# H.R. 3200/Division B/Title I/Subtitle F
## SUBTITLE F — MEDICARE RURAL ACCESS PROTECTIONS
### Sec. 1191. TeleHealth Expansion and Enhancements.

    (a) Additional TeleHealth Site.—
          (1) In General.—
             Paragraph (4)(C)(ii) of section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is amended by adding at the end the following new subclause:
                ``(IX) A renal dialysis facility.´´
          (2) Effective Date.—
             The amendment made by paragraph (1) shall apply to services furnished on or after January 1, 2011.
    (b) 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.—The Secretary shall appoint a TeleHealth Advisory Committee (in this subsection referred to as the ‘Advisory Committee’) to make 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.
                      ``(2) Membership; terms.—
                         ``(A) Membership.—
                            ``(i) In general.—The Advisory Committee shall be composed of 9 members, to be appointed by the Secretary, of whom—
                               ``(I) 5 shall be practicing physicians;
                               ``(II) 2 shall be practicing non-physician health care practitioners; and
                               ``(III) 2 shall be administrators of telehealth programs.
                            ``(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 such term as the Secretary may specify.
                         ``(C) Conflicts of interest.—An advisory committee member may not participate with respect to a particular matter considered in an advisory committee meeting 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.
                      ``(3) Meetings.—The Advisory Committee shall meet twice each calendar year and at such other times as the Secretary may provide.
                      ``(4) Permanent committee.—Section 14 of the Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to the Advisory Committee.´´
          (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).

### Sec. 1192. Extension of Outpatient Hold Harmless Provision.

    Section 1833(t)(7)(D)(i) of the Social Security Act (42 U.S.C. 1395l(t)(7)(D)(i)) is amended—
          (1) in subclause (II)—
                (A) in the first sentence, by striking '``2010´´and inserting ``2012´´; and
                (B) in the second sentence, by striking ``or 2009´´ and inserting ``, 2009, 2010, or 2011´´; and
          (2) in subclause (III), by striking ``January 1, 2010´´ and inserting ``January 1, 2012´´.

### Sec. 1193. Extension of Section 508 Hospital Reclassifications.

    Subsection (a) of section 106 of division B of the Tax Relief and Health Care Act of 2006 (42 U.S.C. 1395 note), as amended by section 117 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173) and section 124 of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110-275), is amended by striking ``September 30, 2009´´ and inserting ``September 30, 2011´´.

### Sec. 1194. Extension of Geographic Floor for Work.

    Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w–4(e)(1)(E)) is amended by striking ``before January 1, 2010´´ and inserting ``before January 1, 2012´´.

### Sec. 1195. Extension of Payment for Technical Component of Certain Physician Pathology Services.

    Section 542(c) of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (as enacted into law by section 1(a)(6) of Public Law 106-554), as amended by section 732 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (42 U.S.C. 1395w–4 note), section 104 of division B of the Tax Relief and Health Care Act of 2006 (42 U.S.C. 1395w–4 note), section 104 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173), and section 136 of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110-275), is amended by striking ``and 2009´´ and inserting ``2009, 2010, and 2011´´.

### Sec. 1196. Extension of Ambulance Add-Ons.

    (a) In General.—
       Section 1834(l)(13) of the Social Security Act (42 U.S.C. 1395m(l)(13)) is amended—
          (1) in subparagraph (A)—
                (A) in the matter preceding clause (i), by striking ``before January 1, 2010´´ and inserting ``before January 1, 2012´´; and
                (B) in each of clauses (i) and (ii), by striking ``before January 1, 2010´´ and inserting ``before January 1, 2012´´.
    (b) Air Ambulance Improvements.—
       Section 146(b)(1) of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110-275) is amended by striking ``ending on December 31, 2009´´ and inserting ``ending on December 31, 2011´´.