[Congressional Record Volume 145, Number 50 (Tuesday, April 13, 1999)]
[Senate]
[Pages S3637-S3638]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CONRAD (for himself, Mr. Daschle, Mr. Murkowski, Mr. 
        Inouye, Mr. Harkin, and Mr. Wellstone):
  S. 770. 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 1999

  Mr. CONRAD. Mr. President, today, I am pleased to be joined by 
Senator Daschle, Senator Wellstone, Senator Inouye, Senator Harkin, and 
Senator Murkowski to introduce 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.
  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. For the first time, technological advances and 
the development of a national information infrastructure give 
telehealth the potential to overcome barriers to health care services 
for rural Americans and afford 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 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.
  We have made progress. The Balanced Budget Act of 1997 includes a 
provision that provides for some Medicare reimbursement of telehealth 
services. Unfortunately, however, the Health Care Financing 
Administration interpreted the legislative language too narrowly and 
severely limited the services that are covered. This bill clarifies the 
intent of Congress regarding Medicare reimbursement and thereby 
increases access to these services in underserved areas.
  The first element of my proposal clarifies and expands Medicare 
reimbursement for telehealth. Medicare reimbursement policy is an 
essential component of helping to integrate telehealth into the health 
care infrastructure and is particularly important in rural areas, where 
many hospitals do as much as 80% of their business with Medicare 
patients. Because the Secretary defined reimbursable services so 
narrowly in the BBA, this legislation clarifies that all services that 
are covered under Medicare Part B if you drive to a doctor's office, 
are covered via telehealth. In particular, it clarifies that the 
technology called ``store and forward'', which is a cost-effective 
method of transferring information, is included in this reimbursement 
policy. Finally, this bill expands coverage from health professional 
shortage areas, as enacted in 1997, to cover all rural areas.
  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

[[Page S3638]]

ease licensing burdens on practitioners 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. Many 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 
their own state. During a 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 more than thirty different states. That means they pay 
thirty different fees, are responsible for thirty different continuing 
education requirements, and are overseen by thirty 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. This will allow us to reach out to the states and 
work together to find solutions to cross-state licensure concerns. 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. The Department of Health and Human Services has 
created an informal interagency task force that is examining our 
federal agency telehealth efforts. This group reported on Federal 
activities related to telehealth and provided a thorough examination of 
many of the important issues in telehealth.
  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 for the Advancement of Telehealth, 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 in contributing to telehealth in a positive way. I 
believe this is especially important in light of the GAO report calling 
for an expanded role for this group and more coordination of telehealth 
issues across the Federal agencies. The efforts of this group, along 
with the ongoing activities of the Congressional Ad Hoc Steering 
Committee, will provide a renewed focus for telehealth across the 
Federal government. 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 both to build a telehealth 
infrastructure and foster rural economic development and incorporates 
many of the most important lessons learned from other grant projects 
and studies on telehealth from across the Federal government.
  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 continues our national efforts to 
integrate telecommunications technology into the rapidly evolving 
health care delivery system. I am very encouraged by the positive 
feedback I have received from telehealth networks across the country. I 
have continued to work with telehealth networks and representatives to 
strengthen this proposal. As a result, I have made several changes in 
the bill that I believe will make this a stronger proposal. But, as 
with any complex issue, I understand that some may prefer different 
approaches. I would like to continue to encourage all interested 
parties to come forward with creative solutions to these important 
issues. It is my hope that telehealth legislation can be included in 
the comprehensive rural health care legislation in this Congress so we 
can continue to improve access to needed health care services for rural 
and underserved populations.
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