Disclosure of Confidential QIO Information to Officials and

10050 - Disclosure of Confidential QIO Information to Officials and Agencies (Rev. 15, Issued: 06-30-06; Effective/Implementation Dates: 06-30-06) A. Disclosure to the Department of Health & Human Services (DHHS) Upon request, disclose confidential information to DHHS as specified at 42 CFR 480.130, except for your QIO deliberations and QRS data, which are governed by 42 CFR 480.139 and 480.140 respectively. For example, a QIO can disclose QRS information with identifiers of a specific practitioner or institution with the written request or consent of the specific practitioner or institution (see 42 CFR 480.140(2)(d)). B. Disclosure for Purposes of Monitoring and Evaluation Upon request, disclose confidential information to CMS or any person, organization, or agency authorized by DHHS or Federal statute to monitor your performance as specified in 42 CFR 480.131. The information that you are required to disclose includes copies of medical records of Medicare beneficiaries that are maintained by health care facilities or health care practitioners. C. Disclosure to Consultants and Subcontractors As specified in 42 CFR 480.135(b), disclose information to consultants and subcontractors when the individual/organization needs the information to provide you with specified services. Consultants and subcontractors should receive the same training and information as your employees. D. Disclosure to Intermediaries and Carriers Disclose confidential information to intermediaries and carriers as specified in 42 CFR 480.136, which authorizes disclosure of information relevant to the intermediary's or carrier's responsibility for making proper payment determinations. This includes disclosures needed to coordinate medical review activities between you and the intermediary or carrier. E. Disclosures to Federal and State Enforcement Agencies As specified at 42 CFR 480.137, disclose information related to investigations of fraud or abuse of the Medicare or Medicaid programs to Federal and State enforcement agencies. F. Disclosure to Licensing, Certification, and Accreditation Bodies Disclose information to licensing and certification bodies as specified in 42 CFR 480.138(a)(1). A licensing or certification body has access to any confidential information directly related to its official duties, including sanction recommendations that you forward to OIG. Unless the disclosure is an exception specified at 42 CFR 480.106, comply with the notification requirements at 42 CFR 480.105 before disclosing your information. The citation at 42 CFR 480.140(a)(1) requires that a QIO disclose, onsite, to accreditation agencies as is required for them to carry out the functions that are within their jurisdiction under State law. G. Disclosures to Other QIOs A QIO may disclose to another QIO information on patients and practitioners who are subject to review by the other QIO only if that data are needed to carry out their Statement of Work or necessary to complete a special study awarded from CMS as a quality improvement initiative. Additionally, you may share identifiable data about patients, practitioners, or providers in your State with another QIO so long as that QIO applies the same confidentiality restrictions to your data that it is required to apply to its own. H. Disclosures to Medical Review Boards Disclose to medical review boards established under §1881 of the Act information on patients, practitioners, and institutions receiving or furnishing end stage renal disease services.