[Congressional Record Volume 154, Number 52 (Thursday, April 3, 2008)]
[Senate]
[Pages S2437-S2439]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
By Mr. CONRAD (for himself and Ms. Stabenow):
S. 2812. A bill to amend title XVIII of the Social Security Act to
improve the provision of telehealth services under the Medicare
program; to the Committee on Finance.
Mr. CONRAD. Mr. President, today I rise with my colleague, Senator
Stabenow, to introduce an important piece of legislation for Medicare
beneficiaries living in rural areas. The Medicare Telehealth
Improvement Act will ensure that rural beneficiaries have access to
health care services by connecting remote areas to the services often
only available in large urban centers.
Fifteen years ago, I cofounded the Congressional Steering Committee
on Telemedicine and Health Care Informatics to bring more attention to
this technology and its potential. I took an interest in this
technology because in large, rural, medically underserved States like
mine, telemedicine provides access to care that is simply unavailable
otherwise. In many areas of North Dakota, routine check-ups with a
specialist can require a 200 mile round trip journey. That's fine for a
young person on a nice spring day. But it doesn't work for seniors in
the middle of a North Dakota blizzard.
That's why in 1997, we fought to provide Medicare coverage of
telemedicine services. But access to this benefit was strictly limited.
For example, the telehealth service must be provided in a health
professional shortage area or county not classified as a metropolitan
statistical area. In addition, only consultations, office visits,
individual psychotherapy and pharmacologic management are covered
services. Moreover, reimbursement, which is the same as the current
physician fee schedule amount, is limited to physicians, nurse
practitioners, physician assistants, nurse midwives, clinical nurse
specialists, clinical psychologists, clinical social workers, and
registered dieticians. Finally, only physician offices, hospitals,
rural health
[[Page S2438]]
clinics, and Federally-qualified health centers are eligible to be
originating sites and receive the ``facility fee.''
While this benefit has been helpful to seniors in rural areas, the
adoption of telemedicine in the Medicare program has been slow. That is
because we had to place too many restrictions on the benefit to control
the estimated costs o covering these services. However, experience has
shown that the use of telemedicine does not dramatically increase
spending. In fact, it can actually save money.
That is why Senator Stabenow and I are introducing the Medicare
Telehealth Improvement Act today. More seniors need to have access to
this technology in all areas of health care, and our bill makes
important changes in Medicare coverage.
First, the Medicare Telehealth Improvement Act would increase the
number of originating sites eligible to receive the facility fee to
include nursing homes, dialysis facilities and community mental health
centers. Moreover, it would allow any other site that has
telecommunications systems to be an originating site, but these sites
would not be eligible for the facility fee.
Second, the bill allows more providers to participate. For a number
of years, we have advocated to include physical therapists,
occupational therapists, audiologists, and speech-language
pathologists. This bill would make that change.
Finally, we would improve the Medicare process for updating the list
of eligible services. Despite widespread support for the inclusion of
new codes, CMS has not sufficiently updated the list of covered
services in recent years. In response, our bill creates an advisory
panel that would give recommendations on the addition or deletion of
services.
Senator Stabenow and I have worked to garner support from a variety
of stakeholders. In fact, the bill we are introducing today has the
support of the American Telemedicine Association, the National Council
on Community Behavioral Healthcare, the American Health Care
Association, the American Health Information Management Association,
the Center for Aging Services Technologies, the National Association
for the Support of Long Term Care, and the National Center for Assisted
Living.
This bill is a meaningful step to further adoption of telehealth in
the Medicare program. It will allow seniors to seek care in the comfort
of their communities, instead of having to drive hundreds of miles. I
urge my colleagues to support this initiative to ensure that every
senior has access to the care they need.
Mr. President, I ask unanimous consent that letters of support be
printed in the Record.
There being no objection, the material was ordered to be placed in
the Record, as follows:
American Telemedicine Association,
Washington, DC, March 12, 2008.
Hon. Kent Conrad,
U.S. Senate,
Washington, DC.
Dear Sen. Conrad: I am pleased to express the strong
support of the American Telemedicine Association for your
proposed legislation, the Medicare Telehealth Improvement Act
of 2008.
This legislation would improve the current Medicare
telehealth program in three significant ways. First, it would
increase the number of eligible sites by adding skilled
nursing facilities, dialysis centers and community mental
health centers to the list of approved originating sites.
These are areas where telemedicine is proven to improve
quality and reduce costs.
Second, this bill would expand the list of eligible
providers under the Medicare telehealth program. This is not
only appropriate but necessary as more and more health
professions develop their telemedicine capabilities.
Finally, your legislation would improve the process used
for updating covered Medicare telehealth services by creating
an advisory committee of telemedicine practitioners to advise
CMS on the appropriate addition of deletion of telehealth
services. This committee, made up of physician and non-
physician providers, will improve the process by providing
the perspective of those directly involved in the provision
of telehealth services.
The ATA is the leading resource and advocate promoting
access to medical care for consumers and health professionals
via telecommunications technology. ATA seeks to bring
together groups from traditional medicine, academic medical
centers, technology and telecommunications companies, e-
health, medical societies, government and others to overcome
barriers to the advancement of telemedicine through the
professional, ethical and equitable improvement in health
care delivery.
ATA is happy to support your proposed bill, the Medicare
Telehealth Improvements Act of 2008.
Sincerely,
Jonathan D. Linkous,
Executive Director.
____
March 18, 2008.
Hon. Kent Conrad,
Chairman, Senate Budget Committee, Hart Senate Office
Building, U.S. Senate, Washington, DC.
Dear Chairman Conrad: Our coalition of long term care and
health information technology organizations is pleased to
support your efforts to expand the use of telehealth to
skilled nursing facilities and other care settings serving
Medicare patients. Telehealth will enhance the quality of
care for those with chronic illnesses, permanent
disabilities, or terminal illnesses and will improve the
communication and information exchange between caregivers and
patients.
According to the June 2007 Centers for Medicare & Medicaid
Services Statistics report, roughly 1.8 million persons
received Medicare-covered care in skilled nursing facilities
in 2005. Long term care is a critical stakeholder in the
adoption of health information technology and the use of
telehealth to ensure continuous quality of care to our
patients and residents.
Your recognition of the importance of telehealth in the
long term care setting will go a long way toward bringing the
benefits of this technology to millions of Medicare patients.
Your legislation will facilitate the adoption of technologies
that can save lives, reduce administrative costs, and provide
better medical care, and we support your efforts
wholeheartedly.
We look forward to continuing to work with you to secure
passage of legislation to accelerate the adoption of
telehealth to increase quality and safety for patients.
Sincerely,
American Health Care Association.
American Health Information Management Association.
Center for Aging Services Technologies.
National Center For Assisted Living.
National Association for the Support of Long Term Care.
____
National Council for
Community Behavioral Healthcare,
Rockville, MD, March 31, 2008.
Hon. Kent Conrad,
Hart Senate Office Bldg.,
Washington, DC.
Hon. Debbie Stabenow,
Hart Senate Office Bldg.,
Washington, DC.
Dear Senator Conrad and Senator Stabenow: On behalf of the
National Council on Community Behavioral Healthcare--
representing 1,400 Community Mental Health Centers and other
community mental health and substance abuse agencies serving
over 6 million low-income Americans with mental illnesses and
addiction disorders--I am writing to express our strong
support for the Conrad/Stabenow Medicare Telehealth
Improvement Act.
The National Council is particularly pleased that you
included provisions designating CMHCs as originating sites,
thereby authorizing to seek reimbursement directly from
Medicare for tele-mental health services in rural areas.
Such proposals have long enjoyed strong bipartisan support.
As an illustration, President George W. Bush's New Freedom
Commission on Mental Health stated: ``Telehealth--using
electronic information and telecommunications technologies to
provide long-distance clinical care and consultation, patient
and professional health-related education, public health and
health administration--is a greatly underused resource for
mental health services.'' The Commission went on to note that
tele-mental health can increase access to care for patients
in remote geographic areas, and is especially important for
individuals with multiple chronic conditions, people with
severe mental illnesses, underserved populations, children
and the frail elderly [Achieving the Promise: Transforming
Mental Health Care in America, pg. 80, July 2003].
Like other safety net providers in rural America, CMHCs
struggle to recruit skilled medical staff in health
professional shortage areas. The only practical means of
expanding access to mental health services in these regions
is through the application of new technologies--including
tele-mental health care.
The National Council is committed to working with both of
your offices to secure passage of the Medicare Telehealth
Improvement Act.
Sincerely,
Linda Rosenberg,
President & CEO.
Ms. STABENOW. I am pleased to join with my good friend, Senator Kent
Conrad, in introducing the Medicare Telehealth Improvement Act, which
improves access for many Medicare beneficiaries by expanding telehealth
services.
[[Page S2439]]
As Senator Conrad has noted, this legislation makes a number of
technical corrections to promote telehealth. First, this bill would
expand the number of sites that provide telehealth services under
Medicare to include nursing homes, dialysis facilities, and community
mental health centers. Also, it would expand the list of providers to
include physical therapists, occupational therapists, speech-language
pathologists, and other providers determined appropriate by the
Secretary of Health and Human Services. Lastly, this bill would require
the Centers for Medicare and Medicaid Services to update the list of
covered telehealth services, along with the creation of a permanent
advisory committee made up of physicians and non-physicians to provide
recommendations to the Secretary and continue expansions of telehealth
services forward.
Michigan providers have been very innovative in using telehealth,
often out of necessity because of geographic isolation. Telehealth
allows providers to collaborate across great distances and share,
rather than duplicate, services. This helps save money and improve
patient access. One innovation is the use of tele-mental health
services. Many Michigan community mental health centers have made
tremendous strides in their ability to monitor patients and provide
clinical consultations long distance.
I am very pleased that both the Michigan Association of Community
Mental Health Boards and the National Council on Community Behavioral
Healthcare support this legislation.
I believe that the Medicare Telehealth Improvement Act will build
upon already successful initiatives happening in my home State of
Michigan and across the country. I urge my colleagues to join with me
and Senator Conrad in expanding upon this promising technology.
Mr. President, I ask unanimous consent that a letter of support be
printed in the Record.
There being no objection, the material was ordered to be placed in
the Record, as follows:
Michigan Association of Community Mental Health Boards,
Lansing, Mi, March 28, 2008.
Hon. Debbie Stabenow,
U.S. Senator; SH-133 Hart Senate Office Bldg., Washington,
DC.
Dear Senator Stabenow: On behalf of the Michigan
Association of Community Mental Health Boards (MACMHB)--
representing county administered community mental health and
substance abuse agencies serving low-income people with
mental illnesses and addiction disorders statewide--I am
writing to express our strong support for the Stabenow/Conrad
Medicare Telehealth Improvement Act.
MACMHB is particularly pleased that you included provisions
designating CMHCs as originating sites, thereby authorizing
these agencies to seek reimbursement directly from Medicare
for tele-mental health services.
As you well know, we have consistently struggled to expand
access to mental health care in the vast northern reaches of
Michigan for many years. In the best of times, MACMHB member
agencies have fought to retain skilled professional staff,
but the current economic challenges that our state confronts
make personnel recruitment and retention along with services
delivery in rural areas--even more difficult. By contrast,
tele-mental health care can partially compensate for these
staff shortages and, furthermore, we believe that these
services can be successfully implemented and expanded in
highly urbanized communities including metropolitan Detroit.
Passage of the Stabenow/Conrad telehealth improvement
legislation would be of greatest benefit to individuals
eligible for both Medicare and Medicaid--who compose roughly
one-third of the combined caseload of our member agencies.
This patient population is likely to have multiple chronic
conditions in addition to severe mental illnesses, and they
generally reside in underserved communities. The expansion of
tele-mental health services will substantially improve our
ability to provide long distance clinical consultation and
health status monitoring for these ``dually eligible''
persons.
Senator Stabenow, we deeply appreciate your support. You
can count on MACMHB and the National Council of Community
Behavioral Healthcare to fight for passage of the Medicare
Telehealth Improvement Act.
Sincerely,
DAVID A, KAKMIA, L.M.S.W.,
Executive Director.
______