US Code

Public Law 119-73 (01/23/2026)

42 U.S.C. § 1395aaa

Contract with a consensus-based entity regarding performance measurement

(a)

Contract

(1)

In general

For purposes of activities conducted under this chapter, the Secretary shall identify and have in effect a contract with a consensus-based entity, such as the National Quality Forum, that meets the requirements described in subsection (c). Such contract shall provide that the entity will perform the duties described in subsection (b).

(2)

Timing for first contract

As soon as practicable after , the Secretary shall enter into the first contract under paragraph (1).

(3)

Period of contract

A contract under paragraph (1) shall be for a period of 4 years (except as may be renewed after a subsequent bidding process).

(4)

Competitive procedures

section 132 of title 41Competitive procedures (as defined in ) shall be used to enter into a contract under paragraph (1).

(b)

Duties

The duties described in this subsection are the following:
(1)

Priority setting process

The entity shall synthesize evidence and convene key stakeholders to make recommendations, with respect to activities conducted under this chapter, on an integrated national strategy and priorities for health care performance measurement in all applicable settings. In making such recommendations, the entity shall—
(A)
ensure that priority is given to measures—
(i)
that address the health care provided to patients with prevalent, high-cost chronic diseases;
(ii)
with the greatest potential for improving the quality, efficiency, and patient-centeredness of health care; and
(iii)
that may be implemented rapidly due to existing evidence, standards of care, or other reasons; and
(B)
take into account measures that—
(i)
may assist consumers and patients in making informed health care decisions;
(ii)
address health disparities across groups and areas; and
(iii)
address the continuum of care a patient receives, including services furnished by multiple health care providers or practitioners and across multiple settings.
(2)

Endorsement of measures

The entity shall provide for the endorsement of standardized health care performance measures. The endorsement process under the preceding sentence shall consider whether a measure—
(A)
is evidence-based, reliable, valid, verifiable, relevant to enhanced health outcomes, actionable at the caregiver level, feasible to collect and report, and responsive to variations in patient characteristics, such as health status, language capabilities, race or ethnicity, and income level; and
(B)
is consistent across types of health care providers, including hospitals and physicians.
(3)

Maintenance of measures

The entity shall establish and implement a process to ensure that measures endorsed under paragraph (2) are updated (or retired if obsolete) as new evidence is developed.

(4)

Removal of measures

The entity may provide input to the Secretary on quality and efficiency measures described in paragraph (7)(B) that could be considered for removal.

(5)

Annual report to Congress and the Secretary; secretarial publication and comment

(A)

1 Annual report

By not later than March 1 of each year (beginning with 2009), the entity shall submit to Congress and the Secretary a report containing the following:
(i)
A description of—
(I)
the implementation of quality measurement initiatives under this chapter and the coordination of such initiatives with quality initiatives implemented by other payers;
(II)
the recommendations made under paragraph (1);
(III)
the performance by the entity of the duties required under the contract entered into with the Secretary under subsection (a);
(IV)
section 280j of this title gaps in endorsed quality measures, which shall include measures that are within priority areas identified by the Secretary under the national strategy established under , and where quality measures are unavailable or inadequate to identify or address such gaps;
(V)
section 280j of this title areas in which evidence is insufficient to support endorsement of quality measures in priority areas identified by the Secretary under the national strategy established under and where targeted research may address such gaps; and
(VI)
the matters described in clauses (i) and (ii) of paragraph (7)(A).
(ii)
An itemization of financial information for the fiscal year ending September 30 of the preceding year, including—
(I)
annual revenues of the entity (including any government funding, private sector contributions, grants, membership revenues, and investment revenue);
(II)
annual expenses of the entity (including grants paid, benefits paid, salaries or other compensation, fundraising expenses, and overhead costs); and
(III)
a breakdown of the amount awarded per contracted task order and the specific projects funded in each task order assigned to the entity.
(iii)
Any updates or modifications of internal policies and procedures of the entity as they relate to the duties of the entity under this section, including—
(I)
specifically identifying any modifications to the disclosure of interests and conflicts of interests for committees, work groups, task forces, and advisory panels of the entity; and
(II)
2
2 So in original. Probably should be “panels).”
information on external stakeholder participation in the duties of the entity under this section (including complete rosters for all committees, work groups, task forces, and advisory panels funded through government contracts, descriptions of relevant interests and any conflicts of interest for members of all committees, work groups, task forces, and advisory panels, and the total percentage by health care sector of all convened committees, work groups, task forces, and advisory panels.
(B)

Secretarial review and publication of annual report

Not later than 6 months after receiving a report under subparagraph (A) for a year, the Secretary shall—
(i)
review such report; and
(ii)
publish such report in the Federal Register, together with any comments of the Secretary on such report.
(6)

Review and endorsement of episode grouper under the physician feedback program

section 1395w–4(n)(9)(A) of this titleThe entity shall provide for the review and, as appropriate, the endorsement of the episode grouper developed by the Secretary under . Such review shall be conducted on an expedited basis.

(7)

Convening multi-stakeholder groups

(A)

In general

The entity shall convene multi-stakeholder groups to provide input on—
(i)
the selection of quality and efficiency measures described in subparagraph (B), from among—
(I)
such measures that have been endorsed by the entity; and
(II)
such measures that have not been considered 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)
section 280j of this titlesection 280j of this title national priorities (as identified under ) for improvement in population health and in the delivery of health care services for consideration under the national strategy established under .
(B)

Quality and efficiency measures

(i)

In general

Subject to clause (ii), the quality and efficiency measures described in this subparagraph are quality and efficiency measures—
(I)
ll3
3 See References in Text note below.
o for use pursuant to sections 1395f(i)(5)(D), 1395(i)(7), 1395(t)(17), 1395w–4(k)(2)(C), 1395cc(k)(3), 1395rr(h)(2)(A)(iii), 1395ww(b)(3)(B)(viii), 1395ww(j)(7)(D), 1395ww(m)(5)(D), 1395ww()(2), 1395ww(s)(4)(D), and 1395fff(b)(3)(B)(v) of this title;
(II)
for use in reporting performance information to the public; and
(III)
for use in health care programs other than for use under this chapter.
(ii)

Exclusion

Data sets (such as the outcome and assessment information set for home health services and the minimum data set for skilled nursing facility services) that are used for purposes of classification systems used in establishing payment rates under this subchapter shall not be quality and efficiency measures described in this subparagraph.

(C)

Requirement for transparency in process

(i)

In general

In convening multi-stakeholder groups under subparagraph (A) with respect to the selection of quality and efficiency measures, the entity shall provide for an open and transparent process for the activities conducted pursuant to such convening.

(ii)

Selection of organizations participating in multi-stakeholder groups

The process described 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)

Multi-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)

Transmission 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-stakeholder groups provided under paragraph (7).

(9)

Prioritization of measure endorsement

The Secretary—
(A)
during the period beginning on , and ending on , shall prioritize the endorsement of measures relating to maternal morbidity and mortality by the entity with a contract under subsection (a) in connection with endorsement of measures described in paragraph (2); and
(B)
on and after , may prioritize the endorsement of such measures by such entity.
(c)

Requirements described

The requirements described in this subsection are the following:
(1)

Private nonprofit

The entity is a private nonprofit entity governed by a board.

(2)

Board membership

The members of the board of the entity include—
(A)
representatives of health plans and health care providers and practitioners or representatives of groups representing such health plans and health care providers and practitioners;
(B)
health care consumers or representatives of groups representing health care consumers; and
(C)
representatives of purchasers and employers or representatives of groups representing purchasers or employers.
(3)

Entity membership

The membership of the entity includes persons who have experience with—
(A)
urban health care issues;
(B)
safety net health care issues;
(C)
rural and frontier health care issues; and
(D)
health care quality and safety issues.
(4)

Open and transparent

With respect to matters related to the contract with the Secretary under subsection (a), the entity conducts its business in an open and transparent manner and provides the opportunity for public comment on its activities.

(5)

Voluntary consensus standards setting organization

Public Law 104–113The entity operates as a voluntary consensus standards setting organization as defined for purposes of section 12(d) of the National Technology Transfer and Advancement Act of 1995 () and Office of Management and Budget Revised Circular A–119 (published in the Federal Register on ).

(6)

Experience

The entity has at least 4 years of experience in establishing national consensus standards.

(7)

Membership fees

If the entity requires a membership fee for participation in the functions of the entity, such fees shall be reasonable and adjusted based on the capacity of the potential member to pay the fee. In no case shall membership fees pose a barrier to the participation of individuals or groups with low or nominal resources to participate in the functions of the entity.

(d)

Funding

(1)
section 1395i of this titlesection 1395t of this title For purposes of carrying out this section, the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under and the Federal Supplementary Medical Insurance Trust Fund under (in such proportion as the Secretary determines appropriate), of $10,000,000 to the Centers for Medicare & Medicaid Services Program Management Account for each of fiscal years 2009 through 2013. Amounts transferred under the preceding sentence shall remain available until expended.
(2)
section 1395aaa–1 of this titlesection 1395i of this titlesection 1395t of this title For purposes of carrying out this section and (other than subsections (e) and (f)), the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under and the Federal Supplementary Medical Insurance Trust Fund under , in such proportion as the Secretary determines appropriate, to the Centers for Medicare & Medicaid Services Program Management Account of $5,000,000 for fiscal year 2014, $30,000,000 for each of fiscal years 2015 through 2017, $7,500,000 for each of fiscal years 2018 and 2019, $20,000,000 for fiscal year 2020, $26,000,000 for fiscal year 2021, $20,000,000 for fiscal year 2022, $20,000,000 for fiscal year 2023, $14,030,000 for the period beginning on , and ending on , and $13,300,000 for fiscal year 2026. Amounts transferred under the preceding sentence shall remain available until expended. Amounts transferred for each of fiscal years 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025, and 2026 shall be in addition to any unobligated funds transferred for a preceding fiscal year that are available under the preceding sentence.
(e)

Annual report by Secretary to Congress

(1)

In general

By not later than March 1 of each year (beginning with 2019), the Secretary shall submit to Congress a report containing the following:
(A)
section 1395aaa–1 of this title A comprehensive plan that identifies the quality measurement needs of programs and initiatives of the Secretary and provides a strategy for using the entity with a contract under subsection (a) and any other entity the Secretary has contracted with or may contract with to perform work associated with to help meet those needs, specifically with respect to the programs under this subchapter and subchapter XIX.
(B)
section 1395aaa–1 of this title The amount of funding provided under subsection (d) for purposes of carrying out this section and that has been obligated by the Secretary, the amount of funding provided that has been expended, and the amount of funding provided that remains unobligated.
(C)
section 1395aaa–1 of this title With respect to the activities described under this section or , a description of how the funds described in paragraph (2) have been obligated or expended, including how much of that funding has been obligated or expended for work performed by the Secretary, the entity with a contract under subsection (a), and any other entity the Secretary has contracted with to perform work.
(D)
section 1395aaa–1 of this title Subject to paragraph (2)(B), a description of the activities for which the funds described in paragraph (2) were used, including task orders and activities assigned to the entity with a contract under subsection (a), activities performed by the Secretary, and task orders and activities assigned to any other entity the Secretary has contracted with to perform work related to carrying out .
(E)
Subject to paragraph (2)(B), the amount of funding described in paragraph (2) that has been obligated or expended for each of the activities described in paragraph (4).
(F)
section 1395aaa–1 of this title Subject to paragraph (2)(B), estimates for, and descriptions of, obligations and expenditures that the Secretary anticipates will be needed in the succeeding two year period to carry out each of the quality measurement activities required under this section and , including any obligations that will require funds to be expended in a future year.
(2)

Additional requirements for reports

(A)

Addressing GAO report

Each of the annual reports submitted in 2021 and 2022 pursuant to paragraph (1) shall also include the following:
(i)
A comprehensive analysis detailing the ways in which the Centers for Medicare & Medicaid Services has addressed each of the recommendations set forth in the report by the Government Accountability Office (GAO–19–628) issued on , and titled “Health Care Quality: CMS Could More Effectively Ensure Its Quality Measurement Activities Promote Its Objectives”.
(ii)
A detailed description of—
(I)
any additional steps that the Centers for Medicare & Medicaid Services expects to take to address the findings and recommendations set forth in such report; and
(II)
the anticipated timing for such steps.
(B)

Ensuring detailed information

(i)

In general

In the case of an annual report submitted in 2021 or a subsequent year pursuant to paragraph (1), the information required under—
(I)
paragraph (1)(D) shall also include detailed information on each of the activities described in clause (ii);
(II)
paragraph (1)(E) shall also include detailed information on the specific amounts obligated or expended on each of the activities described in clause (ii); and
(III)
paragraph (1)(F) shall also include detailed information on the specific quality measurement activities required and future funding needed for each of the activities described in clause (ii).
(ii)

Activities described

The activities described in this clause are the following:
(I)
Measure selection activities.
(II)
Measure development activities.
(III)
Public reporting activities.
(IV)
Education and outreach activities.
(f)

Additional reporting by the Secretary to Congress

(1)

In general

By not later than September 30 of each year (beginning with 2021), the Secretary shall submit to Congress a report on the amount of unobligated balances for appropriations relating to quality measurement. Such report shall include detailed plans on how the Secretary expects to expend such unobligated balances in the upcoming fiscal years.

(2)

Separate report

The annual report required under paragraph (1) shall be separate from the annual report required under subsection (e).

Aug. 14, 1935, ch. 531Pub. L. 110–275, title I, § 183(a)(1)122 Stat. 2583Pub. L. 111–148, title III124 Stat. 367Pub. L. 112–240, title VI, § 609(a)126 Stat. 2349Pub. L. 113–67, div. B, title I, § 1109127 Stat. 1197Pub. L. 113–93, title I, § 109128 Stat. 1043Pub. L. 114–10, title II, § 207129 Stat. 145Pub. L. 115–123, div. E, title II, § 50206(a)132 Stat. 183–185Pub. L. 116–59, div. B, title IV, § 1401133 Stat. 1105Pub. L. 116–69, div. B, title IV, § 1401(a)133 Stat. 1138Pub. L. 116–94, div. N, title I, § 102(a)133 Stat. 3096Pub. L. 116–136, div. A, title III, § 3802(a)134 Stat. 427Pub. L. 116–159, div. C, title II, § 2202134 Stat. 730Pub. L. 116–215, div. B, title I, § 1103134 Stat. 1042Pub. L. 116–260, div. CC, title I, § 102134 Stat. 2940Pub. L. 118–42, div. G, title I, § 301138 Stat. 414Pub. L. 118–158, div. C, title II, § 3204138 Stat. 1765Pub. L. 119–4, div. B, title II, § 2204139 Stat. 43Pub. L. 119–37, div. F, title II, § 6203139 Stat. 631(, title XVIII, § 1890, as added , , ; amended , §§ 3003(b), 3014(a), title X, §§ 10304, 10322(b), , , 384, 938, 954; , , ; , , ; , , ; , , ; –(c)(1), , ; , , ; , , ; , , ; , , ; , , ; , , ; , , ; , , ; , , ; , , ; , , .)

Editorial Notes

References in Text

section 1395rr(h)(2)(A) of this titlePub. L. 113–93, title II, § 217(d)(1)(B)128 Stat. 1062Clause (iii) of , referred to in subsec. (b)(7)(B)(i)(I), was redesignated clause (iv) by , , .

section 12(d) of Pub. L. 104–113section 272 of Title 15Section 12(d) of the National Technology Transfer and Advancement Act of 1995, referred to in subsec. (c)(5), is , which is set out as a note under , Commerce and Trade.

Codification

section 132 of title 4141 U.S.C. 403(5)Pub. L. 111–350, § 6(c)124 Stat. 3854In subsec. (a)(4), “” substituted for “section 4(5) of the Office of Federal Procurement Policy Act ()” on authority of , , , which Act enacted Title 41, Public Contracts.

Prior Provisions

act Aug. 14, 1935, ch. 531, title XVIII, § 1890Pub. L. 100–93, § 10101 Stat. 696Pub. L. 100–360, title IV, § 411(i)(4)(D)(ii)102 Stat. 790Pub. L. 100–485, title VI, § 608(d)(24)(C)(ii)102 Stat. 2421section 1395y(e)(2) of this titleA prior section 1395aaa, , as added , , , which related to limitation of liability of beneficiaries with respect to services furnished by excluded individuals and entities, was amended and transferred to section 1862(e)(2) of act , by , , , as amended by , , , and is classified to .

Amendments

Pub. L. 119–372025—Subsec. (d)(2). substituted “$14,030,000” for “and $14,030,000” and inserted “, and $13,300,000 for fiscal year 2026” before period at end in first sentence and substituted “2024, 2025, and 2026” for “and 2024 and the period beginning on , and ending on ,” in last sentence.

Pub. L. 119–4 substituted “$14,030,000” for “$11,030,000” and substituted “” for “” in two places.

Pub. L. 118–1582024—Subsec. (d)(2). substituted “$11,030,000” for “$9,000,000” and substituted “” for “” in two places.

Pub. L. 118–42 substituted “$20,000,000” for “and $20,000,000” and inserted “, and $9,000,000 for the period beginning on , and ending on ” before period at end in first sentence and substituted “2023, and 2024 and the period beginning on , and ending on ” for “and 2023” in last sentence.

Pub. L. 116–260, § 102(c)2020—Subsec. (b)(4). , added par. (4).

Pub. L. 116–260, § 102(d)Subsec. (b)(9). , added par. (9).

Pub. L. 116–260, § 102(a)Subsec. (d)(2). , substituted “$26,000,000 for fiscal year 2021, $20,000,000 for fiscal year 2022, and $20,000,000 for fiscal year 2023” for “and for the period beginning on , and ending on , the amount equal to the pro rata portion of the amount appropriated for such period for fiscal year 2020” in first sentence and “2020, 2021, 2022, and 2023” for “and 2020, and for the period beginning on , and ending on ” in last sentence.

Pub. L. 116–215 substituted “” for “” in two places.

Pub. L. 116–159 substituted “” for “” in two places.

Pub. L. 116–136, § 3802, substituted “$20,000,000 for fiscal year 2020, and for the period beginning on , and ending on , the amount equal to the pro rata portion of the amount appropriated for such period for fiscal year 2020” for “and $4,830,000 for the period beginning on , and ending on ” in first sentence and “, 2019, and 2020, and for the period beginning on , and ending on ,” for “and 2019 and for the period beginning on , and ending on ” in last sentence.

Pub. L. 116–260, § 102(b)(1)(A)Subsec. (e). , (B), (G), designated existing provisions as par. (1), inserted heading, redesignated former pars. (1) to (6) as subpars. (A) to (F), respectively, of par. (1), and added par. (2).

Pub. L. 116–260, § 102(b)(1)(C)Subsec. (e)(1)(A). , struck out at end “In years after the first plan under this paragraph is submitted, the requirements of this paragraph may be met by providing an update to the plan.”

Pub. L. 116–260, § 102(b)(1)(D)Subsec. (e)(1)(D). , substituted “Subject to paragraph (2)(B), a description” for “A description”.

Pub. L. 116–260, § 102(b)(1)(E)Subsec. (e)(1)(E). , substituted “Subject to paragraph (2)(B), the amount” for “The amount”.

Pub. L. 116–260, § 102(b)(1)(F)Subsec. (e)(1)(F). , substituted “Subject to paragraph (2)(B), estimates” for “Estimates”.

Pub. L. 116–260, § 102(b)(2)Subsec. (f). , added subsec. (f).

Pub. L. 116–942019—Subsec. (d)(2). substituted “$4,830,000 for the period beginning on , and ending on ” for “$1,665,000 for the period beginning on , and ending on ” in first sentence and “” for “,” in last sentence.

Pub. L. 116–69 substituted “$1,665,000 for the period beginning on , and ending on ” for “$1,069,000 for the period beginning on , and ending on ” in first sentence and “” for “” in last sentence.

Pub. L. 116–59 substituted “$7,500,000 for each of fiscal years 2018 and 2019, and $1,069,000 for the period beginning on , and ending on ” for “and $7,500,000 for each of fiscal years 2018 and 2019” in first sentence and inserted “and for the period beginning on , and ending on ,” after “2018 and 2019” in last sentence.

Pub. L. 115–123, § 50206(c)(1)2018—Subsec. (b)(5)(A). , substituted “containing the following:” for “containing a description of—” in introductory provisions, inserted “(i) A description of—”, redesignated former cls. (i) to (vi) as subcls. (I) to (VI), respectively, of cl. (i), realigned margins, and added cls. (ii) and (iii).

Pub. L. 115–123, § 50206(a)Subsec. (d)(2). , substituted “2014,” for “2014 and” and inserted “, and $7,500,000 for each of fiscal years 2018 and 2019” after “through 2017” and “Amounts transferred for each of fiscal years 2018 and 2019 shall be in addition to any unobligated funds transferred for a preceding fiscal year that are available under the preceding sentence.” after “until expended.”

Pub. L. 115–123, § 50206(b)Subsec. (e). , added subsec. (e).

Pub. L. 114–102015—Subsec. (d)(2). substituted “and $30,000,000 for each of fiscal years 2015 through 2017” for “and $15,000,000 for the first 6 months of fiscal year 2015”.

Pub. L. 113–932014—Subsec. (d). designated existing provisions as par. (1) and added par. (2).

Pub. L. 112–240, § 609(a)(2)2013—Subsec. (b)(4). , struck out par. (4). Text read as follows: “The entity shall promote the development and use of electronic health records that contain the functionality for automated collection, aggregation, and transmission of performance measurement information.”

Pub. L. 113–67Subsec. (d). inserted at end “Amounts transferred under the preceding sentence shall remain available until expended.”

Pub. L. 112–240, § 609(a)(1), substituted “fiscal years 2009 through 2013” for “fiscal years 2009 through 2012”.

Pub. L. 111–148, § 3014(a)(2)2010—Subsec. (b)(5)(A)(iv) to (vi). , added cls. (iv) to (vi).

Pub. L. 111–148, § 3003(b)Subsec. (b)(6). , added par. (6).

Pub. L. 111–148, § 10304Subsec. (b)(7). , substituted “quality and efficiency” for “quality” wherever appearing in text.

Pub. L. 111–148, § 3014(a)(1), added par. (7).

Pub. L. 111–148, § 10304Subsec. (b)(7)(B). , which directed substitution of “quality and efficiency” for “quality” wherever appearing, was executed by substituting “Quality and efficiency” for “Quality” in subpar. heading to reflect the probable intent of Congress.

Pub. L. 111–148, § 10322(b)oSubsec. (b)(7)(B)(i)(I). , inserted “1395ww(s)(4)(D),” after “1395ww()(2),”.

Pub. L. 111–148, § 3014(a)(1)Subsec. (b)(8). , added par. (8).

Statutory Notes and Related Subsidiaries

Effective Date of 2020 Amendment

Pub. L. 116–136, div. A, title III, § 3802(b)134 Stat. 427

Public Law 116–94“The amendments made by subsection (a) [amending this section] shall take effect as if included in the enactment of the Further Consolidated Appropriations Act, 2020 ().”
, , , provided that:

Effective Date of 2019 Amendment

Pub. L. 116–94, div. N, title I, § 102(b)133 Stat. 3096

Public Law 116–69“The amendments made by subsection (a) [amending this section] shall take effect as if included in the enactment of the Further Continuing Appropriations Act, 2020, and Further Health Extenders Act of 2019 ().”
, , , provided that:

Pub. L. 116–69, div. B, title IV, § 1401(b)133 Stat. 1138

Public Law 116–59“The amendments made by subsection (a) [amending this section] shall take effect as if included in the enactment of the Continuing Appropriations Act, 2020, and Health Extenders Act of 2019 ().”
, , , provided that:

Effective Date of 2018 Amendment

Pub. L. 115–123, div. E, title II, § 50206(c)(2)132 Stat. 185

“The amendments made by this subsection [amending this section] shall apply to reports submitted for years beginning with 2019.”
, , , provided that: