The duties described in this subsection are the following:
Priority setting process
The entity shall synthesize evidence and convene key stakeholders to make recommendations, with respect to activities conducted under this chapter, on an integrated national strategy and priorities for health care performance measurement in all applicable settings. In making such recommendations, the entity shall—
ensure that priority is given to measures—
that address the health care provided to patients with prevalent, high-cost chronic diseases;
with the greatest potential for improving the quality, efficiency, and patient-centeredness of health care; and
that may be implemented rapidly due to existing evidence, standards of care, or other reasons; and
take into account measures that—
may assist consumers and patients in making informed health care decisions;
address health disparities across groups and areas; and
address the continuum of care a patient receives, including services furnished by multiple health care providers or practitioners and across multiple settings.
Endorsement of measures
The entity shall provide for the endorsement of standardized health care performance measures. The endorsement process under the preceding sentence shall consider whether a measure—
is evidence-based, reliable, valid, verifiable, relevant to enhanced health outcomes, actionable at the caregiver level, feasible to collect and report, and responsive to variations in patient characteristics, such as health status, language capabilities, race or ethnicity, and income level; and
is consistent across types of health care providers, including hospitals and physicians.
Maintenance of measures
The entity shall establish and implement a process to ensure that measures endorsed under paragraph (2) are updated (or retired if obsolete) as new evidence is developed.
[Pub. L. 112–240, title VI, § 609(a)(2)], Jan. 2, 2013, [126 Stat. 2349]
Annual report to Congress and the Secretary; secretarial publication and comment
1 Annual report
By not later than March 1 of each year (beginning with 2009), the entity shall submit to Congress and the Secretary a report containing the following:
A description of—
the implementation of quality measurement initiatives under this chapter and the coordination of such initiatives with quality initiatives implemented by other payers;
the recommendations made under paragraph (1);
the performance by the entity of the duties required under the contract entered into with the Secretary under subsection (a);
gaps in endorsed quality measures, which shall include measures that are within priority areas identified by the Secretary under the national strategy established under section 280j of this title
, and where quality measures are unavailable or inadequate to identify or address such gaps;
areas in which evidence is insufficient to support endorsement of quality measures in priority areas identified by the Secretary under the national strategy established under section 280j of this title
and where targeted research may address such gaps; and
the matters described in clauses (i) and (ii) of paragraph (7)(A).
An itemization of financial information for the fiscal year ending September 30 of the preceding year, including—
annual revenues of the entity (including any government funding, private sector contributions, grants, membership revenues, and investment revenue);
annual expenses of the entity (including grants paid, benefits paid, salaries or other compensation, fundraising expenses, and overhead costs); and
a breakdown of the amount awarded per contracted task order and the specific projects funded in each task order assigned to the entity.
Any updates or modifications of internal policies and procedures of the entity as they relate to the duties of the entity under this section, 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 under this section (including complete rosters for all committees, work groups, task forces, and advisory panels funded through government contracts, descriptions of relevant interests and any conflicts of interest for members of all committees, work groups, task forces, and advisory panels, and the total percentage by health care sector of all convened committees, work groups, task forces, and advisory panels.
So in original. Probably should be “panels).”
Secretarial review and publication of annual report
Not later than 6 months after receiving a report under subparagraph (A) for a year, the Secretary shall—
review such report; and
publish such report in the Federal Register, together with any comments of the Secretary on such report.
Review and endorsement of episode grouper under the physician feedback program
The entity shall provide for the review and, as appropriate, the endorsement of the episode grouper developed by the Secretary under section 1395w–4(n)(9)(A) of this title. Such review shall be conducted on an expedited basis.
Convening multi-stakeholder groups
The entity shall convene multi-stakeholder groups to provide input on—
the selection of quality and efficiency measures described in subparagraph (B), from among—
such measures that have been endorsed by the entity; and
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
Quality and efficiency measures
Subject to clause (ii), the quality and efficiency measures described in this subparagraph are quality and efficiency measures—
for use pursuant to sections 1395f(i)(5)(D), 1395l
(t)(17), 1395w–4(k)(2)(C), 1395cc(k)(3), 1395rr(h)(2)(A)(iii),
See References in Text note below.
1395ww(b)(3)(B)(viii), 1395ww(j)(7)(D), 1395ww(m)(5)(D), 1395ww(o
)(2), 1395ww(s)(4)(D), and 1395fff(b)(3)(B)(v) of this title;
for use in reporting performance information to the public; and
for use in health care programs other than for use under this chapter.
Data sets (such as the outcome and assessment information set for home health services and the minimum data set for skilled nursing facility services) that are used for purposes of classification systems used in establishing payment rates under this subchapter shall not be quality and efficiency measures described in this subparagraph.
Requirement for transparency in process
In convening multi-stakeholder groups under subparagraph (A) with respect to the selection of quality and efficiency measures, the entity shall provide for an open and transparent process for the activities conducted pursuant to such convening.
Selection of organizations participating in multi-stakeholder groups
The process described in clause (i) shall ensure that the selection of representatives comprising such groups provides for public nominations for, and the opportunity for public comment on, such selection.
Multi-stakeholder group defined
In this paragraph, the term “multi-stakeholder group” means, with respect to a quality and efficiency measure, a voluntary collaborative of organizations representing a broad group of stakeholders interested in or affected by the use of such quality and efficiency measure.
Transmission of multi-stakeholder input
Not later than February 1 of each year (beginning with 2012), the entity shall transmit to the Secretary the input of multi-stakeholder groups provided under paragraph (7).
[Aug. 14, 1935, ch. 531], title XVIII, § 1890, as added [Pub. L. 110–275, title I, § 183(a)(1)], July 15, 2008, [122 Stat. 2583]; amended [Pub. L. 111–148, title III], §§ 3003(b), 3014(a), title X, §§ 10304, 10322(b), Mar. 23, 2010, [124 Stat. 367], 384, 938, 954; [Pub. L. 112–240, title VI, § 609(a)], Jan. 2, 2013, [126 Stat. 2349]; [Pub. L. 113–67, div. B, title I, § 1109], Dec. 26, 2013, [127 Stat. 1197]; [Pub. L. 113–93, title I, § 109], Apr. 1, 2014, [128 Stat. 1043]; [Pub. L. 114–10, title II, § 207], Apr. 16, 2015, [129 Stat. 145]; [Pub. L. 115–123, div. E, title II, § 50206(a)]–(c)(1), Feb. 9, 2018, [132 Stat. 183–185]; [Pub. L. 116–59, div. B, title IV, § 1401], Sept. 27, 2019, [133 Stat. 1105]; [Pub. L. 116–69, div. B, title IV, § 1401(a)], Nov. 21, 2019, [133 Stat. 1138]; [Pub. L. 116–94, div. N, title I, § 102(a)], Dec. 20, 2019, [133 Stat. 3096]; [Pub. L. 116–136, div. A, title III, § 3802(a)], Mar. 27, 2020, [134 Stat. 427].)