[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[S. 848 Introduced in Senate (IS)]

112th CONGRESS
  1st Session
                                 S. 848

To provide for the development of reports based on Medicare data, data 
   that is publicly available, or private data that is provided by a 
  requesting entity in order to improve the quality and efficiency of 
                              health care.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 14, 2011

  Mr. Cornyn introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To provide for the development of reports based on Medicare data, data 
   that is publicly available, or private data that is provided by a 
  requesting entity in order to improve the quality and efficiency of 
                              health care.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``The Consumer Information Enhancement 
Act of 2011''.

SEC. 2. QUALITY AND EFFICIENCY REPORTS BASED ON MEDICARE ENROLLMENT, 
              CLAIMS, SURVEY, AND ASSESSMENT DATA.

    Title XVIII of the Social Security Act is amended by adding at the 
end the following new section:

        ``quality and efficiency reports based on medicare data

    ``Sec. 1899B.  (a) Purpose.--The purpose of this section is to 
provide for the development of reports based on Medicare data, data 
that is publicly available, or private data that is provided by a 
requesting entity (as defined in subsection (e)(1)(A)) in order to--
            ``(1) improve the quality and efficiency of health care;
            ``(2) enhance the education and awareness of consumers for 
        evaluating health care services; and
            ``(3) provide the public with reports on national, 
        regional, and provider- and supplier-specific performance, 
        which may be in a provider- or supplier-identifiable format.
    ``(b) Procedures for the Development of Reports.--
            ``(1) In general.--Notwithstanding sections 552(b)(6) and 
        552a(b) of title 5, United States Code, not later than 12 
        months after the date of enactment of this section, the 
        Secretary, in accordance with the purpose described in 
        subsection (a) and the requirements described in subsection 
        (d)(3), shall establish and implement procedures under which a 
        requesting entity may submit an application to a Consumer 
        Information Organization for such Organization to develop a 
        report based on--
                    ``(A) Medicare data disclosed to the Organization 
                under subsection (c);
                    ``(B) data, including clinical data when available, 
                that is publicly available; and
                    ``(C) private data that is provided to the 
                Organization by the requesting entity.
            ``(2) Definitions.--In this section:
                    ``(A) Medicare data.--The term `Medicare data' 
                means--
                            ``(i) enrollment data under this title, 
                        including de-identified beneficiary enrollment 
                        data;
                            ``(ii) all claims for reimbursement for all 
                        items and services furnished by a provider of 
                        services (as defined in section 1861(u)) or a 
                        supplier (as defined in section 1861(d)) under 
                        part A or B in a research identifiable format;
                            ``(iii) on and after January 1, 2011, all 
                        data relating to enrollment in, and coverage 
                        for, qualified prescription drug coverage under 
                        part D; and
                            ``(iv) additional data relating to the 
                        program under this title collected by the 
                        Secretary for the purpose of nationwide quality 
                        measurement and reporting based on surveys and 
                        assessment data determined appropriate by the 
                        Secretary.
                    ``(B) Consumer information organization.--The term 
                `Consumer Information Organization' means an entity 
                with a contract under subsection (d).
            ``(3) Rule of construction.--Nothing in this section shall 
        be construed as authorizing or requiring the Secretary to 
        collect any additional information or data that was not 
        collected by the Secretary prior to the date of enactment of 
        this section.
    ``(c) Access to Medicare Data.--
            ``(1) In general.--The procedures established under 
        subsection (b)(1) shall provide for the secure disclosure of 
        Medicare data to each Consumer Information Organization.
            ``(2) All data.--The Secretary shall ensure that all 
        Medicare data (as described in subsection (b)(2)(A)), beginning 
        with data from January 1, 2005, is disclosed under paragraph 
        (1), including the most recent data available to the Secretary. 
        Not less than every 6 months, the Secretary shall update the 
        Medicare data disclosed under paragraph (1) to each Consumer 
        Information Organization.
    ``(d) Consumer Information Organizations.--
            ``(1) In general.--
                    ``(A) Contracts with private entities.--Subject to 
                subparagraph (B), the Secretary shall enter into a 
                contract with 3 private entities, as well as any State 
                described in subparagraph (C)(i), to serve as Consumer 
                Information Organizations, under which each such entity 
                or State shall--
                            ``(i) store the Medicare data that is to be 
                        disclosed under subsection (c); and
                            ``(ii) develop and release reports pursuant 
                        to subsection (e).
                    ``(B) Additional contracts with private entities.--
                If the Secretary determines that reports are not being 
                developed and released within 6 months of the receipt 
                of the request for the report, the Secretary shall 
                enter into contracts with additional private entities 
                in order to ensure that such reports are developed and 
                released in a timely manner.
                    ``(C) Contracts with states.--
                            ``(i) In general.--At the request of a 
                        State, the Secretary shall enter into a 
                        contract with such State to serve as a Consumer 
                        Information Organization.
                            ``(ii) Existing data use agreements.--
                        Nothing in this section shall be construed to 
                        preempt, modify, or otherwise affect any data 
                        use agreement relating to Medicare patient-
                        level data that has been entered into by the 
                        Secretary and a State prior to the date of 
                        enactment of this section.
            ``(2) Qualifications.--The Secretary shall enter into a 
        contract with a private entity or a State under paragraph (1) 
        only if the Secretary determines that such entity or State--
                    ``(A) has the research capability to conduct and 
                complete reports under this section;
                    ``(B) has in place-
                            ``(i) an information technology 
                        infrastructure to support the entire database 
                        of Medicare data; and
                            ``(ii) operational standards to provide 
                        security for such database;
                    ``(C) has experience with, and expertise on, the 
                development of reports on health care quality and 
                efficiency based on Medicare or private sector claims 
                data;
                    ``(D) is incorporated in the United States;
                    ``(E) has provided sufficient assurances that any 
                data provided to such entity or State under this 
                section shall not be made accessible to any individual 
                or entity residing outside of the United States; and
                    ``(F) has demonstrated the ability to satisfy the 
                requirements described in paragraph (3).
            ``(3) Confidentiality and privacy requirements.--The 
        Secretary shall issue such regulations and include in each 
        contract described in paragraph (1) such terms as are necessary 
        to ensure that each private entity or State meets the following 
        requirements:
                    ``(A) Ensuring beneficiary privacy.--
                            ``(i) HIPAA.--The entity or State shall 
                        meet the requirements imposed on a covered 
                        entity for purposes of applying part C of title 
                        XI and all regulatory provisions promulgated 
                        thereunder, including regulations (relating to 
                        privacy) adopted pursuant to the authority of 
                        the Secretary under section 264(c) of the 
                        Health Insurance Portability and Accountability 
                        Act of 1996 (42 U.S.C. 1320d-2 note).
                            ``(ii) Privacy.--The entity or State shall 
                        provide assurances that such entity or State 
                        will not use the Medicare data disclosed under 
                        subsection (c) in a manner that violates 
                        sections 552 or 552a of title 5, United States 
                        Code, with regard to the privacy of 
                        individually identifiable beneficiary health 
                        information.
                    ``(B) Proprietary information.--The entity or State 
                shall not disclose any trade secrets, commercial or 
                financial information, or pricing data that is 
                identifiable to a particular entity, including--
                            ``(i) part D negotiated price concessions, 
                        such as discounts, direct or indirect 
                        subsidies, rebates, and direct or indirect 
                        remunerations, obtained by prescription drug 
                        plans and MA-PD plans for covered part D drugs;
                            ``(ii) pricing information between a 
                        Medicare Advantage Organization and any 
                        provider, supplier, contractor, or 
                        subcontractor; and
                            ``(iii) any other proprietary cost 
                        information.
                    ``(C) Protection of information.--The entity or 
                State shall use Medicare data disclosed under 
                subsection (c) solely for the purposes described in 
                this section. Nothing in this section shall be 
                construed to limit the requirements imposed on such 
                entity or State by section 1905 of title 18, United 
                States Code, or pursuant to the public disclosure 
                protections provided under section 552(b) of title 5, 
                United States Code.
                    ``(D) Disclosure.--The entity or State shall 
                disclose--
                            ``(i) any financial, reporting, or 
                        contractual relationship between such entity or 
                        State and any provider of services (as defined 
                        in section 1861(u)) or supplier (as defined in 
                        section 1861(d)); and
                            ``(ii) if applicable, the fact that the 
                        entity is managed, controlled, or operated by 
                        any such provider of services or supplier.
                    ``(E) Component of another organization.--If an 
                entity is a component of another organization, such 
                entity--
                            ``(i) shall maintain Medicare data and 
                        reports separately from the rest of the 
                        organization and establish appropriate security 
                        measures to maintain the confidentiality and 
                        privacy of the Medicare data and reports; and
                            ``(ii) shall not make an unauthorized 
                        disclosure to the rest of the organization of 
                        Medicare data or reports in breach of such 
                        confidentiality and privacy requirement.
                    ``(F) Termination or nonrenewal.--If a contract 
                under this section is terminated or not renewed, the 
                following requirements shall apply:
                            ``(i) Confidentiality and privacy 
                        protections.--The entity or State shall 
                        continue to comply with the confidentiality and 
                        privacy requirements under this section with 
                        respect to all Medicare data disclosed to such 
                        entity or State and each report developed by 
                        such entity or State.
                            ``(ii) Disposition of data and reports.--
                        The entity or State shall--
                                    ``(I) return to the Secretary all 
                                Medicare data disclosed to such entity 
                                or State and each report developed by 
                                such entity or State; or
                                    ``(II) if returning the Medicare 
                                data and reports is not practicable, 
                                destroy such data and reports.
            ``(4) Competitive procedures.--Competitive procedures (as 
        defined in section 4(5) of the Federal Procurement Policy Act) 
        shall be used to enter into contracts with private entities 
        under subparagraphs (A) or (B) of paragraph (1).
            ``(5) Review of contract in the event of a merger or 
        acquisition.--For purposes of contracts described under 
        subparagraphs (A) and (B) of paragraph (1), the Secretary shall 
        review the contract with a Consumer Information Organization 
        under this section in the event of a merger or acquisition of 
        the Organization in order to ensure that the requirements under 
        this section will continue to be met.
    ``(e) Development and Release of Reports Based on Requests.--
            ``(1) Request for a report.--
                    ``(A) Requesting entity.--The term `requesting 
                entity' means an individual, group, or State that has 
                submitted a request to a Consumer Information 
                Organization for development of a report based upon 
                Medicare data disclosed to such Organization under 
                subsection (c), data that is publicly available, or 
                private data that is provided by the requesting entity.
                    ``(B) Request.--
                            ``(i) In general.--Subject to the purpose 
                        described in subsection (a), the procedures 
                        established under subsection (b)(1) shall 
                        include a process for a requesting entity to 
                        submit an application to a Consumer Information 
                        Organization for development of a report.
                            ``(ii) Request for specific methodology.--
                        The process described in clause (i) shall 
                        permit a requesting entity to request that a 
                        specific methodology, including appropriate 
                        risk-adjustment, be used by the Consumer 
                        Information Organization in developing the 
                        report. The Organization shall work with the 
                        requesting entity to finalize the methodology 
                        to be used.
                            ``(iii) Request for a specific consumer 
                        information organization.--The process 
                        described in clause (i) shall permit a 
                        requesting entity to submit an application for 
                        a report to any Consumer Information 
                        Organization.
                    ``(C) Release to public.--The procedures 
                established under subsection (b)(1) shall provide that 
                at the time an application for a report is finalized 
                under subparagraph (A) by a Consumer Information 
                Organization, the Organization shall make available to 
                the public, through the Internet Web site of the 
                Centers for Medicare & Medicaid Services and other 
                appropriate means, a brief description of both the 
                requested report and the methodology to be used to 
                develop such report.
                    ``(D) Right of appeal.--The Secretary shall 
                promulgate regulations establishing a right of appeal 
                and appeals process with respect to the denial of a 
                request for development of a report by a Consumer 
                Information Organization, under which the requesting 
                entity may appeal the decision of the Organization.
            ``(2) Development and release of report.--
                    ``(A) Development.--
                            ``(i) In general.--Subject to clauses (ii) 
                        and (iii), if an application for a report 
                        complies with the purpose described in 
                        subsection (a), the Consumer Information 
                        Organization may develop the report based upon 
                        such application.
                            ``(ii) Standards and methodology.--A report 
                        developed under clause (i) shall include a 
                        detailed description of the standards, 
                        methodologies, and measures of quality used in 
                        developing the report.
                            ``(iii) Consultation requirement.--For 
                        purposes of developing a report under clause 
                        (i), the Consumer Information Organization 
                        shall consult with relevant national 
                        professional organizations (as determined 
                        appropriate based upon the content of the 
                        report) and include in the report a summary of 
                        any comments or feedback provided by such 
                        organizations.
                    ``(B) Review of report by secretary to ensure 
                compliance with privacy requirement.--Prior to release 
                of a report by a Consumer Information Organization 
                under subparagraph (C), the Secretary shall review the 
                report to ensure that the report complies with the 
                Federal regulations (concerning the privacy of 
                individually identifiable beneficiary health 
                information) promulgated under section 264(c) of the 
                Health Insurance Portability and Accountability Act of 
                1996 and sections 552 or 552a of title 5, United States 
                Code, with regard to the privacy of individually 
                identifiable beneficiary health information, as well as 
                any requirements described in subsection (d)(3) 
                regarding use and protection of data disclosed to the 
                Organization. The Secretary shall act within 30 
                business days of receiving such report.
                    ``(C) Release of report.--
                            ``(i) Release to entity making request.--If 
                        the Secretary finds that the report complies 
                        with the provisions described in subparagraph 
                        (B), the Consumer Information Organization 
                        shall release the report to the requesting 
                        entity.
                            ``(ii) Release to public.--The procedures 
                        established under subsection (b)(1) shall 
                        provide for the following:
                                    ``(I) Updated description.--At the 
                                time of the release of a report by a 
                                Consumer Information Organization under 
                                clause (i), the requesting entity shall 
                                make available to the public, through 
                                the Internet Web site of the Centers 
                                for Medicare & Medicaid Services and 
                                other appropriate means, an updated 
                                brief description of both the requested 
                                report and the methodology used to 
                                develop such report.
                                    ``(II) Complete report.--Subject to 
                                clause (iii), not later than 1 year 
                                after the date of the release of a 
                                report under clause (i), the report 
                                shall be made available to the public 
                                through the Internet Web site of the 
                                Centers for Medicare & Medicaid 
                                Services and other appropriate means.
                            ``(iii) Public comment.--The Secretary 
                        shall establish a process that provides an 
                        opportunity for public comment, for a period of 
                        not less than 90 days, following the release of 
                        the report to the public under clause (ii)(II), 
                        with any public comments received to be 
                        included with the report on the Internet Web 
                        site of the Centers for Medicare & Medicaid 
                        Services.
    ``(f) Annual Review of Reports and Termination of Contracts.--
            ``(1) Annual review of reports.--The Comptroller General of 
        the United States shall--
                    ``(A) review reports released under subsection 
                (e)(2)(C) to ensure that such reports comply with the 
                purpose described in subsection (a);
                    ``(B) review whether such reports result in 
                limitations on patient access to health care services; 
                and
                    ``(C) annually submit a report to the Secretary on 
                such review.
            ``(2) Termination of contracts.--The Secretary may 
        terminate a contract with a Consumer Information Organization 
        if the Secretary determines that there is a pattern of reports 
        being released by the Organization that do not comply with the 
        purpose described in subsection (a).
    ``(g) Fees.--
            ``(1) Fees for secretary.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                Secretary shall charge each Consumer Information 
                Organization a fee that is sufficient to cover costs 
                incurred by the Secretary in regard to--
                            ``(i) disclosure of Medicare data under 
                        subsection (c); and
                            ``(ii) conducting the review under 
                        subsection (e)(2)(B).
                    ``(B) Comparable to fees charged for existing data 
                use agreements.--For purposes of the fees described in 
                subparagraph (A), such fees shall be reasonably 
                comparable to fees charged by the Secretary in relation 
                to data use agreements described in subsection 
                (d)(1)(C)(ii).
            ``(2) Fees for consumer information organization.--
                    ``(A) In general.--Subject to subparagraphs (B) and 
                (C), a Consumer Information Organization may charge a 
                requesting entity a reasonable fee for the development 
                and release of the report.
                    ``(B) Discount for small entities.--In the case of 
                a requesting entity (including a not-for-profit 
                organization) that has annual revenue that does not 
                exceed $10,000,000, the Consumer Information 
                Organization shall reduce the reasonable fee charged to 
                such entity under subparagraph (A) by an amount equal 
                to 10 percent of such fee.
                    ``(C) Increase for large entities that do not agree 
                to release reports within 6 months.--In the case of a 
                requesting entity that is not described in subparagraph 
                (B) and that does not agree to the report being 
                released to the public under clause (ii)(II) of 
                subsection (e)(2)(C) within 6 months of the date of the 
                release of the report to the entity under clause (i) of 
                such subsection, the Consumer Information Organization 
                shall increase the fee charged to such entity under 
                subparagraph (A) by an amount equal to 10 percent of 
                such fee.
                    ``(D) Rule of construction.--Nothing in this 
                paragraph shall be construed to effect the requirement 
                that a report be released to the public under clause 
                (ii)(II) of subsection (e)(2)(C) by not later than 1 
                year after the date of the release of the report to the 
                requesting entity under clause (i) of such subsection.
    ``(h) Regulations.--Not later than 6 months after the date of 
enactment of this section, the Secretary shall, after providing notice 
and comment opportunities to the public, prescribe regulations to carry 
out this section, including such regulations as are necessary to carry 
out the confidentiality and privacy requirements described in 
subsection (d)(3).''.

SEC. 3. RESEARCH ACCESS TO MEDICARE DATA AND REPORTING ON PERFORMANCE.

    (a) In General.--The Secretary of Health and Human Services shall 
permit researchers that meet criteria used to ensure the 
appropriateness of the release of Centers for Medicare & Medicaid 
Services data for research purposes to--
            (1) have access to all Medicare data (as defined in section 
        1899B(b)(2)(A) of the Social Security Act, as added by section 
        2); and
            (2) report on the performance of providers of services (as 
        defined in subsection (u) of section 1861 of such Act) and 
        suppliers (as defined in subsection (d) of such section), 
        including reporting in a provider- or supplier-identifiable 
        format.
    (b) Confidentiality and Privacy Requirements.--For purposes of 
disclosing any information or data to a researcher under this section, 
the Secretary of Health and Human Services shall ensure that the 
confidentiality and privacy requirements described in subparagraphs (A) 
through (C) of section 1899B(d)(3) of the Social Security Act are 
applied to such researcher in the same manner as such requirements are 
applied to a private entity or State under such subparagraphs.
                                 <all>