Home > 106th Congressional Bills > H.R. 2506 (ih) To amend title IX of the Public Health Service Act to revise and extend the Agency for Health Care Policy and Research. [Introduced in House] ...

H.R. 2506 (ih) To amend title IX of the Public Health Service Act to revise and extend the Agency for Health Care Policy and Research. [Introduced in House] ...


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106th CONGRESS

  1st Session

                               H. R. 2506

_______________________________________________________________________

                                 AN ACT

To amend title IX of the Public Health Service Act to revise and extend 
            the Agency for Health Care Policy and Research.
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
106th CONGRESS
  1st Session
                                H. R. 2506

_______________________________________________________________________

                                 AN ACT


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

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Health 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 HEALTH 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 Health 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, 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;
                    ``(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 Special Populations.--There is 
established within the Agency an office to be known as the Office on 
Special Populations, which shall be headed by an official appointed by 
the Director. The Director, acting through such Office, shall conduct 
and support research and evaluations, and support demonstration 
projects, with respect to--
            ``(1) the delivery of health services in inner-city areas 
        and in rural areas (including frontier areas);
            ``(2) health services for low-income groups, and minority 
        groups;
            ``(3) the health of children;
            ``(4) the elderly; and
            ``(5) people with special health care needs, including 
        disabilities, chronic care and end-of-life health care.

``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 multi-disciplinary 
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;
            ``(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) for the Agency.
            ``(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 members of one of the priority 
        populations and the number of trained researchers who are 
        addressing 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.

               ``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 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;
                    ``(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--

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