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H.R. 804: Expanding the Availability of Medicare Data Act

Title: Expanding the Availability of Medicare Data Act

Introduced: Feb 5, 2015 (114th Congress)

Sponsor: Rep. Paul D. Ryan [R-WI1]

Status: Referred to Committee - Referred to the Subcommittee on Health.

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. 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 (SSAct) 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 SSAct 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).


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