Privacy Act of 1974; Report of a Modified or Altered System of Records, 75175-75180 [E5-7486]

Agencies

• DEPARTMENT OF HEALTH AND HUMAN SERVICES
• Centers for Medicare & Medicaid Services

[Federal Register Volume 70, Number 242 (Monday, December 19, 2005)]
[Notices]
[Pages 75175-75180]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E5-7486]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers For Medicare & Medicaid Services


Privacy Act of 1974; Report of a Modified or Altered System of 
Records

AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of 
Health and Human Services (HHS).

ACTION: Notice of a Modified or Altered System of Records (SOR).

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SUMMARY: In accordance with the requirements of the Privacy Act of 
1974, we are proposing to modify or alter an existing SOR, titled 
``Non-Medicare Beneficiary Workers' Compensation (WC) Set-aside File 
(WCSAF),'' System No. 09-70-0537, last published at 67 FR 36892 (May 
28, 2002). We propose to expand the scope of this system to include 
non-Medicare beneficiaries whose applications for a WC Arrangement have 
not been approved (denied) as submitted. The disclosure provisions 
contained in published routine use number 2 and 3 are deemed to be 
duplicative of each other and as such require corrective action. This 
modified routine use will now be number 2 and will authorize disclosure 
to ``another Federal and/or state agency, agency of a state government, 
an agency established by state law, or its fiscal agent.''
    We are modifying the language in the remaining routine uses to 
provide clarity to CMS's intention to disclose individual-specific 
information contained in this system. The routine uses will then be 
prioritized and reordered according to their usage. We will also take 
the opportunity to update any sections of the system that were affected 
by the recent reorganization and to update language in the 
administrative sections to correspond with language used in other CMS 
SORs.
    The primary purpose of the non-Medicare beneficiary WCSAF is to 
maintain a file of individuals who were injured while employed; are not 
currently Medicare beneficiaries; whose WC Settlement included a WC 
Medicare Set-aside Arrangement that is intended to pay for future 
medical expenses in place of future Medicare benefits; and was approved 
or not approved (denied) by CMS as submitted. The information retrieved 
from this system will be disclosed to: (1) Support regulatory, 
reimbursement, and policy functions performed within the agency or by a 
contractor or consultant; (2) another Federal and/or state agency, 
agency of a state government, an agency established by state law, or 
its fiscal agent to contribute to the accuracy of CMS' proper payment 
of Medicare benefits, enable such agency to administer a Federal health 
benefits program, or enable such agency to fulfill a requirement of a 
Federal statute or regulation that implements a health benefits program 
funded in whole or in part with Federal funds; (3) an individual or 
organization for research, evaluation or epidemiological projects 
related to the prevention of disease or disability, the restoration or 
maintenance of health, or for understanding and improving payment 
projects; (4) support constituent requests made to a Congressional 
representative; (5) support litigation involving the agency; and (6) 
combat fraud and abuse in health benefits programs funded in whole or 
in part by Federal funds. We have provided background information about 
the modified system in the Supplementary Information section, below. 
Although the Privacy Act requires only that the ``routine use'' portion 
of the system be published for comment, CMS invites comments on all 
portions of this notice. See Effective Date section for comment period.

EFFECTIVE DATE: CMS filed a modified or altered SOR report 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 December 13, 2005. We will not disclose 
any information under a routine use until 30 days after publication. We 
may defer implementation of this system or one or more of the routine 
use statements listed below if we receive comments that persuade us to 
defer implementation.

ADDRESSES: The public should address comment to the CMS Privacy 
Officer, Mail Stop 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: Donna Kettish, Division of Medicare 
Secondary Payer Policy Operations, Financial Services Group, Office of 
Financial Management, CMS, Mail stop C3-14-16, 7500 Security Boulevard, 
Baltimore, Maryland 21244-1850. She can be reached by telephone at 
(410) 786-5462, or via e-mail at Donna.Kettish@cms.hhs.gov.

SUPPLEMENTARY INFORMATION: Notice for this system, ``Non Medicare 
Beneficiary Workers' Compensation Set-aside File,'' System No. 09-70-
0537, was most recently published in full at 67 Federal Register 36892 
(May 28, 2002). CMS is responsible for safeguarding the fiscal 
integrity of the Medicare Program. The Health Insurance Portability and 
Accountability Act of 1996 established the ``Medicare Integrity 
Program,'' enabling CMS to competitively award contracts with entities 
to promote the integrity of the Medicare Program. The Coordination of 
Benefit Contractor (COBC) is one of those specialized contractors hired 
to increase efficiency and effectiveness by ensuring that the 
appropriate payer makes benefit payments by coordinating Medicare and 
other benefit payments.
    The Electronic Correspondence Referral System (ECRS) is currently 
used to transfer data between CMS's

[[Page 75176]]

Medicare contractors and the COBC to establish Medicare Secondary Payer 
(MSP) periods of coverage on CMS's Common Working File (CWF) and to 
update CWF with the results of a CMS review of a WC Medicare Set-aside 
Arrangement Proposal. The CWF is a CMS system, containing Medicare 
beneficiary eligibility information that is used for verification and 
validation purposes to ensure Medicare claims are paid properly and by 
the appropriate payer. The WC Case Control System is used to control 
the receipt of WC Medicare Set-aside Arrangement Proposals and tracking 
of each proposal through the review process to establishment of the MSP 
period of coverage via ECRS. ECRS is also used to transmit WC Medicare 
Set-aside Arrangement data from CMS Regional Offices (RO) to the COBC 
for Medicare beneficiaries and non-Medicare beneficiaries who have an 
approved or denied WC Medicare Set-aside Arrangement to cover future 
medical costs resulting from an injury incurred while employed. If the 
injury results in disability payments from the Social Security 
Administration, there is a reasonable expectation that the injured 
individual will also be eligible for Medicare benefits some time after 
the WC settlement is made.
    The ROs or a CMS contractor will transmit the WC Medicare Set-aside 
Arrangement information via ECRS, or the WC Case Control System, for 
non-Medicare beneficiaries once they approve or deny the arrangement. 
The COBC will maintain ECRS and WC Case Control System transmitted data 
in the WCSAF for future matching purposes. The COBC will ``match'' non-
beneficiary WCSAF data against the file it receives each month of new 
Medicare eligibles to identify any non-beneficiaries with impending 
Medicare entitlement. Once a match occurs, the existence of a WC 
Medicare Set-aside Arrangement will be reflected on the new 
beneficiary's CWF record and a Lead Medicare Contractor will be 
assigned for monitoring expenditures from the WC Medicare Set-aside 
Arrangement.
    CMS is drawn into a civil action resulting from a WC claim in a 
consulting position to ensure that a legal settlement involving an 
injured worker considers Medicare's interest with respect to future 
claims. CMS RO approval of a WC Medicare Set-aside Arrangement helps 
direct the treatment of future disorders or health claims by the 
injured worker, ensuring he/she is adequately covered for long-term 
care resulting from their WC injury, first by the WC Medicare Set-aside 
Arrangement and then by Medicare if necessary.

I. Description of the Modified or Altered System of Records

A. Statutory and Regulatory Basis for SOR

    Section 1862 (b)(2) of the Social Security Act (the Act) requires 
that Medicare payment may not be made for any item or service to the 
extent that payment has been made under a WC law or plan. This section 
of the Act and Title 42 Code of Federal Regulations (CFR) 411.46 
require CMS to exclude payments once the injured individual becomes a 
Medicare beneficiary when payment should be made from WC funds that are 
always primary to Medicare payment.

B. Collection and Maintenance of Data in the System

    The WCSAF includes standard data for identification including the 
name, address, date of birth, Social Security Number, date of the WC 
injury/incident, injury diagnosis code(s), effective date and amount of 
the WC Medicare Set-aside Arrangement. In addition, data will be 
included to enable CMS to manage the WC Medicare Set-aside Arrangement 
information when it becomes part of the beneficiary's record on the 
CWF. These data include the WC carrier, the administrator of the Set-
aside Arrangement, and the attorney that prepared the arrangement.

II. Agency Policies, Procedures, and Restrictions on the Routine Use

A. Agency Policies, Procedures, and Restrictions on the Routine Use

    The Privacy Act permits us to disclose information without an 
individual's consent if the information is to be used for a purpose 
that is compatible with the purpose(s) for which the information was 
collected. Any such disclosure of data is known as a ``routine use.'' 
The government will only release WCSAF information that can be 
associated with an individual as provided for under ``Section III. 
Proposed Routine Use Disclosures of Data in the System.'' Both 
identifiable and non-identifiable data may be disclosed under a routine 
use.
    We will only collect the minimum personal data necessary to achieve 
the purpose of WCSAF. CMS has the following policies and procedures 
concerning disclosures of information that will be maintained in the 
system. Disclosure of information from this system will be approved 
only to the extent necessary to accomplish the purpose of the 
disclosure and only after CMS:
    1. Determines that the use or disclosure is consistent with the 
reason that the data are being collected; e.g., ensuring that benefit 
payments are made by the appropriate payer by coordinating Medicare and 
other benefit payments.
    2. Determines that:
    a. The purpose for which the disclosure is to be made can only be 
accomplished if the record is provided in individually identifiable 
form;
    b. The purpose for which the disclosure is to be made is of 
sufficient importance to warrant the effect and/or risk on the privacy 
of the individual that additional exposure of the record might bring; 
and
    c. There is a strong probability that the proposed use of the data 
would in fact accomplish the stated purpose(s).
    3. Requires the information recipient to:
    a. Establish administrative, technical, and physical safeguards to 
prevent unauthorized use of disclosure of the record;
    b. Remove or destroy at the earliest time all patient-identifiable 
information; and
    c. Agree to not use or disclose the information for any purpose 
other than the stated purpose under which the information was 
disclosed.
    4. Determines that the data are valid and reliable.

III. Proposed Routine Use Disclosures of Data in the System

    A. The Privacy Act allows us to disclose information without an 
individual's consent if the information is to be used for a purpose 
that is compatible with the purpose(s) for which the information was 
collected. Any such compatible use of data is known as a ``routine 
use.'' The proposed routine uses in this system meet the compatibility 
requirement of the Privacy Act. We are proposing to establish the 
following routine use disclosures of information maintained in the 
system:
    1. To agency contractors, or consultants that have been contracted 
by the agency to assist in the performance of a service related to this 
system and that need to have access to the records in order to perform 
the activity.
    CMS contemplates disclosing information under this routine use only 
in situations in which CMS may enter into a contractual or similar 
agreement with a third party to assist in accomplishing agency business 
functions relating to purposes for this system.
    CMS occasionally contracts out certain of its functions when doing 
so would contribute to effective and efficient operations. CMS must be 
able

[[Page 75177]]

to give a contractor whatever information is necessary for the 
contractor to fulfill its duties. In these situations, safeguards are 
provided in the contract prohibiting the contractor from using or 
disclosing the information for any purpose other than that described in 
the contract and requires the contractor to return or destroy all 
information at the completion of the contract.
    2. To another Federal and/or state agency, agency of a state 
government, an agency established by state law, or its fiscal agent to:
    a. Contribute to the accuracy of CMS's proper payment of Medicare 
benefits,
    b. Enable such agency to administer a Federal health benefits 
program, or as necessary to enable such agency to fulfill a requirement 
of a Federal statute or regulation that implements a health benefits 
program funded in whole or in part with Federal funds.
    Other Federal or state agencies in their administration of a 
Federal health program may require WCSAF information in order to 
support evaluations and monitoring of Medicare claims information of 
beneficiaries, including proper payment for services provided. Releases 
of information would be allowed if the proposed use(s) for the 
information proved compatible with the purpose for which CMS collects 
the information.
    WCSAF data may be released to the State only on those injured 
individuals who are not currently Medicare beneficiaries but who have a 
WC Medicare Set-aside Arrangement that is intended to pay for future 
medical expenses in place of future Medicare benefits that has been 
approved, or denied, by CMS.
    3. To an individual or organization for research, evaluation or 
epidemiological projects related to the prevention of disease or 
disability, the restoration or maintenance of health, or for 
understanding and improving payment projects.
    The WCSAF data will provide the research and evaluations a broader, 
longitudinal, national perspective of the status of injured individuals 
that are not currently Medicare beneficiaries but have a WC Medicare 
Set-aside Arrangement that is intended to pay for future medical 
expenses in place of future Medicare benefits that has been approved, 
or denied, by CMS.
    4. To a Member of Congress or to a Congressional staff member in 
response to an inquiry of the Congressional Office made at the written 
request of the constituent about whom the record is maintained.
    Individuals sometimes request the help of a Member of Congress in 
resolving some issue relating to a matter before CMS. The Member of 
Congress then writes CMS, and CMS must be able to give sufficient 
information to be responsive to the inquiry.
    5. To the Department of Justice (DOJ), court or adjudicatory body 
when:
    a. The agency or any component thereof, or
    b. Any employee of the agency in his or her official capacity; or
    c. Any employee of the agency in his or her individual capacity 
where the DOJ has agreed to represent the employee, or
    d. The United States Government is a party to litigation or has an 
interest in such litigation, and by careful review, CMS determines that 
the records are both relevant and necessary to the litigation.
    Whenever CMS is involved in litigation, or occasionally when 
another party is involved in litigation and CMS's policies or 
operations could be affected by the outcome of the litigation, CMS 
would be able to disclose information to the DOJ, court or adjudicatory 
body involved. A determination would be made in each instance that, 
under the circumstances involved, the purposes served by the use of the 
information in the particular litigation is compatible with a purpose 
for which CMS collects the information.
    6. To a CMS contractor (including, but not necessarily limited to 
intermediaries and carriers) that assists in the administration of a 
CMS-administered health benefits program, or to a grantee of a CMS-
administered grant program, when disclosure is deemed reasonably 
necessary by CMS to prevent, deter, discover, detect, investigate, 
examine, prosecute, sue with respect to, defend against, correct, 
remedy, or otherwise combat fraud or abuse in such program.
    CMS contemplates disclosing information under this routine use only 
in situations in which CMS may enter into a contractual or similar 
agreement with a third party to assist in accomplishing CMS functions 
relating to the purpose of combating fraud and abuse.
    CMS occasionally contracts out certain of its functions when this 
would contribute to effective and efficient operations. CMS must be 
able to give a contractor whatever information is necessary for the 
contractor to fulfill its duties. In these situations, safeguards (like 
ensuring that the purpose for which the disclosure is to be made is of 
sufficient importance to warrant the effect and/or risk on the privacy 
of the individual that additional exposure of the record might bring 
and those stated in II.B, above), are provided in the contract 
prohibiting the contractor from using or disclosing the information for 
any purpose other than that described in the contract and to return or 
destroy all information.
    7. To another Federal agency or to an instrumentality of any 
governmental jurisdiction within or under the control of the United 
States (including any State or local governmental agency), that 
administers, or that has the authority to investigate potential fraud 
or abuse in, a health benefits program funded in whole or in part by 
Federal funds, when disclosure is deemed reasonably necessary by CMS to 
prevent, deter, discover, detect, investigate, examine, prosecute, sue 
with respect to, defend against, correct, remedy, or otherwise combat 
fraud or abuse in such programs.
    Other State agencies in their administration of a Federal health 
program may require WCSAF information for the purpose of preventing, 
deterring, discovering, detecting, investigating, examining, 
prosecuting, suing with respect to, defending against, correcting, 
remedying, or otherwise combating such fraud and abuse in such 
programs. Releases of information would be allowed if the proposed 
use(s) for the information proved compatible with the purpose for which 
CMS collects the information.

B. Additional Provisions Affecting Routine Use Disclosures

    To the extent this system contains Protected Health Information 
(PHI) as defined by HHS regulation ``Standards for Privacy of 
Individually Identifiable Health Information'' (45 CFR Parts 160 and 
164, 65 FR 82462 (12-28-00), Subparts A and E. Disclosures of such PHI 
that are otherwise authorized by these routine uses may only be made 
if, and as, permitted or required by the ``Standards for Privacy of 
Individually Identifiable Health Information.''
    In addition, our policy will be to prohibit release even of data 
not directly identifiable, except pursuant to one of the routine uses 
or if required by law, if we determine there is a possibility that an 
individual can be identified through implicit deduction based on small 
cell sizes (instances where the patient population is so small that 
individuals who are familiar with the enrollees could, because of the 
small size, use this information to deduce the identity of the 
beneficiary).

IV. Safeguards

    CMS has safeguards in place for authorized users and monitors such

[[Page 75178]]

users to ensure against excessive or unauthorized use. Personnel having 
access to the system have been trained in the Privacy Act and 
information security requirements. Employees who maintain records in 
this system are instructed not to release data until the intended 
recipient agrees to implement appropriate management, operational and 
technical safeguards sufficient to protect the confidentiality, 
integrity and availability of the information and information systems 
and to prevent unauthorized access.
    This system will conform to all applicable Federal laws and 
regulations and Federal, HHS, and CMS policies and standards as they 
relate to information security and data privacy. These laws and 
regulations may apply but are not limited to: the Privacy Act of 1974; 
the Federal Information Security Management Act of 2002; the Computer 
Fraud and Abuse Act of 1986; the Health Insurance Portability and 
Accountability Act of 1996; the E-Government Act of 2002, the Clinger-
Cohen Act of 1996; the Medicare Modernization Act of 2003, and the 
corresponding implementing regulations. OMB Circular A-130, Management 
of Federal Resources, Appendix III, Security of Federal Automated 
Information Resources also applies. Federal, HHS, and CMS policies and 
standards include but are not limited to: all pertinent National 
Institute of Standards and Technology publications; the HHS Information 
Systems Program Handbook and the CMS Information Security Handbook.

V. Effects of the Modified or Altered System of Records on Individual 
Rights

    CMS proposes to modify this system in accordance with the 
principles and requirements of the Privacy Act and will collect, use, 
and disseminate information only as prescribed therein. Data in this 
system will be subject to the authorized releases in accordance with 
the routine uses identified in this system of records.
    CMS will take precautionary measures (see item IV above) to 
minimize the risks of unauthorized access to the records and the 
potential harm to individual privacy or other personal or property 
rights of patients whose data are maintained in the system. CMS will 
collect only that information necessary to perform the system's 
functions. In addition, CMS will make disclosure from the proposed 
system only with consent of the subject individual, or his/her legal 
representative, or in accordance with an applicable exception provision 
of the Privacy Act. CMS, therefore, does not anticipate an unfavorable 
effect on individual privacy as a result of information relating to 
individuals.

    Dated: December 12, 2005.
Charlene Frizzera,
Acting Chief Operating Officer, Centers for Medicare & Medicaid 
Services.
SYSTEM NO. 09-70-0537

System Name:
    ``Non-Medicare Beneficiary Workers' Compensation (WC) Set-aside 
File, (WCSAF).''

Security Classification:
    Level 3 Privacy Act Sensitive.

System Location:
    Group Health Incorporated, 25 Broadway, New York, New York 10004.

Categories of Individuals Covered by the System:
    The system of records will contain data on non-Medicare 
beneficiaries that receive an approval or a denial by the Centers for 
Medicare & Medicaid Services (CMS) of the adequacy of a WC Medicare 
Set-aside Arrangement, as part of a WC settlement that is intended to 
pay for future medical expenses in place of future Medicare benefits.

Categories of Records in the System:
    This system of records will contain the individual-level 
identifying data including, but not limited to, name, address, date of 
birth, social security number (SSN), date of the WC injury/incident, 
injury diagnosis code(s), effective date and amount of the WC Medicare 
Set-aside Arrangement. In addition, data will be included to enable CMS 
to manage the WC Medicare Set-aside Arrangement information when it 
becomes part of a beneficiary's record on the Common Working File. 
These data include the WC carrier, the administrator of the WC Medicare 
Set-aside Arrangement, and the attorney that prepared the arrangement.

Authority for Maintenance of the System:
    Section 1862(b)(2) of the Social Security Act (the Act) requires 
that Medicare payment may not be made for any item or service to the 
extent that payment has been made under a WC law or plan. This section 
of the Act and Title 42 Code of Federal Regulation (CFR) 411.46 require 
CMS to exclude payments once the injured individual becomes a Medicare 
beneficiary when payment should be made from WC funds that are always 
primary to Medicare payment.

Purpose(s) of The System:
    The primary purpose of the non-Medicare beneficiary WCSAF is to 
maintain a file of individuals who were injured while employed; are not 
currently Medicare beneficiaries; whose WC Settlement included a WC 
Medicare Set-aside Arrangement that is intended to pay for future 
medical expenses in place of future Medicare benefits; and was approved 
or not approved (denied) by CMS as submitted. The information retrieved 
from this system will be disclosed to: (1) Support regulatory, 
reimbursement, and policy functions performed within the agency or by a 
contractor or consultant; (2) another Federal and/or state agency, 
agency of a state government, an agency established by state law, or 
its fiscal agent to contribute to the accuracy of CMS' proper payment 
of Medicare benefits, enable such agency to administer a Federal health 
benefits program, or enable such agency to fulfill a requirement of a 
Federal statute or regulation that implements a health benefits program 
funded in whole or in part with Federal funds; (3) an individual or 
organization for research, evaluation or epidemiological projects 
related to the prevention of disease or disability, the restoration or 
maintenance of health, or for understanding and improving payment 
projects; (4) support constituent requests made to a Congressional 
representative; (5) support litigation involving the agency; and (6) 
combat fraud and abuse in health benefits programs funded in whole or 
in part by Federal funds.

Routine Uses of Records Maintained in the System, Including Categories 
or Users and the Purposes of Such Uses:
    A. The Privacy Act allows us to disclose information without an 
individual's consent if the information is to be used for a purpose 
that is compatible with the purpose(s) for which the information was 
collected. Any such compatible use of data is known as a ``routine 
use.'' The proposed routine uses in this system meet the compatibility 
requirement of the Privacy Act. We are proposing to establish the 
following routine use disclosures of information maintained in the 
system:
    1. To agency contractors, or consultants that have been contracted 
by the agency to assist in the performance of a service related to this 
system and that need to have access to the records in order to perform 
the activity.
    2. To another Federal and/or state agency, agency of a state 
government, an agency established by state law, or its fiscal agent to:
    a. Contribute to the accuracy of CMS's proper payment of Medicare 
benefits,

[[Page 75179]]

    b. Enable such agency to administer a Federal health benefits 
program, or as necessary to enable such agency to fulfill a requirement 
of a Federal statute or regulation that implements a health benefits 
program funded in whole or in part with Federal funds.
    3. To an individual or organization for research, evaluation or 
epidemiological projects related to the prevention of disease or 
disability, the restoration or maintenance of health, or for 
understanding and improving payment projects.
    4. To a Member of Congress or to a Congressional staff member in 
response to an inquiry of the Congressional Office made at the written 
request of the constituent about whom the record is maintained.
    5. To the Department of Justice (DOJ), court or adjudicatory body 
when:
    a. The agency or any component thereof, or
    b. Any employee of the agency in his or her official capacity; or
    c. Any employee of the agency in his or her individual capacity 
where the DOJ has agreed to represent the employee, or
    d. The United States Government; is a party to litigation or has an 
interest in such litigation, and by careful review, CMS determines that 
the records are both relevant and necessary to the litigation.
    6. To a CMS contractor (including, but not necessarily limited to 
intermediaries and carriers) that assists in the administration of a 
CMS-administered health benefits program, or to a grantee of a CMS-
administered grant program, when disclosure is deemed reasonably 
necessary by CMS to prevent, deter, discover, detect, investigate, 
examine, prosecute, sue with respect to, defend against, correct, 
remedy, or otherwise combat fraud or abuse in such program.
    7. To another Federal agency or to an instrumentality of any 
governmental jurisdiction within or under the control of the United 
States (including any State or local governmental agency), that 
administers, or that has the authority to investigate potential fraud 
or abuse in, a health benefits program funded in whole or in part by 
Federal funds, when disclosure is deemed reasonably necessary by CMS to 
prevent, deter, discover, detect, investigate, examine, prosecute, sue 
with respect to, defend against, correct, remedy, or otherwise combat 
fraud or abuse in such programs.
    B. Additional Provisions Affecting Routine Use Disclosures:
    To the extent this system contains Protected Health Information 
(PHI) as defined by HHS regulation ``Standards for Privacy of 
Individually Identifiable Health Information'' (45 CFR Parts 160 and 
164, 65 FR 82462 (12-28-00)), Subparts A and E. Disclosures of such PHI 
that are otherwise authorized by these routine uses may only be made 
if, and as, permitted or required by the ``Standards for Privacy of 
Individually Identifiable Health Information.''
    In addition, our policy will be to prohibit release even of data 
not directly identifiable, except pursuant to one of the routine uses 
or if required by law, if we determine there is a possibility that an 
individual can be identified through implicit deduction based on small 
cell sizes (instances where the patient population is so small that 
individuals who are familiar with the enrollees could, because of the 
small size, use this information to deduce the identity of the 
beneficiary).

Policies and Practices for Storing, Retrieving, Accessing, Retaining, 
And Disposing of Records in the System:
Storage:
    All records are stored on magnetic media.

Retievability:
    The records are retrieved alphabetically by the name and/or SSN of 
the subject of the records.

Safeguards:
    CMS has safeguards in place for authorized users and monitors such 
users to ensure against excessive or unauthorized use. Personnel having 
access to the system have been trained in the Privacy Act and 
information security requirements. Employees who maintain records in 
this system are instructed not to release data until the intended 
recipient agrees to implement appropriate management, operational and 
technical safeguards sufficient to protect the confidentiality, 
integrity and availability of the information and information systems 
and to prevent unauthorized access.
    This system will conform to all applicable Federal laws and 
regulations and Federal, HHS, and CMS policies and standards as they 
relate to information security and data privacy. These laws and 
regulations may apply but are not limited to: The Privacy Act of 1974; 
the Federal Information Security Management Act of 2002; the Computer 
Fraud and Abuse Act of 1986; the Health Insurance Portability and 
Accountability Act of 1996; the E-Government Act of 2002, the Clinger-
Cohen Act of 1996; the Medicare Modernization Act of 2003, and the 
corresponding implementing regulations. OMB Circular A-130, Management 
of Federal Resources, Appendix III, Security of Federal Automated 
Information Resources also applies. Federal, HHS, and CMS policies and 
standards include but are not limited to: All pertinent National 
Institute of Standards and Technology publications; the HHS Information 
Systems Program Handbook and the CMS Information Security Handbook.

Retention and Disposal:
    CMS will retain identifiable WCSAF data for a period of 6 years and 
3 months unless the injured individual becomes a Medicare beneficiary 
prior to that period of time. When either of these criteria is met, the 
information stored on the injured individual will be deleted from the 
WCSAF. All claims-related records are encompassed by the document 
preservation order and will be retained until notification is received 
from DOJ.

System Manager And Address:
    Director, Division of Medicare Secondary Payer Policy Operations, 
Financial Services Group, Office of Financial Management, CMS, Mail 
Stop C3-14-16, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.

Notification Procedure:
    For purpose of access, the subject individual should write to the 
system manager who will require the system name, and for verification 
purposes, the subject individual's name (woman's maiden name, if 
applicable), address, date of birth, date of WC injury/incident, 
diagnosis, effective date and amount of the WC Medicare Set-aside 
Arrangement. (Furnishing the SSN is voluntary, but it may make 
searching for a record easier and prevent delay).

Record Access Procedure:
    For purpose of access, use the same procedures outlined in 
Notification Procedures above. Requestors should also reasonably 
specify the record contents being sought. (These procedures are in 
accordance with Department regulation 45 CFR 5b 5(a)(2)).

Contesting Record Procedures:
    The subject individual should contact the system manager named 
above, and reasonably identify the record and specify the information 
to be contested. State the corrective action sought and the reasons for 
the correction with supporting justification. (These procedures are in 
accordance with Department regulation 45 CFR 5b.7).

Record Source Categories:
    The Electronic Correspondence Referral System, Workers Comp Case

[[Page 75180]]

Control System, Medicare contractors and the Coordination of Benefit 
Contractor, Common Working File, CMS Regional Offices, an agency of a 
State government, Medicare beneficiaries and non-Medicare beneficiaries 
that have an approved or denied WC Medicare Set-aside arrangement to 
cover future medical costs resulting from an injury incurred while 
employed and the Social Security Administration.

Systems Exempted From Certain Provision of the Act:
    None.

[FR Doc. E5-7486 Filed 12-16-05; 8:45 am]
BILLING CODE 4120-03-P