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§1191d Standardized Reporting Format

Title 29 › CHAPTER 18 — EMPLOYEE RETIREMENT INCOME SECURITY PROGRAM › SUBCHAPTER I — PROTECTION OF EMPLOYEE BENEFIT RIGHTS › Subtitle B — Regulatory Provisions › part 7 — group health plan requirements › Subpart C — General Provisions › § 1191d

Last updated Sep 23, 2026|Official source

Summary

The Secretary must create a common file format within 1 year after December 27, 2020. Group health plans may use it to report medical, pharmacy, dental claims and eligibility and provider records to State All Payer Claims Databases. The Secretary must also give States guidance on how to collect those records in the new format. Up to $5,000,000 is available for fiscal year 2021 to help carry this out, and the money stays available until spent or until the committee report date described below. Within 90 days after December 27, 2020, the Secretary must set up a 15‑member Advisory Committee to help design the format and guidance. Members serve staggered 3‑year terms and vacancies must be filled within 3 months. The committee will include two senior department officials (or their designees), federal agency representatives (such as CMS, AHRQ, the HHS Office for Civil Rights for privacy, NCHS, and ONC), a State All‑Payer Claims Database representative, plus members appointed by the Comptroller General (including an employer rep, an employee‑organization rep, an academic health researcher, a consumer advocate, and two others). The committee must send recommendations to the Secretary and to these Congressional committees within 180 days after December 27, 2020: Senate HELP, House Energy and Commerce, and House Education and Labor. Once that report is sent, the committee requirement ends.

Title 29, §1191d

Labor, Source: USLM XML via OLRC

(a)In general

Not later than 1 year after December 27, 2020, the Secretary shall establish (and periodically update) a standardized reporting format for the voluntary reporting, by group health plans to State All Payer Claims Databases, of medical claims, pharmacy claims, dental claims, and eligibility and provider files that are collected from private and public payers, and shall provide guidance to States on the process by which States may collect such data from such plans in the standardized reporting format.

(b)Consultation

(1)Advisory Committee

Not later than 90 days after December 27, 2020, the Secretary shall convene an Advisory Committee (referred to in this section as the “Committee”), consisting of 15 members to advise the Secretary regarding the format and guidance described in paragraph (1).

(2)Membership

(A)Appointment

In accordance with subparagraph (B), not later than 90 days after December 27, 2020, the Secretary, in coordination with the Secretary of Health and Human Services, shall appoint under subparagraph (B)(iii), and the Comptroller General of the United States shall appoint under subparagraph (B)(iv), members who have distinguished themselves in the fields of health services research, health economics, health informatics, data privacy and security, or the governance of State All Payer Claims Databases, or who represent organizations likely to submit data to or use the database, including patients, employers, or employee organizations that sponsor group health plans, health care providers, health insurance issuers, or third-party administrators of group health plans. Such members shall serve 3-year terms on a staggered basis. Vacancies on the Committee shall be filled by appointment consistent with this paragraph not later than 3 months after the vacancy arises.

(B)Composition

The Committee shall be comprised of— (i)

(ii)the Assistant Secretary for Planning and Evaluation of the Department of Health and Human Services, or a designee of such Assistant Secretary;

(iii)members appointed by the Secretary, in coordination with the Secretary of Health and Human Services, including—

(I)1 member to serve as the chair of the Committee;

(II)1 representative of the Centers for Medicare & Medicaid Services;

(III)1 representative of the Agency for Healthcare Research and Quality;

(IV)1 representative of the Office for Civil Rights of the Department of Health and Human Services with expertise in data privacy and security;

(V)1 representative of the National Center for Health Statistics;

(VI)1 representative of the Office of the National Coordinator for Health Information Technology; and

(VII)1 representative of a State All-Payer Claims Database;

(iv)members appointed by the Comptroller General of the United States, including—

(I)1 representative of an employer that sponsors a group health plan;

(II)1 representative of an employee organization that sponsors a group health plan;

(III)1 academic researcher with expertise in health economics or health services research;

(IV)1 consumer advocate; and

(V)2 additional members.

(3)Report

Not later than 180 days after December 27, 2020, the Committee shall report to the Secretary, the Committee on Health, Education, Labor, and Pensions of the Senate, and the Committee on Energy and Commerce and the Committee on Education and Labor of the House of Representatives. Such report shall include recommendations on the establishment of the format and guidance described in subsection (a).

(c)State All Payer Claims Database

In this section, 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.

(d)Authorization of appropriations

To carry out this section, there are authorized to be appropriated $5,000,000 for fiscal year 2021, to remain available until expended or, if sooner, until the date described in subsection (e).

(e)Sunset

Beginning on the date on which the report is submitted under subsection (b)(3), subsection (b) shall have no force or effect.

Statutory Notes and Related Subsidiaries

Change of Name

Committee on Education and Labor of House of Representatives changed to Committee on Education and the Workforce of House of Representatives by House Resolution No. 5, One Hundred Eighteenth Congress, Jan. 9, 2023.

§1191d Standardized Reporting Format

Summary

Title 29, §1191d

Notes & Related Subsidiaries

Statutory Notes and Related Subsidiaries

Change of Name

Citations & Metadata