110 HR 6163 IH: Medicare Telehealth Enhancement
U.S. House of Representatives
2008-05-22
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of
contents
(a)This Act may be cited
as the Medicare Telehealth Enhancement
Act of 2008
.
(b)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.
<enum>I</enum><header>Medicare
Program</header>
<section id="H9C6430374A3646CF81F5A450304F29F2"><enum>101.</enum><header>Expansion and
improvement of telehealth services</header>
<subsection id="H6E5BD59F49D24E17BD187056C3E95CFB"><enum>(a)</enum><header>Expanding access
to telehealth services to all areas</header><text>Section 1834(m) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395m(m)) is amended in paragraph (4)(C)(i) 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>
</subsection><subsection id="H7F42F509C19442E497C8FF558E8CA64"><enum>(b)</enum><header>Report to
congress on store and forward technology</header>
<paragraph id="H59FF4BF628CC49A692B6072416D230F1"><enum>(1)</enum><header>Study</header><text display-inline="yes-display-inline">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.</text>
</paragraph><paragraph id="HD8EFB7DFFCEB49B896BC808328294E76"><enum>(2)</enum><header>Report</header><text>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.</text>
</paragraph></subsection></section><section id="HE9170602EC3F4F00ACCFCDAB27F700A4"><enum>102.</enum><header>Increase in
number of types of originating sites; clarification</header>
<subsection id="H024D19461B8F4C8685AECC10DBE17600"><enum>(a)</enum><header>Increase</header><text display-inline="yes-display-inline">Paragraph (4)(C)(ii) of section 1834(m) of
the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(m)</external-xref>) is amended by adding at the end
the following new subclauses:</text>
<quoted-block id="HB0A7D1FF377C42C894CE9CA100F9524B">
<subclause id="HC3F0518DBBBF4B25ACF5B822FC2C8BB"><enum>(VI)</enum><text>A skilled nursing
facility (as defined in section 1819(a)).</text>
</subclause><subclause id="H581F88338DA24441B8FEB1AA6E3FED7E"><enum>(VII)</enum><text>A renal dialysis
facility.</text>
</subclause><subclause id="HC2359DB4C9F340F7BA7C6B7FC18700F5"><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="H4BD692F8819D49C99C1D61C1CB37005D"><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 display-inline="no-display-inline" id="H3F9B4A575D274B87AB8961D4ABB3CC5D" style="OLC">
<paragraph id="HE147C71FBC8E4CB986943CAA4BBC96CD"><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="H7E181BEC7AC54560B35805093C17A254"><enum>103.</enum><header>Facilitating
the provision of telehealth services across State lines</header>
<subsection id="H12EEDFDA2DD2410DAABEBA00B77CA5FA"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">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.</text>
</subsection><subsection id="H6DCA1AD704964A6BA8DD517221A559F4"><enum>(b)</enum><header>Report</header><text display-inline="yes-display-inline">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).</text>
</subsection><subsection id="H02AFC8EDE1F94ACDA0A5EF005FF3CFC"><enum>(c)</enum><header>Definitions</header><text>In
subsection (a):</text>
<paragraph id="H19E5B592FDC249988738A8B6D42900BA"><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)).</text>
</paragraph><paragraph id="HB1A6765DB83A47E68C35A44C85615E57"><enum>(2)</enum><header>State</header><text>The
term <quote>State</quote> has the meaning given that term for purposes of title
XVIII of such Act.</text>
</paragraph></subsection></section><section id="HD4C5F3CBEAA04CA09418F90671C66848"><enum>104.</enum><header>Access to
telehealth services in the home</header>
<subsection id="HE939713D70E34C568B197CB9A0398968"><enum>(a)</enum><header>In
general</header><text>Section 1895(e) of the Social Security Act (42 U.S.C.
1395fff(e)) is amended to read as follows:</text>
<quoted-block id="HE3573767D71D4945A61F88661D7E83BE" style="OLC">
<subsection id="HA6359C4C29BE4819BE0801FDD930F2DC"><enum>(f)</enum><header>Coverage of
Telehealth Services</header>
<paragraph id="HA3972CE86CCF425D91D368E53C62031"><enum>(1)</enum><header>In
general</header><text>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—</text>
<subparagraph id="HA25B0C21760E4D5392C43421522E7224"><enum>(A)</enum><text>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);</text>
</subparagraph><subparagraph id="HB3581E7415A04731B6782B6DAC8E6D97"><enum>(B)</enum><text>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</text>
</subparagraph><subparagraph id="H330F43A44E3C4FB3972B238D0598EB79"><enum>(C)</enum><text>are considered the
equivalent of a visit under criteria developed by the Secretary under paragraph
(3).</text>
</subparagraph></paragraph><paragraph id="HF1B0E2A7341D4A9C9397F802F3D94E9D"><enum>(2)</enum><header>Physician
certification</header><text>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.</text>
</paragraph><paragraph id="HF97DBCD612DF4F62B82E3B7259BD7300"><enum>(3)</enum><header>Criteria for
visit equivalency</header>
<subparagraph id="H72BC8BFFE7CB4852A2FD26AE06F85F33"><enum>(A)</enum><header>Standards</header><text>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—</text>
<clause id="H1511D984601E47F58EF95F38EF92FA7C"><enum>(i)</enum><text>the nature and
amount of service time involved; and</text>
</clause><clause id="H2CEDC79AA57045CB94F0C786463BF6B6"><enum>(ii)</enum><text>the functions of
the telecommunications.</text>
</clause></subparagraph><subparagraph id="H3C6F51E62A8B46BE8040B97894C7CDD3"><enum>(B)</enum><header>Limitation</header><text>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.</text>
</subparagraph></paragraph><paragraph id="HEB1DF503F8804BCEACE44DF6D8B810D6"><enum>(4)</enum><header>Telehealth
service</header>
<subparagraph id="HFCEADB29E05646F2BECBBDE48FD08FCD"><enum>(A)</enum><header>Definition</header><text>For
purposes of this section, the term <term>telehealth service</term> 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).</text>
</subparagraph><subparagraph id="H45FB1CF24EE2490FB3EFE7A3BDA36A7"><enum>(B)</enum><header>Update of hcpcs
codes</header><text>The Secretary shall establish a process for the updating,
not less frequently than annually, of HCPCS codes for telehealth
services.</text>
</subparagraph></paragraph><paragraph id="HB1D63D2886DC4C2D899820B333E9BF01"><enum>(5)</enum><header>Conditions for
payment and coverage</header><text>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).</text>
</paragraph><paragraph id="HFEEFCE284758413D86C808EB75EFA8A9"><enum>(6)</enum><header>Cost
reporting</header><text>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.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H5377418ACC7A40F4875B00F6F7AB2CF7"><enum>(b)</enum><header>Effective
date</header>
<paragraph id="H5EAA38F8D1FE42C793D18292E94167C0"><enum>(1)</enum><text>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.</text>
</paragraph><paragraph id="H4B678812CF1E4DAC007D2BFBF8132956"><enum>(2)</enum><text>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.</text>
</paragraph></subsection></section><section id="HB390A8E09F7347F8B83E5E7389722C74"><enum>105.</enum><header>Coverage of
home health remote patient management services for certain chronic health
conditions</header>
<subsection id="H28E91A4EDD2A4F5DA813F924E2AEA7B"><enum>(a)</enum><header>In
general</header><text>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—</text>
<paragraph id="H56BC9625022B4B598CAB00C384B1F5FB"><enum>(1)</enum><text>in subparagraph
(AA), by striking <quote>and</quote> at the end;</text>
</paragraph><paragraph id="H5D42809254284C02BCD058007CCE4BD7"><enum>(2)</enum><text>in subparagraph
(BB), by inserting <quote>and</quote> at the end; and</text>
</paragraph><paragraph id="H642D8C73257F41EF8BC9068B6C9990E5"><enum>(3)</enum><text>by inserting after
subparagraph (BB) the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="HB3F70C7B21B74A20ADCA301324A27E82" style="OLC">
<subparagraph id="H1A8E80EA429C4163A3BCB2227F821BDE"><enum>(CC)</enum><text>home health
remote patient management services (as defined in subsection
(eee));</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H6F62D2D31D014318B3C840DAF91CBADE"><enum>(b)</enum><header>Services
described</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="HC710888AB8D14D9F962108D6A8A93B63" other-style="archaic" style="other">
<subsection id="HD0ABEB2F299A45F7A12C417069BCFB2E"><enum>(eee)</enum><header>Home health remote patient management services for certain
chronic conditions</header><paragraph commented="no" display-inline="yes-display-inline" id="H3795DFC0FA7847CAB54C48C3529FD876"><enum>(1)</enum><text>The term <term>home
health remote patient management services</term> 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.</text>
</paragraph><paragraph id="H42BD99F78B3E4A46822BA48FE716CA4B" indent="up1"><enum>(2)</enum><text>For purposes of paragraph (1), the
term <term>covered chronic health condition</term> means—</text>
<subparagraph id="HC57EB090D0BE4199BBE51F33F9614CFC"><enum>(A)</enum><text>a covered chronic health condition, as
defined under section 1861(ddd)(2); and</text>
</subparagraph><subparagraph id="HF7A3C96BD4DB43DFBAD9F1A6C902C435"><enum>(B)</enum><text>any other chronic health condition
specified by the
Secretary.</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H72463400E8F54796B7B72F309E02A0FD"><enum>(c)</enum><header>Payment</header>
<paragraph id="H347FEBCD9D2042B5A98DAA9403F57737"><enum>(1)</enum><header>In
general</header><text>Section 1834 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l</external-xref>)
is amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HD18FD9F6489444EEB67E7B858445ED69" style="OLC">
<subsection id="HF836B10D46924CB897196B58BA270085"><enum>(n)</enum><header>Home health
remote patient management services</header>
<paragraph id="H6DFDB42323F948BB8FA52BA546517DF6"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">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.</text>
</paragraph><paragraph id="HA7DE6285D2B841CA83ADCF281D9AEFB"><enum>(2)</enum><header>Savings
described</header>
<subparagraph id="HDB9FEAE8011D4CB38F071555CD00B8D7"><enum>(A)</enum><header>In
general</header><text>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—</text>
<clause id="H1C73C0A1B54F46D885C05C9660B4921"><enum>(i)</enum><text>the
product described in subparagraph (B) for the year, exceeds</text>
</clause><clause id="H04FD5EBAEAFA4A37B255B5FEB5D4A3D7"><enum>(ii)</enum><text>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.</text>
</clause></subparagraph><subparagraph id="H171F3284A5444DB78F1DBACEFFD71237"><enum>(B)</enum><header>Product
described</header><text>The product described in this subparagraph for a year
is the product of—</text>
<clause id="H9C9FB27991564101865410306EB45CE8"><enum>(i)</enum><text>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</text>
</clause><clause id="H5CDD74F5C2584C4388B841633FC796AB"><enum>(ii)</enum><text>the number of
individuals under subparagraph (A)(ii) for the year.</text>
</clause></subparagraph></paragraph><paragraph id="H32FA93DFFF84407DAB952DCED0F5407F"><enum>(3)</enum><header>Limitation</header><text>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.</text>
</paragraph><paragraph id="HE2C50AB7111E469596B84E47EA06F9C"><enum>(4)</enum><header>Clarification</header><text>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.</text>
</paragraph><paragraph id="H201FF818E37249748F93EF62A00A45B"><enum>(5)</enum><header>Payment
transfer</header><text display-inline="yes-display-inline">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—</text>
<subparagraph id="H9472DF5084864BE3A2A34E69ADE1EEBF"><enum>(A)</enum><text>expenditures under
this subsection for the year, and</text>
</subparagraph><subparagraph id="HF72DF4D98F68427197C23CAEB192EA11"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H6592E3D1C4394FB5A2C7279224FEFFA2"><enum>(2)</enum><header>Conforming
amendment</header><text display-inline="yes-display-inline">Section 1833(a)(1)
of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(1)</external-xref>) is amended—</text>
<subparagraph id="HD4411922B4CA4D0800FFA6572E4FCA15"><enum>(A)</enum><text>by striking
<quote>and (V)</quote> and inserting <quote>(V)</quote>; and</text>
</subparagraph><subparagraph id="H1BF322D04F68465382CD1D0022821F8B"><enum>(B)</enum><text>by inserting
before the semicolon at the end the following: <quote>, 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)</quote>.</text>
</subparagraph></paragraph></subsection><subsection id="H7A7D58920F73492EB18182E7D87FC4F8"><enum>(d)</enum><header>Expansion of
home health remote patient management services coverage to additional chronic
health conditions</header><text display-inline="yes-display-inline">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.</text>
</subsection><subsection id="HBE09986AE3864CE4B7AB706DE81E87C0"><enum>(e)</enum><header>Effective
date</header><text>The amendments made by subsections (a), (b), and (c) shall
apply to services furnished on or after January 1, 2010.</text>
</subsection></section><section display-inline="no-display-inline" id="HC48E7A014BFE4B6A80E56B724CB9B44" section-type="subsequent-section"><enum>106.</enum><header>Remote patient
management services for chronic health conditions</header>
<subsection id="H6BF148C81D374A3C9931F94B4E565CB5"><enum>(a)</enum><header>Coverage of
remote patient management services for certain chronic health
conditions</header>
<paragraph id="H6CF5FA3DDABC428F93658CBAEBE7794"><enum>(1)</enum><header>In
general</header><text>Section 1861(s)(2) of the Social Security Act (42 U.S.C.
1395x(s)(2)) is amended—</text>
<subparagraph id="HB51C75165BEB4336B000864C85FBBC4D"><enum>(A)</enum><text>in subparagraph
(Z), by striking <quote>and</quote> at the end;</text>
</subparagraph><subparagraph id="H0F2404C72846468ABFC00024FA1D3DD4"><enum>(B)</enum><text>in subparagraph
(AA), by inserting <quote>and</quote> at the end; and</text>
</subparagraph><subparagraph id="H6444A20BDC134C51BF33A13080C77243"><enum>(C)</enum><text>by inserting after
subparagraph (AA) the following new subparagraph:</text>
<quoted-block id="H1BE69554A60144718E7DA2F20ADABDF" style="OLC">
<paragraph id="H9B76488975534CC3BEE68119A430003F"><enum>(BB)</enum><text>remote patient
management services (as defined in subsection
(ddd));</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="HE0A1D728BC4243548974D89A7AC67AC"><enum>(2)</enum><header>Services
described</header><text>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 (<external-xref legal-doc="public-law" parsable-cite="pl/110/173">Public Law 110–173</external-xref>), is amended by adding at the end the
following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HAF9D1C1D67FB4CA5804DACE0EAFF1F40" other-style="archaic" style="traditional">
<subsection id="HDE9F56DF7D784045A8458B409B19B7B2"><enum>(ddd)</enum><header>Remote patient
management services for chronic health conditions</header><paragraph commented="no" display-inline="yes-display-inline" id="H7EE89866EF6348AC817BD9A9C9F89F32"><enum>(1)</enum><text>The term <term>remote
patient management services</term> 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.</text>
</paragraph><paragraph id="H29F7EC3478464B4FB8D449FCC3DC6686" indent="up1"><enum>(2)</enum><text>For purposes of paragraph (1), the
term <term>covered chronic health condition</term> means—</text>
<subparagraph id="HE13B8122C1B14CFAA58FB737A9F6488"><enum>(A)</enum><text>heart failure; and</text>
</subparagraph><subparagraph id="HEFCF71BE2AAB413598EA746FC77DA7C"><enum>(B)</enum><text>cardiac arrhythmia.</text>
</subparagraph></paragraph><paragraph display-inline="no-display-inline" id="H8B1C21BA19D64048A092E018CEF40BE" indent="up1"><enum>(3)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="HECA5885156954305B587C38C1C27AAF"><enum>(A)</enum><text>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.</text>
</subparagraph><subparagraph id="H647CBB5E6C2A401485C533E4DF5016A4" indent="up1"><enum>(B)</enum><text>The Secretary shall do the
following:</text>
<clause id="HC44CE1624E544C2EA3A647BE67A7D701"><enum>(i)</enum><text>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).</text>
</clause><clause id="HF3173A94506F416BB1668DD4A6D5DA7"><enum>(ii)</enum><text>Periodically review and update such
standards under this subparagraph as
necessary.</text>
</clause></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="H22E01FED134C4F4287D715B8FD4E54B3"><enum>(3)</enum><header>Payment under
the physician fee schedule</header><text>Section 1848 of the Social Security
Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4</external-xref>) is amended—</text>
<subparagraph id="H1356CCDDE4534214BDEF0444D4BE61D0"><enum>(A)</enum><text>in subsection
(c)—</text>
<clause id="H9BEFC7F07A9B440A850059496627FCA8"><enum>(i)</enum><text>in
paragraph (2)((B)—</text>
<subclause id="HF23D976870654373B6A674CABFCE700"><enum>(I)</enum><text>in
clause (ii)(II), by striking <quote>and (v)</quote> and inserting <quote>(v),
(and (vi)</quote>; and</text>
</subclause><subclause id="HD68F6B390BC34C14803947E99415265F"><enum>(II)</enum><text>by adding at the
end the following new clause:</text>
<quoted-block id="H5FFBB4A8525E4160B91DAEE7D02E203E" style="OLC">
<clause id="H2786F247CD48497B8CC13CCC7CFC19E7"><enum>(vi)</enum><header>Budgetary
treatment of certain services</header><text>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.</text>
</clause><after-quoted-block>;
and</after-quoted-block></quoted-block>
</subclause></clause><clause id="HD0913B1521B441AEADA0D23D17C5B9C6"><enum>(ii)</enum><text>by
adding at the end the following new paragraph:</text>
<quoted-block id="H53120644D493415795C562CB2C088294" style="OLC">
<paragraph id="H7D77E31A4AC44C05A4D5FD407B542035"><enum>(7)</enum><header>Treatment of
remote patient management services</header>
<subparagraph id="H86B2B5A409054186ACAE4BEEB3442595"><enum>(A)</enum><text>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—</text>
<clause id="H6938A65DD2814445886F5F8FB28862F7"><enum>(i)</enum><text>physician
resources, including physician time and the level of intensity of services
provided, based on—</text>
<subclause id="HE3424C7A45CD4CDAA5D7EA141B85843C"><enum>(I)</enum><text>the frequency of
evaluation necessary to manage the individual being furnished the
services;</text>
</subclause><subclause id="H5A1A24BBC18F42DDB8976CDD1562F878"><enum>(II)</enum><text>the complexity of
the evaluation, including the information that must be obtained, reviewed, and
analyzed; and</text>
</subclause><subclause id="H3D9AE816B39B4431ACCF52B4A5510207"><enum>(III)</enum><text>the number of
possible diagnoses and the number of management options that must be
considered; and</text>
</subclause></clause><clause id="H241D2B9893304C9F00206CDDCD662244"><enum>(ii)</enum><text>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).</text>
</clause><clause id="HC7E4878C993242ADB87C5D6E6548F132"><enum>(iii)</enum><text>malpractice
expense resources.</text>
</clause></subparagraph><subparagraph id="H53E51189D69E4F7EAAE1081841119000"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</clause></subparagraph><subparagraph id="H9ED090B1072D48B593DF3BAE00927620"><enum>(B)</enum><text>in subsection
(j)(3), by inserting <quote>(2)(BB)</quote> after
<quote>(2)(AA),</quote>.</text>
</subparagraph></paragraph><paragraph id="H64A3EFC963E643E6885D2F67C71E7D4"><enum>(4)</enum><header>Effective
date</header>
<subparagraph id="HEC9C932A52574209B3E8B5DB6C9951F3"><enum>(A)</enum><header>In
general</header><text>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.</text>
</subparagraph><subparagraph id="HDD9E3658612F4A9C993700A600F3009E"><enum>(B)</enum><header>Availability of
codes as of January 1, 2010</header><text>The Secretary of Health and Human
Services shall—</text>
<clause id="H9CA0004EF0434EF880007B2C07B67FE9"><enum>(i)</enum><text>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</text>
</clause><clause id="H32532BF648DF45789E5CCC419359F971"><enum>(ii)</enum><text>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.</text>
</clause></subparagraph></paragraph></subsection><subsection id="HBB75EBF5B95E488C8F409CDE3618251D"><enum>(b)</enum><header>Demonstration
project for the coverage of remote patient management services for additional
chronic health conditions under the Medicare program</header>
<paragraph id="H820F85D0DE544EA28C48A8A66F3F96DC"><enum>(1)</enum><header>Establishment</header>
<subparagraph id="H475383AED90545EC9677B4D0A817E2F1"><enum>(A)</enum><header>In
general</header><text>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.</text>
</subparagraph><subparagraph id="HF62AC54D441444F8B7E1FE163300B270"><enum>(B)</enum><header>Consultation</header><text>In
establishing the demonstration project, the Secretary shall consult with
appropriate physician and supplier groups, eligible beneficiaries, and
organizations representing eligible beneficiaries.</text>
</subparagraph><subparagraph id="H09387FF04A3446FC89971B56EF340211"><enum>(C)</enum><header>Participation</header><text>Any
eligible beneficiary may participate in the demonstration project on a
voluntary basis.</text>
</subparagraph></paragraph><paragraph id="H5BBECB8D89294D23B0054E22BAF62DF5"><enum>(2)</enum><header>Conduct of the
demonstration project</header>
<subparagraph id="H097B0B3B38AC4FDF00713600328CE2BD"><enum>(A)</enum><header>Sites</header>
<clause id="H126012F1608D40D4AC01593D9C46BA20"><enum>(i)</enum><header>Selection of
demonstration sites</header><text>The Secretary shall conduct the demonstration
project at 3 sites.</text>
</clause><clause id="HA411F7149AE24466BE3D95E68FA6E348"><enum>(ii)</enum><header>Geographic
diversity</header><text>In selecting the sites under clause (i), the Secretary
shall ensure that at least 1 of the sites is in a rural area.</text>
</clause></subparagraph><subparagraph id="H048C3BAAAAA8427FBC38A82986737E31"><enum>(B)</enum><header>Implementation;
duration</header>
<clause id="HFCF4AA4273E945F6BA72DA2CE761836E"><enum>(i)</enum><header>Implementation</header><text>The
Secretary shall implement the demonstration project not later than January 1,
2010.</text>
</clause><clause id="HB2A71E29FA924FA9994E8D8567D4CD00"><enum>(ii)</enum><header>Duration</header><text>The
Secretary shall complete the demonstration project by the date that is 2 years
after the date on which the demonstration project is implemented.</text>
</clause></subparagraph></paragraph><paragraph id="H2650F4DC895B434B90F1CF84E0F7053C"><enum>(3)</enum><header>Evaluation and
report</header>
<subparagraph id="H85749BE6B6854A5BADE453B100F7531D"><enum>(A)</enum><header>Evaluation</header><text>The
Secretary shall conduct an evaluation of the demonstration project—</text>
<clause id="H7E0501C2CEDE4C579B8908D9672CA56C"><enum>(i)</enum><text>to
determine improvements in the quality of care and utilization of services
received by eligible beneficiaries participating in the demonstration
project;</text>
</clause><clause id="H1B885B3D572444C5A42CFAD44915313C"><enum>(ii)</enum><text>to
determine the cost of providing payment for remote monitoring services under
the Medicare program;</text>
</clause><clause id="H297782DC224F4BB4B924AB17B3A9B34C"><enum>(iii)</enum><text>to
determine the satisfaction of eligible beneficiaries participating in the
demonstration projects; and</text>
</clause><clause id="H93AF9A02DFCE4080986CEA628CF8D0E4"><enum>(iv)</enum><text>to
evaluate such other matters as the Secretary determines is appropriate.</text>
</clause></subparagraph></paragraph><paragraph id="H050636C204A74CEC974D18D05031112C"><enum>(4)</enum><header>Waiver
authority</header><text>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.</text>
</paragraph><paragraph id="HC078607848DD4045BB4516A62D437451"><enum>(5)</enum><header>Funding</header>
<subparagraph id="HB71325922F2245128465B78153DD6528"><enum>(A)</enum><header>Demonstration</header>
<clause id="H1062C91DFB2540ACB154E7B1DAB6039"><enum>(i)</enum><header>In
general</header><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395t">42 U.S.C. 1395t</external-xref>) of such funds as are
necessary for the costs of carrying out the demonstration project.</text>
</clause><clause id="H0CBBF06B27C546D68E9DC94398D0043"><enum>(ii)</enum><header>Cap on
expenditures</header><text>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—</text>
<subclause id="H74ABAA5555A244B29E88FB4DC3D142C1"><enum>(I)</enum><text>$9,000,000;
or</text>
</subclause><subclause id="H4AF5B67341044FDAB40018727555BFE8"><enum>(II)</enum><text>an amount equal
to the costs of providing remote monitoring services to 7,500 individuals
during such period.</text>
</subclause></clause></subparagraph><subparagraph id="H207242092FA34ED686153626F05BAE09"><enum>(B)</enum><header>Evaluation and
report</header><text>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).</text>
</subparagraph></paragraph><paragraph id="H928A648A813946CA99DA33F96D4307EE"><enum>(6)</enum><header>Definitions</header><text>In
this section:</text>
<subparagraph id="H998338134A2943908BFBE5D622C835DE"><enum>(A)</enum><header>Remote patient
management services</header><text>The term <term>remote patient management
services</term> 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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x</external-xref>))) or supplier (as defined in
subsection (d) of such section) for the purposes of clinical review or response
by the physician or supplier.</text>
</subparagraph><subparagraph id="H250B7EB6DA4D49A295D75663C0760082"><enum>(B)</enum><header>Covered chronic
health condition</header><text>The term <term>covered chronic health
condition</term> means diabetes, sleep apnea, or epilepsy.</text>
</subparagraph><subparagraph id="HF0C3C41878D84996851C53B60080D040"><enum>(C)</enum><header>Demonstration
project</header><text>The term <term>demonstration project</term> means a
demonstration project conducted under this subsection.</text>
</subparagraph><subparagraph id="H87F3599E605744DB9616748D672437FD"><enum>(D)</enum><header>Eligible
beneficiary</header><text>The term <term>eligible beneficiary</term> means an
individual who is enrolled under part B of the Medicare program and has a
covered chronic health condition.</text>
</subparagraph><subparagraph id="H52928CFEEE624A6980F497B691C69CB"><enum>(E)</enum><header>Medicare
program</header><text>The term <term>Medicare program</term> means the health
benefits program under title XVIII of the Social Security Act (42 U.S.C. 1395
et seq.).</text>
</subparagraph><subparagraph id="H7E7823F2516C4DF199EAA7DD9B077C1"><enum>(F)</enum><header>Secretary</header><text>The
term <term>Secretary</term> means the Secretary of Health and Human
Services.</text>
</subparagraph></paragraph></subsection></section><section id="H2E2C1C97B2EC40EC9505808ECD7E5E8B"><enum>107.</enum><header>Definition of
Medicare program</header><text display-inline="no-display-inline">In this
title, the term <term>Medicare program</term> 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>
(<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395 et seq.</external-xref>).</text>
</section><enum>II</enum><header>HRSA
Grant Program</header>
<section id="H61174F63D1EB430981E768A3ACA28DEB"><enum>201.</enum><header>Grant program
for the development of telehealth networks</header>
<subsection id="HC0ABC6827681447D9650756F368450A9"><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="H0D87584B00934CAD802DBE3DE9BEF030"><enum>(b)</enum><header>Eligible
entities</header>
<paragraph id="HEB8DA974459A4A90A07DC48B871AEAE"><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="H1D8FAE160FBB411C9B66910061009530"><enum>(A)</enum><text>A description of
the anticipated need for the grant.</text>
</subparagraph><subparagraph id="HB23CA8A86B384154928E345C7369E0F2"><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="H2FB4B6179DA64D9CA2BF8516A2739009"><enum>(C)</enum><text>A plan for
continuing the project after Federal support under this section is
ended.</text>
</subparagraph><subparagraph id="H8BBEAC1347344E528FDC2AEE2B49387"><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="HADA3200F288249379B9F00DCD4CA7EC5"><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="H1541EDF7D59D4379A00054FDB783D0D6"><enum>(F)</enum><text>The source and
amount of non-Federal funds the entity would pledge for the project.</text>
</subparagraph><subparagraph id="HD9B3FDDB8A2242938C67C8A7452BA000"><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="H71858048CD9047C790B75E5989A4943"><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="H80A705EC2C6D4C068FAA2EF4D5270036"><enum>(A)</enum><text>The organizations
described in this subparagraph are the following:</text>
<clause id="HCCC5DA20822B4631BD979C30344CD08B"><enum>(i)</enum><text>Community or
migrant health centers.</text>
</clause><clause id="HE9F7CDE5D2EC4B09A00199C171C7C9D8"><enum>(ii)</enum><text>Local health
departments.</text>
</clause><clause id="H66C88977FED240539963EBC864E4A2AF"><enum>(iii)</enum><text>Nonprofit
hospitals.</text>
</clause><clause id="H175E1978A24B44F0AA4FAE3BABD6F7EB"><enum>(iv)</enum><text>Private practice
health professionals, including community and rural health clinics.</text>
</clause><clause id="HC5A5CC4500504FE19FDFF48F19202C10"><enum>(v)</enum><text>Other publicly
funded health or social services agencies.</text>
</clause><clause id="HE79301CA511F4879ABFC3F7EA182E8B4"><enum>(vi)</enum><text>Skilled nursing
facilities.</text>
</clause><clause id="H349313D0A6814A8D8FFC88CDBBDF000"><enum>(vii)</enum><text>County mental
health and other publicly funded mental health facilities.</text>
</clause><clause id="HA91AE0B5E2454654AE5046D500003BAF"><enum>(viii)</enum><text>Providers of
home health services.</text>
</clause><clause id="H521329763FCD4A3896939463956C11CA"><enum>(ix)</enum><text>Renal dialysis
facilities.</text>
</clause></subparagraph><subparagraph id="HB80637A23A774DADB918D5863063396"><enum>(B)</enum><text>The institutions
and entities described in this subparagraph are the following:</text>
<clause id="H4FEC580FD268466DA146E8D1A6C436E3"><enum>(i)</enum><text>A
public school.</text>
</clause><clause id="H3EE3D8909861461AB5ABE3CF4137253"><enum>(ii)</enum><text>A
public library.</text>
</clause><clause id="H3826AC5C3E2B46BC8DF26257AA930975"><enum>(iii)</enum><text>A
university or college.</text>
</clause><clause id="H7D72348F1DD948318446728C88876049"><enum>(iv)</enum><text>A
local government entity.</text>
</clause><clause id="HE183D270DDAC45EFA6FB8BFEF46EBBF1"><enum>(v)</enum><text>A
local health entity.</text>
</clause><clause id="HA555C600AE1345BEBFD612EF3DC2C393"><enum>(vi)</enum><text>A
health-related nonprofit foundation.</text>
</clause><clause id="H77B2679E7918420D80EED962F1A462C0"><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="H1C951C536A4640E796941160231F1F10"><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="H758A52D4D78645C78EF3AC10CBDF60FC"><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="H3F23E137686E4A1B9B5E70DAAAAA0054"><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="H336E092F3EF14950B8E5A47CB3FA514"><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="HFD07CD11B53240B4A237AFA280C6987B"><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="HFB98A4FA8CFF460FA29CFD1C1DABB0"><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="H5C8FA84512064F64A4195736B0DDE148"><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="H25684C0B69E84594874741D6FDA414DD"><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="HBD79837C355E473EB2538DD4DE63F99C"><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="H2FC3F9E0F13E42B38230D0F05F28C735"><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="HB85F1C66E72F4BE88721949FF09359CB"><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="H79128FE222BE486DAFC7540000FF1CE6"><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="H87713244C19147E0BE64EFF13750B9FF"><enum>(3)</enum><text>The development
and acquisition of instructional programming.</text>
</paragraph><paragraph id="H6F72BD85A2374D2FB2AB3E02D0679091"><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="HA05EE8E594BE450AA9C9B300E4C34186"><enum>(5)</enum><text>The provision of
telenursing services designed to enhance care coordination and promote patient
self-management skills.</text>
</paragraph><paragraph id="HC460477C907545E9B8A5903E8224B6E"><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="H789050EE96D04F87AD73C6B1A02EF5C8"><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="H0D2F390E380E4385A695BF415164A85C"><enum>(8)</enum><text>Development of
projects to use telehealth to facilitate collaboration between health care
providers.</text>
</paragraph><paragraph id="H8DA72A9F894B4D14AEE902D40AFD8FF"><enum>(9)</enum><text>Electronic archival
of patient records.</text>
</paragraph><paragraph id="H464FBFAB66FA42E58E3BD736337012A2"><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="H44952F9AB05B438280AEE8424AD9B61"><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="HCDEC1F71ABC1420A80CCEAA374F7D5D"><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="HB8EEA455F98A450CA19FB2855F3776AB"><enum>(1)</enum><text>To acquire real
property.</text>
</paragraph><paragraph id="H9FA16D8D54834177BFC38C7B7E003590"><enum>(2)</enum><text>Expenditures 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="H9CE5F1AF831A49BAA1513DD2A130BF6B"><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="H55EDFB0796FE43329B24FE5D77A9E1DD"><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="H3C0E4B7401784E4F81F8BA50F21353B2"><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="HD41EAAEBFFD845B98B843113E7704BBF"><enum>(g)</enum><header>Administration</header>
<paragraph id="HBE66286A940644CB879970E8F4664296"><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="H73C55C6CACB14D89A32D471395053B22"><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="HB170810F7073497EAE06D78E2B81D7A7"><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="HD31702F2869E46D1AE5780C3FE94B264"><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="H156BE99995B741619C2396B81292E11B"><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 2009, and such sums as may be
necessary for each of the fiscal years 2010 through 2014.</text>
</subsection></section><section id="HC855A8C5683D42939D8B7553563D54D4"><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 Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/254c-14">42 U.S.C. 254c–14</external-xref>) is
amended—</text>
<paragraph id="HFB99DAD07AA44C5D9232F8BFA901CF0"><enum>(1)</enum><text>in
paragraph (1)—</text>
<subparagraph id="HFA3F813998164B9DA0878BF582A4F6E5"><enum>(A)</enum><text>by striking
<quote>and</quote> before <quote>such sums</quote>; and</text>
</subparagraph><subparagraph id="H95684A2346194ACDA6C5621741DF571F"><enum>(B)</enum><text>by inserting
<quote>$10,000,000 for fiscal year 2009, and such sums as may be necessary for
each of fiscal years 2010 through 2014</quote> before the semicolon; and</text>
</subparagraph></paragraph><paragraph id="H1A90B71DF6154AA8B100C2BDA600BFF"><enum>(2)</enum><text>in
paragraph (2)—</text>
<subparagraph id="HDB4A16106F924B6A9D7685A5751328AA"><enum>(A)</enum><text>by striking
<quote>and</quote> before <quote>such sums</quote>; and</text>
</subparagraph><subparagraph id="H6313BC97A97B485A982E16423602FDEC"><enum>(B)</enum><text>by inserting
<quote>$10,000,000 for fiscal year 2009, and such sums as may be necessary for
each of fiscal years 2010 through 2014</quote> before the semicolon.</text>
</subparagraph></paragraph></section>