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1 submitted and ending on the date on which
2 the resident is successfully relocated.’’.
3 (c) EFFECTIVE DATE.—The amendments made by
4 this section shall take effect 1 year after the date of the
5 enactment of this Act.
6 PART 3—IMPROVING STAFF TRAINING

7 SEC. 1431. DEMENTIA AND ABUSE PREVENTION TRAINING.

8 (a) SKILLED NURSING FACILITIES.—Section

9 1819(f)(2)(A)(i)(I) of the Social Security Act (42 U.S.C.
10 1395i–3(f)(2)(A)(i)(I)) is amended by inserting ‘‘(includ-
11 ing, in the case of initial training and, if the Secretary
12 determines appropriate, in the case of ongoing training,
13 dementia management training and resident abuse preven-
14 tion training)’’ after ‘‘curriculum’’.
15 (b) NURSING FACILITIES.—Section
16 1919(f)(2)(A)(i)(I) of the Social Security Act (42 U.S.C.
17 1396r(f)(2)(A)(i)(I)) is amended by inserting ‘‘(including,
18 in the case of initial training and, if the Secretary deter-
19 mines appropriate, in the case of ongoing training, demen-
20 tia management training and resident abuse prevention
21 training)’’ after ‘‘curriculum’’.
22 (c) EFFECTIVE DATE.—The amendments made by
23 this section shall take effect 1 year after the date of the
24 enactment of this Act.

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1 SEC. 1432. STUDY AND REPORT ON TRAINING REQUIRED

2 FOR CERTIFIED NURSE AIDES AND SUPER-

3 VISORY STAFF.

4 (a) STUDY.—
5 (1) IN GENERAL.—The Secretary shall conduct
6 a study on the content of training for certified nurse
7 aides and supervisory staff of skilled nursing facili-
8 ties and nursing facilities. The study shall include an
9 analysis of the following:
10 (A) Whether the number of initial training
11 hours for certified nurse aides required under
12 sections 1819(f)(2)(A)(i)(II) and
13 1919(f)(2)(A)(i)(II) of the Social Security Act
14 (42 U.S.C. 1395i–3(f)(2)(A)(i)(II);
15 1396r(f)(2)(A)(i)(II)) should be increased from
16 75 and, if so, what the required number of ini-
17 tial training hours should be, including any rec-
18 ommendations for the content of such training
19 (including training related to dementia).
20 (B) Whether requirements for ongoing
21 training under such sections
22 1819(f)(2)(A)(i)(II) and 1919(f)(2)(A)(i)(II)
23 should be increased from 12 hours per year, in-
24 cluding any recommendations for the content of
25 such training.

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1 (2) CONSULTATION.—In conducting the anal-
2 ysis under paragraph (1)(A), the Secretary shall
3 consult with States that, as of the date of the enact-
4 ment of this Act, require more than 75 hours of
5 training for certified nurse aides.
6 (3) DEFINITIONS.—In this section:
7 (A) NURSING FACILITY.—The term ‘‘nurs-
8 ing facility’’ has the meaning given such term
9 in section 1919(a) of the Social Security Act
10 (42 U.S.C. 1396r(a)).
11 (B) SECRETARY.—The term ‘‘Secretary’’
12 means the Secretary of Health and Human
13 Services, acting through the Assistant Secretary
14 for Planning and Evaluation.
15 (C) SKILLED NURSING FACILITY.—The

16 term ‘‘skilled nursing facility’’ has the meaning

17 given such term in section 1819(a) of the Social
18 Security Act (42 U.S.C. 1395(a)).
19 (b) REPORT.—Not later than 2 years after the date
20 of the enactment of this Act, the Secretary shall submit
21 to Congress a report containing the results of the study
22 conducted under subsection (a), together with rec-
23 ommendations for such legislation and administrative ac-
24 tion as the Secretary determines appropriate.

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1 Subtitle C—Quality Measurements
2 SEC. 1441. ESTABLISHMENT OF NATIONAL PRIORITIES FOR

3 QUALITY IMPROVEMENT.

4 Title XI of the Social Security Act, as amended by

5 section 1401(a), is further amended by adding at the end
6 the following new part:
7 ‘‘PART E—QUALITY IMPROVEMENT
8 ‘‘ESTABLISHMENT OF NATIONAL PRIORITIES FOR

9 PERFORMANCE IMPROVEMENT

10 ‘‘SEC. 1191. (a) ESTABLISHMENT OF NATIONAL PRI-

11 ORITIES BY THE SECRETARY.—The Secretary shall estab-
12 lish and periodically update, not less frequently than tri-
13 ennially, national priorities for performance improvement.
14 ‘‘(b) RECOMMENDATIONS FOR NATIONAL PRIOR-
15 ITIES.—In establishing and updating national priorities
16 under subsection (a), the Secretary shall solicit and con-
17 sider recommendations from multiple outside stake-
18 holders.
19 ‘‘(c) CONSIDERATIONS IN SETTING NATIONAL PRI-
20 ORITIES.—With respect to such priorities, the Secretary
21 shall ensure that priority is given to areas in the delivery
22 of health care services in the United States that—
23 ‘‘(1) contribute to a large burden of disease, in-
24 cluding those that address the health care provided

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1 to patients with prevalent, high-cost chronic dis-
2 eases;
3 ‘‘(2) have the greatest potential to decrease
4 morbidity and mortality in this country, including
5 those that are designed to eliminate harm to pa-
6 tients;
7 ‘‘(3) have the greatest potential for improving
8 the performance, affordability, and patient-
9 centeredness of health care, including those due to
10 variations in care;
11 ‘‘(4) address health disparities across groups
12 and areas; and
13 ‘‘(5) have the potential for rapid improvement
14 due to existing evidence, standards of care or other
15 reasons.
16 ‘‘(d) DEFINITIONS.—In this part:
17 ‘‘(1) CONSENSUS-BASED ENTITY.—The term
18 ‘consensus-based entity’ means an entity with a con-
19 tract with the Secretary under section 1890.
20 ‘‘(2) QUALITY MEASURE.—The term ‘quality
21 measure’ means a national consensus standard for
22 measuring the performance and improvement of pop-
23 ulation health, or of institutional providers of serv-
24 ices, physicians, and other health care practitioners
25 in the delivery of health care services.

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1 ‘‘(e) FUNDING.—
2 ‘‘(1) IN GENERAL.—The Secretary shall provide
3 for the transfer, from the Federal Hospital Insur-
4 ance Trust Fund under section 1817 and the Fed-
5 eral Supplementary Medical Insurance Trust Fund
6 under section 1841 (in such proportion as the Sec-
7 retary determines appropriate), of $2,000,000, for
8 the activities under this section for each of the fiscal
9 years 2010 through 2014.
10 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.—

11 For purposes of carrying out the provisions of this

12 section, in addition to funds otherwise available, out
13 of any funds in the Treasury not otherwise appro-
14 priated, there are appropriated to the Secretary of
15 Health and Human Services $2,000,000 for each of
16 the fiscal years 2010 through 2014.’’.
17 SEC. 1442. DEVELOPMENT OF NEW QUALITY MEASURES;

18 GAO EVALUATION OF DATA COLLECTION

19 PROCESS FOR QUALITY MEASUREMENT.

20 Part E of title XI of the Social Security Act, as added

21 by section 1441, is amended by adding at the end the fol-
22 lowing new sections:
23 ‘‘SEC. 1192. DEVELOPMENT OF NEW QUALITY MEASURES.

24 ‘‘(a) AGREEMENTS WITH QUALIFIED ENTITIES.—

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1 ‘‘(1) IN GENERAL.—The Secretary shall enter
2 into agreements with qualified entities to develop
3 quality measures for the delivery of health care serv-
4 ices in the United States.
5 ‘‘(2) FORM OF AGREEMENTS.—The Secretary
6 may carry out paragraph (1) by contract, grant, or
7 otherwise.
8 ‘‘(3) RECOMMENDATIONS OF CONSENSUS-

9 BASED ENTITY.—In carrying out this section, the

10 Secretary shall—
11 ‘‘(A) seek public input; and
12 ‘‘(B) take into consideration recommenda-
13 tions of the consensus-based entity with a con-
14 tract with the Secretary under section 1890(a).
15 ‘‘(b) DETERMINATION OF AREAS WHERE QUALITY
16 MEASURES ARE REQUIRED.—Consistent with the na-
17 tional priorities established under this part and with the
18 programs administered by the Centers for Medicare &
19 Medicaid Services and in consultation with other relevant
20 Federal agencies, the Secretary shall determine areas in
21 which quality measures for assessing health care services
22 in the United States are needed.
23 ‘‘(c) DEVELOPMENT OF QUALITY MEASURES.—
24 ‘‘(1) PATIENT-CENTERED AND POPULATION-

25 BASED MEASURES.—Quality measures developed

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1 under agreements under subsection (a) shall be de-
2 signed—
3 ‘‘(A) to assess outcomes and functional
4 status of patients;
5 ‘‘(B) to assess the continuity and coordina-
6 tion of care and care transitions for patients
7 across providers and health care settings, in-
8 cluding end of life care;
9 ‘‘(C) to assess patient experience and pa-
10 tient engagement;
11 ‘‘(D) to assess the safety, effectiveness,
12 and timeliness of care;
13 ‘‘(E) to assess health disparities including
14 those associated with individual race, ethnicity,
15 age, gender, place of residence or language;
16 ‘‘(F) to assess the efficiency and resource
17 use in the provision of care;
18 ‘‘(G) to the extent feasible, to be collected
19 as part of health information technologies sup-
20 porting better delivery of health care services;
21 ‘‘(H) to be available free of charge to users
22 for the use of such measures; and
23 ‘‘(I) to assess delivery of health care serv-
24 ices to individuals regardless of age.

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