I 

111TH CONGRESS 

1ST SESSION H. R. 2858 

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

the quality improvement organization (QIO) program. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 12, 2009 

Mr. KIND (for himself, Mr. BURGESS, and Ms. BALDWIN) 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 2009’’. 

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. Use of evaluation and competition. 

Sec. 5. Quality improvement funding. 

Sec. 6. Qualifications for QIOs. 

Sec. 7. Coordination with Medicaid. 

Sec. 8. Conforming name to ‘‘quality improvement organizations’’. 

1 SEC. 2. QUALITY IMPROVEMENT ACTIVITIES. 

2 (a) INCLUSION OF QUALITY IMPROVEMENT FUNC3 TIONS.— 

4 (1) IN GENERAL.—Section 1154(a) of the So5 cial Security Act (42 U.S.C. 1320c–3(a)) is amended 

6 by adding at the end the following new paragraph: 

7 ‘‘(18) The organization shall offer quality im8 provement assistance to providers, practitioners, 

9 Medicare Advantage organizations offering Medicare 

10 Advantage plans under part C of title XVIII, and 

11 prescription drug sponsors offering prescription drug 

12 plans under part D of such title, including the fol13 lowing: 

14 ‘‘(A) Education on quality improvement 

15 initiatives, strategies, and techniques. 

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

17 aggregate, and interpret data on measures that 

18 may be used for quality improvement, public re19 porting, and payment. 

20 ‘‘(C) Instruction on how to conduct root21 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 local 

5 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, efficiency, and safe14 ty of care. 

15 ‘‘(H) Assistance in improving the quality 

16 of care delivered in rural and frontier areas and 

17 reducing health care disparities among racial 

18 and ethnic minorities, as well as gender dispari19 ties, including efforts to prevent or address any 

20 inconsistencies or delays in the rate of adoption 

21 of health information technology and in the ef22 fective use of such technology among such enti23 ties that treat racial and ethnic minorities or 

24 individuals dually eligible for benefits under this 


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1 title and title XVIII or that furnish such serv2 ices in rural areas. 

3 ‘‘(I) Assistance in improving coordination 

4 of care as patients transition between providers 

5 and practitioners, including developing the ca6 pacity to securely exchange electronic health in7 formation and helping providers and practi8 tioners to effectively use secure electronic health 

9 information to improve quality. 

10 ‘‘(J) Preparation of confidential reports 

11 comparing the performance of primary care 

12 physician practices using standardized perform13 ance measures and distribution of such reports 

14 to primary care practices, subject to the fol15 lowing requirements: 

16 ‘‘(i) The organization shall consult 

17 with stakeholders in the State to select 

18 clinical topic areas to address in such re19 ports. 

20 ‘‘(ii) Performance measures must 

21 have been endorsed by a consensus-based 

22 national entity. 

23 ‘‘(iii) The report given to each pri24 mary care practice shall identify that pracVerDate Nov 24 2008 05:02 Jun 13, 2009 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2858.IH H2858

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1 tice, but shall not identify the other prac2 tices in the comparison. 

3 ‘‘(iv) The organization shall offer as4 sistance to primary care practices in im5 proving performance on the measures.’’. 

6 (2) PERMITTING DISCLOSURE OF

7 DEIDENTIFIED INFORMATION.— 

8 (A) IN GENERAL.—Section 1160 of such 

9 Act (42 U.S.C. 1320c–9) is amended— 

10 (i) in subsection (a)(2), by inserting 

11 ‘‘(including the case described in sub12 section (f))’’ after ‘‘in such cases’’; and 

13 (ii) by adding at the end the following 

14 new subsection: 

15 ‘‘(f) An organization with a contract under this part 

16 may provide de-identified patient data to providers treat17 ing the same population of patients for the purpose of 

18 measuring and improving the safety, quality, and effec19 tiveness of transitions of such patients from one provider 

20 of services to another. Nothing in this subsection shall be 

21 construed to limit, alter, or affect the requirements im22 posed pursuant to the HIAA privacy regulations (as de23 fined in section 1180(b)(3)).’’. 

24 (B) PROMULGATION OF REGULATIONS.— 

25 Not later than 180 days after the date of the 


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1 enactment of this Act, the Secretary of Health 

2 and Human Services shall promulgate a regula3 tion that permits the sharing of data under the 

4 amendments made by subparagraph (A). 

5 (b) MEDICARE QUALITY ACCOUNTABILITY PRO6 GRAM.—Paragraph (14) of section 1154(a) of such Act 

7 (42 U.S.C. 1320c–3(a)) is amended to read as follows: 

8 ‘‘(14)(A) The organization shall conduct a re9 view of all complaints about the quality of services 

10 (for which payment may otherwise be made under 

11 title XVIII) not meeting professionally recognized 

12 standards of health care, if the complaint is filed 

13 with the organization by an individual entitled to 

14 benefits for such services under such title (or a per15 son acting on the individual’s behalf). Before the or16 ganization concludes that the quality of services does 

17 not meet professionally recognized standards of 

18 health care, the organization must provide the prac19 titioner or person concerned with reasonable notice 

20 and opportunity for discussion. 

21 ‘‘(B) The organization shall establish and oper22 ate a Medicare quality accountability program con23 sistent with the following: 

24 ‘‘(i) The organization shall actively educate 

25 Medicare beneficiaries of their right to bring 


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1 quality concerns to Quality Improvement Orga2 nizations. 

3 ‘‘(ii) The organization shall report findings 

4 of its investigations to the beneficiary involved 

5 or a representative of such beneficiary, regard6 less of whether such findings involve a provider, 

7 physician or other practitioner, or plan. Such 

8 report shall describe whether the organization 

9 confirms the allegations in the complaint and 

10 any actions taken by the provider, practitioner, 

11 or plan, respectively, with respect to such find12 ings. Such findings may not be used in any 

13 form in a medical malpractice action. 

14 ‘‘(iii) The organization shall assist pro15 viders, practitioners, and plans in adopting best 

16 practices for soliciting and welcoming feedback 

17 about patient concerns, and assist providers, 

18 practitioners, and plans in remedying patient19 reported problems that are confirmed by the or20 ganization and shall report findings of patient 

21 reported problems to the provider, practitioner, 

22 or plan involved before disclosing investigation 

23 results to the patient or patient’s representa24 tive. 


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1 ‘‘(iv) The organization shall determine 

2 whether the complaint allegations about clinical 

3 quality of care are confirmed and assist pro4 viders, practitioners, and plans in remedying 

5 confirmed complaints. 

6 ‘‘(v) The organization shall assist pro7 viders, practitioners, and plans in preventing re8 currence of quality problems caused by unsafe 

9 systems of care, and refer to an appropriate 

10 regulatory body providers, practitioners, or 

11 plans that are unwilling or unable to improve. 

12 ‘‘(vi) The organization shall publish annual 

13 quality reports in each State in which the orga14 nization operates, including aggregate com15 plaint data and provider performance on stand16 ardized quality measures. 

17 ‘‘(vii) The organization shall promote bene18 ficiary awareness and understanding of stand19 ardized quality measures that may be used for 

20 evaluating care and for choosing providers, 

21 practitioners and plans. 

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

23 Congress, regarding— 

24 ‘‘(i) the reliability of complaint determina25 tions by Quality Improvement Organizations; 


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

2 findings on the availability of primary- and spe3 cialty-care physician reviewers; 

4 ‘‘(iii) changes resulting from the systems 

5 change process described in subparagraph 

6 (B)(v); and 

7 ‘‘(iv) trends in civil litigation filed by Medi8 care beneficiaries or their representatives.’’. 

9 SEC. 3. IMPROVED PROGRAM ADMINISTRATION. 

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

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

12 ‘‘PROGRAM ADMINISTRATION

13 ‘‘SEC. 1164. (a) IMPROVED PROGRAM MANAGE14 MENT.—The Secretary shall ensure that Quality Improve15 ment Organizations are provided maximum freedom in de16 signing and applying intervention strategies for local qual17 ity improvement. 

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

19 ensure that Quality Improvement Organizations have 

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

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

22 allowing the data to be integrated and analyzed by such 

23 organizations according to the needs of partners and 

24 Medicare beneficiaries in each jurisdiction. 

25 ‘‘(c) SETTING STRATEGIC PRIORITIES.— 


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1 ‘‘(1) APPOINTMENT OF STRATEGIC ADVISORY

2 COMMITTEE.—The Secretary shall appoint an inde3 pendent strategic advisory committee (in this sub4 section referred to as the ‘committee’), composed of 

5 national quality measurement and improvement ex6 perts, that includes at least three representatives of 

7 organizations holding contracts under this part and 

8 at least one appropriately qualified representative of 

9 each of the following: 

10 ‘‘(A) Medicare beneficiaries. 

11 ‘‘(B) The Agency for Healthcare Research 

12 and Quality. 

13 ‘‘(C) The Federal Employee Health Bene14 fits Program. 

15 ‘‘(D) The Indian Health Service. 

16 ‘‘(E) The TRACER program. 

17 ‘‘(F) The Veterans Health Affairs pro18 gram. 

19 ‘‘(G) State Medicaid programs. 

20 ‘‘(H) Private purchasers. 

21 ‘‘(I) Health care providers. 

22 ‘‘(J) Physicians. 

23 ‘‘(K) Other health care practitioners. 

24 ‘‘(2) DUTIES OF COMMITTEE.— 


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1 ‘‘(A) IN GENERAL.—The committee shall 

2 set national strategic priorities for improvement 

3 in the quality of care, consistent with the Insti4 tute of Medicine’s six aims for health care im5 provement, including safety, effectiveness, pa6 tient centeredness, timeliness, efficiency and eq7 uity, and update these in time to permit prepa8 ration of a draft statement of work and funding 

9 request for each program cycle under this part. 

10 ‘‘(B) SECRETARIAL CONSULTATION WITH

11 COMMITTEE.—Two years before the start of the 

12 contract cycle under this part that begins at 

13 least 30 months after the date of the enactment 

14 of this section, the Secretary shall begin con15 sultation with the committee on the design and 

16 tasks of the statement of work for such con17 tract cycle. 

18 ‘‘(C) PUBLIC FORUM.—Eighteen months 

19 before the beginning of such contract cycle, the 

20 committee shall convene a public forum to so21 licit and receive stakeholder and public com22 ment concerning the design and tasks under the 

23 next contract. 

24 ‘‘(3) INDEPENDENT EVALUATION.—The com25 mittee should ensure that the Quality Improvement 


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1 Organization program is evaluated by an inde2 pendent entity using a study design, such as a cross3 over design, to allow for an assessment of program 

4 performance in a way that does not have an adverse 

5 impact on providers, practitioners, and plans that 

6 may work with the Organization. 

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

8 funds for the strategic advisory committee from the 

9 portion of the funding that does not directly fund 

10 the contracts with Quality Improvement Organiza11 tions, as required under section 1159(b). 

12 ‘‘(d) TAKING INTO ACCOUNT RECOMMENDATIONS

13 FROM STAKEHOLDERS IN STATEMENTS OF WORK.—Each 

14 statement of work under this part for a contract period 

15 beginning on or after August 1, 2009, shall include a task 

16 for the contracting Quality Improvement Organization to 

17 convene stakeholders to identify high priority quality prob18 lems for work in the next contract period that are relevant 

19 to Medicare beneficiaries in the State. Each such organi20 zation shall propose, as part of such statement, one or 

21 more projects to the Secretary taking into consideration 

22 the recommendations of such stakeholders, along with sug23 gested performance measures to evaluate progress on such 

24 item. 


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1 ‘‘(e) ALLOCATION OF RESOURCES TO PRIORITY

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

3 of the funding that directly funds contracts with Quality 

4 Improvement Organizations under section 1159(b) to pro5 mote improvement in one or more locally defined priority 

6 areas identified under subsection (d). 

7 ‘‘(f) QUALITY COORDINATION.—Quality Improve8 ment Organizations holding contracts under this part shall 

9 be an integral part of Federal performance improvement 

10 initiatives and each organization’s activities shall be co11 ordinated with initiatives developed by the Secretary and 

12 other Federal agencies. 

13 ‘‘(g) FUNDING.—The Secretary shall increase con14 tract funding for any significant new work required as a 

15 result of coordinating the activities of contractors with ini16 tiatives developed by the Secretary and other Federal 

17 agencies.’’. 

18 SEC. 4. USE OF EVALUATION AND COMPETITION. 

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

20 1320c–2) is amended— 

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

22 (c) to read as follows: 

23 ‘‘(3) contract terms are consistent with sub24 section (j);’’; 


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

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

3 subcontract’’; 

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

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

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

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

9 subsection, each contract with an organization under this 

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

11 and ending on a common date for all contractors as re12 quired under this subsection and shall be renewable for 

13 5-year terms thereafter. 

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

15 performance as described in paragraph (3), then the Sec16 retary may renew the contract with that organization 

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

18 organization be permitted to hold a contract for more than 

19 10 years without being subject to full and open competi20 tion. 

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

22 contract period, the Secretary shall, in consultation with 

23 the strategic advisory committee appointed under section 

24 1164(c)(1), establish measurable goals for each task to be 

25 included in such proposal. The contract shall include perVerDate Nov 24 2008 05:02 Jun 13, 2009 Jkt 079200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H2858.IH H2858

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1 formance thresholds by which an organization holding a 

2 contract under this section may demonstrate excellent per3 formance. The Secretary may not establish such perform4 ance thresholds in such a way as to predetermine or limit 

5 either the number or percentage of organizations which 

6 may demonstrate excellent performance. 

7 ‘‘(4) The Secretary shall publish the request for pro8 posals no later than four months prior to the beginning 

9 of such contract period. 

10 ‘‘(5) The Secretary shall ensure that measures to be 

11 used in evaluating the performance of organizations hold12 ing a contract under this section have been demonstrated 

13 to be valid, reliable, and feasible for use under the terms 

14 and circumstances of the contract. 

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

16 under this section, if the incumbent organization bidding 

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

18 demonstrates excellent performance in fulfilling the terms 

19 of such contract during the previous contract period, the 

20 Secretary shall award such organization a bonus equiva21 lent to ten percent of the total possible score for the pro22 posal. 

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

24 a contract award below the amount proposed by the bidder 

25 prevailing in a competitive bidding process. 


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1 ‘‘(8) The Secretary shall design the process for per2 formance evaluation of contracts under this section— 

3 ‘‘(A) to avoid interfering with the work of con4 tractors with plans, providers, and practitioners; 

5 ‘‘(B) to hold harmless and not penalize contrac6 tors when performance is impaired or delayed by 

7 failures of the Secretary, personnel of the Depart8 ment of Health and Human Services, or contractors 

9 of the Secretary, to provide timely deliverables by 

10 other entities; 

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

12 with provision for frequent performance updates for 

13 evaluating interim progress; and 

14 ‘‘(D) to require that evaluation metrics be mon15 itored and permit their adjustment based on experi16 ence or evolving science over the course of a contract 

17 cycle.’’. 

18 SEC. 5. QUALITY IMPROVEMENT FUNDING. 

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

20 1320c–8) is amended— 

21 (1) by inserting ‘‘(a)’’ before ‘‘Expenses in22 curred’’; and 

23 (2) by adding at the end the following new sub24 section: 


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

2 under this part that begin after August 1, 2009, shall not 

3 be less than $421,666,000. In addition, there are author4 ized to be apportioned for contract periods in subsequent 

5 years such additional amounts as may be necessary to ade6 quately fund any resource needs in excess of the amount 

7 provided under the previous sentence. 

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

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

10 the contracts held by organizations, as required under sec11 tion 1153(b). 

12 ‘‘(3) The Secretary shall determine the resources 

13 needs for a contract period, taking into account any new 

14 work added by contract modification, during the course 

15 of the contract period or added from one contract cycle 

16 to the next cycle. New work includes— 

17 ‘‘(A) additional core contract tasks, require18 ments, deliverables, and performance thresholds; 

19 ‘‘(B) technical assistance for additional pro20 viders, practitioners, and health plans and additional 

21 provider settings; 

22 ‘‘(C) increased outreach and communications to 

23 Medicare beneficiaries, providers, practitioners, and 

24 plans; and 

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


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

2 under this part for a contract period— 

3 ‘‘(A) the Secretary shall submit a proposed ap4 portionment to the Director of the Office of Manage5 ment and Budget no later than 1 year before the 

6 first date of the contract period; 

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

8 apportionment no later than 9 months before the 

9 first date of such contract period; 

10 ‘‘(C) for tasks the Secretary proposes to con11 tinue from the previous contract period, if the ap12 portionment is not authorized by the deadline speci13 fied in subparagraph (B), funding shall continue for 

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

15 level for the previous contract period, increased by 

16 the percentage increase in the consumer price index 

17 for all urban consumers during the preceding 12- 

18 month period. 

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

20 may enter into contracts with public or private entities in21 cluding providers, practitioners, and payers other than the 

22 Secretary, to provide quality improvement or other serv23 ices if there are arrangements made to avoid or mitigate 

24 potential conflicts of interest. 


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1 ‘‘(6) Such organizations shall be permitted discretion 

2 to allocate contract funds as needed to accomplish the 

3 tasks to be performed for a contract awarded under this 

4 title. 

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

6 may utilize funding allocated to such contracts to pay for 

7 food costs directly related to fulfilling contract require8 ments.’’. 

9 SEC. 6. QUALIFICATIONS FOR QIOS. 

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

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

12 by adding at the end the following new paragraph: 

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

14 a contract under this section with an entity unless the en15 tity has demonstrated success in facilitating clinical and 

16 administrative system redesign to improve the coordina17 tion, effectiveness, and safety of health care, and in facili18 tating cooperation among stakeholders in quality improve19 ment. 

20 ‘‘(B) The Secretary shall ensure that the entity com21 plies with standards to ensure organizational integrity, in22 cluding— 

23 ‘‘(i) appropriate representation of consumers 

24 and other stakeholders in the composition of the 

25 governing body; 


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1 ‘‘(ii) market-based compensation of board mem2 bers and executives; 

3 ‘‘(iii) avoidance and mitigation of board mem4 ber conflict of interest; and 

5 ‘‘(iv) safeguards to ensure appropriate travel 

6 expenses. 

7 To the extent practicable, the Secretary shall utilize stand8 ards developed in the private sector for purposes of car9 rying out this subparagraph and shall conduct audits as 

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

11 (b) USE OF STATES FOR GEOGRAPHIC AREAS.—Sub12 section (a) of such section is amended to read as follows: 

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

14 geographic area with respect to which contracts under this 

15 part will be made.’’. 

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

17 this section shall apply to contract periods beginning after 

18 the date of the enactment of this Act. 

19 SEC. 7. COORDINATION WITH MEDICAID. 

20 (a) PERMITTING ALTERNATIVE QUALITY IMPROVE21 MENT PROGRAM.—Section 1902(a)(30) of the Social Se22 curity Act (42 U.S.C. 1396a(a)(30)) is amended by strik23 ing ‘‘and’’ at the end of subparagraph (A), by adding 

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

25 at the end the following new subparagraph: 


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

2 plan, for a quality improvement program in 

3 place of the program described in subparagraph 

4 (A), in whole or in part, that— 

5 ‘‘(i) establishes priorities for achieving 

6 significant measurable improvement in the 

7 quality of health care services provided to 

8 individuals eligible under this title, and re9 views such priorities at least every five 

10 years for the purpose of making appro11 priate revisions; 

12 ‘‘(ii) provides quality improvement as13 sistance to providers and practitioners con14 sistent with such priorities; and 

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

16 the Secretary on quality performance 

17 under such plan of providers and practi18 tioners using nationally standardized qual19 ity measures;’’. 

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

21 (42 U.S.C. 1396a(d)) is amended— 

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

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

24 paragraph: 


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

2 Organization having a contract with the Secretary under 

3 part B of title XI for the performance of quality improve4 ment program activities required by subsection (a)(30)(C), 

5 such requirements shall be deemed to be met for those 

6 activities by delegation to such an Organization if the con7 tract provides for the performance of activities not incon8 sistent with part B of title XI and provides for such assur9 ances of satisfactory performance by such an entity or or10 ganization as the Secretary may prescribe.’’. 

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

12 (42 U.S.C. 1396b(a)(3)(C)) is amended— 

13 (1) in clause (i), by striking ‘‘1902(d)’’ and in14 serting ‘‘1902(d)(1)’’; and 

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

16 clause: 

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

18 with respect to costs incurred during such 

19 quarter (as found necessary by the Sec20 retary for the proper and efficient adminis21 tration of the State plan) as are attrib22 utable to the performance of quality im23 provement program activities under a con24 tract entered into under section 1902(d)(2) 


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1 by an organization holding a contract 

2 under section 1153; and’’. 

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

4 this section shall apply to contract periods beginning after 

5 the date of the enactment of this Act. 

6 SEC. 8. CONFORMING NAME TO ‘‘QUALITY IMPROVEMENT 

7 ORGANIZATIONS’’. 

8 Part C of title XI of the Social Security Act is amend9 ed by striking ‘‘utilization and quality control peer review’’ 

10 and ‘‘peer review’’ each place either appears before ‘‘orga11 nization’’ or ‘‘organizations’’ and inserting ‘‘quality im12 provement’’. 

Æ 


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