I 
110TH CONGRESS 
2D SESSION 
H. R. 6380 
To amend title XVIII of the Social Security Act to provide payments under 
the Medicare Program for unscheduled physician telephone consultation 
services in the case that such payments are determined to be cost 
and quality effective. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 26, 2008 
Mrs. BIGGERT (for herself, Mr. EMANUEL, and Mrs. EMERSON) introduced 
the following bill; which was referred to the Committee 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 com-
mittee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
payments under the Medicare Program for unscheduled 
physician 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 ‘‘Medicare Physician 
Telephone Consultation Services Coverage Act of 2008’’. 
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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 (Z), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (AA), by adding at 
the end ‘‘and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(BB) subject to section 2(c) of the Medi-
care Physician Telephone Consultation Services 
Coverage Act of 2008, unscheduled telephone 
consultation services (as defined in subsection 
(ccc)(1)) by a physician, with respect to the 
treatment of an individual, if— 
‘‘(i) the Medicare number of the indi-
vidual is associated with the national pro-
vider identifier of the physician; 
‘‘(ii) to ensure the quality and appro-
priateness of such consultation services, 
the utilization of such services by the indi-
vidual can be reviewed by a utilization and 
quality control peer review organization or 
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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 (ccc)(1) with 
which the Secretary enters into a contract) 
for purposes of appropriate review by peers 
of the physician who practice in the same 
medical specialty as the physician and 
Medicare administrative contractor over-
sight of such services; and 
‘‘(iv) the physician provides for the 
submission to the Secretary (or an entity 
described in subsection (ccc)(1) with which 
the Secretary enters into a contract) and 
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the Secretary (or such an entity) records 
and maintains a summary of each such 
consultation service furnished by the physi-
cian 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 physician; 
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: 
‘‘Unscheduled Telephone Consultation Services 
‘‘(ccc)(1) The term ‘unscheduled telephone consulta-
tion service’ means a consultation conducted by means of 
telephone or similar electronic communication device be-
tween a physician and an individual (or a representative 
of such individual), with respect to the treatment of such 
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individual, that is not included as a scheduled physician 
service (as defined by the Secretary in regulations), and 
which is initiated by the individual (or representative) con-
tacting a communication network operated by the Sec-
retary (or an entity with which the Secretary enters into 
a contract) that connects the individual to the physician, 
securely records the consultation for purposes of sub-
section (s)(2)(BB), and maintains the information de-
scribed in clause (iv) of such subsection with respect to 
such consultation. 
‘‘(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 
physician— 
‘‘(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 physician and 
such unscheduled telephone consultation service are 
deemed to be health oversight activities.’’. 
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(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)(BB),’’ after ‘‘(2)(AA),’’. 
(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-
scheduled telephone consultation services (as 
defined in section 1861(ccc) of the Social Secu-
rity Act) by physicians to the extent provided 
under the amendments made by this section to 
a sample group of Medicare beneficiaries. For 
purposes of such demonstration program, the 
Secretary shall find that the provision of such 
coverage is effective if— 
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(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 physicians, labora-
tory fees, pathologist fees, hospital radi-
ology department fees for technical compo-
nents of x-rays, radiologist professional 
fees for interpreting x-rays, hospital res-
piratory department fees for respiratory 
treatments, hospital cardiology department 
fees for electrocardiograms, professional 
fees for interpreting such electrocardio-
grams, 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). 
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(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-
graph, that providing coverage under the 
Medicare Program for unscheduled tele-
phone consultation services by physicians 
(to the extent provided under the amend-
ments made by this section) is effective, 
the amendments made by this section shall 
become effective on the first day of the 
first month beginning after the date the 
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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-
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 physicians (to the extent provided under 
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the amendments made by this section) is 
not effective, in which case the amend-
ments made by this section shall not be-
come 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 physician quality. 
Æ 
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