ESTABLISHMENT OF INSTITUTE

(New Section 1202) Establishes in the Department of Health, Education, and Welfare a separate National Institute of Health Care Delivery. The Institute will carry out a multidisciplinary research and development program to improve health care delivery and shall be the principle government agency for improvement of health care in the United States.

FUNCTIONS OF THE INSTITUTE

(New Section 1203) Provides that the function of the Institute is to improve the effectiveness, efficiency and quality of health care in the United States through initiation and support of studies, research, experimentation, development, demonstration, and evaluation of (but not limited to) the following:

1. the existing health care system, emphasizing means and methods to improve the system and the devising and testing of alternative delivery systems;

2. health care systems and subsystems in states, regions, and communities which would give special attention to the effective combination and coordination of public and private methods or systems for health care delivery;

3. preventive medicine and the techniques and technology, including multiphasic screening and testing, to improve the early diagnosis and treatment of diseases, particularly for preschool children;

4. systems and technical components of emergency health care and services, including at least one experimental statewide helicopter transportation emergency care system, which would utilize, where possible, the skills of returning military corpsmen;

5. systems and components of rural health services;

6. the development of policy with respect to long-term care, particularly for mentally and physically handicapped individuals and senior citizens, with special emphasis on alternatives to institutionalization, including the use of home health aides;

7. methods to meet the nation's medical manpower requirements, including new types of manpower and their utilization and the extent to which tasks performed by physicians and other health professionals could be safely delegated to other appropriately trained individuals in both new and existent health occupations;

8. continuing education and the exploration of programs and methods to help health professionals to stay abreast of current developments and to maintain professional excellence;

9. health manpower credentialing, licensing and certification;

10. the medical malpractice problem, particularly as it relates to quality care, the practice of "defensive medicine" and added costs to the public;

11. programs for educating health manpower and the accreditation of these education programs;

12. application of all forms of technology, including computers and other electronic devices, in health care delivery;

13. the efficiency, management, and utilization of new and existing health care facilities including studies of admission practices and examination of cost-finding techniques;

14. the development of tools and methods to improve planning, management, and decisionmaking in the health care system;

15. the development of information by which quality, efficiency, and cost of health care could be measured;

16. the development of uniform accounting practices, financial reporting, and uniform health records;

17. the development and testing of incentive payment mechanisms that would reward efficiency in health care delivery without compromising the quality of care;

18. the needs of individuals, families, and groups for health care and related services, emphasizing the various life styles, including environmental, recreational, and nutritional factors that would bear on an individual's health; identification of those factors affecting acceptance and utilization of health care and related services; and the development of educational materials and methods communicating to the public the importance of personal decisions and actions on health; 19. the economies of health care and related services, and the impact of the total system of health care delivery and related services upon the standards of living and the general stability of the national

economy;

20. proposals for the financing of health care, including the potential cost and benefits, and their impact on the health care system;

21. concepts and data essential to formation of a factual basis for national health policies; and

22. the effects of health care delivery of the organization, functions, and interrelationships of federal, state and local governmental agencies and programs concerned with planning, organization, and financing of health care delivery.

Also requires the Institute to:

1. develop methods and ways to support the training of those individuals who will research, develop, demonstrate, and evaluate the delivery of health care (and its related services);

2. provide technical assistance and develop methods to transfer new information obtained to those public and private entities that are involved in improving the health care delivery system; and

3. collaborate with foreign health care systems in order to promote the advancement of health care delivery in the United States and in cooperating nations.

Requires the Institute to evaluate Federal health programs and their role in improving health care delivery in the United States.

ADMINISTRATIVE PROVISIONS

(New Section 1204) Authorizes the administrative power that enable the Institute to carry out the provisions of title XII. Such powers include: making grants to public or nonprofit private entities to conduct projects in connection with this title and to train individuals to conduct such projects; making contracts with public or private entities to conduct such projects; appointing and compensating personnel; promulgating rules and regulations; acquiring or constructing facilities, equipment, and real property; leasing buildings; employing experts; appointing advisory committees; utilizing other public agencies; accepting voluntary services; accepting unconditional gifts; transferring available funds; establishing procedures to provide

for coordination of activities carried on under title XII with related research and development activities being carried on by other public and private agencies and organizations; and taking such other actions necessary to accomplish the provisions of title XII.

COMPENSATION

(New Section 1205) Provides for compensation of the Director and Deputy Director of the Institute.

JOINT WAIVER FUNDING AUTHORITY

(New Section 1206) Provides the Director, where funds are advanced for a single project by more than one federal agency, may act for all such agencies in administering such funds and permits a single non-federal share requirement to be established according to the portion of the funds advanced by each federal agency. Also authorizes the Director to waive technical grant or contract requirements which are inconsistent with similar requirements of the Institute.

TRANSFER OF RESEARCH FUNDS

(New Section 1207) Permits the transfer of research funds of other government agencies to the Institute if such agency approves such transfer. Requires that such transfers can be made only if the Institute will use such funds for the purpose for which the transfer was made. TRANSFER OF NATIONAL CENTER FOR HEALTH SERVICES RESEARCH AND DEVELOPMENT

(New Section 1208) Transfers the National Center for Health Services Research and Development to the Institute. Authorizes the President to transfer to the Institute those additional functions of the Department of Health, Education, and Welfare that relate to the functions of the Director of the Institute. Such additional transfers must be made within two years after the enactment of this title.

NATIONAL ADVISORY COUNCIL

(New Section 1209) Establishes a National Advisory Council on Health Care Delivery. Council shall consist of twenty-one members including the Secretary of Health, Education, and Welfare, the Chief Medical Officer of the Veterans' Administration, a Department of Defense Medical Officer, the Administrator of the Health Services and Mental Health Administration, the Director of the National Institutes of Health, the Director of the National Institute of Health Care Delivery, and fifteen additional members who are not fulltime employees of the United States. Such additional members are to be appointed by the President and shall be individuals who are recognized as leaders in the medical sciences or in the organization, delivery, and financing of health care, leaders in the management sciences, or representatives of consumers. Of the fifteen, at least seven shall be representatives of consumers who are not related to the delivery of health care.

Appointed members shall serve a four year term. Such members cannot serve more than two consecutive terms.

The Council is directed to:

1. review programs, policies, and priorities of the Institute and centers established under section 1213;

2. examine and coordinate health care delivery efforts in federal agencies to avoid duplication of efforts; and

3. assure that the findings of the Institute are being disseminated and evaluate the impact of such findings.

Directs the Council to submit a progress report on the Institute and its centers (as an appendix to the report required under section 1210).

ANNUAL REPORT

(New Section 1210) Requires the Director of the Institute to submit an annual report to the Secretary of Health, Education, and Welfare to be transmitted to the President and the Congress. Such report must include:

1. an appraisal of the Institute's activities;

2. annotated bibliographies and summaries of research projects performed or supported by the Institute; and

3. recommendations concerning factors that inhibit the implementation of the Institute's findings or factors which inhibit innovation in health care.

HEALTH CARE DELIVERY INFORMATION SERVICES

(New Section 1211) Creates within the National Institute of Health Care Delivery an Office of Health Care Delivery Information Services. The office would provide:

1. for the provision of indexing, abstracting, translating, and other services leading to a more effective dissemination of information on research and development in health care delivery, to public and private agencies, institutions, and individuals engaged in the improvement of health care delivery and the general public; and

2. for the undertaking of programs to develop new or improved methods for making this information available.

AUTHORIZATION

(New Section 1212) There are authorized to be appropriated to carry out the provisions of new title XII (excluding new section 1213): $80 million for fiscal year 1974;

$125 million for fiscal year 1975; and

$150 million for fiscal year 1976.

REGIONAL AND SPECIAL EMPHASIS CENTERS

(New Section 1213) Authorizes the Director of the Institute to enter into cooperative arrangements with public or nonprofit private agencies or institutions to pay all or part of the costs to plan, establish, and provide basic support for:

1. a maximum of eight regional centers specifically designed to carry out multidisciplinary research and development in health care delivery; and

2. two national special emphasis centers (one to be designated as the Health Care Technology Center and the other to be designated as the Health Care Management Center).

Authorizes Federal payments (under this section) to be used for: 1. construction (as deemed necessary by the National Advisory Council on Health Care Delivery);

2. staffing and basic operating costs;

3. research and development;

4. training; and

5. demonstration purposes.

Excluding construction, support under this section must not exceed $2 million per year per center (excluding the Health Care Technology Center). Such support may be funded for a maximum of three years. However, upon additional recommendations of the Council, the Director may extend a center's support for an additional three years. Requires the Commission to determine the location of regional centers (with a view towards the broad geographical distribution of such centers). Requires the Administrative Officer of each regional and national center to submit an annual report.

There are authorized to be appropriated to carry out the provisions of this section:

$20 million for fiscal year 1974;

$25 million for fiscal year 1975; and

$30 million for fiscal year 1976.

SUPPLEMENTAL INCENTIVE GRANTS

(New Section 1214) Authorizes the Director to provide funds to be used to supplement the Federal contribution to research and development projects (under Federal grant-in-aid programs) over and above the originally authorized Federal contribution. Such funds are to provide the incentive assistance to encourage individuals, institutions, and health facilities to participate in research and development projects that might not otherwise be carried out.

Provides that the Federal contribution (as supplemented under this section) cannot exceed 80 percent of the costs. Defines the term "Federal grant-in-aid programs." Provides that not to exceed 10 percent of the funds authorized by title XII shall be available to carry out this section.