,i  #aacth ,,congress  #b;d ,session    
,h4 ,r4 #ddah  ,,in ,,the ,,house ,,of  
,,representatives  ,april #g1 #bjad ,mr4
 ,ryan of ,wisconsin 7for himself and   
,mr4 ,kind7 introduced the following    
bill2 which was referred to the         
,committee on ,energy and ,commerce1 and
 in addition to the ,committee on ,ways 
and ,means1 for a period to be          
subsequently determined by the ,speaker1
 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 increase  
access to ,medicare data4  #a4 ,short   
title ,this ,act may be cited as the    
,expanding the ,availability of         
,medicare ,data ,act4  #b4 ,expanding   
availability of ,medicare data  7a7     
,expanding uses of ,medicare data by    
qualified entities  7#a7 ,additional    
analyses  7,a7 ,in general ,subject to  
subparagraph 7,b71 to the extent        
consistent with applicable information1 

privacy1 security1 and disclosure laws  
7including paragraph 7#c771             
notwithstanding paragraph 7#d77;,b7 of  
section #ahgd7;e7 of the ,social        
,security ,act 7#db ,u4,s4,c4           
#aciekk7e77 and the second sentence of  
paragraph 7#d77;,d7 of such section1    
beginning ,july #a1 #bjae1 a qualified  
entity may use the combined data        
described in paragraph 7#d77;,b77iii7 of
 such section received by such entity   
under such section1 and information     
derived from the evaluation described in
 such paragraph 7#d77;,d71 to conduct   
additional non-public analyses 7as      
determined appropriate by the           
,secretary7 and provide or sell such    
analyses to authorized users for        
non-public use 7including for the       
purposes of assisting providers of      
services and suppliers to develop and   
participate in quality and patient care 
improvement activities1 including       
developing new models of care74  7,b7   
,limitations with respect to analyses   

7i7 ,employers ,any analyses provided or
 sold under subparagraph 7,a7 to an     
employer described in paragraph         
7#i77;,a77iii7 may only be used by such 
employer for purposes of providing      
health insurance to employees and       
retirees of the employer4  7ii7 ,health 
insurance issuers ,a qualified entity   
may not provide or sell an analysis to a
 health insurance issuer described in   
paragraph 7#i77;,a77iv7 unless the      
issuer is providing the qualified entity
 with data under section                
#ahgd7;e77#d77;,b77iii7 of the ,social  
,security ,act 7#db ,u4,s4,c4           
#aciekk7e77#d77;,b77iii774  7#b7 ,access
 to certain data  7,a7 ,access ,to the  
extent consistent with applicable       
information1 privacy1 security1 and     
disclosure laws 7including paragraph    
7#c771 notwithstanding paragraph        
7#d77;,b7 of section #ahgd7;e7 of the   
,social ,security ,act 7#db ,u4,s4,c4   
#aciekk7e77 and the second sentence of  
paragraph 7#d77;,d7 of such section1    

beginning ,july #a1 #bjae1 a qualified  
entity may--  7i7 provide or sell the   
combined data described in paragraph    
7#d77;,b77iii7 of such section to       
authorized users described in clauses   
7i71 7ii71 and 7v7 of paragraph         
7#i77;,a7 for non-public use1 including 
for the purposes described in           
subparagraph 7,b72 or  7ii7 subject to  
subparagraph 7,c71 provide ,medicare    
claims data to authorized users         
described in clauses 7i71 7ii71 and 7v71
 of paragraph 7#i77;,a7 for non-public  
use1 including for the purposes         
described in subparagraph 7,b74  7,b7   
,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 activities1 including  
developing new models of care4  7,c7    
,medicare claims data must be provided  
at no cost ,a qualified entity may not  
charge a fee for providing the data     

under subparagraph 7,a77ii74  7#c7      
,protection of information  7,a7 ,in    
general ,except as provided in          
subparagraph 7,b71 an analysis or data  
that is provided or sold under paragraph
 7#a7 or 7#b7 shall not contain         
information that individually identifies
 a patient4  7,b7 ,information on       
patients of the provider of services or 
supplier ,to the extent consistent with 
applicable information1 privacy1        
security1 and disclosure laws1 an       
analysis or data that is provided or    
sold to a provider of services or       
supplier under paragraph 7#a7 or 7#b7   
may contain information that            
individually identifies a patient of    
such provider or supplier1 including    
with respect to items and services      
furnished to the patient by other       
providers of services or suppliers4     
7,c7 ,prohibition on using analyses or  
data for marketing purposes ,an         
authorized user shall not use an        
analysis or data provided or sold under 

paragraph 7#a7 or 7#b7 for marketing    
purposes4  7#d7 ,data use agreement ,a  
qualified entity and an authorized user 
described in clauses 7i71 7ii71 and 7v7 
of paragraph 7#i77;,a7 shall enter into 
an agreement regarding the use of any   
data that the qualified entity is       
providing or selling to the authorized  
user under paragraph 7#b74 ,such        
agreement shall describe the            
requirements for privacy and security of
 the data and1 as determined appropriate
 by the ,secretary1 any prohibitions on 
using such data to link to other        
individually identifiable sources of    
information4 ,if the authorized user is 
not a covered entity under the rules    
promulgated pursuant to the ,health     
,insurance ,portability and             
,accountability ,act of #aiif1 the      
agreement shall identify the relevant   
regulations1 as determined by the       
,secretary1 that the user shall comply  
with as if it were acting in the        
capacity of such a covered entity4  7#e7

 ,no redisclosure of analyses or data   
7,a7 ,in general ,except as provided in 
subparagraph 7,b71 an authorized user   
that is provided or sold an analysis or 
data under paragraph 7#a7 or 7#b7 shall 
not redisclose or make public such      
analysis or data or any analysis using  
such data4  7,b7 ,permitted redisclosure
 ,a provider of services or supplier    
that is provided or sold an analysis or 
data under paragraph 7#a7 or 7#b7 may1  
as determined by the ,secretary1        
redisclose such analysis or data for the
 purposes of performance improvement and
 care coordination activities but shall 
not make public such analysis or data or
 any analysis using such data4  7#f7    
,opportunity for providers of services  
and suppliers to review ,prior to a     
qualified entity providing or selling an
 analysis to an authorized user under   
paragraph 7#a71 to the extent that such 
analysis would individually identify a  
provider of services or supplier who is 
not being provided or sold such         

analysis1 such qualified entity shall   
provide such provider or supplier with  
the opportunity to appeal and correct   
errors in the manner described in       
section #ahgd7;e77#d77;,c77ii7 of the   
,social ,security ,act 7#db ,u4,s4,c4   
#aciekk7e77#d77;,c77ii774  7#g7         
,assessment for a breach  7,a7 ,in      
general ,in the case of a breach of a   
data use agreement under this section or
 section #ahgd7;e7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#aciekk7e771 the ,secretary shall impose
 an assessment on the qualified entity  
both in the case of--  7i7 an agreement 
between the ,secretary and a qualified  
entity2 and  7ii7 an agreement between a
 qualified entity and an authorized     
user4  7,b7 ,assessment ,the assessment 
under subparagraph 7,a7 shall be an     
amount up to #ajj for each individual   
entitled to1 or enrolled for1 benefits  
under part ,a of title ,,xviii of the   
,social ,security ,act or enrolled for  
benefits under part ,b of such title--  

7i7 in the case of an agreement         
described in subparagraph 7,a77i71 for  
whom the ,secretary provided data on to 
the qualified entity under paragraph    
7#b72 and  7ii7 in the case of an       
agreement described in subparagraph     
7,a77ii71 for whom the qualified entity 
provided data on to the authorized user 
under paragraph 7#b74  7,c7 ,deposit of 
amounts collected ,any amounts collected
 pursuant to this paragraph shall be    
deposited in ,federal ,supplementary    
,medical ,insurance ,trust ,fund under  
section #ahda of the ,social ,security  
,act 7#db ,u4,s4,c4 #aciet74  7#h7      
,annual reports ,any qualified entity   
that provides or sells an analysis or   
data under paragraph 7#a7 or 7#b7 shall 
annually submit to the ,secretary a     
report that includes--  7,a7 a summary  
of the analyses provided or sold1       
including the number of such analyses1  
the number of purchasers of such        
analyses1 and the total amount of fees  
received for such analyses2  7,b7 a     

description of the topics and purposes  
of such analyses2  7,c7 information on  
the entities who received the data under
 paragraph 7#b71 the uses of the data1  
and the total amount of fees received   
for providing1 selling1 or sharing the  
data2 and  7,d7 other information       
determined appropriate by the           
,secretary4  7#i7 ,definitions ,in this 
subsection and subsection 7b73  7,a7    
,authorized user ,the term authorized   
user means the following3  7i7 ,a       
provider of services4  7ii7 ,a supplier4
  7iii7 ,an employer 7as defined in     
section #c7e7 of the ,employee          
,retirement ,insurance ,security ,act of
 #aigd74  7iv7 ,a health insurance      
issuer 7as defined in section #bgia of  
the ,public ,health ,service ,act74  7v7
 ,a medical society or hospital         
association4  7vi7 ,any entity not      
described in clauses 7i7 through 7v7    
that is approved by the ,secretary      
7other than an employer or health       
insurance issuer not described in       

clauses 7iii7 and 7iv71 respectively1 as
 determined by the ,secretary74  7,b7   
,provider of services ,the term provider
 of services has the meaning given such 
term in section #ahfa7u7 of the ,social 
,security ,act 7#db ,u4,s4,c4           
#aciex7u774  7,c7 ,qualified entity ,the
 term qualified entity has the meaning  
given such term in section #ahgd7;e77#b7
 of the ,social ,security ,act 7#db     
,u4,s4,c4 #aciekk7e774  7,d7 ,secretary 
,the term ,secretary means the          
,secretary of ,health and ,human        
,services4  7,e7 ,supplier ,the term    
supplier has the meaning given such term
 in section #ahfa7;d7 of the ,social    
,security ,act 7#db ,u4,s4,c4           
#aciex7d774  7b7 ,access to ,medicare   
data by qualified clinical data         
registries ,to facilitate quality       
improvement  7#a7 ,access  7,a7 ,in     
general ,to the extent consistent with  
applicable information1 privacy1        
security1 and disclosure laws1 beginning
 ,july #a1 #bjae1 the ,secretary shall1 

at the request of a qualified clinical  
data registry under section             
#ahdh7m77#c77;,e7 of the ,social        
,security ,act 7#db ,u4,s4,c4           
#aciew-#d7m77#c77;,e771 provide the data
 described in subparagraph 7,b7 7in a   
form and manner determined to be        
appropriate7 to such qualified clinical 
data registry for purposes of linking   
such data with clinical outcomes data   
and performing risk-adjusted1           
scientifically valid analyses and       
research to support quality improvement 
or patient safety1 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 7a77#f74  7,b7 ,data      
described ,the data described in this   
subparagraph is--  7i7 claims data under
 the ,medicare program under title      
,,xviii of the ,social ,security ,act2  

and  7ii7 if the ,secretary determines  
appropriate1 claims data under the      
,medicaid program under title ,,xix of  
such ,act and the ,state ,children's    
,health ,insurance ,program under title 
,,xxi of such ,act4  7#b7 ,fee ,data    
described in paragraph 7#a77;,b7 shall  
be provided to a qualified clinical data
 registry under paragraph 7#a7 at a fee 
equal to the cost of providing such     
data4 ,any fee collected pursuant to the
 preceding sentence shall be deposited  
in the ,centers for ,medicare  ,medicaid
 ,services ,program ,management         
,account4  7c7 ,expansion of data       
available to qualified entities ,section
 #ahgd7;e7 of the ,social ,security ,act
 7#db ,u4,s4,c4 #aciekk7e77 is amended--
  7#a7 in the subsection heading1 by    
striking ,medicare2 and  7#b7 in        
paragraph 7#c7--  7,a7 by inserting     
after the first sentence the following  
new sentence3 ,beginning ,july #a1      
#bjae1 if the ,secretary determines     
appropriate1 the data described in this 

paragraph may also include standardized 
extracts 7as determined by the          
,secretary7 of claims data under titles 
,,xix and ,,xxi for assistance provided 
under such titles for one or more       
specified geographic areas and time     
periods requested by a qualified        
entity42 and  7,b7 in the last sentence1
 by inserting or under titles ,,xix or  
,,xxi before the period at the end4  7d7
 ,revision of placement of fees ,section
 #ahgd7;e77#d77;,a7 of the ,social      
,security ,act 7#db ,u4,s4,c4           
#aciekk7e77#d77;,a77 is amended1 in the 
second sentence--  7#a7 by inserting 1  
for periods prior to ,july #a1 #bjae1   
after deposited2 and  7#b7 by inserting 
the following before the period at the  
end3 1 and1 beginning ,july #a1 #bjae1  
into the ,centers for ,medicare         
,medicaid ,services ,program ,management
 ,account4