CMS Finalizes Qualified Entity Rule - McDermott+Consulting

CMS Finalizes Qualified Entity Rule

Expands Access to Medicare and Private Sector Claims

On July 1, 2016, the Centers for Medicare & Medicaid Services (CMS), released a final rule expanding uses of Medicare data by qualified entities. This final rule implements requirements under Section 105 of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 that expands how qualified entities may use and disclose data. CMS describes this rule as a means to “enhance the current qualified entity program to allow innovative use of Medicare data for non-public quality improvement and care delivery efforts while ensuring the privacy and security of beneficiary information.”

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.

The final rule contains few changes from the proposed rule. Future rulemaking is anticipated to expand the data available to qualified entities to include standardized extracts of Medicaid data.

The Final Rule is available here.

More information on the Qualified Entity Program is available here.

More information on MACRA can be found at the McDermottPlus MACRA Resource Center.