I

106TH CONGRESS

2D SESSION H. R. 4841

To amend the Balanced Budget Act of 1997 to provide increased access

to health care for Medicare beneficiaries through telehealth services.

IN THE HOUSE OF REPRESENTATIVES

JULY 12, 2000

Mr. THUNE (for himself, Mrs. EMERSON, Mr. MORAN of Kansas, Mr.

NUSSLE, Mr. POMEROY, and Mrs. CLAYTON) 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 the Balanced Budget Act of 1997 to provide

increased access to health care for Medicare beneficiaries

through telehealth 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 ‘‘Medicare Access to

5 Telehealth Services Act of 2000’’.
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1 SEC. 2. REVISION OF MEDICARE REIMBURSEMENT FOR

2 TELEHEALTH SERVICES.

3 Section 4206 of the Balanced Budget Act of 1997

4 (42 U.S.C. 1395l note) is amended to read as follows:

5 ‘‘(a) TELEHEALTH SERVICES REIMBURSED.—

6 ‘‘(1) IN GENERAL.—Not later than October 1,

7 2000, the Secretary of Health and Human Services

8 shall make payments from the Federal Supple9 mentary Medical Insurance Trust Fund in accord10 ance with the methodology described in subsection

11 (b) for services for which payment may be made

12 under part B of title XVIII of the Social Security

13 Act (42 U.S.C. 1395j et seq.) that are furnished via

14 a telecommunications system by a physician or prac15 titioner to an eligible telehealth beneficiary.

16 ‘‘(2) USE OF STORE-AND-FORWARD TECH17 NOLOGIES.—For purposes of paragraph (1), in the

18 case of any Federal telemedicine demonstration pro19 gram in Alaska or Hawaii, the term ‘telecommuni20 cations system’ includes store-and-forward tech21 nologies that provide for the asynchronous trans22 mission of health care information in single or multi23 media formats.

24 ‘‘(b) METHODOLOGY FOR DETERMINING AMOUNT OF

25 PAYMENTS.—
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1 ‘‘(1) IN GENERAL.—The Secretary shall make

2 payment under this section as follows:

3 ‘‘(A) Subject to subparagraph (B), with re4 spect to a physician or practitioner located at a

5 distant site that furnishes a service to an eligi6 ble medicare beneficiary under subsection (a),

7 an amount equal to the amount that such phy8 sician or practitioner would have been paid had

9 the service been furnished without the use of a

10 telecommunications system.

11 ‘‘(B) In the case of a referring physician

12 or practitioner located at the originating site

13 with respect to the service furnished the eligible

14 medicare beneficiary for which payment is made

15 under subparagraph (A), the amount of the

16 payment under subparagraph (A) shall be

17 shared between the physician or practitioner lo18 cated at the distant site and such referring phy19 sician or practitioner.

20 ‘‘(C) With respect to an originating site, a

21 facility fee equal to—

22 ‘‘(i) for 2000 and 2001, $20; and

23 ‘‘(ii) for a subsequent year, the facil24 ity fee under this subsection for the pre25 vious year increased by the percentage in-
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1 crease in the MEI (as defined in section

2 1842(i)(3)) for such subsequent year.

3 ‘‘(2) APPLICATION OF PART B COINSURANCE

4 AND DEDUCTIBLE.—Any payment made under this

5 section shall be subject to the coinsurance and de6 ductible requirements under subsections (a)(1) and

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

8 U.S.C. 1395l).

9 ‘‘(c) TELEPRESENTER NOT REQUIRED.—Nothing in

10 this section shall be construed as requiring an eligible tele11 health beneficiary to be presented by a physician or practi12 tioner at the originating site for the furnishing of a service

13 via a telecommunications system.

14 ‘‘(d) COVERAGE OF ADDITIONAL SERVICES.—

15 ‘‘(1) STUDY AND REPORT ON ADDITIONAL

16 SERVICES.—

17 ‘‘(A) STUDY.—The Secretary of Health

18 and Human Services shall conduct a study to

19 identify services in addition to those described

20 in subsection (a)(1) that are appropriate for

21 payment under this section.

22 ‘‘(B) REPORT.—Not later than 2 years

23 after the date of enactment of this Act, the Sec24 retary shall submit to Congress a report on the

25 study conducted under subparagraph (A) to-
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1 gether with such recommendations for legisla2 tion that the Secretary determines are appro3 priate.

4 ‘‘(2) IN GENERAL.—The Secretary shall provide

5 for payment under this section for services identified

6 in paragraph (1).

7 ‘‘(e) CONSTRUCTION RELATING TO HOME HEALTH

8 SERVICES.—

9 ‘‘(1) IN GENERAL.—Nothing in this section or

10 in section 1895 of the Social Security Act (42

11 U.S.C. 1395fff) shall be construed as preventing a

12 home health agency furnishing a home health unit of

13 service for which payment is made under the pro14 spective payment system established in such section

15 for such units of service from furnishing the service

16 via a telecommunications system.

17 ‘‘(2) LIMITATION.—The Secretary shall not

18 consider a home health service provided in the man19 ner described in paragraph (1) to be a home health

20 visit for purposes of—

21 ‘‘(A) determining the amount of payment

22 to be made under such prospective payment

23 system; or

24 ‘‘(B) any requirement relating to the cer25 tification of a physician required under section
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1 1814(a)(2)(C) of such Act (42 U.S.C.

2 1395f(a)(2)(C)).

3 ‘‘(f) DEFINITIONS.—In this section:

4 ‘‘(1) ELIGIBLE TELEHEALTH BENEFICIARY.—

5 The term ‘eligible telehealth beneficiary’ means an

6 individual enrolled under part B of title XVIII of the

7 Social Security Act (42 U.S.C. 1395j et seq.) that

8 resides in—

9 ‘‘(A) an area that is designated as a health

10 professional shortage area under section

11 332(a)(1)(A) of the Public Health Service Act

12 (42 U.S.C. 254e(a)(1)(A));

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

14 Metropolitan Statistical Area;

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

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

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

18 254b(b)(3))); or

19 ‘‘(D) an area in which a Federal telemedi20 cine demonstration program is carried out.

21 ‘‘(2) PHYSICIAN.—The term ‘physician’ has the

22 meaning given that term in section 1861(r) of the

23 Social Security Act (42 U.S.C. 1395x(r))

24 ‘‘(3) PRACTITIONER.—The term ‘practitioner’

25 means—
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1 ‘‘(A) a practitioner described in section

2 1842(b)(18)(C) of the Social Security Act (42

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

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

5 therapist.

6 ‘‘(4) DISTANT SITE.—The term ‘distant site’

7 means the site at which the physician or practitioner

8 is located at the time the service is provided via a

9 telecommunications system.

10 ‘‘(5) ORIGINATING SITE.—

11 ‘‘(A) IN GENERAL.—The term ‘originating

12 site’ means any site described in subparagraph

13 (B) at which the eligible telehealth beneficiary

14 is located at the time the service is furnished

15 via a telecommunications system.

16 ‘‘(B) SITES DESCRIBED.—The sites de17 scribed in this subparagraph are as follows:

18 ‘‘(i) On or after October 1, 2000—

19 ‘‘(I) the office of a physician or a

20 practitioner,

21 ‘‘(II) a critical access hospital (as

22 defined in section 1861(mm)(1) of the

23 Social Security Act (42 U.S.C.

24 1395x(mm)(1))),
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1 ‘‘(III) a rural health clinic (as

2 defined in section 1861(aa)(2) of such

3 Act (42 U.S.C. 1395x(aa)(2))), and

4 ‘‘(IV) a Federally qualified health

5 center (as defined in section

6 1861(aa)(4) of such Act (42 U.S.C.

7 1395x(aa)(4))).

8 ‘‘(ii) On or after October 1, 2001—

9 ‘‘(I) a hospital (as defined in sec10 tion 1861(e) of such Act (42 U.S.C.

11 1395x(e))),

12 ‘‘(II) a skilled nursing facility (as

13 defined in section 1861(j) of such Act

14 (42 U.S.C. 1395x(j))),

15 ‘‘(III) a comprehensive outpatient

16 rehabilitation facility (as defined in

17 section 1861(cc)(2) of such Act (42

18 U.S.C. 1395x(cc)(2))),

19 ‘‘(IV) a renal dialysis facility (de20 scribed in section 1881(b)(1) of such

21 Act (42 U.S.C. 1395rr(b)(1))),

22 ‘‘(V) an ambulatory surgical cen23 ter (described in section 1833(i)(1)(A)

24 of such Act (42 U.S.C.

25 1395l(i)(1)(A))),
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1 ‘‘(VI) a hospital or skilled nurs2 ing facility of the Indian Health Serv3 ice (under section 1880 of such Act

4 (42 U.S.C. 1395qq)), and

5 ‘‘(VII) a community mental

6 health center (as defined in section

7 1861(ff)(3)(B) of such Act (42 U.S.C.

8 1395x(ff)(3)(B))).

9 ‘‘(6) FEDERAL SUPPLEMENTARY MEDICAL IN10 SURANCE TRUST FUND.—The term ‘Federal Supple11 mentary Medical Insurance Trust Fund’ means the

12 trust fund established under section 1841 of the

13 Social Security Act (42 U.S.C. 1395t).’’.

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