nished in a month to an individual with respect to whom 
and for such month a reduction in premium subsidy is 
in effect under section 1839(i) if the advance notice de-
scribed in section 1848(g)(8) has been provided and (for 
services furnished on or after January 1, 2008) the physi-
cian furnishing the services submits information in accord-
ance with section 1848(k)(4).’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on or after 
January 1, 2008. 
(e) REVIEW AND REPORT ON IMPACT.— 
(1) REVIEW.—The Secretary of Health and 
Human Services shall monitor and review the impact 
of the amendments made by this section on the ac-
cess of medicare beneficiaries to physicians’ services. 
(2) REPORT.—Not later than January 1, 2009, 
the Secretary shall submit to Congress a report on 
such review and shall include such recommendations 
regarding changes in the amendments made by this 
section (such as reducing the income threshold ap-
plied for purposes of determining applicability of 
such amendments and thereby expanding the appli-
cation of such amendments) as the Secretary deems 
appropriate. 
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TITLE 
II—QUALITY 
IMPROVE-
MENT ORGANIZATION (QIO) 
MODERNIZATION 
SEC. 201. QUALITY IMPROVEMENT ACTIVITIES. 
(a) INCLUSION OF QUALITY IMPROVEMENT FUNC-
TIONS.—Section 1154(a) of the Social Security Act (42 
U.S.C. 1320c–3(a)) is amended by adding at the end the 
following new paragraph: ‘‘ 
‘‘(18) The organization shall offer quality im-
provement assistance to providers, practitioners, 
Medicare Advantage organizations offering Medicare 
Advantage plans under part C of title XVIII, and 
prescription drug sponsors offering prescription drug 
plans under part D of such title, including the fol-
lowing: 
‘‘(A) Education on quality improvement 
initiatives, strategies and techniques. 
‘‘(B) Instruction on how to collect, submit, 
aggregate and interpret data on measures that 
may be used for quality improvement, public re-
porting and payment. 
‘‘(C) Instruction on how to conduct root- 
cause analyses. 
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‘‘(D) Technical assistance for providers 
and practitioners in beneficiary education to fa-
cilitate patient self-management. 
‘‘(E) Facilitating cooperation among var-
ious local stakeholders in quality improvement. 
‘‘(F) Facilitating adoption of procedures 
that encourage timely candid feedback from pa-
tients and their families concerning perceived 
problems. 
‘‘(G) Guidance on redesigning clinical proc-
esses, including the adoption and effective use 
of health information technology, to improve the 
coordination, effectiveness, and safety of care. 
‘‘(H) Assistance in improving the quality 
of care delivered in rural and frontier areas and 
reducing health care disparities among racial 
and ethnic minorities, as well as gender dispari-
ties.’’. 
(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 an ap-
propriate review of all written complaints about the 
quality of services (for which payment may otherwise 
be made under title XVIII) not meeting profes-
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sionally recognized standards of health care, if the 
complaint is filed with the organization by an indi-
vidual entitled to benefits for such services under 
such title (or a person acting on the individual’s be-
half). Before the organization concludes that the 
quality of services does not meet professionally rec-
ognized standards of health care, the organization 
must provide the practitioner or person concerned 
with reasonable notice and opportunity for discus-
sion. 
‘‘(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 
quality concerns to Quality Improvement Orga-
nizations. 
‘‘(ii) The organization shall report findings 
of its investigations to complainants, the bene-
ficiary involved, or their representative, whether 
the complaint findings involve physicians or in-
stitutional providers, practitioners, or Medicare 
Advantage plans, but such complaint findings 
may not be used in any form in a medical mal-
practice action. 
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‘‘(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. 
‘‘(iv) The organization shall determine 
whether the complaint allegations about clinical 
quality of care are confirmed and assist pro-
vider, practitioners, and plans in remedying 
confirmed complaints. 
‘‘(v) 
The 
organization 
shall 
respond 
supportively to quality problems caused by un-
safe systems, and refer for enforcement pro-
viders who 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. 
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‘‘(vii) The organization shall promote bene-
ficiary awareness of standardized quality meas-
ures 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; 
‘‘(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 com-
plainants.’’. 
SEC. 202. 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.— 
‘‘(1) REPORT ON MANAGEMENT OF THE QIO 
PROGRAM.—The Comptroller General of the United 
States shall submit to Congress, no later than 
March 31, 2010, a report on the implementation by 
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the Secretary and the Director of the Office of Man-
agement and Budget of this part and their overall 
management of the program under this part. 
‘‘(2) PROGRAM
MANAGEMENT.—The report 
under paragraph (1) shall include a review of all of 
the following: 
‘‘(A) Implementation of the priorities, rec-
ommendations, and strategies of the strategic 
advisory committee under subsection (c)(1). 
‘‘(B) Implementation of appropriate pro-
gram and contractor evaluation. 
‘‘(C) Ensuring timely issuance of state-
ments of work. 
‘‘(D) Ensuring timely and priority QIO ac-
cess to Medicare data for quality improvement 
purposes. 
‘‘(E) Ensuring timely apportionment of 
funding. 
‘‘(F) Ensuring funding levels for new work 
are added to the QIO contract, as described in 
the second sentence of section 1159(b)(1). 
‘‘(G) The process of developing the appor-
tionment request and determining the funding 
allocation to QIOs. 
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‘‘(H) The identification of and progress to-
wards measures of effective management by the 
Secretary of the QIO program. 
‘‘(I) A review of the experience and quali-
fications of staff of the Centers for Medicare & 
Medicaid Services in overseeing the program. 
‘‘(3) INNOVATION.—The Secretary shall ensure 
that such staff Quality Improvement Organizations 
are provided maximum freedom in designing and ap-
plying intervention strategies for local quality im-
provement. 
‘‘(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 bene-
ficiaries in each jurisdiction. 
‘‘(c) SETTING STRATEGIC PRIORITIES.— 
‘‘(1) APPOINTMENT
OF
STRATEGIC
ADVISORY 
COMMITTEE.—The Secretary shall appoint an inde-
pendent strategic advisory committee, composed of 
national quality measurement and improvement ex-
perts, representatives of beneficiaries, health care 
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providers, and practitioners, and organizations hold-
ing contracts under this part. 
‘‘(2) DUTIES OF COMMITTEE.—Such committee 
shall set national strategic priorities for improve-
ment in the quality of care, consistent with the In-
stitute of Medicine’s six aims for health care im-
provement, including safety, effectiveness, patient 
centeredness, timeliness, efficiency and equity, and 
update these in time to permit preparation of a draft 
statement of work and funding request for each pro-
gram cycle under this part. 
‘‘(3) INDEPENDENT
EVALUATION.—The com-
mittee should ensure that the Quality Improvement 
Organization program is evaluated by an inde-
pendent entity using a study design, such as to a 
crossover design, to allow for a reliable 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 additional funding provided under the 
second sentence of section 1159(b)(1). 
‘‘(d) TAKING INTO ACCOUNT RECOMMENDATIONS 
FROM STAKEHOLDERS IN STATEMENTS OF WORK.—Each 
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statement of work under this part for a contract period 
beginning on or after August 1, 2008, shall include a task 
for the contracting Quality Improvement Organization to 
convene stakeholders to identify high priority quality prob-
lems for work in the contract period that are relevant to 
Medicare beneficiaries in the State. Each such organiza-
tion shall propose, as part of such statement, one or more 
projects to the Secretary taking into consideration the rec-
ommendations of such stakeholders recommendations, 
along with suggested performance measures to evaluate 
progress on such item. 
‘‘(e) ALLOCATION
OF RESOURCES
TO PRIORITY 
AREAS.—The Secretary shall allocate at least 20 percent 
of the additional funding that is provided under the second 
sentence of section 1159(b)(1) to promote improvement in 
one or more locally defined priority areas identified under 
subsection (d).’’. 
SEC. 203. DATA DISCLOSURE. 
Section 1160 of the Social Security Act (42 U.S.C. 
1320c–9) is amended— 
(1) in subsection (a)(3), by striking ‘‘subsection 
(b)’’ and inserting ‘‘subsections (b) and (f)’’; and 
(2) by adding at the end the following new sub-
section: 
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‘‘(f)(1) An organization with a contract with the Sec-
retary under this part may share individual-specific data 
with a physician treating the individual, for quality im-
provement and patient safety purposes. 
‘‘(2) The Secretary shall promulgate, not later than 
30 days after the date of the enactment of this subsection, 
a regulation that permits the sharing of data under para-
graph (1). 
‘‘(3) Nothing in this subsection shall be construed to 
limit, alter, or affect the requirements imposed the regula-
tions promulgated under section 264(c) of the Health In-
surance Portability and Accountability Act of 1996.’’. 
SEC. 204. 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) subject to subsection (k), the contract shall 
be for an initial term of five years and shall be re-
newable for each 5 years thereafter;’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(k)(1) Subject to the succeeding provisions of this 
subsection, at the end of each contract period under sub-
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