CMS Data Sharing. Over the Performance Period of the Model, CMS is willing to accept requests from the GMCB for Medicare data necessary to achieve the purposes of the Model. This Medicare data may include individually-identifiable Medicare eligibility status and demographic information of all Medicare FFS beneficiaries residing in Vermont, and claim and claim line data for services furnished by Medicare-enrolled providers and suppliers to Medicare FFS beneficiaries residing in Vermont. CMS may, upon request of the GMCB, provide additional reports that include the following: utilization, expenditures, quality of care, Medicare FFS eligibility type, VMA ACO alignment, and performance summary comparisons to other states. The GMCB may request individually- identifiable health information that is necessary for carrying out health oversight activities under 45 C.F.R. § 164.512(d)(1). All such requests for individually- identifiable health information must clearly state the HIPAA basis for the requested disclosure and include an assertion that the data requested constitutes the minimum necessary to carry out those activities. CMS will make best efforts to approve, deny, or request additional information regarding data requests within 60 calendar days after the State’s request. CMS will accept or reject such requests on a case-by-case basis and at CMS’s sole discretion. All information will be provided consistent with all applicable laws and regulations, including HIPAA and the regulations governing the confidentiality of substance use disorder patient records under 42 C.F.R. part 2. Appropriate privacy and security protections will be required for any data disclosed under this Agreement.
CMS Data Sharing. Over the Performance Period of the Model, CMS is willing to accept requests from the GMCB for Medicare data necessary to achieve the purposes of the Model. This Medicare data may include individually identifiable Medicare eligibility status and demographic information of all Medicare FFS beneficiaries residing in Vermont, and claim and claim line data for services furnished by Medicare-enrolled providers and suppliers to Medicare FFS beneficiaries residing in Vermont. Additional reports may be provided upon request that include the following: utilization, expenditures, quality of care, Medicare FFS eligibility type, VMA ACO alignment, and performance summary comparisons to other states. All such requests for individually-identifiable health information must clearly state the HIPAA basis for requested disclosure (e.g., for research purposes under 45 C.F.R. § 164.512(i), to enable GMCB to analyze healthcare utilization, quality, expenditures, and system performance under the Vermont All- payer ACO Model). CMS will make best efforts to approve, deny, or request additional information regarding data requests within a reasonable amount of time. All information will be provided consistent with all applicable laws and regulations, including HIPAA and the Part 2 regulations governing the use of information regarding diagnosis and treatment for substance abuse. Appropriate privacy and security protections will be required for any data disclosed under this Model.
