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cluding for the purposes described in sub-
paragraph (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 anal-
ysis or data that is provided or sold to a pro-
vider of services or supplier under paragraph 
(1) or (2) may contain information that individ-
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ually identifies a patient of such provider or 
supplier, including with respect to items and 
services furnished to the patient by other pro-
viders of services or suppliers. 
(C) PROHIBITION ON USING ANALYSES OR 
DATA FOR MARKETING PURPOSES.—An author-
ized user shall not use an analysis or data pro-
vided 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 author-
ized user under paragraph (2). Such agreement shall 
describe the requirements for privacy and security of 
the data and, as determined appropriate by the Sec-
retary, any prohibitions on using such data to link 
to other individually identifiable sources of informa-
tion. 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 regu-
lations, as determined by the Secretary, that the 
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user shall comply with as if it were acting in the ca-
pacity 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 anal-
ysis using such data. 
(B) PERMITTED REDISCLOSURE.—A pro-
vider of services or supplier that is provided or 
sold an analysis or data under paragraph (1) or 
(2) may, as determined by the Secretary, redis-
close such analysis or data for the purposes of 
performance improvement and care coordination 
activities but shall not make public such anal-
ysis or data or any analysis using such data. 
(6) OPPORTUNITY FOR PROVIDERS OF SERV-
ICES AND SUPPLIERS TO REVIEW.—Prior to a quali-
fied entity providing or selling an analysis to an au-
thorized user under paragraph (1), to the extent 
that such analysis would individually identify a pro-
vider of services or supplier who is not being pro-
vided or sold such analysis, such qualified entity 
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shall provide such provider or supplier with the op-
portunity 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)), the Secretary shall impose 
an assessment on the qualified entity both in 
the case of— 
(i) an agreement between the Sec-
retary 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 de-
scribed in subparagraph (A)(i), for whom 
the Secretary provided data on to the 
qualified entity under paragraph (2); and 
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(ii) in the case of an agreement de-
scribed 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 para-
graph shall be deposited in Federal Supple-
mentary 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 pur-
poses of such analyses; 
(C) information on the entities who re-
ceived the data under paragraph (2), the uses 
of the data, and the total amount of fees re-
ceived for providing, selling, or sharing the 
data; and 
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(D) other information determined appro-
priate by the Secretary. 
(9) DEFINITIONS.—In this subsection and sub-
section (b): 
(A) AUTHORIZED USER.—The term ‘‘au-
thorized user’’ means the following: 
(i) A provider of services. 
(ii) A supplier. 
(iii) An employer (as defined in sec-
tion 3(5) of the Employee Retirement In-
surance Security Act of 1974). 
(iv) A health insurance issuer (as de-
fined in section 2791 of the Public Health 
Service Act). 
(v) A medical society or hospital asso-
ciation. 
(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 deter-
mined by the Secretary). 
(B) PROVIDER
OF
SERVICES.—The term 
‘‘provider of services’’ has the meaning given 
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such term in section 1861(u) of the Social Se-
curity Act (42 U.S.C. 1395x(u)). 
(C) QUALIFIED ENTITY.—The term ‘‘quali-
fied entity’’ has the meaning given such term in 
section 1874(e)(2) of the Social Security Act 
(42 U.S.C. 1395kk(e)). 
(D) SECRETARY.—The term ‘‘Secretary’’ 
means the Secretary of Health and Human 
Services. 
(E) SUPPLIER.—The term ‘‘supplier’’ has 
the meaning given such term in section 1861(d) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395x(d)). 
(b) ACCESS
TO MEDICARE DATA
BY QUALIFIED 
CLINICAL DATA REGISTRIES TO FACILITATE QUALITY 
IMPROVEMENT.— 
(1) ACCESS.— 
(A) IN
GENERAL.—To the extent con-
sistent with applicable information, privacy, se-
curity, 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)), provide the data 
described in subparagraph (B) (in a form and 
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manner determined to be appropriate) to such 
qualified clinical data registry for purposes of 
linking such data with clinical outcomes data 
and performing risk-adjusted, scientifically valid 
analyses and research to support quality im-
provement or patient safety, provided that any 
public reporting of such analyses or research 
that identifies a provider of services or supplier 
shall only be conducted with the opportunity of 
such provider or supplier to appeal and correct 
errors in the manner described in subsection 
(a)(6). 
(B) DATA
DESCRIBED.—The data de-
scribed 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 appro-
priate, claims data under the Medicaid 
program under title XIX of such Act and 
the State Children’s Health Insurance Pro-
gram 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 
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providing such data. Any fee collected pursuant to 
the preceding sentence shall be deposited in the Cen-
ters 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)) is amended— 
(1) in the subsection heading, by striking 
‘‘MEDICARE’’; and 
(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 ti-
tles for one or more specified geographic areas 
and time periods requested by a qualified enti-
ty.’’; and 
(B) in the last sentence, by inserting ‘‘or 
under titles XIX or XXI’’ before the period at 
the end. 
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(d) REVISION OF PLACEMENT OF FEES.—Section 
1874(e)(4)(A) of the Social Security Act (42 U.S.C. 
1395kk(e)(4)(A)) is amended, in the second sentence— 
(1) by inserting ‘‘, for periods prior to July 1, 
2015,’’ after ‘‘deposited’’; and 
(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’’. 
SEC. 9. REDUCING ADMINISTRATIVE BURDEN AND OTHER 
PROVISIONS. 
(a) MEDICARE PHYSICIAN AND PRACTITIONER OPT- 
OUT TO PRIVATE CONTRACT.— 
(1) INDEFINITE, CONTINUING AUTOMATIC EX-
TENSION OF OPT OUT ELECTION.— 
(A) IN GENERAL.—Section 1802(b)(3) of 
the Social Security Act (42 U.S.C. 1395a(b)(3)) 
is amended— 
(i) in subparagraph (B)(ii), by strik-
ing ‘‘during the 2-year period beginning on 
the date the affidavit is signed’’ and insert-
ing ‘‘during the applicable 2-year period 
(as defined in subparagraph (D))’’; 
(ii) in subparagraph (C), by striking 
‘‘during the 2-year period described in sub-
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paragraph (B)(ii)’’ and inserting ‘‘during 
the applicable 2-year period’’; and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(D) APPLICABLE
2-YEAR
PERIODS
FOR 
EFFECTIVENESS OF AFFIDAVITS.—In this sub-
section, the term ‘applicable 2-year period’ 
means, with respect to an affidavit of a physi-
cian or practitioner under subparagraph (B), 
the 2-year period beginning on the date the af-
fidavit is signed and includes each subsequent 
2-year period unless the physician or practi-
tioner involved provides notice to the Secretary 
(in a form and manner specified by the Sec-
retary), not later than 30 days before the end 
of the previous 2-year period, that the physician 
or practitioner does not want to extend the ap-
plication of the affidavit for such subsequent 2- 
year period.’’. 
(B) EFFECTIVE DATE.—The amendments 
made by subparagraph (A) shall apply to affi-
davits entered into on or after the date that is 
60 days after the date of the enactment of this 
Act. 
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(2) PUBLIC AVAILABILITY OF INFORMATION ON 
OPT-OUT PHYSICIANS AND PRACTITIONERS.—Section 
1802(b) of the Social Security Act (42 U.S.C. 
1395a(b)) is amended— 
(A) in paragraph (5), by adding at the end 
the following new subparagraph: 
‘‘(D) OPT-OUT PHYSICIAN OR PRACTITIONER.— 
The term ‘opt-out physician or practitioner’ means 
a physician or practitioner who has in effect an affi-
davit under paragraph (3)(B).’’; 
(B) by redesignating paragraph (5) as 
paragraph (6); and 
(C) by inserting after paragraph (4) the 
following new paragraph: 
‘‘(5) POSTING OF INFORMATION ON OPT-OUT 
PHYSICIANS AND PRACTITIONERS.— 
‘‘(A) IN
GENERAL.—Beginning not later 
than February 1, 2015, the Secretary shall 
make publicly available through an appropriate 
publicly accessible website of the Department of 
Health and Human Services information on the 
number and characteristics of opt-out physi-
cians and practitioners and shall update such 
information on such website not less often than 
annually. 
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‘‘(B) INFORMATION
TO
BE
INCLUDED.— 
The information to be made available under 
subparagraph (A) shall include at least the fol-
lowing with respect to opt-out physicians and 
practitioners: 
‘‘(i) Their number. 
‘‘(ii) Their physician or professional 
specialty or other designation. 
‘‘(iii) Their geographic distribution. 
‘‘(iv) The timing of their becoming 
opt-out physicians and practitioners, rel-
ative to when they first entered practice 
and with respect to applicable 2-year peri-
ods. 
‘‘(v) The proportion of such physi-
cians and practitioners who billed for 
emergency or urgent care services.’’. 
(b) GAINSHARING STUDY AND REPORT.—Not later 
than 6 months after the date of the enactment of this Act, 
the Secretary of Health and Human Services, in consulta-
tion with the Inspector General of the Department of 
Health and Human Services, shall submit to Congress a 
report with legislative recommendations to amend existing 
fraud and abuse laws, through exceptions, safe harbors, 
or other narrowly targeted provisions, to permit 
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gainsharing or similar arrangements between physicians 
and hospitals that improve care while reducing waste and 
increasing efficiency. The report shall— 
(1) consider whether such provisions should 
apply to ownership interests, compensation arrange-
ments, or other relationships; 
(2) describe how the recommendations address 
accountability, transparency, and quality, including 
how best to limit inducements to stint on care, dis-
charge patients prematurely, or otherwise reduce or 
limit medically necessary care; and 
(3) consider whether a portion of any savings 
generated by such arrangements should accrue to 
the Medicare program under title XVIII of the So-
cial Security Act. 
(c) PROMOTING INTEROPERABILITY OF ELECTRONIC 
HEALTH RECORD SYSTEMS.— 
(1) RECOMMENDATIONS FOR ACHIEVING WIDE-
SPREAD EHR INTEROPERABILITY.— 
(A) OBJECTIVE.—As a consequence of a 
significant Federal investment in the implemen-
tation of health information technology through 
the Medicare and Medicaid EHR incentive pro-
grams, Congress declares it a national objective 
to achieve widespread exchange of health infor-
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mation through interoperable certified EHR 
technology nationwide by December 31, 2017. 
(B) DEFINITIONS.—In this paragraph: 
(i) 
WIDESPREAD
INTEROPER-
ABILITY.—The term ‘‘widespread inter-
operability’’ means interoperability between 
certified EHR technology systems em-
ployed by meaningful EHR users under 
the Medicare and Medicaid EHR incentive 
programs and other clinicians and health 
care providers on a nationwide basis. 
(ii) INTEROPERABILITY.—The term 
‘‘interoperability’’ means the ability of two 
or more health information systems or 
components to exchange clinical and other 
information and to use the information 
that has been exchanged using common 
standards as to provide access to longitu-
dinal information for health care providers 
in order to facilitate coordinated care and 
improved patient outcomes. 
(C) ESTABLISHMENT
OF
METRICS.—Not 
later than July 1, 2015, and in consultation 
with stakeholders, the Secretary shall establish 
metrics to be used to determine if and to the 
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extent that the objective described in subpara-
graph (A) has been achieved. 
(D) RECOMMENDATIONS
IF
OBJECTIVE 
NOT
ACHIEVED.—If the Secretary of Health 
and Human Services determines that the objec-
tive described in subparagraph (A) has not been 
achieved by December 31, 2017, then the Sec-
retary shall submit to Congress a report, by not 
later than December 31, 2018, that identifies 
barriers to such objective and recommends ac-
tions that the Federal Government can take to 
achieve such objective. Such recommended ac-
tions may include recommendations— 
(i) to adjust payments for not being 
meaningful EHR users under the Medicare 
EHR incentive programs; and 
(ii) for criteria for decertifying cer-
tified EHR technology products. 
(2) PREVENTING BLOCKING THE SHARING OF 
INFORMATION.— 
(A) FOR
MEANINGFUL
EHR
PROFES-
SIONALS.—Section 1848(o)(2)(A)(ii) of the So-
cial 
Security 
Act 
(42 
U.S.C. 
1395w– 
4(o)(2)(A)(ii)) is amended by inserting before 
the period at the end the following: ‘‘, and the 
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professional demonstrates (through a process 
specified by the Secretary, such as the use of an 
attestation) that the professional has not know-
ingly and willfully taken any action to limit or 
restrict the compatibility or interoperability of 
the certified EHR technology’’. 
(B) FOR MEANINGFUL EHR HOSPITALS.— 
Section 1886(n)(3)(A)(ii) of the Social Security 
Act (42 U.S.C. 1395ww(n)(3)(A)(ii)) is amend-
ed by inserting before the period at the end the 
following: ‘‘, and the hospital demonstrates 
(through a process specified by the Secretary, 
such as the use of an attestation) that the hos-
pital has not knowingly and willfully taken any 
action to limit or restrict the compatibility or 
interoperability of the certified EHR tech-
nology’’. 
(C) EFFECTIVE DATE.—The amendments 
made by this subsection shall apply to meaning-
ful EHR users as of the date that is one year 
after the date of the enactment of this Act. 
(3) STUDY AND REPORT ON THE FEASIBILITY 
OF
ESTABLISHING
A
WEBSITE
TO
COMPARE
CER-
TIFIED EHR TECHNOLOGY PRODUCTS.— 
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