§1320b–9b — Title 42 The Public Health and Welfare | U.S. Code

Summary

The Secretary must pick and publish a recommended core set of adult health quality measures for adults on Medicaid. These measures should be chosen the same way child measures are chosen and should include measures already used in public and private plans or in systems that track how long people have health coverage. The Secretary had to publish the recommended set for comment by January 1, 2011, and the initial core set by January 1, 2012. By January 1, 2013, the Secretary had to make a standard reporting format and ways to encourage States to report these measures. The Secretary must set up a Medicaid Quality Measurement Program within 12 months after the recommended set is released, and then publish recommended changes every year starting 24 months after that. Starting with State reports for 2024, States must use all behavioral health measures in the core set when reporting behavioral health quality in the standard format. Every three years starting January 1, 2014, the Secretary must include information about these measures in the report to Congress. Each State with Medicaid must report every year which adult measures it uses and state data on the quality of care, including reviews of managed care organizations and benchmark plans. The Secretary must collect, analyze, and publish those State reports by September 30, 2014, and every year after. The law does not let coverage be limited only to evidence-based services or cut available services. Congress set aside $60,000,000 for each fiscal year 2010 through 2014 to carry out this work, with at least $15,000,000 of that used for the child-measure program.

Title 42, §1320b–9b

The Public Health and Welfare — Source: USLM XML via OLRC

(a)The Secretary shall identify and publish a recommended core set of adult health quality measures for Medicaid eligible adults in the same manner as the Secretary identifies and publishes a core set of child health quality measures under section 1320b–9a of this title, including with respect to identifying and publishing existing adult health quality measures that are in use under public and privately sponsored health care coverage arrangements, or that are part of reporting systems that measure both the presence and duration of health insurance coverage over time, that may be applicable to Medicaid eligible adults.

(b)(1)Not later than January 1, 2011, the Secretary shall identify and publish for comment a recommended core set of adult health quality measures for Medicaid eligible adults.

(2)Not later than January 1, 2012, the Secretary shall publish an initial core set of adult health quality measures that are applicable to Medicaid eligible adults.

(3)(A)Not later than January 1, 2013, the Secretary, in consultation with States, shall develop a standardized format for reporting information based on the initial core set of adult health quality measures and create procedures to encourage States to use such measures to voluntarily report information regarding the quality of health care for Medicaid eligible adults.

(B)Beginning with the State report required under subsection (d)(1) for 2024, the Secretary shall require States to use all behavioral health measures included in the core set of adult health quality measures and any updates or changes to such measures to report information, using the standardized format for reporting information and procedures developed under subparagraph (A), regarding the quality of behavioral health care for Medicaid eligible adults.

(4)Not later than January 1, 2014, and every 3 years thereafter, the Secretary shall include in the report to Congress required under section 1320b–9a(a)(6) of this title information similar to the information required under that section with respect to the measures established under this section.

(5)(A)Not later than 12 months after the release of the recommended core set of adult health quality measures under paragraph (1)) 11 So in original. The second closing parenthesis probably should not appear., the Secretary shall establish a Medicaid Quality Measurement Program in the same manner as the Secretary establishes the pediatric quality measures program under section 1320b–9a(b) of this title.

(B)Beginning not later than 24 months after the establishment of the Medicaid Quality Measurement Program, and annually thereafter, the Secretary shall publish recommended changes to the initial core set of adult health quality measures that shall reflect the results of the testing, validation, and consensus process for the development of adult health quality measures.

(C)Beginning with respect to State reports required under subsection (d)(1) for 2024, the core set of adult health quality measures maintained under this paragraph (and any updates or changes to such measures) shall include behavioral health measures.

(c)Nothing in this section shall be construed as supporting the restriction of coverage, under subchapter XIX or XXI or otherwise, to only those services that are evidence-based, or in anyway limiting available services.

(d)(1)Each State with a State plan or waiver approved under subchapter XIX shall annually report (separately or as part of the annual report required under section 1320b–9a(c) of this title), to the Secretary on the—

(A)State-specific adult health quality measures applied by the State under such plan, including measures described in subsection (b)(5) and, beginning with the report for 2024, all behavioral health measures included in the core set of adult health quality measures maintained under such subsection (b)(5) and any updates or changes to such measures (as required under subsection (b)(3)); and

(B)State-specific information on the quality of health care furnished to Medicaid eligible adults under such plan, including information collected through external quality reviews of managed care organizations under section 1396u–2 of this title and benchmark plans under section 1396u–7 of this title.

(2)Not later than September 30, 2014, and annually thereafter, the Secretary shall collect, analyze, and make publicly available the information reported by States under paragraph (1).

(e)Out of any funds in the Treasury not otherwise appropriated, there is appropriated for each of fiscal years 2010 through 2014, $60,000,000 for the purpose of carrying out this section. Funds appropriated under this subsection shall remain available until expended. Of the funds appropriated under this subsection, not less than $15,000,000 shall be used to carry out section 1320b–9a(b) of this title.

Notes & Related Subsidiaries

Editorial Notes

Amendments

2018—Subsec. (b)(3). Pub. L. 115–271, § 5001(1)(A), designated existing provisions as subpar. (A), inserted heading, and added subpar. (B). Subsec. (b)(5)(C). Pub. L. 115–271, § 5001(1)(B), added subpar. (C). Subsec. (d)(1)(A). Pub. L. 115–271, § 5001(2), substituted “such plan” for “the such plan” and “subsection (b)(5) and, beginning with the report for 2024, all behavioral health measures included in the core set of adult health quality measures maintained under such subsection (b)(5) and any updates or changes to such measures (as required under subsection (b)(3))” for “subsection (a)(5)”. 2014—Subsec. (b)(5)(A). Pub. L. 113–93, § 210(b), struck out at end “The aggregate amount awarded by the Secretary for grants and contracts for the development, testing, and validation of emerging and innovative evidence-based measures under such program shall equal the aggregate amount awarded by the Secretary for grants under section 1320b–9a(b)(4)(A) of this title”. Subsec. (e). Pub. L. 113–93, § 210(a), inserted at end “Of the funds appropriated under this subsection, not less than $15,000,000 shall be used to carry out section 1320b–9a(b) of this title.”

§1320b–9b Adult health quality measures

Summary

Title 42, §1320b–9b

Notes & Related Subsidiaries

Editorial Notes

Amendments

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