Home > 106th Congressional Bills > S. 2563 (is) To reduce temporarily the duty on Baytron C-R. [Introduced in Senate] ...S. 2563 (is) To reduce temporarily the duty on Baytron C-R. [Introduced in Senate] ...
108th CONGRESS
2d Session
S. 2562
To amend title XVIII of the Social Security Act to provide incentives
for the furnishing of quality care under Medicare Advantage plans and
by end stage renal disease providers and facilities, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 23 (legislative day, June 22), 2004
Mr. Baucus introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide incentives
for the furnishing of quality care under Medicare Advantage plans and
by end stage renal disease providers and facilities, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) In General.--This Act may be cited as the ``Medicare Quality
Improvement Act of 2004''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Medicare Advantage and reasonable cost reimbursement contract
quality performance incentive payment
program.
Sec. 4. Quality performance incentive payment program for providers and
facilities that provide services to
medicare beneficiaries with ESRD.
Sec. 5. Medicare innovative quality practice award program.
Sec. 6. Quality improvement demonstration program for pediatric renal
dialysis facilities providing care to
medicare beneficiaries with end stage renal
disease.
Sec. 7. Medicare Quality Advisory Board.
Sec. 8. Studies and reports on financial incentives for quality items
and services under the medicare program.
Sec. 9. MedPAC study and report on use of adjuster mechanisms under
medicare quality performance incentive
payment programs.
Sec. 10. Demonstration program on measuring the quality of health care
furnished to pediatric patients under the
medicaid and SCHIP programs.
Sec. 11. Provisions relating to medicaid quality improvements.
Sec. 12. Demonstration program for Medical Smart Cards.
SEC. 2. FINDINGS.
The Senate makes the following findings:
(1) The Institute of Medicine has highlighted problems with
our health care system in the areas of quality and patient
safety.
(2) The New England Journal of Medicine has published
research in an article entitled ``The Quality of Health Care
Delivered to Adults in the United States'' showing that adults
in the United States receive recommended health care only about
\1/2\ of the time.
(3) Payment policies under the medicare program do not
include mechanisms designed to improve the quality of care.
(4) The medicare program should reward health care
providers who show, through measurement and reporting of
quality indicators and through the practice of innovations,
that they are working to deliver high quality health care to
their patients.
(5) Reimbursement for services provided under the original
medicare fee-for-service program under parts A and B of title
XVIII of the Social Security Act should be based on a pay-for-
performance system.
(6) A more aggressive research agenda on the development of
appropriate quality measurement and payment methodologies under
the medicare program is necessary.
SEC. 3. MEDICARE ADVANTAGE AND REASONABLE COST REIMBURSEMENT CONTRACT
QUALITY PERFORMANCE INCENTIVE PAYMENT PROGRAM.
(a) Program.--Part C of title XVIII of the Social Security Act, as
amended by section 241 of the Medicare Prescription Drug, Improvement,
and Modernization Act of 2003 (Public Law 108-173; 117 Stat. 2214), is
amended by adding at the end the following new section:
``quality performance incentive payment program
``Sec. 1860C-2. (a) Program.--
``(1) In general.--The Secretary shall establish a program
under which financial incentive payments are provided each year
to Medicare Advantage organizations offering Medicare Advantage
plans and organizations that are providing benefits under a
reasonable cost reimbursement contract under section 1876(h)
that demonstrate the provision of superior quality health care
to enrollees under the plan or contract.
``(2) Program to begin in 2007.--The Secretary shall
establish the program so that National Performance Quality
Payments (described in subsection (c)) and National Quality
Improvement Payments (described in subsection (d)) are made
with respect to 2007 and each subsequent year.
``(3) Requirement.--In order for an organization to be
eligible for a financial incentive payment under this section
with respect to a Medicare Advantage plan or a reasonable cost
reimbursement contract under section 1876(h), the organization
shall--
``(A) provide for the collection, analysis, and
reporting of data pursuant to sections 1852(e)(3) and
1876(h)(8), respectively, with respect to the plan or
contract; and
``(B) not later than a date specified by the
Secretary during each baseline year (as defined in
subsection (d)(4)), submit such data on the quality
measures described in subsection (e)(2) as the
Secretary determines appropriate for the purpose of
establishing a baseline with respect to the plan or
contract.
``(4) Use of most recent data.--Financial incentive
payments under this section shall be based upon the most recent
available quality data.
``(5) Timing of quality incentive payments.--The Secretary
shall ensure that financial incentive payments under this
section with respect to a year are made by March 1 of the
subsequent year.
``(6) Applicability of program to ma plans.--For purposes
of this section, the term `Medicare Advantage plan' shall--
``(A) include both MA regional plans and MA local
plans; and
``(B) not include an MA plan described in
subparagraph (A)(ii) or (B) of section 1851(a)(2).
``(b) Quality Incentive Payments.--
``(1) In general.--Beginning with 2007, the Secretary shall
allocate the total amount available for financial incentive
payments in the year under subsection (f) as follows:
``(A) The per beneficiary payment amount for
National Performance Quality Payments established under
paragraph (2) shall be greater than the per beneficiary
payment amount for National Quality Improvement Payments established
under such paragraph.
``(B) With respect to National Performance Quality
Payments, the per beneficiary payment amount
established under paragraph (2) shall be greatest for
the organizations offering the highest performing plans
or contracts.
``(C) With respect to National Quality Improvement
Payments, the per beneficiary payment amount
established under paragraph (2) shall be greatest for
the organizations offering plans or contracts with the
highest degree of improvement.
``(2) Amount of quality incentive payment.--
``(A) In general.--The amount of a financial
incentive payment under subsection (c) or (d) to a
Medicare Advantage organization with respect to a
Medicare Advantage plan or to an organization with
respect to a reasonable cost reimbursement contract
under section 1876(h) shall be determined by
multiplying the number of beneficiaries enrolled under
the plan or contract on the first day of the year for
which the payment is provided by a dollar amount
established by the Secretary (in this section referred
to as the `per beneficiary payment amount') that is the
same for all beneficiaries enrolled under the plan or
contract.
``(B) Limitation on total amount of quality
incentive payments.--The total amount of all the
financial incentive payments given with respect to a
year shall be equal to the amount available for such
payments in the year under subsection (f).
``(3) Use of quality incentive payments.--Financial
incentive payments received under this section may only be used
for the following purposes:
``(A) To reduce any beneficiary cost-sharing
applicable under the plan or contract.
``(B) To reduce any beneficiary premiums applicable
under the plan or contract.
``(C) To initiate, continue, or enhance health care
quality programs for enrollees under the plan or
contract.
``(D) To improve the benefit package under the plan
or contract.
``(4) Reporting on use of quality incentive payments.--
Beginning in 2008, each MA organization that receives a
financial incentive payment under this section shall report to
the Secretary pursuant to section 1854(a)(7) on how the
organization will use such payment.
``(5) Limitations on quality incentive payments.--
``(A) Plan only eligible for 1 payment in a year.--
A Medicare Advantage organization offering a Medicare
Advantage plan or an organization that is providing
benefits under a reasonable cost reimbursement contract
under section 1876(h) may not receive more than 1
financial incentive payment under this section in a
year with respect to such plan or contract. If an
organization with respect to the plan or contract is
eligible for a National Performance Quality Payment and
a National Quality Improvement Payment, the
organization shall be given the National Performance
Quality Payment.
``(B) Plan must be available for entire year.--A
Medicare Advantage organization offering a Medicare
Advantage plan or an organization that is providing
benefits under a reasonable cost reimbursement contract
under section 1876(h) is not eligible for a financial
incentive payment under this section with respect to
such plan or contract unless the plan or contract
offers benefits throughout the year in which the
payment is provided.
``(c) National Performance Quality Payments.--The Secretary shall
make National Performance Quality Payments to the Medicare Advantage
organizations and organizations offering reasonable cost reimbursement
contracts under section 1876(h) with respect to each Medicare Advantage
plan or reasonable cost contract offered by the organization that
receives ratings for the year in the top applicable percent of all
plans and contracts rated by the Secretary pursuant to subsection (e)
for the year. For purposes of the preceding sentence, the term
`applicable percent' means a percent determined appropriate by the
Secretary in consultation with the Quality Advisory Board, but in no
case less than 20 percent.
``(d) National Quality Improvement Payments.--
``(1) In general.--Subject to paragraph (2), the Secretary
shall make National Quality Improvement Payments to Medicare
Advantage organizations and organizations offering reasonable
cost reimbursement contracts under section 1876(h) with respect
to each Medicare Advantage plan or reasonable cost
reimbursement contract offered by the organization that
receives a rating under subsection (e) for the payment year
that exceeds the rating received under such subsection for the
plan or contract for the baseline year.
``(2) National improvement standard.--Beginning with 2009,
the Secretary may implement a national improvement standard
that Medicare Advantage plans and reasonable cost reimbursement
contracts must meet in order to receive a National Quality
Improvement Payment.
``(3) Application of thresholds.--In determining whether a
rating received under subsection (e) for the payment year
exceeds the rating received under such subsection for the
baseline year, the Secretary shall hold any applicable
thresholds constant. For purposes of the preceding sentence,
the term `threshold' means norms used to assess performance.
``(4) Baseline year defined.--In this subsection, the term
`baseline year' means the year prior to the payment year.
``(e) Rating Methodology.--
``(1) Scoring and ranking systems.--
``(A) In general.--The Secretary shall develop
separate scoring and ranking systems for purposes of
determining which organizations offering Medicare
Advantage plans and reasonable cost reimbursement
contracts under section 1876(h) qualify for--
``(i) National Performance Quality
Payments; and
``(ii) National Quality Improvement
Payments.
``(B) Requirements.--In developing, implementing,
and updating the scoring and ranking systems, the
Secretary shall--
``(i) consult with the Quality Advisory
Board established under section 1898;
``(ii) take into account the report on
health care performance measures submitted by
the Institute of Medicine of the National
Academy of Sciences under section 238 of the
Medicare Prescription Drug, Improvement, and
Modernization Act of 2003; and
``(iii) take into account the Managed Care
Organization (MCO) standards and guideline
methodology of the National Committee for
Quality Assurance for awarding total Health
Plan Employer Data and Information Set (HEDIS)
points (based on HEDIS and Consumer Assessment
of Health Plans Survey (CAHPS) measures).
``(2) Measures.--
``(A) In general.--Subject to subparagraph (B), in
developing the scoring and ranking systems under
paragraph (1), the Secretary shall use all measures
determined appropriate by the Secretary. Such measures
may include--
``(i) outcome measures for highly prevalent
chronic conditions;
``(ii) audited HEDIS outcomes and process
Other Popular 106th Congressional Bills Documents:
|
| GovRecords.org presents information on various agencies of the United States Government. Even though all information is believed to be credible and accurate, no guarantees are made on the complete accuracy of our government records archive. Care should be taken to verify the information presented by responsible parties. Please see our reference page for congressional, presidential, and judicial branch contact information. GovRecords.org values visitor privacy. Please see the privacy page for more information. |
 |