This Act expands access to Medicare and Medicaid claims data for qualified clinical and clinician-led registries to facilitate research, quality improvement, and reporting on healthcare provider performance.
John Joyce
Representative
PA-13
The Access to Claims Data Act establishes a system for qualified clinical data registries and clinician-led registries to request Medicare and Medicaid claims data. This access is intended to facilitate research, quality improvement initiatives, and the reporting of care quality metrics. Registries will use the linked data to assess provider performance and publish de-identified findings, provided they pay a fee covering the cost of data provision.
New Data Act Streamlines Access to Medicare Claims for Quality Research by 2026
The Access to Claims Data Act is designed to speed up and simplify how certain organizations get their hands on massive amounts of Medicare claims data. Essentially, by January 1, 2026, the Secretary of Health and Human Services (HHS) has to create a system that lets specific clinical data registries—the ones already recognized as Qualified Clinical Data Registries (QCDRs) or those established under the 21st Century Cures Act—request and receive Medicare claims information. The core idea is to let these registries link the claims data (which shows what services were paid for) with the clinical outcomes data they already collect (which shows how patients actually fared). This combined dataset is gold for improving care quality and patient safety, allowing them to check the performance of doctors and suppliers, report those findings back, and run scientific studies.
Cutting the Red Tape for Quality Control
Think of this as giving the people who are already monitoring quality a fast pass to the information they need. Right now, getting federal health data can be a bureaucratic nightmare. This bill explicitly states that these specific clinical registries won't have to jump through the same hoops or meet the stricter requirements usually applied to other groups (like “qualified entities”) seeking this data. This is a significant streamlining measure intended to accelerate research. For a clinician-led registry trying to figure out why a certain surgical procedure has better outcomes in one state than another, easier access to claims data—which shows costs and utilization—will make that analysis much faster and more robust. The bill also allows the Secretary the option to throw in Medicaid and Children's Health Insurance Program (CHIP) data, which could be a huge win for understanding care across the entire public health system, though that decision is currently discretionary.
The Cost and the Catch
While this bill aims to make data access easier, it’s not free. Any registry requesting the data must pay a “reasonable fee” that is set to cover only the actual cost of providing the data. This is a common-sense provision designed to ensure that taxpayers aren't footing the bill for the administrative work needed to pull and format these huge datasets. The money collected goes right back into the Centers for Medicare & Medicaid Services (CMS) Program Management Account. The biggest practical challenge here involves privacy: the entire purpose is to combine sensitive claims data with clinical results. While the bill requires that any public research findings must use de-identified data (meaning patient names and identifying details are stripped out), the security of that combined, highly detailed dataset while it’s in the hands of the registry is paramount. If a registry’s security protocols aren't top-notch, the risk of a breach, however small, increases simply because they are holding a more comprehensive set of patient information.