42 U.S.C. § 1395ll: Studies and recommendations

The Secretary shall carry on studies and develop recommendations to be submitted from time to time to the Congress relating to health care of the aged and the disabled, including studies and recommendations concerning (1) the adequacy of existing personnel and facilities for health care for purposes of the programs under parts A and B of this subchapter; (2) methods for encouraging the further development of efficient and economical forms of health care which are a constructive alternative to inpatient hospital care; and (3) the effects of the deductibles and coinsurance provisions upon beneficiaries, persons who provide health services, and the financing of the program. The Secretary shall make a continuing study of the operation and administration of this subchapter (including a validation of the accreditation process of national accreditation bodies under section 1395bb(a) of this title 1 the operation and administration of health maintenance organizations authorized by section 226 of the Social Security Amendments of 1972 [ 1 So in original. Probably should be followed by a comma. 42 U.S.C. 1395mm ], the experiments and demonstration projects authorized by section 402 of the Social Security Amendments of 1967 [ 42 U.S.C. 1395b–1 ] and the experiments and demonstration projects authorized by section 222(a) of the Social Security Amendments of 1972 [ 42 U.S.C. 1395b–1 note]), and shall transmit to the Congress annually a report concerning the operation of such programs. Not later than the date that is 2 months after the date of the enactment of this Act [ Dec. 8, 2003 ], the Secretary [of Health and Human Services] shall enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences (in this section referred to as the ‘Institute’) shall conduct an evaluation of leading health care performance measures in the public and private sectors and options to implement policies that align performance with payment under the medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq.). catalogue, review, and evaluate the validity of leading health care performance measures; catalogue and evaluate the success and utility of alternative performance incentive programs in public or private sector settings; and the performance measurement set to be used and how that measurement set will be updated; the payment policy that will reward performance; and the key implementation issues (such as data and information technology requirements) that must be addressed. The health care performance measures described in paragraph (2)(A) shall encompass a variety of perspectives, including physicians, hospitals, other health care providers, health plans, purchasers, and patients. In evaluating the matters described in paragraph (2)(C), the Institute shall consult with the Medicare Payment Advisory Commission established under section 1805 of the Social Security Act ( 42 U.S.C. 1395b–6 ). Not later than the date that is 18 months after the date of enactment of this Act [ Dec. 8, 2003 ], the Institute shall submit to the Secretary and appropriate committees of jurisdiction of the Senate and House of Representatives a report on the evaluation conducted under subsection (a)(1) describing the findings of such evaluation and recommendations for an overall strategy and approach for aligning payment with performance, including options for updating performance measures, in the original medicare fee-for-service program under parts A and B of title XVIII of the Social Security Act [ 42 U.S.C. 1395c et seq., 1395j et seq.], the Medicare Advantage program under part C of such title [ 42 U.S.C. 1395w–21 et seq.], and any other programs under such title XVIII [ 42 U.S.C. 1395 et seq.]. There are authorized to be appropriated such sums as may be necessary for purposes of conducting the evaluation and preparing the report required by this section.” an assessment of the use by beneficiaries of such services through an analysis of claims submitted by physicians for such services under part B of the medicare program [ 42 U.S.C. 1395j et seq.]; an examination of changes in the use by beneficiaries of physicians’ services over time; and an examination of the extent to which physicians are not accepting new medicare beneficiaries as patients. data from claims submitted by physicians under part B of the medicare program [ 42 U.S.C. 1395j et seq.] indicate potential access problems for medicare beneficiaries in certain geographic areas; and access by medicare beneficiaries to physicians’ services may have improved, remained constant, or deteriorated over time.” review the issuance of individual medicare provider numbers and the possible medicare program integrity vulnerabilities of the current process; review direct and indirect costs associated with the current process incurred by the medicare program and groups that retain independent contractor physicians; assess the effect on program integrity by the enrollment of groups that retain independent contractor hospital-based physicians; and develop suggested procedures for the enrollment of these groups. Not later than 1 year after the date of the enactment of this Act [ Dec. 21, 2000 ], the Comptroller General shall submit to Congress a report on the study conducted under subsection (a).” coding and billing; documentation requirements; and the calculation of overpayments. Not later than 18 months after the date of the enactment of this Act [ Dec. 21, 2000 ], the Comptroller General shall submit to Congress a report on the study conducted under paragraph (1) together with specific recommendations for changes or improvements in the post-payment audit process described in such paragraph. The Comptroller General of the United States shall conduct a study on the aggregate effects of regulatory, audit, oversight, and paperwork burdens on physicians and other health care providers participating in the medicare program under title XVIII of the Social Security Act [ 42 U.S.C. 1395 et seq.]. a reduction in paperwork, an ease of administration, or an appropriate change in oversight and review may be accomplished; or additional payments or education are needed to assist physicians and other health care providers in understanding and complying with any legal or regulatory requirements.” The Secretary of Health and Human Services, acting through the Administrator of the Agency for Health Care Policy and Research, shall conduct a study of the issues specified in paragraph (2). improvements in medical capabilities; advancements in scientific technology; demographic changes in the types of medicare beneficiaries that receive benefits under such program; and geographic changes in locations where medicare beneficiaries receive benefits under such program. The rate of usage of physicians’ services under the original medicare fee-for-service program under parts A and B of title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq.) among beneficiaries between ages 65 and 74, 75 and 84, 85 and over, and disabled beneficiaries under age 65. Other factors that may be reliable predictors of beneficiary utilization of physicians’ services under the original medicare fee-for-service program under parts A and B of title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq.). Not later than 3 years after the date of the enactment of this Act [ Nov. 29, 1999 ], the Secretary of Health and Human Services shall submit a report to Congress setting forth the results of the study conducted pursuant to paragraph (1), together with any recommendations the Secretary determines are appropriate. an analysis and evaluation of the report submitted under paragraph (3); and such recommendations as it determines are appropriate.”