Subpart B. Subpart B—Utilization and Quality Control Quality Improvement Organizations (QIOs)

• General Provisions

  • SECTION § 480.101 - Scope and definitions.
  • SECTION § 480.102 - Statutory bases for acquisition and maintenance of information.
  • SECTION § 480.103 - Statutory bases for disclosure of information.
  • SECTION § 480.104 - Procedures for disclosure by a QIO.
  • SECTION § 480.105 - Notice of disclosures made by a QIO.
  • SECTION § 480.106 - Exceptions to QIO notice requirements.
  • SECTION § 480.107 - Limitations on redisclosure.
  • SECTION § 480.108 - Penalties for unauthorized disclosure.
  • SECTION § 480.109 - Applicability of other statutes and regulations.

• QIO Access to Information

  • SECTION § 480.111 - QIO access to records and information of institutions and practitioners.
  • SECTION § 480.112 - QIO access to records and information of intermediaries and carriers.
  • SECTION § 480.113 - QIO access to information collected for QIO purposes.
  • SECTION § 480.114 - Limitation on data collection.

• QIO Responsibilities

  • SECTION § 480.115 - Requirements for maintaining confidentiality.
  • SECTION § 480.116 - Notice to individuals and institutions under review.

• Disclosure of Nonconfidential Information

  • SECTION § 480.120 - Information subject to disclosure.
  • SECTION § 480.121 - Optional disclosure of nonconfidential information.

• Disclosure of Confidential Information

  • SECTION § 480.130 - Disclosure to the Department.
  • SECTION § 480.131 - Access to medical records for the monitoring of QIOs.
  • SECTION § 480.132 - Disclosure of information about patients.
  • SECTION § 480.133 - Disclosure of information about practitioners, reviewers and institutions.
  • SECTION § 480.134 - Verification and amendment of QIO information.
  • SECTION § 480.135 - Disclosure necessary to perform review responsibilities.
  • SECTION § 480.136 - Disclosure to intermediaries and carriers.
  • SECTION § 480.137 - Disclosure to Federal and State enforcement agencies responsible for the investigation or identification of fraud or abuse of the Medicare or Medicaid programs.
  • SECTION § 480.138 - Disclosure for other specified purposes.
  • SECTION § 480.139 - Disclosure of QIO deliberations and decisions.
  • SECTION § 480.140 - Disclosure of quality review study information.
  • SECTION § 480.141 - Disclosure of QIO interpretations on the quality of health care.
  • SECTION § 480.142 - Disclosure of sanction reports.
  • SECTION § 480.143 - QIO involvement in shared health data systems.
  • SECTION § 480.144 - Access to QIO data and information.
  • SECTION § 480.145 - Beneficiary authorization of use of confidential information.