Patient Protection and Affordable Care Act/Title III/Subtitle A/Part II

by United States Congress

PART II--NATIONAL STRATEGY TO IMPROVE HEALTH CARE QUALITY

SEC. 3011. NATIONAL STRATEGY.

Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) is amended by adding at the end the following:

`PART S--HEALTH CARE QUALITY PROGRAMS

`Subpart I--National Strategy for Quality Improvement in Health Care

`SEC. 399HH. NATIONAL STRATEGY FOR QUALITY IMPROVEMENT IN HEALTH CARE.

`(a) Establishment of National Strategy and Priorities-

`(1) NATIONAL STRATEGY- The Secretary, through a transparent collaborative process, shall establish a national strategy to improve the delivery of health care services, patient health outcomes, and population health.

`(2) IDENTIFICATION OF PRIORITIES-

`(A) IN GENERAL- The Secretary shall identify national priorities for improvement in developing the strategy under paragraph (1).

`(B) REQUIREMENTS- The Secretary shall ensure that priorities identified under subparagraph (A) will--

`(i) have the greatest potential for improving the health outcomes, efficiency, and patient-centeredness of health care for all populations, including children and vulnerable populations;

`(ii) identify areas in the delivery of health care services that have the potential for rapid improvement in the quality and efficiency of patient care;

`(iii) address gaps in quality, efficiency, comparative effectiveness information, and health outcomes measures and data aggregation techniques;

`(iv) improve Federal payment policy to emphasize quality and efficiency;

`(v) enhance the use of health care data to improve quality, efficiency, transparency, and outcomes;

`(vi) address the health care provided to patients with high-cost chronic diseases;

`(vii) improve research and dissemination of strategies and best practices to improve patient safety and reduce medical errors, preventable admissions and readmissions, and health care-associated infections;

`(viii) reduce health disparities across health disparity populations (as defined in section 485E) and geographic areas; and

`(ix) address other areas as determined appropriate by the Secretary.

`(C) CONSIDERATIONS- In identifying priorities under subparagraph (A), the Secretary shall take into consideration the recommendations submitted by the entity with a contract under section 1890(a) of the Social Security Act and other stakeholders.

`(D) COORDINATION WITH STATE AGENCIES- The Secretary shall collaborate, coordinate, and consult with State agencies responsible for administering the Medicaid program under title XIX of the Social Security Act and the Children's Health Insurance Program under title XXI of such Act with respect to developing and disseminating strategies, goals, models, and timetables that are consistent with the national priorities identified under subparagraph (A).

`(b) Strategic Plan-

`(1) IN GENERAL- The national strategy shall include a comprehensive strategic plan to achieve the priorities described in subsection (a).

`(2) REQUIREMENTS- The strategic plan shall include provisions for addressing, at a minimum, the following:

`(A) Coordination among agencies within the Department, which shall include steps to minimize duplication of efforts and utilization of common quality measures, where available. Such common quality measures shall be measures identified by the Secretary under section 1139A or 1139B of the Social Security Act or endorsed under section 1890 of such Act.

`(B) Agency-specific strategic plans to achieve national priorities.

`(C) Establishment of annual benchmarks for each relevant agency to achieve national priorities.

`(D) A process for regular reporting by the agencies to the Secretary on the implementation of the strategic plan.

`(E) Strategies to align public and private payers with regard to quality and patient safety efforts.

`(F) Incorporating quality improvement and measurement in the strategic plan for health information technology required by the American Recovery and Reinvestment Act of 2009 (Public Law 111-5).

`(c) Periodic Update of National Strategy- The Secretary shall update the national strategy not less than annually. Any such update shall include a review of short- and long-term goals.

`(d) Submission and Availability of National Strategy and Updates-

`(1) DEADLINE FOR INITIAL SUBMISSION OF NATIONAL STRATEGY- Not later than January 1, 2011, the Secretary shall submit to the relevant committees of Congress the national strategy described in subsection (a).

`(2) UPDATES-

`(A) IN GENERAL- The Secretary shall submit to the relevant committees of Congress an annual update to the strategy described in paragraph (1).

`(B) INFORMATION SUBMITTED- Each update submitted under subparagraph (A) shall include--

`(i) a review of the short- and long-term goals of the national strategy and any gaps in such strategy;

`(ii) an analysis of the progress, or lack of progress, in meeting such goals and any barriers to such progress;

`(iii) the information reported under section 1139A of the Social Security Act, consistent with the reporting requirements of such section; and

`(iv) in the case of an update required to be submitted on or after January 1, 2014, the information reported under section 1139B(b)(4) of the Social Security Act, consistent with the reporting requirements of such section.

`(C) SATISFACTION OF OTHER REPORTING REQUIREMENTS- Compliance with the requirements of clauses (iii) and (iv) of subparagraph (B) shall satisfy the reporting requirements under sections 1139A(a)(6) and 1139B(b)(4), respectively, of the Social Security Act.

`(e) Health Care Quality Internet Website- Not later than January 1, 2011, the Secretary shall create an Internet website to make public information regarding--

`(1) the national priorities for health care quality improvement established under subsection (a)(2);

`(2) the agency-specific strategic plans for health care quality described in subsection (b)(2)(B); and

`(3) other information, as the Secretary determines to be appropriate.'.

SEC. 3012. INTERAGENCY WORKING GROUP ON HEALTH CARE QUALITY.

(a) In General- The President shall convene a working group to be known as the Interagency Working Group on Health Care Quality (referred to in this section as the `Working Group').

(b) Goals- The goals of the Working Group shall be to achieve the following:

(1) Collaboration, cooperation, and consultation between Federal departments and agencies with respect to developing and disseminating strategies, goals, models, and timetables that are consistent with the national priorities identified under section 399HH(a)(2) of the Public Health Service Act (as added by section 3011).

(2) Avoidance of inefficient duplication of quality improvement efforts and resources, where practicable, and a streamlined process for quality reporting and compliance requirements.

(3) Assess alignment of quality efforts in the public sector with private sector initiatives.

(c) Composition-

(1) IN GENERAL- The Working Group shall be composed of senior level representatives of--

(A) the Department of Health and Human Services;

(B) the Centers for Medicare & Medicaid Services;

(C) the National Institutes of Health;

(D) the Centers for Disease Control and Prevention;

(E) the Food and Drug Administration;

(F) the Health Resources and Services Administration;

(G) the Agency for Healthcare Research and Quality;

(H) the Office of the National Coordinator for Health Information Technology;

(I) the Substance Abuse and Mental Health Services Administration;

(J) the Administration for Children and Families;

(K) the Department of Commerce;

(L) the Office of Management and Budget;

(M) the United States Coast Guard;

(N) the Federal Bureau of Prisons;

(O) the National Highway Traffic Safety Administration;

(P) the Federal Trade Commission;

(Q) the Social Security Administration;

(R) the Department of Labor;

(S) the United States Office of Personnel Management;

(T) the Department of Defense;

(U) the Department of Education;

(V) the Department of Veterans Affairs;

(W) the Veterans Health Administration; and

(X) any other Federal agencies and departments with activities relating to improving health care quality and safety, as determined by the President.

(2) CHAIR AND VICE-CHAIR-

(A) CHAIR- The Working Group shall be chaired by the Secretary of Health and Human Services.

(B) VICE CHAIR- Members of the Working Group, other than the Secretary of Health and Human Services, shall serve as Vice Chair of the Group on a rotating basis, as determined by the Group.

(d) Report to Congress- Not later than December 31, 2010, and annually thereafter, the Working Group shall submit to the relevant Committees of Congress, and make public on an Internet website, a report describing the progress and recommendations of the Working Group in meeting the goals described in subsection (b).

SEC. 3013. QUALITY MEASURE DEVELOPMENT.

(a) Public Health Service Act- Title IX of the Public Health Service Act (42 U.S.C. 299 et seq.) is amended--

(1) by redesignating part D as part E;

(2) by redesignating sections 931 through 938 as sections 941 through 948, respectively;

(3) in section 948(1), as so redesignated, by striking `931' and inserting `941'; and

(4) by inserting after section 926 the following:

`PART D--HEALTH CARE QUALITY IMPROVEMENT

`Subpart I--Quality Measure Development

`SEC. 931. QUALITY MEASURE DEVELOPMENT.

`(a) Quality Measure- In this subpart, the term `quality measure' means a standard for measuring the performance and improvement of population health or of health plans, providers of services, and other clinicians in the delivery of health care services.

`(b) Identification of Quality Measures-

`(1) IDENTIFICATION- The Secretary, in consultation with the Director of the Agency for Healthcare Research and Quality and the Administrator of the Centers for Medicare & Medicaid Services, shall identify, not less often than triennially, gaps where no quality measures exist and existing quality measures that need improvement, updating, or expansion, consistent with the national strategy under section 399HH, to the extent available, for use in Federal health programs. In identifying such gaps and existing quality measures that need improvement, the Secretary shall take into consideration--

`(A) the gaps identified by the entity with a contract under section 1890(a) of the Social Security Act and other stakeholders;

`(B) quality measures identified by the pediatric quality measures program under section 1139A of the Social Security Act; and

`(C) quality measures identified through the Medicaid Quality Measurement Program under section 1139B of the Social Security Act.

`(2) PUBLICATION- The Secretary shall make available to the public on an Internet website a report on any gaps identified under paragraph (1) and the process used to make such identification.

`(c) Grants or Contracts for Quality Measure Development-

`(1) IN GENERAL- The Secretary shall award grants, contracts, or intergovernmental agreements to eligible entities for purposes of developing, improving, updating, or expanding quality measures identified under subsection (b).

`(2) PRIORITIZATION IN THE DEVELOPMENT OF QUALITY MEASURES- In awarding grants, contracts, or agreements under this subsection, the Secretary shall give priority to the development of quality measures that allow the assessment of--

`(A) health outcomes and functional status of patients;

`(B) the management and coordination of health care across episodes of care and care transitions for patients across the continuum of providers, health care settings, and health plans;

`(C) the experience, quality, and use of information provided to and used by patients, caregivers, and authorized representatives to inform decisionmaking about treatment options, including the use of shared decisionmaking tools and preference sensitive care (as defined in section 936);

`(D) the meaningful use of health information technology;

`(E) the safety, effectiveness, patient-centeredness, appropriateness, and timeliness of care;

`(F) the efficiency of care;

`(G) the equity of health services and health disparities across health disparity populations (as defined in section 485E) and geographic areas;

`(H) patient experience and satisfaction;

`(I) the use of innovative strategies and methodologies identified under section 933; and

`(J) other areas determined appropriate by the Secretary.

`(3) ELIGIBLE ENTITIES- To be eligible for a grant or contract under this subsection, an entity shall--

`(A) have demonstrated expertise and capacity in the development and evaluation of quality measures;

`(B) have adopted procedures to include in the quality measure development process--

`(i) the views of those providers or payers whose performance will be assessed by the measure; and

`(ii) the views of other parties who also will use the quality measures (such as patients, consumers, and health care purchasers);

`(C) collaborate with the entity with a contract under section 1890(a) of the Social Security Act and other stakeholders, as practicable, and the Secretary so that quality measures developed by the eligible entity will meet the requirements to be considered for endorsement by the entity with a contract under such section 1890(a);

`(D) have transparent policies regarding governance and conflicts of interest; and

`(E) submit an application to the Secretary at such time and in such manner, as the Secretary may require.

`(4) USE OF FUNDS- An entity that receives a grant, contract, or agreement under this subsection shall use such award to develop quality measures that meet the following requirements:

`(A) Such measures support measures required to be reported under the Social Security Act, where applicable, and in support of gaps and existing quality measures that need improvement, as described in subsection (b)(1)(A).

`(B) Such measures support measures developed under section 1139A of the Social Security Act and the Medicaid Quality Measurement Program under section 1139B of such Act, where applicable.

`(C) To the extent practicable, data on such quality measures is able to be collected using health information technologies.

`(D) Each quality measure is free of charge to users of such measure.

`(E) Each quality measure is publicly available on an Internet website.

`(d) Other Activities by the Secretary- The Secretary may use amounts available under this section to update and test, where applicable, quality measures endorsed by the entity with a contract under section 1890(a) of the Social Security Act or adopted by the Secretary.

`(e) Coordination of Grants- The Secretary shall ensure that grants or contracts awarded under this section are coordinated with grants and contracts awarded under sections 1139A(5) and 1139B(4)(A) of the Social Security Act.'.

(b) Social Security Act- Section 1890A of the Social Security Act, as added by section 3014(b), is amended by adding at the end the following new subsection:

`(e) Development of Quality Measures- The Administrator of the Center for Medicare & Medicaid Services shall through contracts develop quality measures (as determined appropriate by the Administrator) for use under this Act. In developing such measures, the Administrator shall consult with the Director of the Agency for Healthcare Research and Quality.'.

(c) Funding- There are authorized to be appropriated to the Secretary of Health and Human Services to carry out this section, $75,000,000 for each of fiscal years 2010 through 2014. Of the amounts appropriated under the preceding sentence in a fiscal year, not less than 50 percent of such amounts shall be used pursuant to subsection (e) of section 1890A of the Social Security Act, as added by subsection (b), with respect to programs under such Act. Amounts appropriated under this subsection for a fiscal year shall remain available until expended.

SEC. 3014. QUALITY MEASUREMENT.

(a) New Duties for Consensus-based Entity-

(1) MULTI-STAKEHOLDER GROUP INPUT- Section 1890(b) of the Social Security Act (42 U.S.C. 1395aaa(b)), as amended by section 3003, is amended by adding at the end the following new paragraphs:

`(7) CONVENING MULTI-STAKEHOLDER GROUPS-

`(A) IN GENERAL- The entity shall convene multi-stakeholder groups to provide input on--

`(i) the selection of quality measures described in subparagraph (B), from among--

`(I) such measures that have been endorsed by the entity; and

`(II) such measures that have not been considered for endorsement by such entity but are used or proposed to be used by the Secretary for the collection or reporting of quality measures; and

`(ii) national priorities (as identified under section 399HH of the Public Health Service Act) for improvement in population health and in the delivery of health care services for consideration under the national strategy established under section 399HH of the Public Health Service Act.

`(B) QUALITY MEASURES-

`(i) IN GENERAL- Subject to clause (ii), the quality measures described in this subparagraph are quality measures--

`(I) for use pursuant to sections 1814(i)(5)(D), 1833(i)(7), 1833(t)(17), 1848(k)(2)(C), 1866(k)(3), 1881(h)(2)(A)(iii), 1886(b)(3)(B)(viii), 1886(j)(7)(D), 1886(m)(5)(D), 1886(o)(2), and 1895(b)(3)(B)(v);

`(II) for use in reporting performance information to the public; and

`(III) for use in health care programs other than for use under this Act.

`(ii) EXCLUSION- Data sets (such as the outcome and assessment information set for home health services and the minimum data set for skilled nursing facility services) that are used for purposes of classification systems used in establishing payment rates under this title shall not be quality measures described in this subparagraph.

`(C) REQUIREMENT FOR TRANSPARENCY IN PROCESS-

`(i) IN GENERAL- In convening multi-stakeholder groups under subparagraph (A) with respect to the selection of quality measures, the entity shall provide for an open and transparent process for the activities conducted pursuant to such convening.

`(ii) SELECTION OF ORGANIZATIONS PARTICIPATING IN MULTI-STAKEHOLDER GROUPS- The process described in clause (i) shall ensure that the selection of representatives comprising such groups provides for public nominations for, and the opportunity for public comment on, such selection.

`(D) MULTI-STAKEHOLDER GROUP DEFINED- In this paragraph, the term `multi-stakeholder group' means, with respect to a quality measure, a voluntary collaborative of organizations representing a broad group of stakeholders interested in or affected by the use of such quality measure.

`(8) TRANSMISSION OF MULTI-STAKEHOLDER INPUT- Not later than February 1 of each year (beginning with 2012), the entity shall transmit to the Secretary the input of multi-stakeholder groups provided under paragraph (7).'.

(2) ANNUAL REPORT- Section 1890(b)(5)(A) of the Social Security Act (42 U.S.C. 1395aaa(b)(5)(A)) is amended--

(A) in clause (ii), by striking `and' at the end;

(B) in clause (iii), by striking the period at the end and inserting a semicolon; and

(C) by adding at the end the following new clauses:

`(iv) gaps in endorsed quality measures, which shall include measures that are within priority areas identified by the Secretary under the national strategy established under section 399HH of the Public Health Service Act, and where quality measures are unavailable or inadequate to identify or address such gaps;

`(v) areas in which evidence is insufficient to support endorsement of quality measures in priority areas identified by the Secretary under the national strategy established under section 399HH of the Public Health Service Act and where targeted research may address such gaps; and

`(vi) the matters described in clauses (i) and (ii) of paragraph (7)(A).'.

(b) Multi-stakeholder Group Input Into Selection of Quality Measures- Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is amended by inserting after section 1890 the following:

`QUALITY MEASUREMENT

`Sec. 1890A. (a) Multi-stakeholder Group Input Into Selection of Quality Measures- The Secretary shall establish a pre-rulemaking process under which the following steps occur with respect to the selection of quality measures described in section 1890(b)(7)(B):

`(1) INPUT- Pursuant to section 1890(b)(7), the entity with a contract under section 1890 shall convene multi-stakeholder groups to provide input to the Secretary on the selection of quality measures described in subparagraph (B) of such paragraph.

`(2) PUBLIC AVAILABILITY OF MEASURES CONSIDERED FOR SELECTION- Not later than December 1 of each year (beginning with 2011), the Secretary shall make available to the public a list of quality measures described in section 1890(b)(7)(B) that the Secretary is considering under this title.

`(3) TRANSMISSION OF MULTI-STAKEHOLDER INPUT- Pursuant to section 1890(b)(8), not later than February 1 of each year (beginning with 2012), the entity shall transmit to the Secretary the input of multi-stakeholder groups described in paragraph (1).

`(4) CONSIDERATION OF MULTI-STAKEHOLDER INPUT- The Secretary shall take into consideration the input from multi-stakeholder groups described in paragraph (1) in selecting quality measures described in section 1890(b)(7)(B) that have been endorsed by the entity with a contract under section 1890 and measures that have not been endorsed by such entity.

`(5) RATIONALE FOR USE OF QUALITY MEASURES- The Secretary shall publish in the Federal Register the rationale for the use of any quality measure described in section 1890(b)(7)(B) that has not been endorsed by the entity with a contract under section 1890.

`(6) ASSESSMENT OF IMPACT- Not later than March 1, 2012, and at least once every three years thereafter, the Secretary shall--

`(A) conduct an assessment of the quality impact of the use of endorsed measures described in section 1890(b)(7)(B); and

`(B) make such assessment available to the public.

`(b) Process for Dissemination of Measures Used by the Secretary-

`(1) IN GENERAL- The Secretary shall establish a process for disseminating quality measures used by the Secretary. Such process shall include the following:

`(A) The incorporation of such measures, where applicable, in workforce programs, training curricula, and any other means of dissemination determined appropriate by the Secretary.

`(B) The dissemination of such quality measures through the national strategy developed under section 399HH of the Public Health Service Act.

`(2) EXISTING METHODS- To the extent practicable, the Secretary shall utilize and expand existing dissemination methods in disseminating quality measures under the process established under paragraph (1).

`(c) Review of Quality Measures Used by the Secretary-

`(1) IN GENERAL- The Secretary shall--

`(A) periodically (but in no case less often than once every 3 years) review quality measures described in section 1890(b)(7)(B); and

`(B) with respect to each such measure, determine whether to--

`(i) maintain the use of such measure; or

`(ii) phase out such measure.

`(2) CONSIDERATIONS- In conducting the review under paragraph (1), the Secretary shall take steps to--

`(A) seek to avoid duplication of measures used; and

`(B) take into consideration current innovative methodologies and strategies for quality improvement practices in the delivery of health care services that represent best practices for such quality improvement and measures endorsed by the entity with a contract under section 1890 since the previous review by the Secretary.

`(d) Rule of Construction- Nothing in this section shall preclude a State from using the quality measures identified under sections 1139A and 1139B.'.

(c) Funding- For purposes of carrying out the amendments made by this section, the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 1395t), in such proportion as the Secretary determines appropriate, of $20,000,000, to the Centers for Medicare & Medicaid Services Program Management Account for each of fiscal years 2010 through 2014. Amounts transferred under the preceding sentence shall remain available until expended.

SEC. 3015. DATA COLLECTION; PUBLIC REPORTING.

Title III of the Public Health Service Act (42 U.S.C. 241 et seq.), as amended by section 3011, is further amended by adding at the end the following:

`SEC. 399II. COLLECTION AND ANALYSIS OF DATA FOR QUALITY AND RESOURCE USE MEASURES.

`(a) In General- The Secretary shall collect and aggregate consistent data on quality and resource use measures from information systems used to support health care delivery to implement the public reporting of performance information, as described in section 399JJ, and may award grants or contracts for this purpose. The Secretary shall ensure that such collection, aggregation, and analysis systems span an increasingly broad range of patient populations, providers, and geographic areas over time.

`(b) Grants or Contracts for Data Collection-

`(1) IN GENERAL- The Secretary may award grants or contracts to eligible entities to support new, or improve existing, efforts to collect and aggregate quality and resource use measures described under subsection (c).

`(2) ELIGIBLE ENTITIES- To be eligible for a grant or contract under this subsection, an entity shall--

`(A) be--

`(i) a multi-stakeholder entity that coordinates the development of methods and implementation plans for the consistent reporting of summary quality and cost information;

`(ii) an entity capable of submitting such summary data for a particular population and providers, such as a disease registry, regional collaboration, health plan collaboration, or other population-wide source; or

`(iii) a Federal Indian Health Service program or a health program operated by an Indian tribe (as defined in section 4 of the Indian Health Care Improvement Act);

`(B) promote the use of the systems that provide data to improve and coordinate patient care;

`(C) support the provision of timely, consistent quality and resource use information to health care providers, and other groups and organizations as appropriate, with an opportunity for providers to correct inaccurate measures; and

`(D) agree to report, as determined by the Secretary, measures on quality and resource use to the public in accordance with the public reporting process established under section 399JJ.

`(c) Consistent Data Aggregation- The Secretary may award grants or contracts under this section only to entities that enable summary data that can be integrated and compared across multiple sources. The Secretary shall provide standards for the protection of the security and privacy of patient data.

`(d) Matching Funds- The Secretary may not award a grant or contract under this section to an entity unless the entity agrees that it will make available (directly or through contributions from other public or private entities) non-Federal contributions toward the activities to be carried out under the grant or contract in an amount equal to $1 for each $5 of Federal funds provided under the grant or contract. Such non-Federal matching funds may be provided directly or through donations from public or private entities and may be in cash or in-kind, fairly evaluated, including plant, equipment, or services.

`(e) Authorization of Appropriations- To carry out this section, there are authorized to be appropriated such sums as may be necessary for fiscal years 2010 through 2014.

`SEC. 399JJ. PUBLIC REPORTING OF PERFORMANCE INFORMATION.

`(a) Development of Performance Websites- The Secretary shall make available to the public, through standardized Internet websites, performance information summarizing data on quality measures. Such information shall be tailored to respond to the differing needs of hospitals and other institutional health care providers, physicians and other clinicians, patients, consumers, researchers, policymakers, States, and other stakeholders, as the Secretary may specify.

`(b) Information on Conditions- The performance information made publicly available on an Internet website, as described in subsection (a), shall include information regarding clinical conditions to the extent such information is available, and the information shall, where appropriate, be provider-specific and sufficiently disaggregated and specific to meet the needs of patients with different clinical conditions.

`(c) Consultation-

`(1) IN GENERAL- In carrying out this section, the Secretary shall consult with the entity with a contract under section 1890(a) of the Social Security Act, and other entities, as appropriate, to determine the type of information that is useful to stakeholders and the format that best facilitates use of the reports and of performance reporting Internet websites.

`(2) CONSULTATION WITH STAKEHOLDERS- The entity with a contract under section 1890(a) of the Social Security Act shall convene multi-stakeholder groups, as described in such section, to review the design and format of each Internet website made available under subsection (a) and shall transmit to the Secretary the views of such multi-stakeholder groups with respect to each such design and format.

`(d) Coordination- Where appropriate, the Secretary shall coordinate the manner in which data are presented through Internet websites described in subsection (a) and for public reporting of other quality measures by the Secretary, including such quality measures under title XVIII of the Social Security Act.

`(e) Authorization of Appropriations- To carry out this section, there are authorized to be appropriated such sums as may be necessary for fiscal years 2010 through 2014.'.