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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2068 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 2068

  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

                             April 23, 2009

Mr. Thompson of California (for himself, Mr. Stupak, Mr. Terry, and Mr. 
Sam Johnson of Texas) 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.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Medicare 
Telehealth Enhancement Act of 2009''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

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. Expansion of eligible telehealth providers and credentialing 
                            of telemedicine practitioners.
Sec. 104. Access to telehealth services in the home.
Sec. 105. Coverage of home health remote patient management services 
                            for chronic health conditions.
Sec. 106. Sense of Congress on the use of remote patient management 
                            services.
Sec. 107. Telehealth Advisory Committee.
                      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.

                       TITLE I--MEDICARE PROGRAM

SEC. 101. EXPANSION AND IMPROVEMENT OF TELEHEALTH SERVICES.

    (a) Expanding Access to Telehealth Services to All Areas.--Section 
1834(m)(4)(C)(i) of the Social Security Act (42 U.S.C. 
1395m(m)(4)(C)(i)) is amended in paragraph (4)(C)(i) by striking ``and 
only if such site is located'' and all that follows and inserting 
``without regard to the geographic area within the United States where 
the site is located.''.
    (b) Expansion of Use of Store-and-Forward Technology.--The second 
sentence of section 1834(m)(1) of such Act (42 U.S.C. 1395m(m)(1)) is 
amended by inserting ``and any telehealth program that has been the 
recipient of any Federal support from the Centers for Medicare & 
Medicaid Services, the Indian Health Service, or the Health Services 
and Resources Administration'' after ``Alaska or Hawaii''.
    (c) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 2010.

SEC. 102. INCREASE IN NUMBER OF TYPES OF ORIGINATING SITES; 
              CLARIFICATION.

    (a) Increase.--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.''
    (b) Clarification of Intent of the Term Originating Site.--Such 
section is further amended by adding at the end the following new 
paragraph:
            ``(5) Construction.--In applying the term `originating 
        site' under this subsection, the Secretary shall apply the term 
        only for the purpose of determining whether a site is eligible 
        to receive a facility fee. Nothing in the application of such 
        term under this subsection shall be construed as affecting the 
        ability of an eligible practitioner to submit claims for 
        telehealth services that are provided to other sites that have 
        telehealth systems and capabilities.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 2010.

SEC. 103. EXPANSION OF ELIGIBLE TELEHEALTH PROVIDERS AND CREDENTIALING 
              OF TELEMEDICINE PRACTITIONERS.

    (a) Expansion of Eligible Telehealth Providers.--Section 1834(m)(1) 
of the Social Security Act (42 U.S.C. 1395m(m)(1)) is amended--
            (1) in paragraph (1)--
                    (A) by striking ``or a practitioner'' and inserting 
                ``, a practitioner'';
                    (B) by inserting ``, or other telehealth provider'' 
                after ``1842(b)(18)(C))''; and
                    (C) by striking ``or practitioner'' and inserting 
                ``, practitioner, or provider'';
            (2) in paragraphs (2), (3)(A), and (4), by striking ``or 
        practitioner'' and inserting ``, practitioner, or other 
        telehealth provider'' each place it appears;
            (3) in paragraph (4), by adding at the end the following 
        new subparagraph:
                    ``(G) Telehealth provider.--The term `telehealth 
                provider' means any supplier or provider of services 
                (other than a physician or practitioner) that is 
                eligible to provide other health services under this 
                title.''.
    (b) Credentialing Telemedicine Practitioners.--Section 1834(m) of 
such Act is amended by adding at the end the following new paragraph:
            ``(5) Hospital credentialing of telemedicine 
        practitioners.--A telemedicine practitioner that is 
        credentialed by a hospital in compliance with the Joint 
        Commission Standards for Telemedicine shall be considered in 
        compliance with Medicare condition of participation and 
        reimbursement credentialing requirements for telemedicine 
        services.''.

SEC. 104. ACCESS TO TELEHEALTH SERVICES IN THE HOME.

    (a) In General.--Section 1895 of the Social Security Act (42 U.S.C. 
1395fff(e)) is amended by adding at the end the following new 
subsection:
    ``(f) Coverage of Telehealth Services.--
            ``(1) In general.--The Secretary shall include telehealth 
        services that are furnished via a telecommunication system by a 
        home health agency to an individual receiving home health 
        services under section 1814(a)(2)(C) or 1835(a)(2)(A) as a home 
        health visit for purposes of eligibility and payment under this 
        title if the telehealth services--
                    ``(A) are ordered as part of a plan of care 
                certified by a physician pursuant to section 
                1814(a)(2)(C) or 1835(a)(2)(A);
                    ``(B) do not substitute for in-person home health 
                services ordered as part of a plan of care certified by 
                a physician pursuant to such respective section; and
                    ``(C) are considered the equivalent of a visit 
                under criteria developed by the Secretary under 
                paragraph (3).
            ``(2) Physician certification.--Nothing in this section 
        shall be construed as waiving the requirement for a physician 
        certification under section 1814(a)(2)(C) or 1835(a)(2)(A) for 
        the payment for home health services, whether or not furnished 
        via a telecommunication system.
            ``(3) Criteria for visit equivalency.--
                    ``(A) Standards.--The Secretary shall establish 
                standards and qualifications for categorizing and 
                coding under HCPCS codes telehealth services under this 
                subsection as equivalent to an in-person visit for 
                purposes of eligibility and payment for home health 
                services under this title. In establishing the 
                standards and qualifications, the Secretary may 
                distinguish between varying modes and modalities of 
                telehealth services and shall consider--
                            ``(i) the nature and amount of service time 
                        involved; and
                            ``(ii) the functions of the 
                        telecommunications.
                    ``(B) Limitation.--A telecommunication that 
                consists solely of a telephone audio conversation, 
                facsimile, electronic text mail, or consultation 
                between two health care practitioners is not considered 
                a visit under this subsection.
            ``(4) Telehealth service.--
                    ``(A) Definition.--For purposes of this subsection, 
                the term `telehealth service' means technology-based 
                professional consultations, patient monitoring, patient 
                training services, clinical observation, assessment, or 
                treatment, and any additional services that utilize 
                technologies specified by the Secretary as HCPCS codes 
                developed under paragraph (3).
                    ``(B) Update of hcpcs codes.--The Secretary shall 
                establish a process for the updating, not less 
                frequently than annually, of HCPCS codes for telehealth 
                services.
            ``(5) Conditions for payment and coverage.--Nothing in this 
        subsection shall be construed as waiving any condition of 
        payment under sections 1814(a)(2)(C) or 1835(a)(2)(A) or 
        exclusion of coverage under section 1862(a)(1).
            ``(6) Cost reporting.--Notwithstanding any provision to the 
        contrary, the Secretary shall provide that the costs of 
        telehealth services under this subsection shall be reported as 
        a reimbursable cost center on any cost report submitted by a 
        home health agency to the Secretary.''.
    (b) Effective Date.--
            (1) The amendment made by subsection (a) shall apply to 
        telehealth services furnished on or after October 1, 2010. The 
        Secretary of Health and Human Services shall develop and 
        implement criteria and standards under section 1895(f)(3) of 
        the Social Security Act, as amended by subsection (a), by no 
        later than July 1, 2010.
            (2) In the event that the Secretary has not complied with 
        these deadlines, beginning October 1, 2010, a home health visit 
        for purpose of eligibility and payment under title XVIII of the 
        Social Security Act shall include telehealth services under 
        section 1895(f) of such Act with the aggregate of 
        telecommunication encounters in a 24-hour period considered the 
        equivalent of one in-person visit.

SEC. 105. COVERAGE OF HOME HEALTH REMOTE PATIENT MANAGEMENT SERVICES 
              FOR CHRONIC HEALTH CONDITIONS.

    (a) Medicare Coverage.--
            (1) In general.--Section 1861(s)(2) of the Social Security 
        Act (42 U.S.C. 1395x(s)(2)) is amended--
                    (A) in subparagraph (DD), by striking ``and'' at 
                the end;
                    (B) in subparagraph (EE), by adding ``and'' at the 
                end; and
                    (C) by inserting after subparagraph (EE) the 
                following new subparagraph:
            ``(FF) home health remote patient management services (as 
        defined in subsection (hhh));''.
            (2) Services described.--Section 1861 of such Act (42 
        U.S.C. 1395x) is amended by adding at the end the following new 
        subsection:
    ``(hhh) Home Health Remote Patient Management Services for Chronic 
Health Conditions.--(1) The term `remote patient management services' 
means the remote monitoring, evaluation, and management of an 
individual with a covered chronic health condition (as defined in 
paragraph (2)) through the utilization of a system of technology that 
allows a remote interface to collect and transmit clinical data between 
the individual and a home health agency, in accordance with a plan of 
care established by a physician, for the purposes of clinical review or 
response by the home health agency. Such term, with respect to an 
individual, does not include any remote monitoring, evaluation, or 
management of the individual if such remote monitoring, evaluation, or 
management, respectively, is included as a home health visit under 
section 1895(f) for purposes of payment under this title.
    ``(2) For purposes of paragraph (1), the term `covered chronic 
health condition' means any chronic health condition specified by the 
Secretary.''.
    (b) Payment.--
            (1) In general.--Section 1834 of such Act (42 U.S.C. 1395l) 
        is amended by adding at the end the following new subsection:
    ``(n) Home Health Remote Patient Management Services.--
            ``(1) In general.--The Secretary shall establish a fee 
        schedule for home health remote patient management services (as 
        defined in section 1861(hhh)) for which payment is made under 
        this part. The fee schedule shall be designed in a manner so 
        that, on an annual basis, the aggregate payment amounts under 
        this title for such services approximates 50 percent of the 
        savings amount described in paragraph (2) for such year.
            ``(2) Savings described.--
                    ``(A) In general.--For purposes of paragraph (1), 
                the savings amount described in this paragraph for a 
                year is the amount (if any), as estimated by the 
                Secretary before the beginning of the year, by which--
                            ``(i) the product described in subparagraph 
                        (B) for the year, exceeds
                            ``(ii) the total payments under this part 
                        and part A for items and services furnished to 
                        individuals receiving home health remote 
                        patient management services at any time during 
                        the year.
                    ``(B) Product described.--The product described in 
                this subparagraph for a year is the product of--
                            ``(i) the average per capita total payments 
                        under this part and part A for items and 
                        services furnished during the year to 
                        individuals not described in subparagraph 
                        (A)(ii), adjusted to remove case mix 
                        differences between such individuals not 
                        described in such subparagraph and the 
                        individuals described in such subparagraph; and
                            ``(ii) the number of individuals under 
                        subparagraph (A)(ii) for the year.
            ``(3) Limitation.--In no case may payments under this 
        subsection result in the aggregate expenditures under this 
        title (including payments under this subsection) exceeding the 
        amount that the Secretary estimates would have been expended if 
        coverage under this title for home health patient management 
        services was not provided.
            ``(4) Clarification.--Payments under the fee schedule under 
        this subsection, with respect to an individual, shall be in 
        addition to any other payments that a home health agency would 
        otherwise receive under this title for items and services 
        furnished to such individual and shall have no effect on the 
        amount of such other payments.
            ``(5) Payment transfer.--There shall be transferred from 
        the Federal Hospital Insurance Trust Fund under section 1817 to 
        the Federal Supplementary Medical Insurance Trust Fund under 
        section 1841 each year an amount equivalent to the product of--
                    ``(A) expenditures under this subsection for the 
                year, and
                    ``(B) the ratio of the portion of the savings 
                described in paragraph (2) for the year that are 
                attributable to part A, to the total savings described 
                in such paragraph for the year.''.
            (2) Conforming amendment.--Section 1833(a)(1) of such Act 
        (42 U.S.C. 1395l(1)) is amended--
                    (A) by striking ``and (W)'' and inserting ``(W)''; 
                and
                    (B) by inserting before the semicolon at the end 
                the following: ``, (X) with respect to home health 
                remote patient management services (as defined in 
                section 1861(hhh)), the amounts paid shall be the 
                amount determined under the fee schedule established 
                under section 1834(n)''.
    (c) Expansion of Home Health Remote Patient Management Services 
Coverage to Additional Chronic Health Conditions.--The Secretary of 
Health and Human Services is authorized to carry out pilot projects for 
purposes of determining the extent to which the coverage under title 
XVIII of the Social Security Act of home health remote patient 
management services (as defined in paragraph (1) of section 1861(hhh) 
of such Act, as added by subsection (a)) should be extended to 
individuals with chronic health conditions other than those initially 
specified by the Secretary under paragraph (2) of such section.
    (d) Effective Date.--The amendments made by subsections (a), (b), 
and (c) shall apply to services furnished on or after January 1, 2010.

SEC. 106. SENSE OF CONGRESS ON THE USE OF REMOTE PATIENT MANAGEMENT 
              SERVICES.

    (a) Findings.--Congress finds as follows:
            (1) Remote patient management services can make chronic 
        disease management more effective and efficient for patients 
        and for the health care system.
            (2) By collecting, analyzing, and transmitting clinical 
        health information to a health care provider, remote patient 
        management services allow patients and providers to manage the 
        medical condition of patients in a consistent and real time 
        fashion.
            (3) Utilization of remote patient management services not 
        only improves the quality of care given to patients, it also 
        reduces the need for frequent office appointments, costly 
        emergency room visits, and unnecessary hospitalizations.
            (4) Management the medical condition or disease of a 
        patient from the patient's home reduces the need for face to 
        face provider interactions. Use of remote patient management 
        services minimizes unnecessary travel and missed work and 
        provides particular value to patients residing in rural or 
        underserved communities who would otherwise face potentially 
        significant access barriers to receiving needed care.
            (5) Among the areas in which remote patient management 
        services are emerging in health care are the treatment of 
        congestive heart failure, diabetes, cardiac arrhythmia, 
        epilepsy, and sleep apnea. Prompt transmission of clinical data 
        on each of these conditions, to the health care provider or the 
        patient as appropriate, is essential to providing timely and 
        appropriate therapeutic interventions which can then reduce 
        expensive hospitalizations.
            (6) Despite these benefits, remote patient management 
        services have failed to diffuse rapidly. A significant barrier 
        to wider adoption is the relative lack of payment mechanisms in 
        fee for service Medicare to reimburse for remote, non face to 
        face patient management.
            (7) Elimination of this barrier to new remote patient 
        management services should be encouraged by requiring 
        reimbursement under the Medicare program for providers' time 
        spent analyzing and responding to patient data transmitted by 
        remote technologies.
            (8) Reimbursement under the Medicare program for health 
        care providers' time spent analyzing and responding to data 
        transmitted to providers by remote technologies should be made 
        on a separate basis and should not be combined with payments 
        for others services (also referred to as ``bundled payments'').
            (9) Payment codes used for reporting and billing for 
        payment for providers' remote patient management services 
        should be revised or adjusted, as appropriate, to encourage the 
        application of such services for other medical conditions.
    (b) Sense of Congress.--It is the sense of the Congress that--
            (1) remote patient management services are integral to 
        improvement in the delivery, care, and efficiency of health 
        care services furnished in the United States; and
            (2) the Administrator of the Centers for Medicare & 
        Medicaid Services should be encouraged to--
                    (A) expand the types of medical conditions for 
                which the use of remote patient management services are 
                reimbursed under the Medicare program;
                    (B) provide for separate, non-bundled payment under 
                the Medicare program for remote patient management 
                services; and
                    (C) create, revise and adjust, as appropriate, 
                codes for the accurate reporting and billing for 
                payment for remote patient management services.

SEC. 107. TELEHEALTH ADVISORY COMMITTEE.

    (a) In General.--Section 1834(m)(4)(F)(ii) of the Social Security 
Act (42 U.S.C. 1395m(m)(4)(F)(ii)) is amended by adding at the end the 
following sentences: ``Such process shall require the Secretary to take 
into account the recommendations of the Telehealth Advisory Committee 
(as established under section 107(b) of the Medicare Telehealth 
Enhancement Act of 2009) 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 a recommendation of the Telehealth 
Advisory Committee, the Secretary shall publish in the Federal Register 
a statement regarding the reason such recommendation was not 
implemented.''.
    (b) Telehealth Advisory Committee.--
            (1) Establishment.--On and after the date that is 6 months 
        after the date of enactment of this Act, the Secretary of 
        Health and Human Services (in this subsection referred to as 
        the ``Secretary'') shall have in place a Telehealth Advisory 
        Committee (in this subsection referred to as the ``Advisory 
        Committee'') to make recommendations to the Secretary on--
                    (A) policies of the Centers for Medicare & Medicaid 
                Services regarding the delivery of telehealth services; 
                and
                    (B) the appropriate addition or deletion of 
                services (and HCPCS codes) to those specified in 
                paragraph (4)(F)(i) of section 1834(m) of the Social 
                Security Act (42 U.S.C. 1395m(m)) 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) five shall be practicing 
                                physicians;
                                    (II) two shall be practicing non-
                                physician health care providers; and
                                    (III) two 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 per 
        year and at such other times as the Advisory Committee 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.
            (5) Waiver of administrative limitation.--The Secretary 
        shall establish the Advisory Committee 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).

                      TITLE II--HRSA GRANT PROGRAM

SEC. 201. GRANT PROGRAM FOR THE DEVELOPMENT OF TELEHEALTH NETWORKS.

    (a) In General.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary''), acting through the 
Director of the Office for the Advancement of Telehealth (of the Health 
Resources and Services Administration), shall make grants to eligible 
entities (as described in subsection (b)(2)) for the purpose of 
expanding access to health care services for individuals in rural 
areas, frontier areas, and urban medically underserved areas through 
the use of telehealth.
    (b) Eligible Entities.--
            (1) Application.--To be eligible to receive a grant under 
        this section, an eligible entity described in paragraph (2) 
        shall, in consultation with the State office of rural health or 
        other appropriate State entity, prepare and submit to the 
        Secretary an application, at such time, in such manner, and 
        containing such information as the Secretary may require, 
        including the following:
                    (A) A description of the anticipated need for the 
                grant.
                    (B) A description of the activities which the 
                entity intends to carry out using amounts provided 
                under the grant.
                    (C) A plan for continuing the project after Federal 
                support under this section is ended.
                    (D) A description of the manner in which the 
                activities funded under the grant will meet health care 
                needs of underserved rural populations within the 
                State.
                    (E) A description of how the local community or 
                region to be served by the network or proposed network 
                will be involved in the development and ongoing 
                operations of the network.
                    (F) The source and amount of non-Federal funds the 
                entity would pledge for the project.
                    (G) A showing of the long-term viability of the 
                project and evidence of health care provider commitment 
                to the network.
        The application should demonstrate the manner in which the 
        project will promote the integration of telehealth in the 
        community so as to avoid redundancy of technology and achieve 
        economies of scale.
            (2) Eligible entities.--
                    (A) In general.--An eligible entity described in 
                this paragraph is a hospital or other health care 
                provider in a health care network of community-based 
                health care providers that includes at least--
                            (i) two of the organizations described in 
                        subparagraph (B); and
                            (ii) one of the institutions and entities 
                        described in subparagraph (C),
                if the institution or entity is able to demonstrate use 
                of the network for purposes of education or economic 
                development (as required by the Secretary).
                    (B) Organizations described.--The organizations 
                described in this subparagraph are the following:
                            (i) Community or migrant health centers.
                            (ii) Local health departments.
                            (iii) Nonprofit hospitals.
                            (iv) Private practice health professionals, 
                        including community and rural health clinics.
                            (v) Other publicly funded health or social 
                        services agencies.
                            (vi) Skilled nursing facilities.
                            (vii) County mental health and other 
                        publicly funded mental health facilities.
                            (viii) Providers of home health services.
                            (ix) Renal dialysis facilities.
                    (C) Institutions and entities described.--The 
                institutions and entities described in this 
                subparagraph are the following:
                            (i) A public school.
                            (ii) A public library.
                            (iii) A university or college.
                            (iv) A local government entity.
                            (v) A local health entity.
                            (vi) A health-related nonprofit foundation.
                            (vii) An academic health center.
        An eligible entity may include for-profit entities so long as 
        the recipient of the grant is a not-for-profit entity.
    (c) Preference.--The Secretary shall establish procedures to 
prioritize financial assistance under this section based upon the 
following considerations:
            (1) The applicant is a health care provider in a health 
        care network or a health care provider that proposes to form 
        such a network that furnishes or proposes to furnish services 
        in a medically underserved area, health professional shortage 
        area, or mental health professional shortage area.
            (2) The applicant is able to demonstrate broad geographic 
        coverage in the rural or medically underserved areas of the 
        State, or States in which the applicant is located.
            (3) The applicant proposes to use Federal funds to develop 
        plans for, or to establish, telehealth systems that will link 
        rural hospitals and rural health care providers to other 
        hospitals, health care providers, and patients.
            (4) The applicant will use the amounts provided for a range 
        of health care applications and to promote greater efficiency 
        in the use of health care resources.
            (5) The applicant is able to demonstrate the long-term 
        viability of projects through cost participation (cash or in-
        kind).
            (6) The applicant is able to demonstrate financial, 
        institutional, and community support for the long-term 
        viability of the network.
            (7) The applicant is able to provide a detailed plan for 
        coordinating system use by eligible entities so that health 
        care services are given a priority over non-clinical uses.
    (d) Maximum Amount of Assistance to Individual Recipients.--The 
Secretary shall establish, by regulation, the terms and conditions of 
the grant and the maximum amount of a grant award to be made available 
to an individual recipient for each fiscal year under this section. The 
Secretary shall cause to have published in the Federal Register or the 
``HRSA Preview'' notice of the terms and conditions of a grant under 
this section and the maximum amount of such a grant for a fiscal year.
    (e) Use of Amounts.--The recipient of a grant under this section 
may use sums received under such grant for the acquisition of 
telehealth equipment and modifications or improvements of 
telecommunications facilities including the following:
            (1) The development and acquisition through lease or 
        purchase of computer hardware and software, audio and video 
        equipment, computer network equipment, interactive equipment, 
        data terminal equipment, and other facilities and equipment 
        that would further the purposes of this section.
            (2) The provision of technical assistance and instruction 
        for the development and use of such programming equipment or 
        facilities.
            (3) The development and acquisition of instructional 
        programming.
            (4) Demonstration projects for teaching or training medical 
        students, residents, and other health profession students in 
        rural or medically underserved training sites about the 
        application of telehealth.
            (5) The provision of telenursing services designed to 
        enhance care coordination and promote patient self-management 
        skills.
            (6) The provision of services designed to promote patient 
        understanding and adherence to national guidelines for common 
        chronic diseases, such as congestive heart failure or diabetes.
            (7) Transmission costs, maintenance of equipment, and 
        compensation of specialists and referring health care 
        providers, when no other form of reimbursement is available.
            (8) Development of projects to use telehealth to facilitate 
        collaboration between health care providers.
            (9) Electronic archival of patient records.
            (10) Collection and analysis of usage statistics and data 
        that can be used to document the cost-effectiveness of the 
        telehealth services.
            (11) Such other uses that are consistent with achieving the 
        purposes of this section as approved by the Secretary.
    (f) Prohibited Uses.--Sums received under a grant under this 
section may not be used for any of the following:
            (1) To acquire real property.
            (2) Expenditures to purchase or lease equipment to the 
        extent the expenditures would exceed more than 40 percent of 
        the total grant funds.
            (3) To purchase or install transmission equipment off the 
        premises of the telehealth site and any transmission costs not 
        directly related to the grant.
            (4) For construction, except that such funds may be 
        expended for minor renovations relating to the installation of 
        equipment.
            (5) Expenditures for indirect costs (as determined by the 
        Secretary) to the extent the expenditures would exceed more 
        than 15 percent of the total grant.
    (g) Administration.--
            (1) Nonduplication.--The Secretary shall ensure that 
        facilities constructed using grants provided under this section 
        do not duplicate adequately established telehealth networks.
            (2) Coordination with other agencies.--The Secretary shall 
        coordinate, to the extent practicable, with other Federal and 
        State agencies and not-for-profit organizations, operating 
        similar grant programs to pool resources for funding 
        meritorious proposals.
            (3) Informational efforts.--The Secretary shall establish 
        and implement procedures to carry out outreach activities to 
        advise potential end users located in rural and medically 
        underserved areas of each State about the program authorized by 
        this section.
    (h) Prompt Implementation.--The Secretary shall take such actions 
as are necessary to carry out the grant program as expeditiously as 
possible.
    (i) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $10,000,000 for fiscal year 
2010, and such sums as may be necessary for each of the fiscal years 
2011 through 2014.

SEC. 202. REAUTHORIZATION OF TELEHEALTH NETWORK AND TELEHEALTH RESOURCE 
              CENTERS GRANT PROGRAMS.

    Subsection (s) of section 330I of the Public Health Service Act (42 
U.S.C. 254c-14) is amended--
            (1) in paragraph (1)--
                    (A) by striking ``and'' before ``such sums''; and
                    (B) by inserting ``$10,000,000 for fiscal year 
                2010, and such sums as may be necessary for each of 
                fiscal years 2011 through 2014'' before the semicolon; 
                and
            (2) in paragraph (2)--
                    (A) by striking ``and'' before ``such sums''; and
                    (B) by inserting ``$10,000,000 for fiscal year 
                2010, and such sums as may be necessary for each of 
                fiscal years 2011 through 2014'' before the semicolon.
                                 <all>
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