Sec. 501. Quality standards
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All standards and quality measures under this Act shall be performed by the Center for Clinical Standards and Quality of the Centers for Medicare & Medicaid Services (referred to in this title as the Center ), in coordination with the Agency for Healthcare Research and Quality and other offices of the Department of Health and Human Services. The Center shall perform the following duties: The Center shall review and evaluate each practice guideline developed under part B of title IX of the Public Health Service Act.
The Center shall determine whether the guideline should be recognized as a national practice guideline. The Center shall review and evaluate each standard of quality, performance measure, and medical review criterion developed under part B of title IX of the Public Health Service Act ( 42 U.S.C. 299 et seq.). The Center shall determine whether the standard, measure, or criterion is appropriate for use in assessing or reviewing the quality of services provided by health care institutions or health care professionals.
In evaluating such standards, the Center shall consider the evidentiary basis for the standard, and the validity, reliability, and feasibility of measuring the standard. The Center shall adopt methodologies for profiling the patterns of practice of health care professionals and for identifying and notifying outliers. The Center shall develop minimum criteria for competence for entities that can qualify to conduct ongoing and continuous external quality reviews in the administrative regions.
Such criteria shall require such an entity to be administratively independent of the individual or board that administers the region and shall ensure that such entities do not provide financial incentives to reviewers to favor one pattern of practice over another. The Center shall ensure coordination and reporting by such entities to ensure national consistency in quality standards. The Center shall report to the Secretary annually specifically on findings from outcomes research and development of practice guidelines that may affect the Secretary’s determination of coverage of services under section 401(a)(1)(G).
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U.S. Code