§247d–11 State All Payer Claims Databases

Summary

The federal government will give one-time grants to states to create or improve State All Payer Claims Databases. Each grant lasts 3 years and is for $2,500,000 total: $1,000,000 in year one, $1,000,000 in year two, and $500,000 in year three. A state must send an application to the Secretary that includes information the Secretary asks for, and must explain how it will collect data in a consistent way and keep the data private and secure. Researchers, employers, insurers, administrators, and health care providers can apply for access to a state’s database. Researchers must explain their methods and show an institutional review board approval when needed. Other groups must say how they will use the data for quality or cost work. Approved users must sign agreements that forbid trying to identify people or to reveal contract-level financial details. Employers can buy custom reports at cost, and all authorized users can get free, non-custom aggregate data. The Secretary can waive some access rules if a database mostly follows them and can give priority to states that work with other states for a single cross-state access application or that add reporting for self-insured group health plans. Definitions used: “individually identifiable health information” (privacy term defined elsewhere); “proprietary financial information” (contract-level payment details); “State All Payer Claims Database” (state database of medical, pharmacy, dental claims and eligibility/provider files from public and private payers). Funding authorized: $50,000,000 for each of fiscal years 2022 and 2023, and $25,000,000 for fiscal year 2024, available until spent.