1.This Act may be cited as
the Quality Reform Expansion and
Savings Act of 2009
.
2.
(a)Congress makes the following
findings:
(1)The United States
health care system urgently needs reform and improvement in the quality of care
delivered, the prevention and detection of illness, and the optimization of
investment in these areas.
(2)The present
system for payment of providers for health care services often acts to deter or
discourage optimal investment in prevention or quality of care
improvement.
(3)Properly tailored
health care reforms can lower medical costs and improve quality of care.
(4)The urgent need
for reform of the American health care system, to improve quality of care and
health outcomes, to lower costs, and to reduce waste and frustration, is not
presently met with a commensurate national effort to design and implement those
reforms.
(5)Many initiatives
underway at the State and local level merit encouragement and support, as they
depend upon and inspire mutual trust and compromise within a community.
(b)It
is the purpose of this Act to establish a program to award grants to local,
regional, or statewide organizations to—
(1)encourage the
coordinated development of local health care quality reforms;
(2)fund the
development of practices beneficial to the health care system;
(3)expand
information technology, electronic health records, and interoperable data
systems in the health care system;
(4)develop
reimbursement practices that align financial incentives with health and
prevention reforms to identify and encourage best practices;
(5)lower the costs
of health care delivery;
(6)encourage reform
initiatives in different regions of the United States; and
(7)reward
cooperation among local entities engaged in reforming the health care
system.
3.Quality reform
grant initiative
(a)The
Secretary of Health and Human Services (referred to in this section as the
Secretary
) shall award quality reform grants to eligible
entities to enhance, encourage, and expedite implementation of quality reform
plans to carry out the purposes of this Act.
(b)Eligibility of
State, local, and regional entitiesTo be eligible to receive a
grant under subsection (a), a qualifying entity shall be a State, local, or
regional organization, including an organization newly formed for the purpose
of carrying out plans under such a grant, dedicated to improving the quality of
health care through broad participation of the local health care community,
with a focus on quality improvement and reporting, expansion of health
information technology, cost-effective prevention, and restructuring of the
reimbursement system to enhance these goals.
(c)
(1)Not
later than 180 days after the date of the enactment of this Act, the Secretary
shall establish a Quality Reform Committee (referred to in this Act as the
Committee
) in accordance with this subsection.
(2)The
Committee shall be composed of not less than 7 members, of which—
(A)one member shall
be appointed by the Administrator of the Centers for Medicare & Medicaid
Services;
(B)one member shall
be appointed by the Director of the National Institutes of Health;
(C)one member shall
be appointed by the Director of the Agency for Healthcare Research and
Quality;
(D)one member shall
be appointed by the National Coordinator for Health Information
Technology;
(E)one member shall
be appointed by the President of the Institute of Medicine;
(F)one member shall
be appointed by the Secretary from among candidates recommended by the National
Governors Association; and
(G)one member shall
be appointed by the Secretary from among candidates recommended by the United
States Conference of Mayors.
(3)The Committee shall—
(A)formally approve
the application of an eligible entity for a grant under this section and
recommend to the Secretary that such a grant be awarded to such entity;
(B)facilitate
communication among eligible entities and other organizations;
(C)evaluate and
exchange best practices relating to activities carried out under the
grants;
(D)share research
and expertise relating to activities under the grants;
(E)encourage
collaboration and cooperation with and among grantees under this
section;
(F)recognize the
achievements of grantees under this section in a public manner;
(G)assist grantees
under this section by serving as an advocate and ombudsman to overcome
bureaucratic and other obstacles within the Federal Government that hinder the
achievement of this effort;
(H)encourage
integration of activities under this section with the private sector;
(I)study, identify,
and report on market failures and anomalies that create economic incentives
adverse to achievement of the goals of quality reform, cost reduction, health
information technology expansion, and illness prevention;
(J)assist with
coordinating information technology infrastructure; and
(K)assign personnel
to serve as facilitators for local programs and as primary Federal points of
contact with grantees under this section.
(4)Members shall be appointed to serve for a term as
determined appropriate by the appointing authority, as the case may be, and
each member shall serve until a successor is appointed.
(5)
(A)The
Committee shall select a Chairperson from among its members.
(B)A
majority of the members of the Committee shall constitute a quorum, but a
lesser number of members may hold hearings.
(C)Not
later than 30 days after the date on which all members of the Committee have
been appointed under paragraph (2), the Committee shall hold its first meeting.
The Committee shall meet at the call of the Chairperson.
(6)
(A)The
Committee may hold hearings, if determined necessary by the Committee to carry
out the purposes of this Act, sit and act at such times and places, take such
testimony, and receive such evidence as the Committee determines appropriate to
carry out the purposes of this Act.
(B)In addition to other meetings the Committee may hold,
the Committee shall hold an annual public meeting for grantees under this
section in order that grantees may report progress toward achieving the
purposes in section 2(b) and in the exchange of information with one another
and with the Committee.
(C)The
Committee may obtain information directly from any Federal department or agency
as the Committee determines is necessary to carry out this section. Upon the
request of the Chairperson of the Committee, the head of such department or
agency shall furnish such information to the Committee.
(D)The
Committee may enter into contracts with qualified independent organizations to
obtain information necessary to assist grantees with the development of best
evidence-based practices and outcomes measurements or any other matters
determined by the Committee to be appropriate and reasonable to carry out this
section.
(E)The Committee may use the United States mails in the
same manner and under the same conditions as other departments and agencies of
the Federal Government.
(7)
(A)Each
member of the Committee who is not an officer or employee of the Federal
Government shall be compensated at a rate equal to the daily equivalent of the
annual rate of basic pay prescribed for level IV of the Executive Schedule
under section 5315 of title 5, United States Code, for each day (including
travel time) during which such member is engaged in the performance of the
duties of the Committee. All members of the Committee who are officers or
employees of the United States shall serve without compensation in addition to
that received for their services as officers or employees of the United
States.
(B)The members of the Committee shall be allowed travel
expenses, including per diem in lieu of subsistence, at rates authorized for
employees of agencies under subchapter I of chapter 57 of title 5, United
States Code, while away from their homes or regular places of business in the
performance of services for the Committee.
(C)The
Chairperson of the Committee may, without regard to the civil service laws and
regulations, appoint and terminate personnel as may be necessary to enable the
Committee to perform its duties.
(D)Detail of
governmental employeesAny Federal Government employee may be
detailed to the Committee without reimbursement upon the request of the
Committee, and such detail shall be without interruption or loss of civil
service status or privilege.
(E)Temporary and
intermittent servicesThe Chairperson of the Committee may
procure temporary and intermittent services under section 3109(b) of title 5,
United States Code, at rates for individuals which do not exceed the daily
equivalent of the annual rate of basic pay prescribed for level V of the
Executive Schedule under section 5316 of such title.
(8)For
the purpose of carrying out this subsection, there are authorized to be
appropriated $2,000,000 for fiscal year 2010 and each subsequent fiscal
year.
(d)
(1)To be eligible to receive a grant under this section, an
entity shall prepare and submit to the Committee, as part of the application
under subsection (b), a plan to seek to improve quality of care, which is
encouraged to include the following elements:
(A)Involvement and
leadership of the local health care community in the area to be served under
the grant.
(B)Strategies to
achieve cost-saving quality improvements in service delivery as a result of
activities carried out under the grant.
(C)Development and
implementation of electronic health record keeping, health information systems,
interoperability, evidence-based clinical decision support, or electronic
prescription of pharmaceuticals.
(D)Methods to
optimize evidence-based investment in early prevention and detection of
illness.
(E)Restructuring of
provider reimbursement provisions to assist in accomplishing the objectives of
the plan.
(F)Efforts to use
savings to expand health care coverage to the uninsured.
(2)The period of a grant awarded under this section shall not
exceed 2 years and may be renewed for subsequent 2-year periods upon
reapplication to the Committee. Nothing in this paragraph shall be construed to
prohibit a grantee from requesting an extension for a period of less than 2
years.
(e)A
State in which a grantee under this section is located shall receive expedited
and priority consideration of waiver requests from the Centers for Medicare
& Medicaid Services when necessary or appropriate to achieve the purposes
for which the grant was awarded.
(f)The amount of a grant awarded to an entity under this
section shall be determined based upon the recommendations of the Committee,
subject to appropriations, but is intended to be an unrestricted grant to
eligible entities with qualifying plans.
(g)
(1)An entity that is awarded a grant under this section
shall submit to the Committee an annual report for the period representing the
entity's fiscal year, that shall contain a description of the results of
activities carried out under the project.
(2)Not later than the end of the 5-year period beginning
on the date on which the first grant is awarded under this section, the
Committee shall prepare and submit to the appropriate committees of Congress, a
report on the progress made by grantees in achieving the purposes of this
Act.
(h)It is the sense of the Senate that, not later than 45 days
after receiving the report submitted under subsection (g)(2), each Committee to
which such report is submitted should hold at least 1 hearing concerning such
report and the recommendations contained in such report.
(i)Authorization
of appropriationsThere are authorized to be appropriated to
carry out this Act, $100,000,000 for the 10-fiscal year period beginning in
fiscal year 2010.