[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: 42CFR480.103]



[Page 484]

 

                         TITLE 42--PUBLIC HEALTH

 

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

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 480_ACQUISITION, PROTECTION, AND DISCLOSURE QUALITY IMPROVEMENT 

 

     Subpart B_Utilization and Quality Control Quality Improvement 

                          Organizations (QIOs)

 

Sec.  480.103  Statutory bases for disclosure of information.



    (a) Section 1154(a)(10) of the Act requires QIOs to exchange 

information with intermediaries and carriers with contracts under 

sections 1816 and 1842 of the Act, other QIOs, and other public or 

private review organizations as appropriate.

    (b) Section 1160 of the Act provides that QIO information must be 

held in confidence and not be disclosed except where--

    (1) Necessary to carry out the purpose of Title XI Part B of the 

Act;

    (2) Specifically permitted or required under this subpart;

    (3) Necessary, and in the manner prescribed under this subpart, to 

assist Federal and State agencies recognized by the Secretary as having 

responsibility for identifying and investigating cases or patterns of 

fraud or abuse;

    (4) Necessary, and in the manner prescribed under the subpart to 

assist Federal or State agencies recognized by the Secretary as having 

responsibility for identifying cases or patterns involving risks to the 

public health;

    (5) Necessary, and in the manner prescribed under this subpart, to 

assist appropriate State agencies having responsibility for licensing or 

certification of providers or practitioners; or

    (6) Necessary, and in the manner prescribed under this subpart to 

assist Federal or State health planning agencies by furnishing them 

aggregate statistical data on a geographical, institutional or other 

basis.



[50 FR 15359, Apr. 17, 1985; 50 FR 41886, Oct. 16, 1985. Redesignated at 

64 FR 66279, Nov. 24, 1999]