I 

111TH CONGRESS 

1ST SESSION H. R. 2948 

To amend title IX of the Public Health Service Act to provide for the 

implementation of best practices in the delivery of health care in the 

United States, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 18, 2009 

Mr. LEVIN (for himself, Mr. HIGGINS, Mr. DOGGETT, Ms. HIRONO, Mr. POMEROY, and Mr. ETHERIDGE) introduced the following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To amend title IX of the Public Health Service Act to 

provide for the implementation of best practices in the 

delivery of health care in the United States, and for 

other purposes. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Healthcare Improve5 ments for Generating High Performance (HIGH Perform6 ance) Act of 2009’’. 

7 SEC. 2. FINDINGS. 

8 The Congress finds the following: 


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1 (1) The United States has some of the best 

2 doctors and hospitals in the world, but, as a whole, 

3 the system is not providing the quality of care it has 

4 the potential to deliver. 

5 (2) On average, patients receive recommended 

6 evidence-based therapies only 55 percent of the time. 

7 (3) In the United States, it takes an average of 

8 17 years for an established clinical guideline to 

9 reach the bedside. 

10 (4) More people die from medical errors and 

11 hospital-acquired infections in a given year than 

12 from AIDS, motor vehicle wrecks, or breast cancer 

13 combined. Many of these errors and infections are 

14 preventable when best practices are utilized. 

15 (5) The United States ranks far behind other 

16 countries in many measures of health care quality. 

17 (6) The cause of poor quality is not a lack of 

18 individual commitment, but a lack of assistance for 

19 providers to implement best practices that are prov20 en to work. 

21 (7) Experiences in Michigan illustrate the im22 provement that can be achieved when hospitals and 

23 physicians have the tools they need to implement 

24 best practices in health care. After Michigan insti25 tuted a program to help hospitals implement best 


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1 practices to prevent hospital-acquired infections in 

2 the intensive care unit (ICU), infections went down 

3 by 66 percent in the first 3 months. After 18 

4 months, Michigan’s ICUs cut infection rates so low 

5 that they outperformed 90 percent of ICUs nation6 wide. 

7 (8) In that time, it is estimated that Michigan 

8 hospitals saved $75,000,000 and over 1,500 lives. If 

9 these results in reducing infections alone were 

10 achieved nationwide, it is estimated that the United 

11 States could save $13,000,000,000 over 10 years. 

12 (9) There is an urgent need to accelerate the 

13 implementation of best practices in health care deliv14 ery to improve the quality and value of health care. 

15 SEC. 3. IMPLEMENTATION OF BEST PRACTICES TO IM16 PROVE HEALTH CARE QUALITY. 

17 Title IX of the Public Health Service Act (42 U.S.C. 

18 299 et seq.) is amended by adding at the end the fol19 lowing: 

20 ‘‘PART E—IMPLEMENTATION OF BEST 

21 PRACTICES TO IMPROVE HEALTH CARE QUALITY 

22 ‘‘SEC. 941. ESTABLISHMENT OF NATIONAL PRIORITIES AND 

23 GOALS. 

24 ‘‘(a) IN GENERAL.—The Secretary shall establish na25 tional priorities and goals for quality improvement in the 


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1 delivery of health care services in the United States. In 

2 establishing these priorities and goals, the Secretary shall 

3 consult with a multistakeholder group convened for the 

4 purposes of reviewing available evidence and recom5 mending national quality improvement targets. Such 

6 group shall include representatives of the various interests 

7 and organizations needed to enable change, including con8 sumers, physicians, nurses, hospitals and other care deliv9 ery organizations, non-Federal purchasers of care, health 

10 care oversight or accrediting bodies, research organiza11 tions, and entities with successful experience in quality im12 provement and quality measurement. 

13 ‘‘(b) AREAS FOR IMPROVEMENT.—Priorities and 

14 goals may be established in at least the following areas 

15 recommended by the Institute of Medicine: safety, effec16 tiveness, patient-centeredness, timeliness, efficiency, and 

17 equity. 

18 ‘‘(c) PERIODIC UPDATES OF NATIONAL PRIORITIES

19 AND GOALS.—The Secretary shall update the national pri20 orities and goals established under this section not less 

21 frequently than once every 3 years. 

22 ‘‘(d) APPLICATION OF NATIONAL PRIORITIES.—The 

23 Secretary shall use the national priorities established and 

24 updated under this section to coordinate, accelerate, and 

25 provide for quality improvement activities and initiatives 


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1 in the delivery of health care services in the United States, 

2 including through the work of the Center for Health Ex3 tension established under section 942. 

4 ‘‘(e) ASSESSMENT OF PROGRESS TOWARD NATIONAL

5 GOALS.—The Secretary shall submit an annual report to 

6 the Congress and the public containing an assessment of 

7 progress toward the national quality improvement goals. 

8 ‘‘(f) INTERAGENCY COORDINATION.—The Secretary 

9 shall convene an interagency committee, which shall in10 clude representatives from the Agency for Healthcare Re11 search and Quality, including the Center for Health Ex12 tension established under section 942, the National Insti13 tutes of Health, the Centers for Disease Control and Pre14 vention, the Centers for Medicare and Medicaid Services, 

15 the Health Resources and Services Administration, the In16 dian Health Service, the Department of Defense, the Vet17 erans Health Administration, and other agencies the Sec18 retary deems appropriate, for the purpose of coordinating 

19 the quality improvement work of such agencies, including 

20 the application of the national priorities. 

21 ‘‘SEC. 942. ESTABLISHMENT OF THE CENTER FOR HEALTH 

22 EXTENSION. 

23 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab24 lish within the Agency for Healthcare Quality and ReVerDate Nov 24 2008 06:05 Jun 19, 2009 Jkt 079200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2948.IH H2948

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1 search a Center for Health Extension (hereinafter referred 

2 to as the ‘Center’). 

3 ‘‘(b) DIRECTOR.—The Center shall be headed by a 

4 Director who shall oversee the operations of the Center 

5 and of the Regional Health Extension Centers established 

6 under section 944. 

7 ‘‘SEC. 943. MISSION AND FUNCTIONS OF THE CENTER FOR 

8 HEALTH EXTENSION. 

9 ‘‘(a) MISSION.—The mission of the Center is to im10 prove health care quality by assisting health care providers 

11 to implement and improve upon clinical, managerial, and 

12 health care delivery best practices, and to evaluate 

13 progress in improving patient outcomes. 

14 ‘‘(b) FUNCTIONS.— 

15 ‘‘(1) IDENTIFY AND DEVELOP BEST PRAC16 TICES.—The Center shall identify and develop clin17 ical, managerial, and health care delivery best prac18 tices for implementation in quality improvement ac19 tivities. 

20 ‘‘(2) ASSIST WITH THE IMPLEMENTATION OF

21 BEST PRACTICES.—The Center shall provide vol22 untary training and technical assistance to hospitals, 

23 other health care facilities, and clinician practices to 

24 assist with the implementation of best practices. 


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1 ‘‘(3) MEASURE PATIENT OUTCOMES AND SATIS2 FACTION.—The Center shall provide for the meas3 urement of patient outcomes and satisfaction, be4 fore, during, and after implementation of quality im5 provement activities. 

6 ‘‘(4) EVALUATE EFFECTIVENESS OF ACTIVI7 TIES.—The Center shall evaluate the effectiveness of 

8 quality improvement activities, and progress improv9 ing patient outcomes. 

10 ‘‘(c) IDENTIFICATION OF BEST PRACTICES.— 

11 ‘‘(1) IN GENERAL.—The Center shall provide 

12 for the identification of highly effective clinical, man13 agerial, and health care delivery practices and inno14 vations that result in excellent patient outcomes and 

15 satisfaction, and can be adapted for use by various 

16 health care providers. 

17 ‘‘(2) SOURCES OF BEST PRACTICES.—The Cen18 ter may identify practices and innovations described 

19 in paragraph (1) from the following sources. 

20 ‘‘(A) PROVIDERS AND OTHER HEALTH

21 CARE ENTITIES.—The Center may identify 

22 practices and innovations employed by hos23 pitals, health care facilities, clinician practices, 

24 community cooperatives, and other health care 

25 entities. 


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1 ‘‘(B) EMPIRICAL STUDIES.—The Center 

2 may identify practices and innovations from a 

3 review of relevant empirical studies. 

4 ‘‘(C) PUBLIC AND PRIVATE ENTITIES.— 

5 The Center may identify practices and innova6 tions developed by public and private entities in 

7 the United States and abroad. 

8 ‘‘(D) OTHER SOURCES.—The Center may 

9 identify practices and innovations from other 

10 sources as the Secretary deems appropriate. 

11 ‘‘(d) DEVELOPMENT OF BEST PRACTICES.— 

12 ‘‘(1) IN GENERAL.—The Center shall provide 

13 for the development of highly effective clinical, man14 agerial, and health care delivery practices, taking 

15 into account the requirements described in para16 graph (2). 

17 ‘‘(2) REQUIREMENTS.—Practices developed 

18 under paragraph (1) shall— 

19 ‘‘(A) be supported by empirical evidence 

20 showing that they have a high likelihood of im21 proving patient outcomes and satisfaction; 

22 ‘‘(B) be specified with sufficient detail of 

23 the individual processes, steps, training, skills, 

24 and knowledge required for implementation and 


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1 incorporation into workflow of health care prac2 titioners in a variety of settings; 

3 ‘‘(C) be designed to be readily adapted by 

4 health care practitioners; 

5 ‘‘(D) where applicable, be designed to be 

6 consistent with standards adopted by the Sec7 retary (under section 3004 of the Public Health 

8 Service Act) for health information technology 

9 used in the collection and reporting of quality 

10 information, including for purposes of the dem11 onstration of meaningful use of certified Elec12 tronic Medical Record technology by physicians 

13 and hospitals under the Medicare program 

14 (under sections 1842(o)(2) and 1886(n)(3), re15 spectively, of the Social Security Act (42 U.S.C. 

16 1395w–4(o)(2), 1395ww(n)(3))); and 

17 ‘‘(E) where applicable, assist health care 

18 practitioners in working with other health care 

19 practitioners across the continuum of care and 

20 in engaging patients and their families in im21 proving the care and patient outcomes. 

22 ‘‘(3) COLLABORATION WITH HEALTH CARE

23 PROVIDERS AND OTHER ENTITIES.—The Center may 

24 collaborate with health care providers and other enti25 ties to foster the development of highly effective 


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1 practices and innovations to improve health care 

2 quality. 

3 ‘‘(4) ATTENTION TO HEALTH CARE DELIVERY

4 DESIGN.—The Center shall specifically provide for 

5 the development of best practices for health care de6 livery design as described in section 943(g). 

7 ‘‘(5) ONGOING REVIEW AND IMPROVEMENT.— 

8 The Center shall provide for regular review, updat9 ing, and improvement of practices developed under 

10 this subsection. 

11 ‘‘(e) TRAINING AND EDUCATION FOR HEALTH CARE

12 PROVIDERS.— 

13 ‘‘(1) IN GENERAL.—Acting through the Re14 gional Health Care Extension Centers established in 

15 section 944 (hereinafter referred to as ‘Extension 

16 Centers’), the Center shall provide for voluntary 

17 training activities for hospitals, other facilities, and 

18 clinician practices to assist with the implementation 

19 of best practices and innovations identified under 

20 subsection (c) or developed under subsection (d) 

21 that— 

22 ‘‘(A) further the priorities established 

23 under section 941, once such priorities have 

24 been established; 


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1 ‘‘(B) have the greatest impact on patient 

2 outcomes and satisfaction; and 

3 ‘‘(C) are determined to be readily employ4 able in health care settings. 

5 ‘‘(2) TECHNICAL ASSISTANCE.—The Center 

6 shall work through the Extension Centers to carry 

7 out the following functions: 

8 ‘‘(A) ESTABLISHMENT OF PARTICIPA9 TION.—The Extension Centers shall seek the 

10 voluntary participation of hospitals, health fa11 cilities, and clinician practices in a region to 

12 enter into arrangements to receive assistance in 

13 implementing highly effective practices identi14 fied under subsection (c) or developed under 

15 subsection (d). Hospitals, health facilities, and 

16 clinician practices entering into such arrange17 ments are hereinafter referred to in this sub18 section as ‘collaborating providers’. 

19 ‘‘(B) ESTABLISHMENT OF COLLABORATIVE

20 TEAM.—The Extension Centers may require 

21 collaborating providers to designate a group of 

22 members from among the professional and ad23 ministrative staff who are responsible for the 

24 implementation of the quality improvement ac25 tivity or initiative. 


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1 ‘‘(C) ASSESSMENT OF EXISTING PRAC2 TICES.—The Extension Centers shall conduct 

3 an assessment of the existing practices as com4 pared to the identified highly effective practice 

5 at each hospital, facility, or practice that par6 ticipates in an arrangement under this sub7 section. 

8 ‘‘(D) DEVELOPMENT OF IMPLEMENTATION

9 PLAN.—Each collaborating provider shall work 

10 with the Extension Center to develop an imple11 mentation plan for the incorporation of the 

12 highly effective practice into the care of the 

13 provider. 

14 ‘‘(E) TRAINING FOR COLLABORATING PRO15 VIDERS.—Staff of the Extension Center shall 

16 work with the collaborating providers to execute 

17 the implementation plan. Such staff shall pro18 vide instruction and training through electronic 

19 media, in-person training sessions, and data 

20 analysis to collaborating providers. Such staff 

21 shall work with the collaborating providers to 

22 carry out this paragraph. 

23 ‘‘(F) MEASUREMENT OF PROGRESS.—Pur24 suant to a data protection agreement entered 

25 into between the Extension Center and the colVerDate Nov 24 2008 06:05 Jun 19, 2009 Jkt 079200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H2948.IH H2948

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1 laborating provider, the Extension Center shall 

2 collect data to measure best practice implemen3 tation and patient outcomes before, during, and 

4 after implementation of quality improvement 

5 activities using, to the extent practicable, data 

6 already reported for other purposes by collabo7 rating providers. Where applicable, the Exten8 sion Center shall also collect data to measure 

9 the culture of safety. 

10 ‘‘(G) TIMELY FEEDBACK TO COLLABO11 RATING PROVIDERS.—The Extension Center 

12 shall provide to each collaborating provider— 

13 ‘‘(i) analysis conducted by the Exten14 sion Center on the collaborating provider’s 

15 progress implementing the highly effective 

16 practice and improving patient outcomes, 

17 and, where applicable, improving the cul18 ture of safety. 

19 ‘‘(ii) information on the collaborating 

20 provider’s performance as compared to 

21 other like entities participating in similar 

22 quality improvement activities, and as 

23 available, as compared to other like entities 

24 nationally. 


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1 ‘‘(H) CULTURE CHANGE.—The Extension 

2 Center may incorporate into instruction and 

3 training for collaborating providers activities to 

4 improve the culture of safety and foster an 

5 ethic of continual improvement among collabo6 rating providers. 

7 ‘‘(I) MEETINGS.—The Extension Center 

8 shall provide for meetings of panels of collabo9 rating providers working with Extension Cen10 ters on similar quality improvement activities 

11 for the purpose of reciprocal learning and infor12 mation exchange. 

13 ‘‘(J) COORDINATION WITH OTHER QUAL14 ITY IMPROVEMENT ENTITIES.—If an Extension 

15 Center is not the organization holding a con16 tract under section 1153 of the Social Security 

17 Act or a health information technology regional 

18 extension center under section 3012(c) of the 

19 Public Health Service Act, the Extension Cen20 ter shall cooperate with and avoid duplicating 

21 the activities of these entities. 

22 ‘‘(K) OTHER DUTIES.—Such other duties 

23 as the Center may specify. 

24 ‘‘(3) INITIAL QUALITY IMPROVEMENT ACTIVI25 TIES.—The Center shall immediately prioritize asVerDate Nov 24 2008 06:05 Jun 19, 2009 Jkt 079200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H2948.IH H2948

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1 sistance for the implementation of best practices 

2 that have been shown to be effective with respect to 

3 improvement in the following areas: 

4 ‘‘(A) HAI.—Health care-associated infec5 tions, including reducing catheter-associated 

6 urinary tract infection, ventilator-associated 

7 pneumonia, and central line-associated blood8 stream infections. 

9 ‘‘(B) SURGERY.—Hospital and outpatient 

10 perioperative care, including reducing surgical11 site infections and surgical errors such as 

12 wrong-site surgery and retained foreign bodies. 

13 ‘‘(C) ER.—Hospital emergency rooms, in14 cluding the development of comprehensive unit15 based safety programs, ‘handovers’ of care 

16 when transferring patients from the emergency 

17 room to other hospital departments or sites for 

18 treatment, early identification and treatment 

19 for sepsis, and use of principles of efficiency of 

20 design and delivery to improve patient flow. 

21 ‘‘(D) OBSTETRICS.—Obstetrical and neo22 natal care, including the appropriate use of ce23 sarean sections, and the implementation of best 

24 practices for labor and delivery care. 


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1 ‘‘(E) CARE TRANSITIONS.—Transitions of 

2 patients between settings, including reduction 

3 of unnecessary hospital readmissions and in4 creased coordination between teams of unaffili5 ated providers. 

6 ‘‘(f) ASSESSMENT OF EFFECTIVENESS OF QUALITY

7 IMPROVEMENT ACTIVITIES.— 

8 ‘‘(1) IMPACT STATEMENTS.—Each Extension 

9 Center shall make available to the public and the 

10 Center impact statements with respect to its activi11 ties to assist health care providers to implement best 

12 practices. Such impact statements shall contain de13 identified information on progress implementing 

14 highly effective practices, the impact of the Exten15 sion Center’s activities on patient outcomes and sat16 isfaction, including lives saved, and cost savings at17 tributable to the activities of the Extension Center, 

18 and shall include such additional information as the 

19 Center may specify. 

20 ‘‘(2) AGGREGATE IMPACT STATEMENT.—The 

21 Center shall aggregate the progress reports of the 

22 Extension Centers into a national impact statement. 

23 The national impact statement shall contain infor24 mation on the aggregate progress implementing 

25 highly effective practices, the aggregate impact of 


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1 the Extension Centers’ activities on patient out2 comes and satisfaction, including lives saved, and 

3 aggregate cost savings attributable to the activities 

4 of the Extension Centers, including cost savings to 

5 Medicare and Medicaid, and shall include such addi6 tional information as the Center may specify. 

7 ‘‘(3) EVALUATION OF EFFECTIVENESS.—To the 

8 extent practicable, the Center shall evaluate the ef9 fect of implementing individual best practices on im10 proving patient outcomes and satisfaction. 

11 ‘‘(g) HEALTH CARE DELIVERY DESIGN.— 

12 ‘‘(1) IN GENERAL.—The Center shall conduct 

13 or fund activities to develop superior designs for the 

14 delivery of health services. This activity may utilize 

15 tools such as operations research, systems engineer16 ing, rapid design laboratories, cognitive and social 

17 psychology studies, materials sciences, and statistics. 

18 ‘‘(2) EXAMPLES OF ACTIVITIES TO BE CON19 DUCTED.—Health care delivery design activities con20 ducted under this paragraph may examine methods 

21 to— 

22 ‘‘(A) improve the arrangement of surgical 

23 suites to facilitate teamwork among physicians, 

24 nurses, and other members of the care team; 


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1 ‘‘(B) increase the likelihood that clinical 

2 guidelines are followed in care settings; 

3 ‘‘(C) design medication systems to prevent 

4 medication errors; 

5 ‘‘(D) improve rounding, handoff, and shift 

6 changes to improve coordination of patient care; 

7 ‘‘(E) develop discharge practices that im8 prove coordination and reduce confusion and 

9 duplicative care; 

10 ‘‘(F) craft and implement effective patient 

11 education procedures; and 

12 ‘‘(G) improve the design and protocols of 

13 emergency rooms to reduce unsafe conditions 

14 and ambulance diversions. 

15 ‘‘(3) SOLICITATION OF INPUT.—The Center 

16 shall solicit input from health care providers on 

17 areas in which development of best practices in 

18 health care delivery are most needed to improve pa19 tient care and satisfaction. 

20 ‘‘(4) REQUIREMENTS.—The health care delivery 

21 design improvement activities conducted under this 

22 paragraph shall— 

23 ‘‘(A) be based on identified need for im24 provement in a specific area of health care de25 livery; 


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1 ‘‘(B) aim to discover or develop designs 

2 that can be readily adopted by health care pro3 viders and facilities; 

4 ‘‘(C) aim to improve patient outcomes and 

5 satisfaction; 

6 ‘‘(D) where applicable, be designed to be 

7 consistent with standards adopted by the Direc8 tor (under section 3004 of the Public Health 

9 Service Act) for health information technology 

10 used in the collection and reporting of quality 

11 information, including for purposes of the dem12 onstration of meaningful use of certified Elec13 tronic Medical Record technology by physicians 

14 and hospitals under the Medicare program 

15 (under sections 1842(o)(2) and 1886(n)(3), re16 spectively, of the Social Security Act (42 U.S.C. 

17 1395w–4(o)(2), 1395ww(n)(3))); and 

18 ‘‘(E) where applicable, assist health care 

19 practitioners in working with other health care 

20 practitioners across the continuum of care and 

21 in engaging patients and their families in im22 proving the care and patient outcomes. 

23 ‘‘(h) RESEARCH AND RELATED ACTIVITIES.—The 

24 Center shall conduct or fund research and other knowl25 edge generation activities on the factors that facilitate beVerDate Nov 24 2008 06:05 Jun 19, 2009 Jkt 079200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\H2948.IH H2948

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1 havior change for the sustainable integration of highly ef2 fective and innovative practices into medical practice and 

3 on the factors that foster an environment of continual im4 provement. 

5 ‘‘(i) PUBLIC DISSEMINATION OF INFORMATION.— 

6 The Center shall provide for the public dissemination of 

7 objective information with respect to activities and re8 search conducted under this Act. Such information shall 

9 be made available through multiple media and appropriate 

10 formats to reflect the varying needs of consumers and di11 verse levels of health literacy. 

12 ‘‘(j) REPORTS.— 

13 ‘‘(1) ANNUAL REPORTS.—Not later than April 

14 1 of each year, beginning in 2011, the Director of 

15 the Center shall submit a report to the Secretary on 

16 the activities of the Center and the Extension Cen17 ters during the preceding year. 

18 ‘‘(2) CONTENT.—Each report submitted under 

19 paragraph (1) shall include information on— 

20 ‘‘(A) the number of arrangements estab21 lished by Extension Centers with collaborating 

22 providers; 

23 ‘‘(B) the progress made accelerating the 

24 implementation of best practices by the collabo25 rating providers during the year involved and 


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1 for such other years as the Director determines 

2 to be appropriate; 

3 ‘‘(C) the level of implementation of best 

4 practices at collaborating providers as compared 

5 to other providers; 

6 ‘‘(D) the impact of the work of each Ex7 tension Center on patient outcomes and patient 

8 safety, including lives saved, and cost savings 

9 attributable to the activity or initiatives of the 

10 Extension Center; 

11 ‘‘(E) the aggregate national impact of the 

12 work of the Center and Extension Centers on 

13 patient outcomes and patient safety, including 

14 lives saved, and cost savings attributable to the 

15 activity or initiatives of the Extension Centers 

16 and the Center, including cost savings to Medi17 care and Medicaid; 

18 ‘‘(F) progress made toward the national 

19 goals for health care quality improvement, as 

20 established under secton 941; 

21 ‘‘(G) evaluations of the impact of imple22 menting individual best practices on patient 

23 outcomes and satisfaction, to the extent such 

24 analysis is practicable; 


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1 ‘‘(H) research and other related activities 

2 conducted or funded by the Center during the 

3 year involved and the results of those efforts in 

4 improving patient safety and the quality of care 

5 in the delivery of health care services or in the 

6 science of improvement; and 

7 ‘‘(I) such other matters as the Center, or 

8 the Secretary, determines to be appropriate. 

9 ‘‘(3) PUBLIC AVAILABILITY.—The Secretary 

10 shall transmit each report under this subsection to 

11 Congress and shall make each such report available 

12 to the public. 

13 ‘‘SEC. 944. REGIONAL HEALTH EXTENSION CENTERS. 

14 ‘‘(a) ESTABLISHMENT OF REGIONAL HEALTH EX15 TENSION CENTERS.—The Center shall establish, either di16 rectly or through contracts with qualified entities (as de17 fined in subsection (b)), Regional Health Extension Cen18 ters (referred to in this Act as ‘Extension Centers’) to 

19 carry out the functions described in section 943(e) within 

20 such States or regions as the Center determines to be ap21 propriate: 

22 ‘‘(b) DEFINITION.—In this section, the term ‘quali23 fied entity’ means an entity that meets all of the following 

24 requirements: 


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1 ‘‘(1) DEMONSTRATED EXPERIENCE.—The enti2 ty has experience— 

3 ‘‘(A) in carrying out the type of functions 

4 described in section 942(e); 

5 ‘‘(B) in operating programs on a statewide, 

6 regionwide, or nationwide basis to improve pa7 tient safety and the quality of health care deliv8 ered in health care settings; and 

9 ‘‘(C) in working with a variety of institu10 tional health care providers, physicians and 

11 other health care practitioners. 

12 ‘‘(2) NONPROFIT ORGANIZATION.—The entity is 

13 a nonprofit entity organized for charitable purposes 

14 under section 501(c) of the Internal Revenue Code 

15 of 1986. 

16 ‘‘(3) GOVERNANCE.—The entity is governed by 

17 a board that includes representatives of multiple 

18 health care and nonhealth care stakeholders (includ19 ing consumers), such that representatives of no sin20 gle stakeholder group constitute a majority. 

21 ‘‘(4) ENTITIES WITH OTHER EXISTING CON22 TRACTS.—The performance of services under this 

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1 ity improvement, health information technology tech2 nical assistance, or data aggregation. 

3 ‘‘(5) AUDITS.—The Extension Centers shall be 

4 subject to periodic audit. 

5 ‘‘SEC. 945. FUNDING. 

6 ‘‘For the purpose of carrying out this part, there is 

7 authorized to be appropriated $200,000,000 for each of 

8 the fiscal years 2010 through 2014.’’. 

Æ 


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