H.R. 4331: Access to Claims Data Act

This bill, known as the Access to Claims Data Act, aims to improve health care research and quality by expanding access to claims data from certain federal health plans. Here’s what it will do:

Purpose of the Bill

The main goal is to require the Secretary of Health and Human Services to set up a process that allows specific clinical data registries to request access to claims data. This data will be used for various health-related purposes, including:

• Linking claims data with clinical outcomes data to gain insights into patient care.
• Conducting assessments of providers' performance and engaging in quality improvement activities.
• Publishing research findings that may include combined de-identified claims and clinical outcomes data.

Types of Claims Data

The claims data that can be accessed under this bill includes:

• Claims data from the Medicare program.
• Possibly, claims data from Medicaid and the State Children’s Health Insurance Program, if deemed appropriate by the Secretary.
• Additional claims data may include information specific to providers, clinical specialties, states, or nationwide data.

Access for Registries

The qualified clinical data registries and clinician-led registries that will access this data will not be required to meet certain qualification standards typically imposed. This aims to simplify the process of obtaining the data.

Fee for Accessing Data

Access to the claims data will come at a reasonable fee, which will be calculated based on the cost of providing the data. Any fees collected will go into the Centers for Medicare & Medicaid Services Program Management Account, ensuring that the process is self-sustaining and does not require additional funding.

The bill sets a deadline of January 1, 2026, for establishing this process, which indicates a timeline for when these changes will start coming into effect.

Summary

In summary, the Access to Claims Data Act is designed to enhance health care quality and research by making it easier for specific registries to access important claims data from federal health programs.

Relevant Companies

• UNH (UnitedHealth Group) - As a major health care provider and insurance company, changes in data access could affect their operations and ability to leverage data for quality improvement initiatives.
• ANTM (Anthem, Inc.) - Adjustments in claims data accessibility may influence how Anthem utilizes claims data for patient care management and research.
• CNC (Centene Corporation) - As a managed care organization, Centene could be impacted in terms of how they report and utilize claims data for health service improvements.