SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Quality En-
hancement Act of 2007’’. 
SEC. 2. QUALITY AND EFFICIENCY REPORTS BASED ON 
MEDICARE ENROLLMENT, CLAIMS, SURVEY, 
AND ASSESSMENT DATA. 
Title XVIII of the Social Security Act is amended by 
adding at the end the following new section: 
‘‘QUALITY AND EFFICIENCY REPORTS BASED ON 
MEDICARE DATA 
‘‘SEC. 1898. (a) PURPOSE.—The purpose of this sec-
tion is to provide for the development of reports based on 
Medicare data and private data that is publicly available 
or is provided by the entity making the request for the 
report in order to— 
‘‘(1) improve the quality and efficiency of 
health care; 
‘‘(2) enhance the education and awareness of 
consumers for evaluating health care services; and 
‘‘(3) provide the public with reports on national, 
regional, and provider- and supplier-specific per-
formance, which may be in a provider- or supplier- 
identifiable format. 
‘‘(b) PROCEDURES FOR THE DEVELOPMENT OF RE-
PORTS.— 
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‘‘(1) IN
GENERAL.—Notwithstanding section 
552(b)(6) or 552a(b) of title 5, United States Code, 
not later than 12 months after the date of enact-
ment of this section, the Secretary, in accordance 
with the purpose described in subsection (a), shall 
establish and implement procedures under which an 
entity may submit a request to a Medicare Quality 
Reporting Organization for the Organization to de-
velop a report based on— 
‘‘(A) Medicare data disclosed to the Orga-
nization under subsection (c); and 
‘‘(B) private data that is publicly available 
or is provided to the Organization by the entity 
making the request for the report. 
‘‘(2) DEFINITIONS.—In this section: 
‘‘(A) MEDICARE DATA.—The term ‘Medi-
care data’ means— 
‘‘(i) enrollment data under this title, 
including de-identified beneficiary enroll-
ment data; 
‘‘(ii) all claims for reimbursement for 
all items and services furnished by a pro-
vider of services (as defined in section 
1861(u)) or a supplier (as defined in sec-
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tion 1861(d)) under part A or B in a re-
search identifiable format; 
‘‘(iii) on and after January 1, 2008, 
all data relating to enrollment in, and cov-
erage for, qualified prescription drug cov-
erage under part D; and 
‘‘(iv) additional data files relating to 
the program under this title collected by 
the Secretary for the purpose of nation-
wide quality measurement and reporting 
based on surveys and assessment data de-
termined appropriate by the Secretary. 
‘‘(B) MEDICARE QUALITY REPORTING OR-
GANIZATION.—The term ‘Medicare Quality Re-
porting Organization’ means an entity with a 
contract under subsection (d). 
‘‘(c) ACCESS TO MEDICARE DATA.— 
‘‘(1) IN GENERAL.—The procedures established 
under subsection (b)(1) shall provide for the secure 
disclosure of Medicare data to each Medicare Quality 
Reporting Organization. 
‘‘(2) ALL DATA.—The Secretary shall ensure 
that all Medicare data files (beginning with files 
from January 1, 1998) are disclosed under para-
graph (1), including the most recent data files avail-
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able to the Secretary. Not less than every 6 months, 
the Secretary shall update the information disclosed 
under paragraph (1) to Medicare Quality Reporting 
Organizations. 
‘‘(d) MEDICARE QUALITY REPORTING ORGANIZA-
TIONS.— 
‘‘(1) IN GENERAL.— 
‘‘(A) THREE CONTRACTS.—Subject to sub-
paragraph (B), the Secretary shall enter into a 
contract with 3 private entities to serve as 
Medicare 
Quality 
Reporting 
Organizations 
under which an entity shall— 
‘‘(i) store the Medicare data that is to 
be disclosed under subsection (c); and 
‘‘(ii) develop and release reports pur-
suant to subsection (e). 
‘‘(B) ADDITIONAL
CONTRACTS.—If the 
Secretary determines that reports are not being 
developed and released within 6 months of the 
receipt of the request for the report, the Sec-
retary shall enter into contracts with additional 
private entities in order to ensure that such re-
ports are developed and released in a timely 
manner. 
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‘‘(2) QUALIFICATIONS.—The Secretary shall 
enter into a contract with an entity under paragraph 
(1) only if the Secretary determines that the enti-
ty— 
‘‘(A) has the research capability to conduct 
and complete reports under this section; 
‘‘(B) has in place— 
‘‘(i) an information technology infra-
structure to support the entire database of 
Medicare data; and 
‘‘(ii) operational standards to provide 
security for such database; 
‘‘(C) has experience with, and expertise on, 
the development of reports on health care qual-
ity and efficiency based on Medicare or private 
sector claims data; and 
‘‘(D) has a significant business presence in 
the United States. 
‘‘(3) CONTRACT
REQUIREMENTS.—Each con-
tract with an entity under paragraph (1) shall con-
tain the following requirements: 
‘‘(A) ENSURING BENEFICIARY PRIVACY.— 
‘‘(i) HIPAA.—The entity shall meet 
the requirements imposed on a covered en-
tity for purposes of applying part C of title 
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XI and all regulatory provisions promul-
gated thereunder, including regulations 
(relating to privacy) adopted pursuant to 
the authority of the Secretary under sec-
tion 264(c) of the Health Insurance Port-
ability and Accountability Act of 1996 (42 
U.S.C. 1320d–2 note). 
‘‘(ii) PRIVACY.—The entity shall pro-
vide assurances that the entity will not use 
the Medicare data disclosed under sub-
section (c) in a manner that violates sec-
tions 552 or 552a of title 5, United States 
Code, with regard to the privacy of individ-
ually identifiable beneficiary health infor-
mation. 
‘‘(B) PROPRIETARY
INFORMATION.—The 
entity shall provide assurances that the entity 
will not, with respect to data relating to part D, 
disclose any negotiated price concessions, such 
as discounts, direct or indirect subsidies, re-
bates, and direct or indirect remunerations, ob-
tained by prescription drug plans and MA–PD 
plans for covered part D drugs, or any other 
proprietary cost information. 
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‘‘(5) REVIEW OF CONTRACT IN THE EVENT OF 
A MERGER OR ACQUISITION.—The Secretary shall 
review the contract with a Medicare Quality Report-
ing Organization under this section in the event of 
a merger or acquisition of the Organization in order 
to ensure that the requirements under this section 
will continue to be met. 
‘‘(e) DEVELOPMENT
AND RELEASE
OF REPORTS 
BASED ON REQUESTS.— 
‘‘(1) REQUEST FOR A REPORT.— 
‘‘(A) REQUEST.— 
‘‘(i) IN
GENERAL.—The procedures 
established under subsection (b)(1) shall 
include a process for an entity to submit a 
request to a Medicare Quality Reporting 
Organization for a report based on Medi-
care data and private data that is publicly 
available or is provided by the entity mak-
ing the request for the report. Such re-
quest shall comply with the purpose de-
scribed in subsection (a). 
‘‘(ii) REQUEST FOR SPECIFIC METH-
ODOLOGY.—The 
process 
described 
in 
clause (i) shall permit an entity making a 
request for a report to request that a spe-
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cific methodology be used by the Medicare 
Quality Reporting Organization in devel-
oping the report. The Organization shall 
work with the entity making the request to 
finalize the methodology to be used. 
‘‘(iii) REQUEST
FOR
A
SPECIFIC 
MQRO.—The process described in clause (i) 
shall permit an entity to submit the re-
quest for a report to any Medicare Quality 
Reporting Organization. 
‘‘(B) RELEASE
TO
PUBLIC.—The proce-
dures established under subsection (b)(1) shall 
provide that at the time a request for a report 
is finalized under subparagraph (A) by a Medi-
care Quality Reporting Organization, the Orga-
nization shall make available to the public, 
through the Internet website of the Centers for 
Medicare & Medicaid Services and other appro-
priate means, a brief description of both the re-
quested report and the methodology to be used 
to develop such report. 
‘‘(2) DEVELOPMENT
AND
RELEASE
OF
RE-
PORT.— 
‘‘(A) DEVELOPMENT.— 
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‘‘(i) IN GENERAL.—If the request for 
a report complies with the purpose de-
scribed in subsection (a), the Medicare 
Quality Reporting Organization may de-
velop the report based on the request. 
‘‘(ii) REQUIREMENT.—A report devel-
oped under clause (i) shall include a de-
tailed description of the standards, meth-
odologies, and measures of quality used in 
developing the report. 
‘‘(B) REVIEW OF REPORT BY SECRETARY 
TO
ENSURE
COMPLIANCE
WITH
PRIVACY
RE-
QUIREMENT.—Prior to a Medicare Quality Re-
porting Organization releasing a report under 
subparagraph (C), the Secretary shall review 
the report to ensure that the report complies 
with the Federal regulations (concerning the 
privacy of individually identifiable beneficiary 
health information) promulgated under section 
264(c) of the Health Insurance Portability and 
Accountability Act of 1996 and sections 552 or 
552a of title 5, United States Code, with regard 
to the privacy of individually identifiable bene-
ficiary health information. The Secretary shall 
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act within 30 business days of receiving such 
report. 
‘‘(C) RELEASE OF REPORT.— 
‘‘(i) RELEASE TO ENTITY MAKING RE-
QUEST.—If the Secretary finds that the re-
port complies with the provisions described 
in subparagraph (B), the Medicare Quality 
Reporting Organization shall release the 
report to the entity that made the request 
for the report. 
‘‘(ii) RELEASE TO PUBLIC.—The pro-
cedures established under subsection (b)(1) 
shall provide for the following: 
‘‘(I) UPDATED
DESCRIPTION.— 
At the time of the release of a report 
by a Medicare Quality Reporting Or-
ganization under clause (i), the entity 
shall make available to the public, 
through the Internet website of the 
Centers for Medicare & Medicaid 
Services and other appropriate means, 
an updated brief description of both 
the requested report and the method-
ology used to develop such report. 
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‘‘(II) COMPLETE
REPORT.—Not 
later than 1 year after the date of the 
release of a report under clause (i), 
the report shall be made available to 
the 
public 
through 
the 
Internet 
website of the Centers for Medicare & 
Medicaid Services and other appro-
priate means. 
‘‘(f) ANNUAL REVIEW
OF REPORTS
AND TERMI-
NATION OF CONTRACTS.— 
‘‘(1) ANNUAL
REVIEW
OF
REPORTS.—The 
Comptroller General of the United States shall re-
view reports released under subsection (e)(2)(C) to 
ensure that such reports comply with the purpose 
described in subsection (a) and annually submit a 
report to the Secretary on such review. 
‘‘(2) TERMINATION OF CONTRACTS.—The Sec-
retary may terminate a contract with a Medicare 
Quality Reporting Organization if the Secretary de-
termines that there is a pattern of reports being re-
leased by the Organization that do not comply with 
the purpose described in subsection (a). 
‘‘(g) FEES.— 
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‘‘(1) FEES
FOR
SECRETARY.—The Secretary 
shall charge a Medicare Quality Reporting Organiza-
tion a fee for— 
‘‘(A) disclosing the data under subsection 
(c); and 
‘‘(B) conducting the review under sub-
section (e)(2)(B). 
The Secretary shall ensure that such fees are suffi-
cient to cover the costs of the activities described in 
subparagraph (A) and (B). 
‘‘(2) FEES FOR MQRO.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graphs (A) and (B), a Medicare Quality Report-
ing Organization may charge an entity making 
a request for a report a reasonable fee for the 
development and release of the report. 
‘‘(B) DISCOUNT FOR SMALL ENTITIES.—In 
the case of an entity making a request for a re-
port (including a not-for-profit) that has annual 
revenue that does not exceed $10,000,000, the 
Medicare Quality Reporting Organization shall 
reduce the reasonable fee charged to such entity 
under subparagraph (A) by an amount equal to 
10 percent of such fee. 
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report to Congress on each of the studies conducted 
under paragraph (1) together with recommendations 
for such legislation and administrative actions as the 
Comptroller General considers appropriate.’’. 
SEC. 3. QUALITY ADVISORY BOARD. 
(a) ESTABLISHMENT.—Not later than 12 months 
after the date of enactment of this Act, the Secretary of 
Health and Human Services shall establish within the Of-
fice of the Secretary a board to be known as the Quality 
Advisory Board (in this section referred to as the 
‘‘Board’’). 
(b) MEMBERSHIP.—The members of the Board shall 
include, but not be limited to, an appropriate number of 
representatives of— 
(1) groups representing Medicare beneficiaries; 
(2) groups representing providers of services (as 
defined in subsection (u) of section 1861 of the So-
cial Security Act (42 U.S.C. 1395x)) and suppliers 
(as defined in subsection (d) of such section) receiv-
ing reimbursement under the Medicare program; 
(3) purchasers and employers or groups rep-
resenting purchasers and employers; 
(4) organizations focused on the development of 
quality health care measures; 
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(5) researchers or research institutions with ex-
perience in the measurement of, and reporting on, 
health care quality; and 
(6) health plans or groups representing health 
plans. 
(c) DUTIES.—The duties of the Board are as follows: 
(1) To submit requests for reports to Medicare 
Quality Reporting Organizations under section 1898 
of the Social Security Act, as added by section 2. 
(2) To examine how clinical registries can be 
linked to Medicare data (as defined in subsection 
(b)(2)(A) of such section 1898) in order to develop 
reports on the quality and efficiency of providers of 
services (as defined in subsection (u) of section 1861 
of the Social Security Act (42 U.S.C. 1395x)) and 
suppliers (as defined in subsection (d) of such sec-
tion). 
(3) To coordinate with existing collaborative ef-
forts identifying quality and efficiency health care 
measures. 
(4) To provide the Secretary of Health and 
Human Services with recommendations for the de-
velopment of model quality health care measure-
ments. 
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(5) Other duties determined appropriate by the 
Secretary. 
(d) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to the Secretary of 
Health and Human Services such sums as may be nec-
essary for the purpose of carrying out this section. 
SEC. 4. RESEARCH ACCESS TO MEDICARE DATA AND RE-
PORTING ON PERFORMANCE. 
The Secretary of Health and Human Services shall 
permit researchers that meet existing criteria used to 
evaluate the appropriateness of the release of Centers for 
Medicare & Medicaid Services (CMS) data for research 
purposes to— 
(1) have access to all Medicare data (as defined 
in section 1898(b)(2)(A) of the Social Security Act, 
as added by section 2); and 
(2) report on the performance of providers of 
services (as defined in subsection (u) of section 1861 
of such Act (42 U.S.C. 1395x)) and suppliers (as 
defined in subsection (d) of such section), including 
reporting in a provider- or supplier-identifiable for-
mat. 
Æ 
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