,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #eaij  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,novemb] #bj1         
#bjai,mr4 ,h>d] ( ,cali=nia 7= himself1 
,mr4 ,"y1 ,mr4 ,=t5b]ry1 ,ms4 ,torres   
,small ( ,new ,mexico1 & ,mr4 ,/eube7   
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce  ,a  
,,bill  ,to am5d ! ,public ,heal?       
,s]vice ,act to provide assi/ance =     
heal? c5t]s & rural heal? cl9ics to     
implem5t electronic provid] consultation
 & relat$ telem$ic9e s]vices4  #a4 ,%ort
 title ,?is ,act may be cit$ z !        
,specialty ,treatm5t to ,access &       
,ref]rals ,act ( #bjai or ! ,,/> ,act4  
#b4 ,f9d+s ,congress f9ds ! foll[+3     
7#a7 ,telem$ic9e involv+ ! deliv]y (    
safe1 effective1 quality heal? c>e      
s]vices by a heal? c>e provid] us+      
electronic in=mation te*nology z ! mode 
( c>e deliv]y is a cl9ically appropriate
 & effici5t me?od ( furni%+ _m heal? c>e
 s]vices4  7#b7 ,consultations betwe5   
heal? c>e provid]s utiliz+ electronic   

in=mation te*nology 79 ?is section      
ref]r$ to z ,e-,consult s]vices7 are    
feasible 9 a v>iety ( sett+s1 flexible 9
 _! application1 & p>ticul>ly useful 9  
facilitat+ ! timely provision (         
in=mation f a cl9ician ) specializ$ k ( 
a relevant m$ical subject matt] to a    
treat+ cl9ician 9 ord] to improve c>e   
quality4  7#c7 ,e-,consult s]vices      
=malize ! role ( m$ical speciali/s1 c be
 und]tak5 entirely )9 electronic ex*ange
 plat=ms t are private & secure1 & d n  
require syn*ron\s communication betwe5  
provid]s4  7#d7 ,e-,consult s]vices     
conduct$ 9 advance ( a telem$ic9e s]vice
 c improve ! effectiv5ess ( ! subsequ5t 
telem$ic9e s]vice4  7#e7 ,e-,consult    
s]vices are be+ utiliz$ ext5sively by ! 
,vet]ans ,heal? ,adm9i/ration & by a    
gr[+ numb] ( academic m$ical c5t]s & o!r
 public & private heal? c>e sett+s bo? 9
 ! ,unit$ ,/ates & int]nationally4  7#f7
 ,!re is a ne$ = additional ext5sive &  
rigor\s rese>* /udies to det]m9e be/    
practices & processes = ,e-,consult     

s]vices & to validate ! impact on access
 to specialty m$ical c>e1 co/s1 &       
cl9ical outcomes4  7#g7 ,provid+ !      
exp]tise & te*nical assi/ance necess>y  
to implem5t ,e-,consult s]vices 9 prim>y
 c>e sett+s c\ld improve access to      
specialty c>e at relatively l[ co/ :ile 
simultane\sly provid+ a te/b$ to        
evaluate ! m]its ( v>y+ approa*es to    
,e-,consult s]vices1 asc]ta9 ! value (  
su* programs1 & exp]im5t ) s]vice       
reimbursem5t /rategies 9 fee-=-s]vice   
environm5ts1 includ+ value-bas$ c>e     
deliv]y arrangem5ts su* z ?r\gh         
acc\ntable c>e organizations4  #c4      
,e-,consult s]vices & relat$ teleheal?  
assi/ance pilot program ,title ,,iii ( !
 ,public ,heal? ,s]vice ,act is am5d$ by
 ins]t+ aft] section #ccj,m 7#db        
,u4,s4,c4 #bed;c-#ai7 ! foll[+ new      
section3  #ccj,n4 ,e-,consult s]vices & 
relat$ teleheal? assi/ance pilot program
  7a7 ,9 g5]al ,! ,secret>y may aw>d    
grants to eligible heal? c5t] controll$ 
networks1 heal? c5t]s1 & rural heal?    

cl9ics describ$ 9 subsection 7e7 to     
conduct pilot projects to implem5t & te/
 ! effectiv5ess ( ,e-,consult s]vices & 
relat$ teleheal? s]vices furni%$ at su* 
networks1 c5t]s1 & cl9ics = purposes (  
address+ ! goals describ$ 9 subsection  
7b74  7b7 ,objectives ,a pilot project  
conduct$ pursuant to a grant aw>d$ "u   
subsection 7a7 %all address ! foll[+    
goals3  7#a7 ,improvem5t 9 pati5t access
 to specialty c>e4  7#b7 ,r$uction 9    
specialty c>e pati5t wait times4  7#c7  
,r$uction 9 pati5t specialty ref]rals4  
7#d7 ,r$uction 9 pati5t miles travel$ = 
specialty c>e consultations4  7#e7      
,increas$ support = prim>y c>e provid]s 
z demon/rat$ by job satisfaction        
measures4  7#f7 ,increas$ pati5t        
satisfaction z demon/rat$ by quality    
surveys4  7#g7 ,heal? c>e co/ sav+s4    
7#h7 ,su* o!r goals z ! ,secret>y may   
id5tify4  7c7 ,duration2 am\nt  7#a7    
,duration ,a grant aw>d$ "u subsection  
7a7 %all be = a t]m ( no m ?an #e ye>s4 
7#b7 ,am\nt ,9 ! case ( a grant made "u 

subsection 7a7 directly to an eligible  
heal? c5t] or rural heal? cl9ic1 ! am\nt
 provid$ may n exce$ #bjj1jjj = ea* c5t]
 or cl9ic facility location4 ,9 ! case (
 an aw>d to an eligible heal? c5t]      
controll$ network1 ! am\nt provid$ may n
 exce$ #e1jjj1jjj1 & ! value ( ! am\nt (
 assi/ance provid$ by su* network to any
 individual p>ticipat+ heal? c5t] or    
rural cl9ic facility location may n     
exce$ #bjj1jjj4  7d7 ,use ( funds ,funds
 provid$ "u a grant pursuant to ?is     
section may only be us$ = ! foll[+1 )   
respect to a pilot project conduct$ by a
 heal? c5t] controll$ network1 heal?    
c5t]1 or rural heal? cl9ic3  7#a7       
,conduct+ assessm5ts ( a p>ticipat+     
facility's infra/ructure 7su* z broadb&1
 equipm5t1 & s(tw>e71 cl9ical           
objectives1 & /aff+ plans4  7#b7 ,bas$  
on assessm5t f9d+s1 develop+ & assi/+ 9 
! execution ( equipm5t & s(tw>e         
procurem5t1 def9+ cl9ical objectives1   
develop+ adequate /aff+ plans1 &        
implem5t+ ,e-,consult s]vices & relat$  

teleheal? s]vices program plan4  7#c7   
,tra9+ p>ticipat+ facility /aff to      
prop]ly utilize te*nology & implem5t    
programs4  7#d7 ,provid+ cl9ical workfl[
 tra9+ to support program implem5tation4
  7#e7 ,provid+ integrat$ c]tifi$ ,,ehr 
te*nology capabilities to support live  
video 7:]e applicable7 & ,e-,consult    
s]vices4  7#f7 ,integrat+ ! facility )  
live ,e-,consult s]vice support provid]s
 & networks t meet ! pati5t goals ( !   
network1 c5t]1 or cl9ic4  7#g7 ,procur+ 
appropriate in=mation te*nology &       
und]tak+ m9or alt]ations ( physical     
space4  7#h7 ,o!rwise c>ry+ out ! pilot 
project to address ! objectives describ$
 9 subsection 7b74  7e7 ,p>ticipat+     
facilities2 ,eligible entities  7#a7    
,p>ticipat+ ,facilities ,a location ( a 
heal? c5t] or rural heal? cl9ic %all    
qualify to p>ticipate 9 a pilot program 
e/abli%$ pursuant to ?is section if !   
c5t] or cl9ic demon/rates 9 a mann]     
det]m9$ by ! ,secret>y t su* location-- 
7,a7 lacks suffici5t access to c>e      

provid$ by m$ical speciali/s1 z det]m9$ 
by ! ,secret>y2 &  7,b7 has n already   
implem5t$ a program ( ,e-,consult       
s]vices & relat$ teleheal? s]vices      
simil> to t describ$ 9 ?is section4     
7#b7 ,requirem5ts to be eligible to     
receive a grant ,to be eligible to      
receive a grant "u subsection 7a71 an   
entity mu/-- 7,a7 be--  7i7 a heal? c5t]
 controll$ network t demon/rates to !   
satisfaction ( ! ,secret>y-- 7,i7       
suffici5t exp]tise & exp]i5ce 9 !       
successful provision ( ! te*nical & o!r 
assi/ance requir$ "u = heal? c5t]s &    
rural heal? cl9ics to conduct a pilot   
project 9 accordance ) ?is section2     
7,,ii7 evid5ce ( suffici5t b9d+         
p>ticipation commitm5ts receiv$ f       
eligible heal? c5t]s & rural heal?      
cl9ics2  7,,iii7 ! ability to assi/     
eligible heal? c5t]s & rural heal?      
cl9ics to conduct ,e-,consult s]vices ) 
m$ical speciali/s & relat$ teleheal?    
s]vices2 &  7,,iv7 a likelihood (       
successfully accompli%+ ! program       

objectives z id5tifi$ 9 subsection 7b72 
or  7ii7 a qualify+ heal? c5t] or rural 
heal? cl9ic t demon/rates to !          
satisfaction ( ! ,secret>y--  7,i7      
suffici5t exp]tise & ability to implem5t
 on its own behalf ! te*nical & o!r     
assi/ance describ$ 9 subp>agraph        
7,a77i72  7,,ii7 a likelihood (         
successfully implem5t+ a program (      
,e-,consult s]vices ) m$ical speciali/s 
& relat$ teleheal? s]vices2 &  7,,iii7 a
 likelihood ( successfully accompli%+ ! 
program objectives z id5tifi$ 9         
subsection 7b72 &  7,b7 submit an       
application describ$ 9 p>agraph 7#c7 to 
! ,secret>y 9 su* =m & mann]1 & 9       
accordance ) su* tim+1 z specifi$ by !  
,secret>y4  7#c7 ,application ,=        
purposes ( p>agraph 7#b77;,b71 an       
application describ$ 9 ?is p>agraph1 )  
respect to an applicant1 is an          
application t demon/rates to !          
satisfaction ( ! ,secret>y--  7,a7 9 !  
case ( an applicant t is a heal? c5t]   
controll$ network1 ! int5tion ( a       

suffici5t m9imum numb] ( eligible heal? 
c5t]s to p>ticipate 9 ! program ?r\gh ! 
network & a plan = recruit+ additional  
c5t]s to p>ticipate2  7,b7 !            
qualification ( propos$ facility        
locations to p>ticipate 9 ! program2    
7,c7 requisite exp]i5ce1 exp]tise1 &    
capacity2  7,d7 likelihood ( meet+      
program objectives describ$ 9 subsection
 7b72 &  7,e7 int]nal program metrics t 
w be employ$ to demon/rate satisfaction 
( program objectives & in=mation to be  
collect$ & provid$ to ! ,secret>y z     
necess>y to conduct program evaluation4 
7f7 ,evaluation2 report ,n lat] ?an #ahj
 days aft] ! date ( ! completion ( ! la/
 pilot projects fund$ "u ?is section1 ! 
,secret>y %all submit to ,congress a    
report1 includ+ an evaluation1 on !     
projects t addresses ! foll[+3  7#a7 ,an
 ov]view ( support$ projects &          
id5tification ( areas ( success &       
failure4  7#b7 ,policies1 practices1 &  
organizational approa*es t ei!r         
facilitate or imp$e ! effective use (   

,e-,consult s]vices 7includ+ p]sonnel   
tra9+ & support1 te*nology usability1   
workfl[1 & provid] communication74  7#c7
 ,relative effectiv5ess ( consultations 
provid$ by ,m$ical ,speciali/s 9 improv+
 outcomes1 quality ( c>e & effici5cy )  
respect to diff]5t specialties1 cl9ical 
conditions1 complexity1 pati5t types1 or
 o!r issues4  7#d7 ,! ext5t to :i*      
in=mation %>$ 9 ! ,e-,consult s]vices   
process is suffici5t1 accurate1 &       
actionable 9 ord] to effectively        
facilitate c>e improvem5t1 & :e!r su*   
bi-directional in=mation fl[s c be      
/&>diz$4  7#e7 ,! ext5t to :i*          
,e-,consults facilitate cont9uity ( c>e4
  7#f7 ,any issues aris+ relat$ to      
ma9ta9+ ! privacy ( p]sonal heal?       
in=mation1 ensur+ cyb]security1 & o!r   
in=mation security issues4  7#g7 ,!     
ext5t to :i* ,e-,consult s]vices        
contribute to improv$ heal? outcomes &  
metrics t c facilitate su* evaluation4  
7#h7 ,any un9t5d$ or adv]se results f   
utiliz+ ,e-,consult s]vices4  7g7       

,def9itions ,= purposes ( ?is section3  
7#a7 ,c]tifi$ ,,ehr te*nology ,! t]m    
c]tifi$ ,,ehr te*nology has ! mean+ giv5
 su* t]m 9 section #cjjj7a74  7#b7      
,e-,consult s]vice ,! t]m ,e-,consult   
s]vice means syn*ron\s or asyn*ron\s1   
consultative1                           
heal?-c>e-provid]-to-heal?-c>e-provid]  
communications t occur )9 a %>$ c]tifi$ 
,,ehr te*nology or secure int]net-bas$  
plat=m & are prim>ily int5d$ to provide 
specialty exp]tise to treat+ cl9icians  
7:o are (t5 prim>y c>e provid]s7 )\t    
requir+ a direct int]action betwe5 !    
pati5t & ! m$ical speciali/4 ,su*       
consultation ord9>ily involves a treat+ 
cl9ician s5d+ in=mation reg>d+ ! pati5t 
& a consultation reque/ to a m$ical     
speciali/ :o may !n respond 9 any ( a   
numb] ( ways1 includ+ provid+ reque/$   
fe$back1 ask+ = additional in=mation1   
recomm5d+ c]ta9 /udies or exam9ations1  
or initiat+ ! s*$ul+ ( an appo9tm5t4    
7#c7 ,heal? c5t] ,! t]m heal? c5t] has !
 mean+ giv5 su* t]m 9 section #ccj7;a74 

7#d7 ,heal? ,c5t] ,controll$ ,network ,!
 t]m heal? c5t] controll$ network means 
a network t is own$ & controll$ by      
con/itu5t heal? c5t]s z describ$ 9      
section #ccj7;e77#a77;,c74  7#e7 ,prim>y
 ,c>e ,provid] ,! t]m prim>y c>e provid]
 means a lic5s$ heal? pr(essional 7z    
def9$ 9 section #ahai7;b77#e77;,g7 ( !  
,social ,security ,act7 or a lic5s$     
provid] ( behavioral heal? s]vices :o   
cu/om>ily provides s]vices describ$ 9   
p>agraph 7#a7 or 7#b7 ( section #ccj7;b7
 to pati5ts4  7#f7 ,m$ical ,speciali/ ,!
 t]m m$ical speciali/ means a lic5s$    
physician or a nurse practition] :o has 
complet$ advanc$ education & cl9ical    
tra9+ 9 a "o or m specific areas (      
m$ic9e & focuses _! m$ical practice on  
su* area or areas4 ,su* t]m may1 if     
specifi$ by ! ,secret>y1 include a      
lic5s$ provid] ( behavioral heal?       
s]vices4  7#g7 ,relat$ ,teleheal?       
,s]vices ,! t]m relat$ teleheal? s]vices
 means teleheal? s]vices aris+ out ( or 
incid5t to an ,e-,consult s]vice1 su* z 

laboratory te/s1 diagno/ic imag+1 or a  
subsequ5t int]action betwe5 a m$ical    
speciali/ & a pati5t4  7#h7 ,rural      
,heal? ,cl9ic ,! t]m rural heal? cl9ic  
has ! mean+ give su* t]m 9 section      
#ahfa7;aa77#b7 ( ! ,social ,security    
,act4  7#i7 ,teleheal? ,! t]m teleheal? 
means ! use ( electronic in=mation &    
telecommunications te*nologies 7includ+ 
videoconf]enc+1 ! int]net1 /ore-&-=w>d  
imag+1 /ream+ m$ia1 & t]re/rial &       
wireless communications7 to support &   
promote long-di/ance cl9ical heal? c>e1 
pati5t & pr(essional heal?-relat$       
education1 public heal?1 & heal?        
adm9i/ration4  7h7 ,au?orization (      
appropriations ,!re are au?oriz$ to be  
appropriat$ to c>ry out ?is section     
#ab1jjj1jjj = ea* ( fiscal ye>s #bjba   
?r\gh #bjbe4  4