A bill to establish telehealth pilot projects, expand access to stroke telehealth services under the Medicare program, improve access to "store-and-forward" telehealth services in facilities of the Indian Health Service and Federally qualified health centers, reimburse facilities of the Indian Health Service as originating sites, establish regulations to consider credentialing and privileging standards for originating sites with respect to receiving telehealth services, and for other purposes.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Rural Telemedicine Enhancing 
Community Health (TECH) Act of 2009''.

SEC. 2. TELEHEALTH PILOT PROJECTS.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall establish 3-
year telehealth pilot projects for the purpose of analyzing the 
clinical outcomes and cost effectiveness associated with telehealth 
services in a variety of geographic areas. The Secretary shall provide 
evaluation and treatment services to entities participating in the 
pilot projects.
    (b) Eligible Entities.--
            (1) In general.--The Secretary shall select eligible 
        entities to participate in the pilot projects under this 
        section.
            (2) Priority.--In selecting eligible entities to 
        participate in the pilot projects under this section, the 
        Secretary shall give priority to such entities located in 
        medically underserved areas and facilities of the Indian Health 
        Service.
    (c) Evaluation.--The Secretary shall, through the pilot projects, 
evaluate--
            (1) the effective and economic delivery of care in treating 
        behavioral health issues (including post-traumatic stress 
        disorder) with the use of telehealth services in medically 
        underserved and tribal areas, including collaborative uses of 
        health professionals, integration of the range of telehealth 
        and other technologies, and exploration of appropriate 
        reimbursement methods for third party payers;
            (2) the effectiveness of improving the capacity of non-
        medical providers and non-specialized medical providers to 
        provide health services for chronic complex diseases in 
        medically underserved and tribal areas; and
            (3) the effectiveness of using telehealth services to 
        provide acute stroke evaluation and treatment, occupational 
        therapy, physical therapy, and speech language pathology 
        services to treat cerebrovascular disease in medically 
        underserved and tribal areas.
    (d) Report.--Not later than 3 years after the pilot projects are 
established under subsection (a), the Secretary shall submit to 
Congress a report describing the outcomes of such pilot projects and 
providing recommendations for expanding the use of telehealth services.
    (e) Expansion of Project.--If the Secretary determines that the 
pilot projects under this section enhance outcomes for patients and 
reduce expenditures for participating entities, the Secretary may 
initiate similar projects for additional medical conditions and 
geographic areas.
    (f) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $13,500,000 for fiscal years 
2011 through 2014.

SEC. 3. EXPANDING ACCESS TO STROKE TELEHEALTH SERVICES.

    (a) Expansion of Originating Sites for Stroke Telehealth 
Services.--Section 1834(m)(4) of the Social Security Act (42 U.S.C. 
1395m(m)(4)) is amended--
            (1) in subparagraph (C)--
                    (A) in clause (i), in the matter preceding 
                subclause (I), by striking ``The term'' and inserting 
                ``Subject to clause (iii), the term''; and
                    (B) by adding at the end the following new clause:
                            ``(iii) Expansion of originating sites for 
                        stroke telehealth services.--In the case of 
                        stroke telehealth services, the term 
                        `originating site' means any site described in 
                        clause (ii) at which the eligible telehealth 
                        individual is located at the time the service 
                        is furnished via a telecommunications system, 
                        regardless of where the site is located.''; and
            (2) 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 or treatment of individuals with 
                acute stroke, occupational therapy, physical therapy, 
                and speech language pathology services furnished 
                subsequent to a stroke, and stroke prevention and 
                education services.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to telehealth services furnished on or after the date that is 6 
months after the date of enactment of this Act.

SEC. 4. IMPROVING ACCESS TO TELEHEALTH SERVICES AT IHS FACILITIES AND 
              FQHCS.

    (a) 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).''.
    (b) Access to Store-and-Forward and Videoconferencing 
Technologies.--
            (1) In general.--Section 1834(m)(1) of such Act (42 U.S.C. 
        1395m(m)(1)) is amended by adding at the end the following 
        sentence: ``For purposes of the first sentence, in the case of 
        telehealth services described in subclause (I) of paragraph 
        (4)(F)(iii) that are furnished by 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)) or a 
        federally qualified health center (as defined in section 
        1861(aa)(4)), the term `telecommunications system' includes 
        store-and-forward technologies described in the preceding 
        sentence and, in the case of telehealth services described in 
        subclause (II) of such paragraph that are furnished by such a 
        facility or federally qualified health center, such term 
        includes videoconferencing technologies.''
            (2) Conforming amendment.--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 clauses:
                            ``(iii) Telehealth services described.--For 
                        purposes of paragraph (1):
                                    ``(I) The telehealth services 
                                described in this subclause include 
                                consultations related to neurosurgery, 
                                neurology, cardiology, dermatology, 
                                pediatric specialty, and orthopedic (as 
                                specified by the Secretary).
                                    ``(II) The telehealth services 
                                described in this subclause are 
                                services related to hepatitis and other 
                                chronic conditions and behavioral 
                                health services (as specified by the 
                                Secretary).''.
    (c) Effective Date.--The amendments made by this section shall 
apply to telehealth services furnished on or after the date that is 6 
months after the date of enactment of this Act.

SEC. 5. 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 reasonable 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 accredited by a 
                national accreditation body recognized by the Secretary 
                under section 1865(a)(1) if the site accepting such 
                credentialing and privileging processes is also so 
                accredited and complies with the applicable 
                requirements for such acceptance.''.

Summary: Rural Telemedicine Enhancing Community Health (TECH) Act of 2009 - Directs the Secretary of Health and Human Services (HHS) to establish telehealth pilot projects for the purpose of analyzing the clinical outcomes and cost effectiveness associated with telehealth services in a variety of geographic areas. Amends title XVIII (Medicare) of the Social Security Act to: (1) provide for expansion of originating telehealth sites for stroke telehealth services. (2) provide access to store-and-forward telehealth services in facilities of the Indian Health Service and federally qualified health centers. And (3) direct the Secretary to establish reasonable regulations to consider the remote credentialing and privileging standards for originating sites with respect to telehealth services.