STAR Act

I 116TH CONGRESS 1ST SESSION H. R. 5190 To amend the Public Health Service Act to provide assistance for health centers and rural health clinics to implement electronic provider consulta- tion and related telemedicine services. IN THE HOUSE OF REPRESENTATIVES NOVEMBER 20, 2019 Mr. HARDER of California (for himself, Mr. YOUNG, Mr. FORTENBERRY, Ms. TORRES SMALL of New Mexico, and Mr. STEUBE) introduced the fol- lowing bill; which was referred to the Committee on Energy and Com- merce A BILL To amend the Public Health Service Act to provide assist- ance for health centers and rural health clinics to imple- ment electronic provider consultation and related tele- medicine services. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Specialty Treatment 4 to Access and Referrals Act of 2019’’ or the ‘‘STAR Act’’. 5 SEC. 2. FINDINGS. 6 Congress finds the following: 7 VerDate Sep 11 2014 02:04 Dec 03, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H5190.IH H5190 aiking on DSK30JT082PROD with BILLS 2 •HR 5190 IH (1) Telemedicine involving the delivery of safe, 1 effective, quality health care services by a health 2 care provider using electronic information technology 3 as the mode of care delivery is a clinically appro- 4 priate and efficient method of furnishing many 5 health care services. 6 (2) Consultations between health care providers 7 utilizing electronic information technology (in this 8 section referred to as ‘‘E–Consult services’’) are fea- 9 sible in a variety of settings, flexible in their applica- 10 tion, and particularly useful in facilitating the timely 11 provision of information from a clinician with spe- 12 cialized knowledge of a relevant medical subject mat- 13 ter to a treating clinician in order to improve care 14 quality. 15 (3) E–Consult services formalize the role of 16 medical specialists, can be undertaken entirely with- 17 in electronic exchange platforms that are private and 18 secure, and do not require synchronous communica- 19 tion between providers. 20 (4) E–Consult services conducted in advance of 21 a telemedicine service can improve the effectiveness 22 of the subsequent telemedicine service. 23 (5) E–Consult services are being utilized exten- 24 sively by the Veterans Health Administration and by 25 VerDate Sep 11 2014 02:04 Dec 03, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5190.IH H5190 aiking on DSK30JT082PROD with BILLS 3 •HR 5190 IH a growing number of academic medical centers and 1 other public and private health care settings both in 2 the United States and internationally. 3 (6) There is a need for additional extensive and 4 rigorous research studies to determine best practices 5 and processes for E–Consult services and to validate 6 the impact on access to specialty medical care, costs, 7 and clinical outcomes. 8 (7) Providing the expertise and technical assist- 9 ance necessary to implement E–Consult services in 10 primary care settings could improve access to spe- 11 cialty care at relatively low cost while simultaneously 12 providing a testbed to evaluate the merits of varying 13 approaches to E–Consult services, ascertain the 14 value of such programs, and experiment with service 15 reimbursement strategies in fee-for-service environ- 16 ments, including value-based care delivery arrange- 17 ments such as through accountable care organiza- 18 tions. 19 SEC. 3. E–CONSULT SERVICES AND RELATED TELEHEALTH 20 ASSISTANCE PILOT PROGRAM. 21 Title III of the Public Health Service Act is amended 22 by inserting after section 330M (42 U.S.C. 254c–19) the 23 following new section: 24 VerDate Sep 11 2014 02:04 Dec 03, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H5190.IH H5190 aiking on DSK30JT082PROD with BILLS 4 •HR 5190 IH ‘‘SEC. 330N. E–CONSULT SERVICES AND RELATED TELE- 1 HEALTH ASSISTANCE PILOT PROGRAM. 2 ‘‘(a) IN GENERAL.—The Secretary may award grants 3 to eligible health center controlled networks, health cen- 4 ters, and rural health clinics described in subsection (e) 5 to conduct pilot projects to implement and test the effec- 6 tiveness of E–Consult services and related telehealth serv- 7 ices furnished at such networks, centers, and clinics for 8 purposes of addressing the goals described in subsection 9 (b). 10 ‘‘(b) OBJECTIVES.—A pilot project conducted pursu- 11 ant to a grant awarded under subsection (a) shall address 12 the following goals: 13 ‘‘(1) Improvement in patient access to specialty 14 care. 15 ‘‘(2) Reduction in specialty care patient wait 16 times. 17 ‘‘(3) Reduction in patient specialty referrals. 18 ‘‘(4) Reduction in patient miles traveled for 19 specialty care consultations. 20 ‘‘(5) Increased support for primary care pro- 21 viders as demonstrated by job satisfaction measures. 22 ‘‘(6) Increased patient satisfaction as dem- 23 onstrated by quality surveys. 24 ‘‘(7) Health care cost savings. 25 VerDate Sep 11 2014 02:04 Dec 03, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5190.IH H5190 aiking on DSK30JT082PROD with BILLS 5 •HR 5190 IH ‘‘(8) Such other goals as the Secretary may 1 identify. 2 ‘‘(c) DURATION; AMOUNT.— 3 ‘‘(1) DURATION.—A grant awarded under sub- 4 section (a) shall be for a term of no more than 5 5 years. 6 ‘‘(2) AMOUNT.—In the case of a grant made 7 under subsection (a) directly to an eligible health 8 center or rural health clinic, the amount provided 9 may not exceed $200,000 for each center or clinic 10 facility location. In the case of an award to an eligi- 11 ble health center controlled network, the amount 12 provided may not exceed $5,000,000, and the value 13 of the amount of assistance provided by such net- 14 work to any individual participating health center or 15 rural clinic facility location may not exceed 16 $200,000. 17 ‘‘(d) USE OF FUNDS.—Funds provided under a grant 18 pursuant to this section may only be used for the fol- 19 lowing, with respect to a pilot project conducted by a 20 health center controlled network, health center, or rural 21 health clinic: 22 ‘‘(1) Conducting assessments of a participating 23 facility’s infrastructure (such as broadband, equip- 24 VerDate Sep 11 2014 02:04 Dec 03, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H5190.IH H5190 aiking on DSK30JT082PROD with BILLS 6 •HR 5190 IH ment, and software), clinical objectives, and staffing 1 plans. 2 ‘‘(2) Based on assessment findings, developing 3 and assisting in the execution of equipment and soft- 4 ware procurement, defining clinical objectives, devel- 5 oping adequate staffing plans, and implementing E– 6 Consult services and related telehealth services pro- 7 gram plan. 8 ‘‘(3) Training participating facility staff to 9 properly utilize technology and implement programs. 10 ‘‘(4) Providing clinical workflow training to 11 support program implementation. 12 ‘‘(5) Providing integrated certified EHR tech- 13 nology capabilities to support live video (where appli- 14 cable) and E–Consult services. 15 ‘‘(6) Integrating the facility with live E–Consult 16 service support providers and networks that meet 17 the patient goals of the network, center, or clinic. 18 ‘‘(7) Procuring appropriate information tech- 19 nology and undertaking minor alterations of physical 20 space. 21 ‘‘(8) Otherwise carrying out the pilot project to 22 address the objectives described in subsection (b). 23 ‘‘(e) PARTICIPATING FACILITIES; ELIGIBLE ENTI- 24 TIES.— 25 VerDate Sep 11 2014 02:04 Dec 03, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H5190.IH H5190 aiking on DSK30JT082PROD with BILLS 7 •HR 5190 IH ‘‘(1) PARTICIPATING FACILITIES.—A location of 1 a health center or rural health clinic shall qualify to 2 participate in a pilot program established pursuant 3 to this section if the center or clinic demonstrates in 4 a manner determined by the Secretary that such lo- 5 cation— 6 ‘‘(A) lacks sufficient access to care pro- 7 vided by medical specialists, as determined by 8 the Secretary; and 9 ‘‘(B) has not already implemented a pro- 10 gram of E–Consult services and related tele- 11 health services similar to that described in this 12 section. 13 ‘‘(2) REQUIREMENTS TO BE ELIGIBLE TO RE- 14 CEIVE A GRANT.—To be eligible to receive a grant 15 under subsection (a), an entity must— 16 ‘‘(A) be— 17 ‘‘(i) a health center controlled network 18 that demonstrates to the satisfaction of the 19 Secretary— 20 ‘‘(I) sufficient expertise and expe- 21 rience in the successful provision of 22 the technical and other assistance re- 23 quired under for health centers and 24 rural health clinics to conduct a pilot 25 VerDate Sep 11 2014 02:04 Dec 03, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H5190.IH H5190 aiking on DSK30JT082PROD with BILLS 8 •HR 5190 IH project in accordance with this sec- 1 tion; 2 ‘‘(II) evidence of sufficient bind- 3 ing participation commitments re- 4 ceived from eligible health centers and 5 rural health clinics; 6 ‘‘(III) the ability to assist eligible 7 health centers and rural health clinics 8 to conduct E–Consult services with 9 medical specialists and related tele- 10 health services; and 11 ‘‘(IV) a likelihood of successfully 12 accomplishing the program objectives 13 as identified in subsection (b); or 14 ‘‘(ii) a qualifying health center or 15 rural health clinic that demonstrates to the 16 satisfaction of the Secretary— 17 ‘‘(I) sufficient expertise and abil- 18 ity to implement on its own behalf the 19 technical and other assistance de- 20 scribed in subparagraph (A)(i); 21 ‘‘(II) a likelihood of successfully 22 implementing a program of E–Consult 23 services with medical specialists and 24 related telehealth services; and 25 VerDate Sep 11 2014 02:04 Dec 03, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H5190.IH H5190 aiking on DSK30JT082PROD with BILLS 9 •HR 5190 IH ‘‘(III) a likelihood of successfully 1 accomplishing the program objectives 2 as identified in subsection (b); and 3 ‘‘(B) submit an application described in 4 paragraph (3) to the Secretary in such form 5 and manner, and in accordance with such tim- 6 ing, as specified by the Secretary. 7 ‘‘(3) APPLICATION.—For purposes of para- 8 graph (2)(B), an application described in this para- 9 graph, with respect to an applicant, is an application 10 that demonstrates to the satisfaction of the Sec- 11 retary— 12 ‘‘(A) in the case of an applicant that is a 13 health center controlled network, the intention 14 of a sufficient minimum number of eligible 15 health centers to participate in the program 16 through the network and a plan for recruiting 17 additional centers to participate; 18 ‘‘(B) the qualification of proposed facility 19 locations to participate in the program; 20 ‘‘(C) requisite experience, expertise, and 21 capacity; 22 ‘‘(D) likelihood of meeting program objec- 23 tives described in subsection (b); and 24 VerDate Sep 11 2014 02:04 Dec 03, 2019 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H5190.IH H5190 aiking on DSK30JT082PROD with BILLS 10 •HR 5190 IH ‘‘(E) internal program metrics that will be 1 employed to demonstrate satisfaction of pro- 2 gram objectives and information to be collected 3 and provided to the Secretary as necessary to 4 conduct program evaluation. 5 ‘‘(f) EVALUATION; REPORT.—Not later than 180 6 days after the date of the completion of the last pilot 7 projects funded under this section, the Secretary shall sub- 8 mit to Congress a report, including an evaluation, on the 9 projects that addresses the following: 10 ‘‘(1) An overview of supported projects and 11 identification of areas of success and failure. 12 ‘‘(2) Policies, practices, and organizational ap- 13 proaches that either facilitate or impede the effective 14 use of E–Consult services (including personnel train- 15 ing and support, technology usability, workflow, and 16 provider communication). 17 ‘‘(3) Relative effectiveness of consultations pro- 18 vided by Medical Specialists in improving outcomes, 19 quality of care and efficiency with respect to dif- 20 ferent specialties, clinical conditions, complexity, pa- 21 tient types, or other issues. 22 ‘‘(4) The extent to which information shared in 23 the E–Consult services process is sufficient, accu- 24 rate, and actionable in order to effectively facilitate 25 VerDate Sep 11 2014 02:04 Dec 03, 2019 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H5190.IH H5190 aiking on DSK30JT082PROD with BILLS 11 •HR 5190 IH care improvement, and whether such bi-directional 1 information flows can be standardized. 2 ‘‘(5) The extent to which E–Consults facilitate 3 continuity of care. 4 ‘‘(6) Any issues arising related to maintaining 5 the privacy of personal health information, ensuring 6 cybersecurity, and other information security issues. 7 ‘‘(7) The extent to which E–Consult services 8 contribute to improved health outcomes and metrics 9 that can facilitate such evaluation. 10 ‘‘(8) Any unintended or adverse results from 11 utilizing E–Consult services. 12 ‘‘(g) DEFINITIONS.—For purposes of this section: 13 ‘‘(1) CERTIFIED EHR TECHNOLOGY.—The term 14 ‘certified EHR technology’ has the meaning given 15 such term in section 3000(1). 16 ‘‘(2) E–CONSULT SERVICE.—The term ‘E–Con- 17 sult service’ means synchronous or asynchronous, 18 consultative, health-care-provider-to-health-care-pro- 19 vider communications that occur within a shared 20 certified EHR technology or secure internet-based 21 platform and are primarily intended to provide spe- 22 cialty expertise to treating clinicians (who are often 23 primary care providers) without requiring a direct 24 interaction between the patient and the medical spe- 25 VerDate Sep 11 2014 02:04 Dec 03, 2019 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H5190.IH H5190 aiking on DSK30JT082PROD with BILLS 12 •HR 5190 IH cialist. Such consultation ordinarily involves a treat- 1 ing clinician sending information regarding the pa- 2 tient and a consultation request to a medical spe- 3 cialist who may then respond in any of a number of 4 ways, including providing requested feedback, asking 5 for additional information, recommending certain 6 studies or examinations, or initiating the scheduling 7 of an appointment. 8 ‘‘(3) HEALTH CENTER.—The term ‘health cen- 9 ter’ has the meaning given such term in section 10 330(a). 11 ‘‘(4) HEALTH CENTER CONTROLLED NET- 12 WORK.—The term ‘health center controlled network’ 13 means a network that is owned and controlled by 14 constituent health centers as described in section 15 330(e)(1)(C). 16 ‘‘(5) PRIMARY CARE PROVIDER.—The term ‘pri- 17 mary care provider’ [Text truncated for display. Full text available on Congress.gov.]