I 

113TH CONGRESS 

1ST SESSION H. R. 2143 

To amend title IX of the Public Health Service Act to revise the operations 

of the United States Preventive Services Task Force. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 23, 2013 

Mrs. BLACKBURN (for herself, Mr. BARROW of Georgia, Mr. TERRY, and Mrs. 

CHRISTENSEN) introduced the following bill; which was referred to the 

Committee on Energy and Commerce, and in addition to the Committee 

on Ways and Means, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

A BILL 

To amend title IX of the Public Health Service Act to 

revise the operations of the United States Preventive 

Services Task Force. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘USPSTF Trans5 parency and Accountability Act of 2013’’. 


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1 SEC. 2. CHANGES TO UNITED STATES PREVENTIVE SERV2 ICES TASK FORCE. 

3 (a) IN GENERAL.—Subsection (a) of section 915 of 

4 the Public Health Service Act (42 U.S.C. 299b–4) is 

5 amended— 

6 (1) by amending the heading to read as follows: 

7 ‘‘UNITED STATES PREVENTIVE SERVICES TASK

8 FORCE’’; 

9 (2) by amending paragraph (1) to read as fol10 lows: 

11 ‘‘(1) ESTABLISHMENT AND PURPOSE.—The Di12 rector may establish and periodically convene the 

13 United States Preventive Services Task Force (in 

14 this section referred to as the ‘Task Force’). The 

15 Task Force shall review the scientific evidence and 

16 new science related to the effectiveness and appro17 priateness of clinical preventive services for the pur18 pose of developing recommendations for primary 

19 care clinicians and the health care community and 

20 updating previous clinical preventive recommenda21 tions.’’; 

22 (3) by redesignating paragraph (3) as para23 graph (5) and paragraphs (4) through (7) as para24 graphs (9) through (12), respectively; 

25 (4) by inserting after paragraph (2) the fol26 lowing new paragraphs: 


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1 ‘‘(3) COMPOSITION.— 

2 ‘‘(A) IN GENERAL.—The Task Force shall 

3 be composed of individuals that collectively have 

4 appropriate scientific expertise, including in 

5 fields of health sciences research, health eco6 nomics, health promotion, disease prevention, 

7 and clinical care. The Task Force shall include 

8 balanced representation of practicing primary 

9 and specialty care providers, patient and health 

10 care consumers, and relevant stakeholders from 

11 the medical products manufacturing commu12 nity. 

13 ‘‘(B) NOTICE.—Before appointing mem14 bers to the Task Force, the Director shall give 

15 persons an opportunity to nominate potential 

16 members. The Director shall provide for the 

17 publication in the Federal Register of a request 

18 for comments on such members and shall pro19 vide a mechanism for persons to submit such 

20 comments through the official website of the 

21 Agency. The Director shall consider any com22 ments submitted in selecting the members of 

23 the Task Force. 

24 ‘‘(4) REVIEW AND CONSULTATION.— 

25 ‘‘(A) RESEARCH PLANS.— 


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1 ‘‘(i) IN GENERAL.—In conducting its 

2 reviews under paragraph (1), the Task 

3 Force, with the concurrence of the Direc4 tor, shall publish one or more proposed re5 search plans (in this subsection referred to 

6 as a ‘research plan’) to guide the Task 

7 Force’s systematic review of the evidence. 

8 Each such plan shall include an analytic 

9 framework, key questions, and a literature 

10 search strategy or research approach, and 

11 shall incorporate the methodological guide12 lines developed under clause (ii). The 

13 Agency shall provide for the publication in 

14 the Federal Register of a request for pub15 lic comments on each plan and shall accept 

16 comments during a period of at least 60 

17 days. Any final research plan shall be 

18 made available to the public and include a 

19 discussion of the comments received and 

20 responses to such comments. The Task 

21 Force, with the concurrence of the Direc22 tor, may change such a research plan 

23 through the same process as applied to the 

24 initial adoption of such plan. 


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1 ‘‘(ii) CRITERIA.—The Director shall 

2 design and regularly update guidelines for 

3 proper methodological standards for incor4 poration into such research plans. Such 

5 guidelines shall include measures for ap6 propriate validity, for risk adjustment, for 

7 timeliness, for input from relevant experts 

8 and peers in the respective communities, 

9 for accounting for all relevant subpopula10 tions (including disparities by race, eth11 nicity, socioeconomic status, and geo12 graphic location), and for other health out13 come measurements. 

14 ‘‘(iii) CONSULTATION ON RESEARCH

15 PLANS.—The Director shall facilitate co16 ordination and interaction with other agen17 cies and departments in the creation of re18 search plans (taking into consideration re19 search and findings by other agencies and 

20 departments) and methodological stand21 ards under clause (ii), including with the 

22 National Institutes of Health, the National 

23 Cancer Institute, the National Institute on 

24 Minority Health and Health Disparities, 

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1 vention, the Department of Defense, the 

2 Department of Veterans Affairs, the Cen3 ters for Medicare & Medicaid Services, and 

4 the Patient-Centered Outcomes Research 

5 Institute. 

6 ‘‘(B) EVIDENCE REPORTS.—The Director 

7 shall make publicly available each draft evi8 dence report and publish in the Federal Reg9 ister a request for public comments on such re10 ports. No such evidence report shall be pub11 lished prior to it being reviewed by a panel of 

12 external subject matter experts that includes 

13 provider and patient representatives. Each such 

14 report shall include a description of the panel 

15 that conducted such review. Such description 

16 shall include information on each panel mem17 ber, including name, academic degree (or de18 grees), affiliations, and related expertise. 

19 ‘‘(C) RECOMMENDATION STATEMENTS.— 

20 ‘‘(i) PUBLICATION OF DRAFT REC21 OMMENDATIONS.—The Director shall make 

22 publicly available each draft recommenda23 tion and shall provide for the publication 

24 in the Federal Register of a request for 


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1 comments and accept comments during a 

2 period of not less than 60 days. 

3 ‘‘(ii) CONSULTATION ON DRAFT REC4 OMMENDATIONS.—Before voting on a draft 

5 recommendation statement, the Task 

6 Force shall consult with relevant stake7 holders, including provider groups, prac8 ticing specialists that treat the specific dis9 ease under review, and relevant patient 

10 and disease advocacy organizations. 

11 ‘‘(iii) PUBLIC AVAILABILITY OF COM12 MENTS AND INCLUSION OF DESCRIPTION

13 OF COMMENTS IN FINAL STATEMENT.— 

14 The Director shall make such comments 

15 received publicly available. Any final rec16 ommendation statement shall include a de17 scription of comments received on the draft 

18 recommendation statement and rec19 ommendations of other Federal agencies or 

20 organizations relating to the topic of the 

21 statement. 

22 ‘‘(iv) CONSIDERATION.—In publishing 

23 recommendation statements, the Task 

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1 nity, whether a preventive service is bene2 ficial for some individuals and the need to 

3 encourage a discussion of benefits and 

4 risks for those individuals, and how its spe5 cific assignment of a grade to a product or 

6 service may affect coverage and access to 

7 such product or service under Federal pro8 grams and private health insurance cov9 erage. 

10 ‘‘(D) GRADING SYSTEM.—In publishing 

11 recommendation statements, the Task Force 

12 shall grade products and services consistent 

13 with the following, subject to subparagraph (E): 

14 ‘‘(i) GRADE A.—The Task Force con15 cludes that the current evidence is suffi16 cient to assess the balance of benefits and 

17 risks of the product or service, and, on the 

18 basis of such evidence, recommends the 

19 product or service and determines that 

20 there is high certainty that the net benefit 

21 from the product or service is substantial. 

22 ‘‘(ii) GRADE B.—The Task Force con23 cludes that the current evidence is suffi24 cient to assess the balance of benefits and 

25 risks of the product or service, and, on the 


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1 basis of such evidence, recommends the 

2 product or service and determines that 

3 there is high certainty that the net benefit 

4 of the product or service is moderate or 

5 there is moderate certainty that the net 

6 benefit of the product or service is mod7 erate to substantial. 

8 ‘‘(iii) GRADE C.—The Task Force 

9 concludes that the current evidence is suf10 ficient to assess the balance of benefits and 

11 risks of the product or service, and, on the 

12 basis of such evidence, does not make a 

13 recommendation of the product or service 

14 and clinicians may provide this product or 

15 service to selected patients depending on 

16 individual circumstances. However, for 

17 most individuals without signs or symp18 toms there is likely to be only a small ben19 efit from this product or service. 

20 ‘‘(iv) GRADE D.—The Task Force 

21 concludes that the current evidence is suf22 ficient to assess the balance of benefits and 

23 risks of the product or service, and, on the 

24 basis of such evidence, recommends 

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1 mines that there is moderate or high cer2 tainty that the product or service has no 

3 net benefit or that the harm of the product 

4 or service outweighs the benefits. Rec5 ommendations against a preventive service 

6 shall only be issued in concurrence with 

7 the Secretary after consultation with other 

8 Federal health agencies and relevant pa9 tient and provider groups. 

10 ‘‘(v) GRADE I.—The Task Force con11 cludes that the current evidence is not suf12 ficient to assess the balance of benefits and 

13 risks of the product or service. 

14 ‘‘(E) CHANGES IN GRADING SYSTEM.— 

15 ‘‘(i) IN GENERAL.—The Director may 

16 provide, by regulation, for changes in the 

17 grading system described in subparagraph 

18 (D). 

19 ‘‘(ii) IMPACT OF CHANGES.—If the 

20 Director makes a change in the grading 

21 system under clause (i) for a particular 

22 grade, the Task Force shall review and re23 grade the services previously classified 

24 within that grade. Such review and regrade 

25 may be done through an expedited process 


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1 but any such change in grade shall not 

2 take effect before such review process is 

3 completed.’’; 

4 (5) in paragraph (5), as redesignated by para5 graph (3)— 

6 (A) by striking ‘‘dissemination of the rec7 ommendations of the Task Force’’ and inserting 

8 ‘‘dissemination of its recommendation state9 ments’’; and 

10 (B) by striking ‘‘Guide’s recommenda11 tions’’ and inserting ‘‘recommendations of the 

12 Task Force’’; 

13 (6) by inserting after paragraph (5), as so re14 designated, the following new paragraphs: 

15 ‘‘(6) PREVENTIVE SERVICES ADVISORY

16 BOARD.— 

17 ‘‘(A) IN GENERAL.—The Task Force shall 

18 convene a preventive services advisory board (in 

19 this subsection referred to as the ‘board’) com20 posed of representatives of appropriate public 

21 and private entities with an interest in clinical 

22 preventive services to advise the Task Force on 

23 developing, updating, publishing, and dissemi24 nating evidence-based recommendations on the 

25 use of clinical preventive services. 


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1 ‘‘(B) MEMBERSHIP.—The members of the 

2 board shall include representatives of the fol3 lowing: 

4 ‘‘(i) Patient groups. 

5 ‘‘(ii) Providers of clinical services, in6 cluding community-based providers and 

7 specialty physicians. 

8 ‘‘(iii) Federal departments and agen9 cies, including— 

10 ‘‘(I) appropriate health agencies 

11 and offices in the Department, includ12 ing the National Institutes of Health, 

13 the National Cancer Institute, the Na14 tional Institute on Minority Health 

15 and Health Disparities, the Centers 

16 for Disease Control and Prevention, 

17 the Administration on Aging, the 

18 Health Resources and Services Ad19 ministration, the Centers for Medicare 

20 & Medicaid Services, the Office of the 

21 Surgeon General of the Public Health 

22 Service, the Department of Defense, 

23 the Department of Veterans Affairs, 

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1 ity Health, and the Office on Wom2 en’s Health; and 

3 ‘‘(II) as appropriate, other Fed4 eral departments and agencies the 

5 programs of which have a significant 

6 impact upon health. 

7 ‘‘(iv) Private health care payors. 

8 ‘‘(C) RESPONSIBILITIES.—In accordance 

9 with subsection (b)(5), the board shall— 

10 ‘‘(i) recommend clinical preventive 

11 services for review by the Task Force; 

12 ‘‘(ii) suggest scientific evidence for 

13 consideration by the Task Force related to 

14 reviews undertaken by the Task Force; 

15 ‘‘(iii) provide feedback regarding the 

16 research plan, the evidence report, and 

17 draft recommendations by the Task Force; 

18 and 

19 ‘‘(iv) assist with efforts regarding dis20 semination of recommendations by the Di21 rector of the Agency for Healthcare Re22 search and Quality. 

23 ‘‘(7) DISCLOSURE AND CONFLICTS OF INTER24 EST.—Members of the Task Force or the board shall 

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1 ment by reason of service on the Task Force or the 

2 board, except members of the Task Force or the 

3 board shall be considered to be special Government 

4 employees within the meaning of section 107 of the 

5 Ethics in Government Act of 1978 (5 U.S.C. App.) 

6 and section 208 of title 18, United States Code, for 

7 the purposes of disclosure and management of con8 flicts of interest under those sections. 

9 ‘‘(8) NO PAY; RECEIPT OF TRAVEL EX10 PENSES.—Members of the Task Force or the board 

11 shall not receive any pay for service on the Task 

12 Force or board, but may receive travel expenses, in13 cluding a per diem, in accordance with applicable 

14 provisions of subchapter I of chapter 57 of title 5, 

15 United States Code.’’; and 

16 (7) by amending paragraph (10), as redesig17 nated by paragraph (3), to read as follows: 

18 ‘‘(10) APPLICATION OF FACA.—The Task Force 

19 shall conduct its activities in compliance with the 

20 Federal Advisory Committee Act (5 U.S.C. App.).’’. 

21 (b) EFFECTIVE DATE; TRANSITION.— 

22 (1) IN GENERAL.—Except as otherwise pro23 vided, the amendments made by subsection (a) shall 

24 take effect on the date of the enactment of this Act. 

25 The United States Preventive Services Task Force 


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1 shall not publish any draft or final recommendations 

2 on or after such date except in accordance with such 

3 amendments. 

4 (2) RECONSTITUTION OF TASK FORCE.—Not 

5 later than 180 days after the date of the enactment 

6 of this Act, the Director of the Agency for 

7 Healthcare Research and Quality shall take steps to 

8 reconstitute the membership of the Task Force con9 sistent with section 915(a)(3) of the Public Health 

10 Service Act, as amended by subsection (a). 

11 (3) PREVIOUSLY PUBLISHED RECOMMENDA12 TIONS.—With respect to recommendations or guide13 lines published by such Task Force before the date 

14 of the enactment of this Act, under procedures es15 tablished by the Director of the Agency for 

16 Healthcare Research and Quality, the reconstituted 

17 Task Force shall undertake a review process con18 sistent with the following: 

19 (A) Interested parties may request the 

20 Task Force to review such previous rec21 ommendations or guidelines. 

22 (B) Based upon such requests, the Task 

23 Force shall establish a process for the review of 

24 previous recommendations or guidelines. 


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1 (C) Such process shall include public no2 tice through the Federal Register and oppor3 tunity for comment and a determination to con4 firm or modify such recommendations or guide5 lines. 

6 (D) The process shall, to the extent fea7 sible, be consistent with the procedures applied 

8 under the amendments made by subsection (a) 

9 for the promulgation of new recommendations. 

10 (c) GAO EVALUATION AND REPORT.—Not later than 

11 1 year after the date of enactment of this Act, the Comp12 troller General of the United States shall submit to Con13 gress a report that contains the following: 

14 (1) A listing of the recommendations of the 

15 United States Preventive Services Task Force as of 

16 the such date, including the date final recommenda17 tions and any subsequent updates were posted or 

18 published. 

19 (2) A comparison of such recommendations and 

20 relevant recommendations of other Federal health 

21 agencies, including the Centers for Disease Control 

22 and Prevention, the Centers for Medicare & Med23 icaid Services, the Department of Defense, the De24 partment of Veterans Affairs, and the Patient-Cen25 tered Outcomes Research Institute, as well as relVerDate Mar 15 2010 23:32 May 30, 2013 Jkt 029200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H2143.IH H2143

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1 evant recommendations from national medical pro2 fessional societies and relevant patient and disease 

3 advocacy organizations. 

4 (3) An analysis of the impact of the rec5 ommendations of the Task Force on public and pri6 vate insurance coverage, access, and outcomes, in7 cluding impact on morbidity and mortality. 

8 (d) ELIMINATION OF SECRETARIAL DISCRETION TO

9 REMOVE CERTAIN PREVENTIVE SERVICES UNDER THE

10 MEDICARE PROGRAM.—Section 1834(n) of the Social Se11 curity Act (42 U.S.C. 1395m(n)), as added by section 

12 4105(a) of Public Law 111–148, is amended— 

13 (1) by striking paragraph (2); 

14 (2) by striking ‘‘; and’’ at the end of paragraph 

15 (1)(B) and inserting a period; 

16 (3) by redesignating subparagraphs (A) and 

17 (B) of paragraph (1) as paragraphs (1) and (2), re18 spectively, and moving their margins 2 ems to the 

19 left; and 

20 (4) by striking ‘‘may’’ and all that follows 

21 through ‘‘modify’’ and inserting ‘‘may modify’’. 

Æ 


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