[106th Congress Public Law 129]
[From the U.S. Government Printing Office]


<DOC>
[DOCID: f:publ129.106]


[[Page 113 STAT. 1653]]

Public Law 106-129
106th Congress

                                 An Act


 
To amend title IX of the Public Health Service Act to revise and extend 
     the Agency for Healthcare Policy and Research. <<NOTE: Dec. 6, 
                           1999 -  [S. 580]>> 

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, <<NOTE: Healthcare 
Research and Quality Act of 1999.>> 

SECTION <<NOTE: 42 USC 201 note.>>  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. <<NOTE: 42 USC 299.>>  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;

[[Page 113 STAT. 1654]]

                    ``(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, 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.-- 
        <<NOTE: Establishment.>> The Director shall establish an Office 
        of Priority Populations to assist in carrying out the 
        requirements of paragraph (1).

``SEC. <<NOTE: 42 USC 299a.>>  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 multidisciplinary 
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;

[[Page 113 STAT. 1655]]

            ``(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.-- <<NOTE: Effective date.>> 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.

[[Page 113 STAT. 1656]]

               ``PART B--HEALTH CARE IMPROVEMENT RESEARCH

``SEC. 911. <<NOTE: 42 USC 299b.>>  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. <<NOTE: 42 USC 299b-1.>>  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;

[[Page 113 STAT. 1657]]

                    ``(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.
                          ``(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.

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    ``(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. <<NOTE: 42 USC 299b-2.>>  INFORMATION ON QUALITY AND COST OF 
            CARE.

    ``(a) In General.--The Director shall--
            ``(1) <<NOTE: Survey. Effective date.>>  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.-- <<NOTE: Effective date.>> 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.-- <<NOTE: Effective date.>> 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. <<NOTE: 42 USC 299b-3.>>  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--

[[Page 113 STAT. 1659]]

            ``(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. <<NOTE: 42 USC 299b-4.>>  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.-- <<NOTE: Establishment.>> 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,

[[Page 113 STAT. 1660]]

        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. <<NOTE: 42 USC 299b-5.>>  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.-- <<NOTE: Deadline. Publication.>> 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.

[[Page 113 STAT. 1661]]

            ``(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 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.-- <<NOTE: Reports.>> 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. <<NOTE: 42 USC 299b-6.>>  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--

[[Page 113 STAT. 1662]]

                    ``(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. <<NOTE: Contracts.>> --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.-- <<NOTE: Contracts.>> The 
                Secretary shall enter into a contract with the Institute 
                of Medicine for the preparation--
                          ``(i) <<NOTE: Deadline. Reports.>>  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

[[Page 113 STAT. 1663]]

                          ``(ii) <<NOTE: Deadline. Report.>>  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. <<NOTE: 42 USC 299c.>>  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;

[[Page 113 STAT. 1664]]

                    ``(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 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.--

[[Page 113 STAT. 1665]]

            ``(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. <<NOTE: 42 USC 299c-1.>>  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

[[Page 113 STAT. 1666]]

        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. <<NOTE: 42 USC 299c-2.>>  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) <<NOTE: Publication.>>  publish, make available, and 
        disseminate such statistics and analyses on as wide a basis as 
        is practicable.

[[Page 113 STAT. 1667]]

    ``(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. <<NOTE: 42 USC 299c-3.>>  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 113 STAT. 1668]]

``SEC. 925. <<NOTE: 42 USC 299c-4.>>  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. <<NOTE: 42 USC 299c-5.>>  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

[[Page 113 STAT. 1669]]

        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.

[[Page 113 STAT. 1670]]

    ``(g) Voluntary and Uncompensated Services.--The Director, in 
carrying out this title, may accept voluntary and uncompensated 
services.

``SEC. 927. <<NOTE: 42 USC 299c-6.>>  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. <<NOTE: 42 USC 299c-7.>>  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) <<NOTE: 42 USC 299 note.>>  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.-- <<NOTE: 42 USC 203 et seq.>> 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:

[[Page 113 STAT. 1671]]

``SEC. 330D. <<NOTE: 42 USC 254c-4.>>  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.
    ``(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. <<NOTE: 42 USC 256e.>>  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.--

[[Page 113 STAT. 1672]]

                    ``(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

[[Page 113 STAT. 1673]]

                          ``(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.

[[Page 113 STAT. 1674]]

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

[[Page 113 STAT. 1675]]

SEC. 5. <<NOTE: 42 USC 295k note.>>  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) <<NOTE: Deadline.>>  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. <<NOTE: 42 USC 254c.>>  REPORT ON TELEMEDICINE.

    Not <<NOTE: Deadline.>>  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.

[[Page 113 STAT. 1676]]

SEC. 7. <<NOTE: 42 USC 241 note.>>  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.

    Approved December 6, 1999.

LEGISLATIVE HISTORY--S. 580 (H.R. 2506):
---------------------------------------------------------------------------

HOUSE REPORTS: No. 106-305 accompanying H.R. 2506 (Comm. on Commerce).
CONGRESSIONAL RECORD, Vol. 145 (1999):
            Nov. 3, considered and passed Senate.
            Nov. 18, considered and passed House.
WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS, Vol. 35 (1999):
            Dec. 6, Presidential statement.

                                  <all>