I 
116TH CONGRESS 
1ST SESSION H. R. 5190 
To amend the Public Health Service Act to provide assistance for health 
centers and rural health clinics to implement electronic provider consulta-
tion and related telemedicine services. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 20, 2019 
Mr. HARDER of California (for himself, Mr. YOUNG, Mr. FORTENBERRY, Ms. 
TORRES SMALL of New Mexico, and Mr. STEUBE) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce 
A BILL 
To amend the Public Health Service Act to provide assist-
ance for health centers and rural health clinics to imple-
ment electronic provider consultation and related tele-
medicine 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 ‘‘Specialty Treatment 
to Access and Referrals Act of 2019’’ or the ‘‘STAR Act’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
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(1) Telemedicine involving the delivery of safe, 
effective, quality health care services by a health 
care provider using electronic information technology 
as the mode of care delivery is a clinically appro-
priate and efficient method of furnishing many 
health care services. 
(2) Consultations between health care providers 
utilizing electronic information technology (in this 
section referred to as ‘‘E–Consult services’’) are fea-
sible in a variety of settings, flexible in their applica-
tion, and particularly useful in facilitating the timely 
provision of information from a clinician with spe-
cialized knowledge of a relevant medical subject mat-
ter to a treating clinician in order to improve care 
quality. 
(3) E–Consult services formalize the role of 
medical specialists, can be undertaken entirely with-
in electronic exchange platforms that are private and 
secure, and do not require synchronous communica-
tion between providers. 
(4) E–Consult services conducted in advance of 
a telemedicine service can improve the effectiveness 
of the subsequent telemedicine service. 
(5) E–Consult services are being utilized exten-
sively by the Veterans Health Administration and by 
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a growing number of academic medical centers and 
other public and private health care settings both in 
the United States and internationally. 
(6) There is a need for additional extensive and 
rigorous research studies to determine best practices 
and processes for E–Consult services and to validate 
the impact on access to specialty medical care, costs, 
and clinical outcomes. 
(7) Providing the expertise and technical assist-
ance necessary to implement E–Consult services in 
primary care settings could improve access to spe-
cialty care at relatively low cost while simultaneously 
providing a testbed to evaluate the merits of varying 
approaches to E–Consult services, ascertain the 
value of such programs, and experiment with service 
reimbursement strategies in fee-for-service environ-
ments, including value-based care delivery arrange-
ments such as through accountable care organiza-
tions. 
SEC. 3. E–CONSULT SERVICES AND RELATED TELEHEALTH 
ASSISTANCE PILOT PROGRAM. 
Title III of the Public Health Service Act is amended 
by inserting after section 330M (42 U.S.C. 254c–19) the 
following new section: 
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‘‘SEC. 330N. E–CONSULT SERVICES AND RELATED TELE-
HEALTH ASSISTANCE PILOT PROGRAM. 
‘‘(a) IN GENERAL.—The Secretary may award grants 
to eligible health center controlled networks, health cen-
ters, and rural health clinics described in subsection (e) 
to conduct pilot projects to implement and test the effec-
tiveness of E–Consult services and related telehealth serv-
ices furnished at such networks, centers, and clinics for 
purposes of addressing the goals described in subsection 
(b). 
‘‘(b) OBJECTIVES.—A pilot project conducted pursu-
ant to a grant awarded under subsection (a) shall address 
the following goals: 
‘‘(1) Improvement in patient access to specialty 
care. 
‘‘(2) Reduction in specialty care patient wait 
times. 
‘‘(3) Reduction in patient specialty referrals. 
‘‘(4) Reduction in patient miles traveled for 
specialty care consultations. 
‘‘(5) Increased support for primary care pro-
viders as demonstrated by job satisfaction measures. 
‘‘(6) Increased patient satisfaction as dem-
onstrated by quality surveys. 
‘‘(7) Health care cost savings. 
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‘‘(8) Such other goals as the Secretary may 
identify. 
‘‘(c) DURATION; AMOUNT.— 
‘‘(1) DURATION.—A grant awarded under sub-
section (a) shall be for a term of no more than 5 
years. 
‘‘(2) AMOUNT.—In the case of a grant made 
under subsection (a) directly to an eligible health 
center or rural health clinic, the amount provided 
may not exceed $200,000 for each center or clinic 
facility location. In the case of an award to an eligi-
ble health center controlled network, the amount 
provided may not exceed $5,000,000, and the value 
of the amount of assistance provided by such net-
work to any individual participating health center or 
rural clinic facility location may not exceed 
$200,000. 
‘‘(d) USE OF FUNDS.—Funds provided under a grant 
pursuant to this section may only be used for the fol-
lowing, with respect to a pilot project conducted by a 
health center controlled network, health center, or rural 
health clinic: 
‘‘(1) Conducting assessments of a participating 
facility’s infrastructure (such as broadband, equip-
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ment, and software), clinical objectives, and staffing 
plans. 
‘‘(2) Based on assessment findings, developing 
and assisting in the execution of equipment and soft-
ware procurement, defining clinical objectives, devel-
oping adequate staffing plans, and implementing E– 
Consult services and related telehealth services pro-
gram plan. 
‘‘(3) Training participating facility staff to 
properly utilize technology and implement programs. 
‘‘(4) Providing clinical workflow training to 
support program implementation. 
‘‘(5) Providing integrated certified EHR tech-
nology capabilities to support live video (where appli-
cable) and E–Consult services. 
‘‘(6) Integrating the facility with live E–Consult 
service support providers and networks that meet 
the patient goals of the network, center, or clinic. 
‘‘(7) Procuring appropriate information tech-
nology and undertaking minor alterations of physical 
space. 
‘‘(8) Otherwise carrying out the pilot project to 
address the objectives described in subsection (b). 
‘‘(e) PARTICIPATING FACILITIES; ELIGIBLE ENTI-
TIES.— 
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‘‘(1) PARTICIPATING FACILITIES.—A location of 
a health center or rural health clinic shall qualify to 
participate in a pilot program established pursuant 
to this section if the center or clinic demonstrates in 
a manner determined by the Secretary that such lo-
cation— 
‘‘(A) lacks sufficient access to care pro-
vided by medical specialists, as determined by 
the Secretary; and 
‘‘(B) has not already implemented a pro-
gram of E–Consult services and related tele-
health services similar to that described in this 
section. 
‘‘(2) REQUIREMENTS TO BE ELIGIBLE TO RE-
CEIVE A GRANT.—To be eligible to receive a grant 
under subsection (a), an entity must— 
‘‘(A) be— 
‘‘(i) a health center controlled network 
that demonstrates to the satisfaction of the 
Secretary— 
‘‘(I) sufficient expertise and expe-
rience in the successful provision of 
the technical and other assistance re-
quired under for health centers and 
rural health clinics to conduct a pilot 
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project in accordance with this sec-
tion; 
‘‘(II) evidence of sufficient bind-
ing participation commitments re-
ceived from eligible health centers and 
rural health clinics; 
‘‘(III) the ability to assist eligible 
health centers and rural health clinics 
to conduct E–Consult services with 
medical specialists and related tele-
health services; and 
‘‘(IV) a likelihood of successfully 
accomplishing the program objectives 
as identified in subsection (b); or 
‘‘(ii) a qualifying health center or 
rural health clinic that demonstrates to the 
satisfaction of the Secretary— 
‘‘(I) sufficient expertise and abil-
ity to implement on its own behalf the 
technical and other assistance de-
scribed in subparagraph (A)(i); 
‘‘(II) a likelihood of successfully 
implementing a program of E–Consult 
services with medical specialists and 
related telehealth services; and 
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‘‘(III) a likelihood of successfully 
accomplishing the program objectives 
as identified in subsection (b); and 
‘‘(B) submit an application described in 
paragraph (3) to the Secretary in such form 
and manner, and in accordance with such tim-
ing, as specified by the Secretary. 
‘‘(3) APPLICATION.—For purposes of para-
graph (2)(B), an application described in this para-
graph, with respect to an applicant, is an application 
that demonstrates to the satisfaction of the Sec-
retary— 
‘‘(A) in the case of an applicant that is a 
health center controlled network, the intention 
of a sufficient minimum number of eligible 
health centers to participate in the program 
through the network and a plan for recruiting 
additional centers to participate; 
‘‘(B) the qualification of proposed facility 
locations to participate in the program; 
‘‘(C) requisite experience, expertise, and 
capacity; 
‘‘(D) likelihood of meeting program objec-
tives described in subsection (b); and 
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‘‘(E) internal program metrics that will be 
employed to demonstrate satisfaction of pro-
gram objectives and information to be collected 
and provided to the Secretary as necessary to 
conduct program evaluation. 
‘‘(f) EVALUATION; REPORT.—Not later than 180 
days after the date of the completion of the last pilot 
projects funded under this section, the Secretary shall sub-
mit to Congress a report, including an evaluation, on the 
projects that addresses the following: 
‘‘(1) An overview of supported projects and 
identification of areas of success and failure. 
‘‘(2) Policies, practices, and organizational ap-
proaches that either facilitate or impede the effective 
use of E–Consult services (including personnel train-
ing and support, technology usability, workflow, and 
provider communication). 
‘‘(3) Relative effectiveness of consultations pro-
vided by Medical Specialists in improving outcomes, 
quality of care and efficiency with respect to dif-
ferent specialties, clinical conditions, complexity, pa-
tient types, or other issues. 
‘‘(4) The extent to which information shared in 
the E–Consult services process is sufficient, accu-
rate, and actionable in order to effectively facilitate 
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care improvement, and whether such bi-directional 
information flows can be standardized. 
‘‘(5) The extent to which E–Consults facilitate 
continuity of care. 
‘‘(6) Any issues arising related to maintaining 
the privacy of personal health information, ensuring 
cybersecurity, and other information security issues. 
‘‘(7) The extent to which E–Consult services 
contribute to improved health outcomes and metrics 
that can facilitate such evaluation. 
‘‘(8) Any unintended or adverse results from 
utilizing E–Consult services. 
‘‘(g) DEFINITIONS.—For purposes of this section: 
‘‘(1) CERTIFIED EHR TECHNOLOGY.—The term 
‘certified EHR technology’ has the meaning given 
such term in section 3000(1). 
‘‘(2) E–CONSULT SERVICE.—The term ‘E–Con-
sult service’ means synchronous or asynchronous, 
consultative, health-care-provider-to-health-care-pro-
vider communications that occur within a shared 
certified EHR technology or secure internet-based 
platform and are primarily intended to provide spe-
cialty expertise to treating clinicians (who are often 
primary care providers) without requiring a direct 
interaction between the patient and the medical spe-
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cialist. Such consultation ordinarily involves a treat-
ing clinician sending information regarding the pa-
tient and a consultation request to a medical spe-
cialist who may then respond in any of a number of 
ways, including providing requested feedback, asking 
for additional information, recommending certain 
studies or examinations, or initiating the scheduling 
of an appointment. 
‘‘(3) HEALTH CENTER.—The term ‘health cen-
ter’ has the meaning given such term in section 
330(a). 
‘‘(4) HEALTH
CENTER
CONTROLLED
NET-
WORK.—The term ‘health center controlled network’ 
means a network that is owned and controlled by 
constituent health centers as described in section 
330(e)(1)(C). 
‘‘(5) PRIMARY CARE PROVIDER.—The term ‘pri-
mary care provider’ means a licensed health profes-
sional (as defined in section 1819(b)(5)(G) of the 
Social Security Act) or a licensed provider of behav-
ioral health services who customarily provides serv-
ices described in paragraph (1) or (2) of section 
330(b) to patients. 
‘‘(6) MEDICAL SPECIALIST.—The term ‘medical 
specialist’ means a licensed physician or a nurse 
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practitioner who has completed advanced education 
and clinical training in a one or more specific areas 
of medicine and focuses their medical practice on 
such area or areas. Such term may, if specified by 
the Secretary, include a licensed provider of behav-
ioral health services. 
‘‘(7) RELATED
TELEHEALTH
SERVICES.—The 
term ‘related telehealth services’ means telehealth 
services arising out of or incident to an E–Consult 
service, such as laboratory tests, diagnostic imaging, 
or a subsequent interaction between a medical spe-
cialist and a patient. 
‘‘(8) RURAL HEALTH CLINIC.—The term ‘rural 
health clinic’ has the meaning give such term in sec-
tion 1861(aa)(2) of the Social Security Act. 
‘‘(9) 
TELEHEALTH.—The 
term 
‘telehealth’ 
means the use of electronic information and tele-
communications technologies (including videoconfer-
encing, the internet, store-and-forward imaging, 
streaming media, and terrestrial and wireless com-
munications) to support and promote long-distance 
clinical health care, patient and professional health- 
related education, public health, and health adminis-
tration. 
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‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$12,000,000 for each of fiscal years 2021 through 2025.’’. 
Æ 
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