II

106TH CONGRESS

1ST SESSION S. 770

To provide reimbursement under the medicare program for telehealth services,

and for other purposes.

IN THE SENATE OF THE UNITED STATES

APRIL 13, 1999

Mr. CONRAD (for himself, Mr. DASCHLE, Mr. MURKOWSKI, Mr. INOUYE, Mr.

HARKIN, and Mr. WELLSTONE) introduced the following bill; which was

read twice and referred to the Committee on Finance

A BILL

To provide reimbursement under the medicare program for

telehealth services, 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 ‘‘Comprehensive Telehealth Act of 1999’’.

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

7 this Act is as follows:

Sec. 1. Short title; table of contents.

Sec. 2. Findings and purposes.

Sec. 3. Definitions.

TITLE I—REVISION AND CLARIFICATION OF MEDICARE

REIMBURSEMENT OF TELEHEALTH SERVICES
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Sec. 101. Revision and clarification of medicare reimbursement of telehealth

services.

TITLE II—TELEHEALTH LICENSURE

Sec. 201. Study and reports to Congress.

TITLE III—JOINT WORKING GROUP ON TELEHEALTH AND

PERIODIC REPORTS TO CONGRESS

Sec. 301. Joint Working Group on Telehealth.

TITLE IV—DEVELOPMENT OF TELEHEALTH NETWORKS

Subtitle A—Development of Telehealth Networks

Sec. 401. Financial assistance authorized.

Sec. 402. Financial assistance described.

Sec. 403. Eligible telehealth networks.

Sec. 404. Use of financial assistance.

Sec. 405. Application.

Sec. 406. Approval of application.

Sec. 407. Administration.

Sec. 408. Regulations.

Sec. 409. Authorization of appropriations.

Subtitle B—Rural Health Outreach and Network Development Grant

Program

Sec. 415. Rural Health Outreach and Network Development Grant Program.

1 SEC. 2. FINDINGS AND PURPOSES.

2 (a) FINDINGS.—Congress finds the following:

3 (1) Hospitals, clinics, and individual health care

4 providers are critically important to the continuing

5 health of rural populations and the economic sta6 bility of rural communities.

7 (2) Rural communities are underserved by spe8 cialty health care providers.

9 (3) Telecommunications technology has made

10 possible the interstate transmission of information

11 regarding a wide range of health care services, edu-
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1 cation, and administrative services between health

2 care providers, patients, and administrators.

3 (4) The delivery of health services by licensed

4 health care providers is a privilege and the licensure

5 of health care providers, along with the ability to

6 discipline such providers, is in the public interest

7 and necessary to protect the health, welfare, and

8 safety of the public.

9 (5) The licensing of health care providers that

10 provide telehealth services has a significant impact

11 on interstate commerce and any unnecessary bar12 riers to the provision of telehealth services across

13 State lines should be eliminated.

14 (6) Rapid advances in the field of telehealth

15 create a need for current information and updates

16 on recent developments in telehealth research, policy,

17 technology, and the use of this technology to supply

18 telehealth services to rural and underserved areas.

19 (7) Telehealth networks can—

20 (A) provide hospitals, clinics, health care

21 providers, and patients in rural and under22 served communities with access to specialty

23 care and continuing education; and
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1 (B) reduce the isolation from other profes2 sionals that these individuals and entities some3 times experience.

4 (8) In order for telehealth systems to fully ben5 efit rural and underserved communities, the program

6 established by section 4206 of the Balanced Budget

7 Act of 1997 that reimburses providers of telehealth

8 services under the medicare program must reim9 burse providers of services in all rural areas for all

10 items and services provided to beneficiaries under

11 the medicare program.

12 (b) PURPOSES.—The purposes of this Act are as fol13 lows:

14 (1) To ensure that the program established by

15 section 4206 of the Balanced Budget Act of 1997

16 that provides for reimbursement of telehealth serv17 ices under the medicare program reimburses bene18 ficiaries in all rural areas—

19 (A) for all items and services provided

20 under the medicare program; and

21 (B) for telehealth services.

22 (2) To determine whether States are making

23 progress in facilitating the provision of interstate

24 telehealth services.
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1 (3) To create a coordinating entity for Federal

2 telehealth research, policy, and program initiatives

3 that annually reports to Congress.

4 (4) To encourage the development of rural tele5 health networks that supply appropriate, cost-effec6 tive care, and that contribute to the economic health

7 and development of rural communities.

8 (5) To encourage research into the clinical effi9 cacy and cost-effectiveness of telehealth diagnosis,

10 treatment, or education on individuals, health care

11 providers, and health care networks.

12 SEC. 3. DEFINITIONS.

13 In this Act:

14 (1) HEALTH CARE PROVIDER.—The term

15 ‘‘health care provider’’ means any individual or enti16 ty licensed or certified under State law to provide

17 health care services that is operating within the

18 scope of such license.

19 (2) SECRETARY.—The term ‘‘Secretary’’ means

20 the Secretary of Health and Human Services.
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1 TITLE I—REVISION AND CLARI2 FICATION OF MEDICARE RE3 IMBURSEMENT OF TELE4 HEALTH SERVICES

5 SEC. 101. REVISION AND CLARIFICATION OF MEDICARE RE6 IMBURSEMENT OF TELEHEALTH SERVICES.

7 (a) IN GENERAL.—Section 4206(a) of the Balanced

8 Budget Act of 1997 (42 U.S.C. 1395l note) is amended

9 to read as follows:

10 ‘‘(a) REIMBURSEMENT OF TELEHEALTH SERVICES

11 AUTHORIZED.—

12 ‘‘(1) IN GENERAL.—Beginning on the date of

13 enactment of the Comprehensive Telehealth Act of

14 1999 and subject to paragraph (3), the Secretary of

15 Health and Human Services shall make payments

16 from the Federal Supplementary Medical Insurance

17 Trust Fund under part B of title XVIII of the So18 cial Security Act (42 U.S.C. 1395j et seq.) in ac19 cordance with the methodology described in sub20 section (b) for items and services for which payment

21 may be made under such part that are provided via

22 telecommunications systems including store-and-for23 ward technologies (as defined in paragraph (2)) by

24 a physician (as defined in section 1861(r) of such

25 Act (42 U.S.C. 1395x(r))) or a practitioner (as de-
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1 fined in paragraph (2)) to a beneficiary under the

2 medicare program residing in a county in a rural

3 area (as defined in section 1886(d)(2)(D) of such

4 Act (42 U.S.C. 1395ww(d)(2)(D))) notwithstanding

5 that the physician or practitioner providing the item

6 or service via telecommunication systems is not at

7 the same location as the medicare beneficiary.

8 ‘‘(2) DEFINITIONS.—

9 ‘‘(A) PRACTITIONER.—For purposes of

10 paragraph (1), the term ‘practitioner’

11 includes—

12 ‘‘(i) a practitioner described in section

13 1842(b)(18)(C) of the Social Security Act

14 (42 U.S.C. 1395u(b)(18)(C)) (including a

15 clinical psychologist); and

16 ‘‘(ii) a physical, occupational, or

17 speech therapist.

18 ‘‘(B) STORE-AND-FORWARD TECH19 NOLOGIES.—For purposes of paragraph (1), the

20 term ‘store-and-forward technologies’ has the

21 meaning given that term by the Secretary, ex22 cept that the term shall include technologies

23 through which information (including any audio

24 recording or visual image) is transferred and

25 stored for purposes of review by a health care
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1 provider if the patient, the referring physician,

2 or the health care provider is not present at the

3 time the asynchronous review occurs at the re4 mote site.

5 ‘‘(3) RULE OF CONSTRUCTION.—Nothing in

6 this subsection shall be construed as requiring pay7 ment for services provided to a patient solely on the

8 basis of information conveyed via facsimile machine

9 or via traditional telephone conversation.’’.

10 (b) ANY HEALTH CARE PRACTITIONER MAY

11 PRESENT BENEFICIARY TO CONSULTING PHYSICIAN.—

12 Section 4206(b) of the Balanced Budget Act of 1997 (42

13 U.S.C. 1395l note) is amended by adding at the end the

14 following:

15 ‘‘(5) Any health care practitioner (whether or

16 not such practitioner is certified under the medicare

17 program) that is acting on instructions from the re18 ferring physician or practitioner may present the

19 beneficiary to the consulting physician or practi20 tioner for the provision of items and services. The

21 referring physician and the practitioner shall not re22 ceive any reimbursement for such presentation other

23 than the payment that the referring physician re24 ceives pursuant to paragraph (1).’’.
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1 (c) ALL CPT BILLING CODES COVERED UNDER

2 TELEHEALTH PROGRAM.—Section 4206 of the Balanced

3 Budget Act of 1997 (42 U.S.C. 1395l note) is amended

4 by adding at the end the following:

5 ‘‘(e) COVERAGE OF SERVICES.—Payment for items

6 and services provided pursuant to subsection (a) shall in7 clude payment for all current procedural terminology bill8 ing codes that are covered under the medicare program

9 under title XVIII of the Social Security Act (42 U.S.C.

10 1395 et seq.).’’.

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

12 this section shall take effect on the date of enactment of

13 this Act.

14 TITLE II—TELEHEALTH

15 LICENSURE

16 SEC. 201. STUDY AND REPORTS TO CONGRESS.

17 (a) STUDY.—The Secretary shall conduct a study

18 regarding—

19 (1) the number, percentage, and types of health

20 care providers licensed to provide telehealth services

21 across State lines, including the number and types

22 of health care providers licensed to provide such

23 services in more than 3 States;
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1 (2) the status of any reciprocal, mutual recogni2 tion, fast-track, or other licensure agreements be3 tween or among various States;

4 (3) the status of any efforts to develop uniform

5 national sets of standards for the licensure of health

6 care providers to provide telehealth services across

7 State lines;

8 (4) a projection of future utilization of tele9 health consultations across State lines;

10 (5) State efforts to increase or reduce licensure

11 as a burden to interstate telehealth practice; and

12 (6) any State licensure requirements that ap13 pear to constitute unnecessary barriers to the provi14 sion of telehealth services across State lines.

15 (b) REPORTS TO CONGRESS.—

16 (1) INITIAL REPORT.—Not later than January

17 1, 2000, the Secretary shall submit to the appro18 priate committees of Congress a detailed report on

19 the study conducted under subsection (a).

20 (2) ANNUAL REPORTS.—

21 (A) IN GENERAL.—Not later than January

22 1, 2001, and each January 1 thereafter, the

23 Secretary shall submit to the appropriate com24 mittees of Congress a report on relevant devel-
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1 opments regarding the matters studied by the

2 Secretary pursuant to subsection (a).

3 (B) RECOMMENDATIONS.—If, with respect

4 to a report submitted under subparagraph (A),

5 the Secretary determines that States are not

6 making progress in facilitating the provision of

7 telehealth services across State lines by elimi8 nating unnecessary requirements, adopting re9 ciprocal licensing arrangements for telehealth

10 services, implementing uniform requirements

11 for telehealth licensure, or other means, the

12 Secretary shall include in the report rec13 ommendations concerning the scope and nature

14 of Federal actions required to reduce licensure

15 as a barrier to the interstate provision of tele16 health services.

17 TITLE III—JOINT WORKING

18 GROUP ON TELEHEALTH AND

19 PERIODIC REPORTS TO CON20 GRESS

21 SEC. 301. JOINT WORKING GROUP ON TELEHEALTH.

22 (a) IN GENERAL.—

23 (1) REDESIGNATION.—The Joint Working

24 Group on Telemedicine, established by the Secretary,

25 shall hereafter be known as the ‘‘Joint Working
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1 Group on Telehealth’’ with the chairperson being

2 designated by the Director of the Office for the Ad3 vancement of Telehealth.

4 (2) MISSION.—The mission of the Joint Work5 ing Group on Telehealth is to—

6 (A) identify, monitor, and coordinate Fed7 eral telehealth projects, data sets, and pro8 grams;

9 (B) analyze—

10 (i) how telehealth systems are expand11 ing access to health care services, edu12 cation, and information;

13 (ii) the clinical, educational, or admin14 istrative efficacy and cost-effectiveness of

15 telehealth applications; and

16 (iii) the quality of the telehealth serv17 ices delivered; and

18 (C) make further recommendations for co19 ordinating Federal and State efforts to increase

20 access to health care services, education, and

21 information in rural and underserved areas.

22 (3) ANNUAL REPORTS.—Not later than Janu23 ary 1, 2000, and annually thereafter, the Joint

24 Working Group on Telehealth shall report to Con-
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1 gress on the status of the Group’s mission and the

2 state of the telehealth field generally.

3 (b) REPORT SPECIFICS.—The annual report required

4 under subsection (a)(3) shall include—

5 (1) an analysis of—

6 (A) the matters described in subsection

7 (a)(2)(B);

8 (B) the Federal activities with respect to

9 telehealth; and

10 (C) the progress of the Joint Working

11 Group on Telehealth’s efforts to coordinate

12 Federal telehealth programs; and

13 (2) recommendations for a coordinated Federal

14 strategy to increase health care access through tele15 health.

16 (c) TERMINATION.—The Joint Working Group on

17 Telehealth shall terminate on the date that the Group sub18 mits the annual report that is due to be submitted on Jan19 uary 1, 2004, under subsection (a)(3).

20 (d) AUTHORIZATION OF APPROPRIATIONS.—There

21 are authorized to be appropriated such sums as are nec22 essary for the Joint Working Group on Telehealth to carry

23 out the purposes of this section.
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1 TITLE IV—DEVELOPMENT OF

2 TELEHEALTH NETWORKS

3 Subtitle A—Development of

4 Telehealth Networks

5 SEC. 401. FINANCIAL ASSISTANCE AUTHORIZED.

6 (a) IN GENERAL.—The Secretary, acting through the

7 Director of the Office for Advancement of Telehealth, shall

8 provide financial assistance (as described in section 402)

9 to eligible telehealth networks (as described in section

10 403) for the purpose of expanding access to health care

11 services for individuals in rural and frontier areas through

12 the use of telehealth networks.

13 (b) MAXIMUM AMOUNT OF FINANCIAL ASSIST14 ANCE.—The Secretary may establish the maximum

15 amount of financial assistance made available to a recipi16 ent for each fiscal year under this title by publishing no17 tice of such amount in the Federal Register or the Health

18 Resources and Services Administration Preview.

19 SEC. 402. FINANCIAL ASSISTANCE DESCRIBED.

20 (a) IN GENERAL.—Financial assistance shall consist

21 of loans (as described under subsection (b)), grants (as

22 described under subsection (c)), or both as apportioned

23 under subsection (d).

24 (b) LOANS.—
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1 (1) IN GENERAL.—The Secretary is authorized

2 to provide loans to eligible telehealth networks under

3 this title.

4 (2) MAXIMUM TERM OF LOANS.—

5 (A) IN GENERAL.—Subject to subpara6 graph (B), the Secretary may establish the

7 maximum term of any loan provided under this

8 title by publishing notice of such term in the

9 Federal Register or the Health Resources and

10 Services Administration Preview.

11 (B) LIMITATION.—The maximum term of

12 any loan provided under this title shall be for

13 a period of not more than 10 years.

14 (3) LOAN SECURITY AND FEASIBILITY.—The

15 Secretary shall make a loan under this title only if

16 the Secretary determines that—

17 (A) the security for the loan is reasonably

18 adequate; and

19 (B) the loan will be repaid within the term

20 of such loan.

21 (4) LOAN FORGIVENESS PROGRAM.—

22 (A) ESTABLISHMENT.—With respect to

23 loans provided under this title, the Secretary

24 shall establish a loan forgiveness program under
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1 which recipients of such loans may apply to

2 have all or a portion of such loans forgiven.

3 (B) APPLICATION.—

4 (i) IN GENERAL.—Any recipient of a

5 loan under this title that desires to have

6 such loan forgiven under the program es7 tablished under subparagraph (A) shall

8 submit an application to the Secretary

9 within 180 days of the end of the term of

10 such loan, in such manner, and accom11 panied by such information as the Sec12 retary may reasonably require.

13 (ii) CONTENTS.—Each application

14 submitted pursuant to clause (i) shall—

15 (I) demonstrate that the recipient

16 has a financial need for such forgive17 ness; and

18 (II) demonstrate that the recipi19 ent has satisfied the quality and cost20 effectiveness criteria developed under

21 subparagraph (C).

22 (C) QUALITY AND COST-EFFECTIVENESS

23 CRITERIA.—As part of the program established

24 under subparagraph (A), the Secretary shall de25 velop criteria for determining the quality and
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1 cost-effectiveness of programs operated with

2 loans provided under this title.

3 (c) GRANTS.—The Secretary is authorized to award

4 grants to eligible telehealth networks under this title.

5 (d) APPORTIONMENT.—

6 (1) IN GENERAL.—Subject to paragraph (2),

7 the Secretary shall determine what portion of the fi8 nancial assistance provided to an eligible telehealth

9 network is a grant and what portion of such finan10 cial assistance is a loan.

11 (2) REQUIREMENTS.—In determining the ap12 portionment under paragraph (1), the Secretary

13 shall—

14 (A) ensure that the Federal Government

15 receives the maximum feasible repayment of the

16 financial assistance by basing such apportion17 ment on the ability of the recipient to repay a

18 loan provided under this title; and

19 (B) fully use the funds made available to

20 carry out this title.

21 SEC. 403. ELIGIBLE TELEHEALTH NETWORKS.

22 (a) IN GENERAL.—An entity that is a health care

23 provider and a member of an existing or proposed tele24 health network, or an entity that is a consortium of health

25 care providers that are members of an existing or proposed
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1 telehealth network shall be eligible for financial assistance

2 under this title.

3 (b) REQUIREMENTS.—

4 (1) IN GENERAL.—A telehealth network re5 ferred to in subsection (a) shall, at a minimum, be

6 composed of a multispecialty entity (as defined in

7 paragraph (2)(A)), a network of community-based

8 health care providers (as defined in paragraph

9 (2)(B)), and a public entity (as defined in paragraph

10 (2)(C)).

11 (2) DEFINITIONS.—

12 (A) MULTISPECIALTY ENTITY.—For pur13 poses of paragraph (1), the term ‘‘multispe14 cialty entity’’ means an entity which—

15 (i) provides 24-hour access to a range

16 of diagnostic and therapeutic services; and

17 (ii) may be located in an urban area.

18 (B) NETWORK OF COMMUNITY-BASED

19 HEALTH CARE PROVIDERS.—For purposes of

20 paragraph (1), the term ‘‘network of commu21 nity-based health care providers’’ means a net22 work located in a rural area (as defined by the

23 Secretary) that includes at least 2 of the fol24 lowing:
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1 (i) A community or migrant health

2 center.

3 (ii) A local health department.

4 (iii) A nonprofit or public hospital.

5 (iv) A health professional in private

6 practice.

7 (v) A rural health clinic.

8 (vi) A skilled nursing facility.

9 (vii) A county mental health facility or

10 other publicly funded mental health facil11 ity.

12 (viii) A provider of home health serv13 ices.

14 (ix) Any other publicly funded health

15 or social services agency.

16 (C) PUBLIC ENTITY.—For purposes of

17 paragraph (1), the term ‘‘public entity’’ means

18 an entity that demonstrates its use of the tele19 health network for purposes of education and

20 economic development (as required by the Sec21 retary), and includes—

22 (i) a public school;

23 (ii) a public library;

24 (iii) a college or university;

25 (iv) a local government entity; or
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1 (v) a local business entity that is not

2 related to the provision of health care serv3 ices.

4 (c) FOR-PROFIT ENTITY.—A telehealth network may

5 include for-profit entities so long as the recipient of finan6 cial assistance under this title is a nonprofit entity.

7 SEC. 404. USE OF FINANCIAL ASSISTANCE.

8 (a) PERMITTED USES.—Any recipient of financial as9 sistance under this title may use such financial assistance

10 for the acquisition of telehealth equipment and modifica11 tions or improvements of telehealth services including—

12 (1) the development and acquisition through

13 lease or purchase of computer hardware and soft14 ware, audio and video equipment, computer network

15 equipment, interactive equipment, data terminal

16 equipment, or other equipment that would further

17 the purposes of this title;

18 (2) the provision of technical assistance and in19 struction for the development and use of such equip20 ment;

21 (3) the development and acquisition of instruc22 tional programming;

23 (4) demonstration projects for teaching or

24 training medical students, residents, and other stu-
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1 dents in health professions in rural training sites re2 garding the application of telehealth;

3 (5) transmission costs, maintenance of equip4 ment, compensation of specialists, and referring

5 health care providers;

6 (6) development of projects to use telehealth to

7 facilitate collaboration among health care providers;

8 (7) electronic archival of patient records;

9 (8) collection and analysis of usage statistics

10 and data that can be used to document the cost-ef11 fectiveness of the telehealth services; or

12 (9) such other uses that are consistent with

13 achieving the purposes of this title as approved by

14 the Secretary.

15 (b) PROHIBITED USES.—Any recipient of financial

16 assistance under this title may not use such financial as17 sistance for the following purposes:

18 (1) To build structures on or acquire real prop19 erty, except that such funds may be expended for

20 minor renovations relating to the installation of

21 equipment.

22 (2) To purchase or lease equipment to the ex23 tent the expenditures would exceed more than 40

24 percent of the financial assistance provided in the

25 form of grants pursuant to section 402(c).
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1 (3) To purchase or install transmission equip2 ment (such as laying cable or telephone lines, micro3 wave towers, amplifiers, and digital switching equip4 ment).

5 (4) For indirect costs (as determined by the

6 Secretary) to the extent the expenditures would ex7 ceed more than 20 percent of the financial assist8 ance.

9 SEC. 405. APPLICATION.

10 (a) IN GENERAL.—Each eligible telehealth network

11 that desires to receive financial assistance under this title,

12 in consultation with the State office of rural health or

13 other appropriate State agency, shall submit an applica14 tion to the Secretary at such time, in such manner, and

15 accompanied by such additional information as the Sec16 retary may reasonably require.

17 (b) CONTENTS.—Each application submitted pursu18 ant to subsection (a) shall include at least the following

19 information:

20 (1) A description of the anticipated need for fi21 nancial assistance.

22 (2) A description of the activities which the en23 tity intends to carry out using the financial assist24 ance provided under this title.
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1 (3) A plan for continuing the project after fi2 nancial assistance provided under this title has

3 ended.

4 (4) A description of the manner in which the

5 activities funded by the financial assistance provided

6 under this title will meet health care needs of under7 served rural populations within the State.

8 (5) A description of how the local community or

9 region to be served by the proposed telehealth net10 work will be involved in the development and ongo11 ing operations of the telehealth network.

12 (6) A description of the source and amount of

13 non-Federal funds the entity would pledge for the

14 project.

15 (7) A description of the long-term viability of

16 the project and evidence of health care provider com17 mitment to the telehealth network.

18 SEC. 406. APPROVAL OF APPLICATION.

19 (a) IN GENERAL.—The Secretary shall approve appli20 cations in accordance with the criteria established in sub21 section (b) and the preferences described in subsection (c).

22 (b) CRITERIA.—The Secretary shall not approve an

23 application under this section unless the Secretary finds

24 the following:
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1 (1) EXPENDITURES IN RURAL AREAS.—At least

2 50 percent of the financial assistance is expended—

3 (A) in a rural area; or

4 (B) to provide services to residents of rural

5 areas.

6 (2) PROMOTION OF INTEGRATION.—The appli7 cation demonstrates that the project will—

8 (A) promote the integration of telehealth

9 in the community;

10 (B) avoid redundancy of technology;

11 (C) achieve economies of scale; and

12 (D) coordinate telehealth services across

13 different networks within a geographic region.

14 (c) PREFERENCES.—In providing financial assistance

15 under this title, the Secretary shall give preference to any

16 applicant telehealth network that—

17 (1) is a health care provider in a telehealth net18 work or a health care provider that proposes to form

19 such a network, in which the majority of the health

20 care providers in such network are located in an

21 area that is designated by the Federal Government

22 or the State as—

23 (A) a medically underserved area; or

24 (B) a health, dental health, or mental

25 health professional shortage area;
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1 (2) proposes to use financial assistance pro2 vided under this title to plan and establish telehealth

3 networks that will link rural hospitals and rural

4 health care providers to other hospitals, health care

5 providers, and patients;

6 (3) proposes to use financial assistance pro7 vided under this title—

8 (A) to offer a range of health care applica9 tions; and

10 (B) to promote greater efficiency in the

11 use of health care resources;

12 (4) demonstrates financial, institutional, and

13 community support for the long-term viability of the

14 telehealth network through cost participation and

15 other indicators determined by the Secretary; and

16 (5) demonstrates a detailed plan for coordi17 nating telehealth network use by eligible telehealth

18 networks so that health care services are given pri19 ority over services that are not related to the provi20 sion of health care services.

21 SEC. 407. ADMINISTRATION.

22 (a) NONDUPLICATION.—The Secretary shall ensure

23 that services and programs developed with financial assist24 ance provided under this title do not duplicate established
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1 telehealth networks that adequately serve rural popu2 lations.

3 (b) COORDINATION WITH OTHER AGENCIES.—The

4 Secretary shall coordinate, to the extent practicable, with

5 other Federal and State agencies with similar grant, loan,

6 or other financial assistance programs to pool resources

7 for funding meritorious proposals for the development of

8 telehealth networks in rural areas.

9 (c) INFORMATIONAL EFFORTS.—The Secretary shall

10 establish and implement procedures to carry out informa11 tional efforts that notify potential applicants located in the

12 rural areas of each State of the financial assistance avail13 able under this title.

14 SEC. 408. REGULATIONS.

15 Not later than 180 days after the date of enactment

16 of this Act, the Secretary shall by regulation prescribe

17 such rules and regulations as the Secretary deems nec18 essary to carry out the provisions of this title.

19 SEC. 409. AUTHORIZATION OF APPROPRIATIONS.

20 There are authorized to be appropriated to carry out

21 this title, $40,000,000 for fiscal year 2000, and such sums

22 as may be necessary for each of fiscal years 2001 through

23 2006.
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1 Subtitle B—Rural Health Outreach

2 and Network Development

3 Grant Program

4 SEC. 415. RURAL HEALTH OUTREACH AND NETWORK DE5 VELOPMENT GRANT PROGRAM.

6 (a) IN GENERAL.—Section 330A of subpart I of part

7 D of title III of the Public Health Service Act (42 U.S.C.

8 254c) is amended—

9 (1) in the heading, by striking ‘‘OUTREACH,

10 NETWORK, DEVELOPMENT, AND TELEMEDI11 CINE’’ and inserting ‘‘OUTREACH AND NETWORK

12 DEVELOPMENT’’;

13 (2) in subsection (c)—

14 (A) in paragraph (1)(A)—

15 (i) by striking ‘‘nonprofit private enti16 ty’’ and inserting ‘‘private nonprofit enti17 ty’’; and

18 (ii) by striking ‘‘three’’ and inserting

19 ‘‘3’’;

20 (B) in paragraph (2), by striking ‘‘so long

21 as’’ and inserting ‘‘as long as’’; and

22 (C) by striking paragraph (3); and

23 (3) in subsection (e)—
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1 (A) in paragraph (1), by striking

2 ‘‘Amounts’’ and inserting ‘‘Subject to para3 graphs (2) and (3), amounts’’;

4 (B) in paragraph (2)—

5 (i) by striking ‘‘RURAL AREAS.—’’ and

6 all that follows through ‘‘In awarding’’ and

7 inserting ‘‘RURAL AREAS.—In awarding’’;

8 and

9 (ii) by striking subparagraph (B); and

10 (C) by striking paragraph (3) and insert11 ing the following:

12 ‘‘(3) LIMITATIONS.—An eligible network de13 scribed in subsection (c) may not use—

14 ‘‘(A) more than 40 percent of the amounts

15 provided under a grant under this section to

16 purchase equipment; or

17 ‘‘(B) any of the amounts provided under a

18 grant under this section—

19 ‘‘(i) to build structures on or acquire

20 real property; or

21 ‘‘(ii) for construction.’’.

22 (b) TRANSITION.—The Secretary of Health and

23 Human Services shall ensure the continued funding of

24 grants made, or contracts or cooperative agreements en25 tered into, under subpart I of part D of title III of the
29

•S770 IS

1 Public Health Service Act (42 U.S.C. 254b et seq.) (as

2 such subpart existed on the day prior to the date of enact3 ment of this Act), until the expiration of the grant period

4 or the term of the contract or cooperative agreement. Such

5 funding shall be continued under the same terms and con6 ditions as were in effect on the date on which the grant,

7 contract or cooperative agreement was awarded, subject

8 to the availability of appropriations.

Æ