Patient Protection and Affordable Care Act
Quality Improvement Initiatives: Improving Access to Health Care Services

Sec. 5605 Key National Indicators

Commission on Key National Indicators

• Composition. The Senate majority and minority together with the House speaker and minority leader will appoint, no later than thirty days following enactment of the ACA, eight members to sit on the Commission for terms of 2 years, except for initial members who may receive appointments for 3 year terms.234 These Congressional leaders should seek appointees that “have shown a dedication to improving civic dialogue and decision-making through the wide use of scientific evidence and factual information.”235 Congressional members and elected government officials at all levels of government cannot receive an appointment.236  Within 60 days following enactment, the Commission members must develop a plan for carrying out their tasks.237 The Commission members must also select two co-chairs.238
• Commission Functions. The ACA tasks the Commission with: (1) overseeing the national indicators system; (2) recommending system improvements; (3) “coordinat[ing] with Federal Government users and information providers to assure access to relevant and quality data;” and (4) contracting with the National Academy of Sciences (“Academy”). The Commission must provide Congress and the President with annual reports containing the Commission’s recommendations, findings, and conclusions.239 The Commission must provide annual reports “to the Academy and a designated Institute” that makes “recommendations concerning potential issue areas and key indicators to be included in the Key National Indicators.”240
• Academy Functions. The contract between the Commission and the Academy must require the Academy to: (1) “review available public and private sector research on the selection of a set of key national indicators;” (2) determine whether the Academy is the best entity to create the system or whether it is best to designate a “private nonprofit organization as an institute” for the purpose of establishing the system; (3) if designating an institute to establish the system, “provide scientific and technical advice to the Institute and create an appropriate governance mechanism that balances Academy involvement and the Independence of the Institute;” and (4) report to the Commission annually regarding “scientific and technical issues” and, if using an Institute, information regarding the Institute’s operation, governance, and budget.241 The Academy, in carrying out these duties, must “convene a multi-sector, multi-disciplinary process to define major scientific and technical issues associated with developing, maintaining, and evolving [the System] and, if an Institute is established, to provide it with scientific and technical advice.”242

National Key Indicator System

• Overview. The National Academy of Sciences must either establish the System pursuant to their institutional capacity or partner with a private Institute to establish the system.243 A private Institute is eligible for such partnership if they are a non-profit and have “an educational mission, a governance structure that emphasizes independence, and characteristics that make such an entity appropriate for establishing” the System.244
• Requirements. The Academy or an Institute, in creating the System, must: (1) identify and select the key national indicator issues; (2) identify and select indicator measures; (3) identify and select population data for the indicators; (4) establish a public website to house a database of indicator information for public access; (5) “develop[] a quality assurance framework to ensure rigorous and independent processes and the selection of quality data;” (6) create a budget for developing and managing the System that contains all Academy funding and Institute information, if applicable; (7) submit annual progress reports to the Commission; and (8) respond to Commission recommendations and Academy inquiries.245
• Governance. The Academy must create a means of governing the system “that incorporates advisory and control functions” and, if applicable, balances an Institute’s independence with Academy involvement in the system.246 The Academy has discretion to change the approach in establishing the System and alter their relationship with an Institute.247 The ACA does not prohibit the Academy or Institute from using private funds to create the System.248 The Academy must submit, within 270 days of enactment, a report to the Commission regarding their “findings and recommendations.”249

Evaluation. The Government Accountability Office (GAO) must (1) study the use of key indicator systems by “public agencies, private organizations, or foreign countries;” (2) conduct an annual financial audit of any Institute designated pursuant to this section and report the findings to the Commission and Congress; and (3) conduct a “programmatic assessment,” at the direction of the Comptroller General, of any Institute designated pursuant to this section and report the findings to the Commission and Congress.250