[Federal Register Volume 88, Number 180 (Tuesday, September 19, 2023)]
[Notices]
[Pages 64660-64753]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-20076]



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Vol. 88

Tuesday,

No. 180

September 19, 2023

Part III





 Department of Health and Human Services





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Secretarial Review and Publication of the 2022 Annual Report to 
Congress and the Secretary Submitted by the Consensus-Based Entity 
Regarding Performance Measurement; Notice

  Federal Register / Vol. 88, No. 180 / Tuesday, September 19, 2023 / 
Notices  

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

[CMS-3432-N]


Secretarial Review and Publication of the 2022 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 
2022 National Quality Forum Annual Report to Congress and the Secretary 
submitted by the consensus-based entity under a contract with the 
Secretary as mandated by the Social Security Act. The Secretary has 
reviewed 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: Carrie Sena, (410) 786-8003.

SUPPLEMENTARY INFORMATION: 

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-year 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.
    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 may 
also provide input to the Secretary on measures that could be 
considered for removal. 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 such measures that 
have not been considered for endorsement by the CBE but are used or 
proposed to be used by

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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 the 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 2022 activities to the Congress 
and the Secretary on March 1, 2023. The Secretary's Comments on this 
report are presented in section II. of this notice, and the 2022 Annual 
Report to the Congress and the Secretary is provided, as submitted to 
HHS, in the addendum to this Federal Register notice in section III.

II. Secretarial Comments on the National Quality Forum 2022 Activities: 
Report to Congress and the Secretary of the Department of Health and 
Human Services

    Across the country, many communities are facing immense challenges 
that have been exacerbated by public health emergencies including the 
opioid crisis, disasters related to climate change, and the COVID-19 
pandemic. Throughout these recent crises and to prudently prepare for 
imminent threats the Department of Health and Human Services (HHS) must 
continue to focus on advancing equity and inclusion, strengthening 
public trust, and building meaningful engagement and learning across 
the health care system. By embedding the cross-cutting principles \1\ 
of equity, public trust, and collaboration into its diverse programs 
and initiatives, HHS is working to improve the health and well-being of 
individuals and families.
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    \1\ HHS Strategic Cross-Cutting Principles, available at https://www.hhs.gov/about/strategic-plan/2022-2026/overview/index.html.
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    HHS values the work of the consensus-based entity for performance 
measurement and our mutual commitment to promote a resilient, high 
value, and safe health care system for all Americans. In 2022, HHS 
supported the work conducted by the CBE to identify health care quality 
measurement priorities and to provide consensus-based recommendations 
about measures to use for assessing and improving quality. As the CBE 
in 2022, the NQF continued to use rigorous standards to review measures 
for quality measure endorsement and maintain highly reliable and 
scientifically sound measures across priority health care topic areas. 
As required by section 1890(b) of the Act, the NQF Measure Applications 
Partnership (MAP) provided input on measures under consideration for 
quality reporting and value-based purchasing programs across various 
settings including ambulatory, acute care, post-acute care and long-
term care. Specifically, the MAP considered measures related to health 
equity, COVID-19, person-centered care, rural health, and care 
coordination. The MAP also deliberated over measures for potential 
removal from HHS programs. The MAP supported HHS and national 
priorities to keep measures that are of the highest-value, aligned 
across programs, prioritizing patient-reported outcome measures, 
digital measures, and those that reflect consideration of social 
determinants of health.
    In 2022, the CBE also convened the Core Quality Measures 
Collaborative (CQMC), a public-private partnership with the Centers for 
Medicare and Medicaid Services (CMS) and America's Health Insurance 
Plans (AHIP), to maximize alignment of quality measures among public 
and private payers. The CBE established a Health Equity Workgroup that 
identified disparity-sensitive measures within the CQMC core sets and 
proposed approaches for future considerations to prioritize measures 
that address social determinants of health. In alignment with HHS 
priorities to advance data interoperability and digital measure use, 
the CQMC Digital Measurement Workgroup continued, in 2022, to identify 
ways to address barriers to using digital quality measures and 
supporting efforts to align data standards for measurement.
    To support the CMS National Quality Strategy \2\ and critical 
health care priorities, the CBE worked with quality measurement 
experts, clinicians, health plans, hospitals, accrediting and 
certifying entities, consumer organizations and others to improve areas 
of behavioral health, rural health, health care communication and 
coordination, and patient-centered care. In 2022, the CBE developed 
measurement frameworks detailing guidance, recommendations, and 
identifying measurement gaps for Opioid-Related Outcomes Among 
Individuals With Co-occurring Behavioral Health Conditions; Leveraging 
Quality Measures to Improve Rural Health; and Leveraging Electronic 
Health Record-Sourced Measures to Improve Care Communication and 
Coordination. Additional CBE projects included provided guidance for 
Best Practices for Developing and Testing Risk Adjustment Models; 
Building a Roadmap From Patient-Reported Outcome Measures to Patient-
Reported Outcome Performance Measures; and establishing a Patient and 
Caregiver Engagement Advisory Group.
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    \2\ CMS National Quality Strategy available at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/CMS-Quality-Strategy.
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    In many ways, the CBE activities detailed in its 2022 Report to 
Congress enhanced quality measurement strategies that support HHS and 
national progress towards safe, accessible, value-based, and equitable 
care for individuals and communities. As our world and the demands on 
our health care system continue to evolve, HHS recognizes the 
increasing importance of varied experiences and perspectives, of 
consensus-based recommendations, and of evidence-based foundations that 
inform policies and strategies to improve the health care system. HHS 
looks forward to the continuity of activities with a new CBE, Battelle, 
who has extensive expertise and experience in collaborating with and 
engaging various health care partners to advance quality performance 
measurement.

III. Collection of Information Requirements

    This document does not impose information collection requirements, 
that is, reporting, recordkeeping or third-party disclosure 
requirements.

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Consequently, there is no need for review by the Office of Management 
and Budget under the authority of the Paperwork Reduction Act of 1995 
(44 U.S.C. 3501 et seq.).

IV. Addendum

    In this Addendum, we are publishing the NQF Report on 2022 
Activities to Congress and the Secretary of the Department of Health 
and Human Services, as submitted to HHS.

    Dated: September 12, 2023.
Xavier Becerra,
Secretary, Department of Health and Human Services.
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[FR Doc. 2023-20076 Filed 9-18-23; 8:45 am]
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