Provision of Certain Claims Data and Beneficiary Reports Clause Samples

Provision of Certain Claims Data and Beneficiary Reports. ‌ A. CMS believes that the health care operations work of the ACO (that is acting on its own behalf as a HIPAA covered entity (CE) or that is a business associate (BA) acting on behalf of its Participant Providers or Preferred Providers that are HIPAA CEs) would benefit from the receipt of certain beneficiary- identifiable data on REACH Beneficiaries and Beneficiaries who have been excluded from alignment to the ACO, including Originally Aligned Beneficiaries. CMS will therefore offer to the ACO an opportunity to request specific Beneficiary-identifiable data by completing the HIPAA-Covered Data Disclosure Request Form. This data set will not include SUD data; however, CMS will notify the ACO in writing if CMS subsequently elects to offer the ACO an opportunity to request Beneficiary-identifiable SUD data by completing the HIPAA-Covered Data Disclosure Request Form. All requests for Beneficiary- identifiable claims data will be granted or denied at CMS’ sole discretion based on CMS’s available resources and technological capabilities, the limitations in the Agreement, and applicable law. B. In offering this Beneficiary-identifiable data, CMS does not represent that the ACO or any Participant Provider or Preferred Provider has met all applicable HIPAA requirements for requesting data under 45 CFR 164.506(c)(4). The ACO and its Participant Providers and Preferred Providers should consult with their own counsel to make those determinations prior to requesting this data from CMS. C. The Beneficiary-identifiable data available for request by completing the HIPAA- Covered Data Disclosure Request Form includes the data and reports described in this Section 6.02.C. The aggregated data described in paragraphs (4) through (6) of this Section 6.02.C will incorporate de-identified data regarding Beneficiaries who have opted out of data sharing or who have received treatment for SUD services. While aggregated, the data described in paragraphs (4) through (6) may be identifiable due to cells that represent fewer than 11 Beneficiaries; when this is the case, the data are subject to all requirements under the Agreement and applicable law.