360 
cable performance standard for a provider 
or facility under this subparagraph is suc-
cessful performance (relative to national 
average) on— 
‘‘(I) such measures of anemia 
management as the Secretary shall 
specify, including measures of hemo-
globin levels or hematocrit levels for 
erythropoietin stimulating agents that 
are consistent with the labeling for 
dosage of erythropoietin stimulating 
agents approved by the Food and 
Drug Administration for treatment of 
anemia in patients with end stage 
renal disease, taking into account 
variations in hemoglobin ranges or 
hematocrit levels of patients; and 
‘‘(II) such other measures, relat-
ing to subjects described in subpara-
graph (D)(i), as the Secretary may 
specify. 
‘‘(D) REPORTING
PERFORMANCE
MEAS-
URES.—The performance measures under this 
subparagraph to be reported shall include— 
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‘‘(i) such measures as the Secretary 
specifies, before the beginning of the per-
formance period involved and taking into 
account measures endorsed by the Na-
tional Quality Forum, including, to the ex-
tent feasible measures on— 
‘‘(I) iron management; 
‘‘(II) dialysis adequacy; and 
‘‘(III) vascular access, including 
for maximizing the placement of arte-
rial venous fistula; and 
‘‘(ii) to the extent feasible, such meas-
ure (or measures) of patient satisfaction as 
the Secretary shall specify. 
The provider or facility submitting information 
on such measures shall attest to the complete-
ness and accuracy of such information. 
‘‘(E) APPLICABLE PERCENTAGE.—The ap-
plicable percentage specified in this subpara-
graph for— 
‘‘(i) the performance period occurring 
in 2008, is 1.0 percent; 
‘‘(ii) the 2009 performance period, is 
2.0 percent; and 
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‘‘(iii) the 2010 performance period, is 
2.0 percent. 
In the case of any performance period which is 
less than an entire year, the applicable percent-
age specified in this subparagraph shall be mul-
tiplied by the ratio of the number of months in 
the year to the number of months in such per-
formance period. In the case of 2010, the appli-
cable percentage specified in this subparagraph 
shall be multiplied by the Secretary’s estimate 
of the ratio of the aggregate payment amount 
described in subparagraph (F)(i) that would 
apply in 2010 if paragraph (14) did not apply, 
to the aggregate payment base under subpara-
graph (F)(ii) for 2010. 
‘‘(F) PAYMENT BASE.—The payment base 
described in this subparagraph for a provider or 
facility is— 
‘‘(i) for performance periods before 
2010, the payment amount determined 
under paragraph (12) for services fur-
nished by the provider or facility during 
the performance period, including the drug 
payment adjustment described in subpara-
graph (B)(ii) of such paragraph; and 
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‘‘(ii) for the 2010 performance period 
is the amount determined under paragraph 
(14) for services furnished by the provider 
or facility during the period. 
‘‘(G) LIMITATION ON FUNDING.— 
‘‘(i) IN
GENERAL.—If the Secretary 
determines that the total payments under 
this paragraph for a performance period is 
projected to exceed the dollar amount spec-
ified in clause (ii) for such period, the Sec-
retary shall reduce, in a pro rata manner, 
the amount of such payments for each pro-
vider or facility for such period to elimi-
nate any such projected excess for the pe-
riod. 
‘‘(ii) DOLLAR
AMOUNT.—The dollar 
amount specified in this clause— 
‘‘(I) for the performance period 
occurring in 2008, is $50,000,000; 
‘‘(II) for the 2009 performance 
period is $100,000,000; and 
‘‘(III) for the 2010 performance 
period is $150,000,000. 
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‘‘(H) FORM OF PAYMENT.—The payment 
under this paragraph shall be in the form of a 
single consolidated payment. 
‘‘(2) QUALITY INCENTIVE PAYMENTS FOR FA-
CILITIES AND PROVIDERS FOR 2011.— 
‘‘(A) INCREASED PAYMENT.—For 2011, in 
the case of a provider or facility that, for the 
performance period (as defined in subparagraph 
(B))— 
‘‘(i) meets (or exceeds) the perform-
ance standard for anemia management 
specified in paragraph (1)(C)(ii)(I); 
‘‘(ii) has substantially improved per-
formance or exceeds a performance stand-
ard (as determined under subparagraph 
(E)); and 
‘‘(iii) reports measures specified in 
paragraph (1)(D), 
with respect to renal dialysis services furnished 
by the provider or facility during the quality 
bonus payment period (as specified in subpara-
graph (C)) the payment amount otherwise made 
to such provider or facility under subsection 
(b)(14) shall be increased, subject to subpara-
graph (F), by the applicable percentage speci-
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fied in subparagraph (D). Payment amounts 
under paragraph (1) shall not be counted for 
purposes of applying the previous sentence. 
‘‘(B) PERFORMANCE
PERIOD.—In this 
paragraph, the term ‘performance period’ 
means a multi-month period specified by the 
Secretary . 
‘‘(C) QUALITY BONUS PAYMENT PERIOD.— 
In this paragraph, the term ‘quality bonus pay-
ment period’ means, with respect to a perform-
ance period, a multi-month period beginning on 
January 1, 2011, specified by the Secretary 
that begins at least 3 months (but not more 
than 9 months) after the end of the perform-
ance period. 
‘‘(D) APPLICABLE PERCENTAGE.—The ap-
plicable percentage specified in this subpara-
graph is a percentage, not to exceed the 2.0 
percent, specified by the Secretary consistent 
with subparagraph (F). Such percentage may 
vary based on the level of performance and im-
provement. The applicable percentage specified 
in this subparagraph shall be multiplied by the 
ratio applied under the third sentence of para-
graph (1)(E) for 2010. 
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‘‘(E) PERFORMANCE
STANDARD.—Based 
on performance of a provider of services or a 
renal dialysis facility on performance measures 
described in paragraph (1)(D) for a perform-
ance period, the Secretary shall determine a 
composite score for such period. 
‘‘(F) LIMITATION
ON
FUNDING.—If the 
Secretary determines that the total amount to 
be paid under this paragraph for a quality 
bonus payment period is projected to exceed 
$200,000,000, the Secretary shall reduce, in a 
uniform manner, the applicable percentage oth-
erwise applied under subparagraph (D) for 
services furnished during the period to elimi-
nate any such projected excess. 
‘‘(3) APPLICATION.— 
‘‘(A) IMPLEMENTATION.—Notwithstanding 
any other provision of law, the Secretary may 
implement by program instruction or otherwise 
this subsection. 
‘‘(B) LIMITATIONS ON REVIEW.— 
‘‘(i) IN GENERAL.—There shall be no 
administrative or judicial review under sec-
tion 1869 or 1878 or otherwise of— 
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‘‘(I) the determination of per-
formance measures and standards 
under this subsection; 
‘‘(II) the determination of suc-
cessful reporting, including a deter-
mination of composite scores; and 
‘‘(III) the determination of the 
quality 
incentive 
payments 
made 
under this subsection. 
‘‘(ii) TREATMENT
OF
DETERMINA-
TIONS.—A determination under this sub-
paragraph shall not be treated as a deter-
mination for purposes of section 1869. 
‘‘(4) TECHNICAL ASSISTANCE.—The Secretary 
shall identify or establish an appropriately skilled 
group or organization, such as the ESRD Networks, 
to provide technical assistance to consistently low- 
performing facilities or providers that are in the bot-
tom quintile. 
‘‘(5) PUBLIC REPORTING.— 
‘‘(A) ANNUAL
NOTICE.—The Secretary 
shall provide an annual written notification to 
each individual who is receiving renal dialysis 
services from a provider of services or renal di-
alysis facility that— 
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‘‘(i) informs such individual of the 
composite scores described in subpara-
graph (A) and other relevant quality meas-
ures with respect to providers of services 
or renal dialysis facilities in the local area; 
‘‘(ii) compares such scores and meas-
ures to the average local and national 
scores and measures; and 
‘‘(iii) provides information on how to 
access additional information on quality of 
such services furnished and options for al-
ternative providers and facilities. 
‘‘(B) CERTIFICATES.—The Secretary shall 
provide certificates to facilities and providers 
who provide services to individuals with end- 
stage renal disease under this title to display in 
patient areas. The certificate shall indicate the 
composite score obtained by the facility or pro-
vider under the quality initiative. 
‘‘(C) WEB-BASED
QUALITY
LIST.—The 
Secretary shall establish a web-based list of fa-
cilities and providers who furnish renal dialysis 
services under this section that indicates their 
composite score of each provider and facility. 
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‘‘(6) RECOMMENDATIONS FOR REPORTING AND 
QUALITY
INCENTIVE
INTITIATIVE
FOR
PHYSI-
CIANS.—The Secretary shall develop recommenda-
tions for applying quality incentive payments under 
this subsection to physicians who receive the month-
ly capitated payment under this title. Such rec-
ommendations shall include the following: 
‘‘(A) Recommendations to include pediatric 
specific measures for physicians with at least 
50 percent of their patients with end stage 
renal disease being individuals under 18 years 
of age. 
‘‘(B) Recommendations on how to struc-
ture quality incentive payments for physicians 
who demonstrate improvements in quality or 
who attain quality standards, as specified by 
the Secretary. 
‘‘(7) REPORTS.— 
‘‘(A) INITIAL
REPORT.—Not later than 
January 1, 2013, the Secretary shall submit to 
Congress a report on the implementation of the 
bundled payment system under subsection 
(b)(14) and the quality initiative under this 
subsection. Such report shall include the fol-
lowing information: 
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‘‘(i) A comparison of the aggregate 
payments under subsection (b)(14) for 
items and services to the cost of such items 
and services. 
‘‘(ii) The changes in utilization rates 
for erythropoietin stimulating agents. 
‘‘(iii) The mode of administering such 
agents, including information on the pro-
portion of such individuals receiving such 
agents 
intravenously 
as 
compared 
to 
subcutaneously. 
‘‘(iv) The frequency of dialysis. 
‘‘(v) Other differences in practice pat-
terns, such as the adoption of new tech-
nology, different modes of practice, and 
variations in use of drugs other than drugs 
described in clause (iii). 
‘‘(vi) The performance of facilities and 
providers under paragraph (2). 
‘‘(vii) Other recommendations for leg-
islative and administrative actions deter-
mined appropriate by the Secretary. 
‘‘(B) SUBSEQUENT
REPORT.—Not later 
than January 1, 2015, the Secretary shall sub-
mit to Congress a report that contains the in-
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formation described in each of clauses (ii) 
through (vii) of subparagraph (A) and a com-
parison of the results of the payment system 
under subsection (b)(14) for renal dialysis serv-
ices furnished during the 2-year period begin-
ning on January 1, 2013, and the results of 
such payment system for such services fur-
nished during the previous two-year period.’’. 
SEC. 638. MEDPAC REPORT ON ESRD BUNDLING SYSTEM. 
Not later than March 1, 2012, the Medicare Payment 
Advisory Commission (established under section 1805 of 
the Social Security Act) shall submit to Congress a report 
on the implementation of the payment system under sec-
tion 1881(b)(14) of the Social Security Act (as added by 
section 7) for renal dialysis services and related services 
(defined in subparagraph (B) of such section). Such report 
shall include, with respect to such payment system for 
such services, an analysis of each of the following: 
(1) An analysis of the overall adequacy of pay-
ment under such system for all such services. 
(2) An analysis that compares the adequacy of 
payment under such system for services furnished 
by— 
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(A) a provider of services or renal dialysis 
facility 
that 
is 
described 
in 
section 
1881(b)(13)(C)(iv) of the Social Security Act; 
(B) a provider of services or renal dialysis 
facility not described in such section; 
(C) a hospital-based facility; 
(D) a freestanding renal dialysis facility; 
(E) a renal dialysis facility located in an 
urban area; and 
(F) a renal dialysis facility located in a 
rural area. 
(3) An analysis of the financial status of pro-
viders of such services and renal dialysis facilities, 
including access to capital, return on equity, and re-
turn on capital. 
(4) An analysis of the adequacy of payment 
under such method and the adequacy of the quality 
improvement payments under section 1881(i) of the 
Social Security Act in ensuring that payments for 
such services under the Medicare program are con-
sistent with costs for such services. 
(5) Recommendations, if appropriate, for modi-
fications to such payment system. 
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SEC. 639. OIG STUDY AND REPORT ON ERYTHROPOIETIN. 
(a) STUDY.—The Inspector General of the Depart-
ment of Health and Human Services shall conduct a study 
on the following: 
(1) The dosing guidelines, standards, protocols, 
and alogorithms for erythropoietin stimulating 
agents recommended or used by providers of services 
and renal dialysis facilities that are described in sec-
tion 1881(b)(13)(C)(iv) of the Social Security Act 
and providers and facilities that are not described in 
such section. 
(2) The extent to which such guidelines, stand-
ards, protocols, and algorithms are consistent with 
the labeling of the Food and Drug Administration 
for such agents. 
(3) The extent to which physicians sign stand-
ing orders for such agents that are consistent with 
such guidelines, standards, protocols, and algorithms 
recommended or used by the provider or facility in-
volved. 
(4) The extent to which the prescribing deci-
sions of physicians, with respect to such agents, are 
independent of— 
(A) such relevant guidelines, standards, 
protocols, and algorithms; or 
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(B) recommendations of an anemia man-
agement nurse or other appropriate employee of 
the provider or facility involved. 
(5) The role of medical directors of providers of 
services and renal dialysis facilities and the financial 
relationships between such providers and facilities 
and the physicians hired as medical directors of such 
providers and facilities, respectively. 
(b) REPORT.—Not later than January 1, 2009, the 
Inspector General of the Department of Health and 
Human Services shall submit to Congress a report on the 
study conducted under subsection (a), together with such 
recommendations as the Inspector General determines ap-
propriate. 
Subtitle D—Miscellaneous 
SEC. 651. LIMITATION ON EXCEPTION TO THE PROHIBI-
TION ON CERTAIN PHYSICIAN REFERRALS 
FOR HOSPITALS. 
(a) IN GENERAL.—Section 1877 of the Social Secu-
rity Act (42 U.S.C. 1395) is amended— 
(1) in subsection (d)(2)— 
(A) in subparagraph (A), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (B), by striking the 
period at the end and inserting ‘‘; and’’; and 
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(C) by adding at the end the following new 
subparagraph: 
‘‘(C) if the entity is a hospital, the hospital 
meets the requirements of paragraph (3)(D).’’; 
(2) in subsection (d)(3)— 
(A) in subparagraph (B), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (C), by striking the 
period at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(D) the hospital meets the requirements 
described in subsection (i)(1) not later than 18 
months after the date of the enactment of this 
subparagraph.’’; and 
(3) by adding at the end the following new sub-
section: 
‘‘(i) REQUIREMENTS FOR HOSPITALS TO QUALIFY 
FOR HOSPITAL EXCEPTION TO OWNERSHIP OR INVEST-
MENT PROHIBITION.— 
‘‘(1) REQUIREMENTS
DESCRIBED.—For pur-
poses of paragraphs subsection (d)(3)(D), the re-
quirements described in this paragraph for a hos-
pital are as follows: 
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‘‘(A) PROVIDER
AGREEMENT.—The hos-
pital had a provider agreement under section 
1866 in effect on July 24, 2007. 
‘‘(B) PROHIBITION OF EXPANSION OF FA-
CILITY
CAPACITY.—The number of operating 
rooms and beds of the hospital at any time on 
or after the date of the enactment of this sub-
section are no greater than the number of oper-
ating rooms and beds as of such date. 
‘‘(C) PREVENTING CONFLICTS OF INTER-
EST.— 
‘‘(i) The hospital submits to the Sec-
retary an annual report containing a de-
tailed description of— 
‘‘(I) the identity of each physi-
cian owner and any other owners of 
the hospital; and 
‘‘(II) the nature and extent of all 
ownership interests in the hospital. 
‘‘(ii) The hospital has procedures in 
place to require that any referring physi-
cian owner discloses to the patient being 
referred, by a time that permits the pa-
tient to make a meaningful decision re-
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garding the receipt of care ,as determined 
by the Secretary— 
‘‘(I) the ownership interest of 
such referring physician in the hos-
pital; and 
‘‘(II) if applicable, any such own-
ership interest of the treating physi-
cian. 
‘‘(iii) The hospital does not condition 
any physician ownership interests either di-
rectly or indirectly on the physician owner 
making or influencing referrals to the hos-
pital or otherwise generating business for 
the hospital. 
‘‘(D) ENSURING
BONA
FIDE
INVEST-
MENT.— 
‘‘(i) Physician owners in the aggregate 
do not own more than 40 percent of the 
total value of the investment interests held 
in the hospital or in an entity whose assets 
include the hospital. 
‘‘(ii) The investment interest of any 
individual physician owner does not exceed 
2 percent of the total value of the invest-
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ment interests held in the hospital or in an 
entity whose assets include the hospital. 
‘‘(iii) Any ownership or investment in-
terests that the hospital offers to a physi-
cian owner are not offered on more favor-
able terms than the terms offered to a per-
son who is not a physician owner. 
‘‘(iv) The hospital does not directly or 
indirectly provide loans or financing for 
any physician owner investments in the 
hospital. 
‘‘(v) The hospital does not directly or 
indirectly guarantee a loan, make a pay-
ment toward a loan, or otherwise subsidize 
a loan, for any individual physician owner 
or group of physician owners that is re-
lated to acquiring any ownership interest 
in the hospital. 
‘‘(vi) Investment returns are distrib-
uted to investors in the hospital in an 
amount that is directly proportional to the 
investment of capital by the physician 
owner in the hospital. 
‘‘(vii) Physician owners do not receive, 
directly or indirectly, any guaranteed re-
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ceipt of or right to purchase other business 
interests related to the hospital, including 
the purchase or lease of any property 
under the control of other investors in the 
hospital or located near the premises of the 
hospital. 
‘‘(viii) The hospital does not offer a 
physician owner the opportunity to pur-
chase or lease any property under the con-
trol of the hospital or any other investor in 
the hospital on more favorable terms than 
the terms offered to an individual who is 
not a physician owner. 
‘‘(E) PATIENT SAFETY.— 
‘‘(i) Insofar as the hospital admits a 
patient and does not have any physician 
available on the premises to provide serv-
ices during all hours in which the hospital 
is providing services to such patient, before 
admitting the patient— 
‘‘(I) the hospital discloses such 
fact to a patient; and 
‘‘(II) following such disclosure, 
the hospital receives from the patient 
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a signed acknowledgment that the pa-
tient understands such fact. 
‘‘(ii) The hospital has the capacity 
to— 
‘‘(I) provide assessment and ini-
tial treatment for patients; and 
‘‘(II) refer and transfer patients 
to hospitals with the capability to 
treat the needs of the patient in-
volved. 
‘‘(2) 
PUBLICATION
OF
INFORMATION
RE-
PORTED.—The Secretary shall publish, and update 
on an annual basis, the information submitted by 
hospitals under paragraph (1)(A)(i) on the public 
Internet website of the Centers for Medicare & Med-
icaid Services. 
‘‘(3) COLLECTION OF OWNERSHIP AND INVEST-
MENT INFORMATION.—For purposes of clauses (i) 
and (ii) of paragraph (1)(D), the Secretary shall col-
lect physician ownership and investment information 
for each hospital as it existed on the date of the en-
actment of this subsection. 
‘‘(4) PHYSICIAN OWNER DEFINED.—For pur-
poses of this subsection, the term ‘physician owner’ 
means a physician (or an immediate family member 
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of such physician) with a direct or an indirect own-
ership interest in the hospital.’’. 
(b) ENFORCEMENT.— 
(1) ENSURING COMPLIANCE.—The Secretary of 
Health and Human Services shall establish policies 
and procedures to ensure compliance with the re-
quirements described in such section 1877(i)(1) of 
the Social Security Act, as added by subsection 
(a)(3), beginning on the date such requirements first 
apply. Such policies and procedures may include un-
announced site reviews of hospitals. 
(2) AUDITS.—Beginning not later than 18 
months after the date of the enactment of this Act, 
the Secretary of Health and Human Services shall 
conduct audits to determine if hospitals violate the 
requirements referred to in paragraph (1). 
TITLE VII—PROVISIONS RELAT-
ING TO MEDICARE PARTS A 
AND B 
SEC. 701. HOME HEALTH PAYMENT UPDATE FOR 2008. 
Section 1895(b)(3)(B)(ii) of the Social Security Act 
(42 U.S.C. 1395fff(b)(3)(B)(ii)) is amended— 
(1) in subclause (IV) at the end, by striking 
‘‘and’’; 
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(2) by redesignating subclause (V) as subclause 
(VII); and 
(3) by inserting after subclause (IV) the fol-
lowing new subclauses: 
‘‘(V) 2007, subject to clause (v), 
the home health market basket per-
centage increase; 
‘‘(VI) 2008, subject to clause (v), 
0 percent; and’’. 
SEC. 702. 2-YEAR EXTENSION OF TEMPORARY MEDICARE 
PAYMENT INCREASE FOR HOME HEALTH 
SERVICES FURNISHED IN A RURAL AREA. 
Section 421 of the Medicare Prescription Drug, Im-
provement, and Modernization Act of 2003 (Public Law 
108–173; 117 Stat. 2283; 42 U.S.C. 1395fff note), as 
amended by section 5201(b) of the Deficit Reduction Act 
of 2005, is amended— 
(1) in the heading, by striking ‘‘ONE-YEAR’’ 
and inserting ‘‘TEMPORARY’’; and 
(2) in subsection (a), by striking ‘‘and episodes 
and visits beginning on or after January 1, 2006, 
and before January 1, 2007’’ and inserting ‘‘epi-
sodes and visits beginning on or after January 1, 
2006, and before January 1, 2007, and episodes and 
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visits beginning on or after January 1, 2008, and 
before January 1, 2010’’. 
SEC. 703. EXTENSION OF MEDICARE SECONDARY PAYER 
FOR 
BENEFICIARIES 
WITH 
END 
STAGE 
RENAL DISEASE FOR LARGE GROUP PLANS. 
(a) IN GENERAL.—Section 1862(b)(1)(C) of the So-
cial Security Act (42 U.S.C. 1395y(b)(1)(C)) is amend-
ed— 
(1) by redesignating clauses (i) and (ii) as sub-
clauses (I) and (II), respectively, and indenting ac-
cordingly; 
(2) by amending the text preceding subclause 
(I), as so redesignated, to read as follows: 
‘‘(C) INDIVIDUALS
WITH
END
STAGE 
RENAL DISEASE.— 
‘‘(i) IN
GENERAL.—A group health 
plan 
(as 
defined 
in 
subparagraph 
(A)(v))—’’; 
(3) in the matter following subclause (II), as so 
redesignated— 
(A) by striking ‘‘clause (i)’’ and inserting 
‘‘subclause (I)’’; 
(B) by striking ‘‘clause (ii)’’ and inserting 
‘‘subclause (II)’’; and 
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(C) by striking ‘‘clauses (i) and (ii)’’ and 
inserting ‘‘subclauses (I) and (II)’’; and 
(D) in the last sentence, by striking ‘‘Ef-
fective for items’’ and inserting ‘‘Subject to 
clause (ii), effective for items’’; and 
(4) by adding at the end the following new 
clause: 
‘‘(ii) SPECIAL
RULE
FOR
LARGE 
GROUP PLANS.—In applying clause (i) to 
a large group health plan (as defined in 
subparagraph (B)(iii)). with respect to pe-
riods beginning on or after the date that is 
30 months prior to January 1, 2008, sub-
clauses (I) and (II) of such clause shall be 
applied by substituting ‘42-month’ for ‘12- 
month’ each place it appears.’’. 
SEC. 704. PLAN FOR MEDICARE PAYMENT ADJUSTMENTS 
FOR NEVER EVENTS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall develop a plan (in this section referred to 
as the ‘‘never events plan’’) to implement, beginning in 
fiscal year 2010, a policy to reduce or eliminate payments 
under title XVIII of the Social Security Act for never 
events. 
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(b) NEVER EVENT DEFINED.—For purposes of this 
section, the term ‘‘never event’’ means an event involving 
the delivery of (or failure to deliver) physicians’ services, 
inpatient or outpatient hospital services, or facility serv-
ices furnished in an ambulatory surgical facility in which 
there is an error in medical care that is clearly identifiable, 
usually preventable, and serious in consequences to pa-
tients, and that indicates a deficiency in the safety and 
process controls of the services furnished with respect to 
the physician, hospital, or ambulatory surgical center in-
volved. 
(c) PLAN DETAILS.— 
(1) DEFINING NEVER EVENTS.—With respect 
to criteria for identifying never events under the 
never events plan, the Secretary should consider 
whether the event meets the following characteris-
tics: 
(A) CLEARLY IDENTIFIABLE.—The event 
is clearly identifiable and measurable and fea-
sible to include in a reporting system for never 
events. 
(B) USUALLY PREVENTABLE.—The event 
is usually preventable taking into consideration 
that, because of the complexity of medical care, 
certain medical events are not always avoidable. 
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