Access to Claims Data Act
- Bill Number
- H.R. 4331
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-07-10: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2025-08-16T08:05:24Z
AI-Generated Summary
Purpose
The Access to Claims Data Act (H.R. 4331) aims to improve healthcare research and quality by requiring the Secretary of Health and Human Services (HHS) to create a system for sharing certain federal health insurance claims data with approved clinical data registries. This would help connect billing information (claims data) with patient health results (clinical outcomes) to support better analysis, provider feedback, and patient safety efforts.
Key Provisions
- Establishment of Process: By January 1, 2026, HHS must set up a method for "qualified clinical data registries" (under Medicare rules) and "clinician-led clinical data registries" (under the 21st Century Cures Act) to request claims data in a suitable format.
- Allowed Uses of Data:
- Linking claims data to clinical outcomes for analysis.
- Performing quality checks and improvement activities for healthcare providers (like hospitals) and suppliers (like medical equipment companies), including reporting results to them and conducting adjusted, evidence-based research on quality and safety.
- Publishing research and analyses, potentially including anonymized (deidentified) combined claims and outcomes data.
- Types of Claims Data:
- Primarily from Medicare (the federal health insurance for seniors and certain disabled people).
- Optionally from Medicaid (health coverage for low-income individuals) and the Children's Health Insurance Program (CHIP), if HHS deems it appropriate.
- Data can be specific to providers, medical specialties, states, or nationwide.
- Access Without Special Status: These registries do not need to qualify as "qualified entities" (special groups approved for data access under current law) to obtain the data.
- Fees: Registries pay a reasonable fee covering only the costs of providing the data, with fees going to the Centers for Medicare & Medicaid Services (CMS) management account.
Significant Changes to Existing Law
- Introduces a new, streamlined process for specific types of clinical data registries to access federal claims data without needing to meet the stricter "qualified entity" requirements under the Social Security Act, which previously limited who could request such data.
- Expands potential data sources to include Medicaid and CHIP claims (beyond just Medicare), though this is at HHS's discretion.
- Mandates fee structures tied directly to costs, ensuring data access is affordable while funding administrative needs.
Potential Impacts
- On Government Agencies: HHS and CMS will need to develop and manage a new data-sharing process, potentially increasing administrative workload but also enabling more efficient use of existing data for public health goals. Fees collected could offset some costs.
- On Citizens: Patients may indirectly benefit from improved healthcare quality and safety through better research and provider feedback, leading to more effective treatments and reduced errors. Privacy is protected via deidentification requirements.
- On International Relations: No direct impacts, as the bill focuses on domestic U.S. health programs.
Main Stakeholders Affected
- Healthcare Registries: Qualified clinical data registries (e.g., those involved in Medicare quality reporting) and clinician-led ones (doctor-driven groups for data collection) gain easier access to data for research.
- Providers and Suppliers: Hospitals, doctors, and medical equipment firms benefit from quality improvement reports and analyses to enhance care delivery.
- Government Entities: HHS and CMS are responsible for implementation and data provision.
- Researchers and Patients: Researchers can conduct more robust studies; patients see potential gains in safer, higher-quality care without direct involvement.
Notable Legal, Constitutional, or Political Implications
- Legal: Builds on existing laws like the Social Security Act and 21st Century Cures Act by creating exemptions and new access pathways, which could face challenges if privacy rules (e.g., under HIPAA, the Health Insurance Portability and Accountability Act) are not adequately addressed in implementation. Emphasizes deidentified data to comply with privacy standards.
- Constitutional: No apparent issues, as it involves federal regulation of health programs within Congress's spending and commerce powers.
- Political: Supports bipartisan goals of advancing healthcare innovation and efficiency, potentially reducing long-term costs through quality improvements, but may spark debates on data privacy and administrative burdens on federal agencies. Referred to key committees (Energy and Commerce, Ways and Means) for review.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (2)
Rep. Schrier, Kim [D-WA-8], Rep. Clarke, Yvette D. [D-NY-9]
Recent Actions
- 2025-07-10: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-07-10: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-07-10: Introduced in House
- 2025-07-10: Introduced in House
Bill Versions
- Access to Claims Data Act — issued 2025-07-10 — PDF (4 pages)