I 

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. 

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 ‘‘Expanding the Avail5 ability of Medicare Data Act’’. 

6 SEC. 2. EXPANDING AVAILABILITY OF MEDICARE DATA. 

7 (a) EXPANDING USES OF MEDICARE DATA BY

8 QUALIFIED ENTITIES.— 

9 (1) ADDITIONAL ANALYSES.— 


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1 (A) IN GENERAL.—Subject to subpara2 graph (B), to the extent consistent with appli3 cable information, privacy, security, and disclo4 sure laws (including paragraph (3)), notwith5 standing paragraph (4)(B) of section 1874(e) of 

6 the Social Security Act (42 U.S.C. 1395kk(e)) 

7 and the second sentence of paragraph (4)(D) of 

8 such section, beginning July 1, 2015, a quali9 fied entity may use the combined data described 

10 in paragraph (4)(B)(iii) of such section received 

11 by such entity under such section, and informa12 tion derived from the evaluation described in 

13 such paragraph (4)(D), to conduct additional 

14 non-public analyses (as determined appropriate 

15 by the Secretary) and provide or sell such anal16 yses to authorized users for non-public use (in17 cluding for the purposes of assisting providers 

18 of services and suppliers to develop and partici19 pate in quality and patient care improvement 

20 activities, including developing new models of 

21 care). 

22 (B) LIMITATIONS WITH RESPECT TO ANAL23 YSES.— 

24 (i) EMPLOYERS.—Any analyses pro25 vided or sold under subparagraph (A) to 


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1 an employer described in paragraph 

2 (9)(A)(iii) may only be used by such em3 ployer for purposes of providing health in4 surance to employees and retirees of the 

5 employer. 

6 (ii) HEALTH INSURANCE ISSUERS.—A 

7 qualified entity may not provide or sell an 

8 analysis to a health insurance issuer de9 scribed in paragraph (9)(A)(iv) unless the 

10 issuer is providing the qualified entity with 

11 data under section 1874(e)(4)(B)(iii) of 

12 the Social Security Act (42 U.S.C. 

13 1395kk(e)(4)(B)(iii)). 

14 (2) ACCESS TO CERTAIN DATA.— 

15 (A) ACCESS.—To the extent consistent 

16 with applicable information, privacy, security, 

17 and disclosure laws (including paragraph (3)), 

18 notwithstanding paragraph (4)(B) of section 

19 1874(e) of the Social Security Act (42 U.S.C. 

20 1395kk(e)) and the second sentence of para21 graph (4)(D) of such section, beginning July 1, 

22 2015, a qualified entity may— 

23 (i) provide or sell the combined data 

24 described in paragraph (4)(B)(iii) of such 

25 section to authorized users described in 


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1 clauses (i), (ii), and (v) of paragraph 

2 (9)(A) for non-public use, including for the 

3 purposes described in subparagraph (B); 

4 or 

5 (ii) subject to subparagraph (C), pro6 vide Medicare claims data to authorized 

7 users described in clauses (i), (ii), and (v), 

8 of paragraph (9)(A) for non-public use, in9 cluding for the purposes described in sub10 paragraph (B). 

11 (B) PURPOSES DESCRIBED.—The purposes 

12 described in this subparagraph are assisting 

13 providers of services and suppliers in developing 

14 and participating in quality and patient care 

15 improvement activities, including developing 

16 new models of care. 

17 (C) MEDICARE CLAIMS DATA MUST BE

18 PROVIDED AT NO COST.—A qualified entity may 

19 not charge a fee for providing the data under 

20 subparagraph (A)(ii). 

21 (3) PROTECTION OF INFORMATION.— 

22 (A) IN GENERAL.—Except as provided in 

23 subparagraph (B), an analysis or data that is 

24 provided or sold under paragraph (1) or (2) 


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1 shall not contain information that individually 

2 identifies a patient. 

3 (B) INFORMATION ON PATIENTS OF THE

4 PROVIDER OF SERVICES OR SUPPLIER.—To the 

5 extent consistent with applicable information, 

6 privacy, security, and disclosure laws, an anal7 ysis or data that is provided or sold to a pro8 vider of services or supplier under paragraph 

9 (1) or (2) may contain information that individ10 ually identifies a patient of such provider or 

11 supplier, including with respect to items and 

12 services furnished to the patient by other pro13 viders of services or suppliers. 

14 (C) PROHIBITION ON USING ANALYSES OR

15 DATA FOR MARKETING PURPOSES.—An author16 ized user shall not use an analysis or data pro17 vided or sold under paragraph (1) or (2) for 

18 marketing purposes. 

19 (4) DATA USE AGREEMENT.—A qualified entity 

20 and an authorized user described in clauses (i), (ii), 

21 and (v) of paragraph (9)(A) shall enter into an 

22 agreement regarding the use of any data that the 

23 qualified entity is providing or selling to the author24 ized user under paragraph (2). Such agreement shall 

25 describe the requirements for privacy and security of 


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1 the data and, as determined appropriate by the Sec2 retary, any prohibitions on using such data to link 

3 to other individually identifiable sources of informa4 tion. If the authorized user is not a covered entity 

5 under the rules promulgated pursuant to the Health 

6 Insurance Portability and Accountability Act of 

7 1996, the agreement shall identify the relevant regu8 lations, as determined by the Secretary, that the 

9 user shall comply with as if it were acting in the ca10 pacity of such a covered entity. 

11 (5) NO REDISCLOSURE OF ANALYSES OR

12 DATA.— 

13 (A) IN GENERAL.—Except as provided in 

14 subparagraph (B), an authorized user that is 

15 provided or sold an analysis or data under 

16 paragraph (1) or (2) shall not redisclose or 

17 make public such analysis or data or any anal18 ysis using such data. 

19 (B) PERMITTED REDISCLOSURE.—A pro20 vider of services or supplier that is provided or 

21 sold an analysis or data under paragraph (1) or 

22 (2) may, as determined by the Secretary, redis23 close such analysis or data for the purposes of 

24 performance improvement and care coordination 


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1 activities but shall not make public such anal2 ysis or data or any analysis using such data. 

3 (6) OPPORTUNITY FOR PROVIDERS OF SERV4 ICES AND SUPPLIERS TO REVIEW.—Prior to a quali5 fied entity providing or selling an analysis to an au6 thorized user under paragraph (1), to the extent 

7 that such analysis would individually identify a pro8 vider of services or supplier who is not being pro9 vided or sold such analysis, such qualified entity 

10 shall provide such provider or supplier with the op11 portunity to appeal and correct errors in the manner 

12 described in section 1874(e)(4)(C)(ii) of the Social 

13 Security Act (42 U.S.C. 1395kk(e)(4)(C)(ii)). 

14 (7) ASSESSMENT FOR A BREACH.— 

15 (A) IN GENERAL.—In the case of a breach 

16 of a data use agreement under this section or 

17 section 1874(e) of the Social Security Act (42 

18 U.S.C. 1395kk(e)), the Secretary shall impose 

19 an assessment on the qualified entity both in 

20 the case of— 

21 (i) an agreement between the Sec22 retary and a qualified entity; and 

23 (ii) an agreement between a qualified 

24 entity and an authorized user. 


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1 (B) ASSESSMENT.—The assessment under 

2 subparagraph (A) shall be an amount up to 

3 $100 for each individual entitled to, or enrolled 

4 for, benefits under part A of title XVIII of the 

5 Social Security Act or enrolled for benefits 

6 under part B of such title— 

7 (i) in the case of an agreement de8 scribed in subparagraph (A)(i), for whom 

9 the Secretary provided data on to the 

10 qualified entity under paragraph (2); and 

11 (ii) in the case of an agreement de12 scribed in subparagraph (A)(ii), for whom 

13 the qualified entity provided data on to the 

14 authorized user under paragraph (2). 

15 (C) DEPOSIT OF AMOUNTS COLLECTED.— 

16 Any amounts collected pursuant to this para17 graph shall be deposited in Federal Supple18 mentary Medical Insurance Trust Fund under 

19 section 1841 of the Social Security Act (42 

20 U.S.C. 1395t). 

21 (8) ANNUAL REPORTS.—Any qualified entity 

22 that provides or sells an analysis or data under 

23 paragraph (1) or (2) shall annually submit to the 

24 Secretary a report that includes— 


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1 (A) a summary of the analyses provided or 

2 sold, including the number of such analyses, the 

3 number of purchasers of such analyses, and the 

4 total amount of fees received for such analyses; 

5 (B) a description of the topics and pur6 poses of such analyses; 

7 (C) information on the entities who re8 ceived the data under paragraph (2), the uses 

9 of the data, and the total amount of fees re10 ceived for providing, selling, or sharing the 

11 data; and 

12 (D) other information determined appro13 priate by the Secretary. 

14 (9) DEFINITIONS.—In this subsection and sub15 section (b): 

16 (A) AUTHORIZED USER.—The term ‘‘au17 thorized user’’ means the following: 

18 (i) A provider of services. 

19 (ii) A supplier. 

20 (iii) An employer (as defined in sec21 tion 3(5) of the Employee Retirement In22 surance Security Act of 1974). 

23 (iv) A health insurance issuer (as de24 fined in section 2791 of the Public Health 

25 Service Act). 


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1 (v) A medical society or hospital asso2 ciation. 

3 (vi) Any entity not described in 

4 clauses (i) through (v) that is approved by 

5 the Secretary (other than an employer or 

6 health insurance issuer not described in 

7 clauses (iii) and (iv), respectively, as deter8 mined by the Secretary). 

9 (B) PROVIDER OF SERVICES.—The term 

10 ‘‘provider of services’’ has the meaning given 

11 such term in section 1861(u) of the Social Se12 curity Act (42 U.S.C. 1395x(u)). 

13 (C) QUALIFIED ENTITY.—The term ‘‘quali14 fied entity’’ has the meaning given such term in 

15 section 1874(e)(2) of the Social Security Act 

16 (42 U.S.C. 1395kk(e)). 

17 (D) SECRETARY.—The term ‘‘Secretary’’ 

18 means the Secretary of Health and Human 

19 Services. 

20 (E) SUPPLIER.—The term ‘‘supplier’’ has 

21 the meaning given such term in section 1861(d) 

22 of the Social Security Act (42 U.S.C. 

23 1395x(d)). 


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1 (b) ACCESS TO MEDICARE DATA BY QUALIFIED

2 CLINICAL DATA REGISTRIES TO FACILITATE QUALITY

3 IMPROVEMENT.— 

4 (1) ACCESS.— 

5 (A) IN GENERAL.—To the extent con6 sistent with applicable information, privacy, se7 curity, and disclosure laws, beginning July 1, 

8 2015, the Secretary shall, at the request of a 

9 qualified clinical data registry under section 

10 1848(m)(3)(E) of the Social Security Act (42 

11 U.S.C. 1395w–4(m)(3)(E)), provide the data 

12 described in subparagraph (B) (in a form and 

13 manner determined to be appropriate) to such 

14 qualified clinical data registry for purposes of 

15 linking such data with clinical outcomes data 

16 and performing risk-adjusted, scientifically valid 

17 analyses and research to support quality im18 provement or patient safety, provided that any 

19 public reporting of such analyses or research 

20 that identifies a provider of services or supplier 

21 shall only be conducted with the opportunity of 

22 such provider or supplier to appeal and correct 

23 errors in the manner described in subsection 

24 (a)(6). 


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1 (B) DATA DESCRIBED.—The data de2 scribed in this subparagraph is— 

3 (i) claims data under the Medicare 

4 program under title XVIII of the Social 

5 Security Act; and 

6 (ii) if the Secretary determines appro7 priate, claims data under the Medicaid 

8 program under title XIX of such Act and 

9 the State Children’s Health Insurance Pro10 gram under title XXI of such Act. 

11 (2) FEE.—Data described in paragraph (1)(B) 

12 shall be provided to a qualified clinical data registry 

13 under paragraph (1) at a fee equal to the cost of 

14 providing such data. Any fee collected pursuant to 

15 the preceding sentence shall be deposited in the Cen16 ters for Medicare & Medicaid Services Program 

17 Management Account. 

18 (c) EXPANSION OF DATA AVAILABLE TO QUALIFIED

19 ENTITIES.—Section 1874(e) of the Social Security Act 

20 (42 U.S.C. 1395kk(e)) is amended— 

21 (1) in the subsection heading, by striking 

22 ‘‘MEDICARE’’; and 

23 (2) in paragraph (3)— 

24 (A) by inserting after the first sentence the 

25 following new sentence: ‘‘Beginning July 1, 


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1 2015, if the Secretary determines appropriate, 

2 the data described in this paragraph may also 

3 include standardized extracts (as determined by 

4 the Secretary) of claims data under titles XIX 

5 and XXI for assistance provided under such ti6 tles for one or more specified geographic areas 

7 and time periods requested by a qualified enti8 ty.’’; and 

9 (B) in the last sentence, by inserting ‘‘or 

10 under titles XIX or XXI’’ before the period at 

11 the end. 

12 (d) REVISION OF PLACEMENT OF FEES.—Section 

13 1874(e)(4)(A) of the Social Security Act (42 U.S.C. 

14 1395kk(e)(4)(A)) is amended, in the second sentence— 

15 (1) by inserting ‘‘, for periods prior to July 1, 

16 2015,’’ after ‘‘deposited’’; and 

17 (2) by inserting the following before the period 

18 at the end: ‘‘, and, beginning July 1, 2015, into the 

19 Centers for Medicare & Medicaid Services Program 

20 Management Account’’. 

Æ 


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