[Federal Register Volume 87, Number 169 (Thursday, September 1, 2022)]
[Notices]
[Pages 54028-54122]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-18906]



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Vol. 87

Thursday,

No. 169

September 1, 2022

Part IV





Department of Health and Human Services





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Secretarial Review and Publication of the 2021 Annual Report to 
Congress and the Secretary Submitted by the Consensus-Based Entity 
Regarding Performance Measurement; Notice

  Federal Register / Vol. 87 , No. 169 / Thursday, September 1, 2022 / 
Notices  

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

[CMS-3417-N]


Secretarial Review and Publication of the 2021 Annual Report to 
Congress and the Secretary Submitted by the Consensus-Based Entity 
Regarding Performance Measurement

AGENCY: Office of the Secretary of Health and Human Services, HHS.

ACTION: Notice.

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SUMMARY:
     This notice acknowledges the Secretary of the Department of Health 
and Human Services' (the Secretary's) receipt and review of the 
National Quality Forum 2021 Annual Activities Report to Congress, 
submitted by the consensus-based entity (CBE) under a contract with the 
Secretary as mandated by the Social Security Act (the Act). The 
Secretary has reviewed the National Quality Forum's 2021 Annual Report 
and is publishing the report in the Federal Register together with the 
Secretary's comments on the report not later than 6 months after 
receiving the report in accordance with section 1890(b)(5)(B) of the 
Act. This notice fulfills the statutory requirements.

FOR FURTHER INFORMATION CONTACT:  LaWanda Burwell, (410) 294-2056.

I. Background

    The United States Department of Health and Human Services (HHS) has 
long recognized that a high functioning health care system that 
provides higher quality care requires accurate, valid, and reliable 
measurement of quality and efficiency. The Medicare Improvements for 
Patients and Providers Act of 2008 (MIPPA) (Pub. L. 110-275) added 
section 1890 of the Social Security Act (the Act), which requires the 
Secretary of HHS (the Secretary) to contract with a consensus based 
entity (CBE) to perform multiple duties to help improve performance 
measurement. Section 3014 of the Patient Protection and Affordable Care 
Act (the Affordable Care Act) (Pub. L. 111-148) expanded the duties of 
the CBE to help in the identification of gaps in available measures and 
to improve the selection of measures used in health care programs. The 
Secretary extends his appreciation to the CBE in their partnership for 
the fulfillment of these statutory requirements.
    In January 2009, a competitive contract was awarded by HHS to the 
National Quality Forum (NQF) to fulfill requirements of section 1890 of 
the Act. A second, multi-year contract was awarded again to NQF after 
an open competition in 2012. A third, multi-contract was awarded again 
to NQF after an open competition in 2017. Section 1890(b) of the Act 
requires the following:
    Priority Setting Process: Formulation of a National Strategy and 
Priorities for Health Care Performance Measurement. The CBE must 
synthesize evidence and convene key stakeholders to make 
recommendations on an integrated national strategy and priorities for 
health care performance measurement in all applicable settings. In 
doing so, the CBE must give priority to measures that: (1) address the 
health care provided to patients with prevalent, high-cost chronic 
diseases; (2) have the greatest potential for improving quality, 
efficiency, and patient-centered health care; and (3) may be 
implemented rapidly due to existing evidence, standards of care, or 
other reasons. Additionally, the CBE must take into account measures 
that: (1) may assist consumers and patients in making informed health 
care decisions; (2) address health disparities across groups and areas; 
and (3) address the continuum of care furnished by multiple providers 
or practitioners across multiple settings.
    Endorsement of Measures. The CBE must provide for the endorsement 
of standardized health care performance measures. This process must 
consider whether measures are evidence-based, reliable, valid, 
verifiable, relevant to enhanced health outcomes, actionable at the 
caregiver level, feasible to collect and report, responsive to 
variations in patient characteristics such as health status, language 
capabilities, race or ethnicity, and income level and are consistent 
across types of health care providers, including hospitals and 
physicians.
    Maintenance of CBE Endorsed Measures. The CBE is required to 
establish and implement a process to ensure that endorsed measures are 
updated (or retired if obsolete) as new evidence is developed.
    Removal of Measures. Section 102(c) of Division CC of the 
Consolidated Appropriations Act, 2021 amended section 1890(b) of the 
Act to permit the CBE to provide input to the Secretary on measures 
that may be considered for removal.
    Convening Multi-Stakeholder Groups. The CBE must convene multi-
stakeholder groups to provide input on: (1) the selection of certain 
categories of quality and efficiency measures, from among such measures 
that have been endorsed by the entity and from among such measures that 
have not been considered for endorsement by such entity but are used or 
proposed to be used by the Secretary for the collection or reporting of 
quality and efficiency measures; and (2) national priorities for 
improvement in population health and in the delivery of health care 
services for consideration under the national strategy. The CBE 
provides input on measures for use in certain specific Medicare 
programs, for use in programs that report performance information to 
the public, and for use in health care programs that are not included 
under the Act. The multi-stakeholder groups provide input on quality 
and efficiency measures for various federal health care quality 
reporting and quality improvement programs including those that address 
certain Medicare services provided through hospices, ambulatory 
surgical centers, hospital inpatient and outpatient facilities, 
physician offices, cancer hospitals, end stage renal disease (ESRD) 
facilities, inpatient rehabilitation facilities, long-term care 
hospitals, psychiatric hospitals, and home health care programs.
    Transmission of Multi-Stakeholder Input. Not later than February 1 
of each year, the CBE must transmit to the Secretary the input of 
multi-stakeholder groups.
    Annual Report to Congress and the Secretary. Not later than March 1 
of each year, the CBE is required to submit to the Congress and the 
Secretary an annual report. The report is to describe:
     The implementation of quality and efficiency measurement 
initiatives and the coordination of such initiatives with quality and 
efficiency initiatives implemented by other payers;
     Recommendations on an integrated national strategy and 
priorities for health care performance measurement;
     Performance of the CBE's duties required under its 
contract with the Secretary;
     Gaps in endorsed quality and efficiency measures, 
including measures that are within priority areas identified by the 
Secretary under the national strategy established under section 399HH 
of the Public Health Service Act (National Quality Strategy), and where 
quality and efficiency measures are unavailable or inadequate to 
identify or address such gaps;
     Areas in which evidence is insufficient to support 
endorsement of quality and efficiency measures in priority areas 
identified by the Secretary under the National Quality Strategy, and 
where targeted research may address such gaps; and
     The convening of multi-stakeholder groups to provide input 
on: (1) the selection of quality and efficiency measures from among 
such measures that have been endorsed by the CBE and

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such measures that have not been considered for endorsement by the CBE 
but are used or proposed to be used by the Secretary for the collection 
or reporting of quality and efficiency measures; and (2) national 
priorities for improvement in population health and the delivery of 
health care services for consideration under the National Quality 
Strategy.
    Section 50206(c)(1) of the Bipartisan Budget Act of 2018 (Pub. L. 
115-123) amended section 1890(b)(5)(A) of the Act to require the CBE's 
annual report to Congress to include the following: (1) an itemization 
of financial information for the previous fiscal year ending September 
30th, including annual revenues of the entity, annual expenses of the 
entity, and a breakdown of the amount awarded per contracted task order 
and the specific projects funded in each task order assigned to the 
entity; and (2) any updates or modifications to internal policies and 
procedures of the entity as they relate to the duties of the CBE 
including specifically identifying any modifications to the disclosure 
of interests and conflicts of interests for committees, work groups, 
task forces, and advisory panels of the entity, and information on 
external stakeholder participation in the duties of the entity.
    The statutory requirements for the CBE to annually report to the 
Congress and the Secretary also specify that the Secretary must review 
and publish the CBE's annual report in the Federal Register, together 
with any comments of the Secretary on the report, not later than 6 
months after receiving it.
    This Federal Register notice complies with the statutory 
requirement for Secretarial review and publication of the CBE's annual 
report. NQF submitted a report on its 2021 activities to the Congress 
and the Secretary on March 1, 2022. The Secretary's Comments on this 
report are presented in section II of this notice, and the National 
Quality Forum 2021 Activities Report to the Congress and the Secretary 
is provided, as submitted to HHS, in the addendum to this Federal 
Register notice in section IV.

II. Secretarial Comments on the National Quality Forum 2021 Activities: 
Report to Congress and the Secretary of the Department of Health and 
Human Services

    The Centers for Disease Control and Prevention reported that Black 
women are 3 times more likely to die from a pregnancy-related cause 
than White women. Understanding that a third of all maternal deaths 
occur between 1 week to a year after childbirth,\1\ HHS implemented new 
policies and funding to ensure safer pregnancies and postpartum 
services for new parents and their babies as a strategy for improving 
maternal health for all women. We have granted first-time approval of 
proposals in five states to expand postpartum Medicaid coverage for 
mothers following delivery and created a new measure in Medicare that 
will encourage hospitals to standardize protocols addressing obstetric 
emergencies and complications arising during pregnancy.\2\
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    \1\ CDC Working Together to Reduce Black Maternal Mortality.
    \2\ HHS Marks Maternal Health Week.
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    In 2021, HHS continued our partnership with the NQF to both explore 
improvements in maternal health and continue to advance health care 
quality measurement through a number of projects and forums. NQF worked 
with a variety of multi-stakeholder groups to identify and address 
national priorities with gaps in quality measurement, including areas 
with underlying health disparities made more prominent by COVID-19 
Public Health Emergency (PHE), and NQF encouraged development of new 
measures in these areas.

Maternal Morbidity & Mortality Measurement

    The dual aim of the NQF Maternal Morbidity and Mortality 
Measurement project was to develop tangible recommendations to enhance 
maternal morbidity and mortality measurement in the United States and 
drive toward improved health outcomes in maternity care. To achieve 
this dual aim, NQF convened a technical expert panel comprised of 
practitioners and policy makers to assess the current state of maternal 
morbidity and mortality measurement; recommended specific short- and 
long-term, innovative, and actionable ways to improve maternal 
morbidity and mortality measurement; and used that measurement to 
improve maternal health outcomes.
    As in other areas of health and health care, COVID-19 magnified 
already disparate maternal health outcomes in 2021. NQF's Maternal 
Morbidity and Mortality Panel suggested approaches to enhance maternal 
morbidity and mortality measurement that focus on patient-reported 
outcomes (PROs) and measures that reflect the impacts of social 
determinants of health. They also emphasized access to care and a 
patient's lived experience to drive toward improved outcomes in 
maternal care.

Measure Applications Partnership

    NQF's Measure Applications Partnership (MAP) advised HHS on which 
measures to use in federal reporting and value-based programs to ensure 
these measures address national health care priorities, fill critical 
measurement gaps, and increase public-private payer alignment. Using 
the existing MAP Coordinating Committee, NQF also piloted an initiative 
to provide recommendations to Centers for Medicare & Medicaid Services 
(CMS) on which measures could potentially be removed from federal 
quality programs. NQF added a new Health Equity Advisory Group to the 
MAP focused specifically on measurement issues related to health 
disparities and critical access hospitals.
    The MAP also identified topics with too few or no measures at the 
individual federal program level: PROs, health equity, telehealth, and 
care coordination. Many of these areas align with critical health care 
priorities and CMS' Meaningful Measures Areas.\3\ NQF publicly posted 
guidance documents with strategic approaches and recommendations for 
measuring performance in these priority gap areas.
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    \3\ CMS Meaningful Measures Initiative.
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Core Quality Measures Collaborative

    NQF partnered with CMS and America's Health Insurance Plans to 
bring together public and private payers in the Core Quality Measures 
Collaborative (CQMC). The CQMC is designed to forge alignment in the 
quality measures used to incentivize high quality, cost-efficient care 
and reduce measurement burden in public- and private-sector value-based 
payment programs. The CQMC continued updating existing core measures to 
reflect the changing measurement landscape and developed a new set of 
cross-cutting measures applicable across multipleclinical conditions, 
settings, and procedures/services.
    HHS values NQF's expertise in bringing many diverse stakeholders to 
the table to drive innovation in quality measurement as a key to 
addressing public health challenges, including improvements in maternal 
health.

III. Collection of Information Requirements

    This document does not impose information collection requirements, 
that is, reporting, recordkeeping or third-party disclosure 
requirements. Consequently, there is no need for review by the Office 
of Management and Budget under the authority of the

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Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et seq.).

IV. Addendum

    In this Addendum, we are publishing the NQF Report on 2021 
Activities to Congress and the Secretary of the Department of Health 
and Human Services, as submitted to HHS.

Xavier Becerra,
Secretary, Department of Health and Human Services.
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[FR Doc. 2022-18906 Filed 8-31-22; 8:45 am]
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