Sec. 10202 Incentives for States to Offer Home and Community-Based Services as a Long-Term Care Alternative to Nursing Homes.
The Secretary of Health and Human Services will provide “balancing incentive payments” to states that qualify as a “balancing incentive payment state.”68 States that expend “less than 50 percent of [their] total expenditures for medical assistance under the State Medicaid program for a fiscal year for long-term services and supports…are for non-institutionally-based long-term services and supports…” qualify if they meet certain conditions and the Secretary selects them for participation.69 The necessary conditions include: (1) an application containing a budget and plans for the State’s expansion of “medical assistance for non-institutionally-based long-term services and supports;” (2) a target spending percentage; (3) the maintenance of eligibility requirements for “medical assistance for non-institutionally-based long-term services and supports;” (4) an agreement to use the funds provided pursuant to this section to expand non-institutionally-based long term services and supports; (5) an agreement to make structural changes (e.g. single point entry system, conflict free case management services); and (6) an agreement to collect services data, quality data, and outcome measures data.70
Sec. 10322 Quality Reporting for Psychiatric Hospitals
Psychiatric hospitals must submit quality measure data to Secretary of Health and Human Services on an annual basis beginning with the rate year of 2014. 71 Please see the Medicare section for more information.
Sec. 10327 Improvements to the Physician Quality Reporting System
Eligible professionals that submit quality data will receive an additional incentive payment via the physician quality reporting system.72 Please see the Medicare section for more information.
Sec. 10331 Physician Compare Website; Public Reporting of Performance Information
- Overview. “Not later than January 1, 2011, the Secretary of Health and Human Services 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).”73 The Secretary must also implement a plan for making comparable information on physician performance, specifically quality and patient experience measures, available to the public on the Physician Compare website. This plan should be in place no later than January 1, 2013, with respect to reporting periods that begin no earlier than January 1, 2012.74
- Information Criteria. The information should include: “(1) measures collected under the Physician Quality Reporting Initiative; (2) an assessment of patient health outcomes and the functional status of patients; (3) an assessment of the continuity and coordination of care and care transitions, including episodes of care and risk-adjusted resource use; (4) an assessment of efficiency; (5) an assessment of patient experience and patient, caregiver, and family engagement; (6) an assessment of the safety, effectiveness, and timeliness of care; and (7) other information as determined appropriate by the Secretary.”75
- Safeguards. The Secretary should include processes to ensure that data being made public is statistically valid and reliable, that a physician or other professional whose performance is being publicly reported has a reasonable opportunity to review his or her individual results before they are made public, that the data available provide a robust and accurate portrayal of a physician’s performance, the data reflects care provided to all patients, not just those under the Medicare program, that appropriate attribution of care is given when multiple providers are involved in the care of a patient, that timely statistical performance feedback is provided to physicians, and computer and data systems that support valid, reliable, and accurate public reporting activities are implemented by the Centers for Medicare & Medicaid Services (CMS).76
- Privacy. Information on physician performance and patient experience should not be disclosed in a manner that violates the privacy of individually identifiable health information.77
Sec. 10332 Availability of Medicare Data for Performance Measurement
The Secretary of Health and Human Services must “develop a prospective payment system for payment for federally qualified health center services.”78 The Secretary will collect data from federally qualified health centers in order to develop the program.79 Please see the Medicare section for more information.
Footnotes
- 68. Affordable Care Act §10202(a); 42 U.S.C. 1396d(a).
- 69. Affordable Care Act §10202(b); 42 U.S.C. 1396d(b).
- 70. Affordable Care Act §10202(c); 42 U.S.C. 1396d(c).
- 71. Affordable Care Act §10322; 42 U.S.C. 1886(s)(4).
- 72. Affordable Care Act §10327; 42 U.S.C. 1395w-4(m)(7).
- 73. Affordable Care Act §10331; 42 USC 7, §1395w-5(a)(1).
- 74. Affordable Care Act §10331; 42 USC 7, §1395w-5(a)(2).
- 75. Affordable Care Act § 10331; 42 USC 7, §1395w-5(a)(2)(A)-(G).
- 76. Affordable Care Act §10331; 42 USC 7, §1395w-5(b)(1)-(7).
- 77. Affordable Care Act §10331; 42 USC 7, §1395w-5(c).
- 78. Affordable Care Act §10501(i)(3)(A); 42 U.S.C. 1395m(o).
- 79. Affordable Care Act §10501(i)(3)(A); 42 U.S.C. 1395m(o).
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