Title: FACTS Act of 2017
Policy area: Health

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.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3447 Introduced in House (IH)]

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115th CONGRESS
  1st Session
                                H. R. 3447

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.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 27, 2017

  Ms. Jenkins of Kansas (for herself, Mr. Thompson of California, Mr. 
 Harper, and Mr. Ben Ray Lujan of New Mexico) 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 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.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Furthering Access to Coordinated 
Treatment for Seniors Act of 2017'' or the ``FACTS Act of 2017''.

SEC. 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)) is amended by adding at the end the following new paragraph:
            ``(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.''.
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