FACTS Act of 2017

To amend title XVIII of the Social Security Act to provide prescription drug plans under part D of the Medicare program with parts A and B Medicare claims data to promote the appropriate use of medications and improve health outcomes. 1. Short title This Act may be cited as the Furthering Access to Coordinated Treatment for Seniors Act of 2017 FACTS Act of 2017 2. Providing prescription drug plans with parts A and B claims data to promote the appropriate use of medications and improve health outcomes Section 1860D–4(c) of the Social Security Act ( 42 U.S.C. 1395w–104(c) (7) Providing prescription drug plans with parts A and B claims data to promote the appropriate use of medications and improve health outcomes (A) Process Subject to subparagraph (C), the Secretary shall establish a process under which a PDP sponsor of a prescription drug plan may submit a request for the Secretary to provide the sponsor, on a periodic basis and in an electronic format, beginning in plan year 2020, data described in subparagraph (D) with respect to enrollees in such plan. Such data shall be provided without regard to whether such enrollees are described in clause (ii) of paragraph (2)(A). (B) Purposes A PDP sponsor may use the data provided to the sponsor pursuant to subparagraph (A) for any of the following purposes: (i) To optimize therapeutic outcomes through improved medication use, as such phrase is used in clause (i) of paragraph (2)(A). (ii) To improve care coordination so as to prevent adverse health outcomes, such as preventable emergency department visits and hospital readmissions. (iii) For any other purpose determined appropriate by the Secretary. (C) Limitations on data use A PDP sponsor shall not use data provided to the sponsor pursuant to subparagraph (A) for any of the following purposes: (i) To inform coverage determinations under this part. (ii) To conduct retroactive reviews of medically accepted indications determinations. (iii) To direct enrollment changes to a different prescription drug plan or an MA–PD plan offered by the same parent organization. (iv) To inform marketing of benefits. (v) For any other purpose that the Secretary determines is necessary to include in order to protect the identity of individuals entitled to, or enrolled for, benefits under this title and to protect the security of personal health information. (D) Data described The data described in this subparagraph are standardized extracts (as determined by the Secretary) of claims data under parts A and B for items and services furnished under such parts for time periods specified by the Secretary. Such data shall include data as current as practicable. .

Summary: Furthering Access to Coordinated Treatment for Seniors Act of 2017 or the FACTS Act of 2017 This bill amends title XVIII (Medicare) of the Social Security Act to allow Medicare prescription drug plan (PDP) sponsors to access certain Medicare claims data. Specifically, the Centers for Medicare & Medicaid Services (CMS) must establish a process for PDP sponsors to request, beginning in plan year 2020, standardized extracts of claims data for Medicare hospital and medical services. PDP sponsors may use such data: (1) to optimize therapeutic outcomes through improved medication use, (2) to improve care coordination so as to prevent adverse health outcomes, or (3) for any other purpose determined appropriate by the CMS. PDP sponsors may not, however, use such data: (1) to inform coverage determinations; (2) to conduct retroactive reviews of medically accepted indications determinations; (3) to direct enrollment changes; (4) to inform marketing of benefits; or (5) for certain other purposes affecting the security of personal health information, as determined by the CMS.