(ACO) regulations - American Society of Anesthesiologists

CMS-1345-P 126
(2) Sharing Data Related to Medicare Part D
Beneficiary identifiable Medicare prescription drug information could also be
beneficial to ACOs for improving the care coordination of their patient population.
Having a complete picture, for example, of the beneficiary's medication regimen can
assist in avoiding duplication or adverse interactions among medications.
We issued a final rule in May of 2008 authorizing the Secretary to recollect Part
D claims data that were originally collected for Part D payment purposes for research,
analysis, reporting, and public health functions (73 FR 30664). In that final rule, we
noted our intent to use the data for a wide variety of purposes including "supporting care
coordination and disease management programs," and "supporting quality improvement
and performance measurement activities." (42 CFR 423.505(f)(3)(v), (vi)). We also
expressed our view that "it is in the interest of public health to share the information
collected…with entities outside of CMS for legitimate research, or in cases of other
governmental agencies, for purposes consistent with their mission." (73 FR 30666).
Accordingly, the regulations specified when data would be shared with outside entities,
such as other government agencies, and external entities, including researchers.
The Part D data rule did not expressly address the question of whether Part D data
could be shared with external entities, such as ACOs, for purposes other than research.
However, in the rule, we noted that sharing Part D claims data, in addition to Parts A and
B data, could have salutary effects on the evaluation and functioning of the Medicare
programs as well as improving the clinical care furnished to beneficiaries. Furthermore,
the rule explicitly contemplated the use of Part D data to support care coordination and
disease management programs, as well as quality improvement and performance