[Congressional Record Volume 142, Number 138 (Monday, September 30, 1996)]
[Senate]
[Pages S11982-S11986]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CONRAD (for himself and Mr. Kerrey):

  S. 2171. A bill to provide reimbursement under the Medicare Program 
for telehealth services, and for other purposes; to the Committee on 
Finance.


                THE COMPREHENSIVE TELEHEALTH ACT OF 1996

 Mr. CONRAD. Mr. President, today, I am introducing legislation 
to help improve health care delivery in rural and underserved 
communities throughout America through the use of telecommunications 
and telehealth technology.
  Telehealth encompasses a wide variety of technologies, ranging from 
the telephone to high-tech equipment that enables a surgeon to perform 
surgery from thousands of miles away. It includes interactive video 
equipment, fax machines and computers along with satellites and fiber 
optics. These technologies can be used to diagnose patients, deliver 
care, transfer health data, read x rays, provide consultation, and 
educate health professionals. Telehealth also includes the electronic 
storage and transmission of personally identifiable health information, 
such as medical records, test results, and insurance claims.

[[Page S11983]]

  The promise of telehealth is becoming increasingly apparent. 
Throughout the country, providers are experimenting with a variety of 
telehealth approaches in an effort to improve access to quality medical 
and other health-related services. Those programs are demonstrating 
that telecommunications technology can alleviate the constraints of 
time and distance, as well as the cost and inconvenience of 
transporting patients to medical providers. Many approaches show 
promising results in reducing health care costs and bringing adequate 
care to all Americans. Technological advances and the development of a 
national information infrastructure for the first time give telehealth 
the potential to overcome barriers to health care services for rural 
Americans and give them the access that most Americans take for 
granted. But it is clear that our Nation must do more to integrate 
telehealth into our overall health care delivery infrastructure.
  Because I believe telehealth holds incredible promise for rural 
America, I formed the ad hoc steering committee on telemedicine and 
health care informatics to explore telehealth and related issues in 
1994. The purpose of the steering committee, which includes 
telehealth experts from Government, private industry, and the health 
care professions, is to evaluate federal policies on telehealth and how 
to use telecommunications technology more effectively to increase 
access to health care throughout America.

  Throughout the last few years, as the steering committee held 
meetings and policy forums, it became increasingly apparent that there 
is enormous energy and financial effort being devoted to telehealth 
today, both by Government and private industry.
  Because so many rural and underserved communities lack the ability to 
attract and support a wide variety of health care professionals and 
services, it is important to find a way to bring the most important 
medical services into those communities. Telehealth provides an 
important part of the answer. It helps bring services to remote areas 
in a quick, cost-effective manner, and can enable patients to avoid 
traveling long distances in order to receive health care treatment.
  Telehealth is already making a difference in my State. The University 
of North Dakota has a fiber optic two-way audio and video interactive 
network that has been used to train students in areas like social work 
and medical technology. Recently, I had the opportunity to spend some 
time with two of the premier telehealth systems in the State of North 
Dakota. I was amazed at the capabilities of these systems. They 
currently supply speciality care to rural North Dakota clinics, manage 
chronic disease, lower administrative costs, and reduce the isolation 
felt by rural and frontier practitioners.
  Because telehealth is in many respects an emerging health care 
application, it is particularly important to constructively capitalize 
on efforts like these. My proposal attempts to facilitate this in a 
number of ways.
  The first element of my proposal builds on current demonstration 
projects to require the Health Care Financing Administration to put in 
place a reimbursement system for telehealth activities under Medicare. 
Medicare reimbursement policy is an essential component of helping 
integrate telehealth into the health care infrastructure, and must be 
explored. It is particularly important in rural areas, where many 
hospitals do as much as 80% of their business with Medicare patients.

  The second element of this proposal asks the Secretary of Health and 
Human Services to submit a report to the Congress on the status of 
efforts to ease licensing burdens on practioners who cross State lines 
in the course of supplying telehealth services. Currently, consultation 
by almost any licensed health professional in this situation requires 
that the practitioner be licensed in both States.
  In talking with telehealth providers in my State, and with experts on 
the Ad Hoc Committee, I have been told repeatedly that this is one of 
the most significant barriers to developing broad integrated telehealth 
systems. More importantly, they tell me States have actively been using 
licensure to close their borders to innovative telehealth practice. In 
the past two years, nine States have taken legislative action to ensure 
that out-of-state practitioners must be fully licensed in their State 
in order to provide telehealth services, even if they are fully 
licensed in the State they are practicing from. During a recent 
discussion with a telehealth practitioner from my home State of North 
Dakota, I was told about a group of telehealth specialists who, among 
their small group practice, were licensed in over 30 different States. 
That means they pay thirty different fees, are responsible for 30 
different continuing education requirements, and are overseen by 30 
different regulatory bodies. This is a costly and burdensome procedure 
for many practitioners, but the burden falls particularly heavily on 
rural practitioners, who face long travel times to acquire continuing 
education, and who frequently run on lower profit margins than urban 
practitioners.
  While I am not prepared at this time to propose that the Federal 
Government get involved with professional licensure, I have asked the 
Secretary to study the issue and report to Congress yearly on the 
status of efforts by states and other interested organizations to 
address this issue. As part of this report, I have asked to the 
Secretary to make recommendations to Congress, if appropriate, about 
possible Federal action to lower the licensure barrier.
  A third element of my proposal involves coordination of the Federal 
telehealth effort. Vice President Gore has been making outstanding 
contributions in the area of the information super highway. The 
Department of Health and Human Services, in large part at the urging of 
the Vice President, has created an informal interagency task force that 
is examining our Federal agency telehealth efforts. My bill attempts to 
use that task force to inventory Federal activity on telehealth and 
related technology, determine what applications have been found 
successful, and recommend an overall Federal policy approach to 
telehealth.

  Many departments and agencies of the Federal Government are engaged 
in telehealth activity, including the Veterans Administration, 
Department of Defense, Department of Agriculture, Office of Rural 
Health Policy, and many others. The more these agencies work together 
to coordinate the Federal effort and consolidate Federal resources, the 
more effective the Federal Government will be at contributing to 
telehealth in a positive way. Such coordination will also help protect 
the American taxpayer from unnecessary duplication of effort.
  The fourth part of my proposal helps communities build home-grown 
telehealth networks. It attempts to both build a telehealth 
infrastructure and foster rural economic development. Clearly, the 
scarcity of resources in many rural communities requires that the 
coordination and use of those resources be maximized. My bill 
encourages cooperation by various local entities in an effort to help 
build sustainable telehealth programs in rural communities. It plants 
seed money to encourage health care providers to join with other 
segments of the community to jointly use telecommunications resources. 
Using a unique loan forgiveness program, it rewards telehealth systems 
that supply appropriate, high-quality care while reducing overall 
health care costs.
  Most importantly, it does not create a system where various 
technological approaches are imposed upon communities. Rather it 
enables potential grantees to determine user-friendly approaches that 
work best for them. This home-grown approach to developing user-
friendly telehealth systems, as well as the preference for coordinating 
resources within communities, will help ensure the long-term viability 
of such programs after the grant expires.
  Mr. President, my proposal is a sound first step in our national 
efforts to integrate telecommunications technology into the rapidly 
evolving health care delivery system. Over the past several weeks, I 
have attempted to reach out to different groups and incorporate their 
ideas into this proposal. I hope the result is a bill that will command 
broad support. But, as with any complex issue, I understand that some 
may prefer different approaches. By introducing this legislation in the 
waning moments of the 104th Congress, I hope to send a message to all 
interested parties that now is the time to

[[Page S11984]]

come forward with creative solutions to these important issues, because 
I am certain that they will be revisited again in the 105th Congress.
  Mr. President, I ask unanimous consent that additional material be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                S. 2171

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

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the 
     ``Comprehensive Telehealth Act of 1996''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings and purposes.

        TITLE I--MEDICARE REIMBURSEMENT FOR TELEHEALTH SERVICES

Sec. 101. Medicare reimbursement for telehealth services.

                     TITLE II--TELEHEALTH LICENSURE

Sec. 201. Initial report to Congress.
Sec. 202. Annual report to Congress.

TITLE III--PERIODIC REPORTS TO CONGRESS FROM THE JOINT WORKING GROUP ON 
                               TELEHEALTH

Sec. 301. Joint working group on telehealth.

              TITLE IV--DEVELOPMENT OF TELEHEALTH NETWORKS

Sec. 401. Development of telehealth networks.
Sec. 402. Administration.
Sec. 403. Guidelines.
Sec. 404. Authorization of appropriations.

     SEC. 2. FINDINGS AND PURPOSES.

       (a) Findings.--The Congress finds the following:
       (1) Hospitals, clinics, and individual health care 
     providers are critically important to the continuing health 
     of rural populations and the economic stability of rural 
     communities.
       (2) Rural communities are underserved by specialty care 
     providers.
       (3) Telecommunications technology has made it possible to 
     provide a wide range of health care services, education, and 
     administrative services between practitioners, patients, and 
     administrators across State lines.
       (4) The delivery of health services by licensed health 
     practitioners is a privilege and the licensure of health care 
     practitioners and the ability to discipline such 
     practitioners is necessary for the protection of citizens and 
     for the public interest, health, welfare, and safety.
       (5) The licensing of health care practitioners to provide 
     telehealth services has a significant impact on interstate 
     commerce and any unnecessary barriers to the provision of 
     telehealth services across State lines should be eliminated.
       (6) Rapid advances in the field of telehealth give the 
     Congress a need for current information and updates on recent 
     developments in telehealth research, policy, technology, and 
     the use of this technology to supply telehealth services to 
     rural and underserved areas.
       (7) Telehealth networks can provide hospitals, clinics, 
     practitioners, and patients in rural and underserved 
     communities with access to specialty care, continuing 
     education, and can act to reduce the isolation from other 
     professionals that these practitioners sometimes experience.
       (8) In order for telehealth systems to continue to benefit 
     rural and underserved communities, medicare must reimburse 
     the provision of health care services from remote locations 
     via telecommunications.
       (b) Purposes.--The purposes of this Act are as follows:
       (1) To mandate that the Health Care Financing 
     Administration reimburse the provision of clinical health 
     services via telecommunications.
       (2) To determine if States are making progress in 
     facilitating the provision of telehealth services across 
     State lines.
       (3) To create a coordinating entity for Federal telehealth 
     research, policy, and program initiatives that reports to 
     Congress annually.
       (4) To encourage the development of rural telehealth 
     networks that supply appropriate, cost-effective care, and 
     which contribute to the economic health and development of 
     rural communities.
       (5) To encourage research into the clinical efficacy and 
     cost-effectiveness of telehealth diagnosis, treatment, or 
     education on individuals, practitioners, and health care 
     networks.
        TITLE I--MEDICARE REIMBURSEMENT FOR TELEHEALTH SERVICES

     SEC. 101. MEDICARE REIMBURSEMENT FOR TELEHEALTH SERVICES.

       (a) In General.--Not later than January 1, 1998, the 
     Secretary of Health and Human Services (hereafter in this 
     section referred to as the ``Secretary'') shall make payments 
     from the Federal Supplementary Medical Insurance Trust Fund 
     under part B of title XVIII of the Social Security Act in 
     accordance with the methodology described in subsection (b) 
     for professional consultation via telecommunication systems 
     with an individual or entity furnishing a service for which 
     payment may be made under such part to a medicare beneficiary 
     residing in a rural area (as defined in section 1886(d)(2)(D) 
     of such Act) or an underserved area, notwithstanding that the 
     individual health care practitioner providing the 
     professional consultation is not at the same location as the 
     individual furnishing the service to the medicare 
     beneficiary.
       (b) Methodology for Determining Amount of Payments.--Taking 
     into account the findings of the report required under 
     section 192 of the Health Insurance Portability and 
     Accountability Act of 1996, including those findings relating 
     to the clinical efficacy and cost-effectiveness of telehealth 
     applications, the Secretary shall establish a methodology for 
     determining the amount of payments made under subsection (a), 
     including the cost of the consultation service, a reasonable 
     overhead adjustment, and a malpractice risk adjustment.
       (c) Additional Analysis Included in Report.--Section 192 of 
     the Health Insurance Portability and Accountability Act of 
     1996 is amended--
       (1) by inserting ``and telehealth'' after ``telemedicine'' 
     each place it appears, and
       (2) by redesignating paragraphs (2) and (3) as paragraphs 
     (3) and (4), respectively, and by inserting after paragraph 
     (1) the following new paragraph:
       ``(2) include an analysis of--
       ``(A) how telemedicine and telehealth systems are expanding 
     access to health care services,
       ``(B) the clinical efficacy and cost-effectiveness of 
     telemedicine and telehealth applications,
       ``(C) the quality of telemedicine and telehealth services 
     delivered, and
       ``(D) the reasonable cost of telecommunications charges 
     incurred in practicing telemedicine and telehealth in rural, 
     frontier, and underserved areas;''.
                     TITLE II--TELEHEALTH LICENSURE

     SEC. 201. INITIAL REPORT TO CONGRESS.

       Not later than July 1, 1997, the Secretary of Health and 
     Human Services shall prepare and submit to the appropriate 
     committees of Congress a report concerning--
       (1) the number, percentage and types of practitioners 
     licensed to provide telehealth services across State lines, 
     including the number and types of practitioners licensed to 
     provide such services in more than 3 States;
       (2) the status of any reciprocal, mutual recognition, fast-
     track, or other licensure agreements between or among various 
     States;
       (3) the status of any efforts to develop uniform national 
     sets of standards for the licensure of practitioners to 
     provide telehealth services across State lines;
       (4) a projection of future utilization of telehealth 
     consultations across State lines;
       (5) State efforts to increase or reduce licensure as a 
     burden to interstate telehealth practice; and
       (6) any State licensure requirements that appear to 
     constitute unnecessary barriers to the provision of 
     telehealth services across State lines.

     SEC. 202. ANNUAL REPORT TO CONGRESS.

       (a) In General.--Not later than July 1, 1998, and each July 
     1 thereafter, the Secretary of Health and Human Services 
     shall prepare and submit to the appropriate committees of 
     Congress, an annual report on relevant developments 
     concerning the matters referred to in paragraphs (1) through 
     (6) of section 201.
       (b) Recommendations.--If, with respect to a report 
     submitted under subsection (a), the Secretary of Health and 
     Human Services determines that States are not making progress 
     in facilitating the provision of telehealth services across 
     State lines by eliminating unnecessary requirements, adopting 
     reciprocal licensing arrangements for telehealth services, 
     implementing uniform requirements for telehealth licensure, 
     or other means, the Secretary shall include in the report 
     recommendations concerning the scope and nature of Federal 
     actions required to reduce licensure as a barrier to the 
     interstate provision of telehealth services.
TITLE III--PERIODIC REPORTS TO CONGRESS FROM THE JOINT WORKING GROUP ON 
                               TELEHEALTH

     SEC. 301. JOINT WORKING GROUP ON TELEHEALTH.

       (a) In General.--
       (1) Redesignation.--The Joint Working Group on 
     Telemedicine, established by the Secretary of Health and 
     Human Services, shall hereafter be known as the ``Joint 
     Working Group on Telehealth'' with the chairperson being 
     designated by the Director of the Office of Rural Health 
     Policy.
       (2) Mission.--The mission of the Joint Working Group on 
     Telehealth is--
       (A) to identify, monitor, and coordinate Federal telehealth 
     projects, data sets, and programs,
       (B) to analyze--
       (i) how telehealth systems are expanding access to health 
     care services, education, and information,
       (ii) the clinical, educational, or administrative efficacy 
     and cost-effectiveness of telehealth applications, and
       (iii) the quality of the services delivered, and
       (C) to make further recommendations for coordinating 
     Federal and State efforts to increase access to health 
     services, education, and information in rural and underserved 
     areas.
       (3) Periodic reports.--The Joint Working Group on 
     Telehealth shall report not later

[[Page S11985]]

     than January 1 of each year (beginning in 1998) to the 
     Congress on the status of the Group's mission and the state 
     of the telehealth field generally.
       (b) Report Specifics.--The annual report required under 
     subsection (a)(3) shall provide--
       (1) an analysis of--
       (A) how telehealth systems are expanding access to health 
     care services,
       (B) the clinical efficacy and cost-effectiveness of 
     telehealth applications,
       (C) the quality of telehealth services delivered,
       (D) the Federal activity regarding telehealth, and
       (E) the progress of the Working Group's efforts to 
     coordinate Federal telehealth programs; and
       (2) recommendations for a coordinated Federal strategy to 
     increase health care access through telehealth.
       (c) Termination.--The Joint Working Group on Telehealth 
     shall terminate immediately after the annual report filed not 
     later than January 1, 2002.
       (d) Authorization of Appropriations.--There are authorized 
     to be appropriated such sums as are necessary for the 
     operation of the Joint Working Group on Telehealth on and 
     after the date of the enactment of this Act.
              TITLE IV--DEVELOPMENT OF TELEHEALTH NETWORKS

     SEC. 401. DEVELOPMENT OF TELEHEALTH NETWORKS.

       (a) In General.--The Secretary of Health and Human Services 
     (hereafter referred to in this title as the ``Secretary''), 
     acting through the Director of the Office of Rural Health 
     Policy (of the Health Resources and Services Administration), 
     shall provide financial assistance (as described in 
     subsection (b)(1)) to recipients (as described in subsection 
     (c)(1)) for the purpose of expanding access to health care 
     services for individuals in rural and frontier areas through 
     the use of telehealth.
       (b) Financial Assistance.--
       (1) In general.--Financial assistance shall consist of 
     grants or cost of money loans, or both.
       (2) Form.--The Secretary shall determine the portion of the 
     financial assistance provided to a recipient that consists of 
     grants and the portion that consists of cost of money loans 
     so as to result in the maximum feasible repayment to the 
     Federal Government of the financial assistance, based on the 
     ability to repay of the recipient and full utilization of 
     funds made available to carry out this title.
       (3) Loan forgiveness program.--
       (A) Establishment.--With respect to cost of money loans 
     provided under this section, the Secretary shall establish a 
     loan forgiveness program under which recipients of such loans 
     may apply to have all or a portion of such loans forgiven.
       (B) Requirements.--A recipient described in subparagraph 
     (A) that desires to have a loan forgiven under the program 
     established under such paragraph shall--
       (i) within 180 days of the end of the loan cycle, submit an 
     application to the Secretary requesting forgiveness of the 
     loan involved;
       (ii) demonstrate that the recipient has a financial need 
     for such forgiveness;
       (iii) demonstrate that the recipient has met the quality 
     and cost-appropriateness criteria developed under 
     subparagraph (C); and
       (iv) provide any other information determined appropriate 
     by the Secretary.
       (C) Criteria.--As part of the program established under 
     subparagraph (A), the Secretary shall establish criteria for 
     determining the cost-effectiveness and quality of programs 
     operated with loans provided under this section.
       (c) Recipients.--
       (1) Application.--To be eligible to receive a grant or loan 
     under this section an 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--
       (A) a description of the anticipated need for the grant or 
     loan;
       (B) a description of the activities which the entity 
     intends to carry out using amounts provided under the grant 
     or loan;
       (C) a plan for continuing the project after Federal support 
     under this section is ended;
       (D) a description of the manner in which the activities 
     funded under the grant or loan will meet health care needs of 
     underserved rural populations within the State;
       (D) 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;
       (E) the source and amount of non-Federal funds the entity 
     would pledge for the project; and
       (F) a showing of the long-term viability of the project and 
     evidence of provider commitment to the network.
     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.
       (2) Eligible entities.--An entity described in this 
     paragraph is a hospital or other health care provider in a 
     health care network of community-based providers that 
     includes at least--
       (A) two of the following:
       (i) community or migrant health centers;
       (ii) local health departments;
       (iii) nonprofit hospitals;
       (iv) private practice health professionals, including rural 
     health clinics;
       (v) other publicly funded health or social services 
     agencies;
       (vi) skilled nursing facilities;
       (vii) county mental health and other publicly funded mental 
     health facilities; and
       (viii) home health providers; and
       (B) one of the following, which must demonstrate use of the 
     network for purposes of education and economic development 
     (as required by the Secretary):
       (i) public schools;
       (ii) public library;
       (iii) universities or colleges;
       (iv) local government entity; or
       (v) local nonhealth-related business entity.
     An eligible entity may include for-profit entities so long as 
     the network grantee is a nonprofit entity.
       (d) Priority.--The Secretary shall establish procedures to 
     prioritize financial assistance under this title considering 
     whether or not the applicant--
       (1) is a health care provider in a rural health care 
     network or a provider that proposes to form such a network, 
     and the majority of the providers in such a network are 
     located in a medically underserved, health professional 
     shortage areas, or mental health professional shortage areas;
       (2) can demonstrate broad geographic coverage in the rural 
     areas of the State, or States in which the applicant is 
     located;
       (3) 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;
       (4) will use the amounts provided for a range of health 
     care applications and to promote greater efficiency in the 
     use of health care resources;
       (5) can demonstrate the long term viability of projects 
     through use of local matching funds (cash or in-kind); and
       (6) can demonstrate financial, institutional, and community 
     support for the long-term viability of the network.
       (e) Maximum Amount of Assistance to Individual 
     Recipients.--The Secretary may establish the maximum amount 
     of financial assistance to be made available to an individual 
     recipient for each fiscal year under this title, and 
     establish the term of the loan or grant, by publishing notice 
     of the maximum amount in the Federal Register.
       (f) Use of Amounts.--
       (1) In general.--Financial assistance provided under this 
     title shall be used--
       (A) with respect to cost of money loans, to encourage the 
     initial development of rural telehealth networks, expand 
     existing networks, or link existing networks together; and
       (B) with respect to grants, as described in paragraph (2).
       (2) Grants and loans.--The recipient of a grant or loan 
     under this title may use financial assistance received under 
     such grant or loan for the acquisition of telehealth 
     equipment and modifications or improvements of 
     telecommunications facilities including--
       (A) 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;
       (B) the provision of technical assistance and instruction 
     for the development and use of such programming equipment or 
     facilities;
       (C) the development and acquisition of instructional 
     programming;
       (D) demonstration projects for teaching or training medical 
     students, residents, and other health professions students in 
     rural training sites about the application of telehealth;
       (E) transmission costs, maintenance of equipment, and 
     compensation of specialists and referring practitioners;
       (F) development of projects to use telehealth to facilitate 
     collaboration between health care providers;
       (G) electronic archival of patient records;
       (H) collection of usage statistics; or
       (I) such other uses that are consistent with achieving the 
     purposes of this section as approved by the Secretary.
       (3) Expenditures in rural areas.--In awarding a grant or 
     cost of money loan under this section, the Secretary shall 
     ensure that not less than 50 percent of the grant or loan 
     award is expended in a rural area or to provide services to 
     residents of rural areas.
       (g) Prohibited Uses.--Financial assistance received under 
     this section may not be used for any of the following:
       (1) To build or acquire real property.
       (2) Expenditures to purchase or lease equipment to the 
     extent the expenditures would exceed more than 40 percent of 
     the total grant funds.
       (3) To purchase or install transmission equipment (such as 
     laying cable or telephone lines, microwave towers, satellite 
     dishes, amplifiers, and digital switching equipment).
       (4) For construction, except that such funds may be 
     expended for minor renovations relating to the installation 
     of equipment.
       (5) Expenditures for indirect costs (as determined by the 
     Secretary) to the extent the

[[Page S11986]]

     expenditures would exceed more than 20 percent of the total 
     grant funds.
       (h) Matching Requirement for Grants.--The Secretary may not 
     make a grant to an entity State under this section unless 
     that entity agrees that, with respect to the costs to be 
     incurred by the entity in carrying out the program for which 
     the grant was awarded, the entity will make available 
     (directly or through donations from public or private 
     entities) non-Federal contributions (in cash or in kind) in 
     an amount equal to not less than 50 percent of the Federal 
     funds provided under the grant.

     SEC. 402. ADMINISTRATION.

       (a) Nonduplication.--The Secretary shall ensure that 
     facilities constructed using financial assistance provided 
     under this title do not duplicate adequate established 
     telehealth networks.
       (b) Loan Maturity.--The maturities of cost of money loans 
     shall be determined by the Secretary, based on the useful 
     life of the facility being financed, except that the loan 
     shall not be for a period of more than 10 years.
       (c) Loan Security and Feasibility.--The Secretary shall 
     make a cost of money loan only if the Secretary determines 
     that the security for the loan is reasonably adequate and 
     that the loan will be repaid within the period of the loan.
       (d) Coordination With Other Agencies.--The Secretary shall 
     coordinate, to the extent practicable, with other Federal and 
     State agencies with similar grant or loan programs to pool 
     resources for funding meritorious proposals in rural areas.
       (e) Informational Efforts.--The Secretary shall establish 
     and implement procedures to carry out informational efforts 
     to advise potential end users located in rural areas of each 
     State about the program authorized by this title.

     SEC. 403. GUIDELINES.

       Not later than 180 days after the date of enactment of this 
     Act, the Secretary shall issue guidelines to carry out this 
     title.

     SEC. 404. AUTHORIZATION OF APPROPRIATIONS.

       There are authorized to be appropriated to carry out this 
     title, $25,000,000 for fiscal year 1997, and such sums as may 
     be necessary for each of the fiscal years 1998 through 2004.
                                                                    ____



                The Comprehensive Telehealth Act of 1996

                              Bill Summary

       Section 1. Short Title; Table of Contents.
       Sec. 2. Findings and Purposes.
       Subtitle A--Medicare Reimbursement For Telehealth Services.
       Sec. 101. Medicare Reimbursement For Telehealth Service.
       Mandates that HCFA reimburse for telehealth services 
     provided to rural and underserved areas by January of 1998. 
     Reimbursement would be given to any Medicare-eligible 
     provider. This provision builds on the results of the HCFA 
     telemedicine reimbursement demonstration program, and adds 
     additional reporting requirements to the reimbursement 
     methodology report that HCFA must forward to Congress by 
     March of 1997.
       Subtitle B--Telehealth Licensure.
       Sec. 201. Initial Report to Congress.
       Asks the Secretary of Health and Human Services to submit 
     an initial report to the Congress on the status of efforts to 
     ease licensing burdens on practioners who cross state lines 
     in the course of supplying telehealth services.
       Sec. 202. Annual Report to Congress.
       Asks the Secretary to report yearly on developments 
     concerning the matters in Sec. 1201. If the Secretary feels 
     the states or other relevant entities are not making progress 
     on removing licensure barriers to multistate telehealth 
     practice, the Secretary may make recommendations about 
     possible federal action necessary to reduce licensure 
     burdens.
       Subtitle C--Periodic Reports to Congress From the Joint 
     Working Group on Telehealth.
       Sec. 301. Joint Working Group on Telehealth.
       The Joint Working Group on Telemedicine (JWGT) is currently 
     operating out of the HHS/HRSA Office of Rural Health Policy, 
     at the request of the Secretary and the Vice-President. The 
     group consists of representatives from over twenty government 
     agencies and divisions that operate or oversee telehealth 
     related projects, including the VHA, DOD, IHS, NASA, USDA, 
     and others. The JWGT coordinates federal programs and 
     telehealth initiatives, and will complete a report on its 
     efforts in January of 1997.
       Under this proposal, the name of the group will change to 
     the ``Joint Working Group on Telehealth'', and the Office of 
     Rural Health Policy will have the authority to select the 
     Chair. It requires yearly updates (through 2002) to Congress 
     on the report on Telehealth due March 1, 1997. The group 
     sunsets in 2002.
       Subtitle D--Development of Telehealth Networks.
       Sec. 401. Development of Telehealth Networks.
       Grants and loans are awarded through the Office of Rural 
     Health Policy (ORHP) to rural hospitals, clinics, schools, 
     libraries, business organizations, and universities to 
     develop local multi-use telehealth systems. Systems are given 
     an incentive to design effective programs; all or part of a 
     loan can be forgiven if the program meets certain cost-
     effectiveness and quality criteria. Grantees must put up not 
     less than a 50 percent match of the federal funds (cash or 
     in-kind).
       Sec. 402. Administration.
       Sec. 403. Guidelines.
       Sec. 404. Authorization of Appropriations.
       Up to $25 million per year through 2004.
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