I

104TH CONGRESS

2D SESSION H. R. 4268

To provide for a project to demonstrate the application of telemedicine and

medical informatics to improving the quality and cost-effectiveness in

the delivery of health care services under the Medicare program and

other health programs.

IN THE HOUSE OF REPRESENTATIVES

SEPTEMBER 27, 1996

Mr. RANGEL (for himself and Mr. HOUGHTON) introduced the following bill;

which was referred to the Committee on 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 provide for a project to demonstrate the application of

telemedicine and medical informatics to improving the

quality and cost-effectiveness in the delivery of health

care services under the Medicare program and other

health programs.

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 ‘‘Medicare Telemedicine

5 and Medical Informatics Demonstration Act of 1996’’.
2

•HR 4268 IH

1 SEC. 2. INFORMATICS, TELEMEDICINE, AND EDUCATION

2 DEMONSTRATION PROJECT.

3 (a) PURPOSE AND AUTHORIZATION.—

4 (1) IN GENERAL.—Under section 1142 of the

5 Social Security Act and consistent with this section,

6 the Secretary of Health and Human Services,

7 through the Agency for Health Care Policy and Re8 search, shall make a grant to an eligible grantee to

9 provide for a project to demonstrate the application

10 of high-capacity computing and advanced networks

11 to the provision of health care to both residents of

12 medically underserved rural areas and residents of

13 medically underserved inner-city areas.

14 (2) FOCUS.—The project shall focus on—

15 (A) improvements in primary care (and

16 prevention of complications) for those residents

17 with diabetes (mellitus), and

18 (B) those residents who are Medicare bene19 ficiaries.

20 (3) DURATION OF PROJECT.—The project shall

21 be conducted over a 4-year period.

22 (4) AUTHORIZATION OF APPROPRIATIONS; MED23 ICARE AND MEDICAID WAIVER AUTHORITY.—The

24 total amount of Federal expenditures that may be

25 provided pursuant to this section under the project

26 shall not exceed $30,000,000. Subject to such limi-
3

•HR 4268 IH

1 tation, the Secretary may waive such provisions of

2 title XVIII and XIX of the Social Security Act as

3 may be appropriate in order to permit and dem4 onstrate the provision of Medicare and Medicaid

5 funding under the project.

6 (b) OBJECTIVES OF PROJECT.—The objectives of the

7 project include the following:

8 (1) Improving patient access to and compliance

9 with appropriate care guidelines for chronic diseases

10 through direct telecommunications link with infor11 mation networks in order to improve patient quality12 of-life and reduce overall health care costs.

13 (2) Developing a curriculum to train, and pro14 viding standards for credentialing and licensure of,

15 health professionals (particularly primary care

16 health professionals) in the use of medical

17 informatics and telecommunciations.

18 (3) Demonstrating the application of advanced

19 technologies, such as video-conferencing from a pa20 tient’s home, remote monitoring of a patient’s medi21 cal condition, interventional informatics, and apply22 ing individualized, automated care guidelines, to as23 sist primary care providers in assisting patients with

24 chronic illnesses in a home setting.
4

•HR 4268 IH

1 (4) Application of medical informatics to resi2 dents with limited English language skills.

3 (5) Developing standards in the application of

4 telemedicine and medical informatics.

5 (6) Developing a model for the cost-effective de6 livery of primary and related care both in a managed

7 care environment and in a fee-for-service environ8 ment.

9 (c) ELIGIBLE GRANTEE.—For purposes of this sec10 tion, the term ‘‘eligible grantee’’ means a consortium that

11 includes at least one tertiary care hospital, at least one

12 medical school, and at least one regional telecommuni13 cations provider and that meets the following require14 ments:

15 (1) The consortium is located in an area with

16 a high concentration of medical schools and tertiary

17 care facilities and has appropriate arrangements

18 (within or outside the consortium) with such schools

19 and facilities, universities, and telecommunications

20 providers, in order to conduct the project.

21 (2) The consortium submits to the Secretary an

22 application at such time, in such manner, and con23 taining such information as the Secretary may re24 quire, including a description of the use to which the

25 consortium would apply any amounts received under
5

•HR 4268 IH

1 the project and the source and amount of non-Fed2 eral contribution towards the project.

3 (3) The consortium demonstrates that it will

4 provide for a contribution toward the project from

5 non-Federal funds or resources in an amount that is

6 not less than 50 percent of the total amount to be

7 expended in carrying out the project.

8 (d) USE OF FUNDS.—

9 (1) IN GENERAL.—Federal payments made

10 available to an eligible grantee under this section

11 shall be used for the development and operation of

12 telemedicine and medical informatics systems and

13 related activities under the project.

14 (2) SPECIFIC USES PERMITTED.—Such pay15 ments may be used for any of the following:

16 (A) The acquisition of telemedicine equip17 ment for use in patients’ homes (but only in the

18 case of patients located in medically under19 served areas).

20 (B) Curriculum development and training

21 of health professionals in medical informatics

22 and telemedicine.

23 (C) Payment of telecommunications costs

24 (including salaries and maintenance of equip25 ment), including costs of telecommunications
6

•HR 4268 IH

1 between patients’ homes and the eligible grant2 ee and between the grantee and other entities

3 under the arrangements described in subsection

4 (c)(1).

5 (D) Payments to practitioners and provid6 ers under the Medicare and Medicaid programs.

7 (3) PROHIBITED USES.—Such payments may

8 not be used for any of the following:

9 (A) The purchase or installation of trans10 mission equipment (other than such equipment

11 used by health professionals to deliver medical

12 informatics services under the project).

13 (B) The establishment or operation of a

14 telecommunications common carrier network.

15 (C) Construction (except for minor renova16 tions related to the installation of reimbursable

17 equipment) or the acquisition or building of real

18 property.

19 (e) REPORTS.—The Secretary shall submit to the

20 Committees on Ways and Means and Commerce of the

21 House of Representatives and the Committees on Finance

22 and Labor and Human Resources of the Senate interim

23 reports on the project and a final report on the project

24 within 6 months after the conclusion of the project. The

25 final report shall include an evaluation of the impact of
7

•HR 4268 IH

1 the use of telemedicine and medical informatics on improv2 ing access of medicare and medicaid beneficiaries to health

3 care services, on reducing the costs of such services, and

4 on improving the quality of life of such beneficiaries.

5 (f) DEFINITIONS.—For purposes of this section:

6 (1) INTERVENTIONAL INFORMATICS.—The term

7 ‘‘interventional informatics’’ means using informa8 tion technology and virtual reality technology to in9 tervene in patient care.

10 (2) MEDICAL INFORMATICS.—The term ‘‘medi11 cal informatics’’ means the storage, retrieval, and

12 use of biomedical and related information for prob13 lem solving and decision-making through computing

14 and communications technologies.

15 (3) PROJECT.—The term ‘‘project’’ means the

16 demonstration project under this section.

17 (4) SECRETARY.—The term ‘‘Secretary’’ means

18 the Secretary of Health and Human Services.

Æ