SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Rural Telemedicine Development Act 
of 1993''.

SEC. 2. PURPOSE.

    It is the purpose of this Act to support the development of 
telemedicine projects that are designed to improve the delivery, 
accessability and affordability of health care services to Americans 
living in rural areas. This Act is intended to--
            (1) assist rural hospitals and other rural health care 
        providers in dealing with personnel shortages and shared 
        staffing arrangements by providing such providers with the 
        telecommunications technology necessary to maintain contact 
        with itinerant staff and remote specialists;
            (2) reduce the cost of care for rural patients and 
        strengthen rural health care providers by using 
        telecommunications technologies to permit such patients to stay 
        in their local hospitals and to receive other health services 
        locally whenever possible and appropriate, by reducing 
        paperwork costs and by improving coordination and efficiency in 
        the delivery of health care;
            (3) provide rural health care providers with access, via 
        telecommunications systems, to equipment, specialists, and 
        continuing education programs that are otherwise generally not 
        available in rural areas; and
            (4) demonstrate the effectiveness of fiber optics 
        telecommunication systems in improving the quality and access 
        of health care services in rural areas.

SEC. 3. ESTABLISHMENT OF GRANT PROGRAMS.

    Title XVII of the Public Health Service Act (42 U.S.C. 300u et 
seq.) is amended--
            (1) in the title heading by striking out ``AND HEALTH 
        PROMOTION'' and inserting in lieu thereof ``, HEALTH PROMOTION 
        AND TELEMEDICINE DEVELOPMENT'';
            (2) by inserting after the title heading the following:

          ``Part A--Health Information and Health Promotion'';

        and
            (3) by adding at the end thereof the following new part:

                   ``Part B--Telemedicine Development

``SEC. 1711. GRANT PROGRAM FOR PROMOTING THE INITIAL DEVELOPMENT OF 
              RURAL TELEMEDICINE NETWORKS.

    ``(a) Establishment.--The Secretary shall award grants to eligible 
entities described in section 1714(a) for the purpose of encouraging 
the initial development of rural telemedicine networks. Grants shall be 
awarded under this section to encourage the formation of rural health 
care networks that could benefit from the use of telecommunications 
technology in providing health services to rural areas.
    ``(b) Application.--To be eligible to receive a grant under this 
section an entity shall prepare and submit to the Secretary an 
application at such time, in such manner and containing such 
information as the Secretary may require, including a description of 
the use to which the entity will apply any amounts received under such 
grant.
    ``(c) Preference in Awarding Grants.--The Secretary shall, in 
awarding grant under subsection (a), give preference to applicants 
that--
            ``(1) are participants in rural health care networks or 
        that propose to form such networks;
            ``(2) can demonstrate broad geographic coverage in the 
        rural areas of the State, or States in which the applicant is 
        located; and
            ``(3) propose to use Federal funds to develop plans for, or 
        to establish, pilot telecommunications systems that will link 
        rural hospitals and other rural health care providers to other 
        hospitals, and health care providers.

``SEC. 1712. GRANT PROGRAM FOR THE ESTABLISHMENT OF ADVANCED RURAL 
              TELEMEDICINE NETWORKS.

    ``(a) Establishment.--The Secretary shall award grants to rural 
health networks for the purpose of linking such networks together using 
advanced telemedicine systems. Grants shall be awarded under this 
section to further develop telemedicine projects initiated by these 
rural health care networks.
    ``(b) Application.--To be eligible to receive a grant under this 
section an entity shall prepare and submit to the Secretary an 
application at such time, in such manner and containing such 
information as the Secretary may require, including a description of 
the use to which the entity will apply any amounts received under such 
grant.
    ``(c) Minimum Qualifications.--The Secretary may not award a grant 
to an applicant under subsection (a) unless--
            ``(1) the applicant is determined by the Secretary to 
        include one or more rural health network; and
            ``(2) the applicant can demonstrate broad geographical 
        coverage in the rural areas of the State or States in which it 
        is located.
    ``(d) Preferences in Awarding Grants.--The Secretary shall, in 
awarding grants under subsection (a), give preference to qualified 
applicants that--
            ``(1) can demonstrate that a majority of the hospitals and 
        other providers participating in the applicant group have 
        functioned as networks for at least 1 year prior to applying 
        for funding under this section; and
            ``(2) will use amounts provided under the grant to provide 
        a range of telecommunications applications such as 
        teleradiology, telepathology, interactive video consultation 
        and remote educational services and to promote areawide health 
        planning and greater efficiency in administrative activities.

``SEC. 1713. GRANT PROGRAM FOR THE ESTABLISHMENT OF ADVANCED FIBER 
              OPTIC BASED RURAL TELEMEDICINE NETWORKS.

    ``(a) Establishment.--The Secretary shall award grants to rural 
health networks for the purpose of linking these networks to existing 
fiber optic telecommunications systems.
    ``(b) Application.--To be eligible to receive a grant under this 
section an entity shall prepare and submit to the Secretary an 
application at such time, in such manner and containing such 
information as the Secretary may require, including a description of 
the use to which the entity will apply any amounts received under such 
grant.
    ``(c) Minimum Qualifications.--The Secretary may not award a grant 
to an applicant under subsection (a) unless--
            ``(1) the applicant is determined by the Secretary to 
        include one or more rural health network;
            ``(2) the applicant group can demonstrate broad 
        geographical coverage in the rural areas of the State or States 
        in which it is located; and
            ``(3) the applicant group will participate in an existing 
        fiber optic telecommunications system.
    ``(d) Preferences in Awarding Grants.--The Secretary shall, in 
awarding grants under subsection (a), give preference to qualified 
applicants that--
            ``(1) will use grant funds to provide a range of 
        telecommunications applications including teleradiology, 
        telepathology, interactive video consultation and remote 
        educational services and to promote areawide health planning 
        and greater efficiency in administrative activities;
            ``(2) demonstrate that the majority of the hospitals and 
        other providers participating in the applicant group have 
        functioned as networks for at least 1 year prior to applying 
        for funding under this section; and
            ``(3) will participate in an existing Statewide fiber 
        optics cable system.

``SEC. 1714. USE OF FUNDS FOR INITIAL DEVELOPMENT GRANT PROGRAMS.

    ``(a) Eligible Entities.--Entities eligible to receive a grant 
under section 1711 shall include hospitals, hospital networks, and 
other health care providers.
    ``(b) Use of Amounts.--Amounts received under a grant awarded under 
section 1711 shall be utilized for the initial development of rural 
telemedicine networks, including the establishment of pilot 
telemedicine projects involving two or more providers. Such amounts may 
be used to cover the costs associated with the development of 
telemedicine networks and the acquisition or construction of 
telecommunications facilities and equipment including--
            ``(1) the development and acquisition through lease or 
        purchase of computer hardware and software, audio and visual 
        equipment, computer network equipment, telecommunications 
        transmission facilities, telecommunications terminal equipment, 
        interactive video equipment, data terminal equipment, and other 
        facilities and equipment that would further the purposes 
        authorized by this part;
            ``(2) the provision of technical assistance and instruction 
        for the development and use of such programming, equipment, or 
        facilities;
            ``(3) the development and acquisition of instructional 
        programming; or
            ``(4) such other uses that are consistent with achieving 
        the purposes of this part as approved by the Secretary.

``SEC. 1715. USE OF FUNDS FOR ADVANCED TELEMEDICINE GRANT PROGRAMS.

    ``Grants under sections 1712 and 1713 shall be available to health 
care networks for the development of telemedicine networks and the 
acquisition or construction of telecommunications facilities and 
equipment including--
            ``(1) the development and acquisition through lease or 
        purchase of computer hardware and software, audio and visual 
        equipment, computer network equipment, telecommunications 
        transmission facilities, telecommunications terminal equipment, 
        interactive video equipment, data terminal equipment, and other 
        facilities and equipment that would further the purposes 
        authorized by this part;
            ``(2) the provision of technical assistance and instruction 
        for the development and use of such programming, equipment, or 
        facilities;
            ``(3) the development and acquisition of instructional 
        programming; or
            ``(4) such other uses that are consistent with achieving 
        the purposes of this part as approved by the Secretary.

``SEC. 1716. DEFINITIONS.

    ``For the purposes of this part:
            ``(1) Computer networks.--The term `computer networks' 
        means computer hardware and software, terminals, signal 
        conversion equipment including both modulators and 
        demodulators, or related devices, used to communicate with 
        other computers to process and exchange data through a 
        telecommunication network in which signals are generated, 
        modified, or prepared for transmission, or received, via 
        telecommunications terminal equipment and telecommunications 
        transmission facilities.
            ``(2) Data terminal equipment.--The term `data terminal 
        equipment' means equipment that converts user information into 
        data signals for transmission, or reconverts the received data 
        signals into user information, and is normally found on the 
        terminal of a circuit and on the premises of the end user.
            ``(3) Fiber optic cable.--The term `fiber optic cable' 
        means a bundle of optical transmission elements or waveguides 
        usually consisting of a fiber core and fiber cladding that can 
        guide a lightwave and that are incorporated into an assembly of 
        materials that provide tensile strength and external 
        protection.
            ``(4) Interactive video equipment.--The term `interactive 
        video equipment' means equipment used to produce and prepare 
        for transmission audio and visual signals from at least two 
        distant locations in order that individuals at such locations 
        can verbally and visually communicate with each other, and such 
        equipment includes monitors, other display devices, cameras or 
        other recording devices, audio pickup devices, and other 
        related equipment.
            ``(5) Health care network.--The term `rural health care 
        network' means a group of rural hospitals or other rural health 
        care providers (including clinics, physicians and non-physician 
        primary care providers) that have entered into a formal 
        relationship with each other or with nonrural hospitals and 
        health care providers for the purpose of strengthening the 
        delivery of health care services in rural areas or specifically 
        to improve their patients' access to telemedicine services. At 
        least 75 percent of hospitals and other health care providers 
        participating in the network shall be located in rural areas.
            ``(6) Statewide fiber optic cable system.--The term 
        `Statewide fiber optic cable system' means a telecommunications 
        system that will carry voice, data, and full motion video 
        traffic through fiber optic cable to a point of presence in 
        every county in the State in which it is located.
            ``(7) Telecommunications terminal equipment.--The term 
        `telecommunications terminal equipment' means the assembly of 
        telecommunications equipment at the end of a circuit, normally 
        located on the premises of the end user, that interfaces with 
        telecommunications transmission facilities, and that is used to 
        modify, convert, encode, or otherwise prepare signals to be 
        transmitted via such telecommunications facilities, or that is 
        used to modify, reconvert or carry signals received from such 
        facilities, the purpose of which is to accomplish the goal for 
        which the circuit was established.
            ``(8) Telecommunications transmission facilities.--The term 
        `telecommunications transmission facilities' means those 
        facilities that transmit, receive, or carry data between the 
        telecommunications terminal equipment at each end of a 
        telecommunications circuit or path. Such facilities include 
        microwave antennae, relay stations and towers, other 
        telecommunications antennae, fiber-optic cables and repeaters, 
        coaxial cables, communication satellite ground station 
        complexes, copper cable electronic equipment associated with 
        telecommunications transmissions, and similar items as defined 
        by the Secretary.

``SEC. 1717. AUTHORIZATION OF APPROPRIATIONS.

    ``For the purposes of carrying out this part, there are authorized 
to be appropriated such sums as may be necessary for each of the fiscal 
years 1994 through 1997.''.
Rural Telemedicine Development Act of 1993 - Amends the Public Health Service Act to direct the Secretary of Health and Human Services to award grants:  (1) to hospitals, hospital networks, and other health care providers to encourage the initial development of rural telemedicine networks to use telecommunications technology in providing health services to rural areas; and (2) for linking such networks together using advanced telemedicine systems and for linking such networks to existing fiber optic telecommunications systems. 
Sets forth provisions regarding:  (1) application requirements; (2) preferences in awarding grants; and (3) use of funds for initial development and advanced telemedicine grant programs.  Authorizes appropriations.
Rural Telemedicine Development Act of 1993