I
106TH CONGRESS
2D SESSION
H. R. 4841
To amend the Balanced Budget Act of 1997 to provide increased access
to health care for Medicare beneficiaries through telehealth services.
IN THE HOUSE OF REPRESENTATIVES
JULY 12, 2000
Mr. THUNE (for himself, Mrs. EMERSON, Mr. MORAN of Kansas, Mr.
NUSSLE, Mr. POMEROY, and Mrs. CLAYTON) 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 provi-
sions as fall within the jurisdiction of the committee concerned
A BILL
To amend the Balanced Budget Act of 1997 to provide
increased access to health care for Medicare beneficiaries
through telehealth services.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Medicare Access to
Telehealth Services Act of 2000’’.
SEC. 2. REVISION OF MEDICARE REIMBURSEMENT FOR
TELEHEALTH SERVICES.
Section 4206 of the Balanced Budget Act of 1997
(42 U.S.C. 1395l note) is amended to read as follows:
‘‘(a) TELEHEALTH SERVICES REIMBURSED.—
‘‘(1) IN GENERAL.—Not later than October 1,
2000, the Secretary of Health and Human Services
shall make payments from the Federal Supple-
mentary Medical Insurance Trust Fund in accord-
ance with the methodology described in subsection
(b) for services for which payment may be made
under part B of title XVIII of the Social Security
Act (42 U.S.C. 1395j et seq.) that are furnished via
a telecommunications system by a physician or prac-
titioner to an eligible telehealth beneficiary.
‘‘(2) USE
OF
STORE-AND-FORWARD
TECH-
NOLOGIES.—For purposes of paragraph (1), in the
case of any Federal telemedicine demonstration pro-
gram in Alaska or Hawaii, the term ‘telecommuni-
cations system’ includes store-and-forward tech-
nologies that provide for the asynchronous trans-
mission of health care information in single or multi-
media formats.
‘‘(b) METHODOLOGY FOR DETERMINING AMOUNT OF
PAYMENTS.—
‘‘(1) IN GENERAL.—The Secretary shall make
payment under this section as follows:
‘‘(A) Subject to subparagraph (B), with re-
spect to a physician or practitioner located at a
distant site that furnishes a service to an eligi-
ble medicare beneficiary under subsection (a),
an amount equal to the amount that such phy-
sician or practitioner would have been paid had
the service been furnished without the use of a
telecommunications system.
‘‘(B) In the case of a referring physician
or practitioner located at the originating site
with respect to the service furnished the eligible
medicare beneficiary for which payment is made
under subparagraph (A), the amount of the
payment under subparagraph (A) shall be
shared between the physician or practitioner lo-
cated at the distant site and such referring phy-
sician or practitioner.
‘‘(C) With respect to an originating site, a
facility fee equal to—
‘‘(i) for 2000 and 2001, $20; and
‘‘(ii) for a subsequent year, the facil-
ity fee under this subsection for the pre-
vious year increased by the percentage in-
crease in the MEI (as defined in section
1842(i)(3)) for such subsequent year.
‘‘(2) APPLICATION
OF
PART
B
COINSURANCE
AND DEDUCTIBLE.—Any payment made under this
section shall be subject to the coinsurance and de-
ductible requirements under subsections (a)(1) and
(b) of section 1833 of the Social Security Act (42
U.S.C. 1395l).
‘‘(c) TELEPRESENTER NOT REQUIRED.—Nothing in
this section shall be construed as requiring an eligible tele-
health beneficiary to be presented by a physician or practi-
tioner at the originating site for the furnishing of a service
via a telecommunications system.
‘‘(d) COVERAGE OF ADDITIONAL SERVICES.—
‘‘(1) STUDY
AND
REPORT
ON
ADDITIONAL
SERVICES.—
‘‘(A) STUDY.—The Secretary of Health
and Human Services shall conduct a study to
identify services in addition to those described
in subsection (a)(1) that are appropriate for
payment under this section.
‘‘(B) REPORT.—Not later than 2 years
after the date of enactment of this Act, the Sec-
retary shall submit to Congress a report on the
study conducted under subparagraph (A) to-
gether with such recommendations for legisla-
tion that the Secretary determines are appro-
priate.
‘‘(2) IN GENERAL.—The Secretary shall provide
for payment under this section for services identified
in paragraph (1).
‘‘(e) CONSTRUCTION RELATING TO HOME HEALTH
SERVICES.—
‘‘(1) IN GENERAL.—Nothing in this section or
in section 1895 of the Social Security Act (42
U.S.C. 1395fff) shall be construed as preventing a
home health agency furnishing a home health unit of
service for which payment is made under the pro-
spective payment system established in such section
for such units of service from furnishing the service
via a telecommunications system.
‘‘(2) LIMITATION.—The Secretary shall not
consider a home health service provided in the man-
ner described in paragraph (1) to be a home health
visit for purposes of—
‘‘(A) determining the amount of payment
to be made under such prospective payment
system; or
‘‘(B) any requirement relating to the cer-
tification of a physician required under section
1814(a)(2)(C) 
of 
such 
Act 
(42 
U.S.C.
1395f(a)(2)(C)).
‘‘(f) DEFINITIONS.—In this section:
‘‘(1) ELIGIBLE TELEHEALTH BENEFICIARY.—
The term ‘eligible telehealth beneficiary’ means an
individual enrolled under part B of title XVIII of the
Social Security Act (42 U.S.C. 1395j et seq.) that
resides in—
‘‘(A) an area that is designated as a health
professional 
shortage 
area 
under 
section
332(a)(1)(A) of the Public Health Service Act
(42 U.S.C. 254e(a)(1)(A));
‘‘(B) a county that is not included in a
Metropolitan Statistical Area;
‘‘(C) an inner-city area that is medically
underserved (as defined in section 330(b)(3) of
the Public Health Service Act (42 U.S.C.
254b(b)(3))); or
‘‘(D) an area in which a Federal telemedi-
cine demonstration program is carried out.
‘‘(2) PHYSICIAN.—The term ‘physician’ has the
meaning given that term in section 1861(r) of the
Social Security Act (42 U.S.C. 1395x(r))
‘‘(3) PRACTITIONER.—The term ‘practitioner’
means—
‘‘(A) a practitioner described in section
1842(b)(18)(C) of the Social Security Act (42
U.S.C. 1395u(b)(18)(C)); and
‘‘(B) a physical, occupational, or speech
therapist.
‘‘(4) DISTANT SITE.—The term ‘distant site’
means the site at which the physician or practitioner
is located at the time the service is provided via a
telecommunications system.
‘‘(5) ORIGINATING SITE.—
‘‘(A) IN GENERAL.—The term ‘originating
site’ means any site described in subparagraph
(B) at which the eligible telehealth beneficiary
is located at the time the service is furnished
via a telecommunications system.
‘‘(B) SITES
DESCRIBED.—The sites de-
scribed in this subparagraph are as follows:
‘‘(i) On or after October 1, 2000—
‘‘(I) the office of a physician or a
practitioner,
‘‘(II) a critical access hospital (as
defined in section 1861(mm)(1) of the
Social 
Security 
Act 
(42 
U.S.C.
1395x(mm)(1))),
‘‘(III) a rural health clinic (as
defined in section 1861(aa)(2) of such
Act (42 U.S.C. 1395x(aa)(2))), and
‘‘(IV) a Federally qualified health
center 
(as 
defined 
in 
section
1861(aa)(4) of such Act (42 U.S.C.
1395x(aa)(4))).
‘‘(ii) On or after October 1, 2001—
‘‘(I) a hospital (as defined in sec-
tion 1861(e) of such Act (42 U.S.C.
1395x(e))),
‘‘(II) a skilled nursing facility (as
defined in section 1861(j) of such Act
(42 U.S.C. 1395x(j))),
‘‘(III) a comprehensive outpatient
rehabilitation facility (as defined in
section 1861(cc)(2) of such Act (42
U.S.C. 1395x(cc)(2))),
‘‘(IV) a renal dialysis facility (de-
scribed in section 1881(b)(1) of such
Act (42 U.S.C. 1395rr(b)(1))),
‘‘(V) an ambulatory surgical cen-
ter (described in section 1833(i)(1)(A)
of 
such 
Act 
(42 
U.S.C.
1395l(i)(1)(A))),
‘‘(VI) a hospital or skilled nurs-
ing facility of the Indian Health Serv-
ice (under section 1880 of such Act
(42 U.S.C. 1395qq)), and
‘‘(VII) 
a 
community 
mental
health center (as defined in section
1861(ff)(3)(B) of such Act (42 U.S.C.
1395x(ff)(3)(B))).
‘‘(6) FEDERAL SUPPLEMENTARY MEDICAL IN-
SURANCE TRUST FUND.—The term ‘Federal Supple-
mentary Medical Insurance Trust Fund’ means the
trust fund established under section 1841 of the
Social Security Act (42 U.S.C. 1395t).’’.
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