Recent bipartisan legislation introduced into the US House of Representatives by House Budget Committee Chairman Paul Ryan (R-Wis) and Representative Ron Kind (D-Wis) entitled “Expanding the Availability of Medicare Data Act” (H.R. 4418) would expand the availability of Medicare claims data that is available to qualified entities under the Centers for Medicare and Medicaid Services’ Qualified Entity Certification Program.  The program currently certifies qualified entities to use Medicare claims data to evaluate how providers and suppliers in particular areas are performing.

Under the Affordable Care Act, a qualified entity is an organization that may apply to CMS to obtain data from Medicare Parts A, B, and D.  Such data is to be combined with non-Medicare claims data to create reports that measure and critique provider and supplier performance.  Qualified entities must also agree to keep the data secure.  Currently, CMS has approved approximately a dozen entities as qualified entities.

If enacted into law as introduced, the legislation would authorize a qualified entity to (1) share analyses of Medicare claims data and non-Medicare claims data with providers, suppliers, and others; (2) give providers or suppliers access to Medicare claims data and non-Medicare claims data so that those individuals or groups could also analyze the data and create improvement activities to meet their specific needs;  and (3) charge others for any non-public analyses.

To review the legislation, click here.