[House Report 114-801]
[From the U.S. Government Publishing Office]
114th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 114-801
======================================================================
NATIONAL CLINICAL CARE COMMISSION ACT
_______
November 14, 2016.--Committed to the Committee of the Whole House on
the State of the Union and ordered to be printed
_______
Mr. Upton, from the Committee on Energy and Commerce, submitted the
following
R E P O R T
[To accompany H.R. 1192]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 1192) to amend the Public Health Service Act to
foster more effective implementation and coordination of
clinical care for people with pre-diabetes, diabetes, and the
chronic diseases and conditions that result from diabetes,
having considered the same, report favorably thereon with
amendments and recommend that the bill as amended do pass.
CONTENTS
Page
Purpose and Summary.............................................. 4
Background and Need for Legislation.............................. 4
Hearings......................................................... 4
Committee Consideration.......................................... 4
Committee Votes.................................................. 5
Committee Oversight Findings..................................... 5
Statement of General Performance Goals and Objectives............ 5
New Budget Authority, Entitlement Authority, and Tax Expenditures 5
Earmark, Limited Tax Benefits, and Limited Tariff Benefits....... 5
Committee Cost Estimate.......................................... 5
Congressional Budget Office Estimate............................. 5
Federal Mandates Statement....................................... 5
Duplication of Federal Programs.................................. 5
Disclosure of Directed Rule Makings.............................. 6
Advisory Committee Statement..................................... 6
Applicability to Legislative Branch.............................. 6
Section-by-Section Analysis of the Legislation................... 6
Changes in Existing Law Made by the Bill, as Reported............ 6
The amendments are as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``National Clinical Care Commission
Act''.
SEC. 2. ESTABLISHMENT OF THE NATIONAL CLINICAL CARE COMMISSION.
Part P of title III of the Public Health Service Act (42 U.S.C. 280g
et seq.) is amended by adding at the end the following new section:
``SEC. 399V-7. NATIONAL CLINICAL CARE COMMISSION.
``(a) Establishment.--There is hereby established, within the
Department of Health and Human Services, a National Clinical Care
Commission (in this section referred to as the `Commission') to
evaluate, and recommend solutions regarding better coordination and
leveraging of, programs within the Department and other Federal
agencies that relate in any way to supporting appropriate clinical care
(such as any interactions between physicians and other health care
providers and their patients related to treatment and care management)
for individuals with--
``(1) a complex metabolic or autoimmune disease;
``(2) a disease resulting from insulin deficiency or insulin
resistance; or
``(3) complications caused by any such disease.
``(b) Membership.--
``(1) In general.--The Commission shall be composed of the
following voting members:
``(A) The heads (or their designees) of the following
Federal agencies and departments:
``(i) The Centers for Medicare & Medicaid
Services.
``(ii) The Agency for Healthcare Research and
Quality.
``(iii) The Centers for Disease Control and
Prevention.
``(iv) The Indian Health Service.
``(v) The Department of Veterans Affairs.
``(vi) The National Institutes of Health.
``(vii) The Food and Drug Administration.
``(viii) The Health Resources and Services
Administration.
``(ix) The Department of Defense.
``(B) Twelve additional voting members appointed
under paragraph (2).
``(C) Such additional voting members as may be
appointed by the Secretary, at the Secretary's
discretion, from among the heads (or their designees)
of governmental or nongovernmental entities that impact
clinical care of individuals with any of the diseases
and complications described in subsection (a).
``(2) Additional members.--The Commission shall include
additional voting members appointed by the Secretary, in
consultation with national medical societies and patient
advocacy organizations with expertise in the care and
epidemiology of any of the diseases and complications described
in subsection (a), including one or more such members from each
of the following categories:
``(A) Clinical endocrinologists.
``(B) Physician specialties (other than as described
in subparagraph (A)) that play a role in diseases and
complications described in subsection (a), such as
cardiologists, nephrologists, and eye care
professionals.
``(C) Primary care physicians.
``(D) Non-physician health care professionals, such
as certified diabetes educators, registered dieticians
and nutrition professionals, nurses, nurse
practitioners, and physician assistants.
``(E) Patient advocates.
``(F) National experts in the duties listed under
subsection (c).
``(G) Health care providers furnishing services to a
patient population that consists of a high percentage
(as specified by the Secretary) of individuals who are
enrolled in a State plan under title XIX of the Social
Security Act or who are not covered under a health plan
or health insurance coverage.
``(3) Chairperson.--The voting members of the Commission
shall select a chairperson from the members appointed under
paragraph (2) from the category under paragraph (2)(A).
``(4) Meetings.--The Commission shall meet at least twice,
and not more than 4 times, a year.
``(5) Board terms.--Members of the Commission appointed
pursuant to subparagraph (B) or (C) of paragraph (1), including
the chairperson, shall serve for a 3-year term. A vacancy on
the Commission shall be filled in the same manner as the
original appointments.
``(c) Duties.--The Commission shall--
``(1) evaluate programs of the Department of Health and Human
Services regarding the utilization of diabetes screening
benefits, annual wellness visits, and other preventive health
benefits that may reduce the incidence of the diseases and
complications described in subsection (a), including explaining
problems regarding such utilization and related data collection
mechanisms;
``(2) identify current activities and critical gaps in
Federal efforts to support clinicians in providing integrated,
high-quality care to individuals with any of the diseases and
complications described in subsection (a);
``(3) make recommendations regarding the coordination of
clinically-based activities that are being supported by the
Federal Government with respect to the diseases and
complications described in subsection (a);
``(4) make recommendations regarding the development and
coordination of federally funded clinical practice support
tools for physicians and other health care professionals in
caring for and managing the care of individuals with any of the
diseases and complications described in subsection (a),
specifically with regard to implementation of new treatments
and technologies;
``(5) evaluate programs described in subsection (a) that are
in existence as of the date of the enactment of this section
and determine if such programs are meeting the needs identified
in paragraph (2) and, if such programs are determined as not
meeting such needs, recommend programs that would be more
appropriate;
``(6) recommend, with respect to the diseases and
complications described in subsection (a), clinical pathways
for new technologies and treatments, including future data
collection activities, that may be developed and then used to
evaluate--
``(A) various care models and methods; and
``(B) the impact of such models and methods on
quality of care as measured by appropriate care
parameters (such as A1C, blood pressure, and
cholesterol levels);
``(7) evaluate and expand education and awareness activities
provided to physicians and other health care professionals
regarding clinical practices for the prevention of the diseases
and complications described in subsection (a);
``(8) review and recommend appropriate methods for outreach
and dissemination of educational resources that--
``(A) regard the diseases and complications described
in subsection (a);
``(B) are funded by the Federal Government; and
``(C) are intended for health care professionals and
the public; and
``(9) carry out other activities, such as activities relating
to the areas of public health and nutrition, that the
Commission deems appropriate with respect to the diseases and
complications described in subsection (a).
``(d) Operating Plan.--
``(1) Initial plan.--Not later than 90 days after its first
meeting, the Commission shall submit to the Secretary and the
Congress an operating plan for carrying out the activities of
the Commission as described in subsection (c). Such operating
plan may include--
``(A) a list of specific activities that the
Commission plans to conduct for purposes of carrying
out the duties described in each of the paragraphs in
subsection (c);
``(B) a plan for completing the activities;
``(C) a list of members of the Commission and other
individuals who are not members of the Commission who
will need to be involved to conduct such activities;
``(D) an explanation of Federal agency involvement
and coordination needed to conduct such activities;
``(E) a budget for conducting such activities;
``(F) a plan for evaluating the value and potential
impact of the Commission's work and recommendations,
including the possible continuation of the Commission
for the purposes of overseeing their implementation;
and
``(G) other information that the Commission deems
appropriate.
``(2) Updates.--The Commission shall periodically update the
operating plan under paragraph (1) and submit such updates to
the Secretary and the Congress.
``(e) Final Report.--By not later than 3 years after the date of the
Commission's first meeting, the Commission shall submit to the
Secretary and the Congress a final report containing all of the
findings and recommendations required by this section. Not later than
120 days after the submission of the final report, the Secretary shall
review the plan required by subsection (d)(1)(F) and submit to the
Congress a recommendation on whether the Commission should be
reauthorized to operate after fiscal year 2019.
``(f) Sunset.--The Commission shall terminate at the end of fiscal
year 2019.''.
Amend the title so as to read:
A bill to amend the Public Health Service Act to foster
more effective implementation and coordination of clinical care
for people with a complex metabolic or autoimmune disease, a
disease resulting from insulin deficiency or insulin
resistance, or complications caused by such a disease, and for
other purposes.
Purpose and Summary
H.R. 1192 was introduced on March 2, 2015, by Rep. Pete
Olson (R-TX). H.R. 1192 establishes a clinical care commission
to evaluate and recommend solutions regarding better
coordinating and leveraging of Federal programs related to
complex metabolic or autoimmune disorders, a disease resulting
from insulin deficiency or resistance, or complications caused
by any such disease.
Background and Need for Legislation
Metabolic disorders take a large toll on human health each
year. Complications from these disorders can lead to
catastrophic health outcomes, such as limb amputation and
kidney failure, and the treatment of metabolic disorders and
their complications costs billions of dollars each year.
There are numerous programs across the Federal government
related to metabolic disorders. Some focus on prevention, while
others focus on the treatment of such conditions. Improving
such efforts, including the coordination among Federal
activities related to metabolic disorders, provides an
opportunity to reduce costs while enhancing health outcomes.
Hearings
The Subcommittee on Health held a hearing on H.R. 1192 on
September 8, 2016. The hearing was entitled ``Examining
Legislation to Improve Public Health'' and witnesses included
the following:
Sonja L. Banks, President and COO, Sickle
Cell Disease Association of America, Inc.;
General Arthur Dean, Chairman and CEO,
Community Anti-Drug Coalitions of America;
Jonathan Leffert, President-Elect, American
Association of Clinical Endocrinologists;
Brad Marino, Chair, Pediatric Congenital
Heart Association; and
R. Sean Morrison, Director, National
Palliative Care Research Center.
Committee Consideration
On September 12 and 13, 2016, the Subcommittee on Health
met in open markup session and forwarded H.R. 1192 to the full
Committee, as amended, by a voice vote.
On September 20 and 21, 2016, the full Committee on Energy
and Commerce met in open markup session and ordered H.R. 1192
reported to the House, without amendment, by a voice vote.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report legislation and amendments thereto.
There were no record votes taken in connection with ordering
H.R. 1192 reported
Committee Oversight Findings
Pursuant to clause 3(c)(1) of rule XIII of the Rules of the
House of Representatives, the Committee held a hearing and made
findings that are reflected in this report.
Statement of General Performance Goals and Objectives
This legislation establishes a clinical care commission to
evaluate and recommend solutions regarding better coordinating
and leveraging of Federal programs that relate to complex
metabolic or autoimmune disorders, a disease resulting from
insulin deficiency or resistance, or complications caused by
any such disease.
New Budget Authority, Entitlement Authority, and Tax Expenditures
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee finds that H.R.
1192 would result in no new or increased budget authority,
entitlement authority, or tax expenditures or revenues.
Earmark, Limited Tax Benefits, and Limited Tariff Benefits
In compliance with clause 9(e), 9(f), and 9(g) of rule XXI
of the Rules of the House of Representatives, the Committee
finds that H.R. 1192 contains no earmarks, limited tax
benefits, or limited tariff benefits.
Committee Cost Estimate
The Committee adopts as its own the cost estimate prepared
by the Director of the Congressional Budget Office pursuant to
section 402 of the Congressional Budget Act of 1974. At the
time this report was filed, the estimate was not available.
Congressional Budget Office Estimate
At the time this report was filed, the cost estimate
prepared by the Director of the Congressional Budget Office
pursuant to section 402 of the Congressional Budget Act of 1974
was not available.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates prepared by the Director of the Congressional Budget
Office pursuant to section 423 of the Unfunded Mandates Reform
Act.
Duplication of Federal Programs
No provision of H.R. 1192 establishes or reauthorizes a
program of the Federal Government known to be duplicative of
another Federal program, a program that was included in any
report from the Government Accountability Office to Congress
pursuant to section 21 of Public Law 111-139, or a program
related to a program identified in the most recent Catalog of
Federal Domestic Assistance.
Disclosure of Directed Rule Makings
The Committee estimates that enacting H.R. 1192
specifically directs to be completed no rule making within the
meaning of 5 U.S.C. 551.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act were created by this
legislation.
Applicability to Legislative Branch
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 provides that the Act may be cited as the
``National Clinical Care Commission Act''.
Section 2. Establishment of the National Clinical Care Commission
Section 2 establishes a National Clinical Care Commission
within the Department of Health and Human Services. The
Commission will evaluate and recommend solutions regarding
better coordination and leveraging of programs within the
Department of Health and Human Services and other Federal
agencies that relate to supporting appropriate clinical care
for individuals with a complex metabolic or autoimmune disease,
a disease resulting from insulin deficiency or resistance, or
complications by any such disease.
The Commission will sunset at the end of fiscal year 2019.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (new matter is
printed in italic and existing law in which no change is
proposed is shown in roman):
PUBLIC HEALTH SERVICE ACT
* * * * * * *
TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE
* * * * * * *
PART P--ADDITIONAL PROGRAMS
* * * * * * *
SEC. 399V-7. NATIONAL CLINICAL CARE COMMISSION.
(a) Establishment.--There is hereby established, within the
Department of Health and Human Services, a National Clinical
Care Commission (in this section referred to as the
``Commission'') to evaluate, and recommend solutions regarding
better coordination and leveraging of, programs within the
Department and other Federal agencies that relate in any way to
supporting appropriate clinical care (such as any interactions
between physicians and other health care providers and their
patients related to treatment and care management) for
individuals with--
(1) a complex metabolic or autoimmune disease;
(2) a disease resulting from insulin deficiency or
insulin resistance; or
(3) complications caused by any such disease.
(b) Membership.--
(1) In general.--The Commission shall be composed of
the following voting members:
(A) The heads (or their designees) of the
following Federal agencies and departments:
(i) The Centers for Medicare &
Medicaid Services.
(ii) The Agency for Healthcare
Research and Quality.
(iii) The Centers for Disease Control
and Prevention.
(iv) The Indian Health Service.
(v) The Department of Veterans
Affairs.
(vi) The National Institutes of
Health.
(vii) The Food and Drug
Administration.
(viii) The Health Resources and
Services Administration.
(ix) The Department of Defense.
(B) Twelve additional voting members
appointed under paragraph (2).
(C) Such additional voting members as may be
appointed by the Secretary, at the Secretary's
discretion, from among the heads (or their
designees) of governmental or nongovernmental
entities that impact clinical care of
individuals with any of the diseases and
complications described in subsection (a).
(2) Additional members.--The Commission shall include
additional voting members appointed by the Secretary,
in consultation with national medical societies and
patient advocacy organizations with expertise in the
care and epidemiology of any of the diseases and
complications described in subsection (a), including
one or more such members from each of the following
categories:
(A) Clinical endocrinologists.
(B) Physician specialties (other than as
described in subparagraph (A)) that play a role
in diseases and complications described in
subsection (a), such as cardiologists,
nephrologists, and eye care professionals.
(C) Primary care physicians.
(D) Non-physician health care professionals,
such as certified diabetes educators,
registered dieticians and nutrition
professionals, nurses, nurse practitioners, and
physician assistants.
(E) Patient advocates.
(F) National experts in the duties listed
under subsection (c).
(G) Health care providers furnishing services
to a patient population that consists of a high
percentage (as specified by the Secretary) of
individuals who are enrolled in a State plan
under title XIX of the Social Security Act or
who are not covered under a health plan or
health insurance coverage.
(3) Chairperson.--The voting members of the
Commission shall select a chairperson from the members
appointed under paragraph (2) from the category under
paragraph (2)(A).
(4) Meetings.--The Commission shall meet at least
twice, and not more than 4 times, a year.
(5) Board terms.--Members of the Commission appointed
pursuant to subparagraph (B) or (C) of paragraph (1),
including the chairperson, shall serve for a 3-year
term. A vacancy on the Commission shall be filled in
the same manner as the original appointments.
(c) Duties.--The Commission shall--
(1) evaluate programs of the Department of Health and
Human Services regarding the utilization of diabetes
screening benefits, annual wellness visits, and other
preventive health benefits that may reduce the
incidence of the diseases and complications described
in subsection (a), including explaining problems
regarding such utilization and related data collection
mechanisms;
(2) identify current activities and critical gaps in
Federal efforts to support clinicians in providing
integrated, high-quality care to individuals with any
of the diseases and complications described in
subsection (a);
(3) make recommendations regarding the coordination
of clinically-based activities that are being supported
by the Federal Government with respect to the diseases
and complications described in subsection (a);
(4) make recommendations regarding the development
and coordination of federally funded clinical practice
support tools for physicians and other health care
professionals in caring for and managing the care of
individuals with any of the diseases and complications
described in subsection (a), specifically with regard
to implementation of new treatments and technologies;
(5) evaluate programs described in subsection (a)
that are in existence as of the date of the enactment
of this section and determine if such programs are
meeting the needs identified in paragraph (2) and, if
such programs are determined as not meeting such needs,
recommend programs that would be more appropriate;
(6) recommend, with respect to the diseases and
complications described in subsection (a), clinical
pathways for new technologies and treatments, including
future data collection activities, that may be
developed and then used to evaluate--
(A) various care models and methods; and
(B) the impact of such models and methods on
quality of care as measured by appropriate care
parameters (such as A1C, blood pressure, and
cholesterol levels);
(7) evaluate and expand education and awareness
activities provided to physicians and other health care
professionals regarding clinical practices for the
prevention of the diseases and complications described
in subsection (a);
(8) review and recommend appropriate methods for
outreach and dissemination of educational resources
that--
(A) regard the diseases and complications
described in subsection (a);
(B) are funded by the Federal Government; and
(C) are intended for health care
professionals and the public; and
(9) carry out other activities, such as activities
relating to the areas of public health and nutrition,
that the Commission deems appropriate with respect to
the diseases and complications described in subsection
(a).
(d) Operating Plan.--
(1) Initial plan.--Not later than 90 days after its
first meeting, the Commission shall submit to the
Secretary and the Congress an operating plan for
carrying out the activities of the Commission as
described in subsection (c). Such operating plan may
include--
(A) a list of specific activities that the
Commission plans to conduct for purposes of
carrying out the duties described in each of
the paragraphs in subsection (c);
(B) a plan for completing the activities;
(C) a list of members of the Commission and
other individuals who are not members of the
Commission who will need to be involved to
conduct such activities;
(D) an explanation of Federal agency
involvement and coordination needed to conduct
such activities;
(E) a budget for conducting such activities;
(F) a plan for evaluating the value and
potential impact of the Commission's work and
recommendations, including the possible
continuation of the Commission for the purposes
of overseeing their implementation; and
(G) other information that the Commission
deems appropriate.
(2) Updates.--The Commission shall periodically
update the operating plan under paragraph (1) and
submit such updates to the Secretary and the Congress.
(e) Final Report.--By not later than 3 years after the date
of the Commission's first meeting, the Commission shall submit
to the Secretary and the Congress a final report containing all
of the findings and recommendations required by this section.
Not later than 120 days after the submission of the final
report, the Secretary shall review the plan required by
subsection (d)(1)(F) and submit to the Congress a
recommendation on whether the Commission should be reauthorized
to operate after fiscal year 2019.
(f) Sunset.--The Commission shall terminate at the end of
fiscal year 2019.
* * * * * * *
[all]