I
106TH CONGRESS
2D SESSION
H. R. 5404
To amend title XVIII of the Social Security Act to establish and implement
a comprehensive system under the Medicare Program to assure quality
of care furnished to medicare beneficiaries, and reduce the incidence
of medical errors, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
OCTOBER 5, 2000
Mr. STARK (for himself, Mr. NEAL of Massachusetts, Mr. JEFFERSON, and
Mr. COYNE) introduced the following bill; which was referred to the Com-
mittee on Ways and Means, and in addition to the Committee on Com-
merce, for a period to be subsequently determined by the Speaker, in
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned
A BILL
To amend title XVIII of the Social Security Act to establish
and implement a comprehensive system under the Medi-
care Program to assure quality of care furnished to
medicare beneficiaries, and reduce the incidence of med-
ical errors, and for other purposes.
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 ‘‘Medicare Comprehen-
sive Quality of Care and Safety Act of 2000’’.
SEC. 2. ESTABLISHMENT OF MEDICARE COMPREHENSIVE
QUALITY OF CARE AND SAFETY SYSTEM.
(a) 
MEDICARE
COMPREHENSIVE
QUALITY
OF
CARE.—
(1) IN GENERAL.—Section 1863 of the Social
Security Act (42 U.S.C. 1395z) is amended to read
as follows:
‘‘COMPREHENSIVE QUALITY OF CARE AND SAFETY
‘‘SEC. 1863. (a) COMPREHENSIVE QUALITY OF CARE
AND SAFETY SYSTEM.—
‘‘(1) ESTABLISHMENT OF SYSTEM.—The Sec-
retary shall establish and maintain a comprehensive
quality of care and safety system for improving and
monitoring the quality of care and safety of medical
care furnished to individuals entitled to benefits
under this title and for reducing medical errors and
protecting the safety of such individuals in their
care. In establishing and maintaining the com-
prehensive quality of care and safety system in this
paragraph, the Secretary shall—
‘‘(A) consult with the Medicare Quality
Advisory Committee established in subsection
(h);
‘‘(B) perform the functions described in
this section and such other functions as the
Secretary determines appropriate in achieving
quality of care and protecting the safety of indi-
viduals entitled to benefits under this title;
‘‘(C) coordinate and, to the extent prac-
ticable, ensure consistency between the quality
of care activities in this section and other qual-
ity of care activities under this title and title
XI, including those for Medicare+Choice plans
under part C of this title; and
‘‘(D) coordinate all medicare quality of
care activities with other quality of care activi-
ties being conducted within the Department of
Health and Human Services.
‘‘(2) CHIEF MEDICARE QUALITY AND SAFETY
OFFICER.—The Secretary shall appoint a Chief
Medicare Quality and Safety Officer to oversee the
comprehensive quality of care and safety system in
this section and other quality of care activities in
this title and title XI.
‘‘(b) QUALITY AND SAFETY IMPROVEMENT.—
‘‘(1) ESTABLISHMENT OF SYSTEM.—The Sec-
retary shall establish a system to achieve continuous
quality and safety improvement in the delivery of
medical care to individuals entitled to benefits under
this title.
‘‘(2) GOALS AND OBJECTIVES.—The Secretary
shall establish goals and specific annual objectives
for achieving continuous quality and safety improve-
ments in the delivery of medical care to individuals
entitled to benefits under this title, including annual
goals and specific objectives for—
‘‘(A) types of providers and suppliers of
services;
‘‘(B) categories of individuals entitled to
benefits under this title, such as racial, gender,
and socioeconomic categories;
‘‘(C) types of services, such as specific pre-
ventive services and other specific services; and
‘‘(D) such other categories as the Sec-
retary determines appropriate and beneficial.
‘‘(3) COMMON SETS OF MEASUREMENTS.—The
Secretary shall establish common sets of quality and
safety standards, performance measures, and best
practices for each type of provider and supplier and
type of service affecting quality and safety of both
individuals receiving care and employees of providers
and suppliers in providing that care. In establishing
such quality and safety standards, performance
measures, and best practices, the Secretary shall—
‘‘(A) collect information concerning quality
and safety standards, performance measures,
and best practices from private sector organiza-
tions and individuals and other governmental
organizations and individuals;
‘‘(B) fund research as appropriate to de-
velop knowledge and understanding of quality
of care, patient safety, and medical errors to
gain insight into better system design to im-
prove quality and safety, and to develop quality
and safety standards and performance meas-
ures; and
‘‘(C) establish and maintain a national
clearinghouse of quality and safety standards,
performance measures, and best practices.
‘‘(c) MONITORING QUALITY OF CARE AND SAFETY.—
‘‘(1) DATA COLLECTION.—The Secretary shall
establish such data collection systems and collect
such data as may be necessary on an ongoing basis
to monitor the quality of care and safety of care pro-
vided to individuals entitled to benefits under this
title, and the safety of employees of providers and
suppliers who provide that care. Such data collection
systems shall include—
‘‘(A) assessments of health and functional
status of individuals receiving care;
‘‘(B) measures of appropriate use and out-
comes of care provided;
‘‘(C) identification of adverse events, in-
cluding adverse events that result from errors;
‘‘(D) performance of providers and sup-
pliers in meeting quality and safety standards
and performance measures;
‘‘(E) corrective actions taken by providers
and suppliers when errors and other adverse
events are identified;
‘‘(F) satisfaction of individuals receiving
care with the care provided; and
‘‘(G) quality standards, performance meas-
ures, and best practices used by providers and
suppliers in achieving improvements in quality
and safety and achieving performance meas-
ures.
‘‘(2) ESTABLISHMENT
OF
COMMON
SETS
OF
DATA
ELEMENTS.—The Secretary shall establish
common sets of data elements and shall ensure com-
parability of data.
‘‘(3) COORDINATION OF DATA.—The Secretary
shall coordinate the data systems described in sub-
section (e)(1) to form a national database of infor-
mation reported to the quality improvement organi-
zations.
‘‘(4) USE OF DATA.—The Secretary shall con-
duct analyses of such data—
‘‘(A) to evaluate achievement in meeting
quality and safety standards and performance
standards among various types of providers and
suppliers;
‘‘(B) to develop knowledge and under-
standing of medical errors and other adverse
events, to gain insight into better system design
to improve quality and safety, and to develop
quality and safety standards and performance
measures; and
‘‘(C) to examine differences in quality of
care, safety, outcomes of care, and satisfaction
with care among different categories of individ-
uals entitled to benefits under this title by gen-
der, race, socioeconomic status, geography, and
type and severity of illness.
‘‘(5) PUBLIC ACCESS TO DATA.—The Secretary
shall make such data available for public use in a
form that does not identify individuals, providers or
suppliers, or reporters of information.
‘‘(d) STANDARD
PATIENT
ASSESSMENT
INSTRU-
MENTS.—
‘‘(1) The Secretary shall establish and imple-
ment standard patient assessment instruments that
provide comparability of information.
‘‘(2) 
CONSULTATION.—In 
establishing 
the
standard patient assessment instruments under this
subsection, the Secretary shall consult with rep-
resentatives of providers of services, suppliers, and
with appropriate organizations and entities rep-
resenting private sector entities to promote the de-
velopment and use of common sets of quality meas-
ures that represent the full spectrum of care ob-
tained by individuals entitled to benefits under this
title.
‘‘(3) SOLE
ASSESSMENT
INSTRUMENTS.—The
standard patient assessment instruments established
under this subsection shall be the sole patient as-
sessment instrument utilized by the Secretary with
respect to items and services furnished under this
title, and shall supersede any patient assessment in-
strument or method utilized by the Secretary with
respect to such items and services.
‘‘(4) ADJUSTMENT TO PAYMENT AMOUNTS FOR
SERVICES.—Notwithstanding any other provision of