I 

111TH CONGRESS 

1ST SESSION H. R. 2252 

To improve the Federal infrastructure for health care quality improvement 

in the United States. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 5, 2009 

Ms. DEGETTE introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on 

Ways and Means, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

A BILL 

To improve the Federal infrastructure for health care quality 

improvement in the United States. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘National Health Care 

5 Quality Act’’. 

6 SEC. 2. DEFINITIONS. 

7 In this Act: 

8 (1) HEALTH CARE QUALITY.—The term ‘‘health 

9 care quality’’ means the degree to which health servVerDate Nov 24 2008 22:45 May 06, 2009 Jkt 079200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2252.IH H2252

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1 ices for individuals and populations increase the like2 lihood of desired health outcomes and are consistent 

3 with current professional knowledge, based upon the 

4 following criteria: 

5 (A) EFFECTIVENESS.—Health care serv6 ices should be provided based upon scientific 

7 knowledge of all who could benefit. 

8 (B) EFFICIENCY.—Waste, including waste 

9 of equipment, supplies, ideas, and energies, 

10 should be avoided. 

11 (C) EQUITY.—The provision of health care 

12 should not vary in quality because of personal 

13 characteristics of the individuals involved. 

14 (D) PATIENT-CENTEREDNESS.—Health 

15 care should be responsive to, and respectful of, 

16 individual patient preferences. 

17 (E) SAFETY.—Injuries to patients from 

18 the health care that is supposed to help them 

19 should be avoided. 

20 (F) TIMELINESS.—Waiting times and 

21 harmful delays in providing health care should 

22 be reduced. 

23 (2) HEALTH CARE QUALITY MEASURE.—The 

24 term ‘‘health care quality measure’’ means a na25 tional consensus standard for measuring the perVerDate Nov 24 2008 22:45 May 06, 2009 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2252.IH H2252

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1 formance and improvement of population health or 

2 of institutional providers of services, physicians, and 

3 other clinicians in the delivery of health care serv4 ices, consistent with the health care quality criteria 

5 described in paragraph (1). 

6 (3) MULTI-STAKEHOLDER GROUP.—The term 

7 ‘‘multi-stakeholder group’’ means, with respect to a 

8 health care quality measure, a voluntary collabo9 rative of public and private organizations rep10 resenting persons interested in, or affected by, the 

11 use of such health care quality measure, including— 

12 (A) health care providers and practitioners, 

13 including providers and practitioners primarily 

14 serving children and those with long-term 

15 health care needs; 

16 (B) health care quality entities; 

17 (C) health plans; 

18 (D) patient advocates and consumer 

19 groups; 

20 (E) employers; 

21 (F) public and private purchasers of health 

22 care items and services; 

23 (G) labor organizations; 

24 (H) relevant departments or agencies of 

25 the United States; 


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1 (I) biopharmaceutical companies and man2 ufacturers of medical devices; and 

3 (J) licensing, credentialing, and accrediting 

4 bodies. 

5 SEC. 3. DEPARTMENT AND AGENCY QUALITY REVIEW. 

6 Each relevant department and agency of the Federal 

7 Government shall review the statutory authority of such 

8 department or agency, effective on the date of enactment 

9 of this Act, administrative regulations, and policies and 

10 procedures for the purpose of determining whether there 

11 are any deficiencies or inconsistencies therein which pro12 hibit full compliance with the purposes and provisions of 

13 this Act. Each department and agency shall, not later than 

14 July 1, 2010, propose to the President such measures as 

15 may be necessary to bring the authority and policies and 

16 procedures of such department or agency into conformity 

17 with the intent, purposes, and provisions set forth in this 

18 Act. 

19 SEC. 4. NATIONAL HEALTH CARE QUALITY PRIORITIES. 

20 (a) ESTABLISHMENT OF THE OFFICE OF NATIONAL

21 HEALTH CARE QUALITY IMPROVEMENT.—There is estab22 lished within the Executive Office of the President an Of23 fice of National Health Care Quality Improvement 

24 (‘‘NHCQI’’) (referred to in this section as the ‘‘Office’’). 

25 The Office shall be headed by a Director of National 


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1 Health Care Quality (referred to in this section as the 

2 ‘‘Director’’) who shall be appointed by the President and 

3 shall report directly to the President. 

4 (b) DIRECTOR.— 

5 (1) RESPONSIBILITIES.—The Director shall 

6 perform the duties of the Office, described in para7 graph (3), in a manner consistent with the develop8 ment of a nationwide health care quality infrastruc9 ture that— 

10 (A) coordinates and implements health 

11 care quality research, measurement, and data 

12 collection and reporting across all Federal agen13 cies involved in purchasing, providing, studying, 

14 or regulating health care services; 

15 (B) incorporates proven public and private 

16 quality improvement best practices; 

17 (C) includes public and private quality im18 provement strategies to address activities other 

19 than health care quality measurement, such as 

20 provider payment models, alternative care mod21 els, licensing, professional certification, medical 

22 education, alternative staffing models, and pub23 lic reporting; and 

24 (D) leads to improved health care out25 comes for patients across the United States. 


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1 (2) QUALIFICATIONS.—The President shall, by 

2 and with the advice and consent of the Senate, ap3 point a Director. The President shall select an indi4 vidual who has— 

5 (A) national recognition for expertise in 

6 health care quality improvement; 

7 (B) experience addressing health care qual8 ity improvement in more than one health care 

9 setting, such as inpatient care, outpatient care, 

10 long-term care, public programs, and private 

11 programs; and 

12 (C) experience addressing health care qual13 ity as it applies to vulnerable populations, in14 cluding children, underserved populations, rural 

15 populations, individuals with disabilities, the el16 derly, and racial and ethnic minorities. 

17 (3) DUTIES OF THE DIRECTOR.—The Director 

18 shall— 

19 (A) advise the President on the quality of 

20 health care in the United States, including pri21 orities and goals for the future; 

22 (B) in coordination with public and private 

23 stakeholders, determine national priorities for 

24 improving health care quality, in accordance 

25 with subsection (c); 


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1 (C) establish annual benchmarks for each 

2 relevant Federal department and agency to 

3 achieve national priorities for health care qual4 ity improvement; 

5 (D) develop an annual report card on the 

6 state of the Nation’s health as it relates to 

7 health care quality; 

8 (E) in coordination with the heads of other 

9 relevant agencies and as part of the annual 

10 budget request of Congress, submit funding re11 quirements, in accordance with subsection (d); 

12 (F) serve as the chairperson of the Quality 

13 Interagency Coordinating Council (QuICC), es14 tablished under section 4; and 

15 (G) in consultation with the National Coor16 dinator of Health Information Technology, de17 velop an open source framework for Federal 

18 quality communication to create and maintain a 

19 standardized, electronic language or interface 

20 that enables all relevant Federal entities to 

21 communicate information or make requests re22 garding quality research, definitions, activities, 

23 or regulations, or to provide any other 

24 functionality, as the Director determines. 


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1 (c) NATIONAL PRIORITIES FOR HEALTH CARE

2 QUALITY IMPROVEMENT.— 

3 (1) IN GENERAL.—Not later than January 1, 

4 2010 and at least every 5 years thereafter, the Di5 rector, in coordination with public and private stake6 holders, shall establish national priorities for health 

7 care quality improvement. 

8 (2) DEVELOPMENT OF PRIORITIES.—In estab9 lishing the national priorities for health care quality 

10 improvement under paragraph (1), the Director shall 

11 consider— 

12 (A) health care outcomes in the United 

13 States in comparison to health outcomes in 

14 other World Health Organization member coun15 tries; 

16 (B) the burden of disease, including the 

17 prevalence, incidence, and cost of disease to the 

18 United States; 

19 (C) demographics; 

20 (D) variability in practice norms; 

21 (E) potential to eliminate harm to pa22 tients; 

23 (F) improvements with the potential for 

24 the greatest impact on morbidity, mortality, 

25 performance, and a focus on the patient; 


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1 (G) quality measures that may be coordi2 nated across different health care settings, in3 cluding impatient and outpatient measures, pri4 mary care, and specialty care; 

5 (H) the specific quality improvement needs 

6 and challenges of rural areas; and 

7 (I) the unique quality improvement needs 

8 disparities and challenges of vulnerable popu9 lations, including children, the elderly, individ10 uals with disabilities, individuals near the end 

11 of life, and racial and ethnic minorities. 

12 (3) INITIAL PRIORITIES.—The first set of na13 tional priorities established under this subsection 

14 shall include as a priority pediatric health care qual15 ity improvement, for children up to age 21. 

16 (4) COLLABORATION WITH MULTI-STAKE17 HOLDER GROUPS.— 

18 (A) IN GENERAL.—The Director shall con19 vene and collaborate with multi-stakeholder 

20 groups in establishing and updating the na21 tional priorities under paragraph (1). 

22 (B) TRANSPARENCY.—All collaboration be23 tween the Director and multi-stakeholder 

24 groups shall be conducted through an open and 

25 transparent process. 


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1 (C) STATUTORY CONSTRUCTION.—Not2 withstanding any other provision in this para3 graph, the Director shall have the final author4 ity to decide whether to accept the rec5 ommendations provided by such multi-stake6 holder groups. 

7 (5) AGENCY- AND DEPARTMENT-SPECIFIC

8 STRATEGIC PLANS.—Not later than October 1, 

9 2010, and annually thereafter, the Director, in con10 sultation with the heads of relevant Federal agencies 

11 and departments, shall develop agency- and depart12 ment-specific strategic plans for health care quality 

13 improvement to achieve national priorities, including 

14 annual benchmarks. 

15 (d) ANNUAL BUDGET REQUEST FOR RESOURCES.— 

16 As part of the annual budget request made by the Presi17 dent to Congress, beginning with such budget request 

18 made in calendar year 2011, the Director, in consultation 

19 with the heads of relevant Federal departments and agen20 cies, shall include— 

21 (1) a description of the agency- and depart22 ment-specific strategic plans for health care quality 

23 improvement; and 


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1 (2) the level of Federal funding required for im2 plementing or maintaining the quality improvement 

3 strategic plans described under paragraph (1). 

4 (e) MONITORING.— 

5 (1) IN GENERAL.—The Director shall institute 

6 mechanisms for monitoring the progress on achiev7 ing national health care quality priorities under sub8 section (c)(1) as well as department- and agency9 specific strategic plans under subsection (c)(5), in10 cluding objectives, metrics, and benchmarks for the 

11 following: 

12 (A) The benefits and drawbacks of specific 

13 quality improvement efforts for public programs 

14 and for the health care system at large. 

15 (B) Coordination and communication of ef16 forts to achieve interagency goals, including in17 formation exchange. 

18 (C) Interagency coordination progress for 

19 national quality efforts. 

20 (D) Methods for ensuring awareness and 

21 recognition among health care providers and 

22 the public at large of the significance of health 

23 care quality improvement. 

24 (2) REPORTING.— 


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1 (A) REPORTING.—Not later than Decem2 ber 31, 2011, and by the end of each calendar 

3 year thereafter, the Director shall submit to the 

4 President and to Congress a report regarding 

5 the progress of Federal agencies in achieving 

6 the quality improvement priorities under para7 graphs (1) and (5) of subsection (c), and shall 

8 make such report publicly available through the 

9 Internet. 

10 (B) ANNUAL NATIONAL HEALTH CARE

11 QUALITY REPORT CARD.—Not later than Janu12 ary 31, 2011, and annually thereafter, the Di13 rector shall publish a national health care qual14 ity report card, which shall include— 

15 (i) the considerations for national 

16 health care quality priorities described in 

17 subsection (c)(2); 

18 (ii) an analysis of the progress of the 

19 department- and agency-specific strategic 

20 plans under subsection (c)(5) in achieving 

21 the national health care quality priorities 

22 established under subsection (c)(1), and 

23 any gaps in such strategic plans; 


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1 (iii) the extent to which private sector 

2 strategies have informed Federal quality 

3 improvement efforts; and 

4 (iv) a summary of consumer feedback 

5 regarding how well current quality im6 provement practices work for such con7 sumers and additional ways to improve 

8 health care quality. 

9 (f) WEBSITE.—Not later than July 1, 2010, the Di10 rector shall create a website to make public information 

11 regarding— 

12 (1) the national priorities for health care qual13 ity improvement established under subsection (c)(1); 

14 (2) the department- and agency-specific stra15 tegic plans for health care quality described in sub16 section (c)(5); 

17 (3) the annual national health care quality re18 port card described in subsection (e)(2)(B); 

19 (4) ongoing health care quality research efforts; 

20 (5) new and innovative health care quality im21 provement practices in the public and private sec22 tors; 

23 (6) a consumer feedback mechanism; and 

24 (7) other information, as the Director deter25 mines to be appropriate. 


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1 (g) STAFF; EXPERTS AND CONSULTANTS; VOL2 UNTARY AND UNCOMPENSATED SERVICE.— 

3 (1) STAFF.—The Director may employ such of4 ficers and employees as may be necessary to enable 

5 the Office to carry out its functions under this Act, 

6 and may employ and fix the compensation of such 

7 officers and employees as may be necessary to carry 

8 out its functions under this Act. 

9 (2) EXPERTS AND CONSULTANTS.—The Direc10 tor may employ and fix the compensation of such ex11 perts and consultants as may be necessary for the 

12 carrying out of its functions under this Act, in ac13 cordance with section 3109 of title 5, United States 

14 Code (without regard to the last sentence). 

15 (3) VOLUNTARY AND UNCOMPENSATED SERV16 ICE.—Notwithstanding section 1342 of title 31, 

17 United States Code, the Office may accept and use 

18 voluntary and uncompensated services, as the Direc19 tor determines necessary. 

20 (h) AUTHORIZATION OF APPROPRIATIONS.—There 

21 are authorized to carry out this section $50,000,000 for 

22 fiscal years 2010 through 2014. 

23 SEC. 5. NATIONAL HEALTH CARE QUALITY COORDINATION. 

24 (a) ESTABLISHMENT.—As of the date of enactment 

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1 tional Health Care Quality Improvement, the Quality 

2 Interagency Coordinating Council (referred to in this sec3 tion as the ‘‘QuICC’’). 

4 (b) PURPOSE.—The purpose of the QuICC is to co5 ordinate health care quality improvement efforts across all 

6 Federal agencies involved in purchasing, providing, study7 ing, or regulating health care services in order to achieve 

8 the common goal of improving patient health outcomes. 

9 (c) ORGANIZATION OF THE QUICC.— 

10 (1) CO-CHAIRPERSONS.—The Director of Na11 tional Health Care Quality (referred to in this sec12 tion as the ‘‘Director’’) and the Secretary of Health 

13 and Human Services shall serve as co-chairpersons 

14 of the QuICC, and the Director shall manage day15 to-day operations of the QuICC. 

16 (2) FEDERAL MEMBERS.—The Federal mem17 bers of the QuICC, each of whom shall have equal 

18 standing in the QuICC, shall include— 

19 (A) the Administrator of the Centers for 

20 Medicare & Medicaid Services; 

21 (B) the Director of the National Institutes 

22 of Health; 

23 (C) the Director of the Centers for Disease 

24 Control and Prevention; 

25 (D) the Commissioner of Food and Drugs; 


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1 (E) the Administrator of the Health Re2 sources and Services Administration; 

3 (F) the Director of the Agency for 

4 Healthcare Research and Quality; 

5 (G) the Assistant Secretary of the Admin6 istration for Children and Families; 

7 (H) the Secretary of Labor; 

8 (I) the Secretary of Defense; 

9 (J) the Secretary of Veterans Affairs; 

10 (K) the Under Secretary for Health of the 

11 Veterans Health Administration; 

12 (L) the Secretary of Commerce; 

13 (M) the Director of the Office of Personnel 

14 Management; 

15 (N) the Director of the Office of Manage16 ment and Budget; 

17 (O) the Commandant of the United States 

18 Coast Guard; 

19 (P) the Director of the Federal Bureau of 

20 Prisons; 

21 (Q) the Administrator of the National 

22 Highway Traffic Safety Administration; 

23 (R) the Chairman of the Federal Trade 

24 Commission; and 


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1 (S) the Commissioner of the Social Secu2 rity Administration. 

3 (d) GOALS.—The goals of the QuICC shall be to 

4 achieve the following: 

5 (1) Collaboration between Federal departments 

6 and agencies with respect to developing goals, mod7 els, and timetables that are consistent with— 

8 (A) reducing the underlying causes of ill9 ness, injury, and disability; 

10 (B) reducing health care errors; 

11 (C) ensuring the appropriate use of health 

12 care services; 

13 (D) expanding research on effectiveness of 

14 treatments; 

15 (E) addressing over-supply and under-sup16 ply of health care resources; and 

17 (F) increasing patient participation in 

18 their care. 

19 (2) Collaboration between Federal departments 

20 and agencies with respect to the development and 

21 utilization of quality improvement strategies, includ22 ing quality measurement, for public sector programs 

23 that are flexible enough to respond to changing 

24 health care needs, technology, and information, while 


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1 being sufficiently standardized to be comparably 

2 measured. 

3 (3) Cooperation between Federal departments 

4 and agencies in the development and dissemination 

5 of evidence-based health care information to help 

6 guide practitioners’ actions in ways that will improve 

7 quality and potentially reduce costs. 

8 (4) Cooperation between Federal departments 

9 and agencies in the development and dissemination 

10 of user-friendly information for both consumer and 

11 business purchasers that facilitates meaningful com12 parisons of quality performances of health care 

13 plans, facilities and practitioners. 

14 (5) Consultation with multi-stakeholder groups, 

15 where appropriate, in order to develop interdepart16 mental and interagency models for quality improve17 ment. 

18 (6) Avoidance of inefficient duplication of ongo19 ing health care quality improvement efforts and re20 sources, where feasible and appropriate. 

21 (7) Coordination and implementation by Fed22 eral departments and agencies of a streamlined proc23 ess for quality reporting and compliance require24 ments to reduce administrative burdens on private 


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1 entities who administer, oversee, or participate in 

2 the Federal health programs. 

3 (e) WORKGROUPS.— 

4 (1) IN GENERAL.—Not later than 30 days after 

5 the establishment of the QuICC, the Director shall 

6 establish within the QuICC workgroups for each of 

7 the national health care priorities established under 

8 section 4(c)(1). 

9 (2) PURPOSE.—Each such workgroup shall 

10 focus on achieving the goals of the QuICC (described 

11 in subsection (d)) for one such priority and shall— 

12 (A) coordinate the implementation of such 

13 priority across all relevant Federal agencies and 

14 departments; and 

15 (B) identify opportunities to improve the 

16 process of implementing such health care pri17 ority. 

18 (3) MEMBERSHIP.— 

19 (A) LEADERSHIP.—Each workgroup shall 

20 be led by 2 relevant Federal departments or 

21 agencies, as determined by the Director. 

22 (B) REPRESENTATION.—Each of the Fed23 eral members listed in subsection (c)(2) may 

24 appoint 1 or more representatives to each 

25 workgroup. 


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1 (4) REPORTING.— 

2 (A) REPORT.—Not later than December 

3 31, 2010, and annually thereafter, the co-chair4 persons of the QuICC shall submit a report to 

5 the relevant committees of Congress describ6 ing— 

7 (i) the QuICC’s progress in meeting 

8 the goals described in subsection (d); 

9 (ii) recommendations for legislation to 

10 improve the processes of health care qual11 ity coordination and prioritization; and 

12 (iii) recommendations for new and in13 novative quality initiatives. 

14 (B) PUBLICATION.—Not later than De15 cember 31, 2010, and annually thereafter, the 

16 co-chairpersons shall publish the report de17 scribed in subparagraph (A) on the website of 

18 the Office of National Health Care Quality Im19 provement. 

20 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

21 are authorized to be appropriated to carry out this section 

22 $5,000,000 for fiscal years 2011 through 2014. 


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1 SEC. 6. INCREASED AUTHORITY OF THE AGENCY FOR 

2 HEALTHCARE RESEARCH AND QUALITY 

3 WITHIN THE DEPARTMENT OF HEALTH AND 

4 HUMAN SERVICES. 

5 (a) DIRECTOR OF THE AGENCY FOR HEALTHCARE

6 RESEARCH AND QUALITY.—Section 901(a) of the Public 

7 Health Service Act (42 U.S.C. 299(a)) is amended by 

8 striking ‘‘by the Secretary’’ and inserting ‘‘by the Presi9 dent, by and with the advice and consent of the Senate’’. 

10 (b) NATIONAL HEALTH CARE QUALITY PRIOR11 ITIES.—Title IX of the Public Health Service Act (42 

12 U.S.C. 299 et seq.) is amended by adding at the end the 

13 following: 

14 ‘‘PART E—NATIONAL HEALTH CARE QUALITY 

15 PRIORITIES 

16 ‘‘SEC. 940. DEFINITIONS. 

17 ‘‘In this part: 

18 ‘‘(1) HEALTH CARE QUALITY.—The term 

19 ‘health care quality’ means the degree to which 

20 health services for individuals and populations in21 crease the likelihood of desired health outcomes and 

22 are consistent with current professional knowledge, 

23 based upon the following criteria: 

24 ‘‘(A) EFFECTIVENESS.—Health care serv25 ices should be provided based upon scientific 

26 knowledge of all who could benefit. 


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1 ‘‘(B) EFFICIENCY.—Waste, including 

2 waste of equipment, supplies, ideas, and ener3 gies, should be avoided. 

4 ‘‘(C) EQUITY.—The provision of health 

5 care should not vary in quality because of per6 sonal characteristics of the individuals involved. 

7 ‘‘(D) PATIENT-CENTEREDNESS.—Health 

8 care should be responsive to, and respectful of, 

9 individual patient preferences. 

10 ‘‘(E) SAFETY.—Injuries to patients from 

11 the health care that is supposed to help them 

12 should be avoided. 

13 ‘‘(F) TIMELINESS.—Waiting times and 

14 harmful delays in providing health care should 

15 be reduced. 

16 ‘‘(2) HEALTH CARE QUALITY MEASURE.—The 

17 term ‘health care quality measure’ means a national 

18 consensus standard for measuring the performance 

19 and improvement of population health or of institu20 tional providers of services, physicians, and other cli21 nicians in the delivery of health care services, con22 sistent with the health care quality criteria described 

23 in paragraph (1). 

24 ‘‘(3) MULTI-STAKEHOLDER GROUP.—The term 

25 ‘multi-stakeholder group’ means, with respect to a 


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1 health care quality measure, a voluntary collabo2 rative of public and private organizations rep3 resenting persons interested in, or affected by, the 

4 use of such health care quality measure, including— 

5 ‘‘(A) health care providers and practi6 tioners, including providers and practitioners 

7 primarily serving children and those with long8 term health care needs; 

9 ‘‘(B) health care quality entities; 

10 ‘‘(C) health plans; 

11 ‘‘(D) patient advocates and consumer 

12 groups; 

13 ‘‘(E) employers; 

14 ‘‘(F) public and private purchasers of 

15 health care items and services; 

16 ‘‘(G) labor organizations; 

17 ‘‘(H) relevant departments or agencies of 

18 the United States; 

19 ‘‘(I) biopharmaceutical companies and 

20 manufacturers of medical devices; and 

21 ‘‘(J) licensing, credentialing, and accred22 iting bodies. 

23 ‘‘(4) the term ‘health care quality measure’ 

24 means a national consensus standard for measuring 

25 the performance and improvement of population 


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1 health or of institutional providers of services, physi2 cians, and other clinicians in the delivery of health 

3 care services; and 

4 ‘‘(5) the term ‘multi-stakeholder group’ means, 

5 with respect to a health care quality measure, a vol6 untary collaborative of public and private organiza7 tions representing persons interested in, or affected 

8 by, the use of such health care quality measure, in9 cluding— 

10 ‘‘(A) hospitals and other health care set11 tings; 

12 ‘‘(B) physicians, including pediatricians; 

13 ‘‘(C) health care quality alliances; 

14 ‘‘(D) nurses and other health care practi15 tioners; 

16 ‘‘(E) health plans; 

17 ‘‘(F) patient advocates and consumer 

18 groups; 

19 ‘‘(G) employers; 

20 ‘‘(H) public and private purchasers of 

21 health care items and services; 

22 ‘‘(I) labor organizations; 

23 ‘‘(J) relevant departments or agencies of 

24 the United States; 


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1 ‘‘(K) biopharmaceutical companies and 

2 manufacturers of medical devices; and 

3 ‘‘(L) licensing, credentialing, and accred4 iting bodies. 

5 ‘‘SEC. 941. RESEARCH PRIORITIES. 

6 ‘‘The Director, in consultation with the heads of 

7 agencies within the Department of Health and Human 

8 Services shall ensure that the health care quality improve9 ment priorities identified by the Director of the Office of 

10 National Health Care Quality Improvement, established 

11 under section 4 of the National Health Care Quality Act, 

12 are taken into consideration in all applicable research con13 ducted under the Department of Health and Human Serv14 ices, including the National Institutes of Health and the 

15 demonstration projects. 

16 ‘‘SEC. 942. QUALITY MEASURES. 

17 ‘‘(a) APPLICATION OF QUALITY MEASURES TO PRO18 GRAMS UNDER THE DEPARTMENT OF HEALTH AND

19 HUMAN SERVICES.— 

20 ‘‘(1) IN GENERAL.—The Director, in consulta21 tion with the Administrator of the Centers for Medi22 care & Medicaid Services, the Director of the Cen23 ters for Disease Control and Prevention, the Direc24 tor of the National Institutes of Health, and a con25 sensus-based entity (as such term is used in section 


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1 1890 of the Social Security Act), shall define uni2 form health care quality measures, which shall apply 

3 to Federal health programs under the Department 

4 of Health and Human Services, including the fol5 lowing Federal programs, in order of priority: 

6 ‘‘(A) The Medicare program under title 

7 XVIII of the Social Security Act, the rural 

8 health and pharmacy programs of the Health 

9 Resources and Services Administration, and the 

10 health programs of the Administration on 

11 Aging. 

12 ‘‘(B) The Medicaid program under title 

13 XIX of the Social Security Act, the Children’s 

14 Health Insurance program under title XXI of 

15 such Act, the health programs of the Adminis16 tration for Children and Families, and the ma17 ternal and child health programs of the Health 

18 Resources and Services Administration. 

19 ‘‘(C) The Indian Health Service. 

20 ‘‘(D) The Substance Abuse and Mental 

21 Health Services Administration. 

22 ‘‘(E) Programs of the Health Resources 

23 and Services Administration other than those 

24 described in subparagraph (B). 


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1 ‘‘(F) Centers of the Food and Drug Ad2 ministration. 

3 ‘‘(2) PRIORITIZATION.—The Director shall 

4 apply the health care quality measures under this 

5 section to the Federal programs in the order of pri6 ority described in paragraph (1). 

7 ‘‘(3) CONSIDERATIONS REGARDING QUALITY

8 MEASURE APPLICATION.—Before applying the health 

9 care quality measures described in paragraph (1), 

10 the Director shall consider— 

11 ‘‘(A) the potential of such measures to im12 prove patient outcomes; 

13 ‘‘(B) the ease of integration as a factor in 

14 health care provider reimbursement; 

15 ‘‘(C) the applicability of such measures 

16 across health care settings; 

17 ‘‘(D) the unique quality improvement 

18 needs of vulnerable populations, including chil19 dren, the elderly, individuals with disabilities, 

20 individuals near the end of life, and racial and 

21 ethnic minorities; 

22 ‘‘(E) the burden of disease, including the 

23 prevalence, incidence, and cost of disease to the 

24 United States; and 


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1 ‘‘(F) payment distortions that encourage 

2 certain practice norms which may not lead to 

3 greater patient health outcomes. 

4 ‘‘(4) UPDATING OF THE APPLICATION OF QUAL5 ITY MEASURES.—The Director, in consultation with 

6 the Administrator of the Centers for Medicare & 

7 Medicaid Services, the Director of the Centers for 

8 Disease Control and Prevention, the Director of the 

9 National Institutes of Health, and a consensus-based 

10 entity (as such term is used in section 1890 of the 

11 Social Security Act), shall develop a process for up12 dating the health care quality measures defined 

13 under paragraph (1) as new research and evidence 

14 become available. 

15 ‘‘(b) QUALITY MEASURE REPORTING TO FEDERAL

16 HEALTH PROGRAMS.—The Director, in cooperation with 

17 the Administrator of the Centers for Medicare & Medicaid 

18 Services, the National Coordinator for Health Information 

19 Technology, the Administrator of the Health Resources 

20 and Services Administration, the Director of the Centers 

21 for Disease Control and Prevention, and the Commis22 sioner of Food and Drugs, shall create a streamlined proc23 ess for health care providers to report quality measures 

24 to the heads of relevant agencies and departments for the 


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1 purpose of quality improvement in the Federal health pro2 grams described in subsection (a)(1). 

3 ‘‘(c) DEVELOPMENT OF ADDITIONAL QUALITY IM4 PROVEMENT STRATEGIES.—The Director, in consultation 

5 with the Administrator of the Centers for Medicare & 

6 Medicaid Services, the Director of the Centers for Disease 

7 Control and Prevention, the Director of the National Insti8 tutes of Health, and multi-stakeholder groups, shall de9 velop quality improvement strategies to address activities 

10 other than health care quality measurement that lead to 

11 improved patient outcomes, such as alternative care mod12 els, licensing, professional certification, medical education, 

13 alternative staffing models, and public reporting. 

14 ‘‘SEC. 943. PUBLIC EDUCATION CAMPAIGNS. 

15 ‘‘(a) IN GENERAL.—The Director shall conduct a 

16 public education campaign, designed to educate health 

17 care providers and consumers of health care about health 

18 care quality improvement. 

19 ‘‘(b) CONSUMER EDUCATION CAMPAIGNS.— 

20 ‘‘(1) IN GENERAL.—The Director, in coordina21 tion with the Administrator of the Centers for Medi22 care & Medicaid Services and the Director of the 

23 Centers for Disease Control and Prevention, shall 

24 create a consumer education campaign to develop ac25 curate and reliable information about health care 


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1 quality. In compiling the information for the con2 sumer education campaign, the Secretary may use 

3 mechanisms and sources of information that are 

4 available through other Federal agencies. 

5 ‘‘(2) REQUIREMENTS.—The consumer edu6 cation campaign shall include information regard7 ing— 

8 ‘‘(A) the importance of quality in health 

9 care decisions; 

10 ‘‘(B) the ways in which health care experts 

11 define and identify quality in health care; 

12 ‘‘(C) the variance of quality among health 

13 insurance plans, health care facilities, health 

14 care organizations, and health care providers; 

15 and 

16 ‘‘(D) the role of consumers in improving 

17 the quality of health care. 

18 ‘‘(3) PUBLICATION.—The Director shall make 

19 the information described in paragraph (1) available 

20 to the public through the Internet. 

21 ‘‘(4) GRANT PROGRAM.—The Director shall 

22 award grants to States and private nonprofit organi23 zations to assist with the creation and dissemination 

24 of the information described in paragraph (1). 


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1 ‘‘(c) QUALITY RESOURCE CENTER FOR HEALTH

2 CARE PROVIDERS.— 

3 ‘‘(1) IN GENERAL.—The Director, in coordina4 tion with the Administrator of the Centers for Medi5 care & Medicaid Services, shall create a National 

6 Quality Resource Center (referred to in this sub7 section as the ‘NQRC’) for health care providers to 

8 assist with the understanding and implementation of 

9 quality improvement initiatives for health care pro10 viders. 

11 ‘‘(2) DUTIES.—The national resource center de12 veloped under paragraph (1) shall— 

13 ‘‘(A) inform providers about quality im14 provement techniques and the value of such 

15 techniques to improving quality; 

16 ‘‘(B) accelerate the transfer of lessons 

17 learned from other initiatives in the public and 

18 private sectors, including those initiatives re19 ceiving Federal financial support; 

20 ‘‘(C) provide a forum for exchange of 

21 knowledge and experience among health care 

22 providers; 

23 ‘‘(D) provide technical assistance to health 

24 care providers for implementing quality im25 provement efforts; and 


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1 ‘‘(E) provide a forum for feedback from 

2 health care providers concerning the effect of 

3 the efforts under subparagraphs (A) through 

4 (D). 

5 ‘‘(3) NATIONAL QUALITY SUPPORT EXTENSION

6 GRANT PROGRAM.— 

7 ‘‘(A) IN GENERAL.—The Director, in co8 ordination with the NQRC, shall award Na9 tional Quality Support Extension grants (re10 ferred to in this paragraph as ‘NQSE grants’ 

11 or the ‘NQSE grant program’), on a competi12 tive basis, to eligible entities for the purpose of 

13 supporting and facilitating local health care 

14 quality improvement efforts throughout the 

15 United States. 

16 ‘‘(B) PURPOSES.—The purposes of the 

17 NQSE grant program are— 

18 ‘‘(i) to assist qualified eligible entities 

19 in carrying out projects related to health 

20 care quality improvement activities among 

21 the provider community to help test and 

22 acclimate to new, innovative quality im23 provement activities; 

24 ‘‘(ii) to facilitate communication 

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1 garding the best practices in the area of 

2 quality improvement and prevention in the 

3 clinical setting; and 

4 ‘‘(iii) to enable, empower, support, 

5 and assist local health care quality im6 provement efforts, particularly those that 

7 facilitate collaboration between inde8 pendent providers. 

9 ‘‘(C) ELIGIBLE ENTITIES.—An entity de10 siring a grant under this paragraph shall— 

11 ‘‘(i) be a public or private nonprofit 

12 entity engaged in health care quality im13 provement; 

14 ‘‘(ii) submit to the Director a program 

15 design that describes the purpose of the 

16 plan for which the entity seeks a grant and 

17 the community leadership that will support 

18 the entity in carrying out such plan; and 

19 ‘‘(iii) submit to the Director an appli20 cation at such time, in such manner, and 

21 containing such information as the Direc22 tor may require. 

23 ‘‘(4) IMPLEMENTATION ASSISTANCE.—The 

24 Health Information Technology regional extension 

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1 sion centers for the NQRC, for the purposes of im2 plementation assistance. 

3 ‘‘(5) TECHNICAL ASSISTANCE FOR HEALTH

4 CARE PROVIDERS WORKING WITH VULNERABLE POP5 ULATIONS.—In carrying out this subsection, the Di6 rector shall give particular attention to the technical 

7 assistance that health care providers who serve vul8 nerable populations need. 

9 ‘‘SEC. 944. FUNDING. 

10 ‘‘(a) TRUST FUNDS.—For purposes of funding the 

11 activities under this part, the Secretary shall provide for 

12 the transfer from the Federal Hospital Insurance Trust 

13 Fund under section 1817 of the Social Security Act (42 

14 U.S.C. 1395i) and the Federal Supplementary Insurance 

15 Trust Fund under section 1841 of the Social Security Act 

16 (42 U.S.C. 1395t), including the Medicare Prescription 

17 Drug Account in such Trust Fund, in such proportion as 

18 determined appropriate by the Secretary, of $150,000,000 

19 for each of fiscal years 2010 through 2014. 

20 ‘‘(b) AMERICAN RECOVERY AND REINVESTMENT

21 FUNDS.—At the end of the recession adjustment period 

22 (as defined in section 5001(h)(3) of the American Recov23 ery and Reinvestment Act (Public Law 111–5; 123 Stat. 

24 496), the Secretary of the Treasury shall transfer any 

25 funds appropriated under such Act and not otherwise exVerDate Nov 24 2008 22:45 May 06, 2009 Jkt 079200 PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 E:\BILLS\H2252.IH H2252

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1 pended to the Agency for purposes of carrying out this 

2 part. 

3 ‘‘(c) MEDICAID AND MEDICARE IMPROVEMENT

4 FUNDS.—For purposes of funding the activities under this 

5 part for fiscal year 2014, the Secretary shall provide for 

6 the transfer of $100,000,000 from the Medicaid Improve7 ment Fund under section 1898 of the Social Security Act 

8 (42 U.S.C. 1395iii), and $100,000,000 from the Medicare 

9 Improvement Fund under section 1941 of such Act (42 

10 U.S.C 1396w–1).’’. 

11 (c) TECHNICAL AMENDMENT.—Section 937(b) of the 

12 Public Health Service Act (42 U.S.C. 299c–6(b)) is 

13 amended by inserting ‘‘except for part E,’’ after ‘‘this 

14 title’’. 

15 (d) DEVELOPMENT OF QUALITY MEASURES FOR

16 FEDERAL HEALTH PROGRAMS.— 

17 (1) PERIOD OF CONTRACT.—Section 1890(a)(3) 

18 of the Social Security Act (42 U.S.C. 

19 1395aaa(a)(3)) is amended— 

20 (A) by striking ‘‘4 years’’ and inserting ‘‘4 

21 years, in the case of the first contract entered 

22 into under such paragraph, and 3 years in the 

23 case of each subsequent contract entered into 

24 under such paragraph’’; and 


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1 (B) by inserting ‘‘for a period of 3 years’’ 

2 after ‘‘renewed’’. 

3 (2) PRIORITY SETTING PROCESS.—Section 

4 1890(b)(1) of the Social Security Act (42 U.S.C. 

5 1395aaa(b)(1)) is amended— 

6 (A) in the matter preceding subparagraph 

7 (A)— 

8 (i) by striking ‘‘an integrated national 

9 strategy and priorities for’’; and 

10 (ii) by inserting ‘‘in a manner con11 sistent with the national priorities for 

12 health care quality improvement (as de13 fined in section 4(c)(1))’’ after ‘‘settings’’; 

14 (B) in subparagraph (A)— 

15 (i) by redesignating clauses (i) 

16 through (iii) as clauses (ii) through (iv), 

17 respectively; and 

18 (ii) by inserting before clause (ii), as 

19 so redesignated, the following new clause: 

20 ‘‘(i) that are consistent with such na21 tional priorities for health care quality im22 provement;’’. 

23 (3) ANNUAL REPORT TO CONGRESS.—Section 

24 1890(b)(5) of the Social Security Act (42 U.S.C. 

25 1395aaa(b)(5)) is amended— 


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1 (A) by redesignating clauses (i) through 

2 (iii) as clauses (ii) through (iv); and 

3 (B) by inserting before clause (ii), as so re4 designated, the following new clause: 

5 ‘‘(i) the extent to which the priorities 

6 set and the quality improvement measures 

7 endorsed by the entity under paragraphs 

8 (1) and (2), respectively, are consistent 

9 with the national priorities for health care 

10 quality improvement (as so defined);’’. 

11 (4) FUNDING.—Section 1890(d) of the Social 

12 Security Act (42 U.S.C. 1395aaa(d)) is amended by 

13 inserting ‘‘and, for purposes of carrying out this sec14 tion under a new or renewed contract, there are au15 thorized to be appropriated such sums as are nec16 essary, taking into consideration the results of the 

17 study contained in the 18-month report submitted to 

18 Congress under section 183(b)(2) of the Medicare 

19 Improvements for Patients and Providers Act of 

20 2008 (Public Law 110–275), for each of fiscal years 

21 2013 through 2015’’ before the period at the end. 

22 SEC. 7. REPORTS TO CONGRESS. 

23 (a) EVALUATION OF THE CONSUMER EDUCATION

24 CAMPAIGN.—Not later than 18 months after the establish25 ment of the quality resource center under section 943(c) 


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1 of the Public Health Service Act (as added by section 6), 

2 the Comptroller General of the United States shall submit 

3 to Congress a report describing— 

4 (1) the effectiveness of the quality resource cen5 ter for health care providers under such section 

6 943(c); and 

7 (2) the effectiveness of the consumer education 

8 program under section 943(b) of such Act (as added 

9 by section 6). 

10 (b) QUALITY DISSEMINATION STRATEGIES.—Not 

11 later than 18 months after the date of enactment of this 

12 Act, the Secretary of Health and Human Services, acting 

13 through the Director of the Agency for Healthcare Re14 search and Quality, shall submit a report to Congress that 

15 includes— 

16 (1) a description of the efforts made to trans17 late clinical information regarding health care qual18 ity improvement into reasonable clinical practice; 

19 (2) the processes through which the Secretary 

20 disseminated the information described in paragraph 

21 (1); and 

22 (3) recommendations for the most effective 

23 methods for translating and disseminating informa24 tion concerning health care quality, and required 


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1 statutory changes to implement the recommended 

2 methods. 

3 (c) IOM REPORT TO CONGRESS REGARDING THE

4 VALUE OF QUALITY MEASURE REPORTING.— 

5 (1) IN GENERAL.—The Secretary of Health and 

6 Human Services shall enter into a contract with the 

7 Director of the Institute of Medicine requiring that, 

8 not later than 18 months after the date of enact9 ment of this Act, the Director submit to Congress a 

10 report regarding the value of quality measure report11 ing in improving patient health outcomes. 

12 (2) CONSIDERATIONS.—In preparing the report 

13 described in paragraph (1), the Director of the Insti14 tutes of Medicine shall consider— 

15 (A) specific instances in the history of ex16 isting public health care programs within the 

17 Federal Government in which quality measure 

18 reporting has been shown, through peer-re19 viewed studies or literature, to result in im20 proved patient health outcomes; and 

21 (B) instances in which quality measure re22 porting has been shown to improve existing 

23 health disparities among vulnerable populations, 

24 including children, underserved populations, 


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1 rural populations, individuals with disabilities, 

2 the elderly, and racial and ethnic minorities. 

3 (3) AUTHORIZATION OF APPROPRIATIONS.— 

4 There are authorized to be appropriated such sums 

5 as may be necessary to carry out this subsection. 

6 (d) GAO STUDY AND REPORTS.—Section 183(b)(1) 

7 of the Medicare Improvements for Patients and Providers 

8 Act of 2008 (Public Law 110–275; 122 Stat. 2586) is 

9 amended— 

10 (1) in subparagraph (A), by striking ‘‘and’’ 

11 after the semicolon; 

12 (2) in subparagraph (B), by striking the period 

13 at the end and inserting a semicolon; and 

14 (3) by inserting after subparagraph (B) the fol15 lowing: 

16 ‘‘(C) any negative effect on patients, par17 ticularly on patients in underserved or vulner18 able populations; and 

19 ‘‘(D) any negative effect on health care 

20 providers, particularly health care providers in 

21 rural and underserved areas.’’. 

22 SEC. 8. DATA COLLECTION. 

23 (a) IN GENERAL.—Not later than January 1, 2011, 

24 and at least every 5 years thereafter, the Comptroller Gen25 eral of the United States (referred to in this section as 


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1 the ‘‘Comptroller General’’) shall conduct evaluations of 

2 the implementation of the data collection processes for 

3 quality measures used by the Federal health programs ad4 ministered through the Department of Health and Human 

5 Services. 

6 (b) CONSIDERATIONS.—In conducting the evalua7 tions under subsection (a), the Comptroller General shall 

8 consider— 

9 (1) whether the system for the collection of 

10 data for quality measures provides for validation of 

11 data in a manner that is relevant, fair, and scientif12 ically credible; 

13 (2) whether data collection efforts under the 

14 system— 

15 (A) use the most efficient and cost-effec16 tive means in a manner that minimizes admin17 istrative burden on persons required to collect 

18 data; 

19 (B) adequately protects the privacy the 

20 personal health information of patients; and 

21 (C) provides data security; 

22 (3) whether standards under the system provide 

23 for an opportunity for health care providers and in24 stitutional providers of services to review and correct 

25 any inaccuracies with regard to the findings; and 


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1 (4) the extent to which quality measures— 

2 (A) assess outcomes and the functional 

3 status of patients; 

4 (B) assess the continuity and coordination 

5 of care and care transitions, including episodes 

6 of care, for patients across providers and health 

7 care settings; 

8 (C) assess patient experience and patient 

9 engagement; 

10 (D) assess the safety, effectiveness, and 

11 timeliness of care; 

12 (E) assess health disparities, including dis13 parities associated with race, ethnicity, age, 

14 gender, place of residence, or language; 

15 (F) assess the efficiency and use of re16 sources in the provision of care; 

17 (G) are designed to be collected as part of 

18 health information technologies supporting bet19 ter delivery of health care services; and 

20 (H) result in direct or indirect costs to 

21 users of such measures. 

22 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

23 are authorized to be appropriated to carry out this section 

24 $1,000,000 for fiscal years 2010 through 2014. 

Æ 


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