Expanding the Availability of Medicare Data Act

To amend title XVIII of the Social Security Act to increase access to Medicare data. 1. Short title This Act may be cited as the Expanding the Availability of Medicare Data Act 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) (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) (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 (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 (C) Qualified entity The term qualified entity (D) Secretary The term Secretary (E) Supplier The term supplier (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) (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) (1) in the subsection heading, by striking Medicare (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. (B) in the last sentence, by inserting or under titles XIX or XXI (d) Revision of placement of fees Section 1874(e)(4)(A) of the Social Security Act ( 42 U.S.C. 1395kk(e)(4)(A) (1) by inserting , for periods prior to July 1, 2015, deposited (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

Summary: 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).