[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 1544 Introduced in Senate (IS)]







110th CONGRESS
  1st Session
                                S. 1544

To amend title XVIII of the Social Security Act to improve the quality 
 and efficiency of health care, to provide the public with information 
on provider and supplier performance, and to enhance the education and 
awareness of consumers for evaluating health care services through the 
   development and release of reports based on Medicare enrollment, 
                  claims, survey, and assessment data.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              June 5, 2007

Mr. Gregg (for himself and Mrs. Clinton) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to improve the quality 
 and efficiency of health care, to provide the public with information 
on provider and supplier performance, and to enhance the education and 
awareness of consumers for evaluating health care services through the 
   development and release of reports based on Medicare enrollment, 
                  claims, survey, and assessment data.

    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 Quality Enhancement Act of 
2007''.

SEC. 2. QUALITY AND EFFICIENCY REPORTS BASED ON MEDICARE ENROLLMENT, 
              CLAIMS, SURVEY, AND ASSESSMENT DATA.

    Title XVIII of the Social Security Act is amended by adding at the 
end the following new section:

        ``quality and efficiency reports based on medicare data

    ``Sec. 1898.  (a) Purpose.--The purpose of this section is to 
provide for the development of reports based on Medicare data and 
private data that is publicly available or is provided by the entity 
making the request for the report in order to--
            ``(1) improve the quality and efficiency of health care;
            ``(2) enhance the education and awareness of consumers for 
        evaluating health care services; and
            ``(3) provide the public with reports on national, 
        regional, and provider- and supplier-specific performance, 
        which may be in a provider- or supplier-identifiable format.
    ``(b) Procedures for the Development of Reports.--
            ``(1) In general.--Notwithstanding section 552(b)(6) or 
        552a(b) of title 5, United States Code, not later than 12 
        months after the date of enactment of this section, the 
        Secretary, in accordance with the purpose described in 
        subsection (a), shall establish and implement procedures under 
        which an entity may submit a request to a Medicare Quality 
        Reporting Organization for the Organization to develop a report 
        based on--
                    ``(A) Medicare data disclosed to the Organization 
                under subsection (c); and
                    ``(B) private data that is publicly available or is 
                provided to the Organization by the entity making the 
                request for the report.
            ``(2) Definitions.--In this section:
                    ``(A) Medicare data.--The term `Medicare data' 
                means--
                            ``(i) enrollment data under this title, 
                        including de-identified beneficiary enrollment 
                        data;
                            ``(ii) all claims for reimbursement for all 
                        items and services furnished by a provider of 
                        services (as defined in section 1861(u)) or a 
                        supplier (as defined in section 1861(d)) under 
                        part A or B in a research identifiable format;
                            ``(iii) on and after January 1, 2008, all 
                        data relating to enrollment in, and coverage 
                        for, qualified prescription drug coverage under 
                        part D; and
                            ``(iv) additional data files relating to 
                        the program under this title collected by the 
                        Secretary for the purpose of nationwide quality 
                        measurement and reporting based on surveys and 
                        assessment data determined appropriate by the 
                        Secretary.
                    ``(B) Medicare quality reporting organization.--The 
                term `Medicare Quality Reporting Organization' means an 
                entity with a contract under subsection (d).
    ``(c) Access to Medicare Data.--
            ``(1) In general.--The procedures established under 
        subsection (b)(1) shall provide for the secure disclosure of 
        Medicare data to each Medicare Quality Reporting Organization.
            ``(2) All data.--The Secretary shall ensure that all 
        Medicare data files (beginning with files from January 1, 1998) 
        are disclosed under paragraph (1), including the most recent 
        data files available to the Secretary. Not less than every 6 
        months, the Secretary shall update the information disclosed 
        under paragraph (1) to Medicare Quality Reporting 
        Organizations.
    ``(d) Medicare Quality Reporting Organizations.--
            ``(1) In general.--
                    ``(A) Three contracts.--Subject to subparagraph 
                (B), the Secretary shall enter into a contract with 3 
                private entities to serve as Medicare Quality Reporting 
                Organizations under which an entity shall--
                            ``(i) store the Medicare data that is to be 
                        disclosed under subsection (c); and
                            ``(ii) develop and release reports pursuant 
                        to subsection (e).
                    ``(B) Additional contracts.--If the Secretary 
                determines that reports are not being developed and 
                released within 6 months of the receipt of the request 
                for the report, the Secretary shall enter into 
                contracts with additional private entities in order to 
                ensure that such reports are developed and released in 
                a timely manner.
            ``(2) Qualifications.--The Secretary shall enter into a 
        contract with an entity under paragraph (1) only if the 
        Secretary determines that the entity--
                    ``(A) has the research capability to conduct and 
                complete reports under this section;
                    ``(B) has in place-
                            ``(i) an information technology 
                        infrastructure to support the entire database 
                        of Medicare data; and
                            ``(ii) operational standards to provide 
                        security for such database;
                    ``(C) has experience with, and expertise on, the 
                development of reports on health care quality and 
                efficiency based on Medicare or private sector claims 
                data; and
                    ``(D) has a significant business presence in the 
                United States.
            ``(3) Contract requirements.--Each contract with an entity 
        under paragraph (1) shall contain the following requirements:
                    ``(A) Ensuring beneficiary privacy.--
                            ``(i) HIPAA.--The entity shall meet the 
                        requirements imposed on a covered entity for 
                        purposes of applying part C of title XI and all 
                        regulatory provisions promulgated thereunder, 
                        including regulations (relating to privacy) 
                        adopted pursuant to the authority of the 
                        Secretary under section 264(c) of the Health 
                        Insurance Portability and Accountability Act of 
                        1996 (42 U.S.C. 1320d-2 note).
                            ``(ii) Privacy.--The entity shall provide 
                        assurances that the entity will not use the 
                        Medicare data disclosed under subsection (c) in 
                        a manner that violates sections 552 or 552a of 
                        title 5, United States Code, with regard to the 
                        privacy of individually identifiable 
                        beneficiary health information.
                    ``(B) Proprietary information.--The entity shall 
                provide assurances that the entity will not, with 
                respect to data relating to part D, disclose any 
                negotiated price concessions, such as discounts, direct 
                or indirect subsidies, rebates, and direct or indirect 
                remunerations, obtained by prescription drug plans and 
                MA-PD plans for covered part D drugs, or any other 
                proprietary cost information.
                    ``(C) Disclosure.--The entity shall disclose--
                            ``(i) any financial, reporting, or 
                        contractual relationship between the entity and 
                        any provider of services (as defined in section 
                        1861(u)) or supplier (as defined in section 
                        1861(d)); and
                            ``(ii) if applicable, the fact that the 
                        entity is managed, controlled, or operated by 
                        any such provider of services or supplier.
                    ``(D) Component of another organization.--If the 
                entity is a component of another organization--
                            ``(i) the entity shall maintain Medicare 
                        data and reports separately from the rest of 
                        the organization and establish appropriate 
                        security measures to maintain the 
                        confidentiality and privacy of the Medicare 
                        data and reports; and
                            ``(ii) the entity shall not make an 
                        unauthorized disclosure to the rest of the 
                        organization of Medicare data or reports in 
                        breach of such confidentiality and privacy 
                        requirement.
                    ``(E) Termination or nonrenewal.--If a contract 
                under this section is terminated or not renewed, the 
                following requirements shall apply:
                            ``(i) Confidentiality and privacy 
                        protections.--The entity shall continue to 
                        comply with the confidentiality and privacy 
                        requirements under this section with respect to 
                        all Medicare data disclosed to the entity and 
                        each report developed by the entity.
                            ``(ii) Disposition of data and reports.--
                        The entity shall--
                                    ``(I) return to the Secretary all 
                                Medicare data disclosed to the entity 
                                and each report developed by the 
                                entity; or
                                    ``(II) if returning the Medicare 
                                data and reports is not practicable, 
                                destroy the reports and Medicare data.
            ``(4) Competitive procedures.--Competitive procedures (as 
        defined in section 4(5) of the Federal Procurement Policy Act) 
        shall be used to enter into contracts under paragraph (1).
            ``(5) Review of contract in the event of a merger or 
        acquisition.--The Secretary shall review the contract with a 
        Medicare Quality Reporting Organization under this section in 
        the event of a merger or acquisition of the Organization in 
        order to ensure that the requirements under this section will 
        continue to be met.
    ``(e) Development and Release of Reports Based on Requests.--
            ``(1) Request for a report.--
                    ``(A) Request.--
                            ``(i) In general.--The procedures 
                        established under subsection (b)(1) shall 
                        include a process for an entity to submit a 
                        request to a Medicare Quality Reporting 
                        Organization for a report based on Medicare 
                        data and private data that is publicly 
                        available or is provided by the entity making 
                        the request for the report. Such request shall 
                        comply with the purpose described in subsection 
                        (a).
                            ``(ii) Request for specific methodology.--
                        The process described in clause (i) shall 
                        permit an entity making a request for a report 
                        to request that a specific methodology be used 
                        by the Medicare Quality Reporting Organization 
                        in developing the report. The Organization 
                        shall work with the entity making the request 
                        to finalize the methodology to be used.
                            ``(iii) Request for a specific mqro.--The 
                        process described in clause (i) shall permit an 
                        entity to submit the request for a report to 
                        any Medicare Quality Reporting Organization.
                    ``(B) Release to public.--The procedures 
                established under subsection (b)(1) shall provide that 
                at the time a request for a report is finalized under 
                subparagraph (A) by a Medicare Quality Reporting 
                Organization, the Organization shall make available to 
                the public, through the Internet website of the Centers 
                for Medicare & Medicaid Services and other appropriate 
                means, a brief description of both the requested report 
                and the methodology to be used to develop such report.
            ``(2) Development and release of report.--
                    ``(A) Development.--
                            ``(i) In general.--If the request for a 
                        report complies with the purpose described in 
                        subsection (a), the Medicare Quality Reporting 
                        Organization may develop the report based on 
                        the request.
                            ``(ii) Requirement.--A report developed 
                        under clause (i) shall include a detailed 
                        description of the standards, methodologies, 
                        and measures of quality used in developing the 
                        report.
                    ``(B) Review of report by secretary to ensure 
                compliance with privacy requirement.--Prior to a 
                Medicare Quality Reporting Organization releasing a 
                report under subparagraph (C), the Secretary shall 
                review the report to ensure that the report complies 
                with the Federal regulations (concerning the privacy of 
                individually identifiable beneficiary health 
                information) promulgated under section 264(c) of the 
                Health Insurance Portability and Accountability Act of 
                1996 and sections 552 or 552a of title 5, United States 
                Code, with regard to the privacy of individually 
                identifiable beneficiary health information. The 
                Secretary shall act within 30 business days of 
                receiving such report.
                    ``(C) Release of report.--
                            ``(i) Release to entity making request.--If 
                        the Secretary finds that the report complies 
                        with the provisions described in subparagraph 
                        (B), the Medicare Quality Reporting 
                        Organization shall release the report to the 
                        entity that made the request for the report.
                            ``(ii) Release to public.--The procedures 
                        established under subsection (b)(1) shall 
                        provide for the following:
                                    ``(I) Updated description.--At the 
                                time of the release of a report by a 
                                Medicare Quality Reporting Organization 
                                under clause (i), the entity shall make 
                                available to the public, through the 
                                Internet website of the Centers for 
                                Medicare & Medicaid Services and other 
                                appropriate means, an updated brief 
                                description of both the requested 
                                report and the methodology used to 
                                develop such report.
                                    ``(II) Complete report.--Not later 
                                than 1 year after the date of the 
                                release of a report under clause (i), 
                                the report shall be made available to 
                                the public through the Internet website 
                                of the Centers for Medicare & Medicaid 
                                Services and other appropriate means.
    ``(f) Annual Review of Reports and Termination of Contracts.--
            ``(1) Annual review of reports.--The Comptroller General of 
        the United States shall review reports released under 
        subsection (e)(2)(C) to ensure that such reports comply with 
        the purpose described in subsection (a) and annually submit a 
        report to the Secretary on such review.
            ``(2) Termination of contracts.--The Secretary may 
        terminate a contract with a Medicare Quality Reporting 
        Organization if the Secretary determines that there is a 
        pattern of reports being released by the Organization that do 
        not comply with the purpose described in subsection (a).
    ``(g) Fees.--
            ``(1) Fees for secretary.--The Secretary shall charge a 
        Medicare Quality Reporting Organization a fee for--
                    ``(A) disclosing the data under subsection (c); and
                    ``(B) conducting the review under subsection 
                (e)(2)(B).
        The Secretary shall ensure that such fees are sufficient to 
        cover the costs of the activities described in subparagraph (A) 
        and (B).
            ``(2) Fees for mqro.--
                    ``(A) In general.--Subject to subparagraphs (A) and 
                (B), a Medicare Quality Reporting Organization may 
                charge an entity making a request for a report a 
                reasonable fee for the development and release of the 
                report.
                    ``(B) Discount for small entities.--In the case of 
                an entity making a request for a report (including a 
                not-for-profit) that has annual revenue that does not 
                exceed $10,000,000, the Medicare Quality Reporting 
                Organization shall reduce the reasonable fee charged to 
                such entity under subparagraph (A) by an amount equal 
                to 10 percent of such fee.
                    ``(C) Increase for large entities that do not agree 
                to release reports within 6 months.--In the case of an 
                entity making a request for a report that is not 
                described in subparagraph (B) and that does not agree 
                to the report being released to the public under clause 
                (ii)(II) of subsection (e)(2)(C) within 6 months of the 
                date of the release of the report to the entity under 
                clause (i) of such subsection, the Medicare Quality 
                Reporting Organization shall increase the reasonable 
                fee charged to such entity under subparagraph (A) by an 
                amount equal to 10 percent of such fee.
                    ``(D) Rule of construction.--Nothing in this 
                paragraph shall be construed to effect the requirement 
                that a report be released to the public under clause 
                (ii)(II) of subsection (e)(2)(C)(ii)(II) by not later 
                than 1 year after the date of the release of the report 
                to the requesting entity under clause (i) of such 
                subsection.
    ``(h) Regulations.--Not later than 6 months after the date of 
enactment of this section, the Secretary shall prescribe regulations to 
carry out this section.
    ``(i) GAO Studies and Report.--
            ``(1) Studies.--The Comptroller General of the United 
        States shall conduct a study on each of the following:
                    ``(A) The feasibility of requiring Medicare 
                Advantage organizations under part C to share 
                utilization and quality data with the Secretary for the 
                purpose of releasing such information to Medicare 
                Quality Reporting Organizations under this section.
                    ``(B) The Medicare data released to Medicare 
                Quality Reporting Organizations under subsection (c) in 
                order to determine the accuracy of such data with 
                respect to--
                            ``(i) the coding of demographic data;
                            ``(ii) diagnosis and procedures; and
                            ``(iii) any other data elements important 
                        for the development of reports under this 
                        section in accordance with the purpose 
                        described in subsection (a).
                    ``(C) The feasibility of collecting State Medicaid 
                data for the purpose of aggregating all Medicaid data 
                for study under this section.
            ``(2) Report.--Not later than 12 months after the date of 
        enactment of this section, the Comptroller General of the 
        United States shall submit a report to Congress on each of the 
        studies conducted under paragraph (1) together with 
        recommendations for such legislation and administrative actions 
        as the Comptroller General considers appropriate.''.

SEC. 3. QUALITY ADVISORY BOARD.

    (a) Establishment.--Not later than 12 months after the date of 
enactment of this Act, the Secretary of Health and Human Services shall 
establish within the Office of the Secretary a board to be known as the 
Quality Advisory Board (in this section referred to as the ``Board'').
    (b) Membership.--The members of the Board shall include, but not be 
limited to, an appropriate number of representatives of--
            (1) groups representing Medicare beneficiaries;
            (2) groups representing providers of services (as defined 
        in subsection (u) of section 1861 of the Social Security Act 
        (42 U.S.C. 1395x)) and suppliers (as defined in subsection (d) 
        of such section) receiving reimbursement under the Medicare 
        program;
            (3) purchasers and employers or groups representing 
        purchasers and employers;
            (4) organizations focused on the development of quality 
        health care measures;
            (5) researchers or research institutions with experience in 
        the measurement of, and reporting on, health care quality; and
            (6) health plans or groups representing health plans.
    (c) Duties.--The duties of the Board are as follows:
            (1) To submit requests for reports to Medicare Quality 
        Reporting Organizations under section 1898 of the Social 
        Security Act, as added by section 2.
            (2) To examine how clinical registries can be linked to 
        Medicare data (as defined in subsection (b)(2)(A) of such 
        section 1898) in order to develop reports on the quality and 
        efficiency of providers of services (as defined in subsection 
        (u) of section 1861 of the Social Security Act (42 U.S.C. 
        1395x)) and suppliers (as defined in subsection (d) of such 
        section).
            (3) To coordinate with existing collaborative efforts 
        identifying quality and efficiency health care measures.
            (4) To provide the Secretary of Health and Human Services 
        with recommendations for the development of model quality 
        health care measurements.
            (5) Other duties determined appropriate by the Secretary.
    (d) Authorization of Appropriations.--There are authorized to be 
appropriated to the Secretary of Health and Human Services such sums as 
may be necessary for the purpose of carrying out this section.

SEC. 4. RESEARCH ACCESS TO MEDICARE DATA AND REPORTING ON PERFORMANCE.

    The Secretary of Health and Human Services shall permit researchers 
that meet existing criteria used to evaluate the appropriateness of the 
release of Centers for Medicare & Medicaid Services (CMS) data for 
research purposes to--
            (1) have access to all Medicare data (as defined in section 
        1898(b)(2)(A) of the Social Security Act, as added by section 
        2); and
            (2) report on the performance of providers of services (as 
        defined in subsection (u) of section 1861 of such Act (42 
        U.S.C. 1395x)) and suppliers (as defined in subsection (d) of 
        such section), including reporting in a provider- or supplier-
        identifiable format.
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