PRIA, Government Policy, Made Personal

Summary

The Secretary must set up a pre-rulemaking process to pick quality and efficiency measures for Medicare. A contracted entity must run multi-stakeholder groups to give advice. By December 1 each year (starting 2011) the Secretary must publish the measures under consideration. The contractor must send the groups’ input to the Secretary by February 1 each year (starting 2012). The Secretary must consider that input when choosing measures, whether or not the contractor has officially endorsed them. If the Secretary uses a measure that the contractor has not endorsed, the Secretary must explain the reason in the Federal Register. By March 1, 2012, and at least every three years after, the Secretary must assess and publish the impact of endorsed measures. The Secretary must also share chosen measures through workforce training and the national strategy, use existing distribution methods when possible, review measures at least every three years to keep or phase them out, avoid duplication, and consider new best practices. States may still use other federally identified measures. The CMS Administrator must develop measures by contract and consult the AHRQ Director. The Secretary should, when possible, report publicly on hospital-acquired condition measures used to adjust hospital payments. Within 180 days after October 24, 2018, the Secretary must set up a technical expert panel on opioid-related measures and may use the contracted entity to do so. Not later than one year after the panel starts (and periodically after), the panel must review existing and developing opioid measures, find gaps, set development priorities, and recommend measures and revisions for programs like MIPS, alternative payment models, the shared savings program, inpatient hospital reporting, and hospital value-based purchasing. The Secretary must consider using those opioid measures in those programs, prioritize developing measures for identified gaps, and prioritize contractor endorsement of opioid measures from October 24, 2018 through December 31, 2023, after which prioritization is optional.

Title 42, §1395aaa–1

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

(a)The Secretary shall establish a pre-rulemaking process under which the following steps occur with respect to the selection of quality and efficiency measures described in section 1395aaa(b)(7)(B) of this title:

(1)Pursuant to section 1395aaa(b)(7) of this title, the entity with a contract under section 1395aaa of this title shall convene multi-stakeholder groups to provide input to the Secretary on the selection of quality and efficiency measures described in subparagraph (B) of such paragraph.

(2)Not later than December 1 of each year (beginning with 2011), the Secretary shall make available to the public a list of quality and efficiency measures described in section 1395aaa(b)(7)(B) of this title that the Secretary is considering under this subchapter.

(3)Pursuant to section 1395aaa(b)(8) of this title, not later than February 1 of each year (beginning with 2012), the entity shall transmit to the Secretary the input of multi-stakeholder groups described in paragraph (1).

(4)The Secretary shall take into consideration the input from multi-stakeholder groups described in paragraph (1) in selecting quality and efficiency measures described in section 1395aaa(b)(7)(B) of this title that have been endorsed by the entity with a contract under section 1395aaa of this title and measures that have not been endorsed by such entity.

(5)The Secretary shall publish in the Federal Register the rationale for the use of any quality and efficiency measure described in section 1395aaa(b)(7)(B) of this title that has not been endorsed by the entity with a contract under section 1395aaa of this title.

(6)Not later than March 1, 2012, and at least once every three years thereafter, the Secretary shall—

(A)conduct an assessment of the quality and efficiency impact of the use of endorsed measures described in section 1395aaa(b)(7)(B) of this title; and

(B)make such assessment available to the public.

(b)(1)The Secretary shall establish a process for disseminating quality and efficiency measures used by the Secretary. Such process shall include the following:

(A)The incorporation of such measures, where applicable, in workforce programs, training curricula, and any other means of dissemination determined appropriate by the Secretary.

(B)The dissemination of such quality and efficiency measures through the national strategy developed under section 280j of this title.

(2)To the extent practicable, the Secretary shall utilize and expand existing dissemination methods in disseminating quality and efficiency measures under the process established under paragraph (1).

(c)(1)The Secretary shall—

(A)periodically (but in no case less often than once every 3 years) review quality and efficiency measures described in section 1395aaa(b)(7)(B) of this title; and

(B)with respect to each such measure, determine whether to—

(i)maintain the use of such measure; or

(ii)phase out such measure.

(2)In conducting the review under paragraph (1), the Secretary shall take steps to—

(A)seek to avoid duplication of measures used; and

(B)take into consideration current innovative methodologies and strategies for quality and efficiency improvement practices in the delivery of health care services that represent best practices for such quality and efficiency improvement and measures endorsed by the entity with a contract under section 1395aaa of this title since the previous review by the Secretary.

(d)Nothing in this section shall preclude a State from using the quality and efficiency measures identified under section 1320b–9a and 1320b–9b of this title.

(e)The Administrator of the Center for Medicare & Medicaid Services shall through contracts develop quality and efficiency measures (as determined appropriate by the Administrator) for use under this chapter. In developing such measures, the Administrator shall consult with the Director of the Agency for Healthcare Research and Quality.

(f)The Secretary shall, to the extent practicable, publicly report on measures for hospital-acquired conditions that are currently utilized by the Centers for Medicare & Medicaid Services for the adjustment of the amount of payment to hospitals based on rates of hospital-acquired infections.

(g)(1)Not later than 180 days after October 24, 2018, the Secretary shall establish a technical expert panel for purposes of reviewing quality measures relating to opioids and opioid use disorders, including care, prevention, diagnosis, health outcomes, and treatment furnished to individuals with opioid use disorders. The Secretary may use the entity with a contract under section 1395aaa(a) of this title and amend such contract as necessary to provide for the establishment of such technical expert panel.

(2)Not later than 1 year after the date the technical expert panel described in paragraph (1) is established (and periodically thereafter as the Secretary determines appropriate), the technical expert panel shall—

(A)review quality measures that relate to opioids and opioid use disorders, including existing measures and those under development;

(B)identify gaps in areas of quality measurement that relate to opioids and opioid use disorders, and identify measure development priorities for such measure gaps; and

(C)make recommendations to the Secretary on quality measures with respect to opioids and opioid use disorders for purposes of improving care, prevention, diagnosis, health outcomes, and treatment, including recommendations for revisions of such measures, need for development of new measures, and recommendations for including such measures in the Merit-Based Incentive Payment System under section 1395w–4(q) of this title, the alternative payment models under section 1395l(z)(3)(C) of this title, the shared savings program under section 1395jjj of this title, the quality reporting requirements for inpatient hospitals under section 1395ww(b)(3)(B)(viii) of this title, and the hospital value-based purchasing program under section 1395ww(o) of this title.

(3)The Secretary shall consider—

(A)using opioid and opioid use disorder measures (including measures used under the Merit-Based Incentive Payment System under section 1395w–4(q) of this title, measures recommended under paragraph (2)(C), and other such measures identified by the Secretary) in alternative payment models under section 1395l(z)(3)(C) of this title and in the shared savings program under section 1395jjj of this title; and

(B)using opioid measures described in subparagraph (A), as applicable, in the quality reporting requirements for inpatient hospitals under section 1395ww(b)(3)(B)(viii) of this title, and in the hospital value-based purchasing program under section 1395ww(o) of this title.

(4)The Secretary shall prioritize for measure development the gaps in quality measures identified under paragraph (2)(B).

(5)The Secretary—

(A)during the period beginning on October 24, 2018, and ending on December 31, 2023, shall prioritize the endorsement of measures relating to opioids and opioid use disorders by the entity with a contract under subsection (a) of section 1395aaa of this title in connection with endorsement of measures described in subsection (b)(2) of such section; and

(B)on and after January 1, 2024, may prioritize the endorsement of such measures by such entity.

Notes & Related Subsidiaries

Editorial Notes

Amendments

2018—Subsec. (g). Pub. L. 115–271 added subsec. (g). 2010—Pub. L. 111–148, § 10304, substituted “quality and efficiency” for “quality” wherever appearing in text. Subsec. (e). Pub. L. 111–148, § 3013(b), added subsec. (e). Subsec. (f). Pub. L. 111–148, § 10303(b), added subsec. (f).

§1395aaa–1 Quality and Efficiency Measurement

Summary

Title 42, §1395aaa–1

Notes & Related Subsidiaries

Editorial Notes

Amendments

Citations & Metadata