Attachment 1 -- Healthcare Research and Quality Act of 1999

S. 580

One Hundred Sixth Congress
of the
United States of America
AT T H E F I R S T S E S S I O N
Begun and held at the City of Washington on Wednesday,
the sixth day of January, one thousand nine hundred and ninety-nine

An Act
To amend title IX of the Public Health Service Act to revise and extend the
Agency for Healthcare Policy and Research.

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.

This Act may be cited as the ‘‘Healthcare Research and Quality
Act of 1999’’.
SEC. 2. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

(a) IN GENERAL.—Title IX of the Public Health Service Act
(42 U.S.C. 299 et seq.) is amended to read as follows:

‘‘TITLE IX—AGENCY FOR HEALTHCARE
RESEARCH AND QUALITY
‘‘PART A—ESTABLISHMENT AND GENERAL
DUTIES
‘‘SEC. 901. MISSION AND DUTIES.

‘‘(a) IN GENERAL.—There is established within the Public
Health Service an agency to be known as the Agency for Healthcare
Research and Quality, which shall be headed by a director appointed
by the Secretary. The Secretary shall carry out this title acting
through the Director.
‘‘(b) MISSION.—The purpose of the Agency is to enhance the
quality, appropriateness, and effectiveness of health services, and
access to such services, through the establishment of a broad base
of scientific research and through the promotion of improvements
in clinical and health system practices, including the prevention
of diseases and other health conditions. The Agency shall promote
health care quality improvement by conducting and supporting—
‘‘(1) research that develops and presents scientific evidence
regarding all aspects of health care, including—
‘‘(A) the development and assessment of methods for
enhancing patient participation in their own care and for
facilitating shared patient-physician decision-making;
‘‘(B) the outcomes, effectiveness, and cost-effectiveness
of health care practices, including preventive measures and
long-term care;
‘‘(C) existing and innovative technologies;

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‘‘(D) the costs and utilization of, and access to health
care;
‘‘(E) the ways in which health care services are organized, delivered, and financed and the interaction and
impact of these factors on the quality of patient care;
‘‘(F) methods for measuring quality and strategies for
improving quality; and
‘‘(G) ways in which patients, consumers, purchasers,
and practitioners acquire new information about best practices and health benefits, the determinants and impact
of their use of this information;
‘‘(2) the synthesis and dissemination of available scientific
evidence for use by patients, consumers, practitioners, providers, purchasers, policy makers, and educators; and
‘‘(3) initiatives to advance private and public efforts to
improve health care quality.
‘‘(c) REQUIREMENTS WITH RESPECT TO RURAL AND INNER-CITY
AREAS AND PRIORITY POPULATIONS.—
‘‘(1) RESEARCH, EVALUATIONS AND DEMONSTRATION
PROJECTS.—In carrying out this title, the Director shall conduct
and support research and evaluations, and support demonstration projects, with respect to—
‘‘(A) the delivery of health care in inner-city areas,
and in rural areas (including frontier areas); and
‘‘(B) health care for priority populations, which shall
include—
‘‘(i) low-income groups;
‘‘(ii) minority groups;
‘‘(iii) women;
‘‘(iv) children;
‘‘(v) the elderly; and
‘‘(vi) individuals with special health care needs,
including individuals with disabilities and individuals
who need chronic care or end-of-life health care.
‘‘(2) PROCESS TO ENSURE APPROPRIATE RESEARCH.—The
Director shall establish a process to ensure that the requirements of paragraph (1) are reflected in the overall portfolio
of research conducted and supported by the Agency.
‘‘(3) OFFICE OF PRIORITY POPULATIONS.—The Director shall
establish an Office of Priority Populations to assist in carrying
out the requirements of paragraph (1).
‘‘SEC. 902. GENERAL AUTHORITIES.

‘‘(a) IN GENERAL.—In carrying out section 901(b), the Director
shall conduct and support research, evaluations, and training, support demonstration projects, research networks, and multidisciplinary centers, provide technical assistance, and disseminate
information on health care and on systems for the delivery of
such care, including activities with respect to—
‘‘(1) the quality, effectiveness, efficiency, appropriateness
and value of health care services;
‘‘(2) quality measurement and improvement;
‘‘(3) the outcomes, cost, cost-effectiveness, and use of health
care services and access to such services;
‘‘(4) clinical practice, including primary care and practiceoriented research;
‘‘(5) health care technologies, facilities, and equipment;

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‘‘(6) health care costs, productivity, organization, and
market forces;
‘‘(7) health promotion and disease prevention, including
clinical preventive services;
‘‘(8) health statistics, surveys, database development, and
epidemiology; and
‘‘(9) medical liability.
‘‘(b) HEALTH SERVICES TRAINING GRANTS.—
‘‘(1) IN GENERAL.—The Director may provide training grants
in the field of health services research related to activities
authorized under subsection (a), to include pre- and post-doctoral fellowships and training programs, young investigator
awards, and other programs and activities as appropriate. In
carrying out this subsection, the Director shall make use of
funds made available under section 487(d)(3) as well as other
appropriated funds.
‘‘(2) REQUIREMENTS.—In developing priorities for the allocation of training funds under this subsection, the Director shall
take into consideration shortages in the number of trained
researchers who are addressing health care issues for the priority populations identified in section 901(c)(1)(B) and in addition, shall take into consideration indications of long-term
commitment, amongst applicants for training funds, to
addressing health care needs of the priority populations.
‘‘(c) MULTIDISCIPLINARY CENTERS.—The Director may provide
financial assistance to assist in meeting the costs of planning and
establishing new centers, and operating existing and new centers,
for multidisciplinary health services research, demonstration
projects, evaluations, training, and policy analysis with respect
to the matters referred to in subsection (a).
‘‘(d) RELATION TO CERTAIN AUTHORITIES REGARDING SOCIAL
SECURITY.—Activities authorized in this section shall be appropriately coordinated with experiments, demonstration projects, and
other related activities authorized by the Social Security Act and
the Social Security Amendments of 1967. Activities under subsection
(a)(2) of this section that affect the programs under titles XVIII,
XIX and XXI of the Social Security Act shall be carried out consistent with section 1142 of such Act.
‘‘(e) DISCLAIMER.—The Agency shall not mandate national
standards of clinical practice or quality health care standards. Recommendations resulting from projects funded and published by
the Agency shall include a corresponding disclaimer.
‘‘(f) RULE OF CONSTRUCTION.—Nothing in this section shall
be construed to imply that the Agency’s role is to mandate a
national standard or specific approach to quality measurement and
reporting. In research and quality improvement activities, the
Agency shall consider a wide range of choices, providers, health
care delivery systems, and individual preferences.
‘‘(g) ANNUAL REPORT.—Beginning with fiscal year 2003, the
Director shall annually submit to the Congress a report regarding
prevailing disparities in health care delivery as it relates to racial
factors and socioeconomic factors in priority populations.

S. 580—4

‘‘PART B—HEALTH CARE IMPROVEMENT
RESEARCH
‘‘SEC. 911. HEALTH CARE OUTCOME IMPROVEMENT RESEARCH.

‘‘(a) EVIDENCE RATING SYSTEMS.—In collaboration with experts
from the public and private sector, the Agency shall identify and
disseminate methods or systems to assess health care research
results, particularly methods or systems to rate the strength of
the scientific evidence underlying health care practice, recommendations in the research literature, and technology assessments. The
Agency shall make methods or systems for evidence rating widely
available. Agency publications containing health care recommendations shall indicate the level of substantiating evidence using such
methods or systems.
‘‘(b) HEALTH CARE IMPROVEMENT RESEARCH CENTERS AND PROVIDER-BASED RESEARCH NETWORKS.—
‘‘(1) IN GENERAL.—In order to address the full continuum
of care and outcomes research, to link research to practice
improvement, and to speed the dissemination of research
findings to community practice settings, the Agency shall
employ research strategies and mechanisms that will link
research directly with clinical practice in geographically diverse
locations throughout the United States, including—
‘‘(A) health care improvement research centers that
combine demonstrated multidisciplinary expertise in outcomes or quality improvement research with linkages to
relevant sites of care;
‘‘(B) provider-based research networks, including plan,
facility, or delivery system sites of care (especially primary
care), that can evaluate outcomes and evaluate and promote
quality improvement; and
‘‘(C) other innovative mechanisms or strategies to link
research with clinical practice.
‘‘(2) REQUIREMENTS.—The Director is authorized to establish the requirements for entities applying for grants under
this subsection.
‘‘SEC. 912. PRIVATE-PUBLIC PARTNERSHIPS TO IMPROVE ORGANIZATION AND DELIVERY.

‘‘(a) SUPPORT FOR EFFORTS TO DEVELOP INFORMATION ON
QUALITY.—
‘‘(1) SCIENTIFIC AND TECHNICAL SUPPORT.—In its role as
the principal agency for health care research and quality, the
Agency may provide scientific and technical support for private
and public efforts to improve health care quality, including
the activities of accrediting organizations.
‘‘(2) ROLE OF THE AGENCY.—With respect to paragraph
(1), the role of the Agency shall include—
‘‘(A) the identification and assessment of methods for
the evaluation of the health of—
‘‘(i) enrollees in health plans by type of plan, provider, and provider arrangements; and
‘‘(ii) other populations, including those receiving
long-term care services;
‘‘(B) the ongoing development, testing, and dissemination of quality measures, including measures of health
and functional outcomes;

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‘‘(C) the compilation and dissemination of health care
quality measures developed in the private and public sector;
‘‘(D) assistance in the development of improved health
care information systems;
‘‘(E) the development of survey tools for the purpose
of measuring participant and beneficiary assessments of
their health care; and
‘‘(F) identifying and disseminating information on
mechanisms for the integration of information on quality
into purchaser and consumer decision-making processes.
‘‘(b) CENTERS FOR EDUCATION AND RESEARCH ON THERAPEUTICS.—
‘‘(1) IN GENERAL.—The Secretary, acting through the
Director and in consultation with the Commissioner of Food
and Drugs, shall establish a program for the purpose of making
one or more grants for the establishment and operation of
one or more centers to carry out the activities specified in
paragraph (2).
‘‘(2) REQUIRED ACTIVITIES.—The activities referred to in
this paragraph are the following:
‘‘(A) The conduct of state-of-the-art research for the
following purposes:
‘‘(i) To increase awareness of—
‘‘(I) new uses of drugs, biological products, and
devices;
‘‘(II) ways to improve the effective use of drugs,
biological products, and devices; and
‘‘(III) risks of new uses and risks of combinations of drugs and biological products.
‘‘(ii) To provide objective clinical information to
the following individuals and entities:
‘‘(I) Health care practitioners and other providers of health care goods or services.
‘‘(II) Pharmacists, pharmacy benefit managers
and purchasers.
‘‘(III) Health maintenance organizations and
other managed health care organizations.
‘‘(IV) Health care insurers and governmental
agencies.
‘‘(V) Patients and consumers.
‘‘(iii) To improve the quality of health care while
reducing the cost of health care through—
‘‘(I) an increase in the appropriate use of
drugs, biological products, or devices; and
‘‘(II) the prevention of adverse effects of drugs,
biological products, and devices and the consequences of such effects, such as unnecessary hospitalizations.
‘‘(B) The conduct of research on the comparative
effectiveness, cost-effectiveness, and safety of drugs,
biological products, and devices.
‘‘(C) Such other activities as the Secretary determines
to be appropriate, except that a grant may not be expended
to assist the Secretary in the review of new drugs, biological
products, and devices.

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‘‘(c) REDUCING ERRORS IN MEDICINE.—The Director shall conduct and support research and build private-public partnerships
to—
‘‘(1) identify the causes of preventable health care errors
and patient injury in health care delivery;
‘‘(2) develop, demonstrate, and evaluate strategies for
reducing errors and improving patient safety; and
‘‘(3) disseminate such effective strategies throughout the
health care industry.
‘‘SEC. 913. INFORMATION ON QUALITY AND COST OF CARE.

‘‘(a) IN GENERAL.—The Director shall—
‘‘(1) conduct a survey to collect data on a nationally representative sample of the population on the cost, use and,
for fiscal year 2001 and subsequent fiscal years, quality of
health care, including the types of health care services Americans use, their access to health care services, frequency of
use, how much is paid for the services used, the source of
those payments, the types and costs of private health insurance,
access, satisfaction, and quality of care for the general population including rural residents and also for populations identified in section 901(c); and
‘‘(2) develop databases and tools that provide information
to States on the quality, access, and use of health care services
provided to their residents.
‘‘(b) QUALITY AND OUTCOMES INFORMATION.—
‘‘(1) IN GENERAL.—Beginning in fiscal year 2001, the
Director shall ensure that the survey conducted under subsection (a)(1) will—
‘‘(A) identify determinants of health outcomes and functional status, including the health care needs of populations
identified in section 901(c), provide data to study the relationships between health care quality, outcomes, access,
use, and cost, measure changes over time, and monitor
the overall national impact of Federal and State policy
changes on health care;
‘‘(B) provide information on the quality of care and
patient outcomes for frequently occurring clinical conditions
for a nationally representative sample of the population
including rural residents; and
‘‘(C) provide reliable national estimates for children
and persons with special health care needs through the
use of supplements or periodic expansions of the survey.
In expanding the Medical Expenditure Panel Survey, as in
existence on the date of the enactment of this title in fiscal
year 2001 to collect information on the quality of care, the
Director shall take into account any outcomes measurements
generally collected by private sector accreditation organizations.
‘‘(2) ANNUAL REPORT.—Beginning in fiscal year 2003, the
Secretary, acting through the Director, shall submit to Congress
an annual report on national trends in the quality of health
care provided to the American people.
‘‘SEC. 914. INFORMATION SYSTEMS FOR HEALTH CARE IMPROVEMENT.

‘‘(a) IN GENERAL.—In order to foster a range of innovative
approaches to the management and communication of health
information, the Agency shall conduct and support research, evaluations, and initiatives to advance—

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‘‘(1) the use of information systems for the study of health
care quality and outcomes, including the generation of both
individual provider and plan-level comparative performance
data;
‘‘(2) training for health care practitioners and researchers
in the use of information systems;
‘‘(3) the creation of effective linkages between various
sources of health information, including the development of
information networks;
‘‘(4) the delivery and coordination of evidence-based health
care services, including the use of real-time health care decision-support programs;
‘‘(5) the utility and comparability of health information
data and medical vocabularies by addressing issues related
to the content, structure, definitions and coding of such information and data in consultation with appropriate Federal, State
and private entities;
‘‘(6) the use of computer-based health records in all settings
for the development of personal health records for individual
health assessment and maintenance, and for monitoring public
health and outcomes of care within populations; and
‘‘(7) the protection of individually identifiable information
in health services research and health care quality improvement.
‘‘(b) DEMONSTRATION.—The Agency shall support demonstrations into the use of new information tools aimed at improving
shared decision-making between patients and their care-givers.
‘‘(c) FACILITATING PUBLIC ACCESS TO INFORMATION.—The
Director shall work with appropriate public and private sector entities to facilitate public access to information regarding the quality
of and consumer satisfaction with health care.
‘‘SEC. 915. RESEARCH SUPPORTING PRIMARY CARE AND ACCESS IN
UNDERSERVED AREAS.

‘‘(a) PREVENTIVE SERVICES TASK FORCE.—
‘‘(1) ESTABLISHMENT AND PURPOSE.—The Director may
periodically convene a Preventive Services Task Force to be
composed of individuals with appropriate expertise. Such a
task force shall review the scientific evidence related to the
effectiveness, appropriateness, and cost-effectiveness of clinical
preventive services for the purpose of developing recommendations for the health care community, and updating previous
clinical preventive recommendations.
‘‘(2) ROLE OF AGENCY.—The Agency shall provide ongoing
administrative, research, and technical support for the operations of the Preventive Services Task Force, including coordinating and supporting the dissemination of the recommendations of the Task Force.
‘‘(3) OPERATION.—In carrying out its responsibilities under
paragraph (1), the Task Force is not subject to the provisions
of Appendix 2 of title 5, United States Code.
‘‘(b) PRIMARY CARE RESEARCH.—
‘‘(1) IN GENERAL.—There is established within the Agency
a Center for Primary Care Research (referred to in this subsection as the ‘Center’) that shall serve as the principal source
of funding for primary care practice research in the Department
of Health and Human Services. For purposes of this paragraph,

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primary care research focuses on the first contact when illness
or health concerns arise, the diagnosis, treatment or referral
to specialty care, preventive care, and the relationship between
the clinician and the patient in the context of the family and
community.
‘‘(2) RESEARCH.—In carrying out this section, the Center
shall conduct and support research concerning—
‘‘(A) the nature and characteristics of primary care
practice;
‘‘(B) the management of commonly occurring clinical
problems;
‘‘(C) the management of undifferentiated clinical problems; and
‘‘(D) the continuity and coordination of health services.
‘‘SEC. 916. HEALTH CARE PRACTICE AND TECHNOLOGY INNOVATION.

‘‘(a) IN GENERAL.—The Director shall promote innovation in
evidence-based health care practices and technologies by—
‘‘(1) conducting and supporting research on the development, diffusion, and use of health care technology;
‘‘(2) developing, evaluating, and disseminating methodologies for assessments of health care practices and technologies;
‘‘(3) conducting intramural and supporting extramural
assessments of existing and new health care practices and
technologies;
‘‘(4) promoting education and training and providing technical assistance in the use of health care practice and technology assessment methodologies and results; and
‘‘(5) working with the National Library of Medicine and
the public and private sector to develop an electronic clearinghouse of currently available assessments and those in progress.
‘‘(b) SPECIFICATION OF PROCESS.—
‘‘(1) IN GENERAL.—Not later than December 31, 2000, the
Director shall develop and publish a description of the methods
used by the Agency and its contractors for health care practice
and technology assessment.
‘‘(2) CONSULTATIONS.—In carrying out this subsection, the
Director shall cooperate and consult with the Assistant Secretary for Health, the Administrator of the Health Care
Financing Administration, the Director of the National
Institutes of Health, the Commissioner of Food and Drugs,
and the heads of any other interested Federal department
or agency, and shall seek input, where appropriate, from professional societies and other private and public entities.
‘‘(3) METHODOLOGY.—The Director shall, in developing the
methods used under paragraph (1), consider—
‘‘(A) safety, efficacy, and effectiveness;
‘‘(B) legal, social, and ethical implications;
‘‘(C) costs, benefits, and cost-effectiveness;
‘‘(D) comparisons to alternate health care practices and
technologies; and
‘‘(E) requirements of Food and Drug Administration
approval to avoid duplication.
‘‘(c) SPECIFIC ASSESSMENTS.—
‘‘(1) IN GENERAL.—The Director shall conduct or support
specific assessments of health care technologies and practices.

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‘‘(2) REQUESTS FOR ASSESSMENTS.—The Director is authorized to conduct or support assessments, on a reimbursable
basis, for the Health Care Financing Administration, the
Department of Defense, the Department of Veterans Affairs,
the Office of Personnel Management, and other public or private
entities.
‘‘(3) GRANTS AND CONTRACTS.—In addition to conducting
assessments, the Director may make grants to, or enter into
cooperative agreements or contracts with, entities described
in paragraph (4) for the purpose of conducting assessments
of experimental, emerging, existing, or potentially outmoded
health care technologies, and for related activities.
‘‘(4) ELIGIBLE ENTITIES.—An entity described in this paragraph is an entity that is determined to be appropriate by
the Director, including academic medical centers, research
institutions and organizations, professional organizations, third
party payers, governmental agencies, minority institutions of
higher education (such as Historically Black Colleges and
Universities, and Hispanic institutions), and consortia of appropriate research entities established for the purpose of conducting technology assessments.
‘‘(d) MEDICAL EXAMINATION OF CERTAIN VICTIMS.—
‘‘(1) IN GENERAL.—The Director shall develop and disseminate a report on evidence-based clinical practices for—
‘‘(A) the examination and treatment by health professionals of individuals who are victims of sexual assault
(including child molestation) or attempted sexual assault;
and
‘‘(B) the training of health professionals, in consultation
with the Health Resources and Services Administration,
on performing medical evidentiary examinations of individuals who are victims of child abuse or neglect, sexual
assault, elder abuse, or domestic violence.
‘‘(2) CERTAIN CONSIDERATIONS.—In identifying the issues
to be addressed by the report, the Director shall, to the extent
practicable, take into consideration the expertise and experience
of Federal and State law enforcement officials regarding the
victims referred to in paragraph (1), and of other appropriate
public and private entities (including medical societies, victim
services organizations, sexual assault prevention organizations,
and social services organizations).
‘‘SEC. 917. COORDINATION OF FEDERAL
IMPROVEMENT EFFORTS.

GOVERNMENT

QUALITY

‘‘(a) REQUIREMENT.—
‘‘(1) IN GENERAL.—To avoid duplication and ensure that
Federal resources are used efficiently and effectively, the Secretary, acting through the Director, shall coordinate all
research, evaluations, and demonstrations related to health
services research, quality measurement and quality improvement activities undertaken and supported by the Federal
Government.
‘‘(2) SPECIFIC ACTIVITIES.—The Director, in collaboration
with the appropriate Federal officials representing all concerned
executive agencies and departments, shall develop and manage
a process to—

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‘‘(A) improve interagency coordination, priority setting,
and the use and sharing of research findings and data
pertaining to Federal quality improvement programs, technology assessment, and health services research;
‘‘(B) strengthen the research information infrastructure, including databases, pertaining to Federal health
services research and health care quality improvement initiatives;
‘‘(C) set specific goals for participating agencies and
departments to further health services research and health
care quality improvement; and
‘‘(D) strengthen the management of Federal health care
quality improvement programs.
‘‘(b) STUDY BY THE INSTITUTE OF MEDICINE.—
‘‘(1) IN GENERAL.—To provide Congress, the Department
of Health and Human Services, and other relevant departments
with an independent, external review of their quality oversight,
quality improvement and quality research programs, the Secretary shall enter into a contract with the Institute of
Medicine—
‘‘(A) to describe and evaluate current quality improvement, quality research and quality monitoring processes
through—
‘‘(i) an overview of pertinent health services
research activities and quality improvement efforts
conducted by all Federal programs, with particular
attention paid to those under titles XVIII, XIX, and
XXI of the Social Security Act; and
‘‘(ii) a summary of the partnerships that the
Department of Health and Human Services has pursued with private accreditation, quality measurement
and improvement organizations; and
‘‘(B) to identify options and make recommendations
to improve the efficiency and effectiveness of quality
improvement programs through—
‘‘(i) the improved coordination of activities across
the medicare, medicaid and child health insurance programs under titles XVIII, XIX and XXI of the Social
Security Act and health services research programs;
‘‘(ii) the strengthening of patient choice and participation by incorporating state-of-the-art quality monitoring tools and making information on quality available; and
‘‘(iii) the enhancement of the most effective programs, consolidation as appropriate, and elimination
of duplicative activities within various Federal agencies.
‘‘(2) REQUIREMENTS.—
‘‘(A) IN GENERAL.—The Secretary shall enter into a
contract with the Institute of Medicine for the
preparation—
‘‘(i) not later than 12 months after the date of
the enactment of this title, of a report providing an
overview of the quality improvement programs of the
Department of Health and Human Services for the
medicare, medicaid, and CHIP programs under titles
XVIII, XIX, and XXI of the Social Security Act; and

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‘‘(ii) not later than 24 months after the date of
the enactment of this title, of a final report containing
recommendations.
‘‘(B) REPORTS.—The Secretary shall submit the reports
described in subparagraph (A) to the Committee on Finance
and the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Ways and Means
and the Committee on Commerce of the House of Representatives.

‘‘PART C—GENERAL PROVISIONS
‘‘SEC. 921. ADVISORY COUNCIL FOR HEALTHCARE RESEARCH AND
QUALITY.

‘‘(a) ESTABLISHMENT.—There is established an advisory council
to be known as the National Advisory Council for Healthcare
Research and Quality.
‘‘(b) DUTIES.—
‘‘(1) IN GENERAL.—The Advisory Council shall advise the
Secretary and the Director with respect to activities proposed
or undertaken to carry out the mission of the Agency under
section 901(b).
‘‘(2) CERTAIN RECOMMENDATIONS.—Activities of the
Advisory Council under paragraph (1) shall include making
recommendations to the Director regarding—
‘‘(A) priorities regarding health care research, especially studies related to quality, outcomes, cost and the
utilization of, and access to, health care services;
‘‘(B) the field of health care research and related disciplines, especially issues related to training needs, and
dissemination of information pertaining to health care
quality; and
‘‘(C) the appropriate role of the Agency in each of
these areas in light of private sector activity and identification of opportunities for public-private sector partnerships.
‘‘(c) MEMBERSHIP.—
‘‘(1) IN GENERAL.—The Advisory Council shall, in accordance with this subsection, be composed of appointed members
and ex officio members. All members of the Advisory Council
shall be voting members other than the individuals designated
under paragraph (3)(B) as ex officio members.
‘‘(2) APPOINTED MEMBERS.—The Secretary shall appoint to
the Advisory Council 21 appropriately qualified individuals.
At least 17 members of the Advisory Council shall be representatives of the public who are not officers or employees of the
United States and at least 1 member who shall be a specialist
in the rural aspects of 1 or more of the professions or fields
described in subparagraphs (A) through (G). The Secretary
shall ensure that the appointed members of the Council, as
a group, are representative of professions and entities concerned
with, or affected by, activities under this title and under section
1142 of the Social Security Act. Of such members—
‘‘(A) three shall be individuals distinguished in the
conduct of research, demonstration projects, and evaluations with respect to health care;

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‘‘(B) three shall be individuals distinguished in the
fields of health care quality research or health care
improvement;
‘‘(C) three shall be individuals distinguished in the
practice of medicine of which at least one shall be a primary
care practitioner;
‘‘(D) three shall be individuals distinguished in the
other health professions;
‘‘(E) three shall be individuals either representing the
private health care sector, including health plans, providers, and purchasers or individuals distinguished as
administrators of health care delivery systems;
‘‘(F) three shall be individuals distinguished in the
fields of health care economics, information systems, law,
ethics, business, or public policy; and
‘‘(G) three shall be individuals representing the
interests of patients and consumers of health care.
‘‘(3) EX OFFICIO MEMBERS.—The Secretary shall designate
as ex officio members of the Advisory Council—
‘‘(A) the Assistant Secretary for Health, the Director
of the National Institutes of Health, the Director of the
Centers for Disease Control and Prevention, the Administrator of the Health Care Financing Administration, the
Commissioner of the Food and Drug Administration, the
Director of the Office of Personnel Management, the Assistant Secretary of Defense (Health Affairs), and the Under
Secretary for Health of the Department of Veterans Affairs;
and
‘‘(B) such other Federal officials as the Secretary may
consider appropriate.
‘‘(d) TERMS.—
‘‘(1) IN GENERAL.—Members of the Advisory Council
appointed under subsection (c)(2) shall serve for a term of
3 years.
‘‘(2) STAGGERED TERMS.—To ensure the staggered rotation
of one-third of the members of the Advisory Council each year,
the Secretary is authorized to appoint the initial members
of the Advisory Council for terms of 1, 2, or 3 years.
‘‘(3) SERVICE BEYOND TERM.—A member of the Council
appointed under subsection (c)(2) may continue to serve after
the expiration of the term of the members until a successor
is appointed.
‘‘(e) VACANCIES.—If a member of the Advisory Council appointed
under subsection (c)(2) does not serve the full term applicable
under subsection (d), the individual appointed to fill the resulting
vacancy shall be appointed for the remainder of the term of the
predecessor of the individual.
‘‘(f) CHAIR.—The Director shall, from among the members of
the Advisory Council appointed under subsection (c)(2), designate
an individual to serve as the chair of the Advisory Council.
‘‘(g) MEETINGS.—The Advisory Council shall meet not less than
once during each discrete 4-month period and shall otherwise meet
at the call of the Director or the chair.
‘‘(h) COMPENSATION AND REIMBURSEMENT OF EXPENSES.—

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‘‘(1) APPOINTED MEMBERS.—Members of the Advisory
Council appointed under subsection (c)(2) shall receive compensation for each day (including travel time) engaged in carrying out the duties of the Advisory Council unless declined
by the member. Such compensation may not be in an amount
in excess of the daily equivalent of the annual rate of basic
pay prescribed for level IV of the Executive Schedule under
section 5315 of title 5, United States Code, for each day during
which such member is engaged in the performance of the duties
of the Advisory Council.
‘‘(2) EX OFFICIO MEMBERS.—Officials designated under subsection (c)(3) as ex officio members of the Advisory Council
may not receive compensation for service on the Advisory
Council in addition to the compensation otherwise received
for duties carried out as officers of the United States.
‘‘(i) STAFF.—The Director shall provide to the Advisory Council
such staff, information, and other assistance as may be necessary
to carry out the duties of the Council.
‘‘(j) DURATION.—Notwithstanding section 14(a) of the Federal
Advisory Committee Act, the Advisory Council shall continue in
existence until otherwise provided by law.
‘‘SEC. 922. PEER REVIEW WITH RESPECT TO GRANTS AND CONTRACTS.

‘‘(a) REQUIREMENT OF REVIEW.—
‘‘(1) IN GENERAL.—Appropriate technical and scientific peer
review shall be conducted with respect to each application
for a grant, cooperative agreement, or contract under this title.
‘‘(2) REPORTS TO DIRECTOR.—Each peer review group to
which an application is submitted pursuant to paragraph (1)
shall report its finding and recommendations respecting the
application to the Director in such form and in such manner
as the Director shall require.
‘‘(b) APPROVAL AS PRECONDITION OF AWARDS.—The Director
may not approve an application described in subsection (a)(1) unless
the application is recommended for approval by a peer review
group established under subsection (c).
‘‘(c) ESTABLISHMENT OF PEER REVIEW GROUPS.—
‘‘(1) IN GENERAL.—The Director shall establish such technical and scientific peer review groups as may be necessary
to carry out this section. Such groups shall be established
without regard to the provisions of title 5, United States Code,
that govern appointments in the competitive service, and without regard to the provisions of chapter 51, and subchapter
III of chapter 53, of such title that relate to classification
and pay rates under the General Schedule.
‘‘(2) MEMBERSHIP.—The members of any peer review group
established under this section shall be appointed from among
individuals who by virtue of their training or experience are
eminently qualified to carry out the duties of such peer review
group. Officers and employees of the United States may not
constitute more than 25 percent of the membership of any
such group. Such officers and employees may not receive compensation for service on such groups in addition to the compensation otherwise received for these duties carried out as
such officers and employees.
‘‘(3) DURATION.—Notwithstanding section 14(a) of the Federal Advisory Committee Act, peer review groups established

S. 580—14
under this section may continue in existence until otherwise
provided by law.
‘‘(4) QUALIFICATIONS.—Members of any peer review group
shall, at a minimum, meet the following requirements:
‘‘(A) Such members shall agree in writing to treat
information received, pursuant to their work for the group,
as confidential information, except that this subparagraph
shall not apply to public records and public information.
‘‘(B) Such members shall agree in writing to recuse
themselves from participation in the peer review of specific
applications which present a potential personal conflict
of interest or appearance of such conflict, including employment in a directly affected organization, stock ownership,
or any financial or other arrangement that might introduce
bias in the process of peer review.
‘‘(d) AUTHORITY FOR PROCEDURAL ADJUSTMENTS IN CERTAIN
CASES.—In the case of applications for financial assistance whose
direct costs will not exceed $100,000, the Director may make appropriate adjustments in the procedures otherwise established by the
Director for the conduct of peer review under this section. Such
adjustments may be made for the purpose of encouraging the entry
of individuals into the field of research, for the purpose of encouraging clinical practice-oriented or provider-based research, and for
such other purposes as the Director may determine to be appropriate.
‘‘(e) REGULATIONS.—The Director shall issue regulations for
the conduct of peer review under this section.
‘‘SEC. 923. CERTAIN PROVISIONS WITH RESPECT TO DEVELOPMENT,
COLLECTION, AND DISSEMINATION OF DATA.

‘‘(a) STANDARDS WITH RESPECT TO UTILITY OF DATA.—
‘‘(1) IN GENERAL.—To ensure the utility, accuracy, and sufficiency of data collected by or for the Agency for the purpose
described in section 901(b), the Director shall establish standard
methods for developing and collecting such data, taking into
consideration—
‘‘(A) other Federal health data collection standards;
and
‘‘(B) the differences between types of health care plans,
delivery systems, health care providers, and provider
arrangements.
‘‘(2) RELATIONSHIP WITH OTHER DEPARTMENT PROGRAMS.—
In any case where standards under paragraph (1) may affect
the administration of other programs carried out by the Department of Health and Human Services, including the programs
under title XVIII, XIX or XXI of the Social Security Act, or
may affect health information that is subject to a standard
developed under part C of title XI of the Social Security Act,
they shall be in the form of recommendations to the Secretary
for such program.
‘‘(b) STATISTICS AND ANALYSES.—The Director shall—
‘‘(1) take appropriate action to ensure that statistics and
analyses developed under this title are of high quality, timely,
and duly comprehensive, and that the statistics are specific,
standardized, and adequately analyzed and indexed; and
‘‘(2) publish, make available, and disseminate such statistics and analyses on as wide a basis as is practicable.

S. 580—15
‘‘(c) AUTHORITY REGARDING CERTAIN REQUESTS.—Upon request
of a public or private entity, the Director may conduct or support
research or analyses otherwise authorized by this title pursuant
to arrangements under which such entity will pay the cost of
the services provided. Amounts received by the Director under
such arrangements shall be available to the Director for obligation
until expended.
‘‘SEC. 924. DISSEMINATION OF INFORMATION.

‘‘(a) IN GENERAL.—The Director shall—
‘‘(1) without regard to section 501 of title 44, United States
Code, promptly publish, make available, and otherwise disseminate, in a form understandable and on as broad a basis as
practicable so as to maximize its use, the results of research,
demonstration projects, and evaluations conducted or supported
under this title;
‘‘(2) ensure that information disseminated by the Agency
is science-based and objective and undertakes consultation as
necessary to assess the appropriateness and usefulness of the
presentation of information that is targeted to specific
audiences;
‘‘(3) promptly make available to the public data developed
in such research, demonstration projects, and evaluations;
‘‘(4) provide, in collaboration with the National Library
of Medicine where appropriate, indexing, abstracting, translating, publishing, and other services leading to a more effective
and timely dissemination of information on research, demonstration projects, and evaluations with respect to health care
to public and private entities and individuals engaged in the
improvement of health care delivery and the general public,
and undertake programs to develop new or improved methods
for making such information available; and
‘‘(5) as appropriate, provide technical assistance to State
and local government and health agencies and conduct liaison
activities to such agencies to foster dissemination.
‘‘(b) PROHIBITION AGAINST RESTRICTIONS.—Except as provided
in subsection (c), the Director may not restrict the publication
or dissemination of data from, or the results of, projects conducted
or supported under this title.
‘‘(c) LIMITATION ON USE OF CERTAIN INFORMATION.—No
information, if an establishment or person supplying the information or described in it is identifiable, obtained in the course of
activities undertaken or supported under this title may be used
for any purpose other than the purpose for which it was supplied
unless such establishment or person has consented (as determined
under regulations of the Director) to its use for such other purpose.
Such information may not be published or released in other form
if the person who supplied the information or who is described
in it is identifiable unless such person has consented (as determined
under regulations of the Director) to its publication or release
in other form.
‘‘(d) PENALTY.—Any person who violates subsection (c) shall
be subject to a civil monetary penalty of not more than $10,000
for each such violation involved. Such penalty shall be imposed
and collected in the same manner as civil money penalties under
subsection (a) of section 1128A of the Social Security Act are
imposed and collected.

S. 580—16
‘‘SEC. 925. ADDITIONAL PROVISIONS WITH RESPECT TO GRANTS AND
CONTRACTS.

‘‘(a) FINANCIAL CONFLICTS OF INTEREST.—With respect to
projects for which awards of grants, cooperative agreements, or
contracts are authorized to be made under this title, the Director
shall by regulation define—
‘‘(1) the specific circumstances that constitute financial
interests in such projects that will, or may be reasonably
expected to, create a bias in favor of obtaining results in the
projects that are consistent with such interests; and
‘‘(2) the actions that will be taken by the Director in
response to any such interests identified by the Director.
‘‘(b) REQUIREMENT OF APPLICATION.—The Director may not,
with respect to any program under this title authorizing the provision of grants, cooperative agreements, or contracts, provide any
such financial assistance unless an application for the assistance
is submitted to the Secretary and the application is in such form,
is made in such manner, and contains such agreements, assurances,
and information as the Director determines to be necessary to
carry out the program involved.
‘‘(c) PROVISION OF SUPPLIES AND SERVICES IN LIEU OF FUNDS.—
‘‘(1) IN GENERAL.—Upon the request of an entity receiving
a grant, cooperative agreement, or contract under this title,
the Secretary may, subject to paragraph (2), provide supplies,
equipment, and services for the purpose of aiding the entity
in carrying out the project involved and, for such purpose,
may detail to the entity any officer or employee of the Department of Health and Human Services.
‘‘(2) CORRESPONDING REDUCTION IN FUNDS.—With respect
to a request described in paragraph (1), the Secretary shall
reduce the amount of the financial assistance involved by an
amount equal to the costs of detailing personnel and the fair
market value of any supplies, equipment, or services provided
by the Director. The Secretary shall, for the payment of
expenses incurred in complying with such request, expend the
amounts withheld.
‘‘(d) APPLICABILITY OF CERTAIN PROVISIONS WITH RESPECT TO
CONTRACTS.—Contracts may be entered into under this part without
regard to sections 3648 and 3709 of the Revised Statutes (31 U.S.C.
529 and 41 U.S.C. 5).
‘‘SEC. 926. CERTAIN ADMINISTRATIVE AUTHORITIES.

‘‘(a) DEPUTY DIRECTOR AND OTHER OFFICERS AND EMPLOYEES.—
‘‘(1) DEPUTY DIRECTOR.—The Director may appoint a deputy
director for the Agency.
‘‘(2) OTHER OFFICERS AND EMPLOYEES.—The Director may
appoint and fix the compensation of such officers and employees
as may be necessary to carry out this title. Except as otherwise
provided by law, such officers and employees shall be appointed
in accordance with the civil service laws and their compensation
fixed in accordance with title 5, United States Code.
‘‘(b) FACILITIES.—The Secretary, in carrying out this title—
‘‘(1) may acquire, without regard to the Act of March 3,
1877 (40 U.S.C. 34), by lease or otherwise through the Administrator of General Services, buildings or portions of buildings
in the District of Columbia or communities located adjacent

S. 580—17
to the District of Columbia for use for a period not to exceed
10 years; and
‘‘(2) may acquire, construct, improve, repair, operate, and
maintain laboratory, research, and other necessary facilities
and equipment, and such other real or personal property
(including patents) as the Secretary deems necessary.
‘‘(c) PROVISION OF FINANCIAL ASSISTANCE.—The Director, in
carrying out this title, may make grants to public and nonprofit
entities and individuals, and may enter into cooperative agreements
or contracts with public and private entities and individuals.
‘‘(d) UTILIZATION OF CERTAIN PERSONNEL AND RESOURCES.—
‘‘(1) DEPARTMENT OF HEALTH AND HUMAN SERVICES.—The
Director, in carrying out this title, may utilize personnel and
equipment, facilities, and other physical resources of the
Department of Health and Human Services, permit appropriate
(as determined by the Secretary) entities and individuals to
utilize the physical resources of such Department, and provide
technical assistance and advice.
‘‘(2) OTHER AGENCIES.—The Director, in carrying out this
title, may use, with their consent, the services, equipment,
personnel, information, and facilities of other Federal, State,
or local public agencies, or of any foreign government, with
or without reimbursement of such agencies.
‘‘(e) CONSULTANTS.—The Secretary, in carrying out this title,
may secure, from time to time and for such periods as the Director
deems advisable but in accordance with section 3109 of title 5,
United States Code, the assistance and advice of consultants from
the United States or abroad.
‘‘(f) EXPERTS.—
‘‘(1) IN GENERAL.—The Secretary may, in carrying out this
title, obtain the services of not more than 50 experts or consultants who have appropriate scientific or professional qualifications. Such experts or consultants shall be obtained in accordance with section 3109 of title 5, United States Code, except
that the limitation in such section on the duration of service
shall not apply.
‘‘(2) TRAVEL EXPENSES.—
‘‘(A) IN GENERAL.—Experts and consultants whose services are obtained under paragraph (1) shall be paid or
reimbursed for their expenses associated with traveling
to and from their assignment location in accordance with
sections 5724, 5724a(a), 5724a(c), and 5726(c) of title 5,
United States Code.
‘‘(B) LIMITATION.—Expenses specified in subparagraph
(A) may not be allowed in connection with the assignment
of an expert or consultant whose services are obtained
under paragraph (1) unless and until the expert agrees
in writing to complete the entire period of assignment,
or 1 year, whichever is shorter, unless separated or
reassigned for reasons that are beyond the control of the
expert or consultant and that are acceptable to the Secretary. If the expert or consultant violates the agreement,
the money spent by the United States for the expenses
specified in subparagraph (A) is recoverable from the expert
or consultant as a statutory obligation owed to the United
States. The Secretary may waive in whole or in part a
right of recovery under this subparagraph.

S. 580—18
‘‘(g) VOLUNTARY AND UNCOMPENSATED SERVICES.—The Director,
in carrying out this title, may accept voluntary and uncompensated
services.
‘‘SEC. 927. FUNDING.

‘‘(a) INTENT.—To ensure that the United States investment
in biomedical research is rapidly translated into improvements in
the quality of patient care, there must be a corresponding investment in research on the most effective clinical and organizational
strategies for use of these findings in daily practice. The authorization levels in subsections (b) and (c) provide for a proportionate
increase in health care research as the United States investment
in biomedical research increases.
‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this title, there are authorized to be appropriated
$250,000,000 for fiscal year 2000, and such sums as may be necessary for each of the fiscal years 2001 through 2005.
‘‘(c) EVALUATIONS.—In addition to amounts available pursuant
to subsection (b) for carrying out this title, there shall be made
available for such purpose, from the amounts made available pursuant to section 241 (relating to evaluations), an amount equal to
40 percent of the maximum amount authorized in such section
241 to be made available for a fiscal year.
‘‘SEC. 928. DEFINITIONS.

‘‘In this title:
‘‘(1) ADVISORY COUNCIL.—The term ‘Advisory Council’
means the National Advisory Council on Healthcare Research
and Quality established under section 921.
‘‘(2) AGENCY.—The term ‘Agency’ means the Agency for
Healthcare Research and Quality.
‘‘(3) DIRECTOR.—The term ‘Director’ means the Director
of the Agency for Healthcare Research and Quality.’’.
(b) RULES OF CONSTRUCTION.—
(1) IN GENERAL.—Section 901(a) of the Public Health
Service Act (as added by subsection (a) of this section) applies
as a redesignation of the agency that carried out title IX of
such Act on the day before the date of the enactment of this
Act, and not as the termination of such agency and the
establishment of a different agency. The amendment made
by subsection (a) of this section does not affect appointments
of the personnel of such agency who were employed at the
agency on the day before such date, including the appointments
of members of advisory councils or study sections of the agency
who were serving on the day before such date of enactment.
(2) REFERENCES.—Any reference in law to the Agency for
Health Care Policy and Research is deemed to be a reference
to the Agency for Healthcare Research and Quality, and any
reference in law to the Administrator for Health Care Policy
and Research is deemed to be a reference to the Director
of the Agency for Healthcare Research and Quality.
SEC. 3. GRANTS REGARDING UTILIZATION OF PREVENTIVE HEALTH
SERVICES.

Subpart I of part D of title III of the Public Health Service
Act (42 U.S.C. 254b et seq.) is amended by adding at the end
the following section:

S. 580—19
‘‘SEC. 330D. CENTERS FOR STRATEGIES ON FACILITATING UTILIZATION OF PREVENTIVE HEALTH SERVICES AMONG VARIOUS POPULATIONS.

‘‘(a) IN GENERAL.—The Secretary, acting through the appropriate agencies of the Public Health Service, shall make grants
to public or nonprofit private entities for the establishment and
operation of regional centers whose purpose is to develop, evaluate,
and disseminate effective strategies, which utilize quality management measures, to assist public and private health care programs
and providers in the appropriate utilization of preventive health
care services by specific populations.
‘‘(b) RESEARCH AND TRAINING.—The activities carried out by
a center under subsection (a) may include establishing programs
of research and training with respect to the purpose described
in such subsection, including the development of curricula for
training individuals in implementing the strategies developed under
such subsection.
‘‘(c) PRIORITY REGARDING INFANTS AND CHILDREN.—In carrying
out the purpose described in subsection (a), the Secretary shall
give priority to various populations of infants, young children, and
their mothers.
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2000
through 2004.’’.
SEC. 4. PROGRAM OF PAYMENTS TO CHILDREN’S HOSPITALS THAT
OPERATE GRADUATE MEDICAL EDUCATION PROGRAMS.

Part D of title III of the Public Health Service Act (42 U.S.C.
254b et seq.) is amended by adding at the end the following subpart:
‘‘Subpart IX—Support of Graduate Medical Education Programs in
Children’s Hospitals
‘‘SEC. 340E. PROGRAM OF PAYMENTS TO CHILDREN’S HOSPITALS
THAT OPERATE GRADUATE MEDICAL EDUCATION PROGRAMS.

‘‘(a) PAYMENTS.—The Secretary shall make two payments under
this section to each children’s hospital for each of fiscal years
2000 and 2001, one for the direct expenses and the other for
indirect expenses associated with operating approved graduate medical residency training programs.
‘‘(b) AMOUNT OF PAYMENTS.—
‘‘(1) IN GENERAL.—Subject to paragraph (2), the amounts
payable under this section to a children’s hospital for an
approved graduate medical residency training program for a
fiscal year are each of the following amounts:
‘‘(A) DIRECT EXPENSE AMOUNT.—The amount determined under subsection (c) for direct expenses associated
with operating approved graduate medical residency
training programs.
‘‘(B) INDIRECT EXPENSE AMOUNT.—The amount determined under subsection (d) for indirect expenses associated
with the treatment of more severely ill patients and the
additional costs relating to teaching residents in such programs.
‘‘(2) CAPPED AMOUNT.—

S. 580—20
‘‘(A) IN GENERAL.—The total of the payments made
to children’s hospitals under paragraph (1)(A) or paragraph
(1)(B) in a fiscal year shall not exceed the funds appropriated under paragraph (1) or (2), respectively, of subsection (f) for such payments for that fiscal year.
‘‘(B) PRO RATA REDUCTIONS OF PAYMENTS FOR DIRECT
EXPENSES.—If the Secretary determines that the amount
of funds appropriated under subsection (f)(1) for a fiscal
year is insufficient to provide the total amount of payments
otherwise due for such periods under paragraph (1)(A),
the Secretary shall reduce the amounts so payable on a
pro rata basis to reflect such shortfall.
‘‘(c) AMOUNT OF PAYMENT FOR DIRECT GRADUATE MEDICAL EDUCATION.—
‘‘(1) IN GENERAL.—The amount determined under this subsection for payments to a children’s hospital for direct graduate
expenses relating to approved graduate medical residency
training programs for a fiscal year is equal to the product
of—
‘‘(A) the updated per resident amount for direct graduate medical education, as determined under paragraph
(2); and
‘‘(B) the average number of full-time equivalent residents in the hospital’s graduate approved medical residency
training programs (as determined under section 1886(h)(4)
of the Social Security Act during the fiscal year.
‘‘(2) UPDATED PER RESIDENT AMOUNT FOR DIRECT GRADUATE
MEDICAL EDUCATION.—The updated per resident amount for
direct graduate medical education for a hospital for a fiscal
year is an amount determined as follows:
‘‘(A) DETERMINATION OF HOSPITAL SINGLE PER RESIDENT
AMOUNT.—The Secretary shall compute for each hospital
operating an approved graduate medical education program
(regardless of whether or not it is a children’s hospital)
a single per resident amount equal to the average (weighted
by number of full-time equivalent residents) of the primary
care per resident amount and the non-primary care per
resident amount computed under section 1886(h)(2) of the
Social Security Act for cost reporting periods ending during
fiscal year 1997.
‘‘(B) DETERMINATION OF WAGE AND NON-WAGE-RELATED
PROPORTION OF THE SINGLE PER RESIDENT AMOUNT.—The
Secretary shall estimate the average proportion of the
single per resident amounts computed under subparagraph
(A) that is attributable to wages and wage-related costs.
‘‘(C) STANDARDIZING PER RESIDENT AMOUNTS.—The Secretary shall establish a standardized per resident amount
for each such hospital—
‘‘(i) by dividing the single per resident amount
computed under subparagraph (A) into a wage-related
portion and a non-wage-related portion by applying
the proportion determined under subparagraph (B);
‘‘(ii) by dividing the wage-related portion by the
factor applied under section 1886(d)(3)(E) of the Social
Security Act for discharges occurring during fiscal year
1999 for the hospital’s area; and

S. 580—21
‘‘(iii) by adding the non-wage-related portion to
the amount computed under clause (ii).
‘‘(D) DETERMINATION OF NATIONAL AVERAGE.—The Secretary shall compute a national average per resident
amount equal to the average of the standardized per resident amounts computed under subparagraph (C) for such
hospitals, with the amount for each hospital weighted by
the average number of full-time equivalent residents at
such hospital.
‘‘(E) APPLICATION TO INDIVIDUAL HOSPITALS.—The Secretary shall compute for each such hospital that is a children’s hospital a per resident amount—
‘‘(i) by dividing the national average per resident
amount computed under subparagraph (D) into a wagerelated portion and a non-wage-related portion by
applying the proportion determined under subparagraph (B);
‘‘(ii) by multiplying the wage-related portion by
the factor described in subparagraph (C)(ii) for the
hospital’s area; and
‘‘(iii) by adding the non-wage-related portion to
the amount computed under clause (ii).
‘‘(F) UPDATING RATE.—The Secretary shall update such
per resident amount for each such children’s hospital by
the estimated percentage increase in the consumer price
index for all urban consumers during the period beginning
October 1997 and ending with the midpoint of the hospital’s
cost reporting period that begins during fiscal year 2000.
‘‘(d) AMOUNT OF PAYMENT FOR INDIRECT MEDICAL EDUCATION.—
‘‘(1) IN GENERAL.—The amount determined under this subsection for payments to a children’s hospital for indirect
expenses associated with the treatment of more severely ill
patients and the additional costs related to the teaching of
residents for a fiscal year is equal to an amount determined
appropriate by the Secretary.
‘‘(2) FACTORS.—In determining the amount under paragraph (1), the Secretary shall—
‘‘(A) take into account variations in case mix among
children’s hospitals and the number of full-time equivalent
residents in the hospitals’ approved graduate medical residency training programs; and
‘‘(B) assure that the aggregate of the payments for
indirect expenses associated with the treatment of more
severely ill patients and the additional costs related to
the teaching of residents under this section in a fiscal
year are equal to the amount appropriated for such
expenses for the fiscal year involved under subsection (f)(2).
‘‘(e) MAKING OF PAYMENTS.—
‘‘(1) INTERIM PAYMENTS.—The Secretary shall determine,
before the beginning of each fiscal year involved for which
payments may be made for a hospital under this section, the
amounts of the payments for direct graduate medical education
and indirect medical education for such fiscal year and shall
(subject to paragraph (2)) make the payments of such amounts
in 26 equal interim installments during such period.

S. 580—22
‘‘(2) WITHHOLDING.—The Secretary shall withhold up to
25 percent from each interim installment for direct graduate
medical education paid under paragraph (1).
‘‘(3) RECONCILIATION.—At the end of each fiscal year for
which payments may be made under this section, the hospital
shall submit to the Secretary such information as the Secretary
determines to be necessary to determine the percent (if any)
of the total amount withheld under paragraph (2) that is due
under this section for the hospital for the fiscal year. Based
on such determination, the Secretary shall recoup any overpayments made, or pay any balance due. The amount so determined
shall be considered a final intermediary determination for purposes of applying section 1878 of the Social Security Act and
shall be subject to review under that section in the same
manner as the amount of payment under section 1886(d) of
such Act is subject to review under such section.
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—
‘‘(1) DIRECT GRADUATE MEDICAL EDUCATION.—
‘‘(A) IN GENERAL.—There are hereby authorized to be
appropriated, out of any money in the Treasury not otherwise appropriated, for payments under subsection
(b)(1)(A)—
‘‘(i) for fiscal year 2000, $90,000,000; and
‘‘(ii) for fiscal year 2001, $95,000,000.
‘‘(B) CARRYOVER OF EXCESS.—The amounts appropriated under subparagraph (A) for fiscal year 2000 shall
remain available for obligation through the end of fiscal
year 2001.
‘‘(2) INDIRECT MEDICAL EDUCATION.—There are hereby
authorized to be appropriated, out of any money in the Treasury
not otherwise appropriated, for payments under subsection
(b)(1)(A)—
‘‘(A) for fiscal year 2000, $190,000,000; and
‘‘(B) for fiscal year 2001, $190,000,000.
‘‘(g) DEFINITIONS.—In this section:
‘‘(1) APPROVED GRADUATE MEDICAL RESIDENCY TRAINING
PROGRAM.—The term ‘approved graduate medical residency
training program’ has the meaning given the term ‘approved
medical residency training program’ in section 1886(h)(5)(A)
of the Social Security Act.
‘‘(2) CHILDREN’S HOSPITAL.—The term ‘children’s hospital’
means a hospital described in section 1886(d)(1)(B)(iii) of the
Social Security Act.
‘‘(3) DIRECT GRADUATE MEDICAL EDUCATION COSTS.—The
term ‘direct graduate medical education costs’ has the meaning
given such term in section 1886(h)(5)(C) of the Social Security
Act.’’.

S. 580—23
SEC. 5. STUDY REGARDING SHORTAGES OF LICENSED PHARMACISTS.

(a) IN GENERAL.—The Secretary of Health and Human Services
(in this section referred to as the ‘‘Secretary’’), acting through the
appropriate agencies of the Public Health Service, shall conduct
a study to determine whether and to what extent there is a shortage
of licensed pharmacists. In carrying out the study, the Secretary
shall seek the comments of appropriate public and private entities
regarding any such shortage.
(b) REPORT TO CONGRESS.—Not later than 1 year after the
date of the enactment of this Act, the Secretary shall complete
the study under subsection (a) and submit to the Congress a report
that describes the findings made through the study and that contains a summary of the comments received by the Secretary pursuant to such subsection.
SEC. 6. REPORT ON TELEMEDICINE.

Not later than January 10, 2001, the Secretary of Health and
Human Services shall submit to the Congress a report that—
(1) identifies any factors that inhibit the expansion and
accessibility of telemedicine services, including factors relating
to telemedicine networks;
(2) identifies any factors that, in addition to geographical
isolation, should be used to determine which patients need
or require access to telemedicine care;
(3) determines the extent to which—
(A) patients receiving telemedicine service have benefited from the services, and are satisfied with the treatment
received pursuant to the services; and
(B) the medical outcomes for such patients would have
differed if telemedicine services had not been available
to the patients;
(4) determines the extent to which physicians involved
with telemedicine services have been satisfied with the medical
aspects of the services;
(5) determines the extent to which primary care physicians
are enhancing their medical knowledge and experience through
the interaction with specialists provided by telemedicine consultations; and
(6) identifies legal and medical issues relating to State
licensing of health professionals that are presented by telemedicine services, and provides any recommendations of the Secretary for responding to such issues.

S. 580—24
SEC. 7. CERTAIN TECHNOLOGIES AND PRACTICES REGARDING SURVIVAL RATES FOR CARDIAC ARREST.

The Secretary of Health and Human Services shall, in consultation with the Administrator of the General Services Administration
and other appropriate public and private entities, develop recommendations regarding the placement of automatic external
defibrillators in Federal buildings as a means of improving the
survival rates of individuals who experience cardiac arrest in such
buildings, including recommendations on training, maintenance,
and medical oversight, and on coordinating with the system for
emergency medical services.

Speaker of the House of Representatives.

Vice President of the United States and
President of the Senate.