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[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 580 Enrolled Bill (ENR)]

        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--
                ``(i) low-income groups;
                ``(ii) minority groups;
                ``(iii) women;
                ``(iv) children;
                ``(v) the elderly; and
                ``(vi) individuals with special health care needs, 
            including individuals with disabilities and individuals who 
            need chronic care or end-of-life health care.
        ``(2) Process to ensure appropriate research.--The Director 
    shall establish a process to ensure that the requirements of 
    paragraph (1) are reflected in the overall portfolio of research 
    conducted and supported by the Agency.
        ``(3) Office of priority populations.--The Director shall 
    establish an Office of Priority Populations to assist in carrying 
    out the requirements of paragraph (1).

``SEC. 902. GENERAL AUTHORITIES.

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

               ``PART B--HEALTH CARE IMPROVEMENT RESEARCH

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

    ``(a) Evidence Rating Systems.--In collaboration with experts from 
the public and private sector, the Agency shall identify and 
disseminate methods or systems to assess health care research results, 
particularly methods or systems to rate the strength of the scientific 
evidence underlying health care practice, recommendations in the 
research literature, and technology assessments. The Agency shall make 
methods or systems for evidence rating widely available. Agency 
publications containing health care recommendations shall indicate the 
level of substantiating evidence using such methods or systems.
    ``(b) Health Care Improvement Research Centers and Provider-Based 
Research Networks.--
        ``(1) In general.--In order to address the full continuum of 
    care and outcomes research, to link research to practice 
    improvement, and to speed the dissemination of research findings to 
    community practice settings, the Agency shall employ research 
    strategies and mechanisms that will link research directly with 
    clinical practice in geographically diverse locations throughout 
    the United States, including--
            ``(A) health care improvement research centers that combine 
        demonstrated multidisciplinary expertise in outcomes or quality 
        improvement research with linkages to relevant sites of care;
            ``(B) provider-based research networks, including plan, 
        facility, or delivery system sites of care (especially primary 
        care), that can evaluate outcomes and evaluate and promote 
        quality improvement; and
            ``(C) other innovative mechanisms or strategies to link 
        research with clinical practice.
        ``(2) Requirements.--The Director is authorized to establish 
    the requirements for entities applying for grants under this 
    subsection.
``SEC. 912. PRIVATE-PUBLIC PARTNERSHIPS TO IMPROVE ORGANIZATION AND 
DELIVERY.
    ``(a) Support for Efforts To Develop Information on Quality.--
        ``(1) Scientific and technical support.--In its role as the 
    principal agency for health care research and quality, the Agency 
    may provide scientific and technical support for private and public 
    efforts to improve health care quality, including the activities of 
    accrediting organizations.
        ``(2) Role of the agency.--With respect to paragraph (1), the 
    role of the Agency shall include--
            ``(A) the identification and assessment of methods for the 
        evaluation of the health of--
                ``(i) enrollees in health plans by type of plan, 
            provider, and provider arrangements; and
                ``(ii) other populations, including those receiving 
            long-term care services;
            ``(B) the ongoing development, testing, and dissemination 
        of quality measures, including measures of health and 
        functional outcomes;
            ``(C) the compilation and dissemination of health care 
        quality measures developed in the private and public sector;
            ``(D) assistance in the development of improved health care 
        information systems;
            ``(E) the development of survey tools for the purpose of 
        measuring participant and beneficiary assessments of their 
        health care; and
            ``(F) identifying and disseminating information on 
        mechanisms for the integration of information on quality into 
        purchaser and consumer decision-making processes.
    ``(b) Centers for Education and Research on Therapeutics.--
        ``(1) In general.--The Secretary, acting through the Director 
    and in consultation with the Commissioner of Food and Drugs, shall 
    establish a program for the purpose of making one or more grants 
    for the establishment and operation of one or more centers to carry 
    out the activities specified in paragraph (2).
        ``(2) Required activities.--The activities referred to in this 
    paragraph are the following:
            ``(A) The conduct of state-of-the-art research for the 
        following purposes:
                ``(i) To increase awareness of--

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

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

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

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

                      ``PART C--GENERAL PROVISIONS

``SEC. 921. ADVISORY COUNCIL FOR HEALTHCARE RESEARCH AND QUALITY.
    ``(a) Establishment.--There is established an advisory council to 
be known as the National Advisory Council for Healthcare Research and 
Quality.
    ``(b) Duties.--
        ``(1) In general.--The Advisory Council shall advise the 
    Secretary and the Director with respect to activities proposed or 
    undertaken to carry out the mission of the Agency under section 
    901(b).
        ``(2) Certain recommendations.--Activities of the Advisory 
    Council under paragraph (1) shall include making recommendations to 
    the Director regarding--
            ``(A) priorities regarding health care research, especially 
        studies related to quality, outcomes, cost and the utilization 
        of, and access to, health care services;
            ``(B) the field of health care research and related 
        disciplines, especially issues related to training needs, and 
        dissemination of information pertaining to health care quality; 
        and
            ``(C) the appropriate role of the Agency in each of these 
        areas in light of private sector activity and identification of 
        opportunities for public-private sector partnerships.
    ``(c) Membership.--
        ``(1) In general.--The Advisory Council shall, in accordance 
    with this subsection, be composed of appointed members and ex 
    officio members. All members of the Advisory Council shall be 
    voting members other than the individuals designated under 
    paragraph (3)(B) as ex officio members.
        ``(2) Appointed members.--The Secretary shall appoint to the 
    Advisory Council 21 appropriately qualified individuals. At least 
    17 members of the Advisory Council shall be representatives of the 
    public who are not officers or employees of the United States and 
    at least 1 member who shall be a specialist in the rural aspects of 
    1 or more of the professions or fields described in subparagraphs 
    (A) through (G). The Secretary shall ensure that the appointed 
    members of the Council, as a group, are representative of 
    professions and entities concerned with, or affected by, activities 
    under this title and under section 1142 of the Social Security Act. 
    Of such members--
            ``(A) three shall be individuals distinguished in the 
        conduct of research, demonstration projects, and evaluations 
        with respect to health care;
            ``(B) three shall be individuals distinguished in the 
        fields of health care quality research or health care 
        improvement;
            ``(C) three shall be individuals distinguished in the 
        practice of medicine of which at least one shall be a primary 
        care practitioner;
            ``(D) three shall be individuals distinguished in the other 
        health professions;
            ``(E) three shall be individuals either representing the 
        private health care sector, including health plans, providers, 
        and purchasers or individuals distinguished as administrators 
        of health care delivery systems;
            ``(F) three shall be individuals distinguished in the 
        fields of health care economics, information systems, law, 
        ethics, business, or public policy; and
            ``(G) three shall be individuals representing the interests 
        of patients and consumers of health care.
        ``(3) Ex officio members.--The Secretary shall designate as ex 
    officio members of the Advisory Council--
            ``(A) the Assistant Secretary for Health, the Director of 
        the National Institutes of Health, the Director of the Centers 
        for Disease Control and Prevention, the Administrator of the 
        Health Care Financing Administration, the Commissioner of the 
        Food and Drug Administration, the Director of the Office of 
        Personnel Management, the Assistant Secretary of Defense 
        (Health Affairs), and the Under Secretary for Health of the 
        Department of Veterans Affairs; and
            ``(B) such other Federal officials as the Secretary may 
        consider appropriate.
    ``(d) Terms.--
        ``(1) In general.--Members of the Advisory Council appointed 
    under subsection (c)(2) shall serve for a term of 3 years.
        ``(2) Staggered terms.--To ensure the staggered rotation of 
    one-third of the members of the Advisory Council each year, the 
    Secretary is authorized to appoint the initial members of the 
    Advisory Council for terms of 1, 2, or 3 years.
        ``(3) Service beyond term.--A member of the Council appointed 
    under subsection (c)(2) may continue to serve after the expiration 
    of 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.
    ``(f) Experts.--
        ``(1) In general.--The Secretary may, in carrying out this 
    title, obtain the services of not more than 50 experts or 
    consultants who have appropriate scientific or professional 
    qualifications. Such experts or consultants shall be obtained in 
    accordance with section 3109 of title 5, United States Code, except 
    that the limitation in such section on the duration of service 
    shall not apply.
        ``(2) Travel expenses.--
            ``(A) In general.--Experts and consultants whose services 
        are obtained under paragraph (1) shall be paid or reimbursed 
        for their expenses associated with traveling to and from their 
        assignment location in accordance with sections 5724, 5724a(a), 
        5724a(c), and 5726(c) of title 5, United States Code.
            ``(B) Limitation.--Expenses specified in subparagraph (A) 
        may not be allowed in connection with the assignment of an 
        expert or consultant whose services are obtained under 
        paragraph (1) unless and until the expert agrees in writing to 
        complete the entire period of assignment, or 1 year, whichever 
        is shorter, unless separated or reassigned for reasons that are 
        beyond the control of the expert or consultant and that are 
        acceptable to the Secretary. If the expert or consultant 
        violates the agreement, the money spent by the United States 
        for the expenses specified in subparagraph (A) is recoverable 
        from the expert or consultant as a statutory obligation owed to 
        the United States. The Secretary may waive in whole or in part 
        a right of recovery under this subparagraph.
    ``(g) Voluntary and Uncompensated Services.--The Director, in 
carrying out this title, may accept voluntary and uncompensated 
services.

``SEC. 927. FUNDING.

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

``SEC. 928. DEFINITIONS.

    ``In this title:
        ``(1) Advisory council.--The term `Advisory Council' means the 
    National Advisory Council on Healthcare Research and Quality 
    established under section 921.
        ``(2) Agency.--The term `Agency' means the Agency for 
    Healthcare Research and Quality.
        ``(3) Director.--The term `Director' means the Director of the 
    Agency for Healthcare Research and Quality.''.
    (b) Rules of Construction.--
        (1) In general.--Section 901(a) of the Public Health Service 
    Act (as added by subsection (a) of this section) applies as a 
    redesignation of the agency that carried out title IX of such Act 
    on the day before the date of the enactment of this Act, and not as 
    the termination of such agency and the establishment of a different 
    agency. The amendment made by subsection (a) of this section does 
    not affect appointments of the personnel of such agency who were 
    employed at the agency on the day before such date, including the 
    appointments of members of advisory councils or study sections of 
    the agency who were serving on the day before such date of 
    enactment.
        (2) References.--Any reference in law to the Agency for Health 
    Care Policy and Research is deemed to be a reference to the Agency 
    for Healthcare Research and Quality, and any reference in law to 
    the Administrator for Health Care Policy and Research is deemed to 
    be a reference to the Director of the Agency for Healthcare 
    Research and Quality.
SEC. 3. GRANTS REGARDING UTILIZATION OF PREVENTIVE HEALTH SERVICES.
    Subpart I of part D of title III of the Public Health Service Act 
(42 U.S.C. 254b et seq.) is amended by adding at the end the following 
section:
``SEC. 330D. CENTERS FOR STRATEGIES ON FACILITATING UTILIZATION OF 
PREVENTIVE HEALTH SERVICES AMONG VARIOUS POPULATIONS.
    ``(a) In General.--The Secretary, acting through the appropriate 
agencies of the Public Health Service, shall make grants to public or 
nonprofit private entities for the establishment and operation of 
regional centers whose purpose is to develop, evaluate, and disseminate 
effective strategies, which utilize quality management measures, to 
assist public and private health care programs and providers in the 
appropriate utilization of preventive health care services by specific 
populations.
    ``(b) Research and Training.--The activities carried out by a 
center under subsection (a) may include establishing programs of 
research and training with respect to the purpose described in such 
subsection, including the development of curricula for training 
individuals in implementing the strategies developed under such 
subsection.
    ``(c) Priority Regarding Infants and Children.--In carrying out the 
purpose described in subsection (a), the Secretary shall give priority 
to various populations of infants, young children, and their mothers.
    ``(d) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 2000 through 2004.''.
SEC. 4. PROGRAM OF PAYMENTS TO CHILDREN'S HOSPITALS THAT OPERATE 
GRADUATE MEDICAL EDUCATION PROGRAMS.
    Part D of title III of the Public Health Service Act (42 U.S.C. 
254b et seq.) is amended by adding at the end the following subpart:

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

``SEC. 340E. PROGRAM OF PAYMENTS TO CHILDREN'S HOSPITALS THAT OPERATE 
GRADUATE MEDICAL EDUCATION PROGRAMS.
    ``(a) Payments.--The Secretary shall make two payments under this 
section to each children's hospital for each of fiscal years 2000 and 
2001, one for the direct expenses and the other for indirect expenses 
associated with operating approved graduate medical residency training 
programs.
    ``(b) Amount of Payments.--
        ``(1) In general.--Subject to paragraph (2), the amounts 
    payable under this section to a children's hospital for an approved 
    graduate medical residency training program for a fiscal year are 
    each of the following amounts:
            ``(A) Direct expense amount.--The amount determined under 
        subsection (c) for direct expenses associated with operating 
        approved graduate medical residency training programs.
            ``(B) Indirect expense amount.--The amount determined under 
        subsection (d) for indirect expenses associated with the 
        treatment of more severely ill patients and the additional 
        costs relating to teaching residents in such programs.
        ``(2) Capped amount.--
            ``(A) In general.--The total of the payments made to 
        children's hospitals under paragraph (1)(A) or paragraph (1)(B) 
        in a fiscal year shall not exceed the funds appropriated under 
        paragraph (1) or (2), respectively, of subsection (f) for such 
        payments for that fiscal year.
            ``(B) Pro rata reductions of payments for direct 
        expenses.--If the Secretary determines that the amount of funds 
        appropriated under subsection (f)(1) for a fiscal year is 
        insufficient to provide the total amount of payments otherwise 
        due for such periods under paragraph (1)(A), the Secretary 
        shall reduce the amounts so payable on a pro rata basis to 
        reflect such shortfall.
    ``(c) Amount of Payment for Direct Graduate Medical Education.--
        ``(1) In general.--The amount determined under this subsection 
    for payments to a children's hospital for direct graduate expenses 
    relating to approved graduate medical residency training programs 
    for a fiscal year is equal to the product of--
            ``(A) the updated per resident amount for direct graduate 
        medical education, as determined under paragraph (2); and
            ``(B) the average number of full-time equivalent residents 
        in the hospital's graduate approved medical residency training 
        programs (as determined under section 1886(h)(4) of the Social 
        Security Act during the fiscal year.
        ``(2) Updated per resident amount for direct graduate medical 
    education.--The updated per resident amount for direct graduate 
    medical education for a hospital for a fiscal year is an amount 
    determined as follows:
            ``(A) Determination of hospital single per resident 
        amount.--The Secretary shall compute for each hospital 
        operating an approved graduate medical education program 
        (regardless of whether or not it is a children's hospital) a 
        single per resident amount equal to the average (weighted by 
        number of full-time equivalent residents) of the primary care 
        per resident amount and the non-primary care per resident 
        amount computed under section 1886(h)(2) of the Social Security 
        Act for cost reporting periods ending during fiscal year 1997.
            ``(B) Determination of wage and non-wage-related proportion 
        of the single per resident amount.--The Secretary shall 
        estimate the average proportion of the single per resident 
        amounts computed under subparagraph (A) that is attributable to 
        wages and wage-related costs.
            ``(C) Standardizing per resident amounts.--The Secretary 
        shall establish a standardized per resident amount for each 
        such hospital--
                ``(i) by dividing the single per resident amount 
            computed under subparagraph (A) into a wage-related portion 
            and a non-wage-related portion by applying the proportion 
            determined under subparagraph (B);
                ``(ii) by dividing the wage-related portion by the 
            factor applied under section 1886(d)(3)(E) of the Social 
            Security Act for discharges occurring during fiscal year 
            1999 for the hospital's area; and
                ``(iii) by adding the non-wage-related portion to the 
            amount computed under clause (ii).
            ``(D) Determination of national average.--The Secretary 
        shall compute a national average per resident amount equal to 
        the average of the standardized per resident amounts computed 
        under subparagraph (C) for such hospitals, with the amount for 
        each hospital weighted by the average number of full-time 
        equivalent residents at such hospital.
            ``(E) Application to individual hospitals.--The Secretary 
        shall compute for each such hospital that is a children's 
        hospital a per resident amount--
                ``(i) by dividing the national average per resident 
            amount computed under subparagraph (D) into a wage-related 
            portion and a non-wage-related portion by applying the 
            proportion determined under subparagraph (B);
                ``(ii) by multiplying the wage-related portion by the 
            factor described in subparagraph (C)(ii) for the hospital's 
            area; and
                ``(iii) by adding the non-wage-related portion to the 
            amount computed under clause (ii).
            ``(F) Updating rate.--The Secretary shall update such per 
        resident amount for each such children's hospital by the 
        estimated percentage increase in the consumer price index for 
        all urban consumers during the period beginning October 1997 
        and ending with the midpoint of the hospital's cost reporting 
        period that begins during fiscal year 2000.
    ``(d) Amount of Payment for Indirect Medical Education.--
        ``(1) In general.--The amount determined under this subsection 
    for payments to a children's hospital for indirect expenses 
    associated with the treatment of more severely ill patients and the 
    additional costs related to the teaching of residents for a fiscal 
    year is equal to an amount determined appropriate by the Secretary.
        ``(2) Factors.--In determining the amount under paragraph (1), 
    the Secretary shall--
            ``(A) take into account variations in case mix among 
        children's hospitals and the number of full-time equivalent 
        residents in the hospitals' approved graduate medical residency 
        training programs; and
            ``(B) assure that the aggregate of the payments for 
        indirect expenses associated with the treatment of more 
        severely ill patients and the additional costs related to the 
        teaching of residents under this section in a fiscal year are 
        equal to the amount appropriated for such expenses for the 
        fiscal year involved under subsection (f)(2).
    ``(e) Making of Payments.--
        ``(1) Interim payments.--The Secretary shall determine, before 
    the beginning of each fiscal year involved for which payments may 
    be made for a hospital under this section, the amounts of the 
    payments for direct graduate medical education and indirect medical 
    education for such fiscal year and shall (subject to paragraph (2)) 
    make the payments of such amounts in 26 equal interim installments 
    during such period.
        ``(2) Withholding.--The Secretary shall withhold up to 25 
    percent from each interim installment for direct graduate medical 
    education paid under paragraph (1).
        ``(3) Reconciliation.--At the end of each fiscal year for which 
    payments may be made under this section, the hospital shall submit 
    to the Secretary such information as the Secretary determines to be 
    necessary to determine the percent (if any) of the total amount 
    withheld under paragraph (2) that is due under this section for the 
    hospital for the fiscal year. Based on such determination, the 
    Secretary shall recoup any overpayments made, or pay any balance 
    due. The amount so determined shall be considered a final 
    intermediary determination for purposes of applying section 1878 of 
    the Social Security Act and shall be subject to review under that 
    section in the same manner as the amount of payment under section 
    1886(d) of such Act is subject to review under such section.
    ``(f) Authorization of Appropriations.--
        ``(1) Direct graduate medical education.--
            ``(A) In general.--There are hereby authorized to be 
        appropriated, out of any money in the Treasury not otherwise 
        appropriated, for payments under subsection (b)(1)(A)--
                ``(i) for fiscal year 2000, $90,000,000; and
                ``(ii) for fiscal year 2001, $95,000,000.
            ``(B) Carryover of excess.--The amounts appropriated under 
        subparagraph (A) for fiscal year 2000 shall remain available 
        for obligation through the end of fiscal year 2001.
        ``(2) Indirect medical education.--There are hereby authorized 
    to be appropriated, out of any money in the Treasury not otherwise 
    appropriated, for payments under subsection (b)(1)(A)--
            ``(A) for fiscal year 2000, $190,000,000; and
            ``(B) for fiscal year 2001, $190,000,000.
    ``(g) Definitions.--In this section:
        ``(1) Approved graduate medical residency training program.--
    The term `approved graduate medical residency training program' has 
    the meaning given the term `approved medical residency training 
    program' in section 1886(h)(5)(A) of the Social Security Act.
        ``(2) Children's hospital.--The term `children's hospital' 
    means a hospital described in section 1886(d)(1)(B)(iii) of the 
    Social Security Act.
        ``(3) Direct graduate medical education costs.--The term 
    `direct graduate medical 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.
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