Quality Data, Quality Healthcare Act of 2013

Summary: Quality Data, Quality Healthcare Act of 2013 - Amends title XVIII (Medicare) of the Social Security Act (SSA) with respect to the use of certain data by qualified public or private entities to evaluate the performance of service providers and suppliers under Medicare insurance programs.   Authorizes a qualified entity to: (1) use Medicare data, and information derived from service provider and supplier performance evaluations, for additional non-public analyses; or (2) provide or sell such data and analyses to specified health care-related entities for non-public use (including for purposes of assisting service providers and suppliers to develop and participate in quality and patient care improvement activities, particularly development of new models of care). Conditions such authorization upon a data use agreement between a qualified entity and a specified health care-related entity under which the latter: (1) may not re-sell such data or analyses; and (2) shall comply with the qualified entity's privacy and security policies in using such data or analyses. Prescribes a civil money penalty for unauthorized use of data and analyses. Requires the Secretary of Health and Human Services (HHS) to provide Medicare claims data to qualified clinical data registries for purposes of linking it with clinical outcomes data and performing and disseminating risk-adjusted, scientifically valid research to support quality improvement. Prohibits a qualified clinical data registry from reporting publicly any claims data thus made available that individually identifies a service provider or supplier without prior consent.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Quality Data, Quality Healthcare Act 
of 2013''.

SEC. 2. EXPANDING THE AVAILABILITY OF MEDICARE DATA.

    (a) Expanding Use of Medicare Data by Qualified Entities.--Section 
1874(e) of the Social Security Act (42 U.S.C. 1395kk(e)) is amended--
            (1) in paragraph (3), in the first sentence, by inserting 
        ``or, such claims data in sufficient detail to identify cost 
        and utilization, as appropriate'' before the period at the end; 
        and
            (2) by adding at the end the following new paragraph:
            ``(5) Expanding use of medicare data by qualified 
        entities.--
                    ``(A) In general.--Beginning January 1, 2014, 
                notwithstanding paragraph (4)(B) and the second 
                sentence of paragraph (4)(D), a qualified entity may--
                            ``(i) use data received by such entity 
                        under this section, and information derived 
                        from the evaluation described in paragraph 
                        (4)(D), for additional non-public analyses (as 
                        determined appropriate by the Secretary); or
                            ``(ii) subject to subparagraph (C), provide 
                        or sell such data and analyses to entities 
                        described in subparagraph (B) 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) Entities described.--The entities described 
                in this subparagraph are the following:
                            ``(i) A health care provider.
                            ``(ii) A health insurance issuer (as 
                        defined in section 2791 of the Public Health 
                        Service Act).
                            ``(iii) An employer (as defined in section 
                        3(5) of the Employee Retirement Insurance 
                        Security Act of 1974).
                            ``(iv) Any organization affiliated with or 
                        representing an entity described in clause (i), 
                        (ii), or (iii), such as a medical society.
                            ``(v) A public health authority (as defined 
                        for purposes of the Health Insurance 
                        Portability and Accountability Act of 1996).
                            ``(vi) A State or local government agency.
                            ``(vii) A research organization that 
                        certifies that it will only use the data or 
                        analyses for the public good and not for 
                        proprietary purposes.
                            ``(viii) Any other entity the Secretary 
                        determines appropriate to further the goals of 
                        this paragraph.
                    ``(C) Requirements.--
                            ``(i) Data use agreement.--A qualified 
                        entity may only provide data or analysis to an 
                        entity under subparagraph (A)(ii) pursuant to a 
                        data use agreement with the entity. Under such 
                        agreement, the entity--
                                    ``(I) may not re-sell such data or 
                                analyses; and
                                    ``(II) shall comply with the 
                                privacy and security policies of the 
                                qualified entity in using such data or 
                                analyses.
                            ``(ii) Civil money penalty.--
                                    ``(I) In general.--If the Secretary 
                                determines that an entity described in 
                                subparagraph (B) knowingly used such 
                                data and analyses for purposes other 
                                than as authorized under this 
                                paragraph, the entity shall be subject 
                                to a civil money penalty in an amount 
                                determined by the Secretary for each 
                                such violation.
                                    ``(II) Procedures.--The provisions 
                                of section 1128A (other than 
                                subsections (a) and (b) of such 
                                section) shall apply to a civil money 
                                penalty under subclause (I) in the same 
                                manner as such provisions apply to a 
                                penalty or proceeding under section 
                                1128A(a).''.
    (b) Access to Medicare Data to Qualified Clinical Data Registries 
To Facilitate Quality Improvement.--Section 1848(m)(3)(E) of the Social 
Security Act (42 U.S.C. 1395w-4(m)(3)(E)) is amended by adding at the 
end the following new clause:
                            ``(vi) Access to medicare data to 
                        facilitate quality improvement.--
                                    ``(I) In general.--Consistent with 
                                applicable laws and regulations with 
                                respect to privacy and other relevant 
                                matters, beginning January 1, 2014, the 
                                Secretary shall, subject to subclause 
                                (II), provide claims data under this 
                                title (in a form and manner determined 
                                to be appropriate) to qualified 
                                clinical data registries under this 
                                subparagraph for purposes of linking 
                                such data with clinical outcomes data 
                                and preforming and disseminating risk-
                                adjusted, scientifically valid research 
                                to support quality improvement.
                                    ``(II) Limitation.--A qualified 
                                clinical data registry may not publicly 
                                report any data made available under 
                                subclause (I) that individually 
                                identifies a provider of services or 
                                supplier unless the registry obtains 
                                the consent of the provider of services 
                                or supplier prior to such reporting.''.