[Congressional Record Volume 155, Number 67 (Monday, May 4, 2009)]
[Senate]
[Pages S5076-S5080]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. REID (for Mr. Rockefeller (for himself and Mr. 
        Whitehouse)):
  S. 966. A bill to improve the Federal infrastructure for health care 
quality improvement in the United States; to the Committee on Finance.
  Mr. ROCKEFELLER. Mr. President, I rise today with my colleague, 
Senator Whitehouse of Rhode Island, to introduce the National Health 
Care Quality Act, legislation that makes health care quality a national 
priority. We have before us an overwhelming opportunity to make 
sweeping changes to our health care system. The dramatic change we need 
to improve America's health care delivery system requires a solid 
coordinated infrastructure to guide quality improvement; however this 
infrastructure does not exist today. The lack of a coordinated effort 
to improve health care quality has hindered our nation's ability to 
improve patient health outcomes and reduce inefficiencies in our health 
care system. In order to achieve our goals for true delivery system 
reform, health care quality must be elevated as a national priority.
  As the cost of health care in America continues to increase, the 
quality of care Americans receive continues to decrease. The average 
cost of health insurance premiums has doubled in the last nine years, 
from $5791 in 1999 to $12,680 in 2008. However, less than half of 
adults receive recommended care. More is spent per person on health 
care in the United States than in any other nation in the world, and 
yet America has some of the worst health outcomes. Wide-spread 
inefficiencies plague our health care system. The Congressional Budget 
Office, CBO, estimates that 30 percent of annual health care spending, 
or as much as $700 billion, could be eliminated with little to no 
impact on the system. Additionally, the Commonwealth Fund estimates 
that more than 100,000 American lives could be saved annually by 
improving health care quality to the level of performance achieved in 
other nations.
  Several entities contribute to health care quality improvement in the 
U.S., including numerous federal departments, several key Federal 
agencies within those departments, and additional private-sector 
partners. While there has been some progress to coordinate efforts 
among these entities and create a framework for navigating quality 
improvement efforts, there is no defined structure in place to guide 
the process of quality improvement, prioritize limited resources, and 
provide oversight to ensure these efforts reflect the best interests of 
all patients. Therefore, legislation is needed to modernize our health 
care structure to create better coordination of quality efforts, and 
make certain the decisions about reimbursement and coverage will allow 
the government to effectively deliver care that is of the highest 
quality.
  The National Health Care Quality Act would create a sensible 
infrastructure for health care quality improvement by creating an 
accountable entity--a new Office of National Health Care Quality 
Improvement within the Executive Office of the President--to set health 
care quality priorities for the nation. This office will be led by a 
new Director of National Health Care Quality, who will work with public 
and private stakeholders to establish and routinely update health care 
quality priorities for the nation based on a number of mandatory 
considerations, including the needs of children and the void in 
pediatric quality measures.
  This legislation also puts forth a construct to coordinate health 
care quality improvement efforts across all federal agencies involved 
in purchasing, providing, studying, or regulating health care services. 
The bill statutorily re-establishes the Quality Interagency 
Coordinating Council, QuICC, first created during the Clinton 
administration, within the Office of National Health Care Quality 
Improvement. The purpose of the Quality Interagency Coordinating 
Council is to coordinate health care quality improvement efforts across 
all relevant Federal departments and agencies involved in health care 
services. It also provides a framework for the development and 
implementation of Department- and agency-specific quality improvement 
strategies.
  Lastly, the legislation enhances health care quality improvement 
efforts within the Department of Health and Human Services, HHS, by 
expanding the authority of the Agency for Healthcare Research and 
Quality and elevating the role of the Director of AHRQ to a Senate-
appointed position. By building on and improving the public-private 
process for health care quality measure development, AHRQ can also help 
to streamline the implementation of quality improvement measures within 
federal health programs under the jurisdiction of HHS. AHRQ will 
establish a standardized method for reporting quality measures and data 
to all federal health programs. Lastly, AHRQ would be required to 
develop and launch a public education campaign, aimed at both providers 
and consumers of health care, about health care quality improvement.
  It is my belief that the multi-pronged approach provided in the 
National Health Care Quality Act will lead to vast improvements in the 
coordination of quality efforts and, most importantly, patient health 
outcomes. Given the current problems in the health care system, 
Congress has a responsibility to the American people to guarantee 
individuals have access to high quality, safe and effective care, and I 
urge my colleagues to join us in support of this important bill.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                 S. 966

       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 ``National Health Care Quality 
     Act''.

     SEC. 2. DEFINITIONS.

       In this Act:
       (1) Health care quality.--The term ``health care quality'' 
     means the degree to which health services for individuals and 
     populations increase the likelihood of desired health 
     outcomes and are consistent with current professional 
     knowledge, based upon the following criteria:
       (A) Effectiveness.--Health care services should be provided 
     based upon scientific knowledge of all who could benefit.
       (B) Efficiency.--Waste, including waste of equipment, 
     supplies, ideas, and energies, should be avoided.
       (C) Equity.--The provision of health care should not vary 
     in quality because of personal characteristics of the 
     individuals involved.
       (D) Patient-centeredness.--Health care should be responsive 
     to, and respectful of, individual patient preferences.
       (E) Safety.--Injuries to patients from the health care that 
     is supposed to help them should be avoided.
       (F) Timeliness.--Waiting times and harmful delays in 
     providing health care should be reduced.
       (2) Health care quality measure.--The term ``health care 
     quality measure'' means a national consensus standard for 
     measuring the performance and improvement of population 
     health or of institutional providers of services, physicians, 
     and other clinicians in the delivery of health care services, 
     consistent with the health care quality criteria described in 
     paragraph (1).
       (3) Multi-stakeholder group.--The term ``multi-stakeholder 
     group'' means, with respect to a health care quality measure, 
     a voluntary collaborative of public and private organizations 
     representing persons interested in, or affected by, the use 
     of such health care quality measure, including--
       (A) health care providers and practitioners, including 
     providers and practitioners primarily serving children and 
     those with long-term health care needs;
       (B) health care quality entities;
       (C) health plans;
       (D) patient advocates and consumer groups;
       (E) employers;
       (F) public and private purchasers of health care items and 
     services;
       (G) labor organizations;
       (H) relevant departments or agencies of the United States;
       (I) biopharmaceutical companies and manufacturers of 
     medical devices; and
       (J) licensing, credentialing, and accrediting bodies.

     SEC. 3. DEPARTMENT AND AGENCY QUALITY REVIEW.

       Each relevant department and agency of the Federal 
     Government shall review the statutory authority of such 
     department or agency, effective on the date of enactment of 
     this Act, administrative regulations, and policies and 
     procedures for the purpose of determining whether there are 
     any deficiencies or inconsistencies therein which prohibit 
     full compliance with the purposes and provisions of this Act. 
     Each department and agency shall, not later than July 1, 
     2010, propose to the President such measures as may be 
     necessary to bring the authority and policies and procedures 
     of such department or agency into conformity with the intent, 
     purposes, and provisions set forth in this Act.

[[Page S5077]]

     SEC. 4. NATIONAL HEALTH CARE QUALITY PRIORITIES.

       (a) Establishment of the Office of National Health Care 
     Quality Improvement.--There is established within the 
     Executive Office of the President an Office of National 
     Health Care Quality Improvement (``NHCQI'') (referred to in 
     this section as the ``Office''). The Office shall be headed 
     by a Director of National Health Care Quality (referred to in 
     this section as the ``Director'') who shall be appointed by 
     the President and shall report directly to the President.
       (b) Director.--
       (1) Responsibilities.--The Director shall perform the 
     duties of the Office, described in paragraph (3), in a manner 
     consistent with the development of a nationwide health care 
     quality infrastructure that--
       (A) coordinates and implements health care quality 
     research, measurement, and data collection and reporting 
     across all Federal agencies involved in purchasing, 
     providing, studying, or regulating health care services;
       (B) incorporates proven public and private quality 
     improvement best practices;
       (C) includes public and private quality improvement 
     strategies to address activities other than health care 
     quality measurement, such as provider payment models, 
     alternative care models, licensing, professional 
     certification, medical education, alternative staffing 
     models, and public reporting; and
       (D) leads to improved health care outcomes for patients 
     across the United States.
       (2) Qualifications.--The President shall, by and with the 
     advice and consent of the Senate, appoint a Director. The 
     President shall select an individual who has--
       (A) national recognition for expertise in health care 
     quality improvement;
       (B) experience addressing health care quality improvement 
     in more than one health care setting, such as inpatient care, 
     outpatient care, long-term care, public programs, and private 
     programs; and
       (C) experience addressing health care quality as it applies 
     to vulnerable populations, including children, underserved 
     populations, rural populations, individuals with 
     disabilities, the elderly, and racial and ethnic minorities.
       (3) Duties of the director.--The Director shall--
       (A) advise the President on the quality of health care in 
     the United States, including priorities and goals for the 
     future;
       (B) in coordination with public and private stakeholders, 
     determine national priorities for improving health care 
     quality, in accordance with subsection (c);
       (C) establish annual benchmarks for each relevant Federal 
     department and agency to achieve national priorities for 
     health care quality improvement;
       (D) develop an annual report card on the state of the 
     Nation's health as it relates to health care quality;
       (E) in coordination with the heads of other relevant 
     agencies and as part of the annual budget request of 
     Congress, submit funding requirements, in accordance with 
     subsection (d);
       (F) serve as the chairperson of the Quality Interagency 
     Coordinating Council (QuICC), established under section 4; 
     and
       (G) in consultation with the National Coordinator of Health 
     Information Technology, develop an open source framework for 
     Federal quality communication to create and maintain a 
     standardized, electronic language or interface that enables 
     all relevant Federal entities to communicate information or 
     make requests regarding quality research, definitions, 
     activities, or regulations, or to provide any other 
     functionality, as the Director determines.
       (c) National Priorities for Health Care Quality 
     Improvement.--
       (1) In general.--Not later than January 1, 2010 and at 
     least every 5 years thereafter, the Director, in coordination 
     with public and private stakeholders, shall establish 
     national priorities for health care quality improvement.
       (2) Development of priorities.--In establishing the 
     national priorities for health care quality improvement under 
     paragraph (1), the Director shall consider--
       (A) health care outcomes in the United States in comparison 
     to health outcomes in other World Health Organization member 
     countries;
       (B) the burden of disease, including the prevalence, 
     incidence, and cost of disease to the United States;
       (C) demographics;
       (D) variability in practice norms;
       (E) potential to eliminate harm to patients;
       (F) improvements with the potential for the greatest impact 
     on morbidity, mortality, performance, and a focus on the 
     patient;
       (G) quality measures that may be coordinated across 
     different health care settings, including impatient and 
     outpatient measures, primary care, and specialty care;
       (H) the specific quality improvement needs and challenges 
     of rural areas; and
       (I) the unique quality improvement needs disparities and 
     challenges of vulnerable populations, including children, the 
     elderly, individuals with disabilities, individuals near the 
     end of life, and racial and ethnic minorities.
       (3) Initial priorities.--The first set of national 
     priorities established under this subsection shall include as 
     a priority pediatric health care quality improvement, for 
     children up to age 21.
       (4) Collaboration with multi-stakeholder groups.--
       (A) In general.--The Director shall convene and collaborate 
     with multi-stakeholder groups in establishing and updating 
     the national priorities under paragraph (1).
       (B) Transparency.--All collaboration between the Director 
     and multi-stakeholder groups shall be conducted through an 
     open and transparent process.
       (C) Statutory construction.--Notwithstanding any other 
     provision in this paragraph, the Director shall have the 
     final authority to decide whether to accept the 
     recommendations provided by such multi-stakeholder groups.
       (5) Agency- and department-specific strategic plans.--Not 
     later than October 1, 2010 and annually thereafter, the 
     Director, in consultation with the heads of relevant Federal 
     agencies and departments, shall develop agency- and 
     department-specific strategic plans for health care quality 
     improvement to achieve national priorities, including annual 
     benchmarks.
       (d) Annual Budget Request for Resources.--As part of the 
     annual budget request made by the President to Congress, 
     beginning with such budget request made in calendar year 
     2011, the Director, in consultation with the heads of 
     relevant Federal departments and agencies, shall include--
       (1) a description of the agency- and department-specific 
     strategic plans for health care quality improvement; and
       (2) the level of Federal funding required for implementing 
     or maintaining the quality improvement strategic plans 
     described under paragraph (1).
       (e) Monitoring.--
       (1) In general.--The Director shall institute mechanisms 
     for monitoring the progress on achieving national health care 
     quality priorities under subsection (c)(1) as well as 
     department- and agency-specific strategic plans under 
     subsection (c)(5), including objectives, metrics, and 
     benchmarks for the following:
       (A) The benefits and drawbacks of specific quality 
     improvement efforts for public programs and for the health 
     care system at large.
       (B) Coordination and communication of efforts to achieve 
     interagency goals, including information exchange.
       (C) Interagency coordination progress for national quality 
     efforts.
       (D) Methods for ensuring awareness and recognition among 
     health care providers and the public at large of the 
     significance of health care quality improvement.
       (2) Reporting.--
       (A) Reporting.--Not later than December 31, 2011, and by 
     the end of each calendar year thereafter, the Director shall 
     submit to the President and to Congress a report regarding 
     the progress of Federal agencies in achieving the quality 
     improvement priorities under paragraphs (1) and (5) of 
     subsection (c), and shall make such report publicly available 
     through the Internet.
       (B) Annual national health care quality report card.--Not 
     later than January 31, 2011, and annually thereafter, the 
     Director shall publish a national health care quality report 
     card, which shall include--
       (i) the considerations for national health care quality 
     priorities described in subsection (c)(2);
       (ii) an analysis of the progress of the department- and 
     agency-specific strategic plans under subsection (c)(5) in 
     achieving the national health care quality priorities 
     established under subsection (c)(1), and any gaps in such 
     strategic plans;
       (iii) the extent to which private sector strategies have 
     informed Federal quality improvement efforts; and
       (iv) a summary of consumer feedback regarding how well 
     current quality improvement practices work for such consumers 
     and additional ways to improve health care quality.
       (f) Website.--Not later than July 1, 2010, the Director 
     shall create a website to make public information regarding--
       (1) the national priorities for health care quality 
     improvement established under subsection (c)(1);
       (2) the department- and agency-specific strategic plans for 
     health care quality described in subsection (c)(5);
       (3) the annual national health care quality report card 
     described in subsection (e)(2)(B);
       (4) ongoing health care quality research efforts;
       (5) new and innovative health care quality improvement 
     practices in the public and private sectors;
       (6) a consumer feedback mechanism; and
       (7) other information, as the Director determines to be 
     appropriate.
       (g) Staff; Experts and Consultants; Voluntary and 
     Uncompensated Service.--
       (1) Staff.--The Director may employ such officers and 
     employees as may be necessary to enable the Office to carry 
     out its functions under this Act, and may employ and fix the 
     compensation of such officers and employees as may be 
     necessary to carry out its functions under this Act.
       (2) Experts and consultants.--The Director may employ and 
     fix the compensation of such experts and consultants as may 
     be necessary for the carrying out of its functions under this 
     Act, in accordance with section 3109 of title 5, United 
     States Code (without regard to the last sentence).
       (3) Voluntary and uncompensated service.--Notwithstanding 
     section 1342 of title 31, United States Code, the Office may 
     accept and use voluntary and uncompensated services, as the 
     Director determines necessary.

[[Page S5078]]

       (h) Authorization of Appropriations.--There are authorized 
     to carry out this section $50,000,000 for fiscal years 2010 
     through 2014.

     SEC. 5. NATIONAL HEALTH CARE QUALITY COORDINATION.

       (a) Establishment.--As of the date of enactment of this 
     Act, there is established within the Office of National 
     Health Care Quality Improvement, the Quality Interagency 
     Coordinating Council (referred to in this section as the 
     ``QuICC'').
       (b) Purpose.--The purpose of the QuICC is to coordinate 
     health care quality improvement efforts across all Federal 
     agencies involved in purchasing, providing, studying, or 
     regulating health care services in order to achieve the 
     common goal of improving patient health outcomes.
       (c) Organization of the QuICC.--
       (1) Co-chairpersons.--The Director of National Health Care 
     Quality (referred to in this section as the ``Director'') and 
     the Secretary of Health and Human Services shall serve as co-
     chairpersons of the QuICC, and the Director shall manage day-
     to-day operations of the QuICC.
       (2) Federal members.--The Federal members of the QuICC, 
     each of whom shall have equal standing in the QuICC, shall 
     include--
       (A) the Administrator of the Centers for Medicare & 
     Medicaid Services;
       (B) the Director of the National Institutes of Health;
       (C) the Director of the Centers for Disease Control and 
     Prevention;
       (D) the Commissioner of Food and Drugs;
       (E) the Administrator of the Health Resources and Services 
     Administration;
       (F) the Director of the Agency for Healthcare Research and 
     Quality;
       (G) the Assistant Secretary of the Administration for 
     Children and Families;
       (H) the Secretary of Labor;
       (I) the Secretary of Defense;
       (J) the Secretary of Veterans Affairs;
       (K) the Under Secretary for Health of the Veterans Health 
     Administration;
       (L) the Secretary of Commerce;
       (M) the Director of the Office of Personnel Management;
       (N) the Director of the Office of Management and Budget;
       (O) the Commandant of the United States Coast Guard;
       (P) the Director of the Federal Bureau of Prisons;
       (Q) the Administrator of the National Highway Traffic 
     Safety Administration;
       (R) the Chairman of the Federal Trade Commission; and
       (S) the Commissioner of the Social Security Administration.
       (d) Goals.--The goals of the QuICC shall be to achieve the 
     following:
       (1) Collaboration between Federal departments and agencies 
     with respect to developing goals, models, and timetables that 
     are consistent with--
       (A) reducing the underlying causes of illness, injury, and 
     disability;
       (B) reducing health care errors;
       (C) ensuring the appropriate use of health care services;
       (D) expanding research on effectiveness of treatments;
       (E) addressing over-supply and under-supply of health care 
     resources; and
       (F) increasing patient participation in their care.
       (2) Collaboration between Federal departments and agencies 
     with respect to the development and utilization of quality 
     improvement strategies, including quality measurement, for 
     public sector programs that are flexible enough to respond to 
     changing health care needs, technology, and information, 
     while being sufficiently standardized to be comparably 
     measured.
       (3) Cooperation between Federal departments and agencies in 
     the development and dissemination of evidence-based health 
     care information to help guide practitioners' actions in ways 
     that will improve quality and potentially reduce costs.
       (4) Cooperation between Federal departments and agencies in 
     the development and dissemination of user-friendly 
     information for both consumer and business purchasers that 
     facilitates meaningful comparisons of quality performances of 
     health care plans, facilities and practitioners.
       (5) Consultation with multi-stakeholder groups, where 
     appropriate, in order to develop interdepartmental and 
     interagency models for quality improvement.
       (6) Avoidance of inefficient duplication of ongoing health 
     care quality improvement efforts and resources, where 
     feasible and appropriate.
       (7) Coordination and implementation by Federal departments 
     and agencies of a streamlined process for quality reporting 
     and compliance requirements to reduce administrative burdens 
     on private entities who administer, oversee, or participate 
     in the Federal health programs.
       (e) Workgroups.--
       (1) In general.--Not later than 30 days after the 
     establishment of the QuICC, the Director shall establish 
     within the QuICC workgroups for each of the national health 
     care priorities established under section 4(c)(1).
       (2) Purpose.--Each such workgroup shall focus on achieving 
     the goals of the QuICC (described in subsection (d)) for one 
     such priority and shall--
       (A) coordinate the implementation of such priority across 
     all relevant Federal agencies and departments; and
       (B) identify opportunities to improve the process of 
     implementing such health care priority.
       (3) Membership.--
       (A) Leadership.--Each workgroup shall be led by 2 relevant 
     Federal departments or agencies, as determined by the 
     Director.
       (B) Representation.--Each of the Federal members listed in 
     subsection (c)(2) may appoint 1 or more representatives to 
     each workgroup.
       (4) Reporting.--
       (A) Report.--Not later than December 31, 2010, and annually 
     thereafter, the co-chairpersons of the QuICC shall submit a 
     report to the relevant committees of Congress describing--
       (i) the QuICC's progress in meeting the goals described in 
     subsection (d);
       (ii) recommendations for legislation to improve the 
     processes of health care quality coordination and 
     prioritization; and
       (iii) recommendations for new and innovative quality 
     initiatives.
       (B) Publication.--Not later than December 31, 2010, and 
     annually thereafter, the co-chairpersons shall publish the 
     report described in subparagraph (A) on the website of the 
     Office of National Health Care Quality Improvement.
       (f) Authorization of Appropriations.--There are authorized 
     to be appropriated to carry out this section $5,000,000 for 
     fiscal years 2011 through 2014.

     SEC. 6. INCREASED AUTHORITY OF THE AGENCY FOR HEALTHCARE 
                   RESEARCH AND QUALITY WITHIN THE DEPARTMENT OF 
                   HEALTH AND HUMAN SERVICES.

       (a) Director of the Agency for Healthcare Research and 
     Quality.--Section 901(a) of the Public Health Service Act (42 
     U.S.C. 299(a)) is amended by striking ``by the Secretary'' 
     and inserting ``by the President, by and with the advice and 
     consent of the Senate''.
       (b) National Health Care Quality Priorities.--Title IX of 
     the Public Health Service Act (42 U.S.C. 299 et seq.) is 
     amended by adding at the end the following:

           ``PART E--NATIONAL HEALTH CARE QUALITY PRIORITIES

     ``SEC. 940. DEFINITIONS.

       ``In this part:
       ``(1) Health care quality.--The term `health care quality' 
     means the degree to which health services for individuals and 
     populations increase the likelihood of desired health 
     outcomes and are consistent with current professional 
     knowledge, based upon the following criteria:
       ``(A) Effectiveness.--Health care services should be 
     provided based upon scientific knowledge of all who could 
     benefit.
       ``(B) Efficiency.--Waste, including waste of equipment, 
     supplies, ideas, and energies, should be avoided.
       ``(C) Equity.--The provision of health care should not vary 
     in quality because of personal characteristics of the 
     individuals involved.
       ``(D) Patient-centeredness.--Health care should be 
     responsive to, and respectful of, individual patient 
     preferences.
       ``(E) Safety.--Injuries to patients from the health care 
     that is supposed to help them should be avoided.
       ``(F) Timeliness.--Waiting times and harmful delays in 
     providing health care should be reduced.
       ``(2) Health care quality measure.--The term `health care 
     quality measure' means a national consensus standard for 
     measuring the performance and improvement of population 
     health or of institutional providers of services, physicians, 
     and other clinicians in the delivery of health care services, 
     consistent with the health care quality criteria described in 
     paragraph (1).
       ``(3) Multi-stakeholder group.--The term `multi-stakeholder 
     group' means, with respect to a health care quality measure, 
     a voluntary collaborative of public and private organizations 
     representing persons interested in, or affected by, the use 
     of such health care quality measure, including--
       ``(A) health care providers and practitioners, including 
     providers and practitioners primarily serving children and 
     those with long-term health care needs;
       ``(B) health care quality entities;
       ``(C) health plans;
       ``(D) patient advocates and consumer groups;
       ``(E) employers;
       ``(F) public and private purchasers of health care items 
     and services;
       ``(G) labor organizations;
       ``(H) relevant departments or agencies of the United 
     States;
       ``(I) biopharmaceutical companies and manufacturers of 
     medical devices; and
       ``(J) licensing, credentialing, and accrediting bodies.
       ``(4) the term `health care quality measure' means a 
     national consensus standard for measuring the performance and 
     improvement of population health or of institutional 
     providers of services, physicians, and other clinicians in 
     the delivery of health care services; and
       ``(5) the term `multi-stakeholder group' means, with 
     respect to a health care quality measure, a voluntary 
     collaborative of public and private organizations 
     representing persons interested in, or affected by, the use 
     of such health care quality measure, including--
       ``(A) hospitals and other health care settings;
       ``(B) physicians, including pediatricians;

[[Page S5079]]

       ``(C) health care quality alliances;
       ``(D) nurses and other health care practitioners;
       ``(E) health plans;
       ``(F) patient advocates and consumer groups;
       ``(G) employers;
       ``(H) public and private purchasers of health care items 
     and services;
       ``(I) labor organizations;
       ``(J) relevant departments or agencies of the United 
     States;
       ``(K) biopharmaceutical companies and manufacturers of 
     medical devices; and
       ``(L) licensing, credentialing, and accrediting bodies.

     ``SEC. 941. RESEARCH PRIORITIES.

       ``The Director, in consultation with the heads of agencies 
     within the Department of Health and Human Services shall 
     ensure that the health care quality improvement priorities 
     identified by the Director of the Office of National Health 
     Care Quality Improvement, established under section 4 of the 
     National Health Care Quality Act, are taken into 
     consideration in all applicable research conducted under the 
     Department of Health and Human Services, including the 
     National Institutes of Health and the demonstration projects.

     ``SEC. 942. QUALITY MEASURES.

       ``(a) Application of Quality Measures to Programs Under the 
     Department of Health and Human Services.--
       ``(1) In general.--The Director, in consultation with the 
     Administrator of the Centers for Medicare & Medicaid 
     Services, the Director of the Centers for Disease Control and 
     Prevention, the Director of the National Institutes of 
     Health, and a consensus-based entity (as such term is used in 
     section 1890 of the Social Security Act), shall define 
     uniform health care quality measures, which shall apply to 
     Federal health programs under the Department of Health and 
     Human Services, including the following Federal programs, in 
     order of priority:
       ``(A) The Medicare program under title XVIII of the Social 
     Security Act, the rural health and pharmacy programs of the 
     Health Resources and Services Administration, and the health 
     programs of the Administration on Aging.
       ``(B) The Medicaid program under title XIX of the Social 
     Security Act, the Children's Health Insurance program under 
     title XXI of such Act, the health programs of the 
     Administration for Children and Families, and the maternal 
     and child health programs of the Health Resources and 
     Services Administration.
       ``(C) The Indian Health Service.
       ``(D) The Substance Abuse and Mental Health Services 
     Administration.
       ``(E) Programs of the Health Resources and Services 
     Administration other than those described in subparagraph 
     (B).
       ``(F) Centers of the Food and Drug Administration.
       ``(2) Prioritization.--The Director shall apply the health 
     care quality measures under this section to the Federal 
     programs in the order of priority described in paragraph (1).
       ``(3) Considerations regarding quality measure 
     application.--Before applying the health care quality 
     measures described in paragraph (1), the Director shall 
     consider--
       ``(A) the potential of such measures to improve patient 
     outcomes;
       ``(B) the ease of integration as a factor in health care 
     provider reimbursement;
       ``(C) the applicability of such measures across health care 
     settings;
       ``(D) the unique quality improvement needs of vulnerable 
     populations, including children, the elderly, individuals 
     with disabilities, individuals near the end of life, and 
     racial and ethnic minorities;
       ``(E) the burden of disease, including the prevalence, 
     incidence, and cost of disease to the United States; and
       ``(F) payment distortions that encourage certain practice 
     norms which may not lead to greater patient health outcomes.
       ``(4) Updating of the application of quality measures.--The 
     Director, in consultation with the Administrator of the 
     Centers for Medicare & Medicaid Services, the Director of the 
     Centers for Disease Control and Prevention, the Director of 
     the National Institutes of Health, and a consensus-based 
     entity (as such term is used in section 1890 of the Social 
     Security Act), shall develop a process for updating the 
     health care quality measures defined under paragraph (1) as 
     new research and evidence become available.
       ``(b) Quality Measure Reporting to Federal Health 
     Programs.--The Director, in cooperation with the 
     Administrator of the Centers for Medicare & Medicaid 
     Services, the National Coordinator for Health Information 
     Technology, the Administrator of the Health Resources and 
     Services Administration, the Director of the Centers for 
     Disease Control and Prevention, and the Commissioner of Food 
     and Drugs, shall create a streamlined process for health care 
     providers to report quality measures to the heads of relevant 
     agencies and departments for the purpose of quality 
     improvement in the Federal health programs described in 
     subsection (a)(1).
       ``(c) Development of Additional Quality Improvement 
     Strategies.--The Director, in consultation with the 
     Administrator of the Centers for Medicare & Medicaid 
     Services, the Director of the Centers for Disease Control and 
     Prevention, the Director of the National Institutes of 
     Health, and multi-stakeholder groups, shall develop quality 
     improvement strategies to address activities other than 
     health care quality measurement that lead to improved patient 
     outcomes, such as alternative care models, licensing, 
     professional certification, medical education, alternative 
     staffing models, and public reporting.

     ``SEC. 943. PUBLIC EDUCATION CAMPAIGNS.

       ``(a) In General.--The Director shall conduct a public 
     education campaign, designed to educate health care providers 
     and consumers of health care about health care quality 
     improvement.
       ``(b) Consumer Education Campaigns.--
       ``(1) In general.--The Director, in coordination with the 
     Administrator of the Centers for Medicare & Medicaid Services 
     and the Director of the Centers for Disease Control and 
     Prevention, shall create a consumer education campaign to 
     develop accurate and reliable information about health care 
     quality. In compiling the information for the consumer 
     education campaign, the Secretary may use mechanisms and 
     sources of information that are available through other 
     Federal agencies.
       ``(2) Requirements.--The consumer education campaign shall 
     include information regarding--
       ``(A) the importance of quality in health care decisions;
       ``(B) the ways in which health care experts define and 
     identify quality in health care;
       ``(C) the variance of quality among health insurance plans, 
     health care facilities, health care organizations, and health 
     care providers; and
       ``(D) the role of consumers in improving the quality of 
     health care.
       ``(3) Publication.--The Director shall make the information 
     described in paragraph (1) available to the public through 
     the Internet.
       ``(4) Grant program.--The Director shall award grants to 
     States and private nonprofit organizations to assist with the 
     creation and dissemination of the information described in 
     paragraph (1).
       ``(c) Quality Resource Center for Health Care Providers.--
       ``(1) In general.--The Director, in coordination with the 
     Administrator of the Centers for Medicare & Medicaid 
     Services, shall create a National Quality Resource Center 
     (referred to in this subsection as the `NQRC')for health care 
     providers to assist with the understanding and implementation 
     of quality improvement initiatives for health care providers.
       ``(2) Duties.--The national resource center developed under 
     paragraph (1) shall--
       ``(A) inform providers about quality improvement techniques 
     and the value of such techniques to improving quality;
       ``(B) accelerate the transfer of lessons learned from other 
     initiatives in the public and private sectors, including 
     those initiatives receiving Federal financial support;
       ``(C) provide a forum for exchange of knowledge and 
     experience among health care providers;
       ``(D) provide technical assistance to health care providers 
     for implementing quality improvement efforts; and
       ``(E) provide a forum for feedback from health care 
     providers concerning the effect of the efforts under 
     subparagraphs (A) through (D).
       ``(3) National quality support extension grant program.--
       ``(A) In general.--The Director, in coordination with the 
     NQRC, shall award National Quality Support Extension grants 
     (referred to in this paragraph as `NQSE grants' or the `NQSE 
     grant program'), on a competitive basis, to eligible entities 
     for the purpose of supporting and facilitating local health 
     care quality improvement efforts throughout the United 
     States.
       ``(B) Purposes.--The purposes of the NQSE grant program 
     are--
       ``(i) to assist qualified eligible entities in carrying out 
     projects related to health care quality improvement 
     activities among the provider community to help test and 
     acclimate to new, innovative quality improvement activities;
       ``(ii) to facilitate communication among local health care 
     quality groups regarding the best practices in the area of 
     quality improvement and prevention in the clinical setting; 
     and
       ``(iii) to enable, empower, support, and assist local 
     health care quality improvement efforts, particularly those 
     that facilitate collaboration between independent providers.
       ``(C) Eligible entities.--An entity desiring a grant under 
     this paragraph shall--
       ``(i) be a public or private nonprofit entity engaged in 
     health care quality improvement;
       ``(ii) submit to the Director a program design that 
     describes the purpose of the plan for which the entity seeks 
     a grant and the community leadership that will support the 
     entity in carrying out such plan; and
       ``(iii) submit to the Director an application at such time, 
     in such manner, and containing such information as the 
     Director may require.
       ``(4) Implementation assistance.--The Health Information 
     Technology regional extension centers under section 3012(c) 
     shall operate as extension centers for the NQRC, for the 
     purposes of implementation assistance.
       ``(5) Technical assistance for health care providers 
     working with vulnerable populations.--In carrying out this 
     subsection, the Director shall give particular attention to 
     the technical assistance that

[[Page S5080]]

     health care providers who serve vulnerable populations need.

     ``SEC. 944. FUNDING.

       ``(a) Trust Funds.--For purposes of funding the activities 
     under this part, the Secretary shall provide for the transfer 
     from the Federal Hospital Insurance Trust Fund under section 
     1817 of the Social Security Act (42 U.S.C. 1395i) and the 
     Federal Supplementary Insurance Trust Fund under section 1841 
     of the Social Security Act (42 U.S.C. 1395t), including the 
     Medicare Prescription Drug Account in such Trust Fund, in 
     such proportion as determined appropriate by the Secretary, 
     of $150,000,000 for each of fiscal years 2010 through 2014.
       ``(b) American Recovery and Reinvestment Funds.--At the end 
     of the recession adjustment period (as defined in section 
     5001(h)(3) of the American Recovery and Reinvestment Act 
     (Public Law 111-5; 123 Stat. 496), the Secretary of the 
     Treasury shall transfer any funds appropriated under such Act 
     and not otherwise expended to the Agency for purposes of 
     carrying out this part.
       ``(c) Medicaid and Medicare Improvement Funds.--For 
     purposes of funding the activities under this part for fiscal 
     year 2014, the Secretary shall provide for the transfer of 
     $100,000,000 from the Medicaid Improvement Fund under section 
     1898 of the Social Security Act (42 U.S.C. 1395iii), and 
     $100,000,000 from the Medicare Improvement Fund under section 
     1941 of such Act (42 U.S.C 1396w-1).''.
       (c) Technical Amendment.--Section 937(b) of the Public 
     Health Service Act (42 U.S.C. 299c-6(b)) is amended by 
     inserting ``except for part E,'' after ``this title''.
       (d) Development of Quality Measures for Federal Health 
     Programs.--
       (1) Period of contract.--Section 1890(a)(3) of the Social 
     Security Act (42 U.S.C. 1395aaa(a)(3)) is amended--
       (A) by striking ``4 years'' and inserting ``4 years, in the 
     case of the first contract entered into under such paragraph, 
     and 3 years in the case of each subsequent contract entered 
     into under such paragraph''; and
       (B) by inserting ``for a period of 3 years'' after 
     ``renewed''.
       (2) Priority setting process.--Section 1890(b)(1) of the 
     Social Security Act (42 U.S.C. 1395aaa(b)(1)) is amended--
       (A) in the matter preceding subparagraph (A)--
       (i) by striking ``an integrated national strategy and 
     priorities for''; and
       (ii) by inserting ``in a manner consistent with the 
     national priorities for health care quality improvement (as 
     defined in section 4(c)(1))'' after ``settings'';
       (B) in subparagraph (A)--
       (i) by redesignating clauses (i) through (iii) as clauses 
     (ii) through (iv), respectively; and
       (ii) by inserting before clause (ii), as so redesignated, 
     the following new clause:
       ``(i) that are consistent with such national priorities for 
     health care quality improvement;''.
       (3) Annual report to congress.--Section 1890(b)(5) of the 
     Social Security Act (42 U.S.C. 1395aaa(b)(5)) is amended--
       (A) by redesignating clauses (i) through (iii) as clauses 
     (ii) through (iv); and
       (B) by inserting before clause (ii), as so redesignated, 
     the following new clause:
       ``(i) the extent to which the priorities set and the 
     quality improvement measures endorsed by the entity under 
     paragraphs (1) and (2), respectively, are consistent with the 
     national priorities for health care quality improvement (as 
     so defined);''.
       (4) Funding.--Section 1890(d) of the Social Security Act 
     (42 U.S.C. 1395aaa(d)) is amended by inserting ``and, for 
     purposes of carrying out this section under a new or renewed 
     contract, there are authorized to be appropriated such sums 
     as are necessary, taking into consideration the results of 
     the study contained in the 18 month report submitted to 
     Congress under section 183(b)(2) of the Medicare Improvements 
     for Patients and Providers Act of 2008 (Public Law 110-275), 
     for each of fiscal years 2013 through 2015'' before the 
     period at the end.

     SEC. 7. REPORTS TO CONGRESS.

       (a) Evaluation of the Consumer Education Campaign.--Not 
     later than 18 months after the establishment of the quality 
     resource center under section 943(c) of the Public Health 
     Service Act (as added by section 6), the Comptroller General 
     of the United States shall submit to Congress a report 
     describing--
       (1) the effectiveness of the quality resource center for 
     health care providers under such section 943(c); and
       (2) the effectiveness of the consumer education program 
     under section 943(b) of such Act (as added by section 6).
       (b) Quality Dissemination Strategies.--Not later than 18 
     months after the date of enactment of this Act, the Secretary 
     of Health and Human Services, acting through the Director of 
     the Agency for Healthcare Research and Quality, shall submit 
     a report to Congress that includes--
       (1) a description of the efforts made to translate clinical 
     information regarding health care quality improvement into 
     reasonable clinical practice;
       (2) the processes through which the Secretary disseminated 
     the information described in paragraph (1); and
       (3) recommendations for the most effective methods for 
     translating and disseminating information concerning health 
     care quality, and required statutory changes to implement the 
     recommended methods.
       (c) IOM Report to Congress Regarding the Value of Quality 
     Measure Reporting.--
       (1) In general.--The Secretary of Health and Human Services 
     shall enter into a contract with the Director of the 
     Institute of Medicine requiring that, not later than 18 
     months after the date of enactment of this Act, the Director 
     submit to Congress a report regarding the value of quality 
     measure reporting in improving patient health outcomes.
       (2) Considerations.--In preparing the report described in 
     paragraph (1), the Director of the Institutes of Medicine 
     shall consider--
       (A) specific instances in the history of existing public 
     health care programs within the Federal Government in which 
     quality measure reporting has been shown, through peer-
     reviewed studies or literature, to result in improved patient 
     health outcomes; and
       (B) instances in which quality measure reporting has been 
     shown to improve existing health disparities among vulnerable 
     populations, including children, underserved populations, 
     rural populations, individuals with disabilities, the 
     elderly, and racial and ethnic minorities.
       (3) Authorization of appropriations.--There are authorized 
     to be appropriated such sums as may be necessary to carry out 
     this subsection.
       (d) GAO Study and Reports.--Section 183(b)(1) of the 
     Medicare Improvements for Patients and Providers Act of 2008 
     (Public Law 110-275; 122 Stat. 2586) is amended--
       (1) in subparagraph (A), by striking ``and'' after the 
     semicolon;
       (2) in subparagraph (B), by striking the period at the end 
     and inserting a semicolon; and
       (3) by inserting after subparagraph (B) the following:
       ``(C) any negative effect on patients, particularly on 
     patients in underserved or vulnerable populations; and
       ``(D) any negative effect on health care providers, 
     particularly health care providers in rural and underserved 
     areas.''.

     SEC. 8. DATA COLLECTION.

       (a) In General.--Not later than January 1, 2011, and at 
     least every 5 years thereafter, the Comptroller General of 
     the United States (referred to in this section as the 
     ``Comptroller General'') shall conduct evaluations of the 
     implementation of the data collection processes for quality 
     measures used by the Federal health programs administered 
     through the Department of Health and Human Services.
       (b) Considerations.--In conducting the evaluations under 
     subsection (a), the Comptroller General shall consider--
       (1) whether the system for the collection of data for 
     quality measures provides for validation of data in a manner 
     that is relevant, fair, and scientifically credible;
       (2) whether data collection efforts under the system--
       (A) use the most efficient and cost-effective means in a 
     manner that minimizes administrative burden on persons 
     required to collect data;
       (B) adequately protects the privacy the personal health 
     information of patients; and
       (C) provides data security;
       (3) whether standards under the system provide for an 
     opportunity for health care providers and institutional 
     providers of services to review and correct any inaccuracies 
     with regard to the findings; and
       (4) the extent to which quality measures--
       (A) assess outcomes and the functional status of patients;
       (B) assess the continuity and coordination of care and care 
     transitions, including episodes of care, for patients across 
     providers and health care settings;
       (C) assess patient experience and patient engagement;
       (D) assess the safety, effectiveness, and timeliness of 
     care;
       (E) assess health disparities, including disparities 
     associated with race, ethnicity, age, gender, place of 
     residence, or language;
       (F) assess the efficiency and use of resources in the 
     provision of care;
       (G) are designed to be collected as part of health 
     information technologies supporting better delivery of health 
     care services; and
       (H) result in direct or indirect costs to users of such 
     measures.
       (c) Authorization of Appropriations.--There are authorized 
     to be appropriated to carry out this section $1,000,000 for 
     fiscal years 2010 through 2014.
                                 ______