[Code of Federal Regulations]
[Title 42, Volume 3, Parts 430 to end]
[Revised as of October 1, 2000]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR480.139]

[Page 401]
 
                         TITLE 42--PUBLIC HEALTH
 
                         CHAPTER IV--HEALTH CARE
                        FINANCING ADMINISTRATION,
                        DEPARTMENT OF HEALTH AND
                       HUMAN SERVICES--(Continued)
 
PART 480--ACQUISITION, PROTECTION, AND DISCLOSURE OF PEER REVIEW INFORMATION--Table of Contents
 
  Subpart B--Utilization and Quality Control Peer Review Organizations 
                                 (PROs)
 
Sec. 480.139  Disclosure of PRO deliberations and decisions.

    (a) PRO deliberations. (1) A PRO must not disclose its deliberations 
except to--
    (i) HCFA, at the PRO office or at a subcontracted organization;
    (ii) HCFA, 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) PRO 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 PRO decisions. (1) A PRO may disclose to those who 
have access to PRO information under other provisions of this subpart, 
the reasons for PRO decisions pertaining to that information provided 
that the opinions or judgements of a particular individual or 
practitioner cannot be identified.
    (2) A PRO must disclose, if requested in connection with the 
administrative hearing or review of a beneficiary's claim, the reasons 
for PRO decisions. The PRO must include the detailed facts, findings and 
conclusions supporting the PRO's determination. The PRO must insure that 
the opinions or judgements of a particular individual or practitioner 
cannot be identified through the materials that are disclosed.