I

104TH CONGRESS

1ST SESSION H. R. 851

To direct the Secretary of Health and Human Services to establish pilot

projects to investigate the effectiveness of the use of rural health care

provider telemedicine networks to provide coverage of physician consultative services under part B of the medicare program to individuals

residing in rural areas.

IN THE HOUSE OF REPRESENTATIVES

FEBRUARY 7, 1995

Mrs. LINCOLN (for herself, Mr. RICHARDSON, and Mr. DICKEY) 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 direct the Secretary of Health and Human Services to

establish pilot projects to investigate the effectiveness

of the use of rural health care provider telemedicine

networks to provide coverage of physician consultative

services under part B of the medicare program to individuals residing in rural areas.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
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1 SECTION 1. SHORT TITLE.

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

3 Act of 1995’’.

4 SEC. 2. ESTABLISHMENT OF PROJECT.

5 (a) IN GENERAL.—The Secretary of Health and

6 Human Services (hereafter referred to as the ‘‘Secretary’’)

7 shall establish not more than 10 pilot projects not later

8 than 9 months after the date of enactment of this Act

9 to investigate over a 3-year period the effectiveness of the

10 use of rural health care provider telemedicine networks to

11 provide coverage of physician consultative services under

12 part B of the medicare program to individuals residing

13 in rural areas.

14 (b) NETWORKS DEFINED.—In this Act, the term

15 ‘‘rural health care provider telemedicine network’’ (here16 after referred to as a ‘‘network’’) means a network of pro17 viders that meets the following requirements:

18 (1) The network serves physicians, clinics, and

19 other nontertiary care providers in a rural area who

20 have entered into agreements with a multispecialty

21 tertiary care provider (without regard to whether or

22 not such tertiary care provider is in the rural area)

23 regarding patient referral and transfer, the use of

24 joint communications systems, and the provision of

25 emergency and nonemergency transportation among

26 the network members.
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1 (2) The area in which the network operates is

2 a rural area designated as a health professional

3 shortage area (under section 332(a) of the Public

4 Health Service Act) or is an underserved rural area

5 in accordance with such other criteria as the Sec6 retary may specify.

7 SEC. 3. MEDICARE PAYMENT FOR PARTICIPANTS.

8 (a) IN GENERAL.—Under the projects established

9 under this Act, the Secretary shall make payments from

10 the Federal Supplementary Medical Insurance Trust

11 Fund under part B of title XVIII of the Social Security

12 Act in accordance with the methodology described in sub13 section (b) for physicians’ services consisting of a profes14 sional consultation with an individual or entity furnishing

15 a service for which payment may be made under such part

16 to a medicare beneficiary in a rural area, notwithstanding

17 that the individual providing the professional consultation

18 is not at the same location as the individual furnishing

19 the service to the medicine beneficiary.

20 (b) METHODOLOGY FOR DETERMINING AMOUNT OF

21 PAYMENTS.—Taking into account the amount of funds

22 available for payments under the project, the Secretary

23 shall establish a methodology for determining the amount

24 of payments made under subsection (a), and shall include

25 in the methodology a method for making payment for rea-
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1 sonable costs incurred in the usage of signal transmission

2 facilities suitable for the conduct of physician consultative

3 services.

4 (c) PAYMENT FOR NONPHYSICIAN PROVIDERS.—

5 Payments may be made under subsection (a) for any serv6 ice described in such paragraph, without regard to wheth7 er or not the individual furnishing such service is a physi8 cian.

9 SEC. 4. ELIGIBILITY OF NETWORKS.

10 (a) IN GENERAL.—A network is eligible to partici11 pate in a pilot project under this Act if—

12 (1) the network submits to the Secretary (at

13 such time and in such form as the Secretary may re14 quire) an application containing such information

15 and assurances as the Secretary may require; and

16 (2) the network agrees to submit to the Sec17 retary such information as the Secretary may re18 quire to determine the amount of payments de19 scribed in section 3(b), to prepare reports under sec20 tion 6, and to otherwise carry out the project.

21 (b) RURAL AREA DEFINED.—In this Act, the term

22 ‘‘rural area’’ has the meaning given such term in section

23 1886(d)(2)(D) of the Social Security Act.
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1 SEC. 5. CRITERIA FOR SELECTING PARTICIPANTS.

2 (a) TECHNOLOGY APPLIED.—In selecting among eli3 gible networks for participation in pilot projects under this

4 Act, the Secretary shall give priority to networks that pro5 vide for consultations between patients and medical spe6 cialists involving transmission of detailed data on the pa7 tient in a manner that serves as a reasonable substitute

8 for inperson interaction between the patients and the spe9 cialists.

10 (b) PERMITTING EXISTING NETWORKS TO PARTICI11 PATE.—Nothing in this Act may be construed to prohibit

12 the Secretary from selecting a network operating at the

13 time of the establishment of the pilot projects from partici14 pating in the project.

15 SEC. 6. REPORTS.

16 (a) INTERIM REPORT ON PARTICIPATING SITES.—

17 Not later than 24 months after the Secretary first makes

18 payment under subsection (b) for services under a pilot

19 project, the Secretary shall submit a report to Congress

20 describing the projects and the networks participating in

21 the projects under this section, including a description of

22 the amounts expended and the number of patients served

23 under the projects.

24 (b) FINAL.—Not later than 1 year after the termi25 nation of the projects, the Secretary shall submit a final
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1 report to Congress describing the operation of the projects

2 and containing—

3 (1) the Secretary’s analysis of the projects’

4 cost-effectiveness and success in promoting the ac5 cess of providers of health care services in rural

6 areas to consultation services of specialist physi7 cians;

8 (2) the Secretary’s analysis of the impact of the

9 projects on the ability of patients to obtain a higher

10 quality and greater range of care; and

11 (3) such recommendations as the Secretary con12 siders appropriate for changes in the medicare pro13 gram relating to telemedicine, including estimates of

14 the costs associated with any such changes.

15 SEC. 7. AUTHORIZATION OF APPROPRIATIONS.

16 There are authorized to be appropriated from the

17 Federal Supplementary Medical Insurance Trust Fund

18 under section 1841 of the Social Security Act a total of

19 $51,000,000 for carrying out the demonstration project

20 under this Act. Of such amount, not more than

21 $1,000,000 may be used for administrative purposes, in22 cluding preparing and submitting reports under section 6.

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