Federal Health Care Quality, Consumer Information and Protection Act

TABLE OF CONTENTS:

Title I: Federal Health Plan Quality Council

Title II: Coverage of Federal Health Care Programs

Title III: Certification of Federal Health Plan Contracts

Title IV: Federal Health Plan Contract Performance

Title V: Expansion of Health Care Quality Activities

Title VI: Miscellaneous Provisions

Federal Health Care Quality, Consumer Information and Protection Act - Title I: Federal Health Plan Quality Council - Establishes as an independent council the Federal Health Plan Quality Council to: (1) oversee and ensure the effective evaluation of health care programs financed under Federal Government authority; (2) endorse and direct Federal participation in regional health care accountability initiatives; and (3) advise the President and the Congress on the protection and quality of the health of Federal health plan contract participants and beneficiaries.

(Sec. 102) Requires that the Council be composed of at least nine members.

(Sec. 104) Establishes the Quality Advisory Institute to advise the Council concerning licensing and certification criteria and comparative measurement methods under this Act.

(Sec. 106) Sets forth Council duties, including: (1) licensing certifying entities; (2) certifying Federal health plan contracts; (3) selecting from existing comparative health care measures to guide consumer choice and improve care delivery; and (4) contracting with an independent entity for the conduct of certification and quality measurement audits.

(Sec. 107) Authorizes appropriations.

Title II: Coverage of Federal Health Care Programs - Requires the administrator of each of the Federal Employee Health Benefit Program, Medicaid (title XIX of the Social Security Act), Medicare (title XVIII of the Social Security Act), TRICARE (under provisions of Federal law relating to the armed forces), and a veterans health care program under provisions of Federal law relating to veterans' benefits to ensure that: (1) coverage under those Programs is provided only through contracts certified under title III of this Act; and (2) information on each Program is collected, available, and disseminated in accordance with title IV of this Act.

(Sec. 202) Requires the Council to establish: (1) a program under which payments are made to various Federal health plan contracts to reward the contracts for meeting or exceeding quality targets; and (2) broad categories of quality targets and performance measures. Requires that the Programs withhold a specified percentage from payments to eligible organizations and disburse such amounts in accordance with a specified formula relating to quality targets and performance measures (amending Medicare and Medicaid provisions accordingly).

Title III: Certification of Federal Health Plan Contracts - Requires that an entity be certified under this title in order to contract with the Government to enroll individuals for health coverage.

(Sec. 302) Mandates procedures to certify such contracts.

(Sec. 303) Requires the Council to establish minimum criteria to be used by licensed certifying entities in contract certification, including: (1) implementing a total quality improvement plan; (2) compiling and annually providing to the certifying entity documentation regarding the credentials of the hospitals and providers reimbursed under the contract; and (3) implementing a program to provide participants and beneficiaries with access to information enabling comparison with other plans.

(Sec. 304) Mandates grievance and appeals procedures.

Title IV: Federal Health Plan Contract Performance - Requires the Council to develop or select measures to be used by individuals to compare the overall quality of Federal health plan contracts. Requires contracting entities to compile and submit specified process and outcomes data.

Title V: Expansion of Health Care Quality Activities - Amends the Public Health Service Act to require the Agency for Health Care Policy and Research to take specified actions regarding health care quality assessment and comparability. Authorizes appropriations.

Title VI: Miscellaneous Provisions - Sets forth the effective dates of this Act.