Federal All-Payer Claims Database Act of 2020

I 116TH CONGRESS 2D SESSION H. R. 8967 To require the Secretary of Health and Human Services to award a contract to an eligible nonprofit entity to establish and maintain a health care claims database for purposes of lowering Americans’ health care costs, and for other purposes. IN THE HOUSE OF REPRESENTATIVES DECEMBER 15, 2020 Mr. BEYER introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Oversight and Reform, Armed Services, and Education and Labor, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdic- tion of the committee concerned A BILL To require the Secretary of Health and Human Services to award a contract to an eligible nonprofit entity to establish and maintain a health care claims database for purposes of lowering Americans’ health care costs, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Federal All-Payer 4 Claims Database Act of 2020’’. 5 VerDate Sep 11 2014 23:53 Jan 02, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H8967.IH H8967 pbinns on DSKJLVW7X2PROD with BILLS 2 •HR 8967 IH SEC. 2. ESTABLISHMENT AND MAINTENANCE OF HEALTH 1 CARE CLAIMS DATABASE TO LOWER HEALTH 2 CARE COSTS. 3 (a) IN GENERAL.—Not later than the date that is 4 180 days after the date of the enactment of this Act, the 5 Secretary of Health and Human Services (referred to in 6 this section as the ‘‘Secretary’’), acting through the Ad- 7 ministrator of the Centers for Medicare & Medicaid Serv- 8 ices and in consultation with the Secretary of Labor, shall 9 award a contract in accordance with subsection (b) to an 10 eligible nonprofit entity described in such subsection for 11 purposes of carrying out the requirements of such entity 12 under this section. 13 (b) CONTRACT WITH ELIGIBLE NONPROFIT ENTI- 14 TY.— 15 (1) COMPETITIVE PROCEDURES.—The Sec- 16 retary shall award the contract described in sub- 17 section (a) to an eligible nonprofit entity described 18 in paragraph (2) using full and open competition 19 procedures pursuant to chapter 33 of title 41, 20 United States Code. 21 (2) ELIGIBLE NONPROFIT ENTITY.—An eligible 22 nonprofit entity described in this paragraph is a 23 nonprofit entity that— 24 (A) is governed by a board that includes— 25 VerDate Sep 11 2014 23:53 Jan 02, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H8967.IH H8967 pbinns on DSKJLVW7X2PROD with BILLS 3 •HR 8967 IH (i) representatives of the academic re- 1 search community; and 2 (ii) individuals with expertise in em- 3 ployer-sponsored insurance, research using 4 health care claims data, and actuarial 5 analysis; and 6 (B) conducts its business in an open and 7 transparent manner that provides the oppor- 8 tunity for public comment on its activities. 9 (3) CONSIDERATIONS.—In awarding a contract 10 to an eligible nonprofit entity under this section, the 11 Secretary shall consider the experience of each eligi- 12 ble nonprofit entity in— 13 (A) collecting and aggregating health care 14 claims data, ensuring quality assurance and se- 15 curity of such claims data, and securing such 16 claims data; 17 (B) supporting academic research on 18 health care costs, spending, and utilization for 19 and by privately insured patients; 20 (C) working with large health insurance 21 issuers, group health plans, and third-party ad- 22 ministrators of group health plans to assemble 23 a health care claims database; 24 VerDate Sep 11 2014 23:53 Jan 02, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H8967.IH H8967 pbinns on DSKJLVW7X2PROD with BILLS 4 •HR 8967 IH (D) effectively collaborating with and en- 1 gaging stakeholders to develop reports; 2 (E) meeting budgets and timelines, includ- 3 ing with respect to developing reports; and 4 (F) facilitating the creation of, or sup- 5 porting, State all-payer claims databases. 6 (4) PERIOD OF CONTRACT.— 7 (A) IN GENERAL.—A contract awarded 8 under this section shall be for a period of 5 9 years and may be renewed, subject to the full 10 and open competition procedures described in 11 paragraph (1). 12 (B) TRANSITION OF CONTRACT.—In the 13 case that a contract is not renewed for a subse- 14 quent 5-year period under subparagraph (A) 15 after the use of the full and open competition 16 procedures described in paragraph (1), the Sec- 17 retary shall require the entity whose contract is 18 expiring to transfer all data maintained by the 19 health care claims database described in para- 20 graph (5)(A) to the entity to whom the Sec- 21 retary has awarded a contract for the subse- 22 quent 5-year period. The entity whose contract 23 is expiring may not disclose such data to any 24 VerDate Sep 11 2014 23:53 Jan 02, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H8967.IH H8967 pbinns on DSKJLVW7X2PROD with BILLS 5 •HR 8967 IH other entity or keep such data after the expira- 1 tion of such contract. 2 (5) REQUIREMENTS OF CONTRACT.—Each con- 3 tract awarded under this section shall require the 4 entity awarded such contract to carry out each of 5 the following: 6 (A) Establish and maintain a health care 7 claims database in accordance with the require- 8 ments of the HIPAA privacy regulation. 9 (B) Ensure that such health care claims 10 database makes available data submitted under 11 subsection (d) in accordance with the require- 12 ments of subsection (c). 13 (C) In the case that the contract is not re- 14 newed after the end of the 5-year period of the 15 contract, carry out the transfer of data required 16 pursuant to paragraph (4)(B) in accordance 17 with a schedule and process determined by the 18 Secretary. 19 (D) Comply with the HIPAA privacy regu- 20 lation in the same manner and to the same ex- 21 tent as such regulation applies to a covered en- 22 tity (as defined pursuant to such regulation). 23 (E) Strictly limit staff access to such 24 health care claims database to staff with appro- 25 VerDate Sep 11 2014 23:53 Jan 02, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H8967.IH H8967 pbinns on DSKJLVW7X2PROD with BILLS 6 •HR 8967 IH priate training, clearance, and background 1 checks, and require such staff to undergo reg- 2 ular privacy and security training. 3 (F) Maintain effective security standards 4 for transferring data from such health care 5 claims database and making such data available 6 to all individuals and entities who are author- 7 ized users pursuant to subsection (c)(2). 8 (G) Adhere to best security practices with 9 respect to the management and use of such 10 data for health services research, in accordance 11 with applicable Federal privacy law. 12 (H) Report on the security methods of the 13 entity to— 14 (i) the Secretary; 15 (ii) the Committee on Health, Edu- 16 cation, Labor, and Pensions, the Com- 17 mittee on Finance, and the Committee on 18 Commerce, Science, and Transportation of 19 the Senate; and 20 (iii) the Committee on Education and 21 Labor, the Committee on Energy and 22 Commerce, the Committee on the Judici- 23 ary, and the Committee on Ways and 24 Means of the House of Representatives. 25 VerDate Sep 11 2014 23:53 Jan 02, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H8967.IH H8967 pbinns on DSKJLVW7X2PROD with BILLS 7 •HR 8967 IH (c) AVAILABILITY OF DATA FROM HEALTH CARE 1 CLAIMS DATABASE.— 2 (1) IN GENERAL.—Subject to paragraph (2), 3 the entity maintaining the health care claims data- 4 base described in subsection (b)(5)(A) shall make 5 available, at cost, the data submitted under sub- 6 section (d)— 7 (A) to patients to inform such patients 8 about the cost, quality, and value of their 9 health care; 10 (B) to health care providers and hos- 11 pitals— 12 (i) to assist such providers and hos- 13 pitals in making informed choices while 14 providing health care; and 15 (ii) to enable such providers and hos- 16 pitals to improve health care services pro- 17 vided to patients and health care outcomes 18 for such patients by benchmarking their 19 performance against that of other health 20 care providers and hospitals; 21 (C) to group health plans and health insur- 22 ance issuers offering individual or group health 23 insurance coverage to assist such group health 24 plans and health insurance issuers in evaluating 25 VerDate Sep 11 2014 23:53 Jan 02, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H8967.IH H8967 pbinns on DSKJLVW7X2PROD with BILLS 8 •HR 8967 IH and reducing health care costs for enrollees of 1 such group health plans and individual or group 2 health insurance coverage, respectively; 3 (D) to States to facilitate State-led initia- 4 tives to lower health care costs and improve the 5 quality of health care; 6 (E) to any State all-payer claims database 7 and regional health care claims database oper- 8 ated pursuant to the authorization of each 9 State covered by such regional health care 10 claims database; 11 (F) to any individual or entity conducting 12 research; 13 (G) to the Secretary of Defense for pur- 14 poses of carrying out the TRICARE program 15 under chapter 55 of title 10, United States 16 Code; 17 (H) to the Director of the Office of Per- 18 sonnel Management for purposes of carrying 19 out the Federal Employees Health Benefits 20 Program established under chapter 89 of title 21 5, United States Code; and 22 (I) to the Director of the Congressional 23 Budget Office, the Comptroller General of the 24 United States, the Executive Director of the 25 VerDate Sep 11 2014 23:53 Jan 02, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H8967.IH H8967 pbinns on DSKJLVW7X2PROD with BILLS 9 •HR 8967 IH Medicare Payment Advisory Commission, and 1 the Executive Director of the Medicaid and 2 CHIP Payment Advisory Commission. 3 (2) AUTHORIZATION FOR ACCESS TO DATA.— 4 (A) IN GENERAL.—The entity maintaining 5 the health care claims database described in 6 subsection (b)(5)(A) may only make available 7 the data described in paragraph (1) to an indi- 8 vidual or entity described in any of subpara- 9 graphs (A) through (F) of such paragraph if 10 such individual or entity submits an application 11 to such entity requesting authorization for ac- 12 cess to such database in accordance with this 13 paragraph. 14 (B) APPLICATION.—An application under 15 this paragraph shall be submitted at such time, 16 in such manner, and containing such informa- 17 tion as the Secretary may require and shall in- 18 clude— 19 (i) in the case of an individual or enti- 20 ty requesting access to the health care 21 claims database described in subsection 22 (b)(5)(A) for research purposes— 23 (I) a description of the uses and 24 methodologies for evaluating health 25 VerDate Sep 11 2014 23:53 Jan 02, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H8967.IH H8967 pbinns on DSKJLVW7X2PROD with BILLS 10 •HR 8967 IH system performance using the data 1 from such database; and 2 (II) documentation of approval of 3 such research purposes by an institu- 4 tional review board, if applicable for a 5 particular plan of research; and 6 (ii) in the case of a group health plan, 7 health insurance issuer, third-party admin- 8 istrator of a group health plan, or health 9 care provider requesting access to such 10 health care claims database for the pur- 11 pose of quality improvement or cost-con- 12 tainment, a description of the intended 13 uses for the data from such database. 14 (C) DATA USE AND CONFIDENTIALITY 15 AGREEMENT.—Upon approval of an application 16 under subparagraph (B), the authorized user 17 shall enter into a data use and confidentiality 18 agreement with the entity that approved such 19 application, which shall include a prohibition on 20 attempts to reidentify and disclose protected 21 health information and proprietary financial in- 22 formation. In the case of an approval of an ap- 23 plication for quality improvement or cost-con- 24 tainment purposes under subparagraph (B)(ii), 25 VerDate Sep 11 2014 23:53 Jan 02, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H8967.IH H8967 pbinns on DSKJLVW7X2PROD with BILLS 11 •HR 8967 IH access to data from the health care claims data- 1 base described in subsection (b)(5)(A) shall be 2 provided in a form and manner such that the 3 authorized user may not obtain individually 4 identifiable price information with respect to di- 5 rect competitors. 6 (3) AVAILABILITY OF REPORTS AND ANALYSES 7 BASED ON DATA.— 8 (A) IN GENERAL.—Subject to subpara- 9 graph (B), the entity maintaining the health 10 care claims database described in subsection 11 (b)(5)(A), in consultation with the advisory 12 committee convened under subsection (e), shall 13 make available to all individuals and entities 14 who are authorized users pursuant to para- 15 graph (2) any report or analysis based on data 16 from such database, including aggregate data 17 sets, free of charge. 18 (B) CUSTOMIZED REPORTS.—Group health 19 plans may request customized reports from the 20 entity maintaining the health care claims data- 21 base described in subsection (b)(5)(A), at cost, 22 but subject to the requirements of the HIPPA 23 privacy regulation. 24 VerDate Sep 11 2014 23:53 Jan 02, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H8967.IH H8967 pbinns on DSKJLVW7X2PROD with BILLS 12 •HR 8967 IH (d) SUBMISSION OF DATA TO HEALTH CARE CLAIMS 1 DATABASE.— 2 (1) IN GENERAL.—Subject to paragraphs (2) 3 and (3), a group health plan (through its sponsor, 4 third-party administrator, pharmacy benefit man- 5 ager, or other entity designated by the group health 6 plan) or a health insurance issuer offering group or 7 individual health insurance coverage shall electroni- 8 cally submit to the health care claims database 9 maintained under this section all claims data (in- 10 cluding claims with respect to treatment of sub- 11 stance use disorders and prescription drug claims) 12 with respect to the plan or group or individual 13 health insurance coverage, respectively. 14 (2) SCOPE OF INFORMATION AND FORMAT OF 15 SUBMISSION.—The entity maintaining the health 16 care claims database under this section, in consulta- 17 tion with the advisory committee convened under 18 subsection (e), shall— 19 (A) specify the data elements required to 20 be submitted under paragraph (1), which shall 21 include all data related to transactions de- 22 scribed in subparagraphs (A) and (E) of section 23 1173(a)(2) of the Social Security Act (42 24 U.S.C. 1320d–2(a)(2)), including all data ele- 2 [Text truncated for display. 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