Author: Tom Entrikin | Posted: 7. December 2011 11:53

The Centers for Medicare and Medicaid Services (CMS) released final rules on December 7 concerning CMS release of standardized extracts of Medicare Part A, B, and D claims data.  The final rules are effective January 6, 2012.  The rules implement section 10332 of the Affordable Care Act (ACA) requiring CMS to release such data extracts to qualified organizations to support measurement and analysis of provider performance.   Qualified organizations must demonstrate the capability to combine the Medicare extracts with Medicaid and other claims data and to generate statistically valid reports using recognized performance measures such as those endorsed by the National Quality Forum (NQF).  Statistical validity encompasses case-mix and severity adjustments among providers, appropriate provider peer groupings, methods for handling statistical outliers, and other analytic techniques to ensure that the data are meaningful and useful to consumers, providers, health plans, researchers, and other stakeholders.  Qualified organizations may include private organizations as well as public organizations including state departments of health and human services.   Publicly reported results of provider performance analysis (not the Medicare data itself) may be used for activities such as Medicaid pay-for-performance initiatives.  Lead organizations may engage contractors in order to meet qualification requirements where their contractors meet the same data use, privacy, and security requirements applicable to the lead organization.  The final rules set forth the data release application requirements and procedures.   CMS will accept applications on a rolling basis after the application template becomes available on the CMS website.