II 

109TH CONGRESS 

1ST SESSION S. 1909 

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 SENATE OF THE UNITED STATES 

OCTOBER 24, 2005 

Mr. BURNS introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To improve the provision of telehealth services under the 

Medicare Program, to provide grants for the development 

of telehealth networks, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

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

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

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—MEDICARE PROGRAM 

Sec. 101. Expanding access to telehealth services to all areas. 
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Sec. 102. Increase in number of types of originating sites; clarification. 

Sec. 103. Expansion of use of store-and-forward technology. 

Sec. 104. Expansion of practitioners eligible to furnish telehealth services. 

Sec. 105. Expansion of covered telehealth services. 

Sec. 106. Facilitating the provision of telehealth services across State lines. 

Sec. 107. Effective Date. 

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. EXPANDING ACCESS TO TELEHEALTH SERVICES 

3 TO ALL AREAS. 

4 Section 1834(m)(4)(C)(i) of the Social Security Act 

5 (42 U.S.C. 1395m(m)(4)(C)(i)) is amended by striking 

6 ‘‘and only if such site is located’’ and all that follows and 

7 inserting ‘‘without regard to the geographic area where 

8 the site is located.’’. 

9 SEC. 102. INCREASE IN NUMBER OF TYPES OF ORIGI10 NATING SITES; CLARIFICATION. 

11 (a) INCREASE.—Section 1834(m)(4)(C)(ii) of the So12 cial Security Act (42 U.S.C. 1395m(m)(4)(C)(ii)) is 

13 amended by adding at the end the following new sub14 clauses: 

15 ‘‘(VI) A skilled nursing facility 

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

17 ‘‘(VII) A renal dialysis facility. 

18 ‘‘(VIII) A county mental health 

19 clinic or other publicly funded mental 

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

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

5 ‘originating site’ under this subsection, the Secretary 

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

8 fee. Nothing in the application of that term under 

9 this subsection shall be construed as affecting the 

10 ability of an eligible practitioner to submit claims for 

11 telehealth services that are provided to other sites 

12 that have telehealth systems and capabilities.’’. 

13 SEC. 103. EXPANSION OF USE OF STORE-AND-FORWARD 

14 TECHNOLOGY. 

15 The second sentence of section 1834(m)(1) of the So16 cial Security Act (42 U.S.C. 1395m(m)(1)) is amended 

17 to read as follows: ‘‘For purposes of the preceding sen18 tence, in the case of any medicare demonstration program 

19 conducted by the Secretary, any disease management pro20 gram under this title, or any site determined appropriate 

21 by the Secretary, the term ‘telecommunications system’ in22 cludes store-and-forward technologies that provide for the 

23 asynchronous transmission of health care information in 

24 single or multimedia formats.’’. 
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1 SEC. 104. EXPANSION OF PRACTITIONERS ELIGIBLE TO 

2 FURNISH TELEHEALTH SERVICES. 

3 Section 1834(m) of the Social Security Act (42 

4 U.S.C. 1395m(m)) is amended— 

5 (1) in paragraph (1), by striking ‘‘(as defined 

6 in section 1861(r)) or a practitioner (described in 

7 section 1842(b)(18)(C))’’ and inserting ‘‘or a practi8 tioner’’; and 

9 (2) by striking paragraph (4)(E) and inserting 

10 the following new subparagraph: 

11 ‘‘(E) PRACTITIONER.—The term ‘practi12 tioner’ means— 

13 ‘‘(i) a practitioner described in section 

14 1842(b)(18)(C); 

15 ‘‘(ii) a physical therapist (as described 

16 in section 1861(p)); 

17 ‘‘(iii) an occupational therapist (as so 

18 described); 

19 ‘‘(iv) a qualified speech-language pa20 thologist (as defined in section 

21 1861(ll)(3)(A)); 

22 ‘‘(v) a certified provider (as described 

23 in section 1861(qq)(2)(A)); and 

24 ‘‘(vi) any other individual or entity de25 termined appropriate by the Secretary.’’. 
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1 SEC. 105. EXPANSION OF COVERED TELEHEALTH SERV2 ICES. 

3 Section 1834(m)(4)(F)(i) of the Social Security Act 

4 (42 U.S.C. 1395m(m)(4)(F)(i)) is amended to read as fol5 lows: 

6 ‘‘(i) IN GENERAL.—The term ‘tele7 health service’ means— 

8 ‘‘(I) any professional service 

9 (identified as of July 1, 2000, by 

10 HCPCS codes approved for face-to11 face care, and as subsequently modi12 fied by the Secretary); and 

13 ‘‘(II) any additional service speci14 fied by the Secretary.’’. 

15 SEC. 106. FACILITATING THE PROVISION OF TELEHEALTH 

16 SERVICES ACROSS STATE LINES. 

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

18 provision of telehealth services, for which payment is made 

19 under the medicare program, across State lines, the Sec20 retary of Health and Human Services shall, in consulta21 tion with representatives of States, physicians, health care 

22 practitioners, and patient advocates, encourage and facili23 tate the adoption of provisions allowing for multistate 

24 practitioner licensure across State lines. 

25 (b) DEFINITIONS.—In subsection (a): 
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1 (1) TELEHEALTH SERVICE.—The term ‘‘tele2 health service’’ has the meaning given that term in 

3 subparagraph (F) of section 1834(m)(4) of the So4 cial Security Act (42 U.S.C. 1395m(m)(4)), as 

5 amended by this title. 

6 (2) PHYSICIAN, PRACTITIONER.—The terms 

7 ‘‘physician’’ and ‘‘practitioner’’ have the meaning 

8 given those terms in subparagraphs (D) and (E), re9 spectively, of such section, as so amended. 

10 (3) MEDICARE PROGRAM.—The term ‘‘medicare 

11 program’’ means the program of health insurance 

12 administered by the Secretary of Health and Human 

13 Services under title XVIII of the Social Security Act 

14 (42 U.S.C. 1395 et seq.). 

15 SEC. 107. EFFECTIVE DATE. 

16 The amendments made by sections 101 through 105 

17 shall apply to services furnished on or after the date that 

18 is 90 days after the date of enactment of this Act. 

19 TITLE II—HRSA GRANT 

20 PROGRAM 

21 SEC. 201. GRANT PROGRAM FOR THE DEVELOPMENT OF 

22 TELEHEALTH NETWORKS. 

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

24 Human Services (in this section referred to as the ‘‘Sec25 retary’’), acting through the Director of the Office for the 
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1 Advancement of Telehealth (of the Health Resources and 

2 Services Administration), shall make grants to eligible en3 tities (as described in subsection (b)(2)) for the purpose 

4 of expanding access to health care services for individuals 

5 in rural areas, frontier areas, and urban medically under6 served areas through the use of telehealth. 

7 (b) ELIGIBLE ENTITIES.— 

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

9 grant under this section, an eligible entity described 

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

11 State office of rural health or other appropriate 

12 State entity, prepare and submit to the Secretary an 

13 application, at such time, in such manner, and con14 taining such information as the Secretary may re15 quire, including the following: 

16 (A) A description of the anticipated need 

17 for the grant. 

18 (B) A description of the activities which 

19 the entity intends to carry out using amounts 

20 provided under the grant. 

21 (C) A plan for continuing the project after 

22 Federal support under this section is ended. 

23 (D) A description of the manner in which 

24 the activities funded under the grant will meet 
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1 health care needs of underserved rural popu2 lations within the State. 

3 (E) A description of how the local commu4 nity or region to be served by the network or 

5 proposed network will be involved in the devel6 opment and ongoing operations of the network. 

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

8 funds the entity would pledge for the project. 

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

10 the project and evidence of health care provider 

11 commitment to the network. 

12 The application should demonstrate the manner in 

13 which the project will promote the integration of 

14 telehealth in the community so as to avoid redun15 dancy of technology and achieve economies of scale. 

16 (2) ELIGIBLE ENTITIES.—An eligible entity de17 scribed in this paragraph is a hospital or other 

18 health care provider in a health care network of 

19 community-based health care providers that includes 

20 at least two of the organizations described in sub21 paragraph (A) and one of the institutions and enti22 ties described in subparagraph (B) if the institution 

23 or entity is able to demonstrate use of the network 

24 for purposes of education or economic development 

25 (as required by the Secretary). 
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1 (A) The organizations described in this 

2 subparagraph are the following: 

3 (i) Community or migrant health cen4 ters. 

5 (ii) Local health departments. 

6 (iii) Nonprofit hospitals. 

7 (iv) Private practice health profes8 sionals, including community and rural 

9 health clinics. 

10 (v) Other publicly funded health or so11 cial services agencies. 

12 (vi) Skilled nursing facilities. 

13 (vii) County mental health and other 

14 publicly funded mental health facilities. 

15 (viii) Providers of home health serv16 ices. 

17 (ix) Renal dialysis facilities. 

18 (B) The institutions and entities described 

19 in this subparagraph are the following: 

20 (i) A public school. 

21 (ii) A public library. 

22 (iii) A university or college. 

23 (iv) A local government entity. 

24 (v) A local health entity. 
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1 (vi) A health-related nonprofit founda2 tion. 

3 (vii) An academic health center. 

4 An eligible entity may include for-profit entities so 

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

6 entity. 

7 (c) PREFERENCE.—The Secretary shall establish pro8 cedures to prioritize financial assistance under this section 

9 based upon the following considerations: 

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

11 a health care network or a health care provider that 

12 proposes to form such a network that furnishes or 

13 proposes to furnish services in a medically under14 served area, health professional shortage area, or 

15 mental health professional shortage area. 

16 (2) The applicant is able to demonstrate broad 

17 geographic coverage in the rural or medically under18 served areas of the State, or States, in which the ap19 plicant is located. 

20 (3) The applicant proposes to use Federal 

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

22 systems that will link rural hospitals and rural 

23 health care providers to other hospitals, health care 

24 providers, and patients. 
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1 (4) The applicant will use the amounts provided 

2 for a range of health care applications and to pro3 mote greater efficiency in the use of health care re4 sources. 

5 (5) The applicant is able to demonstrate the 

6 long-term viability of projects through cost participa7 tion (cash or in-kind). 

8 (6) The applicant is able to demonstrate finan9 cial, institutional, and community support for the 

10 long-term viability of the network. 

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

12 plan for coordinating system use by eligible entities 

13 so that health care services are given a priority over 

14 non-clinical uses. 

15 (d) MAXIMUM AMOUNT OF ASSISTANCE TO INDI16 VIDUAL RECIPIENTS.—The Secretary shall establish, by 

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

18 maximum amount of a grant award to be made available 

19 to an individual recipient for each fiscal year under this 

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

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

22 terms and conditions of a grant under this section and 

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

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

25 under this section may use sums received under such 
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1 grant for the acquisition of telehealth equipment and 

2 modifications or improvements of telecommunications fa3 cilities including the following: 

4 (1) The development and acquisition through 

5 lease or purchase of computer hardware and soft6 ware, audio and video equipment, computer network 

7 equipment, interactive equipment, data terminal 

8 equipment, and other facilities and equipment that 

9 would further the purposes of this section. 

10 (2) The provision of technical assistance and in11 struction for the development and use of such pro12 gramming equipment or facilities. 

13 (3) The development and acquisition of instruc14 tional programming. 

15 (4) Demonstration projects for teaching or 

16 training medical students, residents, and other 

17 health profession students in rural or medically un18 derserved training sites about the application of tele19 health. 

20 (5) The provision of telenursing services de21 signed to enhance care coordination and promote pa22 tient self-management skills. 

23 (6) The provision of services designed to pro24 mote patient understanding and adherence to na-
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1 tional guidelines for common chronic diseases, such 

2 as congestive heart failure or diabetes. 

3 (7) Transmission costs, maintenance of equip4 ment, and compensation of specialists and referring 

5 health care providers, when no other form of reim6 bursement is available. 

7 (8) Development of projects to use telehealth to 

8 facilitate collaboration between health care providers. 

9 (9) Electronic archival of patient records. 

10 (10) Collection and analysis of usage statistics 

11 and data that can be used to document the cost-ef12 fectiveness of the telehealth services. 

13 (11) Such other uses that are consistent with 

14 achieving the purposes of this section as approved by 

15 the Secretary. 

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

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

18 following: 

19 (1) To acquire real property. 

20 (2) To purchase or lease equipment to the ex21 tent the expenditures would exceed more than 40 

22 percent of the total grant funds. 

23 (3) To purchase or install transmission equip24 ment off the premises of the telehealth site and any 

25 transmission costs not directly related to the grant. 
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1 (4) For construction, except that such funds 

2 may be expended for minor renovations relating to 

3 the installation of equipment. 

4 (5) Expenditures for indirect costs (as deter5 mined by the Secretary) to the extent the expendi6 tures would exceed more than 15 percent of the total 

7 grant. 

8 (g) ADMINISTRATION.— 

9 (1) NONDUPLICATION.—The Secretary shall en10 sure that facilities constructed using grants provided 

11 under this section do not duplicate adequately estab12 lished telehealth networks. 

13 (2) COORDINATION WITH OTHER AGENCIES.— 

14 The Secretary shall coordinate, to the extent prac15 ticable, with other Federal and State agencies and 

16 not-for-profit organizations operating similar grant 

17 programs to pool resources for funding meritorious 

18 proposals. 

19 (3) INFORMATIONAL EFFORTS.—The Secretary 

20 shall establish and implement procedures to carry 

21 out outreach activities to advise potential end users 

22 located in rural and medically underserved areas of 

23 each State about the program authorized by this 

24 section. 
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1 (h) PROMPT IMPLEMENTATION.—The Secretary shall 

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

3 program as expeditiously as possible. 

4 (i) AUTHORIZATION OF APPROPRIATIONS.—There 

5 are authorized to be appropriated to carry out this section 

6 $10,000,000 for fiscal year 2006, and such sums as may 

7 be necessary for each of the fiscal years 2007 through 

8 2012. 

9 SEC. 202. REAUTHORIZATION OF TELEHEALTH NETWORK 

10 AND TELEHEALTH RESOURCE CENTERS 

11 GRANT PROGRAMS. 

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

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

14 (1) in paragraph (1)— 

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

16 and 

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

18 year 2007, and such sums as may be necessary 

19 for each of fiscal years 2008 through 2012’’ be20 fore the semicolon at the end; and 

21 (2) in paragraph (2)— 

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

23 and 

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

25 year 2007, and such sums as may be necessary 
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1 for each of fiscal years 2008 through 2012’’ be2 fore the period at the end. 

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