I 

109TH CONGRESS 

1ST SESSION H. R. 2807

To improve the provision of telehealth services under the Medicare Program, 

to provide grants for the development of telehealth networks, and for 

other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 8, 2005

Mr. HULSHOF (for himself and Mr. THOMPSON of California) introduced the 

following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

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.

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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Medicare Telehealth Enhancement Act of 2005’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 this Act is as follows:
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Sec. 1. Short title; table of contents. 

TITLE I—MEDICARE PROGRAM 

Sec. 101. Expansion and improvement of telehealth services. 

Sec. 102. Increase in number of types of originating sites; clarification. 

Sec. 103. Facilitating the provision of telehealth services across State lines. 

Sec. 104. Definition of medicare program. 

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.

1 TITLE I—MEDICARE PROGRAM 

2 SEC. 101. EXPANSION AND IMPROVEMENT OF TELEHEALTH 

3 SERVICES. 

4 (a) EXPANDING ACCESS TO TELEHEALTH SERVICES

5 TO ALL AREAS.—Section 1834(m) of the Social Security 

6 Act (42 U.S.C. 1395m(m)) is amended in paragraph 

7 (4)(C)(i) by striking ‘‘and only if such site is located’’ and 

8 all that follows and inserting ‘‘without regard to the geo9 graphic area where the site is located.’’. 

10 (b) REPORT TO CONGRESS ON STORE AND FORWARD

11 TECHNOLOGY.—

12 (1) STUDY.—The Secretary of Health and 

13 Human Services, acting through the Director of the 

14 Office for the Advancement of Telehealth, shall con15 duct a study on the use of store and forward tech16 nologies (that provide for the asynchronous trans17 mission of health care information in single or multi18 media formats) in the provision of telehealth services 

19 for which payment may be made under the medicare 
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1 program in Alaska and Hawaii and in other States. 

2 Such study shall include an assessment of the feasi3 bility, advisability, and the costs of expanding the 

4 use of such technologies to other areas for use in the 

5 diagnosis and treatment of certain conditions. 

6 (2) REPORT.—Not later than 18 months after 

7 the date of the enactment of this Act, the Secretary 

8 shall submit to Congress a report on the study con9 ducted under subparagraph (A) and shall include in 

10 such report such recommendations for legislation or 

11 administration action as the Secretary determines 

12 appropriate. 

13 SEC. 102. INCREASE IN NUMBER OF TYPES OF ORIGI14 NATING SITES; CLARIFICATION. 

15 (a) INCREASE.—Paragraph (4)(C)(ii) of section 

16 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) 

17 is amended by adding at the end the following new sub18 clauses: 

19 ‘‘(VI) A skilled nursing facility 

20 (as defined in section 1819(a)). 

21 ‘‘(VII) A renal dialysis facility. 

22 ‘‘(VIII) A county mental health 

23 clinic or other publicly funded mental 

24 health facility.’’. 
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1 (b) CLARIFICATION OF INTENT OF THE TERM ORIGI2 NATING SITE.—Such section is further amended by add3 ing at the end the following new paragraph: 

4 ‘‘(5) CONSTRUCTION.—In applying the term 

5 ‘originating site’ under this subsection, the Secretary 

6 shall apply the term only for the purpose of deter7 mining whether a site is eligible to receive a facility 

8 fee. Nothing in the application of that term under 

9 this subsection shall be construed as affecting the 

10 ability of an eligible practitioner to submit claims for 

11 telehealth services that are provided to other sites 

12 that have telehealth systems and capabilities.’’. 

13 SEC. 103. FACILITATING THE PROVISION OF TELEHEALTH 

14 SERVICES ACROSS STATE LINES. 

15 (a) IN GENERAL.—For purposes of expediting the 

16 provision of telehealth services, for which payment is made 

17 under the medicare program, across State lines, the Sec18 retary of Health and Human Services shall, in consulta19 tion with representatives of States, physicians, health care 

20 practitioners, and patient advocates, encourage and facili21 tate the adoption of provisions allowing for multistate 

22 practitioner licensure across State lines. 

23 (b) DEFINITIONS.—In paragraph (1): 

24 (1) TELEHEALTH SERVICE.—The term ‘‘tele25 health service’’ has the meaning given that term in 
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1 subparagraph (F) of section 1834(m)(4) of the So2 cial Security Act (42 U.S.C. 1395m(m)(4)). 

3 (2) PHYSICIAN, PRACTITIONER.—The terms 

4 ‘‘physician’’ and ‘‘practitioner’’ has the meaning 

5 given those terms in subparagraphs (D) and (E), re6 spectively, of such section. 

7 SEC. 104. DEFINITION OF MEDICARE PROGRAM. 

8 In this title, the term ‘‘medicare program’’ means the 

9 program of health insurance administered by the Sec10 retary of Health and Human Services under title XVIII 

11 of the Social Security Act (42 U.S.C. 1395 et seq.). 

12 TITLE II—HRSA GRANT 

13 PROGRAM 

14 SEC. 201. GRANT PROGRAM FOR THE DEVELOPMENT OF 

15 TELEHEALTH NETWORKS. 

16 (a) IN GENERAL.—The Secretary of Health and 

17 Human Services (in this section referred to as the ‘‘Sec18 retary’’), acting through the Director of the Office for the 

19 Advancement of Telehealth (of the Health Resources and 

20 Services Administration), shall make grants to eligible en21 tities (as described in subsection (b)(2)) for the purpose 

22 of expanding access to health care services for individuals 

23 in rural areas, frontier areas, and urban medically under24 served areas through the use of telehealth. 

25 (b) ELIGIBLE ENTITIES.—
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1 (1) APPLICATION.—To be eligible to receive a 

2 grant under this section, an eligible entity described 

3 in paragraph (2) shall, in consultation with the 

4 State office of rural health or other appropriate 

5 State entity, prepare and submit to the Secretary an 

6 application, at such time, in such manner, and con7 taining such information as the Secretary may re8 quire, including the following: 

9 (A) A description of the anticipated need 

10 for the grant. 

11 (B) A description of the activities which 

12 the entity intends to carry out using amounts 

13 provided under the grant. 

14 (C) A plan for continuing the project after 

15 Federal support under this section is ended. 

16 (D) A description of the manner in which 

17 the activities funded under the grant will meet 

18 health care needs of underserved rural popu19 lations within the State. 

20 (E) A description of how the local commu21 nity or region to be served by the network or 

22 proposed network will be involved in the devel23 opment and ongoing operations of the network. 

24 (F) The source and amount of non-Federal 

25 funds the entity would pledge for the project. 
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1 (G) A showing of the long-term viability of 

2 the project and evidence of health care provider 

3 commitment to the network. 

4 The application should demonstrate the manner in 

5 which the project will promote the integration of 

6 telehealth in the community so as to avoid redun7 dancy of technology and achieve economies of scale. 

8 (2) ELIGIBLE ENTITIES.—An eligible entity de9 scribed in this paragraph is a hospital or other 

10 health care provider in a health care network of 

11 community-based health care providers that includes 

12 at least two of the organizations described in sub13 paragraph (A) and one of the institutions and enti14 ties described in subparagraph (B) if the institution 

15 or entity is able to demonstrate use of the network 

16 for purposes of education or economic development 

17 (as required by the Secretary). 

18 (A) The organizations described in this 

19 subparagraph are the following: 

20 (i) Community or migrant health cen21 ters. 

22 (ii) Local health departments. 

23 (iii) Nonprofit hospitals. 
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1 (iv) Private practice health profes2 sionals, including community and rural 

3 health clinics. 

4 (v) Other publicly funded health or so5 cial services agencies. 

6 (vi) Skilled nursing facilities. 

7 (vii) County mental health and other 

8 publicly funded mental health facilities. 

9 (viii) Providers of home health serv10 ices. 

11 (ix) Renal dialysis facilities. 

12 (B) The institutions and entities described 

13 in this subparagraph are the following: 

14 (i) A public school. 

15 (ii) A public library. 

16 (iii) A university or college. 

17 (iv) A local government entity. 

18 (v) A local health entity. 

19 (vi) A health-related nonprofit founda20 tion. 

21 (vii) An academic health center. 

22 An eligible entity may include for-profit entities so 

23 long as the recipient of the grant is a not-for-profit 

24 entity. 
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1 (c) PREFERENCE.—The Secretary shall establish pro2 cedures to prioritize financial assistance under this section 

3 based upon the following considerations: 

4 (1) The applicant is a health care provider in 

5 a health care network or a health care provider that 

6 proposes to form such a network that furnishes or 

7 proposes to furnish services in a medically under8 served area, health professional shortage area, or 

9 mental health professional shortage area. 

10 (2) The applicant is able to demonstrate broad 

11 geographic coverage in the rural or medically under12 served areas of the State, or States in which the ap13 plicant is located. 

14 (3) The applicant proposes to use Federal 

15 funds to develop plans for, or to establish, telehealth 

16 systems that will link rural hospitals and rural 

17 health care providers to other hospitals, health care 

18 providers, and patients. 

19 (4) The applicant will use the amounts provided 

20 for a range of health care applications and to pro21 mote greater efficiency in the use of health care re22 sources. 

23 (5) The applicant is able to demonstrate the 

24 long-term viability of projects through cost participa25 tion (cash or in-kind). 
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1 (6) The applicant is able to demonstrate finan2 cial, institutional, and community support for the 

3 long-term viability of the network. 

4 (7) The applicant is able to provide a detailed 

5 plan for coordinating system use by eligible entities 

6 so that health care services are given a priority over 

7 non-clinical uses. 

8 (d) MAXIMUM AMOUNT OF ASSISTANCE TO INDI9 VIDUAL RECIPIENTS.—The Secretary shall establish, by 

10 regulation, the terms and conditions of the grant and the 

11 maximum amount of a grant award to be made available 

12 to an individual recipient for each fiscal year under this 

13 section. The Secretary shall cause to have published in the 

14 Federal Register or the ‘‘HRSA Preview’’ notice of the 

15 terms and conditions of a grant under this section and 

16 the maximum amount of such a grant for a fiscal year. 

17 (e) USE OF AMOUNTS.—The recipient of a grant 

18 under this section may use sums received under such 

19 grant for the acquisition of telehealth equipment and 

20 modifications or improvements of telecommunications fa21 cilities including the following: 

22 (1) The development and acquisition through 

23 lease or purchase of computer hardware and soft24 ware, audio and video equipment, computer network 

25 equipment, interactive equipment, data terminal 
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1 equipment, and other facilities and equipment that 

2 would further the purposes of this section. 

3 (2) The provision of technical assistance and in4 struction for the development and use of such pro5 gramming equipment or facilities. 

6 (3) The development and acquisition of instruc7 tional programming. 

8 (4) Demonstration projects for teaching or 

9 training medical students, residents, and other 

10 health profession students in rural or medically un11 derserved training sites about the application of tele12 health. 

13 (5) The provision of telenursing services de14 signed to enhance care coordination and promote pa15 tient self-management skills. 

16 (6) The provision of services designed to pro17 mote patient understanding and adherence to na18 tional guidelines for common chronic diseases, such 

19 as congestive heart failure or diabetes. 

20 (7) Transmission costs, maintenance of equip21 ment, and compensation of specialists and referring 

22 health care providers, when no other form of reim23 bursement is available. 

24 (8) Development of projects to use telehealth to 

25 facilitate collaboration between health care providers. 
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1 (9) Electronic archival of patient records. 

2 (10) Collection and analysis of usage statistics 

3 and data that can be used to document the cost-ef4 fectiveness of the telehealth services. 

5 (11) Such other uses that are consistent with 

6 achieving the purposes of this section as approved by 

7 the Secretary. 

8 (f) PROHIBITED USES.—Sums received under a 

9 grant under this section may not be used for any of the 

10 following: 

11 (1) To acquire real property. 

12 (2) Expenditures to purchase or lease equip13 ment to the extent the expenditures would exceed 

14 more than 40 percent of the total grant funds. 

15 (3) To purchase or install transmission equip16 ment off the premises of the telehealth site and any 

17 transmission costs not directly related to the grant. 

18 (4) For construction, except that such funds 

19 may be expended for minor renovations relating to 

20 the installation of equipment. 

21 (5) Expenditures for indirect costs (as deter22 mined by the Secretary) to the extent the expendi23 tures would exceed more than 15 percent of the total 

24 grant. 

25 (g) ADMINISTRATION.—
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1 (1) NONDUPLICATION.—The Secretary shall en2 sure that facilities constructed using grants provided 

3 under this section do not duplicate adequately estab4 lished telehealth networks. 

5 (2) COORDINATION WITH OTHER AGENCIES.—

6 The Secretary shall coordinate, to the extent prac7 ticable, with other Federal and State agencies and 

8 not-for-profit organizations, operating similar grant 

9 programs to pool resources for funding meritorious 

10 proposals. 

11 (3) INFORMATIONAL EFFORTS.—The Secretary 

12 shall establish and implement procedures to carry 

13 out outreach activities to advise potential end users 

14 located in rural and medically underserved areas of 

15 each State about the program authorized by this 

16 section. 

17 (h) PROMPT IMPLEMENTATION.—The Secretary shall 

18 take such actions as are necessary to carry out the grant 

19 program as expeditiously as possible. 

20 (i) AUTHORIZATION OF APPROPRIATIONS.—There 

21 are authorized to be appropriated to carry out this section 

22 $10,000,000 for fiscal year 2006, and such sums as may 

23 be necessary for each of the fiscal years 2007 through 

24 2012. 
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1 SEC. 202. REAUTHORIZATION OF TELEHEALTH NETWORK 

2 AND TELEHEALTH RESOURCE CENTERS 

3 GRANT PROGRAMS. 

4 Subsection (s) of section 330I of the Public Health 

5 Service Act (42 U.S.C. 254c–14) is amended—

6 (1) in paragraph (1)—

7 (A) by striking ‘‘and’’ before ‘‘such sums’’; 

8 and 

9 (B) by inserting ‘‘$10,000,000 for fiscal 

10 year 2007, and such sums as may be necessary 

11 for each of fiscal years 2008 through 2012’’ be12 fore the semicolon; and 

13 (2) in paragraph (2)—

14 (A) by striking ‘‘and’’ before ‘‘such sums’’; 

15 and 

16 (B) by inserting ‘‘$10,000,000 for fiscal 

17 year 2007, and such sums as may be necessary 

18 for each of fiscal years 2008 through 2012’’ be19 fore the semicolon.

Æ