I
104TH CONGRESS
2D SESSION
H. R. 4268
To provide for a project to demonstrate the application of telemedicine and
medical informatics to improving the quality and cost-effectiveness in
the delivery of health care services under the Medicare program and
other health programs.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 27, 1996
Mr. RANGEL (for himself and Mr. HOUGHTON) 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 de-
termined by the Speaker, in each case for consideration of such provisions
as fall within the jurisdiction of the committee concerned
A BILL
To provide for a project to demonstrate the application of
telemedicine and medical informatics to improving the
quality and cost-effectiveness in the delivery of health
care services under the Medicare program and other
health programs.
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 Telemedicine
and Medical Informatics Demonstration Act of 1996’’.
SEC. 2. INFORMATICS, TELEMEDICINE, AND EDUCATION
DEMONSTRATION PROJECT.
(a) PURPOSE AND AUTHORIZATION.—
(1) IN GENERAL.—Under section 1142 of the
Social Security Act and consistent with this section,
the Secretary of Health and Human Services,
through the Agency for Health Care Policy and Re-
search, shall make a grant to an eligible grantee to
provide for a project to demonstrate the application
of high-capacity computing and advanced networks
to the provision of health care to both residents of
medically underserved rural areas and residents of
medically underserved inner-city areas.
(2) FOCUS.—The project shall focus on—
(A) improvements in primary care (and
prevention of complications) for those residents
with diabetes (mellitus), and
(B) those residents who are Medicare bene-
ficiaries.
(3) DURATION OF PROJECT.—The project shall
be conducted over a 4-year period.
(4) AUTHORIZATION OF APPROPRIATIONS; MED-
ICARE
AND
MEDICAID
WAIVER
AUTHORITY.—The
total amount of Federal expenditures that may be
provided pursuant to this section under the project
shall not exceed $30,000,000. Subject to such limi-
tation, the Secretary may waive such provisions of
title XVIII and XIX of the Social Security Act as
may be appropriate in order to permit and dem-
onstrate the provision of Medicare and Medicaid
funding under the project.
(b) OBJECTIVES OF PROJECT.—The objectives of the
project include the following:
(1) Improving patient access to and compliance
with appropriate care guidelines for chronic diseases
through direct telecommunications link with infor-
mation networks in order to improve patient quality-
of-life and reduce overall health care costs.
(2) Developing a curriculum to train, and pro-
viding standards for credentialing and licensure of,
health professionals (particularly primary care
health 
professionals) 
in 
the 
use 
of 
medical
informatics and telecommunciations.
(3) Demonstrating the application of advanced
technologies, such as video-conferencing from a pa-
tient’s home, remote monitoring of a patient’s medi-
cal condition, interventional informatics, and apply-
ing individualized, automated care guidelines, to as-
sist primary care providers in assisting patients with
chronic illnesses in a home setting.
(4) Application of medical informatics to resi-
dents with limited English language skills.
(5) Developing standards in the application of
telemedicine and medical informatics.
(6) Developing a model for the cost-effective de-
livery of primary and related care both in a managed
care environment and in a fee-for-service environ-
ment.
(c) ELIGIBLE GRANTEE.—For purposes of this sec-
tion, the term ‘‘eligible grantee’’ means a consortium that
includes at least one tertiary care hospital, at least one
medical school, and at least one regional telecommuni-
cations provider and that meets the following require-
ments:
(1) The consortium is located in an area with
a high concentration of medical schools and tertiary
care facilities and has appropriate arrangements
(within or outside the consortium) with such schools
and facilities, universities, and telecommunications
providers, in order to conduct the project.
(2) The consortium submits to the Secretary an
application at such time, in such manner, and con-
taining such information as the Secretary may re-
quire, including a description of the use to which the
consortium would apply any amounts received under
the project and the source and amount of non-Fed-
eral contribution towards the project.
(3) The consortium demonstrates that it will
provide for a contribution toward the project from
non-Federal funds or resources in an amount that is
not less than 50 percent of the total amount to be
expended in carrying out the project.
(d) USE OF FUNDS.—
(1) IN
GENERAL.—Federal payments made
available to an eligible grantee under this section
shall be used for the development and operation of
telemedicine and medical informatics systems and
related activities under the project.
(2) SPECIFIC
USES
PERMITTED.—Such pay-
ments may be used for any of the following:
(A) The acquisition of telemedicine equip-
ment for use in patients’ homes (but only in the
case of patients located in medically under-
served areas).
(B) Curriculum development and training
of health professionals in medical informatics
and telemedicine.
(C) Payment of telecommunications costs
(including salaries and maintenance of equip-
ment), including costs of telecommunications
between patients’ homes and the eligible grant-
ee and between the grantee and other entities
under the arrangements described in subsection
(c)(1).
(D) Payments to practitioners and provid-
ers under the Medicare and Medicaid programs.
(3) PROHIBITED
USES.—Such payments may
not be used for any of the following:
(A) The purchase or installation of trans-
mission equipment (other than such equipment
used by health professionals to deliver medical
informatics services under the project).
(B) The establishment or operation of a
telecommunications common carrier network.
(C) Construction (except for minor renova-
tions related to the installation of reimbursable
equipment) or the acquisition or building of real
property.
(e) REPORTS.—The Secretary shall submit to the
Committees on Ways and Means and Commerce of the
House of Representatives and the Committees on Finance
and Labor and Human Resources of the Senate interim
reports on the project and a final report on the project
within 6 months after the conclusion of the project. The
final report shall include an evaluation of the impact of
the use of telemedicine and medical informatics on improv-
ing access of medicare and medicaid beneficiaries to health
care services, on reducing the costs of such services, and
on improving the quality of life of such beneficiaries.
(f) DEFINITIONS.—For purposes of this section:
(1) INTERVENTIONAL INFORMATICS.—The term
‘‘interventional informatics’’ means using informa-
tion technology and virtual reality technology to in-
tervene in patient care.
(2) MEDICAL INFORMATICS.—The term ‘‘medi-
cal informatics’’ means the storage, retrieval, and
use of biomedical and related information for prob-
lem solving and decision-making through computing
and communications technologies.
(3) PROJECT.—The term ‘‘project’’ means the
demonstration project under this section.
(4) SECRETARY.—The term ‘‘Secretary’’ means
the Secretary of Health and Human Services.
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