PUBLIC LAW 101-239—DEC. 19, 1989 103 STAT. 2195 ing may be conducted prior to, or concurrently with, their dissemi- nation under subsection (c). "(e) EVALUATIONS.—The Director shall conduct and support evaluations of the extent to which the guidelines, standards, performance standards, and review criteria developed under section 912 have had an effect on the clinical practice of medicine. "(f) RECOMMENDATIONS TO ADMINISTRATOR.—The Director shall make recommendations to the Administrator on activities that should be carried out under section 902(a)(2) and under section 1142 of the Social Security Act, including recommendations of particular research projects that should be carried out with respect to— "(1) evaluating the outcomes of health care services and procedures; "(2) developing the standards and criteria required in subsec- tion (b); and "(3) promoting the utilization of the guidelines, standards, performance standards, and review criteria developed under section 912(a).". (b) OUTCOMES OP HEALTH CARE SERVICES AND PROCEDURES.— (1) E^ABUSHMENT OP PROGRAM OF RESEARCH.— Part A of title XI of the Social Security Act (42 U.S.C. 1301 et seq.) is cunended by adding at the end the following new section: "RESEARCH ON OUTCOMES OP HEALTH CARE SERVICES AND PROCEDURES s "SEC. 1142. (a) ESTABLISHMENT OF PROGRAM. — 42 USC "(1) IN GENERAL.—The Secretary, acting through the Adminis- I320b-12. trator for Health Care Policy and Research, shall— "(A) conduct and support research with respect to the outcomes, effectiveness, and appropriateness of health care ? services and procedures in order to identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically; and "(B) assure that the needs and priorities of the program under title XVIII are appropriately reflected in the develop- ment and periodic review and updating (through the proc- ^ ess set forth in section 913 of the Public Health Service Act) of treatment-specific or condition-specific practice guide- lines for clinical treatments and conditions in forms appro- priate for use in clinical practice, for use in educational programs, and for use in reviewing quality and appropriate- ness of medical care. "(2) EVALUATIONS OF ALTERNATIVE SERVICES AND PROCE- DURES.—In carrying out paragraph (1), the Secretary shall con- duct or support evaluations of the comparative effects, on health and functional capacity, of alternative services and procedures utilized in preventing, diagnosing, treating, and clinically managing diseases, disorders, and other health condi- tions. "(3) INITIAL GUIDEUNES,— "(A) In carrying out paragraph (I)(B) of this subsection, and section 912(d) of the Public Health Service Act, the Secretary shall, by not later than January 1, 1991, assure ^ i the development of an initial set of the guidelines specified in paragraph (1)(B) that shall include not less than 3 clini- cal treatments or conditions that—
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