,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #cecd  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,june #bg1 #bjai ,mr4 
,ru% 7= himself1 ,mr4 ,david ,p4 ,roe ( 
,t5nessee1 ,ms4 ,judy ,*u ( ,cali=nia1 &
 ,mr4 ,dunn7 introduc$ ! foll[+ bill2   
:i* 0 ref]r$ to ! ,committee on ,en]gy &
 ,comm]ce1 & 9 addition to ! ,committee 
on ,ways & ,means1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title ,,ix 
( ! ,public ,heal? ,s]vice ,act to      
revise ! op]ations ( ! ,unit$ ,/ates    
,prev5tive ,s]vices ,task ,=ce1 & = o!r 
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,,usp/f ,transp>5cy &      
,acc\ntability ,act ( #bjai4  #b4       
,*anges to ,unit$ ,/ates ,prev5tive     
,s]vices ,task ,=ce  7a7 ,9 g5]al       
,subsection 7a7 ( section #iae ( !      
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #bii;b-#d7 is am5d$--  7#a7 by
 am5d+ ! head+ to read z foll[s3 ,unit$ 

,/ates ,prev5tive ,s]vices ,task ,=ce2  
7#b7 by am5d+ p>agraph 7#a7 to read z   
foll[s3  7#a7 ,e/abli%m5t & purpose ,!  
,director may e/abli% & p]iodically     
conv5e ! ,unit$ ,/ates ,prev5tive       
,s]vices ,task ,=ce 79 ?is section      
ref]r$ to z ! ,task ,=ce74 ,! ,task ,=ce
 %all review ! sci5tific evid5ce & new  
sci5ce relat$ to ! effectiv5ess &       
appropriat5ess ( cl9ical prev5tive      
s]vices = ! purpose ( develop+          
recomm5dations = prim>y c>e cl9icians & 
! heal? c>e community & updat+ previ\s  
cl9ical prev5tive recomm5dations4  2    
7#c7 by /rik+ p>agraph 7#c72  7#d7 by   
r$esignat+ p>agraphs 7#d7 ?r\gh 7#g7 z  
p>agraphs 7#i7 ?r\gh 7#ab71             
respectively2  7#e7 by ins]t+ aft]      
p>agraph 7#b7 ! foll[+ new p>agraphs3   
7#c7 ,composition  7,a7 ,9 g5]al ,!     
,task ,=ce %all be compos$ ( individuals
 t collectively h appropriate sci5tific 
exp]tise1 includ+ 9 fields ( heal?      
sci5ces rese>*1 heal? economics1 heal?  
promotion1 disease prev5tion1 & cl9ical 

c>e4 ,! ,task ,=ce %all include a       
balanc$ repres5tation ( practic+ prim>y 
& specialty c>e provid]s 7includ+ 9 !   
fields ( heal? s]vices rese>*1 heal?    
economics1 & cl9ical c>e71 pati5ts1 &   
heal? c>e consum]s4  7,b7 ,notice ,be=e 
appo9t+ memb]s to ! ,task ,=ce1 !       
,director %all provide notice 9 ! ,f$]al
 ,regi/] to give p]sons an opportunity  
to nom9ate pot5tial memb]s4  7#d7       
,review & consultation  7,a7 ,rese>*    
plans  7i7 ,9 g5]al ,9 conduct+ its     
reviews "u p>agraph 7#a71 ! ,task ,=ce  
%all publi% "o or m propos$ rese>* plans
 79 ?is subsection ref]r$ to z a rese>* 
plan7 to guide ! ,task ,=ce's sy/ematic 
review ( ! evid5ce ref]r$ to 9 su*      
p>agraph4 ,ea* su* plan %all include an 
analytic framework1 key que/ions1 & a   
lit]ature se>* /rategy or rese>*        
approa*1 & %all incorporate !           
me?odological guidel9es develop$ "u     
clause 7iii74  7ii7 ,publication2 public
 comm5t p]iod ,! ,task ,=ce %all provide
 = ! publication 9 ! ,f$]al ,regi/] ( a 

reque/ = public comm5ts on ea* rese>*   
plan & %all accept comm5ts on su* plan  
dur+ a p]iod ( n less ?an #de days4 ,!  
,director %all make publicly available  
comm5ts submitt$ 9 response to a reque/ 
= public comm5ts4 ,any f9al rese>* plan 
%all be made available to ! public &    
include a discussion ( ! comm5ts receiv$
 ) respect to su* plan & responses to   
su* comm5ts4 ,! ,task ,=ce1 ) !         
concurr5ce ( ! ,director1 may *ange su* 
a rese>* plan ?r\gh ! same process z    
appli$ to ! initial adoption ( su* plan4
  7iii7 ,crit]ia ,! ,director %all      
design & regul>ly update guidel9es =    
prop] me?odological /&>ds =             
incorporation into su* rese>* plans4    
,su* guidel9es %all include measures =  
appropriate validity1 = risk adju/m5t1 =
 timel9ess1 = input f relevant exp]ts & 
pe]s 9 ! respective communities1 =      
acc\nt+ = all relevant subpopulations   
7includ+ disp>ities by g5d]1 race1      
e?nicity1 socioeconomic /atus1 &        
geographic location71 & = o!r heal?     

outcome measurem5ts4 ,su* guidel9es &   
me?odological /&>ds %all ensure !       
consid]ation ( any evid5ce conc]n+ any  
relevant subpopulations 7includ+        
disp>ities by g5d]1 race1 e?nicity1     
g5etic pr$isposition1 socioeconomic     
/atus1 & geographic location71 any real 
_w evid5ce1 any rec5t evid5ce1 & any    
,unit$ ,/ates-bas$ /udies4  7iv7        
,consultation on rese>* plans ,!        
,director %all facilitate coord9ation & 
int]action ) o!r ag5cies & dep>tm5ts 9 !
 prep>ation & publication ( rese>* plans
 7tak+ into consid]ation rese>* & f9d+s 
by o!r ag5cies & dep>tm5ts7 &           
me?odological /&>ds "u clause 7iii71    
includ+ ) ! ,national ,in/itutes (      
,heal?1 ! ,national ,canc] ,in/itute1 ! 
,national ,in/itute on ,m9ority ,heal? &
 ,heal? ,disp>ities1 ! ,c5t]s = ,disease
 ,control & ,prev5tion1 ! ,dep>tm5t (   
,def5se1 ! ,dep>tm5t ( ,vet]ans         
,affairs1 ! ,c5t]s = ,m$ic>e  ,m$icaid  
,s]vices1 & ! ,pati5t-,c5t]$ ,outcomes  
,rese>* ,in/itute4  7,b7 ,evid5ce       

reports  7i7 ,initial publication ,!    
,director %all make publicly available  
ea* sy/ematic evid5ce review & any      
relat$ reports t s]ve z ! f\ndation =   
any recomm5dation ( ! ,task ,=ce &      
publi% 9 ! ,f$]al ,regi/] a reque/ =    
public comm5ts on su* review or relat$  
reports4  7ii7 ,public comm5t p]iod ,!  
,director %all accept comm5ts on any    
draft evid5ce report publi%$ "u clause  
7i7 dur+ a p]iod ( at lea/ #de days4 ,! 
,director %all make publicly available  
comm5ts submitt$ 9 response to a reque/ 
= public comm5t4 ,ea* f9al evid5ce      
review %all include a description (     
comm5ts submitt$ on ! draft evid5ce     
review & ! response ( ! ,task ,=ce to   
su* comm5ts4  7iii7 ,review by ext]nal  
exp]ts ,no su* evid5ce report %all be   
publi%$ prior to x be+ review$ by a     
panel ( ext]nal subject matt] exp]ts t  
includes provid] & pati5t               
repres5tatives4 ,ea* su* report %all    
include a description ( ! panel t       
conduct$ su* review4 ,su* description   

%all include in=mation on ea* panel     
memb]1 includ+ "n1 academic degree 7or  
degrees71 affiliations1 & relat$        
exp]tise4  7,c7 ,recomm5dation /atem5ts 
7i7 ,publication ( draft recomm5dations 
,! ,director %all make publicly         
available ea* draft recomm5dation       
/atem5t 7z t t]m is us$ = purposes (    
section #g ( ! ,u4,s4 ,prev5tive        
,s]vices ,task ,=ce ,proc$ure ,manual1 z
 9 effect on ,april #a1 #bjai7 & %all   
provide = ! publication 9 ! ,f$]al      
,regi/] ( a reque/ = comm5ts & accept   
comm5ts dur+ a p]iod ( n less ?an #de   
days4  7ii7 ,consultation on            
recomm5dations ,be=e vot+ on a draft or 
f9al recomm5dation /atem5t 7z t t]m is  
us$ = purposes ( section #g ( ! proc$ure
 manual ref]r$ to 9 clause 7i771 ! ,task
 ,=ce %all-- 7,i7 consult ) relevant    
/akehold]s1 includ+ provid] gr\ps1      
practic+ speciali/s t treat ! specific  
disease "u review1 & relevant pati5t &  
disease advocacy organizations2 &       
7,,ii7 take into acc\nt ! fe$back       

provid$ by ! bo>d4  7iii7 ,public       
availability ( comm5ts & inclusion (    
description ( comm5ts 9 f9al /atem5t ,! 
,director %all make comm5ts receiv$     
pursuant to clause 7i7 publicly         
available4 ,any f9al recomm5dation      
/atem5t %all include a description (    
comm5ts receiv$ on ! draft recomm5dation
 /atem5t & recomm5dations ( o!r ,f$]al  
ag5cies or organizations relat+ to !    
topic ( ! /atem5t4 ,! ,director %all    
make f9al recomm5dation /atem5ts        
publicly available1 includ+ ?r\gh       
publication 9 ! ,f$]al ,regi/]4  7iv7   
,consid]ation ,9 publi%+ draft or f9al  
recomm5dation /atem5ts 7z ^? t]ms are   
us$ = purposes ( section #g ( ! proc$ure
 manual ref]r$ to 9 clause 7i771 ! ,task
 ,=ce %all consid]-- 7,i7 ! impact ( its
 recomm5dations on ! heal? c>e          
community2  7,,ii7 :e!r a prev5tive     
s]vice is b5eficial = "s individuals & !
 ne$ to enc\rage a discussion ( b5efits 
& risks = ^? individuals2 &  7,,iii7 h[ 
its specific assignm5t ( a grade to a   

product or s]vice may affect cov]age &  
access to su* product or s]vice "u      
,f$]al programs & private heal?         
insurance cov]age4  7v7 ,dissem9ation ( 
evid5ce-bas$ recomm5dations ,! ,task    
,=ce %all publi% & dissem9ate !         
evid5ce-bas$ recomm5dations aft]        
consultation ) ! foll[+3 7,i7 ,relevant 
pati5t organizations4  7,,ii7 ,provid]s 
( cl9ical s]vices1 includ+              
community-bas$ provid]s & specialty     
physicians4  7,,iii7 ,! ,dep>tm5t (     
,vet]ans ,affairs1 ! ,c5t]s = ,m$ic>e   
,m$icaid ,s]vices1 & ! ,c5t]s = ,disease
 ,control & ,prev5tion4  7,d7 ,grad+    
sy/em ,subject to subp>agraph 7,e71 9   
publi%+ recomm5dation /atem5ts 7z t t]m 
is us$ = purposes ( section #g ( !      
proc$ure manual ref]r$ to 9 clause 7i771
 ! ,task ,=ce %all grade products &     
s]vices consi/5t ) ! foll[+3 7i7 ,grade 
,a ,! ,task ,=ce %all assign a product  
or s]vice ,grade ,a if ! ,task ,=ce     
concludes t ! curr5t evid5ce is         
suffici5t to assess ! balance ( b5efits 

& risks ( ! product or s]vice1 &1 on !  
basis ( su* evid5ce1 recomm5ds ! product
 or s]vice & det]m9es t !re is high     
c]ta9ty t ! net b5efit f ! product or   
s]vice is sub/antial4  7ii7 ,grade ,b ,!
 ,task ,=ce %all assign a product or    
s]vice ,grade ,b if ! ,task ,=ce        
concludes t ! curr5t evid5ce is         
suffici5t to assess ! balance ( b5efits 
& risks ( ! product or s]vice1 &1 on !  
basis ( su* evid5ce1 recomm5ds ! product
 or s]vice & det]m9es t !re is high     
c]ta9ty t ! net b5efit ( ! product or   
s]vice is mod]ate or !re is mod]ate     
c]ta9ty t ! net b5efit ( ! product or   
s]vice is mod]ate to sub/antial4  7iii7 
,grade ,c ,! ,task ,=ce %all assign a   
product or s]vice ,grade ,c if ! ,task  
,=ce concludes t--  7,i7 ! curr5t       
evid5ce is suffici5t to assess ! balance
 ( b5efits & risks ( ! product or       
s]vice2  7,,ii7 on ! basis ( su*        
evid5ce1 does n make a recomm5dation ( !
 product or s]vice & cl9icians may      
provide ?is product or s]vice to select$

 pati5ts dep5d+ on individual           
circum/ances2 &  7,,iii7 = mo/          
individuals )\t signs or symptoms ( a   
p>ticul> disease or condition !re is at 
lea/ mod]ate c]ta9ty t ! net b5efit is  
small4  7iv7 ,grade ,d ,! ,task ,=ce    
%all assign a product or s]vice ,grade  
,d if ! ,task ,=ce concludes t ! curr5t 
evid5ce is suffici5t to assess ! balance
 ( b5efits & risks ( ! product or       
s]vice1 &1 on ! basis ( su* evid5ce1    
recomm5ds aga9/ ! product or s]vice &   
det]m9es t !re is mod]ate or high       
c]ta9ty t ! product or s]vice has no net
 b5efit or t ! h>m ( ! product or s]vice
 outweighs ! b5efits4  7v7 ,grade ,i ,! 
,task ,=ce %all assign a product or     
s]vice ,grade ,i if ! ,task ,=ce        
concludes t ! curr5t evid5ce is n       
suffici5t to assess ! balance ( b5efits 
& risks ( ! product or s]vice4  7,e7    
,*anges 9 grad+ sy/em  7i7 ,9 g5]al ,!  
,director may provide1 by regulation1 = 
*anges 9 ! grad+ sy/em describ$ 9       
subp>agraph 7,d74  7ii7 ,impact ( *anges

 ,if ! ,director makes a *ange 9 ! grad+
 sy/em "u clause 7i7 = a p>ticul> grade1
 ! ,task ,=ce %all review & re-grade !  
products or s]vices previ\sly classifi$ 
)9 t grade4 ,any su* review & regrad+   
may be done ?r\gh an exp$it$ process s  
long z any *ange 9 grade does n take    
effect be=e ! review ( t *ange 9 grade  
is complet$4  7#e7 ,role ( ag5cy ,!     
,ag5cy %all provide ongo+ adm9i/rative1 
rese>*1 & te*nical support = ! op]ations
 ( ! ,task ,=ce1 includ+ coord9at+ &    
support+ ! dissem9ation ( its           
recomm5dation /atem5ts1 ensur+ adequate 
/aff res\rces1 & assi/ance to ^?        
organizations reque/+ x = implem5tation 
( ! recomm5dations ( ! ,task ,=ce4  7#f7
 ,prev5tive s]vices advisory bo>d  7,a7 
,9 g5]al ,! ,task ,=ce %all conv5e a    
prev5tive s]vices advisory bo>d 79 ?is  
subsection ref]r$ to z ! bo>d7 compos$ (
 repres5tatives ( appropriate public &  
private entities ) an int]e/ 9 cl9ical  
prev5tive s]vices to advise ! ,task ,=ce
 ?r\gh\t ! developm5t ( evid5ce-bas$    

recomm5dations on ! use ( cl9ical       
prev5tive s]vices4  7,b7 ,memb]%ip ,!   
memb]s ( ! bo>d %all include            
repres5tatives ( ! foll[+3  7i7 ,pati5t 
gr\ps4  7ii7 ,provid]s ( cl9ical        
s]vices1 includ+ community-bas$ provid]s
 & specialty physicians4  7iii7 ,f$]al  
dep>tm5ts & ag5cies t h exp]tise 9 !    
cl9ical prev5tive s]vice be+ review$4   
7,c7 ,responsibilities ,! bo>d %all--   
7i7 recomm5d cl9ical prev5tive s]vices =
 review by ! ,task ,=ce2  7ii7 sugge/   
sci5tific evid5ce = consid]ation by !   
,task ,=ce relat$ to reviews und]tak5 by
 ! ,task ,=ce2  7iii7 provide fe$back   
reg>d+ ! rese>* plan1 ! evid5ce report1 
& draft recomm5dations by ! ,task ,=ce2 
&  7iv7 assi/ ) ef=ts reg>d+            
dissem9ation ( recomm5dations by !      
,director4  7,d7 ,meet+s ,! bo>d %all   
meet z ! *air ( ! bo>d det]m9es to be   
appropriate to fulfill !                
responsibilities describ$ 9 p>agraph    
7,c71 b n few] ?an #b times ea* ye>4    
7#g7 ,disclosure & conflicts ( int]e/   

,prior to p>ticipat+ 9 a meet+ ( ! ,task
 ,=ce or bo>d1 ea* memb] ( ! ,task ,=ce 
or bo>d1 respectively1 %all disclose to 
! ,director any pot5tial1 relevant      
f9ancial int]e/s 9 ! same mann] & to !  
same ext5t z an employee ( ! executive  
bran* ( ! ,unit$ ,/ates1 if ! employee 7
 p>ticipat+ 9 su* meet+1 w\ld be requir$
 to disclose su* int]e/s "u section #bjh
 ( title #ah1 ,unit$ ,/ates ,code4  7#h7
 ,no pay2 receipt ( travel exp5ses      
,memb]s ( ! ,task ,=ce or ! bo>d %all n 
receive any pay = s]vice on ! ,task ,=ce
 or bo>d1 b may receive travel exp5ses1 
includ+ a p] diem1 9 accordance )       
applicable provisions ( sub*apt] ,i (   
*apt] #eg ( title #e1 ,unit$ ,/ates     
,code4  2 &  7#f7 by am5d+ p>agraph     
7#aj71 z r$esignat$ by p>agraph 7#d71 to
 read z foll[s3  7#aj7 ,application (   
,,faca ,! ,f$]al ,advisory ,committee   
,act 7#e ,u4,s4,c4 ,app47 %all apply to 
! ,task ,=ce except t section #ad ( su* 
,act 7relat+ to t]m9ation ( advisory    
committees7 %all n apply to ! ,task     

,=ce4  4  7b7 ,effective date2          
transition  7#a7 ,9 g5]al ,! ,unit$     
,/ates ,prev5tive ,s]vices ,task ,=ce   
%all n publi% any draft or f9al         
recomm5dations on or aft] su* date      
except 9 accordance ) su* am5dm5ts4     
7#b7 ,recon/itution ( ,task ,=ce ,n lat]
 ?an #ahj days aft] ! date ( ! enactm5t 
( ?is ,act1 ! ,director ( ! ,ag5cy =    
,heal?c>e ,rese>* & ,quality %all take  
/eps to recon/itute ! memb]%ip ( ! ,task
 ,=ce consi/5t ) section #iae7;a77#c7 ( 
! ,public ,heal? ,s]vice ,act1 z am5d$  
by subsection 7a74  7#c7 ,previ\sly     
publi%$ recomm5dations ,) respect to    
recomm5dations or guidel9es publi%$ by  
su* ,task ,=ce be=e ! date ( ! enactm5t 
( ?is ,act1 "u proc$ures e/abli%$ by !  
,director ( ! ,ag5cy = ,heal?c>e ,rese>*
 & ,quality1 ! recon/itut$ ,task ,=ce   
%all und]take a review process consi/5t 
) ! foll[+3  7,a7 ,an organization may  
reque/ ! ,task ,=ce to review any su*   
previ\s recomm5dation or guidel9e if su*
 organization has additional pe]-review$

 sci5tific evid5ce t provides new       
in=mation relevant to ! previ\s         
recomm5dation or guidel9e4  7,b7 ,bas$  
^u su* reque/s1 ! ,task ,=ce %all       
e/abli% a process = ! review ( previ\s  
recomm5dations or guidel9es4  7,c7 ,su* 
process %all include public notice ?r\gh
 ! ,f$]al ,regi/] & opportunity = comm5t
 & a det]m9ation to confirm or modify   
su* recomm5dations or guidel9es4  7,d7  
,! process %all1 to ! ext5t feasible1 be
 consi/5t ) ! proc$ures appli$ "u !     
am5dm5ts made by subsection 7a7 = !     
promulgation ( new recomm5dations4  7c7 
,elim9ation ( ,secret>ial discretion ,to
 remove c]ta9 prev5tive s]vices "u !    
,m$ic>e program ,section #ahcd7n7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7n77 is am5d$-- 7#a7 by /rik+     
p>agraph 7#b72  7#b7 by /rik+ 2 & at !  
end ( p>agraph 7#a77;,b7 & ins]t+ a     
p]iod2  7#c7 by r$esignat+ subp>agraphs 
7,a7 & 7,b7 ( p>agraph 7#a7 z p>agraphs 
7#a7 & 7#b71 respectively1 & mov+ _!    
m>g9s #b ems to ! left2 &  7#d7 by /rik+

 may & all t foll[s ?r\gh modify &      
ins]t+ may modify4  7d7 ,application to 
secret>ial discretion ,to remove c]ta9  
prev5tive s]vices "u ! ,m$ic>e program  
,section #ahcd7n7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciem7n771 z am5d$ 
by subsection 7c71 is fur!r am5d$ by    
add+ at ! end ! foll[+ flu% s5t5ce3     
,effective on ! date ( enactm5t ( !     
,,usp/f ,transp>5cy & ,acc\ntability    
,act ( #bjai1 ! ,secret>y may use !     
au?ority "u ?is subsection only to      
modify cov]age ( a prev5tive s]vice bas$
 on ! recomm5dation or grade ( ! ,unit$ 
,/ates ,prev5tive ,s]vices ,task ,=ce ) 
respect to ! s]vice if su* recomm5dation
 or grade 0 develop$ or updat$ 9        
accordance ) ! am5dm5ts made by section 
#b7;a7 ( su* ,act & if ! ,secret>y has  
concurr$ ) su* recomm5dation or grade   
aft] consultation ) o!r ,f$]al heal?    
ag5cies & relevant pati5t & provid]     
gr\ps44  7e7 ,application to physician  
quality measures "u ! ,m$ic>e program   
,section #ahdh ( ! ,social ,security    

,act 7#db ,u4,s4,c4 #aciew-#d7 is am5d$ 
by add+ at ! end ! foll[+ new           
subsection3  7t7 ,measures relat$ to    
,,usp/f recomm5dations ,effective on !  
date ( enactm5t ( ! ,,usp/f ,transp>5cy 
& ,acc\ntability ,act ( #bjai1 not)/&+  
any o!r provision ( ?is title1 a quality
 measure relat$ to a recomm5dation ( !  
,unit$ ,/ates ,prev5tive ,s]vices ,task 
,=ce may be appli$ "u ?is section only  
if su* recomm5dation 0 develop$ or      
updat$ 9 accordance ) ! am5dm5ts made by
 section #b7;a7 ( su* ,act & if !       
,secret>y has concurr$ ) su*            
recomm5dation or grade aft] consultation
 ) o!r ,f$]al heal? ag5cies & relevant  
pati5t & provid] gr\ps4  4