[Congressional Record Volume 143, Number 76 (Thursday, June 5, 1997)]
[Senate]
[Pages S5367-S5368]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. MURKOWSKI (for himself and Mr. Baucus):
  S. 848. A bill to direct the Secretary of Health and Human Services, 
through the Health Care Financing Administration, to expand and 
strengthen the demonstration project known as the Medicare Telemedicine 
Demonstration Program; to the Committee on Finance.


            THE RURAL TELEMEDICINE DEMONSTRATION ACT OF 1997

  Mr. MURKOWSKI. Mr. President, I rise today to introduce, along with 
my colleague, Senator Baucus of Montana, the Rural Telemedicine 
Demonstration Act of 1997.
  The vast potential of telemedicine technology is clearly under-
utilized. I believe that the answer to growing concerns regarding 
access and affordability of quality health care services in rural 
America is telemedicine. Let me describe just a few of the difficulties 
of rural health care in my home State of Alaska and explain why 
telemedicine is our long-awaited answer.
  Alaska encompasses 586,412 square miles. It is one-fifth the size of 
the contiguous United States; 120 times larger than the State of Rhode 
Island; and larger than the three largest States in the union combined. 
If a map of Alaska were superimposed on a map of the lower 48 States, 
Alaska would touch South Carolina, Mexico, California, and the United 
States-Canadian border. In short, Alaska has 1 million acres of land 
for every day of the year.
  Geography is another defining characteristic of Alaska. My State has 
a climate characterized by significant season fluctuations in 
temperature and precipitation and a topography characterized by 
mountains, wetlands, forests, and rugged coastlines.
  Communities and villages are scattered throughout the vast regions of 
Alaska. And though Alaska contains 586,412 square miles, it only has 
12,200 miles of roads. Vast areas are completely unconnected by roads, 
with access only available by airplane, boat, snowmachine, or dogsled.

[[Page S5368]]

  Meeting the health care needs of these communities and villages is a 
daunting task. Residents have difficulty due to geography, lack of 
providers and poverty. Although excellent medical facilities and 
tertiary care centers are available in Anchorage, direct connection to 
these facilities from most of the State is not possible other than by 
air transportation. Consequently, geographically, 74 percent of the 
State is in medically underserved areas.
  Telemedicine is the cost-effective and practical answer to the Alaska 
dilemma. Currently, there is an exciting project underway known as the 
Alaska Telemedicine project. This consortium of Alaskan health care 
providers and telecommunication carriers has been diligently working to 
unite health care in Alaska. This project has successfully united the 
Native health corporations, military medical facilities, and public and 
private hospitals of Alaska.
  The fragmented nature of health care delivery in Alaska and Alaska 
satellite-based narrow-band telecommunications infrastructure, along 
with the geography and climate of Alaska, make Alaska an ideal place 
for the Alaska Telemedicine project to flourish.
  In 1995, the Health Care Financing Administration [HCFA], pursuant to 
a mandate in 42 U.S.C. 1395(b)(1) which directs HCFA to establish 
demonstration projects that explore innovative methodologies of 
Medicare cost-savings, developed a telemedicine Medicare reimbursement 
project for rural America. Five demonstration sites were established in 
four States: Iowa, West Virginia, North Carolina, and Georgia. The 
purpose of these programs was to investigate Medicare reimbursement for 
telemedicine in rural locations.
  Unfortunately, the HCFA study of rural telemedicine contains a 
glaring omission: The study does not include any sites in rural Western 
locations. The omission of the rural West, which contains extremely 
remote and frontier locations will result in a deficient and likely 
inaccurate study for rural telemedicine.
  Our legislation will expand the HCFA project to better represent 
rural America. A site in Alaska and in Montana will be included. 
Montana, like Alaska, experiences significant difficulties in providing 
health care services in rural areas. Montana's five independent 
telemedicine projects that have formed a united alliance will also be 
included in the HCFA project.
  Mr. President, the goal of telemedicine Medicare reimbursement is to 
ensure that the elderly of America who reside in inaccessible rural 
areas will be allowed to have access to quality health care in the most 
cost-effective manner--via telecommunication networks. Establishing 
Medicare reimbursement stabilizes telemedicine technology, and will 
likely lead to widespread coverage of telehealth services by private 
insurers.
  Senator Baucus and my bill, will merely expand the current 
demonstration project conducted by HCFA. By this expansion, the HCFA 
study will better represent rural telemedicine in the Nation. I ask 
that my colleagues support the Rural Telemedicine Demonstration Act of 
1997.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 848

       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 ``Rural Telemedicine 
     Demonstration Act of 1997''.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) Access to health care providers is critically important 
     to improving the health of individuals residing in rural 
     areas.
       (2) Individuals residing in the rural areas of the Western 
     United States are severely underserved by both primary and 
     specialty health care providers.
       (3) Telecommunications technology has made it possible to 
     provide a wide range of vital health care services to 
     individuals residing in remote locations and over vast 
     distances at a fraction of the costs associated with the 
     provision of such services without such technology.
       (4) On February 17, 1997, the General Accounting Office 
     reported that Federal involvement in telehealth systems is 
     needed for the success of such systems.
       (5) In order for telehealth systems to continue to benefit 
     rural communities, the medicare program under title XVIII of 
     the Social Security Act (42 U.S.C. 1395 et seq.) must 
     eventually reimburse the provision of health care services to 
     remote locations via telecommunication.
       (6) The current Medicare telemedicine demonstration program 
     conducted by the Secretary of Health and Human Services, 
     through the Health Care Financing Administration, does not 
     include any sites in rural areas of the Western United 
     States. Without such sites, such demonstration program will 
     not provide accurate indicators of the success of 
     telemedicine.
       (7)(A) The fragmented nature of Alaska's transportation 
     infrastructure, as well as extremes in geography, climates, 
     and ethnography create severe problems for health care 
     providers to provide health care services to the individuals 
     residing in Alaska.
       (B) The Alaska Telemedicine Project is a statewide 
     telehealth project which overcomes infrastructure problems 
     within Alaska by uniting 40 public and private health care 
     providers across Alaska to provide health care services to 
     the residents of Alaska.
       (8)(A) Health care providers in Montana also experience 
     significant difficulties in providing health care services in 
     rural areas. Five independent telemedicine networks in 
     Montana have formed the Montana Healthcare Telecommunications 
     Alliance (MHTA), an association of telemedicine service 
     providers representing not-for-profit and public medical and 
     mental health facilities throughout the State.
       (B) The goal of the MHTA is to promote cost effective 
     statewide deployment of telemedicine services thereby 
     supporting public and private health care providers and 
     improving access to quality medical and mental health 
     services for all individuals residing in Montana.

     SEC. 3. EXPANSION OF DEMONSTRATION PROJECT.

       (a) In General.--The Secretary, through the Health Care 
     Financing Administration, shall expand the demonstration 
     project known as the Medicare telemedicine demonstration 
     program to include within such demonstration program the 
     Alaska Telemedicine Project (described in section 2(7)) and 
     the Montana Healthcare Telecommunications Alliance (described 
     in section 2(8)).
       (b) Report to Congress.--Not later than March 1 of each 
     year that the demonstration project described in subsection 
     (a) is being conducted, the Secretary, through the Health 
     Care Financing Administration, shall submit a report to 
     Congress that contains--
       (1) an evaluation of the effectiveness of such 
     demonstration project; and
       (2) any legislative recommendations determined appropriate 
     by the Secretary.
       (c) Authorization of Appropriations.--There is authorized 
     to be appropriated $2,000,000 to the Secretary of Health and 
     Human Services to carry out the purposes of the demonstration 
     project described in subsection (a).

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