I
103D CONGRESS
1ST SESSION
H. R. 3249
To amend the Public Health Service Act to provide grants for the development
of rural telemedicine, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
OCTOBER 7, 1993
Mr. SMITH of Iowa introduced the following bill; which was referred to the
Committee on Energy and Commerce
A BILL
To amend the Public Health Service Act to provide grants
for the development of rural telemedicine, 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 ‘‘Rural Telemedicine
Development Act of 1993’’.
SEC. 2. PURPOSE.
It is the purpose of this Act to support the develop-
ment of telemedicine projects that are designed to improve
the delivery, accessability and affordability of health care
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services to Americans living in rural areas. This Act is
intended to—
(1) assist rural hospitals and other rural health
care providers in dealing with personnel shortages
and shared staffing arrangements by providing such
providers with the telecommunications technology
necessary to maintain contact with itinerant staff
and remote specialists;
(2) reduce the cost of care for rural patients
and strengthen rural health care providers by using
telecommunications technologies to permit such pa-
tients to stay in their local hospitals and to receive
other health services locally whenever possible and
appropriate, by reducing paperwork costs and by im-
proving coordination and efficiency in the delivery of
health care;
(3) provide rural health care providers with ac-
cess, via telecommunications systems, to equipment,
specialists, and continuing education programs that
are otherwise generally not available in rural areas;
and
(4) demonstrate the effectiveness of fiber optics
telecommunication systems in improving the quality
and access of health care services in rural areas.
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SEC. 3. ESTABLISHMENT OF GRANT PROGRAMS.
Title XVII of the Public Health Service Act (42
U.S.C. 300u et seq.) is amended—
(1) in the title heading by striking out ‘‘AND
HEALTH PROMOTION’’ and inserting in lieu
thereof 
‘‘, 
HEALTH 
PROMOTION 
AND
TELEMEDICINE DEVELOPMENT’’;
(2) by inserting after the title heading the fol-
lowing:
‘‘Part A—Health Information and Health Promotion’’;
and
(3) by adding at the end thereof the following
new part:
‘‘Part B—Telemedicine Development
‘‘SEC. 1711. GRANT PROGRAM FOR PROMOTING THE INI-
TIAL 
DEVELOPMENT 
OF 
RURAL
TELEMEDICINE NETWORKS.
‘‘(a) ESTABLISHMENT.—The Secretary shall award
grants to eligible entities described in section 1714(a) for
the purpose of encouraging the initial development of rural
telemedicine networks. Grants shall be awarded under this
section to encourage the formation of rural health care
networks that could benefit from the use of telecommuni-
cations technology in providing health services to rural
areas.
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‘‘(b) APPLICATION.—To be eligible to receive a grant
under this section an entity shall prepare and submit to
the Secretary an application at such time, in such manner
and containing such information as the Secretary may re-
quire, including a description of the use to which the entity
will apply any amounts received under such grant.
‘‘(c) PREFERENCE IN AWARDING GRANTS.—The Sec-
retary shall, in awarding grant under subsection (a), give
preference to applicants that—
‘‘(1) are participants in rural health care net-
works or that propose to form such networks;
‘‘(2) can demonstrate broad geographic cov-
erage in the rural areas of the State, or States in
which the applicant is located; and
‘‘(3) propose to use Federal funds to develop
plans for, or to establish, pilot telecommunications
systems that will link rural hospitals and other rural
health care providers to other hospitals, and health
care providers.
‘‘SEC. 1712. GRANT PROGRAM FOR THE ESTABLISHMENT OF
ADVANCED 
RURAL 
TELEMEDICINE 
NET-
WORKS.
‘‘(a) ESTABLISHMENT.—The Secretary shall award
grants to rural health networks for the purpose of linking
such networks together using advanced telemedicine sys-
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tems. Grants shall be awarded under this section to fur-
ther develop telemedicine projects initiated by these rural
health care networks.
‘‘(b) APPLICATION.—To be eligible to receive a grant
under this section an entity shall prepare and submit to
the Secretary an application at such time, in such manner
and containing such information as the Secretary may re-
quire, including a description of the use to which the entity
will apply any amounts received under such grant.
‘‘(c) MINIMUM
QUALIFICATIONS.—The Secretary
may not award a grant to an applicant under subsection
(a) unless—
‘‘(1) the applicant is determined by the Sec-
retary to include one or more rural health network;
and
‘‘(2) the applicant can demonstrate broad geo-
graphical coverage in the rural areas of the State or
States in which it is located.
‘‘(d) PREFERENCES
IN AWARDING GRANTS.—The
Secretary shall, in awarding grants under subsection (a),
give preference to qualified applicants that—
‘‘(1) can demonstrate that a majority of the
hospitals and other providers participating in the ap-
plicant group have functioned as networks for at
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least 1 year prior to applying for funding under this
section; and
‘‘(2) will use amounts provided under the grant
to provide a range of telecommunications applica-
tions such as teleradiology, telepathology, interactive
video consultation and remote educational services
and to promote areawide health planning and great-
er efficiency in administrative activities.
‘‘SEC. 1713. GRANT PROGRAM FOR THE ESTABLISHMENT OF
ADVANCED 
FIBER 
OPTIC 
BASED 
RURAL
TELEMEDICINE NETWORKS.
‘‘(a) ESTABLISHMENT.—The Secretary shall award
grants to rural health networks for the purpose of linking
these networks to existing fiber optic telecommunications
systems.
‘‘(b) APPLICATION.—To be eligible to receive a grant
under this section an entity shall prepare and submit to
the Secretary an application at such time, in such manner
and containing such information as the Secretary may re-
quire, including a description of the use to which the entity
will apply any amounts received under such grant.
‘‘(c) MINIMUM
QUALIFICATIONS.—The Secretary
may not award a grant to an applicant under subsection
(a) unless—
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core and fiber cladding that can guide a lightwave
and that are incorporated into an assembly of mate-
rials that provide tensile strength and external pro-
tection.
‘‘(4) INTERACTIVE
VIDEO
EQUIPMENT.—The
term ‘interactive video equipment’ means equipment
used to produce and prepare for transmission audio
and visual signals from at least two distant locations
in order that individuals at such locations can ver-
bally and visually communicate with each other, and
such equipment includes monitors, other display de-
vices, cameras or other recording devices, audio pick-
up devices, and other related equipment.
‘‘(5) HEALTH
CARE
NETWORK.—The term
‘rural health care network’ means a group of rural
hospitals or other rural health care providers (in-
cluding clinics, physicians and non-physician pri-
mary care providers) that have entered into a formal
relationship with each other or with nonrural hos-
pitals and health care providers for the purpose of
strengthening the delivery of health care services in
rural areas or specifically to improve their patients’
access to telemedicine services. At least 75 percent
of hospitals and other health care providers partici-
pating in the network shall be located in rural areas.
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‘‘(6) STATEWIDE
FIBER
OPTIC
CABLE
SYS-
TEM.—The term ‘Statewide fiber optic cable system’
means a telecommunications system that will carry
voice, data, and full motion video traffic through
fiber optic cable to a point of presence in every coun-
ty in the State in which it is located.
‘‘(7) TELECOMMUNICATIONS TERMINAL EQUIP-
MENT.—The term ‘telecommunications terminal
equipment’ means the assembly of telecommuni-
cations equipment to the end of a circuit, normally
located on the premises of the end user, that inter-
faces with telecommunications transmission facili-
ties, and that is used to modify, convert, encode, or
otherwise prepare signals to be transmitted via such
telecommunications facilities, or that is used to mod-
ify, reconvert or carry signals received from such fa-
cilities, the purpose of which is to accomplish the
goal for which the circuit was established.
‘‘(8) 
TELECOMMUNICIATIONS
TRANSMISSION
FACILITIES.—The term ‘telecommunications trans-
mission facilities’ means these facilities that trans-
mit, receive, or carry data between the telecommuni-
cations terminal equipment at each end of a tele-
communications circuit or path. Such facilities in-
clude microwave antennae, relay stations and towers,
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other telecommunications antennae, fiber-optic ca-
bles and repeaters, coaxial cables, communication
satellite ground station complexes, copper cable elec-
tronic equipment associated with telecommunications
transmissions, and similar items as defined by the
Secretary.
‘‘SEC. 1717. AUTHORIZATION OF APPROPRIATIONS.
‘‘For the purposes of carrying out this part, there are
authorized to be appropriated such sums as may be nec-
essary for each of the fiscal years 1994 through 1997.’’.
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