I 
111TH CONGRESS 
1ST SESSION H. R. 2252 
To improve the Federal infrastructure for health care quality improvement 
in the United States. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 5, 2009 
Ms. DEGETTE introduced the following bill; which was referred to the Com-
mittee 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 improve the Federal infrastructure for health care quality 
improvement in the United States. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘National Health Care 
Quality Act’’. 
SEC. 2. DEFINITIONS. 
In this Act: 
(1) HEALTH CARE QUALITY.—The term ‘‘health 
care quality’’ means the degree to which health serv-
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ices for individuals and populations increase the like-
lihood of desired health outcomes and are consistent 
with current professional knowledge, based upon the 
following criteria: 
(A) EFFECTIVENESS.—Health care serv-
ices should be provided based upon scientific 
knowledge of all who could benefit. 
(B) EFFICIENCY.—Waste, including waste 
of equipment, supplies, ideas, and energies, 
should be avoided. 
(C) EQUITY.—The provision of health care 
should not vary in quality because of personal 
characteristics of the individuals involved. 
(D) 
PATIENT-CENTEREDNESS.—Health 
care should be responsive to, and respectful of, 
individual patient preferences. 
(E) SAFETY.—Injuries to patients from 
the health care that is supposed to help them 
should be avoided. 
(F) 
TIMELINESS.—Waiting 
times 
and 
harmful delays in providing health care should 
be reduced. 
(2) HEALTH
CARE
QUALITY
MEASURE.—The 
term ‘‘health care quality measure’’ means a na-
tional consensus standard for measuring the per-
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formance and improvement of population health or 
of institutional providers of services, physicians, and 
other clinicians in the delivery of health care serv-
ices, consistent with the health care quality criteria 
described in paragraph (1). 
(3) MULTI-STAKEHOLDER
GROUP.—The term 
‘‘multi-stakeholder group’’ means, with respect to a 
health care quality measure, a voluntary collabo-
rative of public and private organizations rep-
resenting persons interested in, or affected by, the 
use of such health care quality measure, including— 
(A) health care providers and practitioners, 
including providers and practitioners primarily 
serving children and those with long-term 
health care needs; 
(B) health care quality entities; 
(C) health plans; 
(D) 
patient 
advocates 
and 
consumer 
groups; 
(E) employers; 
(F) public and private purchasers of health 
care items and services; 
(G) labor organizations; 
(H) relevant departments or agencies of 
the United States; 
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(I) biopharmaceutical companies and man-
ufacturers of medical devices; and 
(J) licensing, credentialing, and accrediting 
bodies. 
SEC. 3. DEPARTMENT AND AGENCY QUALITY REVIEW. 
Each relevant department and agency of the Federal 
Government shall review the statutory authority of such 
department or agency, effective on the date of enactment 
of this Act, administrative regulations, and policies and 
procedures for the purpose of determining whether there 
are any deficiencies or inconsistencies therein which pro-
hibit full compliance with the purposes and provisions of 
this Act. Each department and agency shall, not later than 
July 1, 2010, propose to the President such measures as 
may be necessary to bring the authority and policies and 
procedures of such department or agency into conformity 
with the intent, purposes, and provisions set forth in this 
Act. 
SEC. 4. NATIONAL HEALTH CARE QUALITY PRIORITIES. 
(a) ESTABLISHMENT OF THE OFFICE OF NATIONAL 
HEALTH CARE QUALITY IMPROVEMENT.—There is estab-
lished within the Executive Office of the President an Of-
fice of National Health Care Quality Improvement 
(‘‘NHCQI’’) (referred to in this section as the ‘‘Office’’). 
The Office shall be headed by a Director of National 
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Health Care Quality (referred to in this section as the 
‘‘Director’’) who shall be appointed by the President and 
shall report directly to the President. 
(b) DIRECTOR.— 
(1) RESPONSIBILITIES.—The Director shall 
perform the duties of the Office, described in para-
graph (3), in a manner consistent with the develop-
ment of a nationwide health care quality infrastruc-
ture that— 
(A) coordinates and implements health 
care quality research, measurement, and data 
collection and reporting across all Federal agen-
cies involved in purchasing, providing, studying, 
or regulating health care services; 
(B) incorporates proven public and private 
quality improvement best practices; 
(C) includes public and private quality im-
provement strategies to address activities other 
than health care quality measurement, such as 
provider payment models, alternative care mod-
els, licensing, professional certification, medical 
education, alternative staffing models, and pub-
lic reporting; and 
(D) leads to improved health care out-
comes for patients across the United States. 
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(2) QUALIFICATIONS.—The President shall, by 
and with the advice and consent of the Senate, ap-
point a Director. The President shall select an indi-
vidual who has— 
(A) national recognition for expertise in 
health care quality improvement; 
(B) experience addressing health care qual-
ity improvement in more than one health care 
setting, such as inpatient care, outpatient care, 
long-term care, public programs, and private 
programs; and 
(C) experience addressing health care qual-
ity as it applies to vulnerable populations, in-
cluding children, underserved populations, rural 
populations, individuals with disabilities, the el-
derly, and racial and ethnic minorities. 
(3) DUTIES OF THE DIRECTOR.—The Director 
shall— 
(A) advise the President on the quality of 
health care in the United States, including pri-
orities and goals for the future; 
(B) in coordination with public and private 
stakeholders, determine national priorities for 
improving health care quality, in accordance 
with subsection (c); 
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(C) establish annual benchmarks for each 
relevant Federal department and agency to 
achieve national priorities for health care qual-
ity improvement; 
(D) develop an annual report card on the 
state of the Nation’s health as it relates to 
health care quality; 
(E) in coordination with the heads of other 
relevant agencies and as part of the annual 
budget request of Congress, submit funding re-
quirements, in accordance with subsection (d); 
(F) serve as the chairperson of the Quality 
Interagency Coordinating Council (QuICC), es-
tablished under section 4; and 
(G) in consultation with the National Coor-
dinator of Health Information Technology, de-
velop an open source framework for Federal 
quality communication to create and maintain a 
standardized, electronic language or interface 
that enables all relevant Federal entities to 
communicate information or make requests re-
garding quality research, definitions, activities, 
or regulations, or to provide any other 
functionality, as the Director determines. 
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(c) NATIONAL
PRIORITIES
FOR
HEALTH
CARE 
QUALITY IMPROVEMENT.— 
(1) IN GENERAL.—Not later than January 1, 
2010 and at least every 5 years thereafter, the Di-
rector, in coordination with public and private stake-
holders, shall establish national priorities for health 
care quality improvement. 
(2) DEVELOPMENT OF PRIORITIES.—In estab-
lishing the national priorities for health care quality 
improvement under paragraph (1), the Director shall 
consider— 
(A) health care outcomes in the United 
States in comparison to health outcomes in 
other World Health Organization member coun-
tries; 
(B) the burden of disease, including the 
prevalence, incidence, and cost of disease to the 
United States; 
(C) demographics; 
(D) variability in practice norms; 
(E) potential to eliminate harm to pa-
tients; 
(F) improvements with the potential for 
the greatest impact on morbidity, mortality, 
performance, and a focus on the patient; 
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(G) quality measures that may be coordi-
nated across different health care settings, in-
cluding impatient and outpatient measures, pri-
mary care, and specialty care; 
(H) the specific quality improvement needs 
and challenges of rural areas; and 
(I) the unique quality improvement needs 
disparities and challenges of vulnerable popu-
lations, including children, the elderly, individ-
uals with disabilities, individuals near the end 
of life, and racial and ethnic minorities. 
(3) INITIAL PRIORITIES.—The first set of na-
tional priorities established under this subsection 
shall include as a priority pediatric health care qual-
ity improvement, for children up to age 21. 
(4) 
COLLABORATION
WITH
MULTI-STAKE-
HOLDER GROUPS.— 
(A) IN GENERAL.—The Director shall con-
vene and collaborate with multi-stakeholder 
groups in establishing and updating the na-
tional priorities under paragraph (1). 
(B) TRANSPARENCY.—All collaboration be-
tween 
the 
Director 
and 
multi-stakeholder 
groups shall be conducted through an open and 
transparent process. 
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(C) 
STATUTORY
CONSTRUCTION.—Not-
withstanding any other provision in this para-
graph, the Director shall have the final author-
ity to decide whether to accept the rec-
ommendations provided by such multi-stake-
holder groups. 
(5) 
AGENCY- 
AND
DEPARTMENT-SPECIFIC 
STRATEGIC
PLANS.—Not later than October 1, 
2010, and annually thereafter, the Director, in con-
sultation with the heads of relevant Federal agencies 
and departments, shall develop agency- and depart-
ment-specific strategic plans for health care quality 
improvement to achieve national priorities, including 
annual benchmarks. 
(d) ANNUAL BUDGET REQUEST FOR RESOURCES.— 
As part of the annual budget request made by the Presi-
dent to Congress, beginning with such budget request 
made in calendar year 2011, the Director, in consultation 
with the heads of relevant Federal departments and agen-
cies, shall include— 
(1) a description of the agency- and depart-
ment-specific strategic plans for health care quality 
improvement; and 
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(2) the level of Federal funding required for im-
plementing or maintaining the quality improvement 
strategic plans described under paragraph (1). 
(e) MONITORING.— 
(1) IN GENERAL.—The Director shall institute 
mechanisms for monitoring the progress on achiev-
ing national health care quality priorities under sub-
section (c)(1) as well as department- and agency- 
specific strategic plans under subsection (c)(5), in-
cluding objectives, metrics, and benchmarks for the 
following: 
(A) The benefits and drawbacks of specific 
quality improvement efforts for public programs 
and for the health care system at large. 
(B) Coordination and communication of ef-
forts to achieve interagency goals, including in-
formation exchange. 
(C) Interagency coordination progress for 
national quality efforts. 
(D) Methods for ensuring awareness and 
recognition among health care providers and 
the public at large of the significance of health 
care quality improvement. 
(2) REPORTING.— 
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(A) REPORTING.—Not later than Decem-
ber 31, 2011, and by the end of each calendar 
year thereafter, the Director shall submit to the 
President and to Congress a report regarding 
the progress of Federal agencies in achieving 
the quality improvement priorities under para-
graphs (1) and (5) of subsection (c), and shall 
make such report publicly available through the 
Internet. 
(B) ANNUAL
NATIONAL
HEALTH
CARE 
QUALITY REPORT CARD.—Not later than Janu-
ary 31, 2011, and annually thereafter, the Di-
rector shall publish a national health care qual-
ity report card, which shall include— 
(i) the considerations for national 
health care quality priorities described in 
subsection (c)(2); 
(ii) an analysis of the progress of the 
department- and agency-specific strategic 
plans under subsection (c)(5) in achieving 
the national health care quality priorities 
established under subsection (c)(1), and 
any gaps in such strategic plans; 
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(iii) the extent to which private sector 
strategies have informed Federal quality 
improvement efforts; and 
(iv) a summary of consumer feedback 
regarding how well current quality im-
provement practices work for such con-
sumers and additional ways to improve 
health care quality. 
(f) WEBSITE.—Not later than July 1, 2010, the Di-
rector shall create a website to make public information 
regarding— 
(1) the national priorities for health care qual-
ity improvement established under subsection (c)(1); 
(2) the department- and agency-specific stra-
tegic plans for health care quality described in sub-
section (c)(5); 
(3) the annual national health care quality re-
port card described in subsection (e)(2)(B); 
(4) ongoing health care quality research efforts; 
(5) new and innovative health care quality im-
provement practices in the public and private sec-
tors; 
(6) a consumer feedback mechanism; and 
(7) other information, as the Director deter-
mines to be appropriate. 
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(g) STAFF; EXPERTS
AND CONSULTANTS; VOL-
UNTARY AND UNCOMPENSATED SERVICE.— 
(1) STAFF.—The Director may employ such of-
ficers and employees as may be necessary to enable 
the Office to carry out its functions under this Act, 
and may employ and fix the compensation of such 
officers and employees as may be necessary to carry 
out its functions under this Act. 
(2) EXPERTS AND CONSULTANTS.—The Direc-
tor may employ and fix the compensation of such ex-
perts and consultants as may be necessary for the 
carrying out of its functions under this Act, in ac-
cordance with section 3109 of title 5, United States 
Code (without regard to the last sentence). 
(3) VOLUNTARY AND UNCOMPENSATED SERV-
ICE.—Notwithstanding section 1342 of title 31, 
United States Code, the Office may accept and use 
voluntary and uncompensated services, as the Direc-
tor determines necessary. 
(h) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to carry out this section $50,000,000 for 
fiscal years 2010 through 2014. 
SEC. 5. NATIONAL HEALTH CARE QUALITY COORDINATION. 
(a) ESTABLISHMENT.—As of the date of enactment 
of this Act, there is established within the Office of Na-
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tional Health Care Quality Improvement, the Quality 
Interagency Coordinating Council (referred to in this sec-
tion as the ‘‘QuICC’’). 
(b) PURPOSE.—The purpose of the QuICC is to co-
ordinate health care quality improvement efforts across all 
Federal agencies involved in purchasing, providing, study-
ing, or regulating health care services in order to achieve 
the common goal of improving patient health outcomes. 
(c) ORGANIZATION OF THE QUICC.— 
(1) CO-CHAIRPERSONS.—The Director of Na-
tional Health Care Quality (referred to in this sec-
tion as the ‘‘Director’’) and the Secretary of Health 
and Human Services shall serve as co-chairpersons 
of the QuICC, and the Director shall manage day- 
to-day operations of the QuICC. 
(2) FEDERAL MEMBERS.—The Federal mem-
bers of the QuICC, each of whom shall have equal 
standing in the QuICC, shall include— 
(A) the Administrator of the Centers for 
Medicare & Medicaid Services; 
(B) the Director of the National Institutes 
of Health; 
(C) the Director of the Centers for Disease 
Control and Prevention; 
(D) the Commissioner of Food and Drugs; 
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(E) the Administrator of the Health Re-
sources and Services Administration; 
(F) the Director of the Agency for 
Healthcare Research and Quality; 
(G) the Assistant Secretary of the Admin-
istration for Children and Families; 
(H) the Secretary of Labor; 
(I) the Secretary of Defense; 
(J) the Secretary of Veterans Affairs; 
(K) the Under Secretary for Health of the 
Veterans Health Administration; 
(L) the Secretary of Commerce; 
(M) the Director of the Office of Personnel 
Management; 
(N) the Director of the Office of Manage-
ment and Budget; 
(O) the Commandant of the United States 
Coast Guard; 
(P) the Director of the Federal Bureau of 
Prisons; 
(Q) the Administrator of the National 
Highway Traffic Safety Administration; 
(R) the Chairman of the Federal Trade 
Commission; and 
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(S) the Commissioner of the Social Secu-
rity Administration. 
(d) GOALS.—The goals of the QuICC shall be to 
achieve the following: 
(1) Collaboration between Federal departments 
and agencies with respect to developing goals, mod-
els, and timetables that are consistent with— 
(A) reducing the underlying causes of ill-
ness, injury, and disability; 
(B) reducing health care errors; 
(C) ensuring the appropriate use of health 
care services; 
(D) expanding research on effectiveness of 
treatments; 
(E) addressing over-supply and under-sup-
ply of health care resources; and 
(F) increasing patient participation in 
their care. 
(2) Collaboration between Federal departments 
and agencies with respect to the development and 
utilization of quality improvement strategies, includ-
ing quality measurement, for public sector programs 
that are flexible enough to respond to changing 
health care needs, technology, and information, while 
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health or of institutional providers of services, physi-
cians, and other clinicians in the delivery of health 
care services; and 
‘‘(5) the term ‘multi-stakeholder group’ means, 
with respect to a health care quality measure, a vol-
untary collaborative of public and private organiza-
tions representing persons interested in, or affected 
by, the use of such health care quality measure, in-
cluding— 
‘‘(A) hospitals and other health care set-
tings; 
‘‘(B) physicians, including pediatricians; 
‘‘(C) health care quality alliances; 
‘‘(D) nurses and other health care practi-
tioners; 
‘‘(E) health plans; 
‘‘(F) patient advocates and consumer 
groups; 
‘‘(G) employers; 
‘‘(H) public and private purchasers of 
health care items and services; 
‘‘(I) labor organizations; 
‘‘(J) relevant departments or agencies of 
the United States; 
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