42 USC 1320a-7n – Disclosure of predictive modeling and other analytics technologies to identify and prevent waste, fraud, and abuse
(a) Reference to predictive modeling technologies requirements
For provisions relating to the use of predictive modeling and other analytics technologies to identify and prevent waste, fraud, and abuse with respect to the Medicare program under subchapter XVIII, the Medicaid program under subchapter XIX, and the Children’s Health Insurance Program under subchapter XXI, see section 1320a-7m of this title.
(b) Limiting disclosure of predictive modeling technologies
Terms Used In 42 USC 1320a-7n
- Contract: A legal written agreement that becomes binding when signed.
- Fraud: Intentional deception resulting in injury to another.
- including: when used in a definition contained in this chapter shall not be deemed to exclude other things otherwise within the meaning of the term defined. See 42 USC 1301
- State: when used in such subchapters (but not in subchapter XVI as in effect pursuant to such amendment after December 31, 1973) includes Puerto Rico, the Virgin Islands, and Guam. See 42 USC 1301
In implementing such provisions under such section 1320a-7m with respect to covered algorithms (as defined in subsection (c)), the following shall apply:
(1) Nonapplication of FOIA
The covered algorithms used or developed for purposes of such section 1320a-7m (including by the Secretary or a State (or an entity operating under a contract with a State)) shall be exempt from disclosure under section 552(b)(3) of title 5.
(2) Limitation with respect to use and disclosure of information by State agencies
(A) In general
A State agency may not use or disclose covered algorithms used or developed for purposes of such section 1320a-7m except for purposes of administering the State plan (or a waiver of the plan) under the Medicaid program under subchapter XIX or the State child health plan (or a waiver of the plan) under the Children’s Health Insurance Program under subchapter XXI, including by enabling an entity operating under a contract with a State to assist the State to identify or prevent waste, fraud, and abuse with respect to such programs.
(B) Information security
A State agency shall have in effect data security and control policies that the Secretary finds adequate to ensure the security of covered algorithms used or developed for purposes of such section 1320a-7m and to ensure that access to such information is restricted to authorized persons for purposes of authorized uses and disclosures described in subparagraph (A).
(C) Procedural requirements
State agencies to which information is disclosed pursuant to such section 1320a-7m shall adhere to uniform procedures established by the Secretary.
(c) Covered algorithm defined
In this section, the term “covered algorithm”—
(1) means a predictive modeling or other analytics technology, as used for purposes of section 1320a-7m(a) of this title to identify and prevent waste, fraud, and abuse with respect to the Medicare program under subchapter XVIII, the Medicaid program under subchapter XIX, and the Children’s Health Insurance Program under subchapter XXI; and
(2) includes the mathematical expressions utilized in the application of such technology and the means by which such technology is developed.