C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER F—QUALITY IMPROVEMENT ORGANIZATIONS › PART 480—ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION INFORMATION › Subpart B—Utilization and Quality Control Quality Improvement Organizations (QIOs)

42 C.F.R. § 480.139

Disclosure of QIO deliberations and decisions

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(a)(1) A QIO must not disclose its deliberations except to—

(i) CMS; or

(ii) The Office of the Inspector General, and the Government Accountability 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 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.

[50 FR 15359, Apr. 17, 1985,, as amended at 76 FR 26547, May 6, 2011; 77 FR 68564, Nov. 15, 2012]
Notes of Decisions
Cited in 4 cases, 2006–2009 · leading case: Kootenai Med. Ctr. v. Idaho Dep't of Health & Welfare, 216 P.3d 630 (Idaho 2009).
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Kootenai Med. Ctr. v. Idaho Dep't of Health & Welfare, 216 P.3d 630 (Idaho 2009). · cites it 2× “42 C.F.R. § 480.139 (a)(2). A QIO must disclose, if requested through an administrative hearing or review of a beneficiary’s claim, the reasons for its decision.”
Pediatric Specialty Care, Inc. v. Arkansas Dep't of Human Servs., 444 F.3d 991 (8th Cir. 2006). “42 C.F.R. § 480.139 (a)(1). The regulations further state that a peer review organization may only disclose “information on a particular practitioner or reviewer at the written request of or with the written consent of that practitioner or reviewer.”
Kootenai Med. Ctr. v. Idaho Dept. of Health & Welfare (Idaho 2009). · cites it 2× “42 C.F.R. § 480.139 (a)(2). A QIO must disclose, if requested through an administrative hearing or review of a beneficiary‟s claim, the reasons for its decision.”
Kootenai Med. Ctr. v. Idaho Dept. of Health & Welfare (Idaho 2009). · cites it 2× “42 C.F.R. § 480.139 (a)(2). A QIO must disclose, if requested through an administrative hearing or review of a beneficiary‟s claim, the reasons for its decision.”
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