42 USC 247d-11 - State All Payer Claims Databases

U.S Code last checked for updates: May 06, 2024

§ 247d–11.

State All Payer Claims Databases

(a)

In general

(b)

Uses

A State may use a grant received under subsection (a) for one of the following purposes:

(1)

To establish a State All Payer Claims Database.

(2)

To improve an 1

 So in original.

existing State All Payer Claims Databases.1

(c)

Eligibility

(d)

Grant period and amount

(e)

Authorized users

(1)

Application

An entity desiring authorization for access to a State All Payer Claims Database that has received a grant under this section shall submit to the State All Payer Claims Database an application for such access, which shall include—

(A)

in the case of an entity requesting access for research purposes—

(i)

a description of the uses and methodologies for evaluating health system performance using such data; and

(ii)

documentation of approval of the research by an institutional review board, if applicable for a particular plan of research; or

(B)

in the case of an entity such as an employer, health insurance issuer, third-party administrator, or health care provider, requesting access for the purpose of quality improvement or cost-containment, a description of the intended uses for such data.

(2)

Requirements

(A)

Access for research purposes

(B)

Customized reports

(C)

Non-customized reports

(3)

Waivers

(f)

Expanded access

(1)

Multi-State applications

(2)

Expansion of data sets

(g)

Definitions

In this section—

(1)

the term “individually identifiable health information” has the meaning given such term in section 1320d(6) of this title;

(2)

the term “proprietary financial information” means data that would disclose the terms of a specific contract between an individual health care provider or facility and a specific group health plan, managed care entity (as defined in section 1396u–2(a)(1)(B) of this title) or other managed care organization, or health insurance issuer offering group or individual health insurance coverage; and

(3)

the term “State All Payer Claims Database” means, with respect to a State, a database that may include medical claims, pharmacy claims, dental claims, and eligibility and provider files, which are collected from private and public payers.

(h)

Authorization of appropriations

(July 1, 1944, ch. 373, title III, § 320B, as added Pub. L. 116–260, div. BB, title I, § 115(a), Dec. 27, 2020, 134 Stat. 2875.)

cite as: 42 USC 247d-11