Title VIII of Ryan’s Patients’ Choice Act
August 14, 2012 5 Comments
I have written lots about what I consider to be the hypocrisy of Rep. Paul Ryan for criticizing the IPAB given what is proposed in title VIII of the Patients’ Choice Act (two expert boards) that he introduced along with co-sponors Devin Nunes in the House and Sens. Burr and Coburn on May 20, 2009. This post outlines the argument, and looks closely at selected portions of the text, this one elaborates on the topic given a repeal-of-IPAB-hearing held during the Summer of 2011, and this one follows up by discussing a response from Rep. Ryan’s spokesperson to my criticisms.
Keep in mind that I praised the board contained in the Republican bill in this July 24 2009 newspaper column, and said that such a board based loosely on the base closing commission could represent a bipartisan way ahead to address costs! (silly me).
Here is a link to the full text of the Patients’ Choice Act, and below I reproduce the entirety of title VIII, subtitles A, B and C, so that you can read the text for yourself.
TITLE VIII–HEALTH CARE SERVICES COMMISSION
Subtitle A–Establishment and General Duties
SEC. 801. ESTABLISHMENT.
(a) In General- There is hereby established a Health Care Services Commission (in this title, referred to as the ‘Commission’) to be composed of 5 commissioners (in this title referred to as the ‘Commissioners’) to be appointed by the President by and with the advice and consent of the Senate. Not more than 3 of such Commissioners shall be members of the same political party, and in making appointments members of different political parties shall be appointed alternately as nearly as may be practicable. No Commissioner shall engage in any other business, vocation, or employment than that of serving as Commissioner. Each Commissioner shall hold office for a term of 5 years and until a successor is appointed and has qualified, except that–
(1) such Commissioner shall not so continue to serve beyond the expiration of the next session of Congress subsequent to the expiration of said fixed term of office;
(2) any Commissioner appointed to fill a vacancy occurring prior to the expiration of the term for which a predecessor was appointed shall be appointed for the remainder of such term; and
(3) the terms of office of the Commissioners first taking office after the date of the enactment of this Act shall expire as designated by the President at the time of nomination, 1 at the end of 1 year, 1 at the end of 2 years, 1 at the end of 3 years, 1 at the end of 4 years, and 1 at the end of 5 years, after the date of the enactment of this Act.
(b) Purpose- The purpose of the Commission is to enhance the quality, appropriateness, and effectiveness of health care services, and access to such services, through the establishment of a broad base of scientific research and through the promotion of improvements in clinical practice and in the organization, financing, and delivery of health care services.
(c) Appointment of Chairman- The President shall, from among the Commissioners appointed under subsection (a), designate an individual to serve as the Chairman of the Commission.
SEC. 802. GENERAL AUTHORITIES AND DUTIES.
(a) In General- In carrying out section 801(b), the Commissioners shall conduct and support research, demonstration projects, evaluations, training, guideline development, and the dissemination of information, on health care services and on systems for the delivery of such services, including activities with respect to–
(1) the effectiveness, efficiency, and quality of health care services;
(2) the outcomes of health care services and procedures;
(3) clinical practice, including primary care and practice-oriented research;
(4) health care technologies, facilities, and equipment;
(5) health care costs, productivity, and market forces;
(6) health promotion and disease prevention;
(7) health statistics and epidemiology; and
(8) medical liability.
(b) Requirements With Respect to Rural Areas and Underserved Populations- In carrying out subsection (a), the Commissioners shall undertake and support research, demonstration projects, and evaluations with respect to–
(1) the delivery of health care services in rural areas (including frontier areas); and
(2) the health of low-income groups, minority groups, and the elderly.
SEC. 803. DISSEMINATION.
(a) In General- The Commissioners shall–
(1) promptly publish, make available, and otherwise disseminate, in a form understandable and on as broad a basis as practicable so as to maximize its use, the results of research, demonstration projects, and evaluations conducted or supported under this title and the guidelines, standards, and review criteria developed under this title;
(2) promptly make available to the public data developed in such research, demonstration projects, and evaluations; and
(3) as appropriate, provide technical assistance to State and local government and health agencies and conduct liaison activities to such agencies to foster dissemination.
(b) Prohibition Against Restrictions- Except as provided in subsection (c), the Commissioners may not restrict the publication or dissemination of data from, or the results of, projects conducted or supported under this title.
(c) Limitation on Use of Certain Information- No information, if an establishment or person supplying the information or described in it is identifiable, obtained in the course of activities undertaken or supported under this title may be used for any purpose other than the purpose for which it was supplied unless such establishment or person has consented (as determined under regulations of the Secretary) to its use for such other purpose. Such information may not be published or released in other form if the person who supplied the information or who is described in it is identifiable unless such person has consented (as determined under regulations of the Secretary) to its publication or release in other form.
(d) Certain Interagency Agreement- The Commissioners and the Director of the National Library of Medicine shall enter into an agreement providing for the implementation of subsection (a)(1).
Subtitle B–Forum for Quality and Effectiveness in Health Care
SEC. 811. ESTABLISHMENT OF OFFICE.
There is established within the Commission an office to be known as the Office of the Forum for Quality and Effectiveness in Health Care. The office shall be headed by a director (referred to in this title as the ‘Director’) who shall be appointed by the Commissioners.
SEC. 812. MEMBERSHIP.
(a) In General- The Office of the Forum for Quality and Effectiveness in Health Care shall be composed of 15 individuals nominated by private sector health care organizations and appointed by the Commission and shall include representation from at least the following:
(1) Health insurance industry.
(2) Health care provider groups.
(3) Non-profit organizations.
(4) Rural health organizations.
(1) IN GENERAL- Except as provided in paragraph (2), members of the Office of the Forum for Quality and Effectiveness in Health Care shall serve for a term of 5 years.
(2) STAGGERED ROTATION- Of the members first appointed to the Office of the Forum for Quality and Effectiveness in Health Care, the Commission shall appoint 5 members to serve for a term of 2 years, 5 members to serve for a term of 3 years, and 5 members to serve for a term of 4 years.
(c) Treatment of Other Employment- Each member of the Office of the Forum for Quality and Effectiveness in Health Care shall serve the Office independently from any other position of employment.
SEC. 813. DUTIES.
(a) Establishment of Forum Program- The Commissioners, acting through the Director, shall establish a program to be known as the Forum for Quality and Effectiveness in Health Care. For the purpose of promoting transparency in price, quality, appropriateness, and effectiveness of health care, the Director, using the process set forth in section 814, shall arrange for the development and periodic review and updating of 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) shall–
(1) be based on the best available research and professional judgment regarding the effectiveness and appropriateness of health care services and procedures; and
(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.
(c) Authority for Contracts- In carrying out this subtitle, the Director may enter into contracts with public or nonprofit private entities.
(d) Public Disclosure of Recommendations- For each fiscal year beginning with 2010, the Director shall make publicly available the following:
(1) Quarterly reports for public comment that include proposed recommendations for guidelines, standards, performance measures, and review criteria under subsection (a) and any updates to such guidelines, standards, performance measures, and review criteria.
(2) After consideration of such comments, a final report that contains final recommendations for such guidelines, standards, performance measures, review criteria, and updates.
(e) Date Certain for Initial Guidelines and Standards- The Commissioners, by not later than January 1, 2012, shall assure the development of an initial set of guidelines, standards, performance measures, and review criteria under subsection (a).
SEC. 814. ADOPTION AND ENFORCEMENT OF GUIDELINES AND STANDARDS.
(a) Adoption of Recommendations of Forum for Quality and Effectiveness in Health Care- For each fiscal year, the Commissioners shall adopt the recommendations made for such year in the final report under subsection (d)(2) of section 813 for guidelines, standards, performance measures, and review criteria described in subsection (a) of such section.
(b) Enforcement Authority- The Commissioners, in consultation with the Secretary of Health and Human Services, have the authority to make recommendations to the Secretary to enforce compliance of health care providers with the guidelines, standards, performance measures, and review criteria adopted under subsection (a). Such recommendations may include the following, with respect to a health care provider who is not in compliance with such guidelines, standards, measures, and criteria:
(1) Exclusion from participation in Federal health care programs (as defined in section 1128B(f) of the Social Security Act (42 U.S.C. 1320a-7b(f))).
(2) Imposition of a civil money penalty on such provider.
SEC. 815. ADDITIONAL REQUIREMENTS.
(a) Program Agenda- The Commissioners shall provide for an agenda for the development of the guidelines, standards, performance measures, and review criteria described in section 813(a), including with respect to the standards, performance measures, and review criteria, identifying specific aspects of health care for which the standards, performance measures, and review criteria are to be developed and those that are to be given priority in the development of the standards, performance measures, and review criteria.
Subtitle C–General Provisions
SEC. 821. CERTAIN ADMINISTRATIVE AUTHORITIES.
The Commissioners, in carrying out this title, may accept voluntary and uncompensated services.
SEC. 822. FUNDING.
For the purpose of carrying out this title, there are authorized to be appropriated such sums as may be necessary for fiscal years 2010 through 2014.
SEC. 823. DEFINITIONS.
For purposes of this title:
(1) The term ‘Commissioners’ means the Commissioners of the Health Care Services Commission.
(2) The term ‘Commission’ means the Health Care Services Commission.
(3) The term ‘Director’ means the Director of the Office of the Forum for Quality and Effectiveness in Health Care.
(4) The term ‘Secretary’ means the Secretary of Health and Human Services.