[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;
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``(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--
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``(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,
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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.
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``(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>