Access to Claims Data Act

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4331 Introduced in House (IH)]

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119th CONGRESS
  1st Session
                                H. R. 4331

 To require the Secretary of Health and Human Services to establish a 
 process to expand access to claims data under certain Federal health 
     plans in order to facilitate research and quality improvement.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 10, 2025

Mr. Joyce of Pennsylvania (for himself and Ms. Schrier) 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 require the Secretary of Health and Human Services to establish a 
 process to expand access to claims data under certain Federal health 
     plans in order to facilitate research and quality improvement.

    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 ``Access to Claims Data Act''.

SEC. 2. EXPANDED ACCESS TO CLAIMS DATA TO FACILITATE RESEARCH AND 
              QUALITY IMPROVEMENT.

    (a) In General.--Not later than January 1, 2026, the Secretary of 
Health and Human Services shall establish a process to allow 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)) or a clinician-led 
clinical data registry under section 4005 of the 21st Century Cures Act 
(P.L. 114-255) to request claims data described in subsection (b) (in a 
form and manner determined to be appropriate by the Secretary) for the 
purposes of--
            (1) linking such data with clinical outcomes data;
            (2) conducting quality assessments and quality improvement 
        activities of providers of services (as defined in subsection 
        (u) of section 1861 of the Social Security Act (42 U.S.C. 
        1395x) and suppliers (as defined in subsection (d) of such 
        section)), reporting the results of such assessments and 
        activities to such providers and suppliers, and performing 
        risk-adjusted, scientifically valid analyses and research to 
        support quality improvement or patient safety; and
            (3) publishing research and quality improvement analyses, 
        which may include deidentified combined claims and clinical 
        outcomes data.
    (b) Claims Data Described.--For purposes of subsection (a), the 
claims data described in this subsection--
            (1) are--
                    (A) claims data under the Medicare program under 
                title XVIII of the Social Security Act (42 U.S.C. 1395 
                et seq.); and
                    (B) if the Secretary determines appropriate, claims 
                data under the Medicaid program under title XIX of such 
                Act (42 U.S.C. 1396 et seq.) and the State Children's 
                Health Insurance Program under title XXI of such Act 
                (42 U.S.C. 1397aa et seq.); and
            (2) may include provider-specific claims data, clinical 
        specialty-specific claims data, State-specific claims data, or 
        nationwide claims data.
    (c) Treatment of Qualified Clinical Data Registries and Clinician-
Led Clinical Data Registries.--For the purposes of this section, 
qualified clinical data registries and clinician-led clinical data 
registries shall not be required to be qualified entities, as defined 
in section 1874(e)(2) of the Social Security Act (42 U.S.C. 
1395kk(e)(2)), or quasi-qualified entities, to access claims data 
pursuant to subsection (a).
    (d) Fee.--Data described in subsection (b) shall be made available 
to a qualified clinical data registry or clinician-led clinical data 
registry under this section at a reasonable fee equal to the cost of 
making such data available. Any fee collected pursuant to the preceding 
sentence shall be deposited into the Centers for Medicare & Medicaid 
Services Program Management Account.
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