(ii) to determine the cost of providing 
payment for remote monitoring services 
under the Medicare program; 
(iii) to determine the satisfaction of 
eligible beneficiaries participating in the 
demonstration projects; and 
(iv) to evaluate such other matters as 
the Secretary determines is appropriate. 
(4) WAIVER AUTHORITY.—The Secretary may 
waive such provisions of titles XI and XVIII of the 
Social Security Act as the Secretary determines to 
be appropriate for the conduct of the demonstration 
project. 
(5) FUNDING.— 
(A) DEMONSTRATION.— 
(i) IN
GENERAL.—Subject to clause 
(ii), the Secretary shall provide for the 
transfer from the Federal Supplementary 
Medical Trust Fund under section 1841 of 
the Social Security Act (42 U.S.C. 1395t) 
of such funds as are necessary for the 
costs of carrying out the demonstration 
project. 
(ii) CAP
ON
EXPENDITURES.—The 
amount transferred under clause (i) for the 
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period during which the demonstration 
project is conducted may not exceed an 
amount equal to the lesser of— 
(I) $9,000,000; or 
(II) an amount equal to the costs 
of providing remote monitoring serv-
ices to 7,500 individuals during such 
period. 
(B) EVALUATION
AND
REPORT.—There 
are authorized to be appropriated such sums as 
are necessary for the purpose of conducting the 
evaluation and developing and submitting the 
report to Congress under paragraph (3). 
(6) DEFINITIONS.—In this section: 
(A) REMOTE PATIENT MANAGEMENT SERV-
ICES.—The term ‘‘remote patient management 
services’’ means the remote monitoring, evalua-
tion, and management of an individual with a 
covered chronic health condition (as defined in 
paragraph (B)), insofar as such monitoring, 
evaluation, and management is with respect to 
such condition, through the utilization of a sys-
tem of technology that allows a remote interface 
to collect and transmit clinical data between the 
individual and the responsible physician (as de-
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fined in subsection (r) of section 1861 of the 
Social Security Act (42 U.S.C. 1395x))) or sup-
plier (as defined in subsection (d) of such sec-
tion) for the purposes of clinical review or re-
sponse by the physician or supplier. 
(B) COVERED
CHRONIC
HEALTH
CONDI-
TION.—The term ‘‘covered chronic health condi-
tion’’ means diabetes, sleep apnea, or epilepsy. 
(C) DEMONSTRATION PROJECT.—The term 
‘‘demonstration project’’ means a demonstra-
tion project conducted under this subsection. 
(D) ELIGIBLE
BENEFICIARY.—The term 
‘‘eligible beneficiary’’ means an individual who 
is enrolled under part B of the Medicare pro-
gram and has a covered chronic health condi-
tion. 
(E) 
MEDICARE
PROGRAM.—The 
term 
‘‘Medicare program’’ means the health benefits 
program under title XVIII of the Social Secu-
rity Act (42 U.S.C. 1395 et seq.). 
(F) SECRETARY.—The term ‘‘Secretary’’ 
means the Secretary of Health and Human 
Services. 
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SEC. 107. DEFINITION OF MEDICARE PROGRAM. 
In this title, the term ‘‘Medicare program’’ means the 
program of health insurance administered by the Sec-
retary of Health and Human Services under title XVIII 
of the Social Security Act (42 U.S.C. 1395 et seq.). 
TITLE II—HRSA GRANT 
PROGRAM 
SEC. 201. GRANT PROGRAM FOR THE DEVELOPMENT OF 
TELEHEALTH NETWORKS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’), acting through the Director of the Office for the 
Advancement of Telehealth (of the Health Resources and 
Services Administration), shall make grants to eligible en-
tities (as described in subsection (b)(2)) for the purpose 
of expanding access to health care services for individuals 
in rural areas, frontier areas, and urban medically under-
served areas through the use of telehealth. 
(b) ELIGIBLE ENTITIES.— 
(1) APPLICATION.—To be eligible to receive a 
grant under this section, an eligible entity described 
in paragraph (2) shall, in consultation with the 
State office of rural health or other appropriate 
State entity, prepare and submit to the Secretary an 
application, at such time, in such manner, and con-
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taining such information as the Secretary may re-
quire, including the following: 
(A) A description of the anticipated need 
for the grant. 
(B) A description of the activities which 
the entity intends to carry out using amounts 
provided under the grant. 
(C) A plan for continuing the project after 
Federal support under this section is ended. 
(D) A description of the manner in which 
the activities funded under the grant will meet 
health care needs of underserved rural popu-
lations within the State. 
(E) A description of how the local commu-
nity or region to be served by the network or 
proposed network will be involved in the devel-
opment and ongoing operations of the network. 
(F) The source and amount of non-Federal 
funds the entity would pledge for the project. 
(G) A showing of the long-term viability of 
the project and evidence of health care provider 
commitment to the network. 
The application should demonstrate the manner in 
which the project will promote the integration of 
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telehealth in the community so as to avoid redun-
dancy of technology and achieve economies of scale. 
(2) ELIGIBLE ENTITIES.—An eligible entity de-
scribed in this paragraph is a hospital or other 
health care provider in a health care network of 
community-based health care providers that includes 
at least two of the organizations described in sub-
paragraph (A) and one of the institutions and enti-
ties described in subparagraph (B) if the institution 
or entity is able to demonstrate use of the network 
for purposes of education or economic development 
(as required by the Secretary). 
(A) The organizations described in this 
subparagraph are the following: 
(i) Community or migrant health cen-
ters. 
(ii) Local health departments. 
(iii) Nonprofit hospitals. 
(iv) Private practice health profes-
sionals, including community and rural 
health clinics. 
(v) Other publicly funded health or so-
cial services agencies. 
(vi) Skilled nursing facilities. 
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(vii) County mental health and other 
publicly funded mental health facilities. 
(viii) Providers of home health serv-
ices. 
(ix) Renal dialysis facilities. 
(B) The institutions and entities described 
in this subparagraph are the following: 
(i) A public school. 
(ii) A public library. 
(iii) A university or college. 
(iv) A local government entity. 
(v) A local health entity. 
(vi) A health-related nonprofit founda-
tion. 
(vii) An academic health center. 
An eligible entity may include for-profit entities so 
long as the recipient of the grant is a not-for-profit 
entity. 
(c) PREFERENCE.—The Secretary shall establish pro-
cedures to prioritize financial assistance under this section 
based upon the following considerations: 
(1) The applicant is a health care provider in 
a health care network or a health care provider that 
proposes to form such a network that furnishes or 
proposes to furnish services in a medically under-
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served area, health professional shortage area, or 
mental health professional shortage area. 
(2) The applicant is able to demonstrate broad 
geographic coverage in the rural or medically under-
served areas of the State, or States in which the ap-
plicant is located. 
(3) The applicant proposes to use Federal 
funds to develop plans for, or to establish, telehealth 
systems that will link rural hospitals and rural 
health care providers to other hospitals, health care 
providers, and patients. 
(4) The applicant will use the amounts provided 
for a range of health care applications and to pro-
mote greater efficiency in the use of health care re-
sources. 
(5) The applicant is able to demonstrate the 
long-term viability of projects through cost participa-
tion (cash or in-kind). 
(6) The applicant is able to demonstrate finan-
cial, institutional, and community support for the 
long-term viability of the network. 
(7) The applicant is able to provide a detailed 
plan for coordinating system use by eligible entities 
so that health care services are given a priority over 
non-clinical uses. 
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(d) MAXIMUM AMOUNT OF ASSISTANCE TO INDI-
VIDUAL RECIPIENTS.—The Secretary shall establish, by 
regulation, the terms and conditions of the grant and the 
maximum amount of a grant award to be made available 
to an individual recipient for each fiscal year under this 
section. The Secretary shall cause to have published in the 
Federal Register or the ‘‘HRSA Preview’’ notice of the 
terms and conditions of a grant under this section and 
the maximum amount of such a grant for a fiscal year. 
(e) USE OF AMOUNTS.—The recipient of a grant 
under this section may use sums received under such 
grant for the acquisition of telehealth equipment and 
modifications or improvements of telecommunications fa-
cilities including the following: 
(1) The development and acquisition through 
lease or purchase of computer hardware and soft-
ware, audio and video equipment, computer network 
equipment, interactive equipment, data terminal 
equipment, and other facilities and equipment that 
would further the purposes of this section. 
(2) The provision of technical assistance and in-
struction for the development and use of such pro-
gramming equipment or facilities. 
(3) The development and acquisition of instruc-
tional programming. 
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(4) Demonstration projects for teaching or 
training medical students, residents, and other 
health profession students in rural or medically un-
derserved training sites about the application of tele-
health. 
(5) The provision of telenursing services de-
signed to enhance care coordination and promote pa-
tient self-management skills. 
(6) The provision of services designed to pro-
mote patient understanding and adherence to na-
tional guidelines for common chronic diseases, such 
as congestive heart failure or diabetes. 
(7) Transmission costs, maintenance of equip-
ment, and compensation of specialists and referring 
health care providers, when no other form of reim-
bursement is available. 
(8) Development of projects to use telehealth to 
facilitate collaboration between health care providers. 
(9) Electronic archival of patient records. 
(10) Collection and analysis of usage statistics 
and data that can be used to document the cost-ef-
fectiveness of the telehealth services. 
(11) Such other uses that are consistent with 
achieving the purposes of this section as approved by 
the Secretary. 
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(f) PROHIBITED USES.—Sums received under a 
grant under this section may not be used for any of the 
following: 
(1) To acquire real property. 
(2) Expenditures to purchase or lease equip-
ment to the extent the expenditures would exceed 
more than 40 percent of the total grant funds. 
(3) To purchase or install transmission equip-
ment off the premises of the telehealth site and any 
transmission costs not directly related to the grant. 
(4) For construction, except that such funds 
may be expended for minor renovations relating to 
the installation of equipment. 
(5) Expenditures for indirect costs (as deter-
mined by the Secretary) to the extent the expendi-
tures would exceed more than 15 percent of the total 
grant. 
(g) ADMINISTRATION.— 
(1) NONDUPLICATION.—The Secretary shall en-
sure that facilities constructed using grants provided 
under this section do not duplicate adequately estab-
lished telehealth networks. 
(2) COORDINATION WITH OTHER AGENCIES.— 
The Secretary shall coordinate, to the extent prac-
ticable, with other Federal and State agencies and 
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not-for-profit organizations, operating similar grant 
programs to pool resources for funding meritorious 
proposals. 
(3) INFORMATIONAL EFFORTS.—The Secretary 
shall establish and implement procedures to carry 
out outreach activities to advise potential end users 
located in rural and medically underserved areas of 
each State about the program authorized by this 
section. 
(h) PROMPT IMPLEMENTATION.—The Secretary shall 
take such actions as are necessary to carry out the grant 
program as expeditiously as possible. 
(i) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$10,000,000 for fiscal year 2009, and such sums as may 
be necessary for each of the fiscal years 2010 through 
2014. 
SEC. 202. REAUTHORIZATION OF TELEHEALTH NETWORK 
AND 
TELEHEALTH 
RESOURCE 
CENTERS 
GRANT PROGRAMS. 
Subsection (s) of section 330I of the Public Health 
Service Act (42 U.S.C. 254c–14) is amended— 
(1) in paragraph (1)— 
(A) by striking ‘‘and’’ before ‘‘such sums’’; 
and 
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(B) by inserting ‘‘$10,000,000 for fiscal 
year 2009, and such sums as may be necessary 
for each of fiscal years 2010 through 2014’’ be-
fore the semicolon; and 
(2) in paragraph (2)— 
(A) by striking ‘‘and’’ before ‘‘such sums’’; 
and 
(B) by inserting ‘‘$10,000,000 for fiscal 
year 2009, and such sums as may be necessary 
for each of fiscal years 2010 through 2014’’ be-
fore the semicolon. 
Æ 
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