PROPFRTYOF NOV 16 REC'D HCFALIBRARY I 104t2hdcSoesnsgironess H. R. 4268 Toprovideforaprojecttodemonstratetheapplicationoftelemedicineand medical informatics to improving the quality and cost-effectiveness in the delivery ofhealth care services under the Medicare program and otherhealthprograms. IN THE HOUSE OF REPRESENTATIVES September27,1996 Mr.Rangel(forhimselfandMr.HOUGHTON)introducedthefollowingbill; whichwasreferredtotheCommitteeonCommerce, andinadditionto theCommitteeonWaysandMeans,foraperiodtobesubsequentlyde- terminedbytheSpeaker,ineachcaseforconsiderationofsuchprovisions asfallwithinthejurisdictionofthecommitteeconcerned A BILL To provide for a project to demonstrate the application of telemedicine and medical informatics to improving the quahty and cost-effectiveness in the delivery of health care services under the Medicare program and other healthprograms. 1 BeitenactedbytheSenateandHouseofRepresenta- 2 tivesoftheUnitedStatesofAmericainCongressassembled, 3 SECTION1.SHORTTITLE, 4 ThisActmaybecitedasthe"MedicareTelemedicine 5 andMedicalInformaticsDemonstrationActof1996". — 1 SEC. 2. INFORMATICS, TELEMEDICINE, AND EDUCATION 2 DEMONSTRATIONPROJECT. — 3 (a)PurposeandAuthorization. — 4 (1) In general. Under section 1142 of the 5 Social SecurityAct and consistentwiththis section, 6 the Secretary of Health and Human Services, 7 throughtheAgencyforHealth Care PolicyandRe- 8 search, shall make a grant to an ehgible grantee to 9 provide for aprojectto demonstrate the application 10 of high-capacity computing and advanced networks 11 to the provision of health care to both residents of 12 medically underserved rural areas and residents of 13 medicallyunderservedinner-cityareas. — 14 (2)Focus. Theprojectshallfocuson 15 (A) improvements in primary care (and 16 preventionofcomphcations) forthose residents 17 withdiabetes (melhtus), and 18 (B)thoseresidentswhoareMedicarebene- 19 ficiaries. — 20 (3) Duration ofproject. Theproject shall 21 beconductedovera4-yearperiod. 22 (4)Authorizationofappropriations; med- — 23 ICARE and MEDICAID WATV^R AUTHORITY. The 24 total amount of Federal expenditures that may be 25 provided pursuant to tliis section under the project 26 shall not exceed $30,000,000. Subject to such limi- m •HR4268 3 1 tation, the Secretary may waive such provisions of 2 title XVni and XIX of the Social SecurityAct as 3 may be appropriate in order to permit and dem- 4 onstrate the provision of Medicare and Medicaid 5 fundingundertheproject. — 6 (b) ObjectivesofProject. Theobjectivesofthe 7 projectincludethefollowing: 8 (1) Improvingpatient accessto andcompliance 9 withappropriatecareguidehnesforchronic diseases 10 through direct telecommunications hnk with infor- 11 mationnetworksinordertoimprovepatientquality- 12 of-lifeandreduceoverallhealthcarecosts. 13 (2) Developinga curriculumto train, and pro- 14 viding standards for credentialing and licensure of, 15 health professionals (particularly primary care 16 health professionals) in the use of medical 17 informaticsandtelecommunciations. 18 (3) Demonstrating the application of advanced 19 technologies, such as video-conferencing from a pa- 20 tient'shome, remotemonitoringofapatient's medi- 21 cal condition, interventional informatics, and apply- 22 ingindividualized, automated care guidelines, to as- 23 sistprimarycareprovidersinassistingpatientswith 24 chronicillnessesinahomesetting. •HR4268IH 4 1 (4) Application of medical informatics to resi- 2 dentswithlimitedEnglishlanguageskills. 3 (5) Developing standards in the apphcation of 4 telemedicineandmedicalinformatics. 5 (6)Developingamodelforthecost-effectivede- 6 hveryofprimaryandrelatedcarebothinamanaged 7 care environment and in a fee-for-service environ- 8 ment. — 9 (c) Eligible Grantee. Forpurposes ofthis sec- 10 tion,theterm"eligiblegrantee"meansaconsortiumthat 11 includes at least one tertiary care hospital, at least one 12 medical school, and at least one regional telecommuni- 13 cations provider and that meets the following require- 14 ments: 15 (1) The consortium is located in an area with 16 ahigh concentration ofmedical schools andtertiary 17 care facilities and has appropriate arrangements 18 (withinoroutsidethe consortium) withsuchschools 19 and facilities, universities, and telecommunications 20 providers,inordertoconducttheproject. 21 (2) TheconsortiumsubmitstotheSecretaryan 22 apphcation at such time, in such manner, and con- 23 taining such information as the Secretary may re- 24 quire,includingadescriptionoftheusetowhichthe 25 consortiumwould applyanyamountsreceivedunder m •HR4268 i 5 1 the project and the source and amount ofnon-Fed- 2 era!contributiontowardstheproject. 3 (3) The consortium demonstrates that it will 4 provide for a contribution toward the project from 5 non-Federalfundsorresourcesinanamountthatis 6 not less than 50 percent ofthe total amount to be 7. expendedincarryingouttheproject. — 8 (d)UseofFunds. — 9 (1) In general. Federal payments made 10 available to an eligible grantee under this section 11 shall be used for the development and operation of 12 telemedicine and medical informatics systems and 13 relatedactivitiesundertheproject. — 14 (2) Specific uses permitted. Such pay- 15 mentsmaybeusedforanyofthefollowing: 16 (A) The acquisition oftelemedicine equip- 17 mentforuseinpatients'homes(butonlyinthe 18 case of patients located in medically under- 19 servedareas). 20 (B) Curriculum development and training 21 of health professionals in medical informatics 22 andtelemedicine. 23 (C) Payment of telecommunications costs 24 (including salaries and maintenance of equip- 25 ment), including costs of telecommunications m >HR4268 6 1 betweenpatients' homes andthe ehgible grant- 2 ee and between the grantee and other entities 3 underthearrangements describedinsubsection 4 (c)(1). 5 (D) Pajonentsto practitioners and provid- 6 ersundertheMedicareandMedicaidprograms. — 7 (3) Prohibited uses. Such payments may 8 notbeusedforanyofthefollowing: 9 (A) The purchase or installation oftrans- 10 mission equipment (other than such equipment 11 used by health professionals to deliver medical 12 informaticsservicesundertheproject). 13 (B) The estabhshment or operation of a 14 telecommunicationscommoncarriernetwork. 15 (C) Construction (exceptforminorrenova- 16 tions relatedto theinstallation ofreimbursable 17 equipment) ortheacquisitionorbuildingofreal 18 propert}^ — 19 (e) Reports. The Secretary shall submit to the 20 Committees on Ways and Means and Commerce ofthe 21 HouseofRepresentativesandtheCommitteesonFinance 22 and Labor and Human Resources ofthe Senate interim 23 reports on the project and a final report on the project 24 within 6 months afterthe conclusion ofthe project. The 25 final report shall include an evaluation ofthe impact of •HR4268IH 7 1 theuseoftelemedicineandmedicalinformaticsonimprov- 2 ingaccessofmedicareandmedicaidbeneficiariestohealth 3 care services, onreducingthe costs ofsuch services, and 4 onimprovingthequahtyoflifeofsuchbeneficiaries. — 5 (f)Definitions. Forpurposesoftliissection: — 6 (1) Interventionalintormatics. Theterm 7 "interventional informatics" means using informa- 8 tion technologj^ andvirtual realitytechnologyto in- 9 terveneinpatientcare. — 10 (2) Medical informatics. The term "medi- 11 cal informatics" means the storage, retrieval, and 12 use ofbiomedical and related information for prob- 13 lem solving and decision-makingthrough computing 14 andcommunicationstechnologies. — 15 (3) Project. The term "project" means the 16 demonstrationprojectunderthissection. — 17 (4) Secretary. Theterm"Secretary" means 18 theSecretaryofHealthandHumanServices. O \ m •HR4268 ensLIBRARV flOTS DODlflBOS ^