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CMS Issues Qualified Entity Final Rule Expanding Access to Medicare and Private Payer Claims Data

July 8, 2016—The Centers for Medicare and Medicaid Services July 1 released a final rule that will enhance the current qualified entity program by allowing certain organizations for the first time to sell analyses of Medicare data for non-public quality improvement and care delivery efforts.  Under the rule, personal health information and underlying claims data must be kept confidential between the organizations collecting that data and those acquiring it.

The final rule implements requirements under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 that expands how qualified entities may use and disclose data. The rule will allow qualified entities to perform analyses on chronically ill or other populations to identify which treatments increase quality and reduce costs. Providers could use this analysis to improve care.

The Qualified Entity Program was authorized by the Affordable Care Act and allows organizations that meet certain qualifications to access patient protected Medicare data to produce reports. To access the data, the qualified entities must combine the Medicare data with other claims data (i.e., private payer data) to produce reports showing how providers are performing across multiple payers. 


Gayle Lee
Director, Physician Payment & Quality
Telephone: 202-741-6429


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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.

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Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806