Page:United States Statutes at Large Volume 124.djvu/381

124 STAT. 355 PUBLIC LAW 111–148—MAR. 23, 2010 discharges occurring during fiscal year 2014 or a subse- quent fiscal year, the Secretary shall ensure that meas- ures selected under subparagraph (A) include efficiency measures, including measures of ‘Medicare spending per beneficiary’. Such measures shall be adjusted for factors such as age, sex, race, severity of illness, and other factors that the Secretary determines appro- priate. ‘‘(C) LIMITATIONS.— ‘‘(i) TIME REQUIREMENT FOR PRIOR REPORTING AND NOTICE.—The Secretary may not select a measure under subparagraph (A) for use under the Program with respect to a performance period for a fiscal year (as established under paragraph (4)) unless such measure has been specified under subsection (b)(3)(B)(viii) and included on the Hospital Compare Internet website for at least 1 year prior to the begin- ning of such performance period. ‘‘(ii) MEASURE NOT APPLICABLE UNLESS HOSPITAL FURNISHES SERVICES APPROPRIATE TO THE MEASURE.— A measure selected under subparagraph (A) shall not apply to a hospital if such hospital does not furnish services appropriate to such measure. ‘‘(D) REPLACING MEASURES.—Subclause (VI) of sub- section (b)(3)(B)(viii) shall apply to measures selected under subparagraph (A) in the same manner as such subclause applies to measures selected under such subsection. ‘‘(3) PERFORMANCE STANDARDS.— ‘‘(A) ESTABLISHMENT.—The Secretary shall establish performance standards with respect to measures selected under paragraph (2) for a performance period for a fiscal year (as established under paragraph (4)). ‘‘(B) ACHIEVEMENT AND IMPROVEMENT.—The perform- ance standards established under subparagraph (A) shall include levels of achievement and improvement. ‘‘(C) TIMING.—The Secretary shall establish and announce the performance standards under subparagraph (A) not later than 60 days prior to the beginning of the performance period for the fiscal year involved. ‘‘(D) CONSIDERATIONS IN ESTABLISHING STANDARDS.— In establishing performance standards with respect to measures under this paragraph, the Secretary shall take into account appropriate factors, such as— ‘‘(i) practical experience with the measures involved, including whether a significant proportion of hospitals failed to meet the performance standard during previous performance periods; ‘‘(ii) historical performance standards; ‘‘(iii) improvement rates; and ‘‘(iv) the opportunity for continued improvement. ‘‘(4) PERFORMANCE PERIOD.—For purposes of the Program, the Secretary shall establish the performance period for a fiscal year. Such performance period shall begin and end prior to the beginning of such fiscal year. ‘‘(5) HOSPITAL PERFORMANCE SCORE.— ‘‘(A) IN GENERAL.—Subject to subparagraph (B), the Secretary shall develop a methodology for assessing the