H. R. 3590—845 
qualified Maintenance of Certification Program 
practice assessment. 
‘‘(C) DEFINITIONS.—For purposes of this paragraph: 
‘‘(i) The term ‘Maintenance of Certification Pro-
gram’ means a continuous assessment program, such 
as qualified American Board of Medical Specialties 
Maintenance of Certification program or an equivalent 
program (as determined by the Secretary), that 
advances quality and the lifelong learning and self- 
assessment of board certified specialty physicians by 
focusing on the competencies of patient care, medical 
knowledge, practice-based learning, interpersonal and 
communication skills and professionalism. Such a pro-
gram shall include the following: 
‘‘(I) The program requires the physician to 
maintain a valid, unrestricted medical license in 
the United States. 
‘‘(II) The program requires a physician to 
participate in educational and self-assessment pro-
grams that require an assessment of what was 
learned. 
‘‘(III) The program requires a physician to 
demonstrate, through a formalized, secure exam-
ination, that the physician has the fundamental 
diagnostic skills, medical knowledge, and clinical 
judgment to provide quality care in their respective 
specialty. 
‘‘(IV) The program requires successful comple-
tion of a qualified Maintenance of Certification 
Program practice assessment as described in 
clause (ii). 
‘‘(ii) The term ‘qualified Maintenance of Certifi-
cation Program practice assessment’ means an assess-
ment of a physician’s practice that— 
‘‘(I) includes an initial assessment of an 
eligible professional’s practice that is designed to 
demonstrate the physician’s use of evidence-based 
medicine; 
‘‘(II) includes a survey of patient experience 
with care; and 
‘‘(III) requires a physician to implement a 
quality improvement intervention to address a 
practice weakness identified in the initial assess-
ment under subclause (I) and then to remeasure 
to assess performance improvement after such 
intervention.’’. 
(b) AUTHORITY.—Section 3002(c) of this Act is amended by 
adding at the end the following new paragraph: 
‘‘(3) AUTHORITY.—For years after 2014, if the Secretary 
of Health and Human Services determines it to be appropriate, 
the Secretary may incorporate participation in a Maintenance 
of Certification Program and successful completion of a qualified 
Maintenance of Certification Program practice assessment into 
the composite of measures of quality of care furnished pursuant 
to the physician fee schedule payment modifier, as described 
in section 1848(p)(2) of the Social Security Act (42 U.S.C. 
1395w–4(p)(2)).’’.
H. R. 3590—846 
(c) ELIMINATION OF MA REGIONAL PLAN STABILIZATION FUND.— 
(1) IN GENERAL.—Section 1858 of the Social Security Act 
(42 U.S.C. 1395w–27a) is amended by striking subsection (e). 
(2) TRANSITION.—Any amount contained in the MA 
Regional Plan Stabilization Fund as of the date of the enact-
ment of this Act shall be transferred to the Federal Supple-
mentary Medical Insurance Trust Fund. 
SEC. 10328. IMPROVEMENT IN PART D MEDICATION THERAPY MANAGE-
MENT (MTM) PROGRAMS. 
(a) IN GENERAL.—Section 1860D–4(c)(2) of the Social Security 
Act (42 U.S.C. 1395w–104(c)(2)) is amended— 
(1) by redesignating subparagraphs (C), (D), and (E) as 
subparagraphs (E), (F), and (G), respectively; and 
(2) by inserting after subparagraph (B) the following new 
subparagraphs: 
‘‘(C) REQUIRED INTERVENTIONS.—For plan years begin-
ning on or after the date that is 2 years after the date 
of the enactment of the Patient Protection and Affordable 
Care Act, prescription drug plan sponsors shall offer medi-
cation therapy management services to targeted bene-
ficiaries described in subparagraph (A)(ii) that include, at 
a minimum, the following to increase adherence to prescrip-
tion medications or other goals deemed necessary by the 
Secretary: 
‘‘(i) An annual comprehensive medication review 
furnished person-to-person or using telehealth tech-
nologies (as defined by the Secretary) by a licensed 
pharmacist or other qualified provider. The comprehen-
sive medication review— 
‘‘(I) shall include a review of the individual’s 
medications and may result in the creation of a 
recommended medication action plan or other 
actions in consultation with the individual and 
with input from the prescriber to the extent nec-
essary and practicable; and 
‘‘(II) shall include providing the individual 
with a written or printed summary of the results 
of the review. 
The Secretary, in consultation with relevant stake-
holders, shall develop a standardized format for the 
action plan under subclause (I) and the summary under 
subclause (II). 
‘‘(ii) Follow-up interventions as warranted based 
on the findings of the annual medication review or 
the targeted medication enrollment and which may 
be provided person-to-person or using telehealth tech-
nologies (as defined by the Secretary). 
‘‘(D) ASSESSMENT.—The prescription drug plan sponsor 
shall have in place a process to assess, at least on a 
quarterly basis, the medication use of individuals who are 
at risk but not enrolled in the medication therapy manage-
ment program, including individuals who have experienced 
a transition in care, if the prescription drug plan sponsor 
has access to that information.
H. R. 3590—847 
‘‘(E) AUTOMATIC
ENROLLMENT
WITH
ABILITY
TO
OPT- 
OUT.—The prescription drug plan sponsor shall have in 
place a process to— 
‘‘(i) subject to clause (ii), automatically enroll tar-
geted beneficiaries described in subparagraph (A)(ii), 
including beneficiaries identified under subparagraph 
(D), in the medication therapy management program 
required under this subsection; and 
‘‘(ii) permit such beneficiaries to opt-out of enroll-
ment in such program.’’. 
(b) RULE OF CONSTRUCTION.—Nothing in this section shall limit 
the authority of the Secretary of Health and Human Services to 
modify or broaden requirements for a medication therapy manage-
ment program under part D of title XVIII of the Social Security 
Act or to study new models for medication therapy management 
through the Center for Medicare and Medicaid Innovation under 
section 1115A of such Act, as added by section 3021. 
SEC. 10329. DEVELOPING METHODOLOGY TO ASSESS HEALTH PLAN 
VALUE. 
(a) DEVELOPMENT.—The Secretary of Health and Human Serv-
ices (referred to in this section as the ‘‘Secretary’’), in consultation 
with relevant stakeholders including health insurance issuers, 
health care consumers, employers, health care providers, and other 
entities determined appropriate by the Secretary, shall develop 
a methodology to measure health plan value. Such methodology 
shall take into consideration, where applicable— 
(1) the overall cost to enrollees under the plan; 
(2) the quality of the care provided for under the plan; 
(3) the efficiency of the plan in providing care; 
(4) the relative risk of the plan’s enrollees as compared 
to other plans; 
(5) the actuarial value or other comparative measure of 
the benefits covered under the plan; and 
(6) other factors determined relevant by the Secretary. 
(b) REPORT.—Not later than 18 months after the date of enact-
ment of this Act, the Secretary shall submit to Congress a report 
concerning the methodology developed under subsection (a). 
SEC. 10330. MODERNIZING COMPUTER AND DATA SYSTEMS OF THE 
CENTERS FOR MEDICARE & MEDICAID SERVICES TO SUP-
PORT IMPROVEMENTS IN CARE DELIVERY. 
(a) IN GENERAL.—The Secretary of Health and Human Services 
(in this section referred to as the ‘‘Secretary’’) shall develop a 
plan (and detailed budget for the resources needed to implement 
such plan) to modernize the computer and data systems of the 
Centers for Medicare & Medicaid Services (in this section referred 
to as ‘‘CMS’’). 
(b) CONSIDERATIONS.—In developing the plan, the Secretary 
shall consider how such modernized computer system could— 
(1) in accordance with the regulations promulgated under 
section 264(c) of the Health Insurance Portability and Account-
ability Act of 1996, make available data in a reliable and 
timely manner to providers of services and suppliers to support 
their efforts to better manage and coordinate care furnished 
to beneficiaries of CMS programs; and 
(2) support consistent evaluations of payment and delivery 
system reforms under CMS programs.
H. R. 3590—848 
(c) POSTING OF PLAN.—By not later than 9 months after the 
date of the enactment of this Act, the Secretary shall post on 
the website of the Centers for Medicare & Medicaid Services the 
plan described in subsection (a). 
SEC. 10331. PUBLIC REPORTING OF PERFORMANCE INFORMATION. 
(a) IN GENERAL.— 
(1) DEVELOPMENT.—Not later than January 1, 2011, the 
Secretary shall develop a Physician Compare Internet website 
with information on physicians enrolled in the Medicare pro-
gram under section 1866(j) of the Social Security Act (42 U.S.C. 
1395cc(j)) and other eligible professionals who participate in 
the Physician Quality Reporting Initiative under section 1848 
of such Act (42 U.S.C. 1395w–4). 
(2) PLAN.—Not later than January 1, 2013, and with 
respect to reporting periods that begin no earlier than January 
1, 2012, the Secretary shall also implement a plan for making 
publicly available through Physician Compare, consistent with 
subsection (c), information on physician performance that pro-
vides comparable information for the public on quality and 
patient experience measures with respect to physicians enrolled 
in the Medicare program under such section 1866(j). To the 
extent scientifically sound measures that are developed con-
sistent with the requirements of this section are available, 
such information, to the extent practicable, shall include— 
(A) measures collected under the Physician Quality 
Reporting Initiative; 
(B) an assessment of patient health outcomes and the 
functional status of patients; 
(C) an assessment of the continuity and coordination 
of care and care transitions, including episodes of care 
and risk-adjusted resource use; 
(D) an assessment of efficiency; 
(E) an assessment of patient experience and patient, 
caregiver, and family engagement; 
(F) an assessment of the safety, effectiveness, and time-
liness of care; and 
(G) other information as determined appropriate by 
the Secretary. 
(b) OTHER REQUIRED CONSIDERATIONS.—In developing and 
implementing the plan described in subsection (a)(2), the Secretary 
shall, to the extent practicable, include— 
(1) processes to assure that data made public, either by 
the Centers for Medicare & Medicaid Services or by other 
entities, is statistically valid and reliable, including risk adjust-
ment mechanisms used by the Secretary; 
(2) processes by which a physician or other eligible profes-
sional whose performance on measures is being publicly 
reported has a reasonable opportunity, as determined by the 
Secretary, to review his or her individual results before they 
are made public; 
(3) processes by the Secretary to assure that the 
implementation of the plan and the data made available on 
Physician Compare provide a robust and accurate portrayal 
of a physician’s performance; 
(4) data that reflects the care provided to all patients 
seen by physicians, under both the Medicare program and,