I 

116TH CONGRESS 

1ST SESSION H. R. 5190 

To amend the Public Health Service Act to provide assistance for health 

centers and rural health clinics to implement electronic provider consultation and related telemedicine services. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 20, 2019 

Mr. HARDER of California (for himself, Mr. YOUNG, Mr. FORTENBERRY, Ms. 

TORRES SMALL of New Mexico, and Mr. STEUBE) introduced the following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act to provide assistance for health centers and rural health clinics to implement electronic provider consultation and related telemedicine services. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Specialty Treatment 

5 to Access and Referrals Act of 2019’’ or the ‘‘STAR Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) Telemedicine involving the delivery of safe, 

2 effective, quality health care services by a health 

3 care provider using electronic information technology 

4 as the mode of care delivery is a clinically appro5 priate and efficient method of furnishing many 

6 health care services. 

7 (2) Consultations between health care providers 

8 utilizing electronic information technology (in this 

9 section referred to as ‘‘E–Consult services’’) are fea10 sible in a variety of settings, flexible in their applica11 tion, and particularly useful in facilitating the timely 

12 provision of information from a clinician with spe13 cialized knowledge of a relevant medical subject mat14 ter to a treating clinician in order to improve care 

15 quality. 

16 (3) E–Consult services formalize the role of 

17 medical specialists, can be undertaken entirely with18 in electronic exchange platforms that are private and 

19 secure, and do not require synchronous communica20 tion between providers. 

21 (4) E–Consult services conducted in advance of 

22 a telemedicine service can improve the effectiveness 

23 of the subsequent telemedicine service. 

24 (5) E–Consult services are being utilized exten25 sively by the Veterans Health Administration and by 


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1 a growing number of academic medical centers and 

2 other public and private health care settings both in 

3 the United States and internationally. 

4 (6) There is a need for additional extensive and 

5 rigorous research studies to determine best practices 

6 and processes for E–Consult services and to validate 

7 the impact on access to specialty medical care, costs, 

8 and clinical outcomes. 

9 (7) Providing the expertise and technical assist10 ance necessary to implement E–Consult services in 

11 primary care settings could improve access to spe12 cialty care at relatively low cost while simultaneously 

13 providing a testbed to evaluate the merits of varying 

14 approaches to E–Consult services, ascertain the 

15 value of such programs, and experiment with service 

16 reimbursement strategies in fee-for-service environ17 ments, including value-based care delivery arrange18 ments such as through accountable care organiza19 tions. 

20 SEC. 3. E–CONSULT SERVICES AND RELATED TELEHEALTH 

21 ASSISTANCE PILOT PROGRAM. 

22 Title III of the Public Health Service Act is amended 

23 by inserting after section 330M (42 U.S.C. 254c–19) the 

24 following new section: 


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1 ‘‘SEC. 330N. E–CONSULT SERVICES AND RELATED TELE2 HEALTH ASSISTANCE PILOT PROGRAM. 

3 ‘‘(a) IN GENERAL.—The Secretary may award grants 

4 to eligible health center controlled networks, health cen5 ters, and rural health clinics described in subsection (e) 

6 to conduct pilot projects to implement and test the effec7 tiveness of E–Consult services and related telehealth serv8 ices furnished at such networks, centers, and clinics for 

9 purposes of addressing the goals described in subsection 

10 (b). 

11 ‘‘(b) OBJECTIVES.—A pilot project conducted pursu12 ant to a grant awarded under subsection (a) shall address 

13 the following goals: 

14 ‘‘(1) Improvement in patient access to specialty 

15 care. 

16 ‘‘(2) Reduction in specialty care patient wait 

17 times. 

18 ‘‘(3) Reduction in patient specialty referrals. 

19 ‘‘(4) Reduction in patient miles traveled for 

20 specialty care consultations. 

21 ‘‘(5) Increased support for primary care pro22 viders as demonstrated by job satisfaction measures. 

23 ‘‘(6) Increased patient satisfaction as dem24 onstrated by quality surveys. 

25 ‘‘(7) Health care cost savings. 


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1 ‘‘(8) Such other goals as the Secretary may 

2 identify. 

3 ‘‘(c) DURATION; AMOUNT.— 

4 ‘‘(1) DURATION.—A grant awarded under sub5 section (a) shall be for a term of no more than 5 

6 years. 

7 ‘‘(2) AMOUNT.—In the case of a grant made 

8 under subsection (a) directly to an eligible health 

9 center or rural health clinic, the amount provided 

10 may not exceed $200,000 for each center or clinic 

11 facility location. In the case of an award to an eligi12 ble health center controlled network, the amount 

13 provided may not exceed $5,000,000, and the value 

14 of the amount of assistance provided by such net15 work to any individual participating health center or 

16 rural clinic facility location may not exceed 

17 $200,000. 

18 ‘‘(d) USE OF FUNDS.—Funds provided under a grant 

19 pursuant to this section may only be used for the fol20 lowing, with respect to a pilot project conducted by a 

21 health center controlled network, health center, or rural 

22 health clinic: 

23 ‘‘(1) Conducting assessments of a participating 

24 facility’s infrastructure (such as broadband, equipVerDate Sep 11 2014 02:04 Dec 03, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H5190.IH H5190

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1 ment, and software), clinical objectives, and staffing 

2 plans. 

3 ‘‘(2) Based on assessment findings, developing 

4 and assisting in the execution of equipment and soft5 ware procurement, defining clinical objectives, devel6 oping adequate staffing plans, and implementing E– 

7 Consult services and related telehealth services pro8 gram plan. 

9 ‘‘(3) Training participating facility staff to 

10 properly utilize technology and implement programs. 

11 ‘‘(4) Providing clinical workflow training to 

12 support program implementation. 

13 ‘‘(5) Providing integrated certified EHR tech14 nology capabilities to support live video (where appli15 cable) and E–Consult services. 

16 ‘‘(6) Integrating the facility with live E–Consult 

17 service support providers and networks that meet 

18 the patient goals of the network, center, or clinic. 

19 ‘‘(7) Procuring appropriate information tech20 nology and undertaking minor alterations of physical 

21 space. 

22 ‘‘(8) Otherwise carrying out the pilot project to 

23 address the objectives described in subsection (b). 

24 ‘‘(e) PARTICIPATING FACILITIES; ELIGIBLE ENTI25 TIES.— 


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1 ‘‘(1) PARTICIPATING FACILITIES.—A location of 

2 a health center or rural health clinic shall qualify to 

3 participate in a pilot program established pursuant 

4 to this section if the center or clinic demonstrates in 

5 a manner determined by the Secretary that such lo6 cation— 

7 ‘‘(A) lacks sufficient access to care pro8 vided by medical specialists, as determined by 

9 the Secretary; and 

10 ‘‘(B) has not already implemented a pro11 gram of E–Consult services and related tele12 health services similar to that described in this 

13 section. 

14 ‘‘(2) REQUIREMENTS TO BE ELIGIBLE TO RE15 CEIVE A GRANT.—To be eligible to receive a grant 

16 under subsection (a), an entity must— 

17 ‘‘(A) be— 

18 ‘‘(i) a health center controlled network 

19 that demonstrates to the satisfaction of the 

20 Secretary— 

21 ‘‘(I) sufficient expertise and expe22 rience in the successful provision of 

23 the technical and other assistance re24 quired under for health centers and 

25 rural health clinics to conduct a pilot 


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1 project in accordance with this sec2 tion; 

3 ‘‘(II) evidence of sufficient bind4 ing participation commitments re5 ceived from eligible health centers and 

6 rural health clinics; 

7 ‘‘(III) the ability to assist eligible 

8 health centers and rural health clinics 

9 to conduct E–Consult services with 

10 medical specialists and related tele11 health services; and 

12 ‘‘(IV) a likelihood of successfully 

13 accomplishing the program objectives 

14 as identified in subsection (b); or 

15 ‘‘(ii) a qualifying health center or 

16 rural health clinic that demonstrates to the 

17 satisfaction of the Secretary— 

18 ‘‘(I) sufficient expertise and abil19 ity to implement on its own behalf the 

20 technical and other assistance de21 scribed in subparagraph (A)(i); 

22 ‘‘(II) a likelihood of successfully 

23 implementing a program of E–Consult 

24 services with medical specialists and 

25 related telehealth services; and 


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1 ‘‘(III) a likelihood of successfully 

2 accomplishing the program objectives 

3 as identified in subsection (b); and 

4 ‘‘(B) submit an application described in 

5 paragraph (3) to the Secretary in such form 

6 and manner, and in accordance with such tim7 ing, as specified by the Secretary. 

8 ‘‘(3) APPLICATION.—For purposes of para9 graph (2)(B), an application described in this para10 graph, with respect to an applicant, is an application 

11 that demonstrates to the satisfaction of the Sec12 retary— 

13 ‘‘(A) in the case of an applicant that is a 

14 health center controlled network, the intention 

15 of a sufficient minimum number of eligible 

16 health centers to participate in the program 

17 through the network and a plan for recruiting 

18 additional centers to participate; 

19 ‘‘(B) the qualification of proposed facility 

20 locations to participate in the program; 

21 ‘‘(C) requisite experience, expertise, and 

22 capacity; 

23 ‘‘(D) likelihood of meeting program objec24 tives described in subsection (b); and 


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1 ‘‘(E) internal program metrics that will be 

2 employed to demonstrate satisfaction of pro3 gram objectives and information to be collected 

4 and provided to the Secretary as necessary to 

5 conduct program evaluation. 

6 ‘‘(f) EVALUATION; REPORT.—Not later than 180 

7 days after the date of the completion of the last pilot 

8 projects funded under this section, the Secretary shall sub9 mit to Congress a report, including an evaluation, on the 

10 projects that addresses the following: 

11 ‘‘(1) An overview of supported projects and 

12 identification of areas of success and failure. 

13 ‘‘(2) Policies, practices, and organizational ap14 proaches that either facilitate or impede the effective 

15 use of E–Consult services (including personnel train16 ing and support, technology usability, workflow, and 

17 provider communication). 

18 ‘‘(3) Relative effectiveness of consultations pro19 vided by Medical Specialists in improving outcomes, 

20 quality of care and efficiency with respect to dif21 ferent specialties, clinical conditions, complexity, pa22 tient types, or other issues. 

23 ‘‘(4) The extent to which information shared in 

24 the E–Consult services process is sufficient, accu25 rate, and actionable in order to effectively facilitate 


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1 care improvement, and whether such bi-directional 

2 information flows can be standardized. 

3 ‘‘(5) The extent to which E–Consults facilitate 

4 continuity of care. 

5 ‘‘(6) Any issues arising related to maintaining 

6 the privacy of personal health information, ensuring 

7 cybersecurity, and other information security issues. 

8 ‘‘(7) The extent to which E–Consult services 

9 contribute to improved health outcomes and metrics 

10 that can facilitate such evaluation. 

11 ‘‘(8) Any unintended or adverse results from 

12 utilizing E–Consult services. 

13 ‘‘(g) DEFINITIONS.—For purposes of this section: 

14 ‘‘(1) CERTIFIED EHR TECHNOLOGY.—The term 

15 ‘certified EHR technology’ has the meaning given 

16 such term in section 3000(1). 

17 ‘‘(2) E–CONSULT SERVICE.—The term ‘E–Con18 sult service’ means synchronous or asynchronous, 

19 consultative, health-care-provider-to-health-care-pro20 vider communications that occur within a shared 

21 certified EHR technology or secure internet-based 

22 platform and are primarily intended to provide spe23 cialty expertise to treating clinicians (who are often 

24 primary care providers) without requiring a direct 

25 interaction between the patient and the medical speVerDate Sep 11 2014 02:04 Dec 03, 2019 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H5190.IH H5190

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1 cialist. Such consultation ordinarily involves a treat2 ing clinician sending information regarding the pa3 tient and a consultation request to a medical spe4 cialist who may then respond in any of a number of 

5 ways, including providing requested feedback, asking 

6 for additional information, recommending certain 

7 studies or examinations, or initiating the scheduling 

8 of an appointment. 

9 ‘‘(3) HEALTH CENTER.—The term ‘health cen10 ter’ has the meaning given such term in section 

11 330(a). 

12 ‘‘(4) HEALTH CENTER CONTROLLED NET13 WORK.—The term ‘health center controlled network’ 

14 means a network that is owned and controlled by 

15 constituent health centers as described in section 

16 330(e)(1)(C). 

17 ‘‘(5) PRIMARY CARE PROVIDER.—The term ‘pri18 mary care provider’ means a licensed health profes19 sional (as defined in section 1819(b)(5)(G) of the 

20 Social Security Act) or a licensed provider of behav21 ioral health services who customarily provides serv22 ices described in paragraph (1) or (2) of section 

23 330(b) to patients. 

24 ‘‘(6) MEDICAL SPECIALIST.—The term ‘medical 

25 specialist’ means a licensed physician or a nurse 


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1 practitioner who has completed advanced education 

2 and clinical training in a one or more specific areas 

3 of medicine and focuses their medical practice on 

4 such area or areas. Such term may, if specified by 

5 the Secretary, include a licensed provider of behav6 ioral health services. 

7 ‘‘(7) RELATED TELEHEALTH SERVICES.—The 

8 term ‘related telehealth services’ means telehealth 

9 services arising out of or incident to an E–Consult 

10 service, such as laboratory tests, diagnostic imaging, 

11 or a subsequent interaction between a medical spe12 cialist and a patient. 

13 ‘‘(8) RURAL HEALTH CLINIC.—The term ‘rural 

14 health clinic’ has the meaning give such term in sec15 tion 1861(aa)(2) of the Social Security Act. 

16 ‘‘(9) TELEHEALTH.—The term ‘telehealth’ 

17 means the use of electronic information and tele18 communications technologies (including videoconfer19 encing, the internet, store-and-forward imaging, 

20 streaming media, and terrestrial and wireless com21 munications) to support and promote long-distance 

22 clinical health care, patient and professional health23 related education, public health, and health adminis24 tration. 


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1 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to carry out this section 

3 $12,000,000 for each of fiscal years 2021 through 2025.’’. 

Æ 


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