[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[S. 856 Introduced in Senate (IS)]

112th CONGRESS
  1st Session
                                 S. 856

 To amend title XI of the Social Security Act to make available to the 
public aggregate data on providers of services and suppliers under the 
 Medicare program and to allow qualified individuals and groups access 
 to claims and payment data under the Medicare program for purposes of 
            conducting health research and detecting fraud.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 14, 2011

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

_______________________________________________________________________

                                 A BILL


 
 To amend title XI of the Social Security Act to make available to the 
public aggregate data on providers of services and suppliers under the 
 Medicare program and to allow qualified individuals and groups access 
 to claims and payment data under the Medicare program for purposes of 
            conducting health research and detecting fraud.

    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 ``Medicare Spending Transparency Act 
of 2011''.

SEC. 2. PUBLIC AVAILABILITY OF AGGREGATE DATA ON MEDICARE PROVIDERS OF 
              SERVICES AND SUPPLIERS.

    (a) Purpose.--The purpose of this section is to make aggregate 
information about providers of services and suppliers under the 
Medicare program under title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.) publicly available and to provide a new level of 
transparency in such program.
    (b) Public Availability.--Section 1128J of the Social Security Act 
(42 U.S.C. 1320a-7k) is amended by adding at the end the following new 
subsection:
    ``(f) Public Availability of Certain Medicare Data.--
            ``(1) In general.--The Secretary shall, to the extent 
        consistent with applicable information, privacy, security, and 
        disclosure laws, including the regulations promulgated under 
        the Health Insurance Portability and Accountability Act of 1996 
        and section 552a of title 5, United States Code, make available 
        to the public on the Internet website of the Centers for 
        Medicare & Medicaid Services the following data with respect to 
        title XVIII:
                    ``(A) A complete list of the providers of services 
                and suppliers participating in the program under such 
                title, including the business address of such providers 
                of services and suppliers.
                    ``(B) Aggregate information about each such 
                provider of services and supplier, including--
                            ``(i) the total number of individuals 
                        furnished items or services by the provider of 
                        services or supplier for which payment was made 
                        under such title during the preceding year;
                            ``(ii) the number of unique patient 
                        encounters conducted by the provider of 
                        services or supplier for which payment was made 
                        under such title during the preceding year;
                            ``(iii) the average number of codes billed 
                        under such title by the provider of services of 
                        supplier per patient encounter during the 
                        preceding year;
                            ``(iv) the total amount paid to such 
                        provider of services or supplier under such 
                        title during the preceding year;
                            ``(v) the top 50 billing codes on claims 
                        paid under such title to the provider of 
                        services or supplier during the preceding year, 
                        as determined by volume, including a 
                        description of such codes;
                            ``(vi) the top 50 billing codes on such 
                        claims paid during such year, as determined by 
                        dollar amount, including a description of such 
                        codes; and
                            ``(vii) the top 50 diagnosis and procedure 
                        code pairs on such claims paid during such 
                        year, as determined by volume, including a 
                        description of such codes.
            ``(2) Implementation.--Not later than 1 year after the date 
        of enactment of the Medicare Spending Transparency Act of 2011, 
        the Secretary shall promulgate regulations to carry out this 
        subsection.''.

SEC. 3. ACCESS TO MEDICARE CLAIMS AND PAYMENT DATA BY QUALIFIED 
              INDIVIDUALS AND GROUPS.

    (a) Purpose.--The purpose of this section is to allow qualified 
individuals and groups access to information on claims and payment data 
under the Medicare program for purposes of conducting health research 
and detecting fraud under such program.
    (b) Access to Medicare Claims and Payment Data by Qualified 
Individuals and Groups.--Section 1128J of the Social Security Act (42 
U.S.C. 1320a-7k), as amended by section 2, is amended by adding at the 
end the following new subsection:
    ``(g) Access to Medicare Claims and Payment Data by Qualified 
Individuals and Groups.--
            ``(1) In general.--For purposes of conducting health 
        research and detecting fraud under title XVIII, and to the 
        extent consistent with applicable information, privacy, 
        security, and disclosure laws, including the regulations 
        promulgated under the Health Insurance Portability and 
        Accountability Act of 1996 and section 552a of title 5, United 
        States Code, and subject to any information systems security 
        requirements under such laws or otherwise required by the 
        Secretary, a qualified individual or group shall have access to 
        claims and payment data of the Department of Health and Human 
        Services and its contractors related to title XVIII. 
        Notwithstanding any other provision of law, such data shall 
        include the identity of individual providers of services and 
        suppliers under such title.
            ``(2) Definition of qualified individual or group.--
                    ``(A) In general.--In this subsection, the term 
                `qualified individual or group' means an individual or 
                entity that the Secretary has determined, in accordance 
                with subparagraph (B), has relevant experience, 
                knowledge, and technical expertise in medicine, 
                statistics, health care billing, practice patterns, 
                health care fraud detection, and analysis to use data 
                provided to the individual or the entity under this 
                subsection in an appropriate, responsible, and ethical 
                manner and for the purposes described in paragraph (1).
                    ``(B) Procedures.--The Secretary shall establish 
                procedures for determining, in a timely manner, whether 
                an individual or entity is a qualified individual or 
                group.
            ``(3) Procedures.--The Secretary shall establish procedures 
        for the storage and use of data provided to a qualified 
        individual or group under this subsection. Such procedures 
        shall ensure that, in the case where the qualified individual 
        or group publishes an analysis of such data (or any analysis 
        using such data), the qualified individual or group discloses 
        the following information (in a form and manner, and at a time, 
        specified by the Secretary):
                    ``(A) The name of the qualified individual or 
                group.
                    ``(B) The sources of any funding for the qualified 
                individual or group.
                    ``(C) Any employer or other relevant affiliations 
                of the qualified individual or group.
                    ``(D) The data analysis methods used by the 
                qualified individual or group in the analysis 
                involved.''.
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