[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR431.115]



[Page 32-33]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 431_STATE ORGANIZATION AND GENERAL ADMINISTRATION--Table of Contents

 

        Subpart C_Administrative Requirements: Provider Relations

 

Sec.  431.115  Disclosure of survey information and provider or 



contractor evaluation.



    (a) Basis and purpose. This section implements--

    (1) Section 1902(a)(36) of the Act, which requires a State plan to 

provide that the State survey agency will make publicly available the 

findings from surveys of health care facilities, laboratories, agencies, 

clinics, or organizations; and

    (2) Section 1106(d) of the Act, which places certain restrictions on 

the Medicaid agency's disclosure of contractor and provider evaluations.

    (b) Definition of State survey agency. The State survey agency 

referred to in this section means the agency specified under section 

1902(a)(9) of the Act as responsible for establishing and maintaining 

health standards for private or public institutions in which Medicaid 

recipients may receive services.

    (c) State plan requirements. A State plan must provide that the 

requirements of this section and Sec.  488.325 of this chapter are met.

    (d) Disclosure procedure. The Medicaid agency must have a procedure 

for disclosing pertinent findings obtained from surveys made by the 

State survey agency to determine if a health care facility, laboratory, 

agency, clinic or health care organization meets the requirements for 

participation in the Medicaid program.

    (e) Documents subject to disclosure. Documents subject to disclosure 

include--

    (1) Survey reports, except for Joint Commission on the Accreditation 

of Hospitals reports prohibited from disclosure under Sec.  

422.426(b)(2) of this chapter;

    (2) Official notifications of findings based on survey reports:

    (3) Pertinent parts of written documents furnished by the health 

care provider to the survey agency that relate to the reports and 

findings; and

    (4) Ownership and contract information as specified in Sec.  455.104 

of this subchapter.

    (f) Availability for inspection and copy of statements listing 

deficiencies. The disclosure procedure must provide that the State 

survey agency will--

    (1) Make statements of deficiencies based on the survey reports 

available for inspection and copying in both the public assistance 

office and the Social Security Administration district office serving 

the area where the provider is located; and

    (2) Submit to the Regional Medicaid Director, through the Medicaid 

agency, a plan for making those findings available in other public 

assistance offices in standard metropolitian statistical areas where 

this information would be helpful to persons likely to use the health 

care provider's services.

    (g) When documents must be made available. The disclosure procedure 

must provide that the State survey agency will--

    (1) Retain in the survey agency office and make available upon 

request survey reports and current and accurate ownership information; 

and

    (2) Make available survey reports, findings, and deficiency 

statements immediately upon determining that a health care provider is 

eligible to begin or continue participation in the Medicaid program, or 

within 90 days after completion of the survey, whichever occurs first.

    (h) Evaluation reports on providers and contractors. (1) If the 

Secretary sends the following reports to the Medicaid



[[Page 33]]



agency, the agency must meet the requirements of paragraphs (h) (2) and 

(3) of this section in releasing them:

    (i) Individual contractor performance reviews and other formal 

performance evaluations of carriers, intermediaries, and State agencies, 

including the reports of followup reviews;

    (ii) Comparative performance evaluations of those contractors, 

including comparisons of either overall performance or of any particular 

aspect of contractor operations; and

    (iii) Program validation survey reports and other formal performance 

evaluations of providers, including the reports of followup reviews.

    (2) The agency must not make the reports public until--

    (i) The contractor or provider has had a reasonable opportunity, not 

to exceed 30 days, to comment on them; and

    (ii) Those comments have been incorporated in the report.

    (3) The agency must ensure that the reports contain no 

identification of individual patients, individual health care 

practitioners or other individuals.



[43 FR 45188, Sept. 29, 1978, as amended at 44 FR 41644, July 17, 1979; 

59 FR 56232, Nov. 10, 1994]