II 

112TH CONGRESS 

1ST SESSION S. 848 

To provide for the development of reports based on Medicare data, data 

that is publicly available, or private data that is provided by a requesting 

entity in order to improve the quality and efficiency of health care. 

IN THE SENATE OF THE UNITED STATES 

APRIL 14, 2011 

Mr. CORNYN introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To provide for the development of reports based on Medicare 

data, data that is publicly available, or private data 

that is provided by a requesting entity in order to improve the quality and efficiency of health care. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘The Consumer Infor5 mation Enhancement Act of 2011’’. 

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1 SEC. 2. QUALITY AND EFFICIENCY REPORTS BASED ON 

2 MEDICARE ENROLLMENT, CLAIMS, SURVEY, 

3 AND ASSESSMENT DATA. 

4 Title XVIII of the Social Security Act is amended by 

5 adding at the end the following new section: 

6 ‘‘QUALITY AND EFFICIENCY REPORTS BASED ON

7 MEDICARE DATA

8 ‘‘SEC. 1899B. (a) PURPOSE.—The purpose of this 

9 section is to provide for the development of reports based 

10 on Medicare data, data that is publicly available, or pri11 vate data that is provided by a requesting entity (as de12 fined in subsection (e)(1)(A)) in order to— 

13 ‘‘(1) improve the quality and efficiency of 

14 health care; 

15 ‘‘(2) enhance the education and awareness of 

16 consumers for evaluating health care services; and 

17 ‘‘(3) provide the public with reports on national, 

18 regional, and provider- and supplier-specific per19 formance, which may be in a provider- or supplier20 identifiable format. 

21 ‘‘(b) PROCEDURES FOR THE DEVELOPMENT OF RE22 PORTS.— 

23 ‘‘(1) IN GENERAL.—Notwithstanding sections 

24 552(b)(6) and 552a(b) of title 5, United States 

25 Code, not later than 12 months after the date of en26 actment of this section, the Secretary, in accordance 

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1 with the purpose described in subsection (a) and the 

2 requirements described in subsection (d)(3), shall es3 tablish and implement procedures under which a re4 questing entity may submit an application to a Con5 sumer Information Organization for such Organiza6 tion to develop a report based on— 

7 ‘‘(A) Medicare data disclosed to the Orga8 nization under subsection (c); 

9 ‘‘(B) data, including clinical data when 

10 available, that is publicly available; and 

11 ‘‘(C) private data that is provided to the 

12 Organization by the requesting entity. 

13 ‘‘(2) DEFINITIONS.—In this section: 

14 ‘‘(A) MEDICARE DATA.—The term ‘Medi15 care data’ means— 

16 ‘‘(i) enrollment data under this title, 

17 including de-identified beneficiary enroll18 ment data; 

19 ‘‘(ii) all claims for reimbursement for 

20 all items and services furnished by a pro21 vider of services (as defined in section 

22 1861(u)) or a supplier (as defined in sec23 tion 1861(d)) under part A or B in a re24 search identifiable format; 

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1 ‘‘(iii) on and after January 1, 2011, 

2 all data relating to enrollment in, and cov3 erage for, qualified prescription drug cov4 erage under part D; and 

5 ‘‘(iv) additional data relating to the 

6 program under this title collected by the 

7 Secretary for the purpose of nationwide 

8 quality measurement and reporting based 

9 on surveys and assessment data deter10 mined appropriate by the Secretary. 

11 ‘‘(B) CONSUMER INFORMATION ORGANIZA12 TION.—The term ‘Consumer Information Orga13 nization’ means an entity with a contract under 

14 subsection (d). 

15 ‘‘(3) RULE OF CONSTRUCTION.—Nothing in 

16 this section shall be construed as authorizing or re17 quiring the Secretary to collect any additional infor18 mation or data that was not collected by the Sec19 retary prior to the date of enactment of this section. 

20 ‘‘(c) ACCESS TO MEDICARE DATA.— 

21 ‘‘(1) IN GENERAL.—The procedures established 

22 under subsection (b)(1) shall provide for the secure 

23 disclosure of Medicare data to each Consumer Infor24 mation Organization. 

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1 ‘‘(2) ALL DATA.—The Secretary shall ensure 

2 that all Medicare data (as described in subsection 

3 (b)(2)(A)), beginning with data from January 1, 

4 2005, is disclosed under paragraph (1), including 

5 the most recent data available to the Secretary. Not 

6 less than every 6 months, the Secretary shall update 

7 the Medicare data disclosed under paragraph (1) to 

8 each Consumer Information Organization. 

9 ‘‘(d) CONSUMER INFORMATION ORGANIZATIONS.— 

10 ‘‘(1) IN GENERAL.— 

11 ‘‘(A) CONTRACTS WITH PRIVATE ENTI12 TIES.—Subject to subparagraph (B), the Sec13 retary shall enter into a contract with 3 private 

14 entities, as well as any State described in sub15 paragraph (C)(i), to serve as Consumer Infor16 mation Organizations, under which each such 

17 entity or State shall— 

18 ‘‘(i) store the Medicare data that is to 

19 be disclosed under subsection (c); and 

20 ‘‘(ii) develop and release reports pur21 suant to subsection (e). 

22 ‘‘(B) ADDITIONAL CONTRACTS WITH PRI23 VATE ENTITIES.—If the Secretary determines 

24 that reports are not being developed and re25 leased within 6 months of the receipt of the remstockstill on DSKH9S0YB1PROD with BILLS

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1 quest for the report, the Secretary shall enter 

2 into contracts with additional private entities in 

3 order to ensure that such reports are developed 

4 and released in a timely manner. 

5 ‘‘(C) CONTRACTS WITH STATES.— 

6 ‘‘(i) IN GENERAL.—At the request of 

7 a State, the Secretary shall enter into a 

8 contract with such State to serve as a Con9 sumer Information Organization. 

10 ‘‘(ii) EXISTING DATA USE AGREE11 MENTS.—Nothing in this section shall be 

12 construed to preempt, modify, or otherwise 

13 affect any data use agreement relating to 

14 Medicare patient-level data that has been 

15 entered into by the Secretary and a State 

16 prior to the date of enactment of this sec17 tion. 

18 ‘‘(2) QUALIFICATIONS.—The Secretary shall 

19 enter into a contract with a private entity or a State 

20 under paragraph (1) only if the Secretary deter21 mines that such entity or State— 

22 ‘‘(A) has the research capability to conduct 

23 and complete reports under this section; 

24 ‘‘(B) has in place– 

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1 ‘‘(i) an information technology infra2 structure to support the entire database of 

3 Medicare data; and 

4 ‘‘(ii) operational standards to provide 

5 security for such database; 

6 ‘‘(C) has experience with, and expertise on, 

7 the development of reports on health care qual8 ity and efficiency based on Medicare or private 

9 sector claims data; 

10 ‘‘(D) is incorporated in the United States; 

11 ‘‘(E) has provided sufficient assurances 

12 that any data provided to such entity or State 

13 under this section shall not be made accessible 

14 to any individual or entity residing outside of 

15 the United States; and 

16 ‘‘(F) has demonstrated the ability to sat17 isfy the requirements described in paragraph 

18 (3). 

19 ‘‘(3) CONFIDENTIALITY AND PRIVACY REQUIRE20 MENTS.—The Secretary shall issue such regulations 

21 and include in each contract described in paragraph 

22 (1) such terms as are necessary to ensure that each 

23 private entity or State meets the following require24 ments: 

25 ‘‘(A) ENSURING BENEFICIARY PRIVACY.— 

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1 ‘‘(i) HIPAA.—The entity or State 

2 shall meet the requirements imposed on a 

3 covered entity for purposes of applying 

4 part C of title XI and all regulatory provi5 sions promulgated thereunder, including 

6 regulations (relating to privacy) adopted 

7 pursuant to the authority of the Secretary 

8 under section 264(c) of the Health Insur9 ance Portability and Accountability Act of 

10 1996 (42 U.S.C. 1320d–2 note). 

11 ‘‘(ii) PRIVACY.—The entity or State 

12 shall provide assurances that such entity 

13 or State will not use the Medicare data 

14 disclosed under subsection (c) in a manner 

15 that violates sections 552 or 552a of title 

16 5, United States Code, with regard to the 

17 privacy of individually identifiable bene18 ficiary health information. 

19 ‘‘(B) PROPRIETARY INFORMATION.—The 

20 entity or State shall not disclose any trade se21 crets, commercial or financial information, or 

22 pricing data that is identifiable to a particular 

23 entity, including— 

24 ‘‘(i) part D negotiated price conces25 sions, such as discounts, direct or indirect 

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1 subsidies, rebates, and direct or indirect 

2 remunerations, obtained by prescription 

3 drug plans and MA–PD plans for covered 

4 part D drugs; 

5 ‘‘(ii) pricing information between a 

6 Medicare Advantage Organization and any 

7 provider, supplier, contractor, or subcon8 tractor; and 

9 ‘‘(iii) any other proprietary cost infor10 mation. 

11 ‘‘(C) PROTECTION OF INFORMATION.—The 

12 entity or State shall use Medicare data dis13 closed under subsection (c) solely for the pur14 poses described in this section. Nothing in this 

15 section shall be construed to limit the require16 ments imposed on such entity or State by sec17 tion 1905 of title 18, United States Code, or 

18 pursuant to the public disclosure protections 

19 provided under section 552(b) of title 5, United 

20 States Code. 

21 ‘‘(D) DISCLOSURE.—The entity or State 

22 shall disclose— 

23 ‘‘(i) any financial, reporting, or con24 tractual relationship between such entity or 

25 State and any provider of services (as demstockstill on DSKH9S0YB1PROD with BILLS

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1 fined in section 1861(u)) or supplier (as 

2 defined in section 1861(d)); and 

3 ‘‘(ii) if applicable, the fact that the 

4 entity is managed, controlled, or operated 

5 by any such provider of services or sup6 plier. 

7 ‘‘(E) COMPONENT OF ANOTHER ORGANIZA8 TION.—If an entity is a component of another 

9 organization, such entity— 

10 ‘‘(i) shall maintain Medicare data and 

11 reports separately from the rest of the or12 ganization and establish appropriate secu13 rity measures to maintain the confiden14 tiality and privacy of the Medicare data 

15 and reports; and 

16 ‘‘(ii) shall not make an unauthorized 

17 disclosure to the rest of the organization of 

18 Medicare data or reports in breach of such 

19 confidentiality and privacy requirement. 

20 ‘‘(F) TERMINATION OR NONRENEWAL.—If 

21 a contract under this section is terminated or 

22 not renewed, the following requirements shall 

23 apply: 

24 ‘‘(i) CONFIDENTIALITY AND PRIVACY

25 PROTECTIONS.—The entity or State shall 

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1 continue to comply with the confidentiality 

2 and privacy requirements under this sec3 tion with respect to all Medicare data dis4 closed to such entity or State and each re5 port developed by such entity or State. 

6 ‘‘(ii) DISPOSITION OF DATA AND RE7 PORTS.—The entity or State shall— 

8 ‘‘(I) return to the Secretary all 

9 Medicare data disclosed to such entity 

10 or State and each report developed by 

11 such entity or State; or 

12 ‘‘(II) if returning the Medicare 

13 data and reports is not practicable, 

14 destroy such data and reports. 

15 ‘‘(4) COMPETITIVE PROCEDURES.—Competitive 

16 procedures (as defined in section 4(5) of the Federal 

17 Procurement Policy Act) shall be used to enter into 

18 contracts with private entities under subparagraphs 

19 (A) or (B) of paragraph (1). 

20 ‘‘(5) REVIEW OF CONTRACT IN THE EVENT OF

21 A MERGER OR ACQUISITION.—For purposes of con22 tracts described under subparagraphs (A) and (B) of 

23 paragraph (1), the Secretary shall review the con24 tract with a Consumer Information Organization 

25 under this section in the event of a merger or acquimstockstill on DSKH9S0YB1PROD with BILLS

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1 sition of the Organization in order to ensure that the 

2 requirements under this section will continue to be 

3 met. 

4 ‘‘(e) DEVELOPMENT AND RELEASE OF REPORTS

5 BASED ON REQUESTS.— 

6 ‘‘(1) REQUEST FOR A REPORT.— 

7 ‘‘(A) REQUESTING ENTITY.—The term ‘re8 questing entity’ means an individual, group, or 

9 State that has submitted a request to a Con10 sumer Information Organization for develop11 ment of a report based upon Medicare data dis12 closed to such Organization under subsection 

13 (c), data that is publicly available, or private 

14 data that is provided by the requesting entity. 

15 ‘‘(B) REQUEST.— 

16 ‘‘(i) IN GENERAL.—Subject to the 

17 purpose described in subsection (a), the 

18 procedures established under subsection 

19 (b)(1) shall include a process for a request20 ing entity to submit an application to a 

21 Consumer Information Organization for 

22 development of a report. 

23 ‘‘(ii) REQUEST FOR SPECIFIC METH24 ODOLOGY.—The process described in 

25 clause (i) shall permit a requesting entity 

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1 to request that a specific methodology, in2 cluding appropriate risk-adjustment, be 

3 used by the Consumer Information Organi4 zation in developing the report. The Orga5 nization shall work with the requesting en6 tity to finalize the methodology to be used. 

7 ‘‘(iii) REQUEST FOR A SPECIFIC CON8 SUMER INFORMATION ORGANIZATION.— 

9 The process described in clause (i) shall 

10 permit a requesting entity to submit an ap11 plication for a report to any Consumer In12 formation Organization. 

13 ‘‘(C) RELEASE TO PUBLIC.—The proce14 dures established under subsection (b)(1) shall 

15 provide that at the time an application for a re16 port is finalized under subparagraph (A) by a 

17 Consumer Information Organization, the Orga18 nization shall make available to the public, 

19 through the Internet Web site of the Centers 

20 for Medicare & Medicaid Services and other ap21 propriate means, a brief description of both the 

22 requested report and the methodology to be 

23 used to develop such report. 

24 ‘‘(D) RIGHT OF APPEAL.—The Secretary 

25 shall promulgate regulations establishing a 

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1 right of appeal and appeals process with respect 

2 to the denial of a request for development of a 

3 report by a Consumer Information Organiza4 tion, under which the requesting entity may ap5 peal the decision of the Organization. 

6 ‘‘(2) DEVELOPMENT AND RELEASE OF RE7 PORT.— 

8 ‘‘(A) DEVELOPMENT.— 

9 ‘‘(i) IN GENERAL.—Subject to clauses 

10 (ii) and (iii), if an application for a report 

11 complies with the purpose described in 

12 subsection (a), the Consumer Information 

13 Organization may develop the report based 

14 upon such application. 

15 ‘‘(ii) STANDARDS AND METHOD16 OLOGY.—A report developed under clause 

17 (i) shall include a detailed description of 

18 the standards, methodologies, and meas19 ures of quality used in developing the re20 port. 

21 ‘‘(iii) CONSULTATION REQUIRE22 MENT.—For purposes of developing a re23 port under clause (i), the Consumer Infor24 mation Organization shall consult with rel25 evant national professional organizations 

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1 (as determined appropriate based upon the 

2 content of the report) and include in the 

3 report a summary of any comments or 

4 feedback provided by such organizations. 

5 ‘‘(B) REVIEW OF REPORT BY SECRETARY

6 TO ENSURE COMPLIANCE WITH PRIVACY RE7 QUIREMENT.—Prior to release of a report by a 

8 Consumer Information Organization under sub9 paragraph (C), the Secretary shall review the 

10 report to ensure that the report complies with 

11 the Federal regulations (concerning the privacy 

12 of individually identifiable beneficiary health in13 formation) promulgated under section 264(c) of 

14 the Health Insurance Portability and Account15 ability Act of 1996 and sections 552 or 552a of 

16 title 5, United States Code, with regard to the 

17 privacy of individually identifiable beneficiary 

18 health information, as well as any requirements 

19 described in subsection (d)(3) regarding use 

20 and protection of data disclosed to the Organi21 zation. The Secretary shall act within 30 busi22 ness days of receiving such report. 

23 ‘‘(C) RELEASE OF REPORT.— 

24 ‘‘(i) RELEASE TO ENTITY MAKING RE25 QUEST.—If the Secretary finds that the remstockstill on DSKH9S0YB1PROD with BILLS

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1 port complies with the provisions described 

2 in subparagraph (B), the Consumer Infor3 mation Organization shall release the re4 port to the requesting entity. 

5 ‘‘(ii) RELEASE TO PUBLIC.—The pro6 cedures established under subsection (b)(1) 

7 shall provide for the following: 

8 ‘‘(I) UPDATED DESCRIPTION.— 

9 At the time of the release of a report 

10 by a Consumer Information Organiza11 tion under clause (i), the requesting 

12 entity shall make available to the pub13 lic, through the Internet Web site of 

14 the Centers for Medicare & Medicaid 

15 Services and other appropriate means, 

16 an updated brief description of both 

17 the requested report and the method18 ology used to develop such report. 

19 ‘‘(II) COMPLETE REPORT.—Sub20 ject to clause (iii), not later than 1 

21 year after the date of the release of a 

22 report under clause (i), the report 

23 shall be made available to the public 

24 through the Internet Web site of the 

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1 Centers for Medicare & Medicaid 

2 Services and other appropriate means. 

3 ‘‘(iii) PUBLIC COMMENT.—The Sec4 retary shall establish a process that pro5 vides an opportunity for public comment, 

6 for a period of not less than 90 days, fol7 lowing the release of the report to the pub8 lic under clause (ii)(II), with any public 

9 comments received to be included with the 

10 report on the Internet Web site of the Cen11 ters for Medicare & Medicaid Services. 

12 ‘‘(f) ANNUAL REVIEW OF REPORTS AND TERMI13 NATION OF CONTRACTS.— 

14 ‘‘(1) ANNUAL REVIEW OF REPORTS.—The 

15 Comptroller General of the United States shall— 

16 ‘‘(A) review reports released under sub17 section (e)(2)(C) to ensure that such reports 

18 comply with the purpose described in subsection 

19 (a); 

20 ‘‘(B) review whether such reports result in 

21 limitations on patient access to health care 

22 services; and 

23 ‘‘(C) annually submit a report to the Sec24 retary on such review. 

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1 ‘‘(2) TERMINATION OF CONTRACTS.—The Sec2 retary may terminate a contract with a Consumer 

3 Information Organization if the Secretary deter4 mines that there is a pattern of reports being re5 leased by the Organization that do not comply with 

6 the purpose described in subsection (a). 

7 ‘‘(g) FEES.— 

8 ‘‘(1) FEES FOR SECRETARY.— 

9 ‘‘(A) IN GENERAL.—Subject to subpara10 graph (B), the Secretary shall charge each Con11 sumer Information Organization a fee that is 

12 sufficient to cover costs incurred by the Sec13 retary in regard to— 

14 ‘‘(i) disclosure of Medicare data under 

15 subsection (c); and 

16 ‘‘(ii) conducting the review under sub17 section (e)(2)(B). 

18 ‘‘(B) COMPARABLE TO FEES CHARGED FOR

19 EXISTING DATA USE AGREEMENTS.—For pur20 poses of the fees described in subparagraph (A), 

21 such fees shall be reasonably comparable to fees 

22 charged by the Secretary in relation to data use 

23 agreements described in subsection 

24 (d)(1)(C)(ii). 

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1 ‘‘(2) FEES FOR CONSUMER INFORMATION OR2 GANIZATION.— 

3 ‘‘(A) IN GENERAL.—Subject to subpara4 graphs (B) and (C), a Consumer Information 

5 Organization may charge a requesting entity a 

6 reasonable fee for the development and release 

7 of the report. 

8 ‘‘(B) DISCOUNT FOR SMALL ENTITIES.—In 

9 the case of a requesting entity (including a not10 for-profit organization) that has annual revenue 

11 that does not exceed $10,000,000, the Con12 sumer Information Organization shall reduce 

13 the reasonable fee charged to such entity under 

14 subparagraph (A) by an amount equal to 10 

15 percent of such fee. 

16 ‘‘(C) INCREASE FOR LARGE ENTITIES

17 THAT DO NOT AGREE TO RELEASE REPORTS

18 WITHIN 6 MONTHS.—In the case of a requesting 

19 entity that is not described in subparagraph (B) 

20 and that does not agree to the report being re21 leased to the public under clause (ii)(II) of sub22 section (e)(2)(C) within 6 months of the date of 

23 the release of the report to the entity under 

24 clause (i) of such subsection, the Consumer In25 formation Organization shall increase the fee 

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1 charged to such entity under subparagraph (A) 

2 by an amount equal to 10 percent of such fee. 

3 ‘‘(D) RULE OF CONSTRUCTION.—Nothing 

4 in this paragraph shall be construed to effect 

5 the requirement that a report be released to the 

6 public under clause (ii)(II) of subsection 

7 (e)(2)(C) by not later than 1 year after the date 

8 of the release of the report to the requesting en9 tity under clause (i) of such subsection. 

10 ‘‘(h) REGULATIONS.—Not later than 6 months after 

11 the date of enactment of this section, the Secretary shall, 

12 after providing notice and comment opportunities to the 

13 public, prescribe regulations to carry out this section, in14 cluding such regulations as are necessary to carry out the 

15 confidentiality and privacy requirements described in sub16 section (d)(3).’’. 

17 SEC. 3. RESEARCH ACCESS TO MEDICARE DATA AND RE18 PORTING ON PERFORMANCE. 

19 (a) IN GENERAL.—The Secretary of Health and 

20 Human Services shall permit researchers that meet cri21 teria used to ensure the appropriateness of the release of 

22 Centers for Medicare & Medicaid Services data for re23 search purposes to— 

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1 (1) have access to all Medicare data (as defined 

2 in section 1899B(b)(2)(A) of the Social Security 

3 Act, as added by section 2); and 

4 (2) report on the performance of providers of 

5 services (as defined in subsection (u) of section 1861 

6 of such Act) and suppliers (as defined in subsection 

7 (d) of such section), including reporting in a 

8 provider- or supplier-identifiable format. 

9 (b) CONFIDENTIALITY AND PRIVACY REQUIRE10 MENTS.—For purposes of disclosing any information or 

11 data to a researcher under this section, the Secretary of 

12 Health and Human Services shall ensure that the con13 fidentiality and privacy requirements described in sub14 paragraphs (A) through (C) of section 1899B(d)(3) of the 

15 Social Security Act are applied to such researcher in the 

16 same manner as such requirements are applied to a pri17 vate entity or State under such subparagraphs. 

Æ 

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