458 
‘‘(d) REQUIREMENTS
FOR
HEALTH
CARE
MEAS-
URES.—In carrying out its duties under subsection (b), the 
designated organization shall ensure the following: 
‘‘(1) MEASURES.—The designated organization 
shall ensure that the measures established or endorsed 
under subsection (b) are evidence-based, reliable, and 
valid; and include— 
‘‘(A) measures of clinical processes and out-
comes, patient experience, efficiency, and equity; 
‘‘(B) measures to assess effectiveness, timeli-
ness, 
patient 
self-management, 
patient 
centeredness, and safety; and 
‘‘(C) measures of under use and over use. 
‘‘(2) PRIORITIES.— 
‘‘(A) IN GENERAL.—The designated organi-
zation shall ensure that priority is given to es-
tablishing and endorsing— 
‘‘(i) measures with the greatest poten-
tial impact for improving the effectiveness 
and efficiency of health care; 
‘‘(ii) measures that may be rapidly 
implemented by group health plans, health 
insurance issuers, physicians, hospitals, 
nursing homes, long-term care providers, 
and other providers; 
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459 
‘‘(iii) measures which may inform 
health care decisions made by consumers 
and patients; and 
‘‘(iv) measures that apply to multiple 
services furnished by different providers 
during an episode of care. 
‘‘(B) ANNUAL REPORT ON PRIORITIES; SEC-
RETARIAL PUBLICATION AND COMMENT.— 
‘‘(i) ANNUAL REPORT.—The designated 
organization shall issue and submit to the 
Secretary a report by March 31 of each 
year (beginning with 2009) on the organi-
zation’s recommendations for priorities and 
goals in establishing and endorsing health 
care measures under this section over the 
next five years. 
‘‘(ii) SECRETARIAL REVIEW AND COM-
MENT.—After receipt of the report under 
clause (i) for a year, the Secretary shall 
publish the report in the Federal Register, 
including any comments of the Secretary on 
the priorities and goals set forth in the re-
port. 
‘‘(3) RISK ADJUSTMENT.—The designated orga-
nization, in consultation with health care measure de-
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velopers and other stakeholders, shall establish proce-
dures to assure that health care measures established 
and endorsed under this section account for dif-
ferences in patient health status, patient characteris-
tics, and geographic location, as appropriate. 
‘‘(4) MAINTENANCE.—The designated organiza-
tion, in consultation with owners and developers of 
health care measures, shall require the owners or de-
velopers of such measures to update and enhance such 
measures, including the development of more accurate 
and precise specifications, and retire existing out-
dated measures. Such updating shall occur not more 
often than once during each 12-month period, except 
in the case of emergent circumstances requiring a 
more immediate update to a measure. 
‘‘(e) USE OF HEALTH CARE MEASURES; REPORT-
ING.— 
‘‘(1) USE OF MEASURES.—For purposes of ac-
tivities authorized or required under this title, the 
Secretary shall select from health care measures— 
‘‘(A) recommended by multi-stakeholder 
groups; and 
‘‘(B) endorsed by the designated organiza-
tion under subsection (b)(4). 
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