[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: 42CFR480.139]



[Page 491-492]

 

                         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.  480.139  Disclosure of QIO deliberations and decisions.



    (a) QIO deliberations. (1) A QIO must not disclose its deliberations 

except to--

    (i) CMS, at the QIO office or at a subcontracted organization;

    (ii) CMS, to the extent that the deliberations are incorporated in 

sanction and appeals reports; or

    (iii) The Office of the Inspector General, and the General 

Accounting Office as necessary to carry out statutory responsibilities.

    (2) QIO deliberations are not disclosable, either in written form or 

through oral testimony, in connection with the administrative hearing or 

review of a beneficiary's claim.

    (b) Reasons for QIO decisions. (1) A QIO may disclose to those who 

have access to QIO information under other provisions of this subpart, 

the reasons



[[Page 492]]



for QIO decisions pertaining to that information provided that the 

opinions or judgements of a particular individual or practitioner cannot 

be identified.

    (2) A QIO must disclose, if requested in connection with the 

administrative hearing or review of a beneficiary's claim, the reasons 

for QIO decisions. The QIO must include the detailed facts, findings and 

conclusions supporting the QIO's determination. The QIO must insure that 

the opinions or judgements of a particular individual or practitioner 

cannot be identified through the materials that are disclosed.