[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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