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APPENDIX A PUBLIC LASS 9S-623 NOY. 9' 1978 Public Law 95-623 95th Congress 92 STAT. 3443 An Act To amend the Public Health Service Act to revise and extend the authorities Liov. 9, 1978 under that Act relating to health services research and health statistics and [c :~66] to establish a National Center for Health Care 'technology, and for other purposes. Be if er~`rcted t,V the Senate and Coup of Representati~,es of the United States of America in Congress assembled, Health Services Research, Health Statistics, and Health Glre SECTION 1. (a) This Act may be cited as the "Health Services Technology Act Research, Health Statistics, and Health Care Technology Act Of O4f ~USC20 SHORT TITLE. REFERENCE TO ACT Sect ions 7 and 8 are reproduced below . 81 UDY OF COOTS OF DISEASES AND ADVERSE EFFECT ON HUMANS WHICH WE ENVIROHMENTAI,I Y RELATED SEC. 7. Section 304 (as amended by section 3 (d) ) is Unended by 42 USC 242b. added at the end the following: " (ei(1 ) The Secretary and the National Academy of Sciences (act- ing through the Institute of Medicine and other appropriate unite) shall, jointly and in cooperation with the Administrator of the Environmental Protection Agency, the Secretary of Labor, the Con- sumer Product Safety Commission the Council of Economic Advmers, the Council on Wane and Price Stability, the Council on Ennron- mental Quality, anlother entities of the~Federal Government which the Secretary determines have the expertise in the subject of the study prescribed by this paragraph, conduct, with funds appropriated under section 308('i)~2), an ongoing study of the present and protected future health costs of pollution and other environmental conditions resulting from human activity (including human activity in any place in the indoor or outdoor environment, including places of employment and residence). In conducting the study, the Secretary "d the National Academy of Sciences (hereinafter in this subsection referred to as the 'Academy') shall, to the extent feasibly "(A) identify the pollution (and the pollutants responsible for the pollution) and other environmental conditions which are, or may masonably be anticipated to be, responsible for causing, con- tribut~ng to, ~ncr~ng susce ~t~b~l~ty to, or aggravating Oman diseases and adverse effects on ~ lumps; "(B) identify each such disease and adverse elf - on humans and specifically determine whether cancer, birth defects, genetic damage, emphysema, asthma, bronchitis, and other respiratory diseases, heart disease, stroke, and mental illness and impairment are such a disease or effect; 6'((~) identify (on a national, regional, or other geographical basis) the source or sources of such pollutants and conditions and estimate the portion of each pollutant and the extent of each con- dition which can be traced to a specific type of source; A-1 (This section applies to the NAS.)

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APPENDIX A (cone 'd.). PUBLIC LAW 95-623 Reports to coronal committees. Definition. 42 USC 1395, 1396. "(D) ascertain (i) the extent to which the pollutants and con- ditions identified under subparagraph (A) are, or mar reasonably be anticipated to be, responsible, individually or collectively, for causing, contributing to, increasing susceptibility to, or ag~ra- vatin~ the diseases utd effects identified under subparagraph FIB i, and (ii) the eBect upon the incidence or severity of specific diseases sod effects of individual or collective, as appropriate, incremental reductions in the pollutants and changes ~ Such conditions; and `'(~:) quantify (i) the present and projected future health cows of the diseases and effects identified under subnaraL,,raph (B), and (ii) the reduction in health costs which would result from each incremental reduction and change referred to in subparagraph (D) (ii). "~2) The Secretary shall enter into appropriate arrangements with the Academy under which the Secretary Mall be responsible for expenses incurred by the Academy in connection with the study pre- scribed by paragraph (1) . "~3) The first report on the study prescribed by paragraph (1) shall be made to the Committee on Human Resources of the Senate and the Committee on Interstate and Foreign Commerce of the House of Representatives by the Secretary and the Academy not later than eighteen months after the date of the enactment of this subsection. Subsequent reports on the study shall be made by the Secretary. and the Academy every two years after the date the first report is submitted. Each report shall (A) identify deficiencies and limitations in the data on the matters considered in the study and recommend actions which may be taken to eliminate such deficiencies and limitations, (B) include such reconunendations for legislation an the Secretary detennin~ appropriate, (C) include recommendations for facilitating studies of the effects of hazardous substances on humans, and (D) include a description of any administrative action propose to be taken by the Secretary, the Administrator of the Environmental Protection Agency, the Secretary of labor, and the Conswner Product Safety Communion to reduce the costs which have been quantified under paragraph (1) (E) (i). In conducting the study, the Secretary and the Academy Shall seek assistance from public and private health financing entities in securing the data needed for the study. ~ (4) For purposes of paragraph (1) ~ the term 'health costs of pollu- tion and other environmental conditions' means the costs of human diseases and other adverse eBects on humans which pollution and other environmental conditions are, or may reasonably be anticipated to be, responsible for causing, contributing to, increasing susceptibility to, or aggravating, including the costs of preventing such diseases and effects, the cow of the treatment, cure, convalescence, and rehabilita- tion of persons afflicted by such diseases, costs reasonably attributable to pain and suffering from such diseases and eBects, loss of income and future earnings resulting from such diseases and effects, adverse edects on productivity (and thus increases in production costs and consumer prices) resulting from such rliseases and eRects, loss of tax revenues resulting from such decreases in earnings and plUdUCtiVity, costs to the welfare and unemployment compensation systems an] the pm- grams of health benefits under titles XVIII an] XIX of the Social Security Act resulting from such diseases and erects, the overall increases in costs throughout the economy resulting from such diseases and effects, and other related direct and indimct Is "_ A-2

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APPENDIX A (contend.). PUBLIC LAW 95-623 INl?ORMATION 0~ =~ 0~' little OF THE ~~N~ A EMPI~OYMENT COND1IIONB SEC. 8. (a) Section 306 (as amended by section 5) ~ amended by 42 USC242~. inserting after subsection (k~thefollowin~ new subsection: "~1~(1) The Secretary~acting through the Cen~r,shall develop a Pan. plan for the collection andcoord~nationofstati~icalandepidemiologi- cal data on the eBects of the ennronunent on health. Such plan shall include a review of the data now available on health effects, deficiencies in such data, and methods by which existing data deficiencies can be corrected. The Secretary, shall submit such plan to the Congress not Submittal to later than January 1,1980. Congr~. "~21 (A) The ecretary,acting through the Center,shallestablish, Guidehn - . not later than two years after the date of the enactment of this subsection, guidelines for the collection, compilation, analysis, pub- licat~on, and distribution of statistics and intonation Feces for determining the effects of conditions of employment and indoor and outdoor environmental conditions tin the public health. Guidelines established under this subparagraph shall not (i) authorize or require the d~se1osure of any matter described in section 552(b) {6) of title 5, United States Code, and (ii) authorize or require the disclosure of any statistics or other information which is exempt from disclosure p~'r- suant to subsection (a) of section 552 of title 5, United States Code., by reason of subsection (b) (~) of such section. The guidelines shall be reviewed and, if apptopriate. revised at least e`-erv three fears after the date thee are initially established. (;uidelirres shall take effect on the date of tl~e promulgation of the regulation establishing or revising the guidelines or such later date as may be specified in the guidelines. " ~ B ~ The guidelines shall be deponed `' (i) to Prove coordination of environmental and health studies. statistics and information, and to prevent overlay, and unnecessary duplication with respect to such, studies, statistics, and information; '`(ii) to assure that such studies, statistics, and information will be available to executive departments responsible for the admin- istration of awls relating to the protection of the public health and safety or the environment; "(iii) ~ encourage the more effective use by executive depart- ments of such studies, statistics, and information; "(iv) to improve the statistical validity and reliability of such studies? statistics, and information; and "(v) to assure greater responsiveness by the Department of Health, Education, and Welfare and other executive departments in meeting informational and analytical needs for determining the effects of employment and indoor and outdoor environmental conditions on public health. "(C) In establishing and revising guidelines under subparagraph (A), the Secretary shall take into consideration the plan developed pursuant to paragraph (1~. "(D) The Center shall serve as a clearinghouse for statistics and information with respect to which guidelines have been established under subparagraph (A) and shall assist executive departments in ol~tainin~ such statistics and information for purposes of admin- istering~aws under their jurisdiction relating to environmental health protection or the safety and health of employees. " (E) (i) Each executive department shall comply with the substan- tive and procedural requirements of the guidelines. " (ii) The President shall by Executive order require each executive department to comply with requests, made in accordance with the guidelines, by the Secretary, the Administrator of the Environmental Protection Agency, the Consumer Product Safety Commission, or the Secretary of I;abor for statistics and information. A-3 (This section applies to NCHS. ~ Guidelines, compliance.

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APPENDIX (cons 'd. ) . PUBLIC LAW 95-623 Esempnone. `' (iii) - e President may by Executive order exempt any executive department from compliance with a requirement of the guidelines respecting specific statistics or other information if the President determines that the exemption is necessary ~ the interest of national 8eCUTitye " ( F ) In carrying out his duties under this paragraph, the Secretary, acting through the Center, shall, Insofar as practicable, pronde for coordination of his activities with those of other Federal agencies and interagency task forces relating to the. collection, analysis, publication, or distribution of statistics and information necessary for dete'-~ining the effects of conditions of employment and indoor and outdoor environmental conditions on the public health. "Guided es." "(G) For purposes of this paragraph, the term 'guidelines' means the guidelines, either as initially established or as revised, in effect under this paragraph. Study. " (3) The Secretary, acting through the Center, shall conduct a study of the issues respecting. and the recommendations for. establishing a Federal system to assist, in a manner designed to avoid invasion of . . ~ . . a. . ~ .. .... . . .. . .. . ~ personal privacy, ~ ederal, State, and other entitles in locating lnd~v~d- uals who have been or many have been exposed to hazardous substances to determine the effect on their health of such exposure and to assist them in obtaining appropriate medical care and treatment. In con- ducting such study, the Secretary may consult with any public and private entity which it determines has expertise on any matter to be Report to considered in the study. Not later than one year after the date of the Congress. enactment of this subsection, the Secretary shall complete the study and report to the Congress the results of the study and any recommenda- tions for legislation or administrative action. "~4) In carrying out paragraphs all, (2), and (3), the Secretary shall consult with and take into consideration any recommendations of the Task Force on Environmental Cancer and Heart and Lung Disease, the Administrator of the Environmental Protection Agency, the Secretary of Labor, the Consumer Product Safety Commission, the Council on Environmental Quality, the' National Committee on Vital and Health Statistics, and the National Academy of Sciences (includ- 42 USC 242m ing the' Institute of Medicine and any other unit of the Academy).". (b) The first sentence of subsection (d) of section 308 is amended 42 U5c 242~. by inserting after "unless authorized" the following: "by guidelines In effect un er section 306~1) (2) or . A-4