Access to Claims Data Act

This bill mandates that the Secretary of Health and Human Services establish a process by January 1, 2026, to expand access to federal health plan claims data. This process will allow qualified clinical data registries and clinician-led clinical data registries to request claims data from the Medicare program. The Secretary may also include claims data from the Medicaid and State Children's Health Insurance Programs, and this data can be specific to providers, clinical specialties, states, or be nationwide. The primary goals for this expanded access are to facilitate linking claims data with clinical outcomes data, conduct quality assessments and improvement activities, and publish research and analyses. Importantly, these registries will not be required to meet the existing "qualified entity" or "quasi-qualified entity" definitions to obtain this data. A reasonable fee, covering the cost of data provision, will be charged for access, with funds deposited into the Centers for Medicare & Medicaid Services Program Management Account.