The No Surprises Act (Section 115) | National Association of Health Data Organizations

Section 115 of The No Surprises Act (State All Payer Claims Databases)

2016 - Comments to DOL NPRM Form 5500 and Schedule J
2017 - Outreach to DOL
2018 - Bipartisan Senate "Healthcare Transparency Initiative" Invited Comments and Comments on "Protecting Patients from Surprise Medical Bills Act"
2019 - Discussions and meetings with Senate HELP Committee and Comments on Lower Health Care Costs Act
2020 - Continued discussions on Lowering Health Care Costs Act and other legislative activity; Section 115 of the No Surprises Act
2016-Present - Development, publication and maintenance of the APCD-CDL™

Grant Program
- Grants to states to establish or improve a “State All Payer Claims Database”
- Eligibility based on an application that at least specifies how the State will ensure 1) uniform data collection and 2) the privacy and security of such data
- Grants are for 3 years, $1M in the first two years, followed by $0.5M in the third year
Expectations of Grant Recipients - Authorized Use
- Entities wishing to use the data may submit a request for data directly to states funded under this program for research purposes, quality improvement, or cost containment
- Authorized users will be prohibited from attempting to reidentify and disclose protected data
- Employers may request customized reports at cost
- Grant-funded states shall make aggregate data publicly available free of charge
- Secretary of HHS may waive requirements if the State APCD is substantially in compliance
Expectations of Grant Recipients - Expand Access
- Secretary may prioritize applications that establish a single application for data from multiple states
- Secretary may prioritize applications that will implement the Secretary of Labor’s reporting format for self-funded data

Standardized Reporting Format and Guidance
- The Secretary of Labor shall establish and periodically update a standardized reporting format for the voluntary reporting of data to State APCDs by group health plans
- The Secretary of Labor shall provide guidance to States on how to collect such data in the standardized format
The Advisory Committee Qualifications
- Distinguished themselves in health services research, health economics, health informatics, data privacy and security, State APCD governance, or
- Represent organizations likely to submit or use APCD data – patients, group health plan sponsors, health care providers, insurers or third-party administrators
- Serve three-year staggered terms (or until sunsetted)
- Report (due within 180 days) – Recommendations on the establishment of the format and guidance
The Advisory Committee Composition
- Secretary of Labor to appoint nine members:
  - Assistant Secretary of Employee Benefits and Security Administration
  - Assistant Secretary for Planning and Evaluation (Health and Human Services)
  - In consultation with Secretary of HHS:
    The Committee Chair, CMS, AHRQ, OCR (data privacy and security), NCHS, ONC, a representative of a State APCD
- The Comptroller General (GAO) to appoint six members:
  - Employer, Employee Organization, Academic Researcher, Consumer Advocate, Two additional members

Consolidated Appropriations Act of 2021 Section 115 starts on page 1694 of the pdf document