I
103D CONGRESS
2D SESSION
H. R. 4960
To provide health care quality safeguards for consumers of health care
insurance and health care products and services.
IN THE HOUSE OF REPRESENTATIVES
AUGUST 12, 1994
Mr. WYDEN introduced the following bill; which was referred to the Committee
on Energy and Commerce
A BILL
To provide health care quality safeguards for consumers of
health care insurance and health care products and services.
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 ‘‘Consumer Health
Quality Protection Act of 1994’’.
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TITLE I—DUTIES OF THE SECRETARY AND
THE STATES
SEC. 101. RESPONSIBILITIES OF THE SECRETARY.
The responsibilities of the Secretary of Health and
Human Services (hereinafter referred to as ‘‘the Sec-
retary’’) under this Act are the following:
(1) STATE QUALITY MANAGEMENT PROGRAM.—
Determination of initial and ongoing compliance of
each State health quality management program with
the requirements of section 102.
(2) NATIONAL
QUALITY
MANAGEMENT
PRO-
GRAM.—Establish a national quality management
program (in accordance with section 201).
(3) HEALTH QUALITY IMPROVEMENT FOUNDA-
TIONS.—Establishment of health quality improve-
ment foundations (in accordance with section 202).
(4) CONSUMER HEALTH CARE ADVOCATE.—Es-
tablishment of consumer health care advocate in
each State (in accordance with section 203).
(5) NATIONAL
CONSUMER
REPRESENTATIVE
SUPPORT
CENTER.—Establishment of a national
consumer representative support center (in accord-
ance with section 204).
(6) NATIONAL
MEASURES
OF
QUALITY
PER-
FORMANCE.—Establishment of national measures of
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quality performance for health plans (in accordance
with section 205).
(7) RELATIVE
VALUE
SCALE
FOR
PHARMACY
COUNSELING.—Establishment of a relative value
scale for the purpose of reimbursing pharmacists for
the certain patient counseling services (in accord-
ance with section 206).
SEC. 102. RESPONSIBILITIES OF THE STATES.
STATE RESPONSIBILITIES.—As a condition of receipt
of Federal medical assistance payments under title XIX
of the Social Security Act, a State must comply with the
following requirements of this section:
(1) HEALTH
PLANS.—Certifying health plan
compliance with the quality standards of section
301.
(2) MEDICAL
LICENSURE
BOARD.—Assuring
State medical licensure board compliance with the
requirements of section 302.
TITLE II—NATIONAL HEALTH QUALITY
MANAGEMENT PROGRAM
SEC. 201. ESTABLISHMENT OF NATIONAL QUALITY MAN-
AGEMENT PROGRAM.
(a) IN GENERAL.—Not later than one year after the
date of enactment of this Act, the Secretary shall establish
and oversee a performance-based program of quality man-
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agement and improvement designed to enhance the qual-
ity, appropriateness, and effectiveness of health care items
and services, to be known as the national quality manage-
ment program.
(b) FUNDING.—
(1) IN
GENERAL.—Beginning with the first
quarter of the first calendar year following enact-
ment of this Act and quarterly thereafter, the Sec-
retary shall collect from each health plan certified
under section 301 a fee amounting to 0.25 percent
of the premiums received by the plan.
(2) 
FUNDED
ACTIVITIES.—Funds 
collected
under the authority of paragraph (1) shall be uti-
lized by the Secretary solely to support the activities
described under section 101.
SEC. 202. HEALTH QUALITY IMPROVEMENT FOUNDATIONS.
(a) IN GENERAL.—The Secretary shall, no later than
two years after the date of enactment of this Act, establish
a program of grants to eligible organizations to serve as
health quality improvement foundations and perform the
duties specified in subsection (d) for the population of
each State, and shall oversee the operation of such founda-
tions.
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(b) ELIGIBILITY.—To be eligible for a grant under
this section, entities must demonstrate compliance with
the criteria of subparagraphs (1) through (5).
(1) GOVERNING BODY.—Each entity shall be
governed by a board consisting of health profes-
sionals and public members, no fewer than 51 per-
cent of whom shall be public members.
(2) DEFINITION
OF
PUBLIC
MEMBER.—For
purposes of this paragraph, the term ‘‘public mem-
ber’’ means an individual who resides in the State
and is a person of integrity and good reputation who
has lived in the State for at least five years imme-
diately preceding appointment to the board, and has
not in the preceding five years been authorized to
practice a healing art or had a substantial personal,
business, professional, or pecuniary connection with
a health plan, healing art or with a medical edu-
cation or health care facility, except as a patient or
a potential patient.
(3) STAFFING.—Each entity shall be staffed by
individuals expert in quality improvement, and ex-
perts in the fields of epidemiology, measurement of
risk adjusted health outcomes, use of clinical prac-
tice guidelines, health services data analysis, and
provider education.
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(4) CONTRACT WITH ACADEMIC HEALTH CEN-
TER.—
(A) IN GENERAL.—Each entity shall have
a contract with an academic health center to
assist in fulfilling the duties described under
subsection (d).
(B) DEFINITION.—For purposes of this
paragraph, an ‘‘academic health center’’ means
an entity that—
(i) operates a school of medicine or
osteopathic medicine accredited by the Li-
aison Committee on Medical Education of
the Association of American Medical Col-
leges and the American Medical Associa-
tion, or the American Osteopathic Associa-
tion;
(ii) operates or is affiliated with one
or more schools of nursing; and
(iii) operates or is affiliated with one
or more teaching hospitals.
(5) CONFLICT OF INTEREST.—
(A) IN GENERAL.—An entity seeking to re-
ceive a designation under this section shall be
considered a ‘‘disclosing entity’’ for purposes of
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a description of activities underway and
progress achieved; and
(D) a description of activities undertaken
during the preceding year pursuant to sub-
section (b)(3) and subsection (d)(3)(D).
(5) MULTIPLAN COLLABORATIONS.—Sponsor of
statewide and other collaborations involving multiple
plans or providers to identify opportunities for qual-
ity improvement, and to bring about improvements
in health care.
(6) REFERRALS.—
(A) IN GENERAL.—If a health quality im-
provement foundation finds, after affording rea-
sonable opportunities for improvement, that a
provider or plan—
(i) continues to furnish services char-
acterized by underuse, overuse or poor
technical quality, or
(ii) is unwilling or unable to success-
fully engage in quality improvement activi-
ties related to the services described in
subparagraph (A),
the foundation shall provide notice of such finding to
the officials and entities described in subparagraph
(B), and shall make available to such officials and