[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5190 Introduced in House (IH)]
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116th CONGRESS
1st Session
H. R. 5190
To amend the Public Health Service Act to provide assistance for health
centers and rural health clinics to implement electronic provider
consultation and related telemedicine services.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
November 20, 2019
Mr. Harder of California (for himself, Mr. Young, Mr. Fortenberry, Ms.
Torres Small of New Mexico, and Mr. Steube) introduced the following
bill; which was referred to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to provide assistance for health
centers and rural health clinics to implement electronic provider
consultation and related telemedicine services.
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 ``Specialty Treatment to Access and
Referrals Act of 2019'' or the ``STAR Act''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Telemedicine involving the delivery of safe, effective,
quality health care services by a health care provider using
electronic information technology as the mode of care delivery
is a clinically appropriate and efficient method of furnishing
many health care services.
(2) Consultations between health care providers utilizing
electronic information technology (in this section referred to
as ``E-Consult services'') are feasible in a variety of
settings, flexible in their application, and particularly
useful in facilitating the timely provision of information from
a clinician with specialized knowledge of a relevant medical
subject matter to a treating clinician in order to improve care
quality.
(3) E-Consult services formalize the role of medical
specialists, can be undertaken entirely within electronic
exchange platforms that are private and secure, and do not
require synchronous communication between providers.
(4) E-Consult services conducted in advance of a
telemedicine service can improve the effectiveness of the
subsequent telemedicine service.
(5) E-Consult services are being utilized extensively by
the Veterans Health Administration and by a growing number of
academic medical centers and other public and private health
care settings both in the United States and internationally.
(6) There is a need for additional extensive and rigorous
research studies to determine best practices and processes for
E-Consult services and to validate the impact on access to
specialty medical care, costs, and clinical outcomes.
(7) Providing the expertise and technical assistance
necessary to implement E-Consult services in primary care
settings could improve access to specialty care at relatively
low cost while simultaneously providing a testbed to evaluate
the merits of varying approaches to E-Consult services,
ascertain the value of such programs, and experiment with
service reimbursement strategies in fee-for-service
environments, including value-based care delivery arrangements
such as through accountable care organizations.
SEC. 3. E-CONSULT SERVICES AND RELATED TELEHEALTH ASSISTANCE PILOT
PROGRAM.
Title III of the Public Health Service Act is amended by inserting
after section 330M (42 U.S.C. 254c-19) the following new section:
``SEC. 330N. E-CONSULT SERVICES AND RELATED TELEHEALTH ASSISTANCE PILOT
PROGRAM.
``(a) In General.--The Secretary may award grants to eligible
health center controlled networks, health centers, and rural health
clinics described in subsection (e) to conduct pilot projects to
implement and test the effectiveness of E-Consult services and related
telehealth services furnished at such networks, centers, and clinics
for purposes of addressing the goals described in subsection (b).
``(b) Objectives.--A pilot project conducted pursuant to a grant
awarded under subsection (a) shall address the following goals:
``(1) Improvement in patient access to specialty care.
``(2) Reduction in specialty care patient wait times.
``(3) Reduction in patient specialty referrals.
``(4) Reduction in patient miles traveled for specialty
care consultations.
``(5) Increased support for primary care providers as
demonstrated by job satisfaction measures.
``(6) Increased patient satisfaction as demonstrated by
quality surveys.
``(7) Health care cost savings.
``(8) Such other goals as the Secretary may identify.
``(c) Duration; Amount.--
``(1) Duration.--A grant awarded under subsection (a) shall
be for a term of no more than 5 years.
``(2) Amount.--In the case of a grant made under subsection
(a) directly to an eligible health center or rural health
clinic, the amount provided may not exceed $200,000 for each
center or clinic facility location. In the case of an award to
an eligible health center controlled network, the amount
provided may not exceed $5,000,000, and the value of the amount
of assistance provided by such network to any individual
participating health center or rural clinic facility location
may not exceed $200,000.
``(d) Use of Funds.--Funds provided under a grant pursuant to this
section may only be used for the following, with respect to a pilot
project conducted by a health center controlled network, health center,
or rural health clinic:
``(1) Conducting assessments of a participating facility's
infrastructure (such as broadband, equipment, and software),
clinical objectives, and staffing plans.
``(2) Based on assessment findings, developing and
assisting in the execution of equipment and software
procurement, defining clinical objectives, developing adequate
staffing plans, and implementing E-Consult services and related
telehealth services program plan.
``(3) Training participating facility staff to properly
utilize technology and implement programs.
``(4) Providing clinical workflow training to support
program implementation.
``(5) Providing integrated certified EHR technology
capabilities to support live video (where applicable) and E-
Consult services.
``(6) Integrating the facility with live E-Consult service
support providers and networks that meet the patient goals of
the network, center, or clinic.
``(7) Procuring appropriate information technology and
undertaking minor alterations of physical space.
``(8) Otherwise carrying out the pilot project to address
the objectives described in subsection (b).
``(e) Participating Facilities; Eligible Entities.--
``(1) Participating facilities.--A location of a health
center or rural health clinic shall qualify to participate in a
pilot program established pursuant to this section if the
center or clinic demonstrates in a manner determined by the
Secretary that such location--
``(A) lacks sufficient access to care provided by
medical specialists, as determined by the Secretary;
and
``(B) has not already implemented a program of E-
Consult services and related telehealth services
similar to that described in this section.
``(2) Requirements to be eligible to receive a grant.--To
be eligible to receive a grant under subsection (a), an entity
must--
``(A) be--
``(i) a health center controlled network
that demonstrates to the satisfaction of the
Secretary--
``(I) sufficient expertise and
experience in the successful provision
of the technical and other assistance
required under for health centers and
rural health clinics to conduct a pilot
project in accordance with this
section;
``(II) evidence of sufficient
binding participation commitments
received from eligible health centers
and rural health clinics;
``(III) the ability to assist
eligible health centers and rural
health clinics to conduct E-Consult
services with medical specialists and
related telehealth services; and
``(IV) a likelihood of successfully
accomplishing the program objectives as
identified in subsection (b); or
``(ii) a qualifying health center or rural
health clinic that demonstrates to the
satisfaction of the Secretary--
``(I) sufficient expertise and
ability to implement on its own behalf
the technical and other assistance
described in subparagraph (A)(i);
``(II) a likelihood of successfully
implementing a program of E-Consult
services with medical specialists and
related telehealth services; and
``(III) a likelihood of
successfully accomplishing the program
objectives as identified in subsection
(b); and
``(B) submit an application described in paragraph
(3) to the Secretary in such form and manner, and in
accordance with such timing, as specified by the
Secretary.
``(3) Application.--For purposes of paragraph (2)(B), an
application described in this paragraph, with respect to an
applicant, is an application that demonstrates to the
satisfaction of the Secretary--
``(A) in the case of an applicant that is a health
center controlled network, the intention of a
sufficient minimum number of eligible health centers to
participate in the program through the network and a
plan for recruiting additional centers to participate;
``(B) the qualification of proposed facility
locations to participate in the program;
``(C) requisite experience, expertise, and
capacity;
``(D) likelihood of meeting program objectives
described in subsection (b); and
``(E) internal program metrics that will be
employed to demonstrate satisfaction of program
objectives and information to be collected and provided
to the Secretary as necessary to conduct program
evaluation.
``(f) Evaluation; Report.--Not later than 180 days after the date
of the completion of the last pilot projects funded under this section,
the Secretary shall submit to Congress a report, including an
evaluation, on the projects that addresses the following:
``(1) An overview of supported projects and identification
of areas of success and failure.
``(2) Policies, practices, and organizational approaches
that either facilitate or impede the effective use of E-Consult
services (including personnel training and support, technology
usability, workflow, and provider communication).
``(3) Relative effectiveness of consultations provided by
Medical Specialists in improving outcomes, quality of care and
efficiency with respect to different specialties, clinical
conditions, complexity, patient types, or other issues.
``(4) The extent to which information shared in the E-
Consult services process is sufficient, accurate, and
actionable in order to effectively facilitate care improvement,
and whether such bi-directional information flows can be
standardized.
``(5) The extent to which E-Consults facilitate continuity
of care.
``(6) Any issues arising related to maintaining the privacy
of personal health information, ensuring cybersecurity, and
other information security issues.
``(7) The extent to which E-Consult services contribute to
improved health outcomes and metrics that can facilitate such
evaluation.
``(8) Any unintended or adverse results from utilizing E-
Consult services.
``(g) Definitions.--For purposes of this section:
``(1) Certified ehr technology.--The term `certified EHR
technology' has the meaning given such term in section 3000(1).
``(2) E-Consult service.--The term `E-Consult service'
means synchronous or asynchronous, consultative, health-care-
provider-to-health-care-provider communications that occur
within a shared certified EHR technology or secure internet-
based platform and are primarily intended to provide specialty
expertise to treating clinicians (who are often primary care
providers) without requiring a direct interaction between the
patient and the medical specialist. Such consultation
ordinarily involves a treating clinician sending information
regarding the patient and a consultation request to a medical
specialist who may then respond in any of a number of ways,
including providing requested feedback, asking for additional
information, recommending certain studies or examinations, or
initiating the scheduling of an appointment.
``(3) Health center.--The term `health center' has the
meaning given such term in section 330(a).
``(4) Health center controlled network.--The term `health
center controlled network' means a network that is owned and
controlled by constituent health centers as described in
section 330(e)(1)(C).
``(5) Primary care provider.--The term `primary care
provider' means a licensed health professional (as defined in
section 1819(b)(5)(G) of the Social Security Act) or a licensed
provider of behavioral health services who customarily provides
services described in paragraph (1) or (2) of section 330(b) to
patients.
``(6) Medical specialist.--The term `medical specialist'
means a licensed physician or a nurse practitioner who has
completed advanced education and clinical training in a one or
more specific areas of medicine and focuses their medical
practice on such area or areas. Such term may, if specified by
the Secretary, include a licensed provider of behavioral health
services.
``(7) Related telehealth services.--The term `related
telehealth services' means telehealth services arising out of
or incident to an E-Consult service, such as laboratory tests,
diagnostic imaging, or a subsequent interaction between a
medical specialist and a patient.
``(8) Rural health clinic.--The term `rural health clinic'
has the meaning give such term in section 1861(aa)(2) of the
Social Security Act.
``(9) Telehealth.--The term `telehealth' means the use of
electronic information and telecommunications technologies
(including videoconferencing, the internet, store-and-forward
imaging, streaming media, and terrestrial and wireless
communications) to support and promote long-distance clinical
health care, patient and professional health-related education,
public health, and health administration.
``(h) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $12,000,000 for each of fiscal
years 2021 through 2025.''.
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