CMS Proposes Changes to Qualified Entity Program: Expands Release of Provider Data - McDermott+Consulting

CMS Proposes Changes to Qualified Entity Program: Expands Release of Provider Data

On January 29, 2016 the Centers for Medicare & Medicaid Services (CMS) released a proposed rule, as required by the Medicare Access and CHIP Reauthorization Act (MACRA), to allow organizations approved as qualified entities to confidentially share or sell analyses of Medicare and private sector claims data to providers, employers, and other groups who can use the data to support improved care. In addition, qualified entities will be allowed to provide or sell claims data to providers. The rule also includes strict privacy and security requirements for all entities receiving Medicare analyses or data, as well as new annual reporting requirements. Comments are due by March 29, 2016.


CMS views this proposal to expand the release of provider data as a means to enhance its efforts to improve the quality and drive down costs in the Medicare program.

The qualified entity program was authorized by Section 10332 of the Affordable Care Act and allows organizations that meet certain qualifications to access to 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. Currently, 13 organizations have applied and received approval to be a qualified entity.  Of these organizations, two have completed public reporting while the other 11 are preparing for public reporting.  While CMS has been pleased with the interest in the program so far, they believe these changes required by MACRA will increase interest in the program.


The proposed rule is available here.