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;
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‘‘(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 practiceoriented research;

‘‘(5) health care technologies, facilities, and equipment;
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‘‘(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.
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‘‘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 PRO- VIDER-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;
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‘‘(C) the compilation and dissemination of health care

quality measures developed in the private and public sector;

‘‘(D) assistance in the development of improved health

care information systems;

‘‘(E) the development of survey tools for the purpose

of measuring participant and beneficiary assessments of

their health care; and

‘‘(F) identifying and disseminating information on

mechanisms for the integration of information on quality

into purchaser and consumer decision-making processes.

‘‘(b) CENTERS FOR EDUCATION AND RESEARCH ON THERAPEUTICS.—

‘‘(1) IN GENERAL.—The Secretary, acting through the

Director and in consultation with the Commissioner of Food

and Drugs, shall establish a program for the purpose of making

one or more grants for the establishment and operation of

one or more centers to carry out the activities specified in

paragraph (2).

‘‘(2) REQUIRED ACTIVITIES.—The activities referred to in

this paragraph are the following:

‘‘(A) The conduct of state-of-the-art research for the

following purposes:

‘‘(i) To increase awareness of—

‘‘(I) new uses of drugs, biological products, and

devices;

‘‘(II) ways to improve the effective use of drugs,

biological products, and devices; and

‘‘(III) risks of new uses and risks of combinations of drugs and biological products.

‘‘(ii) To provide objective clinical information to

the following individuals and entities:

‘‘(I) Health care practitioners and other providers of health care goods or services.

‘‘(II) Pharmacists, pharmacy benefit managers

and purchasers.

‘‘(III) Health maintenance organizations and

other managed health care organizations.

‘‘(IV) Health care insurers and governmental

agencies.

‘‘(V) Patients and consumers.

‘‘(iii) To improve the quality of health care while

reducing the cost of health care through—

‘‘(I) an increase in the appropriate use of

drugs, biological products, or devices; and

‘‘(II) the prevention of adverse effects of drugs,

biological products, and devices and the consequences of such effects, such as unnecessary hospitalizations.

‘‘(B) The conduct of research on the comparative

effectiveness, cost-effectiveness, and safety of drugs,

biological products, and devices.

‘‘(C) Such other activities as the Secretary determines

to be appropriate, except that a grant may not be expended

to assist the Secretary in the review of new drugs, biological

products, and devices.
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‘‘(c) REDUCING ERRORS IN MEDICINE.—The Director shall conduct and support research and build private-public partnerships

to—

‘‘(1) identify the causes of preventable health care errors

and patient injury in health care delivery;

‘‘(2) develop, demonstrate, and evaluate strategies for

reducing errors and improving patient safety; and

‘‘(3) disseminate such effective strategies throughout the

health care industry.

‘‘SEC. 913. 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—
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‘‘(1) the use of information systems for the study of health

care quality and outcomes, including the generation of both

individual provider and plan-level comparative performance

data;

‘‘(2) training for health care practitioners and researchers

in the use of information systems;

‘‘(3) the creation of effective linkages between various

sources of health information, including the development of

information networks;

‘‘(4) the delivery and coordination of evidence-based health

care services, including the use of real-time health care decision-support programs;

‘‘(5) the utility and comparability of health information

data and medical vocabularies by addressing issues related

to the content, structure, definitions and coding of such information and data in consultation with appropriate Federal, State

and private entities;

‘‘(6) the use of computer-based health records in all settings

for the development of personal health records for individual

health assessment and maintenance, and for monitoring public

health and outcomes of care within populations; and

‘‘(7) the protection of individually identifiable information

in health services research and health care quality improvement.

‘‘(b) DEMONSTRATION.—The Agency shall support demonstrations into the use of new information tools aimed at improving

shared decision-making between patients and their care-givers.

‘‘(c) FACILITATING PUBLIC ACCESS TO INFORMATION.—The

Director shall work with appropriate public and private sector entities to facilitate public access to information regarding the quality

of and consumer satisfaction with health care.

‘‘SEC. 915. 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,
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primary care research focuses on the first contact when illness

or health concerns arise, the diagnosis, treatment or referral

to specialty care, preventive care, and the relationship between

the clinician and the patient in the context of the family and

community.

‘‘(2) RESEARCH.—In carrying out this section, the Center

shall conduct and support research concerning—

‘‘(A) the nature and characteristics of primary care

practice;

‘‘(B) the management of commonly occurring clinical

problems;

‘‘(C) the management of undifferentiated clinical problems; and

‘‘(D) the continuity and coordination of health services.

‘‘SEC. 916. 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.
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‘‘(2) REQUESTS FOR ASSESSMENTS.—The Director is authorized to conduct or support assessments, on a reimbursable

basis, for the Health Care Financing Administration, the

Department of Defense, the Department of Veterans Affairs,

the Office of Personnel Management, and other public or private

entities.

‘‘(3) GRANTS AND CONTRACTS.—In addition to conducting

assessments, the Director may make grants to, or enter into

cooperative agreements or contracts with, entities described

in paragraph (4) for the purpose of conducting assessments

of experimental, emerging, existing, or potentially outmoded

health care technologies, and for related activities.

‘‘(4) ELIGIBLE ENTITIES.—An entity described in this paragraph is an entity that is determined to be appropriate by

the Director, including academic medical centers, research

institutions and organizations, professional organizations, third

party payers, governmental agencies, minority institutions of

higher education (such as Historically Black Colleges and

Universities, and Hispanic institutions), and consortia of appropriate research entities established for the purpose of conducting technology assessments.

‘‘(d) MEDICAL EXAMINATION OF CERTAIN VICTIMS.—

‘‘(1) IN GENERAL.—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—
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‘‘(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
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‘‘(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;
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‘‘(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.—
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‘‘(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
S. 580—14

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.
S. 580—15

‘‘(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.
S. 580—16

‘‘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
S. 580—17

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.
S. 580—18

‘‘(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:
S. 580—19

‘‘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.—
S. 580—20

‘‘(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
S. 580—21

‘‘(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 wagerelated 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.
S. 580—22

‘‘(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.’’.
S. 580—23

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.
S. 580—24

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.