resentative of the interests of manufacturers of
medical technology); and
‘‘(C) have adequately diversified back-
grounds so that the advisory committee will
provide balanced advice and recommendations;
‘‘(4) exclude from membership on each advisory
committee individuals who are in the full time em-
ploy of the United States and engaged in the admin-
istration of the program established under this title;
‘‘(5) limit the number of members of each advi-
sory committee who are otherwise in the full-time
employ of the United States to not more than 10
percent of the total membership of the advisory com-
mittee;
‘‘(6) impose appropriate term limits for mem-
bers of each advisory committee;
‘‘(7) designate one of the members of each
panel to serve as the chair thereof and appoint an
executive subcommittee comprised of the chairs of
each panel to advise the Secretary regarding—
‘‘(A) establishing priorities; and
‘‘(B) referring issues to appropriate panels;
‘‘(8) permit each panel to independently advise
the Secretary with regard to matters referred to the
panel, without the need to obtain the concurrence
of the full advisory committee;
‘‘(9) provide for appropriate consultation with
outside experts by each advisory committee and its
panels;
‘‘(10) provide for—
‘‘(A) full public participation, to the extent
required or permitted under law, in any meet-
ing of each advisory committee or its panels;
‘‘(B) at least 60 days’ advance notice on
the Internet site of the Department of Health
and Human Services of any such meeting, in-
cluding a statement of the issues to be consid-
ered by the advisory committee or panel, a de-
scription of the specific information that is rel-
evant to such issues, and the text of any pro-
posals the Secretary will ask the advisory com-
mittee or panel to consider;
‘‘(C) consideration by each advisory com-
mittee or panel of relevant information or testi-
mony that is submitted by the public; and
‘‘(D) public access in a central repository
to the information described in subparagraph
(C) at least 20 days before the meeting;
‘‘(11) furnish each advisory committee and its
panels with adequate clerical and other necessary as-
sistance;
‘‘(12) provide for the compensation of members
of each advisory committee and its panels (other
than those in the full time employ of the United
States)—
‘‘(A) while attending meetings or otherwise
engaged in official business at rates to be fixed
by the Secretary, but not at rates exceeding the
daily equivalent of the rate in effect for level IV
of the Executive Schedule for each day so en-
gaged, including travel time; and
‘‘(B) while serving away from their homes
or regular places of business, of travel expenses
(including per diem in lieu of subsistence) as
authorized by section 5703 of Title 5, United
States Code, for persons in the Government
service employed intermittently;
‘‘(13) provide for the panels to meet at least
once every 3 months unless there is no business to
conduct;
‘‘(14) require each advisory committee and its
panels to provide, with any recommendation, a sum-
mary of the reasons for the recommendation and a
summary of the data upon which the recommenda-
tion is based;
‘‘(15) make a verbatim transcript of each advi-
sory committee and panel proceedings (other than
those portions that are closed to the public in ac-
cordance with law) available to the public within 14
days on an official Internet site of the Department
of Health and Human Services; and
‘‘(16) prescribe in regulations the procedures to
be followed by each advisory committee and its pan-
els in making their reviews and recommendations.
‘‘(e) DEFINITIONS.—For purposes of this section—
‘‘(1) the term ‘coding’ means the assignment of
identification codes for medical equipment and sup-
plies, items, services, and other benefits under this
title; and
‘‘(2) the term ‘payment’ means the determina-
tion of appropriate payment amounts for medical
equipment and supplies, items, services, and other
benefits under this title.’’.
(b) TRANSITION, CONTINUING RESPONSIBILITY FOR
UNFINISHED DUTIES.—
(1) Effective on the date the Medicare Access
to Technology Advisory Committee is established,
the Secretary of Health and Human Services shall
provide for the transfer to such committee of any as-
sets and staff of the Medicare Coverage Advisory
Committee and the Medicare Payment and Coding
Advisory Committee, without any loss of benefits or
seniority by virtue of such transfers. Fund balances
available to the Medicare Coverage Advisory Com-
mittee or the Medicare Payment and Coding Advi-
sory Committee for any period shall be available to
the Medicare Access to Technology Advisory Com-
mittee for such period for like purposes.
(2) The Medicare Access to Technology Advi-
sory Committee shall be responsible for the prepara-
tion and submission of reports and recommendations
not yet submitted to the Secretary by the Medicare
Coverage Advisory Committee or the Medicare Pay-
ment and Coding Advisory Committee upon the expi-
ration of those committees.
(c) REPORTING REQUIREMENTS.—
(1) Not later than April 1, 2000, the Secretary
of Health and Human Services shall submit to Con-
gress a report certifying that the committee and
panels required to be established by section 1897(b),
as added by subsection (a), are operational.
(2) Not later than September 1, 2003, the Sec-
retary of Health and Human Services shall submit
to Congress a report certifying that the committee
and panels required to be established by section
1897(c), as added by subsection (a), are operational.
(3) Not later than December 1 of each year be-
ginning with 2000, the Secretary of Health and
Human Services shall submit to Congress a report
describing the timeliness of the Secretary’s national
coverage policy decision making during the preceding
fiscal year measured by the time frames the Sec-
retary has published for the national coverage policy
determination process, and such report shall include
the actual time periods that were necessary to com-
plete and fully implement national coverage policy
determinations and each significant step in the proc-
ess.
(4) Not later than July 1, 2000, the Secretary
of Health and Human Services shall submit to Con-
gress a report, on the nature of the coverage policy
determination processes used by Medicare+Choice
organizations, under part C of title XVIII of the So-
cial Security Act, including a detailed explanation of
any steps taken to ensure that the coverage policy
determination processes under the Medicare+Choice
program—
(A) produce results consistent with the
coverage policy determinations reached under
parts A and B of such title; and
(B) treat any medical device being inves-
tigated under section 520(g) of the Federal
Food, Drug, and Cosmetic Act (42 U.S.C.
360j(g)), in a manner consistent with the treat-
ment afforded such medical device under such
parts.
SEC. 4. ANNUAL ADJUSTMENTS TO MEDICARE PAYMENT
SYSTEMS FOR CHANGES IN TECHNOLOGY
AND MEDICAL PRACTICE.
(a) IN GENERAL.—Title XVIII of the Social Security
Act (42 U.S.C. 1395 et seq.) is amended by inserting after
section 1888 the following new section:
‘‘ANNUAL
ADJUSTMENTS
TO
MEDICARE
PAYMENT
SYS-
TEMS FOR CHANGES IN TECHNOLOGY AND MEDICAL
PRACTICE
‘‘SEC. 1889. (a) IN GENERAL.—Notwithstanding any
other provision of this title, the Secretary shall adjust the
appropriate elements of the payment systems established
under sections 1833(i)(2)(A), 1833(t), 1848, and 1886(d),
and the payment systems referred to in subsection (f), (in-
cluding relative payment weights, relative value units, and
weighting factors) at least annually to ensure that pay-
ments under such systems—
‘‘(1) appropriately reflect changes in medical
technology and medical practice affecting the items
and services for which payment may be made under
such systems; and
‘‘(2) promote the efficient and effective delivery
of high-quality health care.
‘‘(b) RULES FOR DETERMINING ADJUSTMENTS.—
Except as provided in subsection (c), the provisions of sec-
tion 
1833(i)(2)(A), 
section 
1833(t)(6), 
section
1848(c)(2)(B), and section 1886(d)(4)(C), and the appro-
priate provisions of the payments systems referred to in
subsection (f), shall apply to the annual adjustments re-
quired by this section in the same manner and to the same
extent as they apply to the periodic adjustments of relative
payment weights, relative value units, and weighting fac-
tors, respectively, that are authorized or required by such
sections.
‘‘(c) USE OF INTERNAL DATA COLLECTED BY THE
SECRETARY.—
‘‘(1) IN GENERAL.—In determining the adjust-
ments required by this subsection, the Secretary
may not—
‘‘(A) decline to make an adjustment that is
based on data collected by the Secretary in the
administration of the program established
under this title if the data reflect a representa-
tive sample of cases that is statistically valid;
and
‘‘(B) establish a uniform period of time
(such as one year) from which such data must
be drawn.
‘‘(2) DEADLINE
FOR
SUPPLYING
INTERNAL
DATA.—The Secretary shall establish a reasonable
deadline for the submission of data collected by the
Secretary to be used in making the adjustments re-
quired by this section. In no event may the deadline
established under this paragraph be more than 7
months before the first day of the provider payment
update period for which the adjustment or adjust-
ments to which the data relates would be effective.
‘‘(d) USE OF EXTERNAL DATA.—
‘‘(1) IN GENERAL.—Subject to paragraph (2),
in determining the adjustments required by this sec-
tion, the Secretary shall utilize data other than data
collected by the Secretary in the administration of
the program established under this title if—
‘‘(A) data collected by the Secretary in the
administration of such program are not avail-
able at the time such adjustments are being de-
termined; and
‘‘(B) such other data are reliable and
verifiable.
‘‘(2) EXTERNAL DATA FACILITATING THE USE
OF
INTERNAL
DATA.—In determining the adjust-
ments required by this section, the Secretary may
not—
‘‘(A) decline to use data other than data
collected by the Secretary if such other data—
‘‘(i) enable the Secretary to identify or
refine data collected by the Secretary for
use in making such an adjustment; and
‘‘(ii) are based on a representative
sample of cases that is statistically valid;
or
‘‘(B) establish a uniform period of time
(such as one year) from which such data must
be drawn.
‘‘(3) ALTERNATIVE SOURCES OF DATA.—In de-
termining the adjustments required by this section,
the Secretary shall use data, that otherwise meets
the requirements of this subsection, collected by (or
on behalf of)—
‘‘(A) private payers;
‘‘(B) manufacturers of medical tech-
nologies;
‘‘(C) suppliers;
‘‘(D) groups representing physicians and
other health care professionals;
‘‘(E) groups representing providers;
‘‘(F) clinical trials; and
‘‘(G) such other sources as the Secretary
determines to be appropriate.
‘‘(4) CLARIFICATION.—Nothing in this title
shall be construed as—
‘‘(A) requiring the Secretary to identify all
claims submitted under a payment system es-
tablished under section 1833(i)(2)(A), section
1833(t), section 1848, or section 1886(d), or
under the payment systems referred to in sub-
section (f), involving the use of a medical tech-
nology before the Secretary may make the ad-
justments under this section (or under section
1833(i)(2)(A), section 1833(t), section 1848, or
section 1886(d), or under the appropriate sec-
tions with respect to the payment systems re-
ferred to in subsection (f)) with respect to such
technology; or
‘‘(B) authorizing the Secretary to defer ac-
tion on such an adjustment until all such claims
are identifiable.
‘‘(5) DEADLINE
FOR
SUPPLYING
EXTERNAL
DATA.—The Secretary shall establish a reasonable
deadline for the submission of data other than data
collected by the Secretary to be used in making the
adjustments required by this section. In no event
may the deadline established under this paragraph
be more than 9 months before the first day of the
provider payment update period for which the ad-
justment or adjustments to which the data relates
would be effective.
‘‘(e) TIMING OF ADJUSTMENTS.—
‘‘(1) IN
GENERAL.—The annual adjustments
required by this section shall—
‘‘(A) apply to provider payment update pe-
riods beginning on or after October 1, 2000;
and
‘‘(B) be described in the proposed and
final rules published by the Secretary with re-
spect to changes to a payment system estab-
lished under section 1833(i)(2)(A), 1833(t),
1848, or 1886(d), or a payment system referred
to in subsection (f), for the provider payment
update period to which they relate, together
with a description of the data on which such
adjustments are based.