[Congressional Record (Bound Edition), Volume 145 (1999), Part 19]
[Senate]
[Pages 28122-28129]
[From the U.S. Government Publishing Office, www.gpo.gov]



            THE HEALTHCARE RESEARCH AND QUALITY ACT OF 1999

                                 ______
                                 

                 FRIST (AND OTHERS) AMENDMENT NO. 2506

  Mr. GRAMM (for Mr. Frist (for himself, Mr. Jeffords, and Mr. 
Kennedy)) proposed an amendment to the bill (S. 580) to amend title IX 
of the Public Health Service Act to revise and extend the Agency for 
Healthcare Policy and Research; as follows:

       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Healthcare Research and 
     Quality Act of 1999''.

     SEC. 2. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

       (a) In General.--Title IX of the Public Health Service Act 
     (42 U.S.C. 299 et seq.) is amended to read as follows:
         ``TITLE IX--AGENCY FOR HEALTHCARE RESEARCH AND QUALITY

               ``PART A--ESTABLISHMENT AND GENERAL DUTIES

     ``SEC. 901. MISSION AND DUTIES.

       ``(a) In General.--There is established within the Public 
     Health Service an agency to be known as the Agency for 
     Healthcare Research and Quality, which shall be headed by a 
     director appointed by the Secretary. The Secretary shall 
     carry out this title acting through the Director.
       ``(b) Mission.--The purpose of the Agency is to enhance the 
     quality, appropriateness, and effectiveness of health 
     services, and access to such services, through the 
     establishment of a broad base of scientific research and 
     through the promotion of improvements in clinical and health 
     system practices, including the prevention of diseases and 
     other health conditions. The Agency shall promote health care 
     quality improvement by conducting and supporting--
       ``(1) research that develops and presents scientific 
     evidence regarding all aspects of health care, including--
       ``(A) the development and assessment of methods for 
     enhancing patient participation in their own care and for 
     facilitating shared patient-physician decision-making;
       ``(B) the outcomes, effectiveness, and cost-effectiveness 
     of health care practices, including preventive measures and 
     long-term care;
       ``(C) existing and innovative technologies;
       ``(D) the costs and utilization of, and access to health 
     care;
       ``(E) the ways in which health care services are organized, 
     delivered, and financed and the interaction and impact of 
     these factors on the quality of patient care;
       ``(F) methods for measuring quality and strategies for 
     improving quality; and
       ``(G) ways in which patients, consumers, purchasers, and 
     practitioners acquire new information about best practices 
     and health benefits, the determinants and impact of their use 
     of this information;
       ``(2) the synthesis and dissemination of available 
     scientific evidence for use by patients, consumers, 
     practitioners, providers,

[[Page 28123]]

     purchasers, policy makers, and educators; and
       ``(3) initiatives to advance private and public efforts to 
     improve health care quality.
       ``(c) Requirements With Respect to Rural and Inner-city 
     Areas and Priority Populations.--
       ``(1) Research, evaluations and demonstration projects.--In 
     carrying out this title, the Director shall conduct and 
     support research and evaluations, and support demonstration 
     projects, with respect to--
       ``(A) the delivery of health care in inner-city areas, and 
     in rural areas (including frontier areas); and
       ``(B) health care for priority populations, which shall 
     include--
       ``(i) low-income groups;
       ``(ii) minority groups;
       ``(iii) women;
       ``(iv) children;
       ``(v) the elderly; and
       ``(vi) individuals with special health care needs, 
     including individuals with disabilities and individuals who 
     need chronic care or end-of-life health care.
       ``(2) Process to ensure appropriate research.--The Director 
     shall establish a process to ensure that the requirements of 
     paragraph (1) are reflected in the overall portfolio of 
     research conducted and supported by the Agency.
       ``(3) Office of priority populations.--The Director shall 
     establish an Office of Priority Populations to assist in 
     carrying out the requirements of paragraph (1).

     ``SEC. 902. GENERAL AUTHORITIES.

       ``(a) In General.--In carrying out section 901(b), the 
     Director shall conduct and support research, evaluations, and 
     training, support demonstration projects, research networks, 
     and multi-disciplinary centers, provide technical assistance, 
     and disseminate information on health care and on systems for 
     the delivery of such care, including activities with respect 
     to--
       ``(1) the quality, effectiveness, efficiency, 
     appropriateness and value of health care services;
       ``(2) quality measurement and improvement;
       ``(3) the outcomes, cost, cost-effectiveness, and use of 
     health care services and access to such services;
       ``(4) clinical practice, including primary care and 
     practice-oriented research;
       ``(5) health care technologies, facilities, and equipment;
       ``(6) health care costs, productivity, organization, and 
     market forces;
       ``(7) health promotion and disease prevention, including 
     clinical preventive services;
       ``(8) health statistics, surveys, database development, and 
     epidemiology; and
       ``(9) medical liability.
       ``(b) Health Services Training Grants.--
       ``(1) In general.--The Director may provide training grants 
     in the field of health services research related to 
     activities authorized under subsection (a), to include pre- 
     and post-doctoral fellowships and training programs, young 
     investigator awards, and other programs and activities as 
     appropriate. In carrying out this subsection, the Director 
     shall make use of funds made available under section 
     487(d)(3) as well as other appropriated funds.
       ``(2) Requirements.--In developing priorities for the 
     allocation of training funds under this subsection, the 
     Director shall take into consideration shortages in the 
     number of trained researchers who are addressing health care 
     issues for the priority populations identified in section 
     901(c)(1)(B) and in addition, shall take into consideration 
     indications of long-term commitment, amongst applicants for 
     training funds, to addressing health care needs of the 
     priority populations.
       ``(c) Multidisciplinary Centers.--The Director may provide 
     financial assistance to assist in meeting the costs of 
     planning and establishing new centers, and operating existing 
     and new centers, for multidisciplinary health services 
     research, demonstration projects, evaluations, training, and 
     policy analysis with respect to the matters referred to in 
     subsection (a).
       ``(d) Relation to Certain Authorities Regarding Social 
     Security.--Activities authorized in this section shall be 
     appropriately coordinated with experiments, demonstration 
     projects, and other related activities authorized by the 
     Social Security Act and the Social Security Amendments of 
     1967. Activities under subsection (a)(2) of this section that 
     affect the programs under titles XVIII, XIX and XXI of the 
     Social Security Act shall be carried out consistent with 
     section 1142 of such Act.
       ``(e) Disclaimer.--The Agency shall not mandate national 
     standards of clinical practice or quality health care 
     standards. Recommendations resulting from projects funded and 
     published by the Agency shall include a corresponding 
     disclaimer.
       ``(f) Rule of Construction.--Nothing in this section shall 
     be construed to imply that the Agency's role is to mandate a 
     national standard or specific approach to quality measurement 
     and reporting. In research and quality improvement 
     activities, the Agency shall consider a wide range of 
     choices, providers, health care delivery systems, and 
     individual preferences.
       ``(g) Annual Report.--Beginning with fiscal year 2003, the 
     Director shall annually submit to the Congress a report 
     regarding prevailing disparities in health care delivery as 
     it relates to racial factors and socioeconomic factors in 
     priority populations.

               ``PART B--HEALTH CARE IMPROVEMENT RESEARCH

     ``SEC. 911. HEALTH CARE OUTCOME IMPROVEMENT RESEARCH.

       ``(a) Evidence Rating Systems.--In collaboration with 
     experts from the public and private sector, the Agency shall 
     identify and disseminate methods or systems to assess health 
     care research results, particularly methods or systems to 
     rate the strength of the scientific evidence underlying 
     health care practice, recommendations in the research 
     literature, and technology assessments. The Agency shall make 
     methods or systems for evidence rating widely available. 
     Agency publications containing health care recommendations 
     shall indicate the level of substantiating evidence using 
     such methods or systems.
       ``(b) Health Care Improvement Research Centers and 
     Provider-Based Research Networks.--
       ``(1) In general.--In order to address the full continuum 
     of care and outcomes research, to link research to practice 
     improvement, and to speed the dissemination of research 
     findings to community practice settings, the Agency shall 
     employ research strategies and mechanisms that will link 
     research directly with clinical practice in geographically 
     diverse locations throughout the United States, including--
       ``(A) health care improvement research centers that combine 
     demonstrated multidisciplinary expertise in outcomes or 
     quality improvement research with linkages to relevant sites 
     of care;
       ``(B) provider-based research networks, including plan, 
     facility, or delivery system sites of care (especially 
     primary care), that can evaluate outcomes and evaluate and 
     promote quality improvement; and
       ``(C) other innovative mechanisms or strategies to link 
     research with clinical practice.
       ``(2) Requirements.--The Director is authorized to 
     establish the requirements for entities applying for grants 
     under this subsection.

     ``SEC. 912. PRIVATE-PUBLIC PARTNERSHIPS TO IMPROVE 
                   ORGANIZATION AND DELIVERY.

       ``(a) Support for Efforts To Develop Information on 
     Quality.--
       ``(1) Scientific and technical support.--In its role as the 
     principal agency for health care research and quality, the 
     Agency may provide scientific and technical support for 
     private and public efforts to improve health care quality, 
     including the activities of accrediting organizations.
       ``(2) Role of the agency.--With respect to paragraph (1), 
     the role of the Agency shall include--
       ``(A) the identification and assessment of methods for the 
     evaluation of the health of--
       ``(i) enrollees in health plans by type of plan, provider, 
     and provider arrangements; and
       ``(ii) other populations, including those receiving long-
     term care services;
       ``(B) the ongoing development, testing, and dissemination 
     of quality measures, including measures of health and 
     functional outcomes;
       ``(C) the compilation and dissemination of health care 
     quality measures developed in the private and public sector;
       ``(D) assistance in the development of improved health care 
     information systems;
       ``(E) the development of survey tools for the purpose of 
     measuring participant and beneficiary assessments of their 
     health care; and
       ``(F) identifying and disseminating information on 
     mechanisms for the integration of information on quality into 
     purchaser and consumer decision-making processes.
       ``(b) Centers for Education and Research on Therapeutics.--
       ``(1) In general.--The Secretary, acting through the 
     Director and in consultation with the Commissioner of Food 
     and Drugs, shall establish a program for the purpose of 
     making one or more grants for the establishment and operation 
     of one or more centers to carry out the activities specified 
     in paragraph (2).
       ``(2) Required activities.--The activities referred to in 
     this paragraph are the following:
       ``(A) The conduct of state-of-the-art research for the 
     following purposes:
       ``(i) To increase awareness of--

       ``(I) new uses of drugs, biological products, and devices;
       ``(II) ways to improve the effective use of drugs, 
     biological products, and devices; and
       ``(III) risks of new uses and risks of combinations of 
     drugs and biological products.

       ``(ii) To provide objective clinical information to the 
     following individuals and entities:

       ``(I) Health care practitioners and other providers of 
     health care goods or services.
       ``(II) Pharmacists, pharmacy benefit managers and 
     purchasers.
       ``(III) Health maintenance organizations and other managed 
     health care organizations.
       ``(IV) Health care insurers and governmental agencies.
       ``(V) Patients and consumers.

[[Page 28124]]

       ``(iii) To improve the quality of health care while 
     reducing the cost of health care through--

       ``(I) an increase in the appropriate use of drugs, 
     biological products, or devices; and
       ``(II) the prevention of adverse effects of drugs, 
     biological products, and devices and the consequences of such 
     effects, such as unnecessary hospitalizations.

       ``(B) The conduct of research on the comparative 
     effectiveness, cost-effectiveness, and safety of drugs, 
     biological products, and devices.
       ``(C) Such other activities as the Secretary determines to 
     be appropriate, except that a grant may not be expended to 
     assist the Secretary in the review of new drugs, biological 
     products, and devices.
       ``(c) Reducing Errors in Medicine.--The Director shall 
     conduct and support research and build private-public 
     partnerships to--
       ``(1) identify the causes of preventable health care errors 
     and patient injury in health care delivery;
       ``(2) develop, demonstrate, and evaluate strategies for 
     reducing errors and improving patient safety; and
       ``(3) disseminate such effective strategies throughout the 
     health care industry.

     ``SEC. 913. INFORMATION ON QUALITY AND COST OF CARE.

       ``(a) In General.--The Director shall--
       ``(1) conduct a survey to collect data on a nationally 
     representative sample of the population on the cost, use and, 
     for fiscal year 2001 and subsequent fiscal years, quality of 
     health care, including the types of health care services 
     Americans use, their access to health care services, 
     frequency of use, how much is paid for the services used, the 
     source of those payments, the types and costs of private 
     health insurance, access, satisfaction, and quality of care 
     for the general population including rural residents and also 
     for populations identified in section 901(c); and
       ``(2) develop databases and tools that provide information 
     to States on the quality, access, and use of health care 
     services provided to their residents.
       ``(b) Quality and Outcomes Information.--
       ``(1) In general.--Beginning in fiscal year 2001, the 
     Director shall ensure that the survey conducted under 
     subsection (a)(1) will--
       ``(A) identify determinants of health outcomes and 
     functional status, including the health care needs of 
     populations identified in section 901(c), provide data to 
     study the relationships between health care quality, 
     outcomes, access, use, and cost, measure changes over time, 
     and monitor the overall national impact of Federal and State 
     policy changes on health care;
       ``(B) provide information on the quality of care and 
     patient outcomes for frequently occurring clinical conditions 
     for a nationally representative sample of the population 
     including rural residents; and
       ``(C) provide reliable national estimates for children and 
     persons with special health care needs through the use of 
     supplements or periodic expansions of the survey.

     In expanding the Medical Expenditure Panel Survey, as in 
     existence on the date of the enactment of this title in 
     fiscal year 2001 to collect information on the quality of 
     care, the Director shall take into account any outcomes 
     measurements generally collected by private sector 
     accreditation organizations.
       ``(2) Annual report.--Beginning in fiscal year 2003, the 
     Secretary, acting through the Director, shall submit to 
     Congress an annual report on national trends in the quality 
     of health care provided to the American people.

     ``SEC. 914. INFORMATION SYSTEMS FOR HEALTH CARE IMPROVEMENT.

       ``(a) In General.--In order to foster a range of innovative 
     approaches to the management and communication of health 
     information, the Agency shall conduct and support research, 
     evaluations, and initiatives to advance--
       ``(1) the use of information systems for the study of 
     health care quality and outcomes, including the generation of 
     both individual provider and plan-level comparative 
     performance data;
       ``(2) training for health care practitioners and 
     researchers in the use of information systems;
       ``(3) the creation of effective linkages between various 
     sources of health information, including the development of 
     information networks;
       ``(4) the delivery and coordination of evidence-based 
     health care services, including the use of real-time health 
     care decision-support programs;
       ``(5) the utility and comparability of health information 
     data and medical vocabularies by addressing issues related to 
     the content, structure, definitions and coding of such 
     information and data in consultation with appropriate 
     Federal, State and private entities;
       ``(6) the use of computer-based health records in all 
     settings for the development of personal health records for 
     individual health assessment and maintenance, and for 
     monitoring public health and outcomes of care within 
     populations; and
       ``(7) the protection of individually identifiable 
     information in health services research and health care 
     quality improvement.
       ``(b) Demonstration.--The Agency shall support 
     demonstrations into the use of new information tools aimed at 
     improving shared decision-making between patients and their 
     care-givers.
       ``(c) Facilitating Public Access to Information.--The 
     Director shall work with appropriate public and private 
     sector entities to facilitate public access to information 
     regarding the quality of and consumer satisfaction with 
     health care.

     ``SEC. 915. RESEARCH SUPPORTING PRIMARY CARE AND ACCESS IN 
                   UNDERSERVED AREAS.

       ``(a) Preventive Services Task Force.--
       ``(1) Establishment and purpose.--The Director may 
     periodically convene a Preventive Services Task Force to be 
     composed of individuals with appropriate expertise. Such a 
     task force shall review the scientific evidence related to 
     the effectiveness, appropriateness, and cost-effectiveness of 
     clinical preventive services for the purpose of developing 
     recommendations for the health care community, and updating 
     previous clinical preventive recommendations.
       ``(2) Role of agency.--The Agency shall provide ongoing 
     administrative, research, and technical support for the 
     operations of the Preventive Services Task Force, including 
     coordinating and supporting the dissemination of the 
     recommendations of the Task Force.
       ``(3) Operation.--In carrying out its responsibilities 
     under paragraph (1), the Task Force is not subject to the 
     provisions of Appendix 2 of title 5, United States Code.
       ``(b) Primary Care Research.--
       ``(1) In general.--There is established within the Agency a 
     Center for Primary Care Research (referred to in this 
     subsection as the `Center') that shall serve as the principal 
     source of funding for primary care practice research in the 
     Department of Health and Human Services. For purposes of this 
     paragraph, primary care research focuses on the first contact 
     when illness or health concerns arise, the diagnosis, 
     treatment or referral to specialty care, preventive care, and 
     the relationship between the clinician and the patient in the 
     context of the family and community.
       ``(2) Research.--In carrying out this section, the Center 
     shall conduct and support research concerning--
       ``(A) the nature and characteristics of primary care 
     practice;
       ``(B) the management of commonly occurring clinical 
     problems;
       ``(C) the management of undifferentiated clinical problems; 
     and
       ``(D) the continuity and coordination of health services.

     ``SEC. 916. HEALTH CARE PRACTICE AND TECHNOLOGY INNOVATION.

       ``(a) In General.--The Director shall promote innovation in 
     evidence-based health care practices and technologies by--
       ``(1) conducting and supporting research on the 
     development, diffusion, and use of health care technology;
       ``(2) developing, evaluating, and disseminating 
     methodologies for assessments of health care practices and 
     technologies;
       ``(3) conducting intramural and supporting extramural 
     assessments of existing and new health care practices and 
     technologies;
       ``(4) promoting education and training and providing 
     technical assistance in the use of health care practice and 
     technology assessment methodologies and results; and
       ``(5) working with the National Library of Medicine and the 
     public and private sector to develop an electronic 
     clearinghouse of currently available assessments and those in 
     progress.
       ``(b) Specification of Process.--
       ``(1) In general.--Not later than December 31, 2000, the 
     Director shall develop and publish a description of the 
     methods used by the Agency and its contractors for health 
     care practice and technology assessment.
       ``(2) Consultations.--In carrying out this subsection, the 
     Director shall cooperate and consult with the Assistant 
     Secretary for Health, the Administrator of the Health Care 
     Financing Administration, the Director of the National 
     Institutes of Health, the Commissioner of Food and Drugs, and 
     the heads of any other interested Federal department or 
     agency, and shall seek input, where appropriate, from 
     professional societies and other private and public entities.
       ``(3) Methodology.--The Director shall, in developing the 
     methods used under paragraph (1), consider--
       ``(A) safety, efficacy, and effectiveness;
       ``(B) legal, social, and ethical implications;
       ``(C) costs, benefits, and cost-effectiveness;
       ``(D) comparisons to alternate health care practices and 
     technologies; and
       ``(E) requirements of Food and Drug Administration approval 
     to avoid duplication.
       ``(c) Specific Assessments.--
       ``(1) In general.--The Director shall conduct or support 
     specific assessments of health care technologies and 
     practices.
       ``(2) Requests for assessments.--The Director is authorized 
     to conduct or support assessments, on a reimbursable basis, 
     for the Health Care Financing Administration, the Department 
     of Defense, the Department of Veterans Affairs, the Office of 
     Personnel Management, and other public or private entities.
       ``(3) Grants and contracts.--In addition to conducting 
     assessments, the Director may make grants to, or enter into 
     cooperative agreements or contracts with, entities described 
     in paragraph (4) for the purpose of

[[Page 28125]]

     conducting assessments of experimental, emerging, existing, 
     or potentially outmoded health care technologies, and for 
     related activities.
       ``(4) Eligible entities.--An entity described in this 
     paragraph is an entity that is determined to be appropriate 
     by the Director, including academic medical centers, research 
     institutions and organizations, professional organizations, 
     third party payers, governmental agencies, minority 
     institutions of higher education (such as Historically Black 
     Colleges and Universities, and Hispanic institutions), and 
     consortia of appropriate research entities established for 
     the purpose of conducting technology assessments.
       ``(d) Medical Examination of Certain Victims.--
       ``(1) In general.--The Director shall develop and 
     disseminate a report on evidence-based clinical practices 
     for--
       ``(A) the examination and treatment by health professionals 
     of individuals who are victims of sexual assault (including 
     child molestation) or attempted sexual assault; and
       ``(B) the training of health professionals, in consultation 
     with the Health Resources and Services Administration, on 
     performing medical evidentiary examinations of individuals 
     who are victims of child abuse or neglect, sexual assault, 
     elder abuse, or domestic violence.
       ``(2) Certain considerations.--In identifying the issues to 
     be addressed by the report, the Director shall, to the extent 
     practicable, take into consideration the expertise and 
     experience of Federal and State law enforcement officials 
     regarding the victims referred to in paragraph (1), and of 
     other appropriate public and private entities (including 
     medical societies, victim services organizations, sexual 
     assault prevention organizations, and social services 
     organizations).

     ``SEC. 917. COORDINATION OF FEDERAL GOVERNMENT QUALITY 
                   IMPROVEMENT EFFORTS.

       ``(a) Requirement.--
       ``(1) In general.--To avoid duplication and ensure that 
     Federal resources are used efficiently and effectively, the 
     Secretary, acting through the Director, shall coordinate all 
     research, evaluations, and demonstrations related to health 
     services research, quality measurement and quality 
     improvement activities undertaken and supported by the 
     Federal Government.
       ``(2) Specific activities.--The Director, in collaboration 
     with the appropriate Federal officials representing all 
     concerned executive agencies and departments, shall develop 
     and manage a process to--
       ``(A) improve interagency coordination, priority setting, 
     and the use and sharing of research findings and data 
     pertaining to Federal quality improvement programs, 
     technology assessment, and health services research;
       ``(B) strengthen the research information infrastructure, 
     including databases, pertaining to Federal health services 
     research and health care quality improvement initiatives;
       ``(C) set specific goals for participating agencies and 
     departments to further health services research and health 
     care quality improvement; and
       ``(D) strengthen the management of Federal health care 
     quality improvement programs.
       ``(b) Study by the Institute of Medicine.--
       ``(1) In general.--To provide Congress, the Department of 
     Health and Human Services, and other relevant departments 
     with an independent, external review of their quality 
     oversight, quality improvement and quality research programs, 
     the Secretary shall enter into a contract with the Institute 
     of Medicine--
       ``(A) to describe and evaluate current quality improvement, 
     quality research and quality monitoring processes through--
       ``(i) an overview of pertinent health services research 
     activities and quality improvement efforts conducted by all 
     Federal programs, with particular attention paid to those 
     under titles XVIII, XIX, and XXI of the Social Security Act; 
     and
       ``(ii) a summary of the partnerships that the Department of 
     Health and Human Services has pursued with private 
     accreditation, quality measurement and improvement 
     organizations; and
       ``(B) to identify options and make recommendations to 
     improve the efficiency and effectiveness of quality 
     improvement programs through--
       ``(i) the improved coordination of activities across the 
     medicare, medicaid and child health insurance programs under 
     titles XVIII, XIX and XXI of the Social Security Act and 
     health services research programs;
       ``(ii) the strengthening of patient choice and 
     participation by incorporating state-of-the-art quality 
     monitoring tools and making information on quality available; 
     and
       ``(iii) the enhancement of the most effective programs, 
     consolidation as appropriate, and elimination of duplicative 
     activities within various federal agencies.
       ``(2) Requirements.--
       ``(A) In general.--The Secretary shall enter into a 
     contract with the Institute of Medicine for the preparation--
       ``(i) not later than 12 months after the date of the 
     enactment of this title, of a report providing an overview of 
     the quality improvement programs of the Department of Health 
     and Human Services for the medicare, medicaid, and CHIP 
     programs under titles XVIII, XIX, and XXI of the Social 
     Security Act; and
       ``(ii) not later than 24 months after the date of the 
     enactment of this title, of a final report containing 
     recommendations.
       ``(B) Reports.--The Secretary shall submit the reports 
     described in subparagraph (A) to the Committee on Finance and 
     the Committee on Health, Education, Labor, and Pensions of 
     the Senate and the Committee on Ways and Means and the 
     Committee on Commerce of the House of Representatives.

                      ``PART C--GENERAL PROVISIONS

     ``SEC. 921. ADVISORY COUNCIL FOR HEALTHCARE RESEARCH AND 
                   QUALITY.

       ``(a) Establishment.--There is established an advisory 
     council to be known as the National Advisory Council for 
     Healthcare Research and Quality.
       ``(b) Duties.--
       ``(1) In general.--The Advisory Council shall advise the 
     Secretary and the Director with respect to activities 
     proposed or undertaken to carry out the mission of the Agency 
     under section 901(b).
       ``(2) Certain recommendations.--Activities of the Advisory 
     Council under paragraph (1) shall include making 
     recommendations to the Director regarding--
       ``(A) priorities regarding health care research, especially 
     studies related to quality, outcomes, cost and the 
     utilization of, and access to, health care services;
       ``(B) the field of health care research and related 
     disciplines, especially issues related to training needs, and 
     dissemination of information pertaining to health care 
     quality; and
       ``(C) the appropriate role of the Agency in each of these 
     areas in light of private sector activity and identification 
     of opportunities for public-private sector partnerships.
       ``(c) Membership.--
       ``(1) In general.--The Advisory Council shall, in 
     accordance with this subsection, be composed of appointed 
     members and ex officio members. All members of the Advisory 
     Council shall be voting members other than the individuals 
     designated under paragraph (3)(B) as ex officio members.
       ``(2) Appointed members.--The Secretary shall appoint to 
     the Advisory Council 21 appropriately qualified individuals. 
     At least 17 members of the Advisory Council shall be 
     representatives of the public who are not officers or 
     employees of the United States and at least 1 member who 
     shall be a specialist in the rural aspects of 1 or more of 
     the professions or fields described in subparagraphs (A) 
     through (G). The Secretary shall ensure that the appointed 
     members of the Council, as a group, are representative of 
     professions and entities concerned with, or affected by, 
     activities under this title and under section 1142 of the 
     Social Security Act. Of such members--
       ``(A) three shall be individuals distinguished in the 
     conduct of research, demonstration projects, and evaluations 
     with respect to health care;
       ``(B) three shall be individuals distinguished in the 
     fields of health care quality research or health care 
     improvement;
       ``(C) three shall be individuals distinguished in the 
     practice of medicine of which at least one shall be a primary 
     care practitioner;
       ``(D) three shall be individuals distinguished in the other 
     health professions;
       ``(E) three shall be individuals either representing the 
     private health care sector, including health plans, 
     providers, and purchasers or individuals distinguished as 
     administrators of health care delivery systems;
       ``(F) three shall be individuals distinguished in the 
     fields of health care economics, information systems, law, 
     ethics, business, or public policy; and
       ``(G) three shall be individuals representing the interests 
     of patients and consumers of health care.
       ``(3) Ex officio members.--The Secretary shall designate as 
     ex officio members of the Advisory Council--
       ``(A) the Assistant Secretary for Health, the Director of 
     the National Institutes of Health, the Director of the 
     Centers for Disease Control and Prevention, the Administrator 
     of the Health Care Financing Administration, the Commissioner 
     of the Food and Drug Administration, the Director of the 
     Office of Personnel Management, the Assistant Secretary of 
     Defense (Health Affairs), and the Under Secretary for Health 
     of the Department of Veterans Affairs; and
       ``(B) such other Federal officials as the Secretary may 
     consider appropriate.
       ``(d) Terms.--
       ``(1) In general.--Members of the Advisory Council 
     appointed under subsection (c)(2) shall serve for a term of 3 
     years.
       ``(2) Staggered terms.--To ensure the staggered rotation of 
     one-third of the members of the Advisory Council each year, 
     the Secretary is authorized to appoint the initial members of 
     the Advisory Council for terms of 1, 2, or 3 years.
       ``(3) Service beyond term.--A member of the Council 
     appointed under subsection (c)(2) may continue to serve after 
     the expiration of

[[Page 28126]]

     the term of the members until a successor is appointed.
       ``(e) Vacancies.--If a member of the Advisory Council 
     appointed under subsection (c)(2) does not serve the full 
     term applicable under subsection (d), the individual 
     appointed to fill the resulting vacancy shall be appointed 
     for the remainder of the term of the predecessor of the 
     individual.
       ``(f) Chair.--The Director shall, from among the members of 
     the Advisory Council appointed under subsection (c)(2), 
     designate an individual to serve as the chair of the Advisory 
     Council.
       ``(g) Meetings.--The Advisory Council shall meet not less 
     than once during each discrete 4-month period and shall 
     otherwise meet at the call of the Director or the chair.
       ``(h) Compensation and Reimbursement of Expenses.--
       ``(1) Appointed members.--Members of the Advisory Council 
     appointed under subsection (c)(2) shall receive compensation 
     for each day (including travel time) engaged in carrying out 
     the duties of the Advisory Council unless declined by the 
     member. Such compensation may not be in an amount in excess 
     of the daily equivalent of the annual rate of basic pay 
     prescribed for level IV of the Executive Schedule under 
     section 5315 of title 5, United States Code, for each day 
     during which such member is engaged in the performance of the 
     duties of the Advisory Council.
       ``(2) Ex officio members.--Officials designated under 
     subsection (c)(3) as ex officio members of the Advisory 
     Council may not receive compensation for service on the 
     Advisory Council in addition to the compensation otherwise 
     received for duties carried out as officers of the United 
     States.
       ``(i) Staff.--The Director shall provide to the Advisory 
     Council such staff, information, and other assistance as may 
     be necessary to carry out the duties of the Council.
       ``(j) Duration.--Notwithstanding section 14(a) of the 
     Federal Advisory Committee Act, the Advisory Council shall 
     continue in existence until otherwise provided by law.

     ``SEC. 922. PEER REVIEW WITH RESPECT TO GRANTS AND CONTRACTS.

       ``(a) Requirement of Review.--
       ``(1) In general.--Appropriate technical and scientific 
     peer review shall be conducted with respect to each 
     application for a grant, cooperative agreement, or contract 
     under this title.
       ``(2) Reports to director.--Each peer review group to which 
     an application is submitted pursuant to paragraph (1) shall 
     report its finding and recommendations respecting the 
     application to the Director in such form and in such manner 
     as the Director shall require.
       ``(b) Approval as Precondition of Awards.--The Director may 
     not approve an application described in subsection (a)(1) 
     unless the application is recommended for approval by a peer 
     review group established under subsection (c).
       ``(c) Establishment of Peer Review Groups.--
       ``(1) In general.--The Director shall establish such 
     technical and scientific peer review groups as may be 
     necessary to carry out this section. Such groups shall be 
     established without regard to the provisions of title 5, 
     United States Code, that govern appointments in the 
     competitive service, and without regard to the provisions of 
     chapter 51, and subchapter III of chapter 53, of such title 
     that relate to classification and pay rates under the General 
     Schedule.
       ``(2) Membership.--The members of any peer review group 
     established under this section shall be appointed from among 
     individuals who by virtue of their training or experience are 
     eminently qualified to carry out the duties of such peer 
     review group. Officers and employees of the United States may 
     not constitute more than 25 percent of the membership of any 
     such group. Such officers and employees may not receive 
     compensation for service on such groups in addition to the 
     compensation otherwise received for these duties carried out 
     as such officers and employees.
       ``(3) Duration.--Notwithstanding section 14(a) of the 
     Federal Advisory Committee Act, peer review groups 
     established under this section may continue in existence 
     until otherwise provided by law.
       ``(4) Qualifications.--Members of any peer-review group 
     shall, at a minimum, meet the following requirements:
       ``(A) Such members shall agree in writing to treat 
     information received, pursuant to their work for the group, 
     as confidential information, except that this subparagraph 
     shall not apply to public records and public information.
       ``(B) Such members shall agree in writing to recuse 
     themselves from participation in the peer-review of specific 
     applications which present a potential personal conflict of 
     interest or appearance of such conflict, including employment 
     in a directly affected organization, stock ownership, or any 
     financial or other arrangement that might introduce bias in 
     the process of peer-review.
       ``(d) Authority for Procedural Adjustments in Certain 
     Cases.--In the case of applications for financial assistance 
     whose direct costs will not exceed $100,000, the Director may 
     make appropriate adjustments in the procedures otherwise 
     established by the Director for the conduct of peer review 
     under this section. Such adjustments may be made for the 
     purpose of encouraging the entry of individuals into the 
     field of research, for the purpose of encouraging clinical 
     practice-oriented or provider-based research, and for such 
     other purposes as the Director may determine to be 
     appropriate.
       ``(e) Regulations.--The Director shall issue regulations 
     for the conduct of peer review under this section.

     ``SEC. 923. CERTAIN PROVISIONS WITH RESPECT TO DEVELOPMENT, 
                   COLLECTION, AND DISSEMINATION OF DATA.

       ``(a) Standards With Respect to Utility of Data.--
       ``(1) In general.--To ensure the utility, accuracy, and 
     sufficiency of data collected by or for the Agency for the 
     purpose described in section 901(b), the Director shall 
     establish standard methods for developing and collecting such 
     data, taking into consideration--
       ``(A) other Federal health data collection standards; and
       ``(B) the differences between types of health care plans, 
     delivery systems, health care providers, and provider 
     arrangements.
       ``(2) Relationship with other department programs.--In any 
     case where standards under paragraph (1) may affect the 
     administration of other programs carried out by the 
     Department of Health and Human Services, including the 
     programs under title XVIII, XIX or XXI of the Social Security 
     Act, or may affect health information that is subject to a 
     standard developed under part C of title XI of the Social 
     Security Act, they shall be in the form of recommendations to 
     the Secretary for such program.
       ``(b) Statistics and Analyses.--The Director shall--
       ``(1) take appropriate action to ensure that statistics and 
     analyses developed under this title are of high quality, 
     timely, and duly comprehensive, and that the statistics are 
     specific, standardized, and adequately analyzed and indexed; 
     and
       ``(2) publish, make available, and disseminate such 
     statistics and analyses on as wide a basis as is practicable.
       ``(c) Authority Regarding Certain Requests.--Upon request 
     of a public or private entity, the Director may conduct or 
     support research or analyses otherwise authorized by this 
     title pursuant to arrangements under which such entity will 
     pay the cost of the services provided. Amounts received by 
     the Director under such arrangements shall be available to 
     the Director for obligation until expended.

     ``SEC. 924. DISSEMINATION OF INFORMATION.

       ``(a) In General.--The Director shall--
       ``(1) without regard to section 501 of title 44, United 
     States Code, promptly publish, make available, and otherwise 
     disseminate, in a form understandable and on as broad a basis 
     as practicable so as to maximize its use, the results of 
     research, demonstration projects, and evaluations conducted 
     or supported under this title;
       ``(2) ensure that information disseminated by the Agency is 
     science-based and objective and undertakes consultation as 
     necessary to assess the appropriateness and usefulness of the 
     presentation of information that is targeted to specific 
     audiences;
       ``(3) promptly make available to the public data developed 
     in such research, demonstration projects, and evaluations;
       ``(4) provide, in collaboration with the National Library 
     of Medicine where appropriate, indexing, abstracting, 
     translating, publishing, and other services leading to a more 
     effective and timely dissemination of information on 
     research, demonstration projects, and evaluations with 
     respect to health care to public and private entities and 
     individuals engaged in the improvement of health care 
     delivery and the general public, and undertake programs to 
     develop new or improved methods for making such information 
     available; and
       ``(5) as appropriate, provide technical assistance to State 
     and local government and health agencies and conduct liaison 
     activities to such agencies to foster dissemination.
       ``(b) Prohibition Against Restrictions.--Except as provided 
     in subsection (c), the Director may not restrict the 
     publication or dissemination of data from, or the results of, 
     projects conducted or supported under this title.
       ``(c) Limitation on Use of Certain Information.--No 
     information, if an establishment or person supplying the 
     information or described in it is identifiable, obtained in 
     the course of activities undertaken or supported under this 
     title may be used for any purpose other than the purpose for 
     which it was supplied unless such establishment or person has 
     consented (as determined under regulations of the Director) 
     to its use for such other purpose. Such information may not 
     be published or released in other form if the person who 
     supplied the information or who is described in it is 
     identifiable unless such person has consented (as determined 
     under regulations of the Director) to its publication or 
     release in other form.
       ``(d) Penalty.--Any person who violates subsection (c) 
     shall be subject to a civil monetary penalty of not more than 
     $10,000 for each such violation involved. Such penalty shall 
     be imposed and collected in the same manner as civil money 
     penalties under subsection (a) of section 1128A of the Social 
     Security Act are imposed and collected.

[[Page 28127]]



     ``SEC. 925. ADDITIONAL PROVISIONS WITH RESPECT TO GRANTS AND 
                   CONTRACTS.

       ``(a) Financial Conflicts of Interest.--With respect to 
     projects for which awards of grants, cooperative agreements, 
     or contracts are authorized to be made under this title, the 
     Director shall by regulation define--
       ``(1) the specific circumstances that constitute financial 
     interests in such projects that will, or may be reasonably 
     expected to, create a bias in favor of obtaining results in 
     the projects that are consistent with such interests; and
       ``(2) the actions that will be taken by the Director in 
     response to any such interests identified by the Director.
       ``(b) Requirement of Application.--The Director may not, 
     with respect to any program under this title authorizing the 
     provision of grants, cooperative agreements, or contracts, 
     provide any such financial assistance unless an application 
     for the assistance is submitted to the Secretary and the 
     application is in such form, is made in such manner, and 
     contains such agreements, assurances, and information as the 
     Director determines to be necessary to carry out the program 
     involved.
       ``(c) Provision of Supplies and Services in Lieu of 
     Funds.--
       ``(1) In general.--Upon the request of an entity receiving 
     a grant, cooperative agreement, or contract under this title, 
     the Secretary may, subject to paragraph (2), provide 
     supplies, equipment, and services for the purpose of aiding 
     the entity in carrying out the project involved and, for such 
     purpose, may detail to the entity any officer or employee of 
     the Department of Health and Human Services.
       ``(2) Corresponding reduction in funds.--With respect to a 
     request described in paragraph (1), the Secretary shall 
     reduce the amount of the financial assistance involved by an 
     amount equal to the costs of detailing personnel and the fair 
     market value of any supplies, equipment, or services provided 
     by the Director. The Secretary shall, for the payment of 
     expenses incurred in complying with such request, expend the 
     amounts withheld.
       ``(d) Applicability of Certain Provisions With Respect to 
     Contracts.--Contracts may be entered into under this part 
     without regard to sections 3648 and 3709 of the Revised 
     Statutes (31 U.S.C. 529 and 41 U.S.C. 5).

     ``SEC. 926. CERTAIN ADMINISTRATIVE AUTHORITIES.

       ``(a) Deputy Director and Other Officers and Employees.--
       ``(1) Deputy director.--The Director may appoint a deputy 
     director for the Agency.
       ``(2) Other officers and employees.--The Director may 
     appoint and fix the compensation of such officers and 
     employees as may be necessary to carry out this title. Except 
     as otherwise provided by law, such officers and employees 
     shall be appointed in accordance with the civil service laws 
     and their compensation fixed in accordance with title 5, 
     United States Code.
       ``(b) Facilities.--The Secretary, in carrying out this 
     title--
       ``(1) may acquire, without regard to the Act of March 3, 
     1877 (40 U.S.C. 34), by lease or otherwise through the 
     Administrator of General Services, buildings or portions of 
     buildings in the District of Columbia or communities located 
     adjacent to the District of Columbia for use for a period not 
     to exceed 10 years; and
       ``(2) may acquire, construct, improve, repair, operate, and 
     maintain laboratory, research, and other necessary facilities 
     and equipment, and such other real or personal property 
     (including patents) as the Secretary deems necessary.
       ``(c) Provision of Financial Assistance.--The Director, in 
     carrying out this title, may make grants to public and 
     nonprofit entities and individuals, and may enter into 
     cooperative agreements or contracts with public and private 
     entities and individuals.
       ``(d) Utilization of Certain Personnel and Resources.--
       ``(1) Department of health and human services.--The 
     Director, in carrying out this title, may utilize personnel 
     and equipment, facilities, and other physical resources of 
     the Department of Health and Human Services, permit 
     appropriate (as determined by the Secretary) entities and 
     individuals to utilize the physical resources of such 
     Department, and provide technical assistance and advice.
       ``(2) Other agencies.--The Director, in carrying out this 
     title, may use, with their consent, the services, equipment, 
     personnel, information, and facilities of other Federal, 
     State, or local public agencies, or of any foreign 
     government, with or without reimbursement of such agencies.
       ``(e) Consultants.--The Secretary, in carrying out this 
     title, may secure, from time to time and for such periods as 
     the Director deems advisable but in accordance with section 
     3109 of title 5, United States Code, the assistance and 
     advice of consultants from the United States or abroad.
       ``(f) Experts.--
       ``(1) In general.--The Secretary may, in carrying out this 
     title, obtain the services of not more than 50 experts or 
     consultants who have appropriate scientific or professional 
     qualifications. Such experts or consultants shall be obtained 
     in accordance with section 3109 of title 5, United States 
     Code, except that the limitation in such section on the 
     duration of service shall not apply.
       ``(2) Travel expenses.--
       ``(A) In general.--Experts and consultants whose services 
     are obtained under paragraph (1) shall be paid or reimbursed 
     for their expenses associated with traveling to and from 
     their assignment location in accordance with sections 5724, 
     5724a(a), 5724a(c), and 5726(c) of title 5, United States 
     Code.
       ``(B) Limitation.--Expenses specified in subparagraph (A) 
     may not be allowed in connection with the assignment of an 
     expert or consultant whose services are obtained under 
     paragraph (1) unless and until the expert agrees in writing 
     to complete the entire period of assignment, or 1 year, 
     whichever is shorter, unless separated or reassigned for 
     reasons that are beyond the control of the expert or 
     consultant and that are acceptable to the Secretary. If the 
     expert or consultant violates the agreement, the money spent 
     by the United States for the expenses specified in 
     subparagraph (A) is recoverable from the expert or consultant 
     as a statutory obligation owed to the United States. The 
     Secretary may waive in whole or in part a right of recovery 
     under this subparagraph.
       ``(g) Voluntary and Uncompensated Services.--The Director, 
     in carrying out this title, may accept voluntary and 
     uncompensated services.

     ``SEC. 927. FUNDING.

       ``(a) Intent.--To ensure that the United States investment 
     in biomedical research is rapidly translated into 
     improvements in the quality of patient care, there must be a 
     corresponding investment in research on the most effective 
     clinical and organizational strategies for use of these 
     findings in daily practice. The authorization levels in 
     subsections (b) and (c) provide for a proportionate increase 
     in health care research as the United States investment in 
     biomedical research increases.
       ``(b) Authorization of Appropriations.--For the purpose of 
     carrying out this title, there are authorized to be 
     appropriated $250,000,000 for fiscal year 2000, and such sums 
     as may be necessary for each of the fiscal years 2001 through 
     2005.
       ``(c) Evaluations.--In addition to amounts available 
     pursuant to subsection (b) for carrying out this title, there 
     shall be made available for such purpose, from the amounts 
     made available pursuant to section 241 (relating to 
     evaluations), an amount equal to 40 percent of the maximum 
     amount authorized in such section 241 to be made available 
     for a fiscal year.

     ``SEC. 928. DEFINITIONS.

       ``In this title:
       ``(1) Advisory council.--The term `Advisory Council' means 
     the National Advisory Council on Healthcare Research and 
     Quality established under section 921.
       ``(2) Agency.--The term `Agency' means the Agency for 
     Healthcare Research and Quality.
       ``(3) Director.--The term `Director' means the Director of 
     the Agency for Healthcare Research and Quality.''.
       (b) Rules of Construction.--
       (1) In general.--Section 901(a) of the Public Health 
     Service Act (as added by subsection (a) of this section) 
     applies as a redesignation of the agency that carried out 
     title IX of such Act on the day before the date of the 
     enactment of this Act, and not as the termination of such 
     agency and the establishment of a different agency. The 
     amendment made by subsection (a) of this section does not 
     affect appointments of the personnel of such agency who were 
     employed at the agency on the day before such date, including 
     the appointments of members of advisory councils or study 
     sections of the agency who were serving on the day before 
     such date of enactment.
       (2) References.--Any reference in law to the Agency for 
     Health Care Policy and Research is deemed to be a reference 
     to the Agency for Healthcare Research and Quality, and any 
     reference in law to the Administrator for Health Care Policy 
     and Research is deemed to be a reference to the Director of 
     the Agency for Healthcare Research and Quality.

     SEC. 3. GRANTS REGARDING UTILIZATION OF PREVENTIVE HEALTH 
                   SERVICES.

       Subpart I of part D of title III of the Public Health 
     Service Act (42 U.S.C. 254b et seq.) is amended by adding at 
     the end the following section:

     ``SEC. 330D. CENTERS FOR STRATEGIES ON FACILITATING 
                   UTILIZATION OF PREVENTIVE HEALTH SERVICES AMONG 
                   VARIOUS POPULATIONS.

       ``(a) In General.--The Secretary, acting through the 
     appropriate agencies of the Public Health Service, shall make 
     grants to public or nonprofit private entities for the 
     establishment and operation of regional centers whose purpose 
     is to develop, evaluate, and disseminate effective 
     strategies, which utilize quality management measures, to 
     assist public and private health care programs and providers 
     in the appropriate utilization of preventive health care 
     services by specific populations.
       ``(b) Research and Training.--The activities carried out by 
     a center under subsection (a) may include establishing 
     programs of research and training with respect to the purpose 
     described in such subsection, including the development of 
     curricula for training individuals in implementing the 
     strategies developed under such subsection.

[[Page 28128]]

       ``(c) Priority Regarding Infants and Children.--In carrying 
     out the purpose described in subsection (a), the Secretary 
     shall give priority to various populations of infants, young 
     children, and their mothers.
       ``(d) Authorization of Appropriations.--For the purpose of 
     carrying out this section, there are authorized to be 
     appropriated such sums as may be necessary for each of the 
     fiscal years 2000 through 2004.''.

     SEC. 4. PROGRAM OF PAYMENTS TO CHILDREN'S HOSPITALS THAT 
                   OPERATE GRADUATE MEDICAL EDUCATION PROGRAMS.

       Part D of title III of the Public Health Service Act (42 
     U.S.C. 254b et seq.) is amended by adding at the end the 
     following subpart:

    ``Subpart IX--Support of Graduate Medical Education Programs in 
                          Children's Hospitals

     ``SEC. 340E. PROGRAM OF PAYMENTS TO CHILDREN'S HOSPITALS THAT 
                   OPERATE GRADUATE MEDICAL EDUCATION PROGRAMS.

       ``(a) Payments.--The Secretary shall make two payments 
     under this section to each children's hospital for each of 
     fiscal years 2000 and 2001, one for the direct expenses and 
     the other for indirect expenses associated with operating 
     approved graduate medical residency training programs.
       ``(b) Amount of Payments.--
       ``(1) In general.--Subject to paragraph (2), the amounts 
     payable under this section to a children's hospital for an 
     approved graduate medical residency training program for a 
     fiscal year are each of the following amounts:
       ``(A) Direct expense amount.--The amount determined under 
     subsection (c) for direct expenses associated with operating 
     approved graduate medical residency training programs.
       ``(B) Indirect expense amount.--The amount determined under 
     subsection (d) for indirect expenses associated with the 
     treatment of more severely ill patients and the additional 
     costs relating to teaching residents in such programs.
       ``(2) Capped amount.--
       ``(A) In general.--The total of the payments made to 
     children's hospitals under paragraph (1)(A) or paragraph 
     (1)(B) in a fiscal year shall not exceed the funds 
     appropriated under paragraph (1) or (2), respectively, of 
     subsection (f) for such payments for that fiscal year.
       ``(B) Pro rata reductions of payments for direct 
     expenses.--If the Secretary determines that the amount of 
     funds appropriated under subsection (f)(1) for a fiscal year 
     is insufficient to provide the total amount of payments 
     otherwise due for such periods under paragraph (1)(A), the 
     Secretary shall reduce the amounts so payable on a pro rata 
     basis to reflect such shortfall.
       ``(c) Amount of Payment for Direct Graduate Medical 
     Education.--
       ``(1) In general.--The amount determined under this 
     subsection for payments to a children's hospital for direct 
     graduate expenses relating to approved graduate medical 
     residency training programs for a fiscal year is equal to the 
     product of--
       ``(A) the updated per resident amount for direct graduate 
     medical education, as determined under paragraph (2); and
       ``(B) the average number of full-time equivalent residents 
     in the hospital's graduate approved medical residency 
     training programs (as determined under section 1886(h)(4) of 
     the Social Security Act during the fiscal year.
       ``(2) Updated per resident amount for direct graduate 
     medical education.--The updated per resident amount for 
     direct graduate medical education for a hospital for a fiscal 
     year is an amount determined as follows:
       ``(A) Determination of hospital single per resident 
     amount.--The Secretary shall compute for each hospital 
     operating an approved graduate medical education program 
     (regardless of whether or not it is a children's hospital) a 
     single per resident amount equal to the average (weighted by 
     number of full-time equivalent residents) of the primary care 
     per resident amount and the non-primary care per resident 
     amount computed under section 1886(h)(2) of the Social 
     Security Act for cost reporting periods ending during fiscal 
     year 1997.
       ``(B) Determination of wage and non-wage-related proportion 
     of the single per resident amount.--The Secretary shall 
     estimate the average proportion of the single per resident 
     amounts computed under subparagraph (A) that is attributable 
     to wages and wage-related costs.
       ``(C) Standardizing per resident amounts.--The Secretary 
     shall establish a standardized per resident amount for each 
     such hospital--
       ``(i) by dividing the single per resident amount computed 
     under subparagraph (A) into a wage-related portion and a non-
     wage-related portion by applying the proportion determined 
     under subparagraph (B);
       ``(ii) by dividing the wage-related portion by the factor 
     applied under section 1886(d)(3)(E) of the Social Security 
     Act for discharges occurring during fiscal year 1999 for the 
     hospital's area; and
       ``(iii) by adding the non-wage-related portion to the 
     amount computed under clause (ii).
       ``(D) Determination of national average.--The Secretary 
     shall compute a national average per resident amount equal to 
     the average of the standardized per resident amounts computed 
     under subparagraph (C) for such hospitals, with the amount 
     for each hospital weighted by the average number of full-time 
     equivalent residents at such hospital.
       ``(E) Application to individual hospitals.--The Secretary 
     shall compute for each such hospital that is a children's 
     hospital a per resident amount--
       ``(i) by dividing the national average per resident amount 
     computed under subparagraph (D) into a wage-related portion 
     and a non-wage-related portion by applying the proportion 
     determined under subparagraph (B);
       ``(ii) by multiplying the wage-related portion by the 
     factor described in subparagraph (C)(ii) for the hospital's 
     area; and
       ``(iii) by adding the non-wage-related portion to the 
     amount computed under clause (ii).
       ``(F) Updating rate.--The Secretary shall update such per 
     resident amount for each such children's hospital by the 
     estimated percentage increase in the consumer price index for 
     all urban consumers during the period beginning October 1997 
     and ending with the midpoint of the hospital's cost reporting 
     period that begins during fiscal year 2000.
       ``(d) Amount of Payment for Indirect Medical Education.--
       ``(1) In general.--The amount determined under this 
     subsection for payments to a children's hospital for indirect 
     expenses associated with the treatment of more severely ill 
     patients and the additional costs related to the teaching of 
     residents for a fiscal year is equal to an amount determined 
     appropriate by the Secretary.
       ``(2) Factors.--In determining the amount under paragraph 
     (1), the Secretary shall--
       ``(A) take into account variations in case mix among 
     children's hospitals and the number of full-time equivalent 
     residents in the hospitals' approved graduate medical 
     residency training programs; and
       ``(B) assure that the aggregate of the payments for 
     indirect expenses associated with the treatment of more 
     severely ill patients and the additional costs related to the 
     teaching of residents under this section in a fiscal year are 
     equal to the amount appropriated for such expenses for the 
     fiscal year involved under subsection (f)(2).
       ``(e) Making of Payments.--
       ``(1) Interim payments.--The Secretary shall determine, 
     before the beginning of each fiscal year involved for which 
     payments may be made for a hospital under this section, the 
     amounts of the payments for direct graduate medical education 
     and indirect medical education for such fiscal year and shall 
     (subject to paragraph (2)) make the payments of such amounts 
     in 26 equal interim installments during such period.
       ``(2) Withholding.--The Secretary shall withhold up to 25 
     percent from each interim installment for direct graduate 
     medical education paid under paragraph (1).
       ``(3) Reconciliation.--At the end of each fiscal year for 
     which payments may be made under this section, the hospital 
     shall submit to the Secretary such information as the 
     Secretary determines to be necessary to determine the percent 
     (if any) of the total amount withheld under paragraph (2) 
     that is due under this section for the hospital for the 
     fiscal year. Based on such determination, the Secretary shall 
     recoup any overpayments made, or pay any balance due. The 
     amount so determined shall be considered a final intermediary 
     determination for purposes of applying section 1878 of the 
     Social Security Act and shall be subject to review under that 
     section in the same manner as the amount of payment under 
     section 1886(d) of such Act is subject to review under such 
     section.
       ``(f) Authorization of Appropriations.--
       ``(1) Direct graduate medical education.--
       ``(A) In general.--There are hereby authorized to be 
     appropriated, out of any money in the Treasury not otherwise 
     appropriated, for payments under subsection (b)(1)(A)--
       ``(i) for fiscal year 2000, $90,000,000; and
       ``(ii) for fiscal year 2001, $95,000,000.
       ``(B) Carryover of excess.--The amounts appropriated under 
     subparagraph (A) for fiscal year 2000 shall remain available 
     for obligation through the end of fiscal year 2001.
       ``(2) Indirect medical education.--There are hereby 
     authorized to be appropriated, out of any money in the 
     Treasury not otherwise appropriated, for payments under 
     subsection (b)(1)(A)--
       ``(A) for fiscal year 2000, $190,000,000; and
       ``(B) for fiscal year 2001, $190,000,000.
       ``(g) Definitions.--In this section:
       ``(1) Approved graduate medical residency training 
     program.--The term `approved graduate medical residency 
     training program' has the meaning given the term `approved 
     medical residency training program' in section 1886(h)(5)(A) 
     of the Social Security Act.
       ``(2) Children's hospital.--The term `children's hospital' 
     means a hospital described in section 1886(d)(1)(B)(iii) of 
     the Social Security Act.
       ``(3) Direct graduate medical education costs.--The term 
     `direct graduate medical

[[Page 28129]]

     education costs' has the meaning given such term in section 
     1886(h)(5)(C) of the Social Security Act.''.

     SEC. 5. STUDY REGARDING SHORTAGES OF LICENSED PHARMACISTS.

       (a) In General.--The Secretary of Health and Human Services 
     (in this section referred to as the ``Secretary''), acting 
     through the appropriate agencies of the Public Health 
     Service, shall conduct a study to determine whether and to 
     what extent there is a shortage of licensed pharmacists. In 
     carrying out the study, the Secretary shall seek the comments 
     of appropriate public and private entities regarding any such 
     shortage.
       (b) Report to Congress.--Not later than 1 year after the 
     date of the enactment of this Act, the Secretary shall 
     complete the study under subsection (a) and submit to the 
     Congress a report that describes the findings made through 
     the study and that contains a summary of the comments 
     received by the Secretary pursuant to such subsection.

     SEC. 6. REPORT ON TELEMEDICINE.

       Not later than January 10, 2001, the Secretary of Health 
     and Human Services shall submit to the Congress a report 
     that--
       (1) identifies any factors that inhibit the expansion and 
     accessibility of telemedicine services, including factors 
     relating to telemedicine networks;
       (2) identifies any factors that, in addition to 
     geographical isolation, should be used to determine which 
     patients need or require access to telemedicine care;
       (3) determines the extent to which--
       (A) patients receiving telemedicine service have benefited 
     from the services, and are satisfied with the treatment 
     received pursuant to the services; and
       (B) the medical outcomes for such patients would have 
     differed if telemedicine services had not been available to 
     the patients;
       (4) determines the extent to which physicians involved with 
     telemedicine services have been satisfied with the medical 
     aspects of the services;
       (5) determines the extent to which primary care physicians 
     are enhancing their medical knowledge and experience through 
     the interaction with specialists provided by telemedicine 
     consultations; and
       (6) identifies legal and medical issues relating to State 
     licensing of health professionals that are presented by 
     telemedicine services, and provides any recommendations of 
     the Secretary for responding to such issues.

     SEC. 7. CERTAIN TECHNOLOGIES AND PRACTICES REGARDING SURVIVAL 
                   RATES FOR CARDIAC ARREST.

       The Secretary of Health and Human Services shall, in 
     consultation with the Administrator of the General Services 
     Administration and other appropriate public and private 
     entities, develop recommendations regarding the placement of 
     automatic external defibrillators in Federal buildings as a 
     means of improving the survival rates of individuals who 
     experience cardiac arrest in such buildings, including 
     recommendations on training, maintenance, and medical 
     oversight, and on coordinating with the system for emergency 
     medical services.

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