,i  #aaf? ,,congress  #b;d ,session  ,h4
 ,r4 #fjjd  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,febru>y #bg1         
#bjbj,mr4 ,lip9ski introduc$ ! foll[+   
bill2 :i* 0 ref]r$ to ! ,committee on   
,en]gy & ,comm]ce1 & 9 addition to !    
,committee on ,education & ,labor1 = a  
p]iod to be subsequ5tly det]m9$ by !    
,speak]1 9 ea* case = consid]ation ( su*
 provisions z fall )9 ! jurisdiction ( !
 committee conc]n$  ,a ,,bill  ,to am5d 
title ,,xxvii ( ! ,public ,heal? ,s]vice
 ,act to require ! ,secret>y ( ,heal? & 
,human ,s]vices to e/abli% a grant      
program = purposes ( facilitat+ ,/ate   
ef=ts to e/abli% or ma9ta9 all-pay]     
claims databases1 & = o!r purposes4  #a4
 ,%ort title2 f9d+s  7a7 ,%ort title    
,?is ,act may be cit$ z ! ,transp>5cy & 
,acc\ntability 9 ,heal? ,c>e ,co/s &    
,prices ,act ( #bjbj4  7b7 ,f9d+s       
,congress f9ds ! foll[+3 7#a7 ,accord+  
to (ficial e/imates publi%$ by ! ,c5t]s 
= ,m$ic>e  ,m$icaid ,s]vices1 ,am]icans 
sp5t a total ( #c4f trillion on heal?   

c>e 9 #bjah1 or #aa1agb p] p]son4  7#b7 
,sp5d+ on hospital c>e s]vices rea*$    
#a4b trillion 9 #bjah & rose by #d4e    
p]c5t f ! previ\s ye>4 ,?is gr[? occurr$
 ev5 z ,am]icans made few] hospital     
visits because ( gr[? 9 hospital prices4
  7#c7 ,sp5d+ on physician visits &     
cl9ical s]vices rea*$ #gbe4f billion 9  
#bjah & rose by #d4a p]c5t f ! previ\s  
ye>4  7#d7 ,sp5d+ on prescription drugs 
rea*$ #cce billion 9 #bjah & rose by    
#b4e p]c5t f ! previ\s ye>4  7#e7       
,accord+ to a #bjai analysis ( a subset 
( comm]cial insurance claims by !       
indep5d5t1 non-p>tisan ,heal? ,c>e ,co/ 
,in/itute1 prices = common m$ical       
s]vices c\ld v>y up to #be times betwe5 
diff]5t metro areas & up to #ci times = 
! same s]vice )9 ! same metro area4     
7#f7 ,a #bjae analysis ( a subset (     
comm]cial insurance claims by ,yale1    
,univ]sity ( ,p5nsylvania1 ,c>negie     
,mellon1 & ,,mit rese>*]s f\nd t ev5 )9 
"o hospital1 prices = c]ta9 common      
s]vices l l[] limb ,m,r,is1 knee        

replacem5ts1 & colonoscopies c\ld v>y by
 #bc4e p]c5t on av]age dep5d+ on :i*    
insur] cov]$ ! pati5t4  7#g7 ,in=mation 
ab\t contracts betwe5 provid]s & insur]s
 available to rese>*]s1 policymak]s1 & !
 public is limit$ or incomplete because 
^! contracts frequ5tly prohibit         
disclosure ( in=mation ab\t h[ provid]s 
are paid4  7#h7 ,all-pay] claims        
databases 7,a,p,c,ds7 are l>ge-scale    
databases increas+ly adopt$ by ,/ates to
 collect heal? c>e claims data across   
diff]5t pay]s su* z private insur]s1    
gov]nm5t employee heal? plans1 ,m$ic>e1 
& ,m$icaid4  7#i7 ,,apcd data c be %>$ )
 vett$ & au?oriz$ us]s to make x easi]  
to track tr5ds 9 heal? c>e prices1      
create tools = consum]s to *eck price & 
quality1 assi/ employ]s & heal? plans 9 
mak+ m in=m$ decisions :5 develop+      
employ]-sponsor$ heal? plans1 te/ new   
ideas = hold+ d[n heal? c>e co/s1 &     
guide policymak]s 9 develop+ heal? c>e  
policy4  7#aj7 ,9 #bjai1 ! indep5d5t1   
non-p>tisan ,,r& ,corporation publi%$ ! 

fir/ broad-bas$ /udy report+ prices paid
 by private heal? plans to hospitals    
id5tifi$ by "n4 ,?is important /udy     
track$ important disp>ities 9 price     
tr5ds across ! nation1 ) relative prices
 increas+ rapidly f #bjae to #bjag =    
hospitals 9 "s ,/ates1 :ile fall+ 9     
o!rs4 ,?is "w 0 made possible 9 "p ?r\gh
 ! use ( data f ,a,p,c,ds 9 ,new        
,hamp%ire & ,colorado4  7#aa7 ,s9ce     
#bjae1 ,oregon has us$ data f its ,,apcd
 to review insur]s' propos$ premium     
rates1 includ+ det]m9+ :e!r or n propos$
 premiums are excessive4 ,oregon has    
also us$ its ,,apcd to create an annual 
report on hospital reimbursem5t         
v>iations f diff]5t insur]s4  7#ab7     
,m9nesota & ,virg9ia h us$ data f _!    
,a,p,c,ds to %9e a spotlight on sp5d+ = 
l[-value--possibly ev5                  
unnecess>y--m$ical s]vices4  7#ac7      
,wa%+ton ,/ate has us$ data f its ,,apcd
 to create ! ,wa%+ton                   
,health,care,compare tool t helps       
pati5ts le>n ab\t local prices = m$ical 

s]vices at local doctors' (fices1       
hospitals1 & outpati5t c5t]s1 & puts ^? 
prices 9 context by highlight+ :at k9ds 
( prices c be consid]$ typical1 l[1 or  
high4 ,additional ,/ates t h develop$   
price transp>5cy tools f _! ,a,p,c,ds   
include ,new ,hamp%ire1 ,ma9e1          
,massa*usetts1 ,colorado1 ,m>yl&1 &     
,rhode ,isl&4  7#ad7 ,accord+ to !      
,,apcd ,c\ncil1 a le>n+ collaborative ( 
public & private organizations work+ on 
develop+ & e/abli%+ ,a,p,c,ds1 at lea/  
#ah ,/ates h enact$ ,/ate laws e/abli%+ 
,a,p,c,ds4  7#ae7 ,:ile _m ,/ates h or  
are consid]+ e/abli%+ ,a,p,c,ds1 curr5t 
,a,p,c,ds v>y 9 ! types ( data collect$1
 ! types ( us]s all[$ to access ! data1 
! types ( data t c be publi%$1 & h[ mu* 
au?oriz$ us]s are *>g$ to access ! data4
  7#af7 ,a #bjaf ,supreme ,c\rt         
decision1 ,gobeille v4 ,lib]ty ,mutual  
,insurance ,co41 prohibit$ ,/ates f     
requir+ claim submissions to ,a,p,c,ds f
 l>ge employ]s t pay = heal? b5efits    
directly in/ead ( pur*as+ heal? cov]age 

f insurance companies4 ,?is limit$ !    
data t ,/ates c\ld m&ate = inclusion 9  
an ,,apcd4  7#ag7 ,support+ ! e/abli%m5t
 ( ,a,p,c,ds is an important way to     
promote transp>5cy & und]/&+ ( ov]all   
heal? c>e sp5d+4  7#ah7 ,/ate ,a,p,c,ds 
%\ld be enc\rag$ to collect data f m    
types ( pay]s2 make x easi] & m af=dable
 = ,,apcd data to be us$ to assi/       
pati5ts & provid]s 9 mak+ in=m$ *oices  
ab\t c>e2 make x easi] & m af=dable =   
,,apcd data to be us$ = ef=ts to br+    
heal? c>e co/ gr[? "u control & improve 
insurance cov]age2 & p]mit _! data to be
 us$ to report provid]-level prices4    
#b4 ,requir+ ! ,secret>y ( ,heal? &     
,human ,s]vices to e/abli% a grant      
program = purposes ( facilitat+ ,/ate   
ef=ts to e/abli% or ma9ta9 all-pay]     
claims databases ,"p ,c ( title ,,xxvii 
( ! ,public ,heal? ,s]vice ,act 7#db    
,u4,s4,c4 #cjj;gg-#ia et seq47 is am5d$ 
by add+ at ! end ! foll[+ new section3  
#bgie4 ,all-pay] claims database grant  
program  7a7 ,9 g5]al ,n lat] ?an #a ye>

 aft] ! date ( ! enactm5t ( ?is section1
 ! ,secret>y %all e/abli% a grant       
program 79 ?is section ref]r$ to z !    
program7 = purposes ( aw>d+ grants to   
,/ates to facilitate su* ,/ates 9       
e/abli%+ or ma9ta9+ an all-pay] claims  
database4  7b7 ,use ( funds ,a ,/ate use
 funds f a grant aw>d$ "u ! program =   
any ( ! foll[+3 7#a7 ,to e/abli% a ,/ate
 or regional all-pay] claims database or
 to ma9ta9 an exi/+ su* database4  7#b7 
,to exp& ! capabilities ( an exi/+ su*  
database 7su* z ?r\gh improv+ !         
collection ( data conta9$ 9 su* database
 or improv+ ! dissem9ation ( su* data74 
7c7 ,eligibility ,to be eligible to     
receive a grant "u ! program1 a ,/ate   
7or compact ( ,/ates7 %all submit to !  
,secret>y an application at su* "t1 9   
su* mann]1 & conta9+ su* in=mation z !  
,secret>y may specify4 ,su* in=mation   
%all include ! foll[+3 7#a7 ,a          
specification ( h[ ! ,/ate 7or compact (
 ,/ates7 w ensure uni=m data collection 
?r\gh ! all-pay] claims database4  7#b7 

,a description ( privacy & security     
protections = data submitt$ to su*      
database1 includ+ a specification ( h[ !
 ,/ate 7or compact ( ,/ates7 w ensure   
t-- 7,a7 no individually id5tifiable    
heal? in=mation is disclos$ to ! public2
  7,b7 access to su* in=mation is limit$
 to /aff ) appropriate security &       
privacy tra9+2  7,c7 effective security 
/&>ds = transf]r+ su* data or mak+ su*  
data available to au?oriz$ uses ( su*   
database are ma9ta9$2  7,d7 a process = 
provid+ access to su* data = su* us]s is
 secure & ma9ta9s ! confid5tiality ( any
 individually id5tifiable heal?         
in=mation is e/abli%$2  7,e7 su*        
database adh]es to be/ security         
practices relat+ to ! managem5t & use ( 
su* data1 consi/5t ) any applicable     
,f$]al law2 &  7,f7 us]s ( su* database 
are prohibit$ f attempt+ to reid5tify   
su* data & p5aliz$ = any su* attempt4   
7#c7 ,a specification ( :e!r submission 
( data to su* database is 7or w be7     
m&atory or volunt>y4  7#d7 ,a           

specification ( :i* type ( entities 7su*
 z gr\p heal? plans1 heal? insurance    
issues1 nonf$]al gov]nm5tal plans1 &    
,f$]al heal? c>e programs7 are 7or w be7
 submitt+ su* data to su* database4     
7#e7 ,a description ( ! types ( claims  
includ$ 9 su* database 7su* z m$ical    
claims1 ph>macy claims1 & d5tal claims74
  7#f7 ,a description ( ! data release  
policy 9 effect 7or propos$ to be put   
into effect7 ) respect to data conta9$ 9
 su* database1 includ+ a description ( !
 type ( us]s :o are 7or w be7 au?oriz$  
to access su* data 7su* z employ]s1     
employee organizations1 heal? c>e       
provid]s1 rese>*]s1 & policymak]s74     
7#g7 ,any o!r in=mation det]m9$         
appropriate by ! ,secret>y4  7d7 ,aw>d  
priority ,9 mak+ grants "u ! program1 ! 
,secret>y %all prioritize applications  
submitt$ "u subsection 7c7 t demon/rate 
any ( ! foll[+ 7) high] priority be+    
giv5 to applications t demon/rate !     
greate/ numb] ( ! foll[+73 7#a7 ,!      
all-pay] claims database to be e/abli%$1

 ma9ta9$1 or exp&$ ?r\gh su* grant      
requires m&atory report+ ( claims data  
to su* database4  7#b7 ,su* database w  
transition to require su* m&atory       
report+4  7#c7 ,data conta9$ 9 su*      
database is 7or w be7 easily accessible 
& af=dable = us]s to access4  7#d7 ,su* 
database p]mits 7or w p]mit7 su* data to
 be view$ 9 a provid]-specific mann]4   
7#e7 ,a hi/ory ( 7or plann$7 p>tn]%ips )
 us]s ( su* database to facilitate ! use
 ( su* data 9-- 7,a7 in=m+ individuals  
ab\t ! co/1 quality1 & value ( heal?    
c>e2  7,b7 assi/+ heal? c>e provid]s1   
includ+ hospitals1 9 work+ ) individuals
 to make in=m$ decisions reg>d+ heal?   
c>e2  7,c7 enabl+ heal? c>e provid]s1   
includ+ hospitals1 & communities to     
improve ! furni%+ ( items & s]vices &   
heal? outcomes = individuals ?r\gh      
comp>isons ( su* outcomes ) o!r su*     
provid]s & hospitals2  7,d7 enabl+      
entities t pay = items & s]vices1       
includ+ employ]s1 employee              
organizations1 gr\p heal? plans1 & heal?

 insurance issu]s1 to develop value-bas$
 pur*as+ models & improve ! quality &   
co/ ( c>e furni%$ to employees or       
enrollees2  7,e7 enabl+ gr\p heal? plans
 & heal? insurance issu]s to evaluate   
network design1 network con/ruction1 & !
 co/ ( c>e furni%$ to enrollees2  7,f7  
facilitat+ ,/ate-l$ initiatives to l[]  
heal? c>e co/s & improve heal? c>e      
quality2 or  7,g7 promot+ competition   
bas$ on quality & co/4  7e7 ,privacy    
regulations ,! ,secret>y %all promulgate
 regulations specify+ ! ext5t & mann] to
 :i* any applicable ,f$]al law or       
regulation relat+ to privacy %all apply 
to activities c>ri$ out pursuant to a   
grant made "u ! program & may issue any 
additional regulation det]m9$ necess>y  
by ! ,secret>y to ensure appropriate    
confid5tiality ( data associat$ ) su*   
activities4  7f7 ,disclosure ( data ,any
 ,/ate 7or compact ( ,/ates7 receiv+ a  
grant "u ! program to e/abli%1 ma9ta91  
or exp& an all-pay] claims database %all
 "w to make all in=mation conta9$ 9 su* 

database available to ! ,director ( !   
,congressional ,budget ,(fice1 !        
,comptroll] ,g5]al ( ! ,unit$ ,/ates1 ! 
,executive ,director ( ! ,m$ic>e ,paym5t
 ,advisory ,commission1 & ! ,executive  
,director ( ! ,m$icaid & ,,*ip ,advisory
 ,committee ^u reque/1 subject to any   
regulation describ$ 9 subsection 7e7 &  
,/ate law4 ,su* in=mation may be made   
available 9 ! =m ( raw data1 summ>y     
reports1 or su* o!r =mat det]m9$        
appropriate by ! reque/+ entity & !     
,/ate 7or compact ( ,/ates74  7g7       
,def9ition ,= purposes ( ?is section1 ! 
t]m all-pay] claims database means1 )   
respect to a ,/ate 7or compact (        
,/ates71 a ,/ate or regional database   
op]at$ by 7or "u contract )7 a ,/ate 7or
 compact ( ,/ates7 t may include m$ical 
claims1 ph>macy claims1 d5tal claims1   
memb] eligibility1 & provid] files :i*  
are collect$ f private & public pay]s4  
7h7 ,au?orization ( appropriations ,!re 
are au?oriz$ to be appropriat$          
#ajj1jjj1jjj to c>ry out ?is section4  4

  #c4 ,all[+ = collection ( in=mation f 
self-insur$ gr\p heal? plans ,section   
#ead7;b7 ( ! ,employee ,retirem5t       
,income ,security ,act ( #aigd 7#bi     
,u4,s4,c4 #aadd7;b77 is am5d$ by add+ at
 ! end ! foll[+ new p>agraph3  7#aj7    
,subsection 7a7 %all n apply to any     
,/ate law requir+ a gr\p heal? plan     
7includ+ a self-insur$ gr\p heal? plan7 
to provide claims data to an all-pay]   
claims database 7z def9$ 9 section      
#bgie7;g7 ( ! ,public ,heal? ,s]vice    
,act74  4