I
106TH CONGRESS
2D SESSION
H. R. 4771
To amend title XVIII of the Social Security Act to provide increased access
to health care for Medicare beneficiaries through telemedicine.
IN THE HOUSE OF REPRESENTATIVES
JUNE 27, 2000
Mr. MCHUGH introduced the following bill; which was referred to the Com-
mittee on 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 jurisdic-
tion of the committee concerned.
A BILL
To amend title XVIII of the Social Security Act to provide
increased access to health care for Medicare beneficiaries
through telemedicine.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Telehealth Improvement and Modernization Act of
2000’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Revision of telehealth payment methodology and elimination of fee-shar-
ing requirement.
Sec. 3. Elimination of requirement for telepresenter.
Sec. 4. Reimbursement for medicare beneficiaries who do not reside in a
HPSA.
Sec. 5. Telehealth coverage for direct patient care.
Sec. 6. All physicians and practitioners eligible for telehealth reimbursement.
Sec. 7. Telehealth services provided using store-and-forward technologies.
Sec. 8. Construction relating to home health services.
Sec. 9. Effective date.
SEC. 2. REVISION OF TELEHEALTH PAYMENT METHOD-
OLOGY AND ELIMINATION OF FEE-SHARING
REQUIREMENT.
Section 4206(b) of the Balanced Budget Act of 1997
(42 U.S.C. 1395l note) is amended to read as follows:
‘‘(b) METHODOLOGY FOR DETERMINING AMOUNT OF
PAYMENTS.—
‘‘(1) IN
GENERAL.—The Secretary shall pay
to—
‘‘(A) the physician or practitioner at a dis-
tant site that provides an item or service under
subsection (a) an amount equal to the amount
that such physician or provider would have been
paid had the item or service been provided with-
out the use of a telecommunications system;
and
‘‘(B) the originating site a facility fee for
facility services furnished in connection with
such item or service.
‘‘(2) APPLICATION
OF
PART
B
COINSURANCE
AND DEDUCTIBLE.—Any payment made under this
section shall be subject to the coinsurance and de-
ductible requirements under subsections (a)(1) and
(b) of section 1833 of the Social Security Act (42
U.S.C. 1395l).
‘‘(3) DEFINITIONS.—In this subsection:
‘‘(A) DISTANT
SITE.—The term ‘distant
site’ means the site at which the physician or
practitioner is located at the time the item or
service is provided via a telecommunications
system.
‘‘(B) FACILITY
FEE.—The term ‘facility
fee’ means an amount equal to—
‘‘(i) for 2000 and 2001, $20; and
‘‘(ii) for a subsequent year, the facil-
ity fee under this subsection for the pre-
vious year increased by the percentage in-
crease in the MEI (as defined in section
1842(i)(3)) for such subsequent year.
‘‘(C) ORIGINATING SITE.—
‘‘(i) IN GENERAL.—The term ‘origi-
nating site’ means the site described in
clause (ii) at which the eligible telehealth
beneficiary under the medicare program is
located at the time the item or service is
provided via a telecommunications system.
‘‘(ii) SITES
DESCRIBED.—The sites
described in this paragraph are as follows:
‘‘(I) On or before January 1,
2002, the office of a physician or a
practitioner, a critical access hospital,
a rural health clinic, and a Federally
qualified health center.
‘‘(II) On or before January 1,
2003, a hospital, a skilled nursing fa-
cility, a comprehensive outpatient re-
habilitation facility, a renal dialysis
facility, an ambulatory surgical center,
an Indian Health Service facility, and
a community mental health center.’’.
SEC. 3. ELIMINATION OF REQUIREMENT FOR TELEPRE-
SENTER.
Section 4206 of the Balanced Budget Act of 1997
(42 U.S.C. 1395l note) is amended—
(1) in subsection (a), by striking ‘‘, notwith-
standing that the individual physician’’ and all that
follows before the period at the end; and
(2) by adding at the end the following new sub-
section:
‘‘(e) TELEPRESENTER NOT REQUIRED.—Nothing in
this section shall be construed as requiring an eligible tele-
health beneficiary to be presented by a physician or practi-
tioner for the provision of an item or service via a tele-
communications system.’’.
SEC. 4. REIMBURSEMENT FOR MEDICARE BENEFICIARIES
WHO DO NOT RESIDE IN A HPSA.
Section 4206(a) of the Balanced Budget Act of 1997
(42 U.S.C. 1395l note), as amended by section 3, is
amended—
(1) by striking ‘‘IN GENERAL.—Not later than’’
and inserting the following: ‘‘TELEHEALTH SERV-
ICES REIMBURSED.—
‘‘(1) IN GENERAL.—Not later than’’;
(2) by striking ‘‘furnishing a service for which
payment’’ and all that follows before the period and
inserting ‘‘to an eligible telehealth beneficiary’’; and
(3) by adding at the end the following new
paragraph:
‘‘(2) ELIGIBLE TELEHEALTH BENEFICIARY DE-
FINED.—In this section, the term ‘eligible telehealth
beneficiary’ means a beneficiary under the medicare
program under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.) that resides in—
‘‘(A) an area that is designated as a health
professional 
shortage 
area 
under 
section
332(a)(1)(A) of the Public Health Service Act
(42 U.S.C. 254e(a)(1)(A));
‘‘(B) a county that is not included in a
Metropolitan Statistical Area;
‘‘(C) an inner-city area that is medically
underserved (as defined in section 330(b)(3) of
the Public Health Service Act (42 U.S.C.
254b(b)(3))); or
‘‘(D) an area in which there is a Federal
telemedicine demonstration program.’’.
SEC. 5. TELEHEALTH COVERAGE FOR DIRECT PATIENT
CARE.
(a) IN GENERAL.—Section 4206 of the Balanced
Budget Act of 1997 (42 U.S.C. 1395l note), as amended
by section 4, is amended—
(1) in subsection (a)(1), by striking ‘‘profes-
sional consultation via telecommunications systems
with a physician’’ and inserting ‘‘items and services
for which payment may be made under such part
that are furnished via a telecommunications system
by a physician’’; and
(2) by adding at the end the following new sub-
section:
‘‘(f) COVERAGE OF ITEMS AND SERVICES.—Payment
for items and services provided pursuant to subsection (a)
shall include payment for professional consultations, office
visits, office psychiatry services, including any service
identified as of July 1, 2000, by HCPCS codes 99241–
99275, 99201–99215, 90804–90815, and 90862, and any
additional item or service specified by the Secretary.’’.
(b) STUDY AND REPORT REGARDING ADDITIONAL
ITEMS AND SERVICES.—
(1) STUDY.—The Secretary of Health and
Human Services shall conduct a study to identify
items and services in addition to those described in
section 4206(f) of the Balanced Budget Act of 1997
(as added by subsection (a)) that would be appro-
priate to provide payment under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.).
(2) REPORT.—Not later than 2 years after the
date of enactment of this Act, the Secretary shall
submit a report to Congress on the study conducted
under paragraph (1) together with such rec-
ommendations for legislation that the Secretary de-
termines are appropriate.
SEC. 6. ALL PHYSICIANS AND PRACTITIONERS ELIGIBLE
FOR TELEHEALTH REIMBURSEMENT.
Section 4206(a) of the Balanced Budget Act of 1997
(42 U.S.C. 1395l note), as amended by section 5, is
amended—
(1) in paragraph (1), by striking ‘‘(described in
section 1842(b)(18)(C) of such Act (42 U.S.C.
1395u(b)(18)(C))’’; and
(2) by adding at the end the following new
paragraph:
‘‘(3) PRACTITIONER
DEFINED.—For purposes
of paragraph (1), the term ‘practitioner’ includes—
‘‘(A) a practitioner described in section
1842(b)(18)(C) of the Social Security Act (42
U.S.C. 1395u(b)(18)(C)); and
‘‘(B) a physical, occupational, or speech
therapist.’’.
SEC. 7. TELEHEALTH SERVICES PROVIDED USING STORE-
AND-FORWARD TECHNOLOGIES.
Section 4206(a)(1) of the Balanced Budget Act of
1997 (42 U.S.C. 1395l note), as amended by section 6,
is amended by adding at the end the following new para-
graph:
‘‘(4) USE
OF
STORE-AND-FORWARD
TECH-
NOLOGIES.—For purposes of paragraph (1), in the
case of any Federal telemedicine demonstration pro-
gram in Alaska or Hawaii, the term ‘telecommuni-
cations system’ includes store-and-forward tech-
nologies that provide for the asynchronous trans-
mission of health care information in single or multi-
media formats.’’.
SEC. 8. CONSTRUCTION RELATING TO HOME HEALTH
SERVICES.
Section 4206(a) of the Balanced Budget Act of 1997
(42 U.S.C. 1395l note), as amended by section 7, is
amended by adding at the end the following new para-
graph:
‘‘(5) CONSTRUCTION
RELATING
TO
HOME
HEALTH SERVICES.—
‘‘(A) IN GENERAL.—Nothing in this sec-
tion or in section 1895 of the Social Security
Act (42 U.S.C. 1395fff) shall be construed as
preventing a home health agency that is receiv-
ing payment under the prospective payment
system described in such section from fur-
nishing a home health service via a tele-
communications system.
‘‘(B) LIMITATION.—The Secretary shall
not consider a home health service provided in
the manner described in subparagraph (A) to
be a home health visit for purposes of—
‘‘(i) determining the amount of pay-
ment to be made under the prospective
payment system established under section
1895 of the Social Security Act (42 U.S.C.
1395fff); or
‘‘(ii) any requirement relating to the
certification of a physician required under
section 1814(a)(2)(C) of such Act (42
U.S.C. 1395f(a)(2)(C)).’’.
SEC. 9. EFFECTIVE DATE.
The amendments made by this Act shall apply to
items and services provided on or after the date of enact-
ment of this Act.
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