--S.580--
S.580
One Hundred Sixth Congress
of the
United States of America
AT THE FIRST SESSION
Begun and held at the City of Washington on Wednesday,
the sixth day of January, one thousand nine hundred and ninety-nine
An Act
To amend title IX of the Public Health Service Act to revise and
extend the Agency for Healthcare Policy and Research.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the `Healthcare Research and Quality Act of
1999'.
SEC. 2. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.
(a) IN GENERAL- Title IX of the Public Health Service Act (42 U.S.C. 299
et seq.) is amended to read as follows:
`TITLE IX--AGENCY FOR HEALTHCARE RESEARCH AND QUALITY
`PART A--ESTABLISHMENT AND GENERAL DUTIES
`SEC. 901. MISSION AND DUTIES.
`(a) IN GENERAL- There is established within the Public Health Service an
agency to be known as the Agency for Healthcare Research and Quality, which
shall be headed by a director appointed by the Secretary. The Secretary shall
carry out this title acting through the Director.
`(b) MISSION- The purpose of the Agency is to enhance the quality,
appropriateness, and effectiveness of health services, and access to such
services, through the establishment of a broad base of scientific research and
through the promotion of improvements in clinical and health system practices,
including the prevention of diseases and other health conditions. The Agency
shall promote health care quality improvement by conducting and
supporting--
`(1) research that develops and presents scientific evidence regarding
all aspects of health care, including--
`(A) the development and assessment of methods for enhancing patient
participation in their own care and for facilitating shared
patient-physician decision-making;
`(B) the outcomes, effectiveness, and cost-effectiveness of health
care practices, including preventive measures and long-term care;
`(C) existing and innovative technologies;
`(D) the costs and utilization of, and access to health care;
`(E) the ways in which health care services are organized, delivered,
and financed and the interaction and impact of these factors on the
quality of patient care;
`(F) methods for measuring quality and strategies for improving
quality; and
`(G) ways in which patients, consumers, purchasers, and practitioners
acquire new information about best practices and health benefits, the
determinants and impact of their use of this information;
`(2) the synthesis and dissemination of available scientific evidence
for use by patients, consumers, practitioners, providers, 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--
`(vi) individuals with special health care needs, including
individuals with disabilities and individuals who need chronic care or
end-of-life health care.
`(2) PROCESS TO ENSURE APPROPRIATE RESEARCH- The Director shall
establish a process to ensure that the requirements of paragraph (1) are
reflected in the overall portfolio of research conducted and supported by
the Agency.
`(3) OFFICE OF PRIORITY POPULATIONS- The Director shall establish an
Office of Priority Populations to assist in carrying out the requirements of
paragraph (1).
`SEC. 902. GENERAL AUTHORITIES.
`(a) IN GENERAL- In carrying out section 901(b), the Director shall
conduct and support research, evaluations, and training, support demonstration
projects, research networks, and 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;
`(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
`(b) HEALTH SERVICES TRAINING GRANTS-
`(1) IN GENERAL- The Director may provide training grants in the field
of health services research related to activities authorized under
subsection (a), to include pre- and post-doctoral fellowships and training
programs, young investigator awards, and other programs and activities as
appropriate. In carrying out this subsection, the Director shall make use of
funds made available under section 487(d)(3) as well as other appropriated
funds.
`(2) REQUIREMENTS- In developing priorities for the allocation of
training funds under this subsection, the Director shall take into
consideration shortages in the number of trained researchers who are
addressing health care issues for the priority populations identified in
section 901(c)(1)(B) and in addition, shall take into consideration
indications of long-term commitment, amongst applicants for training funds,
to addressing health care needs of the priority populations.
`(c) MULTIDISCIPLINARY CENTERS- The Director may provide financial
assistance to assist in meeting the costs of planning and establishing new
centers, and operating existing and new centers, for multidisciplinary health
services research, demonstration projects, evaluations, training, and policy
analysis with respect to the matters referred to in subsection (a).
`(d) RELATION TO CERTAIN AUTHORITIES REGARDING SOCIAL SECURITY- Activities
authorized in this section shall be appropriately coordinated with
experiments, demonstration projects, and other related activities authorized
by the Social Security Act and the Social Security Amendments of 1967.
Activities under subsection (a)(2) of this section that affect the programs
under titles XVIII, XIX and XXI of the Social Security Act shall be carried
out consistent with section 1142 of such Act.
`(e) DISCLAIMER- The Agency shall not mandate national standards of
clinical practice or quality health care standards. Recommendations resulting
from projects funded and published by the Agency shall include a corresponding
disclaimer.
`(f) RULE OF CONSTRUCTION- Nothing in this section shall be construed to
imply that the Agency's role is to mandate a national standard or specific
approach to quality measurement and reporting. In research and quality
improvement activities, the Agency shall consider a wide range of choices,
providers, health care delivery systems, and individual preferences.
`(g) ANNUAL REPORT- Beginning with fiscal year 2003, the Director shall
annually submit to the Congress a report regarding prevailing disparities in
health care delivery as it relates to racial factors and socioeconomic factors
in priority populations.
`PART B--HEALTH CARE IMPROVEMENT RESEARCH
`SEC. 911. HEALTH CARE OUTCOME IMPROVEMENT RESEARCH.
`(a) EVIDENCE RATING SYSTEMS- In collaboration with experts from the
public and private sector, the Agency shall identify and disseminate methods
or systems to assess health care research results, particularly methods or
systems to rate the strength of the scientific evidence underlying health care
practice, recommendations in the research literature, and technology
assessments. The Agency shall make methods or systems for evidence rating
widely available. Agency publications containing health care recommendations
shall indicate the level of substantiating evidence using such methods or
systems.
`(b) HEALTH CARE IMPROVEMENT RESEARCH CENTERS AND PROVIDER-BASED RESEARCH
NETWORKS-
`(1) IN GENERAL- In order to address the full continuum of care and
outcomes research, to link research to practice improvement, and to speed
the dissemination of research findings to community practice settings, the
Agency shall employ research strategies and mechanisms that will link
research directly with clinical practice in geographically diverse locations
throughout the United States, including--
`(A) health care improvement research centers that combine
demonstrated multidisciplinary expertise in outcomes or quality
improvement research with linkages to relevant sites of care;
`(B) provider-based research networks, including plan, facility, or
delivery system sites of care (especially primary care), that can evaluate
outcomes and evaluate and promote quality improvement; and
`(C) other innovative mechanisms or strategies to link research with
clinical practice.
`(2) REQUIREMENTS- The Director is authorized to establish the
requirements for entities applying for grants under this subsection.
`SEC. 912. PRIVATE-PUBLIC PARTNERSHIPS TO IMPROVE ORGANIZATION AND DELIVERY.
`(a) SUPPORT FOR EFFORTS TO DEVELOP INFORMATION ON QUALITY-
`(1) SCIENTIFIC AND TECHNICAL SUPPORT- In its role as the principal
agency for health care research and quality, the Agency may provide
scientific and technical support for private and public efforts to improve
health care quality, including the activities of accrediting
organizations.
`(2) ROLE OF THE AGENCY- With respect to paragraph (1), the role of the
Agency shall include--
`(A) the identification and assessment of methods for the evaluation
of the health of--
`(i) enrollees in health plans by type of plan, provider, and
provider arrangements; and
`(ii) other populations, including those receiving long-term care
services;
`(B) the ongoing development, testing, and dissemination of quality
measures, including measures of health and functional outcomes;
`(C) the compilation and dissemination of health care quality measures
developed in the private and public sector;
`(D) assistance in the development of improved health care information
systems;
`(E) the development of survey tools for the purpose of measuring
participant and beneficiary assessments of their health care; and
`(F) identifying and disseminating information on mechanisms for the
integration of information on quality into purchaser and consumer
decision-making processes.
`(b) CENTERS FOR EDUCATION AND RESEARCH ON THERAPEUTICS-
`(1) IN GENERAL- The Secretary, acting through the Director and in
consultation with the Commissioner of Food and Drugs, shall establish a
program for the purpose of making one or more grants for the establishment
and operation of one or more centers to carry out the activities specified
in paragraph (2).
`(2) REQUIRED ACTIVITIES- The activities referred to in this paragraph
are the following:
`(A) The conduct of state-of-the-art research for the following
purposes:
`(i) To increase awareness of--
`(I) new uses of drugs, biological products, and
devices;
`(II) ways to improve the effective use of drugs, biological
products, and devices; and
`(III) risks of new uses and risks of combinations of drugs and
biological products.
`(ii) To provide objective clinical information to the following
individuals and entities:
`(I) Health care practitioners and other providers of health care
goods or services.
`(II) Pharmacists, pharmacy benefit managers and
purchasers.
`(III) Health maintenance organizations and other managed health
care organizations.
`(IV) Health care insurers and governmental
agencies.
`(V) Patients and consumers.
`(iii) To improve the quality of health care while reducing the cost
of health care through--
`(I) an increase in the appropriate use of drugs, biological
products, or devices; and
`(II) the prevention of adverse effects of drugs, biological
products, and devices and the consequences of such effects, such as
unnecessary hospitalizations.
`(B) The conduct of research on the comparative effectiveness,
cost-effectiveness, and safety of drugs, biological products, and
devices.
`(C) Such other activities as the Secretary determines to be
appropriate, except that a grant may not be expended to assist the
Secretary in the review of new drugs, biological products, and
devices.
`(c) REDUCING ERRORS IN MEDICINE- The Director shall conduct and support
research and build private-public partnerships to--
`(1) identify the causes of preventable health care errors and patient
injury in health care delivery;
`(2) develop, demonstrate, and evaluate strategies for reducing errors
and improving patient safety; and
`(3) disseminate such effective strategies throughout the health care
industry.
`SEC. 913. INFORMATION ON QUALITY AND COST OF CARE.
`(a) IN GENERAL- The Director shall--
`(1) conduct a survey to collect data on a nationally representative
sample of the population on the cost, use and, for fiscal year 2001 and
subsequent fiscal years, quality of health care, including the types of
health care services Americans use, their access to health care services,
frequency of use, how much is paid for the services used, the source of
those payments, the types and costs of private health insurance, access,
satisfaction, and quality of care for the general population including rural
residents and also for populations identified in section 901(c); and
`(2) develop databases and tools that provide information to States on
the quality, access, and use of health care services provided to their
residents.
`(b) QUALITY AND OUTCOMES INFORMATION-
`(1) IN GENERAL- Beginning in fiscal year 2001, the Director shall
ensure that the survey conducted under subsection (a)(1) will--
`(A) identify determinants of health outcomes and functional status,
including the health care needs of populations identified in section
901(c), provide data to study the relationships between health care
quality, outcomes, access, use, and cost, measure changes over time, and
monitor the overall national impact of Federal and State policy changes on
health care;
`(B) provide information on the quality of care and patient outcomes
for frequently occurring clinical conditions for a nationally
representative sample of the population including rural residents;
and
`(C) provide reliable national estimates for children and persons with
special health care needs through the use of supplements or periodic
expansions of the survey.
In expanding the Medical Expenditure Panel Survey, as in existence on
the date of the enactment of this title in fiscal year 2001 to collect
information on the quality of care, the Director shall take into account any
outcomes measurements generally collected by private sector accreditation
organizations.
`(2) ANNUAL REPORT- Beginning in fiscal year 2003, the Secretary, acting
through the Director, shall submit to Congress an annual report on national
trends in the quality of health care provided to the American people.
`SEC. 914. INFORMATION SYSTEMS FOR HEALTH CARE IMPROVEMENT.
`(a) IN GENERAL- In order to foster a range of innovative approaches to
the management and communication of health information, the Agency shall
conduct and support research, evaluations, and initiatives to advance--
`(1) the use of information systems for the study of health care quality
and outcomes, including the generation of both individual provider and
plan-level comparative performance data;
`(2) training for health care practitioners and researchers in the use
of information systems;
`(3) the creation of effective linkages between various sources of
health information, including the development of information networks;
`(4) the delivery and coordination of evidence-based health care
services, including the use of real-time health care decision-support
programs;
`(5) the utility and comparability of health information data and
medical vocabularies by addressing issues related to the content, structure,
definitions and coding of such information and data in consultation with
appropriate Federal, State and private entities;
`(6) the use of computer-based health records in all settings for the
development of personal health records for individual health assessment and
maintenance, and for monitoring public health and outcomes of care within
populations; and
`(7) the protection of individually identifiable information in health
services research and health care quality improvement.
`(b) DEMONSTRATION- The Agency shall support demonstrations into the use
of new information tools aimed at improving shared decision-making between
patients and their care-givers.
`(c) FACILITATING PUBLIC ACCESS TO INFORMATION- The Director shall work
with appropriate public and private sector entities to facilitate public
access to information regarding the quality of and consumer satisfaction with
health care.
`SEC. 915. RESEARCH SUPPORTING PRIMARY CARE AND ACCESS IN UNDERSERVED AREAS.
`(a) PREVENTIVE SERVICES TASK FORCE-
`(1) ESTABLISHMENT AND PURPOSE- The Director may periodically convene a
Preventive Services Task Force to be composed of individuals with
appropriate expertise. Such a task force shall review the scientific
evidence related to the effectiveness, appropriateness, and
cost-effectiveness of clinical preventive services for the purpose of
developing recommendations for the health care community, and updating
previous clinical preventive recommendations.
`(2) ROLE OF AGENCY- The Agency shall provide ongoing administrative,
research, and technical support for the operations of the Preventive
Services Task Force, including coordinating and supporting the dissemination
of the recommendations of the Task Force.
`(3) OPERATION- In carrying out its responsibilities under paragraph
(1), the Task Force is not subject to the provisions of Appendix 2 of title
5, United States Code.
`(b) PRIMARY CARE RESEARCH-
`(1) IN GENERAL- There is established within the Agency a Center for
Primary Care Research (referred to in this subsection as the `Center') that
shall serve as the principal source of funding for primary care practice
research in the Department of Health and Human Services. For purposes of
this paragraph, primary care research focuses on the first contact when
illness or health concerns arise, the diagnosis, treatment or referral to
specialty care, preventive care, and the relationship between the clinician
and the patient in the context of the family and community.
`(2) RESEARCH- In carrying out this section, the Center shall conduct
and support research concerning--
`(A) the nature and characteristics of primary care practice;
`(B) the management of commonly occurring clinical problems;
`(C) the management of undifferentiated clinical problems;
and
`(D) the continuity and coordination of health services.
`SEC. 916. HEALTH CARE PRACTICE AND TECHNOLOGY INNOVATION.
`(a) IN GENERAL- The Director shall promote innovation in evidence-based
health care practices and technologies by--
`(1) conducting and supporting research on the development, diffusion,
and use of health care technology;
`(2) developing, evaluating, and disseminating methodologies for
assessments of health care practices and technologies;
`(3) conducting intramural and supporting extramural assessments of
existing and new health care practices and technologies;
`(4) promoting education and training and providing technical assistance
in the use of health care practice and technology assessment methodologies
and results; and
`(5) working with the National Library of Medicine and the public and
private sector to develop an electronic clearinghouse of currently available
assessments and those in progress.
`(b) SPECIFICATION OF PROCESS-
`(1) IN GENERAL- Not later than December 31, 2000, the Director shall
develop and publish a description of the methods used by the Agency and its
contractors for health care practice and technology assessment.
`(2) CONSULTATIONS- In carrying out this subsection, the Director shall
cooperate and consult with the Assistant Secretary for Health, the
Administrator of the Health Care Financing Administration, the Director of
the National Institutes of Health, the Commissioner of Food and Drugs, and
the heads of any other interested Federal department or agency, and shall
seek input, where appropriate, from professional societies and other private
and public entities.
`(3) METHODOLOGY- The Director shall, in developing the methods used
under paragraph (1), consider--
`(A) safety, efficacy, and effectiveness;
`(B) legal, social, and ethical implications;
`(C) costs, benefits, and cost-effectiveness;
`(D) comparisons to alternate health care practices and technologies;
and
`(E) requirements of Food and Drug Administration approval to avoid
duplication.
`(c) SPECIFIC ASSESSMENTS-
`(1) IN GENERAL- The Director shall conduct or support specific
assessments of health care technologies and practices.
`(2) REQUESTS FOR ASSESSMENTS- The Director is authorized to conduct or
support assessments, on a reimbursable basis, for the Health Care Financing
Administration, the Department of Defense, the Department of Veterans
Affairs, the Office of Personnel Management, and other public or private
entities.
`(3) GRANTS AND CONTRACTS- In addition to conducting assessments, the
Director may make grants to, or enter into cooperative agreements or
contracts with, entities described in paragraph (4) for the purpose of
conducting assessments of experimental, emerging, existing, or potentially
outmoded health care technologies, and for related activities.
`(4) ELIGIBLE ENTITIES- An entity described in this paragraph is an
entity that is determined to be appropriate by the Director, including
academic medical centers, research institutions and organizations,
professional organizations, third party payers, governmental agencies,
minority institutions of higher education (such as Historically Black
Colleges and Universities, and Hispanic institutions), and consortia of
appropriate research entities established for the purpose of conducting
technology assessments.
`(d) MEDICAL EXAMINATION OF CERTAIN VICTIMS-
`(1) IN GENERAL- The Director shall develop and disseminate a report on
evidence-based clinical practices for--
`(A) the examination and treatment by health professionals of
individuals who are victims of sexual assault (including child
molestation) or attempted sexual assault; and
`(B) the training of health professionals, in consultation with the
Health Resources and Services Administration, on performing medical
evidentiary examinations of individuals who are victims of child abuse or
neglect, sexual assault, elder abuse, or domestic violence.
`(2) CERTAIN CONSIDERATIONS- In identifying the issues to be addressed
by the report, the Director shall, to the extent practicable, take into
consideration the expertise and experience of Federal and State law
enforcement officials regarding the victims referred to in paragraph (1),
and of other appropriate public and private entities (including medical
societies, victim services organizations, sexual assault prevention
organizations, and social services organizations).
`SEC. 917. COORDINATION OF FEDERAL GOVERNMENT QUALITY IMPROVEMENT EFFORTS.
`(1) IN GENERAL- To avoid duplication and ensure that Federal resources
are used efficiently and effectively, the Secretary, acting through the
Director, shall coordinate all research, evaluations, and demonstrations
related to health services research, quality measurement and quality
improvement activities undertaken and supported by the Federal
Government.
`(2) SPECIFIC ACTIVITIES- The Director, in collaboration with the
appropriate Federal officials representing all concerned executive agencies
and departments, shall develop and manage a process to--
`(A) improve interagency coordination, priority setting, and the use
and sharing of research findings and data pertaining to Federal quality
improvement programs, technology assessment, and health services
research;
`(B) strengthen the research information infrastructure, including
databases, pertaining to Federal health services research and health care
quality improvement initiatives;
`(C) set specific goals for participating agencies and departments to
further health services research and health care quality improvement;
and
`(D) strengthen the management of Federal health care quality
improvement programs.
`(b) STUDY BY THE INSTITUTE OF MEDICINE-
`(1) IN GENERAL- To provide Congress, the Department of Health and Human
Services, and other relevant departments with an independent, external
review of their quality oversight, quality improvement and quality research
programs, the Secretary shall enter into a contract with the Institute of
Medicine--
`(A) to describe and evaluate current quality improvement, quality
research and quality monitoring processes through--
`(i) an overview of pertinent health services research activities
and quality improvement efforts conducted by all Federal programs, with
particular attention paid to those under titles XVIII, XIX, and XXI of
the Social Security Act; and
`(ii) a summary of the partnerships that the Department of Health
and Human Services has pursued with private accreditation, quality
measurement and improvement organizations; and
`(B) to identify options and make recommendations to improve the
efficiency and effectiveness of quality improvement programs
through--
`(i) the improved coordination of activities across the medicare,
medicaid and child health insurance programs under titles XVIII, XIX and
XXI of the Social Security Act and health services research
programs;
`(ii) the strengthening of patient choice and participation by
incorporating state-of-the-art quality monitoring tools and making
information on quality available; and
`(iii) the enhancement of the most effective programs, consolidation
as appropriate, and elimination of duplicative activities within various
Federal agencies.
`(A) IN GENERAL- The Secretary shall enter into a contract with the
Institute of Medicine for the preparation--
`(i) not later than 12 months after the date of the enactment of
this title, of a report providing an overview of the quality improvement
programs of the Department of Health and Human Services for the
medicare, medicaid, and CHIP programs under titles XVIII, XIX, and XXI
of the Social Security Act; and
`(ii) not later than 24 months after the date of the enactment of
this title, of a final report containing recommendations.
`(B) REPORTS- The Secretary shall submit the reports described in
subparagraph (A) to the Committee on Finance and the Committee on Health,
Education, Labor, and Pensions of the Senate and the Committee on Ways and
Means and the Committee on Commerce of the House of
Representatives.
`PART C--GENERAL PROVISIONS
`SEC. 921. ADVISORY COUNCIL FOR HEALTHCARE RESEARCH AND QUALITY.
`(a) ESTABLISHMENT- There is established an advisory council to be known
as the National Advisory Council for Healthcare Research and Quality.
`(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.
`(1) IN GENERAL- The Advisory Council shall, in accordance with this
subsection, be composed of appointed members and ex officio members. All
members of the Advisory Council shall be voting members other than the
individuals designated under paragraph (3)(B) as ex officio members.
`(2) APPOINTED MEMBERS- The Secretary shall appoint to the Advisory
Council 21 appropriately qualified individuals. At least 17 members of the
Advisory Council shall be representatives of the public who are not officers
or employees of the United States and at least 1 member who shall be a
specialist in the rural aspects of 1 or more of the professions or fields
described in subparagraphs (A) through (G). The Secretary shall ensure that
the appointed members of the Council, as a group, are representative of
professions and entities concerned with, or affected by, activities under
this title and under section 1142 of the Social Security Act. Of such
members--
`(A) three shall be individuals distinguished in the conduct of
research, demonstration projects, and evaluations with respect to health
care;
`(B) three shall be individuals distinguished in the fields of health
care quality research or health care improvement;
`(C) three shall be individuals distinguished in the practice of
medicine of which at least one shall be a primary care
practitioner;
`(D) three shall be individuals distinguished in the other health
professions;
`(E) three shall be individuals either representing the private health
care sector, including health plans, providers, and purchasers or
individuals distinguished as administrators of health care delivery
systems;
`(F) three shall be individuals distinguished in the fields of health
care economics, information systems, law, ethics, business, or public
policy; and
`(G) three shall be individuals representing the interests of patients
and consumers of health care.
`(3) EX OFFICIO MEMBERS- The Secretary shall designate as ex officio
members of the Advisory Council--
`(A) the Assistant Secretary for Health, the Director of the National
Institutes of Health, the Director of the Centers for Disease Control and
Prevention, the Administrator of the Health Care Financing Administration,
the Commissioner of the Food and Drug Administration, the Director of the
Office of Personnel Management, the Assistant Secretary of Defense (Health
Affairs), and the Under Secretary for Health of the Department of Veterans
Affairs; and
`(B) such other Federal officials as the Secretary may consider
appropriate.
`(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-
`(1) APPOINTED MEMBERS- Members of the Advisory Council appointed under
subsection (c)(2) shall receive compensation for each day (including travel
time) engaged in carrying out the duties of the Advisory Council unless
declined by the member. Such compensation may not be in an amount in excess
of the daily equivalent of the annual rate of basic pay prescribed for level
IV of the Executive Schedule under section 5315 of title 5, United States
Code, for each day during which such member is engaged in the performance of
the duties of the Advisory Council.
`(2) EX OFFICIO MEMBERS- Officials designated under subsection (c)(3) as
ex officio members of the Advisory Council may not receive compensation for
service on the Advisory Council in addition to the compensation otherwise
received for duties carried out as officers of the United States.
`(i) STAFF- The Director shall provide to the Advisory Council such staff,
information, and other assistance as may be necessary to carry out the duties
of the Council.
`(j) DURATION- Notwithstanding section 14(a) of the Federal Advisory
Committee Act, the Advisory Council shall continue in existence until
otherwise provided by law.
`SEC. 922. PEER REVIEW WITH RESPECT TO GRANTS AND CONTRACTS.
`(a) REQUIREMENT OF REVIEW-
`(1) IN GENERAL- Appropriate technical and scientific peer review shall
be conducted with respect to each application for a grant, cooperative
agreement, or contract under this title.
`(2) REPORTS TO DIRECTOR- Each peer review group to which an application
is submitted pursuant to paragraph (1) shall report its finding and
recommendations respecting the application to the Director in such form and
in such manner as the Director shall require.
`(b) APPROVAL AS PRECONDITION OF AWARDS- The Director may not approve an
application described in subsection (a)(1) unless the application is
recommended for approval by a peer review group established under subsection
(c).
`(c) ESTABLISHMENT OF PEER REVIEW GROUPS-
`(1) IN GENERAL- The Director shall establish such technical and
scientific peer review groups as may be necessary to carry out this section.
Such groups shall be established without regard to the provisions of title
5, United States Code, that govern appointments in the competitive service,
and without regard to the provisions of chapter 51, and subchapter III of
chapter 53, of such title that relate to classification and pay rates under
the General Schedule.
`(2) MEMBERSHIP- The members of any peer review group established under
this section shall be appointed from among individuals who by virtue of
their training or experience are eminently qualified to carry out the duties
of such peer review group. Officers and employees of the United States may
not constitute more than 25 percent of the membership of any such group.
Such officers and employees may not receive compensation for service on such
groups in addition to the compensation otherwise received for these duties
carried out as such officers and employees.
`(3) DURATION- Notwithstanding section 14(a) of the Federal Advisory
Committee Act, peer review groups established under this section may
continue in existence until otherwise provided by law.
`(4) QUALIFICATIONS- Members of any peer review group shall, at a
minimum, meet the following requirements:
`(A) Such members shall agree in writing to treat information
received, pursuant to their work for the group, as confidential
information, except that this subparagraph shall not apply to public
records and public information.
`(B) Such members shall agree in writing to recuse themselves from
participation in the peer review of specific applications which present a
potential personal conflict of interest or appearance of such conflict,
including employment in a directly affected organization, stock ownership,
or any financial or other arrangement that might introduce bias in the
process of peer review.
`(d) AUTHORITY FOR PROCEDURAL ADJUSTMENTS IN CERTAIN CASES- In the case of
applications for financial assistance whose direct costs will not exceed
$100,000, the Director may make appropriate adjustments in the procedures
otherwise established by the Director for the conduct of peer review under
this section. Such adjustments may be made for the purpose of encouraging the
entry of individuals into the field of research, for the purpose of
encouraging clinical practice-oriented or provider-based research, and for
such other purposes as the Director may determine to be appropriate.
`(e) REGULATIONS- The Director shall issue regulations for the conduct of
peer review under this section.
`SEC. 923. CERTAIN PROVISIONS WITH RESPECT TO DEVELOPMENT, COLLECTION, AND
DISSEMINATION OF DATA.
`(a) STANDARDS WITH RESPECT TO UTILITY OF DATA-
`(1) IN GENERAL- To ensure the utility, accuracy, and sufficiency of
data collected by or for the Agency for the purpose described in section
901(b), the Director shall establish standard methods for developing and
collecting such data, taking into consideration--
`(A) other Federal health data collection standards; and
`(B) the differences between types of health care plans, delivery
systems, health care providers, and provider arrangements.
`(2) RELATIONSHIP WITH OTHER DEPARTMENT PROGRAMS- In any case where
standards under paragraph (1) may affect the administration of other
programs carried out by the Department of Health and Human Services,
including the programs under title XVIII, XIX or XXI of the Social Security
Act, or may affect health information that is subject to a standard
developed under part C of title XI of the Social Security Act, they shall be
in the form of recommendations to the Secretary for such program.
`(b) STATISTICS AND ANALYSES- The Director shall--
`(1) take appropriate action to ensure that statistics and analyses
developed under this title are of high quality, timely, and duly
comprehensive, and that the statistics are specific, standardized, and
adequately analyzed and indexed; and
`(2) publish, make available, and disseminate such statistics and
analyses on as wide a basis as is practicable.
`(c) AUTHORITY REGARDING CERTAIN REQUESTS- Upon request of a public or
private entity, the Director may conduct or support research or analyses
otherwise authorized by this title pursuant to arrangements under which such
entity will pay the cost of the services provided. Amounts received by the
Director under such arrangements shall be available to the Director for
obligation until expended.
`SEC. 924. DISSEMINATION OF INFORMATION.
`(a) IN GENERAL- The Director shall--
`(1) without regard to section 501 of title 44, United States Code,
promptly publish, make available, and otherwise disseminate, in a form
understandable and on as broad a basis as practicable so as to maximize its
use, the results of research, demonstration projects, and evaluations
conducted or supported under this title;
`(2) ensure that information disseminated by the Agency is science-based
and objective and undertakes consultation as necessary to assess the
appropriateness and usefulness of the presentation of information that is
targeted to specific audiences;
`(3) promptly make available to the public data developed in such
research, demonstration projects, and evaluations;
`(4) provide, in collaboration with the National Library of Medicine
where appropriate, indexing, abstracting, translating, publishing, and other
services leading to a more effective and timely dissemination of information
on research, demonstration projects, and evaluations with respect to health
care to public and private entities and individuals engaged in the
improvement of health care delivery and the general public, and undertake
programs to develop new or improved methods for making such information
available; and
`(5) as appropriate, provide technical assistance to State and local
government and health agencies and conduct liaison activities to such
agencies to foster dissemination.
`(b) PROHIBITION AGAINST RESTRICTIONS- Except as provided in subsection
(c), the Director may not restrict the publication or dissemination of data
from, or the results of, projects conducted or supported under this title.
`(c) LIMITATION ON USE OF CERTAIN INFORMATION- No information, if an
establishment or person supplying the information or described in it is
identifiable, obtained in the course of activities undertaken or supported
under this title may be used for any purpose other than the purpose for which
it was supplied unless such establishment or person has consented (as
determined under regulations of the Director) to its use for such other
purpose. Such information may not be published or released in other form if
the person who supplied the information or who is described in it is
identifiable unless such person has consented (as determined under regulations
of the Director) to its publication or release in other form.
`(d) PENALTY- Any person who violates subsection (c) shall be subject to a
civil monetary penalty of not more than $10,000 for each such violation
involved. Such penalty shall be imposed and collected in the same manner as
civil money penalties under subsection (a) of section 1128A of the Social
Security Act are imposed and collected.
`SEC. 925. ADDITIONAL PROVISIONS WITH RESPECT TO GRANTS AND CONTRACTS.
`(a) FINANCIAL CONFLICTS OF INTEREST- With respect to projects for which
awards of grants, cooperative agreements, or contracts are authorized to be
made under this title, the Director shall by regulation define--
`(1) the specific circumstances that constitute financial interests in
such projects that will, or may be reasonably expected to, create a bias in
favor of obtaining results in the projects that are consistent with such
interests; and
`(2) the actions that will be taken by the Director in response to any
such interests identified by the Director.
`(b) REQUIREMENT OF APPLICATION- The Director may not, with respect to any
program under this title authorizing the provision of grants, cooperative
agreements, or contracts, provide any such financial assistance unless an
application for the assistance is submitted to the Secretary and the
application is in such form, is made in such manner, and contains such
agreements, assurances, and information as the Director determines to be
necessary to carry out the program involved.
`(c) PROVISION OF SUPPLIES AND SERVICES IN LIEU OF FUNDS-
`(1) IN GENERAL- Upon the request of an entity receiving a grant,
cooperative agreement, or contract under this title, the Secretary may,
subject to paragraph (2), provide supplies, equipment, and services for the
purpose of aiding the entity in carrying out the project involved and, for
such purpose, may detail to the entity any officer or employee of the
Department of Health and Human Services.
`(2) CORRESPONDING REDUCTION IN FUNDS- With respect to a request
described in paragraph (1), the Secretary shall reduce the amount of the
financial assistance involved by an amount equal to the costs of detailing
personnel and the fair market value of any supplies, equipment, or services
provided by the Director. The Secretary shall, for the payment of expenses
incurred in complying with such request, expend the amounts withheld.
`(d) APPLICABILITY OF CERTAIN PROVISIONS WITH RESPECT TO CONTRACTS-
Contracts may be entered into under this part without regard to sections 3648
and 3709 of the Revised Statutes (31 U.S.C. 529 and 41 U.S.C. 5).
`SEC. 926. CERTAIN ADMINISTRATIVE AUTHORITIES.
`(a) DEPUTY DIRECTOR AND OTHER OFFICERS AND EMPLOYEES-
`(1) DEPUTY DIRECTOR- The Director may appoint a deputy director for the
Agency.
`(2) OTHER OFFICERS AND EMPLOYEES- The Director may appoint and fix the
compensation of such officers and employees as may be necessary to carry out
this title. Except as otherwise provided by law, such officers and employees
shall be appointed in accordance with the civil service laws and their
compensation fixed in accordance with title 5, United States Code.
`(b) FACILITIES- The Secretary, in carrying out this title--
`(1) may acquire, without regard to the Act of March 3, 1877 (40 U.S.C.
34), by lease or otherwise through the Administrator of General Services,
buildings or portions of buildings in the District of Columbia or
communities located adjacent to the District of Columbia for use for a
period not to exceed 10 years; and
`(2) may acquire, construct, improve, repair, operate, and maintain
laboratory, research, and other necessary facilities and equipment, and such
other real or personal property (including patents) as the Secretary deems
necessary.
`(c) PROVISION OF FINANCIAL ASSISTANCE- The Director, in carrying out this
title, may make grants to public and nonprofit entities and individuals, and
may enter into cooperative agreements or contracts with public and private
entities and individuals.
`(d) UTILIZATION OF CERTAIN PERSONNEL AND RESOURCES-
`(1) DEPARTMENT OF HEALTH AND HUMAN SERVICES- The Director, in carrying
out this title, may utilize personnel and equipment, facilities, and other
physical resources of the Department of Health and Human Services, permit
appropriate (as determined by the Secretary) entities and individuals to
utilize the physical resources of such Department, and provide technical
assistance and advice.
`(2) OTHER AGENCIES- The Director, in carrying out this title, may use,
with their consent, the services, equipment, personnel, information, and
facilities of other Federal, State, or local public agencies, or of any
foreign government, with or without reimbursement of such agencies.
`(e) CONSULTANTS- The Secretary, in carrying out this title, may secure,
from time to time and for such periods as the Director deems advisable but in
accordance with section 3109 of title 5, United States Code, the assistance
and advice of consultants from the United States or abroad.
`(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.
`(A) IN GENERAL- Experts and consultants whose services are obtained
under paragraph (1) shall be paid or reimbursed for their expenses
associated with traveling to and from their assignment location in
accordance with sections 5724, 5724a(a), 5724a(c), and 5726(c) of title 5,
United States Code.
`(B) LIMITATION- Expenses specified in subparagraph (A) may not be
allowed in connection with the assignment of an expert or consultant whose
services are obtained under paragraph (1) unless and until the expert
agrees in writing to complete the entire period of assignment, or 1 year,
whichever is shorter, unless separated or reassigned for reasons that are
beyond the control of the expert or consultant and that are acceptable to
the Secretary. If the expert or consultant violates the agreement, the
money spent by the United States for the expenses specified in
subparagraph (A) is recoverable from the expert or consultant as a
statutory obligation owed to the United States. The Secretary may waive in
whole or in part a right of recovery under this subparagraph.
`(g) VOLUNTARY AND UNCOMPENSATED SERVICES- The Director, in carrying out
this title, may accept voluntary and uncompensated services.
`SEC. 927. FUNDING.
`(a) INTENT- To ensure that the United States investment in biomedical
research is rapidly translated into improvements in the quality of patient
care, there must be a corresponding investment in research on the most
effective clinical and organizational strategies for use of these findings in
daily practice. The authorization levels in subsections (b) and (c) provide
for a proportionate increase in health care research as the United States
investment in biomedical research increases.
`(b) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this
title, there are authorized to be appropriated $250,000,000 for fiscal year
2000, and such sums as may be necessary for each of the fiscal years 2001
through 2005.
`(c) EVALUATIONS- In addition to amounts available pursuant to subsection
(b) for carrying out this title, there shall be made available for such
purpose, from the amounts made available pursuant to section 241 (relating to
evaluations), an amount equal to 40 percent of the maximum amount authorized
in such section 241 to be made available for a fiscal year.
`SEC. 928. DEFINITIONS.
`(1) ADVISORY COUNCIL- The term `Advisory Council' means the National
Advisory Council on Healthcare Research and Quality established under
section 921.
`(2) AGENCY- The term `Agency' means the Agency for Healthcare Research
and Quality.
`(3) DIRECTOR- The term `Director' means the Director of the Agency for
Healthcare Research and Quality.'.
(b) RULES OF CONSTRUCTION-
(1) IN GENERAL- Section 901(a) of the Public Health Service Act (as
added by subsection (a) of this section) applies as a redesignation of the
agency that carried out title IX of such Act on the day before the date of
the enactment of this Act, and not as the termination of such agency and the
establishment of a different agency. The amendment made by subsection (a) of
this section does not affect appointments of the personnel of such agency
who were employed at the agency on the day before such date, including the
appointments of members of advisory councils or study sections of the agency
who were serving on the day before such date of enactment.
(2) REFERENCES- Any reference in law to the Agency for Health Care
Policy and Research is deemed to be a reference to the Agency for Healthcare
Research and Quality, and any reference in law to the Administrator for
Health Care Policy and Research is deemed to be a reference to the Director
of the Agency for Healthcare Research and Quality.
SEC. 3. GRANTS REGARDING UTILIZATION OF PREVENTIVE HEALTH
SERVICES.
Subpart I of part D of title III of the Public Health Service Act (42
U.S.C. 254b et seq.) is amended by adding at the end the following section:
`SEC. 330D. CENTERS FOR STRATEGIES ON FACILITATING UTILIZATION OF
PREVENTIVE HEALTH SERVICES AMONG VARIOUS POPULATIONS.
`(a) IN GENERAL- The Secretary, acting through the appropriate agencies of
the Public Health Service, shall make grants to public or nonprofit private
entities for the establishment and operation of regional centers whose purpose
is to develop, evaluate, and disseminate effective strategies, which utilize
quality management measures, to assist public and private health care programs
and providers in the appropriate utilization of preventive health care
services by specific populations.
`(b) RESEARCH AND TRAINING- The activities carried out by a center under
subsection (a) may include establishing programs of research and training with
respect to the purpose described in such subsection, including the development
of curricula for training individuals in implementing the strategies developed
under such subsection.
`(c) PRIORITY REGARDING INFANTS AND CHILDREN- In carrying out the purpose
described in subsection (a), the Secretary shall give priority to various
populations of infants, young children, and their mothers.
`(d) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this
section, there are authorized to be appropriated such sums as may be necessary
for each of the fiscal years 2000 through 2004.'.
SEC. 4. PROGRAM OF PAYMENTS TO CHILDREN'S HOSPITALS THAT OPERATE
GRADUATE MEDICAL EDUCATION PROGRAMS.
Part D of title III of the Public Health Service Act (42 U.S.C. 254b et
seq.) is amended by adding at the end the following subpart:
`Subpart IX--Support of Graduate Medical Education Programs in Children's
Hospitals
`SEC. 340E. PROGRAM OF PAYMENTS TO CHILDREN'S HOSPITALS THAT OPERATE
GRADUATE MEDICAL EDUCATION PROGRAMS.
`(a) PAYMENTS- The Secretary shall make two payments under this section to
each children's hospital for each of fiscal years 2000 and 2001, one for the
direct expenses and the other for indirect expenses associated with operating
approved graduate medical residency training programs.
`(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.
`(A) IN GENERAL- The total of the payments made to children's
hospitals under paragraph (1)(A) or paragraph (1)(B) in a fiscal year
shall not exceed the funds appropriated under paragraph (1) or (2),
respectively, of subsection (f) for such payments for that fiscal
year.
`(B) PRO RATA REDUCTIONS OF PAYMENTS FOR DIRECT EXPENSES- If the
Secretary determines that the amount of funds appropriated under
subsection (f)(1) for a fiscal year is insufficient to provide the total
amount of payments otherwise due for such periods under paragraph (1)(A),
the Secretary shall reduce the amounts so payable on a pro rata basis to
reflect such shortfall.
`(c) AMOUNT OF PAYMENT FOR DIRECT GRADUATE MEDICAL EDUCATION-
`(1) IN GENERAL- The amount determined under this subsection for
payments to a children's hospital for direct graduate expenses relating to
approved graduate medical residency training programs for a fiscal year is
equal to the product of--
`(A) the updated per resident amount for direct graduate medical
education, as determined under paragraph (2); and
`(B) the average number of full-time equivalent residents in the
hospital's graduate approved medical residency training programs (as
determined under section 1886(h)(4) of the Social Security Act during the
fiscal year.
`(2) UPDATED PER RESIDENT AMOUNT FOR DIRECT GRADUATE MEDICAL EDUCATION-
The updated per resident amount for direct graduate medical education for a
hospital for a fiscal year is an amount determined as follows:
`(A) DETERMINATION OF HOSPITAL SINGLE PER RESIDENT AMOUNT- The
Secretary shall compute for each hospital operating an approved graduate
medical education program (regardless of whether or not it is a children's
hospital) a single per resident amount equal to the average (weighted by
number of full-time equivalent residents) of the primary care per resident
amount and the non-primary care per resident amount computed under section
1886(h)(2) of the Social Security Act for cost reporting periods ending
during fiscal year 1997.
`(B) DETERMINATION OF WAGE AND NON-WAGE-RELATED PROPORTION OF THE
SINGLE PER RESIDENT AMOUNT- The Secretary shall estimate the average
proportion of the single per resident amounts computed under subparagraph
(A) that is attributable to wages and wage-related costs.
`(C) STANDARDIZING PER RESIDENT AMOUNTS- The Secretary shall establish
a standardized per resident amount for each such hospital--
`(i) by dividing the single per resident amount computed under
subparagraph (A) into a wage-related portion and a non-wage-related
portion by applying the proportion determined under subparagraph
(B);
`(ii) by dividing the wage-related portion by the factor applied
under section 1886(d)(3)(E) of the Social Security Act for discharges
occurring during fiscal year 1999 for the hospital's area;
and
`(iii) by adding the non-wage-related portion to the amount computed
under clause (ii).
`(D) DETERMINATION OF NATIONAL AVERAGE- The Secretary shall compute a
national average per resident amount equal to the average of the
standardized per resident amounts computed under subparagraph (C) for such
hospitals, with the amount for each hospital weighted by the average
number of full-time equivalent residents at such hospital.
`(E) APPLICATION TO INDIVIDUAL HOSPITALS- The Secretary shall compute
for each such hospital that is a children's hospital a per resident
amount--
`(i) by dividing the national average per resident amount computed
under subparagraph (D) into a wage-related portion and a
non-wage-related portion by applying the proportion determined under
subparagraph (B);
`(ii) by multiplying the wage-related portion by the factor
described in subparagraph (C)(ii) for the hospital's area;
and
`(iii) by adding the non-wage-related portion to the amount computed
under clause (ii).
`(F) UPDATING RATE- The Secretary shall update such per resident
amount for each such children's hospital by the estimated percentage
increase in the consumer price index for all urban consumers during the
period beginning October 1997 and ending with the midpoint of the
hospital's cost reporting period that begins during fiscal year
2000.
`(d) AMOUNT OF PAYMENT FOR INDIRECT MEDICAL EDUCATION-
`(1) IN GENERAL- The amount determined under this subsection for
payments to a children's hospital for indirect expenses associated with the
treatment of more severely ill patients and the additional costs related to
the teaching of residents for a fiscal year is equal to an amount determined
appropriate by the Secretary.
`(2) FACTORS- In determining the amount under paragraph (1), the
Secretary shall--
`(A) take into account variations in case mix among children's
hospitals and the number of full-time equivalent residents in the
hospitals' approved graduate medical residency training programs;
and
`(B) assure that the aggregate of the payments for indirect expenses
associated with the treatment of more severely ill patients and the
additional costs related to the teaching of residents under this section
in a fiscal year are equal to the amount appropriated for such expenses
for the fiscal year involved under subsection (f)(2).
`(1) INTERIM PAYMENTS- The Secretary shall determine, before the
beginning of each fiscal year involved for which payments may be made for a
hospital under this section, the amounts of the payments for direct graduate
medical education and indirect medical education for such fiscal year and
shall (subject to paragraph (2)) make the payments of such amounts in 26
equal interim installments during such period.
`(2) WITHHOLDING- The Secretary shall withhold up to 25 percent from
each interim installment for direct graduate medical education paid under
paragraph (1).
`(3) RECONCILIATION- At the end of each fiscal year for which payments
may be made under this section, the hospital shall submit to the Secretary
such information as the Secretary determines to be necessary to determine
the percent (if any) of the total amount withheld under paragraph (2) that
is due under this section for the hospital for the fiscal year. Based on
such determination, the Secretary shall recoup any overpayments made, or pay
any balance due. The amount so determined shall be considered a final
intermediary determination for purposes of applying section 1878 of the
Social Security Act and shall be subject to review under that section in the
same manner as the amount of payment under section 1886(d) of such Act is
subject to review under such section.
`(f) AUTHORIZATION OF APPROPRIATIONS-
`(1) DIRECT GRADUATE MEDICAL EDUCATION-
`(A) IN GENERAL- There are hereby authorized to be appropriated, out
of any money in the Treasury not otherwise appropriated, for payments
under subsection (b)(1)(A)--
`(i) for fiscal year 2000, $90,000,000; and
`(ii) for fiscal year 2001, $95,000,000.
`(B) CARRYOVER OF EXCESS- The amounts appropriated under subparagraph
(A) for fiscal year 2000 shall remain available for obligation through the
end of fiscal year 2001.
`(2) INDIRECT MEDICAL EDUCATION- There are hereby authorized to be
appropriated, out of any money in the Treasury not otherwise appropriated,
for payments under subsection (b)(1)(A)--
`(A) for fiscal year 2000, $190,000,000; and
`(B) for fiscal year 2001, $190,000,000.
`(g) DEFINITIONS- In this section:
`(1) APPROVED GRADUATE MEDICAL RESIDENCY TRAINING PROGRAM- The term
`approved graduate medical residency training program' has the meaning given
the term `approved medical residency training program' in section
1886(h)(5)(A) of the Social Security Act.
`(2) CHILDREN'S HOSPITAL- The term `children's hospital' means a
hospital described in section 1886(d)(1)(B)(iii) of the Social Security
Act.
`(3) DIRECT GRADUATE MEDICAL EDUCATION COSTS- The term `direct graduate
medical education costs' has the meaning given such term in section
1886(h)(5)(C) of the Social Security Act.'.
SEC. 5. STUDY REGARDING SHORTAGES OF LICENSED PHARMACISTS.
(a) IN GENERAL- The Secretary of Health and Human Services (in this
section referred to as the `Secretary'), acting through the appropriate
agencies of the Public Health Service, shall conduct a study to determine
whether and to what extent there is a shortage of licensed pharmacists. In
carrying out the study, the Secretary shall seek the comments of appropriate
public and private entities regarding any such shortage.
(b) REPORT TO CONGRESS- Not later than 1 year after the date of the
enactment of this Act, the Secretary shall complete the study under subsection
(a) and submit to the Congress a report that describes the findings made
through the study and that contains a summary of the comments received by the
Secretary pursuant to such subsection.
SEC. 6. REPORT ON TELEMEDICINE.
Not later than January 10, 2001, the Secretary of Health and Human
Services shall submit to the Congress a report that--
(1) identifies any factors that inhibit the expansion and accessibility
of telemedicine services, including factors relating to telemedicine
networks;
(2) identifies any factors that, in addition to geographical isolation,
should be used to determine which patients need or require access to
telemedicine care;
(3) determines the extent to which--
(A) patients receiving telemedicine service have benefited from the
services, and are satisfied with the treatment received pursuant to the
services; and
(B) the medical outcomes for such patients would have differed if
telemedicine services had not been available to the patients;
(4) determines the extent to which physicians involved with telemedicine
services have been satisfied with the medical aspects of the services;
(5) determines the extent to which primary care physicians are enhancing
their medical knowledge and experience through the interaction with
specialists provided by telemedicine consultations; and
(6) identifies legal and medical issues relating to State licensing of
health professionals that are presented by telemedicine services, and
provides any recommendations of the Secretary for responding to such
issues.
SEC. 7. CERTAIN TECHNOLOGIES AND PRACTICES REGARDING SURVIVAL RATES FOR
CARDIAC ARREST.
The Secretary of Health and Human Services shall, in consultation with the
Administrator of the General Services Administration and other appropriate
public and private entities, develop recommendations regarding the placement
of automatic external defibrillators in Federal buildings as a means of
improving the survival rates of individuals who experience cardiac arrest in
such buildings, including recommendations on training, maintenance, and
medical oversight, and on coordinating with the system for emergency medical
services.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.
END