42 U.S. Code § 1395aaa - Contract with a consensus-based entity regarding performance measurement
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(1) In general
For purposes of activities conducted under this chapter, the Secretary shall identify and have in effect a contract with a consensus-based entity, such as the National Quality Forum, that meets the requirements described in subsection (c). Such contract shall provide that the entity will perform the duties described in subsection (b).
(2) Timing for first contract
As soon as practicable after July 15, 2008, the Secretary shall enter into the first contract under paragraph (1).
(3) Period of contract
A contract under paragraph (1) shall be for a period of 4 years (except as may be renewed after a subsequent bidding process).
The duties described in this subsection are the following:
(1) Priority setting process
The entity shall synthesize evidence and convene key stakeholders to make recommendations, with respect to activities conducted under this chapter, on an integrated national strategy and priorities for health care performance measurement in all applicable settings. In making such recommendations, the entity shall—
(A) ensure that priority is given to measures—
(ii) with the greatest potential for improving the quality, efficiency, and patient-centeredness of health care; and
(B) take into account measures that—
(2) Endorsement of measures
The entity shall provide for the endorsement of standardized health care performance measures. The endorsement process under the preceding sentence shall consider whether a measure—
(A) is evidence-based, reliable, valid, verifiable, relevant to enhanced health outcomes, actionable at the caregiver level, feasible to collect and report, and responsive to variations in patient characteristics, such as health status, language capabilities, race or ethnicity, and income level; and
(3) Maintenance of measures
The entity shall establish and implement a process to ensure that measures endorsed under paragraph (2) are updated (or retired if obsolete) as new evidence is developed.
(5) Annual report to Congress and the Secretary; secretarial publication and comment
(A) Annual report
By not later than March 1 of each year (beginning with 2009), the entity shall submit to Congress and the Secretary a report containing a description of—
(i) the implementation of quality measurement initiatives under this chapter and the coordination of such initiatives with quality initiatives implemented by other payers;
(iii) the performance by the entity of the duties required under the contract entered into with the Secretary under subsection (a);
(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 280j of this title, 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 280j of this title and where targeted research may address such gaps; and
(6) Review and endorsement of episode grouper under the physician feedback program
(7) Convening multi-stakeholder groups
(A) In general
The entity shall convene multi-stakeholder groups to provide input on—
(i) the selection of quality and efficiency measures described in subparagraph (B), from among—
(B) Quality and efficiency measures
(i) In general Subject to clause (ii), the quality and efficiency measures described in this subparagraph are quality and efficiency measures—
(I) for use pursuant to sections 1395f (i)(5)(D), 1395l (i)(7), 1395l (t)(17), 1395w–4 (k)(2)(C), 1395cc (k)(3), 1395rr (h)(2)(A)(iii),  1395ww (b)(3)(B)(viii), 1395ww (j)(7)(D), 1395ww (m)(5)(D), 1395ww (o)(2), 1395ww (s)(4)(D), and 1395fff (b)(3)(B)(v) of this title;
(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 subchapter shall not be quality and efficiency 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 and efficiency measures, the entity shall provide for an open and transparent process for the activities conducted pursuant to such convening.
(D) Multi-stakeholder group defined
In this paragraph, the term “multi-stakeholder group” means, with respect to a quality and efficiency measure, a voluntary collaborative of organizations representing a broad group of stakeholders interested in or affected by the use of such quality and efficiency measure.
(c) Requirements described
The requirements described in this subsection are the following:
(2) Board membership
The members of the board of the entity include—
(A) representatives of health plans and health care providers and practitioners or representatives of groups representing such health plans and health care providers and practitioners;
(3) Entity membership
The membership of the entity includes persons who have experience with—
(4) Open and transparent
With respect to matters related to the contract with the Secretary under subsection (a), the entity conducts its business in an open and transparent manner and provides the opportunity for public comment on its activities.
(5) Voluntary consensus standards setting organization
The entity operates as a voluntary consensus standards setting organization as defined for purposes of section 12(d) of the National Technology Transfer and Advancement Act of 1995 (Public Law 104–113) and Office of Management and Budget Revised Circular A–119 (published in the Federal Register on February 10, 1998).
The entity has at least 4 years of experience in establishing national consensus standards.
(7) Membership fees
If the entity requires a membership fee for participation in the functions of the entity, such fees shall be reasonable and adjusted based on the capacity of the potential member to pay the fee. In no case shall membership fees pose a barrier to the participation of individuals or groups with low or nominal resources to participate in the functions of the entity.
(1) For purposes of carrying out this section, the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1395i of this title and the Federal Supplementary Medical Insurance Trust Fund under section 1395t of this title (in such proportion as the Secretary determines appropriate), of $10,000,000 to the Centers for Medicare & Medicaid Services Program Management Account for each of fiscal years 2009 through 2013. Amounts transferred under the preceding sentence shall remain available until expended.
(2) For purposes of carrying out this section and section 1395aaa–1 of this title (other than subsections (e) and (f)), the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1395i of this title and the Federal Supplementary Medical Insurance Trust Fund under section 1395t of this title, in such proportion as the Secretary determines appropriate, to the Centers for Medicare & Medicaid Services Program Management Account of $5,000,000 for fiscal year 2014 and $15,000,000 for the first 6 months of fiscal year 2015. Amounts transferred under the preceding sentence shall remain available until expended.
 See References in Text note below.
Source(Aug. 14, 1935, ch. 531, title XVIII, § 1890, as added Pub. L. 110–275, title I, § 183(a)(1),July 15, 2008, 122 Stat. 2583; amended Pub. L. 111–148, title III, §§ 3003(b), 3014 (a), title X, §§ 10304, 10322(b),Mar. 23, 2010, 124 Stat. 367, 384, 938, 954; Pub. L. 112–240, title VI, § 609(a),Jan. 2, 2013, 126 Stat. 2349; Pub. L. 113–67, div. B, title I, § 1109,Dec. 26, 2013, 127 Stat. 1197; Pub. L. 113–93, title I, § 109,Apr. 1, 2014, 128 Stat. 1043.)
References in Text
Clause (iii) of section 1395rr (h)(2)(A) of this title, referred to in subsec. (b)(7)(B)(i)(I), was redesignated clause (iv) by Pub. L. 113–93, title II, § 217(d)(1)(B),Apr. 1, 2014, 128 Stat. 1062.
Section 12(d) of the National Technology Transfer and Advancement Act of 1995, referred to in subsec. (c)(5), is section 12(d) ofPub. L. 104–113, which is set out as a note under section 272 of Title 15, Commerce and Trade.
In subsec. (a)(4), “section 132 of title 41” substituted for “section 4(5) of the Office of Federal Procurement Policy Act (41 U.S.C. 403(5))” on authority of Pub. L. 111–350, § 6(c),Jan. 4, 2011, 124 Stat. 3854, which Act enacted Title 41, Public Contracts.
A prior section 1395aaa, act Aug. 14, 1935, ch. 531, title XVIII, § 1890, as added Aug. 18, 1987, Pub. L. 100–93, § 10, 101 Stat. 696, which related to limitation of liability of beneficiaries with respect to services furnished by excluded individuals and entities, was amended and transferred to section 1862(e)(2) of act Aug. 14, 1935, by Pub. L. 100–360, title IV, § 411(i)(4)(D)(ii),July 1, 1988, 102 Stat. 790, as amended by Pub. L. 100–485, title VI, § 608(d)(24)(C)(ii),Oct. 13, 1988, 102 Stat. 2421, and is classified to section 1395y (e)(2) of this title.
2014—Subsec. (d). Pub. L. 113–93designated existing provisions as par. (1) and added par. (2).
2013—Subsec. (b)(4). Pub. L. 112–240, § 609(a)(2), struck out par. (4). Text read as follows: “The entity shall promote the development and use of electronic health records that contain the functionality for automated collection, aggregation, and transmission of performance measurement information.”
Subsec. (d). Pub. L. 113–67inserted at end “Amounts transferred under the preceding sentence shall remain available until expended.”
Pub. L. 112–240, § 609(a)(1), substituted “fiscal years 2009 through 2013” for “fiscal years 2009 through 2012”.
2010—Subsec. (b)(5)(A)(iv) to (vi). Pub. L. 111–148, § 3014(a)(2), added cls. (iv) to (vi).
Subsec. (b)(6). Pub. L. 111–148, § 3003(b), added par. (6).
Subsec. (b)(7). Pub. L. 111–148, § 10304, substituted “quality and efficiency” for “quality” wherever appearing in text.
Pub. L. 111–148, § 3014(a)(1), added par. (7).
Subsec. (b)(7)(B). Pub. L. 111–148, § 10304, which directed substitution of “quality and efficiency” for “quality” wherever appearing, was executed by substituting “Quality and efficiency” for “Quality” in subpar. heading to reflect the probable intent of Congress.
Subsec. (b)(7)(B)(i)(I). Pub. L. 111–148, § 10322(b), inserted “1395ww(s)(4)(D),” after “1395ww(o)(2),”.
Subsec. (b)(8). Pub. L. 111–148, § 3014(a)(1), added par. (8).
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