I 

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. 

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 2009’’. 

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

7 this Act is as follows: 


SMARTINEZ on PROD1PC64 with BILLS
2 

•HR 2068 IH

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. 

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)(4)(C)(i) of the Social 

6 Security Act (42 U.S.C. 1395m(m)(4)(C)(i)) is amended 

7 in paragraph (4)(C)(i) by striking ‘‘and only if such site 

8 is located’’ and all that follows and inserting ‘‘without re9 gard to the geographic area within the United States 

10 where the site is located.’’. 

11 (b) EXPANSION OF USE OF STORE-AND-FORWARD

12 TECHNOLOGY.—The second sentence of section 

13 1834(m)(1) of such Act (42 U.S.C. 1395m(m)(1)) is 

14 amended by inserting ‘‘and any telehealth program that 

15 has been the recipient of any Federal support from the 

16 Centers for Medicare & Medicaid Services, the Indian 


SMARTINEZ on PROD1PC64 with BILLS
3 

•HR 2068 IH

1 Health Service, or the Health Services and Resources Ad2 ministration’’ after ‘‘Alaska or Hawaii’’. 

3 (c) EFFECTIVE DATE.—The amendments made by 

4 this section shall apply to services furnished on or after 

5 January 1, 2010. 

6 SEC. 102. INCREASE IN NUMBER OF TYPES OF ORIGI7 NATING SITES; CLARIFICATION. 

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

9 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) 

10 is amended by adding at the end the following new sub11 clause: 

12 ‘‘(IX) A renal dialysis facility.’’ 

13 (b) CLARIFICATION OF INTENT OF THE TERM ORIGI14 NATING SITE.—Such section is further amended by add15 ing at the end the following new paragraph: 

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

17 ‘originating site’ under this subsection, the Secretary 

18 shall apply the term only for the purpose of deter19 mining whether a site is eligible to receive a facility 

20 fee. Nothing in the application of such term under 

21 this subsection shall be construed as affecting the 

22 ability of an eligible practitioner to submit claims for 

23 telehealth services that are provided to other sites 

24 that have telehealth systems and capabilities.’’. 


SMARTINEZ on PROD1PC64 with BILLS
4 

•HR 2068 IH

1 (c) EFFECTIVE DATE.—The amendments made by 

2 this section shall apply to services furnished on or after 

3 January 1, 2010. 

4 SEC. 103. EXPANSION OF ELIGIBLE TELEHEALTH PRO5 VIDERS AND CREDENTIALING OF TELEMEDI6 CINE PRACTITIONERS. 

7 (a) EXPANSION OF ELIGIBLE TELEHEALTH PRO8 VIDERS.—Section 1834(m)(1) of the Social Security Act 

9 (42 U.S.C. 1395m(m)(1)) is amended— 

10 (1) in paragraph (1)— 

11 (A) by striking ‘‘or a practitioner’’ and in12 serting ‘‘, a practitioner’’; 

13 (B) by inserting ‘‘, or other telehealth pro14 vider’’ after ‘‘1842(b)(18)(C))’’; and 

15 (C) by striking ‘‘or practitioner’’ and in16 serting ‘‘, practitioner, or provider’’; 

17 (2) in paragraphs (2), (3)(A), and (4), by strik18 ing ‘‘or practitioner’’ and inserting ‘‘, practitioner, 

19 or other telehealth provider’’ each place it appears; 

20 (3) in paragraph (4), by adding at the end the 

21 following new subparagraph: 

22 ‘‘(G) TELEHEALTH PROVIDER.—The term 

23 ‘telehealth provider’ means any supplier or pro24 vider of services (other than a physician or 


SMARTINEZ on PROD1PC64 with BILLS
5 

•HR 2068 IH

1 practitioner) that is eligible to provide other 

2 health services under this title.’’. 

3 (b) CREDENTIALING TELEMEDICINE PRACTI4 TIONERS.—Section 1834(m) of such Act is amended by 

5 adding at the end the following new paragraph: 

6 ‘‘(5) HOSPITAL CREDENTIALING OF TELEMEDI7 CINE PRACTITIONERS.—A telemedicine practitioner 

8 that is credentialed by a hospital in compliance with 

9 the Joint Commission Standards for Telemedicine 

10 shall be considered in compliance with Medicare con11 dition of participation and reimbursement 

12 credentialing requirements for telemedicine serv13 ices.’’. 

14 SEC. 104. ACCESS TO TELEHEALTH SERVICES IN THE 

15 HOME. 

16 (a) IN GENERAL.—Section 1895 of the Social Secu17 rity Act (42 U.S.C. 1395fff(e)) is amended by adding at 

18 the end the following new subsection: 

19 ‘‘(f) COVERAGE OF TELEHEALTH SERVICES.— 

20 ‘‘(1) IN GENERAL.—The Secretary shall include 

21 telehealth services that are furnished via a tele22 communication system by a home health agency to 

23 an individual receiving home health services under 

24 section 1814(a)(2)(C) or 1835(a)(2)(A) as a home 


SMARTINEZ on PROD1PC64 with BILLS
6 

•HR 2068 IH

1 health visit for purposes of eligibility and payment 

2 under this title if the telehealth services— 

3 ‘‘(A) are ordered as part of a plan of care 

4 certified by a physician pursuant to section 

5 1814(a)(2)(C) or 1835(a)(2)(A); 

6 ‘‘(B) do not substitute for in-person home 

7 health services ordered as part of a plan of care 

8 certified by a physician pursuant to such re9 spective section; and 

10 ‘‘(C) are considered the equivalent of a 

11 visit under criteria developed by the Secretary 

12 under paragraph (3). 

13 ‘‘(2) PHYSICIAN CERTIFICATION.—Nothing in 

14 this section shall be construed as waiving the re15 quirement for a physician certification under section 

16 1814(a)(2)(C) or 1835(a)(2)(A) for the payment for 

17 home health services, whether or not furnished via 

18 a telecommunication system. 

19 ‘‘(3) CRITERIA FOR VISIT EQUIVALENCY.— 

20 ‘‘(A) STANDARDS.—The Secretary shall es21 tablish standards and qualifications for catego22 rizing and coding under HCPCS codes tele23 health services under this subsection as equiva24 lent to an in-person visit for purposes of eligi25 bility and payment for home health services 


SMARTINEZ on PROD1PC64 with BILLS
7 

•HR 2068 IH

1 under this title. In establishing the standards 

2 and qualifications, the Secretary may distin3 guish between varying modes and modalities of 

4 telehealth services and shall consider— 

5 ‘‘(i) the nature and amount of service 

6 time involved; and 

7 ‘‘(ii) the functions of the telecommuni8 cations. 

9 ‘‘(B) LIMITATION.—A telecommunication 

10 that consists solely of a telephone audio con11 versation, facsimile, electronic text mail, or con12 sultation between two health care practitioners 

13 is not considered a visit under this subsection. 

14 ‘‘(4) TELEHEALTH SERVICE.— 

15 ‘‘(A) DEFINITION.—For purposes of this 

16 subsection, the term ‘telehealth service’ means 

17 technology-based professional consultations, pa18 tient monitoring, patient training services, clin19 ical observation, assessment, or treatment, and 

20 any additional services that utilize technologies 

21 specified by the Secretary as HCPCS codes de22 veloped under paragraph (3). 

23 ‘‘(B) UPDATE OF HCPCS CODES.—The 

24 Secretary shall establish a process for the upVerDate Nov 24 2008 03:50 Apr 25, 2009 Jkt 079200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2068.IH H2068

SMARTINEZ on PROD1PC64 with BILLS
8 

•HR 2068 IH

1 dating, not less frequently than annually, of 

2 HCPCS codes for telehealth services. 

3 ‘‘(5) CONDITIONS FOR PAYMENT AND COV4 ERAGE.—Nothing in this subsection shall be con5 strued as waiving any condition of payment under 

6 sections 1814(a)(2)(C) or 1835(a)(2)(A) or exclu7 sion of coverage under section 1862(a)(1). 

8 ‘‘(6) COST REPORTING.—Notwithstanding any 

9 provision to the contrary, the Secretary shall provide 

10 that the costs of telehealth services under this sub11 section shall be reported as a reimbursable cost cen12 ter on any cost report submitted by a home health 

13 agency to the Secretary.’’. 

14 (b) EFFECTIVE DATE.— 

15 (1) The amendment made by subsection (a) 

16 shall apply to telehealth services furnished on or 

17 after October 1, 2010. The Secretary of Health and 

18 Human Services shall develop and implement cri19 teria and standards under section 1895(f)(3) of the 

20 Social Security Act, as amended by subsection (a), 

21 by no later than July 1, 2010. 

22 (2) In the event that the Secretary has not 

23 complied with these deadlines, beginning October 1, 

24 2010, a home health visit for purpose of eligibility 

25 and payment under title XVIII of the Social SecuVerDate Nov 24 2008 03:50 Apr 25, 2009 Jkt 079200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2068.IH H2068

SMARTINEZ on PROD1PC64 with BILLS
9 

•HR 2068 IH

1 rity Act shall include telehealth services under sec2 tion 1895(f) of such Act with the aggregate of tele3 communication encounters in a 24-hour period con4 sidered the equivalent of one in-person visit. 

5 SEC. 105. COVERAGE OF HOME HEALTH REMOTE PATIENT 

6 MANAGEMENT SERVICES FOR CHRONIC 

7 HEALTH CONDITIONS. 

8 (a) MEDICARE COVERAGE.— 

9 (1) IN GENERAL.—Section 1861(s)(2) of the 

10 Social Security Act (42 U.S.C. 1395x(s)(2)) is 

11 amended— 

12 (A) in subparagraph (DD), by striking 

13 ‘‘and’’ at the end; 

14 (B) in subparagraph (EE), by adding 

15 ‘‘and’’ at the end; and 

16 (C) by inserting after subparagraph (EE) 

17 the following new subparagraph: 

18 ‘‘(FF) home health remote patient management 

19 services (as defined in subsection (hhh));’’. 

20 (2) SERVICES DESCRIBED.—Section 1861 of 

21 such Act (42 U.S.C. 1395x) is amended by adding 

22 at the end the following new subsection: 

23 ‘‘(hhh) HOME HEALTH REMOTE PATIENT MANAGE24 MENT SERVICES FOR CHRONIC HEALTH CONDITIONS.— 

25 (1) The term ‘remote patient management services’ means 


SMARTINEZ on PROD1PC64 with BILLS
10 

•HR 2068 IH

1 the remote monitoring, evaluation, and management of an 

2 individual with a covered chronic health condition (as de3 fined in paragraph (2)) through the utilization of a system 

4 of technology that allows a remote interface to collect and 

5 transmit clinical data between the individual and a home 

6 health agency, in accordance with a plan of care estab7 lished by a physician, for the purposes of clinical review 

8 or response by the home health agency. Such term, with 

9 respect to an individual, does not include any remote mon10 itoring, evaluation, or management of the individual if 

11 such remote monitoring, evaluation, or management, re12 spectively, is included as a home health visit under section 

13 1895(f) for purposes of payment under this title. 

14 ‘‘(2) For purposes of paragraph (1), the term ‘cov15 ered chronic health condition’ means any chronic health 

16 condition specified by the Secretary.’’. 

17 (b) PAYMENT.— 

18 (1) IN GENERAL.—Section 1834 of such Act 

19 (42 U.S.C. 1395l) is amended by adding at the end 

20 the following new subsection: 

21 ‘‘(n) HOME HEALTH REMOTE PATIENT MANAGE22 MENT SERVICES.— 

23 ‘‘(1) IN GENERAL.—The Secretary shall estab24 lish a fee schedule for home health remote patient 

25 management services (as defined in section 


SMARTINEZ on PROD1PC64 with BILLS
11 

•HR 2068 IH

1 1861(hhh)) for which payment is made under this 

2 part. The fee schedule shall be designed in a manner 

3 so that, on an annual basis, the aggregate payment 

4 amounts under this title for such services approxi5 mates 50 percent of the savings amount described in 

6 paragraph (2) for such year. 

7 ‘‘(2) SAVINGS DESCRIBED.— 

8 ‘‘(A) IN GENERAL.—For purposes of para9 graph (1), the savings amount described in this 

10 paragraph for a year is the amount (if any), as 

11 estimated by the Secretary before the beginning 

12 of the year, by which— 

13 ‘‘(i) the product described in subpara14 graph (B) for the year, exceeds 

15 ‘‘(ii) the total payments under this 

16 part and part A for items and services fur17 nished to individuals receiving home health 

18 remote patient management services at any 

19 time during the year. 

20 ‘‘(B) PRODUCT DESCRIBED.—The product 

21 described in this subparagraph for a year is the 

22 product of— 

23 ‘‘(i) the average per capita total pay24 ments under this part and part A for items 

25 and services furnished during the year to 


SMARTINEZ on PROD1PC64 with BILLS
12 

•HR 2068 IH

1 individuals not described in subparagraph 

2 (A)(ii), adjusted to remove case mix dif3 ferences between such individuals not de4 scribed in such subparagraph and the indi5 viduals described in such subparagraph; 

6 and 

7 ‘‘(ii) the number of individuals under 

8 subparagraph (A)(ii) for the year. 

9 ‘‘(3) LIMITATION.—In no case may payments 

10 under this subsection result in the aggregate expend11 itures under this title (including payments under 

12 this subsection) exceeding the amount that the Sec13 retary estimates would have been expended if cov14 erage under this title for home health patient man15 agement services was not provided. 

16 ‘‘(4) CLARIFICATION.—Payments under the fee 

17 schedule under this subsection, with respect to an 

18 individual, shall be in addition to any other pay19 ments that a home health agency would otherwise 

20 receive under this title for items and services fur21 nished to such individual and shall have no effect on 

22 the amount of such other payments. 

23 ‘‘(5) PAYMENT TRANSFER.—There shall be 

24 transferred from the Federal Hospital Insurance 

25 Trust Fund under section 1817 to the Federal SupVerDate Nov 24 2008 03:50 Apr 25, 2009 Jkt 079200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H2068.IH H2068

SMARTINEZ on PROD1PC64 with BILLS
13 

•HR 2068 IH

1 plementary Medical Insurance Trust Fund under 

2 section 1841 each year an amount equivalent to the 

3 product of— 

4 ‘‘(A) expenditures under this subsection 

5 for the year, and 

6 ‘‘(B) the ratio of the portion of the savings 

7 described in paragraph (2) for the year that are 

8 attributable to part A, to the total savings de9 scribed in such paragraph for the year.’’. 

10 (2) CONFORMING AMENDMENT.—Section 

11 1833(a)(1) of such Act (42 U.S.C. 1395l(1)) is 

12 amended— 

13 (A) by striking ‘‘and (W)’’ and inserting 

14 ‘‘(W)’’; and 

15 (B) by inserting before the semicolon at 

16 the end the following: ‘‘, (X) with respect to 

17 home health remote patient management serv18 ices (as defined in section 1861(hhh)), the 

19 amounts paid shall be the amount determined 

20 under the fee schedule established under section 

21 1834(n)’’. 

22 (c) EXPANSION OF HOME HEALTH REMOTE PA23 TIENT MANAGEMENT SERVICES COVERAGE TO ADDI24 TIONAL CHRONIC HEALTH CONDITIONS.—The Secretary 

25 of Health and Human Services is authorized to carry out 


SMARTINEZ on PROD1PC64 with BILLS
14 

•HR 2068 IH

1 pilot projects for purposes of determining the extent to 

2 which the coverage under title XVIII of the Social Security 

3 Act of home health remote patient management services 

4 (as defined in paragraph (1) of section 1861(hhh) of such 

5 Act, as added by subsection (a)) should be extended to 

6 individuals with chronic health conditions other than those 

7 initially specified by the Secretary under paragraph (2) 

8 of such section. 

9 (d) EFFECTIVE DATE.—The amendments made by 

10 subsections (a), (b), and (c) shall apply to services fur11 nished on or after January 1, 2010. 

12 SEC. 106. SENSE OF CONGRESS ON THE USE OF REMOTE 

13 PATIENT MANAGEMENT SERVICES. 

14 (a) FINDINGS.—Congress finds as follows: 

15 (1) Remote patient management services can 

16 make chronic disease management more effective 

17 and efficient for patients and for the health care sys18 tem. 

19 (2) By collecting, analyzing, and transmitting 

20 clinical health information to a health care provider, 

21 remote patient management services allow patients 

22 and providers to manage the medical condition of 

23 patients in a consistent and real time fashion. 

24 (3) Utilization of remote patient management 

25 services not only improves the quality of care given 


SMARTINEZ on PROD1PC64 with BILLS
15 

•HR 2068 IH

1 to patients, it also reduces the need for frequent of2 fice appointments, costly emergency room visits, and 

3 unnecessary hospitalizations. 

4 (4) Management the medical condition or dis5 ease of a patient from the patient’s home reduces 

6 the need for face to face provider interactions. Use 

7 of remote patient management services minimizes 

8 unnecessary travel and missed work and provides 

9 particular value to patients residing in rural or un10 derserved communities who would otherwise face po11 tentially significant access barriers to receiving need12 ed care. 

13 (5) Among the areas in which remote patient 

14 management services are emerging in health care 

15 are the treatment of congestive heart failure, diabe16 tes, cardiac arrhythmia, epilepsy, and sleep apnea. 

17 Prompt transmission of clinical data on each of 

18 these conditions, to the health care provider or the 

19 patient as appropriate, is essential to providing time20 ly and appropriate therapeutic interventions which 

21 can then reduce expensive hospitalizations. 

22 (6) Despite these benefits, remote patient man23 agement services have failed to diffuse rapidly. A 

24 significant barrier to wider adoption is the relative 

25 lack of payment mechanisms in fee for service MediVerDate Nov 24 2008 03:50 Apr 25, 2009 Jkt 079200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H2068.IH H2068

SMARTINEZ on PROD1PC64 with BILLS
16 

•HR 2068 IH

1 care to reimburse for remote, non face to face pa2 tient management. 

3 (7) Elimination of this barrier to new remote 

4 patient management services should be encouraged 

5 by requiring reimbursement under the Medicare pro6 gram for providers’ time spent analyzing and re7 sponding to patient data transmitted by remote 

8 technologies. 

9 (8) Reimbursement under the Medicare pro10 gram for health care providers’ time spent analyzing 

11 and responding to data transmitted to providers by 

12 remote technologies should be made on a separate 

13 basis and should not be combined with payments for 

14 others services (also referred to as ‘‘bundled pay15 ments’’). 

16 (9) Payment codes used for reporting and bill17 ing for payment for providers’ remote patient man18 agement services should be revised or adjusted, as 

19 appropriate, to encourage the application of such 

20 services for other medical conditions. 

21 (b) SENSE OF CONGRESS.—It is the sense of the 

22 Congress that— 

23 (1) remote patient management services are in24 tegral to improvement in the delivery, care, and effiVerDate Nov 24 2008 03:50 Apr 25, 2009 Jkt 079200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H2068.IH H2068

SMARTINEZ on PROD1PC64 with BILLS
17 

•HR 2068 IH

1 ciency of health care services furnished in the 

2 United States; and 

3 (2) the Administrator of the Centers for Medi4 care & Medicaid Services should be encouraged to— 

5 (A) expand the types of medical conditions 

6 for which the use of remote patient manage7 ment services are reimbursed under the Medi8 care program; 

9 (B) provide for separate, non-bundled pay10 ment under the Medicare program for remote 

11 patient management services; and 

12 (C) create, revise and adjust, as appro13 priate, codes for the accurate reporting and bill14 ing for payment for remote patient manage15 ment services. 

16 SEC. 107. TELEHEALTH ADVISORY COMMITTEE. 

17 (a) IN GENERAL.—Section 1834(m)(4)(F)(ii) of the 

18 Social Security Act (42 U.S.C. 1395m(m)(4)(F)(ii)) is 

19 amended by adding at the end the following sentences: 

20 ‘‘Such process shall require the Secretary to take into ac21 count the recommendations of the Telehealth Advisory 

22 Committee (as established under section 107(b) of the 

23 Medicare Telehealth Enhancement Act of 2009) when 

24 adding or deleting services (and HCPCS codes) and in es25 tablishing policies of the Centers for Medicare & Medicaid 


SMARTINEZ on PROD1PC64 with BILLS
18 

•HR 2068 IH

1 Services regarding the delivery of telehealth services. If 

2 the Secretary does not implement a recommendation of 

3 the Telehealth Advisory Committee, the Secretary shall 

4 publish in the Federal Register a statement regarding the 

5 reason such recommendation was not implemented.’’. 

6 (b) TELEHEALTH ADVISORY COMMITTEE.— 

7 (1) ESTABLISHMENT.—On and after the date 

8 that is 6 months after the date of enactment of this 

9 Act, the Secretary of Health and Human Services 

10 (in this subsection referred to as the ‘‘Secretary’’) 

11 shall have in place a Telehealth Advisory Committee 

12 (in this subsection referred to as the ‘‘Advisory 

13 Committee’’) to make recommendations to the Sec14 retary on— 

15 (A) policies of the Centers for Medicare & 

16 Medicaid Services regarding the delivery of tele17 health services; and 

18 (B) the appropriate addition or deletion of 

19 services (and HCPCS codes) to those specified 

20 in paragraph (4)(F)(i) of section 1834(m) of 

21 the Social Security Act (42 U.S.C. 1395m(m)) 

22 for authorized payment under paragraph (1) of 

23 such section. 

24 (2) MEMBERSHIP; TERMS.— 

25 (A) MEMBERSHIP.— 


SMARTINEZ on PROD1PC64 with BILLS
19 

•HR 2068 IH

1 (i) IN GENERAL.—The Advisory Com2 mittee shall be composed of 9 members, to 

3 be appointed by the Secretary, of whom— 

4 (I) five shall be practicing physi5 cians; 

6 (II) two shall be practicing non7 physician health care providers; and 

8 (III) two shall be administrators 

9 of telehealth programs. 

10 (ii) REQUIREMENTS FOR APPOINTING

11 MEMBERS.—In appointing members of the 

12 Advisory Committee, the Secretary shall— 

13 (I) ensure that each member has 

14 prior experience with the practice of 

15 telemedicine or telehealth; 

16 (II) give preference to individuals 

17 who are currently providing telemedi18 cine or telehealth services or who are 

19 involved in telemedicine or telehealth 

20 programs; 

21 (III) ensure that the membership 

22 of the Advisory Committee represents 

23 a balance of specialties and geo24 graphic regions; and 


SMARTINEZ on PROD1PC64 with BILLS
20 

•HR 2068 IH

1 (IV) take into account the rec2 ommendations of stakeholders. 

3 (B) TERMS.—The members of the Advi4 sory Committee shall serve for such term as the 

5 Secretary may specify. 

6 (C) CONFLICTS OF INTEREST.—An advi7 sory committee member may not participate 

8 with respect to a particular matter considered 

9 in an advisory committee meeting if such mem10 ber (or an immediate family member of such 

11 member) has a financial interest that could be 

12 affected by the advice given to the Secretary 

13 with respect to such matter. 

14 (3) MEETINGS.—The Advisory Committee shall 

15 meet twice per year and at such other times as the 

16 Advisory Committee may provide. 

17 (4) PERMANENT COMMITTEE.—Section 14 of 

18 the Federal Advisory Committee Act (5 U.S.C. 

19 App.) shall not apply to the Advisory Committee. 

20 (5) WAIVER OF ADMINISTRATIVE LIMITA21 TION.—The Secretary shall establish the Advisory 

22 Committee notwithstanding any limitation that may 

23 apply to the number of advisory committees that 

24 may be established (within the Department of 

25 Health and Human Services or otherwise). 


SMARTINEZ on PROD1PC64 with BILLS
21 

•HR 2068 IH

1 TITLE II—HRSA GRANT 

2 PROGRAM 

3 SEC. 201. GRANT PROGRAM FOR THE DEVELOPMENT OF 

4 TELEHEALTH NETWORKS. 

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

6 Human Services (in this section referred to as the ‘‘Sec7 retary’’), acting through the Director of the Office for the 

8 Advancement of Telehealth (of the Health Resources and 

9 Services Administration), shall make grants to eligible en10 tities (as described in subsection (b)(2)) for the purpose 

11 of expanding access to health care services for individuals 

12 in rural areas, frontier areas, and urban medically under13 served areas through the use of telehealth. 

14 (b) ELIGIBLE ENTITIES.— 

15 (1) APPLICATION.—To be eligible to receive a 

16 grant under this section, an eligible entity described 

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

18 State office of rural health or other appropriate 

19 State entity, prepare and submit to the Secretary an 

20 application, at such time, in such manner, and con21 taining such information as the Secretary may re22 quire, including the following: 

23 (A) A description of the anticipated need 

24 for the grant. 


SMARTINEZ on PROD1PC64 with BILLS
22 

•HR 2068 IH

1 (B) A description of the activities which 

2 the entity intends to carry out using amounts 

3 provided under the grant. 

4 (C) A plan for continuing the project after 

5 Federal support under this section is ended. 

6 (D) A description of the manner in which 

7 the activities funded under the grant will meet 

8 health care needs of underserved rural popu9 lations within the State. 

10 (E) A description of how the local commu11 nity or region to be served by the network or 

12 proposed network will be involved in the devel13 opment and ongoing operations of the network. 

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

15 funds the entity would pledge for the project. 

16 (G) A showing of the long-term viability of 

17 the project and evidence of health care provider 

18 commitment to the network. 

19 The application should demonstrate the manner in 

20 which the project will promote the integration of 

21 telehealth in the community so as to avoid redun22 dancy of technology and achieve economies of scale. 

23 (2) ELIGIBLE ENTITIES.— 

24 (A) IN GENERAL.—An eligible entity de25 scribed in this paragraph is a hospital or other 


SMARTINEZ on PROD1PC64 with BILLS
23 

•HR 2068 IH

1 health care provider in a health care network of 

2 community-based health care providers that in3 cludes at least— 

4 (i) two of the organizations described 

5 in subparagraph (B); and 

6 (ii) one of the institutions and entities 

7 described in subparagraph (C), 

8 if the institution or entity is able to dem9 onstrate use of the network for purposes of 

10 education or economic development (as required 

11 by the Secretary). 

12 (B) ORGANIZATIONS DESCRIBED.—The or13 ganizations described in this subparagraph are 

14 the following: 

15 (i) Community or migrant health cen16 ters. 

17 (ii) Local health departments. 

18 (iii) Nonprofit hospitals. 

19 (iv) Private practice health profes20 sionals, including community and rural 

21 health clinics. 

22 (v) Other publicly funded health or so23 cial services agencies. 

24 (vi) Skilled nursing facilities. 


SMARTINEZ on PROD1PC64 with BILLS
24 

•HR 2068 IH

1 (vii) County mental health and other 

2 publicly funded mental health facilities. 

3 (viii) Providers of home health serv4 ices. 

5 (ix) Renal dialysis facilities. 

6 (C) INSTITUTIONS AND ENTITIES DE7 SCRIBED.—The institutions and entities de8 scribed in this subparagraph are the following: 

9 (i) A public school. 

10 (ii) A public library. 

11 (iii) A university or college. 

12 (iv) A local government entity. 

13 (v) A local health entity. 

14 (vi) A health-related nonprofit founda15 tion. 

16 (vii) An academic health center. 

17 An eligible entity may include for-profit entities so 

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

19 entity. 

20 (c) PREFERENCE.—The Secretary shall establish pro21 cedures to prioritize financial assistance under this section 

22 based upon the following considerations: 

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

24 a health care network or a health care provider that 

25 proposes to form such a network that furnishes or 


SMARTINEZ on PROD1PC64 with BILLS
25 

•HR 2068 IH

1 proposes to furnish services in a medically under2 served area, health professional shortage area, or 

3 mental health professional shortage area. 

4 (2) The applicant is able to demonstrate broad 

5 geographic coverage in the rural or medically under6 served areas of the State, or States in which the ap7 plicant is located. 

8 (3) The applicant proposes to use Federal 

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

10 systems that will link rural hospitals and rural 

11 health care providers to other hospitals, health care 

12 providers, and patients. 

13 (4) The applicant will use the amounts provided 

14 for a range of health care applications and to pro15 mote greater efficiency in the use of health care re16 sources. 

17 (5) The applicant is able to demonstrate the 

18 long-term viability of projects through cost participa19 tion (cash or in-kind). 

20 (6) The applicant is able to demonstrate finan21 cial, institutional, and community support for the 

22 long-term viability of the network. 

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

24 plan for coordinating system use by eligible entities 


SMARTINEZ on PROD1PC64 with BILLS
26 

•HR 2068 IH

1 so that health care services are given a priority over 

2 non-clinical uses. 

3 (d) MAXIMUM AMOUNT OF ASSISTANCE TO INDI4 VIDUAL RECIPIENTS.—The Secretary shall establish, by 

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

6 maximum amount of a grant award to be made available 

7 to an individual recipient for each fiscal year under this 

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

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

10 terms and conditions of a grant under this section and 

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

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

13 under this section may use sums received under such 

14 grant for the acquisition of telehealth equipment and 

15 modifications or improvements of telecommunications fa16 cilities including the following: 

17 (1) The development and acquisition through 

18 lease or purchase of computer hardware and soft19 ware, audio and video equipment, computer network 

20 equipment, interactive equipment, data terminal 

21 equipment, and other facilities and equipment that 

22 would further the purposes of this section. 

23 (2) The provision of technical assistance and in24 struction for the development and use of such pro25 gramming equipment or facilities. 


SMARTINEZ on PROD1PC64 with BILLS
27 

•HR 2068 IH

1 (3) The development and acquisition of instruc2 tional programming. 

3 (4) Demonstration projects for teaching or 

4 training medical students, residents, and other 

5 health profession students in rural or medically un6 derserved training sites about the application of tele7 health. 

8 (5) The provision of telenursing services de9 signed to enhance care coordination and promote pa10 tient self-management skills. 

11 (6) The provision of services designed to pro12 mote patient understanding and adherence to na13 tional guidelines for common chronic diseases, such 

14 as congestive heart failure or diabetes. 

15 (7) Transmission costs, maintenance of equip16 ment, and compensation of specialists and referring 

17 health care providers, when no other form of reim18 bursement is available. 

19 (8) Development of projects to use telehealth to 

20 facilitate collaboration between health care providers. 

21 (9) Electronic archival of patient records. 

22 (10) Collection and analysis of usage statistics 

23 and data that can be used to document the cost-ef24 fectiveness of the telehealth services. 


SMARTINEZ on PROD1PC64 with BILLS
28 

•HR 2068 IH

1 (11) Such other uses that are consistent with 

2 achieving the purposes of this section as approved by 

3 the Secretary. 

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

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

6 following: 

7 (1) To acquire real property. 

8 (2) Expenditures to purchase or lease equip9 ment to the extent the expenditures would exceed 

10 more than 40 percent of the total grant funds. 

11 (3) To purchase or install transmission equip12 ment off the premises of the telehealth site and any 

13 transmission costs not directly related to the grant. 

14 (4) For construction, except that such funds 

15 may be expended for minor renovations relating to 

16 the installation of equipment. 

17 (5) Expenditures for indirect costs (as deter18 mined by the Secretary) to the extent the expendi19 tures would exceed more than 15 percent of the total 

20 grant. 

21 (g) ADMINISTRATION.— 

22 (1) NONDUPLICATION.—The Secretary shall en23 sure that facilities constructed using grants provided 

24 under this section do not duplicate adequately estab25 lished telehealth networks. 


SMARTINEZ on PROD1PC64 with BILLS
29 

•HR 2068 IH

1 (2) COORDINATION WITH OTHER AGENCIES.— 

2 The Secretary shall coordinate, to the extent prac3 ticable, with other Federal and State agencies and 

4 not-for-profit organizations, operating similar grant 

5 programs to pool resources for funding meritorious 

6 proposals. 

7 (3) INFORMATIONAL EFFORTS.—The Secretary 

8 shall establish and implement procedures to carry 

9 out outreach activities to advise potential end users 

10 located in rural and medically underserved areas of 

11 each State about the program authorized by this 

12 section. 

13 (h) PROMPT IMPLEMENTATION.—The Secretary shall 

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

15 program as expeditiously as possible. 

16 (i) AUTHORIZATION OF APPROPRIATIONS.—There 

17 are authorized to be appropriated to carry out this section 

18 $10,000,000 for fiscal year 2010, and such sums as may 

19 be necessary for each of the fiscal years 2011 through 

20 2014. 

21 SEC. 202. REAUTHORIZATION OF TELEHEALTH NETWORK 

22 AND TELEHEALTH RESOURCE CENTERS 

23 GRANT PROGRAMS. 

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

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


SMARTINEZ on PROD1PC64 with BILLS
30 

•HR 2068 IH

1 (1) in paragraph (1)— 

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

3 and 

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

5 year 2010, and such sums as may be necessary 

6 for each of fiscal years 2011 through 2014’’ be7 fore the semicolon; and 

8 (2) in paragraph (2)— 

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

10 and 

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

12 year 2010, and such sums as may be necessary 

13 for each of fiscal years 2011 through 2014’’ be14 fore the semicolon. 

Æ 


SMARTINEZ on PROD1PC64 with BILLS