42 CFR § 480.101
Federal
Scope and definitions.
42 CFR § 480.101
Source text
11 segments
42 CFR § 480.101
42 CFR § 480.101
Scope and definitions.
(a)
Scope. This subpart sets forth the policies and procedures governing—
(1)
Disclosure of information collected, acquired or generated by a Utilization and Quality Control Quality Improvement Organization (QIO) (or the review component of a QIO subcontractor) in performance of its responsibilities under the Act and these regulations; and
(2)
Acquisition and maintenance of information by a QIO to comply with its responsibilities under the Act.
(b)
Definitions. Abuse means any unlawful conduct relating to items or services for which payment is sought under Title XVIII of the Act. Aggregate statistical data means any utilization, admission, discharge or diagnostic related group (DRG) data arrayed on a geographic, institutional or other basis in which the volume and frequency of services are shown without identifying any individual. Confidential information means any of the following: As used in this part:
(1)
The QIO and its officers, members and employees;
(2)
QIO subcontractors;
(3)
Health care institutions and practitioners whose services are reviewed;
(4)
QIO reviewers and supporting staff;
(5)
Data support organizations; and
(6)
Quality review study means an assessment, conducted by or for a QIO, of a patient care problem for the purpose of improving patient care through peer analysis, intervention, resolution of the problem and follow-up. Quality review study information means all documentation related to the quality review study process. Reviewer means review coordinator, physician, or other person authorized to perform QIO review functions. Sanction report means a report filed pursuant to section 1156 of the Act and part 474 of this chapter documenting the QIO's determination that a practitioner or institution has failed to meet obligations imposed by section 1156 of the Act. Shared health data system means an agency or other entity authorized by Federal or State law that is used by the QIO review system to provide information or to conduct or arrange for the collection, processing, and dissemination of information on health care services. Subcontractor means a facility or a non-facility organization under contract with a QIO to perform QIO review functions. CMS.
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