I 
112TH CONGRESS 
1ST SESSION 
H. R. 92 
To amend title XVIII of the Social Security Act to provide payments under 
the Medicare Program to licensed health care practitioners for unsched-
uled telephone consultation services in the case that such payments 
are determined to be cost and quality effective. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 5, 2011 
Mrs. BIGGERT 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 amend title XVIII of the Social Security Act to provide 
payments under the Medicare Program to licensed health 
care practitioners for unscheduled telephone consultation 
services in the case that such payments are determined 
to be cost and quality effective. 
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 ‘‘Tele-Care Act of 
2011’’. 
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SEC. 2. MEDICARE PAYMENT FOR UNSCHEDULED PHYSI-
CIAN TELEPHONE SERVICES. 
(a) COVERAGE UNDER PART B.— 
(1) IN
GENERAL.—Section 1861(s)(2) of the 
Social Security Act (42 U.S.C. 1395x(s)(2)) is 
amended— 
(A) in subparagraph (EE), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (FF), by adding at 
the end ‘‘and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(GG) subject to section 2(c) of the Tele- 
Care Act of 2011, unscheduled telephone con-
sultation services (as defined in subsection 
(iii)(1)) by a licensed health care practitioner, 
as defined by the Secretary (such as a physi-
cian, nurse practitioner, physician assistant, or 
nurse midwife), with respect to the furnishing 
of primary care services to an individual, if— 
‘‘(i) the Medicare number of the indi-
vidual is associated with the national pro-
vider identifier of the licensed health care 
practitioner; 
‘‘(ii) to ensure the quality and appro-
priateness of such consultation services, 
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the utilization of such services by the indi-
vidual can be reviewed by a utilization and 
quality control peer review organization or 
eligible entity with which the Secretary has 
entered into a contract under part B of 
title XI or section 1893, respectively, by 
the organization or entity applying for pur-
poses of the review under this subpara-
graph the processes and standards used by 
such organization or entity under such 
part or section, respectively, in the same 
manner that such processes and standards 
apply for purposes of carrying out utiliza-
tion and quality review under such part or 
section, respectively; 
‘‘(iii) such consultation services are 
securely recorded by the Secretary (or an 
entity described in subsection (iii)(1) with 
which the Secretary enters into a contract) 
for purposes of appropriate review by peers 
of the licensed health care practitioner who 
practice in the same medical specialty as 
the licensed health care practitioner and 
Medicare administrative contractor over-
sight of such services; and 
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‘‘(iv) the licensed health care practi-
tioner provides for the submission to the 
Secretary (or an entity described in sub-
section (iii)(1) with which the Secretary 
enters into a contract) and the Secretary 
(or such an entity) records and maintains 
a summary of each such consultation serv-
ice furnished by the licensed health care 
practitioner that includes— 
‘‘(I) the date and time (including 
duration) of the consultation service; 
‘‘(II) a unique medical record 
number specified by the Secretary (or 
such entity) to identify the consulta-
tion service; 
‘‘(III) the name of the individual; 
‘‘(IV) the name of the licensed 
health care practitioner; and 
‘‘(V) a summary of the content 
of the consultation service;’’. 
(2) UNSCHEDULED TELEPHONE CONSULTATION 
SERVICES DEFINED.—Section 1861 of such Act (42 
U.S.C. 1395x) is amended by adding at the end the 
following new subsection: 
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‘‘Unscheduled Telephone Consultation Services 
‘‘(iii)(1) The term ‘unscheduled telephone consulta-
tion service’ means a consultation conducted by means of 
telephone or similar electronic communication device be-
tween a licensed health care practitioner described in sub-
section (s)(2)(GG) and an individual (or a representative 
of such individual), with respect to the furnishing of pri-
mary care services to such individual, that is not included 
as a scheduled physician service (as defined by the Sec-
retary in regulations), and which is initiated by the indi-
vidual (or representative) contacting a communication net-
work operated by the Secretary (or an entity with which 
the Secretary enters into a contract) that connects the in-
dividual to the licensed health care practitioner, securely 
records the consultation for purposes of subsection 
(s)(2)(GG), and maintains the information described in 
clause (iv) of such subsection with respect to such con-
sultation. 
‘‘(2) For purposes of applying the regulations pro-
mulgated pursuant to section 264(c) of the Health Insur-
ance Portability and Accountability Act of 1996 (Public 
Law 104–191; 110 Stat. 2033) with respect to an un-
scheduled telephone consultation service furnished by a li-
censed health care practitioner— 
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‘‘(A) an entity with which the Secretary con-
tracts under this subsection shall be treated as a 
health oversight agency; and 
‘‘(B) activities of such an entity described in 
subparagraph (A) in relation to such licensed health 
care practitioner and such unscheduled telephone 
consultation service are deemed to be health over-
sight activities.’’. 
(b) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 
Section 1848(j)(3) of such Act (42 U.S.C. 1395w–4(j)(3)) 
is amended by inserting ‘‘(2)(GG),’’ after ‘‘health risk as-
sessment),’’. 
(c) CONTINGENT EFFECTIVE DATE, DEMONSTRA-
TION PROGRAM.— 
(1) 
CONTINGENT
EFFECTIVE
DATE.—The 
amendments made by this section shall become ef-
fective (if at all) in accordance with paragraph (2). 
(2) DEMONSTRATION PROGRAM.— 
(A) 
IN
GENERAL.—The 
Secretary 
of 
Health and Human Services (in this paragraph 
referred to as the ‘‘Secretary’’) shall establish a 
demonstration program to begin not later than 
6 months after the date of the enactment of 
this Act to test the effectiveness of providing 
coverage under the Medicare program for un-
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scheduled telephone consultation services (as 
defined in section 1861(iii) of the Social Secu-
rity Act, as added by subsection (a)(2)), by li-
censed health care practitioners to the extent 
provided under the amendments made by this 
section to a sample group of Medicare bene-
ficiaries. For purposes of such demonstration 
program, the Secretary shall find that the pro-
vision of such coverage is effective if— 
(i) the coverage reduces costs to the 
Medicare program (such as through a re-
duction in admissions to the emergency de-
partments of hospitals), whether or not 
such reduction is demonstrated in a reduc-
tion in the facility fees of hospital emer-
gency departments, professional fees of 
emergency department licensed health care 
practitioners, laboratory fees, pathologist 
fees, hospital radiology department fees for 
technical components of x-rays, radiologist 
professional fees for interpreting x-rays, 
hospital respiratory department fees for 
respiratory treatments, hospital cardiology 
department fees for electrocardiograms, 
professional fees for interpreting such elec-
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trocardiograms, or any other cost specified 
by the Secretary; and 
(ii) the coverage results in patient 
health outcomes that are at least as favor-
able as would apply in the absence of such 
coverage (as determined in accordance with 
criteria established by the Centers for 
Medicare & Medicaid Services, in consulta-
tion with physician organizations). 
(B) INITIAL PERIOD OF DEMONSTRATION 
PROGRAM.—The demonstration program under 
subparagraph (A) shall be conducted for an ini-
tial period of 24 months. 
(C) REPORT TO CONGRESS.— 
(i) IN GENERAL.—Not later than 30 
days after the last day of the initial period 
under subparagraph (B), the Secretary 
shall submit to Congress a report on the 
results of the demonstration program 
under this paragraph. 
(ii) FINDING
THAT
PAYMENTS
ARE 
EFFECTIVE.—If the Secretary finds, on the 
basis of the data derived from the dem-
onstration program under subparagraph 
(A) and in accordance with such subpara-
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graph, that providing coverage under the 
Medicare program for unscheduled tele-
phone consultation services by licensed 
health care practitioners (to the extent 
provided under the amendments made by 
this section) is effective, the amendments 
made by this section shall become effective 
on the first day of the first month begin-
ning after the date the report under clause 
(i) is submitted to Congress. 
(iii) FINDING
THAT
PAYMENTS
ARE 
NOT EFFECTIVE.—If the Secretary finds, 
on the basis of the data derived from the 
demonstration program under subpara-
graph (A) and in accordance with such 
subparagraph, that a finding of effective-
ness (as described in clause (ii)) cannot be 
made, the demonstration program shall 
continue for a period of an additional 24 
months. Not later than 30 days after the 
last day of such period, the Secretary shall 
submit to Congress a final report on the 
results of such program. The amendments 
made by this section shall become effective 
on the first day of the first month begin-
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ning after the date such report is sub-
mitted to Congress unless the report con-
tains a finding by the Secretary, on the 
basis of such data and in accordance with 
such subparagraph, that providing cov-
erage under the Medicare program for un-
scheduled telephone consultation services 
by licensed health care practitioners (to the 
extent provided under the amendments 
made by this section) is not effective, in 
which case the amendments made by this 
section shall not become effective. 
(d) CLARIFICATION.—Nothing in the provisions of 
this section or the amendments made by this section shall 
be construed as authorizing the creation of a national re-
porting system on licensed health care practitioner quality. 
Æ 
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