II

104TH CONGRESS

1ST SESSION S. 980

To amend the Public Health Service Act and the Social Security Act to

protect and improve the availability, quality and affordability of health

care in rural areas, and for other purposes.

IN THE SENATE OF THE UNITED STATES

JUNE 28 (legislative day, JUNE 19), 1995

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

to the Committee on Finance

A BILL

To amend the Public Health Service Act and the Social

Security Act to protect and improve the availability, quality and affordability of health care in rural areas, 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 Health Care

5 Protection and Improvement Act of 1995’’.
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1 SEC. 2. IMPROVING HEALTH CARE ACCESS AND REDUCING

2 HEALTH CARE COSTS THROUGH

3 TELEMEDICINE.

4 (a) IN GENERAL.—Title XVII of the Public Health

5 Service Act (42 U.S.C. 300u et seq.) is amended—

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

7 HEALTH PROMOTION’’ and inserting ‘‘,

8 HEALTH PROMOTION AND TELEMEDICINE

9 DEVELOPMENT’’;

10 (2) by inserting after the title heading the fol11 lowing:

12 ‘‘PART A—HEALTH INFORMATION AND HEALTH

13 PROMOTION’’; AND

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

15 new part:

16 ‘‘PART B—TELEMEDICINE DEVELOPMENT

17 ‘‘SEC. 1711. GRANT PROGRAM FOR PROMOTING THE DEVEL18 OPMENT OF RURAL TELEMEDICINE NET19 WORKS.

20 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab21 lish a program to award grants to eligible entities in ac22 cordance with this subsection to promote the development

23 of rural telemedicine networks.

24 ‘‘(b) GRANTS FOR DEVELOPMENT OF RURAL

25 TELEMEDICINE.—The Secretary of Health and Human

26 Services, acting through the Office of Rural Health Policy,
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1 shall award grants to eligible entities that have applica2 tions approved under subsection (d) for the purpose of ex3 panding access to health care services for individuals in

4 rural areas through the use of telemedicine. Grants shall

5 be awarded under this section to—

6 ‘‘(1) encourage the initial development of rural

7 telemedicine networks;

8 ‘‘(2) expand existing networks;

9 ‘‘(3) link existing networks together; or

10 ‘‘(4) link such networks to existing fiber optic

11 telecommunications systems.

12 ‘‘(c) ELIGIBLE ENTITY DEFINED.—For the purposes

13 of this section the term ‘eligible entity’ means hospitals

14 and other health care providers operating in a health care

15 network of community-based providers that includes at

16 least three of the following—

17 ‘‘(1) community or migrant health centers;

18 ‘‘(2) local health departments;

19 ‘‘(3) community mental health centers;

20 ‘‘(4) nonprofit hospitals;

21 ‘‘(5) private practice health professionals, in22 cluding rural health clinics; or

23 ‘‘(6) other publicly funded health or social serv24 ices agencies.
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1 ‘‘(d) APPLICATION.—To be eligible to receive a grant

2 under this section an eligible entity shall prepare and sub3 mit to the Secretary an application at such time, in such

4 manner and containing such information as the Secretary

5 may require, including a description of—

6 ‘‘(1) the need of the entity for the grant;

7 ‘‘(2) the use to which the entity would apply

8 any amounts received under such grant;

9 ‘‘(3) the source and amount of non-Federal

10 funds that the entity will pledge for the project

11 funded under the grant; and

12 ‘‘(4) the long-term viability of the project and

13 evidence of the providers commitment to the net14 work.

15 ‘‘(e) PREFERENCE IN AWARDING GRANTS.—In

16 awarding grants under this section, the Secretary shall

17 give preference to applicants that—

18 ‘‘(1) are health care providers operating in

19 rural health care networks or that propose to form

20 such networks with the majority of the providers in

21 such networks being located in a medically

22 undeserved area or health professional shortage

23 area;
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1 ‘‘(2) can demonstrate broad geographic cov2 erage in the rural areas of the State, or States in

3 which the applicant is located; and

4 ‘‘(3) propose to use funds received under the

5 grant to develop plans for, or to establish,

6 telemedicine systems that will link rural hospitals

7 and rural health care providers to other hospitals

8 and health care providers;

9 ‘‘(4) will use the amounts provided under the

10 grant for a range of health care applications and to

11 promote greater efficiency in the use of health care

12 resources;

13 ‘‘(5) demonstrate the long-term viability of

14 projects through use of local matching funds (in

15 cash or in-kind); and

16 ‘‘(6) demonstrate financial, institutional, and

17 community support and the long-range viability of

18 the network.

19 ‘‘(f) USE OF AMOUNTS.—Amounts received under a

20 grant awarded under this section shall be utilized for the

21 development of telemedicine networks. Such amounts may

22 be used to cover the costs associated with the development

23 of telemedicine networks and the acquisition of

24 telemedicine equipment and modifications or improve25 ments of telecommunications facilities, including—
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1 ‘‘(1) the development and acquisition through

2 lease or purchase of computer hardware and soft3 ware, audio and visual equipment, computer network

4 equipment, modification or improvements to tele5 communications transmission facilities, telecommuni6 cations terminal equipment, interactive video equip7 ment, data terminal equipment, and other facilities

8 and equipment that would further the purposes of

9 this section;

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

11 instruction for the development and use of such pro12 gramming equipment or facilities;

13 ‘‘(3) the development and acquisition of instruc14 tional programming;

15 ‘‘(4) the development of projects for teaching or

16 training medical students, residents, and other

17 health professions students in rural training sites

18 about the application of telemedicine;

19 ‘‘(5) transmission costs, maintenance of equip20 ment, and compensation of specialists and referring

21 practitioners;

22 ‘‘(6) the development of projects to use

23 telemedicine to facilitate collaboration between

24 health care providers; and
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1 ‘‘(7) such other uses that are consistent with

2 achieving the purposes of this section as approved by

3 the Secretary.

4 ‘‘(g) PROHIBITED USE OF AMOUNTS.—Amounts re5 ceived under a grant awarded under this section shall not

6 be used for—

7 ‘‘(1) expenditures to purchase or lease equip8 ment to the extent the expenditures would exceed

9 more than 60 percent of the total grant funds; or

10 ‘‘(2) expenditures for indirect costs (as deter11 mined by the Secretary) to the extent the expendi12 tures would exceed more than 10 percent of the total

13 grant funds.

14 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There

15 are authorized to be appropriated such sums as may be

16 necessary to carry out this section.

17 ‘‘(i) DEFINITION.—For the purposes of this section,

18 the term ‘rural health care network’ means a group of

19 rural hospitals or other rural health care providers (includ20 ing clinics, physicians and non-physicians primary care

21 providers) that have entered into a relationship with each

22 other or with nonrural hospitals and health care providers

23 for the purpose of strengthening the delivery of health care

24 services in rural areas or specifically to improve their pa25 tients’ access to telemedicine services. At least 75 percent
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1 of hospitals and other health care providers participating

2 in the network shall be located in rural areas.

3 ‘‘(j) REGULATIONS ON REIMBURSEMENT OF

4 TELEMEDICINE.—Not later than July 1, 1996, the Sec5 retary, in consultation with the Office of Rural Health and

6 the Health Care Financing Administration, shall issue

7 regulations regarding reimbursement for telemedicine

8 services provided under title XVIII of the Social Security

9 Act.’’.

10 SEC. 3. ESTABLISHMENT OF RURAL HEALTH OUTREACH

11 GRANT PROGRAM.

12 Title III of the Public Health Service Act (42 U.S.C.

13 241 et seq.) is amended by adding at the end thereof the

14 following new part:

15 ‘‘PART O—RURAL HEALTH OUTREACH GRANTS

16 ‘‘SEC. 399O. RURAL HEALTH OUTREACH GRANT PROGRAM.

17 ‘‘(a) IN GENERAL.—The Secretary may make grants

18 to demonstrate the effectiveness of outreach to populations

19 in rural areas that do not normally seek or do not have

20 access to health or mental health services. Grants shall

21 be awarded to enhance linkages, integration, and coopera22 tion in order to provide health or mental health services,

23 to enhance services, or increase access to or utilization of

24 health or mental health services.
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1 ‘‘(b) MISSION OF THE OUTREACH PROJECTS.—

2 Projects funded under subsection (a) should be designed

3 to facilitate the integration and coordination of services

4 in or among rural communities in order to address the

5 needs of populations living in rural or frontier commu6 nities.

7 ‘‘(c) COMPOSITION OF PROGRAM.—

8 ‘‘(1) CONSORTIUM ARRANGEMENT.—To be eli9 gible to participate in the grant program established

10 under subsection (a), an applicant entity shall be a

11 consortium of three or more separate and distinct

12 entities formed to carry out an outreach project

13 under subsection (b).

14 ‘‘(2) CERTAIN REQUIREMENTS.—A consortium

15 under paragraph (1) shall be composed of three or

16 more public or private nonprofit health care or social

17 service providers. Consortium members may include

18 local health departments, community or migrant

19 health centers, community mental health centers,

20 hospitals or private practices, or other publicly fund21 ed health or social service agencies.

22 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—For the

23 purpose of carrying out this section, there are authorized

24 to be appropriated $30,000,000 for fiscal year 1996, and
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1 such sums as may be necessary for each of the fiscal years

2 1997 through 2000.’’.

3 SEC. 4. EXTENSION OF CERTAIN PAYMENT PROVISIONS

4 FOR MEDICARE DEPENDENT SMALL RURAL

5 HOSPITALS.

6 (a) IN GENERAL.—Section 1886(d)(5)(G)(i) of the

7 Social Security Act (42 U.S.C. 1395ww(d)(5)(G)(i)) is

8 amended by striking ‘‘October 1, 1994’’ and inserting

9 ‘‘October 1, 1999’’.

10 (b) PAYMENT.—Section 1886(b)(3)(D) of such Act

11 (42 U.S.C. 1395ww(b)(3)(D)) is amended by striking

12 ‘‘September 30, 1994’’ and inserting ‘‘September 30,

13 1999’’.

14 (C) EFFECTIVE DATE.—The amendments made by

15 this section shall take effect as if enacted on October 1,

16 1994.

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