Privacy Act of 1974; Computer Match No. 2005-03, 42560-42562 [05-14563]
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42560
Federal Register / Vol. 70, No. 141 / Monday, July 25, 2005 / Notices
pursuant to the routine use as set forth
in the system notice.
Medicare Beneficiary Database,
System No. 09–70–0536 was published
in the Federal Register at 66 FR 63392
(December 6, 2001). Matched data will
be released to ODJFS pursuant to the
routine use as set forth in the system
notice.
The data for ODJFS are/is maintained
in the following Medical Data
Warehouse Files:
DRUGOUT.txt DRUG pre-convert layout
EDRUGOUT.txt Encounter Drug extract
layout (no pre-convert)
EFACOUT.txt Encounter Facility extract
layouts (no pre-convert and there are 4
extract files)
ELIGOUT.txt Eligibility pre-convert layout
EPROFOUT.txt Encounter Prof. extract
layout (no pre-convert)
FACOUT.txt Facility pre-convert layout
GROSSOUT.txt Gross financial extract (no
pre-convert)
PROFOUT.txt Professional pre-convert
layout
PROVOUT.txt Provider pre-convert layout.
ODJFS may change files maintained
in the Medical Data Warehouse after
giving reasonable notice to CMS and the
Custodian.
Inclusive Dates of the Match
The CMP shall become effective no
sooner than 40 days after the report of
the Matching Program is sent to OMB
and Congress, or 30 days after
publication in the Federal Register,
which ever is later. The matching
program will continue for 18 months
from the effective date and may be
extended for an additional 12 months
thereafter, if certain conditions are met.
[FR Doc. 05–14562 Filed 7–22–05; 8:45 am]
BILLING CODE 4120–03–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Privacy Act of 1974; Computer Match
No. 2005–03
Department of Health and
Human Services (HHS), Centers for
Medicare & Medicaid Services (CMS).
ACTION: Notice of Computer Matching
Program (CMP).
AGENCY:
SUMMARY: In accordance with the
requirements of the Privacy Act of 1974,
as amended, this Notice announces the
establishment of a CMP that CMS plans
to conduct with the Washington
Department of Social and Health
Services (DSHS). We have provided
background information about the
14:21 Jul 22, 2005
Jkt 205001
matched with other Federal, State, or
local government records. It requires
Federal agencies involved in computer
matching programs to:
1. Negotiate written agreements with
the other agencies participating in the
matching programs;
2. Obtain the Data Integrity Board
approval of the match agreements;
3. Furnish detailed reports about
matching programs to Congress and
OMB;
4. Notify applicants and beneficiaries
that the records are subject to matching;
and,
5. Verify match findings before
reducing, suspending, terminating, or
denying an individual’s benefits or
payments.
B. CMS Computer Matches Subject to
the Privacy Act
CMS has taken action to ensure that
all CMPs that this Agency participates
in comply with the requirements of the
Privacy Act of 1974, as amended.
Dated: July 12, 2005.
John R. Dyer,
Chief Operating Officer, Centers for Medicare
& Medicaid Services.
Computer Match No. 2005–03
Name
‘‘Computer Matching Agreement
Between the Centers for Medicare &
Medicaid Services (CMS) and the State
of Washington Department of Social and
Health Services for Disclosure of
Medicare and Medicaid Information.’’
Security Classification
Level Three Privacy Act Sensitive.
Participating Agencies
The Centers for Medicare & Medicaid
Services, and State of Washington
Department of Social and Health
Services.
Description of the Matching Program
Centers for Medicare & Medicaid
Services
VerDate jul<14>2003
proposed Matching Program in the
section
below. The Privacy Act requires that
CMS provide an opportunity for
interested persons to comment on the
proposed matching program. We may
defer implementation of this Matching
Program if we receive comments that
persuade us to defer implementation.
See DATES section below for comment
period.
DATES: CMS filed a report of the CMP
with the Chair of the House Committee
on Government Reform and Oversight,
the Chair of the Senate Committee on
Governmental Affairs, and the
Administrator, Office of Information
and Regulatory Affairs, Office of
Management and Budget (OMB) on July
14, 2005. We will not disclose any
information under a Matching
Agreement until 40 days after filing a
report to OMB and Congress or 30 days
after publication.
ADDRESSES: The public should address
comments to: CMS Privacy Officer,
Division of Privacy Compliance Data
Development (DPCDD), Enterprise
Databases Group, Office of Information
Services, CMS, Mailstop N2–04–27,
7500 Security Boulevard, Baltimore,
Maryland 21244–1850. Comments
received will be available for review at
this location, by appointment, during
regular business hours, Monday through
Friday from 9 a.m.–3 p.m., eastern
daylight time.
FOR FURTHER INFORMATION CONTACT:
Phillip Kauzlarich, Health Insurance
Specialist, Centers for Medicare &
Medicaid Services, Office of Financial
Management, Program Integrity Group,
Mail-stop C3–02–16, 7500 Security
Boulevard, Baltimore Maryland 21244–
1850. The telephone number is (410)–
786–7170 and e-mail is
pkauzlarich@cms.hhs.gov.
SUPPLEMENTARY INFORMATION:
SUPPLEMENTARY INFORMATION
Authority for Conducting Matching
Program
A. General
The Computer Matching and Privacy
Protection Act of 1988 (Pub. L. 100–
503), amended the Privacy Act (5 U.S.C.
552a) by describing the manner in
which computer matching involving
Federal agencies could be performed
and adding certain protections for
individuals applying for and receiving
Federal benefits. Section 7201 of the
Omnibus Budget Reconciliation Act of
1990 (Pub. L. 101–508) further amended
the Privacy Act regarding protections for
such individuals. The Privacy Act, as
amended, regulates the use of computer
matching by Federal agencies when
records in a system of records are
This CMA is executed to comply with
the Privacy Act of 1974 (Title 5 United
States Code (U.S.C.) 552a), as amended,
(as amended by Pub. L. 100–503, the
Computer Matching and Privacy
Protection Act (CMPPA) of 1988), the
Office of Management and Budget
(OMB) Circular A–130, titled
‘‘Management of Federal Information
Resources’’ at 65 Federal Register (FR)
77677 (December 12, 2000), 61 FR 6435
(February 20, 1996), and OMB
guidelines pertaining to computer
matching at 54 FR 25818 (June 19,
1989).
This Agreement provides for
information matching fully consistent
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Federal Register / Vol. 70, No. 141 / Monday, July 25, 2005 / Notices
with the authority of the Secretary of the
Department of Health and Human
Services (Secretary). Section 1816 of the
Social Security Act (the Act) permits the
Secretary to contract with fiscal
intermediaries ‘‘to make such audits of
the records of providers as may be
necessary to insure that proper
payments are made under this part,’’
and ‘‘to perform such other functions as
are necessary to carry out this
subsection.’’ (42 U.S.C. 1395h(a)).
Section 1842 of the Act provides that
the Secretary may contract with entities
known as carriers to ‘‘make such audits
of the records of providers of services as
may be necessary to assure that proper
payments are made’’ (42 U.S.C.
1395u(a)(1)(C)); ‘‘assist in the
application of safeguards against
unnecessary utilization of services
furnished by providers of services and
other persons to individuals entitled to
benefits’ (42 U.S.C. 1395u(a)(2)(B)); and
‘‘otherwise assist * * * in discharging
administrative duties necessary to carry
out the purposes of this part’’ (42 U.S.C.
1395u(a)(4)).
Furthermore, § 1874(b) of the Act
authorizes the Secretary to ‘‘contract
with any person, agency, or institution
to secure on a reimbursable basis such
special data, actuarial information, and
other information as may be necessary
in the carrying out of his functions’’
under this title (42 U.S.C. 1395kk(b)).
Section 1893 of the Act establishes
the Medicare Integrity Program, under
which the Secretary may contract with
eligible entities to conduct a variety of
program safeguard activities, including
fraud review employing equipment and
software technologies that surpass the
existing capabilities of Fiscal
Intermediaries and carriers (42 U.S.C.
1395ddd). The contracting entities are
called Program Safeguards Contractors
(PSC).
DSHS is charged with the
administration of the Medicaid program
in Washington and is the single state
agency for such purpose. The Revised
Code of Washington (RCW) 74.09.500
established the Medical Assistance
Program and authorized DSHS to
comply with Federal requirements for
the medical assistance program
provided in the Social Security Act and
Title XIX of Public Law (89–97) in order
to secure Federal matching funds for the
program. DSHS provides eligible
individuals with health care and
remedial or preventive services,
including both Medicaid services and
Medical Care Services defined in RCW
74.09.035 and authorized for payment
solely from State funds.
DSHS’ disclosure of the Medicaid
data pursuant to this Agreement is for
VerDate jul<14>2003
14:21 Jul 22, 2005
Jkt 205001
purposes directly connected with the
administration of the Medicaid Program,
in compliance with 42 CFR 431.300
through 431.307 and RCW 74.09.200,
74.09.210 and 74.09.290. Those
purposes include the detection,
prosecution and deterrence of fraud and
abuse (F&A) in the Medicaid Program.
Purpose(s) of the Matching Program
The purpose of this Agreement is to
establish the conditions, safeguards, and
procedures under which the Centers for
Medicare & Medicaid Services (CMS)
will conduct a computer matching
program with the State of Washington
Department of Social and Health
Services (DSHS), to study claims,
billing, and eligibility information to
detect suspected instances of Medicare
and Medicaid fraud and abuse (F&A) in
the State of Washington. CMS and
DSHS will provide Computer Services
Corporation, a CMS contractor
(hereinafter referred to as the
‘‘Custodian’’), with Medicare and
Medicaid records pertaining to
eligibility, claims, and billing which the
Custodian will match in order to merge
the information into a single database.
Utilizing fraud detection software, the
information will then be used to
identify patterns of aberrant practices
requiring further investigation. The
following are examples of the type of
aberrant practices that may constitute
F&A by practitioners, providers, and
suppliers in the State of Washington
expected to be identified in this
matching program: (1) Billing for
provision of more than 24 hours of
services in one day; (2) providing
treatment and services in ways more
statistically significant than similar
practitioner groups; and (3) up-coding
and billing for services more expensive
than those actually performed.
Categories of Records and Individuals
Covered by the Match
This CMP will enhance the ability of
CMS and DSHS to detect F&A by
matching claims data, eligibility, and
practitioner, provider, and supplier
enrollment records of Medicare
beneficiaries, practitioners, providers,
and suppliers in the State of
Washington against records of
Washington Medicaid beneficiaries,
practitioners, providers, and suppliers
in the State of Washington.
Description of Records to be Used in the
Matching Program
The data for CMS are maintained in
the following Systems of Records:
National Claims History (NCH),
System No. 09–70–0005 was most
recently published in the Federal
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Frm 00031
Fmt 4703
Sfmt 4703
42561
Register, at 67 FR 57015 (September 6,
2002). NCH contains records needed to
facilitate obtaining Medicare utilization
review data that can be used to study
the operation and effectiveness of the
Medicare program. Matched data will be
released to DSHS pursuant to the
routine use as set forth in the system
notice.
Carrier Medicare Claims Record,
System No. 09–70–0501 was published
in the Federal Register at 67 FR 54428
(August 22, 2002). Matched data will be
released to DSHS pursuant to the
routine use as set forth in the system
notice.
Enrollment Database, System No. 09–
70–0502 was published in the Federal
Register at 67 FR 3203 (January 23,
2002). Matched data will be released to
DSHS pursuant to the routine use set
forth in the system notice.
Unique Physician/Provider
Identification Number, System No. 09–
70–0525, was most recently published
in the Federal Register at 69 FR 75316
(December 16, 2004). Matched data will
be released to DSHS pursuant to the
routine use as set forth in the system
notice.
Medicare Supplier Identification File,
System No. 09–70–0530 was most
recently published in the Federal
Register, at 67 FR 48184 (July 23, 2002).
Matched data will be released to DSHS
pursuant to the routine use as set forth
in the system notice.
Medicare Beneficiary Database,
System No. 09–70–0536 was published
in the Federal Register at 66 FR 63392
(December 6, 2001). Matched data will
be released to DSHS pursuant to the
routine use as set forth in the system
notice.
Intermediary Medicare Claims
Record, System No. 09–70–0503 was
published in the Federal Register at 67
FR 65982 (October 29, 2002). Matched
data will be released to DSHS pursuant
to the routine use as set forth in the
system notice.
The data for DSHS are maintained in
the Washington Medicaid Management
Information System (MMIS). In 2001,
DSHS procured the development and
operation of a Decision Support System
by DSHS’ contractor HWT, Inc. The
MMIS provides an electronic data feed
to the HWT–DSS on a weekly basis. The
DSS will be used to extract data for
purposes of this computer matching
agreement. The following HWT–DSS
tables will be utilized:
—Washington Medicaid Management
Information System (MMIS) Paid
Claims Table;
—Washington MMIS Provider Master
Table; and
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Federal Register / Vol. 70, No. 141 / Monday, July 25, 2005 / Notices
—Washington MMIS Eligibility Table.
Inclusive Dates of the Match
The CMP shall become effective no
sooner than 40 days after the report of
the Matching Program is sent to OMB
and Congress, or 30 days after
publication in the Federal Register,
whichever is later. The matching
program will continue for 18 months
from the effective date and may be
extended for an additional 12 months
thereafter, if certain conditions are met.
[FR Doc. 05–14563 Filed 7–22–05; 8:45 am]
BILLING CODE 4120–03–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Administration for Children and
Families
Proposed Information Collection
Activity; Comment Request
Proposed Projects:
Title: title IV–E State Plan for the
Foster Care, Independent Living and
Adoption Assistance Programs.POMB
No.: 0980–0141.
Description: A State plan is required
by sections 471 and 477(b)(2), part IV–
E of the Social Security Act (the Act) for
each public child welfare agency
requesting Federal funding for foster
care, independent living services and
adoption assistance under the Act. The
State plan is a comprehensive narrative
Number of
respondents
Instrument
Title IV–E State Plan .......................................................................................
In compliance with the requirements
of Section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the
Administration for Children and
Families is soliciting public comment
on the specific aspects of the
information collection described above.
Copies of the proposed collection of
information can be obtained and
comments may be forwarded by writing
to the Administration for Children and
Families, Office of Administration,
Office of Information Services, 370
L’Enfant Promenade, SW., Washington,
DE 20447, Attn: ACF Reports Clearance
Officer. E-mail address:
grjohnson@acf.hhs.gov. All requests
should be identified by the title of the
information collection.
The Department specifically requests
comments on: (a) Whether the proposed
collection of information is necessary
for the proper performance of the
functions of the agency, including
whether the information shall have
practical utility; (b) the accuracy of the
agency’s estimate of the burden of the
proposed collection of information; (c)
the quality, utility, and clarity of the
information to be collected; and (d)
ways to minimize the burden of the
collection of information on
respondents, including through the use
of automated collection techniques or
other forms of information technology.
Consideration will be given to
comments and suggestions submitted
within 60 days of this publication.
VerDate jul<14>2003
14:21 Jul 22, 2005
Jkt 205001
BILLING CODE 4184–01–M
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Administration for Children and
Families
Grants and Cooperative Agreements;
Availability, etc.: Child Development
Associate Credentialing Program
Program Office: Administration on
Children, Youth and Families Head
Start Bureau.
Funding Opportunity Title: Child
Development Associate (CDA) National
Credentialing Program.
Announcement Type: Cooperative
Agreement.
Funding Opportunity Number: HHS–
2005–ACF–ACYF–YD–0064.
CFDA Number: 93.600.
Due Date for Applications: September
23, 2005.
Executive Summary: The
Administration for Children and
Families (ACF), Administration on
Children, Youth and Families (ACYF)
announces the availability of $1,000,000
annually for each of five years to
support staff development for all
individuals employed in local Head
Start, Early Head Start, and other child
care programs to increase the
understanding and skills necessary to
Frm 00032
Fmt 4703
Sfmt 4703
Number of responses per
respondent
Average burden hours per
response
1
15
12
Dated: July 19, 2005.
Robert Sargis,
Reports Clearance, Officer.
[FR Doc. 05–14616 Filed 7–22–05; 8:45 am]
PO 00000
description of the nature and scope of
a State’s programs and provides
assurances that the programs will be
administered in conformity with the
specific requirements stipulated in title
IV–E. The plan must include all
applicable State statutory, regulatory, or
policy references and citations for each
requirement as well as supporting
documentation. A State may use the
pre-print format prepared by the
Children’s Bureau of the Administration
for Children and Families or a different
format, on the condition that the format
used includes all of the title IV–E State
plan requirements of the law.
Respondents: State and Territorial
Agencies (State Agencies) administering
or supervising the administration of the
title IV–E programs.
Annual Burden Estimates:
Total burden
hours
180
carry out their jobs, as well as
professional development leading to
credentials and degrees. A cooperative
agreement is a form of Federal financial
assistance that allows substantial
Federal involvement in the activities for
which funds are awarded.
I. Funding Opportunity Description
Head Start is a national program that
provides comprehensive developmental
services for preschool children, ages
three through five, and under the Early
Head Start program for infants, toddlers,
and pregnant women. Since the
inception of Head Start in 1965, over 22
million children and their families have
been served. In 2004, nearly 900,000
Head Start and Early Head Start
children and their families and 6,227
pregnant women received services
based on the requirements of The Head
Start Program Performance Standards
and Other Regulations.
The Head Start Act as amended in
1998, Sec. 648(e) (42 U.S.C. 9843),
Technical Assistance and Training,
requires that the Secretary shall provide,
either directly or through grants or other
arrangements, funds from programs
authorized under this subchapter to
support an organization to administer a
centralized child development and
national assessment program leading to
recognized credentials for personnel
working in early childhood
development and child care programs.
In 2004, 47,000 classrooms were
staffed with more than 56,208 infant,
toddler, and preschool teachers, and
E:\FR\FM\25JYN1.SGM
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]]>Agencies
[Federal Register Volume 70, Number 141 (Monday, July 25, 2005)]
[Notices]
[Pages 42560-42562]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-14563]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
Privacy Act of 1974; Computer Match No. 2005-03
AGENCY: Department of Health and Human Services (HHS), Centers for
Medicare & Medicaid Services (CMS).
ACTION: Notice of Computer Matching Program (CMP).
-----------------------------------------------------------------------
SUMMARY: In accordance with the requirements of the Privacy Act of
1974, as amended, this Notice announces the establishment of a CMP that
CMS plans to conduct with the Washington Department of Social and
Health Services (DSHS). We have provided background information about
the proposed Matching Program in the SUPPLEMENTARY INFORMATION section
below. The Privacy Act requires that CMS provide an opportunity for
interested persons to comment on the proposed matching program. We may
defer implementation of this Matching Program if we receive comments
that persuade us to defer implementation. See DATES section below for
comment period.
DATES: CMS filed a report of the CMP with the Chair of the House
Committee on Government Reform and Oversight, the Chair of the Senate
Committee on Governmental Affairs, and the Administrator, Office of
Information and Regulatory Affairs, Office of Management and Budget
(OMB) on July 14, 2005. We will not disclose any information under a
Matching Agreement until 40 days after filing a report to OMB and
Congress or 30 days after publication.
ADDRESSES: The public should address comments to: CMS Privacy Officer,
Division of Privacy Compliance Data Development (DPCDD), Enterprise
Databases Group, Office of Information Services, CMS, Mailstop N2-04-
27, 7500 Security Boulevard, Baltimore, Maryland 21244-1850. Comments
received will be available for review at this location, by appointment,
during regular business hours, Monday through Friday from 9 a.m.-3
p.m., eastern daylight time.
FOR FURTHER INFORMATION CONTACT: Phillip Kauzlarich, Health Insurance
Specialist, Centers for Medicare & Medicaid Services, Office of
Financial Management, Program Integrity Group, Mail-stop C3-02-16, 7500
Security Boulevard, Baltimore Maryland 21244-1850. The telephone number
is (410)-786-7170 and e-mail is pkauzlarich@cms.hhs.gov.
SUPPLEMENTARY INFORMATION:
Description of the Matching Program
A. General
The Computer Matching and Privacy Protection Act of 1988 (Pub. L.
100-503), amended the Privacy Act (5 U.S.C. 552a) by describing the
manner in which computer matching involving Federal agencies could be
performed and adding certain protections for individuals applying for
and receiving Federal benefits. Section 7201 of the Omnibus Budget
Reconciliation Act of 1990 (Pub. L. 101-508) further amended the
Privacy Act regarding protections for such individuals. The Privacy
Act, as amended, regulates the use of computer matching by Federal
agencies when records in a system of records are matched with other
Federal, State, or local government records. It requires Federal
agencies involved in computer matching programs to:
1. Negotiate written agreements with the other agencies
participating in the matching programs;
2. Obtain the Data Integrity Board approval of the match
agreements;
3. Furnish detailed reports about matching programs to Congress and
OMB;
4. Notify applicants and beneficiaries that the records are subject
to matching; and,
5. Verify match findings before reducing, suspending, terminating,
or denying an individual's benefits or payments.
B. CMS Computer Matches Subject to the Privacy Act
CMS has taken action to ensure that all CMPs that this Agency
participates in comply with the requirements of the Privacy Act of
1974, as amended.
Dated: July 12, 2005.
John R. Dyer,
Chief Operating Officer, Centers for Medicare & Medicaid Services.
Computer Match No. 2005-03
Name
``Computer Matching Agreement Between the Centers for Medicare &
Medicaid Services (CMS) and the State of Washington Department of
Social and Health Services for Disclosure of Medicare and Medicaid
Information.''
Security Classification
Level Three Privacy Act Sensitive.
Participating Agencies
The Centers for Medicare & Medicaid Services, and State of
Washington Department of Social and Health Services.
Authority for Conducting Matching Program
This CMA is executed to comply with the Privacy Act of 1974 (Title
5 United States Code (U.S.C.) 552a), as amended, (as amended by Pub. L.
100-503, the Computer Matching and Privacy Protection Act (CMPPA) of
1988), the Office of Management and Budget (OMB) Circular A-130, titled
``Management of Federal Information Resources'' at 65 Federal Register
(FR) 77677 (December 12, 2000), 61 FR 6435 (February 20, 1996), and OMB
guidelines pertaining to computer matching at 54 FR 25818 (June 19,
1989).
This Agreement provides for information matching fully consistent
[[Page 42561]]
with the authority of the Secretary of the Department of Health and
Human Services (Secretary). Section 1816 of the Social Security Act
(the Act) permits the Secretary to contract with fiscal intermediaries
``to make such audits of the records of providers as may be necessary
to insure that proper payments are made under this part,'' and ``to
perform such other functions as are necessary to carry out this
subsection.'' (42 U.S.C. 1395h(a)).
Section 1842 of the Act provides that the Secretary may contract
with entities known as carriers to ``make such audits of the records of
providers of services as may be necessary to assure that proper
payments are made'' (42 U.S.C. 1395u(a)(1)(C)); ``assist in the
application of safeguards against unnecessary utilization of services
furnished by providers of services and other persons to individuals
entitled to benefits' (42 U.S.C. 1395u(a)(2)(B)); and ``otherwise
assist * * * in discharging administrative duties necessary to carry
out the purposes of this part'' (42 U.S.C. 1395u(a)(4)).
Furthermore, Sec. 1874(b) of the Act authorizes the Secretary to
``contract with any person, agency, or institution to secure on a
reimbursable basis such special data, actuarial information, and other
information as may be necessary in the carrying out of his functions''
under this title (42 U.S.C. 1395kk(b)).
Section 1893 of the Act establishes the Medicare Integrity Program,
under which the Secretary may contract with eligible entities to
conduct a variety of program safeguard activities, including fraud
review employing equipment and software technologies that surpass the
existing capabilities of Fiscal Intermediaries and carriers (42 U.S.C.
1395ddd). The contracting entities are called Program Safeguards
Contractors (PSC).
DSHS is charged with the administration of the Medicaid program in
Washington and is the single state agency for such purpose. The Revised
Code of Washington (RCW) 74.09.500 established the Medical Assistance
Program and authorized DSHS to comply with Federal requirements for the
medical assistance program provided in the Social Security Act and
Title XIX of Public Law (89-97) in order to secure Federal matching
funds for the program. DSHS provides eligible individuals with health
care and remedial or preventive services, including both Medicaid
services and Medical Care Services defined in RCW 74.09.035 and
authorized for payment solely from State funds.
DSHS' disclosure of the Medicaid data pursuant to this Agreement is
for purposes directly connected with the administration of the Medicaid
Program, in compliance with 42 CFR 431.300 through 431.307 and RCW
74.09.200, 74.09.210 and 74.09.290. Those purposes include the
detection, prosecution and deterrence of fraud and abuse (F&A) in the
Medicaid Program.
Purpose(s) of the Matching Program
The purpose of this Agreement is to establish the conditions,
safeguards, and procedures under which the Centers for Medicare &
Medicaid Services (CMS) will conduct a computer matching program with
the State of Washington Department of Social and Health Services
(DSHS), to study claims, billing, and eligibility information to detect
suspected instances of Medicare and Medicaid fraud and abuse (F&A) in
the State of Washington. CMS and DSHS will provide Computer Services
Corporation, a CMS contractor (hereinafter referred to as the
``Custodian''), with Medicare and Medicaid records pertaining to
eligibility, claims, and billing which the Custodian will match in
order to merge the information into a single database. Utilizing fraud
detection software, the information will then be used to identify
patterns of aberrant practices requiring further investigation. The
following are examples of the type of aberrant practices that may
constitute F&A by practitioners, providers, and suppliers in the State
of Washington expected to be identified in this matching program: (1)
Billing for provision of more than 24 hours of services in one day; (2)
providing treatment and services in ways more statistically significant
than similar practitioner groups; and (3) up-coding and billing for
services more expensive than those actually performed.
Categories of Records and Individuals Covered by the Match
This CMP will enhance the ability of CMS and DSHS to detect F&A by
matching claims data, eligibility, and practitioner, provider, and
supplier enrollment records of Medicare beneficiaries, practitioners,
providers, and suppliers in the State of Washington against records of
Washington Medicaid beneficiaries, practitioners, providers, and
suppliers in the State of Washington.
Description of Records to be Used in the Matching Program
The data for CMS are maintained in the following Systems of
Records:
National Claims History (NCH), System No. 09-70-0005 was most
recently published in the Federal Register, at 67 FR 57015 (September
6, 2002). NCH contains records needed to facilitate obtaining Medicare
utilization review data that can be used to study the operation and
effectiveness of the Medicare program. Matched data will be released to
DSHS pursuant to the routine use as set forth in the system notice.
Carrier Medicare Claims Record, System No. 09-70-0501 was published
in the Federal Register at 67 FR 54428 (August 22, 2002). Matched data
will be released to DSHS pursuant to the routine use as set forth in
the system notice.
Enrollment Database, System No. 09-70-0502 was published in the
Federal Register at 67 FR 3203 (January 23, 2002). Matched data will be
released to DSHS pursuant to the routine use set forth in the system
notice.
Unique Physician/Provider Identification Number, System No. 09-70-
0525, was most recently published in the Federal Register at 69 FR
75316 (December 16, 2004). Matched data will be released to DSHS
pursuant to the routine use as set forth in the system notice.
Medicare Supplier Identification File, System No. 09-70-0530 was
most recently published in the Federal Register, at 67 FR 48184 (July
23, 2002). Matched data will be released to DSHS pursuant to the
routine use as set forth in the system notice.
Medicare Beneficiary Database, System No. 09-70-0536 was published
in the Federal Register at 66 FR 63392 (December 6, 2001). Matched data
will be released to DSHS pursuant to the routine use as set forth in
the system notice.
Intermediary Medicare Claims Record, System No. 09-70-0503 was
published in the Federal Register at 67 FR 65982 (October 29, 2002).
Matched data will be released to DSHS pursuant to the routine use as
set forth in the system notice.
The data for DSHS are maintained in the Washington Medicaid
Management Information System (MMIS). In 2001, DSHS procured the
development and operation of a Decision Support System by DSHS'
contractor HWT, Inc. The MMIS provides an electronic data feed to the
HWT-DSS on a weekly basis. The DSS will be used to extract data for
purposes of this computer matching agreement. The following HWT-DSS
tables will be utilized:
--Washington Medicaid Management Information System (MMIS) Paid Claims
Table;
--Washington MMIS Provider Master Table; and
[[Page 42562]]
--Washington MMIS Eligibility Table.
Inclusive Dates of the Match
The CMP shall become effective no sooner than 40 days after the
report of the Matching Program is sent to OMB and Congress, or 30 days
after publication in the Federal Register, whichever is later. The
matching program will continue for 18 months from the effective date
and may be extended for an additional 12 months thereafter, if certain
conditions are met.
[FR Doc. 05-14563 Filed 7-22-05; 8:45 am]
BILLING CODE 4120-03-P
