II 

111TH CONGRESS 

1ST SESSION S. 2741 

To establish telehealth pilot projects, expand access to stroke telehealth services under the Medicare program, improve access to ‘‘store-and-forward’’ 

telehealth services in facilities of the Indian Health Service and federally 

qualified health centers, reimburse facilities of the Indian Health Service 

as originating sites, establish regulations to consider credentialing and 

privileging standards for originating sites with respect to receiving telehealth services, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

NOVEMBER 5, 2009 

Mr. UDALL of New Mexico introduced the following bill; which was read twice 

and referred to the Committee on Finance 

A BILL 

To establish telehealth pilot projects, expand access to stroke 

telehealth services under the Medicare program, improve 

access to ‘‘store-and-forward’’ telehealth services in facilities of the Indian Health Service and federally qualified 

health centers, reimburse facilities of the Indian Health 

Service as originating sites, establish regulations to consider credentialing and privileging standards for originating sites with respect to receiving 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, 


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1 SECTION 1. SHORT TITLE. 

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

3 Enhancing Community Health (TECH) Act of 2009’’. 

4 SEC. 2. TELEHEALTH PILOT PROJECTS. 

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

6 Human Services (referred to in this section as the ‘‘Sec7 retary’’) shall establish 3-year telehealth pilot projects for 

8 the purpose of analyzing the clinical outcomes and cost 

9 effectiveness associated with telehealth services in a vari10 ety of geographic areas. The Secretary shall provide eval11 uation and treatment services to entities participating in 

12 the pilot projects. 

13 (b) ELIGIBLE ENTITIES.— 

14 (1) IN GENERAL.—The Secretary shall select el15 igible entities to participate in the pilot projects 

16 under this section. 

17 (2) PRIORITY.—In selecting eligible entities to 

18 participate in the pilot projects under this section, 

19 the Secretary shall give priority to such entities lo20 cated in medically underserved areas and facilities of 

21 the Indian Health Service. 

22 (c) EVALUATION.—The Secretary shall, through the 

23 pilot projects, evaluate— 

24 (1) the effective and economic delivery of care 

25 in treating behavioral health issues (including post26 traumatic stress disorder) with the use of telehealth 


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1 services in medically underserved and tribal areas, 

2 including collaborative uses of health professionals, 

3 integration of the range of telehealth and other tech4 nologies, and exploration of appropriate reimburse5 ment methods for third party payers; 

6 (2) the effectiveness of improving the capacity 

7 of non-medical providers and non-specialized medical 

8 providers to provide health services for chronic com9 plex diseases in medically underserved and tribal 

10 areas; and 

11 (3) the effectiveness of using telehealth services 

12 to provide acute stroke evaluation and treatment, oc13 cupational therapy, physical therapy, and speech lan14 guage pathology services to treat cerebrovascular 

15 disease in medically underserved and tribal areas. 

16 (d) REPORT.—Not later than 3 years after the pilot 

17 projects are established under subsection (a), the Sec18 retary shall submit to Congress a report describing the 

19 outcomes of such pilot projects and providing rec20 ommendations for expanding the use of telehealth services. 

21 (e) EXPANSION OF PROJECT.—If the Secretary de22 termines that the pilot projects under this section enhance 

23 outcomes for patients and reduce expenditures for partici24 pating entities, the Secretary may initiate similar projects 

25 for additional medical conditions and geographic areas. 


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1 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 

2 out this section, there is authorized to be appropriated 

3 $13,500,000 for fiscal years 2011 through 2014. 

4 SEC. 3. EXPANDING ACCESS TO STROKE TELEHEALTH 

5 SERVICES. 

6 (a) EXPANSION OF ORIGINATING SITES FOR STROKE

7 TELEHEALTH SERVICES.—Section 1834(m)(4) of the So8 cial Security Act (42 U.S.C. 1395m(m)(4)) is amended— 

9 (1) in subparagraph (C)— 

10 (A) in clause (i), in the matter preceding 

11 subclause (I), by striking ‘‘The term’’ and in12 serting ‘‘Subject to clause (iii), the term’’; and 

13 (B) by adding at the end the following new 

14 clause: 

15 ‘‘(iii) EXPANSION OF ORIGINATING

16 SITES FOR STROKE TELEHEALTH SERV17 ICES.—In the case of stroke telehealth 

18 services, the term ‘originating site’ means 

19 any site described in clause (ii) at which 

20 the eligible telehealth individual is located 

21 at the time the service is furnished via a 

22 telecommunications system, regardless of 

23 where the site is located.’’; and 

24 (2) by adding at the end the following new sub25 paragraph: 


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1 ‘‘(G) STROKE TELEHEALTH SERVICES.— 

2 The term ‘stroke telehealth services’ means a 

3 telehealth service used for the evaluation or 

4 treatment of individuals with acute stroke, oc5 cupational therapy, physical therapy, and 

6 speech language pathology services furnished 

7 subsequent to a stroke, and stroke prevention 

8 and education services.’’. 

9 (b) EFFECTIVE DATE.—The amendments made by 

10 subsection (a) shall apply to telehealth services furnished 

11 on or after the date that is 6 months after the date of 

12 enactment of this Act. 

13 SEC. 4. IMPROVING ACCESS TO TELEHEALTH SERVICES AT 

14 IHS FACILITIES AND FQHCS. 

15 (a) INCLUSION OF IHS FACILITIES AS ORIGINATING

16 SITES.—Section 1834(m)(4)(C)(ii) of the Social Security 

17 Act (42 U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding 

18 at the end the following new subclause: 

19 ‘‘(IX) A facility of the Indian 

20 Health Service, whether operated by 

21 such Service or by an Indian tribe or 

22 tribal organization (as those terms are 

23 defined in section 4 of the Indian 

24 Health Care Improvement Act).’’. 


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1 (b) ACCESS TO STORE-AND-FORWARD AND

2 VIDEOCONFERENCING TECHNOLOGIES.— 

3 (1) IN GENERAL.—Section 1834(m)(1) of such 

4 Act (42 U.S.C. 1395m(m)(1)) is amended by adding 

5 at the end the following sentence: ‘‘For purposes of 

6 the first sentence, in the case of telehealth services 

7 described in subclause (I) of paragraph (4)(F)(iii) 

8 that are furnished by a facility of the Indian Health 

9 Service (whether operated by such Service or by an 

10 Indian tribe or tribal organization (as those terms 

11 are defined in section 4 of the Indian Health Care 

12 Improvement Act)) or a federally qualified health 

13 center (as defined in section 1861(aa)(4)), the term 

14 ‘telecommunications system’ includes store-and-for15 ward technologies described in the preceding sen16 tence and, in the case of telehealth services described 

17 in subclause (II) of such paragraph that are fur18 nished by such a facility or federally qualified health 

19 center, such term includes videoconferencing tech20 nologies.’’ 

21 (2) CONFORMING AMENDMENT.—Section 

22 1834(m)(4)(F) of such Act (42 U.S.C. 

23 1395m(m)(4)(F)) is amended by adding at the end 

24 the following new clauses: 


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1 ‘‘(iii) TELEHEALTH SERVICES DE2 SCRIBED.—For purposes of paragraph (1): 

3 ‘‘(I) The telehealth services de4 scribed in this subclause include con5 sultations related to neurosurgery, 

6 neurology, cardiology, dermatology, 

7 pediatric specialty, and orthopedic (as 

8 specified by the Secretary). 

9 ‘‘(II) The telehealth services de10 scribed in this subclause are services 

11 related to hepatitis and other chronic 

12 conditions and behavioral health serv13 ices (as specified by the Secretary).’’. 

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

15 this section shall apply to telehealth services furnished on 

16 or after the date that is 6 months after the date of enact17 ment of this Act. 

18 SEC. 5. IMPROVING CREDENTIALING AND PRIVILEGING 

19 STANDARDS FOR TELEHEALTH SERVICES. 

20 Section 1834(m) of the Social Security Act (42 

21 U.S.C. 1395m(m)) is amended by adding at the end the 

22 following new paragraph: 

23 ‘‘(5) ESTABLISHMENT OF REMOTE

24 CREDENTIALING AND PRIVILEGING STANDARDS.— 


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1 ‘‘(A) IN GENERAL.—Not later than 2 years 

2 after the date of the enactment of this para3 graph, the Secretary shall establish reasonable 

4 regulations for considering the remote 

5 credentialing and privileging standards applica6 ble to telehealth services, including interpreta7 tive services, for originating sites under this 

8 subsection. Such regulations shall allow an orig9 inating site to accept, and not duplicate, the 

10 credentialing and privileging processes and deci11 sions made by another site. 

12 ‘‘(B) CLARIFICATION REGARDING ACCEPT13 ANCE OF PROCESSES AND DECISIONS PRIOR TO

14 ENACTMENT OF REGULATIONS.—During the pe15 riod beginning on such date of enactment and 

16 ending on the effective date of the regulations 

17 under subparagraph (A), the Secretary shall 

18 not take any punitive action under any rule or 

19 regulation against an originating site on the 

20 basis of that site’s acceptance, for purposes of 

21 receiving telehealth services (including interpre22 tive services), the credentialing and privileging 

23 processes and decisions made by another site 

24 that is accredited by a national accreditation 

25 body recognized by the Secretary under section 


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1 1865(a)(1) if the site accepting such 

2 credentialing and privileging processes is also so 

3 accredited and complies with the applicable re4 quirements for such acceptance.’’. 

Æ 


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