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CMS Finalizes Rule Giving Providers and Employers Improved Access to Information for Better Patient Care

CMS Finalizes Rule Giving Providers and Employers Improved Access to Information for Better Patient Care

The Centers for Medicare & Medicaid Services (CMS) has finalized a new rule that expands access to analyses and data that will help providers, employers, and others make more informed decisions about care delivery and quality improvement. The final rule contains a few changes and clarifications to the proposed rule.

The new rule, as required by the Medicare Access and CHIP Reauthorization Act (MACRA), allows organizations, approved as qualified entities, to confidentially share or sell analyses of Medicare and private sector claims data to providers, employers, and other groups who can use the data to support improved care. In addition, qualified entities may provide or sell claims data to providers and suppliers, such as doctors, nurses, and skilled nursing facilities among others.

The rule also includes strict privacy and security requirements for all entities receiving patient identifiable and beneficiary de-identified analyses or data, as well as expanded annual reporting requirements. For example, if entities receive patient identifiable data or analyses, they must use protections that are at least as stringent as what is required of covered entities and their business associates for protected health information (PHI) under the HIPAA Privacy and Security Rules.

This initiative is part of a broader effort by the Obama Administration to use data to help create a health care system that delivers better care for patients, spends dollars more wisely, and results in healthier people.

The Qualified Entity Program was authorized by Section 10332 of the Affordable Care Act and allows organizations that meet certain qualifications to access patient-protected Medicare data to produce public reports. Qualified entities must combine the Medicare data with other claims data (e.g., private payer data) to produce quality reports that are representative of how providers and suppliers are performing across multiple payers, for example Medicare, Medicaid, or various commercial payers. Currently, 15 organizations have applied and received approval to be a qualified entity.  Of these organizations, two have completed public reporting while the other 13 are preparing for public reporting.



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