{"identifier":"/us/usc/t42/s1320a\u20137n","title":42,"num":"\u00a7\u202f1320a\u20137n.","heading":"Disclosure of predictive modeling and other analytics technologies to identify and prevent waste, fraud, and abuse","text":"\u00a7\u202f1320a\u20137n.\nDisclosure of predictive modeling and other analytics technologies to identify and prevent waste, fraud, and abuse\n(a)\nReference to predictive modeling technologies requirements\nFor 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\u2019s Health Insurance Program under subchapter XXI, see\nsection 1320a\u20137m of this title\n(b)\nLimiting disclosure of predictive modeling technologies\nIn implementing such provisions under such section 1320a\u20137m with respect to covered algorithms (as defined in subsection (c)), the following shall apply:\n(1)\nNonapplication of FOIA\nThe covered algorithms used or developed for purposes of such section 1320a\u20137m (including by the Secretary or a State (or an entity operating under a contract with a State)) shall be exempt from disclosure under\nsection 552(b)(3) of title 5\n(2)\nLimitation with respect to use and disclosure of information by State agencies\n(A)\nIn general\nA State agency may not use or disclose covered algorithms used or developed for purposes of such section 1320a\u20137m 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\u2019s 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.\n(B)\nInformation security\nA 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\u20137m and to ensure that access to such information is restricted to authorized persons for purposes of authorized uses and disclosures described in subparagraph (A).\n(C)\nProcedural requirements\nState agencies to which information is disclosed pursuant to such section 1320a\u20137m shall adhere to uniform procedures established by the Secretary.\n(c)\nCovered algorithm defined\nIn this section, the term \u201ccovered algorithm\u201d\u2014\n(1) means a predictive modeling or other analytics technology, as used for purposes of\nsection 1320a\u20137m(a) of this title\n(2) includes the mathematical expressions utilized in the application of such technology and the means by which such technology is developed.","url":"https://projectusc.org/usc/t42/s1320a\u20137n.html","content":[{"t":"sec","id":"/us/usc/t42/s1320a\u20137n","children":[{"t":"num","text":"\u00a7\u202f1320a\u20137n."},{"t":"heading","text":"Disclosure of predictive modeling and other analytics technologies to identify and prevent waste, fraud, and abuse"},{"t":"subsec","id":"/us/usc/t42/s1320a\u20137n/a","children":[{"t":"num","text":"(a)"},{"t":"heading","text":"Reference to predictive modeling technologies requirements"},{"t":"content","children":[{"t":"p","text":"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\u2019s Health Insurance Program under subchapter XXI, see ","children":[{"t":"ref","text":"section 1320a\u20137m of this title","href":"/us/usc/t42/s1320a\u20137m","tail":"."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subsec","id":"/us/usc/t42/s1320a\u20137n/b","children":[{"t":"num","text":"(b)"},{"t":"heading","text":"Limiting disclosure of predictive modeling technologies"},{"t":"chapeau","text":"In implementing such provisions under such section 1320a\u20137m with respect to covered algorithms (as defined in subsection (c)), the following shall apply:"},{"t":"para","id":"/us/usc/t42/s1320a\u20137n/b/1","children":[{"t":"num","text":"(1)"},{"t":"heading","text":"Nonapplication of FOIA"},{"t":"content","children":[{"t":"p","text":"The covered algorithms used or developed for purposes of such section 1320a\u20137m (including by the Secretary or a State (or an entity operating under a contract with a State)) shall be exempt from disclosure under ","children":[{"t":"ref","text":"section 552(b)(3) of title 5","href":"/us/usc/t5/s552/b/3","tail":"."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1320a\u20137n/b/2","children":[{"t":"num","text":"(2)"},{"t":"heading","text":"Limitation with respect to use and disclosure of information by State agencies"},{"t":"subpara","id":"/us/usc/t42/s1320a\u20137n/b/2/A","children":[{"t":"num","text":"(A)"},{"t":"heading","text":"In general"},{"t":"content","children":[{"t":"p","text":"A State agency may not use or disclose covered algorithms used or developed for purposes of such section 1320a\u20137m 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\u2019s 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.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1320a\u20137n/b/2/B","children":[{"t":"num","text":"(B)"},{"t":"heading","text":"Information security"},{"t":"content","children":[{"t":"p","text":"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\u20137m and to ensure that access to such information is restricted to authorized persons for purposes of authorized uses and disclosures described in subparagraph (A).","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1320a\u20137n/b/2/C","children":[{"t":"num","text":"(C)"},{"t":"heading","text":"Procedural requirements"},{"t":"content","children":[{"t":"p","text":"State agencies to which information is disclosed pursuant to such section 1320a\u20137m shall adhere to uniform procedures established by the Secretary.","tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subsec","id":"/us/usc/t42/s1320a\u20137n/c","children":[{"t":"num","text":"(c)"},{"t":"heading","text":"Covered algorithm defined"},{"t":"chapeau","text":"In this section, the term \u201ccovered algorithm\u201d\u2014"},{"t":"para","id":"/us/usc/t42/s1320a\u20137n/c/1","children":[{"t":"num","text":"(1)"},{"t":"content","text":" means a predictive modeling or other analytics technology, as used for purposes of ","children":[{"t":"ref","text":"section 1320a\u20137m(a) of this title","href":"/us/usc/t42/s1320a\u20137m/a","tail":" 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\u2019s Health Insurance Program under subchapter XXI; and"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1320a\u20137n/c/2","children":[{"t":"num","text":"(2)"},{"t":"content","text":" includes the mathematical expressions utilized in the application of such technology and the means by which such technology is developed.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"text","text":"\n"}]}]}