II
109th CONGRESS
1st Session
S. 1909
IN THE SENATE OF THE UNITED STATES
October 24, 2005
Mr. Burns introduced the following bill; which was read twice and referred to the Committee on Finance
A BILL
To improve the provision of telehealth services under the Medicare Program, to provide grants for the development of telehealth networks, and for other purposes.
Short title; table of contents
Short title
This Act may be cited as the Medicare Telehealth Enhancement Act of
2005
.
Table of contents
The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I—Medicare Program
Sec. 101. Expanding access to telehealth services to all areas.
Sec. 102. Increase in number of types of originating sites; clarification.
Sec. 103. Expansion of use of store-and-forward technology.
Sec. 104. Expansion of practitioners eligible to furnish telehealth services.
Sec. 105. Expansion of covered telehealth services.
Sec. 106. Facilitating the provision of telehealth services across State lines.
Sec. 107. Effective Date.
TITLE II—HRSA grant program
Sec. 201. Grant program for the development of telehealth networks.
Sec. 202. Reauthorization of telehealth network and telehealth resource centers grant programs.
Medicare Program
Expanding access to telehealth services to all areas
Section 1834(m)(4)(C)(i) of the
Social Security Act (42 U.S.C.
1395m(m)(4)(C)(i)) is amended by striking and only if such site is
located
and all that follows and inserting without regard to the
geographic area where the site is located.
.
Increase in number of types of originating sites; clarification
Increase
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 subclauses:
A skilled nursing facility (as defined in section 1819(a)).
A renal dialysis facility.
A county mental health clinic or other publicly funded mental health facility.
.
Clarification of intent of the term originating site
Such section is further amended by adding at the end the following new paragraph:
Construction
In applying the term originating site under this subsection, the Secretary shall apply the term only for the purpose of determining whether a site is eligible to receive a facility fee. Nothing in the application of that term under this subsection shall be construed as affecting the ability of an eligible practitioner to submit claims for telehealth services that are provided to other sites that have telehealth systems and capabilities.
.
Expansion of use of store-and-forward technology
The second sentence of section 1834(m)(1) of
the Social Security Act (42 U.S.C.
1395m(m)(1)) is amended to read as follows: For purposes of the
preceding sentence, in the case of any medicare demonstration program conducted
by the Secretary, any disease management program under this title, or any site
determined appropriate by the Secretary, the term
.telecommunications
system
includes store-and-forward technologies that provide for the
asynchronous transmission of health care information in single or multimedia
formats.
Expansion of practitioners eligible to furnish telehealth services
Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is amended—
in paragraph (1),
by striking (as defined in section 1861(r)) or a practitioner (described
in section 1842(b)(18)(C))
and inserting or a
practitioner
; and
by striking paragraph (4)(E) and inserting the following new subparagraph:
Practitioner
The term practitioner means—
a practitioner described in section 1842(b)(18)(C);
a physical therapist (as described in section 1861(p));
an occupational therapist (as so described);
a qualified speech-language pathologist (as defined in section 1861(ll)(3)(A));
a certified provider (as described in section 1861(qq)(2)(A)); and
any other individual or entity determined appropriate by the Secretary.
.
Expansion of covered telehealth services
Section 1834(m)(4)(F)(i) of the Social Security Act (42 U.S.C. 1395m(m)(4)(F)(i)) is amended to read as follows:
In general
The term telehealth service
means—
any professional service (identified as of July 1, 2000, by HCPCS codes approved for face-to-face care, and as subsequently modified by the Secretary); and
any additional service specified by the Secretary.
.
Facilitating the provision of telehealth services across State lines
In general
For purposes of expediting the provision of telehealth services, for which payment is made under the medicare program, across State lines, the Secretary of Health and Human Services shall, in consultation with representatives of States, physicians, health care practitioners, and patient advocates, encourage and facilitate the adoption of provisions allowing for multistate practitioner licensure across State lines.
Definitions
In subsection (a):
Telehealth service
The term telehealth service has the meaning given that term in subparagraph (F) of section 1834(m)(4) of the Social Security Act (42 U.S.C. 1395m(m)(4)), as amended by this title.
Physician, practitioner
The terms physician and practitioner have the meaning given those terms in subparagraphs (D) and (E), respectively, of such section, as so amended.
Medicare program
The term medicare program
means the
program of health insurance administered by the Secretary of Health and Human
Services under title XVIII of the Social Security
Act (42 U.S.C. 1395 et seq.).
Effective Date
The amendments made by sections 101 through 105 shall apply to services furnished on or after the date that is 90 days after the date of enactment of this Act.
HRSA grant program
Grant program for the development of telehealth networks
In general
The Secretary of Health and Human Services (in this
section referred to as the Secretary
), acting through the
Director of the Office for the Advancement of Telehealth (of the Health
Resources and Services Administration), shall make grants to eligible entities
(as described in subsection (b)(2)) for the purpose of expanding access to
health care services for individuals in rural areas, frontier areas, and urban
medically underserved areas through the use of telehealth.
Eligible entities
Application
To be eligible to receive a grant under this section, an eligible entity described in paragraph (2) shall, in consultation with the State office of rural health or other appropriate State entity, prepare and submit to the Secretary an application, at such time, in such manner, and containing such information as the Secretary may require, including the following:
A description of the anticipated need for the grant.
A description of the activities which the entity intends to carry out using amounts provided under the grant.
A plan for continuing the project after Federal support under this section is ended.
A description of the manner in which the activities funded under the grant will meet health care needs of underserved rural populations within the State.
A description of how the local community or region to be served by the network or proposed network will be involved in the development and ongoing operations of the network.
The source and amount of non-Federal funds the entity would pledge for the project.
A showing of the long-term viability of the project and evidence of health care provider commitment to the network.
Eligible entities
An eligible entity described in this paragraph is a hospital or other health care provider in a health care network of community-based health care providers that includes at least two of the organizations described in subparagraph (A) and one of the institutions and entities described in subparagraph (B) if the institution or entity is able to demonstrate use of the network for purposes of education or economic development (as required by the Secretary).
The organizations described in this subparagraph are the following:
Community or migrant health centers.
Local health departments.
Nonprofit hospitals.
Private practice health professionals, including community and rural health clinics.
Other publicly funded health or social services agencies.
Skilled nursing facilities.
County mental health and other publicly funded mental health facilities.
Providers of home health services.
Renal dialysis facilities.
The institutions and entities described in this subparagraph are the following:
A public school.
A public library.
A university or college.
A local government entity.
A local health entity.
A health-related nonprofit foundation.
An academic health center.
Preference
The Secretary shall establish procedures to prioritize financial assistance under this section based upon the following considerations:
The applicant is a health care provider in a health care network or a health care provider that proposes to form such a network that furnishes or proposes to furnish services in a medically underserved area, health professional shortage area, or mental health professional shortage area.
The applicant is able to demonstrate broad geographic coverage in the rural or medically underserved areas of the State, or States, in which the applicant is located.
The applicant proposes to use Federal funds to develop plans for, or to establish, telehealth systems that will link rural hospitals and rural health care providers to other hospitals, health care providers, and patients.
The applicant will use the amounts provided for a range of health care applications and to promote greater efficiency in the use of health care resources.
The applicant is able to demonstrate the long-term viability of projects through cost participation (cash or in-kind).
The applicant is able to demonstrate financial, institutional, and community support for the long-term viability of the network.
The applicant is able to provide a detailed plan for coordinating system use by eligible entities so that health care services are given a priority over non-clinical uses.
Maximum amount of assistance to individual recipients
The Secretary shall
establish, by regulation, the terms and conditions of the grant and the maximum
amount of a grant award to be made available to an individual recipient for
each fiscal year under this section. The Secretary shall cause to have
published in the Federal Register or the HRSA Preview
notice of
the terms and conditions of a grant under this section and the maximum amount
of such a grant for a fiscal year.
Use of amounts
The recipient of a grant under this section may use sums received under such grant for the acquisition of telehealth equipment and modifications or improvements of telecommunications facilities including the following:
The development and acquisition through lease or purchase of computer hardware and software, audio and video equipment, computer network equipment, interactive equipment, data terminal equipment, and other facilities and equipment that would further the purposes of this section.
The provision of technical assistance and instruction for the development and use of such programming equipment or facilities.
The development and acquisition of instructional programming.
Demonstration projects for teaching or training medical students, residents, and other health profession students in rural or medically underserved training sites about the application of telehealth.
The provision of telenursing services designed to enhance care coordination and promote patient self-management skills.
The provision of services designed to promote patient understanding and adherence to national guidelines for common chronic diseases, such as congestive heart failure or diabetes.
Transmission costs, maintenance of equipment, and compensation of specialists and referring health care providers, when no other form of reimbursement is available.
Development of projects to use telehealth to facilitate collaboration between health care providers.
Electronic archival of patient records.
Collection and analysis of usage statistics and data that can be used to document the cost-effectiveness of the telehealth services.
Such other uses that are consistent with achieving the purposes of this section as approved by the Secretary.
Prohibited uses
Sums received under a grant under this section may not be used for any of the following:
To acquire real property.
To purchase or lease equipment to the extent the expenditures would exceed more than 40 percent of the total grant funds.
To purchase or install transmission equipment off the premises of the telehealth site and any transmission costs not directly related to the grant.
For construction, except that such funds may be expended for minor renovations relating to the installation of equipment.
Expenditures for indirect costs (as determined by the Secretary) to the extent the expenditures would exceed more than 15 percent of the total grant.
Administration
Nonduplication
The Secretary shall ensure that facilities constructed using grants provided under this section do not duplicate adequately established telehealth networks.
Coordination with other agencies
The Secretary shall coordinate, to the extent practicable, with other Federal and State agencies and not-for-profit organizations operating similar grant programs to pool resources for funding meritorious proposals.
Informational efforts
The Secretary shall establish and implement procedures to carry out outreach activities to advise potential end users located in rural and medically underserved areas of each State about the program authorized by this section.
Prompt implementation
The Secretary shall take such actions as are necessary to carry out the grant program as expeditiously as possible.
Authorization of appropriations
There are authorized to be appropriated to carry out this section $10,000,000 for fiscal year 2006, and such sums as may be necessary for each of the fiscal years 2007 through 2012.
Reauthorization of telehealth network and telehealth resource centers grant programs
Subsection (s) of section 330I of the Public Health Service Act (42 U.S.C. 254c–14) is amended—
in paragraph (1)—
by striking
and
before such sums
; and
by inserting
, $10,000,000 for fiscal year 2007, and such sums as may be necessary
for each of fiscal years 2008 through 2012
before the semicolon at the
end; and
in paragraph (2)—
by striking
and
before such sums
; and
by inserting
, $10,000,000 for fiscal year 2007, and such sums as may be necessary
for each of fiscal years 2008 through 2012
before the period at the
end.