115 HR 2194 IH: Cigarette Smoking Reduction and Electronic Vapor Alternatives Act of 2017
U.S. House of Representatives
2017-04-27
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I115th CONGRESS1st SessionH. R. 2194IN THE HOUSE OF REPRESENTATIVESApril 27, 2017Mr. Hunter introduced the following bill; which was referred to the Committee on Energy and CommerceA BILLTo protect the public health by providing the Food and Drug Administration with certain authority
			 to regulate e-liquids and personal electronic vaporizers, to reduce the
			 morbidity and mortality resulting from cigarette smoking through the
			 responsible regulation of e-liquids and personal electronic vaporizers as
			 a tobacco harm reduction strategy, and for other purposes.

		1.Short title; table of contents
 (a)Short titleThis Act may be cited as the Cigarette Smoking Reduction and Electronic Vapor Alternatives Act of 2017. (b)Table of contentsThe table of contents of this Act is as follows:

					Sec. 1. Short title; table of contents.
					Sec. 2. Findings.
					Sec. 3. Purposes of the Family Smoking Prevention and Tobacco Control Act.
					Sec. 4. Regulation of electronic vapor products.
					Sec. 5. Joint comparative health risk assessment.

 2.FindingsThe Congress finds the following: (1)Cigarette smoking is the practice of burning tobacco rolled in a paper and inhaling the smoke. According to the Department of Health and Human Services—
 (A)the burning of tobacco produces a chemical mixture of more than 7,000 compounds; (B)cigarette smoking causes cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease, and harms nearly every organ of the body;
 (C)cigarette smoking causes more than 480,000 deaths each year, including nearly 42,000 deaths due to secondhand tobacco smoke;
 (D)the economic cost of cigarette smoking is more than $300 billion a year, including nearly $170 billion in direct medical care, and more than $156 billion in lost productivity; and
 (E)nearly 7 in 10 adult cigarette smokers want to quit smoking. (2)Electronic vapor products, also known as electronic cigarettes or e-cigarettes, are battery-operated devices that use low heat to turn e-liquid, which generally contains nicotine, into a vaporized aerosol which is inhaled—there is no burning of tobacco or generation of smoke for inhalation.
 (3)Evidence from numerous studies strongly suggests that electronic vapor products are magnitudes safer than traditional, combustible cigarettes. Studies have found that several million regular vapers in the United States no longer regularly smoke cigarettes.
 (4)Studies of cigarette smokers who switched to vapor found significant improvements in lung function, including a study finding asthmatic smokers who switched to vapor had significant improvements in spirometry data, asthma control, airway hyperresponsiveness, and lower blood pressure.
 (5)The Royal College of Physicians 2016 report on e-cigarettes titled, Nicotine without smoke: Tobacco harm reduction issued the following findings: (A)The available evidence to date indicates that e-cigarettes are being used almost exclusively as safer alternatives to smoked tobacco, by confirmed smokers who are trying to reduce harm to themselves or others from smoking, or to quit smoking completely.
 (B)The hazard to health arising from long-term vapor inhalation from the e-cigarettes available today is unlikely to exceed 5 percent of the harm from smoking tobacco.
 (C)E-cigarettes are marketed as consumer products and are proving much more popular than Food and Drug Administration-approved nicotine replacement therapies (NRT) as a substitute and competitor for tobacco cigarettes.
 (6)E-liquid is the liquid that is heated into vapor. It contains, principally, propylene glycol, vegetable glycerin, in some cases food flavoring, in some cases nicotine, and in some cases water; propylene glycol and vegetable glycerin are designated as generally recognized as safe by the Food and Drug Administration (FDA) as food additives.
 (7)Surveys have found that a significant majority of regular users of electronic vapor products had previously tried FDA-approved smoking cessation drugs to quit smoking without success.
 (8)An expert independent evidence review published by Public Health England (PHE) concluded that— (A)the use of vapor products is about 95 percent less harmful than cigarette smoking;
 (B)nearly half the population doesn’t realize vapor is much less harmful than smoking; and (C)there is no evidence suggesting electronic vapor products act as a route into smoking for children or nonsmokers.
 (9)Electronic vapor product sales in the United States have increased from an estimated $100 million in 2010 to $4 billion in 2016 while cigarette consumption in the United States declined from $307 billion in 2010 to an estimated $265 billion in 2016.
 (10)On May 10, 2016, the Food and Drug Administration issued its Deeming Regulation to deem e-cigarettes or electronic vapor products to be subject to its authority. The regulation will, as a practical matter, because of its significant compliance costs and poorly articulated standard for protecting public health, ban the sale of all electronic vapor products by August 2018.
 (11)The Food and Drug Administration’s Deeming Regulation, by effectively banning electronic vapor products, will push vapers who have quit or reduced cigarette smoking by switching to electronic vapor products back to smoking deadly cigarettes.
 (12)The 2015 Monitoring the Future survey of the National Institute on Drug Abuse found past-30-day use of an electronic vapor product by 8th, 10th, and 12th graders combined declined from 13.9 percent in 2014 to 9.9 percent in 2016; however, that survey found that fewer than 20 percent of teens who used an electronic vapor product in the past 30 days reported using a product containing nicotine.
 (13)Electronic vapor products show tremendous promise in reducing cigarette smoking, and cigarette smoking attributable morbidity, mortality, and health care costs.
 (14)According to an April 13, 2017, Centers for Disease Control and Prevention study, more Americans who are trying to quit smoking use vapor products (35.3 percent) than any other smoking cessation tool. This includes using a nicotine patch or gum (25.4 percent), getting help from a doctor or other health professional (15.2 percent), using smoking cessation medications approved by the Food and Drug Administration (12.2 percent), and getting help from a website (7.1 percent) or a telephone quitline (5.4 percent).
 (15)Since the Food and Drug Administration was granted authority to regulate tobacco products in 2009, the agency has failed to grant market approval to any modified risk tobacco product.
 3.Purposes of the Family Smoking Prevention and Tobacco Control ActSection 3 of the Family Smoking Prevention and Tobacco Control Act (21 U.S.C. 387 note) is amended by amending paragraph (9) to read as follows:

 (9)to promote— (A)cessation to reduce disease risk and the social costs associated with tobacco-related diseases; and
 (B)harm reduction strategies; and. 4.Regulation of electronic vapor products (a)Center for tobacco products and tobacco harm reductionSection 901(e) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 387a(e)) is amended—
 (1)in the subsection heading, by striking Center for Tobacco Products and inserting Center for Tobacco Products and Tobacco Harm Reduction; (2)by striking Center for Tobacco Products and inserting Center for Tobacco Products and Tobacco Harm Reduction; and
 (3)by striking this chapter and inserting this chapter and chapter X. (b)FDA authority over electronic vapor products (1)Exclusion from definition of tobacco productSection 201(rr) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321(rr)) is amended—
 (A)in paragraph (2), by inserting an e-liquid (as defined in section 1001), a personal electronic vaporizer (as defined in section 1001), before or a combination product; and
 (B)in paragraph (3), by inserting after The products described in paragraph (2) the following: (other than an e-liquid or personal electronic vaporizer). (2)Combination productsSection 503(g) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 353(g)) is amended—
 (A)in paragraph (1)— (i)in subparagraph (A), by striking or biological product and inserting , biological product, e-liquid, or personal electronic vaporizer; and
 (ii)in subparagraph (D)— (I)in clause (ii), by striking or at the end;
 (II)in clause (iii), by striking the period at the end and inserting ; or; and (III)by adding at the end the following:

 (iv)an e-liquid or personal electronic vaporizer, the agency center charged with regulating e-liquids and personal electronic vaporizers shall have primary jurisdiction.; and
 (B)in paragraph (9)— (i)by redesignating subparagraphs (C) and (D) as subparagraphs (D) and (E), respectively; and
 (ii)by inserting after subparagraph (B) the following:  (C)The terms e-liquid and personal electronic vaporizer have the meanings given to such terms in section 1001..
 (3)Regulatory authorityThe Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.) is amended— (A)by redesignating chapter X as chapter XI;
 (B)by redesignating sections 1001 through 1014 as sections 1101 through 1114, respectively; (C)in section 505(n)(2), by striking 1004 and inserting 1104;
 (D)in sections 523(b)(2)(D) and 704(g)(13), by striking 1003(g) and inserting 1103(g); (E)in section 1109(a)(5)(A), as redesignated by paragraph (4), by striking 1008 and inserting 1108; and
 (F)by inserting after chapter IX the following:  XElectronic Vapor Products 1001.DefinitionsIn this chapter:
 (1)The term e-liquid means any liquid solution that— (A)may or may not contain nicotine; and
 (B)is intended to be converted into an aerosol, vapor, or vapor-like mist for users to inhale through the mouthpiece of a personal electronic vaporizer.
 (2)The term personal electronic vaporizer means an electronic device that employs a heating element or atomizer that converts an e-liquid into an aerosol, vapor, or vapor-like mist through a noncombustive process.
 (3)The terms e-liquid and personal electronic vaporizer exclude— (A)a drug as defined in section 201(g)(1);
 (B)a device as defined in section 201(h); and (C)a biological product as defined in section 351 of the Public Health Service Act.
 1002.Exclusive authority for regulating e-liquids and personal electronic vaporizersThe authorities vested by this chapter constitute the exclusive authorities of the Secretary to regulate e-liquids and personal electronic vaporizers, except to the extent e-liquids and personal electronic vaporizers are within combination products regulated pursuant to section 503(g).
								1003.Prohibited acts; penalties
									(a)Prohibitions
 (1)In generalThe following acts and the causing thereof are hereby prohibited: (A)The sale of an electronic vapor product or e-liquid to any person younger than 18 years of age.
 (B)The manufacture of an e-liquid or personal electronic vaporizer in noncompliance with the standards under section 1004(b) in violation of an order issued under section 1004(e).
 (C)The offering of e-liquids or personal electronic vaporizers for sale in interstate commerce by an e-liquid or personal electronic vaporizer manufacturer that does not have a certification in effect as required by section 1004(c).
 (D)The failure by an e-liquid or personal electronic vaporizer manufacturer to provide access for inspection as required by section 1004(d).
 (E)The introduction or delivery for introduction in interstate commerce of an e-liquid or personal electronic vaporizer by any person that is adulterated or misbranded, as described in subsection (b) or (c) respectively.
 (2)RetailersNotwithstanding subparagraphs (A) and (E) of paragraph (1), a retailer may be found to be in violation of either such subparagraph (with respect to sale or introduction or delivery for introduction in interstate commerce at retail) only if the violation occurs knowingly.
 (b)AdulterationAn e-liquid or personal electronic vaporizer shall be treated as adulterated if— (1)it was manufactured in noncompliance with the standards under section 1004(b) in violation of an order issued under section 1004(e); or
 (2)it was manufactured by an e-liquid or personal electronic vaporizer manufacturer that does not have a certification in effect as required by section 1004(c).
 (c)MisbrandingAn e-liquid or personal electronic vaporizer shall be treated as misbranded if its labeling (as such term is defined in section 201 with respect to drugs) is in noncompliance with the standards under section 1004(b) in violation of an order issued under section 1004(e).
 (d)PenaltiesAny person who violates a provision of subsection (a) shall be imprisoned not more than 3 years, fined not more than $10,000 (notwithstanding section 3571(e) of title 18, United States Code) for each day on which the violation continues, or both.
									1004.Standards for the manufacturing of e-liquids and personal electronic vaporizers; compliance
 (a)RequirementBeginning on the date that is 1 year after the date of enactment of the Cigarette Smoking Reduction and Electronic Vapor Alternatives Act of 2017, any e-liquid or personal electronic vaporizer introduced or delivered for introduction into interstate commerce shall conform to the e-liquid or personal electronic vaporizer (as applicable) manufacturing standards under subsection (b), including the labeling standards therein.
									(b)Manufacturing standards
 (1)E-liquidsThe manufacturing standards for e-liquids under this subsection shall consist of the following: (A)Interim standardsThe e-liquid manufacturing standards issued by the American E-Liquid Manufacturing Standards Association (version 2.3.2) on March 8, 2017 (including any revision to such standards made in accordance with paragraph (3)), apply to the introduction or delivery for introduction into interstate commerce of e-liquids during the period beginning on the date described in subsection (a) and ending on the date described in subparagraph (B).
 (B)Subsequent standardsThe e-liquid manufacturing standards of the American National Standards Institute (including any revision to such standards made in accordance with paragraph (3)) apply to the introduction or delivery for introduction into interstate commerce of e-liquids beginning on the date of the adoption of such standards by the American National Standards Institute.
 (2)Personal electronic vaporizersThe manufacturing standards for personal electronic vaporizers under this subsection shall consist of the following:
 (A)Battery safetyAny battery used in a personal electronic vaporizer shall conform to the IEC 62133 standards of the International Electrotechnical Commission, as in effect on the date of enactment of the Cigarette Smoking Reduction and Electronic Vapor Alternatives Act of 2017 and including any revision to such standards made in accordance with paragraph (3).
 (B)Short circuit protectionA personal electronic vaporizer shall have a mechanism to ensure user and battery safety in the event of a short circuit of the heating element.
 (C)Discharge monitoringA rechargeable personal electronic vaporizer shall have a mechanism to prevent the battery from being discharged below a safe voltage during use or discharged faster than the battery can sustain safely.
 (D)Charge monitoringA personal electronic vaporizer that contains an onboard charger shall include circuitry to monitor the battery voltage and charge current and limit these to safe levels. A personal electronic vaporizer that contains multiple battery cells in series shall monitor the cells individually.
 (E)Serial and lot numbersA personal electronic vaporizer shall include a serial or lot number on the label that allows the vaporizer to be traced to its time and place of manufacture. Notwithstanding the preceding sentence, a single-use personal electronic vaporizer may have such serial or lot number on the packaging of the vaporizer other than the label.
 (F)Verification and validationA personal electronic vaporizer shall be constructed with sufficiently validated processes, or subject to sufficient verification and testing, to ensure that each individual vaporizer conforms to its specifications.
 (G)Tracking and RecallsThe manufacturer of a personal electronic vaporizer shall record all shipments of one or more personal electronic vaporizers by the manufacturer to a distributor, retailer, or end user, and correlate each such shipment to serial or lot numbers, to enable batch tracking and recalls.
 (H)MaterialsThe manufacturer of a personal electronic vaporizer shall ensure that— (i)materials that come in contact with e-liquids or vapor during manufacture or reasonably foreseeable use of the personal electronic vaporizer are limited to approved medical or food contact grade products with established safety and biocompatibility characteristics; and
 (ii)components of a personal electronic vaporizer which are expected to be subject to heat are appropriate for the expected temperatures.
 (3)RevisionsBefore issuing a revision to the standards applicable under paragraph (1)(A), (1)(B), or (2)(A), the American E-Liquid Manufacturing Standards Association, the American National Standards Institute, or the International Electrotechnical Commission, as applicable, shall notify the Secretary in writing of the proposed revision. Not later than 90 days after the date of receipt of such notice, the Secretary shall determine whether the proposed revision enhances the safety and quality of e-liquid products or personal electronic vaporizers, as applicable. If the Secretary determines that the proposed revision does enhance the safety and quality of e-liquid products or personal electronic vaporizers, as applicable, the Secretary shall give notice of such determination to the public for a period of 90 days and, effective at the end of such period, incorporate the revision into the standards applicable under paragraph (1)(A), (1)(B), or (2)(A), as applicable.
 (c)Certification of compliance with manufacturing standardsBeginning not later than 1 year after the date of enactment of the Cigarette Smoking Reduction and Electronic Vapor Alternatives Act of 2017, each e-liquid and personal electronic vaporizer manufacturer offering e-liquids for sale in interstate commerce shall have in effect a certification filed with the Secretary in writing that all such e-liquids or personal electronic vaporizers, as applicable, are manufactured, labeled, and otherwise in compliance with the standards under subsection (b).
 (d)Inspections for compliance with manufacturing standardsE-liquid and personal electronic vaporizer manufacturers shall provide the Secretary with access to their facilities used in manufacturing e-liquids or personal electronic vaporizers, as applicable, for inspection.
									(e)Failure To comply with manufacturing standards
 (1)In generalIf the Secretary finds that an e-liquid or personal electronic vaporizer manufacturer is in noncompliance with the standards under subsection (b)—
 (A)the Secretary shall not take any enforcement action based on such noncompliance unless— (i)the Secretary gives the manufacturer notice of, and a period of 90 days to correct, such noncompliance; and
 (ii)the manufacturer fails, by the end of such 90-day period, to correct such noncompliance; and (B)if the manufacturer fails to correct such noncompliance, as described in paragraph (1)(A)(ii), the Secretary may issue an order requiring the manufacturer—
 (i)to suspend any commercial activity that the Secretary finds to be in noncompliance; and (ii)to not resume such activity until the manufacturer demonstrates to the Secretary’s satisfaction that such noncompliance has been corrected.
 (2)Immediate danger to public healthNotwithstanding paragraph (1), if the Secretary determines that an e-liquid or personal electronic vaporizer manufacturer is in noncompliance with the standards under subsection (b), and that such noncompliance presents an immediate danger to public health, the Secretary may issue an order requiring the manufacturer to suspend production of such e-liquid or personal electronic vaporizer until the Secretary determines that such noncompliance is corrected.
										1005.Prohibition against advertising or promoting to minors
 (a)ProhibitionThe Secretary may by regulation prohibit any manufacturer of an e-liquid or personal electronic vaporizer from advertising or promoting the e-liquid or personal electronic vaporizer to individuals who have not attained 18 years of age.
 (b)PenaltyIf a manufacturer violates a prohibition established under subsection (a), the Secretary may refuse to accept for filing or renewal, and may revoke, the manufacturer’s certification under section 1004(c).
									1006.Preemption of certain State and local requirements
 (a)In generalNo State or political subdivision of a State may establish or continue in effect any requirement with respect to the manufacture, warning requirements, marketing, distribution, or sale of an e-liquid or personal electronic vaporizer which is different from, or in addition to, any requirement under the provisions of this chapter or pursuant to section 503(g), including the exclusion of e-liquids and personal electronic vaporizers from the definition of a tobacco product under section 201.
 (b)ExceptionInformation disclosed to a State consistent with subsection (a) that is exempt from disclosure under section 552(b)(4) of title 5, United States Code, shall be treated as a trade secret and confidential information by the State.
 1007.Office for e-liquid and personal electronic vaporizer standards complianceNot later than 90 days after the date of enactment of the Cigarette Smoking Reduction and Electronic Vapor Alternatives Act of 2017, the Secretary shall establish within the Food and Drug Administration’s Center for Tobacco Products and Tobacco Harm Reduction an Office of E-Liquid and Personal Electronic Vaporizer Standards Compliance. The Office shall—
 (1)be responsible for the implementation of this chapter and related matters assigned by the Director of such Center; and
 (2)provide technical and other nonfinancial assistance to e-liquid and personal electronic vaporizer manufacturers to assist them in complying with the requirements of this Act..
 5.Joint comparative health risk assessmentChapter X of the Federal Food, Drug, and Cosmetic Act, as added by section 4, is further amended by adding at the end the following:

				1008.Tobacco products and nicotine delivery alternatives: comparative health risk assessment
 (a)AssessmentThe Secretary shall undertake a tobacco products and other nicotine delivery alternatives comparative health risk assessment and rank each category of products on a scale according to the reasonable expectation for morbidity and mortality risk when compared to smoking cigarettes based on laboratory studies and existing scientific data. For purposes of such assessment, tobacco and nicotine delivery alternative product categories shall include at a minimum—
 (1)cigarettes; (2)loose tobacco for roll-your-own tobacco products;
 (3)little cigars; (4)cigars;
 (5)pipe tobacco; (6)moist snuff;
 (7)dry snuff; (8)chewing tobacco;
 (9)snus; (10)vaporized tobacco, meaning heat not burn technology intended for inhalation;
 (11)vapor produced by a personalized electronic vaporizer containing e-liquid with nicotine; (12)shisha and other tobacco products that are heated and inhaled via a hookah, water pipe, or other type of pipe (treated collectively as a single category);
 (13)dissolvable, chewable, drinkable, and other tobacco and nicotine products intended for oral ingestion (treated collectively as a single category);
 (14)tobacco and nicotine skin creams, patches, and other tobacco and nicotine products intended for transdermal consumption (treated collectively as a single category);
 (15)tobacco and nicotine sprays, droplets, and mists intended for nasal consumption (treated as a single category); and
 (16)other nicotine-containing products (treated collectively as a single category). (b)ReportNot later than 18 months after the date of enactment of the Cigarette Smoking Reduction and Electronic Vapor Alternatives Act of 2017, the Secretary shall report to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate on the results of the comparative health risk assessment under subsection (a). Based on such results, such report shall include recommendations on—
 (1)new or improved tobacco harm reduction strategies; and (2)the possible need for additional legislative authorities to implement such strategies..


113 HR 5170 : Federal Records Accountability Act of 2014
U.S. House of Representatives
2014-09-17
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

		IIB
		113th CONGRESS
		2d Session
		H. R. 5170
		IN THE SENATE OF THE UNITED STATES
		September 17 (legislative day, September 16), 2014Received; read twice and referred to the Committee on Homeland Security and Governmental AffairsAN ACT
		To improve Federal employee compliance with the Federal and Presidential recordkeeping
			 requirements, and for other purposes.

		1.Short title; table of contents
			(a)In generalThis Act may be cited as the Federal Records Accountability Act of 2014.
			(b)Table of contentsThe table of contents for this Act is as follows:

					Sec. 1. Short title; table of contents.
					Sec. 2. Removal for deliberate destruction of Federal records.
					Sec. 3. Use of non-official electronic messaging accounts.
					Sec. 4. Reporting of the loss or potential loss of records.
					Sec. 5. Senior Agency Official for Records Compliance.
					Sec. 6. Preservation of electronic messages and other records.
					Sec. 7. Presidential records.
					Sec. 8. Retention of electronic correspondence.

			2.Removal for deliberate destruction of Federal records
			(a)In generalChapter 75 of title 5, United States Code, is amended by adding after subchapter V the following:

					VIFederal Records
						7551.DefinitionsIn this subchapter the following definitions apply:
							(1)EmployeeThe term employee means—
								(A)an individual in the competitive service who is not serving a probationary or trial period under an
			 initial appointment or who has completed 1 year of current continuous
			 employment in the same or similar positions under other than a temporary
			 appointment limited to 1 year or less; or
								(B)a career appointee in the Senior Executive Service who—
									(i)has completed the probationary period prescribed under section 3393(d) of this title; or
									(ii)was covered by the provisions of subchapter II of this chapter immediately before appointment to
			 the Senior Executive Service.
									(2)SuspensionThe term suspension has the meaning given that term in section 7501 of this title.
							7552.Suspension and removal
							(a)Inspector General findingIf the Inspector General of an agency determines an employee of the agency has willfully and
			 unlawfully concealed, removed, mutilated, obliterated, falsified, or
			 destroyed any record, proceeding, map, book, document, paper, or other
			 thing in the custody of such employee, or verifies a violation under
			 section 2208 or 2911 of title 44, the Inspector General shall promptly
			 inform the head of the agency of that determination in writing.
							(b)SuspensionNotwithstanding any other provision of law, the head of an agency shall suspend an employee of that
			 agency who has been determined by the Inspector General under subsection
			 (a) to have willfully and unlawfully concealed, removed, mutilated,
			 obliterated, falsified, or destroyed any record, proceeding, map, book,
			 document, paper, or other thing in the custody of such employee, or who
			 has been verified by the Inspector General to be in violation of section
			 2208 or 2911 of title 44.
							(c)Requirements after suspensionAn employee suspended under subsection (b) is entitled, after suspension and before removal, to—
								(1)be represented by an attorney or other representative;
								(2)a written statement of the charges against the employee within 15 days after suspension, which may
			 be amended within 30 days thereafter;
								(3)an opportunity within 15 days after the receipt of the written statement under paragraph (2), plus
			 an additional 15 days if the charges are amended, to answer the charges
			 and submit affidavits;
								(4)a hearing, at the request of the employee, by an agency authority duly constituted for this
			 purpose;
								(5)a review of the employee’s case by the head of the agency or a designee, before a decision adverse
			 to the employee is made final; and
								(6)a written statement of the decision of the head of the agency.
								(d)RemovalSubject to subsection (c) of this section and after any investigation and review the head of the
			 agency considers necessary, the head of an agency shall remove an employee
			 suspended under subsection (b) if such head determines that the employee
			 willfully and unlawfully concealed, removed, mutilated, obliterated,
			 falsified, or destroyed any record, proceeding, map, book, document,
			 paper, or other thing in the custody of such employee.
							(e)AppealAn employee who is removed under subsection (d) is entitled to appeal to the Merit Systems
			 Protection Board under section 7701 of this title.
							.
			(b)Technical and conforming amendments
				(1)Table of sectionsThe table of sections for chapter 75 of title 5, United States Code, is amended by adding at the
			 end the following new items:

							Subchapter VI—Federal Records
							7551. Definitions.
							7552. Suspension and removal.
						.
				(2)Subchapter II applicabilitySection 7512 of such title is amended—
					(A)in subparagraph (D), by striking or at the end;
					(B)in subparagraph (E), by striking the period at the end and inserting , or; and
					(C)by adding at the end the following:

							(F)a suspension or removal under section 7552 of this title.
							.
					3.Use of non-official electronic messaging accounts
			(a)Presidential records actChapter 22 of title 44, United States Code is amended by adding at the end the following new
			 section:

					2208.Disclosure requirement for official business conducted using non-official electronic messaging
			 accounts
						(a)In generalThe President, Vice President, or covered employee may not create or send a Presidential or Vice
			 Presidential record using a non-official electronic messaging account (in
			 this section, referred to as applicable electronic message) unless the President, Vice President, or covered employee—
							(1)includes an official electronic messaging account of the President, Vice President, or covered
			 employee, as applicable, as a recipient in the original creation or
			 transmission of the applicable electronic message and identifies all
			 recipients of the applicable electronic message in such message;
							(2)forwards a complete copy of the applicable electronic message, including a complete list of the
			 recipients of such message, to an official electronic messaging account of
			 the President, Vice President, or covered employee, as applicable, within
			 fifteen days after the original creation or transmission of the message;
			 or
							(3)prints a complete copy of the applicable electronic message, including a complete list of the
			 recipients of such message, and submits the message to the appropriate
			 location or individual for appropriate archival storage by the Executive
			 Office of the President within fifteen days after the original creation or
			 transmission of the message.
							(b)Adverse actionsAn intentional violation of subsection (a) (including any rules, regulations, or other implementing
			 guidelines) by a covered employee, as determined by the appropriate
			 supervisor, shall be forwarded to the Inspector General of the agency for
			 a verification of the violation, and upon verification, shall be subject
			 to the suspension and removal provisions under section 7552 of title 5.
						(c)DefinitionsIn this section:
							(1)Covered employeeThe term covered employee means—
								(A)the immediate staff of the President;
								(B)the immediate staff of the Vice President;
								(C)an individual of the Executive Office of the President whose function is to advise and assist the
			 President; or
								(D)an individual of the Office of the Vice President whose function is to advise and assist the Vice
			 President.
								(2)Electronic messageThe term electronic message means electronic mail and all other means by which individuals and groups may communicate with
			 each other electronically.
							(3)Electronic messaging accountThe term electronic messaging account means any account that sends an electronic message.
							.
			(b)Federal recordsChapter 29 of title 44, United States Code is amended by adding at the end the following new
			 section:

					2911.Disclosure requirement for official business conducted using non-official electronic messaging
			 accounts
						(a)In generalAn officer or employee of a Federal agency may not create or send a record using a non-official
			 electronic messaging account (in this section, referred to as applicable electronic message) unless such officer or employee—
							(1)includes an official electronic messaging account of the officer or employee as a recipient in the
			 original creation or transmission of the applicable electronic message and
			 identifies all recipients of the applicable electronic message in such
			 message;
							(2)forwards a complete copy of the applicable electronic message, including a complete list of the
			 recipients of such message, to an official electronic messaging account of
			 the officer or employee within fifteen days after the original creation or
			 transmission of the record; or
							(3)prints a complete copy of the applicable electronic message, including a complete list of the
			 recipients of such message, and submits it to the appropriate location or
			 individual for appropriate archival storage by the Federal agency within
			 fifteen days after the original creation or transmission of the message.
							(b)Adverse actionsAn intentional violation of subsection (a) (including any rules, regulations, or other implementing
			 guidelines) by an officer or employee of a Federal agency, as determined
			 by the appropriate supervisor, shall be forwarded to the Inspector General
			 of the agency for a verification of the violation, and upon verification,
			 shall be subject to the suspension and removal provisions under section
			 7552 of title 5.
						(c)DefinitionsIn this section:
							(1)Electronic messageThe term electronic message means electronic mail and all other means by which individuals and groups may communicate with
			 each other electronically.
							(2)Electronic messaging accountThe term electronic messaging account means any account that sends an electronic message.
							.
			(c)Technical and conforming amendments
				(1)Chapter 22The table of sections at the beginning of chapter 22 of title 44, United States Code, is amended by
			 adding at the end the following new item:

							2208. Disclosure requirement for official business conducted using non-official electronic
			 messaging accounts.
						.
				(2)Chapter 29The table of sections at the beginning of chapter 29 of title 44, United States Code, is amended by
			 adding at the end the following new item:

							2911. Disclosure requirement for official business conducted using non-official electronic
			 messaging accounts.
						.
				4.Reporting of the loss or potential loss of recordsSection 3106 of title 44, United States Code, is amended to read as follows:

				3106.Unlawful removal, destruction of records
					(a)Notification
						(1)Archivist and public notificationWhenever the actual, impending, or threatened unlawful concealment, removal, mutilation,
			 obliteration, falsification, or destruction of any record, proceeding,
			 map, book, document, paper, or other thing in the custody of an agency
			 comes to the attention of the head of the Federal agency, the head of the
			 agency shall—
							(A)notify the Archivist; and
							(B)publish a general description of the records at risk or that have been lost on the website of the
			 agency.
							(2)Agency notificationWhenever the actual, impending, or threatened unlawful concealment, removal, mutilation,
			 obliteration, falsification, or destruction of any record, proceeding,
			 map, book, document, paper, or other thing in the custody of an agency
			 comes to the attention of a Senior Agency Official for Records Management,
			 such official shall immediately notify the head of the agency.
						(b)Reclamation of recordsWith the assistance of the Archivist, the head of a Federal agency shall initiate action through
			 the Attorney General for the recovery of records the head knows or has
			 reason to believe have been unlawfully removed from the agency, or from
			 another Federal agency whose records have been transferred to the legal
			 custody of such head.
					(c)Action by the ArchivistIn any case in which the head of the agency does not initiate an action for the recovery of records
			 described in subsection (b) or other redress within a reasonable period of
			 time after being notified of any such unlawful removal, the Archivist
			 shall request the Attorney General to initiate an action described in
			 subsection (b), and shall notify the Congress not later than 5 days after
			 the date on which such a request has been submitted to the Attorney
			 General.
					.
		5.Senior Agency Official for Records Compliance
			(a)Senior agency officialChapter 31 of title 44, United States Code, is amended by adding at the end the following new
			 section:

					3108.Senior Agency Official for Records Compliance
						(a)DesignationNot later than November 15, 2014, the head of each Federal agency shall designate a Senior Agency
			 Official for Records Management, and not later than November 15 of each
			 year thereafter the head of each Federal agency shall reaffirm or
			 designate a new Senior Agency Official for Records Management.
						(b)Authorities and responsibilitiesThe Senior Agency Official for Records Management shall—
							(1)be at least at the level of an Assistant Secretary or the equivalent; and
							(2)be responsible for the coordinating with the appropriate Agency Records Officer and appropriate
			 agency officials to ensure compliance with all applicable records
			 management statutes, regulations, and any guidance issued by the
			 Archivist.
							(c)Federal agency coordinationIn addition to the designation made pursuant to subsection (a), the head of a Federal agency may
			 designate additional Senior Agency Officials for Records Management as the
			 head of the agency determines to be necessary.
						.
			(b)Technical and conforming amendmentThe table of sections at the beginning of chapter 31 of title 44, United States Code, is amended by
			 adding at the end the following new item:

						3108. Senior Agency Official for Records Compliance.
					.
			6.Preservation of electronic messages and other records
			(a)Requirement for Preservation of Electronic MessagesChapter 29 of title 44, United States Code, as amended by section 3(b), is further amended by
			 adding at the end the following new section:

					2912.Preservation of electronic messages and other records
						(a)Regulations requiredNot later than 18 months after the date of the enactment of this section, the Archivist shall
			 promulgate regulations governing Federal agency preservation of electronic
			 messages that are determined to be records (as such term is defined under
			 section 3301 of this title). Such regulations shall, at a minimum—
							(1)require the electronic capture, management, and preservation of such electronic records in
			 accordance with the records disposition requirements of chapter 33 of this
			 title;
							(2)require that such electronic records are readily accessible for retrieval through electronic
			 searches;
							(3)establish mandatory minimum functional requirements for electronic records management systems to
			 ensure compliance with the requirements in paragraphs (1) and (2);
							(4)establish a process to certify that Federal agencies’ electronic records management systems meet
			 the functional requirements established under paragraph (3); and
							(5)include timelines for Federal agency compliance with the regulations that ensure compliance as
			 expeditiously as practicable but not later than 2 years after the date of
			 the enactment of this section.
							(b)Coverage of other electronic recordsTo the extent practicable, the regulations promulgated under subsection (a) shall also include
			 requirements for the capture, management, and preservation of other
			 electronic records.
						(c)Compliance by Federal agenciesEach Federal agency shall comply with the regulations promulgated under subsection (a).
						(d)Review of regulations requiredThe Archivist shall periodically review and, as necessary, amend the regulations promulgated under
			 subsection (a).
						(e)Reports on implementation of regulations
							(1)Agency report to ArchivistNot later than 3 years after the date of the enactment of this section, the head of each Federal
			 agency shall submit to the Archivist a report on the agency’s compliance
			 with the regulations promulgated under this section.
							(2)Archivist report to CongressNot later than 90 days after receipt of all reports required by paragraph (1), the Archivist shall
			 submit to the Committee on Homeland Security and Governmental Affairs of
			 the Senate and the Committee on Oversight and Government Reform of the
			 House of Representatives a report on Federal agency compliance with the
			 regulations promulgated under subsection (a).
							.
			(b)Clerical amendmentThe table of sections at the beginning of chapter 29 of title 44, United States Code, as amended by
			 section 3(c)(2), is further amended by adding after the item relating to
			 section 2911 the following new item:

						2912. Preservation of electronic messages and other records.
					.
			(c)DefinitionsSection 2901 of title 44, United States Code, is amended—
				(1)by striking and at the end of paragraph (14); and
				(2)by striking paragraph (15) and inserting the following new paragraphs:

						(15)the term electronic messages means electronic mail and other electronic messaging systems that are used for purposes of
			 communicating between individuals; and
						(16)the term electronic records management system means software designed to manage electronic records, including by—
							(A)categorizing and locating records;
							(B)ensuring that records are retained as long as necessary;
							(C)identifying records that are due for disposition; and
							(D)ensuring the storage, retrieval, and disposition of records.
							.
				7.Presidential records
			(a)Additional Regulations Relating to Presidential Records
				(1)In generalSection 2206 of title 44, United States Code, is amended—
					(A)by striking and at the end of paragraph (3);
					(B)by striking the period at the end of paragraph (4) and inserting ; and; and
					(C)by adding at the end the following:

							(5)provisions for establishing standards necessary for the economical and efficient management of
			 electronic Presidential records during the President’s term of office,
			 including—
								(A)records management controls necessary for the capture, management, and preservation of electronic
			 messages;
								(B)records management controls necessary to ensure that electronic messages are readily accessible for
			 retrieval through electronic searches; and
								(C)a process to certify the electronic records management system to be used by the President for the
			 purposes of complying with the requirements in subparagraphs (A) and (B).
								.
					(2)DefinitionsSection 2201 of title 44, United States Code, is amended by adding at the end the following new
			 paragraphs:

						(6)The term electronic messages has the meaning given that term under section 2901(15) of this title.
						(7)The term electronic records management system has the meaning given that term under section 2901(16) of this title.
						.
				(b)Certification of President’s Management of Presidential Records
				(1)Certification requiredChapter 22 of title 44, United States Code, as amended by section 3(a), is further amended by
			 adding at the end the following new section:

						2209.Certification of the President’s management of Presidential records
							(a)Annual CertificationThe Archivist shall annually certify whether the electronic records management controls established
			 by the President meet requirements under sections 2203(a) and 2206(5) of
			 this title.
							(b)Report to CongressThe Archivist shall report annually to the Committee on Homeland Security and Governmental Affairs
			 of the Senate and the Committee on Oversight and Government Reform of the
			 House of Representatives on the status of the certification.
							.
				(2)Clerical amendmentThe table of sections at the beginning of chapter 22 of title 44, United States Code, as amended by
			 section 3(c)(1), is further amended by adding at the end the following new
			 item:

							2209. Certification of the President’s management of Presidential records.
						.
				(c)Report to CongressSection 2203(f) of title 44, United States Code, is amended by adding at the end the following:

					(4)One year following the conclusion of a President’s term of office, or if a President serves
			 consecutive terms one year following the conclusion of the last term, the
			 Archivist shall submit to the Committee on Homeland Security and
			 Governmental Affairs of the Senate and the Committee on Oversight and
			 Government Reform of the House of Representatives a report on—
						(A)the volume and format of electronic Presidential records deposited into that President’s
			 Presidential archival depository; and
						(B)whether the electronic records management controls of that President met the requirements under
			 subsection (a) and section 2206(5) of this title.
						.
			(d)Effective dateThe amendments made by this section shall take effect one year after the date of the enactment of
			 this Act.
			8.Retention of electronic correspondence
			(a)Retention of records of high level officialsSection 3102 of title 44, United States Code, is amended—
				(1)in paragraph (2), by striking ; and and inserting a semicolon;
				(2)in paragraph (3), by striking the period at the end and inserting ; and; and
				(3)by adding at the end the following:

						(4)the identification of electronic messaging accounts (as defined in section 2911) that should be
			 preserved because such accounts are most likely to contain records that
			 should be preserved as permanent Federal records and the automatic
			 retention of those records, including the accounts of each head of a
			 Federal agency, the deputies and assistants of such head, the head of each
			 program office and staff office, each assistant secretary, each
			 administrator, each commissioner, each director of an office, bureau, or
			 the equivalent, each principal regional official, each staff assistant to
			 such official (such as a special assistant, confidential assistant, and
			 administrative assistant), each career Federal employee, each political
			 appointee, and each member of the Armed Forces serving in equivalent or
			 comparable positions; and
						(5)electronic capture, management, and preservation of the electronic messaging accounts (as defined
			 in section 2911) described in paragraph (4), in accordance with the
			 records disposal requirements of chapter 33 of this title such that—
							(A)electronic records are readily accessible for retrieval through electronic searches; and
							(B)there are mandatory minimum functional requirements for electronic records management systems to
			 ensure compliance with this section.
							.
				(b)Review by the Comptroller General of the United StatesSection 3107 of title 44, United States Code, is amended—
				(1)by striking Chapters 21 and inserting (a) In general.—Chapters 21; and
				(2)by adding at the end the following:

						(b)Comptroller General evaluationThe Comptroller General shall evaluate and report to Congress not less than every two years on
			 agency management of electronic mail records required under paragraphs (4)
			 and (5) of section 3102.
						.
				(c)Review by Inspector GeneralSection 4(a) of the Inspector General Act (5 U.S.C. App) is amended—
				(1)in paragraph (4), by striking ; and and inserting a semicolon;
				(2)in paragraph (5), by striking the period at the end and inserting ; and; and
				(3)by adding at the end the following new paragraph:

						(6)to review existing and proposed legislation and regulations relating to records retention
			 requirements under the chapters 21, 29, 31 and 33 of title 44, United
			 States Code (commonly referred to as the Federal Records Act) for programs
			 and operations of such establishment and to make recommendations in the
			 semiannual reports required by section 5(a) concerning compliance with
			 records retention requirements.
						.
				(d)Effective dateThis section and the amendments made by this section shall take effect on December 31, 2016.

	Passed the House of Representatives September 16, 2014.Karen L. Haas,Clerk


116 HR 286 IH: Florida Coastal Protection Act
U.S. House of Representatives
2019-01-08
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I116th CONGRESS1st SessionH. R. 286IN THE HOUSE OF REPRESENTATIVESJanuary 8, 2019Ms. Castor of Florida (for herself, Mr. Rooney of Florida, Mr. Crist, and Mr. Buchanan) introduced the following bill; which was referred to the Committee on Natural ResourcesA BILLTo amend the Outer Continental Shelf Lands Act to prohibit oil and gas preleasing, leasing, and related activities in certain areas of the Outer Continental Shelf off the coast of Florida, and for other purposes.
1.Short titleThis Act may be cited as the Florida Coastal Protection Act. 2.Prohibition of oil and natural gas preleasing, leasing, and related activities in certain areas off the coast of FloridaSection 18 of the Outer Continental Shelf Lands Act (43 U.S.C. 1344) is amended by adding at the end the following:

(i)Prohibition of oil and natural gas preleasing, leasing, and related activities in certain areas off the coast of Florida
(1)ProhibitionNotwithstanding any other provision of this section or any other law, the Secretary may not offer for oil and gas leasing or preleasing or any related activity, any tract located in— (A)any area of the Eastern Gulf of Mexico that is referred to in section 104(a) of the Gulf of Mexico Energy Security Act of 2006;
(B)the portion of the South Atlantic Planning Area south of 30 degrees 43 minutes North Latitude; or (C)the Straits of Florida Planning Area.
(2)Limitation on effectNothing in this subsection affects any right under any lease issued under this Act before the date of enactment of this subsection..


114 S2071 IS: Ambulatory Surgical Center Quality and Access Act of 2015
U.S. Senate
2015-09-24
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

II114th CONGRESS1st SessionS. 2071IN THE SENATE OF THE UNITED STATESSeptember 24, 2015Mr. Crapo (for himself, Mr. Alexander, Mr. Blumenthal, and Mr. Murphy) introduced the following bill; which was read twice and referred to the Committee on FinanceA BILLTo amend title XVIII of the Social Security Act to modernize payments for ambulatory surgical
			 centers under the Medicare program, and for other purposes.

 1.Short titleThis Act may be cited as the Ambulatory Surgical Center Quality and Access Act of 2015. 2.Aligning updates for ambulatory surgical center services with updates for OPD servicesSection 1833(i)(2)(D) of the Social Security Act (42 U.S.C. 1395l(i)(2)(D)) is amended—
 (1)in clause (v)— (A)in the first sentence, by inserting before the period the following: and, in the case of 2016 or a subsequent year, by the adjustment described in subsection (t)(3)(G) for the respective year; and
 (B)by moving the margin 6 ems to the left; (2)by redesignating clause (vi) as clause (vii); and
 (3)by inserting after clause (v) the following new clause:  (vi)In implementing the system described in clause (i) for 2016 and each subsequent year, there shall be an annual update under such system for the year equal to the OPD fee schedule increase factor specified under subsection (t)(3)(C)(iv) for such year, adjusted in accordance with clauses (iv) and (v)..
 3.Transparency of quality reporting and Medicare beneficiary informationParagraph (7) of section 1833(i) of the Social Security Act (42 U.S.C. 1395l(i)) is amended by adding at the end the following new subparagraphs:

 (C)To the extent that quality measures implemented by the Secretary under this paragraph for ambulatory surgical centers and under section 1833(t)(17) for hospital outpatient departments are applicable to the provision of surgical services in both ambulatory surgical centers and hospital outpatient departments, the Secretary shall make reported data on such centers and departments available on the website Medicare.gov in a manner that will permit side-by-side comparisons on such measures for ambulatory surgical centers and hospital outpatient departments in the same geographic area.
 (D)For each procedure covered for payment in an ambulatory surgical center, the Secretary shall publish, along with the quality reporting comparisons provided for in subparagraph (C), comparisons of the Medicare payment and beneficiary copayment amounts for the procedure when performed in ambulatory surgical centers and hospital outpatient departments in the same geographic area.
 (E)The Secretary shall ensure that an ambulatory surgery center and a hospital has the opportunity to review, and submit any corrections for, the data to be made public with respect to the ambulatory surgery center under subparagraph (C) prior to such data being made public.
 (F)The Secretary shall develop materials and inform beneficiaries under this title of publicly available comparisons provided for in subparagraphs (C) and (D)..
		4.Advisory Panel on Hospital Outpatient Payment Representation
 (a)ASC representativeThe second sentence of section 1833(t)(9)(A) of the Social Security Act (42 U.S.C. 1395l(t)(9)(A)) is amended by inserting and suppliers subject to the prospective payment system (including at least one ambulatory surgical center representative) after an appropriate selection of representatives of providers.
 (b)Effective dateThe amendment made by subsection (a) shall take effect on the date of the enactment of this Act. 5.Reasons for excluding additional procedures from ASC approved list (a)In generalSection 1833(i)(1) of the Social Security Act (42 U.S.C. 1395l(i)(1)) is amended by adding at the end the following: In updating such lists for application in years beginning after the date of the enactment of this sentence, for each procedure that was requested to be included in such lists during the public comment period but which the Secretary does not propose (in the final rule updating such lists) to so include in such lists, the Secretary shall cite in such final rule the specific criteria in paragraph (b) or (c) of section 416.166 of title 42, Code of Federal Regulations, based on which the procedure was excluded. If paragraph (b) of such section is cited for exclusion of a procedure, the Secretary shall identify the peer reviewed research or the evidence upon which such determination is based. The Secretary may not use or cite section 416.166(c)(7) of such title as criteria or a basis for exclusion of a procedure from such lists..
 (b)Effective dateThe amendment made by subsection (a) shall apply to lists of ambulatory surgery procedures for application in years beginning after the date of the enactment of this Act.


116 HJ 53 IH: Proposing an amendment to the Constitution of the United States to require that the Supreme Court be composed of not more than nine justices.
U.S. House of Representatives
2019-03-25
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

IA116th CONGRESS1st SessionH. J. RES. 53IN THE HOUSE OF REPRESENTATIVESMarch 25, 2019Mr. Gallagher (for himself and Mr. Norman) submitted the following joint resolution; which was referred to the Committee on the JudiciaryJOINT RESOLUTIONProposing an amendment to the Constitution of the United States to require that the Supreme Court
			 be composed of not more than nine justices.

 That the following article is proposed as an amendment to the Constitution of the United States, which shall be valid to all intents and purposes as part of the Constitution when ratified by the legislatures of three-fourths of the several States within seven years after the date of its submission for ratification:

				 —
 1.The Supreme Court shall be composed of not more than nine justices. 2.The Congress shall have the power to enforce this article by appropriate legislation.
					.


110 HR 4412 IH: To suspend temporarily the duty on hydraulic control units.
U.S. House of Representatives
2007-12-11
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I
110th CONGRESS 1st Session
H. R. 4412
IN THE HOUSE OF REPRESENTATIVES

December 11, 2007
Mr. Camp of Michigan introduced the following bill; which was referred to the Committee on Ways and Means

A BILL
To suspend temporarily the duty on hydraulic control units.

1.Hydraulic control units
(a)In generalSubchapter II of chapter 99 of the Harmonized Tariff Schedule of the United States is amended by inserting in numerical sequence the following new heading:

9902.90.01Hydraulic control units designed for braking systems of hybrid motor vehicles of heading 8703 (provided for in subheading 9032.89.60)FreeNo changeNo changeOn or before 12/31/2011    .
(b)Effective dateThe amendment made by subsection (a) applies to goods entered, or withdrawn from warehouse for consumption, on or after the 15th day after the date of enactment of this Act.


		I
		111th CONGRESS
		1st Session
		H. R. 2068
		IN THE HOUSE OF REPRESENTATIVES

			April 23, 2009
			Mr. Thompson of
			 California (for himself, Mr.
			 Stupak, Mr. Terry, and
			 Mr. Sam Johnson of Texas) 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
			 committee concerned

		A BILL
		To improve the provision of telehealth services under the
		  Medicare Program, to provide grants for the development of telehealth networks,
		  and for other purposes.

		1.Short title; table of
			 contents
			(a)Short
			 titleThis Act may be cited
			 as the Medicare Telehealth Enhancement
			 Act of 2009.
			(b)Table of
			 contentsThe table of contents of this Act is as follows:

					Sec. 1. Short title; table of contents.
					Title I—Medicare Program
					Sec. 101. Expansion and improvement of telehealth
				services.
					Sec. 102. Increase in number of types of originating sites;
				clarification.
					Sec. 103. Expansion of eligible telehealth providers and
				credentialing of telemedicine practitioners.
					Sec. 104. Access to telehealth services in the
				home.
					Sec. 105. Coverage of home health remote patient management
				services for chronic health conditions.
					Sec. 106. Sense of Congress on the use of remote patient
				management services.
					Sec. 107. Telehealth Advisory Committee.
					Title II—HRSA Grant Program
					Sec. 201. Grant program for the development of telehealth
				networks.
					Sec. 202. Reauthorization of telehealth network and telehealth
				resource centers grant programs.

			IMedicare
			 Program
			101.Expansion and
			 improvement of telehealth services
				(a)Expanding access
			 to telehealth services to all areasSection 1834(m)(4)(C)(i) of
			 the Social Security Act (42 U.S.C.
			 1395m(m)(4)(C)(i)) is amended in paragraph (4)(C)(i) by striking and
			 only if such site is located and all that follows and inserting
			 without regard to the geographic area within the United States where the
			 site is located..
				(b)Expansion of use
			 of store-and-forward technologyThe second sentence of section 1834(m)(1)
			 of such Act (42 U.S.C. 1395m(m)(1)) is amended by inserting and any
			 telehealth program that has been the recipient of any Federal support from the
			 Centers for Medicare & Medicaid Services, the Indian Health Service, or the
			 Health Services and Resources Administration after Alaska or
			 Hawaii.
				(c)Effective
			 dateThe amendments made by this section shall apply to services
			 furnished on or after January 1, 2010.
				102.Increase in
			 number of types of originating sites; clarification
				(a)IncreaseParagraph
			 (4)(C)(ii) of section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m))
			 is amended by adding at the end the following new subclause:

						(IX)A renal dialysis
				facility.

				(b)Clarification of
			 Intent of the Term Originating SiteSuch section is further
			 amended by adding at the end the following new paragraph:

						(5)ConstructionIn
				applying the term originating site under this subsection, the
				Secretary shall apply the term only for the purpose of determining whether a
				site is eligible to receive a facility fee. Nothing in the application of such
				term under this subsection shall be construed as affecting the ability of an
				eligible practitioner to submit claims for telehealth services that are
				provided to other sites that have telehealth systems and
				capabilities.
						.
				(c)Effective
			 dateThe amendments made by this section shall apply to services
			 furnished on or after January 1, 2010.
				103.Expansion of
			 eligible telehealth providers and credentialing of telemedicine
			 practitioners
				(a)Expansion of
			 eligible telehealth providersSection 1834(m)(1) of the Social
			 Security Act (42 U.S.C. 1395m(m)(1)) is amended—
					(1)in
			 paragraph (1)—
						(A)by striking
			 or a practitioner and inserting , a
			 practitioner;
						(B)by inserting
			 , or other telehealth provider after
			 1842(b)(18)(C)); and
						(C)by striking
			 or practitioner and inserting , practitioner, or
			 provider;
						(2)in paragraphs (2),
			 (3)(A), and (4), by striking or practitioner and inserting
			 , practitioner, or other telehealth provider each place it
			 appears;
					(3)in paragraph (4),
			 by adding at the end the following new subparagraph:

							(G)Telehealth
				providerThe term
				telehealth provider means any supplier or provider of services
				(other than a physician or practitioner) that is eligible to provide other
				health services under this
				title.
							.
					(b)Credentialing
			 Telemedicine PractitionersSection 1834(m) of such Act is amended
			 by adding at the end the following new paragraph:

						(5)Hospital
				credentialing of telemedicine practitionersA telemedicine practitioner that is
				credentialed by a hospital in compliance with the Joint Commission Standards
				for Telemedicine shall be considered in compliance with Medicare condition of
				participation and reimbursement credentialing requirements for telemedicine
				services. Hospitals that credential telemedicine
				practitioners in compliance with the Joint Commission Standards for
				Telemedicine shall be considered in compliance with Medicare condition of
				participation and reimbursement credentialing requirements for telemedicine
				services.
						.
				104.Access to
			 telehealth services in the home
				(a)In
			 generalSection 1895 of the Social Security Act (42 U.S.C.
			 1395fff(e)) is amended by adding at the end the following new
			 subsection:

						(f)Coverage of
				Telehealth Services
							(1)In
				generalThe Secretary shall include telehealth services that are
				furnished via a telecommunication system by a home health agency to an
				individual receiving home health services under section 1814(a)(2)(C) or
				1835(a)(2)(A) as a home health visit for purposes of eligibility and payment
				under this title if the telehealth services—
								(A)are ordered as
				part of a plan of care certified by a physician pursuant to section
				1814(a)(2)(C) or 1835(a)(2)(A);
								(B)do not substitute
				for in-person home health services ordered as part of a plan of care certified
				by a physician pursuant to such respective section; and
								(C)are considered the
				equivalent of a visit under criteria developed by the Secretary under paragraph
				(3).
								(2)Physician
				certificationNothing in this section shall be construed as
				waiving the requirement for a physician certification under section
				1814(a)(2)(C) or 1835(a)(2)(A) for the payment for home health services,
				whether or not furnished via a telecommunication system.
							(3)Criteria for visit
				equivalency
								(A)StandardsThe
				Secretary shall establish standards and qualifications for categorizing and
				coding under HCPCS codes telehealth services under this subsection as
				equivalent to an in-person visit for purposes of eligibility and payment for
				home health services under this title. In establishing the standards and
				qualifications, the Secretary may distinguish between varying modes and
				modalities of telehealth services and shall consider—
									(i)the nature and
				amount of service time involved; and
									(ii)the functions of
				the telecommunications.
									(B)LimitationA
				telecommunication that consists solely of a telephone audio conversation,
				facsimile, electronic text mail, or consultation between two health care
				practitioners is not considered a visit under this subsection.
								(4)Telehealth
				service
								(A)DefinitionFor
				purposes of this subsection, the term telehealth service means
				technology-based professional consultations, patient monitoring, patient
				training services, clinical observation, assessment, or treatment, and any
				additional services that utilize technologies specified by the Secretary as
				HCPCS codes developed under paragraph (3).
								(B)Update of hcpcs
				codesThe Secretary shall establish a process for the updating,
				not less frequently than annually, of HCPCS codes for telehealth
				services.
								(5)Conditions for
				payment and coverageNothing in this subsection shall be
				construed as waiving any condition of payment under sections 1814(a)(2)(C) or
				1835(a)(2)(A) or exclusion of coverage under section 1862(a)(1).
							(6)Cost
				reportingNotwithstanding any provision to the contrary, the
				Secretary shall provide that the costs of telehealth services under this
				subsection shall be reported as a reimbursable cost center on any cost report
				submitted by a home health agency to the
				Secretary.
							.
				(b)Effective
			 date
					(1)The
			 amendment made by subsection (a) shall apply to telehealth services furnished
			 on or after October 1, 2010. The Secretary of Health and Human Services shall
			 develop and implement criteria and standards under section 1895(f)(3) of the
			 Social Security Act, as amended by subsection (a), by no later than July 1,
			 2010.
					(2)In the event that
			 the Secretary has not complied with these deadlines, beginning October 1, 2010,
			 a home health visit for purpose of eligibility and payment under title XVIII of
			 the Social Security Act shall include telehealth services under section 1895(f)
			 of such Act with the aggregate of telecommunication encounters in a 24-hour
			 period considered the equivalent of one in-person visit.
					105.Coverage of home
			 health remote patient management services for chronic health
			 conditions
				(a)Medicare
			 coverage
					(1)In
			 generalSection 1861(s)(2) of the Social Security Act (42 U.S.C.
			 1395x(s)(2)) is amended—
						(A)in subparagraph
			 (DD), by striking and at the end;
						(B)in subparagraph
			 (EE), by adding and at the end; and
						(C)by inserting after
			 subparagraph (EE) the following new subparagraph:

								(FF)home health
				remote patient management services (as defined in subsection
				(hhh));
								.
						(2)Services
			 describedSection 1861 of such Act (42 U.S.C. 1395x) is amended
			 by adding at the end the following new subsection:

							(hhh)Home health
				remote patient management services for chronic health conditions(1)The term remote patient management
				services means the remote monitoring, evaluation, and management of an
				individual with a covered chronic health condition (as defined in paragraph
				(2)) through the utilization of a system of technology that allows a remote
				interface to collect and transmit clinical data between the individual and a
				home health agency, in accordance with a plan of care established by a
				physician, for the purposes of clinical review or response by the home health
				agency. Such term, with respect to an individual, does not include any remote
				monitoring, evaluation, or management of the individual if such remote
				monitoring, evaluation, or management, respectively, is included as a home
				health visit under section 1895(f) for purposes of payment under this
				title.
								(2)For purposes of paragraph (1), the
				term covered chronic health condition means any chronic health
				condition specified by the
				Secretary.
								.
					(b)Payment
					(1)In
			 generalSection 1834 of such
			 Act (42 U.S.C. 1395l) is amended by adding at the end the following new
			 subsection:

							(n)Home Health
				Remote Patient Management Services
								(1)In
				generalThe Secretary shall establish a fee schedule for home
				health remote patient management services (as defined in section 1861(hhh)) for
				which payment is made under this part. The fee schedule shall be designed in a
				manner so that, on an annual basis, the aggregate payment amounts under this
				title for such services approximates 50 percent of the savings amount described
				in paragraph (2) for such year.
								(2)Savings
				described
									(A)In
				generalFor purposes of paragraph (1), the savings amount
				described in this paragraph for a year is the amount (if any), as estimated by
				the Secretary before the beginning of the year, by which—
										(i)the product
				described in subparagraph (B) for the year, exceeds
										(ii)the total
				payments under this part and part A for items and services furnished to
				individuals receiving home health remote patient management services at any
				time during the year.
										(B)Product
				describedThe product described in this subparagraph for a year
				is the product of—
										(i)the average per
				capita total payments under this part and part A for items and services
				furnished during the year to individuals not described in subparagraph (A)(ii),
				adjusted to remove case mix differences between such individuals not described
				in such subparagraph and the individuals described in such subparagraph;
				and
										(ii)the number of
				individuals under subparagraph (A)(ii) for the year.
										(3)LimitationIn
				no case may payments under this subsection result in the aggregate expenditures
				under this title (including payments under this subsection) exceeding the
				amount that the Secretary estimates would have been expended if coverage under
				this title for home health patient management services was not provided.
								(4)ClarificationPayments
				under the fee schedule under this subsection, with respect to an individual,
				shall be in addition to any other payments that a home health agency would
				otherwise receive under this title for items and services furnished to such
				individual and shall have no effect on the amount of such other
				payments.
								(5)Payment
				transferThere shall be
				transferred from the Federal Hospital Insurance Trust Fund under section 1817
				to the Federal Supplementary Medical Insurance Trust Fund under section 1841
				each year an amount equivalent to the product of—
									(A)expenditures under
				this subsection for the year, and
									(B)the ratio of the
				portion of the savings described in paragraph (2) for the year that are
				attributable to part A, to the total savings described in such paragraph for
				the
				year.
									.
					(2)Conforming
			 amendmentSection 1833(a)(1)
			 of such Act (42 U.S.C. 1395l(1)) is amended—
						(A)by striking
			 and (W) and inserting (W); and
						(B)by inserting
			 before the semicolon at the end the following: , (X) with respect to
			 home health remote patient management services (as defined in section
			 1861(hhh)), the amounts paid shall be the amount determined under the fee
			 schedule established under section 1834(n).
						(c)Expansion of
			 Home Health Remote Patient Management Services Coverage to Additional Chronic
			 Health ConditionsThe
			 Secretary of Health and Human Services is authorized to carry out pilot
			 projects for purposes of determining the extent to which the coverage under
			 title XVIII of the Social Security Act of home health remote patient management
			 services (as defined in paragraph (1) of section 1861(hhh) of such Act, as
			 added by subsection (a)) should be extended to individuals with chronic health
			 conditions other than those initially specified by the Secretary under
			 paragraph (2) of such section.
				(d)Effective
			 dateThe amendments made by
			 subsections (a), (b), and (c) shall apply to services furnished on or after
			 January 1, 2010.
				106.Sense of
			 Congress on the use of remote patient management services
				(a)FindingsCongress
			 finds as follows:
					(1)Remote patient
			 management services can make chronic disease management more effective and
			 efficient for patients and for the health care system.
					(2)By collecting,
			 analyzing, and transmitting clinical health information to a health care
			 provider, remote patient management services allow patients and providers to
			 manage the medical condition of patients in a consistent and real time
			 fashion.
					(3)Utilization of
			 remote patient management services not only improves the quality of care given
			 to patients, it also reduces the need for frequent office appointments, costly
			 emergency room visits, and unnecessary hospitalizations.
					(4)Management the
			 medical condition or disease of a patient from the patient's home reduces the
			 need for face to face provider interactions. Use of remote patient management
			 services minimizes unnecessary travel and missed work and provides particular
			 value to patients residing in rural or underserved communities who would
			 otherwise face potentially significant access barriers to receiving needed
			 care.
					(5)Among the areas in
			 which remote patient management services are emerging in health care are the
			 treatment of congestive heart failure, diabetes, cardiac arrhythmia, epilepsy,
			 and sleep apnea. Prompt transmission of clinical data on each of these
			 conditions, to the health care provider or the patient as appropriate, is
			 essential to providing timely and appropriate therapeutic interventions which
			 can then reduce expensive hospitalizations.
					(6)Despite these
			 benefits, remote patient management services have failed to diffuse rapidly. A
			 significant barrier to wider adoption is the relative lack of payment
			 mechanisms in fee for service Medicare to reimburse for remote, non face to
			 face patient management.
					(7)Elimination of
			 this barrier to new remote patient management services should be encouraged by
			 requiring reimbursement under the Medicare program for providers’ time spent
			 analyzing and responding to patient data transmitted by remote
			 technologies.
					(8)Reimbursement
			 under the Medicare program for health care providers’ time spent analyzing and
			 responding to data transmitted to providers by remote technologies should be
			 made on a separate basis and should not be combined with payments for others
			 services (also referred to as bundled payments).
					(9)Payment codes used
			 for reporting and billing for payment for providers’ remote patient management
			 services should be revised or adjusted, as appropriate, to encourage the
			 application of such services for other medical conditions.
					(b)Sense of
			 congressIt is the sense of the Congress that—
					(1)remote patient
			 management services are integral to improvement in the delivery, care, and
			 efficiency of health care services furnished in the United States; and
					(2)the Administrator
			 of the Centers for Medicare & Medicaid Services should be encouraged
			 to—
						(A)expand the types
			 of medical conditions for which the use of remote patient management services
			 are reimbursed under the Medicare program;
						(B)provide for
			 separate, non-bundled payment under the Medicare program for remote patient
			 management services; and
						(C)create, revise and
			 adjust, as appropriate, codes for the accurate reporting and billing for
			 payment for remote patient management services.
						107.Telehealth
			 Advisory Committee
				(a)In
			 generalSection 1834(m)(4)(F)(ii) of the Social Security Act (42
			 U.S.C. 1395m(m)(4)(F)(ii)) is amended by adding at the end the following
			 sentences: Such process shall require the Secretary to take into account
			 the recommendations of the Telehealth Advisory Committee (as established under
			 section 107(b) of the Medicare Telehealth Enhancement Act of 2009) when adding
			 or deleting services (and HCPCS codes) and in establishing policies of the
			 Centers for Medicare & Medicaid Services regarding the delivery of
			 telehealth services. If the Secretary does not implement a recommendation of
			 the Telehealth Advisory Committee, the Secretary shall publish in the Federal
			 Register a statement regarding the reason such recommendation was not
			 implemented..
				(b)Telehealth
			 Advisory Committee
					(1)EstablishmentOn
			 and after the date that is 6 months after the date of enactment of this Act,
			 the Secretary of Health and Human Services (in this subsection referred to as
			 the Secretary) shall have in place a Telehealth Advisory
			 Committee (in this subsection referred to as the Advisory
			 Committee) to make recommendations to the Secretary on—
						(A)policies of the Centers for Medicare &
			 Medicaid Services regarding the delivery of telehealth services; and
						(B)the appropriate
			 addition or deletion of services (and HCPCS codes) to those specified in
			 paragraph (4)(F)(i) of section 1834(m) of the Social Security Act (42 U.S.C.
			 1395m(m)) for authorized payment under paragraph (1) of such section.
						(2)Membership;
			 terms
						(A)Membership
							(i)In
			 generalThe Advisory Committee shall be composed of 9 members, to
			 be appointed by the Secretary, of whom—
								(I)five shall be
			 practicing physicians;
								(II)two shall be
			 practicing non-physician health care providers; and
								(III)two shall be administrators of telehealth
			 programs.
								(ii)Requirements
			 for appointing membersIn appointing members of the Advisory
			 Committee, the Secretary shall—
								(I)ensure that each
			 member has prior experience with the practice of telemedicine or
			 telehealth;
								(II)give preference to individuals who are
			 currently providing telemedicine or telehealth services or who are involved in
			 telemedicine or telehealth programs;
								(III)ensure that the
			 membership of the Advisory Committee represents a balance of specialties and
			 geographic regions; and
								(IV)take into account
			 the recommendations of stakeholders.
								(B)TermsThe
			 members of the Advisory Committee shall serve for such term as the Secretary
			 may specify.
						(C)Conflicts of
			 interestAn advisory
			 committee member may not participate with respect to a particular matter
			 considered in an advisory committee meeting if such member (or an immediate
			 family member of such member) has a financial interest that could be affected
			 by the advice given to the Secretary with respect to such matter.
						(3)MeetingsThe
			 Advisory Committee shall meet twice per year and at such other times as the
			 Advisory Committee may provide.
					(4)Permanent
			 committeeSection 14 of the Federal Advisory Committee Act (5
			 U.S.C. App.) shall not apply to the Advisory Committee.
					(5)Waiver of
			 administrative limitationThe Secretary shall establish the
			 Advisory Committee notwithstanding any limitation that may apply to the number
			 of advisory committees that may be established (within the Department of Health
			 and Human Services or otherwise).
					IIHRSA
			 Grant Program
			201.Grant program
			 for the development of telehealth networks
				(a)In
			 generalThe Secretary of Health and Human Services (in this
			 section referred to as the Secretary), acting through the
			 Director of the Office for the Advancement of Telehealth (of the Health
			 Resources and Services Administration), shall make grants to eligible entities
			 (as described in subsection (b)(2)) for the purpose of expanding access to
			 health care services for individuals in rural areas, frontier areas, and urban
			 medically underserved areas through the use of telehealth.
				(b)Eligible
			 entities
					(1)ApplicationTo
			 be eligible to receive a grant under this section, an eligible entity described
			 in paragraph (2) shall, in consultation with the State office of rural health
			 or other appropriate State entity, prepare and submit to the Secretary an
			 application, at such time, in such manner, and containing such information as
			 the Secretary may require, including the following:
						(A)A description of
			 the anticipated need for the grant.
						(B)A description of
			 the activities which the entity intends to carry out using amounts provided
			 under the grant.
						(C)A plan for
			 continuing the project after Federal support under this section is
			 ended.
						(D)A description of
			 the manner in which the activities funded under the grant will meet health care
			 needs of underserved rural populations within the State.
						(E)A description of
			 how the local community or region to be served by the network or proposed
			 network will be involved in the development and ongoing operations of the
			 network.
						(F)The source and
			 amount of non-Federal funds the entity would pledge for the project.
						(G)A showing of the
			 long-term viability of the project and evidence of health care provider
			 commitment to the network.
						The
			 application should demonstrate the manner in which the project will promote the
			 integration of telehealth in the community so as to avoid redundancy of
			 technology and achieve economies of scale.(2)Eligible
			 entities
						(A)In
			 generalAn eligible entity described in this paragraph is a
			 hospital or other health care provider in a health care network of
			 community-based health care providers that includes at least—
							(i)two
			 of the organizations described in subparagraph (B); and
							(ii)one
			 of the institutions and entities described in subparagraph (C),
							if the
			 institution or entity is able to demonstrate use of the network for purposes of
			 education or economic development (as required by the Secretary).(B)Organizations
			 describedThe organizations described in this subparagraph are
			 the following:
							(i)Community or
			 migrant health centers.
							(ii)Local health
			 departments.
							(iii)Nonprofit
			 hospitals.
							(iv)Private practice
			 health professionals, including community and rural health clinics.
							(v)Other publicly
			 funded health or social services agencies.
							(vi)Skilled nursing
			 facilities.
							(vii)County mental
			 health and other publicly funded mental health facilities.
							(viii)Providers of
			 home health services.
							(ix)Renal dialysis
			 facilities.
							(C)Institutions and
			 entities describedThe institutions and entities described in
			 this subparagraph are the following:
							(i)A
			 public school.
							(ii)A
			 public library.
							(iii)A
			 university or college.
							(iv)A
			 local government entity.
							(v)A
			 local health entity.
							(vi)A
			 health-related nonprofit foundation.
							(vii)An
			 academic health center.
							An eligible
			 entity may include for-profit entities so long as the recipient of the grant is
			 a not-for-profit entity.(c)PreferenceThe
			 Secretary shall establish procedures to prioritize financial assistance under
			 this section based upon the following considerations:
					(1)The applicant is a
			 health care provider in a health care network or a health care provider that
			 proposes to form such a network that furnishes or proposes to furnish services
			 in a medically underserved area, health professional shortage area, or mental
			 health professional shortage area.
					(2)The applicant is
			 able to demonstrate broad geographic coverage in the rural or medically
			 underserved areas of the State, or States in which the applicant is
			 located.
					(3)The applicant
			 proposes to use Federal funds to develop plans for, or to establish, telehealth
			 systems that will link rural hospitals and rural health care providers to other
			 hospitals, health care providers, and patients.
					(4)The applicant will
			 use the amounts provided for a range of health care applications and to promote
			 greater efficiency in the use of health care resources.
					(5)The applicant is
			 able to demonstrate the long-term viability of projects through cost
			 participation (cash or in-kind).
					(6)The applicant is
			 able to demonstrate financial, institutional, and community support for the
			 long-term viability of the network.
					(7)The applicant is
			 able to provide a detailed plan for coordinating system use by eligible
			 entities so that health care services are given a priority over non-clinical
			 uses.
					(d)Maximum amount
			 of assistance to individual recipientsThe Secretary shall
			 establish, by regulation, the terms and conditions of the grant and the maximum
			 amount of a grant award to be made available to an individual recipient for
			 each fiscal year under this section. The Secretary shall cause to have
			 published in the Federal Register or the HRSA Preview notice of
			 the terms and conditions of a grant under this section and the maximum amount
			 of such a grant for a fiscal year.
				(e)Use of
			 amountsThe recipient of a grant under this section may use sums
			 received under such grant for the acquisition of telehealth equipment and
			 modifications or improvements of telecommunications facilities including the
			 following:
					(1)The development
			 and acquisition through lease or purchase of computer hardware and software,
			 audio and video equipment, computer network equipment, interactive equipment,
			 data terminal equipment, and other facilities and equipment that would further
			 the purposes of this section.
					(2)The provision of
			 technical assistance and instruction for the development and use of such
			 programming equipment or facilities.
					(3)The development
			 and acquisition of instructional programming.
					(4)Demonstration
			 projects for teaching or training medical students, residents, and other health
			 profession students in rural or medically underserved training sites about the
			 application of telehealth.
					(5)The provision of
			 telenursing services designed to enhance care coordination and promote patient
			 self-management skills.
					(6)The provision of
			 services designed to promote patient understanding and adherence to national
			 guidelines for common chronic diseases, such as congestive heart failure or
			 diabetes.
					(7)Transmission costs,
			 maintenance of equipment, and compensation of specialists and referring health
			 care providers, when no other form of reimbursement is available.
					(8)Development of
			 projects to use telehealth to facilitate collaboration between health care
			 providers.
					(9)Electronic
			 archival of patient records.
					(10)Collection and
			 analysis of usage statistics and data that can be used to document the
			 cost-effectiveness of the telehealth services.
					(11)Such other uses
			 that are consistent with achieving the purposes of this section as approved by
			 the Secretary.
					(f)Prohibited
			 usesSums received under a grant under this section may not be
			 used for any of the following:
					(1)To acquire real
			 property.
					(2)Expenditures to
			 purchase or lease equipment to the extent the expenditures would exceed more
			 than 40 percent of the total grant funds.
					(3)To purchase or
			 install transmission equipment off the premises of the telehealth site and any
			 transmission costs not directly related to the grant.
					(4)For construction,
			 except that such funds may be expended for minor renovations relating to the
			 installation of equipment.
					(5)Expenditures for
			 indirect costs (as determined by the Secretary) to the extent the expenditures
			 would exceed more than 15 percent of the total grant.
					(g)Administration
					(1)NonduplicationThe
			 Secretary shall ensure that facilities constructed using grants provided under
			 this section do not duplicate adequately established telehealth
			 networks.
					(2)Coordination
			 with other agenciesThe Secretary shall coordinate, to the extent
			 practicable, with other Federal and State agencies and not-for-profit
			 organizations, operating similar grant programs to pool resources for funding
			 meritorious proposals.
					(3)Informational
			 effortsThe Secretary shall establish and implement procedures to
			 carry out outreach activities to advise potential end users located in rural
			 and medically underserved areas of each State about the program authorized by
			 this section.
					(h)Prompt
			 implementationThe Secretary shall take such actions as are
			 necessary to carry out the grant program as expeditiously as possible.
				(i)Authorization of
			 appropriationsThere are authorized to be appropriated to carry
			 out this section $10,000,000 for fiscal year 2010, and such sums as may be
			 necessary for each of the fiscal years 2011 through 2014.
				202.Reauthorization
			 of telehealth network and telehealth resource centers grant
			 programsSubsection (s) of
			 section 330I of the Public Health Service Act (42 U.S.C. 254c–14) is
			 amended—
				(1)in paragraph
			 (1)—
					(A)by striking
			 and before such sums; and
					(B)by inserting
			 $10,000,000 for fiscal year 2010, and such sums as may be necessary for
			 each of fiscal years 2011 through 2014 before the semicolon; and
					(2)in paragraph
			 (2)—
					(A)by striking
			 and before such sums; and
					(B)by inserting
			 $10,000,000 for fiscal year 2010, and such sums as may be necessary for
			 each of fiscal years 2011 through 2014 before the semicolon.