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292

Sec. 3008

PPACA (Consolidated)

‘‘(3) H

OSPITAL ACQUIRED CONDITIONS

.—For purposes of this

subsection, the term ‘hospital acquired condition’ means a con-

dition identified for purposes of subsection (d)(4)(D)(iv) and any

other condition determined appropriate by the Secretary that

an individual acquires during a stay in an applicable hospital,

as determined by the Secretary.

‘‘(4) A

PPLICABLE PERIOD

.—In this subsection, the term ‘ap-

plicable period’ means, with respect to a fiscal year, a period

specified by the Secretary.

‘‘(5) R

EPORTING TO HOSPITALS

.—Prior to fiscal year 2015

and each subsequent fiscal year, the Secretary shall provide

confidential reports to applicable hospitals with respect to hos-

pital acquired conditions of the applicable hospital during the

applicable period.

‘‘(6) R

EPORTING HOSPITAL SPECIFIC INFORMATION

.—

‘‘(A) I

N GENERAL

.—The Secretary shall make informa-

tion available to the public regarding hospital acquired

conditions of each applicable hospital.

‘‘(B) O

PPORTUNITY TO REVIEW

AND SUBMIT CORREC

TIONS

.—The Secretary shall ensure that an applicable hos-

pital has the opportunity to review, and submit corrections

for, the information to be made public with respect to the

hospital under subparagraph (A) prior to such information

being made public.

‘‘(C) W

EBSITE

.—Such information shall be posted on

the Hospital Compare Internet website in an easily under-

standable format.

‘‘(7) L

IMITATIONS ON REVIEW

.—There shall be no adminis-

trative or judicial review under section 1869, section 1878, or

otherwise of the following:

‘‘(A) The criteria described in paragraph (2)(A).

‘‘(B) The specification of hospital acquired conditions

under paragraph (3).

‘‘(C) The specification of the applicable period under

paragraph (4).

‘‘(D) The provision of reports to applicable hospitals

under paragraph (5) and the information made available to

the public under paragraph (6).’’.

(b) S

TUDY AND

EPORT ON

XPANSION OF

EALTHCARE

QUIRED

ONDITIONS

OLICY TO

THER

ROVIDERS

.—

(1) S

TUDY

.—The Secretary of Health and Human Services

shall conduct a study on expanding the healthcare acquired

conditions policy under subsection (d)(4)(D) of section 1886 of

the Social Security Act (42 U.S.C. 1395ww) to payments made

to other facilities under the Medicare program under title

XVIII of the Social Security Act, including such payments

made to inpatient rehabilitation facilities, long-term care hos-

pitals (as described in subsection(d)(1)(B)(iv) of such section),

hospital outpatient departments, and other hospitals excluded

from the inpatient prospective payment system under such sec-

tion, skilled nursing facilities, ambulatory surgical centers, and

health clinics. Such study shall include an analysis of how such

policies could impact quality of patient care, patient safety,

and spending under the Medicare program.

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293

Sec. 3011\399HH PHSA

PPACA (Consolidated)

(2) R

EPORT

.—Not later than January 1, 2012, the Sec-

retary shall submit to Congress a report containing the results

of the study conducted under paragraph (1), together with rec-

ommendations for such legislation and administrative action as

the Secretary determines appropriate.

PART 2—NATIONAL STRATEGY TO IMPROVE

HEALTH CARE QUALITY

SEC. 3011. NATIONAL STRATEGY.

Title III of the Public Health Service Act (42 U.S.C. 241 et

seq.) is amended by adding at the end the following:

‘‘PART S—HEALTH CARE QUALITY PROGRAMS

‘‘Subpart I—National Strategy for Quality

Improvement in Health Care

‘‘SEC. 399HH ø42 U.S.C. 280j¿. NATIONAL STRATEGY FOR QUALITY IM-

PROVEMENT IN HEALTH CARE.

‘‘(a) E

STABLISHMENT OF

ATIONAL

TRATEGY AND

RIORITIES

.—

‘‘(1) N

ATIONAL STRATEGY

.—The Secretary, through a trans-

parent collaborative process, shall establish a national strategy

to improve the delivery of health care services, patient health

outcomes, and population health.

‘‘(2) I

DENTIFICATION OF PRIORITIES

.—

‘‘(A) I

N GENERAL

.—The Secretary shall identify na-

tional priorities for improvement in developing the strat-

egy under paragraph (1).

‘‘(B) R

EQUIREMENTS

.—The Secretary shall ensure that

priorities identified under subparagraph (A) will—

‘‘(i) have the greatest potential for improving the

health outcomes, efficiency, and patient-centeredness

of health care for all populations, including children

and vulnerable populations;

‘‘(ii) identify areas in the delivery of health care

services that have the potential for rapid improvement

in the quality and efficiency of patient care;

‘‘(iii) address gaps in quality, efficiency, compara-

tive effectiveness information (taking into consider-

ation the limitations set forth in subsections (c) and

(d) of section 1182 of the Social Security Act), and

health outcomes measures and data aggregation tech-

niques; øAs revised by section 10302¿

‘‘(iv) improve Federal payment policy to emphasize

quality and efficiency;

‘‘(v) enhance the use of health care data to im-

prove quality, efficiency, transparency, and outcomes;

‘‘(vi) address the health care provided to patients

with high-cost chronic diseases;

‘‘(vii) improve research and dissemination of strat-

egies and best practices to improve patient safety and

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294

Sec. 3011\399HH PHSA

PPACA (Consolidated)

reduce medical errors, preventable admissions and re-

admissions, and health care-associated infections;

‘‘(viii) reduce health disparities across health dis-

parity populations (as defined in section 485E) and ge-

ographic areas; and

‘‘(ix) address other areas as determined appro-

priate by the Secretary.

‘‘(C) C

ONSIDERATIONS

.—In identifying priorities under

subparagraph (A), the Secretary shall take into consider-

ation the recommendations submitted by the entity with a

contract under section 1890(a) of the Social Security Act

and other stakeholders.

‘‘(D) C

OORDINATION WITH STATE AGENCIES

.—The Sec-

retary shall collaborate, coordinate, and consult with State

agencies responsible for administering the Medicaid pro-

gram under title XIX of the Social Security Act and the

Children’s Health Insurance Program under title XXI of

such Act with respect to developing and disseminating

strategies, goals, models, and timetables that are con-

sistent with the national priorities identified under sub-

paragraph (A).

‘‘(b) S

TRATEGIC

LAN

.—

‘‘(1) I

N GENERAL

.—The national strategy shall include a

comprehensive strategic plan to achieve the priorities described

in subsection (a).

‘‘(2) R

EQUIREMENTS

.—The strategic plan shall include pro-

visions for addressing, at a minimum, the following:

‘‘(A) Coordination among agencies within the Depart-

ment, which shall include steps to minimize duplication of

efforts and utilization of common quality measures, where

available. Such common quality measures shall be meas-

ures identified by the Secretary under section 1139A or

1139B of the Social Security Act or endorsed under section

1890 of such Act.

‘‘(B) Agency-specific strategic plans to achieve national

priorities.

‘‘(C) Establishment of annual benchmarks for each rel-

evant agency to achieve national priorities.

‘‘(D) A process for regular reporting by the agencies to

the Secretary on the implementation of the strategic plan.

‘‘(E) Strategies to align public and private payers with

regard to quality and patient safety efforts.

‘‘(F) Incorporating quality improvement and measure-

ment in the strategic plan for health information tech-

nology required by the American Recovery and Reinvest-

ment Act of 2009 (Public Law 111–5).

‘‘(c) P

ERIODIC

PDATE OF

ATIONAL

TRATEGY

.—The Secretary

shall update the national strategy not less than annually. Any such

update shall include a review of short- and long-term goals.

‘‘(d) S

UBMISSION AND

VAILABILITY OF

ATIONAL

TRATEGY AND

PDATES

.—

‘‘(1) D

EADLINE FOR INITIAL SUBMISSION OF NATIONAL STRAT

EGY

.—Not later than January 1, 2011, the Secretary shall sub-

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295

Sec. 3012

PPACA (Consolidated)

mit to the relevant committees of Congress the national strat-

egy described in subsection (a).

‘‘(2) U

PDATES

.—

‘‘(A) I

N GENERAL

.—The Secretary shall submit to the

relevant committees of Congress an annual update to the

strategy described in paragraph (1).

‘‘(B) I

NFORMATION

SUBMITTED

.—Each update sub-

mitted under subparagraph (A) shall include—

‘‘(i) a review of the short- and long-term goals of

the national strategy and any gaps in such strategy;

‘‘(ii) an analysis of the progress, or lack of

progress, in meeting such goals and any barriers to

such progress;

‘‘(iii) the information reported under section 1139A

of the Social Security Act, consistent with the report-

ing requirements of such section; and

‘‘(iv) in the case of an update required to be sub-

mitted on or after January 1, 2014, the information re-

ported under section 1139B(b)(4) of the Social Security

Act, consistent with the reporting requirements of

such section.

‘‘(C) S

ATISFACTION

OF OTHER

REPORTING

REQUIRE

MENTS

.—Compliance with the requirements of clauses (iii)

and (iv) of subparagraph (B) shall satisfy the reporting re-

quirements under sections 1139A(a)(6) and 1139B(b)(4), re-

spectively, of the Social Security Act.

‘‘(e) H

EALTH

ARE

UALITY

NTERNET

EBSITE

.—Not later

than January 1, 2011, the Secretary shall create an Internet

website to make public information regarding—

‘‘(1) the national priorities for health care quality improve-

ment established under subsection (a)(2);

‘‘(2) the agency-specific strategic plans for health care

quality described in subsection (b)(2)(B); and

‘‘(3) other information, as the Secretary determines to be

appropriate.’’.

SEC. 3012 ø42 U.S.C. 280j note¿. INTERAGENCY WORKING GROUP ON

HEALTH CARE QUALITY.

(a) I

ENERAL

.—The President shall convene a working group

to be known as the Interagency Working Group on Health Care

Quality (referred to in this section as the ‘‘Working Group’’).

(b) G

OALS

.—The goals of the Working Group shall be to

achieve the following:

(1) Collaboration, cooperation, and consultation between

Federal departments and agencies with respect to developing

and disseminating strategies, goals, models, and timetables

that are consistent with the national priorities identified under

section 399HH(a)(2) of the Public Health Service Act (as added

by section 3011).

(2) Avoidance of inefficient duplication of quality improve-

ment efforts and resources, where practicable, and a stream-

lined process for quality reporting and compliance require-

ments.

(3) Assess alignment of quality efforts in the public sector

with private sector initiatives.

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296

Sec. 3013

PPACA (Consolidated)

OMPOSITION

.—

(1) I

NGENERAL

.—The Working Group shall be composed of

senior level representatives of—

(A) the Department of Health and Human Services;

(B) the Centers for Medicare & Medicaid Services;

(D) the Centers for Disease Control and Prevention;

(E) the Food and Drug Administration;

(F) the Health Resources and Services Administration;

(G) the Agency for Healthcare Research and Quality;

(H) the Office of the National Coordinator for Health

Information Technology;

(I) the Substance Abuse and Mental Health Services

Administration;

(J) the Administration for Children and Families;

(K) the Department of Commerce;

(L) the Office of Management and Budget;

(M) the United States Coast Guard;

(N) the Federal Bureau of Prisons;

(O) the National Highway Traffic Safety Administra-

tion;

(P) the Federal Trade Commission;

(Q) the Social Security Administration;

(R) the Department of Labor;

(S) the United States Office of Personnel Management;

(T) the Department of Defense;

(U) the Department of Education;

(V) the Department of Veterans Affairs;

(W) the Veterans Health Administration; and

(X) any other Federal agencies and departments with

activities relating to improving health care quality and

safety, as determined by the President.

(2) C

HAIR AND VICE

CHAIR

.—

(A) C

HAIR

.—The Working Group shall be chaired by

the Secretary of Health and Human Services.

(B) V

ICE CHAIR

.—Members of the Working Group,

other than the Secretary of Health and Human Services,

shall serve as Vice Chair of the Group on a rotating basis,

as determined by the Group.

(d) R

EPORT TO

ONGRESS

.—Not later than December 31, 2010,

and annually thereafter, the Working Group shall submit to the

relevant Committees of Congress, and make public on an Internet

website, a report describing the progress and recommendations of

the Working Group in meeting the goals described in subsection

(b).

SEC. 3013. QUALITY MEASURE DEVELOPMENT.

(a) P

UBLIC

EALTH

ERVICE

.—Title IX of the Public

Health Service Act (42 U.S.C. 299 et seq.) is amended—

(1) by redesignating part D as part E;

(2) by redesignating sections 931 through 938 as sections

941 through 948, respectively;

(3) in section 948(1), as so redesignated, by striking ‘‘931’’

and inserting ‘‘941’’; and

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297

Sec. 3013\931 PHSA

PPACA (Consolidated)

(4) by inserting after section 926 the following:

‘‘PART D—HEALTH CARE QUALITY

IMPROVEMENT

‘‘Subpart I—Quality Measure Development

‘‘SEC. 931 ø42 U.S.C. 299b–31¿. QUALITY MEASURE DEVELOPMENT.

‘‘(a) Q

UALITY

EASURE

.—In this subpart, the term ‘quality

measure’ means a standard for measuring the performance and im-

provement of population health or of health plans, providers of

services, and other clinicians in the delivery of health care services.

‘‘(b) I

DENTIFICATION OF

UALITY

EASURES

.—

‘‘(1) I

DENTIFICATION

.—The Secretary, in consultation with

the Director of the Agency for Healthcare Research and Qual-

ity and the Administrator of the Centers for Medicare & Med-

icaid Services, shall identify, not less often than triennially,

gaps where no quality measures exist and existing quality

measures that need improvement, updating, or expansion, con-

sistent with the national strategy under section 399HH, to the

extent available, for use in Federal health programs. In identi-

fying such gaps and existing quality measures that need im-

provement, the Secretary shall take into consideration—

‘‘(A) the gaps identified by the entity with a contract

under section 1890(a) of the Social Security Act and other

stakeholders;

‘‘(B) quality measures identified by the pediatric qual-

ity measures program under section 1139A of the Social

Security Act; and

‘‘(C) quality measures identified through the Medicaid

Quality Measurement Program under section 1139B of the

Social Security Act.

‘‘(2) P

UBLICATION

.—The Secretary shall make available to

the public on an Internet website a report on any gaps identi-

fied under paragraph (1) and the process used to make such

identification.

‘‘(c) G

RANTS OR

ONTRACTS FOR

UALITY

EASURE

EVELOP

MENT

.—

‘‘(1) I

N GENERAL

.—The Secretary shall award grants, con-

tracts, or intergovernmental agreements to eligible entities for

purposes of developing, improving, updating, or expanding

quality measures identified under subsection (b).

‘‘(2) P

RIORITIZATION

THE DEVELOPMENT OF QUALITY

MEASURES

.—In awarding grants, contracts, or agreements

under this subsection, the Secretary shall give priority to the

development of quality measures that allow the assessment

of—

‘‘(A) health outcomes and functional status of patients;

‘‘(B) the management and coordination of health care

across episodes of care and care transitions for patients

across the continuum of providers, health care settings,

and health plans;

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298

Sec. 3013\931 PHSA

PPACA (Consolidated)

‘‘(C) the experience, quality, and use of information

provided to and used by patients, caregivers, and author-

ized representatives to inform decisionmaking about treat-

ment options, including the use of shared decisionmaking

tools and preference sensitive care (as defined in section

936);

‘‘(D) the meaningful use of health information tech-

nology;

‘‘(E) the safety, effectiveness, patient-centeredness, ap-

propriateness, and timeliness of care;

‘‘(F) the efficiency of care;

‘‘(G) the equity of health services and health dispari-

ties across health disparity populations (as defined in sec-

tion 485E) and geographic areas;

‘‘(H) patient experience and satisfaction;

‘‘(I) the use of innovative strategies and methodologies

identified under section 933; and

‘‘(J) other areas determined appropriate by the Sec-

retary.

‘‘(3) E

LIGIBLE ENTITIES

.—To be eligible for a grant or con-

tract under this subsection, an entity shall—

‘‘(A) have demonstrated expertise and capacity in the

development and evaluation of quality measures;

‘‘(B) have adopted procedures to include in the quality

measure development process—

‘‘(i) the views of those providers or payers whose

performance will be assessed by the measure; and

‘‘(ii) the views of other parties who also will use

the quality measures (such as patients, consumers,

and health care purchasers);

‘‘(C) collaborate with the entity with a contract under

section 1890(a) of the Social Security Act and other stake-

holders, as practicable, and the Secretary so that quality

measures developed by the eligible entity will meet the re-

quirements to be considered for endorsement by the entity

with a contract under such section 1890(a);

‘‘(D) have transparent policies regarding governance

and conflicts of interest; and

‘‘(E) submit an application to the Secretary at such

time and in such manner, as the Secretary may require.

‘‘(4) U

SE OF FUNDS

.—An entity that receives a grant, con-

tract, or agreement under this subsection shall use such award

to develop quality measures that meet the following require-

ments:

‘‘(A) Such measures support measures required to be

reported under the Social Security Act, where applicable,

and in support of gaps and existing quality measures that

need improvement, as described in subsection (b)(1)(A).

‘‘(B) Such measures support measures developed under

section 1139A of the Social Security Act and the Medicaid

Quality Measurement Program under section 1139B of

such Act, where applicable.

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June 9, 2010

299

Sec. 3013

PPACA (Consolidated)

‘‘(C) To the extent practicable, data on such quality

measures is able to be collected using health information

technologies.

‘‘(D) Each quality measure is free of charge to users of

such measure.

‘‘(E) Each quality measure is publicly available on an

Internet website.

‘‘(d) O

THER

CTIVITIES BY THE

ECRETARY

.—The Secretary may

use amounts available under this section to update and test, where

applicable, quality measures endorsed by the entity with a contract

under section 1890(a) of the Social Security Act or adopted by the

Secretary.

‘‘(e) C

OORDINATION OF

RANTS

.—The Secretary shall ensure

that grants or contracts awarded under this section are coordinated

with grants and contracts awarded under sections 1139A(5) and

1139B(4)(A) of the Social Security Act.

‘‘(f) D

EVELOPMENT OF

UTCOME

EASURES

.—øAs added by sec-

tion 10303(a)¿

‘‘(1) I

N GENERAL

.—The Secretary shall develop, and peri-

odically update (not less than every 3 years), provider-level

outcome measures for hospitals and physicians, as well as

other providers as determined appropriate by the Secretary.

‘‘(2) C

ATEGORIES OF MEASURES

.—The measures developed

under this subsection shall include, to the extent determined

appropriate by the Secretary—

‘‘(A) outcome measurement for acute and chronic dis-

eases, including, to the extent feasible, the 5 most preva-

lent and resource-intensive acute and chronic medical con-

ditions; and

‘‘(B) outcome measurement for primary and preventa-

tive care, including, to the extent feasible, measurements

that cover provision of such care for distinct patient popu-

lations (such as healthy children, chronically ill adults, or

infirm elderly individuals).

‘‘(3) G

OALS

.—In developing such measures, the Secretary

shall seek to—

‘‘(A) address issues regarding risk adjustment, ac-

countability, and sample size;

‘‘(B) include the full scope of services that comprise a

cycle of care; and

‘‘(C) include multiple dimensions.

‘‘(4) T

IMEFRAME

.—

‘‘(A) A

CUTE AND CHRONIC DISEASES

.—Not later than 24

months after the date of enactment of this Act, the Sec-

retary shall develop not less than 10 measures described

in paragraph (2)(A).

‘‘(B) P

RIMARY AND PREVENTIVE CARE

.—Not later than

36 months after the date of enactment of this Act, the Sec-

retary shall develop not less than 10 measures described

in paragraph (2)(B).’’.

(b) S

OCIAL

ECURITY

.—Section 1890A of the Social Secu-

rity Act, as added by section 3014(b), is amended by adding at the

end the following new subsection: øNote: amendment made by sec-

tion 10304 strikes ‘‘quality’’ and inserts ‘‘quality and efficiency’’ in

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June 9, 2010

300

Sec. 3014

PPACA (Consolidated)

section 1890A of the Social Security Act but did not specifically

amend headings below (which have different typeface)¿

‘‘(e) D

EVELOPMENT OF

UALITY

FFICIENCY

] M

EASURES

.—

The Administrator of the Center for Medicare & Medicaid Services

shall through contracts develop quality and efficiency measures (as

determined appropriate by the Administrator) for use under this

Act. In developing such measures, the Administrator shall consult

with the Director of the Agency for Healthcare Research and Qual-

ity.

øA subsection (f) was also added by section 10303 as shown

below:¿

‘‘(f) H

OSPITAL

CQUIRED

ONDITIONS

.—The Secretary shall, to

the extent practicable, publicly report on measures for hospital-ac-

quired conditions that are currently utilized by the Centers for

Medicare & Medicaid Services for the adjustment of the amount of

payment to hospitals based on rates of hospital-acquired infec-

tions.’’.

UNDING

.—There are authorized to be appropriated to the

Secretary of Health and Human Services to carry out this section,

$75,000,000 for each of fiscal years 2010 through 2014. Of the

amounts appropriated under the preceding sentence in a fiscal

year, not less than 50 percent of such amounts shall be used pursu-

ant to subsection (e) of section 1890A of the Social Security Act, as

added by subsection (b), with respect to programs under such Act.

Amounts appropriated under this subsection for a fiscal year shall

remain available until expended.

SEC. 3014. QUALITY MEASUREMENT.

(a) N

UTIES FOR

ONSENSUS

BASED

NTITY

.—

(1) M

ULTI

STAKEHOLDER GROUP INPUT

.—Section 1890(b) of

the Social Security Act (42 U.S.C. 1395aaa(b)), as amended by

section 3003, is amended by adding at the end the following

new paragraphs: øamendment by section 10304 strikes ‘‘qual-

ity’’ and inserts ‘‘quality and efficiency’’ in new paragraph (7)

but did not specifically amend heading of paragraph (7)(B)

below (which has different typeface).¿

‘‘(7) C

ONVENING MULTI

STAKEHOLDER GROUPS

.—

‘‘(A) I

N GENERAL

.—The entity shall convene multi-

stakeholder groups to provide input on—

‘‘(i) the selection of quality and efficiency meas-

ures described in subparagraph (B), from among—

‘‘(I) such measures that have been endorsed

by the entity; and

‘‘(II) such measures that have not been con-

sidered for endorsement by such entity but are

used or proposed to be used by the Secretary for

the collection or reporting of quality and efficiency

measures; and

‘‘(ii) national priorities (as identified under section

399HH of the Public Health Service Act) for improve-

ment in population health and in the delivery of

health care services for consideration under the na-

tional strategy established under section 399HH of the

Public Health Service Act.

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June 9, 2010

301

Sec. 3014

PPACA (Consolidated)

‘‘(B) Q

UALITY [AND EFFICIENCY] MEASURES

.—

‘‘(i) I

NGENERAL

.—Subject to clause (ii), the quality

and efficiency measures described in this subpara-

graph are quality and efficiency measures—

‘‘(I) for use pursuant to sections 1814(i)(5)(D),

1833(i)(7), 1833(t)(17), 1848(k)(2)(C), 1866(k)(3),

1881(h)(2)(A)(iii), 1886(b)(3)(B)(viii), 1886(j)(7)(D),

1886(m)(5)(D), 1886(o)(2), 1886(s)(4)(D), and

1895(b)(3)(B)(v); øAs revised by section 10322(b)¿

‘‘(II) for use in reporting performance informa-

tion to the public; and

‘‘(III) for use in health care programs other

than for use under this Act.

‘‘(ii) E

XCLUSION

.—Data sets (such as the outcome

and assessment information set for home health serv-

ices and the minimum data set for skilled nursing fa-

cility services) that are used for purposes of classifica-

tion systems used in establishing payment rates under

this title shall not be quality and efficiency measures

described in this subparagraph.

‘‘(C) R

EQUIREMENT FOR TRANSPARENCY IN PROCESS

.—

‘‘(i) I

N GENERAL

.—In convening multi-stakeholder

groups under subparagraph (A) with respect to the se-

lection of quality and efficiency measures, the entity

shall provide for an open and transparent process for

the activities conducted pursuant to such convening.

‘‘(ii) S

ELECTION OF ORGANIZATIONS PARTICIPATING

MULTI

STAKEHOLDER

GROUPS

.—The process de-

scribed in clause (i) shall ensure that the selection of

representatives comprising such groups provides for

public nominations for, and the opportunity for public

comment on, such selection.

‘‘(D) M

ULTI

STAKEHOLDER GROUP DEFINED

.—In this

paragraph, the term ‘multi-stakeholder group’ means, with

respect to a quality and efficiency measure, a voluntary

collaborative of organizations representing a broad group

of stakeholders interested in or affected by the use of such

quality and efficiency measure.

‘‘(8) T

RANSMISSION

OF MULTI

STAKEHOLDER INPUT

.—Not

later than February 1 of each year (beginning with 2012), the

entity shall transmit to the Secretary the input of multi-stake-

holder groups provided under paragraph (7).’’.

(2) A

NNUAL REPORT

.—Section 1890(b)(5)(A) of the Social

Security Act (42 U.S.C. 1395aaa(b)(5)(A)) is amended—

(A) in clause (ii), by striking ‘‘and’’ at the end;

(B) in clause (iii), by striking the period at the end and

inserting a semicolon; and

‘‘(iv) gaps in endorsed quality measures, which

shall include measures that are within priority areas

identified by the Secretary under the national strategy

established under section 399HH of the Public Health

Service Act, and where quality measures are unavail-

able or inadequate to identify or address such gaps;

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