periodic revision and selection of Q & E meas-
ures consistent with the provisions of this para-
graph and the application of such revised Q & 
E measures on a prospective basis beginning 
with a following year. 
‘‘(3) PUBLIC DISCLOSURE OF COVERED PRO-
VIDERS’ PERFORMANCE ON Q & E MEASURES.— 
‘‘(A) IN GENERAL.—Not later than Janu-
ary 1, 2010, the Secretary shall establish proce-
dures to require that information with respect 
to the quality and efficiency demonstrated by a 
covered provider of covered outpatient therapy 
services during a year (based on the Q & E 
measures submitted under paragraph (1)(A) by 
the covered provider involved for such year) is 
made available to the public in a clear and un-
derstandable form. 
‘‘(B) COVERED
PROVIDER
NOTIFICATION 
AND
OPPORTUNITY
FOR
COMMENT; APPEALS 
PROCESS.— 
‘‘(i) NOTIFICATION AND OPPORTUNITY 
FOR COMMENT.— 
‘‘(I) IN GENERAL.—For purposes 
of subparagraph (A), before making 
the information described in such sub-
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paragraph available to the public with 
respect to a covered provider for years 
beginning with 2010, the Secretary 
shall notify the provider of the per-
formance of the provider on the Q & 
E measures (including information on 
the performance of the provider in re-
lation to the aggregate performance of 
the peers of such provider) and pro-
vide the opportunity for the provider 
to submit to the Secretary written 
comments with respect to such per-
formance. The Secretary shall respond 
in writing to the comments and seek 
to reach agreement on the perform-
ance of the provider on the Q & E 
measures for the year involved. 
‘‘(II) 
ADMINISTRATIVE
PROVI-
SION.—For purposes of subclause (I), 
notification provided by the Secretary 
and comments submitted by a pro-
vider shall be provided and submitted, 
respectively, in such manner and form 
and by such time as specified by the 
Secretary. 
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‘‘(III) PEER DEFINED.—For pur-
poses of subclause (I), the term ‘peer’ 
means, with respect to a covered pro-
vider that practices in a type of ther-
apy, other covered providers that 
practice in the same type of therapy 
in the United States. 
‘‘(ii) APPEALS
PROCESS.—The Sec-
retary shall establish a formal appeals 
process for purposes of hearing cases in 
which agreements under clause (i)(I) can-
not be reached. Upon conclusion of the ap-
peals process, if the provider submits com-
ments relating directly to the information 
made available under subparagraph (A) 
with respect to such provider, the Sec-
retary shall make such comments available 
to the public with such information. 
‘‘(C) EXCEPTIONS
TO
PUBLIC
DISCLO-
SURE.—The procedures established under sub-
paragraph (A) shall include exceptions to the 
requirement described in such subparagraph. In 
providing for such exceptions, the Secretary 
shall take into account whether or not the cov-
ered provider involved was a new covered pro-
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vider, as specified by the Secretary, for covered 
outpatient therapy services or otherwise had in-
sufficient information to provide to the Sec-
retary for a measurement of the quality and ef-
ficiency performance of such covered provider. 
‘‘(4) NATIONAL
THERAPY
OUTCOMES
DATA-
BASE.— 
‘‘(A) IN GENERAL.—For purposes of this 
subsection and subsection (o), the Secretary 
shall provide for at least one national therapy 
outcomes database to analyze Q & E provider 
information submitted under paragraph (1)(A) 
and, based on such information, generate values 
(that are adjusted for the risk characteristics of 
the individuals provided covered outpatient 
therapy services) for the following: 
‘‘(i) How much functional improve-
ment an individual is expected to experi-
ence over a designated period, with respect 
to services involved. 
‘‘(ii) The period over which an indi-
vidual with such characteristics is expected 
to experience the maximum functional im-
provement through the receipt of covered 
outpatient therapy services. 
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‘‘(B) INTEROPERABILITY.—If the Sec-
retary provides for more than one national ther-
apy outcomes database under subparagraph 
(A), the Secretary shall ensure that such data-
bases are interoperable. 
‘‘(C) 
CONTRACTING
AUTHORITY.—For 
purposes of subparagraph (A), the Secretary 
may enter into an agreement with a private en-
tity to use a database of such entity that is ca-
pable of performing the functions described in 
such subparagraph or to have such entity estab-
lish and monitor such a database. For purposes 
of selecting a private entity with which to enter 
into such an agreement, the Secretary shall 
provide for a process that ensures fair and open 
competition amongst private entities. 
‘‘(5) DEFINITIONS.—For purposes of this sub-
section and subsection (o): 
‘‘(A) COVERED
OUTPATIENT
THERAPY 
SERVICES.—The term ‘covered outpatient ther-
apy services’ means— 
‘‘(i) physical therapy services— 
‘‘(I) of the type described in sec-
tion 1861(p), including speech-lan-
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