shall be submitted in a form and manner, and at a time, specified by the secretary for purposes of this subparagraph. "(d) quality measures. "(i) in general. subject to clause (ii), any measure specified by the secretary under this subparagraph must have been endorsed by the entity with a contract under section 1890(a). "(ii) exception. in the case of a specified area or medical topic determined appropriate by the secretary for which a feasible and practical 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. "(iii) time frame. not later than october 1, 2012, the secretary shall publish the measures selected under this subparagraph that will be applicable with respect to rate year 2014.

"(e) public availability of data submitted. the secretary shall establish procedures for making data submitted under subparagraph (c) available to the public. such procedures shall ensure that a psychiatric hospital and a psychiatric unit has the opportunity to review the data that is to be made public with respect to the hospital or unit prior to such data being made public. the secretary shall report quality measures that relate to services furnished in inpatient settings in psychiatric hospitals and psychiatric units on the internet website of the centers for medicare & medicaid services." (b) conforming

to be an environmental exposure affected individual described in subsection (e)(2) shall be

"(b) optional pilot programs.-the secretary may establish a separate pilot program, in accordance with this subsection, with respect to each geographic area subject to an emergency declaration (other than the declaration of june 17, 2009), in order to furnish such comprehensive, coordinated and cost-effective care to individuals described in subparagraph (2)(b) who reside in each such area. "(2) individual described.-for purposes of paragraph (1), an individual described in this paragraph is an individual who enrolls in part b, submits to the secretary an application to participate in the applicable

pilot program under this subsection, and- "(a) is an environmental exposure affected individual described in subsection (e)(2) who resides in or around the geographic area subject to an emergency declaration made as of june 17, 2009; or "(b) is an environmental exposure affected individual described in subsection (e)(3) who- "(i) is deemed under subsection (a)(2); and "(ii) meets such other criteria or conditions for participation in a pilot program under paragraph (1)(b) as the secretary specifies. "(3) flexible benefits and services. a pilot program under this subsection may provide for the furnishing of benefits, items, or services not otherwise covered or authorized under this title, if the secretary determines that furnishing such

benefits, items, or services will further the purposes of such pilot program (as described in paragraph (1)). "(4) innovative reimbursement methodologies. for purposes of the pilot program under this subsection, the secretary- "(a) shall develop and implement appropriate methodologies to reimburse providers for furnishing benefits, items, or services for which payment is not otherwise covered or authorized under this title, if such benefits, items, or services are furnished pursuant to paragraph (3); and "(b) may develop and implement innovative approaches to reimbursing providers for any benefits, items, or services furnished under this subsection. "(5) limitation. consistent with section 1862(b), no payment shall be made under the pilot program under this subsection with respect to benefits, items, or services

furnished to an environmental exposure affected individual (as defined in subsection (e)) to the extent that such individual is eligible to receive such benefits, items, or services through any other public or private benefits plan or legal agreement. "(6) waiver authority. the secretary may waive such provisions of this title and title xi as are necessary to carry out pilot programs under this subsection. "(7) funding. for purposes of carrying out pilot programs under this subsection, 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 such sums as the secretary determines necessary, to the centers for medicare & medicaid services

program management account. "(8) waiver of budget neutrality. the secretary shall not require that pilot programs under this subsection be budget neutral with respect to expenditures under this title. "(c) determinations. "(1) by the commissioner of social security. for purposes of this section, the commissioner of social security, in consultation with the secretary, and using the cost allocation method prescribed in section 201(g), shall determine whether individuals are environmental exposure affected individuals. "(2) by the secretary. the secretary shall determine eligibility for pilot programs under subsection (b). "(d) emergency declaration defined. for purposes of this section, the term 'emergency declaration' means a declaration of a public health emergency under section

104(a) of the comprehensive environmental response, compensation, and liability act of 1980. "(e) environmental exposure affected individual defined. "(1) in general. for purposes of this section, the term 'environmental exposure affected individual' means- "(a) an individual described in paragraph (2); and "(b) an individual described in paragraph (3). "(2) individual described. "(a) in general. an individual described in this paragraph is any individual who- "(i) is diagnosed with 1 or more conditions described in subparagraph (b); "(ii) as demonstrated in such manner as the secretary determines appropriate, has been present for an aggregate total of 6 months in the geographic area subject to an emergency declaration specified in subsection (b)(2)(a), during a period ending- "(i) not less than 10 years prior to such diagnosis; and "(ii) prior to the

implementation of all the remedial and removal actions specified in the record of decision for operating unit 4 and the record of decision for operating unit 7; "(iii) files an application for benefits under this title (or has an application filed on behalf of the individual), including pursuant to this section; and "(iv) is determined under this section to meet the criteria in this subparagraph. "(b) conditions described. for purposes of subparagraph (a), the following conditions are described in this subparagraph: "(i) asbestosis, pleural thickening, or pleural plaques as established by- "(i) interpretation by a 'b reader' qualified physician of a plain chest x-ray or interpretation of a computed

tomographic radiograph of the chest by a qualified physician, as determined by the secretary; or "(ii) such other diagnostic standards as the secretary specifies except that this clause shall not apply to pleural thickening or pleural plaques unless there are symptoms or conditions requiring medical treatment as a result of these diagnoses. "(ii) mesothelioma, or malignancies of the lung, colon, rectum, larynx, stomach, esophagus, pharynx, or ovary, as established by- "(i) pathologic examination of biopsy tissue; "(ii) cytology from bronchioalveolar lavage; or "(iii) such other diagnostic standards as the secretary specifies. "(iii) any other diagnosis which the secretary, in consultation

with the commissioner of social security, determines is an asbestos-related medical condition, as established by such diagnostic standards as the secretary specifies. "(3) other individual described. an individual described in this paragraph is any individual who- "(a) is not an individual described in paragraph (2); "(b) is diagnosed with a medical condition caused by the exposure of the individual to a public health hazard to which an emergency declaration applies, based on such medical conditions, diagnostic standards, and other criteria as the secretary specifies; "(c) as demonstrated in such manner as the secretary determines appropriate, has been present for an aggregate total of 6 months in the geographic area subject to the emergency declaration involved, during a period determined appropriate by the secretary; "(d) files an application for benefits under this title (or has an application filed on behalf of the individual), including pursuant to this

section; and "(e) is determined under this section to meet the criteria in this paragraph.". (b) program for early detection of certain medical conditions related to environmental health hazards. title xx of the social security act (42 u.s.c. 1397 et seq.), as amended by section 5507, is amended by adding at the end the following: "sec. 2009. program for early detection of certain medical conditions related to environmental health hazards. "(a) program establishment. the secretary shall establish a program in accordance with this section to make competitive grants to eligible entities specified in subsection (b) for the purpose of- "(1) screening at-risk individuals (as defined in subsection (c)(1)) for environmental health conditions (as defined in subsection (c)(3)); and

"(2) developing and disseminating public information and education concerning- "(a) the availability of screening under the program under this section; "(b) the detection, prevention, and treatment of environmental health conditions; and "(c) the availability of medicare benefits for certain individuals diagnosed with environmental health conditions under section 1881a. "(b) eligible entities. "(1) in general. for purposes of this section, an eligible entity is an entity described in paragraph (2) which submits an application to the secretary in such form and manner, and containing such information and assurances, as the secretary determines appropriate. "(2) types of eligible entities. the entities described in this paragraph are the following: "(a) a hospital or community health center. "(b) a federally qualified health center. "(c) a facility of the indian health service. "(d) a national cancer

institute-designated cancer center. "(e) an agency of any state or local government. "(f) a nonprofit organization. "(g) any other entity the secretary determines appropriate. "(c) definitions. in this section: "(1) at-risk individual. the term 'at-risk individual' means an individual who- "(a) (i) as demonstrated in such manner as the secretary determines appropriate, has been present for an aggregate total of 6 months in the geographic area subject to an emergency declaration specified under paragraph (2), during a period ending- "(i) not less than 10 years prior to the date of such individual's application under subparagraph (b); and "(ii) prior to the implementation of all the remedial and removal actions specified in the record of decision for operating unit 4 and the record of decision for operating unit 7; or

"(ii) meets such other criteria as the secretary determines appropriate considering the type of environmental health condition at issue; and "(b) has submitted an "(b) has submitted an application (or has an application submitted on the individual's behalf), to an eligible entity receiving a grant under this section, for screening under the program under this section. "(2) emergency declaration.-the term 'emergency declaration' means a declaration of a public health emergency under section 104(a) of the comprehensive environmental response, compensation, and liability act of 1980. "(3) environmental health condition.-the term 'environmental health condition' means- "(a) asbestosis, pleural thickening, or pleural plaques, as established by- "(i) interpretation by a 'b reader' qualified physician of a plain chest x-ray or interpretation of a computed tomographic radiograph of the

chest by a qualified physician, as determined by the secretary; or "(ii) such other diagnostic standards as the secretary specifies; "(b) mesothelioma, or malignancies of the lung, colon, rectum, larynx, stomach, esophagus, pharynx, or ovary, as established by-- "(i) pathologic examination of biopsy tissue; "(ii) cytology from bronchioalveolar lavage; or "(iii) such other diagnostic standards as the secretary specifies; and "(c) any other medical condition which the secretary determines is caused by exposure to a hazardous substance or pollutant or contaminant at a superfund site to which an emergency declaration applies, based on such criteria and as established by such diagnostic standards as the secretary specifies. "(4) hazardous substance; pollutant; contaminant.-the

terms 'hazardous substance', 'pollutant', and 'contaminant' have the meanings given those terms in section 101 of the comprehensive environmental response, compensation, and liability act of 1980 (42 u.s.c. 9601). "(5) superfund site.-the term 'superfund site' means a site included on the national priorities list developed by the president in accordance with section 105(a)(8)(b) of the comprehensive environmental response, compensation, and liability act of 1980 (42 u.s.c. 9605(a)(8)(b)). "(d) health coverage unaffected.-nothing in this section shall be construed to affect any coverage obligation of a governmental or private health plan or program relating to an at-risk individual. "(e) funding.- "(1) in general.-out of any

funds in the treasury not otherwise appropriated, there are appropriated to the secretary, to carry out the program under this section- "(a) $23,000,000 for the period of fiscal years 2010 through 2014; and "(b) $20,000,000 for each 5-fiscal year period thereafter. "(2) availability.-funds appropriated under paragraph (1) shall remain available until expended. "(f) nonapplication.- "(1) in general.-except as provided in paragraph (2), the preceding sections of this title shall not apply to grants awarded under this section. "(2) limitations on use of grants.-section 2005(a) shall apply to a grant awarded under this section to the same extent and in the same manner as such section applies to payments to

states under this title, except that paragraph (4) of such section shall not be construed to prohibit grantees from conducting screening for environmental health conditions as authorized under this section.". sec. 10324. protections for frontier states. (a) floor on area wage index for hospitals in frontier states.- (1) in general.-section 1886(d)(3)(e) of the social security act (42 u.s.c. 1395ww(d)(3)(e)) is amended- (a) in clause (i), by striking "clause (ii)" and inserting "clause (ii) or (iii)"; and (b) by adding at the end the following new clause: "(iii) floor on area wage index for hospitals in frontier states.- "(i) in general.-subject to

subclause (iv), for discharges occurring on or after october 1, 2010, the area wage index applicable under this subparagraph to any hospital which is located in a frontier state (as defined in subclause (ii)) may not be less than 1.00. "(ii) frontier state defined.-in this clause, the term 'frontier state' means a state in which at least 50 percent of the counties in the state are frontier counties. "(iii) frontier county defined.-in this clause, the term 'frontier county' means a county in which the population per square mile is less than 6. "(iv) limitation.-this clause shall not apply to any hospital located in a state that receives a non-labor related share adjustment under paragraph (5)(h).".

(2) waiving budget neutrality.-section 1886(d)(3)(e) of the social security act (42 u.s.c. 1395ww(d)(3)(e)), as amended by subsection (a), is amended in the third sentence by inserting "and the amendments made by section 10324(a)(1) of the patient protection and affordable care act" after "2003". (b) floor on area wage adjustment factor for hospital outpatient department services in frontier states.-section 1833(t) of the social security act (42 u.s.c. 1395l(t)), as amended by section 3138, is amended- (1) in paragraph (2)(d), by

striking "the secretary" and inserting "subject to paragraph (19), the secretary"; and (2) by adding at the end the following new paragraph: "(19) floor on area wage adjustment factor for hospital outpatient department services in frontier states.- "(a) in general.-subject to subparagraph (b), with respect to covered opd services furnished on or after january 1, 2011, the area wage adjustment factor applicable under the payment system established under this subsection to any hospital outpatient department which is located in a frontier state (as defined in section 1886(d)(3)(e)(iii)(ii)) may not be less than 1.00. the preceding sentence shall not be applied in a budget neutral manner. "(b) limitation.-this paragraph

shall not apply to any hospital outpatient department located in a state that receives a non-labor related share adjustment under section 1886(d)(5)(h).". (c) floor for practice expense index for physicians' services furnished in frontier states.-section 1848(e)(1) of the social security act (42 u.s.c. 1395w-4(e)(1)), as amended by section 3102, is amended- (1) in subparagraph (a), by striking "and (h)" and inserting "(h), and (i)"; and (2) by adding at the end the following new subparagraph: "(i) floor for practice expense index for services furnished in frontier states.- "(i) in general.-subject to clause (ii), for purposes of

payment for services furnished in a frontier state (as defined in section 1886(d)(3)(e)(iii)(ii)) on or after january 1, 2011, after calculating the practice expense index in subparagraph (a)(i), the secretary shall increase any such index to 1.00 if such index would otherwise be less that 1.00. the preceding sentence shall not be applied in a budget neutral manner. "(ii) limitation.-this subparagraph shall not apply to services furnished in a state that receives a non-labor related share adjustment under section 1886(d)(5)(h).". sec. 10325. revision to skilled

nursing facility prospective payment system. (a) temporary delay of rug-iv.-notwithstanding any other provision of law, the secretary of health and human services shall not, prior to october 1, 2011, implement version 4 of the resource utilization groups (in this subsection refereed to as "rug-iv") published in the federal register on august 11, 2009, entitled "prospective payment system and consolidated billing for skilled nursing facilities for fy 2010; minimum data set, version 3.0 for skilled nursing facilities and medicaid nursing facilities" (74 fed. reg. 40288). beginning on october 1, 2010, the secretary of health and human services shall implement the change specific to therapy furnished on a concurrent basis that is a component of rug-iv and changes

to the lookback period to ensure that only those services furnished after admission to a skilled nursing facility are used as factors in determining a case mix classification under the skilled nursing facility prospective payment system under section 1888(e) of the social security act (42 u.s.c. 1395yy(e)). (b) construction.-nothing in this section shall be interpreted as delaying the implementation of version 3.0 of the minimum data sets (mds 3.0) beyond the planned implementation date of october 1, 2010. sec. 10326. pilot testing pay-for-performance programs for certain medicare providers. (a) in general.-not later than january 1, 2016, the secretary of health and human services (in this section referred to as the "secretary") shall, for each provider described in subsection

(b), conduct a separate pilot program under title xviii of the social security act to test the implementation of a value-based purchasing program for payments under such title for the provider. (b) providers described.-the providers described in this paragraph are the following: (1) psychiatric hospitals (as described in clause (i) of section 1886(d)(1)(b) of such act (42 u.s.c. 1395ww(d)(1)(b))) and psychiatric units (as described in the matter following clause (v) of such section). (2) long-term care hospitals (as described in clause (iv) of such section). (3) rehabilitation hospitals (as described in clause (ii) of such section). (4) pps-exempt cancer hospitals (as described in clause (v) of such section). (5) hospice programs (as defined in section 1861(dd)(2) of such

act (42 u.s.c. 1395x(dd)(2))). (c) waiver authority.-the secretary may waive such requirements of titles xi and xviii of the social security act as may be necessary solely for purposes of carrying out the pilot programs under this section. (d) no additional program expenditures.-payments under this section under the separate pilot program for value based purchasing (as described in subsection (a)) for each provider type described in paragraphs (1) through (5) of subsection (b) for applicable items and services under title xviii of the social security act for a year shall be established in a manner that does not result in spending more under each such value based purchasing program for such year than would otherwise be expended for such provider type for such year if the pilot program were not implemented, as estimated by the secretary. (e) expansion of pilot program.-the secretary may, at any point after january 1, 2018,

expand the duration and scope of a pilot program conducted under this subsection, to the extent determined appropriate by the secretary, if- (1) the secretary determines that such expansion is expected to- (a) reduce spending under title xviii of the social security act without reducing the quality of care; or (b) improve the quality of care and reduce spending; (2) the chief actuary of the centers for medicare & medicaid services certifies that such expansion would reduce program spending under such title xviii; and (3) the secretary determines that such expansion would not deny or limit the coverage or provision of benefits under such title xiii for medicare beneficiaries. sec. 10327. improvements to the physician quality reporting system. (a) in general.-section 1848(m) of the social security act (42 u.s.c. 1395w-4(m)) is amended by adding at the end the following new paragraph: "(7) additional incentive

payment.- "(a) in general.-for 2011 through 2014, if an eligible professional meets the requirements described in subparagraph (b), the applicable quality percent for such year, as described in clauses (iii) and (iv) of paragraph (1)(b), shall be increased by 0.5 percentage points. "(b) requirements described.-in order to qualify for the additional incentive payment described in subparagraph (a), an eligible professional shall meet the following requirements: "(i) the eligible professional shall- "(i) satisfactorily submit data on quality measures for purposes of paragraph (1) for a year; and "(ii) have such data submitted on their behalf through a maintenance of certification program (as defined in subparagraph (c)(i)) that meets- "(aa) the criteria for a registry (as described in subsection (k)(4)); or "(bb) an alternative form and manner determined appropriate by the secretary. "(ii) the eligible professional,

more frequently than is required to qualify for or maintain board certification status- "(i) participates in such a maintenance of certification program for a year; and "(ii) successfully completes a qualified maintenance of certification program practice assessment (as defined in subparagraph (c)(ii)) for such year. "(iii) a maintenance of certification program submits to the secretary, on behalf of the eligible professional, information- "(i) in a form and manner specified by the secretary, that the eligible professional has successfully met the requirements of clause (ii) (which may be in the form of a structural measure); "(ii) if requested by the secretary, on the survey of patient experience with care (as described in subparagraph (c)(ii)(ii)); and "(iii) as the secretary may require, on the methods, measures, and data used under the maintenance of certification program and the qualified maintenance of certification program practice assessment. "(c) definitions.-for purposes of this paragraph: "(i) the term 'maintenance of

certification program' means a continuous assessment program, such as qualified american board of medical specialties maintenance of certification program or an equivalent program (as determined by the secretary), that advances quality and the lifelong learning and self-assessment of board certified specialty physicians by focusing on the competencies of patient care, medical knowledge, practice-based learning, interpersonal and communication skills and professionalism. such a program shall include the following: "(i) the program requires the physician to maintain a valid, unrestricted medical license in the united states. "(ii) the program requires a physician to participate in educational and self-assessment programs that require an assessment of what was learned. "(iii) the program requires a physician to demonstrate, through a formalized, secure examination, that the physician has the fundamental diagnostic skills, medical knowledge, and clinical judgment to provide quality care in their respective specialty. "(iv) the program requires successful completion of a

qualified maintenance of certification program practice assessment as described in clause (ii). "(ii) the term 'qualified maintenance of certification program practice assessment' means an assessment of a physician's practice that- "(i) includes an initial assessment of an eligible professional's practice that is designed to demonstrate the physician's use of evidence-based medicine; "(ii) includes a survey of patient experience with care; and "(iii) requires a physician to implement a quality improvement intervention to address a practice weakness identified in the initial assessment under subclause (i) and then to remeasure to assess performance improvement after such intervention.". (b) authority.-section 3002(c) of this act is amended by adding at the end the following new paragraph: "(3) authority.-for years after 2014, if the secretary of health and human services determines it to be appropriate, the secretary may incorporate participation in a maintenance of certification

program and successful completion of a qualified maintenance of certification program practice assessment into the composite of measures of quality of care furnished pursuant to the physician fee schedule payment modifier, as described in section 1848(p)(2) of the social security act (42 u.s.c. 1395w-4(p)(2)).". (c) elimination of ma regional plan stabilization fund.- (1) in general.-section 1858 of the social security act (42 u.s.c. 1395w-27a) is amended by striking subsection (e). (2) transition.-any amount contained in the ma regional plan stabilization fund as of the date of the enactment of this act shall be transferred to the federal supplementary medical insurance trust fund. sec. 10328. improvement in part d medication therapy management (mtm) programs. (a) in general.-section 1860d-4(c)(2) of the social security act (42 u.s.c.

1395w-104(c)(2)) is amended- (1) by redesignating subparagraphs (c), (d), and (e) as subparagraphs (e), (f), and (g), respectively; and (2) by inserting after subparagraph (b) the following new subparagraphs: "(c) required interventions.-for plan years beginning on or after the date that is 2 years after the date of the enactment of the patient protection and affordable care act, prescription drug plan sponsors shall offer medication therapy management services to targeted beneficiaries described in subparagraph (a)(ii) that include, at a minimum, the following to increase adherence to prescription medications or other goals deemed necessary by the secretary: "(i) an annual comprehensive medication review furnished person-to-person or using telehealth technologies (as defined by the secretary) by a licensed pharmacist or other the comprehensive medication review- "(i) shall include a review of

the individual's medications and may result in the creation of a recommended medication action plan or other actions in consultation with the individual and with input from the prescriber to the extent necessary and practicable; and "(ii) shall include providing the individual with a written or printed summary of the results of the review. the secretary, in consultation with relevant stakeholders, shall develop a standardized format for the action plan under subclause (i) and the summary under subclause (ii). "(ii) follow-up interventions as warranted based on the findings of the annual medication review or the targeted medication enrollment and which may be provided person-to-person or using telehealth technologies (as defined by the secretary). "(d) assessment.-the prescription drug plan sponsor shall have in place a process to assess, at least on a quarterly basis, the medication use of individuals who are at risk but not enrolled in the medication therapy management program, including individuals who have experienced a transition in care, if the prescription drug plan sponsor has access to that information.

"(e) automatic enrollment with ability to opt-out.-the prescription drug plan sponsor shall have in place a process to- "(i) subject to clause (ii), automatically enroll targeted beneficiaries described in subparagraph (a)(ii), including beneficiaries identified under subparagraph (d), in the medication therapy management program required under this subsection; and "(ii) permit such beneficiaries to opt-out of enrollment in such program.". (b) rule of construction.-nothing in this section shall limit the authority of the secretary of health and human services to modify or broaden requirements for a medication therapy management program under part d of title xviii of the social security act or to study new models for medication therapy management through the center for medicare and medicaid innovation under section 1115a of such act, as added by section 3021.

sec. 10329. developing methodology to assess health plan value. (a) development.-the secretary of health and human services (referred to in this section as the "secretary"), in consultation with relevant stakeholders including health insurance issuers, health care consumers, employers, health care providers, and other entities determined appropriate by the secretary, shall develop a methodology to measure health plan value. such methodology shall take into consideration, where applicable- (1) the overall cost to enrollees under the plan; (2) the quality of the care provided for under the plan; (3) the efficiency of the plan in providing care; (4) the relative risk of the plan's enrollees as compared to other plans; (5) the actuarial value or other comparative measure of the benefits covered under the plan; and (6) other factors determined relevant by the secretary. (b) report.-not later than 18 months after the date of enactment of this act, the enactment of this act, the

congress a report concerning the methodology developed under subsection (a). sec. 10330. modernizing computer and data systems of the centers for medicare & medicaid services to support improvements in care delivery. (a) in general.-the secretary of health and human services (in this section referred to as the "secretary") shall develop a plan (and detailed budget for the resources needed to implement such plan) to modernize the computer and data systems of the centers for medicare & medicaid services (in this section referred to as "cms"). (b) considerations.-in developing the plan, the secretary shall consider how such modernized computer system could- (1) in accordance with the regulations promulgated under section 264(c) of the health insurance portability and accountability act of 1996, make available data in a reliable and timely manner to providers of services and suppliers to support their efforts to better manage and coordinate care furnished to beneficiaries of cms programs; and (2) support consistent

evaluations of payment and delivery system reforms under cms programs. (c) posting of plan.-by not later than 9 months after the date of the enactment of this act, the secretary shall post on the website of the centers for medicare & medicaid services the plan described in subsection (a). sec. 10331. 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. sec. 10332. availability of medicare data for performance measurement. (a) in general. section 1874 of the social security act (42 u.s.c. 1395kk) is amended by adding at the end the following new subsection: "(e) availability of medicare data. "(1) in general. subject to paragraph (4), the secretary shall make available to qualified entities (as defined in paragraph (2)) data described in paragraph (3) for the evaluation of the performance of providers of services and suppliers. "(2) qualified entities. for purposes of this subsection, the term 'qualified entity' means a public or private entity that- "(a) is qualified (as determined by the secretary) to use claims data to evaluate the performance

of providers of services and suppliers on measures of quality, efficiency, effectiveness, and resource use; and "(b) agrees to meet the requirements described in paragraph (4) and meets such other requirements as the secretary may specify, such as ensuring security of data. "(3) data described. the data described in this paragraph are standardized extracts (as determined by the secretary) of claims data under parts a, b, and d for items and services furnished under such parts for one or more specified geographic areas and time periods requested by a qualified entity. the secretary shall take such actions as the secretary deems necessary to protect the identity of individuals entitled to or enrolled for benefits under such parts. "(4) requirements. "(4) requirements. "(a) fee. data described in paragraph (3) shall be made available to a qualified entity under this subsection at a fee equal to the cost of making such data available. any fee collected

pursuant to the preceding sentence shall be deposited into the federal supplementary medical insurance trust fund under section 1841. "(b) specification of uses and methodologies. a qualified entity requesting data under this subsection shall- "(i) submit to the secretary a description of the methodologies that such qualified entity will use to evaluate the performance of providers of services and suppliers using such data; "(ii) (i) except as provided in subclause (ii), if available, use standard measures, such as measures endorsed by the entity with a contract under section 1890(a) and measures developed pursuant to section 931 of the public health service act; or "(ii) use alternative measures if the secretary, in consultation with appropriate stakeholders, determines that use of such alternative measures would be more valid, reliable, responsive to consumer preferences, cost-effective, or relevant to dimensions of quality and resource use not addressed by such standard measures; "(iii) include data made available under this subsection

with claims data from sources other than claims data under this title in the evaluation of performance of providers of services and suppliers; "(iv) only include information on the evaluation of performance of providers and suppliers in reports described in subparagraph (c); "(v) make available to providers of services and suppliers, upon their request, data made available under this subsection; and "(vi) prior to their release, submit to the secretary the format of reports under subparagraph (c). "(c) reports. any report by a qualified entity evaluating the performance of providers of services and suppliers using data made available under this subsection shall- "(i) include an understandable description of the measures, which shall include quality measures and the rationale for use of other measures described in subparagraph (b)(ii)(ii), risk adjustment methods, physician attribution methods, other applicable methods, data

specifications and limitations, and the sponsors, so that consumers, providers of services and suppliers, health plans, researchers, and other stakeholders can assess such reports; "(ii) be made available confidentially, to any provider of services or supplier to be identified in such report, prior to the public release of such report, and provide an opportunity to appeal and correct errors; "(iii) only include information on a provider of services or supplier in an aggregate form as determined appropriate by the secretary; and "(iv) except as described in clause (ii), be made available to the public. "(d) approval and limitation of uses. the secretary shall not make data described in paragraph (3) available to a qualified entity unless the qualified entity agrees to release the information on the evaluation of performance of providers of services and suppliers. such entity shall only use such data, and information derived from such evaluation, for the reports

under subparagraph (c). data released to a qualified entity under this subsection shall not be subject to discovery or admission as evidence in judicial or administrative proceedings without consent of the applicable provider of services or supplier.". (b) effective date.-the amendment made by subsection (a) shall take effect on january 1, 2012. sec. 10333. community-based collaborative care networks. part d of title iii of the public health service act (42 u.s.c. 254b et seq.) is amended by adding at the end the following new subpart: "subpart xi-community-based collaborative care network program "sec. 340h. community-based collaborative care network program. "(a) in general. the secretary may award grants to eligible entities to support community-based collaborative care networks that meet the requirements of subsection (b). "(b) community-based collaborative care networks.

community-based collaborative care network (referred to in this section as a 'network') shall be a consortium of health care providers with a joint governance structure (including providers within a single entity) that provides comprehensive coordinated and integrated health care services (as defined by the secretary) for low-income populations. "(2) required inclusion. a network shall include the following providers (unless such provider does not exist within the community, declines or refuses to participate, or places unreasonable conditions on their participation): "(a) a hospital that meets the criteria in section 1923(b)(1) of the social security act; and "(b) all federally qualified health centers (as defined in section 1861(aa) of the social security act located in the community. "(3) priority. in awarding grants, the secretary shall give priority to networks that include- "(a) the capability to provide the broadest range of services to low-income individuals; "(b) the broadest range of providers that currently serve a high volume of low-income individuals; and "(c) a county or municipal department of health.

"(c) application. "(1) application. a network described in subsection (b) shall submit an application to the secretary. "(2) renewal. in subsequent years, based on the performance of grantees, the secretary may provide renewal grants to prior year grant recipients. "(d) use of funds.- "(1) use by grantees. grant funds may be used for the following activities: "(a) assist low-income individuals to- "(i) access and appropriately use health services; "(ii) enroll in health coverage programs; and "(iii) obtain a regular primary care provider or a medical home. "(b) provide case management and care management. "(c) perform health outreach using neighborhood health workers or through other means. "(d) provide transportation. "(e) expand capacity, including through telehealth, after-hours services or urgent care. "(f) provide direct patient care services. "(2) grant funds to hrsa grantees. the secretary may limit the percent of grant funding that

may be spent on direct care services provided by grantees of programs administered by the health resources and services administration or impose other requirements on such grantees deemed necessary. "(e) authorization of appropriations. there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2011 through 2015.". sec. 10334. minority health. (a) office of minority health.- (1) in general. section 1707 of the public health service act (42 u.s.c. 300u-6) is amended- (a) in subsection (a), by striking "within the office of public health and science" and all that follows through the end and inserting ". the office of minority health as existing on

the date of enactment of the patient protection and affordable care act shall be transferred to the office of the secretary in such manner that there is established in the office of the secretary, the office of minority health, which shall be headed by the deputy assistant secretary for minority health who shall report directly to the secretary, and shall retain and strengthen authorities (as in existence on such date of enactment) for the purpose of improving minority health and the quality of health care minorities receive, and eliminating racial and ethnic disparities. in carrying out this subsection, the secretary, acting through the deputy assistant secretary, shall award grants, contracts, enter into memoranda of understanding, cooperative, interagency, intra-agency and other agreements with public and nonprofit private entities, agencies, as well as departmental and cabinet agencies and organizations, and with organizations that are indigenous human resource providers in communities of color to assure improved health status of racial and ethnic

minorities, and shall develop measures to evaluate the effectiveness of activities aimed at reducing health disparities and supporting the local community. such measures shall evaluate community outreach activities, language services, workforce cultural competence, and other areas as determined by the secretary."; and (b) by striking subsection (h) and inserting the following: "(h) authorization of appropriations. for the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of fiscal years 2011 through 2016." (2) transfer of functions. there are transferred to the office of minority health in the

office of the secretary of health and human services, all duties, responsibilities, authorities, accountabilities, functions, staff, funds, award mechanisms, and other entities under the authority of the office of minority health of the public health service as in effect on the date before the date of enactment of this act, which shall continue in effect according to the terms in effect on the date before such date of enactment, until modified, terminated, superseded, set aside, or revoked in accordance with law by the president, the secretary, a court of competent jurisdiction, or by operation of law. (3) reports. not later than 1 year after the date of enactment of this section, and biennially thereafter, the secretary of health and human services shall prepare and submit to the appropriate committees of congress a report describing the activities carried out under section 1707 of the public health service act (as amended