2002 
(1) EVALUATION.—The Inspector Gen-
eral of the Department of Health and 
Human Services shall evaluate the pilot 
program. Such evaluation shall— 
(A) determine whether the inde-
pendent monitor program should be 
established on a permanent basis; 
and 
(B) if the Inspector General deter-
mines that the independent monitor 
program should be established on a 
permanent basis, recommend appro-
priate procedures and mechanisms 
for such establishment. 
(2) REPORT.—Not later than 180 days 
after the completion of the pilot program, 
the Inspector General shall submit to 
Congress and the Secretary a report con-
taining the results of the evaluation con-
ducted under paragraph (1), together 
with recommendations for such legisla-
tion and administrative action as the In-
spector General determines appropriate. 
SEC. 1423. NOTIFICATION OF FACILITY CLOSURE. 
(a) SKILLED NURSING FACILITIES.— 
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(1) IN GENERAL.—Section 1819(c) of the 
Social Security Act (42 U.S.C. 1395i–3(c)) 
is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(7) NOTIFICATION
OF
FACILITY
CLO-
SURE.— 
‘‘(A) IN GENERAL.—Any individual 
who is the administrator of a skilled 
nursing facility must— 
‘‘(i) submit to the Secretary, 
the State long-term care ombuds-
man, residents of the facility, and 
the legal representatives of such 
residents or other responsible 
parties, written notification of an 
impending closure— 
‘‘(I) subject to subclause 
(II), not later than the date 
that is 60 days prior to the 
date of such closure; and 
‘‘(II) in the case of a facil-
ity where the Secretary termi-
nates the facility’s participa-
tion under this title, not later 
than the date that the Sec-
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retary 
determines 
appro-
priate; 
‘‘(ii) ensure that the facility 
does not admit any new residents 
on or after the date on which 
such written notification is sub-
mitted; and 
‘‘(iii) include in the notice a 
plan for the transfer and ade-
quate relocation of the residents 
of the facility by a specified date 
prior to closure that has been ap-
proved by the State, including as-
surances that the residents will 
be transferred to the most appro-
priate facility or other setting in 
terms of quality, services, and lo-
cation, taking into consideration 
the needs and best interests of 
each resident. 
‘‘(B) RELOCATION.— 
‘‘(i) IN
GENERAL.—The State 
shall ensure that, before a facility 
closes, all residents of the facility 
have been successfully relocated 
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to another facility or an alter-
native 
home 
and 
community- 
based setting. 
‘‘(ii) 
CONTINUATION
OF
PAY-
MENTS
UNTIL
RESIDENTS
RELO-
CATED.—The Secretary may, as the 
Secretary 
determines 
appro-
priate, continue to make pay-
ments under this title with re-
spect to residents of a facility that 
has 
submitted 
a 
notification 
under subparagraph (A) during 
the period beginning on the date 
such notification is submitted and 
ending on the date on which the 
resident 
is 
successfully 
relo-
cated.’’. 
(2) 
CONFORMING
AMENDMENTS.—Sec-
tion 1819(h)(4) of the Social Security Act 
(42 U.S.C. 1395i–3(h)(4)) is amended— 
(A) in the first sentence, by strik-
ing ‘‘the Secretary shall terminate’’ 
and inserting ‘‘the Secretary, subject 
to subsection (c)(7), shall terminate’’; 
and 
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(B) in the second sentence, by 
striking ‘‘subsection (c)(2)’’ and in-
serting ‘‘paragraphs (2) and (7) of sub-
section (c)’’. 
(b) NURSING FACILITIES.— 
(1) IN GENERAL.—Section 1919(c) of the 
Social Security Act (42 U.S.C. 1396r(c)) is 
amended by adding at the end the fol-
lowing new paragraph: 
‘‘(9) NOTIFICATION
OF
FACILITY
CLO-
SURE.— 
‘‘(A) IN GENERAL.—Any individual 
who is an administrator of a nursing 
facility must— 
‘‘(i) submit to the Secretary, 
the State long-term care ombuds-
man, residents of the facility, and 
the legal representatives of such 
residents or other responsible 
parties, written notification of an 
impending closure— 
‘‘(I) subject to subclause 
(II), not later than the date 
that is 60 days prior to the 
date of such closure; and 
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‘‘(II) in the case of a facil-
ity where the Secretary termi-
nates the facility’s participa-
tion under this title, not later 
than the date that the Sec-
retary 
determines 
appro-
priate; 
‘‘(ii) ensure that the facility 
does not admit any new residents 
on or after the date on which 
such written notification is sub-
mitted; and 
‘‘(iii) include in the notice a 
plan for the transfer and ade-
quate relocation of the residents 
of the facility by a specified date 
prior to closure that has been ap-
proved by the State, including as-
surances that the residents will 
be transferred to the most appro-
priate facility or other setting in 
terms of quality, services, and lo-
cation, taking into consideration 
the needs and best interests of 
each resident. 
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‘‘(B) RELOCATION.— 
‘‘(i) IN
GENERAL.—The State 
shall ensure that, before a facility 
closes, all residents of the facility 
have been successfully relocated 
to another facility or an alter-
native 
home 
and 
community- 
based setting. 
‘‘(ii) 
CONTINUATION
OF
PAY-
MENTS
UNTIL
RESIDENTS
RELO-
CATED.—The Secretary may, as the 
Secretary 
determines 
appro-
priate, continue to make pay-
ments under this title with re-
spect to residents of a facility that 
has 
submitted 
a 
notification 
under subparagraph (A) during 
the period beginning on the date 
such notification is submitted and 
ending on the date on which the 
resident 
is 
successfully 
relo-
cated.’’. 
(c) EFFECTIVE
DATE.—The amendments 
made by this section shall take effect 1 year 
after the date of the enactment of this Act. 
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recommendations for the content of 
such training. 
(2) CONSULTATION.—In conducting the 
analysis under paragraph (1)(A), the Sec-
retary shall consult with States that, as of 
the date of the enactment of this Act, re-
quire more than 75 hours of training for 
certified nurse aides. 
(3) DEFINITIONS.—In this section: 
(A) NURSING
FACILITY.—The term 
‘‘nursing facility’’ has the meaning 
given such term in section 1919(a) of 
the Social Security Act (42 U.S.C. 
1396r(a)). 
(B) SECRETARY.—The term ‘‘Sec-
retary’’ means the Secretary of Health 
and Human Services, acting through 
the Assistant Secretary for Planning 
and Evaluation. 
(C) SKILLED
NURSING
FACILITY.— 
The term ‘‘skilled nursing facility’’ 
has the meaning given such term in 
section 1819(a) of the Social Security 
Act (42 U.S.C. 1395(a)). 
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(b) REPORT.—Not later than 2 years after 
the date of the enactment of this Act, the Sec-
retary shall submit to Congress a report con-
taining the results of the study conducted 
under subsection (a), together with rec-
ommendations for such legislation and ad-
ministrative action as the Secretary deter-
mines appropriate. 
Subtitle C—Quality Measurements 
SEC. 1441. ESTABLISHMENT OF NATIONAL PRIORITIES FOR 
QUALITY IMPROVEMENT. 
Title XI of the Social Security Act, as 
amended by section 1401(a), is further amend-
ed by adding at the end the following new 
part: 
‘‘PART E—QUALITY IMPROVEMENT 
‘‘ESTABLISHMENT OF NATIONAL PRIORITIES FOR 
PERFORMANCE IMPROVEMENT 
‘‘SEC. 1191. (a) ESTABLISHMENT
OF
NA-
TIONAL PRIORITIES
BY
THE SECRETARY.—The 
Secretary shall establish and periodically up-
date, not less frequently than triennially, na-
tional priorities for performance improve-
ment. 
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‘‘(b) RECOMMENDATIONS FOR NATIONAL PRI-
ORITIES.—In establishing and updating na-
tional priorities under subsection (a), the Sec-
retary shall solicit and consider recommenda-
tions from multiple outside stakeholders. 
‘‘(c) CONSIDERATIONS IN SETTING NATIONAL 
PRIORITIES.—With respect to such priorities, 
the Secretary shall ensure that priority is 
given to areas in the delivery of health care 
services in the United States that— 
‘‘(1) contribute to a large burden of 
disease, including those that address the 
health care provided to patients with 
prevalent, high-cost chronic diseases; 
‘‘(2) have the greatest potential to de-
crease morbidity and mortality in this 
country, including those that are de-
signed to eliminate harm to patients; 
‘‘(3) have the greatest potential for 
improving the performance, affordability, 
and patient-centeredness of health care, 
including those due to variations in care; 
‘‘(4) address health disparities across 
groups and areas; and 
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‘‘(5) have the potential for rapid im-
provement 
due 
to 
existing 
evidence, 
standards of care or other reasons. 
‘‘(d) DEFINITIONS.—In this part: 
‘‘(1) 
CONSENSUS-BASED
ENTITY.—The 
term ‘consensus-based entity’ means an 
entity with a contract with the Secretary 
under section 1890. 
‘‘(2) 
QUALITY
MEASURE.—The 
term 
‘quality measure’ means a national con-
sensus standard for measuring the per-
formance and improvement of population 
health, or of institutional providers of 
services, physicians, and other health 
care practitioners in the delivery of 
health care services. 
‘‘(e) FUNDING.— 
‘‘(1) IN GENERAL.—The Secretary shall 
provide for the transfer, from the Federal 
Hospital Insurance Trust Fund under 
section 1817 and the Federal Supple-
mentary Medical Insurance Trust Fund 
under section 1841 (in such proportion as 
the Secretary determines appropriate), of 
$2,000,000, for the activities under this 
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section for each of the fiscal years 2010 
through 2014. 
‘‘(2) 
AUTHORIZATION
OF
APPROPRIA-
TIONS.—For purposes of carrying out the 
provisions of this section, in addition to 
funds otherwise available, out of any 
funds in the Treasury not otherwise ap-
propriated, there are appropriated to the 
Secretary of Health and Human Services 
$2,000,000 for each of the fiscal years 2010 
through 2014.’’. 
SEC. 1442. DEVELOPMENT OF NEW QUALITY MEASURES; 
GAO EVALUATION OF DATA COLLECTION 
PROCESS FOR QUALITY MEASUREMENT. 
Part E of title XI of the Social Security 
Act, as added by section 1441, is amended by 
adding at the end the following new sections: 
‘‘SEC. 1192. DEVELOPMENT OF NEW QUALITY MEASURES. 
‘‘(a) AGREEMENTS WITH QUALIFIED ENTI-
TIES.— 
‘‘(1) IN GENERAL.—The Secretary shall 
enter into agreements with qualified enti-
ties to develop quality measures for the 
delivery of health care services in the 
United States. 
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‘‘(2) FORM OF AGREEMENTS.—The Sec-
retary may carry out paragraph (1) by 
contract, grant, or otherwise. 
‘‘(3) RECOMMENDATIONS OF CONSENSUS- 
BASED ENTITY.—In carrying out this sec-
tion, the Secretary shall— 
‘‘(A) seek public input; and 
‘‘(B) take into consideration rec-
ommendations of the consensus-based 
entity with a contract with the Sec-
retary under section 1890(a). 
‘‘(b) DETERMINATION
OF
AREAS
WHERE 
QUALITY
MEASURES
ARE
REQUIRED.—Con-
sistent with the national priorities estab-
lished under this part and with the programs 
administered by the Centers for Medicare & 
Medicaid Services and in consultation with 
other relevant Federal agencies, the Sec-
retary shall determine areas in which quality 
measures for assessing health care services in 
the United States are needed. 
‘‘(c) DEVELOPMENT OF QUALITY MEASURES.— 
‘‘(1) 
PATIENT-CENTERED
AND
POPU-
LATION-BASED
MEASURES.—Quality meas-
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ures developed under agreements under 
subsection (a) shall be designed— 
‘‘(A) to assess outcomes and func-
tional status of patients; 
‘‘(B) to assess the continuity and 
coordination of care and care transi-
tions for patients across providers 
and health care settings, including 
end of life care; 
‘‘(C) to assess patient experience 
and patient engagement; 
‘‘(D) to assess the safety, effective-
ness, and timeliness of care; 
‘‘(E) to assess health disparities 
including those associated with indi-
vidual race, ethnicity, age, gender, 
place of residence or language; 
‘‘(F) to assess the efficiency and 
resource use in the provision of care; 
‘‘(G) to the extent feasible, to be 
collected as part of health informa-
tion technologies supporting better 
delivery of health care services; 
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‘‘(H) to be available free of charge 
to users for the use of such measures; 
and 
‘‘(I) to assess delivery of health 
care services to individuals regard-
less of age. 
‘‘(2) AVAILABILITY
OF
MEASURES.—The 
Secretary shall make quality measures 
developed under this section available to 
the public. 
‘‘(3) TESTING OF PROPOSED MEASURES.— 
The Secretary may use amounts made 
available under subsection (f) to fund the 
testing of proposed quality measures by 
qualified entities. Testing funded under 
this paragraph shall include testing of 
the feasibility and usability of proposed 
measures. 
‘‘(4) UPDATING
OF
ENDORSED
MEAS-
URES.—The Secretary may use amounts 
made available under subsection (f) to 
fund the updating (and testing, if applica-
ble) by consensus-based entities of qual-
ity measures that have been previously 
endorsed by such an entity as new evi-
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dence is developed, in a manner con-
sistent with section 1890(b)(3). 
‘‘(d) QUALIFIED ENTITIES.—Before entering 
into agreements with a qualified entity, the 
Secretary shall ensure that the entity is a 
public, nonprofit or academic institution with 
technical expertise in the area of health qual-
ity measurement. 
‘‘(e) APPLICATION FOR GRANT.—A grant may 
be made under this section only if an applica-
tion for the grant is submitted to the Sec-
retary and the application is in such form, is 
made in such manner, and contains such 
agreements, assurances, and information as 
the Secretary determines to be necessary to 
carry out this section. 
‘‘(f) FUNDING.— 
‘‘(1) IN GENERAL.—The Secretary shall 
provide for the transfer, from the Federal 
Hospital Insurance Trust Fund under 
section 1817 and the Federal Supple-
mentary Medical Insurance Trust Fund 
under section 1841 (in such proportion as 
the Secretary determines appropriate), of 
$25,000,000, to the Secretary for purposes 
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of carrying out this section for each of 
the fiscal years 2010 through 2014. 
‘‘(2) 
AUTHORIZATION
OF
APPROPRIA-
TIONS.—For purposes of carrying out the 
provisions of this section, in addition to 
funds otherwise available, out of any 
funds in the Treasury not otherwise ap-
propriated, there are appropriated to the 
Secretary of Health and Human Services 
$25,000,000 for each of the fiscal years 
2010 through 2014. 
‘‘SEC. 1193. GAO EVALUATION OF DATA COLLECTION PROC-
ESS FOR QUALITY MEASUREMENT. 
‘‘(a) GAO EVALUATIONS.—The Comptroller 
General of the United States shall conduct 
periodic evaluations of the implementation of 
the data collection processes for quality meas-
ures used by the Secretary. 
‘‘(b) CONSIDERATIONS.—In carrying out the 
evaluation under subsection (a), the Comp-
troller General shall determine— 
‘‘(1) whether the system for the collec-
tion of data for quality measures pro-
vides for validation of data as relevant 
and scientifically credible; 
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‘‘(2) whether data collection efforts 
under the system use the most efficient 
and cost-effective means in a manner 
that minimizes administrative burden on 
persons required to collect data and that 
adequately protects the privacy of pa-
tients’ personal health information and 
provides data security; 
‘‘(3) whether standards under the sys-
tem provide for an appropriate oppor-
tunity for physicians and other clinicians 
and institutional providers of services to 
review and correct findings; and 
‘‘(4) the extent to which quality meas-
ures 
are 
consistent 
with 
section 
1192(c)(1) or result in direct or indirect 
costs to users of such measures. 
‘‘(c) REPORT.—The Comptroller General 
shall submit reports to Congress and to the 
Secretary containing a description of the find-
ings and conclusions of the results of each 
such evaluation.’’. 
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SEC. 1443. MULTI-STAKEHOLDER PRE-RULEMAKING INPUT 
INTO SELECTION OF QUALITY MEASURES. 
Section 1808 of the Social Security Act (42 
U.S.C. 1395b–9) is amended by adding at the 
end the following new subsection: 
‘‘(d) MULTI-STAKEHOLDER PRE-RULEMAKING 
INPUT INTO SELECTION OF QUALITY MEASURES.— 
‘‘(1) LIST OF MEASURES.—Not later than 
December 1 before each year (beginning 
with 2011), the Secretary shall make pub-
lic a list of measures being considered for 
selection for quality measurement by the 
Secretary in rulemaking with respect to 
payment systems under this title begin-
ning in the payment year beginning in 
such year and for payment systems be-
ginning in the calendar year following 
such year, as the case may be. 
‘‘(2) CONSULTATION
ON
SELECTION
OF 
ENDORSED
QUALITY
MEASURES.—A 
con-
sensus-based entity that has entered into 
a contract under section 1890 shall, as 
part of such contract, convene multi- 
stakeholder 
groups 
to 
provide 
rec-
ommendations on the selection of indi-
vidual or composite quality measures, for 
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use in reporting performance informa-
tion to the public or for use in public 
health care programs. 
‘‘(3) MULTI-STAKEHOLDER
INPUT.—Not 
later than February 1 of each year (be-
ginning with 2011), the consensus-based 
entity described in paragraph (2) shall 
transmit 
to 
the 
Secretary 
the 
rec-
ommendations 
of 
multi-stakeholder 
groups provided under paragraph (2). 
Such recommendations shall be included 
in the transmissions the consensus-based 
entity makes to the Secretary under the 
contract provided for under section 1890. 
‘‘(4) REQUIREMENT
FOR
TRANSPARENCY 
IN PROCESS.— 
‘‘(A) IN
GENERAL.—In convening 
multi-stakeholder groups under para-
graph (2) with respect to the selection 
of quality measures, the consensus- 
based entity described in such para-
graph shall provide for an open and 
transparent process for the activities 
conducted pursuant to such con-
vening. 
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‘‘(B) SELECTION OF ORGANIZATIONS 
PARTICIPATING
IN
MULTI-STAKEHOLDER 
GROUPS.—The process under para-
graph (2) shall ensure that the selec-
tion of representatives of multi-stake-
holder groups includes provision for 
public nominations for, and the op-
portunity for public comment on, 
such selection. 
‘‘(5) USE
OF
INPUT.—The respective 
proposed rule shall contain a summary of 
the recommendations made by the multi- 
stakeholder groups under paragraph (2), 
as well as other comments received re-
garding the proposed measures, and the 
extent to which such proposed rule fol-
lows such recommendations and the ra-
tionale 
for 
not 
following 
such 
rec-
ommendations. 
‘‘(6) MULTI-STAKEHOLDER GROUPS.—For 
purposes of this subsection, the term 
‘multi-stakeholder groups’ means, with 
respect to a quality measure, a voluntary 
collaborative 
of 
organizations 
rep-
resenting persons interested in or af-
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fected by the use of such quality meas-
ure, such as the following: 
‘‘(A) Hospitals and other institu-
tional providers. 
‘‘(B) Physicians. 
‘‘(C) Health care quality alliances. 
‘‘(D) Nurses and other health care 
practitioners. 
‘‘(E) Health plans. 
‘‘(F) Patient advocates and con-
sumer groups. 
‘‘(G) Employers. 
‘‘(H) 
Public 
and 
private 
pur-
chasers of health care items and serv-
ices. 
‘‘(I) Labor organizations. 
‘‘(J) 
Relevant 
departments 
or 
agencies of the United States. 
‘‘(K) 
Biopharmaceutical 
compa-
nies and manufacturers of medical 
devices. 
‘‘(L) Licensing, credentialing, and 
accrediting bodies. 
‘‘(7) FUNDING.— 
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‘‘(A) IN
GENERAL.—The Secretary 
shall provide for the transfer, from 
the Federal Hospital Insurance Trust 
Fund under section 1817 and the Fed-
eral Supplementary Medical Insur-
ance Trust Fund under section 1841 
(in such proportion as the Secretary 
determines 
appropriate), 
of 
$1,000,000, to the Secretary for pur-
poses of carrying out this subsection 
for each of the fiscal years 2010 
through 2014. 
‘‘(B) AUTHORIZATION OF APPROPRIA-
TIONS.—For purposes of carrying out 
the provisions of this subsection, in 
addition to funds otherwise available, 
out of any funds in the Treasury not 
otherwise appropriated, there are ap-
propriated to the Secretary of Health 
and Human Services $1,000,000 for 
each of the fiscal years 2010 through 
2014.’’. 
SEC. 1444. APPLICATION OF QUALITY MEASURES. 
(a) INPATIENT HOSPITAL SERVICES.—Section 
1886(b)(3)(B) 
of 
such 
Act 
(42 
U.S.C. 
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1395ww(b)(3)(B)) is amended by adding at the 
end the following new clause: 
‘‘(x)(I) Subject to subclause (II), for pur-
poses of reporting data on quality measures 
for inpatient hospital services furnished dur-
ing fiscal year 2012 and each subsequent fis-
cal year, the quality measures specified under 
clause (viii) shall be measures selected by the 
Secretary from measures that have been en-
dorsed by the entity with a contract with the 
Secretary under section 1890(a). 
‘‘(II) In the case of a specified area or med-
ical topic determined appropriate by the Sec-
retary for which a feasible and practical qual-
ity measure has not been endorsed by the en-
tity with a contract under section 1890(a), the 
Secretary may specify a measure that is not 
so endorsed as long as due consideration is 
given to measures that have been endorsed or 
adopted by a consensus organization identi-
fied by the Secretary. The Secretary shall sub-
mit such a non-endorsed measure to the enti-
ty for consideration for endorsement. If the 
entity considers but does not endorse such a 
measure and if the Secretary does not phase- 
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out use of such measure, the Secretary shall 
include the rationale for continued use of 
such a measure in rulemaking.’’. 
(b) OUTPATIENT HOSPITAL SERVICES.—Sec-
tion 
1833(t)(17) 
of 
such 
Act 
(42 
U.S.C. 
1395l(t)(17)) is amended by adding at the end 
the following new subparagraph: 
‘‘(F) USE
OF
ENDORSED
QUALITY 
MEASURES.—The provisions of clause 
(x) of section 1886(b)(3)(C) shall apply 
to quality measures for covered OPD 
services under this paragraph in the 
same manner as such provisions 
apply to quality measures for inpa-
tient hospital services.’’. 
(c) 
PHYSICIANS’ 
SERVICES.—Section 
1848(k)(2)(C)(ii) of such Act (42 U.S.C. 1395w- 
4(k)(2)(C)(ii)) is amended by adding at the end 
the following: ‘‘The Secretary shall submit 
such a non-endorsed measure to the entity for 
consideration for endorsement. If the entity 
considers but does not endorse such a meas-
ure and if the Secretary does not phase-out 
use of such measure, the Secretary shall in-
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