37D6DC">
<paragraph id="ID1E0825FBFFB24AA592E3429A8F22925D"><enum>(5)</enum><header>Construction</header><text>In
applying the term <term>originating site</term> 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.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="id580C5E49EA81405584EEBF0B6D387B63"><enum>103.</enum><header>Expansion of
use of store-and-forward technology</header><text display-inline="no-display-inline">The second sentence of section 1834(m)(1) of
the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395m(m)(1)) is amended to read as follows: <quote>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 <quote>telecommunications
system</quote> includes store-and-forward technologies that provide for the
asynchronous transmission of health care information in single or multimedia
formats.</quote>.</text>
</section><section id="id74C8E71700C94934AFD9F2209143FE60"><enum>104.</enum><header>Expansion of
practitioners eligible to furnish telehealth services</header>
<subsection id="ID236823ABFD9D4FB384AE3A3592BAADF6"><enum></enum><text>Section 1834(m)
of the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395m(m)) is amended—</text>
<paragraph id="idFCB09794B0614FA8A22A24DC11E33301"><enum>(1)</enum><text>in paragraph (1),
by striking <quote>(as defined in section 1861(r)) or a practitioner (described
in section 1842(b)(18)(C))</quote> and inserting <quote>or a
practitioner</quote>; and</text>
</paragraph><paragraph id="id7FBC010A233045D89F4B7EC7CBDCCD07"><enum>(2)</enum><text>by striking
paragraph (4)(E) and inserting the following new subparagraph:</text>
<quoted-block act-name="Social Security Act" display-inline="no-display-inline" id="IDE00E489B0A984839A0B168EADEE189D7" style="OLC">
<subparagraph id="IDD0DAA95941CA42E499BA656CA0B91BA1"><enum>(E)</enum><header>Practitioner</header><text>The
term <term>practitioner</term> means—</text>
<clause id="ID8DA2A4281904408E84E1352674756D39"><enum>(i)</enum><text>a
practitioner described in section 1842(b)(18)(C);</text>
</clause><clause id="ID594A24D7ADCE4650B3499924DF9AE417"><enum>(ii)</enum><text>a physical
therapist (as described in section 1861(p));</text>
</clause><clause id="ID297FE4CC95DA4001A60C4F7C91FDFFCF"><enum>(iii)</enum><text>an occupational
therapist (as so described);</text>
</clause><clause commented="no" display-inline="no-display-inline" id="IDD806039EA03D4B76941359D596DFE476"><enum>(iv)</enum><text>a qualified
speech-language pathologist (as defined in section 1861(ll)(3)(A));</text>
</clause><clause commented="no" display-inline="no-display-inline" id="id5914229ABCF64C769C8673CB0996480D"><enum>(v)</enum><text>a certified
provider (as described in section 1861(qq)(2)(A)); and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="id9066B7331D7841198AAD80559A2D445B"><enum>(vi)</enum><text>any other
individual or entity determined appropriate by the
Secretary.</text>
</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection></section><section id="id621F98032BEF4443B41920529622EF4C"><enum>105.</enum><header>Expansion of
covered telehealth services</header><text display-inline="no-display-inline">Section 1834(m)(4)(F)(i) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395m(m)(4)(F)(i)) is amended to read as follows:</text>
<quoted-block display-inline="no-display-inline" id="id0ADFFC45B34640369D886E3C5A82186B" style="OLC">
<clause id="idCDE8FB66D86C4B8395E0DD708B701B80"><enum>(i)</enum><header>In
general</header><text>The term <quote>telehealth service</quote> means—</text>
<subclause id="id8EEC348E6A2A4EFD8FB9D0E54AA6C8E3"><enum>(I)</enum><text>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</text>
</subclause><subclause id="idA8AD7D2BE867492FB2C1B8E52E417569"><enum>(II)</enum><text>any additional
service specified by the
Secretary.</text>
</subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="ID9A6FF121C6BF4A1A8FBDE8FFC8AE663E"><enum>106.</enum><header>Facilitating
the provision of telehealth services across State lines</header>
<subsection id="ID39A9E55570AF4B67855F4935846F2863"><enum>(a)</enum><header>In
general</header><text>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.</text>
</subsection><subsection id="ID4A5E74E8E24F4221A790800ED732545B"><enum>(b)</enum><header>Definitions</header><text>In
subsection (a):</text>
<paragraph id="ID6E4F8D8189A145E6B9B022718503C7A5"><enum>(1)</enum><header>Telehealth
service</header><text>The term <term>telehealth service</term> has the meaning
given that term in subparagraph (F) of section 1834(m)(4) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395m(m)(4)), as amended by this title.</text>
</paragraph><paragraph id="ID4F2E9F8EDA304316A1F201DAFD62B5ED"><enum>(2)</enum><header>Physician,
practitioner</header><text>The terms <term>physician</term> and
<term>practitioner</term> have the meaning given those terms in subparagraphs
(D) and (E), respectively, of such section, as so amended.</text>
</paragraph><paragraph id="id41BBE758276147D0A201779BEF90D32C"><enum>(3)</enum><header>Medicare
program</header><text>The term <quote>medicare program</quote> means the
program of health insurance administered by the Secretary of Health and Human
Services under title XVIII of the <act-name parsable-cite="SSA">Social Security
Act</act-name> (42 U.S.C. 1395 et seq.).</text>
</paragraph></subsection></section><section id="id0871895D3CD54E9890E4ED38062FAC1F"><enum>107.</enum><header>Effective
Date</header><text display-inline="no-display-inline">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.</text>
</section><enum>II</enum><header>HRSA grant
program</header>
<section id="IDAA7F9B42E0E64B2390FACB625544F26A"><enum>201.</enum><header>Grant program
for the development of telehealth networks</header>
<subsection id="ID2F9D7E2357DE4699A95DDE597DB6D226"><enum>(a)</enum><header>In
general</header><text>The Secretary of Health and Human Services (in this
section referred to as the <quote>Secretary</quote>), 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.</text>
</subsection><subsection id="ID8BBD59E73B1644FAB64E013F0C618095"><enum>(b)</enum><header>Eligible
entities</header>
<paragraph id="ID50D407BB35B64398BD0E8D1EE083340C"><enum>(1)</enum><header>Application</header><text>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:</text>
<subparagraph id="ID2A5454520172462FBA401014946E168D"><enum>(A)</enum><text>A description of
the anticipated need for the grant.</text>
</subparagraph><subparagraph id="ID91C9BC1B702C48269C292DEE7D7DDA79"><enum>(B)</enum><text>A description of
the activities which the entity intends to carry out using amounts provided
under the grant.</text>
</subparagraph><subparagraph id="IDA687DAAD5C604352AE43E2B4073DC56B"><enum>(C)</enum><text>A plan for
continuing the project after Federal support under this section is
ended.</text>
</subparagraph><subparagraph id="ID419D3FCF7F974FE7B6C00762BB8960B9"><enum>(D)</enum><text>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.</text>
</subparagraph><subparagraph id="ID2D3E4CDD50164D94A7E5BDC7088A4E96"><enum>(E)</enum><text>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.</text>
</subparagraph><subparagraph id="IDB093D2587DC5445485C3351612B604FD"><enum>(F)</enum><text>The source and
amount of non-Federal funds the entity would pledge for the project.</text>
</subparagraph><subparagraph id="ID6552B0E1522C4426843804F4843592EF"><enum>(G)</enum><text>A showing of the
long-term viability of the project and evidence of health care provider
commitment to the network.</text>
</subparagraph><continuation-text continuation-text-level="paragraph">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.</continuation-text></paragraph><paragraph id="IDB850AD0082F745F48504010EED5104D2"><enum>(2)</enum><header>Eligible
entities</header><text>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).</text>
<subparagraph id="IDDC5EAD3B20BB4FB4BC3D1B12369BD88C"><enum>(A)</enum><text>The organizations
described in this subparagraph are the following:</text>
<clause id="ID6BD4B9593C6B4202833EB7D0201D2FD1"><enum>(i)</enum><text>Community or
migrant health centers.</text>
</clause><clause id="ID795E7F9523864953909ACE1C8F9B2A8D"><enum>(ii)</enum><text>Local health
departments.</text>
</clause><clause id="ID02A8FC72582F4F0793B1EAB15AEEF49D"><enum>(iii)</enum><text>Nonprofit
hospitals.</text>
</clause><clause id="IDD069F217545B44808B34E18CC16DD3FD"><enum>(iv)</enum><text>Private practice
health professionals, including community and rural health clinics.</text>
</clause><clause id="IDADAFCB4B57294BE6949631CBDE9456C8"><enum>(v)</enum><text>Other publicly
funded health or social services agencies.</text>
</clause><clause id="IDCBD520F62B7E431F950E597AB65686B9"><enum>(vi)</enum><text>Skilled nursing
facilities.</text>
</clause><clause id="ID2820EF1DC27149558EDF8955F958D656"><enum>(vii)</enum><text>County mental
health and other publicly funded mental health facilities.</text>
</clause><clause id="ID1255FA50DA2F4EFD99EA643C1ADC5D34"><enum>(viii)</enum><text>Providers of
home health services.</text>
</clause><clause id="IDB54ABFDED95945B8AD187270BAAA9253"><enum>(ix)</enum><text>Renal dialysis
facilities.</text>
</clause></subparagraph><subparagraph id="ID6B0F09F90CE84D20AE56B5D1774375CA"><enum>(B)</enum><text>The institutions
and entities described in this subparagraph are the following:</text>
<clause id="ID6927E7F73BA54906B9E08317687152BD"><enum>(i)</enum><text>A
public school.</text>
</clause><clause id="ID6A5230B9EFCA400A914F862F5B410028"><enum>(ii)</enum><text>A
public library.</text>
</clause><clause id="ID62A63074C6E5466EBE29DA58A5BF85C8"><enum>(iii)</enum><text>A
university or college.</text>
</clause><clause id="IDF7102442B3AD4022A798A5A2D26C696B"><enum>(iv)</enum><text>A
local government entity.</text>
</clause><clause id="ID69C2191B518A499CA9F871F22D6E71EA"><enum>(v)</enum><text>A
local health entity.</text>
</clause><clause id="ID7743234F9601482C9549F6DDCD3A44F4"><enum>(vi)</enum><text>A
health-related nonprofit foundation.</text>
</clause><clause id="ID420D02BEEFF84F5F94F668783D80C1FA"><enum>(vii)</enum><text>An academic
health center.</text>
</clause></subparagraph><continuation-text continuation-text-level="paragraph">An eligible
entity may include for-profit entities so long as the recipient of the grant is
a not-for-profit entity.</continuation-text></paragraph></subsection><subsection id="ID165028F0852349F1B3176442DEF6AF51"><enum>(c)</enum><header>Preference</header><text>The
Secretary shall establish procedures to prioritize financial assistance under
this section based upon the following considerations:</text>
<paragraph id="ID58E88405438E4FF59104EFB4B7DA6836"><enum>(1)</enum><text>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.</text>
</paragraph><paragraph id="ID940DB56F64374E62B388EC058254F00A"><enum>(2)</enum><text>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.</text>
</paragraph><paragraph id="ID9E5BACBC977F45C184CCA92CB423BBCA"><enum>(3)</enum><text>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.</text>
</paragraph><paragraph id="IDD0C233B6A76A43A59D37F592B049E77A"><enum>(4)</enum><text>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.</text>
</paragraph><paragraph id="IDE82CD8AB0997471895763B519BA04406"><enum>(5)</enum><text>The applicant is
able to demonstrate the long-term viability of projects through cost
participation (cash or in-kind).</text>
</paragraph><paragraph id="ID775ACACA6DD64B6C99D90DD27D8AC22D"><enum>(6)</enum><text>The applicant is
able to demonstrate financial, institutional, and community support for the
long-term viability of the network.</text>
</paragraph><paragraph id="ID6887DE4C513B444E8A2F600E421EAB2D"><enum>(7)</enum><text>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.</text>
</paragraph></subsection><subsection id="ID9E0B0797FCB44F00858EB7E939469818"><enum>(d)</enum><header>Maximum amount
of assistance to individual recipients</header><text>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 <quote>HRSA Preview</quote> notice of
the terms and conditions of a grant under this section and the maximum amount
of such a grant for a fiscal year.</text>
</subsection><subsection id="ID62A9EBED9F3E47EE9981A5EBFE6ABD57"><enum>(e)</enum><header>Use of
amounts</header><text>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:</text>
<paragraph id="ID89714FD3A1934AF7A04644C99B20ACB7"><enum>(1)</enum><text>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.</text>
</paragraph><paragraph id="ID8C2C3A032D6B4410897144FCE0E7B4C0"><enum>(2)</enum><text>The provision of
technical assistance and instruction for the development and use of such
programming equipment or facilities.</text>
</paragraph><paragraph id="IDE74FA61F3D5A40E7A90A93D0094D5910"><enum>(3)</enum><text>The development
and acquisition of instructional programming.</text>
</paragraph><paragraph id="IDC660398880BE4449AB2EABA1BA0E7104"><enum>(4)</enum><text>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.</text>
</paragraph><paragraph id="ID116D2697A67C424CAE1DD55B39434A83"><enum>(5)</enum><text>The provision of
telenursing services designed to enhance care coordination and promote patient
self-management skills.</text>
</paragraph><paragraph id="ID606DA6AEA5AA4AEBADE8427AE672CBB6"><enum>(6)</enum><text>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.</text>
</paragraph><paragraph id="ID37B047B1CF024A438A4AB5FB2F82230D"><enum>(7)</enum><text>Transmission
costs, maintenance of equipment, and compensation of specialists and referring
health care providers, when no other form of reimbursement is available.</text>
</paragraph><paragraph id="ID21831A8311D9435B81679C423DB16CD5"><enum>(8)</enum><text>Development of
projects to use telehealth to facilitate collaboration between health care
providers.</text>
</paragraph><paragraph id="ID3EA28CA0808F463FB58AE4ED0E8A9985"><enum>(9)</enum><text>Electronic
archival of patient records.</text>
</paragraph><paragraph id="ID70F6631F64EB420990324A6EDE5FDF5A"><enum>(10)</enum><text>Collection and
analysis of usage statistics and data that can be used to document the
cost-effectiveness of the telehealth services.</text>
</paragraph><paragraph id="IDAB609053484149ED8F1380EA2EB679B3"><enum>(11)</enum><text>Such other uses
that are consistent with achieving the purposes of this section as approved by
the Secretary.</text>
</paragraph></subsection><subsection id="IDD17FE9F4FBBC42D3B9D47268B6267A15"><enum>(f)</enum><header>Prohibited
uses</header><text>Sums received under a grant under this section may not be
used for any of the following:</text>
<paragraph id="ID3B4D9C07EF334E78BAC3EBCBAE509342"><enum>(1)</enum><text>To acquire real
property.</text>
</paragraph><paragraph id="ID5B33D0CF68B644CCBB36DF6A7F56FABD"><enum>(2)</enum><text>To purchase or
lease equipment to the extent the expenditures would exceed more than 40
percent of the total grant funds.</text>
</paragraph><paragraph id="ID19A93D931BB14EF4BF3C123651203FD0"><enum>(3)</enum><text>To purchase or
install transmission equipment off the premises of the telehealth site and any
transmission costs not directly related to the grant.</text>
</paragraph><paragraph id="ID763BFA9CD3DF431CA7F72BF21201FA6A"><enum>(4)</enum><text>For construction,
except that such funds may be expended for minor renovations relating to the
installation of equipment.</text>
</paragraph><paragraph id="IDAD69BC809E4C434297EA7BC64178BE39"><enum>(5)</enum><text>Expenditures for
indirect costs (as determined by the Secretary) to the extent the expenditures
would exceed more than 15 percent of the total grant.</text>
</paragraph></subsection><subsection id="ID50C748E3BE284EA18A9EF8E7EA557F5F"><enum>(g)</enum><header>Administration</header>
<paragraph id="ID4CC3F581AD664A5BB762B03EB86E0CA3"><enum>(1)</enum><header>Nonduplication</header><text>The
Secretary shall ensure that facilities constructed using grants provided under
this section do not duplicate adequately established telehealth
networks.</text>
</paragraph><paragraph id="IDDD0006898557484D84AC4172162F7ED2"><enum>(2)</enum><header>Coordination
with other agencies</header><text>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.</text>
</paragraph><paragraph id="ID421BF4D0402C4F4789073BBF19F14706"><enum>(3)</enum><header>Informational
efforts</header><text>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.</text>
</paragraph></subsection><subsection id="ID29B3A88731D9485598315172FCCB6B3B"><enum>(h)</enum><header>Prompt
implementation</header><text>The Secretary shall take such actions as are
necessary to carry out the grant program as expeditiously as possible.</text>
</subsection><subsection id="ID153FF5458FF048EC9C6218221810F159"><enum>(i)</enum><header>Authorization
of appropriations</header><text>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.</text>
</subsection></section><section id="ID44AE40B9758E4793984E7ED90D4B1C80"><enum>202.</enum><header>Reauthorization
of telehealth network and telehealth resource centers grant
programs</header><text display-inline="no-display-inline">Subsection (s) of
section 330I of the <act-name parsable-cite="PHSA">Public Health Service
Act</act-name> (42 U.S.C. 254c–14) is amended—</text>
<paragraph id="ID9AB2337CBDDA44F789C929FCD489CDB1"><enum>(1)</enum><text>in paragraph
(1)—</text>
<subparagraph id="ID60F0CB0AA7E94591902C66FAE220D086"><enum>(A)</enum><text>by striking
<quote>and</quote> before <quote>such sums</quote>; and</text>
</subparagraph><subparagraph id="ID7665888865C24BDCA649AC0B40EB423F"><enum>(B)</enum><text>by inserting
<quote>, $10,000,000 for fiscal year 2007, and such sums as may be necessary
for each of fiscal years 2008 through 2012</quote> before the semicolon at the
end; and</text>
</subparagraph></paragraph><paragraph id="ID9B805091E8E0462B88075306728B9EA6"><enum>(2)</enum><text>in paragraph
(2)—</text>
<subparagraph id="ID1587205349544442911A073E66383ACA"><enum>(A)</enum><text>by striking
<quote>and</quote> before <quote>such sums</quote>; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID37998902E5534AEFB6027A1620F81A74"><enum>(B)</enum><text>by inserting
<quote>, $10,000,000 for fiscal year 2007, and such sums as may be necessary
for each of fiscal years 2008 through 2012</quote> before the period at the
end.</text>
</subparagraph></paragraph></section>