[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: 42CFR480.138]



[Page 491]

 

                         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.  480.138  Disclosure for other specified purposes.



    (a) General requirements for disclosure. Except as specified in 

paragraph (b) of this section, the following provisions are required of 

the QIO.

    (1) Disclosure to licensing and certification bodies. (i) A QIO must 

disclose confidential information upon request, to State or Federal 

licensing bodies responsible for the professional licensure of a 

practitioner or a particular institution. Confidential information, 

including QIO medical necessity determinations that display the practice 

or performance patterns of that practitioner, must be disclosed by the 

QIO but only to the extent that it is required by the agency to carry 

out a function within the jurisdiction of the agency under Federal or 

State law.

    (ii) A QIO may provide the information specified in paragraph 

(a)(1)(i) of this section to the State or Federal licensing body without 

request.

    (2) Disclosure to State and local public health officials. A QIO 

must disclose QIO information to State and local public health officials 

whenever the QIO determines that the disclosure of the information is 

necessary to protect against a substantial risk to the public health.

    (3) Disclosure to the courts. Patient identified records in the 

possession of a QIO are not subject to subpoena or discovery in a civil 

action, including an administrative, judicial or arbitration proceeding.

    (b) Exceptions. (1) The restriction set forth in paragraph (a)(3) of 

this section does not apply to HHS, including Inspector General, 

administrative subpoenas issued in the course of audits and 

investigations of Department programs, in the course of administrative 

hearings held under the Social Security Act or to disclosures to the 

General Accounting Office as necessary to carry out its statutory 

responsibilities.

    (2) A QIO must disclose information regarding QIO deliberations and 

quality review study information only as specified in Sec. Sec.  

480.139(a) and 480.140.



[50 FR 15359, Apr. 17, 1985; 50 FR 41887, Oct. 16, 1985. Redesignated at 

64 FR 66279, Nov. 24, 1999, as amended at 69 FR 49267, Aug. 11, 2004]