[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.
                                 ______