Telehealth Improvement Act of 2004 - Amends the Social Security Act to: (1) increase the type of originating sites allowed to offer telehealth services, including skilled nursing facilities, assisted living facilities, and county or community health clinics; and (2) remove the requirement that such originating sites must be in rural areas.
Amends the Public Health Service Act to require the Secretary of Health and Human Services to convene a conference of State licensing boards, local telehealth projects, health care practitioners, and patient advocates to promote interstate licensure for telehealth projects.
Authorizes the Director of the Office of the Advancement of Telehealth to award grants to: (1) demonstrate how telehealth technologies can be used to expand access to, coordinate, and improve the quality of health care services and to improve and expand the training of health care providers and the quality of health information available; (2) provide telehealth services to patients who reside in areas under the jurisdiction of Indian tribes or tribal organizations; and (3) provide oral health services to patients who reside in rural areas.
Directs the Secretary to establish a Joint Working Group on Telehealth to: (1) identify, monitor, and coordinate Federal telehealth projects, data sets, and programs; (2) analyze how telehealth systems are expanding access to health care services, education, and information; (3) analyze the clinical, educational, or administrative efficacy and cost-effectiveness of telehealth applications; (4) analyze the quality of the telehealth services delivered; and (5) make recommendations for coordinating Federal and State efforts to increase access to health services, education, and information in rural and medically underserved areas.
[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 2325 Introduced in Senate (IS)]
108th CONGRESS
2d Session
S. 2325
To strengthen telehealth programs.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
April 21, 2004
Mr. Edwards introduced the following bill; which was read twice and
referred to the Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To strengthen telehealth programs.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Telehealth Improvement Act of
2004''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) 36,000,000 people of the United States lack access to
doctors who are willing or able to care for them.
(2) Many individuals lack access to treatment because
appropriate transportation is too expensive or limited by
weather factors, or because the patient involved is too sick to
use the options that are available.
(3) Telehealth services can improve access to quality
health care and can help control skyrocketing medical costs.
(4) Sophisticated audio and video telehealth services link
physicians and nurses with patients for checkups and diagnoses.
Those services give patients access to quality health care
without having to travel to a hospital or doctor's office,
which is critical for patients in rural and underserved urban
areas and for patients who have difficulty leaving their homes.
(5) Telehealth services have also been pivotal in
protecting lives during emergency situations, including large-
scale natural disasters.
(6) The Department of Commerce found that the United States
maintains a ``competitive advantage for exporting telehealth
technologies and services'', yet the ``international market for
telehealth technologies and major projects has been largely
overlooked by U.S. industry''. A 2003 report by the Department
of Commerce stated that ``with effective marketing and
responsiveness to sales opportunities, American firms can also
lead in world market share''.
SEC. 3. INCREASING TYPES OF ORIGINATING TELEHEALTH SITES AND
FACILITATING THE PROVISION OF TELEHEALTH SERVICES ACROSS
STATE LINES.
(a) Increasing Types of Originating Sites.--Section
1834(m)(4)(C)(ii) of the Social Security Act (42 U.S.C.
1395m(m)(4)(C)(ii)) is amended by adding at the end the following:
``(VI) A skilled nursing facility
(as defined in section 1819(a)).
``(VII) An assisted-living facility
(as defined by the Secretary).
``(VIII) A board-and-care home (as
defined by the Secretary).
``(IX) A county or community health
clinic (as defined by the Secretary).
``(X) A community mental health
center (as described in section
1861(ff)(2)(B)).
``(XI) A facility operated by the
Indian Health Service or by an Indian
tribe, tribal organization, or an urban
Indian organization (as such terms are
defined in section 4 of the Indian
Health Care Improvement Act (25 U.S.C.
1603)) directly, or under contract or
other arrangement.
``(XII) A site in a State in which
the respective State medical board has
adopted a formal policy regarding
licensing or certification requirements
for providers at distant sites who do
not have a license to practice medicine
at the originating site.''.
(b) Expanding Eligibility for Reimbursement.--Section
1834(m)(4)(C)(i)(I) of the Social Security Act (42 U.S.C.
1395m(m)(4)(C)(i)(I)) is amended by striking ``rural''.
SEC. 4. STRENGTHENING TELEHEALTH SERVICES IN RURAL AND UNDERSERVED
URBAN AMERICA.
Subpart I of part D of title III of the Public Health Service Act
(42 U.S.C. 254b et seq.) is amended--
(1) in section 330L--
(A) by redesignating subsection (b) as subsection
(c); and
(B) by inserting after subsection (a) the
following:
``(b) Conference.--Within 1 year of the date of enactment of the
Telehealth Improvement Act of 2004, the Secretary shall convene a
conference of State licensing boards, local telehealth projects, health
care practitioners, and patient advocates to promote interstate
licensure for telehealth projects.''; and
(2) by adding at the end the following:
``SEC. 330M. INTEGRATIVE ELDERCARE TELEHEALTH DEMONSTRATION PROJECT.
``(a) Purposes.--The purposes of this section are to encourage the
creation of programs to--
``(1) evaluate the use of telehealth services in an
integrative eldercare setting;
``(2) eliminate fragmented service delivery while promoting
enhanced continuity of care and more simplified access to
services;
``(3) develop community-based options that promote patient
independence and leverage telehealth services and equipment to
enable the use of the most cost-effective, least restrictive
care settings; and
``(4) promote access for elderly patients in rural and
underserved urban areas to improvements in medical technology
and training across an integrated spectrum of care; and to make
health care services more flexible and responsive to the diverse and
changing needs of elderly patients in rural areas.
``(b) Grants Authorized--
``(1) In general.--The Director may award grants to
eligible providers for projects to demonstrate how telehealth
technologies can be used through telehealth networks in rural
areas, frontier communities, and medically underserved areas,
and for medically underserved populations, to--
``(A) expand access to, coordinate, and improve the
quality of health care services;
``(B) improve and expand the training of health
care providers; and
``(C) expand and improve the quality of health
information available to health care providers, and
patients and their families, for decisionmaking.
``(2) Grant period.--The Director shall award grants under
this subsection for a period of up to 4 years.
``(3) Number of grants.--Not to exceed 20 grants shall be
awarded under this subsection, of which at least \1/2\ shall be
dedicated to providing services in rural communities.
``(c) Use of Funds.--Grants awarded pursuant to subsection (b) may
be used for activities including--
``(1) improving access to coordinated health care services
at the lowest intensity and resource level of care consistent
with quality health care services and optimal patient outcomes,
improving the quality of such care, increasing patient
satisfaction with such care, and reducing the cost of such care
through advanced telecommunication technologies;
``(2) developing effective care management practices and
educational curricula to train health care professionals,
paraprofessionals, and caregivers, including family members,
and to increase the general level of competency of such
individuals through such training; and
``(3) developing curricula to train health care
professionals, paraprofessionals, and caregivers, including
family members, serving integrative eldercare patients in the
use of telecommunications.
``(d) Applications.--To be eligible to receive a grant under
subsection (b), an eligible provider, in consultation with the
appropriate State office of rural health or another appropriate State
entity, shall prepare and submit to the Director an application, at
such time, in such manner, and containing such information as the
Director may require, including--
``(1) a description of the project that the eligible entity
will carry out using the funds provided under the grant;
``(2) a description of the manner in which the project
funded under the grant will meet the health care needs of rural
or other populations to be served through the project, or
improve the access to services of, and the quality of the
services received by, those populations;
``(3) evidence of local support for the project, and a
description of how the areas, communities, or populations to be
served will be involved in the development and ongoing
operations of the project;
``(4) a plan for sustaining the project after Federal
support for the project has ended;
``(5) information on the source and amount of non-Federal
funds that the entity will provide for the project;
``(6) information demonstrating the long-term viability of
the project, and other evidence of institutional commitment of
the entity to the project;
``(7) in the case of an application for a project involving
a telehealth network, information demonstrating how the project
will promote the integration of telehealth technologies into
the operations of health care providers, to avoid redundancy,
and improve access to and the quality of care; and
``(8) other such information as the Director determines to
be appropriate.
``(e) Report.--
``(1) Final report.--Not later than 9 months after the date
of termination of the last grant to be awarded under this
section, the Director shall submit to Congress a final report--
``(A) describing the results of the programs funded
by grants awarded pursuant to this section; and
``(B) evaluating the impact of the use of
telehealth services in an integrative eldercare setting
on--
``(i) access to care for patients served by
integrative eldercare programs; and
``(ii) the quality of, patient satisfaction
with, and the cost of, such care.
``(2) Ensuring access to quality care.--In conducting the
evaluation under paragraph (1)(B), the Director shall--
``(A) give special consideration to the impact of
programs funded under this section on face-to-face
access to medical providers; and
``(B) develop specific measures to evaluate the
quality of care provided to those participating in such
programs to ensure that telehealth augments the plan of
care.
``(f) Eligible Provider.--The term `eligible provider' means a
consortia of home and facility-based care providers that includes
providers from no less than 2 of the following:
``(1) An adult congregate care facility.
``(2) A continuing care retirement community.
``(3) An assisted living facility.
``(4) An Alzheimer's facility.
``(5) An institutional hospice facility.
``(6) A residential care facility.
``(7) An adult foster home.
``(8) A State-licensed nursing home, including a skilled
nursing facility, an intermediate care facility, licensed home
health provider or other health care provider that the Director
deems appropriate and consistent with the purposes of this
section.
``(g) Definitions.--In this section:
``(1) Director; office.--The terms `Director' and `Office'
mean the Director of the Office for the Advancement of
Telehealth and the Office for the Advancement of Telehealth.
``(2) Integrative eldercare.--The term `integrative
eldercare' includes case management and coordination of care
for elderly patients recovering from acute illness or coping
with chronic disease at the lowest intensity and resource level
of care consistent with quality health care services and
optimal patient outcomes.
``(3) Telehealth services.--The term `telehealth services'
means services provided through telehealth technologies.
``(4) Telehealth technologies.--The term `telehealth
technologies' means technologies relating to the use of
electronic information, and telecommunications technologies, to
support and promote, at a distance, health care, patient and
professional health-related education, health administration,
and public health.
``(h) Authorization of Appropriations.--There are authorized to be
appropriated to the Office for the Advancement of Telehealth to carry
out this section $30,000,000 for fiscal year 2005 and such sums as may
be necessary for each of fiscal years 2006 through 2008.
``SEC. 330N. AMERICAN INDIAN AND ALASKA NATIVE TELEHEALTH DEMONSTRATION
PROJECT.
``(a) Purpose.--The purpose of this section is to evaluate the use
of telehealth services in areas under the jurisdiction of Indian tribes
or tribal organizations, including efforts to develop more effective
case management for chronic and acute disease and preventive health
care programs.
``(b) Grants Authorized.--
``(1) In general.--The Director may award grants to
eligible providers, individually or as part of a network of
eligible providers, for the provision of telehealth services to
improve patient care, prevent health care complications,
improve patient outcomes, and achieve efficiencies in the
delivery of care to patients who reside in areas under the
jurisdiction of Indian tribes or tribal organizations.
``(2) Grant period.--The Director shall award grants under
this section for a period of up to 4 years.
``(3) Number of grants.--Not to exceed 20 grants shall be
awarded under this section, of which at least \1/2\ shall be
dedicated to providing services in rural communities.
``(c) Use of Funds.--Grants awarded under this section may be used
for activities including--
``(1) improving access to care for home care patients
served by eligible providers, improving the quality of such
care, increasing patient satisfaction with such care, and
reducing the cost of such care through advanced
telecommunication technologies;
``(2) developing effective telehealth management practices
and educational curricula to train health professionals and
paraprofessionals and increase their general level of
competency through such training; and
``(3) developing curricula to train health care
professionals and paraprofessionals serving patients of
eligible providers in the use of telecommunications.
``(d) Collaboration.--The Director shall ensure that eligible
providers receiving grants under this section collaborate to enable
comparisons across programs and to share relevant, de-identified
information to better facilitate program performance evaluation.
``(e) Applications.--To be eligible to receive a grant under
subsection (b), an eligible entity, in consultation with the
appropriate State office of rural health or another appropriate State
entity, shall prepare and submit to the Director an application, at
such time, in such manner, and containing such information as the
Director may require, including--
``(1) a description of the project that the eligible entity
will carry out using the funds provided under the grant;
``(2) a description of the manner in which the project
funded under the grant will meet the health care needs of rural
or other populations to be served through the project, or
improve the access to services of, and the quality of the
services received by, those populations;
``(3) evidence of local support for the project, and a
description of how the areas, communities, or populations to be
served will be involved in the development and ongoing
operations of the project;
``(4) a plan for sustaining the project after Federal
support for the project has ended;
``(5) information on the source and amount of non-Federal
funds that the entity will provide for the project;
``(6) information demonstrating the long-term viability of
the project, and other evidence of institutional commitment of
the entity to the project;
``(7) in the case of an application for a project involving
a telehealth network, information demonstrating how the project
will promote the integration of telehealth technologies into
the operations of health care providers, to avoid redundancy,
and improve access to and the quality of care; and
``(8) other such information as the Director determines to
be appropriate.
``(f) Report.--
``(1) Final report.--Not later than 9 months after the date
of termination of the last grant to be awarded under this
section, the Director shall submit to Congress a final report--
``(A) describing the results of the programs funded
by grants awarded pursuant to this section; and
``(B) evaluating the impact of telehealth services
in an institutional long-term care setting on--
``(i) access to care for patients of
eligible providers; and
``(ii) the quality of, patient satisfaction
with, and the cost of, such care.
``(2) Ensuring access to quality care.--In conducting the
evaluation under paragraph (1)(B), the Director shall--
``(A) give special consideration to the impact of
programs funded under this section on face-to-face
access to medical providers; and
``(B) develop specific measures to evaluate the
quality of care provided to those participating in such
programs to ensure that telemedicine augments the plan
of care.
``(g) Definitions.--In this section:
``(1) Director; office.--The terms `Director' and `Office'
mean the Director of the Office for the Advancement of
Telehealth and the Office for the Advancement of Telehealth.
``(2) Eligible provider.--The term `eligible provider'
includes any public or private nonprofit health care provider a
majority of whose patient practice is Native American or any
Indian tribe or tribal organization that provides health care
services for its members.
``(3) Indian tribe.--The term `Indian tribe' has the
meaning given such term in section 4 of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450b).
``(4) Native american.--The term `Native American' means a
member of an Indian tribe, a Native Hawaiian (as defined in
section 338K(c)), or a Native American Pacific Islander.
``(5) Native american pacific islander.--The term `Native
American Pacific Islander' means an individual who is
indigenous to a United States territory or possession located
in the Pacific Ocean.
``(6) Tribal organization.--The term ``tribal
organization'' has the meaning given such term in section 4 of
the Indian Self-Determination and Education Assistance Act (25
U.S.C. 450b).
``(h) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $30,000,000 for fiscal year 2005
and such sums as may be necessary for each of fiscal years 2006 through
2008.
``SEC. 330O. ORAL HEALTH TELEHEALTH DEMONSTRATION PROJECT.
``(a) Purpose.--The purpose of this section is to evaluate the use
of telehealth services to expand access to oral health services and
improve oral health outcomes among rural and underserved urban
patients.
``(b) Grants Authorized.--
``(1) In general.--The Director is authorized to award
competitive grants to eligible providers, individually or as
part of a network of eligible providers, for the provision of
oral health services to improve patient care, prevent health
care complications, improve patient outcomes, and achieve
efficiencies in the delivery of oral health care to patients
who reside in rural areas.
``(2) Grant period.--The Director shall award grants under
this section for a period of up to 4 years.
``(3) Number of grants.--The number of grants awarded under
this section shall not exceed 10 grants.
``(c) Use of Funds.--Grants awarded pursuant to subsection (b) may
be used for activities including--
``(1) improving access to care for rural and underserved
urban patients served by eligible providers, improving the
quality of that care, increasing patient satisfaction with that
care, and reducing the cost of that care through advanced
telecommunication technologies;
``(2) developing effective oral telehealth care management
practices and educational curricula to train oral health
professionals and paraprofessionals and increase their general
level of competency through that training; and
``(3) developing curricula to train health care
professionals and paraprofessionals, serving rural and
underserved urban patients in the use of telecommunications.
``(d) Applications.--To be eligible to receive a grant under
subsection (b), an eligible entity, in consultation with the
appropriate State office of rural health or another appropriate State
entity, shall prepare and submit to the Director an application, at
such time, in such manner, and containing such information as the
Director may require, including--
``(1) a description of the project that the eligible entity
will carry out using the funds provided under the grant;
``(2) a description of the manner in which the project
funded under the grant will meet the health care needs of rural
or other populations to be served through the project, or
improve the access to services of, and the quality of the
services received by, those populations;
``(3) evidence of local support for the project, and a
description of how the areas, communities, or populations to be
served will be involved in the development and ongoing
operations of the project;
``(4) a plan for sustaining the project after Federal
support for the project has ended;
``(5) information on the source and amount of non-Federal
funds that the entity will provide for the project;
``(6) information demonstrating the long-term viability of
the project, and other evidence of institutional commitment of
the entity to the project;
``(7) in the case of an application for a project involving
a telehealth network, information demonstrating how the project
will promote the integration of telehealth technologies into
the operations of health care providers, to avoid redundancy,
and improve access to and the quality of care; and
``(8) other such information as the Director determines to
be appropriate.
``(e) Report.--
``(1) Final report.--Not later than 9 months after the date
of termination of the last grant to be awarded under this
section, the Director shall submit to Congress a final report--
``(A) describing the results of the programs funded
by grants awarded pursuant to this section; and
``(B) including an evaluation of the impact of the
use of oral telehealth services on--
``(i) access to oral health care for rural
patients; and
``(ii) the quality of, patient satisfaction
with, and the cost of, that care.
``(2) Ensuring access to quality care.--In conducting the
evaluation under paragraph (1)(B), the Director shall--
``(A) give special consideration to the impact of
programs funded under this section on face-to-face
access to medical providers; and
``(B) develop specific measures to evaluate the
quality of care provided to those participating in such
programs to ensure that telemedicine augments the plan
of care.
``(f) Definition of Eligible Provider.--In this section the term
`eligible provider' includes dentists, periodontists, orthodontists,
dental and oral health clinics, and schools of dentistry and oral
health, where a majority of the patient population resides in a rural
area, and may include other rural oral health providers that the
Director deems appropriate.
``(g) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $30,000,000 for fiscal year 2005
and such sums as may be necessary for each of fiscal years 2006 through
2008.''.
SEC. 5. JOINT WORKING GROUP ON TELEHEALTH.
(a) In General.--
(1) Representation of rural areas.--The Secretary of Health
and Human Services shall establish, within the Health Resources
and Services Administration Office for the Advancement of
Telehealth, and under the leadership of the Director of the
Office for the Advancement of Telehealth, a Joint Working Group
on Telehealth. In establishing such Group, the Secretary shall
ensure that all relevant Federal agencies are represented and
that input from relevant industry groups, including
representatives of rural areas and medically underserved areas,
is fully considered.
(2) Mission.--The mission of the Joint Working Group on
Telehealth is--
(A) to identify, monitor, and coordinate Federal
telehealth projects, data sets, and programs;
(B) to analyze--
(i) how telehealth systems are expanding
access to health care services, education, and
information;
(ii) the clinical, educational, or
administrative efficacy and cost-effectiveness
of telehealth applications; and
(iii) the quality of the telehealth
services delivered; and
(C) to make further recommendations for
coordinating Federal and State efforts to increase
access to health services, education, and information
in rural and medically underserved areas.
(3) Annual reports.--Not later than 2 years after the date
of enactment of this Act, and each January 1 thereafter, the
Joint Working Group on Telehealth shall submit to Congress a
report on the status of the Group's mission and the state of
the telehealth field generally.
(b) Report Specifics.--The annual report required under subsection
(a)(3) shall provide--
(1) an analysis of--
(A) the matters described in subsection (a)(2)(B);
(B) Federal activities with respect to telehealth;
and
(C) the process of the Joint Working Group on
Telehealth's efforts to coordinate Federal telehealth
programs; and
(2) recommendations for a coordinated Federal strategy to
increase health care access through telehealth.
(c) Authorization of Appropriations.--There are authorized to be
appropriated such sums as may be necessary to enable the Joint Working
Group on Telehealth to carry out this section.
<all>
Introduced in Senate
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
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