,,ii #aaeth ,,congress #ast ,session ,s4 #acag ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,june #h1 #bjag,mr4 ,brown introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend titles ,,xi and ,,xix of the ,social ,security ,act to establish a comprehensive and nationwide system to evaluate the quality of care provided to beneficiaries of ,medicaid and the ,children's ,health ,insurance ,program and to provide incentives for voluntary quality improvement4 #a4 ,short title ,this ,act may be cited as the ,medicaid and ,,chip ,quality ,improvement ,act of #bjag4 #b4 ,findings ,congress finds the following3 7#a7 ,despite the fact that ,federal and ,state governments spend hundreds of billions of dollars every year on care for ,americans through the ,medicaid and ,,chip programs1 there is no nationwide1 systematic method of reporting1 collecting1 evaluating1 or improving the quality of care across all payment and delivery systems 7fee-for-service1 managed care1 primary care case management1 or other mechanisms74 7#b7 ,although the quality of care delivered through ,medicaid health plans is frequently measured1 there is no method or mechanism to systematically improve the quality of care provided to all ,medicaid and ,,chip beneficiaries4 7#c7 ,for the majority of ,medicaid and ,,chip enrollees who are served by primary care case management or fee-for-service arrangements1 there are no ,federal requirements for comparable quality monitoring or improvement4 ,thus there currently is no ability to make fair assessments across all modes of care for ,medicaid and ,,chip enrollees4 7#d7 ,state flexibility and the resulting opportunities for innovation are hallmarks of the partnership between ,federal and ,state governments in the ,medicaid and ,,chip programs4 ,without a way to systematically measure quality1 however1 policymakers cannot know which innovations are the most effective4 #c4 ,measuring and reporting on comparable health care quality measures for all persons enrolled in ,medicaid 7a7 ,quality assurance standards ,section #aicb7;c77#a77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#b7;c77#a77;,a77 is amended by inserting or comparable primary care case management services providers described in section #aije7t7 as well as health care services furnished in fee-for-service settings or other delivery systems after #aijc7m74 7b7 ,adult health quality measures ,section #aaci;,b of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i;b7 is amended-- 7#a7 in subsection 7b7-- 7,a7 by redesignating paragraphs 7#d7 and 7#e7 as paragraphs 7#e7 and 7#f71 respectively2 and 7,b7 by inserting after paragraph 7#c71 the following3 7#d7 ,quality reporting for medicaid eligible adults ,beginning not later than ,january #a of the calendar year that begins on or after the date that is #b years after the date of enactment of the ,medicaid and ,,chip ,quality ,improvement ,act of #bjag1 and annually thereafter1 the ,secretary shall require ,states to use the measures and approaches identified in paragraph 7#c7 to report on the initial core set of quality measures for ,medicaid eligible adults identified in paragraph 7#b71 subject to revisions made in accordance with paragraph 7#f77;,b74 ,such reporting shall be stratified by delivery system1 including managed care organizations under section #aicb1 benchmark plans under section #aicg1 primary care case management services providers described in section #aije7t71 health care services in fee-for-service settings1 and other delivery systems1 except that the ,secretary may determine that reporting on certain measures should not be stratified by delivery system because such stratification would not be feasible or the delivery systems are not comparable with respect to the application of such measures4 ,in addition to the stratification required under the previous sentence1 the ,secretary shall have the discretion to further stratify reporting on certain measures based on factors such as eligibility category1 income level1 or other differentiating factors that could have an impact on the comparability of the measure4 2 and 7#b7 in subsection 7d7-- 7,a7 in paragraph 7#a77;,a71 by striking under the such plan and all that follows through subsection 7a77#e7 and inserting under such plan or waiver1 including measures described in subsection 7b77#b71 subject to revisions made in accordance with subsection 7b77#f77;,b72 7,b7 in paragraph 7#a77;,b71 by inserting 1 or comparable primary care case management services providers described in section #aije7t71 as well as health care services furnished in fee-for-service settings or other delivery systems after section #aicg2 and 7,c7 in paragraph 7#b71 by inserting before the period the following3 1 including analysis of comparable quality measures for ,medicaid eligible adults who receive their health services through managed care1 primary care case management1 and fee-for-service settings or other delivery systems4 7c7 ,pediatric health care measures 7#a7 ,in general ,section #aaci;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i;a7 is amended-- 7,a7 in subsection 7a7-- 7i7 by redesignating paragraphs 7#e7 through 7#h7 as paragraphs 7#f7 through 7#i71 respectively2 and 7ii7 by inserting after paragraph 7#d7 the following3 7#e7 ,reporting of pediatric health care measures ,beginning not later than ,january #a of the calendar year that begins on or after the date that is #b years after the date of enactment of the ,medicaid and ,,chip ,quality ,improvement ,act of #bjag1 and annually thereafter1 the ,secretary shall require ,states to use the measures and approaches identified in paragraph 7#d7 to report on the initial core child health care quality measures established under this subsection and as such measures subsequently are updated under subsection 7b77#e74 ,such reporting shall be stratified by delivery system1 including managed care organizations under section #aicb1 benchmark plans under sections #aicg and #bajc1 primary care case management services providers described in section #aije7t71 health care services in fee-for-service settings1 and other delivery systems1 except that the ,secretary may determine that reporting on certain measures should not be stratified by delivery system because such stratification would not be feasible or the delivery systems are not comparable with respect to the application of such measures4 ,in addition to the stratification required under the previous sentence1 the ,secretary shall have the discretion to further stratify reporting on certain measures based on factors such as eligibility category1 income level1 or other differentiating factors that could have an impact on the comparability of the measure4 2 and 7,b7 in subsection 7c7-- 7i7 in paragraph 7#a77;,a71 by striking measures described in subparagraphs 7,a7 and 7,b7 of subsection 7a77#f7 and inserting the core measures described in subsection 7a71 as revised in accordance with subsection 7b77#e72 7ii7 in paragraph 7#a77;,b71 by inserting before the period the following3 1 or comparable primary care case management services providers described in section #aije7t71 as well as healthcare services furnished in fee-for-service settings or other delivery systems2 and 7iii7 in paragraph 7#b71 by inserting before the period the following3 1 including analysis of comparable quality measures for children eligible for medical assistance under title ,,xix or child health assistance under title ,,xxi who receive their health services through managed care1 primary care case management1 and fee-for-service settings or other delivery systems4 7#b7 ,effective date ,the amendments made by this subsection shall take effect as if included in the enactment of section #aaci;,a of the ,social ,security ,act1 as added by section #dja7;a7 of the ,children's ,health ,insurance ,program ,reauthorization ,act of #bjji 7,public ,law #aaa-c74 #d4 ,performance bonuses for significant achievement in ,medicaid and ,,chip quality performance ,section #aijc of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 is amended by adding at the end the following new subsection3 7aa7 ,performance bonus for quality performance achievement 7#a7 ,in general ,the ,secretary shall establish a ,medicaid ,quality ,performance ,bonus fund for awarding performance bonuses to ,states for high attainment and improvement on a core set of quality measures related to the goals and purposes of the ,medicaid program under this title4 7#b7 ,quality performance bonus methodology ,not later than #c years after the date of enactment of the ,medicaid and ,,chip ,quality ,improvement ,act of #bjag1 the ,secretary shall establish a methodology for awarding ,medicaid quality performance bonuses to ,states not less than annually in accordance with paragraph 7#c7 and subject to the availability of appropriations4 ,medicaid quality performance bonuses shall be awarded on the basis of the annual ,state reports required under sections #aaci;,a and #aaci;,b and in accordance with regulations promulgated by the ,secretary4 7#c7 ,quality performance measurement bonuses ,medicaid quality performance bonuses shall be awarded to the following #aj ,states3 7,a7 ,the top #e ,states achieving the designation of superior quality performing ,state under criteria established by the ,secretary4 7,b7 ,the #e ,states that-- 7i7 are not among the ,states described in subparagraph 7,a72 and 7ii7 demonstrate the greatest relative level of annual improvement in quality performance under criteria established by the ,secretary4 7#d7 ,initial appropriation 7,a7 ,in general ,the total amount of ,medicaid quality performance bonuses made under this subsection for all fiscal years shall be equal to #ejj1jjj1jjj1 to be available until expended4 7,b7 ,budget authority ,this paragraph constitutes budget authority in advance of appropriations ,acts and represents the obligation of the ,secretary to provide for the payment of amounts provided under this paragraph4 7#e7 ,use of quality performance bonus funds 7,a7 ,designation for quality improvement activities ,as a condition of receiving a ,medicaid quality performance bonus under this subsection1 a ,state shall agree to designate at least #ge percent of the bonus funds paid to the ,state under this subsection for a fiscal year for the development and operation of quality-related initiatives that will directly benefit providers or managed care entities participating in the ,state plan under this title or under a waiver of such plan1 including-- 7i7 pay-for-performance programs2 7ii7 collaboration initiatives that have been demonstrated to improve performance on quality2 7iii7 quality improvement initiatives1 including those aimed at improving care for special and hard-to-reach populations1 and those directed to managed care entities2 and 7iv7 such other ,secretary-approved activities and initiatives that a ,state may pursue to encourage quality improvement and patient-focused high value care4 7,b7 ,state option to establish criteria ,a ,state may establish criteria for the ,state performance program carried out under subparagraph 7,a7 that limits the award to a particular provider or entity type1 that limits application to a specific geographic area1 or that directs incentive programs for quality related activities for specific populations1 including individuals eligible under this title and title ,,xviii and hard-to-reach populations4 7,c7 ,remaining bonus funds ,a ,state may designate up to #be percent of the bonus funds paid to the ,state under this subsection for a fiscal year for activities related to the goals and purposes of the ,state program under this title4 4