Expanding the Availability of Medicare Data Act - Expands the kinds of uses of Medicare data available to qualified entities for quality and patient care improvement activities.
(A "qualified entity" is a public or private entity that: [1] is qualified to use claims data to evaluate the performance of service providers and suppliers on measures of quality, efficiency, effectiveness, and resource use; and [2] agrees to meet specified requirements, such as ensuring data security.)
Authorizes a qualified entity to use claims data combined with non-claims data the entity has received, as well as information derived from evaluation of service provider and supplier performance, to conduct additional non-public analyses and provide or sell them to authorized users for non-public use (including to assist service providers and suppliers to develop and participate in quality and patient care improvement activities, including new models of care).
Defines "authorized users" as service providers, suppliers, employers, health insurance issuers, medical societies or hospital associations, or any other entities approved by the Secretary of Health and Human Services (HHS).
Prohibits a qualified entity from charging a fee to provide Medicare claims data.
Requires a qualified entity and an authorized user to enter into a data use agreement, and prohibits the use of data or analyses for marketing purposes or, except in certain circumstances, its redisclosure.
Directs the Secretary to provide Medicare data to qualified clinical data registries for purposes of linking it with clinical outcomes data and performing risk-adjusted, scientifically valid analyses and research to support quality improvement or patient safety. Requires charging a fee to a registry for such data.
Amends title XVIII (Medicare) of the Social Security Act (SSA) to include among standardized extracts of Medicare claims data that may be made available to qualified entities, if the Secretary determines appropriate, also claims data under SSA titles XIX (Medicaid) and XXI (State Children's Health Insurance) (CHIP).
Requires any fees charged for making standardized extracts available to qualified entities to be deposited into the Centers for Medicare & Medicaid Services Program Management Account (currently, into the Federal Supplementary Medical Insurance Trust Fund).
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4418 Introduced in House (IH)]
113th CONGRESS
2d Session
H. R. 4418
To amend title XVIII of the Social Security Act to increase access to
Medicare data.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 7, 2014
Mr. Ryan of Wisconsin (for himself and Mr. Kind) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committee on Ways and Means, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to increase access to
Medicare data.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Expanding the Availability of
Medicare Data Act''.
SEC. 2. EXPANDING AVAILABILITY OF MEDICARE DATA.
(a) Expanding Uses of Medicare Data by Qualified Entities.--
(1) Additional analyses.--
(A) In general.--Subject to subparagraph (B), to
the extent consistent with applicable information,
privacy, security, and disclosure laws (including
paragraph (3)), notwithstanding paragraph (4)(B) of
section 1874(e) of the Social Security Act (42 U.S.C.
1395kk(e)) and the second sentence of paragraph (4)(D)
of such section, beginning July 1, 2015, a qualified
entity may use the combined data described in paragraph
(4)(B)(iii) of such section received by such entity
under such section, and information derived from the
evaluation described in such paragraph (4)(D), to
conduct additional non-public analyses (as determined
appropriate by the Secretary) and provide or sell such
analyses to authorized users for non-public use
(including for the purposes of assisting providers of
services and suppliers to develop and participate in
quality and patient care improvement activities,
including developing new models of care).
(B) Limitations with respect to analyses.--
(i) Employers.--Any analyses provided or
sold under subparagraph (A) to an employer
described in paragraph (9)(A)(iii) may only be
used by such employer for purposes of providing
health insurance to employees and retirees of
the employer.
(ii) Health insurance issuers.--A qualified
entity may not provide or sell an analysis to a
health insurance issuer described in paragraph
(9)(A)(iv) unless the issuer is providing the
qualified entity with data under section
1874(e)(4)(B)(iii) of the Social Security Act
(42 U.S.C. 1395kk(e)(4)(B)(iii)).
(2) Access to certain data.--
(A) Access.--To the extent consistent with
applicable information, privacy, security, and
disclosure laws (including paragraph (3)),
notwithstanding paragraph (4)(B) of section 1874(e) of
the Social Security Act (42 U.S.C. 1395kk(e)) and the
second sentence of paragraph (4)(D) of such section,
beginning July 1, 2015, a qualified entity may--
(i) provide or sell the combined data
described in paragraph (4)(B)(iii) of such
section to authorized users described in
clauses (i), (ii), and (v) of paragraph (9)(A)
for non-public use, including for the purposes
described in subparagraph (B); or
(ii) subject to subparagraph (C), provide
Medicare claims data to authorized users
described in clauses (i), (ii), and (v), of
paragraph (9)(A) for non-public use, including
for the purposes described in subparagraph (B).
(B) Purposes described.--The purposes described in
this subparagraph are assisting providers of services
and suppliers in developing and participating in
quality and patient care improvement activities,
including developing new models of care.
(C) Medicare claims data must be provided at no
cost.--A qualified entity may not charge a fee for
providing the data under subparagraph (A)(ii).
(3) Protection of information.--
(A) In general.--Except as provided in subparagraph
(B), an analysis or data that is provided or sold under
paragraph (1) or (2) shall not contain information that
individually identifies a patient.
(B) Information on patients of the provider of
services or supplier.--To the extent consistent with
applicable information, privacy, security, and
disclosure laws, an analysis or data that is provided
or sold to a provider of services or supplier under
paragraph (1) or (2) may contain information that
individually identifies a patient of such provider or
supplier, including with respect to items and services
furnished to the patient by other providers of services
or suppliers.
(C) Prohibition on using analyses or data for
marketing purposes.--An authorized user shall not use
an analysis or data provided or sold under paragraph
(1) or (2) for marketing purposes.
(4) Data use agreement.--A qualified entity and an
authorized user described in clauses (i), (ii), and (v) of
paragraph (9)(A) shall enter into an agreement regarding the
use of any data that the qualified entity is providing or
selling to the authorized user under paragraph (2). Such
agreement shall describe the requirements for privacy and
security of the data and, as determined appropriate by the
Secretary, any prohibitions on using such data to link to other
individually identifiable sources of information. If the
authorized user is not a covered entity under the rules
promulgated pursuant to the Health Insurance Portability and
Accountability Act of 1996, the agreement shall identify the
relevant regulations, as determined by the Secretary, that the
user shall comply with as if it were acting in the capacity of
such a covered entity.
(5) No redisclosure of analyses or data.--
(A) In general.--Except as provided in subparagraph
(B), an authorized user that is provided or sold an
analysis or data under paragraph (1) or (2) shall not
redisclose or make public such analysis or data or any
analysis using such data.
(B) Permitted redisclosure.--A provider of services
or supplier that is provided or sold an analysis or
data under paragraph (1) or (2) may, as determined by
the Secretary, redisclose such analysis or data for the
purposes of performance improvement and care
coordination activities but shall not make public such
analysis or data or any analysis using such data.
(6) Opportunity for providers of services and suppliers to
review.--Prior to a qualified entity providing or selling an
analysis to an authorized user under paragraph (1), to the
extent that such analysis would individually identify a
provider of services or supplier who is not being provided or
sold such analysis, such qualified entity shall provide such
provider or supplier with the opportunity to appeal and correct
errors in the manner described in section 1874(e)(4)(C)(ii) of
the Social Security Act (42 U.S.C. 1395kk(e)(4)(C)(ii)).
(7) Assessment for a breach.--
(A) In general.--In the case of a breach of a data
use agreement under this section or section 1874(e) of
the Social Security Act (42 U.S.C. 1395kk(e)), the
Secretary shall impose an assessment on the qualified
entity both in the case of--
(i) an agreement between the Secretary and
a qualified entity; and
(ii) an agreement between a qualified
entity and an authorized user.
(B) Assessment.--The assessment under subparagraph
(A) shall be an amount up to $100 for each individual
entitled to, or enrolled for, benefits under part A of
title XVIII of the Social Security Act or enrolled for
benefits under part B of such title--
(i) in the case of an agreement described
in subparagraph (A)(i), for whom the Secretary
provided data on to the qualified entity under
paragraph (2); and
(ii) in the case of an agreement described
in subparagraph (A)(ii), for whom the qualified
entity provided data on to the authorized user
under paragraph (2).
(C) Deposit of amounts collected.--Any amounts
collected pursuant to this paragraph shall be deposited
in Federal Supplementary Medical Insurance Trust Fund
under section 1841 of the Social Security Act (42
U.S.C. 1395t).
(8) Annual reports.--Any qualified entity that provides or
sells an analysis or data under paragraph (1) or (2) shall
annually submit to the Secretary a report that includes--
(A) a summary of the analyses provided or sold,
including the number of such analyses, the number of
purchasers of such analyses, and the total amount of
fees received for such analyses;
(B) a description of the topics and purposes of
such analyses;
(C) information on the entities who received the
data under paragraph (2), the uses of the data, and the
total amount of fees received for providing, selling,
or sharing the data; and
(D) other information determined appropriate by the
Secretary.
(9) Definitions.--In this subsection and subsection (b):
(A) Authorized user.--The term ``authorized user''
means the following:
(i) A provider of services.
(ii) A supplier.
(iii) An employer (as defined in section
3(5) of the Employee Retirement Insurance
Security Act of 1974).
(iv) A health insurance issuer (as defined
in section 2791 of the Public Health Service
Act).
(v) A medical society or hospital
association.
(vi) Any entity not described in clauses
(i) through (v) that is approved by the
Secretary (other than an employer or health
insurance issuer not described in clauses (iii)
and (iv), respectively, as determined by the
Secretary).
(B) Provider of services.--The term ``provider of
services'' has the meaning given such term in section
1861(u) of the Social Security Act (42 U.S.C.
1395x(u)).
(C) Qualified entity.--The term ``qualified
entity'' has the meaning given such term in section
1874(e)(2) of the Social Security Act (42 U.S.C.
1395kk(e)).
(D) Secretary.--The term ``Secretary'' means the
Secretary of Health and Human Services.
(E) Supplier.--The term ``supplier'' has the
meaning given such term in section 1861(d) of the
Social Security Act (42 U.S.C. 1395x(d)).
(b) Access to Medicare Data by Qualified Clinical Data Registries
To Facilitate Quality Improvement.--
(1) Access.--
(A) In general.--To the extent consistent with
applicable information, privacy, security, and
disclosure laws, beginning July 1, 2015, the Secretary
shall, at the request of a qualified clinical data
registry under section 1848(m)(3)(E) of the Social
Security Act (42 U.S.C. 1395w-4(m)(3)(E)), provide the
data described in subparagraph (B) (in a form and
manner determined to be appropriate) to such qualified
clinical data registry for purposes of linking such
data with clinical outcomes data and performing risk-
adjusted, scientifically valid analyses and research to
support quality improvement or patient safety, provided
that any public reporting of such analyses or research
that identifies a provider of services or supplier
shall only be conducted with the opportunity of such
provider or supplier to appeal and correct errors in
the manner described in subsection (a)(6).
(B) Data described.--The data described in this
subparagraph is--
(i) claims data under the Medicare program
under title XVIII of the Social Security Act;
and
(ii) if the Secretary determines
appropriate, claims data under the Medicaid
program under title XIX of such Act and the
State Children's Health Insurance Program under
title XXI of such Act.
(2) Fee.--Data described in paragraph (1)(B) shall be
provided to a qualified clinical data registry under paragraph
(1) at a fee equal to the cost of providing such data. Any fee
collected pursuant to the preceding sentence shall be deposited
in the Centers for Medicare & Medicaid Services Program
Management Account.
(c) Expansion of Data Available to Qualified Entities.--Section
1874(e) of the Social Security Act (42 U.S.C. 1395kk(e)) is amended--
(1) in the subsection heading, by striking ``Medicare'';
and
(2) in paragraph (3)--
(A) by inserting after the first sentence the
following new sentence: ``Beginning July 1, 2015, if
the Secretary determines appropriate, the data
described in this paragraph may also include
standardized extracts (as determined by the Secretary)
of claims data under titles XIX and XXI for assistance
provided under such titles for one or more specified
geographic areas and time periods requested by a
qualified entity.''; and
(B) in the last sentence, by inserting ``or under
titles XIX or XXI'' before the period at the end.
(d) Revision of Placement of Fees.--Section 1874(e)(4)(A) of the
Social Security Act (42 U.S.C. 1395kk(e)(4)(A)) is amended, in the
second sentence--
(1) by inserting ``, for periods prior to July 1, 2015,''
after ``deposited''; and
(2) by inserting the following before the period at the
end: ``, and, beginning July 1, 2015, into the Centers for
Medicare & Medicaid Services Program Management Account''.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
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