EXPANDING THE WORK OF MEDICARE QUALITY IMPROVEMENT ORGANIZATIONS TO INCLUDE PARTS C AND D.

SEC. 109. EXPANDING THE WORK OF MEDICARE QUALITY IMPROVEMENT ORGANIZATIONS TO INCLUDE PARTS C AND D.(a) Application to Medicare Managed Care and Prescription Drug Coverage.—Section 1154(a)(1) (42 U.S.C. 1320c–3(a)(1)) is amended by inserting “, to Medicare Advantage organizations pursuant to contracts under part C, and to prescription drug sponsors pursuant to contracts under part D” after “under section 1876”. (b) Prescription Drug Therapy Quality Improvement.—Section 1154(a) (42 U.S.C. 1320c–3(a)) is amended by adding at the end the following new paragraph:“(17) The organization shall execute its responsibilities under subparagraphs (A) and (B) of paragraph (1) by offering to providers, practitioners, Medicare Advantage organizations offering Medicare Advantage plans under part C, and prescription drug sponsors offering prescription drug plans under part D quality improvement assistance pertaining to prescription drug therapy. For purposes of this part and title XVIII, the functions described in this paragraph shall be treated as a review function.”.(c) Effective Date.—The amendments made by this section shall apply on and after January 1, 2004.(d) IOM Study of QIOs.—(1) In general.—The Secretary shall request the Institute of Medicine of the National Academy of Sciences to conduct an evaluation of the program under part B of title XI of the Social Security Act. The study shall include a review of the following:(A) An overview of the program under such part. (B) The duties of organizations with contracts with the Secretary under such part.(C) The extent to which quality improvement organizations improve the quality of care for medicare beneficiaries.(D) The extent to which other entities could perform such quality improvement functions as well as, or better than, quality improvement organizations.117 STAT. 2174(E) The effectiveness of reviews and other actions conducted by such organizations in carrying out those duties.(F) The source and amount of funding for such organizations.(G) The conduct of oversight of such organizations.(2) Report to congress.—Not later than June 1, 2006, the Secretary shall submit to Congress a report on the results of the study described in paragraph (1), including any recommendations for legislation.(3) Increased competition.—If the Secretary finds based on the study conducted under paragraph (1) that other entities could improve quality in the medicare program as well as, or better than, the current quality improvement organizations, then the Secretary shall provide for such increased competition through the addition of new types of entities which may perform quality improvement functions.