42 USC 247d-11 - State All Payer Claims Databases

United States Code

USC most recently checked for updates: Oct 01, 2023

§ 247d-10. Pilot program for public health laboratories to detect fentanyl and other synthetic opioids

§ 247d-12. Coordination and collaboration regarding blood supply

U.S. Code
Notes

§ 247d–11.

State All Payer Claims Databases

(a)

In general

The Secretary shall make one-time grants to eligible States for the purposes described in subsection (b).

(b)

Uses

A State may use a grant received under subsection (a) for one of the following purposes:

(1)

To establish a State All Payer Claims Database.

(2)

To improve an 1

 So in original.

existing State All Payer Claims Databases.1

(c)

Eligibility

To be eligible to receive a grant under subsection (a), a State shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary specifies, including, with respect to a State All Payer Claims Database, at least specifics on how the State will ensure uniform data collection and the privacy and security of such data.

(d)

Grant period and amount

Grants awarded under this section shall be for a period of 3-years,2

 So in original. Probably should be “3 years,”.

and in an amount of $2,500,000, of which $1,000,000 shall be made available to the State for each of the first 2 years of the grant period, and $500,000 shall be made available to the State for the third year of the grant period.

(e)

Authorized users

(1)

Application

An entity desiring authorization for access to a State All Payer Claims Database that has received a grant under this section shall submit to the State All Payer Claims Database an application for such access, which shall include—

(A)

in the case of an entity requesting access for research purposes—

(i)

a description of the uses and methodologies for evaluating health system performance using such data; and

(ii)

documentation of approval of the research by an institutional review board, if applicable for a particular plan of research; or

(B)

in the case of an entity such as an employer, health insurance issuer, third-party administrator, or health care provider, requesting access for the purpose of quality improvement or cost-containment, a description of the intended uses for such data.

(2)

Requirements

(A)

Access for research purposes

Upon approval of an application for research purposes under paragraph (1)(A), the authorized user shall enter into a data use and confidentiality agreement with the State All Payer Claims Database that has received a grant under this subsection, which shall include a prohibition on attempts to reidentify and disclose individually identifiable health information and proprietary financial information.

(B)

Customized reports

Employers and employer organizations may request customized reports from a State All Payer Claims Database that has received a grant under this section, at cost, subject to the requirements of this section with respect to privacy, security, and proprietary financial information.

(C)

Non-customized reports

A State All Payer Claims Database that has received a grant under this section shall make available to all authorized users aggregate data sets available through the State All Payer Claims Database, free of charge.

(3)

Waivers

The Secretary may waive the requirements of this subsection of a State All Payer Claims Database to provide access of entities to such database if such State All Payer Claims Database is substantially in compliance with this subsection.

(f)

Expanded access

(1)

Multi-State applications

The Secretary may prioritize applications submitted by a State whose application demonstrates that the State will work with other State All Payer Claims Databases to establish a single application for access to data by authorized users across multiple States.

(2)

Expansion of data sets

The Secretary may prioritize applications submitted by a State whose application demonstrates that the State will implement the reporting format for self-insured group health plans described in section 1191d of title 29.

(g)

Definitions

In this section—

(1)

the term “individually identifiable health information” has the meaning given such term in section 1320d(6) of this title;

(2)

the term “proprietary financial information” means data that would disclose the terms of a specific contract between an individual health care provider or facility and a specific group health plan, managed care entity (as defined in section 1396u–2(a)(1)(B) of this title) or other managed care organization, or health insurance issuer offering group or individual health insurance coverage; and

(3)

the term “State All Payer Claims Database” means, with respect to a State, a database that may include medical claims, pharmacy claims, dental claims, and eligibility and provider files, which are collected from private and public payers.

(h)

Authorization of appropriations

To carry out this section, there is authorized to be appropriated $50,000,000 for each of fiscal years 2022 and 2023, and $25,000,000 for fiscal year 2024, to remain available until expended.

(July 1, 1944, ch. 373, title III, § 320B, as added Pub. L. 116–260, div. BB, title I, § 115(a), Dec. 27, 2020, 134 Stat. 2875.)

cite as: 42 USC 247d-11