[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 1947 Introduced in Senate (IS)]







110th CONGRESS
  1st Session
                                S. 1947

  To amend title XI of the Social Security Act to improve the quality 
                improvement organization (QIO) program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             August 2, 2007

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

_______________________________________________________________________

                                 A BILL


 
  To amend title XI of the Social Security Act to improve the quality 
                improvement organization (QIO) program.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Continuing the 
Advancement of Quality Improvement Act of 2007''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Responsibilities of utilization and quality control peer review 
                            organizations.
Sec. 3. Priorities for selection of providers to provide technical 
                            assistance.
Sec. 4. Data processing.
Sec. 5. Qualifications for utilization and quality control peer review 
                            organizations.
Sec. 6. Funding.
Sec. 7. Improvements to annual reports.

SEC. 2. RESPONSIBILITIES OF UTILIZATION AND QUALITY CONTROL PEER REVIEW 
              ORGANIZATIONS.

    (a) Responsibilities.--
            (1) 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) Notwithstanding the preceding provisions of this section, 
beginning on August 1, 2009, any utilization and quality control peer 
review organization entering into a contract with the Secretary under 
this part shall only perform the function of providing technical 
assistance for quality improvement and performance measurement to 
providers, practitioners, and Medicare Advantage organizations offering 
Medicare Advantage plans under part C of title XVIII, including the 
following:
            ``(1) Instruction on how to collect, aggregate, and 
        interpret data on measures that may be used for internal 
        quality improvement, public reporting, and payment.
            ``(2) Instruction on how to conduct root-cause analyses and 
        deep case studies of sentinel events and other problems.
            ``(3) Assistance to improve the validity and accuracy of 
        data submitted by providers and practitioners who participate 
        in the program under title XVIII.
            ``(4) Advice and guidance on how to bring about, sustain, 
        and diffuse internal system redesign and process changes, 
        particularly those redesign and process changes that--
                    ``(A) are related to the use of information 
                technology for quality improvement; and
                    ``(B) promote care coordination and efficiency 
                through an episode of care.
            ``(5) Promotion of best practices identified by research, 
        provider, and industry groups.
            ``(6) Improvement of, and provision of technical support 
        for, the direct role of providers in the education of 
        individuals eligible for benefits under the program under title 
        XVIII as an integral component of improved care, better patient 
        experience, and patient self-management.
            ``(7) Assistance with bringing together and promoting 
        cooperation among various stakeholders in providing care.''.
            (2) Conforming amendments.--Section 1154 of the Social 
        Security Act (42 U.S.C. 1320c-3) is amended--
                    (A) in the heading, by inserting ``and other 
                organizations'' after ``organizations''; and
                    (B) in subsection (a)--
                            (i) in paragraph (1), in the matter 
                        preceding subparagraph (A)--
                                    (I) by inserting ``of such title'' 
                                after ``part C''; and
                                    (II) by inserting ``of such title'' 
                                after ``part D''; and
                            (ii) in paragraph (17)--
                                    (I) by inserting ``of title XVIII'' 
                                after ``part C''; and
                                    (II) by inserting ``of such title'' 
                                after ``part D''.
    (b) Transfer of Responsibilities for Performing Other Functions.--
Part B of title XI of the Social Security Act (42 U.S.C. 1320c et seq.) 
is amended by adding at the end the following new section:

``SEC. 1164. TRANSFER OF RESPONSIBILITY FOR PERFORMING CERTAIN 
              FUNCTIONS.

    ``(a) In General.--
            ``(1) Transition plan.--Not later than 6 months after the 
        date of enactment of this section, the Secretary shall develop 
        and transmit to the Committee on Finance of the Senate and the 
        Committees on Energy and Commerce and Ways and Means of the 
        House of Representatives a transition plan under which the 
        functions of utilization and quality control peer review 
        organizations under section 1154, as in effect on the day 
        before such date of enactment, are transferred from the 
        responsibility of such organizations to other agencies and 
        organizations (in this part referred to as `Medicare provider 
        review organizations'). The transition plan shall include a 
        description of the steps the Secretary will take in 
        implementing the plan and a timeline for such implementation. 
        The transition plan shall be developed in a manner that will 
        ensure that the intended beneficiaries of the functions 
        transferred will neither be harmed as a result of such transfer 
        of responsibility nor experience a disruption or decrease in 
        services under section 1154.
            ``(2) Medicare provider review organizations.--In 
        determining which agency or organization the responsibility for 
        a function is transferred to under the transition plan 
        implemented under paragraph (1), the Secretary shall take into 
        account the following considerations:
                    ``(A) Whether the agency or organization is 
                comparable (in terms of experience, capabilities, and 
                capacity) to the organization that performed such 
                responsibilities as of the day before such date of 
                enactment.
                    ``(B) Whether the agency or organization is able to 
                ensure that at least the same level of access to 
                services is available when responsibilities are 
                transferred to the agency or organization.
                    ``(C) Whether the transfer of responsibility to the 
                agency or organization will ensure the least amount of 
                disruption and minimize both the risk of harm to the 
                intended beneficiaries of the transferred 
                responsibilities and the disruption or decrease in 
                services under section 1154.
                    ``(D) In the case where the responsibility 
                transferred is a review function required under section 
                1154 as of the day before such date of enactment, 
                whether the agency or organization is able, in the 
                judgment of the Secretary, to perform such review 
                function in a manner consistent with the efficient and 
                effective administration of this part.
                    ``(E) Whether the transferred responsibilities 
                would be most effectively and efficiently performed at 
                a nationwide, Statewide, or regional level.
                    ``(F) Whether the transfer of responsibility to the 
                agency or organization will not result in a conflict of 
                interest.
            ``(3) Limitation.--A utilization and quality control peer 
        review organization may not be a Medicare provider review 
        organization in any area in which the utilization and quality 
        control peer review organization provides technical assistance 
        under section 1154(g).
            ``(4) Transfer of responsibility.--Not later than July 31, 
        2009, the Secretary shall fully implement the transition plan 
        under this subsection and transfer the functions described in 
        paragraph (1) from utilization and quality control peer review 
        organizations to Medicare provider review organizations.
    ``(b) Sharing of Information With Utilization and Quality Control 
Peer Review Organizations.--The Secretary shall develop and implement a 
process by which a Medicare provider review organization that, as a 
result of the transfer of responsibility under subsection (a), conducts 
case review or has responsibility for addressing beneficiary appeals or 
beneficiary complaints shares information with utilization and quality 
control peer review organizations for purposes of providing technical 
assistance for quality improvement and performance measurement under 
section 1154(g).''.
    (c) Medicare Provider Review Organizations Addressing Beneficiary 
Complaints.--
            (1) In general.--Section 1164 of the Social Security Act, 
        as added by subsection (b), is amended by adding at the end the 
        following new subsection:
    ``(c) Medicare Quality Accountability Program.--On or after the 
date on which the transition plan is fully implemented under subsection 
(a), a Medicare provider review organization that has responsibility 
for addressing beneficiary complaints shall, instead of the 
requirements described in paragraph (14) of section 1154(a), meet the 
following requirements:
            ``(1) Complaint review.--The Medicare provider review 
        organization shall conduct a review of all complaints about the 
        quality of services (for which payment may otherwise be made 
        under title XVIII) not meeting professionally recognized 
        standards of health care, if the complaint is filed with the 
        organization by an individual entitled to benefits for such 
        services under such title (or a person acting on the 
        individual's behalf). Before the organization concludes that 
        the quality of services does not meet professionally recognized 
        standards of health care, the organization must provide the 
        provider, practitioner, plan, or person concerned with 
        reasonable notice and opportunity for comment and discussion.
            ``(2) Medicare quality accountability program.--The 
        Medicare provider review organization shall establish and 
        operate a Medicare quality accountability program consistent 
        with the following:
                    ``(A) The organization shall actively educate 
                Medicare beneficiaries in an efficient and effective 
                manner of their right to bring quality concerns to such 
                Medicare provider review organizations.
                    ``(B) The organization shall report all findings of 
                its investigations to the beneficiary involved or a 
                representative of such beneficiary, regardless of 
                whether such findings involve a provider, practitioner, 
                or plan. Such reports shall describe, at a minimum, 
                whether the organization confirms the allegations in 
                the complaint and any actions taken by the provider, 
                practitioner, or plan, respectively, with respect to 
                such findings. Such reports, and any other 
                documentation prepared by the organization during the 
                course of investigating complaints, may not be used in 
                a tort claim or cause of action arising under State 
                law.
                    ``(C) The organization shall determine whether the 
                complaint allegations about clinical quality of care 
                are confirmed. In the case where such allegations are 
                confirmed, in whole or in part, the organization shall 
                (based on criteria issued by the Secretary) refer the 
                provider, practitioner, or plan to 1 or both of the 
                following:
                            ``(i) A utilization and quality control 
                        peer review organization with a contract with 
                        the Secretary under this part for technical 
                        assistance under section 1154(g).
                            ``(ii) The appropriate regulatory body for 
                        sanctions.
                    ``(D) The organization shall publish and submit to 
                the Secretary annual reports in each State in which the 
                organization operates. Such reports shall include 
                aggregate complaint data (including the number, nature, 
                and disposition of complaints) and a description of any 
                follow-up activity conducted with respect to such 
                complaints.
                    ``(E) The organization shall promote beneficiary 
                awareness of standardized quality measures that may be 
                used for evaluating care and for choosing providers, 
                practitioners, and plans.''.
            (2) Conforming amendment.--Section 1154(a)(14) of the 
        Social Security Act (42 U.S.C. 1320c-3(a)(14)) is amended by 
        striking ``The organization'' and inserting ``Subject to 
        section 1164(c), the organization''.
    (d) Reference to Agencies and Organizations Performing Transferred 
Functions.--Section 1164 of the Social Security Act, as added by 
subsection (b) and amended by subsection (c), is amended by adding at 
the end the following new subsection:
    ``(d) Reference to Agencies and Organizations Performing 
Transferred Functions.--On and after the date on which the transition 
plan is fully implemented under subsection (a), any reference in this 
Act to a utilization and quality control peer review organization, a 
peer review organization, an organization, or organizations with 
respect to the performance of functions for which responsibility has 
been transferred under such subsection, shall be deemed a reference to 
the Medicare provider review organization to which such responsibility 
has been transferred. In the case where such a reference is deemed a 
reference to a Medicare provider review organization, the Medicare 
provider review organization shall not be required to meet--
            ``(1) the definition of a utilization and quality control 
        peer review organization under section 1152 (as amended by 
        section 5 of the Continuing the Advancement of Quality 
        Improvement Act of 2007); or
            ``(2) contract requirements applicable to a utilization and 
        quality control peer review organization under section 1153 (as 
        amended by such section 5).''.

SEC. 3. PRIORITIES FOR SELECTION OF PROVIDERS TO PROVIDE TECHNICAL 
              ASSISTANCE.

    Section 1153 of the Social Security Act (42 U.S.C. 1320c-2) is 
amended by adding at the end the following new subsection:
    ``(j) The Secretary shall establish priorities for utilization and 
quality control peer review organizations to use in selecting providers 
and practitioners to provide technical assistance under section 1154(g) 
in the event demand for such assistance exceeds the available resources 
of such organizations. The priorities established shall include--
            ``(1) whether the provider or practitioner is located in a 
        rural or underserved area;
            ``(2) the financial needs of the provider or practitioner;
            ``(3) low performance in measures that may be used for 
        public reporting and payment;
            ``(4) whether there has been a significant number of 
        beneficiary complaints with respect to the practitioner or 
        provider; and
            ``(5) such other measures of performance or quality as are 
        available to the Secretary.''.

SEC. 4. DATA PROCESSING.

    (a) In General.--Section 1160 of the Social Security Act (42 U.S.C. 
1320c-9) is amended--
            (1) in subsection (a)(3), by striking ``subsection (b)'' 
        and inserting ``subsections (b) and (f)''; and
            (2) by adding at the end the following new subsection:
    ``(f)(1) A utilization and quality control peer review organization 
and a Medicare provider review organization may share individual-
specific data obtained from another provider or practitioner with a 
provider or practitioner who is treating the individual, for quality 
improvement and patient safety purposes.
    ``(2) A utilization and quality control peer review organization 
and a Medicare provider review organization may share provider-specific 
data with the Secretary.
    ``(3) The Secretary shall promulgate, not later than 1 year after 
the date of the enactment of this subsection, a regulation that--
            ``(A) specifies the process for sharing data under 
        paragraphs (1) and (2); and
            ``(B) includes safeguards to ensure the confidentiality of 
        the data shared.
    ``(4) Nothing in this subsection shall be construed to limit, 
alter, or affect the requirements imposed by the regulations 
promulgated under section 264(c) of the Health Insurance Portability 
and Accountability Act of 1996.''.
    (b) Comprehensive Review.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this section referred to as the ``Secretary'') shall 
        conduct a comprehensive review of the data-sharing systems, 
        processes, and regulations of the Department of Health and 
        Human Services in order to--
                    (A) identify best practices and procedures, 
                including abstraction of medical chart data; and
                    (B) ensure that such systems, processes, and 
                regulations do not--
                            (i) restrict the sharing of data by 
                        utilization and quality control peer review 
                        organizations with a contract under part B of 
                        title XI of the Social Security Act (42 U.S.C. 
                        1320c et seq.) for quality improvement and 
                        patient safety purposes; or
                            (ii) inhibit prompt feedback to such 
                        organizations and to providers, practitioners, 
                        and Medicare Advantage organizations offering 
                        Medicare Advantage plans under part C of title 
                        XVIII of the Social Security Act (42 U.S.C. 
                        1395 et seq.) on the performance of such 
                        providers, practitioners, and organizations.
            (2) Report.--Not later than 6 months after the date of 
        enactment of this Act, the Secretary shall submit a detailed 
        report to the Committee on Finance of the Senate and the 
        Committees on Energy and Commerce and Ways and Means of the 
        House of Representatives containing--
                    (A) the results of the review conducted under 
                paragraph (1);
                    (B) a timeline for the implementation of any 
                administrative action the Secretary determines to be 
                appropriate; and
                    (C) recommendations for such legislation as the 
                Secretary determines to be appropriate.
    (c) Supporting National Reporting and Integrating Care Data.--The 
Secretary shall ensure that the program under part B of title XI of the 
Social Security Act, as amended by this Act, supports the processes of 
national reporting of performance measures, data aggregation, data 
analysis, and feedback.

SEC. 5. QUALIFICATIONS FOR UTILIZATION AND QUALITY CONTROL PEER REVIEW 
              ORGANIZATIONS.

    (a) Removal of Physician-Access and Physician-Sponsored 
Requirements.--
            (1) In general.--Section 1152 of the Social Security Act 
        (42 U.S.C. 1320c-1) is amended by striking paragraph (1) and 
        inserting the following:
            ``(1) has expertise in quality improvement and performance 
        measurement; and''.
            (2) Conforming amendment.--Section 1153(b)(1) of the Social 
        Security Act (42 U.S.C. 1320c-2(b)(1)) is amended by striking 
        the second sentence.
    (b) Qualifications.--Part B of title XI of the Social Security Act 
(42 U.S.C. 1320c), as amended by section 3, is amended--
            (1) in section 1152--
                    (A) by striking paragraph (2);
                    (B) by redesignating paragraph (3) as paragraph 
                (2); and
                    (C) in paragraph (2), as redesignated by 
                subparagraph (B), by inserting ``and, beginning on the 
                date that is 1 year after the date of enactment of the 
                Continuing the Advancement of Quality Improvement Act 
                of 2007, that meets the requirements described in 
                section 1153(k)(1)'' before the period at the end; and
            (2) in section 1153, by adding at the end the following new 
        subsection:
    ``(k)(1) The requirements described in this paragraph are as 
follows:
            ``(A) The governing board of the utilization and quality 
        control peer review organization is appropriately diverse, has 
        relationships with providers and stakeholders within the State, 
        and provides for transparency.
            ``(B)(i) Subject to clause (ii), the governing board of the 
        utilization and quality control peer review organization is 
        made up of individuals from diverse areas, disciplines, and 
        expertise, including--
                    ``(I) quality improvement and performance 
                measurement professionals from within and outside of 
                the health care field;
                    ``(II) providers of services under the program 
                under title XVIII, including physicians and other 
                health care practitioners;
                    ``(III) public or population health professionals;
                    ``(IV) information technology implementation, 
                management, and oversight professionals;
                    ``(V) certified public accountants, auditors, and 
                attorneys; and
                    ``(VI) Medicare beneficiary and consumer groups.
            ``(ii) A majority of the members of the governing board of 
        the utilization and quality control peer review organization do 
        not come from any 1 of the 5 areas, disciplines, and expertise 
        described in subclauses (I) through (V) of clause (i).
            ``(C) The governing board of the utilization and quality 
        control peer review organization has--
                    ``(i) developed and implemented a compliance 
                program that includes--
                            ``(I) written policies, procedures, and 
                        standards of conduct that articulate the 
                        organization's commitment to comply with all 
                        applicable Federal and State standards;
                            ``(II) effective compliance training and 
                        education for employees, managers, and members 
                        of the governing board;
                            ``(III) the designation of--
                                    ``(aa) a compliance officer; and
                                    ``(bb) a compliance committee 
                                comprised of a majority of members who 
                                are independent of the governing board 
                                and to which the governing board refers 
                                issues of conflicts of interest, 
                                ethics, program integrity, and the 
                                compensation (including benefits) and 
                                travel costs of senior executive staff 
                                and members of the governing board;
                            ``(IV) effective lines of communication 
                        between the compliance officer designated under 
                        subclause (III)(aa) and the organization's 
                        employees;
                            ``(V) enforcement of policies, procedures, 
                        and standards of conduct through publicized 
                        disciplinary guidelines;
                            ``(VI) procedures for periodic internal 
                        monitoring and auditing;
                            ``(VII) procedures for ensuring prompt 
                        response to detected offenses and the 
                        development of corrective action initiatives; 
                        and
                            ``(VIII) such other requirements as the 
                        Secretary determines to be necessary for 
                        ensuring appropriate governance; and
                    ``(ii) set overall policy and direction for the 
                organization and has retained oversight responsibility 
                over the organization.
            ``(D) The governing board of the utilization and quality 
        control peer review organization and the utilization and 
        quality control peer review organization comply with the 
        following requirements for transparency and accountability:
                    ``(i) The governing board of the utilization and 
                quality control peer review organization discloses to 
                the public information regarding the board, including--
                            ``(I) the size of the board;
                            ``(II) the length of appointment of members 
                        to the board;
                            ``(III) any cap on the length of service as 
                        a member of the board;
                            ``(IV) when appointments to the board are 
                        made;
                            ``(V) what portion of the board is 
                        typically appointed each year;
                            ``(VI) names, affiliation, and compensation 
                        of board members; and
                            ``(VII) such other disclosure requirements 
                        as the Secretary determines to be appropriate.
                    ``(ii) The governing board of the utilization and 
                quality control peer review organization meets contract 
                requirements developed by the Secretary--
                            ``(I) with respect to the length of 
                        service, independence, and duties of board 
                        members; and
                            ``(II) with respect to compliance officer 
                        and compliance committee duties.
                    ``(iii) The governing board of the utilization and 
                quality control peer review organization complies with 
                guidelines developed by the Secretary as to what 
                constitutes reasonable compensation for members of the 
                governing board of a utilization and quality control 
                peer review organization (including the chief executive 
                officer, chief operating officer, and chief financial 
                officer).
                    ``(iv) The utilization and quality control peer 
                review organization has in place formal and documented 
                procedures for addressing potential board member and 
                executive conflicts of interests, ethical issues, and 
                program integrity.
                    ``(v) The utilization and quality control peer 
                review organization implements formal and documented 
                procedures to evaluate individual board member actions 
                and activities and overall board performance not less 
                frequently than on an annual basis.
    ``(2) Each contract with a utilization and quality control peer 
review organization under this part shall require that the organization 
comply with a system established by the Secretary to identify, cure (by 
resolving or waiving), and report conflicts of interest with respect to 
the governing board of such an organization, such organization, and 
entities that subcontract with such organization. Such system shall 
include the following:
            ``(A) Guidelines as to what constitutes a conflict of 
        interest, including a member of the governing board receiving 
        compensation from the organization, directly or indirectly, for 
        the provision of services outside the scope of their duties and 
        responsibilities as a member of the governing board.
            ``(B) The requirement to disclose any potential conflicts 
        of interest.
            ``(C) A process by which conflicts of interest shall be 
        disclosed.
            ``(D) Methods by which conflicts of interest shall be 
        resolved or waived.
    ``(3) Each contract with a utilization and quality control peer 
review organization under this part shall require that the organization 
meet requirements pertaining to the development and conduct or 
implementation of--
            ``(A) annual performance evaluations for members of the 
        governing board of such an organization (including the chief 
        executive officer, chief operating officer, and chief financial 
        officer);
            ``(B) an annual self-assessment to be conducted by the 
        governing board of such an organization; and
            ``(C) an overall performance improvement plan for the 
        governing board of such an organization.''.
    (c) Duration of Contracts, Selection Criteria, and Ensuring 
Value.--Section 1153 of the Social Security Act (42 U.S.C. 1320c-2) is 
amended--
            (1) by striking paragraph (3) of subsection (c) and 
        inserting the following new paragraph:
            ``(3) contract terms are consistent with subsection (i);''; 
        and
            (2) by striking subsection (i) and inserting the following 
        new subsection:
    ``(i)(1) Subject to the succeeding provisions of this subsection, 
each contract with a utilization and quality control peer review 
organization under this part shall be for an initial term of 5 years, 
beginning and ending on a common date for all contractors as required 
under this subsection and shall be renewable for 5-year terms 
thereafter.
    ``(2) Each contract with a utilization and quality control peer 
review organization under this part--
            ``(A) shall be bid on through a competitive process; and
            ``(B) shall not be renewed without going through a 
        competitive process.
    ``(3) The Secretary shall use criteria for selecting utilization 
and quality control peer review organizations to enter into a contract 
with under this part that takes into consideration--
            ``(A) any previous experience and performance of the 
        organization under a contract under this part;
            ``(B) whether the organization has demonstrated a capacity 
        to support quality improvement and performance measurement; and
            ``(C) the financial integrity of the organization.
    ``(4) The Secretary shall develop performance measures, including 
interim and final goals, for the functions to be performed by the 
utilization and quality control peer review organization under the 
contract. The performance measures shall be based on nationwide 
priorities developed or adopted by the Secretary. Such measures shall 
be made available to utilization and quality control peer review 
organizations during the bidding process. The Secretary shall provide 
financial incentives and penalties that reward high performance and 
penalize poor performance under such contracts, taking into 
consideration the measures developed under this paragraph.
    ``(5) The Secretary shall develop procedures for the conduct of 
interim and final evaluations to assess the performance of the 
utilization and quality control peer review organization under the 
contract against the performance measures developed under paragraph 
(4). Such procedures shall provide for 3 types of evaluations to be 
conducted at each of the following levels:
            ``(A) The program under this part as a whole.
            ``(B) Individual utilization and quality control peer 
        review organizations with respect to the contract entered into 
        with such organization under this part.
            ``(C) Selected quality improvement interventions 
        implemented by such organizations.
    ``(6) The Secretary shall enter into a contract with an entity to 
conduct an independent external evaluation of the overall contributions 
of the program under this part toward quality improvement and 
performance measurement. Such an evaluation shall be conducted not less 
frequently than once during each contract cycle.
    ``(7) The Secretary shall extend each contract with a utilization 
and quality control peer review organization under this part the 
contract period for which began on or after August 1, 2005, and on or 
before February 1, 2006, so that the subsequent contract period begins 
on August 1, 2009.''.
    (d) Scope of Work.--Section 1153 of the Social Security Act (42 
U.S.C. 1320c-2), as amended by subsections (b) and (c), is amended--
            (1) in paragraph (3) of subsection (c), by striking 
        ``subsection (i)'' and inserting ``subsections (i) and (l)''; 
        and
            (2) by adding at the end the following new subsection:
    ``(l)(1) The scope of work required under a contract with a 
utilization and quality control peer review organization under this 
part shall reflect the priorities of--
            ``(A) quality improvement in individual provider settings 
        and across multiple-provider settings; and
            ``(B) performance measurement which may be used for 
        purposes of public reporting and payment under title XVIII.
    ``(2) In advance of each contract cycle, the Secretary shall 
conduct an assessment of the need for technical assistance for quality 
improvement and performance measurement by obtaining feedback from 
providers within each provider setting under the program under title 
XVIII. The feedback obtained shall be on applicable areas, including 
the following:
            ``(A) Internal capacities of providers for quality 
        improvement and performance measurement.
            ``(B) Past and current quality improvement and performance 
        measurement activities.
            ``(C) Technical assistance that providers are currently 
        receiving on quality improvement and performance measurement.
            ``(D) Current gaps in technical assistance for quality 
        improvement and performance measurement.''.
    (e) Effective Date.--Except as provided in subsection (b)(1)(C), 
the amendments made by this section shall apply to contracts entered 
into on or after August 1, 2009.

SEC. 6. FUNDING.

    (a) In General.--
            (1) Funding.--Section 1159 of the Social Security Act (42 
        U.S.C. 1320c-8) is amended--
                    (A) in the matter preceding paragraph (1), by 
                inserting ``(a)'' before ``Expenses incurred''; and
                    (B) by adding at the end the following new 
                subsections:
    ``(b) Subject to subsection (c), funding for contracts under this 
part shall be used solely for providing technical assistance for 
quality improvement and performance measurement. The decision whether 
to fund such contracts under this part shall be based on the results of 
evaluations conducted by the Secretary to determine--
            ``(1) the overall impact of the program under this part on 
        quality improvement and performance measurement;
            ``(2) the specific quality improvement methods and 
        techniques used by an organization;
            ``(3) which organizations that the Secretary contracts with 
        under this part are most successful; and
            ``(4) whether there is continued demand for technical 
        assistance for quality improvement and performance measurement, 
        as demonstrated by--
                    ``(A) demand by providers for such assistance;
                    ``(B) the activities of utilization and quality 
                control peer review organizations; and
                    ``(C) referrals made by the Secretary, Medicare 
                provider review organizations, and other agencies and 
                organizations (including contractors) for such 
                assistance.
    ``(c) Expenses incurred by Medicare provider review organizations 
in carrying out functions the responsibility for which was transferred 
under section 1164(a) shall be payable from funds authorized under 
subsection (a).''
            (2) Effective date.--The amendments made by this subsection 
        shall apply to contracts entered into on or after August 1, 
        2009.
    (b) Limitations on Use and Reduction of Funding.--
            (1) In general.--Section 1159 of the Social Security Act 
        (42 U.S.C. 1320c-8), as amended by subsection (a), is amended--
                    (A) in subsection (b), by striking ``subsection 
                (c)'' and inserting ``subsections (c) and (d)''; and
                    (B) by adding at the end the following new 
                subsections:
    ``(d) Funding for contracts under this part may not be used for 
either of the following purposes:
            ``(1) To pay dues for membership in an organization that 
        engages in lobbying activities (as defined in section 3 of the 
        Lobbying Disclosure Act of 1995 (2 U.S.C. 1602)).
            ``(2) To pay fees to any individual for lobbying activities 
        (as so defined).
    ``(e) The Secretary may not reduce the amount of funding under a 
contract under this part unless the scope of work has been reduced. In 
the case where the scope of work has been reduced, any reduction in 
contract funding shall be commensurate with the reduction in the scope 
of work.''.
            (2) Effective date.--The amendments made by this subsection 
        shall take effect on the date that is 1 year after the date of 
        enactment of this Act.

SEC. 7. IMPROVEMENTS TO ANNUAL REPORTS.

    Section 1161 of the Social Security Act (42 U.S.C. 1320c-1) is 
amended--
            (1) in the matter preceding paragraph (1), by striking 
        ``the Congress'' and inserting ``the Committee on Finance of 
        the Senate and the Committees on Energy and Commerce and Ways 
        and Means of the House of Representatives'';
            (2) by redesignating paragraphs (4), (5), and (6) as 
        paragraphs (5), (6), and (7), respectively; and
            (3) by inserting after paragraph (3) the following new 
        paragraph:
            ``(4) in the case of reports submitted on or after April 1, 
        2010--
                    ``(A) the number and type of practitioners and 
                providers that are provided technical assistance for 
                quality improvement and performance measurement under 
                section 1154(g);
                    ``(B) the performance of organizations under a 
                contract under this part against performance measures, 
                including interim and final goals, developed under 
                section 1153(i)(4);
                    ``(C) the number and nature of complaints 
                investigated by Medicare provider review organizations, 
                and the disposition of such complaints by such 
                organizations;
                    ``(D) a compilation of the data contained in 
                quality reports submitted to the Secretary under 
                section 1164(c)(2)(D);
                    ``(E) the amount and apportionment of funding from 
                the Federal Hospital Insurance Trust Fund and the 
                Federal Supplementary Medical Insurance Trust Fund to 
                administer this part under section 1159, including how 
                such funds were allocated based on the recipient, 
                purpose, and amount; and
                    ``(F) any weaknesses identified in audits conducted 
                with respect to the financial statements of utilization 
                and quality control peer review organizations and 
                Medicare provider review organizations.''.
                                 <all>