1.Short title; table of
contents
(a)This Act may be cited
as the Medicare Telehealth Enhancement
Act of 2009
.
(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. Expansion of eligible telehealth providers and
credentialing of telemedicine practitioners.
Sec. 104. Access to telehealth services in the
home.
Sec. 105. Coverage of home health remote patient management
services for chronic health conditions.
Sec. 106. Sense of Congress on the use of remote patient
management services.
Sec. 107. Telehealth Advisory Committee.
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="HF20FE6DA636649CCB69C498E33CAAC9B"><enum>101.</enum><header>Expansion and
improvement of telehealth services</header>
<subsection id="H9091B5F49F454BCD8B5C93D071C5BA7"><enum>(a)</enum><header>Expanding access
to telehealth services to all areas</header><text>Section 1834(m)(4)(C)(i) of
the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395m(m)(4)(C)(i)) is amended 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 within the United States where the
site is located.</quote>.</text>
</subsection><subsection id="HCB600F7963F84397A53E006C004D6175"><enum>(b)</enum><header>Expansion of use
of store-and-forward technology</header><text display-inline="yes-display-inline">The second sentence of section 1834(m)(1)
of such Act (42 U.S.C. 1395m(m)(1)) is amended by inserting <quote>and any
telehealth program that has been the recipient of any Federal support from the
Centers for Medicare & Medicaid Services, the Indian Health Service, or the
Health Services and Resources Administration</quote> after <quote>Alaska or
Hawaii</quote>.</text>
</subsection><subsection id="H135CF805157E40BE8E40D9DA35521B3C"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to services
furnished on or after January 1, 2010.</text>
</subsection></section><section id="H1885E2BD8D6D42AFBA50B467CFA70826"><enum>102.</enum><header>Increase in
number of types of originating sites; clarification</header>
<subsection id="H6D080AA449F04DD082E35E2C6B9DE2C5"><enum>(a)</enum><header>Increase</header><text>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 subclause:</text>
<quoted-block id="H4D16475E7D83471F005B9D9DC5B7E5B" style="OLC">
<subclause id="H050949111FDD4EE79C7CA0B545E545C"><enum>(IX)</enum><text>A renal dialysis
facility.</text>
</subclause><after-quoted-block></after-quoted-block></quoted-block>
</subsection><subsection id="HC22AB9D293FA49059577C7E75B8F501E"><enum>(b)</enum><header>Clarification of
Intent of the Term Originating Site</header><text>Such section is further
amended by adding at the end the following new paragraph:</text>
<quoted-block id="H6C41C78E0899448B87A600538C25DB98" style="OLC">
<paragraph id="H45F8E9C9521B4619BEEB8179EEC76796"><enum>(5)</enum><header>Construction</header><text>In
applying the term <quote>originating site</quote> 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 such
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><subsection display-inline="no-display-inline" id="H31DB175947D347B19F65D14E9650D0AF"><enum>(c)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to services
furnished on or after January 1, 2010.</text>
</subsection></section><section id="H5854F2C7C7484E26BA82DDEC92902B3C"><enum>103.</enum><header>Expansion of
eligible telehealth providers and credentialing of telemedicine
practitioners</header>
<subsection id="HE6889C8CFCC141AFB3F185B100E22C6E"><enum>(a)</enum><header>Expansion of
eligible telehealth providers</header><text>Section 1834(m)(1) of the Social
Security Act (42 U.S.C. 1395m(m)(1)) is amended—</text>
<paragraph id="H7F8ACF194E484DB3927075CFDD1026E"><enum>(1)</enum><text>in
paragraph (1)—</text>
<subparagraph id="H24C7BF63964045FDA75DDB08FD8B3DD6"><enum>(A)</enum><text>by striking
<quote>or a practitioner</quote> and inserting <quote>, a
practitioner</quote>;</text>
</subparagraph><subparagraph id="H6C14E7FC06674898874F5D1F2EF60057"><enum>(B)</enum><text>by inserting
<quote>, or other telehealth provider</quote> after
<quote>1842(b)(18)(C))</quote>; and</text>
</subparagraph><subparagraph id="H85516FE3743749679CEB618E07EEBC40"><enum>(C)</enum><text>by striking
<quote>or practitioner</quote> and inserting <quote>, practitioner, or
provider</quote>;</text>
</subparagraph></paragraph><paragraph id="HF052E38355584747B989A87024ABCC41"><enum>(2)</enum><text>in paragraphs (2),
(3)(A), and (4), by striking <quote>or practitioner</quote> and inserting
<quote>, practitioner, or other telehealth provider</quote> each place it
appears;</text>
</paragraph><paragraph id="HE7CC344606EB4A318CBA00AF4B1047C2"><enum>(3)</enum><text>in paragraph (4),
by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="HB419C71459F840F9A770BB9F43A9F62" style="OLC">
<subparagraph id="H7AC256BBDD8843678509E59057D05B6"><enum>(G)</enum><header>Telehealth
provider</header><text display-inline="yes-display-inline">The term
<quote>telehealth provider</quote> means any supplier or provider of services
(other than a physician or practitioner) that is eligible to provide other
health services under this
title.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H0F378D334B6C47E5869BE831FCE7B690"><enum>(b)</enum><header>Credentialing
Telemedicine Practitioners</header><text>Section 1834(m) of such Act is amended
by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HFC2E313E560D426BBE4642FBDBBCFAF0" style="OLC">
<paragraph id="HD1DD31A7464C47BEBBD3FF120542B8FF"><enum>(5)</enum><header>Hospital
credentialing of telemedicine practitioners</header><text display-inline="yes-display-inline">A telemedicine practitioner that is
credentialed by a hospital in compliance with the Joint Commission Standards
for Telemedicine shall be considered in compliance with Medicare condition of
participation and reimbursement credentialing requirements for telemedicine
services. <inline-comment display="no">Hospitals that credential telemedicine
practitioners in compliance with the Joint Commission Standards for
Telemedicine shall be considered in compliance with Medicare condition of
participation and reimbursement credentialing requirements for telemedicine
services.</inline-comment></text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="H26FD40CE17534BF9A532DAF7CC205608"><enum>104.</enum><header>Access to
telehealth services in the home</header>
<subsection id="H54A2F21B654044F4823B215420F673AB"><enum>(a)</enum><header>In
general</header><text>Section 1895 of the Social Security Act (42 U.S.C.
1395fff(e)) is amended by adding at the end the following new
subsection:</text>
<quoted-block id="HE2C647156B7D42EFA8721CCA063BD9D1" style="OLC">
<subsection id="H28534FEA11204CAF9D68FAA4E7AEF780"><enum>(f)</enum><header>Coverage of
Telehealth Services</header>
<paragraph id="HFE376E77B5B74EAD863E5CF800056497"><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="HD891A57B564F4CD2ABC31B3BAD93064D"><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="H2C2312C39215484793BBC00118176B0"><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="H6A0F9434F8B741AAA71810ECF9A3F4E5"><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="H48F1A153A76B4FEF9D00E2B513BFE496"><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="H840C9D3AA8084F17BBCA294A5EF4F"><enum>(3)</enum><header>Criteria for visit
equivalency</header>
<subparagraph id="HA7F0D245631044C5A57FCA4DBB0030ED"><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="H549F4A354ABB4D38B03F9500E9BACB91"><enum>(i)</enum><text>the nature and
amount of service time involved; and</text>
</clause><clause id="H71B35272E5204E7797FD478DF0BF1EDC"><enum>(ii)</enum><text>the functions of
the telecommunications.</text>
</clause></subparagraph><subparagraph id="H76F9F32E00D64B4AAFFC50DA4A792E3"><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="HC3537A9FC6C1411182749872A8C10057"><enum>(4)</enum><header>Telehealth
service</header>
<subparagraph id="H4D8AF503FC71413A883E00B7DB0052BD"><enum>(A)</enum><header>Definition</header><text>For
purposes of this subsection, 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="HF302BC2E460549C1A7D275BEFAA6B2D8"><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="H0A85B2E3E69A4EB79B74028F23F2363E"><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="H68649C32AD894D90A11E6CEB348EAF05"><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="H3179D0FD9D5D4A630095BDB29F6C15E9"><enum>(b)</enum><header>Effective
date</header>
<paragraph id="HD2A02B2CA1FC4796AFB8562F541549"><enum>(1)</enum><text>The
amendment made by subsection (a) shall apply to telehealth services furnished
on or after October 1, 2010. 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,
2010.</text>
</paragraph><paragraph id="H9FC5E7ECDDFC40B3A98E3588F92FAB2D"><enum>(2)</enum><text>In the event that
the Secretary has not complied with these deadlines, beginning October 1, 2010,
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 display-inline="no-display-inline" id="H8DE2E5CF4B494505909C00D192B35040" section-type="subsequent-section"><enum>105.</enum><header>Coverage of home
health remote patient management services for chronic health
conditions</header>
<subsection id="HE599E6E993C3440C9600CA66CDEB39A7"><enum>(a)</enum><header>Medicare
coverage</header>
<paragraph id="H5AEC5FD8AAD84395911721482D8983F5"><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="HB5A814C3FBE346D5A63684F946B5D4F9"><enum>(A)</enum><text>in subparagraph
(DD), by striking <quote>and</quote> at the end;</text>
</subparagraph><subparagraph id="HE3FE2499A9E64B58B7736B7B00A134D"><enum>(B)</enum><text>in subparagraph
(EE), by adding <quote>and</quote> at the end; and</text>
</subparagraph><subparagraph id="H442D878399A94F76AFD5BB251E59B8"><enum>(C)</enum><text>by inserting after
subparagraph (EE) the following new subparagraph:</text>
<quoted-block id="HB57EA962C7C749568EC9393121F8005F" style="OLC">
<paragraph id="HD395AC6BD6644BF89BA897C1FFBA95FA"><enum>(FF)</enum><text>home health
remote patient management services (as defined in subsection
(hhh));</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="H4F3F7B3E500F476E9BF70057ADB77FC"><enum>(2)</enum><header>Services
described</header><text>Section 1861 of such Act (42 U.S.C. 1395x) is amended
by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H6D7BDD897D3A46F08434BC8BDA00CC86" other-style="archaic" style="traditional">
<subsection id="HA0333B97208F4E38B6EC6926BB7FCA"><enum>(hhh)</enum><header>Home health
remote patient management services for chronic health conditions</header><paragraph commented="no" display-inline="yes-display-inline" id="H443678327B2C46E8868FAE10F10052CD"><enum>(1)</enum><text display-inline="yes-display-inline">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)) 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 the 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(f) for purposes of payment under this
title.</text>
</paragraph><paragraph id="H8E436D820F8840DFA900CD644871B88" indent="up1"><enum>(2)</enum><text>For purposes of paragraph (1), the
term <term>covered chronic health condition</term> means any chronic health
condition specified by the
Secretary.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H6055DC50141649E9963151CC330A5E2C"><enum>(b)</enum><header>Payment</header>
<paragraph id="HB5395CA7CBCD48CB993C72DDD195EE96"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 1834 of such
Act (42 U.S.C. 1395l) is amended by adding at the end the following new
subsection:</text>
<quoted-block display-inline="no-display-inline" id="H6C06CAA4F0AE46FAADB92D2AC261F60F" style="OLC">
<subsection id="HDD7B5903C3494853A9DDFFF6E082296F"><enum>(n)</enum><header>Home Health
Remote Patient Management Services</header>
<paragraph id="H95F817316B81487AA6864CB1DBACFCB4"><enum>(1)</enum><header>In
general</header><text>The Secretary shall establish a fee schedule for home
health remote patient management services (as defined in section 1861(hhh)) 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="HE47FFC6CB2414C97BC32F263BBF2C20B"><enum>(2)</enum><header>Savings
described</header>
<subparagraph id="H5A693B14736D4CD59C400C44A8CB006E"><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="H3BC8B642F3EF4A4F9179D593A7B3F10D"><enum>(i)</enum><text>the product
described in subparagraph (B) for the year, exceeds</text>
</clause><clause id="HB4F56EA5D6124B828C20F2419863D0FF"><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="H0EA1194DA5F64E8BA69C81E4115C55E0"><enum>(B)</enum><header>Product
described</header><text>The product described in this subparagraph for a year
is the product of—</text>
<clause id="HEA7C6BED81C9467985760C7B011580ED"><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="H18CCB7437C214E27BB8C63EF4A085D5D"><enum>(ii)</enum><text>the number of
individuals under subparagraph (A)(ii) for the year.</text>
</clause></subparagraph></paragraph><paragraph id="H23C07D1C6A8B4E61A8F98C444D5AA2B1"><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="H9959D99786D7482DB030A74136EB9DE2"><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="H13DEEB035629478FA132B3E41AA40AC9"><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="H745A0AF6C23E4B10A8497C9023AC5D28"><enum>(A)</enum><text>expenditures under
this subsection for the year, and</text>
</subparagraph><subparagraph id="HC13B055C47A14470B653843C8D2F1375"><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="H1F47CDEC25E34AA4AA5F39FD563A75C8"><enum>(2)</enum><header>Conforming
amendment</header><text display-inline="yes-display-inline">Section 1833(a)(1)
of such Act (42 U.S.C. 1395l(1)) is amended—</text>
<subparagraph id="H5307BA59CAA3485798785BAD4863A203"><enum>(A)</enum><text>by striking
<quote>and (W)</quote> and inserting <quote>(W)</quote>; and</text>
</subparagraph><subparagraph id="HEE27FC3B9BDE46569E18A4AC08BEA820"><enum>(B)</enum><text>by inserting
before the semicolon at the end the following: <quote>, (X) with respect to
home health remote patient management services (as defined in section
1861(hhh)), the amounts paid shall be the amount determined under the fee
schedule established under section 1834(n)</quote>.</text>
</subparagraph></paragraph></subsection><subsection id="H83D6CB7126E144BB8AF7B5A84992E277"><enum>(c)</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(hhh) of such Act, as
added by subsection (a)) should be extended to individuals with chronic health
conditions other than those initially specified by the Secretary under
paragraph (2) of such section.</text>
</subsection><subsection id="H98EA882B70F14532BD7753910062E676"><enum>(d)</enum><header>Effective
date</header><text display-inline="yes-display-inline">The amendments made by
subsections (a), (b), and (c) shall apply to services furnished on or after
January 1, 2010.</text>
</subsection></section><section id="HC17117926889486AA754382F54EA71C3"><enum>106.</enum><header>Sense of
Congress on the use of remote patient management services</header>
<subsection id="H1B8609F7B56C4BC8B7AD86A8113DC129"><enum>(a)</enum><header>Findings</header><text>Congress
finds as follows:</text>
<paragraph id="H285D673B5B3A489898305AD06DE3C157"><enum>(1)</enum><text>Remote patient
management services can make chronic disease management more effective and
efficient for patients and for the health care system.</text>
</paragraph><paragraph id="HDA5DEF1249284EADB15DCDD61C06B284"><enum>(2)</enum><text>By collecting,
analyzing, and transmitting clinical health information to a health care
provider, remote patient management services allow patients and providers to
manage the medical condition of patients in a consistent and real time
fashion.</text>
</paragraph><paragraph id="H83D60AB54C7D4AC8925713A754E1BD77"><enum>(3)</enum><text>Utilization of
remote patient management services not only improves the quality of care given
to patients, it also reduces the need for frequent office appointments, costly
emergency room visits, and unnecessary hospitalizations.</text>
</paragraph><paragraph id="HE6088CD416E54AF291595F5677CE193B"><enum>(4)</enum><text>Management the
medical condition or disease of a patient from the patient's home reduces the
need for face to face provider interactions. Use of remote patient management
services minimizes unnecessary travel and missed work and provides particular
value to patients residing in rural or underserved communities who would
otherwise face potentially significant access barriers to receiving needed
care.</text>
</paragraph><paragraph id="HCCAA9F7D1D5945DDA60E7C349981A13F"><enum>(5)</enum><text>Among the areas in
which remote patient management services are emerging in health care are the
treatment of congestive heart failure, diabetes, cardiac arrhythmia, epilepsy,
and sleep apnea. Prompt transmission of clinical data on each of these
conditions, to the health care provider or the patient as appropriate, is
essential to providing timely and appropriate therapeutic interventions which
can then reduce expensive hospitalizations.</text>
</paragraph><paragraph id="HB8941D7B13E74365AD1C64324A671573"><enum>(6)</enum><text>Despite these
benefits, remote patient management services have failed to diffuse rapidly. A
significant barrier to wider adoption is the relative lack of payment
mechanisms in fee for service Medicare to reimburse for remote, non face to
face patient management.</text>
</paragraph><paragraph id="HEDCB4F298D68469B8B77108F8248F547"><enum>(7)</enum><text>Elimination of
this barrier to new remote patient management services should be encouraged by
requiring reimbursement under the Medicare program for providers’ time spent
analyzing and responding to patient data transmitted by remote
technologies.</text>
</paragraph><paragraph id="H5961140F32AD44A7B28AC0E0418BC802"><enum>(8)</enum><text>Reimbursement
under the Medicare program for health care providers’ time spent analyzing and
responding to data transmitted to providers by remote technologies should be
made on a separate basis and should not be combined with payments for others
services (also referred to as <quote>bundled payments</quote>).</text>
</paragraph><paragraph id="HE6BA2D3655B142BD8A0BDE3B4283B192"><enum>(9)</enum><text>Payment codes used
for reporting and billing for payment for providers’ remote patient management
services should be revised or adjusted, as appropriate, to encourage the
application of such services for other medical conditions.</text>
</paragraph></subsection><subsection id="HB144748D9CC348C394EBDEDB9DC725F2"><enum>(b)</enum><header>Sense of
congress</header><text>It is the sense of the Congress that—</text>
<paragraph id="H7736F6D5BE8B4AC5814CAC73114AA051"><enum>(1)</enum><text>remote patient
management services are integral to improvement in the delivery, care, and
efficiency of health care services furnished in the United States; and</text>
</paragraph><paragraph id="HAFD68C4145034E40A61E65A57D02C2F3"><enum>(2)</enum><text>the Administrator
of the Centers for Medicare & Medicaid Services should be encouraged
to—</text>
<subparagraph id="H7046443C63F84353828B7DF2A6F0C999"><enum>(A)</enum><text>expand the types
of medical conditions for which the use of remote patient management services
are reimbursed under the Medicare program;</text>
</subparagraph><subparagraph id="H6D877CA671B947C09C087D1EB7D9A189"><enum>(B)</enum><text>provide for
separate, non-bundled payment under the Medicare program for remote patient
management services; and</text>
</subparagraph><subparagraph id="H6E75DD026E3A4AB9ADBF79A015A21530"><enum>(C)</enum><text>create, revise and
adjust, as appropriate, codes for the accurate reporting and billing for
payment for remote patient management services.</text>
</subparagraph></paragraph></subsection></section><section id="HD1EB6CF31E544973A409749830CAA8E"><enum>107.</enum><header>Telehealth
Advisory Committee</header>
<subsection id="H5086D0A62E4547C6BC7194A8AF174634"><enum>(a)</enum><header>In
general</header><text>Section 1834(m)(4)(F)(ii) of the Social Security Act (42
U.S.C. 1395m(m)(4)(F)(ii)) is amended by adding at the end the following
sentences: <quote>Such process shall require the Secretary to take into account
the recommendations of the Telehealth Advisory Committee (as established under
section 107(b) of the Medicare Telehealth Enhancement Act of 2009) when adding
or deleting services (and HCPCS codes) and in establishing policies of the
Centers for Medicare & Medicaid Services regarding the delivery of
telehealth services. If the Secretary does not implement a recommendation of
the Telehealth Advisory Committee, the Secretary shall publish in the Federal
Register a statement regarding the reason such recommendation was not
implemented.</quote>.</text>
</subsection><subsection id="H4CDE9349C3CC40B5A8E59EBFE1A633C2"><enum>(b)</enum><header>Telehealth
Advisory Committee</header>
<paragraph id="HA60EBF2F7C8847F48E3E537E4799EF30"><enum>(1)</enum><header>Establishment</header><text>On
and after the date that is 6 months after the date of enactment of this Act,
the Secretary of Health and Human Services (in this subsection referred to as
the <quote>Secretary</quote>) shall have in place a Telehealth Advisory
Committee (in this subsection referred to as the <quote>Advisory
Committee</quote>) to make recommendations to the Secretary on—</text>
<subparagraph id="HC33A4FF153A54045BEC82F0B473E14F1"><enum>(A)</enum><text display-inline="yes-display-inline">policies of the Centers for Medicare &
Medicaid Services regarding the delivery of telehealth services; and</text>
</subparagraph><subparagraph id="H42A2035DB6E145718593604778886DB8"><enum>(B)</enum><text>the appropriate
addition or deletion of services (and HCPCS codes) to those specified in
paragraph (4)(F)(i) of section 1834(m) of the Social Security Act (42 U.S.C.
1395m(m)) for authorized payment under paragraph (1) of such section.</text>
</subparagraph></paragraph><paragraph id="H3831B2B20CEC4A9887FE1E5D45B17E67"><enum>(2)</enum><header>Membership;
terms</header>
<subparagraph id="HF179AE19A6324ACC894BBF90CF01CAAB"><enum>(A)</enum><header>Membership</header>
<clause id="H93F19EFE269941DB923653537E81DBAA"><enum>(i)</enum><header>In
general</header><text>The Advisory Committee shall be composed of 9 members, to
be appointed by the Secretary, of whom—</text>
<subclause id="H2FBCBE458315400A9C302FD6A5003991"><enum>(I)</enum><text>five shall be
practicing physicians;</text>
</subclause><subclause id="HF607FE0A75BB4B73B6FB75FD211351D"><enum>(II)</enum><text>two shall be
practicing non-physician health care providers; and</text>
</subclause><subclause id="H8CA183547FED4672A1045840C5D1FC17"><enum>(III)</enum><text display-inline="yes-display-inline">two shall be administrators of telehealth
programs.</text>
</subclause></clause><clause id="H134D19946CEA4E5CADADD02D8F5D34A5"><enum>(ii)</enum><header>Requirements
for appointing members</header><text>In appointing members of the Advisory
Committee, the Secretary shall—</text>
<subclause id="H83C4C2096E2D427496414F31EAB98DC"><enum>(I)</enum><text>ensure that each
member has prior experience with the practice of telemedicine or
telehealth;</text>
</subclause><subclause id="H6DD6331129AD425BAF8123CEFA062EBD"><enum>(II)</enum><text display-inline="yes-display-inline">give preference to individuals who are
currently providing telemedicine or telehealth services or who are involved in
telemedicine or telehealth programs;</text>
</subclause><subclause id="H5206559B73B84EB0854C6DF0062800CD"><enum>(III)</enum><text>ensure that the
membership of the Advisory Committee represents a balance of specialties and
geographic regions; and</text>
</subclause><subclause id="H452B0E34432B48ACBAE357CF53F0AF05"><enum>(IV)</enum><text>take into account
the recommendations of stakeholders.</text>
</subclause></clause></subparagraph><subparagraph id="HE896029BC06B497CB7AE7D3C00D9FF55"><enum>(B)</enum><header>Terms</header><text>The
members of the Advisory Committee shall serve for such term as the Secretary
may specify.</text>
</subparagraph><subparagraph id="HC59206A185534B12AB8F0EC049A4B879"><enum>(C)</enum><header>Conflicts of
interest</header><text display-inline="yes-display-inline">An advisory
committee member may not participate with respect to a particular matter
considered in an advisory committee meeting if such member (or an immediate
family member of such member) has a financial interest that could be affected
by the advice given to the Secretary with respect to such matter.</text>
</subparagraph></paragraph><paragraph id="H89B2527178BB4B89A9B20792C39B01C"><enum>(3)</enum><header>Meetings</header><text>The
Advisory Committee shall meet twice per year and at such other times as the
Advisory Committee may provide.</text>
</paragraph><paragraph id="H5B83CB0BF1554CCB98F0A32637F05D2F"><enum>(4)</enum><header>Permanent
committee</header><text>Section 14 of the Federal Advisory Committee Act (5
U.S.C. App.) shall not apply to the Advisory Committee.</text>
</paragraph><paragraph id="H80D38011694C40FE94E7FF707289F752"><enum>(5)</enum><header>Waiver of
administrative limitation</header><text>The Secretary shall establish the
Advisory Committee notwithstanding any limitation that may apply to the number
of advisory committees that may be established (within the Department of Health
and Human Services or otherwise).</text>
</paragraph></subsection></section><enum>II</enum><header>HRSA
Grant Program</header>
<section id="H78A41160F68741D081B3CFA92E58E94F"><enum>201.</enum><header>Grant program
for the development of telehealth networks</header>
<subsection id="HF9923AE825D843E0BF1842C0758963A"><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="H6778E89834BD4C5EAE593D0026C721C4"><enum>(b)</enum><header>Eligible
entities</header>
<paragraph id="H47304CCE6DDE4A12B1C9CB30F86D32F8"><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="HAB1B98CC8BDF4F5EBA88F879D16D06EC"><enum>(A)</enum><text>A description of
the anticipated need for the grant.</text>
</subparagraph><subparagraph id="HADD2859D8E9842BB89A82C5CFA86E2C"><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="H9C24B32CEAF849E083BE47B9006594D6"><enum>(C)</enum><text>A plan for
continuing the project after Federal support under this section is
ended.</text>
</subparagraph><subparagraph id="H75A3F6B076D14699A706D8DCA520AFD"><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="H6BA0AF6744104B57A07B347B5DC36D4"><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="HC95C18A748C34573B7AE993DA20064D6"><enum>(F)</enum><text>The source and
amount of non-Federal funds the entity would pledge for the project.</text>
</subparagraph><subparagraph id="H1313E9747EB24E7083AAA339C9626450"><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="H0BE92B0009994F93BFBD179FE2904374"><enum>(2)</enum><header>Eligible
entities</header>
<subparagraph id="H23ACB29BFCB74617B272362F74003FF4"><enum>(A)</enum><header>In
general</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—</text>
<clause id="H767CA0023F27447BBFE94857B369A3F8"><enum>(i)</enum><text>two
of the organizations described in subparagraph (B); and</text>
</clause><clause id="H18A2DDF22C424C0BA156B3609F2605B0"><enum>(ii)</enum><text>one
of the institutions and entities described in subparagraph (C),</text>
</clause><continuation-text continuation-text-level="subparagraph">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).</continuation-text></subparagraph><subparagraph id="H663268ACE2034AF3A8E54C37A2022C8B"><enum>(B)</enum><header>Organizations
described</header><text>The organizations described in this subparagraph are
the following:</text>
<clause id="H1EE5374AB4104C67ACE601F6AFA3355"><enum>(i)</enum><text>Community or
migrant health centers.</text>
</clause><clause id="H952B5FEF30304AC69FB1B4B93CBD2083"><enum>(ii)</enum><text>Local health
departments.</text>
</clause><clause id="HE42BC7BAA65B42F9971800009BDE66E8"><enum>(iii)</enum><text>Nonprofit
hospitals.</text>
</clause><clause id="H4C81DDF7701140EF00008C17E091AABF"><enum>(iv)</enum><text>Private practice
health professionals, including community and rural health clinics.</text>
</clause><clause id="HAB9FB2985C50467A8B50D30545D6507F"><enum>(v)</enum><text>Other publicly
funded health or social services agencies.</text>
</clause><clause id="H59114B39C91F4C5D8B895C340442C7E6"><enum>(vi)</enum><text>Skilled nursing
facilities.</text>
</clause><clause id="H73B2B9A527C14FC99D46D52E3925A5B7"><enum>(vii)</enum><text>County mental
health and other publicly funded mental health facilities.</text>
</clause><clause id="H08EA5575DFBB4BBBAB7DE6F00885363"><enum>(viii)</enum><text>Providers of
home health services.</text>
</clause><clause id="HF67AF4FF0DDD41D995A9448615C34B3D"><enum>(ix)</enum><text>Renal dialysis
facilities.</text>
</clause></subparagraph><subparagraph id="H92696F73878D4BD6B64B3D2F5D707244"><enum>(C)</enum><header>Institutions and
entities described</header><text>The institutions and entities described in
this subparagraph are the following:</text>
<clause id="HF21C50AA431A44DABBFCB4544D27DBD7"><enum>(i)</enum><text>A
public school.</text>
</clause><clause id="H73907319AC504B938320FE012CD91206"><enum>(ii)</enum><text>A
public library.</text>
</clause><clause id="H80A8D5E5575945E5BBFBF9790212255D"><enum>(iii)</enum><text>A
university or college.</text>
</clause><clause id="HF9FF5B126A3F484DAA35F1E7E11FDB48"><enum>(iv)</enum><text>A
local government entity.</text>
</clause><clause id="HD7A68D06EEB342758F571B7758202490"><enum>(v)</enum><text>A
local health entity.</text>
</clause><clause id="H0612BC52A38548FDA29E288FD269DF3B"><enum>(vi)</enum><text>A
health-related nonprofit foundation.</text>
</clause><clause id="HD5B3CE2699E54ED4B535D4C8B030B689"><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="HE6FDADB617074A528D83F2F75F266202"><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="H64CCCA72801B434398929C6DA28131EC"><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="HB6158136CFE640ADB1037BF197DD25DF"><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="H69BCDE79AB0A4BAC85A42F18FCBD6F68"><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="H0D120DE246D34363B113AD2DD4BAF1F7"><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="HA49484B1D7784DCD831755EED1EAFBC"><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="H04B4FBAC6CC846F4AD2702F8FDC8C9E"><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="HBBFA1BE85F534D39A1A8AFE51DD2C04F"><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="H03BFEB28006349F7AD379B006303F125"><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="H203EB5FF5CA74608B020BDE3ABC2734"><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="HECF00B075A424ECDB7E9C0F0ECD89BBB"><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="H8D5EB1ABC51741049C8322E00008DE12"><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="H4B91B945789C4C5895F23394AC8E9138"><enum>(3)</enum><text>The development
and acquisition of instructional programming.</text>
</paragraph><paragraph id="HA1CBE8DC1E9243ECB5BFD0FDF45FFAF1"><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="HBE113904C03441819FDF931EE38140DF"><enum>(5)</enum><text>The provision of
telenursing services designed to enhance care coordination and promote patient
self-management skills.</text>
</paragraph><paragraph id="H7C0491C740CB4585A5184554E0F24000"><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="H0367DD3AB4444F58B785FB1DCCCD22B"><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="HC7444115FF59481884ACEF4C4500F485"><enum>(8)</enum><text>Development of
projects to use telehealth to facilitate collaboration between health care
providers.</text>
</paragraph><paragraph id="H01083BEC7BBD473FBA8D76FB24D98100"><enum>(9)</enum><text>Electronic
archival of patient records.</text>
</paragraph><paragraph id="H1FEE58A3C10C40CC8F3773B622C053B"><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="H7A292C6B46FD4BECBE8B087E7BC3E1E0"><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="H5731B5C4E22D4823AF4C27906F40693E"><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="H152D44C42DFA463CB5881EB25363ED8B"><enum>(1)</enum><text>To acquire real
property.</text>
</paragraph><paragraph id="H4F8220C74CB945E0004B77C8DED36655"><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="HC637B1EAC5FA4E2EAFAA1617389782CB"><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="H0616E2B5A7BB498D88185CE42B18A39F"><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="H65E860EC983940E8B280D97C4D6D2F8E"><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="HD8271EC777E94A41BF74D4435827B6A1"><enum>(g)</enum><header>Administration</header>
<paragraph id="HD23EC98E81D94FD8B71D269DD52CF787"><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="HCFE17361A0654A9AAD40EA7B40A9E815"><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="H1F6D6B1A1D094651822C7DC6DB99500"><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="H352C307950FE47D7BFA97BA22F671717"><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="H78AB2FF334FA49519947324BEAF62060"><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 2010, and such sums as may be
necessary for each of the fiscal years 2011 through 2014.</text>
</subsection></section><section id="HB20DE0FA2B63416395E4F4FC12731B4"><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 (42 U.S.C. 254c–14) is
amended—</text>
<paragraph id="HBEB1731899B64CE38465A55E7F7F21C2"><enum>(1)</enum><text>in paragraph
(1)—</text>
<subparagraph id="H3E912E439B524832B1BF50F924C96C5"><enum>(A)</enum><text>by striking
<quote>and</quote> before <quote>such sums</quote>; and</text>
</subparagraph><subparagraph commented="no" id="H67DC4BAD071B4339BADB34384788F07F"><enum>(B)</enum><text>by inserting
<quote>$10,000,000 for fiscal year 2010, and such sums as may be necessary for
each of fiscal years 2011 through 2014</quote> before the semicolon; and</text>
</subparagraph></paragraph><paragraph id="H4E78923036454F50A24DE725EF000664"><enum>(2)</enum><text>in paragraph
(2)—</text>
<subparagraph id="HDABBCFDE68D94FC6BC00862910476D6E"><enum>(A)</enum><text>by striking
<quote>and</quote> before <quote>such sums</quote>; and</text>
</subparagraph><subparagraph commented="no" id="HE2B077F55A044D60B8DBAF60389D764E"><enum>(B)</enum><text>by inserting
<quote>$10,000,000 for fiscal year 2010, and such sums as may be necessary for
each of fiscal years 2011 through 2014</quote> before the semicolon.</text>
</subparagraph></paragraph></section>