I

106TH CONGRESS

2D SESSION H. R. 4771

To amend title XVIII of the Social Security Act to provide increased access

to health care for Medicare beneficiaries through telemedicine.

IN THE HOUSE OF REPRESENTATIVES

JUNE 27, 2000

Mr. MCHUGH introduced the following bill; which was referred to the Committee on 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 amend title XVIII of the Social Security Act to provide

increased access to health care for Medicare beneficiaries

through telemedicine.

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 ‘‘Telehealth Improvement and Modernization Act of

6 2000’’.

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

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

Sec. 2. Revision of telehealth payment methodology and elimination of fee-sharing requirement.

Sec. 3. Elimination of requirement for telepresenter.

Sec. 4. Reimbursement for medicare beneficiaries who do not reside in a

HPSA.

Sec. 5. Telehealth coverage for direct patient care.

Sec. 6. All physicians and practitioners eligible for telehealth reimbursement.

Sec. 7. Telehealth services provided using store-and-forward technologies.

Sec. 8. Construction relating to home health services.

Sec. 9. Effective date.

1 SEC. 2. REVISION OF TELEHEALTH PAYMENT METHOD2 OLOGY AND ELIMINATION OF FEE-SHARING

3 REQUIREMENT.

4 Section 4206(b) of the Balanced Budget Act of 1997

5 (42 U.S.C. 1395l note) is amended to read as follows:

6 ‘‘(b) METHODOLOGY FOR DETERMINING AMOUNT OF

7 PAYMENTS.—

8 ‘‘(1) IN GENERAL.—The Secretary shall pay

9 to—

10 ‘‘(A) the physician or practitioner at a dis11 tant site that provides an item or service under

12 subsection (a) an amount equal to the amount

13 that such physician or provider would have been

14 paid had the item or service been provided with15 out the use of a telecommunications system;

16 and

17 ‘‘(B) the originating site a facility fee for

18 facility services furnished in connection with

19 such item or service.
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1 ‘‘(2) APPLICATION OF PART B COINSURANCE

2 AND DEDUCTIBLE.—Any payment made under this

3 section shall be subject to the coinsurance and de4 ductible requirements under subsections (a)(1) and

5 (b) of section 1833 of the Social Security Act (42

6 U.S.C. 1395l).

7 ‘‘(3) DEFINITIONS.—In this subsection:

8 ‘‘(A) DISTANT SITE.—The term ‘distant

9 site’ means the site at which the physician or

10 practitioner is located at the time the item or

11 service is provided via a telecommunications

12 system.

13 ‘‘(B) FACILITY FEE.—The term ‘facility

14 fee’ means an amount equal to—

15 ‘‘(i) for 2000 and 2001, $20; and

16 ‘‘(ii) for a subsequent year, the facil17 ity fee under this subsection for the pre18 vious year increased by the percentage in19 crease in the MEI (as defined in section

20 1842(i)(3)) for such subsequent year.

21 ‘‘(C) ORIGINATING SITE.—

22 ‘‘(i) IN GENERAL.—The term ‘origi23 nating site’ means the site described in

24 clause (ii) at which the eligible telehealth

25 beneficiary under the medicare program is
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1 located at the time the item or service is

2 provided via a telecommunications system.

3 ‘‘(ii) SITES DESCRIBED.—The sites

4 described in this paragraph are as follows:

5 ‘‘(I) On or before January 1,

6 2002, the office of a physician or a

7 practitioner, a critical access hospital,

8 a rural health clinic, and a Federally

9 qualified health center.

10 ‘‘(II) On or before January 1,

11 2003, a hospital, a skilled nursing fa12 cility, a comprehensive outpatient re13 habilitation facility, a renal dialysis

14 facility, an ambulatory surgical center,

15 an Indian Health Service facility, and

16 a community mental health center.’’.

17 SEC. 3. ELIMINATION OF REQUIREMENT FOR TELEPRE18 SENTER.

19 Section 4206 of the Balanced Budget Act of 1997

20 (42 U.S.C. 1395l note) is amended—

21 (1) in subsection (a), by striking ‘‘, notwith22 standing that the individual physician’’ and all that

23 follows before the period at the end; and

24 (2) by adding at the end the following new sub25 section:
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1 ‘‘(e) TELEPRESENTER NOT REQUIRED.—Nothing in

2 this section shall be construed as requiring an eligible tele3 health beneficiary to be presented by a physician or practi4 tioner for the provision of an item or service via a tele5 communications system.’’.

6 SEC. 4. REIMBURSEMENT FOR MEDICARE BENEFICIARIES

7 WHO DO NOT RESIDE IN A HPSA.

8 Section 4206(a) of the Balanced Budget Act of 1997

9 (42 U.S.C. 1395l note), as amended by section 3, is

10 amended—

11 (1) by striking ‘‘IN GENERAL.—Not later than’’

12 and inserting the following: ‘‘TELEHEALTH SERV13 ICES REIMBURSED.—

14 ‘‘(1) IN GENERAL.—Not later than’’;

15 (2) by striking ‘‘furnishing a service for which

16 payment’’ and all that follows before the period and

17 inserting ‘‘to an eligible telehealth beneficiary’’; and

18 (3) by adding at the end the following new

19 paragraph:

20 ‘‘(2) ELIGIBLE TELEHEALTH BENEFICIARY DE21 FINED.—In this section, the term ‘eligible telehealth

22 beneficiary’ means a beneficiary under the medicare

23 program under title XVIII of the Social Security Act

24 (42 U.S.C. 1395 et seq.) that resides in—
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1 ‘‘(A) an area that is designated as a health

2 professional shortage area under section

3 332(a)(1)(A) of the Public Health Service Act

4 (42 U.S.C. 254e(a)(1)(A));

5 ‘‘(B) a county that is not included in a

6 Metropolitan Statistical Area;

7 ‘‘(C) an inner-city area that is medically

8 underserved (as defined in section 330(b)(3) of

9 the Public Health Service Act (42 U.S.C.

10 254b(b)(3))); or

11 ‘‘(D) an area in which there is a Federal

12 telemedicine demonstration program.’’.

13 SEC. 5. TELEHEALTH COVERAGE FOR DIRECT PATIENT

14 CARE.

15 (a) IN GENERAL.—Section 4206 of the Balanced

16 Budget Act of 1997 (42 U.S.C. 1395l note), as amended

17 by section 4, is amended—

18 (1) in subsection (a)(1), by striking ‘‘profes19 sional consultation via telecommunications systems

20 with a physician’’ and inserting ‘‘items and services

21 for which payment may be made under such part

22 that are furnished via a telecommunications system

23 by a physician’’; and

24 (2) by adding at the end the following new sub25 section:
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1 ‘‘(f) COVERAGE OF ITEMS AND SERVICES.—Payment

2 for items and services provided pursuant to subsection (a)

3 shall include payment for professional consultations, office

4 visits, office psychiatry services, including any service

5 identified as of July 1, 2000, by HCPCS codes 99241–

6 99275, 99201–99215, 90804–90815, and 90862, and any

7 additional item or service specified by the Secretary.’’.

8 (b) STUDY AND REPORT REGARDING ADDITIONAL

9 ITEMS AND SERVICES.—

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

11 Human Services shall conduct a study to identify

12 items and services in addition to those described in

13 section 4206(f) of the Balanced Budget Act of 1997

14 (as added by subsection (a)) that would be appro15 priate to provide payment under title XVIII of the

16 Social Security Act (42 U.S.C. 1395 et seq.).

17 (2) REPORT.—Not later than 2 years after the

18 date of enactment of this Act, the Secretary shall

19 submit a report to Congress on the study conducted

20 under paragraph (1) together with such rec21 ommendations for legislation that the Secretary de22 termines are appropriate.
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1 SEC. 6. ALL PHYSICIANS AND PRACTITIONERS ELIGIBLE

2 FOR TELEHEALTH REIMBURSEMENT.

3 Section 4206(a) of the Balanced Budget Act of 1997

4 (42 U.S.C. 1395l note), as amended by section 5, is

5 amended—

6 (1) in paragraph (1), by striking ‘‘(described in

7 section 1842(b)(18)(C) of such Act (42 U.S.C.

8 1395u(b)(18)(C))’’; and

9 (2) by adding at the end the following new

10 paragraph:

11 ‘‘(3) PRACTITIONER DEFINED.—For purposes

12 of paragraph (1), the term ‘practitioner’ includes—

13 ‘‘(A) a practitioner described in section

14 1842(b)(18)(C) of the Social Security Act (42

15 U.S.C. 1395u(b)(18)(C)); and

16 ‘‘(B) a physical, occupational, or speech

17 therapist.’’.

18 SEC. 7. TELEHEALTH SERVICES PROVIDED USING STORE19 AND-FORWARD TECHNOLOGIES.

20 Section 4206(a)(1) of the Balanced Budget Act of

21 1997 (42 U.S.C. 1395l note), as amended by section 6,

22 is amended by adding at the end the following new para23 graph:

24 ‘‘(4) USE OF STORE-AND-FORWARD TECH25 NOLOGIES.—For purposes of paragraph (1), in the

26 case of any Federal telemedicine demonstration pro-
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1 gram in Alaska or Hawaii, the term ‘telecommuni2 cations system’ includes store-and-forward tech3 nologies that provide for the asynchronous trans4 mission of health care information in single or multi5 media formats.’’.

6 SEC. 8. CONSTRUCTION RELATING TO HOME HEALTH

7 SERVICES.

8 Section 4206(a) of the Balanced Budget Act of 1997

9 (42 U.S.C. 1395l note), as amended by section 7, is

10 amended by adding at the end the following new para11 graph:

12 ‘‘(5) CONSTRUCTION RELATING TO HOME

13 HEALTH SERVICES.—

14 ‘‘(A) IN GENERAL.—Nothing in this sec15 tion or in section 1895 of the Social Security

16 Act (42 U.S.C. 1395fff) shall be construed as

17 preventing a home health agency that is receiv18 ing payment under the prospective payment

19 system described in such section from fur20 nishing a home health service via a tele21 communications system.

22 ‘‘(B) LIMITATION.—The Secretary shall

23 not consider a home health service provided in

24 the manner described in subparagraph (A) to

25 be a home health visit for purposes of—
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1 ‘‘(i) determining the amount of pay2 ment to be made under the prospective

3 payment system established under section

4 1895 of the Social Security Act (42 U.S.C.

5 1395fff); or

6 ‘‘(ii) any requirement relating to the

7 certification of a physician required under

8 section 1814(a)(2)(C) of such Act (42

9 U.S.C. 1395f(a)(2)(C)).’’.

10 SEC. 9. EFFECTIVE DATE.

11 The amendments made by this Act shall apply to

12 items and services provided on or after the date of enact13 ment of this Act.

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