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Code · STATUTE-COMPILATIONS · Trade Adjustment Assistance Extension Act of 2011 · Sec. 261

Sec. 261. IMPROVEMENTS TO CONTRACTS WITH MEDICARE QUALITY IMPROVEMENT ORGANIZATIONS (QIOS) IN ORDER TO IMPROVE THE QUALITY OF CARE FURNISHED TO MEDICARE BENEFICIARIES

1,408 words·~6 min read·/statute-compilations/comps-9622/sec-261

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## SEC. 261 IMPROVEMENTS TO CONTRACTS WITH MEDICARE QUALITY IMPROVEMENT ORGANIZATIONS
(QIOS)IN ORDER TO IMPROVE THE QUALITY OF CARE FURNISHED TO MEDICARE BENEFICIARIES ###
(a)Authority to Contract With a Broad Range of Entities ####
(1)Definition Section 1152 of the Social Security Act (42 U.S.C. 1320c-1) is amended by striking paragraphs
(1)and
(2)and inserting the following new paragraphs: > > #### “(1) > > is able, as determined by the Secretary, to perform its functions under this part in a manner consistent with the efficient and effective administration of this part and title XVIII; > > > #### “(2) > > has at least one individual who is a representative of health care providers on its governing body; and” > . ####
(2)Name change Part B of title XI of the Social Security Act (42 U.S.C. 1320c et seq.) is amended— #####
(A)**[**[42 U.S.C. 1320c-1](/us/usc/t42/s1320c-1)**]** in the headings for sections 1152 and 1153, by striking “utilization and quality control peer review” and inserting “quality improvement”; #####
(B)**[**[42 U.S.C. 1320c-3](/us/usc/t42/s1320c-3)**]** in the heading for section 1154, by striking “peer review” and inserting “quality improvement”; and #####
(C)**[**[42 U.S.C. 1320c-1320](/us/usc/t42/s1320c-1320)**]** by striking “utilization and quality control peer review” and “peer review” each place it appears before “organization” or “organizations” and inserting “quality improvement”. ####
(3)Conforming amendments to the medicare program Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is amended— #####
(A)**[**[42 U.S.C. 1395y](/us/usc/t42/s1395y)**]** by striking “utilization and quality control peer review” and inserting “quality improvement” each place it appears; #####
(B)**[**[42 U.S.C. 1395g](/us/usc/t42/s1395g)**]** by striking “quality control and peer review” and inserting “quality improvement” each place it appears; #####
(C)**[**[42 U.S.C. 1395u](/us/usc/t42/s1395u)**]** in paragraphs (1)(A)(iii)(I) and
(2)of section 1842(l), by striking “peer review organization” and inserting “quality improvement organization”; #####
(D)**[**[42 U.S.C. 1395cc](/us/usc/t42/s1395cc)**]** in subparagraphs
(A)and
(B)of section 1866(a)(3), by striking “peer review” and inserting “quality improvement”; #####
(E)**[**[42 U.S.C. 1395dd](/us/usc/t42/s1395dd)**]** in section 1867(d)(3), in the heading, by striking “peer review” and inserting “quality improvement”; and #####
(F)**[**[42 U.S.C. 1395ff](/us/usc/t42/s1395ff)**]** in section 1869(c)(3)(G), by striking “peer review organizations” and inserting “quality improvement organizations”. ###
(b)Improvements With Respect to the Contract ####
(1)Flexibility with respect to the geographic scope of contracts Section 1153 of the Social Security Act (42 U.S.C. 1320c-2) is amended— #####
(A)by striking subsection
(a)and inserting the following new subsection: > > ### “(a) > > The Secretary shall establish throughout the United States such local, State, regional, national, or other geographic areas as the Secretary determines appropriate with respect to which contracts under this part will be made.” > ; #####
(B)in subsection (b)(1), as amended by subsection (a)(2)— ######
(i)in the first sentence, by striking “a contract with a quality improvement organization” and inserting “contracts with one or more quality improvement organizations”; and ######
(ii)in the second sentence, by striking “meets the requirements” and all that follows before the period at the end and inserting “will be operating in an area, the Secretary shall ensure that there is no duplication of the functions carried out by such organizations within the area”; #####
(C)in subsection (b)(2)(B), by inserting “or the Secretary determines that there is a more qualified entity to perform one or more of the functions in section 1154(a)” after “under this part”; #####
(D)in subsection (b)(3)— ######
(i)in subparagraph (A), by striking “, or association of such facilities,”; and ######
(ii)in subparagraph (B)— ######
(I)by striking “or association of such facilities”; and ######
(II)by striking “or associations”; and #####
(E)by striking subsection (i). ####
(2)Extension of length of contracts Section 1153(c)(3) of the Social Security Act (42 U.S.C. 1320c-2(c)(3)) is amended— #####
(A)by striking “three years” and inserting “five years”; and #####
(B)by striking “on a triennial basis” and inserting “for terms of five years”. ####
(3)Authority to terminate in a manner consistent with the federal acquisition regulation Section 1153 of the Social Security Act (42 U.S.C. 1320c-2) is amended— #####
(A)in subsection (b), by adding at the end the following new paragraph: > > #### “(4) > > The Secretary may consider a variety of factors in selecting the contractors that the Secretary determines would provide for the most efficient and effective administration of this part, such as geographic location, size, and prior experience in health care quality improvement. Quality improvement organizations operating as of January 1, 2012, shall be allowed to compete for new contracts (as determined appropriate by the Secretary) along with other qualified organizations and are eligible for renewal of contracts for terms five years thereafter (as determined appropriate by the Secretary).” > ; #####
(B)in subsection (c), by striking paragraphs
(4)through
(6)and redesignating paragraphs
(7)and
(8)as paragraphs
(4)and (5), respectively; and #####
(C)by striking subsection (d). ####
(4)Administrative improvement Section 1153(c)(5) of the Social Security Act (42 U.S.C. 1320c-2(c)(5)), as redesignated by this subsection, is amended to read as follows: > > #### “(5) > > reimbursement shall be made to the organization on a monthly basis, with payments for any month being made consistent with the Federal Acquisition Regulation.” > . ###
(c)Authority for Quality Improvement Organizations To Perform Specialized Functions and to Eliminate Conflicts of Interest Part B of title XI of the Social Security Act (42 U.S.C. 1320c et seq.) is amended— ####
(1)**[**[42 U.S.C. 1320c-2](/us/usc/t42/s1320c-2)**]** in section 1153— #####
(A)in subsection (b)(1), as amended by subsection (b)(1)(B), by inserting after the first sentence the following new sentence: “In entering into contracts with such qualified organizations, the Secretary shall, to the extent appropriate, seek to ensure that each of the functions described in section 1154(a) are carried out within an area established under subsection (a).”; and #####
(B)in subsection (c)(1), by striking “the functions set forth in section 1154(a), or may subcontract for the performance of all or some of such functions” and inserting “a function or functions under section 1154 directly or may subcontract for the performance of all or some of such function or functions”; and ####
(2)**[**[42 U.S.C. 1320c-3](/us/usc/t42/s1320c-3)**]** in section 1154— #####
(A)in subsection (a)— ######
(i)in the matter preceding paragraph (1)— ######
(I)by striking “Any” and inserting “Subject to subsection (b), any”; and ######
(II)by inserting “one or more of” before “the following functions”; ######
(ii)in paragraph (4), by striking subparagraph (C); ######
(iii)by inserting after paragraph
(11)the following new paragraph: > > #### “(12) > > As part of the organization’s review responsibility under paragraph (1), the organization shall review all ambulatory surgical procedures specified pursuant to section 1833(i)(1)(A) which are performed in the area, or, at the discretion of the Secretary, a sample of such procedures.” > ; and ######
(iv)in paragraph (15), by striking “significant on-site review activities” and all that follows before the period at the end and inserting “on-site review activities as the Secretary determines appropriate”. #####
(B)by striking subsection
(d)and redesignating subsections
(b)and
(c)as subsections
(c)and (d), respectively; and #####
(C)by inserting after subsection
(a)the following new subsection: > > ### “(b) > > A quality improvement organization entering into a contract with the Secretary to perform a function described in a paragraph under subsection
(a)must perform all of the activities described in such paragraph, except to the extent otherwise negotiated with the Secretary pursuant to the contract or except for a function for which the Secretary determines it is not appropriate for the organization to perform, such as a function that could cause a conflict of interest with another function.” > . ###
(d)Quality Improvement as Specified Function Section 1154(a) of the Social Security Act (42 U.S.C. 1320c-3(a)) is amended by adding at the end the following new paragraph: > > #### “(18) > > The organization shall perform, subject to the terms of the contract, such other activities as the Secretary determines may be necessary for the purposes of improving the quality of care furnished to individuals with respect to items and services for which payment may be made under title XVIII.” > . ###
(e)Effective Date **[**[42 U.S.C. 1320c note](/us/usc/t42/s1320c)**]** The amendments made by this section shall apply to contracts entered into or renewed on or after January 1, 2012.
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  • 42 USC 1320c-1320
Citation graph
cites case law
Sec. 261
IMPROVEMENTS TO CONTRACTS WITH MEDICARE QUALITY IMPROVEMENT ORGANIZATIONS (QIOS) IN ORDER TO IMPROVE THE QUALITY OF CARE FURNISHED TO MEDICARE BENEFICIARIES
U.S.C.§ 1320c–1
U.S.C.§ 1320c
U.S.C.§ 1320c–3
U.S.C.§ 1395
U.S.C.§ 1395y
U.S.C.§ 1395g
U.S.C.§ 1395u
U.S.C.§ 1395cc
U.S.C.§ 1395dd
Cite42 USC 1320c-1320
Cites 12 · showing 10Cited by 0 across 0 sources
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