[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6163 Introduced in House (IH)]







110th CONGRESS
  2d Session
                                H. R. 6163

  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 HOUSE OF REPRESENTATIVES

                              May 22, 2008

 Mr. Thompson of California (for himself, Mr. Stupak, Mr. Hulshof, and 
  Ms. Eshoo) 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 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 2008''.
    (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. Expansion and improvement of telehealth services.
Sec. 102. Increase in number of types of originating sites; 
                            clarification.
Sec. 103. Facilitating the provision of telehealth services across 
                            State lines.
Sec. 104. Access to telehealth services in the home.
Sec. 105. Coverage of home health remote patient management services 
                            for certain chronic health conditions.
Sec. 106. Remote patient management services for chronic health 
                            conditions.
Sec. 107. Definition of Medicare program.
                      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. EXPANSION AND IMPROVEMENT OF TELEHEALTH SERVICES.

    (a) Expanding Access to Telehealth Services to All Areas.--Section 
1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is amended in 
paragraph (4)(C)(i) 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.''.
    (b) Report to Congress on Store and Forward Technology.--
            (1) Study.--The Secretary of Health and Human Services, 
        acting through the Director of the Office for the Advancement 
        of Telehealth, shall conduct a study on the use of store and 
        forward technologies (that provide for the asynchronous 
        transmission of health care information in single or multimedia 
        formats) in the provision of telehealth services for which 
        payment may be made under the Medicare program in Alaska and 
        Hawaii and in other States. Such study shall include an 
        assessment of the feasibility, advisability, and the costs of 
        expanding the use of such technologies to other areas for use 
        in the diagnosis and treatment of certain conditions.
            (2) Report.--Not later than 18 months after the date of the 
        enactment of this Act, the Secretary shall submit to Congress a 
        report on the study conducted under subparagraph (A) and shall 
        include in such report such recommendations for legislation or 
        administration action as the Secretary determines appropriate.

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

    (a) Increase.--Paragraph (4)(C)(ii) of section 1834(m) of the 
Social Security Act (42 U.S.C. 1395m(m)) 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. FACILITATING THE PROVISION OF TELEHEALTH SERVICES ACROSS 
              STATE LINES.

    (a) In General.--The Secretary of Health and Human Services shall, 
in coordination with physicians, health care practitioners, patient 
advocates, and representatives of States, encourage and facilitate the 
adoption of State reciprocity agreements for practitioner licensure in 
order to expedite the provision across State lines of telehealth 
services.
    (b) Report.--Not later than 18 months after the date of the 
enactment of this Act, the Secretary of Health and Human Services shall 
submit to Congress a report on the actions taken to carry out 
subsection (a).
    (c) 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)).
            (2) State.--The term ``State'' has the meaning given that 
        term for purposes of title XVIII of such Act.

SEC. 104. ACCESS TO TELEHEALTH SERVICES IN THE HOME.

    (a) In General.--Section 1895(e) of the Social Security Act (42 
U.S.C. 1395fff(e)) is amended to read as follows:
    ``(f) Coverage of Telehealth Services.--
            ``(1) In general.--The Secretary shall include telehealth 
        services that are furnished via a telecommunication system by a 
        home health agency to an individual receiving home health 
        services under section 1814(a)(2)(C) or 1835(a)(2)(A) as a home 
        health visit for purposes of eligibility and payment under this 
        title if the telehealth services--
                    ``(A) are ordered as part of a plan of care 
                certified by a physician pursuant to section 
                1814(a)(2)(C) or 1835(a)(2)(A);
                    ``(B) do not substitute for in-person home health 
                services ordered as part of a plan of care certified by 
                a physician pursuant to such respective section; and
                    ``(C) are considered the equivalent of a visit 
                under criteria developed by the Secretary under 
                paragraph (3).
            ``(2) Physician certification.--Nothing in this section 
        shall be construed as waiving the requirement for a physician 
        certification under section 1814(a)(2)(C) or 1835(a)(2)(A) for 
        the payment for home health services, whether or not furnished 
        via a telecommunication system.
            ``(3) Criteria for visit equivalency.--
                    ``(A) Standards.--The Secretary shall establish 
                standards and qualifications for categorizing and 
                coding under HCPCS codes telehealth services under this 
                subsection as equivalent to an in-person visit for 
                purposes of eligibility and payment for home health 
                services under this title. In establishing the 
                standards and qualifications, the Secretary may 
                distinguish between varying modes and modalities of 
                telehealth services and shall consider--
                            ``(i) the nature and amount of service time 
                        involved; and
                            ``(ii) the functions of the 
                        telecommunications.
                    ``(B) Limitation.--A telecommunication that 
                consists solely of a telephone audio conversation, 
                facsimile, electronic text mail, or consultation 
                between two health care practitioners is not considered 
                a visit under this subsection.
            ``(4) Telehealth service.--
                    ``(A) Definition.--For purposes of this section, 
                the term `telehealth service' means technology-based 
                professional consultations, patient monitoring, patient 
                training services, clinical observation, assessment, or 
                treatment, and any additional services that utilize 
                technologies specified by the Secretary as HCPCS codes 
                developed under paragraph (3).
                    ``(B) Update of hcpcs codes.--The Secretary shall 
                establish a process for the updating, not less 
                frequently than annually, of HCPCS codes for telehealth 
                services.
            ``(5) Conditions for payment and coverage.--Nothing in this 
        subsection shall be construed as waiving any condition of 
        payment under sections 1814(a)(2)(C) or 1835(a)(2)(A) or 
        exclusion of coverage under section 1862(a)(1).
            ``(6) Cost reporting.--Notwithstanding any provision to the 
        contrary, the Secretary shall provide that the costs of 
        telehealth services under this subsection shall be reported as 
        a reimbursable cost center on any cost report submitted by a 
        home health agency to the Secretary.''.
    (b) Effective Date.--
            (1) The amendment made by subsection (a) shall apply to 
        telehealth services furnished on or after October 1, 2009. The 
        Secretary of Health and Human Services shall develop and 
        implement criteria and standards under section 1895(f)(3) of 
        the Social Security Act, as amended by subsection (a), by no 
        later than July 1, 2009.
            (2) In the event that the Secretary has not complied with 
        these deadlines, beginning October 1, 2009, a home health visit 
        for purpose of eligibility and payment under title XVIII of the 
        Social Security Act shall include telehealth services under 
        section 1895(f) of such Act with the aggregate of 
        telecommunication encounters in a 24-hour period considered the 
        equivalent of one in-person visit.

SEC. 105. COVERAGE OF HOME HEALTH REMOTE PATIENT MANAGEMENT SERVICES 
              FOR CERTAIN CHRONIC HEALTH CONDITIONS.

    (a) In General.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)), as amended by section 4(a)(1), is further 
amended--
            (1) in subparagraph (AA), by striking ``and'' at the end;
            (2) in subparagraph (BB), by inserting ``and'' at the end; 
        and
            (3) by inserting after subparagraph (BB) the following new 
        subparagraph:
                    ``(CC) home health remote patient management 
                services (as defined in subsection (eee));''.
    (b) Services Described.--Section 1861 of the Social Security Act 
(42 U.S.C. 1395x), as amended by section 4(a)(2), is further amended by 
adding at the end the following new subsection:

 ``Home Health Remote Patient Management Services for Certain Chronic 
                               Conditions

    ``(eee)(1) The term `home health remote patient management 
services' means the remote monitoring, evaluation, and management of an 
individual with a covered chronic health condition (as defined in 
paragraph (2)) through the utilization of a system of technology that 
allows a remote interface to collect and transmit clinical data between 
the individual and a home health agency, in accordance with a plan of 
care established by a physician, for purposes of clinical review or 
response by the home health agency. Such term, with respect to an 
individual, does not include any remote monitoring, evaluation, or 
management of the individual if such remote monitoring, evaluation, or 
management, respectively, is included as a home health visit under 
section 1895(e) for purposes of payment under this title.
    ``(2) For purposes of paragraph (1), the term `covered chronic 
health condition' means--
            ``(A) a covered chronic health condition, as defined under 
        section 1861(ddd)(2); and
            ``(B) any other chronic health condition specified by the 
        Secretary.''.
    (c) Payment.--
            (1) In general.--Section 1834 of the Social Security Act 
        (42 U.S.C. 1395l) is amended by adding at the end the following 
        new subsection:
    ``(n) Home Health Remote Patient Management Services.--
            ``(1) In general.--The Secretary shall establish a fee 
        schedule for home health remote patient management services (as 
        defined in section 1861(eee)) for which payment is made under 
        this part. The fee schedule shall be designed in a manner so 
        that, on an annual basis, the aggregate payment amounts under 
        this title for such services approximates 50 percent of the 
        savings amount described in paragraph (2) for such year.
            ``(2) Savings described.--
                    ``(A) In general.--For purposes of paragraph (1), 
                the savings amount described in this paragraph for a 
                year is the amount (if any), as estimated by the 
                Secretary before the beginning of the year, by which--
                            ``(i) the product described in subparagraph 
                        (B) for the year, exceeds
                            ``(ii) the total payments under this part 
                        and part A for items and services furnished to 
                        individuals receiving home health remote 
                        patient management services at any time during 
                        the year.
                    ``(B) Product described.--The product described in 
                this subparagraph for a year is the product of--
                            ``(i) the average per capita total payments 
                        under this part and part A for items and 
                        services furnished during the year to 
                        individuals not described in subparagraph 
                        (A)(ii), adjusted to remove case mix 
                        differences between such individuals not 
                        described in such subparagraph and the 
                        individuals described in such subparagraph; and
                            ``(ii) the number of individuals under 
                        subparagraph (A)(ii) for the year.
            ``(3) Limitation.--In no case may payments under this 
        subsection result in the aggregate expenditures under this 
        title (including payments under this subsection) exceeding the 
        amount that the Secretary estimates would have been expended if 
        coverage under this title for home health patient management 
        services was not provided.
            ``(4) Clarification.--Payments under the fee schedule under 
        this subsection, with respect to an individual, shall be in 
        addition to any other payments that a home health agency would 
        otherwise receive under this title for items and services 
        furnished to such individual and shall have no effect on the 
        amount of such other payments.
            ``(5) Payment transfer.--There shall be transferred from 
        the Federal Hospital Insurance Trust Fund under section 1817 to 
        the Federal Supplementary Medical Insurance Trust Fund under 
        section 1841 each year an amount equivalent to the product of--
                    ``(A) expenditures under this subsection for the 
                year, and
                    ``(B) the ratio of the portion of the savings 
                described in paragraph (2) for the year that are 
                attributable to part A, to the total savings described 
                in such paragraph for the year.''.
            (2) Conforming amendment.--Section 1833(a)(1) of such Act 
        (42 U.S.C. 1395l(1)) is amended--
                    (A) by striking ``and (V)'' and inserting ``(V)''; 
                and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (W) with respect to home health 
                remote patient management services (as defined in 
                section 1861(eee)), the amounts paid shall be the 
                amount determined under the fee schedule established 
                under section 1834(n)''.
    (d) Expansion of Home Health Remote Patient Management Services 
Coverage to Additional Chronic Health Conditions.--The Secretary of 
Health and Human Services is authorized to carry out pilot projects for 
purposes of determining the extent to which the coverage under title 
XVIII of the Social Security Act of home health remote patient 
management services (as defined in paragraph (1) of section 1861(eee) 
of such Act, as added by subsection (b)) should be extended to 
individuals with chronic health conditions other than those described 
in paragraph (2)(A) of such section.
    (e) Effective Date.--The amendments made by subsections (a), (b), 
and (c) shall apply to services furnished on or after January 1, 2010.

SEC. 106. REMOTE PATIENT MANAGEMENT SERVICES FOR CHRONIC HEALTH 
              CONDITIONS.

    (a) Coverage of Remote Patient Management Services for Certain 
Chronic Health Conditions.--
            (1) In general.--Section 1861(s)(2) of the Social Security 
        Act (42 U.S.C. 1395x(s)(2)) is amended--
                    (A) in subparagraph (Z), by striking ``and'' at the 
                end;
                    (B) in subparagraph (AA), by inserting ``and'' at 
                the end; and
                    (C) by inserting after subparagraph (AA) the 
                following new subparagraph:
            ``(BB) remote patient management services (as defined in 
        subsection (ddd));''.
            (2) Services described.--Section 1861 of the Social 
        Security Act (42 U.S.C. 1395x), as amended by section 114(a) of 
        the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public 
        Law 110-173), is amended by adding at the end the following new 
        subsection:
    ``(ddd) Remote Patient Management Services for Chronic Health 
Conditions.--(1) The term `remote patient management services' means 
the remote monitoring, evaluation, and management of an individual with 
a covered chronic health condition (as defined in paragraph (2)), 
insofar as such monitoring, evaluation, and management is with respect 
to such condition, through the utilization of a system of technology 
that allows a remote interface to collect and transmit clinical data 
between the individual and the responsible physician (as defined in 
subsection (r)) or supplier (as defined in subsection (d)) for the 
purposes of clinical review or response by the physician or supplier.
    ``(2) For purposes of paragraph (1), the term `covered chronic 
health condition' means--
            ``(A) heart failure; and
            ``(B) cardiac arrhythmia.
    ``(3)(A) Not later than January 1, 2010, the Secretary, in 
consultation with appropriate physician and supplier groups, shall 
develop guidelines on the frequency of billing for remote patient 
management services. Such guidelines shall be determined based on 
medical necessity and shall be sufficient to ensure appropriate and 
timely monitoring of individuals being furnished such services.
    ``(B) The Secretary shall do the following:
            ``(i) Not later than 2 years after the date of the 
        enactment of this subsection, develop, in consultation with 
        appropriate physician and supplier groups, standards (governing 
        such matters as qualifications of personnel and the maintenance 
        of equipment) for remote patient management services for the 
        covered chronic health conditions specified in subparagraphs 
        (A) and (B) of paragraph (2).
            ``(ii) Periodically review and update such standards under 
        this subparagraph as necessary.''.
            (3) Payment under the physician fee schedule.--Section 1848 
        of the Social Security Act (42 U.S.C. 1395w-4) is amended--
                    (A) in subsection (c)--
                            (i) in paragraph (2)((B)--
                                    (I) in clause (ii)(II), by striking 
                                ``and (v)'' and inserting ``(v), (and 
                                (vi)''; and
                                    (II) by adding at the end the 
                                following new clause:
                            ``(vi) Budgetary treatment of certain 
                        services.--The additional expenditures 
                        attributable to services described in section 
                        1861(s)(2)(BB) shall not be taken into account 
                        in applying clause (ii)(II) for 2010.''; and
                            (ii) by adding at the end the following new 
                        paragraph:
            ``(7) Treatment of remote patient management services.--
                    ``(A) In determining relative value units for 
                remote patient management services (as defined in 
                section 1861(ddd)), the Secretary, in consultation with 
                appropriate physician groups, shall take into 
                consideration--
                            ``(i) physician resources, including 
                        physician time and the level of intensity of 
                        services provided, based on--
                                    ``(I) the frequency of evaluation 
                                necessary to manage the individual 
                                being furnished the services;
                                    ``(II) the complexity of the 
                                evaluation, including the information 
                                that must be obtained, reviewed, and 
                                analyzed; and
                                    ``(III) the number of possible 
                                diagnoses and the number of management 
                                options that must be considered; and
                            ``(ii) practice expense costs associated 
                        with such services, including installation and 
                        information transmittal costs, costs of remote 
                        patient management technology (including 
                        equipment and software), and resource costs 
                        necessary for patient monitoring and follow-up 
                        (but not including costs of any related item or 
                        non-physician service otherwise reimbursed 
                        under this title).
                            ``(iii) malpractice expense resources.
                    ``(B) Using the relative value units determined in 
                subparagraph (A), the Secretary shall provide for 
                separate payment for such services and shall not adjust 
                the relative value units assigned to other services 
                that might otherwise have been determined to include 
                such separately paid remote patient management 
                services.''; and
                    (B) in subsection (j)(3), by inserting ``(2)(BB)'' 
                after ``(2)(AA),''.
            (4) Effective date.--
                    (A) In general.--The amendments made by this 
                section shall apply to services furnished on or after 
                January 1, 2010 without regard to whether the 
                guidelines under paragraph (3)(A) or the standards 
                under paragraph (3)(B) of section 1861(ddd) of the 
                Social Security Act (as added by paragraph (2)) have 
                been developed.
                    (B) Availability of codes as of january 1, 2010.--
                The Secretary of Health and Human Services shall--
                            (i) promptly evaluate existing codes that 
                        would be used to bill for remote patient 
                        management services (as defined in paragraph 
                        (1) of such section 1861(ddd), as so added) 
                        under title XVIII of the Social Security Act; 
                        and
                            (ii) if the Secretary determines that new 
                        codes are necessary to ensure accurate 
                        reporting and billing of such services under 
                        such title, issue such codes so that they are 
                        available for use as of January 1, 2010.
    (b) Demonstration Project for the Coverage of Remote Patient 
Management Services for Additional Chronic Health Conditions Under the 
Medicare Program.--
            (1) Establishment.--
                    (A) In general.--The Secretary shall establish a 
                demonstration project for the purpose of evaluating the 
                impact and benefits of covering under the Medicare 
                program remote patient management services for certain 
                chronic health conditions.
                    (B) Consultation.--In establishing the 
                demonstration project, the Secretary shall consult with 
                appropriate physician and supplier groups, eligible 
                beneficiaries, and organizations representing eligible 
                beneficiaries.
                    (C) Participation.--Any eligible beneficiary may 
                participate in the demonstration project on a voluntary 
                basis.
            (2) Conduct of the demonstration project.--
                    (A) Sites.--
                            (i) Selection of demonstration sites.--The 
                        Secretary shall conduct the demonstration 
                        project at 3 sites.
                            (ii) Geographic diversity.--In selecting 
                        the sites under clause (i), the Secretary shall 
                        ensure that at least 1 of the sites is in a 
                        rural area.
                    (B) Implementation; duration.--
                            (i) Implementation.--The Secretary shall 
                        implement the demonstration project not later 
                        than January 1, 2010.
                            (ii) Duration.--The Secretary shall 
                        complete the demonstration project by the date 
                        that is 2 years after the date on which the 
                        demonstration project is implemented.
            (3) Evaluation and report.--
                    (A) Evaluation.--The Secretary shall conduct an 
                evaluation of the demonstration project--
                            (i) to determine improvements in the 
                        quality of care and utilization of services 
                        received by eligible beneficiaries 
                        participating in the demonstration project;
                            (ii) to determine the cost of providing 
                        payment for remote monitoring services under 
                        the Medicare program;
                            (iii) to determine the satisfaction of 
                        eligible beneficiaries participating in the 
                        demonstration projects; and
                            (iv) to evaluate such other matters as the 
                        Secretary determines is appropriate.
            (4) Waiver authority.--The Secretary may waive such 
        provisions of titles XI and XVIII of the Social Security Act as 
        the Secretary determines to be appropriate for the conduct of 
        the demonstration project.
            (5) Funding.--
                    (A) Demonstration.--
                            (i) In general.--Subject to clause (ii), 
                        the Secretary shall provide for the transfer 
                        from the Federal Supplementary Medical Trust 
                        Fund under section 1841 of the Social Security 
                        Act (42 U.S.C. 1395t) of such funds as are 
                        necessary for the costs of carrying out the 
                        demonstration project.
                            (ii) Cap on expenditures.--The amount 
                        transferred under clause (i) for the period 
                        during which the demonstration project is 
                        conducted may not exceed an amount equal to the 
                        lesser of--
                                    (I) $9,000,000; or
                                    (II) an amount equal to the costs 
                                of providing remote monitoring services 
                                to 7,500 individuals during such 
                                period.
                    (B) Evaluation and report.--There are authorized to 
                be appropriated such sums as are necessary for the 
                purpose of conducting the evaluation and developing and 
                submitting the report to Congress under paragraph (3).
            (6) Definitions.--In this section:
                    (A) Remote patient management services.--The term 
                ``remote patient management services'' means the remote 
                monitoring, evaluation, and management of an individual 
                with a covered chronic health condition (as defined in 
                paragraph (B)), insofar as such monitoring, evaluation, 
                and management is with respect to such condition, 
                through the utilization of a system of technology that 
                allows a remote interface to collect and transmit 
                clinical data between the individual and the 
                responsible physician (as defined in subsection (r) of 
                section 1861 of the Social Security Act (42 U.S.C. 
                1395x))) or supplier (as defined in subsection (d) of 
                such section) for the purposes of clinical review or 
                response by the physician or supplier.
                    (B) Covered chronic health condition.--The term 
                ``covered chronic health condition'' means diabetes, 
                sleep apnea, or epilepsy.
                    (C) Demonstration project.--The term 
                ``demonstration project'' means a demonstration project 
                conducted under this subsection.
                    (D) Eligible beneficiary.--The term ``eligible 
                beneficiary'' means an individual who is enrolled under 
                part B of the Medicare program and has a covered 
                chronic health condition.
                    (E) Medicare program.--The term ``Medicare 
                program'' means the health benefits program under title 
                XVIII of the Social Security Act (42 U.S.C. 1395 et 
                seq.).
                    (F) Secretary.--The term ``Secretary'' means the 
                Secretary of Health and Human Services.

SEC. 107. DEFINITION OF MEDICARE PROGRAM.

    In this title, 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.).

                      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) Expenditures 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 
2009, and such sums as may be necessary for each of the fiscal years 
2010 through 2014.

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 
                2009, and such sums as may be necessary for each of 
                fiscal years 2010 through 2014'' before the semicolon; 
                and
            (2) in paragraph (2)--
                    (A) by striking ``and'' before ``such sums''; and
                    (B) by inserting ``$10,000,000 for fiscal year 
                2009, and such sums as may be necessary for each of 
                fiscal years 2010 through 2014'' before the semicolon.
                                 <all>