[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: 42CFR480.107]



[Page 485-486]

 

                         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.  480.107  Limitations on redisclosure.



    Persons or organizations that obtain confidential QIO information 

must not further disclose the information to any other person or 

organization except--

    (a) As directed by the QIO to carry out a disclosure permitted or 

required under a particular provision of this part;



[[Page 486]]



    (b) As directed by CMS to carry out specific responsibilities of the 

Secretary under the Act;

    (c) As necessary for CMS to carry out its responsibilities for 

appeals under section 1155 of the Act or for CMS to process sanctions 

under section 1156 of the Act;

    (d) If the health care services furnished to an individual patient 

are reimbursed from more than one source, these sources of reimbursement 

may exchange confidential information as necessary for the payment of 

claims;

    (e) If the information is acquired by the QIO from another source 

and the receiver of the information is authorized under its own 

authorities to acquire the information directly from the source, the 

receiver may disclose the information in accordance with the source's 

redisclosure rules;

    (f) As necessary for the General Accounting Office to carry out its 

statutory responsibilities;

    (g) Information pertaining to a patient or practitioner may be 

disclosed by that individual provided it does not identify any other 

patient or practitioner;

    (h) An institution may disclose information pertaining to itself 

provided it does not identify an individual patient or practitioner;

    (i) Governmental fraud or abuse agencies and State licensing or 

certification agencies recognized by CMS may disclose information as 

necessary in a judicial, administrative or other formal legal proceeding 

resulting from an investigation conducted by the agency;

    (j) State and local public health officials to carry out their 

responsibilities, as necessary, to protect against a substantial risk to 

the public health; or

    (k) As necessary for the Office of the Inspector General to carry 

out its statutory responsibilities.



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

64 FR 66279, Nov. 24, 1999]