[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 92 Introduced in House (IH)]

112th CONGRESS
  1st Session
                                 H. R. 92

  To amend title XVIII of the Social Security Act to provide payments 
 under the Medicare Program to licensed health care practitioners for 
   unscheduled telephone consultation services in the case that such 
       payments are determined to be cost and quality effective.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            January 5, 2011

 Mrs. Biggert introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
  To amend title XVIII of the Social Security Act to provide payments 
 under the Medicare Program to licensed health care practitioners for 
   unscheduled telephone consultation services in the case that such 
       payments are determined to be cost and quality effective.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Tele-Care Act of 2011''.

SEC. 2. MEDICARE PAYMENT FOR UNSCHEDULED PHYSICIAN TELEPHONE SERVICES.

    (a) Coverage Under Part B.--
            (1) In general.--Section 1861(s)(2) of the Social Security 
        Act (42 U.S.C. 1395x(s)(2)) is amended--
                    (A) in subparagraph (EE), by striking ``and'' at 
                the end;
                    (B) in subparagraph (FF), by adding at the end 
                ``and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(GG) subject to section 2(c) of the Tele-Care Act 
                of 2011, unscheduled telephone consultation services 
                (as defined in subsection (iii)(1)) by a licensed 
                health care practitioner, as defined by the Secretary 
                (such as a physician, nurse practitioner, physician 
                assistant, or nurse midwife), with respect to the 
                furnishing of primary care services to an individual, 
                if--
                            ``(i) the Medicare number of the individual 
                        is associated with the national provider 
                        identifier of the licensed health care 
                        practitioner;
                            ``(ii) to ensure the quality and 
                        appropriateness of such consultation services, 
                        the utilization of such services by the 
                        individual can be reviewed by a utilization and 
                        quality control peer review organization or 
                        eligible entity with which the Secretary has 
                        entered into a contract under part B of title 
                        XI or section 1893, respectively, by the 
                        organization or entity applying for purposes of 
                        the review under this subparagraph the 
                        processes and standards used by such 
                        organization or entity under such part or 
                        section, respectively, in the same manner that 
                        such processes and standards apply for purposes 
                        of carrying out utilization and quality review 
                        under such part or section, respectively;
                            ``(iii) such consultation services are 
                        securely recorded by the Secretary (or an 
                        entity described in subsection (iii)(1) with 
                        which the Secretary enters into a contract) for 
                        purposes of appropriate review by peers of the 
                        licensed health care practitioner who practice 
                        in the same medical specialty as the licensed 
                        health care practitioner and Medicare 
                        administrative contractor oversight of such 
                        services; and
                            ``(iv) the licensed health care 
                        practitioner provides for the submission to the 
                        Secretary (or an entity described in subsection 
                        (iii)(1) with which the Secretary enters into a 
                        contract) and the Secretary (or such an entity) 
                        records and maintains a summary of each such 
                        consultation service furnished by the licensed 
                        health care practitioner that includes--
                                    ``(I) the date and time (including 
                                duration) of the consultation service;
                                    ``(II) a unique medical record 
                                number specified by the Secretary (or 
                                such entity) to identify the 
                                consultation service;
                                    ``(III) the name of the individual;
                                    ``(IV) the name of the licensed 
                                health care practitioner; and
                                    ``(V) a summary of the content of 
                                the consultation service;''.
            (2) Unscheduled telephone consultation services defined.--
        Section 1861 of such Act (42 U.S.C. 1395x) is amended by adding 
        at the end the following new subsection:

             ``Unscheduled Telephone Consultation Services

    ``(iii)(1) The term `unscheduled telephone consultation service' 
means a consultation conducted by means of telephone or similar 
electronic communication device between a licensed health care 
practitioner described in subsection (s)(2)(GG) and an individual (or a 
representative of such individual), with respect to the furnishing of 
primary care services to such individual, that is not included as a 
scheduled physician service (as defined by the Secretary in 
regulations), and which is initiated by the individual (or 
representative) contacting a communication network operated by the 
Secretary (or an entity with which the Secretary enters into a 
contract) that connects the individual to the licensed health care 
practitioner, securely records the consultation for purposes of 
subsection (s)(2)(GG), and maintains the information described in 
clause (iv) of such subsection with respect to such consultation.
    ``(2) For purposes of applying the regulations promulgated pursuant 
to section 264(c) of the Health Insurance Portability and 
Accountability Act of 1996 (Public Law 104-191; 110 Stat. 2033) with 
respect to an unscheduled telephone consultation service furnished by a 
licensed health care practitioner--
            ``(A) an entity with which the Secretary contracts under 
        this subsection shall be treated as a health oversight agency; 
        and
            ``(B) activities of such an entity described in 
        subparagraph (A) in relation to such licensed health care 
        practitioner and such unscheduled telephone consultation 
        service are deemed to be health oversight activities.''.
    (b) Payment Under Physician Fee Schedule.--Section 1848(j)(3) of 
such Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting ``(2)(GG),'' 
after ``health risk assessment),''.
    (c) Contingent Effective Date, Demonstration Program.--
            (1) Contingent effective date.--The amendments made by this 
        section shall become effective (if at all) in accordance with 
        paragraph (2).
            (2) Demonstration program.--
                    (A) In general.--The Secretary of Health and Human 
                Services (in this paragraph referred to as the 
                ``Secretary'') shall establish a demonstration program 
                to begin not later than 6 months after the date of the 
                enactment of this Act to test the effectiveness of 
                providing coverage under the Medicare program for 
                unscheduled telephone consultation services (as defined 
                in section 1861(iii) of the Social Security Act, as 
                added by subsection (a)(2)), by licensed health care 
                practitioners to the extent provided under the 
                amendments made by this section to a sample group of 
                Medicare beneficiaries. For purposes of such 
                demonstration program, the Secretary shall find that 
                the provision of such coverage is effective if--
                            (i) the coverage reduces costs to the 
                        Medicare program (such as through a reduction 
                        in admissions to the emergency departments of 
                        hospitals), whether or not such reduction is 
                        demonstrated in a reduction in the facility 
                        fees of hospital emergency departments, 
                        professional fees of emergency department 
                        licensed health care practitioners, laboratory 
                        fees, pathologist fees, hospital radiology 
                        department fees for technical components of x-
                        rays, radiologist professional fees for 
                        interpreting x-rays, hospital respiratory 
                        department fees for respiratory treatments, 
                        hospital cardiology department fees for 
                        electrocardiograms, professional fees for 
                        interpreting such electrocardiograms, or any 
                        other cost specified by the Secretary; and
                            (ii) the coverage results in patient health 
                        outcomes that are at least as favorable as 
                        would apply in the absence of such coverage (as 
                        determined in accordance with criteria 
                        established by the Centers for Medicare & 
                        Medicaid Services, in consultation with 
                        physician organizations).
                    (B) Initial period of demonstration program.--The 
                demonstration program under subparagraph (A) shall be 
                conducted for an initial period of 24 months.
                    (C) Report to congress.--
                            (i) In general.--Not later than 30 days 
                        after the last day of the initial period under 
                        subparagraph (B), the Secretary shall submit to 
                        Congress a report on the results of the 
                        demonstration program under this paragraph.
                            (ii) Finding that payments are effective.--
                        If the Secretary finds, on the basis of the 
                        data derived from the demonstration program 
                        under subparagraph (A) and in accordance with 
                        such subparagraph, that providing coverage 
                        under the Medicare program for unscheduled 
                        telephone consultation services by licensed 
                        health care practitioners (to the extent 
                        provided under the amendments made by this 
                        section) is effective, the amendments made by 
                        this section shall become effective on the 
                        first day of the first month beginning after 
                        the date the report under clause (i) is 
                        submitted to Congress.
                            (iii) Finding that payments are not 
                        effective.--If the Secretary finds, on the 
                        basis of the data derived from the 
                        demonstration program under subparagraph (A) 
                        and in accordance with such subparagraph, that 
                        a finding of effectiveness (as described in 
                        clause (ii)) cannot be made, the demonstration 
                        program shall continue for a period of an 
                        additional 24 months. Not later than 30 days 
                        after the last day of such period, the 
                        Secretary shall submit to Congress a final 
                        report on the results of such program. The 
                        amendments made by this section shall become 
                        effective on the first day of the first month 
                        beginning after the date such report is 
                        submitted to Congress unless the report 
                        contains a finding by the Secretary, on the 
                        basis of such data and in accordance with such 
                        subparagraph, that providing coverage under the 
                        Medicare program for unscheduled telephone 
                        consultation services by licensed health care 
                        practitioners (to the extent provided under the 
                        amendments made by this section) is not 
                        effective, in which case the amendments made by 
                        this section shall not become effective.
    (d) Clarification.--Nothing in the provisions of this section or 
the amendments made by this section shall be construed as authorizing 
the creation of a national reporting system on licensed health care 
practitioner quality.
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