103 STAT. 2196 PUBLIC LAW 101-239—DEC. 19, 1989 Reports. "(i)(1) account for a significant portion of expendi- tures under title XVIII; and "(II) have a significant variation in the fi-equency or the type of treatment provided; or .K.< •• "(ii) otherwise meet the needs and priorities of the program under title XVIII, as set forth under subsec- tion (b)(3). "(B)(i) The Secretary shall provide for the use of guide- lines developed under subparagrah (A) to improve the qual- ity, effectiveness, and appropriateness of care provided under title XVIII. The Secretary shall determine the impact of such use on the quality, appropriateness, effectiveness, and cost of medical care provided under such title and shall report to the Congress on such determination by not later than January 1, 1993. "(ii) For the purpose of carrying out clause (i), the Sec- retary shall expend, from the amounts specified in clause (iii), $1,000,000 for fiscal year 1990 and $1,500,000 for each of the fiscal years 1991 and 1992. "(iii) For each fiscal year, for purposes of expenditures required in clause (ii)— "(I) 60 percent of an amount equal to the expenditure involved is appropriated from the Federal Hospital
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Insurance Trust Fund (established under section 1817); and "(II) 40 percent of an amount equal to the expendi- - ture involved is appropriated from the Federal Supple- mentary Medical Insurance Trust Fund (established under section 1841). "(b) PRIORITIES. — "(1) IN GENERAL.— The Secretary shall establish priorities with respect to the diseases, disorders, and other health condi- tions for which research and evaluations are to be conducted or supported under subsection (a). In establishing such priorities, the Secretary shall, with respect to a disease, disorder, or other health condition, consider the extent to which— "(A) improved methods of prevention, diagnosis, treat- ment, and clinical management can benefit a significant number of individuals; "(B) there is significant variation among physicians in the particular services and procedures utilized in making diagnoses and providing treatments or there is significant variation in the outcomes of health care services or proce- dures due to different patterns of diagnosis or treatment; ^ "(C) the services and procedures utilized for diagnosis and treatment result in relatively substantial expenditures; and "(D) the data necessary for such evaluations are readily available or can readily be developed. "(2) PREUMINARY ASSESSMENTS. — For the purpose of establish- ing priorities under paragraph (1), the Secretary may, with respect to services and procedures utilized in preventing, di- agnosing, treating, and clinically managing diseases, disorders, and other health conditions, conduct or support assessments of the extent to which— "(A) rates of utilization vary among similar populations for particular diseases, disorders, and other health condi- tions;
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