Requesting CMS Data Files: Qualified Entity Program
Welcome to ResDAC's data request information page for qualified entities under Section 10332 of the 2010 Patient Protection and Affordable Care Act. This page provides information about the Qualified Entity Program, the process for applying to become a qualified entity, and the process for requesting data.
Program Overview | Become a Qualified Entity | Request Data | Technical Support
Overview of the Qualified Entity Program
On March 23, 2010, the Patient Protection and Affordable Care Act, (‘‘Affordable Care Act’’) Public Law 111– 148, was enacted. Effective January 1, 2012, section 10332 of the Affordable Care Act will amend section 1874 of the Social Security Act (the Act) by adding a new subsection (e) requiring standardized extracts of Medicare claims data under parts A, B, and D be made available to ‘‘qualified entities’’ for the evaluation of the performance of providers of services and suppliers. For more information, please see the Final Rule for Availability of
Medicare Data for Performance Measurement.
Qualified entities may use the information obtained under section 1874(e) of the Act for the sole purpose of evaluating the performance of providers of services and suppliers, and to generate specified public reports. Qualified entities may receive data for one or more specified geographic areas and must pay a fee equal to the cost of making the data available. Congress also required that qualified entities combine the Medicare claims data from at least one other claims data source to evaluate the performance of providers of services and suppliers.
CMS believes the sharing of Medicare data with qualified entities through this program and the resulting reports produced by qualified entities will be an important driver of improving quality and reducing costs in Medicare, as well as for the healthcare system in general. Additionally, CMS believes this program will increase the transparency of provider and supplier performance, while ensuring beneficiary privacy.
Become a Qualified Entity
To be eligible to receive data as a qualified entity under section 10332, CMS has established eligibility criteria, which can be reviewed in Section 401.703 of the Final Rule. Applicants to the Qualified Entity Certification for Medicare Data Program (QECP) will be evaluated individually to ensure they are prepared to meet the requirements in the statute for serving as a qualified entity. CMS will not limit the number of qualified entities. Any entity that meets the eligibility criteria, as determined by CMS, will be able to become a qualified entity.
To apply to become a qualified entity, visit the QECP Portal.
Request Medicare Data from CMS
After receiving certification as a qualified entity, you must submit a data request application. To begin the data request review process, email the following materials in their original format (.xls, .pdf, .doc) to resdac@umn.edu.
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Specifications Worksheet
- Data Use Agreement (DUA)
The DUA delineates the confidentiality requirements of the Privacy Act and CMS's data release policies and procedures. See CMS DUA Guidelines [19K, pdf] for additional information regarding a DUA.
NOTE: All requests should include the following as the name of the study/project in Section 4 of the DUA: “Qualified Entity Program.” - DUA Signature Addendum
If anyone other than the requester or custodian is going to handle CMS data, a signature addendum will be required.
- Information Exchange Agreement (IEA)
The Information Exchange Agreement delineates additional protections and requirements specific to the release of data to qualified entities. Please review the Qualified Entity Program System of Records for more information on the new routine use of Medicare data for this purpose.
Technical Support
ResDAC is available to provide technical support to qualified entities in understanding and using the Medicare claims data. Please contact us by phone at 1-888-973-7322 or by email at resdac@umn.edu for assistance.
Last Modified February 1, 2012