Identifying Health Care Quality Measures for Medicaid-Eligible Adults: Background Report

Subtitle I—Improving the Quality of Medicaid for Patients and Providers

SEC. 2701. ADULT HEALTH QUALITY MEASURES.

    Title XI of the Social Security Act (42 U.S.C. 1301 et seq.), as amended by section 401 of the Children's Health Insurance Program  Reauthorization Act of 2009 (Public Law 111-3), is amended by inserting after section 1139A the following new section:

"SEC. 1139B. ADULT HEALTH QUALITY MEASURES.

    "(a) Development of Core Set of Health Care Quality Measures for Adults Eligible for Benefits Under Medicaid.—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  1139A, 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) Deadlines.—
            "(1) Recommended measures.—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) Dissemination.—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) Standardized reporting.—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.
            "(4) Reports to congress.—Not later than January 1, 2014,
        and every 3 years thereafter, the Secretary shall include in the
        report to Congress required under section 1139A(a)(6)
        information similar to the information required under that
        section with respect to the measures established under this
        section.
            "(5) Establishment of medicaid quality measurement program.—
                    "(A) In general.—Not later than 12 months after
                the release of the recommended core set of adult health
                quality measures under paragraph (1), the Secretary
                shall establish a Medicaid Quality Measurement Program
                in the same manner as the Secretary establishes the
                pediatric quality measures program under section
                1139A(b). 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 1139A(b)(4)(A)
                    "(B) Revising, strengthening, and improving initial
                core measures.—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) Construction.—Nothing in this section shall be construed as
supporting the restriction of coverage, under title XIX or XXI or
otherwise, to only those services that are evidence-based, or in anyway
limiting available services.
    "(d) Annual State Reports Regarding State-Specific Quality of Care
Measures Applied Under Medicaid.—
            "(1) Annual state reports.—Each State with a State plan or
        waiver approved under title XIX shall annually report
        (separately or as part of the annual report required under
        section 1139A(c)), to the Secretary on the—
                    "(A) State-specific adult health quality measures
                applied by the State under the such plan, including
                measures described in subsection (a)(5); 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 1932 and benchmark plans under section
                1937.
            "(2) Publication.—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) Appropriation.—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.".