,,ii  #aae? ,,congress  #a/ ,session    
,s4 #acag  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,june #h1 #bjag,mr4    
,br[n introduc$ ! foll[+ bill2 :i* 0    
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to am5d titles ,,xi
 & ,,xix ( ! ,social ,security ,act to  
e/abli% a compreh5sive & nationwide     
sy/em to evaluate ! quality ( c>e       
provid$ to b5efici>ies ( ,m$icaid & !   
,*ildr5's ,heal? ,insurance ,program &  
to provide inc5tives = volunt>y quality 
improvem5t4  #a4 ,%ort title ,?is ,act  
may be cit$ z ! ,m$icaid & ,,*ip        
,quality ,improvem5t ,act ( #bjag4  #b4 
,f9d+s ,congress f9ds ! foll[+3 7#a7    
,despite ! fact t ,f$]al & ,/ate        
gov]nm5ts sp5d hundr$s ( billions (     
doll>s e ye> on c>e = ,am]icans ?r\gh ! 
,m$icaid & ,,*ip programs1 !re is no    
nationwide1 sy/ematic me?od ( report+1  
collect+1 evaluat+1 or improv+ ! quality
 ( c>e across all paym5t & deliv]y      
sy/ems 7fee-=-s]vice1 manag$ c>e1 prim>y
 c>e case managem5t1 or o!r me*anisms74 

7#b7 ,al?\gh ! quality ( c>e deliv]$    
?r\gh ,m$icaid heal? plans is frequ5tly 
measur$1 !re is no me?od or me*anism to 
sy/ematically improve ! quality ( c>e   
provid$ to all ,m$icaid & ,,*ip         
b5efici>ies4  7#c7 ,= ! majority (      
,m$icaid & ,,*ip enrollees :o are s]v$  
by prim>y c>e case managem5t or         
fee-=-s]vice arrangem5ts1 !re are no    
,f$]al requirem5ts = comp>able quality  
monitor+ or improvem5t4 ,?us !re        
curr5tly is no ability to make fair     
assessm5ts across all modes ( c>e =     
,m$icaid & ,,*ip enrollees4  7#d7 ,/ate 
flexibility & ! result+ opportunities = 
innovation are hallm>ks ( ! p>tn]%ip    
betwe5 ,f$]al & ,/ate gov]nm5ts 9 !     
,m$icaid & ,,*ip programs4 ,)\t a way to
 sy/ematically measure quality1 h[ev]1  
policymak]s _c "k :i* innovations are ! 
mo/ effective4  #c4 ,measur+ & report+  
on comp>able heal? c>e quality measures 
= all p]sons enroll$ 9 ,m$icaid  7a7    
,quality assurance /&>ds ,section       
#aicb7;c77#a77;,a7 ( ! ,social ,security

 ,act 7#db ,u4,s4,c4                    
#acifu-#b7;c77#a77;,a77 is am5d$ by     
ins]t+ or comp>able prim>y c>e case     
managem5t s]vices provid]s describ$ 9   
section #aije7t7 z well z heal? c>e     
s]vices furni%$ 9 fee-=-s]vice sett+s or
 o!r deliv]y sy/ems aft] #aijc7m74  7b7 
,adult heal? quality measures ,section  
#aaci;,b ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #acbj;b-#i;b7 is am5d$-- 7#a7
 9 subsection 7b7--  7,a7 by r$esignat+ 
p>agraphs 7#d7 & 7#e7 z p>agraphs 7#e7 &
 7#f71 respectively2 &  7,b7 by ins]t+  
aft] p>agraph 7#c71 ! foll[+3  7#d7     
,quality report+ = m$icaid eligible     
adults ,beg9n+ n lat] ?an ,janu>y #a ( !
 cal5d> ye> t beg9s on or aft] ! date t 
is #b ye>s aft] ! date ( enactm5t ( !   
,m$icaid & ,,*ip ,quality ,improvem5t   
,act ( #bjag1 & annually !reaft]1 !     
,secret>y %all require ,/ates to use !  
measures & approa*es id5tifi$ 9 p>agraph
 7#c7 to report on ! initial core set ( 
quality measures = ,m$icaid eligible    
adults id5tifi$ 9 p>agraph 7#b71 subject

 to revisions made 9 accordance )       
p>agraph 7#f77;,b74 ,su* report+ %all be
 /ratifi$ by deliv]y sy/em1 includ+     
manag$ c>e organizations "u section     
#aicb1 b5*m>k plans "u section #aicg1   
prim>y c>e case managem5t s]vices       
provid]s describ$ 9 section #aije7t71   
heal? c>e s]vices 9 fee-=-s]vice sett+s1
 & o!r deliv]y sy/ems1 except t !       
,secret>y may det]m9e t report+ on c]ta9
 measures %\ld n be /ratifi$ by deliv]y 
sy/em because su* /ratification w\ld n  
be feasible or ! deliv]y sy/ems are n   
comp>able ) respect to ! application (  
su* measures4 ,9 addition to !          
/ratification requir$ "u ! previ\s      
s5t5ce1 ! ,secret>y %all h ! discretion 
to fur!r /ratify report+ on c]ta9       
measures bas$ on factors su* z          
eligibility category1 income level1 or  
o!r diff]5tiat+ factors t c\ld h an     
impact on ! comp>ability ( ! measure4  2
 &  7#b7 9 subsection 7d7-- 7,a7 9      
p>agraph 7#a77;,a71 by /rik+ "u ! su*   
plan & all t foll[s ?r\gh subsection    

7a77#e7 & ins]t+ "u su* plan or waiv]1  
includ+ measures describ$ 9 subsection  
7b77#b71 subject to revisions made 9    
accordance ) subsection 7b77#f77;,b72   
7,b7 9 p>agraph 7#a77;,b71 by ins]t+ 1  
or comp>able prim>y c>e case managem5t  
s]vices provid]s describ$ 9 section     
#aije7t71 z well z heal? c>e s]vices    
furni%$ 9 fee-=-s]vice sett+s or o!r    
deliv]y sy/ems aft] section #aicg2 &    
7,c7 9 p>agraph 7#b71 by ins]t+ be=e !  
p]iod ! foll[+3 1 includ+ analysis (    
comp>able quality measures = ,m$icaid   
eligible adults :o receive _! heal?     
s]vices ?r\gh manag$ c>e1 prim>y c>e    
case managem5t1 & fee-=-s]vice sett+s or
 o!r deliv]y sy/ems4  7c7 ,p$iatric     
heal? c>e measures  7#a7 ,9 g5]al       
,section #aaci;,a ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acbj;b-#i;a7 is    
am5d$-- 7,a7 9 subsection 7a7--  7i7 by 
r$esignat+ p>agraphs 7#e7 ?r\gh 7#h7 z  
p>agraphs 7#f7 ?r\gh 7#i71 respectively2
 &  7ii7 by ins]t+ aft] p>agraph 7#d7 ! 
foll[+3  7#e7 ,report+ ( p$iatric heal? 

c>e measures ,beg9n+ n lat] ?an ,janu>y 
#a ( ! cal5d> ye> t beg9s on or aft] !  
date t is #b ye>s aft] ! date ( enactm5t
 ( ! ,m$icaid & ,,*ip ,quality          
,improvem5t ,act ( #bjag1 & annually    
!reaft]1 ! ,secret>y %all require ,/ates
 to use ! measures & approa*es id5tifi$ 
9 p>agraph 7#d7 to report on ! initial  
core *ild heal? c>e quality measures    
e/abli%$ "u ?is subsection & z su*      
measures subsequ5tly are updat$ "u      
subsection 7b77#e74 ,su* report+ %all be
 /ratifi$ by deliv]y sy/em1 includ+     
manag$ c>e organizations "u section     
#aicb1 b5*m>k plans "u sections #aicg & 
#bajc1 prim>y c>e case managem5t s]vices
 provid]s describ$ 9 section #aije7t71  
heal? c>e s]vices 9 fee-=-s]vice sett+s1
 & o!r deliv]y sy/ems1 except t !       
,secret>y may det]m9e t report+ on c]ta9
 measures %\ld n be /ratifi$ by deliv]y 
sy/em because su* /ratification w\ld n  
be feasible or ! deliv]y sy/ems are n   
comp>able ) respect to ! application (  
su* measures4 ,9 addition to !          

/ratification requir$ "u ! previ\s      
s5t5ce1 ! ,secret>y %all h ! discretion 
to fur!r /ratify report+ on c]ta9       
measures bas$ on factors su* z          
eligibility category1 income level1 or  
o!r diff]5tiat+ factors t c\ld h an     
impact on ! comp>ability ( ! measure4  2
 &  7,b7 9 subsection 7c7-- 7i7 9       
p>agraph 7#a77;,a71 by /rik+ measures   
describ$ 9 subp>agraphs 7,a7 & 7,b7 (   
subsection 7a77#f7 & ins]t+ ! core      
measures describ$ 9 subsection 7a71 z   
revis$ 9 accordance ) subsection        
7b77#e72  7ii7 9 p>agraph 7#a77;,b71 by 
ins]t+ be=e ! p]iod ! foll[+3 1 or      
comp>able prim>y c>e case managem5t     
s]vices provid]s describ$ 9 section     
#aije7t71 z well z heal?c>e s]vices     
furni%$ 9 fee-=-s]vice sett+s or o!r    
deliv]y sy/ems2 &  7iii7 9 p>agraph     
7#b71 by ins]t+ be=e ! p]iod ! foll[+3 1
 includ+ analysis ( comp>able quality   
measures = *ildr5 eligible = m$ical     
assi/ance "u title ,,xix or *ild heal?  
assi/ance "u title ,,xxi :o receive _!  

heal? s]vices ?r\gh manag$ c>e1 prim>y  
c>e case managem5t1 & fee-=-s]vice      
sett+s or o!r deliv]y sy/ems4  7#b7     
,effective date ,! am5dm5ts made by ?is 
subsection %all take effect z if includ$
 9 ! enactm5t ( section #aaci;,a ( !    
,social ,security ,act1 z add$ by       
section #dja7;a7 ( ! ,*ildr5's ,heal?   
,insurance ,program ,reau?orization ,act
 ( #bjji 7,public ,law #aaa-c74  #d4    
,p]=mance bonuses = significant         
a*ievem5t 9 ,m$icaid & ,,*ip quality    
p]=mance ,section #aijc ( ! ,social     
,security ,act 7#db ,u4,s4,c4 #acif;b7  
is am5d$ by add+ at ! end ! foll[+ new  
subsection3  7aa7 ,p]=mance bonus =     
quality p]=mance a*ievem5t  7#a7 ,9     
g5]al ,! ,secret>y %all e/abli% a       
,m$icaid ,quality ,p]=mance ,bonus fund 
= aw>d+ p]=mance bonuses to ,/ates =    
high atta9m5t & improvem5t on a core set
 ( quality measures relat$ to ! goals & 
purposes ( ! ,m$icaid program "u ?is    
title4  7#b7 ,quality p]=mance bonus    
me?odology ,n lat] ?an #c ye>s aft] !   

date ( enactm5t ( ! ,m$icaid & ,,*ip    
,quality ,improvem5t ,act ( #bjag1 !    
,secret>y %all e/abli% a me?odology =   
aw>d+ ,m$icaid quality p]=mance bonuses 
to ,/ates n less ?an annually 9         
accordance ) p>agraph 7#c7 & subject to 
! availability ( appropriations4        
,m$icaid quality p]=mance bonuses %all  
be aw>d$ on ! basis ( ! annual ,/ate    
reports requir$ "u sections #aaci;,a &  
#aaci;,b & 9 accordance ) regulations   
promulgat$ by ! ,secret>y4  7#c7        
,quality p]=mance measurem5t bonuses    
,m$icaid quality p]=mance bonuses %all  
be aw>d$ to ! foll[+ #aj ,/ates3 7,a7 ,!
 top #e ,/ates a*iev+ ! designation (   
sup]ior quality p]=m+ ,/ate "u crit]ia  
e/abli%$ by ! ,secret>y4  7,b7 ,! #e    
,/ates t-- 7i7 are n among ! ,/ates     
describ$ 9 subp>agraph 7,a72 &  7ii7    
demon/rate ! greate/ relative level (   
annual improvem5t 9 quality p]=mance "u 
crit]ia e/abli%$ by ! ,secret>y4  7#d7  
,initial appropriation  7,a7 ,9 g5]al ,!
 total am\nt ( ,m$icaid quality p]=mance

 bonuses made "u ?is subsection = all   
fiscal ye>s %all be equal to            
#ejj1jjj1jjj1 to be available until     
exp5d$4  7,b7 ,budget au?ority ,?is     
p>agraph con/itutes budget au?ority 9   
advance ( appropriations ,acts &        
repres5ts ! obligation ( ! ,secret>y to 
provide = ! paym5t ( am\nts provid$ "u  
?is p>agraph4  7#e7 ,use ( quality      
p]=mance bonus funds  7,a7 ,designation 
= quality improvem5t activities ,z a    
condition ( receiv+ a ,m$icaid quality  
p]=mance bonus "u ?is subsection1 a     
,/ate %all agree to designate at lea/   
#ge p]c5t ( ! bonus funds paid to !     
,/ate "u ?is subsection = a fiscal ye> =
 ! developm5t & op]ation (              
quality-relat$ initiatives t w directly 
b5efit provid]s or manag$ c>e entities  
p>ticipat+ 9 ! ,/ate plan "u ?is title  
or "u a waiv] ( su* plan1 includ+--  7i7
 pay-=-p]=mance programs2  7ii7         
collaboration initiatives t h be5       
demon/rat$ to improve p]=mance on       
quality2  7iii7 quality improvem5t      

initiatives1 includ+ ^? aim$ at improv+ 
c>e = special & h>d-to-rea* populations1
 & ^? direct$ to manag$ c>e entities2 & 
7iv7 su* o!r ,secret>y-approv$          
activities & initiatives t a ,/ate may  
pursue to enc\rage quality improvem5t & 
pati5t-focus$ high value c>e4  7,b7     
,/ate option to e/abli% crit]ia ,a ,/ate
 may e/abli% crit]ia = ! ,/ate p]=mance 
program c>ri$ out "u subp>agraph 7,a7 t 
limits ! aw>d to a p>ticul> provid] or  
entity type1 t limits application to a  
specific geographic area1 or t directs  
inc5tive programs = quality relat$      
activities = specific populations1      
includ+ individuals eligible "u ?is     
title & title ,,xviii & h>d-to-rea*     
populations4  7,c7 ,rema9+ bonus funds  
,a ,/ate may designate up to #be p]c5t (
 ! bonus funds paid to ! ,/ate "u ?is   
subsection = a fiscal ye> = activities  
relat$ to ! goals & purposes ( ! ,/ate  
program "u ?is title4  4