[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5141 Introduced in House (IH)]







107th CONGRESS
  2d Session
                                H. R. 5141

To amend title XVIII of the Social Security Act to direct the Secretary 
    of Health and Human Services to establish a continuous quality 
   improvement program for providers that furnish services under the 
 Medicare Program to individuals with end stage renal disease, and for 
                            other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 16, 2002

  Mr. Stark introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, 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 direct the Secretary 
    of Health and Human Services to establish a continuous quality 
   improvement program for providers that furnish services under the 
 Medicare Program to individuals with end stage renal disease, 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 ``ESRD Quality Improvement Act of 
2002''.

SEC. 2. CONTINUOUS QUALITY IMPROVEMENT PROGRAM FOR ESRD FACILITIES 
              UNDER MEDICARE.

    (a) In General.--Section 1881 of the Social Security Act (42 U.S.C. 
1395rr) is amended by adding at the end the following new subsection:
    ``(h) Continuous Quality Improvement and Quality Assurance 
Program.--
            ``(1) CQI and QA programs.--
                    ``(A) In general.--Not later than 1 year after the 
                date of the enactment of this subsection, the Secretary 
                shall establish a mandatory continuous quality 
                improvement program (in this section referred to as the 
                `CQI Program') and a mandatory quality assurance 
                program (in this section referred to as the `QA 
                Program') for furnishing services to individuals 
                determined to have end stage renal disease under this 
                section. In establishing the CQI Program and the QA 
                Program, the Secretary shall consult with 
                representatives of patients, providers of services and 
                renal dialysis facilities (including facility 
                administrators, physicians (including nephrologists), 
                dietitians, social workers, and nurses), facilities, 
                quality improvement experts, and ESRD Network 
                Administrative Organizations (as defined in paragraph 
                (8)).
                    ``(B) Provisions relating to qa program only.--The 
                Secretary shall contract with the ESRD Network 
                Administrative Organizations and with State survey 
                agencies to conduct a coordinated quality assurance 
                program (in this section referred to as the `QA 
                Program') that recognizes excellent ESRD clinical 
                outcomes and imposes sanctions for chronically 
                substandard care.
                    ``(C) Coordination with established department or 
                organization programs.--The CQI Program required under 
                this subsection, the ESRD Clinical Performance Measures 
                required under paragraph (4), the information 
                management system required under paragraph (5), the QA 
                Program, and other components of this subsection, as 
                appropriate, shall be established or developed in 
                conjunction with relevant quality improvement goals 
                established by the Secretary, or by ESRD Network 
                Administrative Organizations, which are in effect or in 
                the process of development as of the date of the 
                enactment of this subsection.
            ``(2) Duties of the secretary.--Under the CQI Program the 
        Secretary--
                    ``(A) shall establish, and publish in the Federal 
                Register, the ESRD Clinical Performance Measures as 
                described in paragraph (4);
                    ``(B) shall collect and analyze data from providers 
                and facilities as described in paragraph (5);
                    ``(C) shall identify and reward outstanding 
                providers and facilities as described in paragraph (6);
                    ``(D) shall identify and provide for additional 
                training to providers and facilities in need of such 
                training as described in paragraph (7) and shall 
                institute such disciplinary actions as deemed 
                appropriate against those providers and facilities that 
                fail to improve;
                    ``(E) shall develop, in conjunction with the Work 
                Group, and implement a methodology to identify serious 
                medical errors and injuries involving end-stage renal 
                disease patients and to analyze the causes for such 
                injuries (such implementation may first be initiated 
                through a  demonstration project that is coordinated by 
the ESRD Network Administrative Organizations);
                    ``(F) delineate the shared and distinctive duties 
                of the ESRD Network Administrative Organizations and 
                State survey agencies with respect to facility or 
                provider certification and investigation;
                    ``(G) develop standards to evaluate the performance 
                of ESRD Network Administrative Organizations and State 
                survey agencies; and
                    ``(H) determine an appropriate uniform minimum 
                frequency for on-site dialysis certification and 
                recertification surveys.
            ``(3) Duties of ESRD Network Administrative 
        Organizations.--ESRD Network Administrative Organizations shall 
        perform the following functions:
                    ``(A) Collection and analysis of data on processes 
                and outcomes of care; use of esrd clinical performance 
                measures.--
                            ``(i) In general.--The ESRD Network 
                        Administrative Organizations shall provide for 
                        the routine and timely data collection, and 
                        statistical evaluation, of the processes and 
                        outcomes of care for patients undergoing kidney 
                        transplant, hemodialysis and other modalities 
                        requiring blood access, and peritoneal 
                        dialysis.
                            ``(ii) Data used.--In carrying out such 
                        measurements and evaluations, the ESRD Network 
                        Administrative Organizations shall use, among 
                        other data, the ESRD Clinical Performance 
                        Measures established under paragraph (4), and 
                        data acquired under subparagraphs (F) and (H) 
                        of subsection (c)(2), including medical 
                        injuries and their causes, medical errors, and 
                        evidence of Hepatitis B and C serologic 
                        conversion of patients or staff.
                            ``(iii) Feedback to providers and 
                        facilities.--The ESRD Network Administrative 
                        Organizations shall provide feedback to 
                        providers, facilities, and physicians, from 
                        whom data has been collected of their patterns 
                        of practice and ESRD Clinical Performance 
                        Measures outcomes as compared to the following:
                                    ``(I) National averages of such 
                                patterns and outcomes.
                                    ``(II) State, Network, and where 
                                statistically appropriate, local 
                                averages of such patterns and outcomes.
                                    ``(III) Clinical goals established 
                                by the Secretary of such patterns and 
                                outcomes.
                    ``(B) Dissemination of recommended clinical 
                practices.--The ESRD Network Administrative 
                Organizations shall disseminate recommended clinical 
                practices derived from evidence based practice 
                guidelines or clinical algorithms to medical directors 
                of dialysis facilities and to such other providers of 
                services as the Secretary determines appropriate.
                    ``(C) Monitoring patient and staff satisfaction.--
                The ESRD Network Administrative Organizations, 
                individual renal dialysis facilities, and individual 
                providers of services shall collaborate to develop a 
                uniform mechanism--
                            ``(i) to monitor patient and staff 
                        satisfaction and shall ensure an effective and 
                        integrated complaint system; and
                            ``(ii) for the reporting of data by 
                        dialysis facility to the Network of the nurse 
                        to patient ratio and the technician to patient 
                        ratio of the facility.
                State survey agencies shall also collaborate in the 
                establishment of the mechanism with respect to clause 
                (i).
                    ``(D) Peer review.--The ESRD Network Administrative 
                Organizations shall conduct regional and national peer 
                review of renal dialysis facilities and providers of 
                services.
                    ``(E) Technical assistance.--The ESRD Network 
                Administrative Organizations shall provide technical 
                assistance for quality improvement efforts and identify 
                quality improvement activities to reflect evolving 
                needs of facilities and patients including 
                rehabilitation, patient education, community outreach, 
                grievance resolution, and patient rights and 
                responsibilities.
                    ``(F) Guidance on collection and calculation of 
                clinical performance measures.--In consultation with 
                the Work Group (as defined in paragraph (8), the ESRD 
                Network Administrative Organizations shall provide 
                guidance to providers of services and renal dialysis 
                facilities on the collection and measurement of the 
                ESRD Clinical Performance Measures.
                    ``(G) Dissemination of information on cqi program 
                and qa program.--
                            ``(i) In general.--The ESRD Network 
                        Administrative Organizations shall make 
                        information and materials under the program 
                        available for the use of--
                                    ``(I) facilities and providers in 
                                Medicare+Choice organizations;
                                    ``(II) facilities and providers 
                                that do not receive payments under this 
                                title;
                                    ``(III) private payers of services 
                                for end stage renal disease patients; 
                                and
                                    ``(IV) end stage renal disease 
                                patients and families.
                            ``(ii) Requirements relating to patient 
                        information.--
                                    ``(I) In general.--In making 
                                available information under clause (i) 
                                for patients and families, the 
ESRD Network Administrative Organizations shall make available the 
information described in subclause (II) in printed and electronic 
format. The content of such information shall be determined by the Work 
Group.
                                    ``(II) Information described.--The 
                                information referred to in subclause 
                                (I) is CQI Program information and 
                                facility-specific ESRD Clinical 
                                Performance measures and outcomes, 
                                including comparisons to clinical goals 
                                established by the Secretary under 
                                subparagraph (A)(iii)(III) and national 
                                and appropriate State, Network, and 
                                local averages of such measures and 
                                outcomes.
            ``(4) ESRD clinical performance measures.--
                    ``(A) Development of initial indicators.--Not later 
                than 1 year after the date of the enactment of this 
                subsection, the Work Group as defined in paragraph (8), 
                shall define a set of ESRD Clinical Performance 
                Measures.
                    ``(B) Updating of indicators.--The Work Group shall 
                periodically update the ESRD Clinical Performance 
                Measures defined in subparagraph (A).
                    ``(C) Authority to consider certain indicators.--
                The ESRD Clinical Performance Measures defined under 
                subparagraph (A) and updated under subparagraph (B) may 
                include patient outcome measures based upon the 
                following types of indicators:
                            ``(i) Adequacy of hemodialysis and 
                        peritoneal dialysis.
                            ``(ii) Adequacy of nutrition including bone 
                        and mineral metabolism.
                            ``(iii) Vascular access.
                            ``(iv) Anemia management including average 
                        per patient dosage of anti-anemia medications.
                            ``(v) Standardized mortality ratios.
                            ``(vi) Standardized hospitalization ratios 
                        and average length of hospital stay.
                            ``(vii) Standardized transplantation 
                        ratios.
                            ``(viii) Adequacy of blood pressure 
                        control.
                            ``(ix) Successful vocational maintenance or 
                        rehabilitation.
                            ``(x) Referral for self-treatment at home.
                            ``(xi) Appropriate administration of 
                        clinical laboratory tests.
                            ``(xii) Such other indicators as the Work 
                        Group considers appropriate, including any 
                        appropriate unique measures for kidney 
                        transplant centers.
                    ``(D) Coordination with established department or 
                organization quality improvement goals.--To the 
                greatest extent possible, the ESRD Clinical Performance 
                Measures shall be defined in conjunction with relevant 
                quality improvement goals established by the Secretary, 
                or by ESRD Network Administrative Organizations, which 
                are in effect or in the process of development as of 
                the date of the enactment of this paragraph, including 
                information system design and implementation, and 
                enhanced data collection, analysis, and reporting 
                initiatives.
                    ``(E) Authority for organizations to establish 
                certain specific indicators.--The ESRD Network 
                Administrative Organizations, individual renal dialysis 
                facilities, and individual providers of services may 
                establish additional independent patient-specific, 
                physician-specific or facility-specific performance 
                measures.
                    ``(F) Publication in the Federal Register.--The 
                Secretary shall publish in the Federal Register the 
                ESRD Clinical Performance Measures as defined under 
                subparagraph (A), and as updated in subparagraph (B).
            ``(5) ESRD cqi program.--
                    ``(A) Information management system.--Not later 
                than 2 years after the date of the enactment of this 
                subsection, the Secretary shall establish an 
                information management system. The purpose of the 
                information management system is to provide for the 
                electronic transfer of data obtained under the CQI 
                Program and the QA Program among providers of services, 
                renal dialysis facilities, the Secretary, ESRD Network 
                Administrative Organizations, and state agencies under 
                contract with the Secretary to conduct surveys of 
                dialysis facilities. The Secretary shall provide for 
                technical assistance in the use of the information 
                management system and for the development (or purchase) 
                and distribution of appropriate electronic software for 
                access to the information management system.
                    ``(B) Manner of use of information management 
                system.--
                            ``(i) Providers of services and 
                        facilities.--Each provider of services and each 
                        renal dialysis facility shall contribute data 
                        obtained under the CQI Program and the QA 
                        Program to the information management system.
                            ``(ii) ESRD Network Administrative 
                        Organizations.--Each ESRD Network 
                        Administrative Organization shall generate 
                        clinical profiles on the performance of renal 
                        dialysis facilities and individual providers of 
                        services, and shall monitor trends relevant to 
                        performance of facilities and providers.
                    ``(C) Duties of the secretary.--With respect to 
                data contributed to the information management system, 
                the Secretary shall perform the following duties:
                            ``(i) Collection of unadjusted data.--The 
                        Secretary shall use the information management 
                        system to collect, at least biannually, the 
                        unadjusted data required to compute standards 
                        on all patient outcomes--
                                    ``(I) from each provider of 
                                services and renal dialysis facility; 
                                and
                                    ``(II) from physicians providing 
                                services to individuals determined to 
                                have end stage renal disease under this 
                                section.
                            ``(ii) Compilation of data.--The Secretary 
                        shall combine the data collected under clause 
                        (i) on individual patient outcomes into 
                        aggregate data for each provider of services 
                        and renal dialysis facility and for each such 
                        physician.
                            ``(iii) Risk-adjusted comparisons of 
                        providers.--To the extent possible, the 
                        Secretary shall adjust the data combined under 
                        clause (ii) to establish risk adjusted 
                        comparisons of the ESRD Clinical Performance 
                        Measures of--
                                    ``(I) each provider of services and 
                                renal dialysis facility with other such 
                                providers and facilities;
                                    ``(II) each such physician with 
                                other such physicians in the network 
                                area and the nation; and
                                    ``(III) the current clinical 
                                outcome goals established by the 
                                Secretary (as periodically updated).
                            ``(iv) National clinical performance 
                        measures database.--The Secretary shall 
                        administer a national clinical performance 
                        measures database from the data combined and 
                        adjusted under this subparagraph.
                            ``(v) Confidential reports.--Using CQI 
                        reports that preserve patient confidentiality 
                        and confidentiality between providers and 
                        facilities, the Secretary shall report--
                                    ``(I) each provider's and 
                                facility's combined and adjusted data 
                                under this subparagraph to the provider 
                                or facility and each such physician's 
                                combined and adjusted data under this 
                                subparagraph to the physician;
                                    ``(II) how that provider, facility, 
                                and physician (as the case may be) 
                                compare in various CQI indicators to 
                                other providers, facilities, or 
                                physicians in the same network, in all 
                                networks, and to the ESRD Clinical 
                                Performance Measures; and
                                    ``(III) such data to the ESRD 
                                Network Administrative Organization for 
                                the network area in which the provider, 
                                facility or physician is located.
                            ``(vi) Dissemination of certain data.--
                        While protecting patient, provider, and 
                        facility confidentiality, the Secretary shall 
                        provide the data collected under clauses (i), 
                        (ii), and (iii) to the United States Renal Data 
                        System, State survey agencies, and other public 
                        entities that the Secretary determines is 
                        engaged in efforts to improve the quality of 
                        services for renal patients.
                    ``(D) Requirement to report data on patients 
                discharged for noncompliance with treatment plan.--In 
                the case of an individual who is discharged from a 
                facility or provider by the facility, provider, or a 
                physician, for noncompliance with the treatment plan 
                established for the individual by the facility, 
                provider, or physician, as the case may be, the 
                facility, provider, or physician shall report such 
                discharge and reasons for the discharge to the 
                Secretary.
                    ``(E) Plan to improve services.--In the case of a 
                facility notified under paragraph (7)(B), the ESRD 
                Network Administrative Organization for the network 
                area in which the facility is located, in conjunction 
                with the facility, shall develop strategies to improve 
                the provision of services at the facility and shall 
                provide appropriate training in CQI Program processes 
                to the facility.
                    ``(F) Physician training.--The ESRD Network 
                Administrative Organization for the network area in 
                which the facility is located, in conjunction with the 
                facility, shall review the quality of service provided 
                by physicians notified under paragraph (7)(B) or 
                identified under subparagraph (E) at such facility for 
                the purposes of identifying those physicians that 
                require training in CQI Program processes. In the case 
                of a physician notified under paragraph (7)(B) or 
                identified under subparagraph (E), the ESRD Network 
                Administrative Organization for the area in which the 
                physician is located, in conjunction with the 
                physician, shall develop strategies to improve the 
                provision of services by the physician, and shall 
                provide appropriate training in CQI Program processes 
                to the physician.
            ``(6) Awards for outstanding providers and facilities.--
                    ``(A) Designation of facility or physician as a 
                medicare dialysis provider of achievement.--For each of 
                2005, 2006, and 2007, the Secretary shall designate 
                Medicare Dialysis Providers of Achievement (as defined 
                in subparagraph (B)).
                    ``(B) Definition of medicare dialysis provider of 
                achievement.--A Medicare Dialysis Provider of 
                Achievement is a renal dialysis facility, or a 
                physician, identified by the Secretary as being 2 
                standard deviations above the national norm for a 
                preponderance of ESRD  Clinical Performance Measures on 
a case severity-risk adjusted basis for 2 consecutive reporting periods 
(covering in the aggregate a period of at least 1 year).
                    ``(C) Authority to make bonus payments.--The 
                Secretary may make a payment to a Medicare Dialysis 
                Provider of Achievement--
                            ``(i) in a single monetary payment of not 
                        less than $1,000 and not greater than to 
                        $5,000; or
                            ``(ii) by increasing the reimbursement rate 
                        otherwise applicable under this section to the 
                        facility or physician by 1 to 3 percent for a 
                        period of 1 year.
                    ``(D) Report on successful processes and 
                techniques.--Upon request by any ESRD Network 
                Administrative Organization, a Medicare Dialysis 
                Provider of Achievement designated under subparagraph 
                (A) shall submit to such organization a report on the 
                clinical process and monitoring techniques which the 
                facility determines are most responsible for the 
                facility's or physician's successful outcomes for use 
                as a model for other facilities and physicians.
                    ``(E) List of medicare dialysis providers of 
                achievement.--The Secretary shall maintain and update a 
                list of Medicare Dialysis Providers of Achievement. Not 
                later than March 1 of each of 2006, 2007, and 2008, the 
                Secretary shall publish such list for the applicable 
                preceding year in the Federal Register. The appropriate 
                ESRD Network Administrative Organization shall publicly 
                recognize such providers of achievement at an annual 
                meeting.
            ``(7) ESRD qa program.--
                    ``(A) Review of cqi data to identify chronically 
                substandard providers.--
                            ``(i) In general.--The ESRD Network 
                        Administrative Organizations shall review the 
                        quantitative, evidence-based ESRD Clinical 
                        Performance Measures to identify chronically 
                        substandard facilities, providers, and 
                        physicians.
                            ``(ii) Use of data.--Data identified by the 
                        ESRD Network Administrative Organizations under 
                        clause (i) shall be submitted to the 
                        appropriate State survey agency to initiate 
                        review and appropriate subsequent actions. Such 
                        actions shall be coordinated with the 
                        appropriate ESRD Network Administrative 
                        Organization.
                    ``(B) Notice of substandard services.--If the 
                Secretary or the ESRD Network Administrative 
                Organization for the network area in which a dialysis 
                facility or physician is located determines that the 
                facility or physician is 2 standard deviations below 
                the national norm for a preponderance of the ESRD 
                Clinical Performance Measures selected for this purpose 
                by the Work Group on a case severity-risk adjusted 
                basis for 2 consecutive reporting periods (covering in 
                the aggregate a period of at least 1 year), the 
                Secretary or ESRD Network Administrative Organization 
                shall notify the facility's medical director and any 
                affected attending physicians of such determination.
                    ``(C) Sanctions for esrd networks.--If the 
                Secretary finds that an ESRD Network Administrative 
                Organization has not made a good faith effort to carry 
                out all of the data collection, CQI Program, QA 
                Program, administrative and oversight activities 
                assigned, the Secretary may--
                            ``(i) require within a specified time 
                        frame, a plan of correction; and
                            ``(ii) terminate any contracts with the 
                        ESRD Network Administrative Organization and 
                        reshape the networks by merging or otherwise 
                        redefining the geographic areas of 
                        responsibility.
                    ``(D) Sanctions for facilities.--If the Secretary 
                finds that the facility or medical director has not 
                made a good faith effort to improve its performance 
                under this paragraph, the Secretary shall--
                            ``(i) subject to subparagraph (F)--
                                    ``(I) assess a civil monetary 
                                penalty of not less than $500 and not 
                                more than $10,000;
                                    ``(II) reduce reimbursement rates 
                                under this section by not less than 1 
                                and not more than 3 percent for a 
                                period not to exceed one year, or
                                    ``(III) in the event of life-
                                threatening or recurrent violations, 
                                terminate or withhold certification of 
                                the facility for purposes of payment 
                                under this section; and
                            ``(ii) notify and work collaboratively with 
                        the ESRD Network Administrative Organization 
                        involved and appropriate State survey agency to 
                        carry out (if appropriate) one or more of the 
                        following actions:
                                    ``(I) Recommend that a substitute 
                                administrator or director be appointed 
                                by the appropriate State agency or 
                                officer with the authority to hire, 
                                terminate and reassign staff, obligate 
                                funds, and alter facility procedures as 
                                appropriate.
                                    ``(II) Require corrective action 
                                within specified time frames according 
                                to a plan developed by the network, the 
                                State, or the temporary manager (if any 
                                is appointed).
                                    ``(III) Place an on-site monitor to 
                                ensure the facility achieves and 
                                maintains acceptable levels of quality 
                                in furnishing services.
                                    ``(IV) Carry out such other actions 
                                as the Secretary determines 
                                appropriate.
                    ``(E) Sanctions for physicians.--If the Secretary 
                finds that the attending physician has not made a good 
                faith effort to improve performance under this 
                paragraph, the Secretary shall initiate--
                            ``(i) further investigation of the 
                        physician; or
                            ``(ii) such other actions as the Secretary 
                        determines appropriate, after consultation with 
                        the appropriate ESRD Network Administrative 
                        Organization and State survey agency.
                    ``(F) Determination of responsibility for 
                substandard services.--If the Secretary terminates or 
                withholds the certification of a facility under 
                subparagraph (D)(i)(III), the State survey organization 
                and the ESRD Network Administrative Organizations 
                involved shall submit to the Secretary a statement with 
                respect to the relative responsibility of the facility, 
                the medical director, and attending physician for the 
                deficiencies involved.
            ``(8) Definitions.--As used in this subsection:
                    ``(A) ESRD network administrative organization.--
                The term `ESRD Network Administrative Organization' 
                means a network administrative organization designated 
                under subsection (c)(1)(A)(i)(II).
                    ``(B) Work Group.--The term `Work Group' means the 
                ESRD Clinical Performance Measures Work Group 
                established under this subparagraph as follows:
                            ``(i) Composition.--The Work Group shall be 
                        composed of the Secretary and of such 
                        representatives of patient advocacy groups, 
                        providers of renal services, the network 
                        administrative organizations, the United States 
                        Renal Data System, patient vocational and 
                        rehabilitation organizations, and quality 
                        improvement organizations that the Secretary 
                        appoints.
                            ``(ii) Term.--Members of the Work Group who 
                        are appointed by the Secretary may not serve 
                        for more than three consecutive terms.
                            ``(iii) Application of faca.--The 
                        provisions of the Federal Advisory Committee 
                        Act (5 U.S.C. App.), other than section 
                        14(a)(2)(B) of such Act (relating to the 
                        termination of advisory committees), shall 
                        apply to the Work Group.''.
    (b) Responsibilities of ESRD Providers, Facilities, Networks and 
State Survey Agencies.--
            (1) Participation in cqi program and qa program as 
        requirement for medicare payment for providers and 
        facilities.--
                    (A) In general.--The second sentence of section 
                1881(b)(1) of the Social Security Act (42 U.S.C. 
                1395rr(b)(1)) is amended by inserting before the period 
                the following: ``, and a requirement that the provider 
                of services or renal dialysis facility meet the 
                requirements of subsection (i) with respect to 
                participation in the CQI Program and the QA Program 
                under subsection (h)''.
                    (B) Specific requirements described.--Section 1881 
                of such Act (42 U.S.C. 1395rr), as amended by 
                subsection a, is amended by adding at the end the 
                following new subsection:
    ``(i) Mandatory Participation in CQI Program.--
            ``(1) In general.--For purposes of subsection (b)(1), each 
        provider of services or renal dialysis facility shall take such 
        actions as may be required for the provider or facility to 
        participate in the CQI Program and the QA Program under 
        subsection (h), including--
                    ``(A) establishing a CQI team (as defined in 
                paragraph (3));
                    ``(B) developing and operating a quality 
                improvement program consistent with the requirements of 
                the CQI Program under subsection (h);
                    ``(C) furnishing information required for the 
                collection and reporting of data under subsection 
                (h)(4);
                    ``(D) posting in a prominent location of the 
                provider or facility the data described in subsection 
                (h)(3)(A)(ii); and
                    ``(E) taking any other action which the Secretary 
                or the ESRD Network Administrative Organizations may 
                require in the administration of the CQI Program or the 
                QA Program.
            ``(2) Sanctions for reporting false data.--If the Secretary 
        determines that a facility or provider has knowingly and 
        willfully reported false data under the CQI Program or the QA 
        Program, the Secretary shall terminate certification of the 
        facility or provider for the purposes of payment for services 
        furnished to individuals with end stage renal disease and shall 
        ensure the placement of the facility's patients with another 
        qualified provider.
            ``(3) Definition of cqi team.--The term `CQI team' means a 
        group established by a provider of services or renal dialysis 
        facility as follows:
                    ``(A) Composition.--
                            ``(i) In general.--The group shall consist 
                        of the medical director, director of nursing, 
                        social worker, dietitian, and chief technician 
                        of the provider or facility, and shall include 
                        representatives of the patients of the provider 
                        or facility.
                            ``(ii) Director.--The group shall designate 
                        one of its members as the Director of 
                        Continuous Quality Improvement for the provider 
                        or facility who shall coordinate with the ESRD 
                        Network Administrative Organization for the 
                        network area in which the provider or facility 
                        is located on CQI Program issues.
                    ``(B) Duties.--The group shall--
                            ``(i) ensure that the provider or facility 
                        meets the requirements of this paragraph;
                            ``(ii) consistent with the standards of the 
                        CQI Program under subsection (h), promote 
                        clinical practice guidelines or algorithms for 
                        the use of the provider or facility; and
                            ``(iii) take any other actions which may be 
                        required to ensure the full participation of 
                        the provider or facility in the CQI Program 
                        under subsection (h).
                    ``(C) Meetings.--The group shall periodically hold 
                meetings, which shall be open to patients and personnel 
                of the provider or facility, and make minutes of the 
                meetings available to patients and personnel for a 
                reasonable period of time.''.
            (2) Responsibilities of esrd network administrative 
        organizations.--
                    (A) Assistance in operation of program.--Section 
                1881(c)(2)(B) of such Act (42 U.S.C. 1395rr(c)(2)(B)) 
                is amended by inserting after ``(B)'' the following: 
                ``assisting the Secretary in the administration of the 
                CQI Program under subsection (h) and (consistent with 
                the operation of such Program)''.
                    (B) Collection and dissemination of cqi data.--
                Section 1881(c)(2) of such Act (42 U.S.C. 1395rr 
                (c)(2)) is amended--
                            (i) by striking ``and'' at the end of 
                        subparagraph (G);
                            (ii) by redesignating subparagraph (H) as 
                        subparagraph (I); and
                            (iii) by inserting after subparagraph (G) 
                        the following new subparagraph:
            ``(H) collecting and making public data on facilities and 
        providers generated under the CQI Program under subsection (h) 
        (in accordance with standards established by the Secretary in 
        consultation with representatives of providers, facilities, and 
        patients) and auditing samples of such data to ensure its 
        accuracy.''.
            (3) Responsibilities of state survey agencies.--Section 
        1881, as amended by subsection (a) and paragraph (1)(B), is 
        further amended by adding at the end the following new 
        subsection:
    ``(j) Assistance of State Survey Agencies.--Each State agency 
responsible for the licensing of a provider or facility shall provide 
the following assistance under this section:
            ``(1) Assistance in operation of program.--The State agency 
        shall provide such assistance to the Secretary and the ESRD 
        Network Administrative Organizations in the administration of 
        the CQI Program and the QA Program under subsection (h) and 
        (consistent with the operation of such Program) as the 
        Secretary requires.
            ``(2) Collection and dissemination of cqi data.--The State 
        agency shall forward copies of all complaints, investigations 
        and surveys of providers or facilities to the appropriate ESRD 
        Network Administrative Organizations.''.
            (4) Effective date.--The amendments made by this subsection 
        shall apply to services furnished on or after the date that is 
        one year after the date of the enactment of this Act.
    (c) Payments of Dialysis User Fees for All Dialysis Performed.--
            (1) In general.--The seventh sentence of section 1881(b)(7) 
        of the Social Security Act (42 U.S.C. 1395rr(b)(7)) is amended 
        by inserting after ``50 cents'' the following: ``(and in the 
        case of each treatment furnished to individuals during the 30-
        month period during which section 1862(b)(1)(C) applies, the 
        Secretary shall pay 50 cents)''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall apply to services furnished on or after the date of the 
        enactment of this Act.
                                 <all>