STATE ALL PAYER CLAIMS DATABASES.

SEC. 115. STATE ALL PAYER CLAIMS DATABASES. (a) Grants to States.—Part B of title III of the Public Health Service Act (42 U.S.C. 243 et seq.) is amended by adding at the end the following: “SEC. 320B. [42 U.S.C. 247d-11] STATE ALL PAYER CLAIMS DATABASES “(a) In General.—The Secretary shall make one-time grants to eligible States for the purposes described in subsection (b). “(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 existing State All Payer Claims Databases. “(c) Eligibility.—To be eligible to receive a grant under subsection (a), a State shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary specifies, including, with respect to a State All Payer Claims Database, at least specifics on how the State will ensure uniform data collection and the privacy and security of such data. “(d) Grant Period and Amount.—Grants awarded under this section shall be for a period of 3-years, and in an amount of $2,500,000, of which $1,000,000 shall be made available to the State for each of the first 2 years of the grant period, and $500,000 shall be made available to the State for the third year of the grant period. “(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.—Upon approval of an application for research purposes under paragraph (1)(A), the authorized user shall enter into a data use and confidentiality agreement with the State All Payer Claims Database that has received a grant under this subsection, which shall include a prohibition on attempts to reidentify and disclose individually identifiable health information and proprietary financial information. “(B) Customized reports.—Employers and employer organizations may request customized reports from a State All Payer Claims Database that has received a grant under this section, at cost, subject to the requirements of this section with respect to privacy, security, and proprietary financial information. “(C) Non-customized reports.—A State All Payer Claims Database that has received a grant under this section shall make available to all authorized users aggregate data sets available through the State All Payer Claims Database, free of charge. “(3) Waivers.—The Secretary may waive the requirements of this subsection of a State All Payer Claims Database to provide access of entities to such database if such State All Payer Claims Database is substantially in compliance with this subsection. “(f) Expanded Access.— “(1) Multi-state applications.—The Secretary may prioritize applications submitted by a State whose application demonstrates that the State will work with other State All Payer Claims Databases to establish a single application for access to data by authorized users across multiple States. “(2) Expansion of data sets.—The Secretary may prioritize applications submitted by a State whose application demonstrates that the State will implement the reporting format for self-insured group health plans described in section 735 of the Employee Retirement Income Security Act of 1974. “(g) Definitions.—In this section— “(1) the term ‘individually identifiable health information’ has the meaning given such term in section 1171(6) of the Social Security Act; “(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 1932(a)(1)(B) of the Social Security Act) 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.—To carry out this section, there is authorized to be appropriated $50,000,000 for each of fiscal years 2022 and 2023, and $25,000,000 for fiscal year 2024, to remain available until expended.” . (b) Standardized Reporting Format.—Subpart C of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1191 et seq.) is amended by adding at the end the following: “SEC. 735. [29 U.S.C. 1191d] STANDARDIZED REPORTING FORMAT “(a) In General.—Not later than 1 year after the date of enactment of this section, 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 the date of enactment of this section, 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 the date of enactment this section, 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) the Assistant Secretary of Employee Benefits and Security Administration of the Department of Labor, or a designee of such Assistant Secretary; “(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 the date of enactment of this section, 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.” .