Sec. 2. Limiting disclosure of predictive modeling and other analytics technologies to identify and prevent waste, fraud, and abuse
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Title XI of the Social Security Act is amended by inserting after section 1128J ( 42 U.S.C. 1320a–7k ) the following new section: 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 title XVIII, the Medicaid program under title XIX, and the Children’s Health Insurance Program under title XXI, see section 4241 of the Small Business Jobs Act of 2010 ( 42 U.S.C. 1320a–7m ).
In implementing such provisions under such section 4241 with respect to covered algorithms (as defined in subsection (c)), the following shall apply: The covered algorithms used or developed for purposes of such section (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, United States Code. A State agency may not use or disclose covered algorithms used or developed for purposes of such section except for purposes of administering the State plan (or a waiver of the plan) under the Medicaid program under title XIX or the State child health plan (or a waiver of the plan) under the Children’s Health Insurance Program under title 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.
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 4241 and to ensure that access to such information is restricted to authorized persons for purposes of authorized uses and disclosures described in subparagraph (A). State agencies to which information is disclosed pursuant to such section 4241 shall adhere to uniform procedures established by the Secretary.
In this section, the term covered algorithm — means a predictive modeling or other analytics technology, as used for purposes of section 4241(a) of the Small Business Jobs Act of 2010 (42 U.S.C. 1320a–7m(a)) to identify and prevent waste, fraud, and abuse with respect to the Medicare program under title XVIII, the Medicaid program under title XIX, and the Children’s Health Insurance Program under title XXI; and includes the mathematical expressions utilized in the application of such technology and the means by which such technology is developed. .
Section 1902(a) of the Social Security Act ( 42 U.S.C. 1396a(a) ) is amended— in paragraph (80), by striking and at the end; in paragraph (81), by striking the period at the end and inserting ; and ; and by inserting after paragraph
(81)the following new paragraph: provide that the State agency responsible for administering the State plan under this title provides assurances to the Secretary that the State agency is in compliance with subparagraphs (A), (B), and
(C)of section 1128K(b)(2). . Section 2102(a)(7) of the Social Security Act ( 42 U.S.C. 1397bb(a)(7) ) is amended— in subparagraph (A), by striking , and at the end and inserting a semicolon; in subparagraph (B), by striking the period at the end and inserting ; and ; and by adding at the end the following new subparagraph: to ensure that the State agency involved is in compliance with subparagraphs (A), (B), and
(C)of section 1128K(b)(2). .
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- 42 USC 1320a–7k
- 42 USC 1320a–7m
- 42 USC 1320a–7m(a)
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Sec. 2
Limiting disclosure of predictive modeling and other analytics technologies to identify and prevent waste, fraud, and abuse
Cite42 USC 1320a–7k
Cite42 USC 1320a–7m
Cite42 USC 1320a–7m(a)
Cites 5Cited by 0 across 0 sources