Home > 106th Congressional Bills > S. 580 (is) To amend title IX of the Public Health Service Act to revise and extend the Agency for Healthcare Policy and Research. [Introduced in Senate] ...S. 580 (is) To amend title IX of the Public Health Service Act to revise and extend the Agency for Healthcare Policy and Research. [Introduced in Senate] ...
106th CONGRESS
1st Session
S. 580
_______________________________________________________________________
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;
``(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 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) 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.
``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;
``(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
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