[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5404 Introduced in House (IH)]







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 
   Committee on Ways and Means, and in addition to the Committee on 
Commerce, for a period to be subsequently determined by the Speaker, in 
   each case for consideration of such provisions as fall within the 
                jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
   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.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Comprehensive 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 Secretary 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 comprehensive 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 individuals entitled to 
                benefits under this title;
                    ``(C) coordinate and, to the extent practicable, 
                ensure consistency between the quality of care 
                activities in this section and other quality 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 activities 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 Secretary 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 improvements 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 
                preventive services and other specific services; and
                    ``(D) such other categories as the Secretary 
                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 organizations and 
                individuals and other governmental organizations and 
                individuals;
                    ``(B) fund research as appropriate to develop 
                knowledge and understanding of quality of care, patient 
                safety, and medical errors to gain insight into better 
                system design to improve quality and safety, and to 
                develop quality and safety standards and performance 
                measures; 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 provided 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 outcomes of 
                care provided;
                    ``(C) identification of adverse events, including 
                adverse events that result from errors;
                    ``(D) performance of providers and suppliers 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 measures, and 
                best practices used by providers and suppliers in 
                achieving improvements in quality and safety and 
                achieving performance measures.
            ``(2) Establishment of common sets of data elements.--The 
        Secretary shall establish common sets of data elements and 
        shall ensure comparability of data.
            ``(3) Coordination of data.--The Secretary shall coordinate 
        the data systems described in subsection (e)(1) to form a 
        national database of information reported to the quality 
        improvement organizations.
            ``(4) Use of data.--The Secretary shall conduct 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 understanding 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 individuals entitled to 
                benefits under this title by gender, 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 Instruments.--
            ``(1) The Secretary shall establish and implement 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 representatives of providers of services, 
        suppliers, and with appropriate organizations and entities 
        representing private sector entities to promote the development 
        and use of common sets of quality measures that represent the 
        full spectrum of care obtained 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 assessment instrument utilized by the 
        Secretary with respect to items and services furnished under 
        this title, and shall supersede any patient assessment 
        instrument 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 law, the Secretary shall 
        use the standard patient assessment instruments established 
        under this subsection in determining payments amounts under 
        this title for items and services.
    ``(e) Requirements for Quality Improvement Organizations.--The 
Secretary shall enter into agreements with quality improvement 
organizations to carry out the following functions:
            ``(1) Implementation of data collection system.--To 
        implement a standard data collection system established by the 
        Secretary to collect--
                    ``(A) mandatory reports from providers and 
                suppliers on serious preventable adverse events (as 
                determined by the Secretary in regulations);
                    ``(B) voluntary reports of near misses (as 
                determined by the Secretary in regulations), clinical 
                systems problems, or other failures to meet quality or 
                safety standards or performance standards;
                    ``(C) reports of investigations of root causes of 
                serious preventable adverse events and near misses;
                    ``(D) corrective actions taken to address 
                identified quality and safety problems;
                    ``(E) data and information obtained in conducting 
                sampling of medical records and other investigations of 
                medical care;
                    ``(F) data on performance of providers and 
                suppliers in achieving quality standards and 
                performance measures; and
                    ``(G) such other information as the Secretary 
                determines appropriate.
            ``(2) Removal from data of personally identifiable 
        information.--To modify the data received to remove 
        identification of patients, providers or suppliers, and 
        reporters of the information, and to enter the information into 
        a database.
            ``(3) Investigations of adverse events.--To investigate 
        serious preventable adverse events at providers and suppliers 
        as reported through the mandatory reporting system.
            ``(4) Assistance with corrective action plans.--To assist 
        providers and suppliers to implement appropriate corrective 
        action plans in response to identification of serious 
        preventable adverse events.
            ``(5) Dissemination of information to providers.--To 
        provide dissemination of information and ongoing training to 
        providers and suppliers regarding quality and safety standards, 
        performance measures, best practices, analyses of information 
        regarding quality or safety, and other quality and safety 
        improvement information.
            ``(6) Forums for discussions of best practices and medical 
        errors.--To provide a means of convening of providers and 
        suppliers to discuss medical errors, failures to achieve 
        quality or safety standards, performance measures, best 
        practices, lessons learned by other providers and suppliers, 
        and other quality and safety issues.
            ``(7) Review of medical records.--To conduct ongoing 
        sampling and clinical data abstraction of medical records of 
        providers and suppliers and data submitted by providers and 
        suppliers on patient assessment instruments to identify quality 
        and safety problems and opportunities for improvement.
            ``(8) Analysis of data.--To conduct analyses of the data 
        included in the database to identify issues indicating quality 
        or safety problems, needed systems changes, and opportunities 
        for improvement.
            ``(9) Feedback to providers.--To provide ongoing feedback 
        to providers, suppliers, and other individuals regarding 
        reports, lessons learned from reports, investigations, and 
        corrective actions.
            ``(10) Protecting personally identifiable information.--The 
        provisions of section 1160 (relating to prohibition against 
        disclosure of information) apply with respect to data or 
        information on adverse events reported to quality improvement 
        organizations under this section, including such information 
        disseminated or discussed as provided for under this 
        subsection, in the same manner as such provisions apply to 
        information data or information acquired by such an 
        organization in the exercise of its duties and functions under 
        section 1160.
            ``(11) Maintenance of a toll-free telephone number.--To 
        provide information via a toll-free telephone number.
    ``(f) Requirements for Providers and Suppliers.--Providers and 
suppliers furnishing items and services under this title shall 
establish and maintain a Medicare Quality and Safety Program, which 
shall include the following elements:
            ``(1) Chief medical quality and safety officer.--
        Designation of a senior level Chief Medical Quality and Safety 
        Officer.
            ``(2) Written standards of quality care.--Written standards 
        for quality of care and patient and employee safety, including 
        error prevention, consistent with those promulgated by the 
        Secretary under subsection (b)(2), and policies and procedures 
        for implementing those standards, including disciplinary 
        standards.
            ``(3) Written standards for patients care.--Written 
        standards for patient assessment, preparation of a plan of care 
        for each patient (including participation of the patient in 
        clinical decision making), coordination of services among all 
        those providing services for the patient, monitoring of 
        quality, safety, and patient improvement, and records 
        management.
            ``(4) Ongoing education and training.--Ongoing conduct of 
        effective education and training of employees regarding quality 
        and safety, including the prevention of errors.
            ``(5) Ongoing monitoring and reporting.--Ongoing monitoring 
        and internal reporting of medical quality and safety, including 
        monitoring and reporting of serious preventable adverse events.
            ``(6) Prompt discussion of adverse events.--Prompt 
        discussion with patients of adverse events, including adverse 
        events that result from errors, and providing access to the 
        patients of information relating to such events.
            ``(7) Prompt reporting of medical errors.--Prompt reporting 
        (as determined by the Secretary) to the quality improvement 
        organizations of serious preventable adverse events, including 
        adverse events that result from errors, using standard formats 
        promulgated by the Secretary, and including encouragement of 
        reporting by employees.
            ``(8) Cooperation in case of investigations.--Cooperation 
        with the quality improvement organizations in investigating 
        causes of serious preventable adverse events, including adverse 
        events that result from errors, near misses, or other 
        investigations of quality or safety.
            ``(9) Cooperation in development of corrective action 
        plans.--Cooperation with the quality improvement organizations 
        in developing corrective action plans to address a serious 
        preventable adverse event, including an adverse event that 
        results from an error, or a corrective action plan to address 
        other quality or safety problems.
            ``(10) Cooperation in preparing annual reports.--
        Cooperation with the quality improvement organizations in 
        preparing public annual reports on progress in meeting quality 
        and safety standards and performance measures, as determined by 
the Secretary.
Notwithstanding any other provision of law, a provider or supplier may 
report adverse events, including those resulting from errors, as 
provided under this section without the consent of the individual who 
was furnished the medical care which gave rise to the adverse event.
    ``(g) Whistleblower Protections.--A provider of services or 
supplier may not penalize or take adverse action against an employee 
because the employee reports an adverse event to a quality improvement 
organization, or submits data or information to the Secretary with 
respect to the quality of items or services furnished under this title 
by such provider or supplier, consistent with the requirements of this 
section.
    ``(h) Medicare Quality and Safety Advisory Committee.--
            ``(1) Establishment.--The Secretary shall establish the 
        Medicare Quality Advisory Committee (hereinafter in this 
        subsection referred to as the `Committee'). The Secretary shall 
        consult with the Committee, and may consult directly with any 
        panel that the Committee establishes.
            ``(2) Duties.--The Committee, and its panels, shall provide 
        advice and recommendations to the Secretary with respect to--
                    ``(A) the quality and safety of medical care 
                furnished to individuals entitled to benefits under 
                this title, including such individuals enrolled in 
                Medicare+Choice plans under part C of this title;
                    ``(B) establishment of goals and specific annual 
                objectives with respect to such quality and safety; and
                    ``(C) other issues relating to such quality and 
                safety, including--
                            ``(i) reporting and collection of data,
                            ``(ii) appropriate research and analysis of 
                        data,
                            ``(iii) quality and safety standards, 
                        performance measures, and best practices,
                            ``(iv) dissemination of information to 
                        beneficiaries on treatment options,
                            ``(v) dissemination of information on 
                        quality of care and safety to providers and 
                        suppliers, and
                            ``(vi) such other quality of care and 
                        safety issues as the Committee may consider 
                        appropriate, or of which as the Secretary 
                        requests recommendations.
            ``(3) Membership; terms; compensation.--
                    ``(A) Membership.--
                            ``(i) Number and appointment.--The 
                        Commission shall be composed of 17 members, of 
                        whom 14 shall be appointed in accordance with 
                        clause (ii) and 3 appointed in accordance with 
                        in clause (iii).
                            ``(ii) Private individuals.--
                                    ``(I) In general.--The Secretary 
                                shall appoint 14 members from among 
                                individuals who are qualified by 
                                training and experience to evaluate the 
                                matters referred to the Committee and 
                                who are not officers or employees of 
                                the United States.
                                    ``(II) Provisions for conflict of 
                                interest.--Members shall recuse 
                                themselves from participation in 
                                matters which present a potential 
                                personal conflict of interest or 
                                appearance of such conflict that might 
                                introduce bias in the process of making 
                                recommendations under this subsection.
                            ``(iii) Individuals representing 
                        organizations.--The Secretary shall appoint one 
                        member from each of the following 
                        organizations:
                                    ``(I) The Medicare Coverage 
                                Advisory Committee.
                                    ``(II) A quality improvement 
                                organization.
                                    ``(III) The National Advisory 
                                Council for Healthcare Research and 
                                Quality.
                    ``(B) Terms.--
                            ``(i) In general.--Members of the Committee 
                        appointed under subparagraph (A) shall serve 
                        for a term of 3 years.
                            ``(ii) Staggered terms.--To ensure the 
                        staggered rotation of one-third of the members 
                        of the Committee each year, the Secretary is 
                        authorized to appoint the initial members of 
                        the Committee for terms of 1, 2, or 3 years.
                            ``(iii) Service beyond term.--A member of 
                        the Committee appointed under subparagraph (A) 
                        may continue to serve after the expiration of 
                        the term of the members until a successor is 
                        appointed.
                            ``(iv) Vacancies.--If a member of the 
                        Advisory Council appointed under subparagraph 
                        (A) does not serve the full term applicable 
                        under this subparagraph, the individual 
                        appointed to fill the resulting vacancy shall 
                        be appointed for the remainder of the term of 
                        the predecessor of the individual.
                            ``(v) Chair.--The Secretary shall, from 
                        among the members of the Committee appointed 
                        under subparagraph (A)(ii), designate an 
                        individual to serve as the chair of the 
                        Committee.
                    ``(C) Compensation.--
                            ``(i) Private individuals.--Members of the 
                        Committee appointed under subparagraph (A)(ii) 
                        shall receive compensation for each day 
                        (including travel time) engaged in carrying out 
                        the duties of the Advisory Council unless 
                        declined by the member. Such compensation may 
                        not be in an amount in excess of the daily 
                        equivalent of the annual rate of basic pay 
prescribed for level IV of the Executive Schedule under section 5315 of 
title 5, United States Code, for each day during which such member is 
engaged in the performance of the duties of the Advisory Council.
                            ``(ii) Individuals representing 
                        organizations.--Members appointed under 
                        subparagraph (A)(iii) may not receive 
                        compensation for service on the Committee in 
                        addition to the compensation otherwise received 
                        for duties carried out as members of the 
                        organization.
            ``(4) Report.--
                    ``(A) Annual report to the secretary.--Not later 
                than May 1 of every year beginning with 2002, the 
                Committee shall submit to the Secretary a report on--
                            ``(i) the activities of the Committee 
                        during the preceding year;
                            ``(ii) progress by providers of services 
                        and suppliers in meeting goals and objectives 
                        for improvement of the quality of items and 
                        services furnished under this title during such 
                        fiscal year; and
                            ``(iii) any recommendation of the Committee 
                        with respect to quality of care issues under 
                        this title.
                    ``(B) Publication of report.--Not later than 60 
                days after receipt of the report under subparagraph 
                (A), the Secretary shall publish the report, together 
                with any supplemental views of the Secretary, on the 
                Internet site of the Department of Health and Human 
                Services.
            ``(5) Duration.--Section 14(a)(2)(B) of the Federal 
        Advisory Committee Act (5 U.S.C. App.; relating to the 
        termination of advisory committees) shall not apply to the 
        Committee.
    ``(i) Report to Congress.--The Secretary shall submit to Congress 
an annual report on the progress of providers and suppliers in meeting 
the goals and objectives for improving quality of medical care and 
safety for individuals entitled to benefits under this title.
    ``(j) Definitions.--In this section:
            ``(1) Adverse event.--The term `adverse event' means an 
        unintended effect of medical intervention that results in harm 
        to a patient.
            ``(2) Preventable adverse event.--The term `preventable 
        adverse event' means an adverse event that is preventable, 
        including those that result from errors.''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall apply to items and services furnished on or after--
                    (A) in the case of a hospital, rehabilitation unit, 
                or end stage renal disease provider, October 1, 2001; 
                and
                    (B) in the case of any other provider or supplier, 
                at such time as the Secretary determines appropriate, 
                but in no event earlier than October 1, 2001.
            (3) Conforming Amendments.--
                    (A) Consultation with state agencies.--(i) Section 
                1864 of the Social Security Act (42 U.S.C. 1395aa) is 
                amended by adding at the end the following new 
                subsection:
    ``(f) In carrying out functions, relating to determination of 
conditions of participation by providers of services, under subsections 
(e)(9), (f)(4), (j)(15), (o)(6), (cc)(2)(I), and (dd)(2) of section 
1861, or by ambulatory surgical centers under section 1832(a)(2)(F)(i), 
the Secretary shall consult with appropriate State agencies and 
recognized national listing or accrediting bodies, and may consult with 
appropriate local agencies. Such conditions prescribed under any of 
such subsections may be varied for different areas or different classes 
of institutions or agencies and may, at the request of a State, provide 
higher requirements for such State than for other States; except that, 
in the case of any State or political subdivision of a State which 
imposes higher requirements on institutions as a condition to the 
purchase of services (or of certain specified services) in such 
institutions under a State plan approved under title I, XVI, or XIX, 
the Secretary shall impose like requirements as a condition to the 
payment for services (or for the services specified by the State or 
subdivision) in such institutions in such State or subdivision.''.
            (ii) The heading to such section is amended by adding at 
        the end the following:

 ``consultation with state agencies and other organizations to develop 
        conditions of participation for providers of services''.

                    (B) Chief medicare quality and safety officer.--
                Section 1117 of the Social Security Act (42 U.S.C. 
                1317) is amended--
                            (i) in the heading, by striking ``and chief 
                        actuary'' and inserting ``, chief actuary, and 
                        chief medicare quality and safety officer''; 
                        and
                            (ii) by adding at the end the following:
    ``(c)(1) There is established in the Health Care Financing 
Administration the position of Chief Medicare Quality and Safety 
Officer. The Chief Medicare Quality and Safety Officer shall be 
appointed by, and in direct line of authority to, the Administrator of 
such Administration. The Chief Medicare Quality and Safety Officer 
shall be appointed from among individuals who have demonstrated, by 
their education and experience, superior expertise in the quality in 
the delivery of health care services. The Chief Medicare Quality and 
Safety Officer shall exercise such duties as are appropriate for the 
office of the Chief Medicare Quality and Safety Officer. The Chief 
Medicare Quality and Safety Officer may be removed only for cause.
    ``(2) The Chief Medicare Quality and Safety Officer shall be 
compensated at the highest rate of basic pay for the Senior Executive 
Service under section 5382(b) of title 5, United States Code.''.
    (b) Agreements With Providers and Suppliers.--
            (1) In general.--Section 1866(a)(1) of the Social Security 
        Act (42 U.S.C. 1395cc(a)(1)) is amended--
                    (A) at the end of subparagraph (R) by striking 
                ``and'';
                    (B) at the end of subparagraph (S) by striking the 
                period and inserting ``, and''; and
                    (C) by inserting after subparagraph (S) the 
                following new subparagraph:
            ``(T) to carry out requirements with respect to 
        comprehensive quality of medical care and safety for items and 
        services furnished to individuals entitled to benefits under 
        this title imposed under section 1863, in such manner and 
        within such timeframes as the Secretary establishes in 
        regulations, including prompt reporting of medical errors to 
        the Secretary or to quality improvement organizations.''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply to items and services furnished on or after--
                    (A) in the case of a hospital, rehabilitation unit, 
                or end stage renal disease provider, October 1, 2001; 
                and
                    (B) in the case of any other provider or supplier, 
                at such time as the Secretary determines appropriate, 
                but in no event earlier than October 1, 2001.
    (c) Redesignation of Peer Review Organization as Quality 
Improvement Organization.--
            (1) Utilization and quality control peer review 
        organization.--
                    (A) In general.--The following sections of the 
                Social Security Act are each amended by striking 
                ``utilization and quality control peer review 
                organization'' each place it appears and inserting 
                ``quality improvement organization'':
                            (i) Title xi.--1128A(h), 1151, 1153(b)(1), 
                        the second sentence of 1153(c), 1153(d)(3), 
                        1153(d)(4), 1154(a), 1154(c), 1154(d), 1156(c), 
                        1158(a), and 1161(a)(1) (42 U.S.C. 1320a-7a(h), 
                        1320c, 1320c-2(b)(1), 1320c-2(c), 1320c-
                        2(d)(3), 1320c-2(d)(4), 1320c-3(a), 1320c-3(c), 
                        1320c-3(d), 1320c-5(c), 1320c-7(a), 1320c-
                        10(a)(1), respectively).
                            (ii) Title xviii.--1862(a)(15)(A), 1862(g), 
                        1866(a)(1)(F)(i), 1866(a)(1)(F)(ii), 
                        1867(d)(3), 1876(i)(7)(A), 1879(a), and 
                        1886(f)(2) (42 U.S.C. 1395y(a)(15)(A), 
                        1395y(g), 1395cc(a)(1)(F)(i), 
                        1395cc(a)(1)(F)(ii), 1395dd(d)(3), 
                        1395mm(i)(7)(A), 1395pp(a), and 1395ww(f)(2) 
                        respectively).
                            (iii) Title xix.--1902(d), 
                        1903(a)(3)(C)(i), and section 1921(b)(4) (42 
                        U.S.C. 1396a(d), 1396b(a)(3)(C)(i), and 1396r-
                        2(b)(4), respectively).
                    (B) Headings.--The headings of the following 
                sections of title XI of the Social Security Act are 
                each amended by striking ``utilization and quality 
                control peer review organization'' each place it 
                appears and inserting ``quality improvement 
                organization'': 1152, 1153, and 1163 (42 U.S.C. 1320c-
                1, 1320c-2, and 1320c-12, respectively).
            (2) Peer review organization.--The following sections of 
        the Social Security Act are each amended by striking ``peer 
        review organization'' each place it appears and inserting 
        ``quality improvement organization'':
                    (A) Title xi.--1153(e)(2), 1153(h)(3), 
                1154(a)(2)(B), 1154(a)(3)(E)(i), 1154(a)(4)(A), 
                1154(a)(4)(C), 1154(e)(2), 1154(e)(3)(A)(ii), 
                1154(e)(3)(B), 1154(e)(4)(B), 1155, 1156(a)(3), and 
                1160(b)(1) (42 U.S.C. 1320c-2(e)(2), 1320c-2(h)(3), 
                1320c-3(a)(2)(B), 1320c-3(a)(3)(E)(i), 1320c-
                3(a)(4)(A), 1320c-3(a)(4)(C), 1320c-3(e)(2), 1320c-
                3(e)(3)(A)(ii), 1320c-3(e)(3)(B), 1320c-3(e)(4)(B), 
                1320c-4, 1320c-5(a)(3), and 1320c-9(b)(1), 
                respectively).
                    (B) Title xviii.--1820(c)(2)(B)(iii), 
                1820(d)(2)(C)(ii), 1842(l)(1)(A)(iii)(I), 1842(l)(2), 
                and 1866(a)(3) (42 U.S.C. 1395i-4(c)(2)(B)(iii), 1395i-
                4(d)(2)(C)(ii), 1395u(l)(1)(A)(iii)(I), 1395u(l)(2), 
                and 1395cc(a)(3), respectively).
                    (C) Title xix.--1921(a)(1) (42 U.S.C. 1396r-
                2(a)(1)).
            (3) Peer review organizations.--
                    (A) In general.--Sections 1151, 1153(g), 
                1154(a)(10)(B), and 1154(f) of the Social Security Act 
                (42 U.S.C. 1320c, 1320c-2(g), and 1320c-3(a)(10)(B), 
                respectively) are each amended by striking ``peer 
                review organizations'' each place it appears and 
                inserting ``quality improvement organizations''.
                    (B) Headings.--The headings of sections 1154 and 
                1867(d)(3) of the Social Security Act (42 U.S.C. 1320c-
                3 and 1395dd, respectively) are each amended by 
                striking ``peer review organizations'' and inserting 
                ``quality improvement organizations''.
            (4) Quality control and peer review organization.--The 
        following sections of title XVIII of the Social Security Act 
        are each amended by striking ``quality control and peer review 
        organization'' each place it appears and inserting ``quality 
        improvement organization'': 1815(b), 1832(a)(2)(F)(ii)(I), 
        1861(v)(1)(G)(i), 1861(w)(2), and 1879(e) (42 U.S.C. 1395g(b), 
        1395k(a)(2)(F)(ii)(I), 1395x(v)(1)(G)(i), 1395x(w)(2), and 
        1395pp, respectively).
            (5) References.--Any reference in a law, regulation, 
        document, paper, or other record of the United States to a 
        ``peer review organization'', ``utilization and quality control 
        peer review organization'', or ``quality control and peer 
        review organization'' under part B of title XI of the Social 
        Security Act shall be deemed to be a reference to a ``quality 
        improvement organization'' under such part.
    (d) Additional Provisions Regarding Quality Improvement 
Organizations.--
            (1) Expansion of quality review authority to all providers 
        and suppliers.--
                    (A) In general.--Section 1154 of the Social 
                Security Act (42 U.S.C. 1320c-3) is amended by adding 
                at the end the following new subsection:
    ``(g) In this section, the terms `providers of health care 
services' and `provider' includes suppliers of items under title XVIII 
and Medicare+Choice organizations offering Medicare+Choice plans under 
part C of such title.
                    (B) Expansion of category of services for which 
                review may be requested.--Section 1154(e) of the Social 
                Security Act (42 U.S.C. 1320c-3(e)) is amended--
                            (i) in paragraph (1)(A)--
                                    (I) by striking ``hospital'' and 
                                inserting ``provider''; and
                                    (II) by striking ``inpatient 
                                hospital care'' and inserting ``items 
                                or services furnished'';
                            (ii) in paragraph (1)(B) by striking 
                        ``hospital's'' and inserting ``provider's'';
                            (iii) in the matter following subparagraph 
                        (B) of paragraph (1), by striking ``hospital'' 
                        and inserting ``provider'';
                            (iv) in paragraph (2)(A)--
                                    (I) by striking ``hospital'' and 
                                inserting ``provider''; and
                                    (II) by striking ``inpatient 
                                hospital care'' and inserting ``items 
                                or services furnished'';
                            (v) in paragraph (2)(B) by striking 
                        ``hospital's'' and inserting ``provider's'';
                            (vi) in the matter following subparagraph 
                        (B) of paragraph (2)--
                                    (I) by striking ``hospital'' each 
                                place it appears and inserting 
                                ``provider''; and
                                    (II) by striking ``hospital's'' and 
                                inserting ``provider's'';
                            (vii) in paragraph (3)(A), in the matter 
                        following clause (ii) of such paragraph--
                                    (I) by striking ``hospital's'' and 
                                inserting ``provider's'';
                                    (II) by striking ``the hospital'' 
                                each place it appears and inserting 
                                ``the provider''; and
                                    (III) by striking ``continued 
                                hospital care'' and inserting 
                                ``continued care'';
                            (viii) in paragraph (3)(B)--
                                    (I) in the matter preceding clause 
                                (i), by striking ``an inpatient in the 
                                hospital'' and inserting ``a patient 
                                being furnished items or services by 
                                the provider''; and
                                    (II) in clause (i), by striking 
                                ``hospital'' and inserting 
                                ``provider''; and
                            (ix) in paragraph (4)--
                                    (I) by striking ``the hospital'' 
                                and inserting ``the provider''; and
                                    (II) by striking ``inpatient 
                                hospital services'' and inserting 
                                ``items or services''.
                    (C) Condition of participation for all providers, 
                suppliers, and medicare+choice organizations.--Section 
                1886(a) of the Social Security Act (42 U.S.C. 
                1395ww(a)) is amended--
                            (i) in paragraph (1)(F)(ii), by striking 
                        ``and home health agencies,'' and ``or agency'' 
                        and inserting ``home health agencies, other 
                        provider of services, suppliers, and 
                        Medicare+Choice organizations offering 
                        Medicare+Choice plans under part '' and 
                        ``agency, other provider of services, supplier, 
                        or Medicare+Choice organization'', 
                        respectively; and
                            (ii) in paragraph (3), by striking ``or 
                        agency'' each place it appears and inserting 
                        ``agency, other provider of services, supplier, 
                        or Medicare+Choice organization''.
                    (D) Conduct of provider and supplier profiling.--
                Section 1154(a) of the Social Security Act (42 U.S.C. 
                1320c-3(a)) is amended by adding at the end the 
                following new paragraph:
            ``(17) The organization shall monitor and profile billing 
        patterns of providers of services within each area or locality 
        and provide comparative data to providers of services whose 
        utilization patterns vary significantly from other providers of 
        services in the same payment area or locality.''.
            (2) Prohibition on conduct of fraud and abuse 
        investigations.--Section 1154(a) of the Social Security Act (42 
        U.S.C. 1320c-3(a)) is amended by inserting after paragraph (11) 
        the following new paragraph:
            ``(12) The organization shall not conduct activities that 
        the Secretary, acting through the Office of the Inspector 
        General of the Department of Health and Human Services, and the 
        Attorney General conduct under sections 1128C, 1128D, or 1128E 
        with respective to the program to control fraud and abuse 
        established and carried out under those sections and under the 
        Medicare Integrity Program under section 1893.''.
            (3) Authorizing the secretary to approve contract 
        objectives.--(A) Section 1153(c)(7) of the Social Security Act 
        (42 U.S.C. 1320c-2(c)(7)) is amended--
                    (i) by striking ``shall'' and inserting ``may''; 
                and
                    (ii) by striking ``negotiated'' each place it 
                appears.
            (B) Section 1154(a)(4)(A) of such Act (42 U.S.C. 1320c-
        3(a)(4)(A)) is amended by striking ``after consultation with 
        the Secretary'' and inserting ``upon approval of the 
        Secretary''.
            (4) Clarifying the authority of the secretary to require 
        organizations to consider certain criteria and cases.--Section 
        1154(a)(4)(A) of the Social Security Act (42 U.S.C. 1320c-
        3(a)(4)(A)), as amended by paragraph (3)(B), is further amended 
        by inserting after the first sentence the following: ``IN 
        carrying out the previous sentence, the organization shall 
        consider types and kinds of cases and shall apply such 
        guidelines as the Secretary determines appropriate, including 
        national, professionally-developed standards of care.''.
            (5) Elimination of requirement for mandatory prior approval 
        for use of assistant at cataract surgery.--Section 1862(a)(15) 
        of the Social Security Act (42 U.S.C. 1395y(a)(15)) is amended 
        by striking ``(A) which are for'' and all that follows through 
        ``(B) which are for'' and inserting ``which are for''.
            (6) Elimination of on site review requirement.--Section 
        1154(a) of the Social Security Act (42 U.S.C. 1320c-3(a)) is 
        amended by striking paragraph (15).
            (7) Clarifying the authority of the secretary to decline to 
        renew a contract with an organization for reasons other than 
        poor performance.--Section 1153(c)(4) of the Social Security 
        Act (42 U.S.C. 1320c-2(c)(4)) is amended by inserting ``on the 
        basis of the organization's performance or of any other 
        criteria the Secretary determines appropriate'' after ``if the 
        Secretary intends not to renew a contract''.
            (8) Elimination of duplicative reporting requirement.--
        Title XI of the Social Security Act (42 U.S.C. 1301 et seq.) is 
        amended by striking section 1161.
            (9) Effective date.--The amendments made by this subsection 
        take effect the date of the enactment of this Act and apply to 
        contracts entered into or renewed on or after that date.
                                 <all>