The Centers for Medicare & Medicaid Services issued a final rule Monday for the release and use of Medicare claims data to qualified entities to measure the performance of Medicare providers under the Patient Protection and Affordable Care Act.
Beginning in 2012, the ACA requires the Health and Human Services secretary to provide standardized extracts of Medicare Parts A, B and D claims data to qualified entities on request.
Among other changes to the proposed rule, CMS estimates the average cost for a qualified entity for the first year of the program is $40,000, down from $200,000 in the proposed rule. The estimate assumes 25 qualified entities will request data for an average 2.5 million beneficiaries.
Before receiving Medicare data, qualified entities will be required to sign a Data Use Agreement (DUA) with CMS that requires them to submit documentation of any inappropriate disclosures or uses of individually identifiable data to CMS, and to inform each individual whose health information has been inappropriately accessed.
The rule requires qualified entities to confidentially share measures, measurement methodologies and measure results with providers and suppliers at least 60 calendar days prior to making measurement results public, compared to 30 business days in the proposed rule.
The final rule on Availability of Medicare Data for Performance Measurement can be accessed at the Office of the Federal Register.
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