,i #aafth ,,congress #ast ,session ,h4 ,r4 #eaij ,,in ,,the ,,house ,,of ,,representatives ,november #bj1 #bjai,mr4 ,harder of ,california 7for himself1 ,mr4 ,young1 ,mr4 ,fortenberry1 ,ms4 ,torres ,small of ,new ,mexico1 and ,mr4 ,steube7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce ,a ,,bill ,to amend the ,public ,health ,service ,act to provide assistance for health centers and rural health clinics to implement electronic provider consultation and related telemedicine services4 #a4 ,short title ,this ,act may be cited as the ,specialty ,treatment to ,access and ,referrals ,act of #bjai or the ,,star ,act4 #b4 ,findings ,congress finds the following3 7#a7 ,telemedicine involving the delivery of safe1 effective1 quality health care services by a health care provider using electronic information technology as the mode of care delivery is a clinically appropriate and efficient method of furnishing many health care services4 7#b7 ,consultations between health care providers utilizing electronic information technology 7in this section referred to as ,e-,consult services7 are feasible in a variety of settings1 flexible in their application1 and particularly useful in facilitating the timely provision of information from a clinician with specialized knowledge of a relevant medical subject matter to a treating clinician in order to improve care quality4 7#c7 ,e-,consult services formalize the role of medical specialists1 can be undertaken entirely within electronic exchange platforms that are private and secure1 and do not require synchronous communication between providers4 7#d7 ,e-,consult services conducted in advance of a telemedicine service can improve the effectiveness of the subsequent telemedicine service4 7#e7 ,e-,consult services are being utilized extensively by the ,veterans ,health ,administration and by a growing number of academic medical centers and other public and private health care settings both in the ,united ,states and internationally4 7#f7 ,there is a need for additional extensive and rigorous research studies to determine best practices and processes for ,e-,consult services and to validate the impact on access to specialty medical care1 costs1 and clinical outcomes4 7#g7 ,providing the expertise and technical assistance necessary to implement ,e-,consult services in primary care settings could improve access to specialty care at relatively low cost while simultaneously providing a testbed to evaluate the merits of varying approaches to ,e-,consult services1 ascertain the value of such programs1 and experiment with service reimbursement strategies in fee-for-service environments1 including value-based care delivery arrangements such as through accountable care organizations4 #c4 ,e-,consult services and related telehealth assistance pilot program ,title ,,iii of the ,public ,health ,service ,act is amended by inserting after section #ccj,m 7#db ,u4,s4,c4 #bed;c-#ai7 the following new section3 #ccj,n4 ,e-,consult services and related telehealth assistance pilot program 7a7 ,in general ,the ,secretary may award grants to eligible health center controlled networks1 health centers1 and rural health clinics described in subsection 7e7 to conduct pilot projects to implement and test the effectiveness of ,e-,consult services and related telehealth services furnished at such networks1 centers1 and clinics for purposes of addressing the goals described in subsection 7b74 7b7 ,objectives ,a pilot project conducted pursuant to a grant awarded under subsection 7a7 shall address the following goals3 7#a7 ,improvement in patient access to specialty care4 7#b7 ,reduction in specialty care patient wait times4 7#c7 ,reduction in patient specialty referrals4 7#d7 ,reduction in patient miles traveled for specialty care consultations4 7#e7 ,increased support for primary care providers as demonstrated by job satisfaction measures4 7#f7 ,increased patient satisfaction as demonstrated by quality surveys4 7#g7 ,health care cost savings4 7#h7 ,such other goals as the ,secretary may identify4 7c7 ,duration2 amount 7#a7 ,duration ,a grant awarded under subsection 7a7 shall be for a term of no more than #e years4 7#b7 ,amount ,in the case of a grant made under subsection 7a7 directly to an eligible health center or rural health clinic1 the amount provided may not exceed #bjj1jjj for each center or clinic facility location4 ,in the case of an award to an eligible health center controlled network1 the amount provided may not exceed #e1jjj1jjj1 and the value of the amount of assistance provided by such network to any individual participating health center or rural clinic facility location may not exceed #bjj1jjj4 7d7 ,use of funds ,funds provided under a grant pursuant to this section may only be used for the following1 with respect to a pilot project conducted by a health center controlled network1 health center1 or rural health clinic3 7#a7 ,conducting assessments of a participating facility's infrastructure 7such as broadband1 equipment1 and software71 clinical objectives1 and staffing plans4 7#b7 ,based on assessment findings1 developing and assisting in the execution of equipment and software procurement1 defining clinical objectives1 developing adequate staffing plans1 and implementing ,e-,consult services and related telehealth services program plan4 7#c7 ,training participating facility staff to properly utilize technology and implement programs4 7#d7 ,providing clinical workflow training to support program implementation4 7#e7 ,providing integrated certified ,,ehr technology capabilities to support live video 7where applicable7 and ,e-,consult services4 7#f7 ,integrating the facility with live ,e-,consult service support providers and networks that meet the patient goals of the network1 center1 or clinic4 7#g7 ,procuring appropriate information technology and undertaking minor alterations of physical space4 7#h7 ,otherwise carrying out the pilot project to address the objectives described in subsection 7b74 7e7 ,participating facilities2 ,eligible entities 7#a7 ,participating ,facilities ,a location of a health center or rural health clinic shall qualify to participate in a pilot program established pursuant to this section if the center or clinic demonstrates in a manner determined by the ,secretary that such location-- 7,a7 lacks sufficient access to care provided by medical specialists1 as determined by the ,secretary2 and 7,b7 has not already implemented a program of ,e-,consult services and related telehealth services similar to that described in this section4 7#b7 ,requirements to be eligible to receive a grant ,to be eligible to receive a grant under subsection 7a71 an entity must-- 7,a7 be-- 7i7 a health center controlled network that demonstrates to the satisfaction of the ,secretary-- 7,i7 sufficient expertise and experience in the successful provision of the technical and other assistance required under for health centers and rural health clinics to conduct a pilot project in accordance with this section2 7,,ii7 evidence of sufficient binding participation commitments received from eligible health centers and rural health clinics2 7,,iii7 the ability to assist eligible health centers and rural health clinics to conduct ,e-,consult services with medical specialists and related telehealth services2 and 7,,iv7 a likelihood of successfully accomplishing the program objectives as identified in subsection 7b72 or 7ii7 a qualifying health center or rural health clinic that demonstrates to the satisfaction of the ,secretary-- 7,i7 sufficient expertise and ability to implement on its own behalf the technical and other assistance described in subparagraph 7,a77i72 7,,ii7 a likelihood of successfully implementing a program of ,e-,consult services with medical specialists and related telehealth services2 and 7,,iii7 a likelihood of successfully accomplishing the program objectives as identified in subsection 7b72 and 7,b7 submit an application described in paragraph 7#c7 to the ,secretary in such form and manner1 and in accordance with such timing1 as specified by the ,secretary4 7#c7 ,application ,for purposes of paragraph 7#b77;,b71 an application described in this paragraph1 with respect to an applicant1 is an application that demonstrates to the satisfaction of the ,secretary-- 7,a7 in the case of an applicant that is a health center controlled network1 the intention of a sufficient minimum number of eligible health centers to participate in the program through the network and a plan for recruiting additional centers to participate2 7,b7 the qualification of proposed facility locations to participate in the program2 7,c7 requisite experience1 expertise1 and capacity2 7,d7 likelihood of meeting program objectives described in subsection 7b72 and 7,e7 internal program metrics that will be employed to demonstrate satisfaction of program objectives and information to be collected and provided to the ,secretary as necessary to conduct program evaluation4 7f7 ,evaluation2 report ,not later than #ahj days after the date of the completion of the last pilot projects funded under this section1 the ,secretary shall submit to ,congress a report1 including an evaluation1 on the projects that addresses the following3 7#a7 ,an overview of supported projects and identification of areas of success and failure4 7#b7 ,policies1 practices1 and organizational approaches that either facilitate or impede the effective use of ,e-,consult services 7including personnel training and support1 technology usability1 workflow1 and provider communication74 7#c7 ,relative effectiveness of consultations provided by ,medical ,specialists in improving outcomes1 quality of care and efficiency with respect to different specialties1 clinical conditions1 complexity1 patient types1 or other issues4 7#d7 ,the extent to which information shared in the ,e-,consult services process is sufficient1 accurate1 and actionable in order to effectively facilitate care improvement1 and whether such bi-directional information flows can be standardized4 7#e7 ,the extent to which ,e-,consults facilitate continuity of care4 7#f7 ,any issues arising related to maintaining the privacy of personal health information1 ensuring cybersecurity1 and other information security issues4 7#g7 ,the extent to which ,e-,consult services contribute to improved health outcomes and metrics that can facilitate such evaluation4 7#h7 ,any unintended or adverse results from utilizing ,e-,consult services4 7g7 ,definitions ,for purposes of this section3 7#a7 ,certified ,,ehr technology ,the term certified ,,ehr technology has the meaning given such term in section #cjjj7a74 7#b7 ,e-,consult service ,the term ,e-,consult service means synchronous or asynchronous1 consultative1 health-care-provider-to-health-care-prov ider communications that occur within a shared certified ,,ehr technology or secure internet-based platform and are primarily intended to provide specialty expertise to treating clinicians 7who are often primary care providers7 without requiring a direct interaction between the patient and the medical specialist4 ,such consultation ordinarily involves a treating clinician sending information regarding the patient and a consultation request to a medical specialist who may then respond in any of a number of ways1 including providing requested feedback1 asking for additional information1 recommending certain studies or examinations1 or initiating the scheduling of an appointment4 7#c7 ,health center ,the term health center has the meaning given such term in section #ccj7;a74 7#d7 ,health ,center ,controlled ,network ,the term health center controlled network means a network that is owned and controlled by constituent health centers as described in section #ccj7;e77#a77;,c74 7#e7 ,primary ,care ,provider ,the term primary care provider means a licensed health professional 7as defined in section #ahai7;b77#e77;,g7 of the ,social ,security ,act7 or a licensed provider of behavioral health services who customarily provides services described in paragraph 7#a7 or 7#b7 of section #ccj7;b7 to patients4 7#f7 ,medical ,specialist ,the term medical specialist means a licensed physician or a nurse practitioner who has completed advanced education and clinical training in a one or more specific areas of medicine and focuses their medical practice on such area or areas4 ,such term may1 if specified by the ,secretary1 include a licensed provider of behavioral health services4 7#g7 ,related ,telehealth ,services ,the term related telehealth services means telehealth services arising out of or incident to an ,e-,consult service1 such as laboratory tests1 diagnostic imaging1 or a subsequent interaction between a medical specialist and a patient4 7#h7 ,rural ,health ,clinic ,the term rural health clinic has the meaning give such term in section #ahfa7;aa77#b7 of the ,social ,security ,act4 7#i7 ,telehealth ,the term telehealth means the use of electronic information and telecommunications technologies 7including videoconferencing1 the internet1 store-and-forward imaging1 streaming media1 and terrestrial and wireless communications7 to support and promote long-distance clinical health care1 patient and professional health-related education1 public health1 and health administration4 7h7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section #ab1jjj1jjj for each of fiscal years #bjba through #bjbe4 4