Text: H.R.6163 — 110th Congress (2007-2008)All Information (Except Text)

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Introduced in House (05/22/2008)


110th CONGRESS
2d Session
H. R. 6163


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


IN THE HOUSE OF REPRESENTATIVES

May 22, 2008

Mr. Thompson of California (for himself, Mr. Stupak, Mr. Hulshof, and Ms. Eshoo) 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.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. Short title; table of contents.

(a) Short title.—This Act may be cited as the “Medicare Telehealth Enhancement Act of 2008”.

(b) Table of contents.—The table of contents of this Act is as follows:


Sec. 1. Short title; table of contents.

Sec. 101. Expansion and improvement of telehealth services.

Sec. 102. Increase in number of types of originating sites; clarification.

Sec. 103. Facilitating the provision of telehealth services across State lines.

Sec. 104. Access to telehealth services in the home.

Sec. 105. Coverage of home health remote patient management services for certain chronic health conditions.

Sec. 106. Remote patient management services for chronic health conditions.

Sec. 107. Definition of Medicare program.

Sec. 201. Grant program for the development of telehealth networks.

Sec. 202. Reauthorization of telehealth network and telehealth resource centers grant programs.

SEC. 101. Expansion and improvement of telehealth services.

(a) Expanding access to telehealth services to all areas.—Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) 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 where the site is located.”.

(b) Report to congress on store and forward technology.—

(1) STUDY.—The Secretary of Health and Human Services, acting through the Director of the Office for the Advancement of Telehealth, shall conduct a study on the use of store and forward technologies (that provide for the asynchronous transmission of health care information in single or multimedia formats) in the provision of telehealth services for which payment may be made under the Medicare program in Alaska and Hawaii and in other States. Such study shall include an assessment of the feasibility, advisability, and the costs of expanding the use of such technologies to other areas for use in the diagnosis and treatment of certain conditions.

(2) REPORT.—Not later than 18 months after the date of the enactment of this Act, the Secretary shall submit to Congress a report on the study conducted under subparagraph (A) and shall include in such report such recommendations for legislation or administration action as the Secretary determines appropriate.

SEC. 102. Increase in number of types of originating sites; clarification.

(a) Increase.—Paragraph (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 subclauses:

“(VI) A skilled nursing facility (as defined in section 1819(a)).

“(VII) A renal dialysis facility.

“(VIII) A county mental health clinic or other publicly funded mental health facility.”.

(b) Clarification of intent of the term originating site.—Such section is further amended by adding at the end the following new paragraph:

“(5) CONSTRUCTION.—In 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 that 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.”.

SEC. 103. Facilitating the provision of telehealth services across State lines.

(a) In general.—The Secretary of Health and Human Services shall, in coordination with physicians, health care practitioners, patient advocates, and representatives of States, encourage and facilitate the adoption of State reciprocity agreements for practitioner licensure in order to expedite the provision across State lines of telehealth services.

(b) Report.—Not later than 18 months after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit to Congress a report on the actions taken to carry out subsection (a).

(c) Definitions.—In subsection (a):

(1) TELEHEALTH SERVICE.—The term “telehealth service” has the meaning given that term in subparagraph (F) of section 1834(m)(4) of the Social Security Act (42 U.S.C. 1395m(m)(4)).

(2) STATE.—The term “State” has the meaning given that term for purposes of title XVIII of such Act.

SEC. 104. Access to telehealth services in the home.

(a) In general.—Section 1895(e) of the Social Security Act (42 U.S.C. 1395fff(e)) is amended to read as follows:

“(f) Coverage of Telehealth Services.—

“(1) IN GENERAL.—The 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 CERTIFICATION.—Nothing 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) STANDARDS.—The 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) LIMITATION.—A 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) DEFINITION.—For purposes of this section, 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 CODES.—The Secretary shall establish a process for the updating, not less frequently than annually, of HCPCS codes for telehealth services.

“(5) CONDITIONS FOR PAYMENT AND COVERAGE.—Nothing 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 REPORTING.—Notwithstanding 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, 2009. 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, 2009.

(2) In the event that the Secretary has not complied with these deadlines, beginning October 1, 2009, 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.

SEC. 105. Coverage of home health remote patient management services for certain chronic health conditions.

(a) In general.—Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)), as amended by section 4(a)(1), is further amended—

(1) in subparagraph (AA), by striking “and” at the end;

(2) in subparagraph (BB), by inserting “and” at the end; and

(3) by inserting after subparagraph (BB) the following new subparagraph:

“(CC) home health remote patient management services (as defined in subsection (eee));”.

(b) Services described.—Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by section 4(a)(2), is further amended by adding at the end the following new subsection:

“Home Health Remote Patient Management Services For Certain Chronic Conditions

“(eee) (1) The term ‘home health 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 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(e) for purposes of payment under this title.

“(2) For purposes of paragraph (1), the term ‘covered chronic health condition’ means—

“(A) a covered chronic health condition, as defined under section 1861(ddd)(2); and

“(B) any other chronic health condition specified by the Secretary.”.

(c) Payment.—

(1) IN GENERAL.—Section 1834 of the Social Security 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 GENERAL.—The Secretary shall establish a fee schedule for home health remote patient management services (as defined in section 1861(eee)) 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 GENERAL.—For 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 DESCRIBED.—The 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) LIMITATION.—In 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) CLARIFICATION.—Payments 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 TRANSFER.—There 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 AMENDMENT.—Section 1833(a)(1) of such Act (42 U.S.C. 1395l(1)) is amended—

(A) by striking “and (V)” and inserting “(V)”; and

(B) by inserting before the semicolon at the end the following: “, and (W) with respect to home health remote patient management services (as defined in section 1861(eee)), the amounts paid shall be the amount determined under the fee schedule established under section 1834(n)”.

(d) Expansion of home health remote patient management services coverage to additional chronic health conditions.—The 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(eee) of such Act, as added by subsection (b)) should be extended to individuals with chronic health conditions other than those described in paragraph (2)(A) of such section.

(e) Effective date.—The amendments made by subsections (a), (b), and (c) shall apply to services furnished on or after January 1, 2010.

SEC. 106. Remote patient management services for chronic health conditions.

(a) Coverage of remote patient management services for certain chronic health conditions.—

(1) IN GENERAL.—Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)) is amended—

(A) in subparagraph (Z), by striking “and” at the end;

(B) in subparagraph (AA), by inserting “and” at the end; and

(C) by inserting after subparagraph (AA) the following new subparagraph:

“(BB) remote patient management services (as defined in subsection (ddd));”.

(2) SERVICES DESCRIBED.—Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by section 114(a) of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110–173), is amended by adding at the end the following new subsection:

“(ddd) 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)), insofar as such monitoring, evaluation, and management is with respect to such condition, through the utilization of a system of technology that allows a remote interface to collect and transmit clinical data between the individual and the responsible physician (as defined in subsection (r)) or supplier (as defined in subsection (d)) for the purposes of clinical review or response by the physician or supplier.

“(2) For purposes of paragraph (1), the term ‘covered chronic health condition’ means—

“(A) heart failure; and

“(B) cardiac arrhythmia.

“(3)(A) Not later than January 1, 2010, the Secretary, in consultation with appropriate physician and supplier groups, shall develop guidelines on the frequency of billing for remote patient management services. Such guidelines shall be determined based on medical necessity and shall be sufficient to ensure appropriate and timely monitoring of individuals being furnished such services.

“(B) The Secretary shall do the following:

“(i) Not later than 2 years after the date of the enactment of this subsection, develop, in consultation with appropriate physician and supplier groups, standards (governing such matters as qualifications of personnel and the maintenance of equipment) for remote patient management services for the covered chronic health conditions specified in subparagraphs (A) and (B) of paragraph (2).

“(ii) Periodically review and update such standards under this subparagraph as necessary.”.

(3) PAYMENT UNDER THE PHYSICIAN FEE SCHEDULE.—Section 1848 of the Social Security Act (42 U.S.C. 1395w–4) is amended—

(A) in subsection (c)—

(i) in paragraph (2)((B)—

(I) in clause (ii)(II), by striking “and (v)” and inserting “(v), (and (vi)”; and

(II) by adding at the end the following new clause:

“(vi) BUDGETARY TREATMENT OF CERTAIN SERVICES.—The additional expenditures attributable to services described in section 1861(s)(2)(BB) shall not be taken into account in applying clause (ii)(II) for 2010.”; and

(ii) by adding at the end the following new paragraph:

“(7) TREATMENT OF REMOTE PATIENT MANAGEMENT SERVICES.—

“(A) In determining relative value units for remote patient management services (as defined in section 1861(ddd)), the Secretary, in consultation with appropriate physician groups, shall take into consideration—

“(i) physician resources, including physician time and the level of intensity of services provided, based on—

“(I) the frequency of evaluation necessary to manage the individual being furnished the services;

“(II) the complexity of the evaluation, including the information that must be obtained, reviewed, and analyzed; and

“(III) the number of possible diagnoses and the number of management options that must be considered; and

“(ii) practice expense costs associated with such services, including installation and information transmittal costs, costs of remote patient management technology (including equipment and software), and resource costs necessary for patient monitoring and follow-up (but not including costs of any related item or non-physician service otherwise reimbursed under this title).

“(iii) malpractice expense resources.

“(B) Using the relative value units determined in subparagraph (A), the Secretary shall provide for separate payment for such services and shall not adjust the relative value units assigned to other services that might otherwise have been determined to include such separately paid remote patient management services.”; and

(B) in subsection (j)(3), by inserting “(2)(BB)” after “(2)(AA),”.

(4) EFFECTIVE DATE.—

(A) IN GENERAL.—The amendments made by this section shall apply to services furnished on or after January 1, 2010 without regard to whether the guidelines under paragraph (3)(A) or the standards under paragraph (3)(B) of section 1861(ddd) of the Social Security Act (as added by paragraph (2)) have been developed.

(B) AVAILABILITY OF CODES AS OF JANUARY 1, 2010.—The Secretary of Health and Human Services shall—

(i) promptly evaluate existing codes that would be used to bill for remote patient management services (as defined in paragraph (1) of such section 1861(ddd), as so added) under title XVIII of the Social Security Act; and

(ii) if the Secretary determines that new codes are necessary to ensure accurate reporting and billing of such services under such title, issue such codes so that they are available for use as of January 1, 2010.

(b) Demonstration project for the coverage of remote patient management services for additional chronic health conditions under the Medicare program.—

(1) ESTABLISHMENT.—

(A) IN GENERAL.—The Secretary shall establish a demonstration project for the purpose of evaluating the impact and benefits of covering under the Medicare program remote patient management services for certain chronic health conditions.

(B) CONSULTATION.—In establishing the demonstration project, the Secretary shall consult with appropriate physician and supplier groups, eligible beneficiaries, and organizations representing eligible beneficiaries.

(C) PARTICIPATION.—Any eligible beneficiary may participate in the demonstration project on a voluntary basis.

(2) CONDUCT OF THE DEMONSTRATION PROJECT.—

(A) SITES.—

(i) SELECTION OF DEMONSTRATION SITES.—The Secretary shall conduct the demonstration project at 3 sites.

(ii) GEOGRAPHIC DIVERSITY.—In selecting the sites under clause (i), the Secretary shall ensure that at least 1 of the sites is in a rural area.

(B) IMPLEMENTATION; DURATION.—

(i) IMPLEMENTATION.—The Secretary shall implement the demonstration project not later than January 1, 2010.

(ii) DURATION.—The Secretary shall complete the demonstration project by the date that is 2 years after the date on which the demonstration project is implemented.

(3) EVALUATION AND REPORT.—

(A) EVALUATION.—The Secretary shall conduct an evaluation of the demonstration project—

(i) to determine improvements in the quality of care and utilization of services received by eligible beneficiaries participating in the demonstration project;

(ii) to determine the cost of providing payment for remote monitoring services under the Medicare program;

(iii) to determine the satisfaction of eligible beneficiaries participating in the demonstration projects; and

(iv) to evaluate such other matters as the Secretary determines is appropriate.

(4) WAIVER AUTHORITY.—The Secretary may waive such provisions of titles XI and XVIII of the Social Security Act as the Secretary determines to be appropriate for the conduct of the demonstration project.

(5) FUNDING.—

(A) DEMONSTRATION.—

(i) IN GENERAL.—Subject to clause (ii), the Secretary shall provide for the transfer from the Federal Supplementary Medical Trust Fund under section 1841 of the Social Security Act (42 U.S.C. 1395t) of such funds as are necessary for the costs of carrying out the demonstration project.

(ii) CAP ON EXPENDITURES.—The amount transferred under clause (i) for the period during which the demonstration project is conducted may not exceed an amount equal to the lesser of—

(I) $9,000,000; or

(II) an amount equal to the costs of providing remote monitoring services to 7,500 individuals during such period.

(B) EVALUATION AND REPORT.—There are authorized to be appropriated such sums as are necessary for the purpose of conducting the evaluation and developing and submitting the report to Congress under paragraph (3).

(6) DEFINITIONS.—In this section:

(A) REMOTE PATIENT MANAGEMENT SERVICES.—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 (B)), insofar as such monitoring, evaluation, and management is with respect to such condition, through the utilization of a system of technology that allows a remote interface to collect and transmit clinical data between the individual and the responsible physician (as defined in subsection (r) of section 1861 of the Social Security Act (42 U.S.C. 1395x))) or supplier (as defined in subsection (d) of such section) for the purposes of clinical review or response by the physician or supplier.

(B) COVERED CHRONIC HEALTH CONDITION.—The term “covered chronic health condition” means diabetes, sleep apnea, or epilepsy.

(C) DEMONSTRATION PROJECT.—The term “demonstration project” means a demonstration project conducted under this subsection.

(D) ELIGIBLE BENEFICIARY.—The term “eligible beneficiary” means an individual who is enrolled under part B of the Medicare program and has a covered chronic health condition.

(E) MEDICARE PROGRAM.—The term “Medicare program” means the health benefits program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).

(F) SECRETARY.—The term “Secretary” means the Secretary of Health and Human Services.

SEC. 107. Definition of Medicare program.

In this title, the term “Medicare program” means the program of health insurance administered by the Secretary of Health and Human Services under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).

SEC. 201. Grant program for the development of telehealth networks.

(a) In general.—The 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) APPLICATION.—To 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.—An 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 two of the organizations described in subparagraph (A) and one of the institutions and entities described in subparagraph (B) 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).

(A) The 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.

(B) The 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) Preference.—The 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 recipients.—The 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 amounts.—The 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 uses.—Sums 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) NONDUPLICATION.—The Secretary shall ensure that facilities constructed using grants provided under this section do not duplicate adequately established telehealth networks.

(2) COORDINATION WITH OTHER AGENCIES.—The 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 EFFORTS.—The 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 implementation.—The Secretary shall take such actions as are necessary to carry out the grant program as expeditiously as possible.

(i) Authorization of appropriations.—There are authorized to be appropriated to carry out this section $10,000,000 for fiscal year 2009, and such sums as may be necessary for each of the fiscal years 2010 through 2014.

SEC. 202. Reauthorization of telehealth network and telehealth resource centers grant programs.

Subsection (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 2009, and such sums as may be necessary for each of fiscal years 2010 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 2009, and such sums as may be necessary for each of fiscal years 2010 through 2014” before the semicolon.