CMS to Ease Restrictions on Federal Claims Data

February 10, 2016

The Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule that would allow for the sale of claims data from federal health programs, combined with patient data from sources in the private sector, by research organizations authorized to do so.

The initiative is an attempt to boost use of data from Medicare, Medicaid, and the Children’s Health Insurance Program, which—according to an article in Modern Healthcare—initially became available 4 years ago under the Patient Protection and Affordable Care Act but was rife with restrictions.

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“They're saying, we're going to take another shot at this,” attorney and health care privacy expert Kirk Nahra told Modern Healthcare. “The positive for the government was, for the past couple of decades, nobody was getting this data for any purpose. Now, the recognition is there is a tremendous amount of data and good things could come from these data analytics."

Under the rule, sales and donations of data are limited to health care providers, health insurance issuers, medical societies, and other “authorized” users, according to the article.

“The proposed expansion of the initiative,” Modern Healthcare reports, “would allow data analysts to combine the federal data with claims data from other sources and then sell the data combinations to evaluate provider and supplier performance. The work of these data analysts is subject to review and correction by the affected providers and suppliers. Then, their work is to be made public.”

Privacy and security of patient data are addressed in the proposed rule, according to the article. Sales of data and analyses must comply with Health Insurance Portability and Accountability Act privacy requirements and prohibit identifiable patient information when the buyer does not have an established, existing patient relationship with the individual. CMS recommends its authorized research organizations use data use agreements to legally bind customers from using the data or analyses to harm patients.

The proposed rule was authorized by the 2015 Medicare Access and CHIP Reauthorization Act.—Jolynn Tumolo

Reference: Conn J. Medicare’s big-data experiment depends on data use agreements to protect privacy. Modern Healthcare. February 1, 2016.