enactment of this Act, the Secretary of Health 
and Human Services shall promulgate a regula-
tion that permits the sharing of data under the 
amendments made by subparagraph (A). 
(b) MEDICARE
QUALITY
ACCOUNTABILITY
PRO-
GRAM.—Paragraph (14) of section 1154(a) of such Act 
(42 U.S.C. 1320c–3(a)) is amended to read as follows: 
‘‘(14)(A) The organization shall conduct a re-
view of all complaints about the quality of services 
(for which payment may otherwise be made under 
title XVIII) not meeting professionally recognized 
standards of health care, if the complaint is filed 
with the organization by an individual entitled to 
benefits for such services under such title (or a per-
son acting on the individual’s behalf). Before the or-
ganization concludes that the quality of services does 
not meet professionally recognized standards of 
health care, the organization must provide the prac-
titioner or person concerned with reasonable notice 
and opportunity for discussion. 
‘‘(B) The organization shall establish and oper-
ate a Medicare quality accountability program con-
sistent with the following: 
‘‘(i) The organization shall actively educate 
Medicare beneficiaries of their right to bring 
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quality concerns to Quality Improvement Orga-
nizations. 
‘‘(ii) The organization shall report findings 
of its investigations to the beneficiary involved 
or a representative of such beneficiary, regard-
less of whether such findings involve a provider, 
physician or other practitioner, or plan. Such 
report shall describe whether the organization 
confirms the allegations in the complaint and 
any actions taken by the provider, practitioner, 
or plan, respectively, with respect to such find-
ings. Such findings may not be used in any 
form in a medical malpractice action. 
‘‘(iii) The organization shall assist pro-
viders, practitioners, and plans in adopting best 
practices for soliciting and welcoming feedback 
about patient concerns, and assist providers, 
practitioners, and plans in remedying patient- 
reported problems that are confirmed by the or-
ganization and shall report findings of patient 
reported problems to the provider, practitioner, 
or plan involved before disclosing investigation 
results to the patient or patient’s representa-
tive. 
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‘‘(iv) The organization shall determine 
whether the complaint allegations about clinical 
quality of care are confirmed and assist pro-
viders, practitioners, and plans in remedying 
confirmed complaints. 
‘‘(v) The organization shall assist pro-
viders, practitioners, and plans in preventing re-
currence of quality problems caused by unsafe 
systems of care, and refer to an appropriate 
regulatory body providers, practitioners, or 
plans that are unwilling or unable to improve. 
‘‘(vi) The organization shall publish annual 
quality reports in each State in which the orga-
nization operates, including aggregate com-
plaint data and provider performance on stand-
ardized quality measures. 
‘‘(vii) The organization shall promote bene-
ficiary awareness and understanding of stand-
ardized quality measures that may be used for 
evaluating care and for choosing providers, 
practitioners and plans. 
‘‘(C) The Secretary shall monitor and report to 
Congress, regarding— 
‘‘(i) the reliability of complaint determina-
tions by Quality Improvement Organizations; 
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‘‘(ii) the effect of disclosure of complaint 
findings on the availability of primary- and spe-
cialty-care physician reviewers; 
‘‘(iii) changes resulting from the systems 
change process described in subparagraph 
(B)(v); and 
‘‘(iv) trends in civil litigation filed by Medi-
care beneficiaries or their representatives.’’. 
SEC. 3. IMPROVED PROGRAM ADMINISTRATION. 
Part B of title XI of the Social Security Act is 
amended by adding at the end the following new section: 
‘‘PROGRAM ADMINISTRATION 
‘‘SEC. 1164. (a) IMPROVED PROGRAM MANAGE-
MENT.—The Secretary shall ensure that Quality Improve-
ment Organizations are provided maximum freedom in de-
signing and applying intervention strategies for local qual-
ity improvement. 
‘‘(b) ASSURING DATA ACCESS.—The Secretary shall 
ensure that Quality Improvement Organizations have 
timely, top priority access to Medicare data for all parts 
of Medicare pertinent to the contract activities, in a form 
allowing the data to be integrated and analyzed by such 
organizations according to the needs of partners and 
Medicare beneficiaries in each jurisdiction. 
‘‘(c) SETTING STRATEGIC PRIORITIES.— 
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‘‘(1) APPOINTMENT
OF
STRATEGIC
ADVISORY 
COMMITTEE.—The Secretary shall appoint an inde-
pendent strategic advisory committee (in this sub-
section referred to as the ‘committee’), composed of 
national quality measurement and improvement ex-
perts, that includes at least three representatives of 
organizations holding contracts under this part and 
at least one appropriately qualified representative of 
each of the following: 
‘‘(A) Medicare beneficiaries. 
‘‘(B) The Agency for Healthcare Research 
and Quality. 
‘‘(C) The Federal Employee Health Bene-
fits Program. 
‘‘(D) The Indian Health Service. 
‘‘(E) The TRACER program. 
‘‘(F) The Veterans Health Affairs pro-
gram. 
‘‘(G) State Medicaid programs. 
‘‘(H) Private purchasers. 
‘‘(I) Health care providers. 
‘‘(J) Physicians. 
‘‘(K) Other health care practitioners. 
‘‘(2) DUTIES OF COMMITTEE.— 
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‘‘(A) IN GENERAL.—The committee shall 
set national strategic priorities for improvement 
in the quality of care, consistent with the Insti-
tute of Medicine’s six aims for health care im-
provement, including safety, effectiveness, pa-
tient centeredness, timeliness, efficiency and eq-
uity, and update these in time to permit prepa-
ration of a draft statement of work and funding 
request for each program cycle under this part. 
‘‘(B) SECRETARIAL CONSULTATION WITH 
COMMITTEE.—Two years before the start of the 
contract cycle under this part that begins at 
least 30 months after the date of the enactment 
of this section, the Secretary shall begin con-
sultation with the committee on the design and 
tasks of the statement of work for such con-
tract cycle. 
‘‘(C) PUBLIC
FORUM.—Eighteen months 
before the beginning of such contract cycle, the 
committee shall convene a public forum to so-
licit and receive stakeholder and public com-
ment concerning the design and tasks under the 
next contract. 
‘‘(3) INDEPENDENT
EVALUATION.—The com-
mittee should ensure that the Quality Improvement 
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Organization program is evaluated by an inde-
pendent entity using a study design, such as a cross-
over design, to allow for an assessment of program 
performance in a way that does not have an adverse 
impact on providers, practitioners, and plans that 
may work with the Organization. 
‘‘(4) FUNDING.—The Secretary shall allocate 
funds for the strategic advisory committee from the 
portion of the funding that does not directly fund 
the contracts with Quality Improvement Organiza-
tions, as required under section 1159(b). 
‘‘(d) TAKING INTO ACCOUNT RECOMMENDATIONS 
FROM STAKEHOLDERS IN STATEMENTS OF WORK.—Each 
statement of work under this part for a contract period 
beginning on or after August 1, 2009, shall include a task 
for the contracting Quality Improvement Organization to 
convene stakeholders to identify high priority quality prob-
lems for work in the next contract period that are relevant 
to Medicare beneficiaries in the State. Each such organi-
zation shall propose, as part of such statement, one or 
more projects to the Secretary taking into consideration 
the recommendations of such stakeholders, along with sug-
gested performance measures to evaluate progress on such 
item. 
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‘‘(e) ALLOCATION
OF RESOURCES
TO PRIORITY 
AREAS.—The Secretary shall allocate at least 20 percent 
of the funding that directly funds contracts with Quality 
Improvement Organizations under section 1159(b) to pro-
mote improvement in one or more locally defined priority 
areas identified under subsection (d). 
‘‘(f) QUALITY
COORDINATION.—Quality Improve-
ment Organizations holding contracts under this part shall 
be an integral part of Federal performance improvement 
initiatives and each organization’s activities shall be co-
ordinated with initiatives developed by the Secretary and 
other Federal agencies. 
‘‘(g) FUNDING.—The Secretary shall increase con-
tract funding for any significant new work required as a 
result of coordinating the activities of contractors with ini-
tiatives developed by the Secretary and other Federal 
agencies.’’. 
SEC. 4. USE OF EVALUATION AND COMPETITION. 
Section 1153 of the Social Security Act (42 U.S.C. 
1320c–2) is amended— 
(1) by amending paragraph (3) of subsection 
(c) to read as follows: 
‘‘(3) contract terms are consistent with sub-
section (j);’’; 
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(2) in subsection (c)(1), by inserting ‘‘, at the 
sole discretion of the organization,’’ after ‘‘or may 
subcontract’’; 
(3) in subsection (e), by striking ‘‘(1) Except as 
provided’’ and all that follows through ‘‘(2)’’; and 
(4) by adding at the end the following new sub-
section: 
‘‘(j)(1) Subject to the succeeding provisions of this 
subsection, each contract with an organization under this 
section shall be for an initial term of five years, beginning 
and ending on a common date for all contractors as re-
quired under this subsection and shall be renewable for 
5-year terms thereafter. 
‘‘(2) If an incumbent organization achieves excellent 
performance as described in paragraph (3), then the Sec-
retary may renew the contract with that organization 
without full and open competition, but in no case may an 
organization be permitted to hold a contract for more than 
10 years without being subject to full and open competi-
tion. 
‘‘(3) Before publishing a request for proposal for a 
contract period, the Secretary shall, in consultation with 
the strategic advisory committee appointed under section 
1164(c)(1), establish measurable goals for each task to be 
included in such proposal. The contract shall include per-
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formance thresholds by which an organization holding a 
contract under this section may demonstrate excellent per-
formance. The Secretary may not establish such perform-
ance thresholds in such a way as to predetermine or limit 
either the number or percentage of organizations which 
may demonstrate excellent performance. 
‘‘(4) The Secretary shall publish the request for pro-
posals no later than four months prior to the beginning 
of such contract period. 
‘‘(5) The Secretary shall ensure that measures to be 
used in evaluating the performance of organizations hold-
ing a contract under this section have been demonstrated 
to be valid, reliable, and feasible for use under the terms 
and circumstances of the contract. 
‘‘(6) In the case of an open competition for a contract 
under this section, if the incumbent organization bidding 
for the contract in the State in which it holds the contract 
demonstrates excellent performance in fulfilling the terms 
of such contract during the previous contract period, the 
Secretary shall award such organization a bonus equiva-
lent to ten percent of the total possible score for the pro-
posal. 
‘‘(7) The Secretary may not reduce the amount of 
a contract award below the amount proposed by the bidder 
prevailing in a competitive bidding process. 
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‘‘(8) The Secretary shall design the process for per-
formance evaluation of contracts under this section— 
‘‘(A) to avoid interfering with the work of con-
tractors with plans, providers, and practitioners; 
‘‘(B) to hold harmless and not penalize contrac-
tors when performance is impaired or delayed by 
failures of the Secretary, personnel of the Depart-
ment of Health and Human Services, or contractors 
of the Secretary, to provide timely deliverables by 
other entities; 
‘‘(C) to use a continuous measurement strategy 
with provision for frequent performance updates for 
evaluating interim progress; and 
‘‘(D) to require that evaluation metrics be mon-
itored and permit their adjustment based on experi-
ence or evolving science over the course of a contract 
cycle.’’. 
SEC. 5. QUALITY IMPROVEMENT FUNDING. 
Section 1159 of the Social Security Act (42 U.S.C. 
1320c–8) is amended— 
(1) by inserting ‘‘(a)’’ before ‘‘Expenses in-
curred’’; and 
(2) by adding at the end the following new sub-
section: 
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