II 

109TH CONGRESS 

2D SESSION S. 3900 

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 

SEPTEMBER 14, 2006 

Mr. GREGG (for himself, Mr. FRIST, Mr. BURR, Mr. CORNYN, and Mr. BENNETT) 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 2006’’. 

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 the Medicare Quality Enhancement Act of 

5 2006, the Secretary, in accordance with the purpose 

6 described in subsection (a), shall establish and im7 plement procedures under which an entity may sub8 mit a request to a Medicare Quality Reporting Orga9 nization for the Organization to develop a report 

10 based on— 

11 ‘‘(A) Medicare data disclosed to the Orga12 nization under subsection (c); and 

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

14 or is provided to the Organization by the entity 

15 making the request for the report. 

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

17 ‘‘(A) MEDICARE DATA.—The term ‘Medi18 care data’ means— 

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

20 including de-identified beneficiary enroll21 ment data; 

22 ‘‘(ii) all claims for reimbursement for 

23 all items and services furnished by a pro24 vider of services (as defined in section 

25 1861(u)) or a supplier (as defined in secVerDate Aug 31 2005 00:39 Sep 16, 2006 Jkt 049200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3900.IS S3900

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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 disclo20 sure of Medicare data to each Medicare Quality Re21 porting 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 00:39 Sep 16, 2006 Jkt 049200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S3900.IS S3900

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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) IN GENERAL.—Subject to subpara9 graph (B), the Secretary shall enter into a con10 tract with at least 4 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) REQUIREMENT.—The Secretary shall 

18 enter into contracts with a sufficient number of 

19 entities to develop and release such reports in 

20 a timely manner. 

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

22 enter into a contract with an entity under paragraph 

23 (1) only if the Secretary determines that the enti24 ty— 


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

2 and complete reports under this section; 

3 ‘‘(B) has in place– 

4 ‘‘(i) an information technology infra5 structure to support the entire database of 

6 Medicare data; and 

7 ‘‘(ii) operational standards to provide 

8 security for such database; 

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

10 the development of reports on health care qual11 ity and efficiency based on Medicare or private 

12 sector claims data; and 

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

14 the United States. 

15 ‘‘(3) CONTRACT REQUIREMENTS.—Each con16 tract with an entity under paragraph (1) shall con17 tain the following requirements: 

18 ‘‘(A) ENSURING BENEFICIARY PRIVACY.— 

19 The entity shall provide assurances that the en20 tity will not use the Medicare data disclosed 

21 under subsection (c) in a manner that vio22 lates— 

23 ‘‘(i) the Federal regulations (con24 cerning the privacy of individually identifi25 able beneficiary health information) proVerDate Aug 31 2005 00:39 Sep 16, 2006 Jkt 049200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S3900.IS S3900

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1 mulgated under section 264(c) of the 

2 Health Insurance Portability and Account3 ability Act of 1996; or 

4 ‘‘(ii) sections 552 or 552a of title 5, 

5 United States Code, with regards to the 

6 privacy of individually identifiable bene7 ficiary health information. 

8 ‘‘(B) DISCLOSURE.—The entity shall dis9 close— 

10 ‘‘(i) any financial, reporting, or con11 tractual relationship between the entity 

12 and any provider of services (as defined in 

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

14 section 1861(d)); and 

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

16 entity is not managed, controlled, and op17 erated independently from any such pro18 vider of services or supplier. 

19 ‘‘(C) COMPONENT OF ANOTHER ORGANIZA20 TION.—If the entity is a component of another 

21 organization— 

22 ‘‘(i) the entity shall maintain Medi23 care data and reports separately from the 

24 rest of the organization and establish ap25 propriate security measures to maintain 


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1 the confidentiality and privacy of the Medi2 care data and reports; and 

3 ‘‘(ii) the entity shall not make an un4 authorized disclosure to the rest of the or5 ganization of Medicare data or reports in 

6 breach of such confidentiality and privacy 

7 requirement. 

8 ‘‘(D) TERMINATION OR NONRENEWAL.—If 

9 a contract under this section is terminated or 

10 not renewed, the following requirements shall 

11 apply: 

12 ‘‘(i) CONFIDENTIALITY AND PRIVACY

13 PROTECTIONS.—The entity shall continue 

14 to comply with the confidentiality and pri15 vacy requirements under this section with 

16 respect to all Medicare data disclosed to 

17 the entity and each report developed by the 

18 entity. 

19 ‘‘(ii) DISPOSITION OF DATA AND RE20 PORTS.—The entity shall— 

21 ‘‘(I) return to the Secretary all 

22 Medicare data disclosed to the entity 

23 and each report developed by the enti24 ty; or 


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1 ‘‘(II) if returning the Medicare 

2 data and reports is not practicable, 

3 destroy the reports and Medicare 

4 data. 

5 ‘‘(4) COMPETITIVE PROCEDURES.—Competitive 

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

7 Procurement Policy Act) shall be used to enter into 

8 contracts under paragraph (1). 

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

10 A MERGER OR ACQUISITION.—The Secretary shall 

11 review the contract with a Medicare Quality Report12 ing Organization under this section in the event of 

13 a merger or acquisition of the Organization in order 

14 to ensure that the requirements under this section 

15 will continue to be met. 

16 ‘‘(e) DEVELOPMENT AND RELEASE OF REPORTS

17 BASED ON REQUESTS.— 

18 ‘‘(1) REQUEST FOR A REPORT.— 

19 ‘‘(A) REQUEST.— 

20 ‘‘(i) IN GENERAL.—The procedures 

21 established under subsection (b)(1) shall 

22 include a process for an entity to submit a 

23 request to a Medicare Quality Reporting 

24 Organization for a report based on Medi25 care data and private data that is publicly 


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1 available or is provided by the entity mak2 ing the request for the report. Such re3 quest shall comply with the purpose de4 scribed in subsection (a). 

5 ‘‘(ii) REQUEST FOR SPECIFIC METH6 ODOLOGY.—The process described in 

7 clause (i) shall permit an entity making a 

8 request for a report to request that a spe9 cific methodology be used by the Medicare 

10 Quality Reporting Organization in devel11 oping the report. The Organization shall 

12 work with the entity making the request to 

13 finalize the methodology to be used. 

14 ‘‘(iii) REQUEST FOR A SPECIFIC

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

16 shall permit an entity to submit the re17 quest for a report to any Medicare Quality 

18 Reporting Organization. 

19 ‘‘(B) RELEASE TO PUBLIC.—The proce20 dures established under subsection (b)(1) shall 

21 provide that at the time a request for a report 

22 is finalized under subparagraph (A) by a Medi23 care Quality Reporting Organization, the Orga24 nization shall make available to the public, 

25 through the Internet website of the Centers for 


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1 Medicare & Medicaid Services and other appro2 priate means, a brief description of both the re3 quested report and the methodology to be used 

4 to develop such report. 

5 ‘‘(2) DEVELOPMENT AND RELEASE OF RE6 PORT.— 

7 ‘‘(A) DEVELOPMENT.— 

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

9 a report complies with the purpose de10 scribed in subsection (a), the Medicare 

11 Quality Reporting Organization may de12 velop the report based on the request. 

13 ‘‘(ii) REQUIREMENT.—A report devel14 oped under clause (i) shall include a de15 tailed description of the standards, meth16 odologies, and measures of quality used in 

17 developing the report. 

18 ‘‘(B) REVIEW OF REPORT BY SECRETARY

19 TO ENSURE COMPLIANCE WITH PRIVACY RE20 QUIREMENT.—Prior to a Medicare Quality Re21 porting Organization releasing a report under 

22 subparagraph (C), the Secretary shall review 

23 the report to ensure that the report complies 

24 with the Federal regulations (concerning the 

25 privacy of individually identifiable beneficiary 


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1 health information) promulgated under section 

2 264(c) of the Health Insurance Portability and 

3 Accountability Act of 1996 and sections 552 or 

4 552a of title 5, United States Code, with re5 gards to the privacy of individually identifiable 

6 beneficiary health information. The Secretary 

7 shall act within 30 business days of receiving 

8 such report. 

9 ‘‘(C) RELEASE OF REPORT.— 

10 ‘‘(i) RELEASE TO ENTITY MAKING RE11 QUEST.—If the Secretary finds that the re12 port complies with the provisions described 

13 in subparagraph (B), the Medicare Quality 

14 Reporting Organization shall release the 

15 report to the entity that made the request 

16 for the report. 

17 ‘‘(ii) RELEASE TO PUBLIC.—The pro18 cedures established under subsection (b)(1) 

19 shall provide for the following: 

20 ‘‘(I) UPDATED DESCRIPTION.— 

21 At the time of the release of a report 

22 by a Medicare Quality Reporting Or23 ganization under clause (i), the entity 

24 shall make available to the public, 

25 through the Internet website of the 


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1 Centers for Medicare & Medicaid 

2 Services and other appropriate means, 

3 an updated brief description of both 

4 the requested report and the method5 ology used to develop such report. 

6 ‘‘(II) COMPLETE REPORT.—Not 

7 later than 1 year after the date of the 

8 release of a report under clause (i), 

9 the report shall be made available to 

10 the public through the Internet 

11 website of the Centers for Medicare & 

12 Medicaid Services and other appro13 priate means. 

14 ‘‘(f) PERIODIC REVIEW OF REPORTS.—The Sec15 retary shall periodically review reports released under sub16 section (e)(2)(C) to ensure that such reports comply with 

17 the purpose described in subsection (a). The Secretary 

18 may terminate a contract with a Medicare Quality Report19 ing Organization if the Secretary determines that there 

20 is a pattern of reports being released by the Organization 

21 that do not comply with such purpose. 

22 ‘‘(g) FEES.— 

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

24 shall charge a Medicare Quality Reporting Organiza25 tion a fee for— 


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1 ‘‘(A) disclosing the data under subsection 

2 (c); and 

3 ‘‘(B) conducting the review under sub4 section (e)(2)(B). 

5 The Secretary shall ensure that such fees are suffi6 cient to cover the costs of the activities described in 

7 subparagraph (A) and (B). 

8 ‘‘(2) FEES FOR MQRO.—A Medicare Quality 

9 Reporting Organization may charge an entity mak10 ing a request for a report a reasonable fee for the 

11 development and release of the report. 

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

13 the date of enactment of the Medicare Quality Enhance14 ment Act of 2006, the Secretary shall prescribe regula15 tions to carry out this section. 

16 ‘‘(i) GAO STUDIES AND REPORT.— 

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

18 the United States shall conduct a study on each of 

19 the following: 

20 ‘‘(A) The feasibility of requiring Medicare 

21 Advantage organizations under part C to share 

22 utilization and quality data with the Secretary 

23 for the purpose of releasing such information to 

24 Medicare Quality Reporting Organizations 

25 under this section. 


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1 ‘‘(B) The Medicare data released to Medi2 care Quality Reporting Organizations under 

3 subsection (c) in order to determine the accu4 racy of such data with respect to— 

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

6 ‘‘(ii) diagnosis and procedures; and 

7 ‘‘(iii) any other data elements impor8 tant for the development of reports under 

9 this section in accordance with the purpose 

10 described in subsection (a). 

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

12 the date of enactment of the Medicare Quality En13 hancement Act of 2006, the Comptroller General of 

14 the United States shall submit a report to Congress 

15 on each of the studies conducted under paragraph 

16 (1) together with recommendations for such legisla17 tion and administrative actions as the Comptroller 

18 General considers appropriate.’’. 

19 SEC. 3. QUALITY ADVISORY BOARD. 

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

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

22 Health and Human Services shall establish within the Of23 fice of the Secretary a board to be known as the Quality 

24 Advisory Board (in this section referred to as the 

25 ‘‘Board’’). 


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

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

3 representatives of— 

4 (1) groups representing Medicare beneficiaries; 

5 (2) groups representing providers of services (as 

6 defined in subsection (u) of section 1861 of the So7 cial Security Act (42 U.S.C. 1395x)) and suppliers 

8 (as defined in subsection (d) of such section) receiv9 ing reimbursement under the Medicare program; 

10 (3) purchasers and employers or groups rep11 resenting purchasers and employers; 

12 (4) organizations focused on the development of 

13 quality health care measures; 

14 (5) researchers or research institutions with ex15 perience in the measurement of, and reporting on, 

16 health care quality; and 

17 (6) health plans or groups representing health 

18 plans. 

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

20 (1) To coordinate existing collaborative efforts 

21 identifying quality and efficiency health care meas22 ures. 

23 (2) To provide the Secretary of Health and 

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1 velopment of model quality health care measure2 ments. 

3 (3) To submit requests to Medicare Quality Re4 porting Organizations under section 1898 of the So5 cial Security Act, as added by section 2, for reports 

6 on existing recommended model quality and effi7 ciency health care measures. 

8 (4) To examine how clinical registries can be 

9 linked to Medicare data (as defined in subsection 

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

11 reports on the quality and efficiency of providers of 

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

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

14 suppliers (as defined in subsection (d) of such sec15 tion). 

16 (5) Other duties determined appropriate by the 

17 Secretary. 

18 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

19 are authorized to be appropriated to the Secretary of 

20 Health and Human Services such sums as may be nec21 essary for the purpose of carrying out this section. 

22 SEC. 4. RESEARCH ACCESS TO MEDICARE DATA AND RE23 PORTING ON PERFORMANCE. 

24 The Secretary of Health and Human Services shall 

25 permit researchers that meet existing criteria used to 


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1 evaluate the appropriateness of the release of Centers for 

2 Medicare & Medicaid Services (CMS) data for research 

3 purposes to— 

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

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

6 as added by section 2); and 

7 (2) report on the performance of providers of 

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

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

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

11 reporting in a provider- or supplier-identifiable for12 mat. 

Æ 


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