Agency for Health Care Policy and Research Reauthorization Act of 1992
PL 102-410 (H.R.5673), enacted 10/13/1992

106 STAT. 2094 
PUBLIC LAW 102-410—OCT. 13, 1992 
Public Law 102-410 
102d Congress 
An Act 
Oct. 13,1992 
[H.R. 5673] 
Agency for 
Health Care 
Policy and 
Research 
Reauthorization 
Act of 1992. 
42 u s e 201 note. 
Establishment. 
To amend the Public Health Service Act to revise and extend the programs of 
the Agency for Health Care 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; AMENDATORY REFERENCES. 
(a) SHORT TITLE.—^This Act may be cited as the "Agency for 
Health Care Policy and Research Reauthorization Act of 1992". 
(b) AMENDATORY REFERENCES.—^Except as otherwise specifically 
provided, whenever in this Act an amendment or repeal is expressed 
m terms of an amendment to, or a repeal of, a section or other 
provision, the reference shall be considered to be made to that 
section or other provision of the PubUc Health Service Act (42 
U.S.C. 201 et seq.). 
SEC. 2. ESTABLISHMENT AND GENERAL AUTHORITIES. 
(a) ESTABLISHMENT.—Section 901(b) (42 U.S.C. 299(b)) is 
amended by inserting after "improvements in clinical practice" the 
following: "(including the prevention of diseases and other health 
conditions)". 
(b) GENERAL AUTHORITIES.—Section 902 (42 U.S.C. 299a) is 
amended— 
(1) by redesignating subsections (c) and (d) as subsections 
(d) and (e), respectively; and 
(2) by inserting aiter subsection (b), the following sub-
section: 
"(c) HEALTH SERVICES TRAINING GRANTS.—The Administrator 
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 
mvestigator awards, and other programs and activities as appro-
priate. . 
SEC. 3. DISSEMINATION. 
Section 903 (42 U.S.C. 299a-l) is amended by adding at the 
end the following subsection: 
"(e) INFORMATION CENTER.— 
"(1) IN GENERAL.—There shall be established at the 
National Libraiy of Medicine an information center on health 
services researcn, and on selected technology assessments and 
cUnical practice guidelines produced by the Agency and other 
public and private sources. 
"(2) IDENTIFICATION SYSTEM.—The Administrator shall 
ensure that information under paragraph (1) concerning clinical 
practice guidelines is collected and maintained electronically 
and in a convenient format. The Administrator, in consultation 
with the Director of the National Library of Medicine, shall 
develop and publish criteria for the inclusion of practice guide-
PUBLIC LAW 102-410—OCT. 13, 1992 
106 STAT. 2095 
lines and technology assessments in the information center 
database. 
"(3) INTERAGENCY AGREEMENT.—^The Administrator shall 
enter into an agreement providing for the implementation of 
paragraph (1) with the Director of the National Library of 
Medicine.". 
SEC. 4. HEALTH CARE TECHNOLOGY ASSESSMENT. 
(a) IN GENERAL.—Section 904 (42 U.S.C. 299a-2) is amended— 
(1) in subsection (a)— 
(A) by striking "and" at the end of paragraph (4); 
(B) by striking the period at the end of paragraph 
(5) and inserting "; and"; and 
(C) by adding at the end the following paragraph: 
"(6) by conducting assessments and reassessments of exist-
ing and new health care technologies."; 
(2) in subsection (b)(2)— 
(A) by striking "cost-effectiveness,"; and 
(B) by adding at the end the following sentence: "In 
carrying out such paragraph, the Administrator shall also 
consider the cost effectiveness of such technologies where 
cost information is available and reliable."; and 
(3) in subsection (c) to read as follows: 
"(c) AGENDA AND PRIORITIES.— 
"(1) ESTABLISHMENT OF PRIORITIES.—In accordance with 
paragraph (2), the Administrator, in consultation with the 
Advisory Council established under section 921, shall establish 
an annual list of technology assessments under consideration 
by the Agency, including those assessments performed at the 
request of the Health Care Financing Administration and the 
Department of Defense and those assessments performed under 
subsections (d) and (f). 
"(2) PUBLIC NOTICE.—^The Administrator, in consultation 
Federal 
with the Advisory Council, shall publish the list established 
^^sister, 
in paragraph (1) annually in the Federal Register."; 
publication. 
(4) in subsection (d), to read as follows: 
"(d) CONDUCT OF ASSESSMENTS.— 
"(1) IN GENERAL.—^The Administrator may conduct tech-
nology assessments in addition to those assessments performed 
at the request of the Administrator of the Health Care Financ-
ing Administration or of the Secretary of Defense. 
"(2) CRITERIA.—^The Administrator shall develop criteria 
for determining the priority of assessments performed under 
this subsection. Such criteria shall include— 
"(A) the prevalence of the health condition for which 
the technology aims to prevent, diagnose, treat and clini-
cally manage; 
"(B) variations in current practice; 
"(C) the economic burden posed by the prevention, 
diagnosis, treatment, and clinical management of the 
health condition, including the impact on publicly-funded 
programs; 
"(D) aggregate cost of the use of technology; 
"(E) the morbidity and mortality associated with the 
health condition; and 
106 STAT. 2096 
PUBLIC LAW 102-410—OCT. 13, 1992 
"(F) the potential of an assessment to improve health 
outcomes or affect costs associated with the prevention, 
diagnosis, or treatment of the condition."; and 
(5) by adding at the end the following subsections: 
"(e) DESCRIPTION OF PROCESS.—Not later than January 1,1994, 
the Administrator shall develop and publish a description of the 
methodology used to establish priorities for technology assessment 
and the process used to conduct its technology assessments under 
this section. 
"(f) PROGRAM OF INNOVATIVE ASSESSMENTS.— 
"(1) IN GENERAL.—The Administrator may make grants 
to, or enter cooperative agreements or contracts with, entities 
described in paragraph (2) for the establishment of collaborative 
arrangements for the purpose of conducting assessments of 
experimental, emerging, existing, or potentially outmoded 
health care technologies, and for related activities. Such assess-
ments may include controlled clinical trials, large simple trials, 
and other methodologies that can be conducted in partnership 
between the public and private sectors or among multiple 
government agencies. 
"(2) ELIGIBLE ENTITIES.—The entities referred to in para-
graph (1) are entities determined to be appropriate by the 
Administrator, which entities may include academic medical 
centers, research institutions, nonprofit professional organiza-
tions, public or private third party payers, other governmental 
agencies, and consortia of appropriate research entities estab-
lished for the purpose of conducting technology assessments. 
"(3) USE OF AWARD.—^A grant, cooperative agreement, or 
contract under paragraph (1) may be expended for data collec-
tion, data analysis, protocol development, report development, 
dissemination and evaluation, and other activities determined 
to be appropriate by the Administrator. Such funds shall not 
be used for direct services. 
"(4) APPLICATION FOR AWARD.—^To be eligible to receive 
a grant, cooperative agreement, or contract under paragraph 
(1), an entity shall prepare and submit to the Administrator 
an application, at such time, in such form, and containing 
such information as the Administrator may require. 
"(5) 
INTERAGENCY MEMORANDA OF UNDERSTANDING.—In 
carrying out paragraph (1), the Administrator may enter into 
memoranda of imderstanding with the heads of other Federal 
agencies.". 
42USC299a-2 
(b) REPORT REGARDING INNOVATIVE ASSESSMENTS.—Not later 
than January 1, 1994, the Administrator for Health Care Policy 
and Research shall submit to the Committee on Energy and Com-
merce of the House of Representatives, and the Committee on 
Labor and Human Resources of the Senate, a report concerning 
the program established in section 904(f) of the Public Health 
Service Act (as added by subsection (a) of this section), including 
the plan of such Administrator for implementing the program. 
SEC. 5. FORUM FOR QUALITY AND EFFECTIVENESS IN HEALTH CARE. 
(a) REQUIREMENTS FOR GUIDELINES, STANDARDS, PERFORMANCE 
MEASURES, AND REVIEW CRITERIA.— 
(1) ADDITIONAL REQUIREMENTS.—Section 912(b) (42 U.S.C. 
299b-l) is amended— 
note. 
PUBLIC LAW 102-410—OCT. 13, 1992 
106 STAT. 2097 
(A) in paragraph (2), by striking "and" after the semi-
colon at the end; 
(B) in paragraph (3), by striking the period at the 
end and inserting "; and"; and 
(C) by adding at the end the following paragraphs: 
"(4) include information on risks and benefits oi alternative 
strategies for prevention, diagnosis, treatment, and manage-
ment of a given disease, disorder, or other health condition; 
and 
"(5) include information on the costs of alternative strate-
gies for the prevention, diagnosis, treatment, and management 
of a given disease, disorder, or other health condition, where 
cost information is available and reliable.". 
(2) STUDY.— 
42 use 299b-i 
(A) To assist in carrying out the requirements of section note. 
912(b)(4) of the Public Health Service Act, as added by 
paragraph (1) of this subsection, the Administrator for 
Health Care Policy and Research shall conduct or support 
a study to develop methods for collecting and analyzing 
primary and secondary data to be used in generating cost 
estimates of alternative strategies for the prevention, diag-
nosis, treatment, and management of a given disease, dis-
order, or the health condition to be included in gmdeline 
documents. 
(B) Not later than June 1, 1994, the Administrator Reports. 
for Health Care Policy and Research shall submit to the 
Committee on Energy and Commerce of the House of Rep-
resentatives, and to the Committee on Labor and Human 
Resources of the Senate, a report concerning the study 
conducted under subparagraph (A). 
(b) ADMINISTRATION OF OFFICE.—Section 911 (42 U.S.C. 299b) 
is amended by adding at the end the following sentence: "The 
Administrator shall carry out this part acting through the Direc-
tor.". 
(c) CONFORMING AMENDMENTS.—Part B of title IX (42 U.S.C. 
299b et seq.) is amended— 
(1) in section 912— 
42 use 299b-l. 
(A) in subsection (a)— 
(i) in the first sentence, by striking "The" and 
all that follows through "shall 
and inserting "The 
Administrator shall"; and 
(ii) in the second sentence, by striking "Director" 
and inserting "Administrator"; and 
(B) in subsection (c), by striking "Director" and insert-
ing "Administrator"; 
(2) in section 913— 
42 use 299b-2. 
(A) in subsection (a), in the matter preceding paragraph 
(1), by striking "Director" and inserting "Administrator"; 
(B) in subsection (b), in the matter preceding paragraph 
(1), by striking "Director" and inserting "Administrator"; 
and 
(C) in subsection (c), by striking "Director" each place 
such term appears and inserting "Administrator"; and 
(3) in section 914— 
42 USC 299b-3. 
(A) in subsection (b)— 
(i) in paragraph (1), by striking "Director" and 
inserting "Administrator^; 
106 STAT. 2098 
PUBLIC LAW 102-410—OCT. 13, 1992 
(ii) in paragraph (2), by striking "Director^ and 
inserting "Administrator"; 
(iii) in paragraph (3), in the matter preceding 
subparagraph (A), bv striking "Director" and inserting 
"Administrator"; and 
(iv) in paragraph (4), by striking "Director" and 
inserting "Administrator"; 
(B) in subsection (c), in the first sentence, by striking 
"Director" and inserting "Administrator"; 
(C) in subsection (d), in the first sentence, by striking 
"Director" and inserting "Administrator"; and 
(D) in subsection (e), by striking "Director" and insert-
ing "Administrator". 
. 
(d) PEER REVIEW WITH RESPECT TO GRANTS AND CONTRACTS.— 
(1) ESTABLISHMENT OF PEER REVIEW GROUPS.—Section 
922(cX2) (42 U.S.C. 299c-l(cX2)) is amended— 
(A) by striking "from among individuals" and all that 
follows through "virtue" and inserting "from among individ-
uals who by virtue"; and 
(B) by adding at the end the following sentences: "Offi-
cers 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 duties carried out as such officers 
and employees.". 
(2) CATEGORIES OF REVIEW.—Section 922(d)(1) (42 U.S.C. 
299c-l(dXl)) is amended to read as follows: 
"(1) IN GENERAL.—^With respect to technical and scientific 
peer review under this section, there shall be two categories 
of peer review groups as follows: 
"(A) One category of such groups shall, subject to 
subparagraph (B), review applications with respect to 
research, demonstration projects, or evaluations. 
"(B) The other category of such groups shall review 
applications with respect to dissemination activities or the 
development of research agendas (including conferences, 
workshops, and meetings). If the purpose of a proposal 
presented in an application is a matter described in the 
preceding sentence, the application shall be reviewed by 
the groups referred to in such sentence, notwithstanding 
that the proposal involves research, demonstration projects, 
or evaluations.". 
(e) CERTAIN PROVISIONS WITH RESPECT TO DEVELOPMENT, 
COLLECTION, AND DISSEMINATION OF DATA.—Section 923 (42 U.S.C. 
299c-2) is amended by adding at the end the following subsection: 
"(c) AUTHORITY REGARDING CERTAIN REQUESTS.—^Upon the 
request of a public or nonprofit private entity, the Administrator 
may tabulate and analyze statistics under arrangements under 
which such entity will pay the cost of the service provided. Amoimts 
appropriated to the Administrator from payments made under such 
arrangements shall be available to the Administrator for obligation 
until expended.". 
(f) PROCESS FOR DEVELOPMENT OF GUIDELINES AND STAND-
ARDS.— 
(1) MEMBERSHIP OF PANELS.— 
(A) Section 913(c) (42 U.S.C. 299b-2(c)) is amended— 
PUBLIC LAW 102-410—OCT. 13, 1992 
106 STAT. 2099 
(i) by inserting after the subsection designation 
the following sentence: The Administrator shall select 
the chairpersons and the members of the panels con-
vened as well as other participants in the guideline 
process under this section."; and 
(ii) by adding at the end the following sentences: 
"In making such selections, tiie Administrator shall 
ensiu'e that a balance is maintained between individ-
uals selected from academic settings and individuals 
selected without full-time academic appointments. At 
least two other members of such panels shall be 
individuals who do not derive their primary source 
of revenue directly from the performance of procedures 
discussed in the guideline. The Administrator shall 
ensure that at least one participant in the guideline 
process shall have expertise in epidemiology as well 
as familiarity with the clinical condition or treatment 
in question. The Administrator shall also ensure that 
at least one participant in the guideline process shall 
have expertise in health services research or health 
economics as well as familiarity with the clinical condi-
tion or treatment in question.". 
(B) The amendments made by subparagraph (A) shall 
apply only with respect to panels convened under section 
913 of the Public Health Service Act on or after the date 
of enactment of this Act. 
(2) STUDY OF PROCESS.— 
(A) The Administrator for Health Care Policy and 
Research shall conduct or support a study to evaluate 
the process described in section 913 of the Public Health 
Service Act for the development of guidelines, standards, 
and review criteria. The evaluation shall address— 
(i) the optimal methods for setting priorities for 
guideline topics; 
(ii) the different methods for generating guidelines, 
comparing the cost of producing the Adelines and 
the validity and utility of the guidelmes produced; 
and 
(iii) the methods for assessing the quality of prac-
tice guidelines, including an evaluation of the validity, 
reliability, and impact oi the guidelines. 
(B) Not later than Jime 1, 1995, the Administrator 
for Health Care Policy and Research shall submit to the 
Committee on Energy and Commerce of the House of Rep-
resentatives, and to the Committee on Labor and Human 
Resources of the Senate, a report concerning the study 
conducted under subparagraph (A). 
SEC. 6. PREVENTION. 
(a) PROGRAM AGENDA.—Section 914(aX2XA) (42 U.S.C. 299b-
3(a)(2XA)) is amended— 
(1) by striking clause (i); 
(2) by redesignating clauses (ii) and (iii) as clauses (iii) 
and (iv), respectively; and 
(3) by inserting before clause (iii) (as so redesignated) the 
following clauses: 
"(i) to improve methods for disease prevention; 
42 use 299b-2 
note. 
42 use 299b-2 
note. 
Reports. 
106 STAT. 2100 
PUBLIC LAW 102-410—OCT. 13, 1992 
"(ii) to improve methods of diagnosis, treatment, 
and clinical management for the benefit of a significant 
number of individuals;"; and 
(b) DUTIES.—Section 912 (42 U.S.C. 299b-l) is amended by 
adding at the end the following subsection: 
"(f) DEVELOPMENT OF CERTAIN GUIDELINES AND STANDARDS.— 
Not later than January 1, 1996, the Administrator shall ensure 
that a set of guidelines, standards, performance measures, and 
review criteria, are developed under subsection (a)(1) that address 
the prevention of not fewer than three conditions that account 
for significant national health expenditures. In carrying out this 
subsection the Administrator shall consult with the United States 
Preventive Services Task Force and other recognized experts in 
the field of disease prevention.". 
SEC. 7. ADDITIONAL REQUIREMENTS. 
Section 914 (42 U.S.C. 299b-3) is amended— 
(1) in subsection (a)(2), by adding at the end the following 
subparagraph: 
"(C) The Administrator shall develop and publish a 
methodology for establishing priorities for guideline topics. 
Such methodology may include the considerations described 
in section 904(c)(2) or 914(a)(2), and other considerations 
Federal 
determined by the Administrator to be appropriate. Using 
^u^^*T 
^^^^ methodology, the Administrator shall establish and 
pu ica ion. 
publish annually in the Federal Register a list of guideline 
topics under consideration."; and 
(2) in subsection (e), by adding at the end the following 
sentence: "Evaluations shall be developed prior to the comple-
tion and release of the guideline, so that baseline data concern-
ing practice patterns and health care costs may be obtained 
as part of the evaluation.". 
SEC. 8. ADVISORY COUNCIL. 
Section 921 (42 U.S.C. 299c) is amended— 
(1) by striking subsection (d); 
(2) by redesignating subsections (e) through (k) as sub-
sections (d) through (j), respectively; and 
(3) in subsection (e) (as so redesignated), by striking "sub-
section (e)" and inserting "subsection (d)". 
SEC. 9. FINANCIAL CONFLICTS OF INTEREST. 
Section 924 (42 U.S.C. 299c-3) is amended— 
(1) by redesignating subsections (a) through (c) as sub-
sections (b) through (d), respectively; and 
(2) by inserting before subsection (b) (as so redesignated) 
the following subsection: 
"(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 Adminis-
trator 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 Administrator 
in response to any such interests identified by the Adminis-
trator.". 
PUBLIC LAW 102-410—OCT. 13, 1992 
106 STAT. 2101 
SEC. 10. AUTHORIZATION OF APPROPRIATIONS. 
Section 926 (42 U.S.C. 299c-5) is amended— 
(1) in subsection (a), to read as follows: 
"(a) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carrying out this title, there are authorized to be appropriated 
$115,000,000 for fiscal year 1993, $145,000,000 for fiscal year 1994, 
and $175,000,000 for fiscal year 1995."; and 
(2) by adding at the end the following subsections: 
"(c) INFORMATION CENTER.—For purposes of carrying out the 
activities under section 903(e), there are authorized to be appro-
priated $3,000,000 for fiscal year 1993, and such sums as may 
be necessary for each of the fiscal years 1994 and 1995. 
"(d) HEALTH CARE TECHNOLOGY ASSESSMENT.—^For the purpose 
of carrying out technology assessment activities under section 
904(d), there are authorized to be appropriated $2,000,000 for fiscal 
year 1993, and such sums as may be necessary for each of the 
fiscal years 1994 and 1995. 
"(e) PROGRAM OF INNOVATIVE ASSESSMENTS.—For purposes of 
establishing the program of innovative assessments under section 
904(f), there are authorized to be appropriated $2,000,000 for fiscal 
year 1993, and such sums as may be necessary in each of the 
fiscal years 1994 and 1995.". 
SEC. 11. EMERGENCY MEDICAL SERVICE FOR CHILDREN. 
Section 1910 (42 U.S.C. 300w-9) is amended— 
(1) in subsection (a), by striking "not more than four grants 
in any fiscal year" and inserting "grants"; and 
(2) in subsection (d)— 
(A) by striking "and $5,000,000" and inserting 
"$5,000,000"; and 
(B) by inserting before the period the following: ", 
and such sums as may be necessary for each of the fiscal 
years 1993 through 1997". 
Approved October 13, 1992. 
LEGISLATIVE HISTORY—H.R. 5673: 
HOUSE REPORTS: No. 102-892 (Comm. on Energy and Commerce). 
CONGRESSIONAL RECORD, Vol. 138 (1992): 
Sept. 22, 24, considered and passed House. 
Sept. 30, considered and passed Senate.