I 

111TH CONGRESS 

1ST SESSION H. R. 3826 

To amend title XVIII of the Social Security Act to provide payments under 

the Medicare Program to licensed health care practitioners for unscheduled telephone consultation services in the case that such payments 

are determined to be cost and quality effective. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 15, 2009 

Mrs. BIGGERT (for herself and Mrs. CAPPS) 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 amend title XVIII of the Social Security Act to provide 

payments under the Medicare Program to licensed health 

care practitioners for unscheduled telephone consultation 

services in the case that such payments are determined 

to be cost and quality effective. 

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 ‘‘Tele-Care Act of 

5 2009’’. 


jbell on DSKDVH8Z91PROD with BILLS
2 

•HR 3826 IH

1 SEC. 2. MEDICARE PAYMENT FOR UNSCHEDULED PHYSI2 CIAN TELEPHONE SERVICES. 

3 (a) COVERAGE UNDER PART B.— 

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

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

6 amended— 

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

8 ‘‘and’’ at the end; 

9 (B) in subparagraph (EE), by adding at 

10 the end ‘‘and’’; and 

11 (C) by adding at the end the following new 

12 subparagraph: 

13 ‘‘(FF) subject to section 2(c) of the Tele14 Care Act of 2009, unscheduled telephone con15 sultation services (as defined in subsection 

16 (hhh)(1)) by a licensed health care practitioner, 

17 as defined by the Secretary (such as a physi18 cian, nurse practitioner, physician assistant, or 

19 nurse midwife), with respect to the furnishing 

20 of primary care services to an individual, if— 

21 ‘‘(i) the Medicare number of the indi22 vidual is associated with the national pro23 vider identifier of the licensed health care 

24 practitioner; 

25 ‘‘(ii) to ensure the quality and appro26 priateness of such consultation services, 


jbell on DSKDVH8Z91PROD with BILLS
3 

•HR 3826 IH

1 the utilization of such services by the indi2 vidual can be reviewed by a utilization and 

3 quality control peer review organization or 

4 eligible entity with which the Secretary has 

5 entered into a contract under part B of 

6 title XI or section 1893, respectively, by 

7 the organization or entity applying for pur8 poses of the review under this subpara9 graph the processes and standards used by 

10 such organization or entity under such 

11 part or section, respectively, in the same 

12 manner that such processes and standards 

13 apply for purposes of carrying out utiliza14 tion and quality review under such part or 

15 section, respectively; 

16 ‘‘(iii) such consultation services are 

17 securely recorded by the Secretary (or an 

18 entity described in subsection (hhh)(1) 

19 with which the Secretary enters into a con20 tract) for purposes of appropriate review 

21 by peers of the licensed health care practi22 tioner who practice in the same medical 

23 specialty as the licensed health care practi24 tioner and Medicare administrative con25 tractor oversight of such services; and 


jbell on DSKDVH8Z91PROD with BILLS
4 

•HR 3826 IH

1 ‘‘(iv) the licensed health care practi2 tioner provides for the submission to the 

3 Secretary (or an entity described in sub4 section (hhh)(1) with which the Secretary 

5 enters into a contract) and the Secretary 

6 (or such an entity) records and maintains 

7 a summary of each such consultation serv8 ice furnished by the licensed health care 

9 practitioner that includes— 

10 ‘‘(I) the date and time (including 

11 duration) of the consultation service; 

12 ‘‘(II) a unique medical record 

13 number specified by the Secretary (or 

14 such entity) to identify the consulta15 tion service; 

16 ‘‘(III) the name of the individual; 

17 ‘‘(IV) the name of the licensed 

18 health care practitioner; and 

19 ‘‘(V) a summary of the content 

20 of the consultation service;’’. 

21 (2) UNSCHEDULED TELEPHONE CONSULTATION

22 SERVICES DEFINED.—Section 1861 of such Act (42 

23 U.S.C. 1395x) is amended by adding at the end the 

24 following new subsection: 


jbell on DSKDVH8Z91PROD with BILLS
5 

•HR 3826 IH

1 ‘‘Unscheduled Telephone Consultation Services 

2 ‘‘(hhh)(1) The term ‘unscheduled telephone consulta3 tion service’ means a consultation conducted by means of 

4 telephone or similar electronic communication device be5 tween a licensed health care practitioner described in sub6 section (s)(2)(FF) and an individual (or a representative 

7 of such individual), with respect to the furnishing of pri8 mary care services to such individual, that is not included 

9 as a scheduled physician service (as defined by the Sec10 retary in regulations), and which is initiated by the indi11 vidual (or representative) contacting a communication net12 work operated by the Secretary (or an entity with which 

13 the Secretary enters into a contract) that connects the in14 dividual to the licensed health care practitioner, securely 

15 records the consultation for purposes of subsection 

16 (s)(2)(FF), and maintains the information described in 

17 clause (iv) of such subsection with respect to such con18 sultation. 

19 ‘‘(2) For purposes of applying the regulations pro20 mulgated pursuant to section 264(c) of the Health Insur21 ance Portability and Accountability Act of 1996 (Public 

22 Law 104–191; 110 Stat. 2033) with respect to an un23 scheduled telephone consultation service furnished by a li24 censed health care practitioner— 


jbell on DSKDVH8Z91PROD with BILLS
6 

•HR 3826 IH

1 ‘‘(A) an entity with which the Secretary con2 tracts under this subsection shall be treated as a 

3 health oversight agency; and 

4 ‘‘(B) activities of such an entity described in 

5 subparagraph (A) in relation to such licensed health 

6 care practitioner and such unscheduled telephone 

7 consultation service are deemed to be health over8 sight activities.’’. 

9 (b) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 

10 Section 1848(j)(3) of such Act (42 U.S.C. 1395w–4(j)(3)) 

11 is amended by inserting ‘‘(2)(FF),’’ after ‘‘(2)(EE),’’. 

12 (c) CONTINGENT EFFECTIVE DATE, DEMONSTRA13 TION PROGRAM.— 

14 (1) CONTINGENT EFFECTIVE DATE.—The 

15 amendments made by this section shall become ef16 fective (if at all) in accordance with paragraph (2). 

17 (2) DEMONSTRATION PROGRAM.— 

18 (A) IN GENERAL.—The Secretary of 

19 Health and Human Services (in this paragraph 

20 referred to as the ‘‘Secretary’’) shall establish a 

21 demonstration program to begin not later than 

22 6 months after the date of the enactment of 

23 this Act to test the effectiveness of providing 

24 coverage under the Medicare program for un25 scheduled telephone consultation services (as 


jbell on DSKDVH8Z91PROD with BILLS
7 

•HR 3826 IH

1 defined in section 1861(hhh) of the Social Secu2 rity Act, as added by subsection (a)(2)), by li3 censed health care practitioners to the extent 

4 provided under the amendments made by this 

5 section to a sample group of Medicare bene6 ficiaries. For purposes of such demonstration 

7 program, the Secretary shall find that the pro8 vision of such coverage is effective if— 

9 (i) the coverage reduces costs to the 

10 Medicare program (such as through a re11 duction in admissions to the emergency de12 partments of hospitals), whether or not 

13 such reduction is demonstrated in a reduc14 tion in the facility fees of hospital emer15 gency departments, professional fees of 

16 emergency department licensed health care 

17 practitioners, laboratory fees, pathologist 

18 fees, hospital radiology department fees for 

19 technical components of x-rays, radiologist 

20 professional fees for interpreting x-rays, 

21 hospital respiratory department fees for 

22 respiratory treatments, hospital cardiology 

23 department fees for electrocardiograms, 

24 professional fees for interpreting such elecVerDate Nov 24 2008 00:46 Oct 17, 2009 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3826.IH H3826

jbell on DSKDVH8Z91PROD with BILLS
8 

•HR 3826 IH

1 trocardiograms, or any other cost specified 

2 by the Secretary; and 

3 (ii) the coverage results in patient 

4 health outcomes that are at least as favor5 able as would apply in the absence of such 

6 coverage (as determined in accordance with 

7 criteria established by the Centers for 

8 Medicare & Medicaid Services, in consulta9 tion with physician organizations). 

10 (B) INITIAL PERIOD OF DEMONSTRATION

11 PROGRAM.—The demonstration program under 

12 subparagraph (A) shall be conducted for an ini13 tial period of 24 months. 

14 (C) REPORT TO CONGRESS.— 

15 (i) IN GENERAL.—Not later than 30 

16 days after the last day of the initial period 

17 under subparagraph (B), the Secretary 

18 shall submit to Congress a report on the 

19 results of the demonstration program 

20 under this paragraph. 

21 (ii) FINDING THAT PAYMENTS ARE

22 EFFECTIVE.—If the Secretary finds, on the 

23 basis of the data derived from the dem24 onstration program under subparagraph 

25 (A) and in accordance with such subparaVerDate Nov 24 2008 00:46 Oct 17, 2009 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3826.IH H3826

jbell on DSKDVH8Z91PROD with BILLS
9 

•HR 3826 IH

1 graph, that providing coverage under the 

2 Medicare program for unscheduled tele3 phone consultation services by licensed 

4 health care practitioners (to the extent 

5 provided under the amendments made by 

6 this section) is effective, the amendments 

7 made by this section shall become effective 

8 on the first day of the first month begin9 ning after the date the report under clause 

10 (i) is submitted to Congress. 

11 (iii) FINDING THAT PAYMENTS ARE

12 NOT EFFECTIVE.—If the Secretary finds, 

13 on the basis of the data derived from the 

14 demonstration program under subpara15 graph (A) and in accordance with such 

16 subparagraph, that a finding of effective17 ness (as described in clause (ii)) cannot be 

18 made, the demonstration program shall 

19 continue for a period of an additional 24 

20 months. Not later than 30 days after the 

21 last day of such period, the Secretary shall 

22 submit to Congress a final report on the 

23 results of such program. The amendments 

24 made by this section shall become effective 

25 on the first day of the first month beginVerDate Nov 24 2008 00:46 Oct 17, 2009 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3826.IH H3826

jbell on DSKDVH8Z91PROD with BILLS
10 

•HR 3826 IH

1 ning after the date such report is sub2 mitted to Congress unless the report con3 tains a finding by the Secretary, on the 

4 basis of such data and in accordance with 

5 such subparagraph, that providing cov6 erage under the Medicare program for un7 scheduled telephone consultation services 

8 by licensed health care practitioners (to the 

9 extent provided under the amendments 

10 made by this section) is not effective, in 

11 which case the amendments made by this 

12 section shall not become effective. 

13 (d) CLARIFICATION.—Nothing in the provisions of 

14 this section or the amendments made by this section shall 

15 be construed as authorizing the creation of a national re16 porting system on licensed health care practitioner quality. 

Æ 


jbell on DSKDVH8Z91PROD with BILLS