II 

114TH CONGRESS 

1ST SESSION S. 1151 

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

of the United States Preventive Services Task Force, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

APRIL 30, 2015 

Mr. VITTER introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To amend title IX of the Public Health Service Act to 

revise the operations of the United States Preventive 

Services Task Force, and for other purposes. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘USPSTF Trans5 parency and Accountability Act of 2015’’. 

6 SEC. 2. CHANGES TO UNITED STATES PREVENTIVE SERV7 ICES TASK FORCE. 

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

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

10 amended— 


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

2 ‘‘UNITED STATES PREVENTIVE SERVICES TASK

3 FORCE’’; 

4 (2) by amending paragraph (1) to read as fol5 lows: 

6 ‘‘(1) ESTABLISHMENT AND PURPOSE.—The Di7 rector may establish and periodically convene the 

8 United States Preventive Services Task Force (in 

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

10 Task Force shall review the scientific evidence and 

11 new science related to the effectiveness and appro12 priateness of clinical preventive services for the pur13 pose of developing recommendations for primary 

14 care clinicians and the health care community and 

15 updating previous clinical preventive recommenda16 tions.’’; 

17 (3) by redesignating paragraph (3) as para18 graph (5) and paragraphs (4) through (7) as para19 graphs (9) through (12), respectively; 

20 (4) by inserting after paragraph (2) the fol21 lowing new paragraphs: 

22 ‘‘(3) COMPOSITION.— 

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

24 be composed of individuals that collectively have 

25 appropriate scientific expertise, including in 


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1 fields of health sciences research, health eco2 nomics, health promotion, disease prevention, 

3 and clinical care. The Task Force shall include 

4 balanced representation of practicing primary 

5 and specialty care providers, patient and health 

6 care consumers, and relevant stakeholders from 

7 the medical products manufacturing commu8 nity. 

9 ‘‘(B) NOTICE.—Before appointing mem10 bers to the Task Force, the Director shall give 

11 persons an opportunity to nominate potential 

12 members. The Director shall provide for the 

13 publication in the Federal Register of a request 

14 for comments on such members and shall pro15 vide a mechanism for persons to submit such 

16 comments through the official Internet website 

17 of the Agency. The Director shall consider any 

18 comments submitted in selecting the members 

19 of the Task Force. 

20 ‘‘(4) REVIEW AND CONSULTATION.— 

21 ‘‘(A) RESEARCH PLANS.— 

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

23 reviews under paragraph (1), the Task 

24 Force, with the concurrence of the Direc25 tor, shall publish one or more proposed reVerDate Sep 11 2014 23:35 May 08, 2015 Jkt 049200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1151.IS S1151

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1 search plans (in this subsection referred to 

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

3 Force’s systematic review of the evidence. 

4 Each such plan shall include an analytic 

5 framework, key questions, and a literature 

6 search strategy or research approach, and 

7 shall incorporate the methodological guide8 lines developed under clause (ii). The 

9 Agency shall provide for the publication in 

10 the Federal Register of a request for pub11 lic comments on each plan and shall accept 

12 comments during a period of at least 60 

13 days. Any final research plan shall be 

14 made available to the public and include a 

15 discussion of the comments received and 

16 responses to such comments. The Task 

17 Force, with the concurrence of the Direc18 tor, may change such a research plan 

19 through the same process as applied to the 

20 initial adoption of such plan. 

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

22 design and regularly update guidelines for 

23 proper methodological standards for incor24 poration into such research plans. Such 

25 guidelines shall include measures for apVerDate Sep 11 2014 23:35 May 08, 2015 Jkt 049200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1151.IS S1151

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1 propriate validity, for risk adjustment, for 

2 timeliness, for input from relevant experts 

3 and peers in the respective communities, 

4 for accounting for all relevant subpopula5 tions (including disparities by race, eth6 nicity, socioeconomic status, and geo7 graphic location), and for other health out8 come measurements. 

9 ‘‘(iii) CONSULTATION ON RESEARCH

10 PLANS.—The Director shall facilitate co11 ordination and interaction with other agen12 cies and departments in the creation of re13 search plans (taking into consideration re14 search and findings by other agencies and 

15 departments) and methodological stand16 ards under clause (ii), including with the 

17 National Institutes of Health, the National 

18 Cancer Institute, the National Institute on 

19 Minority Health and Health Disparities, 

20 the Centers for Disease Control and Pre21 vention, the Department of Defense, the 

22 Department of Veterans Affairs, the Cen23 ters for Medicare & Medicaid Services, and 

24 the Patient-Centered Outcomes Research 

25 Institute. 


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

2 shall make publicly available each draft evi3 dence report and publish in the Federal Reg4 ister a request for public comments on such re5 ports. No such evidence report shall be pub6 lished prior to it being reviewed by a panel of 

7 external subject matter experts that includes 

8 provider and patient representatives. Each such 

9 report shall include a description of the panel 

10 that conducted such review. Such description 

11 shall include information on each panel mem12 ber, including name, academic degree (or de13 grees), affiliations, and related expertise. 

14 ‘‘(C) RECOMMENDATION STATEMENTS.— 

15 ‘‘(i) PUBLICATION OF DRAFT REC16 OMMENDATIONS.—The Director shall make 

17 publicly available each draft recommenda18 tion and shall provide for the publication 

19 in the Federal Register of a request for 

20 comments and accept comments during a 

21 period of not less than 60 days. 

22 ‘‘(ii) CONSULTATION ON DRAFT REC23 OMMENDATIONS.—Before voting on a draft 

24 recommendation statement, the Task 

25 Force shall consult with relevant stakeVerDate Sep 11 2014 23:35 May 08, 2015 Jkt 049200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1151.IS S1151

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1 holders, including provider groups, prac2 ticing specialists that treat the specific dis3 ease under review, and relevant patient 

4 and disease advocacy organizations. 

5 ‘‘(iii) PUBLIC AVAILABILITY OF COM6 MENTS AND INCLUSION OF DESCRIPTION

7 OF COMMENTS IN FINAL STATEMENT.— 

8 The Director shall make such comments 

9 received publicly available. Any final rec10 ommendation statement shall include a de11 scription of comments received on the draft 

12 recommendation statement and rec13 ommendations of other Federal agencies or 

14 organizations relating to the topic of the 

15 statement. 

16 ‘‘(iv) CONSIDERATION.—In publishing 

17 recommendation statements, the Task 

18 Force shall consider the impact of its rec19 ommendations on the health care commu20 nity, whether a preventive service is bene21 ficial for some individuals and the need to 

22 encourage a discussion of benefits and 

23 risks for those individuals, and how its spe24 cific assignment of a grade to a product or 

25 service may affect coverage and access to 


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1 such product or service under Federal pro2 grams and private health insurance cov3 erage. 

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

5 recommendation statements, the Task Force 

6 shall grade products and services consistent 

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

8 ‘‘(i) GRADE A.—The Task Force con9 cludes that the current evidence is suffi10 cient to assess the balance of benefits and 

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

12 basis of such evidence, recommends the 

13 product or service and determines that 

14 there is high certainty that the net benefit 

15 from the product or service is substantial. 

16 ‘‘(ii) GRADE B.—The Task Force con17 cludes that the current evidence is suffi18 cient to assess the balance of benefits and 

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

20 basis of such evidence, recommends the 

21 product or service and determines that 

22 there is high certainty that the net benefit 

23 of the product or service is moderate or 

24 there is moderate certainty that the net 


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1 benefit of the product or service is mod2 erate to substantial. 

3 ‘‘(iii) GRADE C.—The Task Force 

4 concludes that the current evidence is suf5 ficient to assess the balance of benefits and 

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

7 basis of such evidence, does not make a 

8 recommendation of the product or service 

9 and clinicians may provide this product or 

10 service to selected patients depending on 

11 individual circumstances. However, for 

12 most individuals without signs or symp13 toms there is likely to be only a small ben14 efit from this product or service. 

15 ‘‘(iv) GRADE D.—The Task Force 

16 concludes that the current evidence is suf17 ficient to assess the balance of benefits and 

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

19 basis of such evidence, recommends 

20 against the product or service and deter21 mines that there is moderate or high cer22 tainty that the product or service has no 

23 net benefit or that the harm of the product 

24 or service outweighs the benefits. Rec25 ommendations against a preventive service 


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1 shall be issued only in concurrence with 

2 the Secretary after consultation with other 

3 Federal health agencies and relevant pa4 tient and provider groups. 

5 ‘‘(v) GRADE I.—The Task Force con6 cludes that the current evidence is not suf7 ficient to assess the balance of benefits and 

8 risks of the product or service. 

9 ‘‘(E) CHANGES IN GRADING SYSTEM.— 

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

11 provide, by regulation, for changes in the 

12 grading system described in subparagraph 

13 (D). 

14 ‘‘(ii) IMPACT OF CHANGES.—If the 

15 Director makes a change in the grading 

16 system under clause (i) for a particular 

17 grade, the Task Force shall review and re18 grade the services previously classified 

19 within that grade. Such review and regrade 

20 may be done through an expedited process 

21 but any such change in grade shall not 

22 take effect before such review process is 

23 completed.’’; 

24 (5) in paragraph (5), as redesignated by para25 graph (3)— 


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1 (A) by striking ‘‘dissemination of the rec2 ommendations of the Task Force’’ and inserting 

3 ‘‘dissemination of the recommendation state4 ments of the Task Force’’; and 

5 (B) by striking ‘‘Guide’s recommenda6 tions’’ and inserting ‘‘recommendations of the 

7 Task Force’’; 

8 (6) by inserting after paragraph (5), as so re9 designated, the following new paragraphs: 

10 ‘‘(6) PREVENTIVE SERVICES ADVISORY

11 BOARD.— 

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

13 convene a preventive services advisory board (in 

14 this subsection referred to as the ‘board’) com15 posed of representatives of appropriate public 

16 and private entities with an interest in clinical 

17 preventive services to advise the Task Force on 

18 developing, updating, publishing, and dissemi19 nating evidence-based recommendations on the 

20 use of clinical preventive services. 

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

22 board shall include representatives of the fol23 lowing: 

24 ‘‘(i) Patient groups. 


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1 ‘‘(ii) Providers of clinical services, in2 cluding community-based providers and 

3 specialty physicians. 

4 ‘‘(iii) Federal departments and agen5 cies, including— 

6 ‘‘(I) appropriate health agencies 

7 and offices in the Department, includ8 ing the National Institutes of Health, 

9 the National Cancer Institute, the Na10 tional Institute on Minority Health 

11 and Health Disparities, the Centers 

12 for Disease Control and Prevention, 

13 the Administration on Aging, the 

14 Health Resources and Services Ad15 ministration, the Centers for Medicare 

16 & Medicaid Services, the Office of the 

17 Surgeon General of the Public Health 

18 Service, the Department of Defense, 

19 the Department of Veterans Affairs, 

20 the Patient-Centered Outcomes Re21 search Institute, the Office of Minor22 ity Health, and the Office on Wom23 en’s Health; and 

24 ‘‘(II) as appropriate, other Fed25 eral departments and agencies the 


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1 programs of which have a significant 

2 impact upon health. 

3 ‘‘(iv) Private health care payors. 

4 ‘‘(C) RESPONSIBILITIES.—The board 

5 shall— 

6 ‘‘(i) recommend clinical preventive 

7 services for review by the Task Force; 

8 ‘‘(ii) suggest scientific evidence for 

9 consideration by the Task Force related to 

10 reviews undertaken by the Task Force; 

11 ‘‘(iii) provide feedback regarding the 

12 research plan, the evidence report, and 

13 draft recommendations by the Task Force; 

14 and 

15 ‘‘(iv) assist with efforts regarding dis16 semination of recommendations by the Di17 rector of the Agency for Healthcare Re18 search and Quality. 

19 ‘‘(7) DISCLOSURE AND CONFLICTS OF INTER20 EST.—Members of the Task Force or the board shall 

21 not be considered employees of the Federal Govern22 ment by reason of service on the Task Force or the 

23 board, except members of the Task Force or the 

24 board shall be considered to be special Government 

25 employees within the meaning of section 107 of the 


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

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

3 the purposes of disclosure and management of con4 flicts of interest under those sections. 

5 ‘‘(8) NO PAY; RECEIPT OF TRAVEL EX6 PENSES.—Members of the Task Force or the board 

7 shall not receive any pay for service on the Task 

8 Force or board, but may receive travel expenses, in9 cluding a per diem, in accordance with applicable 

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

11 United States Code.’’; and 

12 (7) by amending paragraph (10), as redesig13 nated by paragraph (3), to read as follows: 

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

15 shall conduct its activities in compliance with the 

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

17 (b) EFFECTIVE DATE; TRANSITION.— 

18 (1) IN GENERAL.—Except as otherwise pro19 vided, the amendments made by subsection (a) shall 

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

21 The United States Preventive Services Task Force 

22 shall not publish any draft or final recommendations 

23 on or after such date except in accordance with such 

24 amendments. 


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1 (2) RECONSTITUTION OF TASK FORCE.—Not 

2 later than 180 days after the date of the enactment 

3 of this Act, the Director of the Agency for 

4 Healthcare Research and Quality shall take steps to 

5 reconstitute the membership of the Task Force con6 sistent with section 915(a)(3) of the Public Health 

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

8 (3) PREVIOUSLY PUBLISHED RECOMMENDA9 TIONS.—With respect to recommendations or guide10 lines published by such Task Force before the date 

11 of the enactment of this Act, under procedures es12 tablished by the Director of the Agency for 

13 Healthcare Research and Quality, the reconstituted 

14 Task Force shall undertake a review process con15 sistent with the following: 

16 (A) Interested parties may request the 

17 Task Force to review such previous rec18 ommendations or guidelines. 

19 (B) Based upon such requests, the Task 

20 Force shall establish a process for the review of 

21 previous recommendations or guidelines. 

22 (C) Such process shall include public no23 tice through the Federal Register and oppor24 tunity for comment and a determination to conVerDate Sep 11 2014 23:35 May 08, 2015 Jkt 049200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\S1151.IS S1151

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1 firm or modify such recommendations or guide2 lines. 

3 (D) The process shall, to the extent fea4 sible, be consistent with the procedures applied 

5 under the amendments made by subsection (a) 

6 for the promulgation of new recommendations. 

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

8 1 year after the date of enactment of this Act, the Comp9 troller General of the United States shall submit to Con10 gress a report that contains the following: 

11 (1) A listing of the recommendations of the 

12 United States Preventive Services Task Force as of 

13 such date, including the date final recommendations 

14 and any subsequent updates were posted or pub15 lished. 

16 (2) A comparison of such recommendations and 

17 relevant recommendations of other Federal health 

18 agencies, including the Centers for Disease Control 

19 and Prevention, the Centers for Medicare & Med20 icaid Services, the Department of Defense, the De21 partment of Veterans Affairs, and the Patient-Cen22 tered Outcomes Research Institute, as well as rel23 evant recommendations from national medical pro24 fessional societies and relevant patient and disease 

25 advocacy organizations. 


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1 (3) An analysis of the impact of the rec2 ommendations of the Task Force on public and pri3 vate insurance coverage, access, and outcomes, in4 cluding impact on morbidity and mortality. 

5 (d) ELIMINATION OF SECRETARIAL DISCRETION TO

6 REMOVE CERTAIN PREVENTIVE SERVICES UNDER THE

7 MEDICARE PROGRAM.—Section 1834(n) of the Social Se8 curity Act (42 U.S.C. 1395m(n)) is amended— 

9 (1) by striking paragraph (2); 

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

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

12 (3) by redesignating subparagraphs (A) and 

13 (B) of paragraph (1) as paragraphs (1) and (2), re14 spectively, and moving their margins 2 ems to the 

15 left; and 

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

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

Æ 


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