Healthcare Research and Quality Act of 1999
PL 106-129 (S.580), enacted 12/06/1999

PUBLIC LAW 106-129—DEC. 6, 1999 
113 STAT. 1653 
Public Law 106-129 
106th Congress 
An Act 
To amend title IX of the Public Health Service Act to revise and extend the 
Dec. 6, 1999 
Agency for Healthcare Policy and Research. 
[S. 580] 
Be it enacted by the Senate and House of Representatives 
of 
the United States of America in Congress assembled. 
Healthcare 
R6S6£Li^li dud 
SECTION 1. SHORT TITLE. 
Quality Act of 
1999. 
This Act may be cited as the "Healthcare Research and Quahty 42 USC 201 note. 
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 
•«EC. 901. MISSION AND DUTIES. 
42 USC 299. 
"(a) IN GENERAL.—There is established within the Public 
Health Service an agency to be known as the Agency for Healthcare 
Research £ind 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 £md 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; 
113 STAT. 1654 
PUBLIC LAW 106-129—DEC. 6, 1999 
"(D) the costs and utilization of, and access to health 
care; 
"(E) the ways in which health care services are orga-
nized, 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 prac-
tices 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, pro-
viders, 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 can:ying out this title, the Director shall conduct 
and support research and evaluations, and support demonstra-
tion 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 require-
ments of paragraph (1) are reflected in the overall portfolio 
of research conducted and supported by the Agency. 
Establishment. 
"(3) OFFICE OF PRIORITY POPULATIONS.—The Director s h a l l 
establish an Office of Priority Populations to assist in carrying 
out the requirements of paragraph (1). 
42 u s e 299a. 
"SEC. 902. GENERAL AUTHORITIES. 
"(a) IN GENERAL.—In carrying out section 901(b), the Director 
shall conduct and support research, evaluations, and training, sup-
port demonstration projects, research networks, and multidisci-
plinary centers, provide technical assistance, and disseminate 
information on health care and on systems for the delivery of 
such care, including activities with respect to— 
"(1) the quality, effectiveness, efficiency, appropriateness 
and value of health care services; 
"(2) quality measurement and improvement; 
"(3) the outcomes, cost, cost-effectiveness, and use of health 
care services and access to such services; 
"(4) clinical practice, including primary care and practice-
oriented research; 
"(5) health care technologies, facilities, and equipment; 
PUBLIC LAW 106-129—DEC. 6, 1999 
113 STAT. 1655 
"(6) health care costs, productivity, organization, and 
market forces; 
"(7) health promotion and disease prevention, including 
clinical preventive services; 
"(8) heedth statistics, surveys, database development, and 
epidemiology; and 
"(9) medicaUiability. 
"(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-doc-
toral 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 alloca-
tion 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 pri-
ority populations identified in section 901(c)(1)(B) and in addi-
tion, shall take into consideration indications of long-term 
commitment, 
amongst 
applicgmts 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 appro-
priately 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 con-
sistent with section 1142 of such Act. 
"(e) DISCLAIMER.—The Agency shall not mandate national 
standards of clinical practice or quality health care standards. Rec-
ommendations 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 Effective date. 
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. 
113 STAT. 1656 
PUBLIC LAW 106-129—DEC. 6, 1999 
" P A R T B — H E A L T H C A R E I M P R O V E M E N T 
R E S E A R C H 
42 use 299b. 
"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 £ind 
disseminate methods or systems to assess health care research 
results, particuleirly methods or systems to rate the strength of 
the scientific evidence underlying health care practice, recommenda-
tions in the research literature, and technology assessments. The 
Agency shall make methods or systems for evidence rating widely 
available. Agency publications containing health care recommenda-
tions 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 continuimi 
of care and outcomes research, to link research to practice 
improvement, eind 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 out-
comes 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 estab-
lish the requirements for entities applying for grants under 
this subsection. 
42 use 299b-l. 
"SEC. 912. PRIVATE-PUBLIC PARTNERSHIPS TO IMPROVE ORGANIZA-
TION 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 technicEil 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) enroUees in health plans by tj^e of plan, pro-
vider, and provider arrsingements; and 
"(ii) other populations, including those receiving 
long-term care services; 
"(B) the ongoing development, testing, and dissemina-
tion of quality measures, including measures of health 
and functional outcomes; 
PUBLIC LAW 106-129—DEC. 6, 1999 
113 STAT. 1657 
"(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 THERA-
PEUTICS.— 
"(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 o
f
— 
"(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 combina-
tions of drugs and biological products, 
"(ii) To provide objective clinical information to 
the following individuals and entities: 
"(I) Health care practitioners and other pro-
viders of health care goods or services. 
"(II) Pharmacists, pharmacy benefit managers 
and purchasers. 
"(Ill) 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, £ind devices and the con-
sequences of such effects, such as unnecessary hos-
pitalizations. 
"(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. 
113 STAT. 1658 
PUBLIC LAW 106-129—DEC. 6, 1999 
"(c) REDUCING ERRORS IN MEDICINE.—The Director shall con-
duct and support research and build private-public partnerships 
to— 
"(1) identify the causes of preventable health care errors 
for 
£ind patient injury in health care delivery; 
(2) develop, demonstrate, and evaluate strategies 
reducing errors and improving patient safety; gind 
"(3) disseminate such effective strategies throughout the 
health care industry. 
42 use 299b-2. 
"SEC. 913. INFORMATION ON QUALITY AND COST OF CAKE. 
"(a) IN GENERAL.—The Director shall— 
Survey. 
"(1) conduct a survey to collect data on a nationally rep-
Effective date, 
resentative 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 Ameri-
cans use, their access to health care services, fi*equency of 
use, how much is paid for the services used, the source of 
those pajnnents, the types and costs of private health insurance, 
access, satisfaction, and quality of care for the general popu-
lation including rural residents £ind also for populations identi-
fied 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.— 
Effective date. 
"(1) IN GENERAL.—Beginning in fiscal year 2001, the 
Director shall ensure that the survey conducted under sub-
section (a)(1) will— 
"(A) identify determinants of health outcomes and fiinc-
tional status, including the health care needs of populations 
identified in section 901(c), provide data to study the rela-
tionships 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 fi*equently occurring clinical conditions 
for a nationally representative sample of the population 
including rural residents; and 
"(C) provide reliable national estimates for children 
Eind persons with specied hesdth care needs through the 
use of supplements or periodic expansions of the survey. 
In expcmding 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. 
Effective date. 
"(2) ANNUAL REPORT.—Beginning in fiscal year 2003, the 
Secretfiry, acting through the Director, shall submit to Congress 
an annual report on national trends in the qusdity of health 
care provided to the American people. 
42 use 299b-3. 
"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, evalua-
tions, and initiatives to adveuice— 
PUBLIC LAW 106-129—DEC. 6, 1999 
113 STAT. 1659 
"(1) the use of information systems for the study of health 
care quality and outcomes, including the generation of both 
individual provider and plem-level comparative performsince 
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 deci-
sion-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 informa-
tion and data in consultation with appropriate Federal, State 
Eind private entities; 
"(6) the use of computer-based health records in all settings 
for the development of personed health records for individual 
health assessment and mainteneince, and for monitoring public 
health £md outcomes of care within populations; and 
"(7) the protection of individually identifiable information 
in health services research and health care qusdity improve-
ment. 
"(b) DEMONSTRATION.—^The Agency shall support demonstra-
tions into the use of new information tools edmed at improving 
shared decision-meiking between patients and their care-givers. 
"(c) 
FACILITATING PUBLIC 
ACCESS 
TO INFORMATION.—The 
Director shall work with appropriate public Eind private sector enti-
ties 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 
42 USC 299b-4. 
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 recommenda-
tions for the health care community, and updating previous 
clinical preventive recommendations. 
"(2) ROLE OF AGENCY.—The Agency shall provide ongoing 
administrative, research, and teclmicai support for the oper-
ations of the Preventive Services Task Force, including coordi-
nating and supporting the dissemination of the recommenda-
tions 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 Establishment, 
a Center for Primary Care Research (referred to in this sub-
section 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. 
113 STAT. 1660 
PUBLIC LAW 106-129—DEC. 6, 1999 
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 prob-
lems; and 
"(D) the continuity and coordination of health services. 
42 use 299b-5. 
"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 develop-
ment, diffusion, and use of health care technology; 
"(2) developing, evaluating, and disseminating methodolo-
gies 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 tech-
nical assistance in the use of health care practice and tech-
nology assessment methodologies and results; and 
"(5) working with the National Library of Medicine and 
the public and private sector to develop an electronic clearing-
house of currently available assessments and those in progress. 
"(b) SPECIFICATION OF PROCESS.— 
Deadline. 
"(1) IN GENERAL.—Not later than December 31, 2000, the 
Publication. 
Director shall develop Eind publish a description of the methods 
used by the Agency Eind its contractors for health care practice 
emd technology assessment. 
"(2) CONSULTATIONS.—In carrying out this subsection, the 
Director shall cooperate and consult with the Assistant Sec-
retary 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, eind shall seek input, where appropriate, from profes-
sional 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. 
PUBLIC LAW 106-129—DEC. 6, 1999 
113 STAT. 1661 
"(2) REQUESTS FOR ASSESSMENTS.—The Director is author-
ized 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 para-
graph is an entity that is determined to be appropriate by 
the Director, including academic medical centers, research 
institutions and orgginizations, 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 appro-
priate research entities established for the purpose of con-
ducting technology assessments. 
"(d) MEDICAL EXAMINATION OF CERTAIN VICTIMS.— 
"(1) IN GENERAL.—The Director shall develop and dissemi- Reports. 
nate a report on evidence-based clinical practices for— 
"(A) the examination £ind treatment by health profes-
sionals 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 individ-
uals 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 £ind experience 
of Federsd 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 42 USC 299b-6. 
IMPROVEMENT EFFORTS. 
"(a) REQUIREMENT.— 
"(1) IN GENERAL.—^To avoid duplication and ensure that 
Federal resources are used efficiently and effectively, the Sec-
retary, acting through the Director, shall coordinate all 
research, evaluations, and demonstrations related to health 
services research, quality measurement and quality improve-
ment activities undertaken and supported by the Federal 
(jovemment. 
"(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— 
113 STAT. 1662 
PUBLIC LAW 106-129—DEC. 6, 1999 
Contracts. 
Contracts. 
Deadline. 
Reports. 
"(A) improve interagency coordination, priority setting, 
and the use and sharing of research findings and data 
pertaining to Federal quality improvement programs, tech-
nology assessment, and health services research; 
"(B) strengthen the research information infrastruc-
ture, including databases, pertaining to Federal health 
services research and health care quality improvement ini-
tiatives; 
"(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 Sec-
retary shall enter into a contract with the Institute of 
Medicine— 
"(A) to describe and evaluate current quality improve-
ment, 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 pur-
sued 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 pro-
grams under titles XVIII, XIX and XXI of the Social 
Security Act and health services research programs; 
"(ii) the strengthening of patient choice and partici-
pation by incorporating state-of-the-art quality moni-
toring tools and making information on quality avail-
able; £md 
"(iii) the enhancement of the most effective pro-
grams, consolidation as appropriate, and elimination 
of duplicative activities within various Federal agen-
cies. 
"(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 imder titles 
XVIII, XIX, and XXI of the Social Security Act; and 
PUBLIC LAW 106-129—DEC. 6, 1999 
113 STAT. 1663 
"(ii) not later than 24 months after the date of Deadline. 
the enactment of this title, of a final report containing Report. 
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 Pen-
sions of the Senate and the Committee on Ways and Means 
and the Committee on Commerce of the House of Rep-
resentatives. 
"PART C—GENERAL PROVISIONS 
"SEC. 921. ADVISORY COUNCIL FOR HEALTHCARE RESEARCH ^V^D 42 USC 299c. 
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, espe-
cially 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 dis-
ciplines, 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 identifica-
tion of opportunities for public-private sector partnerships. 
"(c) MEMBERSHIP.— 
"(1) IN GENERAL.—The Advisory Council shall, in accord-
ance 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 Coimcil shall be represent-
atives 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 rescEirch, demonstration projects, and evalua-
tions with respect to health care; 
113 STAT. 1664 
PUBLIC LAW 106-129—DEC. 6, 1999 
"(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, pro-
viders, 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 Coimcil— 
"(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 Adminis-
trator of the Health Care Financing Administration, the 
Commissioner of the Food and Drug Administration, the 
Director of the Office of Personnel Management, the Assist-
ant Secretary of Defense (Health Affairs), and the Under 
Secreteiry for Health of the Department of Veterans Affairs; 
and 
"(B) such other Federal officieds 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 
imder 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, fi-om 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 Coimcil 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.— 
PUBLIC LAW 106-129—DEC. 6, 1999 
113 STAT. 1665 
"(1) 
APPOINTED MEMBERS.—Members of the 
Advisory 
Council appointed under subsection (c)(2) shall receive com-
pensation for each day (including travel time) engaged in car-
rying 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 sub-
section (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. 42 USC 299c-l. 
"(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 £in 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 tech-
nical and scientific peer review groups as may be necessary 
to c£irry 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 with-
out 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 th£in 25 percent of the membership of any 
such group. Such officers and employees may not receive com-
pensation for service on such groups in addition to the com-
pensation otherwise received for these duties carried out as 
such officers and employees. 
"(3) DURATION.—Notwithstanding section 14(a) of the Fed-
eral Advisory Committee Act, peer review groups established 
113 STAT. 1666 
PUBLIC LAW 106-129—DEC. 6, 1999 
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 employ-
ment 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 appro-
E
riate 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 encour-
aging clinical practice-oriented or provider-based research, and for 
such other purposes as the Director may determine to be appro-
priate. 
"(e) REGULATIONS.—The Director shall issue regulations for 
the conduct of peer review under this section. 
42 USE 299C-2. 
"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 suffi-
ciency 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 Depart-
ment 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 
Publication. 
"(2) publish, make available, and disseminate such statis-
tics and analyses on as wide a basis as is practicable. 
PUBLIC LAW 106-129—DEC. 6, 1999 
113 STAT. 1667 
"(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 pursusmt 
to arrsingements 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. 
42 USC 299c-3. 
"(a) IN GENERAL.—^The Director shall— 
"(1) without regard to section 501 of title 44, United States 
Code, promptly publish, make available, and otherwise dissemi-
nate, 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, trans-
lating, publishing, and other services leading to a more effective 
and timely dissemination of information on research, dem-
onstration 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 informa-
tion 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 
imder 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. 
113 STAT. 1668 
PUBLIC LAW 106-129—DEC. 6, 1999 
42 use 299c-^. 
"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 provi-
sion 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 Depart-
ment 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 nneincial 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 compl5dng 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). 
42 use 299C-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 £ind 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 Adminis-
trator of General Services, buildings or portions of buildings 
in the District of Columbia or communities located adjacent 
PUBLIC LAW 106-129—DEC. 6, 1999 
113 STAT. 1669 
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 grgmts 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 canying 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 £ind 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, fi*om 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 fi-om 
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 consult-
ants who have appropriate scientific or professional qualifica-
tions. Such experts or consultants shall be obtained in accord-
ance 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 serv-
ices are obtained under paragraph (1) shall be paid or 
reimbursed for their expenses associated with traveling 
to and fi'om 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 Sec-
retary. 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. 
113 STAT. 1670 
PUBLIC LAW 106-129—DEC. 6, 1999 
"(g) VOLUNTARY AND UNCOMPENSATED SERVICES.—The Director, 
in canying out this title, may accept voluntary and uncompensated 
services. 
42 use 299C-6. 
"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 invest-
ment in research on the most effective clinical and organizational 
strategies for use of these findings in daily practice. The authoriza-
tion 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 nec-
essary for each of the fiscal years 2001 through 2005. 
"(c) EVALUATIONS.—In addition to amounts available pursuant 
to subsection (b) for canying out this title, there shall be made 
available for such purpose, from the amounts made available pursu-
ant 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. 
42 use 299C-7. 
"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 £md Quality.". 
42 use 299 note. 
(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 D
C 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. 
42 use 203 et 
(2) REFERENCES.—Any reference in law to the Agency for 
s«9- 
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: 
PUBLIC LAW 106-129—DEC. 6, 1999 
113 STAT. 1671 
-SEC. 330D. CENTERS FOR STRATEGIES ON FACILITATING UTILIZA- 42 USC 254c--t. 
TION OF PREVENTIVE HEALTH SERVICES AMONG VAR-
IOUS POPULATIONS. 
"(a) IN GENERAL.—The Secretary, acting through the appro-
priate agencies of the PubHc 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 manage-
ment 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 veirious 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 
42USC256e. 
THAT OPERATE GRADUATE MEDICAL EDUCATION PRO-
GRAMS. 
"(a) PAYMENTS.—The Secretary shall make two pa3mients under 
this section to each children's hospital for each of fiscal years 
2000 £ind 2001, one for the direct expenses and the other for 
indirect expenses associated with operating approved graduate med-
ical 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 deter-
mined under subsection (c) for direct expenses associated 
with operating approved 
graduate 
medical 
residency 
training programs. 
"(B) INDIRECT EXPENSE AMOUNT.—The amount deter-
mined 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 pro-
grams. 
"(2) CAPPED AMOUNT.— 
113 STAT. 1672 
PUBLIC LAW 106-129—DEC. 6, 1999 
"(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 appro-
priated under paragraph (1) or (2), respectively, of sub-
section (f) for such pa)mients 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 pa3niients 
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 EDU-
CATION.— 
"(1) IN GENERAL.—The amount determined under this sub-
section 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 grad-
uate medical education, as determined under paragraph 
(2); and 
"(B) the average number of full-time equivalent resi-
dents in the hospital's graduate approved medical residency 
training progreuns (as determined under section 1886(h)(4) 
of the Socigd Security Act during the fiscal year. 
"(2) UPDATED PER RESIDENT AMOUNT FOR DIRECT GRADUATE 
MEDICAL EDUCATION.—^The updated per resident Eimount for 
direct graduate medical education for a hospital for a fiscal 
ye£u* 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 fiill-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 Sec-
retary 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 imder section 1886(d)(3)(E) of the Social 
Security Act for discharges occurring during fiscal year 
1999 for the hospital's area; and 
PUBLIC LAW 106-129—DEC. 6, 1999 
113 STAT. 1673 
"(iii) by adding the non-wage-related portion to 
the amount computed under clause (ii). 
"(D) DETERMINATION OF NATIONAL AVERAGE.—The Sec-
retary shall compute a national average per resident 
amount equal to the average of the standardized per resi-
dent 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 Sec-
retary shall compute for each such hospital that is a chil-
dren's hospital a per resident amount— 
"(i) by dividing the national average per resident 
amount computed under subparagraph (D) into a wage-
related portion and a non-wage-related portion by 
applying the proportion determined under subpara-
graph (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 gimount computed under clause (ii). 
"(F) UPDATING RATE.—The Secretary shall update such 
per resident amount for each such children's hospitsd 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 sub-
section 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 amoimt determined 
appropriate by the Secretary. 
"(2) FACTORS.—In determining the amount under para-
graph (1), the Secretary shall— 
"(A) t£ike into account variations in case mix among 
children's hospitals and the number of full-time equivalent 
residents in the hospitals' approved graduate medical resi-
dency 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 
pajonents may be made for a hospital under this section, the 
amounts of the pa3nnents 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. 
113 STAT. 1674 
PUBLIC LAW 106-129—DEC. 6, 1999 
"(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 einy) 
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 overpay-
ments made, or pay any balance due. The amount so determined 
shall be considered a final intermediary determination for pur-
poses 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 pa3rment luider 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 other-
wise 
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 amoimts appro-
priated under subpeiragraph (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(n)(5)(A) 
of the Social Security Act. 
"(2) CHILDREN'S HOSPITAL.—The term 'children's hospital' 
means a hospital described in section 1886(d)(l)(B)(iii) of the 
Social Security Act. 
"(3) 
DIRECT GRADUATE MEDICAL EDUCATION COSTS.—The 
term 'direct graduate medical education costs' has the mesining 
given such term in section 1886(hX5)(C) of the Social Security 
Act.". 
PUBLIC LAW 106-129—DEC. 6, 1999 
113 STAT. 1675 
SEC. 5. STUDY REGARDING SHORTAGES OF LICENSED PHARMACISTS. 
(a) IN GENERAL.—The Secretary of HeeJth and Human Services 
(in this section referred to as the "Secretary"), acting through the 
appropriate agencies of the PubUc 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 con-
tains a summary of the comments received by the Secretary pursu-
ant 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 emy 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 bene-
fited fi*om 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 physici£ins 
are enhancing their medical knowledge and experience through 
the interaction with specialists provided by telemedicine con-
sultations; and 
(6) identifies legal £m.d mediced issues relating to State 
licensing of health professionals that are presented by telemedi-
cine services, and provides any recommendations of the Sec-
retary for responding to such issues. 
42 use 295k 
note. 
Deadline. 
42 use 254c. 
Deadline. 
113 STAT. 1676 
PUBLIC LAW 106-129—DEC. 6, 1999 
42 use 241 note. SEC. 7. CERTAIN TECHNOLOGIES AND PRACTICES REGARDING SUR-
VIVAL RATES FOR CARDIAC ARREST. 
The Secretary of Health and Human Services shall, in consulta-
tion with the Administrator of the General Services Administration 
and other appropriate public and private entities, develop rec-
ommendations 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. 
Approved December 6, 1999. 
LEGISLATIVE HISTORY—S. 580 (H.R. 2506): 
HOUSE REPORTS: No. 106-305 accompanying H.R. 2506 (Comm. on Commerce). 
CONGRESSIONAL RECORD, Vol. 145 (1999): 
Nov. 3, considered and passed Senate. 
Nov. 18, considered and passed House. 
WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS, Vol. 35 (1999): 
Dec. 6, Presidential statement.