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Title 42 Part 1007 → Subpart C → §1007.20

Title 42 → Chapter V → Subchapter B → Part 1007 → Subpart C → §1007.20

Electronic Code of Federal Regulations e-CFR

Title 42 Part 1007 → Subpart C → §1007.20

e-CFR data is current as of September 18, 2019

Title 42Chapter VSubchapter BPart 1007Subpart C → §1007.20


Title 42: Public Health
PART 1007—STATE MEDICAID FRAUD CONTROL UNITS
Subpart C—Federal Financial Participation (FFP)


§1007.20   Circumstances of permissible data mining.

(a) Notwithstanding §1007.19(e)(2), a Unit may engage in data mining as defined in this part and receive FFP only under the following conditions:

(1) The Unit identifies the methods of coordination between the Unit and the Medicaid agency, the individuals serving as primary points of contact for data mining, as well as the contact information, title, and office of such individuals;

(2) Unit employees engaged in data mining receive specialized training in data mining techniques;

(3) The Unit describes how it will comply with paragraphs (a)(1) and (2) of this section as part of the agreement required by §1007.9(d); and

(4) OIG, in consultation with CMS, approves in advance the provisions of the agreement as defined in paragraph (a)(3) of this section.

(i) OIG will act on a request from a Unit for review and approval of the agreement within 90 days after receipt of a written request, or the request shall be considered approved if OIG fails to respond within 90 days after receipt of the written request.

(ii) If OIG requests additional information in writing, the 90-day period for OIG action on the request begins on the day OIG receives the information from the Unit.

(iii) The approval is for 3 years.

(iv) A Unit may request renewal of its data-mining approval for additional 3-year periods by submitting a written request for renewal to OIG, along with an updated agreement with the Medicaid agency.