II

103D CONGRESS

1ST SESSION S. 1088

To amend the Public Health Service Act to provide grants for the development

of rural telemedicine, and for other purposes.

IN THE SENATE OF THE UNITED STATES

JUNE 10, 1993

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

to the Committee on Agriculture, Nutrition, and Forestry

A BILL

To amend the Public Health Service Act to provide grants

for the development of rural telemedicine, 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.

4 This Act may be cited as the ‘‘Rural Telemedicine

5 Development Act of 1993’’.

6 SEC. 2. PURPOSE.

7 It is the purpose of this Act to support the develop8 ment of telemedicine projects that are designed to improve

9 the delivery, accessability and affordability of health care
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1 services to Americans living in rural areas. This Act is

2 intended to—

3 (1) assist rural hospitals and other rural health

4 care providers in dealing with personnel shortages

5 and shared staffing arrangements by providing such

6 providers with the telecommunications technology

7 necessary to maintain contact with itinerant staff

8 and remote specialists;

9 (2) reduce the cost of care for rural patients

10 and strengthen rural health care providers by using

11 telecommunications technologies to permit such pa12 tients to stay in their local hospitals and to receive

13 other health services locally whenever possible and

14 appropriate, by reducing paperwork costs and by im15 proving coordination and efficiency in the delivery of

16 health care;

17 (3) provide rural health care providers with ac18 cess, via telecommunications systems, to equipment,

19 specialists, and continuing education programs that

20 are otherwise generally not available in rural areas;

21 and

22 (4) demonstrate the effectiveness of fiber optics

23 telecommunication systems in improving the quality

24 and access of health care services in rural areas.
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1 SEC. 3. ESTABLISHMENT OF GRANT PROGRAMS.

2 Title XVII of the Public Health Service Act (42

3 U.S.C. 300u et seq.) is amended—

4 (1) in the title heading by striking out ‘‘AND

5 HEALTH PROMOTION’’ and inserting in lieu

6 thereof ‘‘, HEALTH PROMOTION AND

7 TELEMEDICINE DEVELOPMENT’’;

8 (2) by inserting after the title heading the fol9 lowing:

10 ‘‘Part A—Health Information and Health Promotion’’;

11 and

12 (3) by adding at the end thereof the following

13 new part:

14 ‘‘Part B—Telemedicine Development

15 ‘‘SEC. 1711. GRANT PROGRAM FOR PROMOTING THE INI16 TIAL DEVELOPMENT OF RURAL

17 TELEMEDICINE NETWORKS.

18 ‘‘(a) ESTABLISHMENT.—The Secretary shall award

19 grants to eligible entities described in section 1714(a) for

20 the purpose of encouraging the initial development of rural

21 telemedicine networks. Grants shall be awarded under this

22 section to encourage the formation of rural health care

23 networks that could benefit from the use of telecommuni24 cations technology in providing health services to rural

25 areas.
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1 ‘‘(b) APPLICATION.—To be eligible to receive a grant

2 under this section an entity shall prepare and submit to

3 the Secretary an application at such time, in such manner

4 and containing such information as the Secretary may re5 quire, including a description of the use to which the entity

6 will apply any amounts received under such grant.

7 ‘‘(c) PREFERENCE IN AWARDING GRANTS.—The Sec8 retary shall, in awarding grant under subsection (a), give

9 preference to applicants that—

10 ‘‘(1) are participants in rural health care net11 works or that propose to form such networks;

12 ‘‘(2) can demonstrate broad geographic cov13 erage in the rural areas of the State, or States in

14 which the applicant is located; and

15 ‘‘(3) propose to use Federal funds to develop

16 plans for, or to establish, pilot telecommunications

17 systems that will link rural hospitals and other rural

18 health care providers to other hospitals, and health

19 care providers.

20 ‘‘SEC. 1712. GRANT PROGRAM FOR THE ESTABLISHMENT OF

21 ADVANCED RURAL TELEMEDICINE NET22 WORKS.

23 ‘‘(a) ESTABLISHMENT.—The Secretary shall award

24 grants to rural health networks for the purpose of linking

25 such networks together using advanced telemedicine sys-
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1 tems. Grants shall be awarded under this section to fur2 ther develop telemedicine projects initiated by these rural

3 health care networks.

4 ‘‘(b) APPLICATION.—To be eligible to receive a grant

5 under this section an entity shall prepare and submit to

6 the Secretary an application at such time, in such manner

7 and containing such information as the Secretary may re8 quire, including a description of the use to which the entity

9 will apply any amounts received under such grant.

10 ‘‘(c) MINIMUM QUALIFICATIONS.—The Secretary

11 may not award a grant to an applicant under subsection

12 (a) unless—

13 ‘‘(1) the applicant is determined by the Sec14 retary to include one or more rural health network;

15 and

16 ‘‘(2) the applicant can demonstrate broad geo17 graphical coverage in the rural areas of the State or

18 States in which it is located.

19 ‘‘(d) PREFERENCES IN AWARDING GRANTS.—The

20 Secretary shall, in awarding grants under subsection (a),

21 give preference to qualified applicants that—

22 ‘‘(1) can demonstrate that a majority of the

23 hospitals and other providers participating in the ap24 plicant group have functioned as networks for at
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1 least 1 year prior to applying for funding under this

2 section; and

3 ‘‘(2) will use amounts provided under the grant

4 to provide a range of telecommunications applica5 tions such as teleradiology, telepathology, interactive

6 video consultation and remote educational services

7 and to promote areawide health planning and great8 er efficiency in administrative activities.

9 ‘‘SEC. 1713. GRANT PROGRAM FOR THE ESTABLISHMENT OF

10 ADVANCED FIBER OPTIC BASED RURAL

11 TELEMEDICINE NETWORKS.

12 ‘‘(a) ESTABLISHMENT.—The Secretary shall award

13 grants to rural health networks for the purpose of linking

14 these networks to existing fiber optic telecommunications

15 systems.

16 ‘‘(b) APPLICATION.—To be eligible to receive a grant

17 under this section an entity shall prepare and submit to

18 the Secretary an application at such time, in such manner

19 and containing such information as the Secretary may re20 quire, including a description of the use to which the entity

21 will apply any amounts received under such grant.

22 ‘‘(c) MINIMUM QUALIFICATIONS.—The Secretary

23 may not award a grant to an applicant under subsection

24 (a) unless—
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1 ‘‘(1) the applicant is determined by the Sec2 retary to include one or more rural health network;

3 ‘‘(2) the applicant group can demonstrate broad

4 geographical coverage in the rural areas of the State

5 or States in which it is located; and

6 ‘‘(3) the applicant group will participate in an

7 existing fiber optic telecommunications system.

8 ‘‘(d) PREFERENCES IN AWARDING GRANTS.—The

9 Secretary shall, in awarding grants under subsection (a),

10 give preference to qualified applicants that—

11 ‘‘(1) will use grant funds to provide a range of

12 telecommunications applications including

13 teleradiology, telepathology, interactive video con14 sultation and remote educational services and to pro15 mote areawide health planning and greater efficiency

16 in administrative activities;

17 ‘‘(2) demonstrate that the majority of the hos18 pitals and other providers participating in the appli19 cant group have functioned as networks for at least

20 1 year prior to applying for funding under this sec21 tion; and

22 ‘‘(3) will participate in an existing Statewide

23 fiber optics cable system.
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1 ‘‘SEC. 1714. USE OF FUNDS FOR INITIAL DEVELOPMENT

2 GRANT PROGRAMS.

3 ‘‘(a) ELIGIBLE ENTITIES.—Entities eligible to re4 ceive a grant under section 1711 shall include hospitals,

5 hospital networks, and other health care providers.

6 ‘‘(b) USE OF AMOUNTS.—Amounts received under a

7 grant awarded under section 1711 shall be utilized for the

8 initial development of rural telemedicine networks, includ9 ing the establishment of pilot telemedicine projects involv10 ing two or more providers. Such amounts may be used

11 to cover the costs associated with the development of

12 telemedicine networks and the acquisition or construction

13 of telecommunications facilities and equipment includ14 ing—

15 ‘‘(1) the development and acquisition through

16 lease or purchase of computer hardware and soft17 ware, audio and visual equipment, computer network

18 equipment, telecommunications transmission facili19 ties, telecommunications terminal equipment, inter20 active video equipment, data terminal equipment,

21 and other facilities and equipment that would fur22 ther the purposes authorized by this part;

23 ‘‘(2) the provision of technical assistance and

24 instruction for the development and use of such pro25 gramming, equipment, or facilities;
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1 ‘‘(3) the development and acquisition of instruc2 tional programming; or

3 ‘‘(4) such other uses that are consistent with

4 achieving the purposes of this part as approved by

5 the Secretary.

6 ‘‘SEC. 1715. USE OF FUNDS FOR ADVANCED TELEMEDICINE

7 GRANT PROGRAMS.

8 ‘‘Grants under sections 1712 and 1713 shall be avail9 able to health care networks for the development of

10 telemedicine networks and the acquisition or construction

11 of telecommunications facilities and equipment includ12 ing—

13 ‘‘(1) the development and acquisition through

14 lease or purchase of computer hardware and soft15 ware, audio and visual equipment, computer network

16 equipment, telecommunications transmission facili17 ties, telecommunications terminal equipment, inter18 active video equipment, data terminal equipment,

19 and other facilities and equipment that would fur20 ther the purposes authorized by this part;

21 ‘‘(2) the provision of technical assistance and

22 instruction for the development and use of such pro23 gramming, equipment, or facilities;

24 ‘‘(3) the development and acquisition of instruc25 tional programming; or
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1 ‘‘(4) such other uses that are consistent with

2 achieving the purposes of this part as approved by

3 the Secretary.

4 ‘‘SEC. 1716. DEFINITIONS.

5 ‘‘For the purposes of this part:

6 ‘‘(1) COMPUTER NETWORKS.—The term ‘com7 puter networks’ means computer hardware and soft8 ware, terminals, signal conversion equipment includ9 ing both modulators and demodulators, or related

10 devices, used to communicate with other computers

11 to process and exchange data through a tele12 communication network in which signals are gen13 erated, modified, or prepared for transmission, or re14 ceived, via telecommunications terminal equipment

15 and telecommunications transmission facilities.

16 ‘‘(2) DATA TERMINAL EQUIPMENT.—The term

17 ‘data terminal equipment’ means equipment that

18 converts user information into data signals for

19 transmission, or reconverts the received data signals

20 into user information, and is normally found on the

21 terminal of a circuit and on the premises of the end

22 user.

23 ‘‘(3) FIBER OPTIC CABLE.—The term ‘fiber

24 optic cable’ means a bundle of optical transmission

25 elements or waveguides usually consisting of a fiber
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1 core and fiber cladding that can guide a lightwave

2 and that are incorporated into an assembly of mate3 rials that provide tensile strength and external pro4 tection.

5 ‘‘(4) INTERACTIVE VIDEO EQUIPMENT.—The

6 term ‘interactive video equipment’ means equipment

7 used to produce and prepare for transmission audio

8 and visual signals from at least two distant locations

9 in order that individuals at such locations can ver10 bally and visually communicate with each other, and

11 such equipment includes monitors, other display de12 vices, cameras or other recording devices, audio pick13 up devices, and other related equipment.

14 ‘‘(5) HEALTH CARE NETWORK.—The term

15 ‘rural health care network’ means a group of rural

16 hospitals or other rural health care providers (in17 cluding clinics, physicians and non-physician pri18 mary care providers) that have entered into a formal

19 relationship with each other or with nonrural hos20 pitals and health care providers for the purpose of

21 strengthening the delivery of health care services in

22 rural areas or specifically to improve their patients’

23 access to telemedicine services. At least 75 percent

24 of hospitals and other health care providers partici25 pating in the network shall be located in rural areas.
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1 ‘‘(6) STATEWIDE FIBER OPTIC CABLE SYS2 TEM.—The term ‘Statewide fiber optic cable system’

3 means a telecommunications system that will carry

4 voice, data, and full motion video traffic through

5 fiber optic cable to a point of presence in every coun6 ty in the State in which it is located.

7 ‘‘(7) TELECOMMUNICATIONS TERMINAL EQUIP8 MENT.—The term ‘telecommunications terminal

9 equipment’ means the assembly of telecommuni10 cations equipment at the end of a circuit, normally

11 located on the premises of the end user, that inter12 faces with telecommunications transmission facili13 ties, and that is used to modify, convert, encode, or

14 otherwise prepare signals to be transmitted via such

15 telecommunications facilities, or that is used to mod16 ify, reconvert or carry signals received from such fa17 cilities, the purpose of which is to accomplish the

18 goal for which the circuit was established.

19 ‘‘(8) TELECOMMUNICATIONS TRANSMISSION FA20 CILITIES.—The term ‘telecommunications trans21 mission facilities’ means those facilities that trans22 mit, receive, or carry data between the telecommuni23 cations terminal equipment at each end of a tele24 communications circuit or path. Such facilities in25 clude microwave antennae, relay stations and towers,
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1 other telecommunications antennae, fiber-optic ca2 bles and repeaters, coaxial cables, communication

3 satellite ground station complexes, copper cable elec4 tronic equipment associated with telecommunications

5 transmissions, and similar items as defined by the

6 Secretary.

7 ‘‘SEC. 1717. AUTHORIZATION OF APPROPRIATIONS.

8 ‘‘For the purposes of carrying out this part, there are

9 authorized to be appropriated such sums as may be nec10 essary for each of the fiscal years 1994 through 1997.’’.

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