Title 42, The Public Health and WelfareRelease 119-110
§299b–7 Research on Outcomes of Health Care Items and Services
Title 42 › CHAPTER 6A — PUBLIC HEALTH SERVICE › SUBCHAPTER VII — AGENCY FOR HEALTHCARE RESEARCH AND QUALITY › Part B — Health Care Improvement Research › § 299b–7
Summary
The Secretary, through the Director of the Agency for Healthcare Research and Quality, must run and support research to make health care under titles XVIII, XIX, and XXI of the Social Security Act better, safer, and more efficient. That work must study outcomes, which treatments work best, whether care is appropriate (including prescription drugs), and ways to organize and deliver care more efficiently. The Secretary can use grants, contracts, interagency agreements, demonstrations, evaluations, technology assessments, and provide technical or scientific help. The Secretary must set research priorities with wide public and stakeholder input, make an initial priority list within 6 months after December 8, 2003, and finish the first evaluations within 18 months after that list. Findings and any gaps in evidence must be shared with prescription drug plans under part D and MA–PD plans under part C of title XVIII, other health plans, and the public in easy-to-understand and searchable formats. All scientific evidence and methods used must be made public unless law (including section 1905 of title 18) protects them, and data used must follow the confidentiality rules of title IX of the Public Health Service Act. The Director must not set national rules for clinical practice or quality, and any recommendations must say so. Research should help doctors and patients get the best available evidence while recognizing different patient groups and preferences. The Secretary must also evaluate how these activities affect care and use, and within 18 months after December 8, 2003 identify options to give timelier information, speed adoption of improvements, and develop management tools for titles XIX and XXI (including studying use of claims data for oversight, quality, and cost estimates). The CMS Administrator may not use data from this work to deny coverage of a prescription drug. Congress authorized $50,000,000 for fiscal year 2004 and whatever sums are needed after that.
Full Legal Text
Title 42, §299b–7
The Public Health and Welfare, Source: USLM XML via OLRC
(a)Research, demonstrations, and evaluations
(1)Improvement of effectiveness and efficiency
(A)In general
To improve the quality, effectiveness, and efficiency of health care delivered pursuant to the programs established under titles XVIII, XIX, and XXI of the Social Security Act [42 U.S.C. 1395 et seq., 1396 et seq., 1397aa et seq.], the Secretary acting through the Director of the Agency for Healthcare Research and Quality (in this section referred to as the “Director”), shall conduct and support research to meet the priorities and requests for scientific evidence and information identified by such programs with respect to—
(i)the outcomes, comparative clinical effectiveness, and appropriateness of health care items and services (including prescription drugs); and
(ii)strategies for improving the efficiency and effectiveness of such programs, including the ways in which such items and services are organized, managed, and delivered under such programs.
(B)Specification
To respond to priorities and information requests in subparagraph (A), the Secretary may conduct or support, by grant, contract, or interagency agreement, research, demonstrations, evaluations, technology assessments, or other activities, including the provision of technical assistance, scientific expertise, or methodological assistance.
(2)Priorities
(A)In general
The Secretary shall establish a process to develop priorities that will guide the research, demonstrations, and evaluation activities undertaken pursuant to this section.
(B)Initial list
Not later than 6 months after December 8, 2003, the Secretary shall establish an initial list of priorities for research related to health care items and services (including prescription drugs).
(C)Process
In carrying out subparagraph (A), the Secretary—
(i)shall ensure that there is broad and ongoing consultation with relevant stakeholders in identifying the highest priorities for research, demonstrations, and evaluations to support and improve the programs established under titles XVIII, XIX, and XXI of the Social Security Act [42 U.S.C. 1395 et seq., 1396 et seq., 1397aa et seq.];
(ii)may include health care items and services which impose a high cost on such programs, as well as those which may be underutilized or overutilized and which may significantly improve the prevention, treatment, or cure of diseases and conditions (including chronic conditions) which impose high direct or indirect costs on patients or society; and
(iii)shall ensure that the research and activities undertaken pursuant to this section are responsive to the specified priorities and are conducted in a timely manner.
(3)Evaluation and synthesis of scientific evidence
(A)In general
The Secretary shall—
(i)evaluate and synthesize available scientific evidence related to health care items and services (including prescription drugs) identified as priorities in accordance with paragraph (2) with respect to the comparative clinical effectiveness, outcomes, appropriateness, and provision of such items and services (including prescription drugs);
(ii)identify issues for which existing scientific evidence is insufficient with respect to such health care items and services (including prescription drugs);
(iii)disseminate to prescription drug plans and MA–PD plans under part D of title XVIII of the Social Security Act [42 U.S.C. 1395w–101 et seq.], other health plans, and the public the findings made under clauses (i) and (ii); and
(iv)work in voluntary collaboration with public and private sector entities to facilitate the development of new scientific knowledge regarding health care items and services (including prescription drugs).
(B)Initial research
The Secretary shall complete the evaluation and synthesis of the initial research required by the priority list developed under paragraph (2)(B) not later than 18 months after the development of such list.
(C)Dissemination
(i)In general
To enhance patient safety and the quality of health care, the Secretary shall make available and disseminate in appropriate formats to prescription drugs plans under part D, and MA–PD plans under part C, of title XVIII of the Social Security Act [42 U.S.C. 1395w–101 et seq., 1395w–21 et seq.], other health plans, and the public the evaluations and syntheses prepared pursuant to subparagraph (A) and the findings of research conducted pursuant to paragraph (1). In carrying out this clause the Secretary, in order to facilitate the availability of such evaluations and syntheses or findings at every decision point in the health care system, shall—
(I)present such evaluations and syntheses or findings in a form that is easily understood by the individuals receiving health care items and services (including prescription drugs) under such plans and periodically assess that the requirements of this subclause have been met; and
(II)provide such evaluations and syntheses or findings and other relevant information through easily accessible and searchable electronic mechanisms, and in hard copy formats as appropriate.
(ii)Rule of construction
Nothing in this section shall be construed as—
(I)affecting the authority of the Secretary or the Commissioner of Food and Drugs under the Federal Food, Drug, and Cosmetic Act [21 U.S.C. 301 et seq.] or the Public Health Service Act [42 U.S.C. 201 et seq.]; or
(II)conferring any authority referred to in subclause (I) to the Director.
(D)Accountability
In carrying out this paragraph, the Secretary shall implement activities in a manner that—
(i)makes publicly available all scientific evidence relied upon and the methodologies employed, provided such evidence and method are not protected from public disclosure by section 1905 of title 18 or other applicable law so that the results of the research, analyses, or syntheses can be evaluated or replicated; and
(ii)ensures that any information needs and unresolved issues identified in subparagraph (A)(ii) are taken into account in priority-setting for future research conducted by the Secretary.
(4)Confidentiality
(A)In general
In making use of administrative, clinical, and program data and information developed or collected with respect to the programs established under titles XVIII, XIX, and XXI of the Social Security Act [42 U.S.C. 1395 et seq., 1396 et seq., 1397aa et seq.], for purposes of carrying out the requirements of this section or the activities authorized under title IX of the Public Health Service Act (42 U.S.C. 299 et seq.), such data and information shall be protected in accordance with the confidentiality requirements of title IX of the Public Health Service Act.
(B)Rule of construction
Nothing in this section shall be construed to require or permit the disclosure of data provided to the Secretary that is otherwise protected from disclosure under the Federal Food, Drug, and Cosmetic Act [21 U.S.C. 301 et seq.], section 1905 of title 18, or other applicable law.
(5)Evaluations
The Secretary shall conduct and support evaluations of the activities carried out under this section to determine the extent to which such activities have had an effect on outcomes and utilization of health care items and services.
(6)Improving information available to health care providers, patients, and policymakers
Not later than 18 months after December 8, 2003, the Secretary shall identify options that could be undertaken in voluntary collaboration with private and public entities (as appropriate) for the—
(A)provision of more timely information through the programs established under titles XVIII, XIX, and XXI of the Social Security Act [42 U.S.C. 1395 et seq., 1396 et seq., 1397aa et seq.], regarding the outcomes and quality of patient care, including clinical and patient-reported outcomes, especially with respect to interventions and conditions for which clinical trials would not be feasible or raise ethical concerns that are difficult to address;
(B)acceleration of the adoption of innovation and quality improvement under such programs; and
(C)development of management tools for the programs established under titles XIX and XXI of the Social Security Act [42 U.S.C. 1396 et seq., 1397aa et seq.], and with respect to the programs established under such titles, assess the feasibility of using administrative or claims data, to—
(i)improve oversight by State officials;
(ii)support Federal and State initiatives to improve the quality, safety, and efficiency of services provided under such programs; and
(iii)provide a basis for estimating the fiscal and coverage impact of Federal or State program and policy changes.
(b)Recommendations
(1)Disclaimer
In carrying out this section, the Director shall—
(A)not mandate national standards of clinical practice or quality health care standards; and
(B)include in any recommendations resulting from projects funded and published by the Director, a corresponding reference to the prohibition described in subparagraph (A).
(2)Requirement for implementation
Research, evaluation, and communication activities performed pursuant to this section shall reflect the principle that clinicians and patients should have the best available evidence upon which to make choices in health care items and services, in providers, and in health care delivery systems, recognizing that patient subpopulations and patient and physician preferences may vary.
(3)Rule of construction
Nothing in this section shall be construed to provide the Director with authority to mandate a national standard or require a specific approach to quality measurement and reporting.
(c)Research with respect to dissemination
The Secretary, acting through the Director, may conduct or support research with respect to improving methods of disseminating information in accordance with subsection (a)(3)(C).
(d)Limitation on CMS
The Administrator of the Centers for Medicare & Medicaid Services may not use data obtained in accordance with this section to withhold coverage of a prescription drug.
(e)Authorization of appropriations
There is authorized to be appropriated to carry out this section, $50,000,000 for fiscal year 2004, and such sums as may be necessary for each fiscal year thereafter.
Legislative History
Notes & Related Subsidiaries
Editorial Notes
References in Text
The Social Security Act, referred to in subsec. (a)(1)(A), (2)(C)(i), (3)(A)(iii), (C)(i), (4)(A), (6)(A), (C), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Titles XVIII, XIX, and XXI of the Act are classified generally to subchapters XVIII (§ 1395 et seq.), XIX (§ 1396 et seq.), and XXI (§ 1397aa et seq.), respectively, of chapter 7 of this title. Parts C and D of title XVIII of the Act are classified generally to parts C (§ 1395w–21 et seq.) and D (§ 1395w–101 et seq.), respectively, of subchapter XVIII of chapter 7 of this title. For complete classification of this Act to the Code, see section 1305 of this title and Tables. The Federal Food, Drug, and Cosmetic Act, referred to in subsec. (a)(3)(C)(ii)(I), (4)(B), is act
June 25, 1938, ch. 675, 52 Stat. 1040, which is classified generally to chapter 9 (§ 301 et seq.) of Title 21, Food and Drugs. For complete classification of this Act to the Code, see section 301 of Title 21 and Tables. The Public Health Service Act, referred to in subsec. (a)(3)(C)(ii)(I), (4)(A), is act
July 1, 1944, ch. 373, 58 Stat. 682, which is classified generally to this chapter. Title IX of the Act is classified generally to this subchapter. For complete classification of this Act to the Code, see
Short Title
note set out under section 201 of this title and Tables. Codification Section was enacted as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, and not as part of the Public Health Service Act which comprises this chapter.
Statutory Notes and Related Subsidiaries
Definition of “Secretary”“Secretary” means the Secretary of Health and Human Services, see section 1(c)(2) of Pub. L. 108–173, set out as a note under section 1301 of this title.
Reference
Citations & Metadata
Citation
42 U.S.C. § 299b–7
Title 42, The Public Health and Welfare
Last Updated
Sep 23, 2026
Release point: 119-110