I 

110TH CONGRESS 

1ST SESSION H. R. 1046 

To amend titles XI and XVIII of the Social Security Act to modernize 

the quality improvement organization (QIO) program. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 14, 2007 

Mr. BURGESS 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 amend titles XI and XVIII of the Social Security Act 

to modernize the quality improvement organization (QIO) 

program. 

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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Medicare Quality Improvement Organization Moderniza6 tion Act of 2007’’. 

7 (b) TABLE OF CONTENTS.—The table of contents of 

8 this Act is as follows: 


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Sec. 1. Short title; table of contents. 

Sec. 2. Quality improvement activities. 

Sec. 3. Improved program administration. 

Sec. 4. Data disclosure. 

Sec. 5. Use of evaluation and competition. 

Sec. 6. Quality improvement funding. 

Sec. 7. Qualifications for QIOs. 

Sec. 8. Coordination with medicaid. 

Sec. 9. Conforming name to ‘‘quality improvement organizations.’’. 

1 SEC. 2. QUALITY IMPROVEMENT ACTIVITIES. 

2 (a) INCLUSION OF QUALITY IMPROVEMENT FUNC3 TIONS.—Section 1154(a) of the Social Security Act (42 

4 U.S.C. 1320c–3(a)) is amended by adding at the end the 

5 following new paragraph: 

6 ‘‘(18) The organization shall offer quality im7 provement assistance to providers, practitioners, 

8 Medicare Advantage organizations offering Medicare 

9 Advantage plans under part C of title XVIII, and 

10 prescription drug sponsors offering prescription drug 

11 plans under part D of such title, including the fol12 lowing: 

13 ‘‘(A) Education on quality improvement 

14 initiatives, strategies, and techniques. 

15 ‘‘(B) Instruction on how to collect, submit, 

16 aggregate, and interpret data on measures that 

17 may be used for quality improvement, public re18 porting, and payment. 

19 ‘‘(C) Instruction on how to conduct root20 cause analyses. 


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1 ‘‘(D) Technical assistance for providers 

2 and practitioners in beneficiary education to fa3 cilitate patient self-management. 

4 ‘‘(E) Facilitating cooperation among var5 ious local stakeholders in quality improvement. 

6 ‘‘(F) Facilitating adoption of procedures 

7 that encourage timely candid feedback from pa8 tients and their families concerning perceived 

9 problems. 

10 ‘‘(G) Guidance on redesigning clinical proc11 esses, including the adoption and effective use 

12 of health information technology, to improve the 

13 coordination, effectiveness, and safety of care. 

14 ‘‘(H) Assistance in improving the quality 

15 of care delivered in rural and frontier areas and 

16 reducing health care disparities among racial 

17 and ethnic minorities, as well as gender dispari18 ties, including efforts to prevent or address any 

19 inconsistencies or delays in the rate of adoption 

20 of health information technology and in the ef21 fective use of such technology among such enti22 ties that treat racial and ethnic minorities or 

23 individuals dually eligible for benefits under this 

24 title and title XVIII or that furnish such serv25 ices in rural areas. 


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1 ‘‘(I) Assistance in improving coordination 

2 of care as patients transition between providers 

3 and practitioners, including developing the ca4 pacity to securely exchange electronic health in5 formation and helping providers and practi6 tioners to effectively use secure electronic health 

7 information to improve quality.’’. 

8 (b) MEDICARE QUALITY ACCOUNTABILITY PRO9 GRAM.—Paragraph (14) of section 1154(a) of such Act 

10 (42 U.S.C. 1320c–3(a)) is amended to read as follows: 

11 ‘‘(14)(A) The organization shall conduct a re12 view of all written complaints about the quality of 

13 services (for which payment may otherwise be made 

14 under title XVIII) not meeting professionally recog15 nized standards of health care, if the complaint is 

16 filed with the organization by an individual entitled 

17 to benefits for such services under such title (or a 

18 person acting on the individual’s behalf). Before the 

19 organization concludes that the quality of services 

20 does not meet professionally recognized standards of 

21 health care, the organization must provide the prac22 titioner or person concerned with reasonable notice 

23 and opportunity for discussion. 


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1 ‘‘(B) The organization shall establish and oper2 ate a Medicare quality accountability program con3 sistent with the following: 

4 ‘‘(i) The organization shall actively educate 

5 Medicare beneficiaries of their right to bring 

6 quality concerns to Quality Improvement Orga7 nizations. 

8 ‘‘(ii) The organization shall report findings 

9 of its investigations to the beneficiary involved 

10 or a representative of such beneficiary, regard11 less of whether such findings involve a provider, 

12 physician or other practitioner, or plan. Such 

13 report shall describe whether the organization 

14 confirms the allegations in the complaint and 

15 any actions taken by the provider, practitioner, 

16 or plan, respectively, with respect to such find17 ings. Such findings may not be used in any 

18 form in a medical malpractice action. 

19 ‘‘(iii) The organization shall assist pro20 viders, practitioners, and plans in adopting best 

21 practices for soliciting and welcoming feedback 

22 about patient concerns, and assist providers, 

23 practitioners, and plans in remedying patient24 reported problems that are confirmed by the or25 ganization and shall report findings of patient 


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1 reported problems to the provider, practitioner, 

2 or plan involved before disclosing investigation 

3 results to the patient or patient’s representa4 tive. 

5 ‘‘(iv) The organization shall determine 

6 whether the complaint allegations about clinical 

7 quality of care are confirmed and assist pro8 viders, practitioners, and plans in remedying 

9 confirmed complaints. 

10 ‘‘(v) The organization shall assist pro11 viders, practitioners, and plans in preventing re12 currence of quality problems caused by unsafe 

13 systems of care, and refer to an appropriate 

14 regulatory body providers, practitioners, or 

15 plans that are unwilling or unable to improve. 

16 ‘‘(vi) The organization shall publish annual 

17 quality reports in each State in which the orga18 nization operates, including aggregate com19 plaint data and provider performance on stand20 ardized quality measures. 

21 ‘‘(vii) The organization shall promote bene22 ficiary awareness of standardized quality meas23 ures that may be used for evaluating care and 

24 for choosing providers, practitioners and plans. 


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1 ‘‘(C) The Secretary shall monitor and report to 

2 Congress, regarding— 

3 ‘‘(i) the reliability of complaint determina4 tions by Quality Improvement Organizations; 

5 ‘‘(ii) the effect of disclosure of complaint 

6 findings on the availability of primary- and spe7 cialty-care physician reviewers; 

8 ‘‘(iii) changes resulting from the systems 

9 change process described in subparagraph 

10 (B)(v); and 

11 ‘‘(iv) trends in civil litigation filed by Medi12 care beneficiaries or their representatives.’’. 

13 SEC. 3. IMPROVED PROGRAM ADMINISTRATION. 

14 Part B of title XI of the Social Security Act is 

15 amended by adding at the end the following new section: 

16 ‘‘PROGRAM ADMINISTRATION

17 ‘‘SEC. 1164. (a) IMPROVED PROGRAM MANAGE18 MENT.— 

19 ‘‘(1) REPORT ON MANAGEMENT OF THE QIO

20 PROGRAM.—The Comptroller General of the United 

21 States shall submit to Congress, no later than 

22 March 31, 2010, a report on the implementation by 

23 the Secretary and the Director of the Office of Man24 agement and Budget of this part and their overall 

25 management of the program under this part. 


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1 ‘‘(2) PROGRAM MANAGEMENT.—The report 

2 under paragraph (1) shall include a review of all of 

3 the following: 

4 ‘‘(A) Implementation of the priorities, rec5 ommendations, and strategies of the strategic 

6 advisory committee under subsection (c)(1). 

7 ‘‘(B) Implementation of appropriate pro8 gram and contractor evaluation. 

9 ‘‘(C) Ensuring timely issuance of state10 ments of work. 

11 ‘‘(D) Ensuring timely and priority QIO ac12 cess to Medicare data for quality improvement 

13 purposes. 

14 ‘‘(E) Ensuring timely apportionment of 

15 funding. 

16 ‘‘(F) Ensuring funding levels are commen17 surate with new work added to the QIO con18 tract, as described in the second sentence of 

19 section 1159(b)(1). 

20 ‘‘(G) The process of developing the appor21 tionment request and determining the funding 

22 allocation to QIOs. 

23 ‘‘(H) The identification of and progress to24 wards measures of effective management by the 

25 Secretary of the QIO program. 


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1 ‘‘(I) A review of the experience and quali2 fications of staff of the Centers for Medicare & 

3 Medicaid Services in overseeing the program. 

4 ‘‘(3) INNOVATION.—The Secretary shall ensure 

5 that Quality Improvement Organizations are pro6 vided maximum freedom in designing and applying 

7 intervention strategies for local quality improvement. 

8 ‘‘(b) ASSURING DATA ACCESS.—The Secretary shall 

9 ensure that Quality Improvement Organizations have 

10 timely, top priority access to Medicare data for all parts 

11 of Medicare pertinent to the contract activities, in a form 

12 allowing the data to be integrated and analyzed by such 

13 organizations according to the needs of partners and 

14 Medicare beneficiaries in each jurisdiction. 

15 ‘‘(c) SETTING STRATEGIC PRIORITIES.— 

16 ‘‘(1) APPOINTMENT OF STRATEGIC ADVISORY

17 COMMITTEE.—The Secretary shall appoint an inde18 pendent strategic advisory committee, composed of 

19 national quality measurement and improvement ex20 perts, that includes at least three representatives of 

21 organizations holding contracts under this part and 

22 at least one appropriately qualified representative of 

23 each of the following: 

24 ‘‘(A) Medicare beneficiaries. 


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1 ‘‘(B) The Agency for Healthcare Research 

2 and Quality. 

3 ‘‘(C) The Federal Employee Health Bene4 fits Program. 

5 ‘‘(D) The Indian Health Service. 

6 ‘‘(E) The TRICARE program. 

7 ‘‘(F) The Veterans Health Affairs pro8 gram. 

9 ‘‘(G) State Medicaid programs. 

10 ‘‘(H) Private purchasers. 

11 ‘‘(I) Health care providers. 

12 ‘‘(J) Physicians. 

13 ‘‘(K) Other health care practitioners. 

14 ‘‘(2) DUTIES OF COMMITTEE.—Such committee 

15 shall set national strategic priorities for improve16 ment in the quality of care, consistent with the In17 stitute of Medicine’s six aims for health care im18 provement, including safety, effectiveness, patient 

19 centeredness, timeliness, efficiency and equity, and 

20 update these in time to permit preparation of a draft 

21 statement of work and funding request for each pro22 gram cycle under this part. 

23 ‘‘(3) INDEPENDENT EVALUATION.—The com24 mittee should ensure that the Quality Improvement 

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1 pendent entity using a study design, such as a cross2 over design, to allow for an assessment of program 

3 performance in a way that does not have an adverse 

4 impact on providers, practitioners, and plans that 

5 may work with the Organization. 

6 ‘‘(4) FUNDING.—The Secretary shall allocate 

7 funds for the strategic advisory committee from the 

8 portion of the funding that does not directly fund 

9 the contracts with Quality Improvement Organiza10 tions, as required under section 1159(b). 

11 ‘‘(d) TAKING INTO ACCOUNT RECOMMENDATIONS

12 FROM STAKEHOLDERS IN STATEMENTS OF WORK.—Each 

13 statement of work under this part for a contract period 

14 beginning on or after August 1, 2008, shall include a task 

15 for the contracting Quality Improvement Organization to 

16 convene stakeholders to identify high priority quality prob17 lems for work in the next contract period that are relevant 

18 to Medicare beneficiaries in the State. Each such organi19 zation shall propose, as part of such statement, one or 

20 more projects to the Secretary taking into consideration 

21 the recommendations of such stakeholders, along with sug22 gested performance measures to evaluate progress on such 

23 item. 

24 ‘‘(e) ALLOCATION OF RESOURCES TO PRIORITY

25 AREAS.—The Secretary shall allocate at least 20 percent 


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1 of the funding that directly funds contracts with Quality 

2 Improvement Organizations under section 1159(b) to pro3 mote improvement in one or more locally defined priority 

4 areas identified under subsection (d). 

5 ‘‘(f) QUALITY COORDINATION.—Quality Improve6 ment Organizations holding contracts under this part shall 

7 be an integral part of Federal performance improvement 

8 initiatives and each organization’s activities shall be co9 ordinated with initiatives developed by the Secretary and 

10 other Federal agencies.’’. 

11 SEC. 4. DATA DISCLOSURE. 

12 Section 1160 of the Social Security Act (42 U.S.C. 

13 1320c–9) is amended— 

14 (1) in subsection (a)(3), by striking ‘‘subsection 

15 (b)’’ and inserting ‘‘subsections (b) and (f)’’; and 

16 (2) by adding at the end the following new sub17 section: 

18 ‘‘(f)(1) An organization with a contract with the Sec19 retary under this part may share individual-specific data 

20 with a physician treating the individual, for quality im21 provement and patient safety purposes. 

22 ‘‘(2) The Secretary shall promulgate, not later than 

23 180 days after the date of the enactment of this sub24 section, a regulation that permits the sharing of data 

25 under paragraph (1). 


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1 ‘‘(3) Nothing in this subsection shall be construed to 

2 limit, alter, or affect the requirements imposed by the reg3 ulations promulgated under section 264(c) of the Health 

4 Insurance Portability and Accountability Act of 1996.’’. 

5 SEC. 5. USE OF EVALUATION AND COMPETITION. 

6 Section 1153 of the Social Security Act (42 U.S.C. 

7 1320c–2) is amended— 

8 (1) by amending paragraph (3) of subsection 

9 (c) to read as follows: 

10 ‘‘(3) contract terms are consistent with sub11 section (j);’’; 

12 (2) in subsection (c)(1), by inserting ‘‘, at the 

13 sole discretion of the organization,’’ after ‘‘or may 

14 subcontract’’; 

15 (3) in subsection (e), by striking ‘‘(1) Except as 

16 provided’’ and all that follows through ‘‘(2)’’; and 

17 (4) by adding at the end the following new sub18 sections: 

19 ‘‘(j)(1) Subject to the succeeding provisions of this 

20 subsection, each contract with an organization under this 

21 section shall be for an initial term of five years, beginning 

22 and ending on a common date for all contractors as re23 quired under this subsection and shall be renewable for 

24 5 year terms thereafter. 


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1 ‘‘(2) If an incumbent organization achieves excellent 

2 performance as described in paragraph (3), then the Sec3 retary may renew the contract with that organization 

4 without full and open competition, but in no case may an 

5 organization be permitted to hold a contract for more than 

6 10 years without being subject to full and open competi7 tion. 

8 ‘‘(3) Before publishing a request for proposal for a 

9 contract period, the Secretary shall, in consultation with 

10 the strategic advisory committee appointed under section 

11 1164(c)(1), establish measurable goals for each task to be 

12 included in such proposal. The contract shall include per13 formance thresholds by which an organization holding a 

14 contract under this section may demonstrate excellent per15 formance. The Secretary may not establish such perform16 ance thresholds in such a way as to predetermine or limit 

17 either the number or percentage of organizations which 

18 may demonstrate excellent performance. 

19 ‘‘(4) The Secretary shall publish the request for pro20 posals no later than four months prior to the beginning 

21 of such contract period. 

22 ‘‘(5) The Secretary shall utilize the strategic advisory 

23 committee appointed under section 1164(c)(1) to qualify 

24 the validity, reliability, and feasibility of measures to be 

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1 ing a contract under this section. Before any performance 

2 measure may be used for such purpose, it must have been 

3 designated by such committee to be valid, reliable, and fea4 sible for use under similar circumstances, as demonstrated 

5 in at least one reliable and valid study. 

6 ‘‘(6) In the case of an open competition for a contract 

7 under this section, if the incumbent organization bidding 

8 for the contract in the State in which it holds the contract 

9 demonstrates excellent performance in fulfilling the terms 

10 of such contract during the previous contract period, the 

11 Secretary shall award such organization a bonus equiva12 lent to ten percent of the total possible score for the pro13 posal. 

14 ‘‘(7) The Secretary may not reduce the amount of 

15 a contract award below the amount proposed by the bidder 

16 prevailing in a competitive bidding process. 

17 ‘‘(8) The Secretary shall design the process for per18 formance evaluation of contracts under this section— 

19 ‘‘(A) to avoid interfering with the work of con20 tractors with plans, providers, and practitioners; 

21 ‘‘(B) to hold harmless and not penalize contrac22 tors when performance is impaired or delayed by 

23 failures of the Secretary, personnel of the Depart24 ment of Health and Human Services, or contractors 


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1 of the Secretary, to provide timely deliverables by 

2 other entities; 

3 ‘‘(C) to use a continuous measurement strategy 

4 with provision for frequent performance updates for 

5 evaluating interim progress; and 

6 ‘‘(D) to require that evaluation metrics be mon7 itored and permit their adjustment based on experi8 ence or evolving science over the course of a contract 

9 cycle. 

10 ‘‘(k)(1) The Secretary shall extend each contract 

11 under this section the contract period for which began on 

12 or after August 1, 2005, and before February 1, 2006, 

13 so that the subsequent contract period begins on October 

14 1, 2009. 

15 ‘‘(2) The Secretary shall apportion adequate funding 

16 so that organizations with contracts extended under this 

17 subsection can perform existing and new tasks, as deter18 mined by the Secretary, during the period of the contract 

19 extension. 

20 ‘‘(3) There are authorized to be appropriated such 

21 sums as are necessary to respond to increased personnel 

22 requirements resulting from starting all contracts simulta23 neously, as provided under this subsection.’’. 


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1 SEC. 6. QUALITY IMPROVEMENT FUNDING. 

2 Section 1159 of the Social Security Act (42 U.S.C. 

3 1320c–8) is amended— 

4 (1) by inserting ‘‘(a)’’ before ‘‘Expenses in5 curred’’; and 

6 (2) by adding at the end the following new sub7 section: 

8 ‘‘(b)(1) The aggregate annual funding for contracts 

9 under this part that begin after August 1, 2008, shall not 

10 be less than $421,666,000. In addition, there are author11 ized to be apportioned for contract periods in subsequent 

12 years such additional amounts as may be necessary to ade13 quately fund any resource needs in excess of the amount 

14 provided under the previous sentence. 

15 ‘‘(2) At least 80 percent of the funding under this 

16 part in a contract period shall be expended to directly fund 

17 the contracts held by organizations, as required under sec18 tion 1153(b). 

19 ‘‘(3) The Secretary shall determine the resource 

20 needs for a contract period in consultation with represent21 atives from existing contractors. The determination shall 

22 take into account factors including any new work added 

23 via contract modification during the course of the contract 

24 period or added from one contract cycle to the next cycle. 

25 New work includes— 


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1 ‘‘(A) additional core contract tasks, require2 ments, deliverables, and performance thresholds; 

3 ‘‘(B) technical assistance for additional pro4 viders, practitioners, and health plans and additional 

5 provider settings; 

6 ‘‘(C) increased outreach and communications to 

7 Medicare beneficiaries, providers, practitioners, and 

8 plans; and 

9 ‘‘(D) increased volume of medical reviews. 

10 ‘‘(4) With respect to the apportionment of funds 

11 under this part for a contract period— 

12 ‘‘(A) the Secretary shall submit a proposed ap13 portionment to the Director of the Office of Manage14 ment and Budget no later than 1 year before the 

15 first date of the contract period; 

16 ‘‘(B) such Director shall approve an proposed 

17 apportionment no later than 9 months before the 

18 first date of such contract period; 

19 ‘‘(C) for tasks the Secretary proposes to con20 tinue from the previous contract period, if the ap21 portionment is not authorized by the deadline speci22 fied in subparagraph (B), funding shall continue for 

23 the next contract period at a level no less than the 

24 level for the previous contract period, increased by 

25 the percentage increase in the consumer price index 


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1 for all urban consumers during the preceding 12- 

2 month period. 

3 ‘‘(5) Organizations with a contract under this part 

4 may enter into contracts with public or private entities in5 cluding providers, practitioners, and payers other than the 

6 Secretary, to provide quality improvement or other serv7 ices if there are arrangements made to avoid or mitigate 

8 potential conflicts of interest. 

9 ‘‘(6) Such organizations shall have the ability to meet 

10 the terms of a contract by allocating funds to functions 

11 established by the Secretary at its discretion. The Sec12 retary shall review whether the organization met the func13 tions and goals set out for the organization, regardless of 

14 allocation of funds at the initial acceptance of the con15 tract. 

16 ‘‘(7) Organizations with a contract under this part 

17 may utilize funding allocated to such contracts to pay for 

18 food costs directly related to fulfilling contract require19 ments.’’. 

20 SEC. 7. QUALIFICATIONS FOR QIOS. 

21 (a) IN GENERAL.—Subsection (b) of section 1153 of 

22 the Social Security Act (42 U.S.C. 1320c–2) is amended 

23 by adding at the end the following new paragraph: 

24 ‘‘(4)(A) The Secretary shall not enter into or renew 

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1 tity has demonstrated success in facilitating clinical and 

2 administrative system redesign to improve the coordina3 tion, effectiveness, and safety of health care, and in facili4 tating cooperation among stakeholders in quality improve5 ment. 

6 ‘‘(B) The Secretary shall ensure that the entity com7 plies with standards to ensure organizational integrity, in8 cluding— 

9 ‘‘(i) appropriate representation of consumers 

10 and other stakeholders in the composition of the 

11 governing body; 

12 ‘‘(ii) market-based compensation of board mem13 bers and executives; 

14 ‘‘(iii) avoidance and mitigation of board mem15 ber conflict of interest; and 

16 ‘‘(iv) safeguards to ensure appropriate travel 

17 expenses. 

18 To the extent practicable, the Secretary shall utilize stand19 ards developed in the private sector for purposes of car20 rying out this subparagraph and shall conduct audits as 

21 necessary to ensure compliance with such standards.’’. 

22 (b) USE OF STATES FOR GEOGRAPHIC AREAS.—Sub23 section (a) of such section is amended to read as follows: 


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1 ‘‘(a) The Secretary shall designate each State as a 

2 geographic area with respect to which contracts under this 

3 part will be made.’’. 

4 (c) EFFECTIVE DATE.—The amendments made by 

5 this section shall apply to contract periods beginning after 

6 the date of the enactment of this Act. 

7 SEC. 8. COORDINATION WITH MEDICAID. 

8 (a) PERMITTING ALTERNATIVE QUALITY IMPROVE9 MENT PROGRAM.—Section 1902(a)(30) of the Social Se10 curity Act (42 U.S.C. 1396a(a)(30)) is amended by strik11 ing ‘‘and’’ at the end of subparagraph (A), by adding 

12 ‘‘and’’ and the end of subparagraph (B), and by adding 

13 at the end the following new subparagraph: 

14 ‘‘(C) provide, at the discretion of the State 

15 plan, for a quality improvement program in 

16 place of the program described in subparagraph 

17 (A), in whole or in part, that— 

18 ‘‘(i) establishes priorities for achieving 

19 significant measurable improvement in the 

20 quality of health care services provided to 

21 individuals eligible under this title, and re22 views such priorities at least every five 

23 years for the purpose of making appro24 priate revisions; 


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1 ‘‘(ii) provides quality improvement as2 sistance to providers and practitioners con3 sistent with such priorities; and 

4 ‘‘(iii) provides for an annual report to 

5 the Secretary on quality performance 

6 under such plan of providers and practi7 tioners using nationally standardized qual8 ity measures;’’. 

9 (b) ROLE OF QIOS.—Section 1902(d) of such Act 

10 (42 U.S.C. 1396a(d)) is amended— 

11 (1) by inserting ‘‘(1)’’ after ‘‘(d)’’; and 

12 (2) by adding at the end the following new 

13 paragraph: 

14 ‘‘(2) If a State contracts with a Quality Improvement 

15 Organization having a contract with the Secretary under 

16 part B of title XI for the performance of quality improve17 ment program activities required by subsection (a)(30)(C), 

18 such requirements shall be deemed to be met for those 

19 activities by delegation to such an Organization if the con20 tract provides for the performance of activities not incon21 sistent with part B of title XI and provides for such assur22 ances of satisfactory performance by such an entity or or23 ganization as the Secretary may prescribe.’’. 

24 (c) FUNDING.—Section 1903(a)(3)(C) of such Act 

25 (42 U.S.C. 1396b(a)(3)(C)) is amended— 


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1 (1) in clause (i), by striking ‘‘1902(d)’’ and in2 serting ‘‘1902(d)(1)’’; and 

3 (2) by adding at the end the following new 

4 clause: 

5 ‘‘(iii) 75 percent of the sums expended 

6 with respect to costs incurred during such 

7 quarter (as found necessary by the Sec8 retary for the proper and efficient adminis9 tration of the State plan) as are attrib10 utable to the performance of quality im11 provement program activities under a con12 tract entered into under section 1902(d)(2) 

13 by an organization holding a contract 

14 under section 1153; and’’. 

15 (d) EFFECTIVE DATE.—The amendments made by 

16 this section shall apply to contract periods beginning after 

17 the date of the enactment of this Act. 

18 SEC. 9. CONFORMING NAME TO ‘‘QUALITY IMPROVEMENT 

19 ORGANIZATIONS’’. 

20 Part C of title XI of the Social Security Act is amend21 ed by striking ‘‘utilization and quality control peer review’’ 

22 (and ‘‘peer review’’) each place it appears before ‘‘organi23 zation’’ or ‘‘organizations’’ and inserting ‘‘quality im24 provement’’. 

Æ 


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