II 

110TH CONGRESS 

1ST SESSION S. 1544 

To amend title XVIII of the Social Security Act to improve the quality 

and efficiency of health care, to provide the public with information 

on provider and supplier performance, and to enhance the education 

and awareness of consumers for evaluating health care services through 

the development and release of reports based on Medicare enrollment, 

claims, survey, and assessment data. 

IN THE SENATE OF THE UNITED STATES 

JUNE 5, 2007 

Mr. GREGG (for himself and Mrs. CLINTON) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to improve 

the quality and efficiency of health care, to provide the 

public with information on provider and supplier performance, and to enhance the education and awareness 

of consumers for evaluating health care services through 

the development and release of reports based on Medicare enrollment, claims, survey, and assessment data. 

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


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Medicare Quality En3 hancement Act of 2007’’. 

4 SEC. 2. QUALITY AND EFFICIENCY REPORTS BASED ON 

5 MEDICARE ENROLLMENT, CLAIMS, SURVEY, 

6 AND ASSESSMENT DATA. 

7 Title XVIII of the Social Security Act is amended by 

8 adding at the end the following new section: 

9 ‘‘QUALITY AND EFFICIENCY REPORTS BASED ON

10 MEDICARE DATA

11 ‘‘SEC. 1898. (a) PURPOSE.—The purpose of this sec12 tion is to provide for the development of reports based on 

13 Medicare data and private data that is publicly available 

14 or is provided by the entity making the request for the 

15 report in order to— 

16 ‘‘(1) improve the quality and efficiency of 

17 health care; 

18 ‘‘(2) enhance the education and awareness of 

19 consumers for evaluating health care services; and 

20 ‘‘(3) provide the public with reports on national, 

21 regional, and provider- and supplier-specific per22 formance, which may be in a provider- or supplier23 identifiable format. 

24 ‘‘(b) PROCEDURES FOR THE DEVELOPMENT OF RE25 PORTS.— 


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1 ‘‘(1) IN GENERAL.—Notwithstanding section 

2 552(b)(6) or 552a(b) of title 5, United States Code, 

3 not later than 12 months after the date of enact4 ment of this section, the Secretary, in accordance 

5 with the purpose described in subsection (a), shall 

6 establish and implement procedures under which an 

7 entity may submit a request to a Medicare Quality 

8 Reporting Organization for the Organization to de9 velop a report based on— 

10 ‘‘(A) Medicare data disclosed to the Orga11 nization under subsection (c); and 

12 ‘‘(B) private data that is publicly available 

13 or is provided to the Organization by the entity 

14 making the request for the report. 

15 ‘‘(2) DEFINITIONS.—In this section: 

16 ‘‘(A) MEDICARE DATA.—The term ‘Medi17 care data’ means— 

18 ‘‘(i) enrollment data under this title, 

19 including de-identified beneficiary enroll20 ment data; 

21 ‘‘(ii) all claims for reimbursement for 

22 all items and services furnished by a pro23 vider of services (as defined in section 

24 1861(u)) or a supplier (as defined in secVerDate Aug 31 2005 22:05 Jun 06, 2007 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1544.IS S1544

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1 tion 1861(d)) under part A or B in a re2 search identifiable format; 

3 ‘‘(iii) on and after January 1, 2008, 

4 all data relating to enrollment in, and cov5 erage for, qualified prescription drug cov6 erage under part D; and 

7 ‘‘(iv) additional data files relating to 

8 the program under this title collected by 

9 the Secretary for the purpose of nation10 wide quality measurement and reporting 

11 based on surveys and assessment data de12 termined appropriate by the Secretary. 

13 ‘‘(B) MEDICARE QUALITY REPORTING OR14 GANIZATION.—The term ‘Medicare Quality Re15 porting Organization’ means an entity with a 

16 contract under subsection (d). 

17 ‘‘(c) ACCESS TO MEDICARE DATA.— 

18 ‘‘(1) IN GENERAL.—The procedures established 

19 under subsection (b)(1) shall provide for the secure 

20 disclosure of Medicare data to each Medicare Quality 

21 Reporting Organization. 

22 ‘‘(2) ALL DATA.—The Secretary shall ensure 

23 that all Medicare data files (beginning with files 

24 from January 1, 1998) are disclosed under para25 graph (1), including the most recent data files availVerDate Aug 31 2005 22:05 Jun 06, 2007 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1544.IS S1544

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1 able to the Secretary. Not less than every 6 months, 

2 the Secretary shall update the information disclosed 

3 under paragraph (1) to Medicare Quality Reporting 

4 Organizations. 

5 ‘‘(d) MEDICARE QUALITY REPORTING ORGANIZA6 TIONS.— 

7 ‘‘(1) IN GENERAL.— 

8 ‘‘(A) THREE CONTRACTS.—Subject to sub9 paragraph (B), the Secretary shall enter into a 

10 contract with 3 private entities to serve as 

11 Medicare Quality Reporting Organizations 

12 under which an entity shall— 

13 ‘‘(i) store the Medicare data that is to 

14 be disclosed under subsection (c); and 

15 ‘‘(ii) develop and release reports pur16 suant to subsection (e). 

17 ‘‘(B) ADDITIONAL CONTRACTS.—If the 

18 Secretary determines that reports are not being 

19 developed and released within 6 months of the 

20 receipt of the request for the report, the Sec21 retary shall enter into contracts with additional 

22 private entities in order to ensure that such re23 ports are developed and released in a timely 

24 manner. 


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1 ‘‘(2) QUALIFICATIONS.—The Secretary shall 

2 enter into a contract with an entity under paragraph 

3 (1) only if the Secretary determines that the enti4 ty— 

5 ‘‘(A) has the research capability to conduct 

6 and complete reports under this section; 

7 ‘‘(B) has in place– 

8 ‘‘(i) an information technology infra9 structure to support the entire database of 

10 Medicare data; and 

11 ‘‘(ii) operational standards to provide 

12 security for such database; 

13 ‘‘(C) has experience with, and expertise on, 

14 the development of reports on health care qual15 ity and efficiency based on Medicare or private 

16 sector claims data; and 

17 ‘‘(D) has a significant business presence in 

18 the United States. 

19 ‘‘(3) CONTRACT REQUIREMENTS.—Each con20 tract with an entity under paragraph (1) shall con21 tain the following requirements: 

22 ‘‘(A) ENSURING BENEFICIARY PRIVACY.— 

23 ‘‘(i) HIPAA.—The entity shall meet 

24 the requirements imposed on a covered en25 tity for purposes of applying part C of title 


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1 XI and all regulatory provisions promul2 gated thereunder, including regulations 

3 (relating to privacy) adopted pursuant to 

4 the authority of the Secretary under sec5 tion 264(c) of the Health Insurance Port6 ability and Accountability Act of 1996 (42 

7 U.S.C. 1320d–2 note). 

8 ‘‘(ii) PRIVACY.—The entity shall pro9 vide assurances that the entity will not use 

10 the Medicare data disclosed under sub11 section (c) in a manner that violates sec12 tions 552 or 552a of title 5, United States 

13 Code, with regard to the privacy of individ14 ually identifiable beneficiary health infor15 mation. 

16 ‘‘(B) PROPRIETARY INFORMATION.—The 

17 entity shall provide assurances that the entity 

18 will not, with respect to data relating to part D, 

19 disclose any negotiated price concessions, such 

20 as discounts, direct or indirect subsidies, re21 bates, and direct or indirect remunerations, ob22 tained by prescription drug plans and MA–PD 

23 plans for covered part D drugs, or any other 

24 proprietary cost information. 


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1 ‘‘(C) DISCLOSURE.—The entity shall dis2 close— 

3 ‘‘(i) any financial, reporting, or con4 tractual relationship between the entity 

5 and any provider of services (as defined in 

6 section 1861(u)) or supplier (as defined in 

7 section 1861(d)); and 

8 ‘‘(ii) if applicable, the fact that the 

9 entity is managed, controlled, or operated 

10 by any such provider of services or sup11 plier. 

12 ‘‘(D) COMPONENT OF ANOTHER ORGANIZA13 TION.—If the entity is a component of another 

14 organization— 

15 ‘‘(i) the entity shall maintain Medi16 care data and reports separately from the 

17 rest of the organization and establish ap18 propriate security measures to maintain 

19 the confidentiality and privacy of the Medi20 care data and reports; and 

21 ‘‘(ii) the entity shall not make an un22 authorized disclosure to the rest of the or23 ganization of Medicare data or reports in 

24 breach of such confidentiality and privacy 

25 requirement. 


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1 ‘‘(E) TERMINATION OR NONRENEWAL.—If 

2 a contract under this section is terminated or 

3 not renewed, the following requirements shall 

4 apply: 

5 ‘‘(i) CONFIDENTIALITY AND PRIVACY

6 PROTECTIONS.—The entity shall continue 

7 to comply with the confidentiality and pri8 vacy requirements under this section with 

9 respect to all Medicare data disclosed to 

10 the entity and each report developed by the 

11 entity. 

12 ‘‘(ii) DISPOSITION OF DATA AND RE13 PORTS.—The entity shall— 

14 ‘‘(I) return to the Secretary all 

15 Medicare data disclosed to the entity 

16 and each report developed by the enti17 ty; or 

18 ‘‘(II) if returning the Medicare 

19 data and reports is not practicable, 

20 destroy the reports and Medicare 

21 data. 

22 ‘‘(4) COMPETITIVE PROCEDURES.—Competitive 

23 procedures (as defined in section 4(5) of the Federal 

24 Procurement Policy Act) shall be used to enter into 

25 contracts under paragraph (1). 


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1 ‘‘(5) REVIEW OF CONTRACT IN THE EVENT OF

2 AMERGER OR ACQUISITION.—The Secretary shall 

3 review the contract with a Medicare Quality Report4 ing Organization under this section in the event of 

5 a merger or acquisition of the Organization in order 

6 to ensure that the requirements under this section 

7 will continue to be met. 

8 ‘‘(e) DEVELOPMENT AND RELEASE OF REPORTS

9 BASED ON REQUESTS.— 

10 ‘‘(1) REQUEST FOR AREPORT.— 

11 ‘‘(A) REQUEST.— 

12 ‘‘(i) IN GENERAL.—The procedures 

13 established under subsection (b)(1) shall 

14 include a process for an entity to submit a 

15 request to a Medicare Quality Reporting 

16 Organization for a report based on Medi17 care data and private data that is publicly 

18 available or is provided by the entity mak19 ing the request for the report. Such re20 quest shall comply with the purpose de21 scribed in subsection (a). 

22 ‘‘(ii) REQUEST FOR SPECIFIC METH23 ODOLOGY.—The process described in 

24 clause (i) shall permit an entity making a 

25 request for a report to request that a speVerDate Aug 31 2005 22:05 Jun 06, 2007 Jkt 059200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1544.IS S1544

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1 cific methodology be used by the Medicare 

2 Quality Reporting Organization in devel3 oping the report. The Organization shall 

4 work with the entity making the request to 

5 finalize the methodology to be used. 

6 ‘‘(iii) REQUEST FOR ASPECIFIC

7 MQRO.—The process described in clause (i) 

8 shall permit an entity to submit the re9 quest for a report to any Medicare Quality 

10 Reporting Organization. 

11 ‘‘(B) RELEASE TO PUBLIC.—The proce12 dures established under subsection (b)(1) shall 

13 provide that at the time a request for a report 

14 is finalized under subparagraph (A) by a Medi15 care Quality Reporting Organization, the Orga16 nization shall make available to the public, 

17 through the Internet website of the Centers for 

18 Medicare & Medicaid Services and other appro19 priate means, a brief description of both the re20 quested report and the methodology to be used 

21 to develop such report. 

22 ‘‘(2) DEVELOPMENT AND RELEASE OF RE23 PORT.— 

24 ‘‘(A) DEVELOPMENT.— 


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1 ‘‘(i) IN GENERAL.—If the request for 

2 a report complies with the purpose de3 scribed in subsection (a), the Medicare 

4 Quality Reporting Organization may de5 velop the report based on the request. 

6 ‘‘(ii) REQUIREMENT.—A report devel7 oped under clause (i) shall include a de8 tailed description of the standards, meth9 odologies, and measures of quality used in 

10 developing the report. 

11 ‘‘(B) REVIEW OF REPORT BY SECRETARY

12 TO ENSURE COMPLIANCE WITH PRIVACY RE13 QUIREMENT.—Prior to a Medicare Quality Re14 porting Organization releasing a report under 

15 subparagraph (C), the Secretary shall review 

16 the report to ensure that the report complies 

17 with the Federal regulations (concerning the 

18 privacy of individually identifiable beneficiary 

19 health information) promulgated under section 

20 264(c) of the Health Insurance Portability and 

21 Accountability Act of 1996 and sections 552 or 

22 552a of title 5, United States Code, with regard 

23 to the privacy of individually identifiable bene24 ficiary health information. The Secretary shall 


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1 act within 30 business days of receiving such 

2 report. 

3 ‘‘(C) RELEASE OF REPORT.— 

4 ‘‘(i) RELEASE TO ENTITY MAKING RE5 QUEST.—If the Secretary finds that the re6 port complies with the provisions described 

7 in subparagraph (B), the Medicare Quality 

8 Reporting Organization shall release the 

9 report to the entity that made the request 

10 for the report. 

11 ‘‘(ii) RELEASE TO PUBLIC.—The pro12 cedures established under subsection (b)(1) 

13 shall provide for the following: 

14 ‘‘(I) UPDATED DESCRIPTION.— 

15 At the time of the release of a report 

16 by a Medicare Quality Reporting Or17 ganization under clause (i), the entity 

18 shall make available to the public, 

19 through the Internet website of the 

20 Centers for Medicare & Medicaid 

21 Services and other appropriate means, 

22 an updated brief description of both 

23 the requested report and the method24 ology used to develop such report. 


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1 ‘‘(II) COMPLETE REPORT.—Not 

2 later than 1 year after the date of the 

3 release of a report under clause (i), 

4 the report shall be made available to 

5 the public through the Internet 

6 website of the Centers for Medicare & 

7 Medicaid Services and other appro8 priate means. 

9 ‘‘(f) ANNUAL REVIEW OF REPORTS AND TERMI10 NATION OF CONTRACTS.— 

11 ‘‘(1) ANNUAL REVIEW OF REPORTS.—The 

12 Comptroller General of the United States shall re13 view reports released under subsection (e)(2)(C) to 

14 ensure that such reports comply with the purpose 

15 described in subsection (a) and annually submit a 

16 report to the Secretary on such review. 

17 ‘‘(2) TERMINATION OF CONTRACTS.—The Sec18 retary may terminate a contract with a Medicare 

19 Quality Reporting Organization if the Secretary de20 termines that there is a pattern of reports being re21 leased by the Organization that do not comply with 

22 the purpose described in subsection (a). 

23 ‘‘(g) FEES.— 


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1 ‘‘(1) FEES FOR SECRETARY.—The Secretary 

2 shall charge a Medicare Quality Reporting Organiza3 tion a fee for— 

4 ‘‘(A) disclosing the data under subsection 

5 (c); and 

6 ‘‘(B) conducting the review under sub7 section (e)(2)(B). 

8 The Secretary shall ensure that such fees are suffi9 cient to cover the costs of the activities described in 

10 subparagraph (A) and (B). 

11 ‘‘(2) FEES FOR MQRO.— 

12 ‘‘(A) IN GENERAL.—Subject to subpara13 graphs (A) and (B), a Medicare Quality Report14 ing Organization may charge an entity making 

15 a request for a report a reasonable fee for the 

16 development and release of the report. 

17 ‘‘(B) DISCOUNT FOR SMALL ENTITIES.—In 

18 the case of an entity making a request for a re19 port (including a not-for-profit) that has annual 

20 revenue that does not exceed $10,000,000, the 

21 Medicare Quality Reporting Organization shall 

22 reduce the reasonable fee charged to such entity 

23 under subparagraph (A) by an amount equal to 

24 10 percent of such fee. 


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1 ‘‘(C) INCREASE FOR LARGE ENTITIES

2 THAT DO NOT AGREE TO RELEASE REPORTS

3 WITHIN 6 MONTHS.—In the case of an entity 

4 making a request for a report that is not de5 scribed in subparagraph (B) and that does not 

6 agree to the report being released to the public 

7 under clause (ii)(II) of subsection (e)(2)(C) 

8 within 6 months of the date of the release of 

9 the report to the entity under clause (i) of such 

10 subsection, the Medicare Quality Reporting Or11 ganization shall increase the reasonable fee 

12 charged to such entity under subparagraph (A) 

13 by an amount equal to 10 percent of such fee. 

14 ‘‘(D) RULE OF CONSTRUCTION.—Nothing 

15 in this paragraph shall be construed to effect 

16 the requirement that a report be released to the 

17 public under clause (ii)(II) of subsection 

18 (e)(2)(C)(ii)(II) by not later than 1 year after 

19 the date of the release of the report to the re20 questing entity under clause (i) of such sub21 section. 

22 ‘‘(h) REGULATIONS.—Not later than 6 months after 

23 the date of enactment of this section, the Secretary shall 

24 prescribe regulations to carry out this section. 

25 ‘‘(i) GAO STUDIES AND REPORT.— 


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1 ‘‘(1) STUDIES.—The Comptroller General of 

2 the United States shall conduct a study on each of 

3 the following: 

4 ‘‘(A) The feasibility of requiring Medicare 

5 Advantage organizations under part C to share 

6 utilization and quality data with the Secretary 

7 for the purpose of releasing such information to 

8 Medicare Quality Reporting Organizations 

9 under this section. 

10 ‘‘(B) The Medicare data released to Medi11 care Quality Reporting Organizations under 

12 subsection (c) in order to determine the accu13 racy of such data with respect to— 

14 ‘‘(i) the coding of demographic data; 

15 ‘‘(ii) diagnosis and procedures; and 

16 ‘‘(iii) any other data elements impor17 tant for the development of reports under 

18 this section in accordance with the purpose 

19 described in subsection (a). 

20 ‘‘(C) The feasibility of collecting State 

21 Medicaid data for the purpose of aggregating 

22 all Medicaid data for study under this section. 

23 ‘‘(2) REPORT.—Not later than 12 months after 

24 the date of enactment of this section, the Comp25 troller General of the United States shall submit a 


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1 report to Congress on each of the studies conducted 

2 under paragraph (1) together with recommendations 

3 for such legislation and administrative actions as the 

4 Comptroller General considers appropriate.’’. 

5 SEC. 3. QUALITY ADVISORY BOARD. 

6 (a) ESTABLISHMENT.—Not later than 12 months 

7 after the date of enactment of this Act, the Secretary of 

8 Health and Human Services shall establish within the Of9 fice of the Secretary a board to be known as the Quality 

10 Advisory Board (in this section referred to as the 

11 ‘‘Board’’). 

12 (b) MEMBERSHIP.—The members of the Board shall 

13 include, but not be limited to, an appropriate number of 

14 representatives of— 

15 (1) groups representing Medicare beneficiaries; 

16 (2) groups representing providers of services (as 

17 defined in subsection (u) of section 1861 of the So18 cial Security Act (42 U.S.C. 1395x)) and suppliers 

19 (as defined in subsection (d) of such section) receiv20 ing reimbursement under the Medicare program; 

21 (3) purchasers and employers or groups rep22 resenting purchasers and employers; 

23 (4) organizations focused on the development of 

24 quality health care measures; 


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1 (5) researchers or research institutions with ex2 perience in the measurement of, and reporting on, 

3 health care quality; and 

4 (6) health plans or groups representing health 

5 plans. 

6 (c) DUTIES.—The duties of the Board are as follows: 

7 (1) To submit requests for reports to Medicare 

8 Quality Reporting Organizations under section 1898 

9 of the Social Security Act, as added by section 2. 

10 (2) To examine how clinical registries can be 

11 linked to Medicare data (as defined in subsection 

12 (b)(2)(A) of such section 1898) in order to develop 

13 reports on the quality and efficiency of providers of 

14 services (as defined in subsection (u) of section 1861 

15 of the Social Security Act (42 U.S.C. 1395x)) and 

16 suppliers (as defined in subsection (d) of such sec17 tion). 

18 (3) To coordinate with existing collaborative ef19 forts identifying quality and efficiency health care 

20 measures. 

21 (4) To provide the Secretary of Health and 

22 Human Services with recommendations for the de23 velopment of model quality health care measure24 ments. 


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1 (5) Other duties determined appropriate by the 

2 Secretary. 

3 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

4 are authorized to be appropriated to the Secretary of 

5 Health and Human Services such sums as may be nec6 essary for the purpose of carrying out this section. 

7 SEC. 4. RESEARCH ACCESS TO MEDICARE DATA AND RE8 PORTING ON PERFORMANCE. 

9 The Secretary of Health and Human Services shall 

10 permit researchers that meet existing criteria used to 

11 evaluate the appropriateness of the release of Centers for 

12 Medicare & Medicaid Services (CMS) data for research 

13 purposes to— 

14 (1) have access to all Medicare data (as defined 

15 in section 1898(b)(2)(A) of the Social Security Act, 

16 as added by section 2); and 

17 (2) report on the performance of providers of 

18 services (as defined in subsection (u) of section 1861 

19 of such Act (42 U.S.C. 1395x)) and suppliers (as 

20 defined in subsection (d) of such section), including 

21 reporting in a provider- or supplier-identifiable for22 mat. 

Æ 


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