I 
116TH CONGRESS 
2D SESSION 
H. R. 8967 
To require the Secretary of Health and Human Services to award a contract 
to an eligible nonprofit entity to establish and maintain a health care 
claims database for purposes of lowering Americans’ health care costs, 
and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 15, 2020 
Mr. BEYER introduced the following bill; which was referred to the Committee 
on Energy and Commerce, and in addition to the Committees on Ways 
and Means, Oversight and Reform, Armed Services, and Education and 
Labor, for a period to be subsequently determined by the Speaker, in 
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned 
A BILL 
To require the Secretary of Health and Human Services 
to award a contract to an eligible nonprofit entity to 
establish and maintain a health care claims database 
for purposes of lowering Americans’ health care costs, 
and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Federal All-Payer 
Claims Database Act of 2020’’. 
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SEC. 2. ESTABLISHMENT AND MAINTENANCE OF HEALTH 
CARE CLAIMS DATABASE TO LOWER HEALTH 
CARE COSTS. 
(a) IN GENERAL.—Not later than the date that is 
180 days after the date of the enactment of this Act, the 
Secretary of Health and Human Services (referred to in 
this section as the ‘‘Secretary’’), acting through the Ad-
ministrator of the Centers for Medicare & Medicaid Serv-
ices and in consultation with the Secretary of Labor, shall 
award a contract in accordance with subsection (b) to an 
eligible nonprofit entity described in such subsection for 
purposes of carrying out the requirements of such entity 
under this section. 
(b) CONTRACT WITH ELIGIBLE NONPROFIT ENTI-
TY.— 
(1) COMPETITIVE
PROCEDURES.—The Sec-
retary shall award the contract described in sub-
section (a) to an eligible nonprofit entity described 
in paragraph (2) using full and open competition 
procedures pursuant to chapter 33 of title 41, 
United States Code. 
(2) ELIGIBLE NONPROFIT ENTITY.—An eligible 
nonprofit entity described in this paragraph is a 
nonprofit entity that— 
(A) is governed by a board that includes— 
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(i) representatives of the academic re-
search community; and 
(ii) individuals with expertise in em-
ployer-sponsored insurance, research using 
health care claims data, and actuarial 
analysis; and 
(B) conducts its business in an open and 
transparent manner that provides the oppor-
tunity for public comment on its activities. 
(3) CONSIDERATIONS.—In awarding a contract 
to an eligible nonprofit entity under this section, the 
Secretary shall consider the experience of each eligi-
ble nonprofit entity in— 
(A) collecting and aggregating health care 
claims data, ensuring quality assurance and se-
curity of such claims data, and securing such 
claims data; 
(B) supporting academic research on 
health care costs, spending, and utilization for 
and by privately insured patients; 
(C) working with large health insurance 
issuers, group health plans, and third-party ad-
ministrators of group health plans to assemble 
a health care claims database; 
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(D) effectively collaborating with and en-
gaging stakeholders to develop reports; 
(E) meeting budgets and timelines, includ-
ing with respect to developing reports; and 
(F) facilitating the creation of, or sup-
porting, State all-payer claims databases. 
(4) PERIOD OF CONTRACT.— 
(A) IN
GENERAL.—A contract awarded 
under this section shall be for a period of 5 
years and may be renewed, subject to the full 
and open competition procedures described in 
paragraph (1). 
(B) TRANSITION
OF
CONTRACT.—In the 
case that a contract is not renewed for a subse-
quent 5-year period under subparagraph (A) 
after the use of the full and open competition 
procedures described in paragraph (1), the Sec-
retary shall require the entity whose contract is 
expiring to transfer all data maintained by the 
health care claims database described in para-
graph (5)(A) to the entity to whom the Sec-
retary has awarded a contract for the subse-
quent 5-year period. The entity whose contract 
is expiring may not disclose such data to any 
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other entity or keep such data after the expira-
tion of such contract. 
(5) REQUIREMENTS OF CONTRACT.—Each con-
tract awarded under this section shall require the 
entity awarded such contract to carry out each of 
the following: 
(A) Establish and maintain a health care 
claims database in accordance with the require-
ments of the HIPAA privacy regulation. 
(B) Ensure that such health care claims 
database makes available data submitted under 
subsection (d) in accordance with the require-
ments of subsection (c). 
(C) In the case that the contract is not re-
newed after the end of the 5-year period of the 
contract, carry out the transfer of data required 
pursuant to paragraph (4)(B) in accordance 
with a schedule and process determined by the 
Secretary. 
(D) Comply with the HIPAA privacy regu-
lation in the same manner and to the same ex-
tent as such regulation applies to a covered en-
tity (as defined pursuant to such regulation). 
(E) Strictly limit staff access to such 
health care claims database to staff with appro-
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priate training, clearance, and background 
checks, and require such staff to undergo reg-
ular privacy and security training. 
(F) Maintain effective security standards 
for transferring data from such health care 
claims database and making such data available 
to all individuals and entities who are author-
ized users pursuant to subsection (c)(2). 
(G) Adhere to best security practices with 
respect to the management and use of such 
data for health services research, in accordance 
with applicable Federal privacy law. 
(H) Report on the security methods of the 
entity to— 
(i) the Secretary; 
(ii) the Committee on Health, Edu-
cation, Labor, and Pensions, the Com-
mittee on Finance, and the Committee on 
Commerce, Science, and Transportation of 
the Senate; and 
(iii) the Committee on Education and 
Labor, the Committee on Energy and 
Commerce, the Committee on the Judici-
ary, and the Committee on Ways and 
Means of the House of Representatives. 
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(c) AVAILABILITY OF DATA FROM HEALTH CARE 
CLAIMS DATABASE.— 
(1) IN GENERAL.—Subject to paragraph (2), 
the entity maintaining the health care claims data-
base described in subsection (b)(5)(A) shall make 
available, at cost, the data submitted under sub-
section (d)— 
(A) to patients to inform such patients 
about the cost, quality, and value of their 
health care; 
(B) to health care providers and hos-
pitals— 
(i) to assist such providers and hos-
pitals in making informed choices while 
providing health care; and 
(ii) to enable such providers and hos-
pitals to improve health care services pro-
vided to patients and health care outcomes 
for such patients by benchmarking their 
performance against that of other health 
care providers and hospitals; 
(C) to group health plans and health insur-
ance issuers offering individual or group health 
insurance coverage to assist such group health 
plans and health insurance issuers in evaluating 
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and reducing health care costs for enrollees of 
such group health plans and individual or group 
health insurance coverage, respectively; 
(D) to States to facilitate State-led initia-
tives to lower health care costs and improve the 
quality of health care; 
(E) to any State all-payer claims database 
and regional health care claims database oper-
ated pursuant to the authorization of each 
State covered by such regional health care 
claims database; 
(F) to any individual or entity conducting 
research; 
(G) to the Secretary of Defense for pur-
poses of carrying out the TRICARE program 
under chapter 55 of title 10, United States 
Code; 
(H) to the Director of the Office of Per-
sonnel Management for purposes of carrying 
out the Federal Employees Health Benefits 
Program established under chapter 89 of title 
5, United States Code; and 
(I) to the Director of the Congressional 
Budget Office, the Comptroller General of the 
United States, the Executive Director of the 
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Medicare Payment Advisory Commission, and 
the Executive Director of the Medicaid and 
CHIP Payment Advisory Commission. 
(2) AUTHORIZATION FOR ACCESS TO DATA.— 
(A) IN GENERAL.—The entity maintaining 
the health care claims database described in 
subsection (b)(5)(A) may only make available 
the data described in paragraph (1) to an indi-
vidual or entity described in any of subpara-
graphs (A) through (F) of such paragraph if 
such individual or entity submits an application 
to such entity requesting authorization for ac-
cess to such database in accordance with this 
paragraph. 
(B) APPLICATION.—An application under 
this paragraph shall be submitted at such time, 
in such manner, and containing such informa-
tion as the Secretary may require and shall in-
clude— 
(i) in the case of an individual or enti-
ty requesting access to the health care 
claims database described in subsection 
(b)(5)(A) for research purposes— 
(I) a description of the uses and 
methodologies for evaluating health 
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system performance using the data 
from such database; and 
(II) documentation of approval of 
such research purposes by an institu-
tional review board, if applicable for a 
particular plan of research; and 
(ii) in the case of a group health plan, 
health insurance issuer, third-party admin-
istrator of a group health plan, or health 
care provider requesting access to such 
health care claims database for the pur-
pose of quality improvement or cost-con-
tainment, a description of the intended 
uses for the data from such database. 
(C) DATA
USE
AND
CONFIDENTIALITY 
AGREEMENT.—Upon approval of an application 
under subparagraph (B), the authorized user 
shall enter into a data use and confidentiality 
agreement with the entity that approved such 
application, which shall include a prohibition on 
attempts to reidentify and disclose protected 
health information and proprietary financial in-
formation. In the case of an approval of an ap-
plication for quality improvement or cost-con-
tainment purposes under subparagraph (B)(ii), 
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access to data from the health care claims data-
base described in subsection (b)(5)(A) shall be 
provided in a form and manner such that the 
authorized user may not obtain individually 
identifiable price information with respect to di-
rect competitors. 
(3) AVAILABILITY OF REPORTS AND ANALYSES 
BASED ON DATA.— 
(A) IN
GENERAL.—Subject to subpara-
graph (B), the entity maintaining the health 
care claims database described in subsection 
(b)(5)(A), in consultation with the advisory 
committee convened under subsection (e), shall 
make available to all individuals and entities 
who are authorized users pursuant to para-
graph (2) any report or analysis based on data 
from such database, including aggregate data 
sets, free of charge. 
(B) CUSTOMIZED REPORTS.—Group health 
plans may request customized reports from the 
entity maintaining the health care claims data-
base described in subsection (b)(5)(A), at cost, 
but subject to the requirements of the HIPPA 
privacy regulation. 
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(d) SUBMISSION OF DATA TO HEALTH CARE CLAIMS 
DATABASE.— 
(1) IN GENERAL.—Subject to paragraphs (2) 
and (3), a group health plan (through its sponsor, 
third-party administrator, pharmacy benefit man-
ager, or other entity designated by the group health 
plan) or a health insurance issuer offering group or 
individual health insurance coverage shall electroni-
cally submit to the health care claims database 
maintained under this section all claims data (in-
cluding claims with respect to treatment of sub-
stance use disorders and prescription drug claims) 
with respect to the plan or group or individual 
health insurance coverage, respectively. 
(2) SCOPE OF INFORMATION AND FORMAT OF 
SUBMISSION.—The entity maintaining the health 
care claims database under this section, in consulta-
tion with the advisory committee convened under 
subsection (e), shall— 
(A) specify the data elements required to 
be submitted under paragraph (1), which shall 
include all data related to transactions de-
scribed in subparagraphs (A) and (E) of section 
1173(a)(2) of the Social Security Act (42 
U.S.C. 1320d–2(a)(2)), including all data ele-
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ments normally present in such transactions 
when adjudicated, and enrollment information; 
(B) specify the form and manner for sub-
missions under this subsection and the histor-
ical period to be included in the initial submis-
sion; and 
(C) offer an automated submission option 
to minimize administrative burdens relating to 
the submission of data under this subsection. 
(3) DE-IDENTIFICATION OF DATA.—The entity 
maintaining the health care claims database under 
this section, in consultation with the advisory com-
mittee convened under subsection (e), shall— 
(A) establish a process under which data is 
de-identified 
in 
accordance 
with 
section 
164.514(a) of title 45, Code of Federal Regula-
tions (or any successor regulations), while re-
taining the ability to link data longitudinally for 
the purposes of research on cost and quality 
and the ability to complete risk adjustment and 
geographic analysis; 
(B) ensure that any third-party sub-
contractors who perform the de-identification 
process described in subparagraph (A) retain 
the minimum necessary information to perform 
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such process and adhere to effective security 
and encryption practices in data storage and 
transmission; 
(C) store claims and other data collected 
under this subsection only in de-identified form, 
in accordance with section 164.514(a) of title 
45, Code of Federal Regulations (or any suc-
cessor regulations); and 
(D) ensure that data is encrypted, in ac-
cordance with the HIPAA privacy regulation. 
(4) OTHER DATA.— 
(A) MEDICAID DATA.—The Administrator 
of the Centers for Medicare & Medicaid Serv-
ices shall submit all health care claims data 
with respect to the Medicare program under 
title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.) and the Medicaid program 
under title XIX of such Act (42 U.S.C. 1396 et 
seq.) in accordance with scope, format, and de- 
identification requirements applicable pursuant 
to paragraphs (2) and (3). 
(B) TRICARE.—The Secretary of Defense 
shall submit all health care claims data with re-
spect to the TRICARE program under chapter 
55 of title 10, United States Code, in accord-
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ance with scope, format, and de-identification 
requirements applicable pursuant to paragraphs 
(2) and (3). 
(C) FEHB.—The Director of the Office of 
Personnel Management shall submit all health 
care claims data with respect to the Federal 
Employee Health Benefits program in accord-
ance with scope, format, and de-identification 
requirements applicable pursuant to paragraphs 
(2) and (3). 
(D) STATE DATA.—The entity maintaining 
the health care claims database under this sec-
tion may collect data from State all-payer 
claims databases that seek access to such health 
care claims database. A State may require 
health insurance issuers and other payers to 
submit claims data to a State-mandated all- 
payer claims database, provided that such data 
is submitted in a form and manner established 
by the Secretary. A State may also require 
health insurance issuers and other payers to 
submit claims data to the health care claims 
database maintained under this section, pro-
vided that such data is submitted in a form and 
manner established by the Secretary and con-
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sistent with scope, format, and de-identification 
requirements applicable pursuant to paragraphs 
(2) and (3). 
(5) PROHIBITION.—Any individual or entity re-
quired to submit data under this subsection may not 
place any restrictions on the use of such data by au-
thorized users under subsection (c)(2). 
(e) ADVISORY COMMITTEE.— 
(1) IN GENERAL.—Not later than the date that 
is 180 days after the date of the enactment of this 
Act, the Secretary shall convene an advisory com-
mittee (referred to in this subsection as the ‘‘Com-
mittee’’) to advise the Secretary, any entity awarded 
a contract under subsection (b), and Congress on 
the establishment, operations, and use of the health 
care claims database established and maintained 
under this section. 
(2) MEMBERSHIP.— 
(A) APPOINTMENT.—In accordance with 
clause (ii), the Secretary, in consultation with 
the Comptroller General of the United States, 
shall appoint members to the Committee who 
have distinguished themselves in the fields of 
health services research, health economics, 
health informatics, or the governance of State 
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all-payer claims databases, or who represent or-
ganizations likely to submit data to or use the 
health care claims database established and 
maintained under this section, including pa-
tients, health care providers, group health 
plans, health insurance issuers, and third-party 
administrators of group health plans. 
(B) 
COMPOSITION.—For 
purposes 
of 
clause (i)— 
(i) the Secretary shall appoint to the 
Committee— 
(I) one member to serve as the 
chair of the Committee; 
(II) the Assistant Secretary for 
Planning and Evaluation of the De-
partment of Health and Human Serv-
ices; 
(III) one representative from the 
Centers for Medicare & Medicaid 
Services; 
(IV) one representative from the 
Agency for Health Research and 
Quality; 
(V) one representative from the 
Office for Civil Rights of the Depart-
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ment of Health and Human Services 
with expertise in data privacy and se-
curity; and 
(VI) one representative of the 
National Center for Health Statistics; 
and 
(ii) the Comptroller General of the 
United States shall appoint to the Com-
mittee— 
(I) one representative from an 
employer that sponsors a group health 
plan; 
(II) one representative from an 
employee organization that sponsors a 
group health plan; 
(III) one academic researcher 
with expertise in health economics or 
health services research; 
(IV) one patient advocate; 
(V) one representative of Des-
ignated Standards Maintenance Orga-
nizations named by the Secretary of 
Health and Human Services to main-
tain standards adopted under regula-
tions 
promulgated 
under 
section 
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264(c) of the Health Insurance Port-
ability and Accountability Act of 1996 
(42 U.S.C. 1320d–2 note); 
(VI) one representative with ex-
pertise in the governance of State all- 
payer claims databases; and 
(VII) two additional members. 
(C) TERMS AND VACANCIES.—Members of 
the Committee shall serve three-year terms on 
a staggered basis. A vacancy on the Committee 
shall be filled by appointment in a manner con-
sistent with the requirements of this subsection 
not later than 90 days after the vacancy arises. 
(3) DUTIES.—The Committee shall— 
(A) assist and advise the Secretary on the 
management of contracts awarded under sub-
section (b); 
(B) assist and advise entities awarded such 
contracts in establishing— 
(i) the appropriate uses of data by all 
individuals and entities who are authorized 
users pursuant to subsection (c)(2), includ-
ing developing standards for the approval 
of applications submitted pursuant to such 
subsection; and 
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(ii) the appropriate formats and meth-
ods for making available to the public re-
ports and analyses based on the health 
care claims database maintained under this 
section; 
(C) conduct an annual review of whether 
data from such health care claims database was 
used according to the appropriate uses de-
scribed in subparagraph (B)(ii); 
(D) report, as appropriate, to the Sec-
retary and Congress on the operations of such 
health care claims database and opportunities 
to better achieve the objectives of this section; 
(E) establish additional restrictions on re-
searchers who receive compensation from enti-
ties specified by the Committee in order to pro-
tect proprietary financial information; and 
(F) establish objectives for research and 
public reporting. 
(f) FUNDING.— 
(1) INITIAL FUNDING.—There are authorized to 
be appropriated, and there are appropriated, out of 
monies in the Treasury not otherwise appropriated, 
$20,000,000 for fiscal year 2021, for the implemen-
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tation of the initial contract and establishment of 
the database under this section. 
(2) ONGOING FUNDING.—There are authorized 
to be appropriated $15,000,000 for each of fiscal 
years 2022 through 2026, for purposes of carrying 
out this section (other than the grant program 
under subsection (h)). 
(g) ANNUAL REPORT.—Not later than March 1, 
2022, and March 1 of each year thereafter, the entity with 
a contract in effect under subsection (b) shall submit to 
Congress and the Secretary, and make publicly available 
on an internet website, a report containing a description 
of— 
(1) trends in the price, utilization, and total 
spending on health care services, including a geo-
graphic analysis of differences in such trends; 
(2) limitations in the data set; 
(3) progress towards the objectives of this sec-
tion; and 
(4) the performance by the entity of the duties 
required under such contract. 
(h) GRANTS TO STATES.— 
(1) IN GENERAL.—The Secretary may award 
grants to States for the purpose of establishing and 
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maintaining State all-payer claims databases that 
improve transparency of health care claims data. 
(2) FUNDING.—There is authorized to be ap-
propriated $100,000,000 for the period of fiscal 
years 2021 through 2028 for the purpose of award-
ing grants to States under this subsection. 
(i) EXEMPTION FROM PUBLIC DISCLOSURE.— 
(1) IN
GENERAL.—Data submitted to the 
health care claims database under subsection (d) 
shall not be considered public records and shall be 
exempt from any Federal law relating to public dis-
closure requirements. 
(2) RESTRICTIONS ON USES FOR CERTAIN PRO-
CEEDINGS.—Such data may not be subject to dis-
covery or admission as public information or evi-
dence in judicial or administrative proceedings with-
out the consent of the affected parties. 
(j) DEFINITIONS.—In this section: 
(1) HIPAA PRIVAY
REGULATION.—The term 
‘‘HIPAA privacy regulation’’ has the meaning given 
such term in section 1180(b)(3) of the Social Secu-
rity Act (42 U.S.C. 1320d–9(b)(3)). 
(2) PHSA DEFINITIONS.—The terms ‘‘group 
health plan’’, ‘‘group health insurance coverage’’, 
‘‘health insurance issuer’’, and ‘‘individual health in-
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surance coverage’’ have the meanings given such 
terms in section 2791 of the Public Health Service 
Act (42 U.S.C. 300gg–91). 
(3) PROTECTED HEALTH INFORMATION.—The 
term ‘‘protected health information’’ has the mean-
ing given such term in section 160.103 of title 45, 
Code of Federal Regulations (or any successor regu-
lations). 
(4) PROPRIETARY FINANCIAL INFORMATION.— 
The term ‘‘proprietary financial information’’— 
(A) means data that would disclose the 
terms of a specific contract between an indi-
vidual health care provider or facility and a spe-
cific group health plan, Medicaid managed care 
organization or other managed care entity, or 
health insurance issuer offering group or indi-
vidual health insurance coverage; and 
(B) does not include any billing or pay-
ment information from claims between such a 
provider or facility and such a health plan, 
managed care organization or other managed 
care entity, or health insurance issuer. 
(k) CONFORMING AMENDMENTS.— 
(1) PHSA.—Subpart II of part A of title 
XXVII of the Public Health Service Act (42 U.S.C. 
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300gg–11 et seq.) is amended by adding at the end 
the following new section: 
‘‘SEC. 2730. HEALTH CARE CLAIMS DATABASE REPORTING 
REQUIREMENT. 
‘‘A group health plan and a health insurance issuer 
offering group or individual health insurance coverage 
shall comply with the provisions of section 1(d) of the Fed-
eral All-Payer Claims Database Act of 2020.’’. 
(2) ERISA.— 
(A) IN GENERAL.—Subpart B of part 7 of 
subtitle B of title I of the Employee Retirement 
Income Security Act of 1974 (29 U.S.C. 1185 
et seq.) is amended by adding at the end the 
following new section: 
‘‘SEC. 716. HEALTH CARE CLAIMS DATABASE REPORTING 
REQUIREMENT. 
‘‘A group health plan and a health insurance issuer 
offering group health insurance coverage shall comply with 
the provisions of section 1(d) of the Federal All-Payer 
Claims Database Act of 2020.’’. 
(B) CLERICAL AMENDMENT.—The table of 
contents in section 1 of such Act is amended by 
inserting after the item relating to section 714 
the following new items: 
‘‘Sec. 715. Additional market reforms. 
‘‘Sec. 716. Health care claims database reporting requirement.’’. 
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(3) IRC.— 
(A) IN GENERAL.—Subchapter B of chap-
ter 100 of the Internal Revenue Code of 1986 
is amended by adding at the end the following 
new section: 
‘‘SEC. 9816. HEALTH CARE CLAIMS DATABASE REPORTING 
REQUIREMENT. 
‘‘A group health plan shall comply with the provisions 
of section 1(d) of the Federal All-Payer Claims Database 
Act of 2020.’’. 
(B) CLERICAL AMENDMENT.—The table of 
sections for such subchapter is amended by 
adding at the end the following new items: 
‘‘Sec. 9815. Additional market reforms. 
‘‘Sec. 9816. Health care claims database reporting requirement.’’. 
SEC. 3. STUDY AND REPORTS BY COMPTROLLER GENERAL. 
(a) STUDY.—The Comptroller General of the United 
States shall conduct a study on— 
(1) the performance of each entity awarded a 
contract under subsection (b) of section 1; 
(2) the privacy and security of any data sub-
mitted to such entity under subsection (d) of such 
section; and 
(3) the costs incurred by such entity in per-
forming duties under such a contract. 
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(b) REPORTS.—Not later than two years after the ef-
fective date of the first contract awarded under section 
1(b), and again not later than four years after such effec-
tive date, the Comptroller General of the United States 
shall submit to Congress a report containing the results 
of the study conducted under subsection (a), together with 
recommendations for such legislation and administrative 
action as the Comptroller General determines appropriate. 
Æ 
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