(c) EFFECTIVE DATE.-The amendments made by this section shall take effect 1 year after the date of the enactment of this Act. SEC. 1432. STUDY AND REPORT ON TRAINING REQUIRED FOR CERTIFIED NURSE AIDES AND SUPERVISORY STAFF. (a) STUDY. (1) IN GENERAL.-The Secretary shall conduct a study on the content of training for certified nurse aides and supervisory staff of skilled nursing facilities and nursing facilities. The study shall include an analysis of the following: (A) Whether the number of initial training hours for certified nurse aides required under sections 1819(f)(2)(A)(i)(II) and 1919(f)(2)(A)(i)(II) of the Social Security Act (42 U.S.C. 13951-3(f)(2)(A)(i)(II); 1396r(f)(2)(A)(i)(II)) should be increased from 75 and, if so, what the required number of initial training hours should be, including any recommendations for the content of such training (including training related to dementia). (B) Whether requirements for ongoing training under such sections 1819(f)(2)(A)(i)(II) and 1919(f)(2)(A)(i)(II) should be increased from 12 hours per year, including any recommendations for the content of such training. (2) CONSULTATION.-In conducting the analysis under paragraph (1)(A), the Secretary shall consult with States that, as of the date of the enactment of this Act, require more than 75 hours of training for certified nurse aides. (3) DEFINITIONS.-In this section: (A) NURSING FACILITY.-The term "nursing facility" has the meaning given such term in section 1919(a) of the Social Security Act (42 U.S.C. 1396r(a)). (B) SECRETARY.-The term "Secretary" means the Secretary of Health and Human Services, acting through the Assistant Secretary for Planning and Evaluation. (C) SKILLED NURSING FACILITY.-The term "skilled nursing facility" has the meaning given such term in section 1819(a) of the Social Security Act (42 U.S.C. 1395(a)). (b) REPORT.-Not later than 2 years after the date of the enactment of this Act, the Secretary shall submit to Congress a report containing the results of the study conducted under subsection (a), together with recommendations for such legislation and administrative action as the Secretary determines appropriate. SEC. 1433. QUALIFICATION OF DIRECTOR OF FOOD SERVICES OF A MEDICAID NURSING FA CILITY. (a) IN GENERAL.-Section 1919(b)(4)(A) of the Social Security Act (42 U.S.C. 1396r(b)(4)(A)) is amended by adding at the end the following: "With respect to meeting the staffing requirement imposed by the Secretary to carry out clause (iv), the full-time director of food services of the facility, if not a qualified dietitian (as defined in section 483.35(a)(2) of title 42, Code of Federal Regulations, as in effect as of the date of the enactment of this section), shall be a Certified Dietary Manager meeting the requirements of the Certifying Board for Dietary Managers, or a Dietetic Technician, Registered meeting the requirements of the Commission on Dietetic Registration or have equivalent military or academic qualifications (as specified by the Secretary).”. (b) EFFECTIVE DATE.-The amendment made by subsection (a) shall take effect on the date that is 180 days after the date of enactment of this Act. Subtitle C-Quality Measurements SEC. 1441. ESTABLISHMENT OF NATIONAL PRIORITIES FOR QUALITY IMPROVEMENT. Title XI of the Social Security Act, as amended by section 1401(a), is further amended by adding at the end the following new part: "PART E-QUALITY IMPROVEMENT "ESTABLISHMENT OF NATIONAL PRIORITIES FOR PERFORMANCE IMPROVEMENT "SEC. 1191. (a) ESTABLISHMENT OF NATIONAL PRIORITIES BY THE SECRETARY.-The Secretary shall establish and periodically update, not less frequently than triennially, national priorities for performance improvement. "(b) RECOMMENDATIONS FOR NATIONAL PRIORITIES.-In establishing and updating national priorities under subsection (a), the Secretary shall solicit and consider recommendations from multiple outside stakeholders. "(c) CONSIDERATIONS IN SETTING NATIONAL PRIORITIES.-With respect to such priorities, the Secretary shall ensure that priority is given to areas in the delivery of health care services in the United States that "(1) contribute to a large burden of disease, including those that address the health care provided to patients with prevalent, high-cost chronic diseases; "(2) have the greatest potential to decrease morbidity and mortality in this country, including those that are designed to eliminate harm to patients; "(3) have the greatest potential for improving the performance, affordability, and patient-centeredness of health care, including those due to variations in care; "(4) address health disparities across groups and areas; and "(5) have the potential for rapid improvement due to existing evidence, standards of care or other reasons. "(d) DEFINITIONS.-In this part: "(1) CONSENSUS-BASED ENTITY.—The term 'consensus-based entity' means an entity with a contract with the Secretary under section 1890. “(2) QUALITY MEASURE.-The term 'quality measure' means a national consensus standard for measuring the performance and improvement of population health, or of institutional providers of services, physicians, and other health care practitioners in the delivery of health care services. "(e) FUNDING. “(1) IN GENERAL.-The Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 and the Federal Supplementary Medical Insurance Trust Fund under section 1841 (in such proportion as the Secretary determines appropriate), of $2,000,000, for the activities under this section for each of the fiscal years 2010 through 2014. "(2) AUTHORIZATION OF APPROPRIATIONS.-For purposes of carrying out the provisions of this section, in addition to funds otherwise available, out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary of Health and Human Services $2,000,000 for each of the fiscal years 2010 through 2014.". SEC. 1442. DEVELOPMENT OF NEW QUALITY MEASURES; GAO EVALUATION OF DATA COLLECTION PROCESS FOR QUALITY MEASUREMENT. Part E of title XI of the Social Security Act, as added by section 1441, is amended by adding at the end the following new sections: "SEC. 1192. DEVELOPMENT OF NEW QUALITY MEASURES. "(a) AGREEMENTS WITH QUALIFIED ENTITIES. "(1) IN GENERAL.-The Secretary shall enter into agreements with qualified entities to develop quality measures for the delivery of health care services in the United States. "(2) FORM OF AGREEMENTS.-The Secretary may carry out paragraph (1) by contract, grant, or otherwise. "(3) RECOMMENDATIONS OF CONSENSUS-BASED ENTITY.—In carrying out this section, the Secretary shall "(A) seek public input; and "(B) take into consideration recommendations of the consensus-based entity with a contract with the Secretary under section 1890(a). “(b) DETERMINATION OF AREAS WHERE QUALITY MEASURES ARE REQUIRED.—Consistent with the national priorities established under this part and with the programs administered by the Centers for Medicare & Medicaid Services and in consultation with other relevant Federal agencies, the Secretary shall determine areas in which quality measures for assessing health care services in the United States are needed. "(c) DEVELOPMENT OF QUALITY MEASURES. "(1) PATIENT-CENTERED AND POPULATION-BASED MEASURES.—Quality measures developed under agreements under subsection (a) shall be designed "(A) to assess outcomes, presence of impairment, and functional status of patients; "(B) to assess the continuity and coordination of care and care transitions for patients across providers and health care settings, including end of life care; "(C) to assess patient experience and patient engagement; "(E) to assess health disparities including those associated with individual race, ethnicity, age, gender, place of residence or language; "(F) to assess the efficiency and resource use in the provision of care; "(G) to the extent feasible, to be collected as part of health information technologies supporting better delivery of health care services; "(H) to be available free of charge to users for the use of such measures; and "(I) to assess delivery of health care services to individuals regardless of age. "(2) AVAILABILITY OF MEASURES.-The Secretary shall make quality measures developed under this section available to the public. "(3) TESTING OF PROPOSED MEASURES.-The Secretary may use amounts made available under subsection (f) to fund the testing of proposed quality measures by qualified entities. Testing funded under this paragraph shall include testing of the feasibility and usability of proposed measures. "(4) UPDATING OF ENDORSED MEASURES.-The Secretary may use amounts made available under subsection (f) to fund the updating (and testing, if applicable) by consensus-based entities of quality measures that have been previously endorsed by such an entity as new evidence is developed, in a manner consistent with section 1890(b)(3). "(d) QUALIFIED ENTITIES.-Before entering into agreements with a qualified entity, the Secretary shall ensure that the entity is a public, nonprofit or academic institution with technical expertise in the area of health quality measurement. "(e) APPLICATION FOR GRANT.-A grant may be made under this section only if an application for the grant is submitted to the Secretary and the application is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this section. "(f) FUNDING. "(1) IN GENERAL.-The Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 and the Federal Supplementary Medical Insurance Trust Fund under section 1841 (in such proportion as the Secretary determines appropriate), of $25,000,000, to the Secretary for purposes of carrying out this section for each of the fiscal years 2010 through 2014. "(2) AUTHORIZATION OF APPROPRIATIONS.-For purposes of carrying out the provisions of this section, in addition to funds otherwise available, out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary of Health and Human Services $25,000,000 for each of the fiscal years 2010 through 2014. "SEC. 1193. GAO EVALUATION OF DATA COLLECTION PROCESS FOR QUALITY MEASUREMENT. "(a) GAO EVALUATIONS.-The Comptroller General of the United States shall conduct periodic evaluations of the implementation of the data collection processes for quality measures used by the Secretary. “(b) CONSIDERATIONS.-In carrying out the evaluation under subsection (a), the Comptroller General shall determine "(1) whether the system for the collection of data for quality measures provides for validation of data as relevant and scientifically credible; "(2) whether data collection efforts under the system use the most efficient and cost-effective means in a manner that minimizes administrative burden on persons required to collect data and that adequately protects the privacy of patients' personal health information and provides data security; "(3) whether standards under the system provide for an appropriate opportunity for physicians and other clinicians and institutional providers of services to review and correct findings; and "(4) the extent to which quality measures are consistent with section 1192(c)(1) or result in direct or indirect costs to users of such measures. "(c) REPORT.-The Comptroller General shall submit reports to Congress and to the Secretary containing a description of the findings and conclusions of the results of each such evaluation.". SEC. 1443. MULTISTAKEHOLDER PRERULEMAKING INPUT INTO SELECTION OF QUALITY MEASURES. Section 1808 of the Social Security Act (42 U.S.C. 1395b-9) is amended by adding at the end the following new subsection: "(d) MULTI-STAKEHOLDER PRE-RULEMAKING INPUT INTO SELECTION OF QUALITY MEASURES. "(1) LIST OF MEASURES.-Not later than December 1 before each year (beginning with 2011), the Secretary shall make public a list of measures being considered for selection for quality measurement by the Secretary in rulemaking with respect to payment systems under this title beginning in the payment year beginning in such year and for payment systems beginning in the calendar year following such year, as the case may be. "(2) CONSULTATION ON SELECTION OF ENDORSED QUALITY MEASURES.-A consensus-based entity that has entered into a contract under section 1890 shall, as part of such contract, convene multi-stakeholder groups to provide recommendations on the selection of individual or composite quality measures, for use in reporting performance information to the public or for use in public health care programs. “(3) MULTI-STAKEHOLDER INPUT.-Not later than February 1 of each year (beginning with 2011), the consensus-based entity described in paragraph (2) shall transmit to the Secretary the recommendations of multi-stakeholder groups provided under paragraph (2). Such recommendations shall be included in the transmissions the consensus-based entity makes to the Secretary under the contract provided for under section 1890. "(4) REQUIREMENT FOR TRANSPARENCY IN PROCESS.— "(A) IN GENERAL.-In convening multi-stakeholder groups under paragraph (2) with respect to the selection of quality measures, the consensusbased entity described in such paragraph shall provide for an open and transparent process for the activities conducted pursuant to such convening. "(B) SELECTION OF ORGANIZATIONS PARTICIPATING IN MULTI-STAKEHOLDER GROUPS. The process under paragraph (2) shall ensure that the selection of representatives of multi-stakeholder groups includes provision for public nominations for, and the opportunity for public comment on, such selection. “(5) USE OF INPUT.-The respective proposed rule shall contain a summary of the recommendations made by the multi-stakeholder groups under paragraph (2), as well as other comments received regarding the proposed measures, and the extent to which such proposed rule follows such recommendations and the rationale for not following such recommendations. "(6) MULTI-STAKEHOLDER GROUPS.-For purposes of this subsection, the term 'multi-stakeholder groups' means, with respect to a quality measure, a voluntary collaborative of organizations representing persons interested in or affected by the use of such quality measure, such as the following: "(A) Hospitals and other institutional providers. "(B) Physicians. "(C) Health care quality alliances. "(D) Nurses and other health care practitioners. "(F) Patient advocates and consumer groups. "(G) Employers. "(H) Public and private purchasers of health care items and services. "(I) Labor organizations. "(J) Relevant departments or agencies of the United States. "(K) Biopharmaceutical companies and manufacturers of medical devices. "(L) Licensing, credentialing, and accrediting bodies. "(7) FUNDING. "(A) IN GENERAL.-The Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 and the Federal Supplementary Medical Insurance Trust Fund under section 1841 (in such proportion as the Secretary determines appropriate), of $1,000,000, to the Secretary for purposes of carrying out this subsection for each of the fiscal years 2010 through 2014. "(B) AUTHORIZATION OF APPROPRIATIONS.-For purposes of carrying out the provisions of this subsection, in addition to funds otherwise available, out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary of Health and Human Services $1,000,000 for each of the fiscal years 2010 through 2014.". SEC. 1444. APPLICATION OF QUALITY MEASURES. (a) INPATIENT HOSPITAL SERVICES.-Section 1886(b)(3)(B) of such Act (42 U.S.C. 1395ww(b)(3)(B)) is amended by adding at the end the following new clause: "(x)(I) Subject to subclause (II), for purposes of reporting data on quality measures for inpatient hospital services furnished during fiscal year 2012 and each subsequent fiscal year, the quality measures specified under clause (viii) shall be measures selected by the Secretary from measures that have been endorsed by the entity with a contract with the Secretary under section 1890(a). "(II) In the case of a specified area or medical topic determined appropriate by the Secretary for which a feasible and practical quality measure has not been endorsed by the entity with a contract under section 1890(a), the Secretary may specify a measure that is not so endorsed as long as due consideration is given to measures that have been endorsed or adopted by a consensus organization identified by the Secretary. The Secretary shall submit such a non-endorsed measure to the entity for consideration for endorsement. If the entity considers but does not endorse such a measure and if the Secretary does not phase-out use of such measure, the Secretary shall include the rationale for continued use of such a measure in rulemaking.". (b) OUTPATIENT HOSPITAL SERVICES.-Section 1833(t)(17) of such Act (42 U.S.C. 13951(t)(17)) is amended by adding at the end the following new subparagraph: "(F) USE OF ENDORSED QUALITY MEASURES.-The provisions of clause (x) of section 1886(b)(3)(C) shall apply to quality measures for covered OPD services under this paragraph in the same manner as such provisions apply to quality measures for inpatient hospital services.". (c) PHYSICIANS' SERVICES.-Section 1848(k)(2)(C)(ii) of such Act (42 U.S.C. 1395w4(k)(2)(C)(ii)) is amended by adding at the end the following: "The Secretary shall submit such a non-endorsed measure to the entity for consideration for endorsement. If the entity considers but does not endorse such a measure and if the Secretary does not phase-out use of such measure, the Secretary shall include the rationale for continued use of such a measure in rulemaking.". (d) RENAL DIALYSIS SERVICES.-Section 1881(h)(2)(B)(ii) of such Act (42 U.S.C. 1395rr(h)(2)(B)(ii)) is amended by adding at the end the following: "The Secretary shall submit such a non-endorsed measure to the entity for consideration for endorsement. If the entity considers but does not endorse such a measure and if the Secretary does not phase-out use of such measure, the Secretary shall include the rationale for continued use of such a measure in rulemaking.". (e) ENDORSEMENT OF STANDARDS.-Section 1890(b)(2) of the Social Security Act (42 U.S.C. 1395aaa(b)(2)) is amended by adding after and below subparagraph (B) the following: "If the entity does not endorse a measure, such entity shall explain the reasons and provide suggestions about changes to such measure that might make it a potentially endorsable measure.". (f) EFFECTIVE DATE.-Except as otherwise provided, the amendments made by this section shall apply to quality measures applied for payment years beginning with 2012 or fiscal year 2012, as the case may be. SEC. 1445. CONSENSUS-BASED ENTITY FUNDING. Section 1890(d) of the Social Security Act (42 U.S.C. 1395aaa(d)) is amended by striking "for each of fiscal years 2009 through 2012" and inserting "for fiscal year 2009, and $12,000,000 for each of the fiscal years 2010 through 2012". SEC. 1446. QUALITY INDICATORS FOR CARE OF PEOPLE WITH ALZHEIMER'S DISEASE. (a) QUALITY INDICATORS.-The Secretary of Health and Human Services, acting through the Agency for Healthcare Research and Quality (AHRQ), shall develop, either directly or with commissioned projects, a core set of quality indicators for the provision of medical services to people with Alzheimer's disease and other dementias and a plan for implementing the indicators to measure the quality of care provided for people with these conditions by physicians, hospitals, and other medical, residential and home care agencies and providers. (b) REPORT.-The Secretary shall submit a report to the Committees on Energy and Commerce and Ways and Means of the United States House of Representatives and to the Committees on Finance and Health, Education, and Pensions of the United States Senate not later than 12 months after the date of the enactment of this Act setting forth the status of their efforts to implement the requirements of subsection (a). United States shall conduct a study successor program) established by The study shall SEC. 1447. STUDY ON FIVE STAR QUALITY RATING SYSTEM. (a) STUDY.-The Comptroller General of the on the Five-Star Quality Rating System (or a the Centers for Medicare & Medicaid Services. (1) determine whether the composite star rating should be eliminated in favor of a multi-dimensional system under which a star rating is assigned to each individual domain; (2) determine whether an appeals process should be implemented for the Five Star Rating System to address situations in which questionable, inaccurate, or incomplete data has been identified; (3) evaluate the appropriateness of any weighting methodology used to adjust quality measures, including an assessment of whether such methodology is validated, whether it takes into account resident characteristics, the appropriateness of the weighting of individual quality measures, and whether the accuracy of information to consumers would be enhanced if the standard survey were weighted more heavily than the complaint survey; (4) assess the appropriateness of the case-mix adjustment methodology used to evaluate staffing levels, along with the appropriateness of the staffing levels established by the Centers for Medicare & Medicaid Services to achieve a 5-star |