I 
109TH CONGRESS 
2D SESSION 
H. R. 6394 
To facilitate the provision of telehealth services, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 6, 2006 
Mr. JEFFERSON introduced the following bill; which was referred to the Com-
mittee on Energy and 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 facilitate the provision of telehealth services, and for 
other purposes. 
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 ‘‘Telehealth and Medi-
cally Underserved and Advancement Act of 2006’’. 
SEC. 2. FINDINGS. 
The Congress finds as follows: 
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(1) Studies state that telehealth improves ac-
cess to medical care for geographically or socio-eco-
nomically isolated patients. 
(2) Research has consistently shown that the 
use of telehealth is a major factor in preventing un-
necessary patient travel to secondary or tertiary 
health care centers. 
(3) Literature states that the use of telehealth 
can augment the quality, continuity, and afford-
ability of medical care. 
(4) The practice of teleheatlh preserves the pa-
tient’s current provider-to-patient relationship while 
facilitating access to specialty care. 
(5) The use of telehealth will ensure educational 
and training support for rural-based providers and 
remove the obstacle of professional isolation. 
(6) Telehealth allows patients to obtain medical 
consultation in their own communities, and the ex-
panded use of telehealth technology will improve the 
quality of chronic disease care, increase wellness ini-
tiatives, and reduce health disparities for patients. 
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SEC. 3. INCREASING TYPES OF ORIGINATING TELEHEALTH 
SITES AND FACILITATING THE PROVISION OF 
TELEHEALTH 
SERVICES 
ACROSS 
STATE 
LINES. 
(a) INCREASING TYPES OF ORIGINATING SITES.— 
Section 1834(m)(4)(C)(ii) of the Social Security Act (42 
U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding at the 
end the following: 
‘‘(VI) A skilled nursing facility 
(as defined in section 1819(a)). 
‘‘(VII) An assisted-living facility 
(as defined by the Secretary). 
‘‘(VIII) A board-and-care home 
(as defined by the Secretary). 
‘‘(IX) A county or community 
health clinic (as defined by the Sec-
retary). 
‘‘(X) A community mental health 
center 
(as 
described 
in 
section 
1861(ff)(2)(B)). 
‘‘(XI) A facility operated by the 
Indian Health Service or by an Indian 
tribe, tribal organization, or an urban 
Indian organization (as such terms 
are defined in section 4 of the Indian 
Health Care Improvement Act (25 
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U.S.C. 1603)) directly, or under con-
tract or other arrangement. 
‘‘(XII) A site in a State in which 
the respective State medical board has 
adopted a formal policy regarding li-
censing or certification requirements 
for providers at distant sites who do 
not have a license to practice medicine 
at the originating site.’’. 
(b) EXPANDING
ELIGIBILITY
FOR
REIMBURSE-
MENT.—Section 1834(m)(4)(C)(i)(I) of the Social Secu-
rity Act (42 U.S.C. 1395m(m)(4)(C)(i)(I)) is amended by 
striking ‘‘rural’’. 
SEC. 
4. 
STRENGTHENING 
TELEHEALTH 
SERVICES 
IN 
RURAL AND UNDERSERVED URBAN AMERICA. 
Subpart I of part D of title III of the Public Health 
Service Act (42 U.S.C. 254b et seq.) is amended— 
(1) in section 330L— 
(A) by redesignating subsection (b) as sub-
section (c); and 
(B) by inserting after subsection (a) the 
following: 
‘‘(b) CONFERENCE.—Within 2 years of the date of 
enactment of the Telehealth Medically Underserved and 
Advancement Act of 2006, the Secretary shall convene a 
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conference of State licensing boards, local telehealth 
projects, health care practitioners, and patient advocates 
to promote interstate licensure for telehealth projects.’’; 
and 
(2) by inserting after section 330L the fol-
lowing: 
‘‘SEC. 330M. INTEGRATIVE ELDERCARE TELEHEALTH DEM-
ONSTRATION PROJECT. 
‘‘(a) PURPOSES.—The purposes of this section are to 
encourage the creation of programs to— 
‘‘(1) evaluate the use of telehealth services in 
an integrative eldercare setting; 
‘‘(2) eliminate fragmented service delivery while 
promoting enhanced continuity of care, elimination 
of health disparities, and more simplified access to 
services; 
‘‘(3) develop community-based options that pro-
mote patient independence and leverage telehealth 
services and equipment to enable the use of the most 
cost-effective, least restrictive care settings; and 
‘‘(4) promote access for elderly patients in rural 
and underserved urban areas to improvements in 
medical technology and training across an integrated 
spectrum of care; and 
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‘‘(5) make health care services more flexible 
and responsive to the diverse and changing needs of 
elderly patients in rural areas. 
‘‘(b) GRANTS AUTHORIZED.— 
‘‘(1) IN GENERAL.—The Director may award 
grants to eligible providers for projects to dem-
onstrate how telehealth technologies can be used 
through telehealth networks in rural areas, frontier 
communities, and medically underserved areas, and 
for medically underserved populations, to— 
‘‘(A) expand access to, coordinate, and im-
prove the quality of health care services; 
‘‘(B) improve and expand the training of 
health care providers; 
‘‘(C) expand and improve the quality of 
health information available to health care pro-
viders, and patients and their families, for deci-
sion making; and 
‘‘(D) expand and improve efforts to elimi-
nate health care disparities. 
‘‘(2) GRANT
PERIOD.—The Director shall 
award grants under this subsection for a period of 
up to 5 years. 
‘‘(3) NUMBER OF GRANTS.—Not to exceed 50 
grants shall be awarded under this subsection, of 
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which at least 1⁄2 shall be dedicated to providing 
services in rural communities. 
‘‘(c) USE OF FUNDS.—Grants awarded pursuant to 
subsection (b) may be used for activities including— 
‘‘(1) improving access to coordinated health 
care services and resource levels of care consistent 
with quality health care services and optimal patient 
outcomes, improving the quality of such care, in-
creasing patient satisfaction with such care, and re-
ducing the cost of such care through advanced tele-
communication technologies; 
‘‘(2) developing effective care management 
practices and educational curricula to train health 
care professionals, paraprofessionals, and caregivers, 
including family members, and to increase the gen-
eral level of competency of such individuals through 
such training; and 
‘‘(3) developing culturally competent curricula 
to train health care professionals, paraprofessionals, 
and caregivers, including family members, serving 
integrative eldercare patients in the use of tele-
communications. 
‘‘(d) APPLICATIONS.—To be eligible to receive a 
grant under subsection (b), an eligible provider, in con-
sultation with the appropriate State office of rural health 
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or another appropriate State entity, shall prepare and sub-
mit to the Director an application, at such time, in such 
manner, and containing such information as the Director 
may require, including— 
‘‘(1) a description of the project that the eligi-
ble entity will carry out using the funds provided 
under the grant; 
‘‘(2) a description of the manner in which the 
project funded under the grant will meet the health 
care needs of rural or other populations to be served 
through the project, or improve the access to serv-
ices of, and the quality of the services received by, 
those populations; 
‘‘(3) evidence of local support for the project, 
and a description of how the areas, communities, or 
populations to be served will be involved in the devel-
opment and ongoing operations of the project; 
‘‘(4) a plan for sustaining the project after Fed-
eral support for the project has ended; 
‘‘(5) information on the source and amount of 
non-Federal funds that the entity will provide for 
the project; 
‘‘(6) information demonstrating the long-term 
viability of the project, and other evidence of institu-
tional commitment of the entity to the project; 
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‘‘(7) information on how services will be used to 
eliminate health care disparities; 
‘‘(8) in the case of an application for a project 
involving a telehealth network, information dem-
onstrating how the project will promote the integra-
tion of telehealth technologies into the operations of 
health care providers, to avoid redundancy, and im-
prove access to and the quality of care; and 
‘‘(9) other such information as the Director de-
termines to be appropriate. 
‘‘(e) REPORT.— 
‘‘(1) FINAL REPORT.—Not later than 1 year 
after the date of termination of the last grant to be 
awarded under this section, the Director shall sub-
mit to Congress a final report— 
‘‘(A) describing the results of the programs 
funded by grants awarded pursuant to this sec-
tion; and 
‘‘(B) evaluating the impact of the use of 
telehealth services in an integrative eldercare 
setting on— 
‘‘(i) access to care for patients served 
by integrative eldercare programs; and 
‘‘(ii) the quality of, patient satisfac-
tion with, and the cost of, such care. 
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‘‘(2) ENSURING ACCESS TO QUALITY CARE.—In 
conducting the evaluation under paragraph (1)(B), 
the Director shall— 
‘‘(A) give special consideration to the im-
pact of programs funded under this section on 
face-to-face access to medical providers; and 
‘‘(B) develop specific measures to evaluate 
the quality of care provided to those partici-
pating in such programs to ensure that tele-
health augments the plan of care. 
‘‘(f) ELIGIBLE PROVIDER.—The term ‘eligible pro-
vider’ means a consortia of home and facility-based care 
providers that includes providers from no less than 2 of 
the following: 
‘‘(1) An adult congregate care facility. 
‘‘(2) A continuing care retirement community. 
‘‘(3) An assisted living facility. 
‘‘(4) An Alzheimer’s facility. 
‘‘(5) An institutional hospice facility. 
‘‘(6) A residential care facility. 
‘‘(7) An adult foster home. 
‘‘(8) A State-licensed nursing home, including a 
skilled nursing facility, an intermediate care facility, 
licensed home health provider or other health care 
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provider that the Director deems appropriate and 
consistent with the purposes of this section. 
‘‘(g) DEFINITIONS.—In this section: 
‘‘(1) DIRECTOR; OFFICE.—The terms ‘Director’ 
and ‘Office’ mean the Director of the Office for the 
Advancement of Telehealth and the Office for the 
Advancement of Telehealth, respectively. 
‘‘(2) INTEGRATIVE ELDERCARE.—The term ‘in-
tegrative eldercare’ includes case management and 
coordination of care for elderly patients recovering 
from acute illness or coping with chronic disease at 
the lowest intensity and resource level of care con-
sistent with quality health care services and optimal 
patient outcomes. 
‘‘(3) TELEHEALTH SERVICES.—The term ‘tele-
health services’ means services provided through 
telehealth technologies. 
‘‘(4) TELEHEALTH TECHNOLOGIES.—The term 
‘telehealth technologies’ means technologies relating 
to the use of electronic information, and tele-
communications technologies, to support and pro-
mote, at a distance, health care, patient and profes-
sional health-related education, health administra-
tion, and public health. 
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‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to the Office for the Ad-
vancement of Telehealth to carry out this section 
$45,000,000 for fiscal year 2007 and such sums as may 
be necessary for each of fiscal years 2008 through 2012. 
‘‘SEC. 330N. ORAL HEALTH TELEHEALTH DEMONSTRATION 
PROJECT. 
‘‘(a) PURPOSE.—The purpose of this section is to 
evaluate the use of telehealth services to expand access 
to oral health services and improve oral health outcomes 
among rural and underserved urban patients. 
‘‘(b) GRANTS AUTHORIZED.— 
‘‘(1) IN GENERAL.—The Director is authorized 
to award competitive grants to eligible providers, in-
dividually or as part of a network of eligible pro-
viders, for the provision of oral health services to im-
prove patient care, prevent health care complica-
tions, improve patient outcomes, and achieve effi-
ciencies in the delivery of oral health care to patients 
who reside in rural areas. 
‘‘(2) GRANT
PERIOD.—The Director shall 
award grants under this section for a period of up 
to 5 years. 
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‘‘(3) NUMBER
OF
GRANTS.—The number of 
grants awarded under this section shall not exceed 
30 grants. 
‘‘(c) USE OF FUNDS.—Grants awarded pursuant to 
subsection (b) may be used for activities including— 
‘‘(1) improving access to care for rural and un-
derserved urban patients served by eligible providers, 
improving the quality of that care, increasing patient 
satisfaction with that care, and reducing the cost of 
that care through advanced telecommunication tech-
nologies; 
‘‘(2) developing effective oral telehealth care 
management practices and culturally competent edu-
cational curricula to train oral health professionals 
and paraprofessionals and increase their general 
level of competency through that training; and 
‘‘(3) developing culturally competent curricula 
to train health care professionals and paraprofes-
sionals, serving rural and underserved urban pa-
tients in the use of telecommunications. 
‘‘(d) APPLICATIONS.—To be eligible to receive a 
grant under subsection (b), an eligible entity, in consulta-
tion with the appropriate State office of rural health or 
another appropriate State entity, shall prepare and submit 
to the Director an application, at such time, in such man-
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ner, and containing such information as the Director may 
require, including— 
‘‘(1) a description of the project that the eligi-
ble entity will carry out using the funds provided 
under the grant; 
‘‘(2) a description of the manner in which the 
project funded under the grant will meet the health 
care needs of rural or other populations to be served 
through the project, or improve the access to serv-
ices of, and the quality of the services received by, 
those populations; 
‘‘(3) evidence of local support for the project, 
and a description of how the areas, communities, or 
populations to be served will be involved in the devel-
opment and ongoing operations of the project; 
‘‘(4) a plan for sustaining the project after Fed-
eral support for the project has ended; 
‘‘(5) information on the source and amount of 
non-Federal funds that the entity will provide for 
the project; 
‘‘(6) information demonstrating the long-term 
viability of the project, and other evidence of institu-
tional commitment of the entity to the project; 
‘‘(7) information on how services will be used to 
eliminate health care disparities; 
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‘‘(8) in the case of an application for a project 
involving a telehealth network, information dem-
onstrating how the project will promote the integra-
tion of telehealth technologies into the operations of 
health care providers, to avoid redundancy, and im-
prove access to and the quality of care; and 
‘‘(9) other such information as the Director de-
termines to be appropriate. 
‘‘(e) REPORT.— 
‘‘(1) FINAL REPORT.—Not later than 1 year 
after the date of termination of the last grant to be 
awarded under this section, the Director shall sub-
mit to Congress a final report— 
‘‘(A) describing the results of the programs 
funded by grants awarded pursuant to this sec-
tion; and 
‘‘(B) including an evaluation of the impact 
of the use of oral telehealth services on— 
‘‘(i) access to oral health care for 
rural patients; and 
‘‘(ii) the quality of, patient satisfac-
tion with, and the cost of, that care. 
‘‘(2) ENSURING ACCESS TO QUALITY CARE.—In 
conducting the evaluation under paragraph (1)(B), 
the Director shall— 
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‘‘(A) give special consideration to the im-
pact of programs funded under this section on 
face-to-face access to medical providers; and 
‘‘(B) develop specific measures to evaluate 
the quality of care provided to those partici-
pating in such programs to ensure that tele-
medicine augments the plan of care. 
‘‘(f) DEFINITION OF ELIGIBLE PROVIDER.—In this 
section, the term ‘eligible provider’ includes dentists, 
periodontists, orthodontists, dental and oral health clinics, 
and schools of dentistry and oral health, where a majority 
of the patient population resides in a rural area, and may 
include other rural oral health providers that the Director 
deems appropriate. 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$30,000,000 for fiscal year 2007 and such sums as may 
be necessary for each of fiscal years 2008 through 2010.’’. 
SEC. 5. JOINT WORKING GROUP ON TELEHEALTH. 
(a) IN GENERAL.— 
(1) REPRESENTATION OF RURAL AND URBAN 
AREAS.—The Secretary of Health and Human Serv-
ices shall establish, within the Office for the Ad-
vancement of Telehealth in the Health Resources 
and Services Administration, and under the leader-
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ship of the Director of such Office, a Joint Working 
Group on Telehealth. In establishing such Group, 
the Secretary shall ensure that all relevant Federal 
agencies are represented and that input from rel-
evant industry groups, including representatives of 
rural areas and medically underserved areas, is fully 
considered. 
(2) MISSION.—The mission of the Joint Work-
ing Group on Telehealth is— 
(A) to identify, monitor, and coordinate 
Federal telehealth projects, data sets, and pro-
grams in rural and urban areas; 
(B) to analyze— 
(i) how telehealth systems are expand-
ing access to health care services, edu-
cation, and information; 
(ii) the clinical, educational, or admin-
istrative efficacy and cost-effectiveness of 
telehealth applications; and 
(iii) the quality of the telehealth serv-
ices delivered; 
(iv) how telehealth systems can ad-
vance the improvement of health care qual-
ity and the elimination of health care dis-
parities; and 
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(v) the level of Federal resources 
needed to accomplish the stated objectives 
of telehealth programs as established 
under this Act; and 
(C) to make further recommendations for 
coordinating Federal and State efforts to in-
crease access to health services, education, and 
information in rural and urban medically un-
derserved areas . 
(3) ANNUAL REPORTS.—Not later than 2 years 
after the date of enactment of this Act, and each 
January 1 thereafter, the Joint Working Group on 
Telehealth shall submit to Congress a report on the 
status of the Group’s mission and the state of the 
telehealth field generally. 
(b) REPORT SPECIFICS.—The annual report required 
under subsection (a)(3) shall provide— 
(1) an analysis of— 
(A) the matters described in subsection 
(a)(2)(B); 
(B) Federal activities with respect to tele-
health; and 
(C) the process of the Joint Working 
Group on Telehealth’s efforts to coordinate 
Federal telehealth programs; and 
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(2) recommendations for a coordinated Federal 
strategy to increase health care access through tele-
health. 
(c) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary to enable the Joint Working Group on Tele-
health to carry out this section. 
Æ 
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