§299b–1. Duties

(a) Establishment of forum program

The Administrator shall establish a program to be known as the Forum for Quality and Effectiveness in Health Care. For the purpose of promoting the quality, appropriateness, and effectiveness of health care, the Administrator, using the process set forth in section 299b–2 of this title, shall arrange for the development and periodic review and updating of-

(1) clinically relevant guidelines that may be used by physicians, educators, and health care practitioners to assist in determining how diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically; and

(2) standards of quality, performance measures, and medical review criteria through which health care providers and other appropriate entities may assess or review the provision of health care and assure the quality of such care.

(b) Certain requirements

Guidelines, standards, performance measures, and review criteria under subsection (a) of this section shall-

(1) be based on the best available research and professional judgment regarding the effectiveness and appropriateness of health care services and procedures;

(2) be presented in formats appropriate for use by physicians, health care practitioners, providers, medical educators, and medical review organizations and in formats appropriate for use by consumers of health care;

(3) include treatment-specific or condition-specific practice guidelines for clinical treatments and conditions in forms appropriate for use in clinical practice, for use in educational programs, and for use in reviewing quality and appropriateness of medical care; and ¹

(4) include information on risks and benefits of alternative strategies for prevention, diagnosis, treatment, and management of a given disease, disorder, or other health condition; and

(5) include information on the costs of alternative strategies for the prevention, diagnosis, treatment, and management of a given disease, disorder, or other health condition, where cost information is available and reliable.

(c) Authority for contracts

In carrying out this part, the Administrator may enter into contracts with public or nonprofit private entities.

(d) Date certain for initial guidelines and standards

The Administrator, by not later than January 1, 1991, shall assure the development of an initial set of guidelines, standards, performance measures, and review criteria under subsection (a) of this section that includes not less than 3 clinical treatments or conditions described in section 1142(a)(3) of the Social Security Act [42 U.S.C. 1320b–12(a)(3)].

(e) Relationship with medicare program

To assure an appropriate reflection of the needs and priorities of the program under title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.], activities under this part that affect such program shall be conducted consistent with section 1142 of such Act [42 U.S.C. 1320b–12].

(f) Development of certain guidelines and standards

Not later than January 1, 1996, the Administrator shall ensure that a set of guidelines, standards, performance measures, and review criteria, are developed under subsection (a)(1) of this section that address the prevention of not fewer than three conditions that account for significant national health expenditures. In carrying out this subsection the Administrator shall consult with the United States Preventive Services Task Force and other recognized experts in the field of disease prevention.

(July 1, 1944, ch. 373, title IX, §912, as added Dec. 19, 1989, Pub. L. 101–239, title VI, §6103(a), 103 Stat. 2192 ; amended Oct. 13, 1992, Pub. L. 102–410, §§5(a)(1), (c)(1), 6(b), 106 Stat. 2096 , 2097, 2100.)

References in Text

The Social Security Act, referred to in subsec. (e), is act Aug. 14, 1935, ch. 531, 49 Stat. 620 , as amended. Title XVIII of the Social Security Act is classified generally to subchapter XVIII (§1395 et seq.) of chapter 7 of this title. For complete classification of this Act to the Code, see section 1305 of this title and Tables.

Amendments

1992-Subsec. (a). Pub. L. 102–410, §5(c)(1)(A), struck out ", acting through the Director," after "The Administrator" and substituted "Administrator" for "Director" after "health care, the".

Subsec. (b)(4), (5). Pub. L. 102–410, §5(a)(1), added pars. (4) and (5).

Subsec. (c). Pub. L. 102–410, §5(c)(1)(B), substituted "Administrator" for "Director".

Subsec. (f). Pub. L. 102–410, §6(b), added subsec. (f).

Study and Report on Methods for Collecting and Analyzing Data

Section 5(a)(2) of Pub. L. 102–410 directed Administrator for Health Care Policy and Research to conduct or support a study to develop methods for collecting and analyzing primary and secondary data to be used in generating cost estimates of alternative strategies for the prevention, diagnosis, treatment, and management of a given disease, disorder, or the health condition to be included in guideline documents and to submit to Congress, not later than June 1, 1994, a report concerning such study.

Section Referred to in Other Sections

This section is referred to in sections 299b–2, 299b–3, 1320b–12 of this title.

¹ So in original. The word "and" probably should not appear.