S.Amdt. 3136

SA 3136. Mr. UDALL of New Mexico submitted an amendment intended to
be proposed to amendment SA 2786 proposed by Mr. Reid (for himself, Mr.
Baucus, Mr. Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the
Internal Revenue Code of 1986 to modify the first-time homebuyers
credit in the case of members of the Armed Forces and certain other
Federal employees, and for other purposes; which was ordered to lie on
the table; as follows:

On page 796, between lines 5 and 6, insert the following:

PART IV--TELEHEALTH AND REMOTE PATIENT MONITORING

SEC. 3031. TELEHEALTH AND REMOTE PATIENT MONITORING.

(a) Improving Credentialing and Privileging Standards for
Telehealth Services.--Section 1834(m) of the Social Security
Act (42 U.S.C. 1395m(m)) is amended by adding at the end the
following new paragraph:
``(5) Establishment of remote credentialing and privileging
standards.--
``(A) In general.--Not later than 2 years after the date of
the enactment of this paragraph, the Secretary shall
establish regulations for considering the remote
credentialing and privileging standards applicable to
telehealth services, including interpretative services, for
originating sites under this subsection. Such regulations
shall allow an originating site to accept, and not duplicate,
the credentialing and privileging processes and decisions
made by another site.
``(B) Clarification regarding acceptance of processes and
decisions prior to enactment of regulations.--During the
period beginning on such date of enactment and ending on the
effective date of the regulations under subparagraph (A), the
Secretary shall not take any punitive action under any rule
or regulation against an originating site on the basis of
that site's acceptance, for purposes of receiving telehealth
services (including interpretive services), the credentialing
and privileging processes and decisions made by another site
that is certified by a national body recognized by the
Secretary if the site accepting such credentialing and
privileging processes is also so certified and complies with
the applicable requirements for such acceptance.''.
(b) Expanding Access to Stroke Telehealth Evaluation.--
(1) In general.--Section 1834(m)(4) of the Social Security
Act (42 U.S.C. 1395m(m)(4)) is amended by adding at the end
the following new subparagraph:
``(G) Stroke telehealth services.--The term `stroke
telehealth services' means a telehealth service used for the
evaluation of individuals with acute stroke.''.
(2) Effective date.--The amendment made by this subsection
shall apply to telehealth services furnished on or after the
date that is 6 months after the date of enactment of this
Act.
(c) Improving Access to Telehealth Services at IHS
Facilities.--
(1) Coverage of metropolitan sites.--Section
1834(m)(4)(C)(i) of such Act (42 U.S.C. 1395m(m)(4)(C)(i)) is
amended--
(A) in subclause (II), by deleting ``or'' at the end;
(B) in subclause (III), by deleting the period at the end
and inserting ``; or''; and
(C) by adding at the end the following subclause:

``(IV) from a facility of the Indian Health Service
(whether operated by such Service or by an Indian tribe or
tribal organization (as

[[Page S12935]]

those terms are defined in section 4 of the Indian Health
Care Improvement Act)).''.

(2) Inclusion of ihs facilities as originating sites.--
Section 1834(m)(4)(C)(ii) of the Social Security Act (42
U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding at the end
the following new subclause:

``(IX) A facility of the Indian Health Service, whether
operated by such Service or by an Indian tribe or tribal
organization (as those terms are defined in section 4 of the
Indian Health Care Improvement Act).''.

(3) Effective date.--The amendments made by this subsection
apply to telehealth services furnished on or after the date
that is 6 months after the date of enactment of this Act.
(d) Community-Based Patient Monitoring.--Section 3026(B) of
this Act is amended by adding at the end the following new
clause:
``(vi) Utilizing telehealth, remote patient monitoring, and
other technology when medically appropriate to enhance care
transition services provided across the continuum of care.''.
(e) Telehealth Advisory Committee.--
(1) Establishment.--Section 1868 of the Social Security Act
(42 U.S.C. 1395ee) is amended--
(A) in the heading, by adding at the end the following:
``telehealth advisory committee''; and
(B) by adding at the end the following new subsection:
``(c) Telehealth Advisory Committee.--
``(1) In general.--A Telehealth Advisory Committee (in this
subsection referred to as the `Advisory Committee') shall be
appointed by the Secretary to make annual recommendations to
the Secretary on policies of the Centers for Medicare &
Medicaid Services regarding telehealth services as
established under section 1834(m), including the appropriate
addition or deletion of services (and HCPCS codes) to those
specified in paragraphs (4)(F)(i) and (4)(F)(ii) of such
section and for authorized payment under paragraph (1) of
such section, and to Congress on areas in which originating
sites are located (as specified in paragraph (4)(C)(i) of
such section) and eligible telehealth sites (as described in
paragraph (4)(C)(ii) of such section).
``(2) Membership; terms.--
``(A) Membership.--
``(i) In general.--The Advisory Committee shall be composed
of 10 members, to be appointed by the Secretary, of whom--

``(I) 5 shall be practicing physicians;
``(II) 2 shall be practicing nonphysician health care
practitioners;
``(III) 2 shall be administrators of telehealth programs;
and
``(IV) 1 shall be an informatics or technology expert.

``(ii) Requirements for appointing members.--In appointing
members of the Advisory Committee, the Secretary shall--

``(I) ensure that each member has prior experience with the
practice of telemedicine or telehealth;
``(II) give preference to individuals who are currently
providing telemedicine or telehealth services or who are
involved in telemedicine or telehealth programs;
``(III) ensure that the membership of the Advisory
Committee represents a balance of specialties and geographic
regions; and
``(IV) take into account the recommendations of
stakeholders.

``(B) Terms.--The members of the Advisory Committee shall
serve for a 3-year term.
``(C) Conflicts of interest.--A member of the Advisory
Committee may not participate with respect to a particular
matter considered in a meeting of the Advisory Committee if
such member (or an immediate family member of such member)
has a financial interest that could be affected by the advice
given to the Secretary with respect to such matter.
``(D) Priority areas for consideration.--In making
recommendations under paragraph (1), the committee shall
consider recommendations to Congress on the following:
``(i) Increasing coverage of telehealth services to all
geographic areas of the United States. Such consideration
shall take into account the costs to the Federal Government
of such increased coverage and the total offsetting savings
accrued to the Federal Government as a result of investments
in telehealth.
``(ii) Including providing payments under section 1834(m)
for store and forward services for all eligible areas. Such
consideration should take into account the experience in
Alaska and Hawaii in providing such services under this
title, including the impact on costs, the effect on the
quality and availability of health services, and ways in
which the Federal Government can minimize the risk of fraud
and abuse for such services.
``(iii) Expanding coverage under this title of remote
monitoring services for--

``(I) individuals with chronic diseases;
``(II) individuals recently discharged from a facility that
is an originating site under such section; and
``(III) individuals assigned to an accountable care
organization under section 1899, individuals discharged from
a hospital that receives disproportionate share payments
under section 1886(d)(5)(F) who are in need of transitional
care, and individuals who are furnished services under the
national pilot program on payment bundling under section
1866D.

Each recommendation made under paragraph (1) shall take into
consideration the costs to the Federal Government and the
total offsetting savings accrued to the Federal Government as
a result of investments in telehealth and ways in which the
Federal Government can minimize the risk of fraud and abuse
for telehealth services.
``(3) Requirement to review and provide recommendations.--
The Advisory Committee shall review and provide
recommendations to the Secretary on legislation that would
allow other providers of services and suppliers to provide
telehealth services to Medicare beneficiaries.
``(4) Deadline.--Not later than December 31, 2010, the
Advisory Committee shall submit to Congress any
recommendations to Congress under paragraph (1), including
the recommendations considered under paragraph (2)(D).''.
(2) Following recommendations.--Section 1834(m)(4)(F) of
such Act (42 U.S.C. 1395m(m)(4)(F)) is amended by adding at
the end the following new clause:
``(iii) Recommendations of the telehealth advisory
committee.--In making determinations under clauses (i) and
(ii), the Secretary shall take into account the
recommendations of the Telehealth Advisory Committee
(established under section 1868(c)) when adding or deleting
services (and HCPCS codes) and in establishing policies of
the Centers for Medicare & Medicaid Services regarding the
delivery of telehealth services. If the Secretary does not
implement such a recommendation, the Secretary shall publish
in the Federal Register a statement regarding the reason such
recommendation was not implemented.''.
(3) Waiver of administrative limitation.--The Secretary of
Health and Human Services shall establish the Telehealth
Advisory Committee under the amendment made by paragraph (1)
notwithstanding any limitation that may apply to the number
of advisory committees that may be established (within the
Department of Health and Human Services or otherwise).
(f) List of Covered Telehealth Services.--Section
1834(m)(4)(F) of such Act (42 U.S.C. 1395m(m)(4)(F)), as
amended by subsection (e), is further amended--
(1) by redesignating clauses (ii) and (iii) as clauses
(iii) and (iv);
(2) by inserting after clause (i) the following new clause:
``(ii) Originating site services.--

``(I) In general.--Subject to subclause (II), the Secretary
may make payments under this subsection to an originating
site described in subparagraph (C)(ii) for services
originating at the site.
``(II) Limitation.--The Secretary may not make such
payments with respect to a service described in subclause (I)
if the Secretary finds, upon review of the available
evidence, that a service is not safe, effective, or medically
beneficial when performed as a telehealth service.''; and

(3) by striking clause (iii), as redesignated under
paragraph (1), and inserting the following new clause:
``(iii) Yearly update.--The Secretary shall establish a
process that provides, on an annual basis--

``(I) for the addition of telehealth services (and HCPCS
codes), to those specified in clauses (i) and (ii) for
authorized payment under this subsection, unless the
Secretary finds, upon review of the available evidence, that
a service is not safe, effective, or medically beneficial
when performed as a telehealth service; and
``(II) for the deletion of such services (and HCPCS codes),
from those specified in clauses (i) and (ii) for authorized
payment under this subsection, that the Secretary finds, upon
review of additional evidence, are not safe, effective, or
medically beneficial when performed as a telehealth
service.''.

(g) Telehealth Access to Small Population Metropolitan
Counties.--Section 1834(m)(4)(C)(i)(II) of such Act (42
U.S.C. 1395m(4)(C)(i)(II)) is amended to read as follows:

``(II) in a county with a population of less than 35,000,
according to the most recent decennial census, or that is not
included in a Metropolitan Statistical Area; or''.

(h) Telehealth Access for ``Store and Forward'' Diagnostic
Consultations.--Section 1834(m)(1) of such Act (42 U.S.C.
1395(m)(1)) is amended by adding at the end the following
sentence: ``For purposes of the first sentence, in the case
of telehealth services that are furnished by a facility of
the Indian Health Service, a rural health clinic, a Federally
qualified health center, or a critical access hospital (as
described in paragraph (4)(C)(ii)) , or a sole community
hospital (as defined in section 1886(d)(5)(D)(iii)), the term
`telecommunications system' includes store-and-forward
technologies described in the preceding sentence.''.
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