S.Amdt. 3215

SA 3215. Mr. LIEBERMAN (for himself, Ms. Collins, Mr. Specter, and
Mr. Whitehouse) submitted an amendment intended to be proposed to
amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr.
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal
Revenue Code of 1986 to modify the first-time homebuyers credit in the
case of members of the Armed Forces and certain other Federal
employees, and for other purposes; which was ordered to lie on the
table; as follows:

On page 1134, between lines 3 and 4, insert the following:

Subtitle G--Additional Health Care Quality and Efficiency Improvements

SEC. 3601. REPORT ON DEMONSTRATION AND PILOT PROGRAMS.

(a) Report.--Not later than 12 months after the date of
enactment of this Act, and every 3 years thereafter, the
Secretary of Health and Human Services shall submit to the
appropriate committees of Congress a report that describes
all pilot programs and demonstration projects that the
Secretary has authority to carry out (regardless of whether
such programs or projects are actually implemented), as
authorized by law, during the period for which the report is
submitted.
(b) Requirements.--A report under subsection (a) shall--
(1) list all pilot programs or demonstration projects
involved and indicate whether each program or project is--
(A) not yet being implemented;
(B) currently being implemented; or
(C) complete and awaiting further determinations; and
(2) with respect to programs or projects described in
subparagraphs (A) or (B) of paragraph (1), include the
recommendations of the Secretary as to whether such programs
or projects are necessary.
(c) Actions Based on Recommendations.--Based on the
recommendations of the Secretary under subsection (b)(2)--
(1) if the Secretary determines that a program or project
is necessary, the Secretary shall submit to Congress a
strategic plan for the implementation of the program or
project and may transfer such program or project into the
jurisdiction of the Innovation Center of the Centers for
Medicare & Medicaid Services; or
(2) if the Secretary determines that a program or project
is unnecessary, the Secretary may terminate the program.
(d) Action by Congress.--Congress may continue in effect
any program or project terminated by the Secretary under
subsection (c)(2) through the enactment of a Concurrent
Resolution expressing the sense of Congress to continue the
program or project involved.

SEC. 3602. AVAILABILITY OF DATA ON DENIAL OF CLAIMS.

Section 2715(b)(3) of the Public Health Service Act, as
added by section 1001, is amended--
(1) in subparagraph (H), by striking ``and'' at the end;
(2) by redesignating subparagraph (I) as subparagraph (J):
and
(3) by inserting after subparagraph (H) the following new
subparagraph:
``(I) a statement relating to claims procedures including
the percentage of claims that are annually denied by the plan
or coverage and the percentage of such denials that are
overturned on appeal; and''.

SEC. 3603. ACCELERATION AND INCREASE OF THE PAYMENT
ADJUSTMENT FOR CONDITIONS ACQUIRED IN
HOSPITALS.

Section 1886(p) of the Social Security Act (42 U.S.C.
1395(p)), as added by section 3008(a), is amended--
(1) in paragraph (1)--
(A) by striking ``2015'' and inserting ``2013''; and
(B) by striking ``99 percent'' and inserting ``98
percent''; and
(2) in paragraph (5), by striking ``2015'' and inserting
``2013''.

SEC. 3604. IMPROVEMENTS TO NATIONAL PILOT PROGRAM ON PAYMENT
BUNDLING.

Section 1866D of the Social Security Act, as added by
section 3023, is amended--
(1) in subsection (a)(3), by striking ``January 1, 2013''
and inserting ``January 1, 2012''; and
(2) by amending subsection (g) to read as follows:
``(g) Authority to Expand Implementation.--
``(1) In general.--Taking into account the evaluation under
subparagraph (e), the Secretary may, through rulemaking,
expand (including implementation nationwide on a voluntary
basis) the duration and the scope of the pilot program, to
the extent determined appropriate by the Secretary, if--
``(A) the Secretary determines that such expansion is
expected to--
``(i) reduce spending under this title without reducing the
quality of care; or
``(ii) improve the quality of care and reduce spending; and
``(B) the Chief Actuary of the Centers for Medicare &
Medicaid Services certifies that such expansion would reduce
program spending under this title.
``(2) Implementation plan.--In the case where the Secretary
does not exercise the authority under paragraph (1) by
January 1, 2015, not later than such date, the Secretary
shall submit a plan for the implementation of an expansion of
the pilot program if the

[[Page S13200]]

Secretary determines that such expansion will result in
improving or not reducing the quality of patient care and
reducing spending under this title.''.

SEC. 3605. PUBLIC REPORTING OF PERFORMANCE INFORMATION.

(a) In General.--
(1) Development.--Not later than January 1, 2011, the
Secretary shall develop a Physician Compare Internet website
with information on physicians enrolled in the Medicare
program under section 1866(j) of the Social Security Act (42
U.S.C. 1395cc(j)) and other eligible professionals who
participate in the Physician Quality Reporting Initiative
under section 1848 of such Act (42 U.S.C. 1395w-4).
(2) Plan.--Not later than January 1, 2013, and with respect
to reporting periods that begin no earlier than January 1,
2012, the Secretary shall also implement a plan for making
publicly available through Physician Compare, consistent with
subsection (c), information on physician performance that
provides comparable information for the public on quality and
patient experience measures with respect to physicians
enrolled in the Medicare program under such section 1866(j).
To the extent scientifically sound measures that are
developed consistent with the requirements of this section
are available, such information, to the extent practicable,
shall include--
(A) measures collected under the Physician Quality
Reporting Initiative;
(B) an assessment of patient health outcomes and the
functional status of patients;
(C) an assessment of the continuity and coordination of
care and care transitions, including episodes of care and
risk-adjusted resource use;
(D) an assessment of efficiency;
(E) an assessment of patient experience and patient,
caregiver, and family engagement;
(F) an assessment of the safety, effectiveness, and
timeliness of care; and
(G) other information as determined appropriate by the
Secretary.
(b) Other Required Considerations.--In developing and
implementing the plan described in subsection (a)(2), the
Secretary shall, to the extent practicable, include--
(1) processes to assure that data made public, either by
the Centers for Medicare & Medicaid Services or by other
entities, is statistically valid and reliable, including risk
adjustment mechanisms used by the Secretary;
(2) processes by which a physician or other eligible
professional whose performance on measures is being publicly
reported has a reasonable opportunity, as determined by the
Secretary, to review his or her individual results before
they are made public;
(3) processes by the Secretary to assure that the
implementation of the plan and the data made available on
Physician Compare provide a robust and accurate portrayal of
a physician's performance;
(4) data that reflects the care provided to all patients
seen by physicians, under both the Medicare program and, to
the extent practicable, other payers, to the extent such
information would provide a more accurate portrayal of
physician performance;
(5) processes to ensure appropriate attribution of care
when multiple physicians and other providers are involved in
the care of a patient;
(6) processes to ensure timely statistical performance
feedback is provided to physicians concerning the data
reported under any program subject to public reporting under
this section; and
(7) implementation of computer and data systems of the
Centers for Medicare & Medicaid Services that support valid,
reliable, and accurate public reporting activities authorized
under this section.
(c) Ensuring Patient Privacy.--The Secretary shall ensure
that information on physician performance and patient
experience is not disclosed under this section in a manner
that violates sections 552 or 552a of title 5, United States
Code, with regard to the privacy of individually identifiable
health information.
(d) Feedback From Multi-Stakeholder Groups.--The Secretary
shall take into consideration input provided by multi-
stakeholder groups, consistent with sections 1890(b)(7) and
1890A of the Social Security Act, as added by section 3014 of
this Act, in selecting quality measures for use under this
section.
(e) Consideration of Transition to Value-Based
Purchasing.--In developing the plan under this subsection
(a)(2), the Secretary shall, as the Secretary determines
appropriate, consider the plan to transition to a value-based
purchasing program for physicians and other practitioners
developed under section 131 of the Medicare Improvements for
Patients and Providers Act of 2008 (Public Law 110-275).
(f) Report to Congress.--Not later than January 1, 2015,
the Secretary shall submit to Congress a report on the
Physician Compare Internet website developed under subsection
(a)(1). Such report shall include information on the efforts
of and plans made by the Secretary to collect and publish
data on physician quality and efficiency and on patient
experience of care in support of value-based purchasing and
consumer choice, together with recommendations for such
legislation and administrative action as the Secretary
determines appropriate.
(g) Expansion.--At any time before the date on which the
report is submitted under subsection (f), the Secretary may
expand (including expansion to other providers of services
and suppliers under title XVIII of the Social Security Act)
the information made available on such website.
(h) Financial Incentives to Encourage Consumers to Choose
High Quality Providers.--The Secretary may establish a
demonstration program, not later than January 1, 2019, to
provide financial incentives to Medicare beneficiaries who
are furnished services by high quality physicians, as
determined by the Secretary based on factors in subparagraphs
(A) through (G) of subsection (a)(2). In no case may Medicare
beneficiaries be required to pay increased premiums or cost
sharing or be subject to a reduction in benefits under title
XVIII of the Social Security Act as a result of such
demonstration program. The Secretary shall ensure that any
such demonstration program does not disadvantage those
beneficiaries without reasonable access to high performing
physicians or create financial inequities under such title.
(i) Definitions.--In this section:
(1) Eligible professional.--The term ``eligible
professional'' has the meaning given that term for purposes
of the Physician Quality Reporting Initiative under section
1848 of the Social Security Act (42 U.S.C. 1395w-4)
(2) Physician.--The term ``physician'' has the meaning
given that term in section 1861(r) of such Act (42 U.S.C.
1395x(r)).
(3) Physician compare.--The term ``Physician Compare''
means the Internet website developed under subsection (a)(1).
(4) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
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