Privacy Act of 1974; Report of a New System of Records, 24718-24723 [E6-6210]
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24718
Federal Register / Vol. 71, No. 80 / Wednesday, April 26, 2006 / Notices
Dated: April 13, 2006.
Kelly Cronin,
Director, Office of Programs and
Coordination, Office of the National
Coordinator.
[FR Doc. 06–3918 Filed 4–25–06; 8:45 am]
FOR FURTHER INFORMATION CONTACT:
https://www.hhs.gov/healthit/ahic/
bio_main.html.
The
meeting will be available via Web cast
at https://www.eventcenterlive.com/
cfmx/ec/login/login1.cfm?BID=67.
SUPPLEMENTARY INFORMATION:
BILLING CODE 4150–24–M
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Office of the National Coordinator,
American Health Information
Community Electronic Health Records
Workgroup Meeting
ACTION:
Announcement of meeting.
SUMMARY: This notice announces the
fifth meeting of the American Health
Information Community Electronic
Health Records Workgroup in
accordance with the Federal Advisory
Committee Act (Pub. L. 92–463, 5
U.S.C., App.).
DATES: May 2, 2006 from 1 p.m. to 5
p.m.
Dated: April 13, 2006.
Kelly Cronin,
Director, Office of Programs and
Coordination, Office of the National
Coordinator.
[FR Doc. 06–3920 Filed 4–25–06; 8:45 am]
BILLING CODE 4150–24–M
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Office of the National Coordinator;
American Health Information
Community Consumer Empowerment
Workgroup Meeting
ACTION:
Announcement of meeting.
Mary C. Switzer Building
(330 C Street, SW., Washington, DC
20201), Conference Room 4090.
FOR FURTHER INFORMATION CONTACT:
https://www.hhs.gov/healthit/ahic/
ehr_main.html.
The
meeting will be available via Web cast
at https://www.eventcenterlive.com/
cfmx/ec/login/login1.cfm?BID=67.
SUMMARY: This notice announces the
fifth meeting of the American Health
Information Community Consumer
Empowerment Workgroup in
accordance with the Federal Advisory
Committee Act (Pub. L. No. 92–463, 5
U.S.C., App.)
DATES: May 1, 2006 from 1 p.m. to 5
p.m.
ADDRESSES:
ADDRESSES:
SUPPLEMENTARY INFORMATION:
Dated: April 13, 2006.
Kelly Cronin,
Director, Office of Programs and
Coordination, Office of the National
Coordinator.
[FR Doc. 06–3919 Filed 4–25–06; 8:45 am]
BILLING CODE 4150–24–M
Dated: April 13, 2006.
Kelly Cronin,
Director, Office of Programs and
Coordination, Office of the National
Coordinator.
[FR Doc. 06–3921 Filed 4–25–06; 8:45 am]
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Office of the National Coordinator;
American Health Information
Community Biosurveillance
Workgroup Meeting
wwhite on PROD1PC61 with NOTICES
ACTION:
BILLING CODE 4150–24–M
Announcement of meeting.
SUMMARY: This notice announces the
fifth of the American Health Information
Community Biosurveillance Workgroup
in accordance with the Federal
Advisory Committee Act (Pub. L. 92–
463, 5 U.S.C., App.).
DATES: May 4, 2006 from 1 p.m. to 5
p.m.
Mary C. Switzer Building
(330 C Street, SW., Washington, DC
20201), Conference Room 4090.
ADDRESSES:
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Mary C. Switzer Building
(330 C Street, SW., Washington, DC
20201), Conference Room 4090.
FOR FURTHER INFORMATION CONTACT:
https://www.hhs.gov/healthit/ahic/
ce_main.html.
SUPPLEMENTARY INFORMATION: The
meeting will be available via Web cast
at https://www.eventcenterlive.com/
cfmx/ec/login/login1.cfm?BID=67.
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Disease Control and
Prevention
Advisory Committee on Immunization
Practices
In accordance with section 10(a)(2) of
the Federal Advisory Committee Act
(Pub. L. 92–463), the Centers for Disease
Control and Prevention (CDC)
announces the following teleconference.
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Name: Advisory Committee on
Immunization Practices (ACIP).
Time and Date: 2 p.m.–4 p.m., May 4,
2006.
Place: National Immunization Program
(NIP), Atlanta, Georgia. To participate, please
call 1–888–769–8923, pass code 3537839.
Status: Open to the public, limited only by
the availability of telephone ports.
Purpose: The committee is charged with
advising the Director, CDC, on the
appropriate uses of immunizing agents. In
addition, under 42 U.S.C. 1396s, the
committee is mandated to establish and
periodically review and, as appropriate,
revise the list of vaccines for administration
to vaccine-eligible children through the
Vaccines for Children (VFC) program, along
with schedules regarding the appropriate
periodicity, dosage, and contraindications
applicable to the vaccines.
Matters To Be Discussed: Varicella
vaccination policy options.
This notice is being published less than 15
days as provided under 41 CFR 102–3.150(b),
the public health urgency of this agency
business requires that the teleconference be
held prior to the first available date for
publication of this notice in the Federal
Register.
Contact Person for More Information:
Demetria Gardner, Epidemiology and
Surveillance Division, National
Immunization Program, CDC, 1600 Clifton
Road, NE, Mail Stop E–61, Atlanta, Georgia
30333, telephone 404–639–8096, fax 404–
639–8616.
The Director, Management Analysis and
Services Office, has been delegated the
authority to sign Federal Register notices
pertaining to announcements of meetings and
other committee management activities for
both the CDC and the Agency for Toxic
Substances and Disease Registry.
Dated: April 20, 2006.
Alvin Hall,
Director, Management Analysis and Services
Office, Centers for Disease Control and
Prevention.
[FR Doc. 06–3987 Filed 4–25–06; 8:45 am]
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DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
Privacy Act of 1974; Report of a New
System of Records
Department of Health and
Human Services (HHS), Centers for
Medicare & Medicaid Services (CMS).
ACTION: Notice of a New System of
Records (SOR).
AGENCY:
SUMMARY: In accordance with the
requirements of the Privacy Act of 1974,
we are proposing to establish a new
system titled, ‘‘Medicare Health Support
System (MHS), System No. 09–70–
0574.’’ The program is mandated by
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Federal Register / Vol. 71, No. 80 / Wednesday, April 26, 2006 / Notices
Section 721 of the Medicare
Prescription Drug Improvement, and
Modernization Act of 2003 (MMA) (Pub.
L. 108–173), which was enacted into
law on December 8, 2003, and amended
Title XVIII of the Social Security Act
(the Act). The MHS program seeks to
improve beneficiary self-care and
provide beneficiaries and their
providers enhanced information and
support in order to increase adherence
to evidence-based care. Improvements
in these areas are expected to generate
savings to the Medicare program to
offset the costs of the payments. The
statute is designed to support dynamic
evolution of the program over time,
based on program experience and
outcomes. Section 1807(c)(1) of the Act
requires the Secretary of HHS to enter
into agreements to expand the
implementation of successful programs
or components to additional geographic
areas, which may include the
implementation of the program on a
national basis. Prior to widespread
implementation of the program, an
initial 3-year Phase I must provide proof
of concept through an experimental
design involving random assignment of
beneficiaries to either an intervention or
control group.
The purpose of this system is to
collect and maintain demographic and
health related data on the target
population of Medicare beneficiaries
who are potential participants in the
MHS program. We will also collect
certain identifying information on
Medicare providers who provide
services to such beneficiaries.
Information retrieved from this system
may be disclosed to: (1) Support
regulatory, reimbursement, and policy
functions performed within the agency
or by a contractor, grantee, consultant or
other legal agent; (2) assist another
Federal or state agency with information
to contribute to the accuracy of CMS’s
proper payment of Medicare benefits,
enable such agency to administer a
Federal health benefits program, or to
enable such agency to fulfill a
requirement of Federal statute or
regulation that implements a health
benefits program funded in whole or in
part with Federal funds; (3) support an
individual or organization for a research
project or in support of an evaluation
project related to the prevention of
disease or disability, the restoration or
maintenance of health, or payment
related projects; (4) support constituent
requests made to a Congressional
representative; (5) support litigation
involving the agency; and (6) combat
fraud and abuse in certain Federallyfunded health benefits programs. We
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have provided background information
about the new system in the
SUPPLEMENTARY INFORMATION section
below. Although the Privacy Act
requires only that CMS provide an
opportunity for interested persons to
comment on the proposed routine uses,
CMS invites comments on all portions
of this notice. See EFFECTIVE DATES
section for comment period.
EFFECTIVE DATES: CMS filed a new SOR
report with the Chair of the House
Committee on Government Reform and
Oversight, the Chair of the Senate
Committee on Homeland Security &
Governmental Affairs, and the
Administrator, Office of Information
and Regulatory Affairs, Office of
Management and Budget (OMB) on
April 18, 2006. To ensure that all parties
have adequate time in which to
comment, the new system will become
effective 30 days from the publication of
the notice, or 40 days from the date it
was submitted to OMB and the
Congress, whichever is later. 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.
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 time.
FOR FURTHER INFORMATION CONTACT:
Melissa Dehn, Division of Chronic Care
Improvement Programs, Provider Billing
Group, Center for Medicare
Management, Mail Stop C4–10–07,
Centers for Medicare & Medicaid
Services, 7500 Security Boulevard,
Baltimore, MD 21244–1849. She can be
reached by telephone at 410–786–5721,
or via e-mail at
Melissa.Dehn@cms.hhs.gov.
ADDRESSES:
The MHS
program pays monthly fees to Chronic
Care Improvement Organizations (CCIO)
for improving the quality and
effectiveness of health care services
delivered to Medicare Fee-For-Service
(FFS) beneficiaries. Mandated by § 721
of the MMA, the MHS program seeks to:
(1) Improve beneficiary self-care, (2)
provide beneficiaries and their
providers enhanced information and
support to increase adherence to
evidence-based care, and (3) improve
clinical quality and both beneficiary and
provider satisfaction. This program is
designed to achieve Medicare spending
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targets for populations with one or more
chronic health conditions. The MHS
program enables CMS to test the
program business design, and program
components and to test the effect on
utilization, cost, and quality of care to
Medicare FFS beneficiaries.
Medicare claims for participating
beneficiaries will continue to be paid of
an FFS basis. Separate payments to
participating CCIOs will be made on a
per-person per-month basis, to be
derived from savings expected through
improvements in care coordination for
an assigned beneficiary population.
CMS will evaluate and monitor these
individual MHS programs using more
than 60 individual measures, in four
distinct areas of performance: (1)
Clinical performance, (2) healthcare
utilization, (3) program activity, and (4)
participant satisfaction. Additionally,
the pilot phase of the program will be
evaluated on its effectiveness in
achieving program goals, and its
potential for expansion to additional
geographic areas.
I. Description of the Proposed System of
Records
A. Statutory and Regulatory Basis for
SOR
The statutory authority for this system
is given under the provisions of Section
721 of the Medicare Prescription Drug
Improvement, and Modernization Act of
2003 and Section 1807(a)(1) of the
Social Security Act.
B. Collection and Maintenance of Data
in the System
This system will collect and maintain
individually identifiable and other data
collected on Medicare beneficiaries who
are potential participants in the MHS
program and providers who provide
services to such beneficiaries. Data will
be collected from Medicare
administrative and claims records, CCIO
administrative data systems, patient
medical charts, physician records, and
via survey instruments administered to
beneficiaries and providers. The
collected information will include, but
is not limited to: Medicare claims and
eligibility data, name, address,
telephone number, health insurance
claims number, race/ethnicity, gender,
date of birth, provider name, unique
provider identification number, medical
record number, as well as clinical,
demographic, health/well-being, family
and/or caregiver contact information,
and background information relating to
Medicare issues. It will also include
chronic care diagnosis, treatment,
program participation, and evaluation,
survey, and research information
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needed to evaluate the program and
develop research reports on findings.
4. Determines that the data are valid
and reliable.
II. Agency Policies, Procedures, and
Restrictions on the Routine Use
A. 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 MHS 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
MHS.
CMS has the following policies and
procedures concerning disclosures of
information that will be maintained in
the system. Disclosure of information
from the 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 is being collected; e.g., to
collect and maintain demographic and
health related data on the target
population of Medicare beneficiaries
who are potential participants in the
MHS program. We will also collect
certain identifying information on
Medicare providers who provide
services to such beneficiaries.
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.
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, consultants
or grantees, who have been engaged by
the agency to assist in the performance
of a service related to this collection and
who need to have access to the records
in order to perform the activity.
We contemplate 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 function 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
to give a contractor, consultant or
grantee whatever information is
necessary for the contractor or
consultant to fulfill its duties. In these
situations, safeguards are provided in
the contract prohibiting the contractor,
consultant or grantee from using or
disclosing the information for any
purpose other than that described in the
contract and requires the contractor,
consultant or grantee to return or
destroy all information at the
completion of the contract.
2. To another Federal or state agency
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; and/or
c. Assist Federal/state Medicaid
programs within the state.
Other Federal or state agencies, in
their administration of a Federal health
program, may require MHS information
in order to support evaluations and
monitoring of Medicare claims
information of beneficiaries, including
proper reimbursement for services
provided.
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3. To an individual or organization for
a research project or in support of an
evaluation project related to the
prevention of disease or disability, the
restoration or maintenance of health, or
payment related projects.
The MHS data will provide for
research or support of evaluation
projects and a broader, longitudinal,
national perspective of the status of
Medicare beneficiaries. CMS anticipates
that many researchers will have
legitimate requests to use these data in
projects that could ultimately improve
the care provided to Medicare
beneficiaries and the policies that
govern their care.
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.
Beneficiaries sometimes request the
help of a Member of Congress in
resolving an issue relating to a matter
before CMS. The Member of Congress
then writes to 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 and that the use of such
records by the DOJ, court or
adjudicatory body is compatible with
the purpose for which the agency
collected the records.
Whenever CMS is involved in
litigation, and occasionally when
another party is involved in litigation
and CMS 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.
6. To a CMS contractor (including, but
not necessarily limited to, fiscal
intermediaries and carriers) that assists
in the administration of a CMSadministered 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,
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remedy, or otherwise combat fraud or
abuse in such program.
We contemplate disclosing
information under this routine use only
in situations in which CMS may enter
into a contractual, grantee, cooperative
agreement or consultant relationship
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 or makes grants
or cooperative agreements when doing
so would contribute to effective and
efficient operations. CMS must be able
to give a contractor, grantee, consultant
or other legal agent whatever
information is necessary for the agent to
fulfill its duties. In these situations,
safeguards are provided in the contract
prohibiting the agent from using or
disclosing the information for any
purpose other than that described in the
contract and requiring the agent 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 agencies may require MHS
information for the purpose of
combating fraud and abuse in such
Federally-funded 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, subparts A and E) 65 FR 82462
(12–28–00). 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.’’ (See
45 CFR 164.512(a)(1)).
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
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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
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 EGovernment Act of 2002, the ClingerCohen 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 Proposed System of
Records on Individual Rights
CMS proposes to establish 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 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
this system. CMS will collect only that
information necessary to perform the
system’s functions. In addition, CMS
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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.
John R. Dyer,
Chief Operating Officer, Centers for Medicare
& Medicaid Services.
System No. 09–70–0574
SYSTEM NAME:
‘‘Medicare Health Support System
(MHS),’’ HHS/CMS/CMM.
SECURITY CLASSIFICATION:
Level Three Privacy Act Sensitive
Data.
SYSTEM LOCATION:
CMS Data Center, 7500 Security
Boulevard, North Building, First Floor,
Baltimore, Maryland 21244–1850 and at
various co-locations of CMS agents.
CATEGORIES OF INDIVIDUALS COVERED BY THE
SYSTEM:
This system will collect and maintain
individually identifiable and other data
collected on Medicare beneficiaries who
are potential participants in the MHS
program and their providers who
provide services to such beneficiaries.
Data will be collected from Medicare
administrative and claims records, CCIO
administrative data systems, patient
medical charts, physician records, and
via survey instruments administered to
beneficiaries and providers.
CATEGORIES OF RECORDS IN THE SYSTEM:
The collected information will
include, but is not limited to: Medicare
claims and eligibility data, name,
address, telephone number, health
insurance claims number, race/
ethnicity, gender, date of birth, provider
name, unique provider identification
number, medical record number, as well
as clinical, demographic, health/wellbeing, family and/or caregiver contact
information, and background
information relating to Medicare issues.
It will also include chronic care
diagnosis, treatment, program
participation, and evaluation, survey,
and research information needed to
evaluate the program and develop
research reports on findings.
AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
The statutory authority for this system
is given under the provisions of Section
721 of the Medicare Prescription Drug
Improvement, and Modernization Act of
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2003 and Section 1807(a)(1) of the
Social Security Act.
PURPOSE(S) OF THE SYSTEM:
The purpose of this system is to
collect and maintain demographic and
health related data on the target
population of Medicare beneficiaries
who are potential participants in the
MHS program. We will also collect
certain identifying information on
Medicare providers who provide
services to such beneficiaries.
Information retrieved from this system
may be disclosed to: (1) Support
regulatory, reimbursement, and policy
functions performed within the agency
or by a contractor, grantee, consultant or
other legal agent; (2) assist another
Federal or state agency with information
to contribute to the accuracy of CMS’s
proper payment of Medicare benefits,
enable such agency to administer a
Federal health benefits program, or to
enable such agency to fulfill a
requirement of Federal statute or
regulation that implements a health
benefits program funded in whole or in
part with Federal funds; (3) support an
individual or organization for a research
project or in support of an evaluation
project related to the prevention of
disease or disability, the restoration or
maintenance of health, or payment
related projects; (4) support constituent
requests made to a Congressional
representative; (5) support litigation
involving the agency; and (6) combat
fraud and abuse in certain Federallyfunded health benefits programs.
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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, consultants
or grantees, who have been engaged by
the agency to assist in the performance
of a service related to this collection and
who need to have access to the records
in order to perform the activity.
2. To another Federal or state agency
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
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16:58 Apr 25, 2006
Jkt 208001
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; and/or
c. Assist Federal/state Medicaid
programs within the state.
3. To an individual or organization for
a research project or in support of an
evaluation project related to the
prevention of disease or disability, the
restoration or maintenance of health, or
payment related 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 and that the use of such
records by the DOJ, court or
adjudicatory body is compatible with
the purpose for which the agency
collected the records.
6. To a CMS contractor (including, but
not necessarily limited to, fiscal
intermediaries and carriers) that assists
in the administration of a CMSadministered 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
PO 00000
Frm 00086
Fmt 4703
Sfmt 4703
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, Subparts A and E) 65 FR 82462
(12–28–00). 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.’’ (See
45 CFR 164.512(a)(1)).
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 electronic
media.
RETRIEVABILITY:
The collected data are retrieved by an
individual identifier; e.g., beneficiary
name or HICN.
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 EGovernment Act of 2002, the Clinger-
E:\FR\FM\26APN1.SGM
26APN1
24723
Federal Register / Vol. 71, No. 80 / Wednesday, April 26, 2006 / Notices
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 information for a total
period not to exceed 25 years. 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 Chronic Care
Improvement Programs, Provider Billing
Group, Center for Medicare
Management, CMS, Mail Stop C4–10–
07, 7500 Security Boulevard, Baltimore,
Maryland 21244–1850.
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).
RECORDS SOURCE CATEGORIES:
The data contained in this system of
records will be collected from Medicare
administrative and claims records, CCIO
administrative data systems, patient
medical charts, physician records, and
via survey instruments administered to
beneficiaries and providers.
SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS
OF THE ACT:
None.
NOTIFICATION PROCEDURE:
[FR Doc. E6–6210 Filed 4–25–06; 8:45 am]
For purpose of access, the subject
individual should write to the system
manager who will require the system
name, employee identification number,
tax identification number, national
provider number, and for verification
purposes, the subject individual’s name
(woman’s maiden name, if applicable),
HICN, and/or SSN (furnishing the SSN
is voluntary, but it may make searching
for a record easier and prevent delay).
BILLING CODE 4120–03–P
RECORD ACCESS PROCEDURE:
OMB No.: 0980–0270.
Description: As required by Federal
statute and regulation, each State
Protection and Advocacy (P&A) System
must prepare and submit to public
comment a Statement of Goals and
Priorities (SGP) for the P&A for
Developmental Disabilities (PADD)
program for each coming fiscal year.
The P&A is mandated to protect and
advocate under a range of different
Federally authorized disabilities
programs, but only the PADD program
requires an SGP. The final version of
this SGP, following the required public
input for the coming fiscal year, is
submitted to the Administration on
Developmental Disabilities (ADD). The
information in the SGP will be
aggregated into a national profile of
programmatic emphasis for P&A
Systems in the coming year. It will
provide ADD with a tool for monitoring
of the public input requirement.
Furthermore, it will provide an
overview of program direction, and
permit ADD to track accomplishments
against goals/targets, permitting the
formulation of technical assistance and
compliance with the Government
Performance and Results Act of 1993.
Respondents: State and Tribal
Governments.
Title: Developmental Disabilities
Protection and Advocacy Statement of
Goals and Priorities.
For purpose of access, use the same
procedures outlined in Notification
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Administration for Children and
Families
Proposed Information Collection
Activity; Comment Request Proposed
Projects
ANNUAL BURDEN ESTIMATES
Number of
respondents
Instrument
wwhite on PROD1PC61 with NOTICES
P&A SGP .........................................................................................................
Estimated Total Annual Burden
Hours: 2,508.
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
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16:58 Apr 25, 2006
Jkt 208001
57
Families, Office of Administration,
Office of Information Services, 370
L’Enfant Promenade, SW., Washington,
DC 20447, Attn: ACF Reports Clearance
Officer. E-mail address:
infocollection@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
PO 00000
Frm 00087
Fmt 4703
Sfmt 4703
Number of
responses per
respondent
1
Average
burden hours
per response
44
Total burden
hours
2,508
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
E:\FR\FM\26APN1.SGM
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Agencies
[Federal Register Volume 71, Number 80 (Wednesday, April 26, 2006)]
[Notices]
[Pages 24718-24723]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E6-6210]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
Privacy Act of 1974; Report of a New System of Records
AGENCY: Department of Health and Human Services (HHS), Centers for
Medicare & Medicaid Services (CMS).
ACTION: Notice of a New System of Records (SOR).
-----------------------------------------------------------------------
SUMMARY: In accordance with the requirements of the Privacy Act of
1974, we are proposing to establish a new system titled, ``Medicare
Health Support System (MHS), System No. 09-70-0574.'' The program is
mandated by
[[Page 24719]]
Section 721 of the Medicare Prescription Drug Improvement, and
Modernization Act of 2003 (MMA) (Pub. L. 108-173), which was enacted
into law on December 8, 2003, and amended Title XVIII of the Social
Security Act (the Act). The MHS program seeks to improve beneficiary
self-care and provide beneficiaries and their providers enhanced
information and support in order to increase adherence to evidence-
based care. Improvements in these areas are expected to generate
savings to the Medicare program to offset the costs of the payments.
The statute is designed to support dynamic evolution of the program
over time, based on program experience and outcomes. Section 1807(c)(1)
of the Act requires the Secretary of HHS to enter into agreements to
expand the implementation of successful programs or components to
additional geographic areas, which may include the implementation of
the program on a national basis. Prior to widespread implementation of
the program, an initial 3-year Phase I must provide proof of concept
through an experimental design involving random assignment of
beneficiaries to either an intervention or control group.
The purpose of this system is to collect and maintain demographic
and health related data on the target population of Medicare
beneficiaries who are potential participants in the MHS program. We
will also collect certain identifying information on Medicare providers
who provide services to such beneficiaries. Information retrieved from
this system may be disclosed to: (1) Support regulatory, reimbursement,
and policy functions performed within the agency or by a contractor,
grantee, consultant or other legal agent; (2) assist another Federal or
state agency with information to contribute to the accuracy of CMS's
proper payment of Medicare benefits, enable such agency to administer a
Federal health benefits program, or to enable such agency to fulfill a
requirement of Federal statute or regulation that implements a health
benefits program funded in whole or in part with Federal funds; (3)
support an individual or organization for a research project or in
support of an evaluation project related to the prevention of disease
or disability, the restoration or maintenance of health, or payment
related projects; (4) support constituent requests made to a
Congressional representative; (5) support litigation involving the
agency; and (6) combat fraud and abuse in certain Federally-funded
health benefits programs. We have provided background information about
the new system in the SUPPLEMENTARY INFORMATION section below. Although
the Privacy Act requires only that CMS provide an opportunity for
interested persons to comment on the proposed routine uses, CMS invites
comments on all portions of this notice. See EFFECTIVE DATES section
for comment period.
EFFECTIVE DATES: CMS filed a new SOR report with the Chair of the House
Committee on Government Reform and Oversight, the Chair of the Senate
Committee on Homeland Security & Governmental Affairs, and the
Administrator, Office of Information and Regulatory Affairs, Office of
Management and Budget (OMB) on April 18, 2006. To ensure that all
parties have adequate time in which to comment, the new system will
become effective 30 days from the publication of the notice, or 40 days
from the date it was submitted to OMB and the Congress, whichever is
later. 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 time.
FOR FURTHER INFORMATION CONTACT: Melissa Dehn, Division of Chronic Care
Improvement Programs, Provider Billing Group, Center for Medicare
Management, Mail Stop C4-10-07, Centers for Medicare & Medicaid
Services, 7500 Security Boulevard, Baltimore, MD 21244-1849. She can be
reached by telephone at 410-786-5721, or via e-mail at
Melissa.Dehn@cms.hhs.gov.
SUPPLEMENTARY INFORMATION: The MHS program pays monthly fees to Chronic
Care Improvement Organizations (CCIO) for improving the quality and
effectiveness of health care services delivered to Medicare Fee-For-
Service (FFS) beneficiaries. Mandated by Sec. 721 of the MMA, the MHS
program seeks to: (1) Improve beneficiary self-care, (2) provide
beneficiaries and their providers enhanced information and support to
increase adherence to evidence-based care, and (3) improve clinical
quality and both beneficiary and provider satisfaction. This program is
designed to achieve Medicare spending targets for populations with one
or more chronic health conditions. The MHS program enables CMS to test
the program business design, and program components and to test the
effect on utilization, cost, and quality of care to Medicare FFS
beneficiaries.
Medicare claims for participating beneficiaries will continue to be
paid of an FFS basis. Separate payments to participating CCIOs will be
made on a per-person per-month basis, to be derived from savings
expected through improvements in care coordination for an assigned
beneficiary population. CMS will evaluate and monitor these individual
MHS programs using more than 60 individual measures, in four distinct
areas of performance: (1) Clinical performance, (2) healthcare
utilization, (3) program activity, and (4) participant satisfaction.
Additionally, the pilot phase of the program will be evaluated on its
effectiveness in achieving program goals, and its potential for
expansion to additional geographic areas.
I. Description of the Proposed System of Records
A. Statutory and Regulatory Basis for SOR
The statutory authority for this system is given under the
provisions of Section 721 of the Medicare Prescription Drug
Improvement, and Modernization Act of 2003 and Section 1807(a)(1) of
the Social Security Act.
B. Collection and Maintenance of Data in the System
This system will collect and maintain individually identifiable and
other data collected on Medicare beneficiaries who are potential
participants in the MHS program and providers who provide services to
such beneficiaries. Data will be collected from Medicare administrative
and claims records, CCIO administrative data systems, patient medical
charts, physician records, and via survey instruments administered to
beneficiaries and providers. The collected information will include,
but is not limited to: Medicare claims and eligibility data, name,
address, telephone number, health insurance claims number, race/
ethnicity, gender, date of birth, provider name, unique provider
identification number, medical record number, as well as clinical,
demographic, health/well-being, family and/or caregiver contact
information, and background information relating to Medicare issues. It
will also include chronic care diagnosis, treatment, program
participation, and evaluation, survey, and research information
[[Page 24720]]
needed to evaluate the program and develop research reports on
findings.
II. Agency Policies, Procedures, and Restrictions on the Routine Use
A. 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 MHS 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 MHS.
CMS has the following policies and procedures concerning
disclosures of information that will be maintained in the system.
Disclosure of information from the 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 is being collected; e.g., to collect and maintain
demographic and health related data on the target population of
Medicare beneficiaries who are potential participants in the MHS
program. We will also collect certain identifying information on
Medicare providers who provide services to such beneficiaries.
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, consultants or grantees, who have been
engaged by the agency to assist in the performance of a service related
to this collection and who need to have access to the records in order
to perform the activity.
We contemplate 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 function
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 to give a contractor, consultant or grantee whatever information
is necessary for the contractor or consultant to fulfill its duties. In
these situations, safeguards are provided in the contract prohibiting
the contractor, consultant or grantee from using or disclosing the
information for any purpose other than that described in the contract
and requires the contractor, consultant or grantee to return or destroy
all information at the completion of the contract.
2. To another Federal or state agency 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; and/or
c. Assist Federal/state Medicaid programs within the state.
Other Federal or state agencies, in their administration of a
Federal health program, may require MHS information in order to support
evaluations and monitoring of Medicare claims information of
beneficiaries, including proper reimbursement for services provided.
3. To an individual or organization for a research project or in
support of an evaluation project related to the prevention of disease
or disability, the restoration or maintenance of health, or payment
related projects.
The MHS data will provide for research or support of evaluation
projects and a broader, longitudinal, national perspective of the
status of Medicare beneficiaries. CMS anticipates that many researchers
will have legitimate requests to use these data in projects that could
ultimately improve the care provided to Medicare beneficiaries and the
policies that govern their care.
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.
Beneficiaries sometimes request the help of a Member of Congress in
resolving an issue relating to a matter before CMS. The Member of
Congress then writes to 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 and
that the use of such records by the DOJ, court or adjudicatory body is
compatible with the purpose for which the agency collected the records.
Whenever CMS is involved in litigation, and occasionally when
another party is involved in litigation and CMS 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.
6. To a CMS contractor (including, but not necessarily limited to,
fiscal 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,
[[Page 24721]]
remedy, or otherwise combat fraud or abuse in such program.
We contemplate disclosing information under this routine use only
in situations in which CMS may enter into a contractual, grantee,
cooperative agreement or consultant relationship 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 or makes grants or cooperative agreements when doing so
would contribute to effective and efficient operations. CMS must be
able to give a contractor, grantee, consultant or other legal agent
whatever information is necessary for the agent to fulfill its duties.
In these situations, safeguards are provided in the contract
prohibiting the agent from using or disclosing the information for any
purpose other than that described in the contract and requiring the
agent 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 agencies may require MHS information for the purpose of
combating fraud and abuse in such Federally-funded 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, subparts A and E) 65 FR 82462 (12-28-00). 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.'' (See 45 CFR
164.512(a)(1)).
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
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 Proposed System of Records on Individual Rights
CMS proposes to establish 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 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 this 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.
John R. Dyer,
Chief Operating Officer, Centers for Medicare & Medicaid Services.
System No. 09-70-0574
SYSTEM NAME:
``Medicare Health Support System (MHS),'' HHS/CMS/CMM.
SECURITY CLASSIFICATION:
Level Three Privacy Act Sensitive Data.
SYSTEM LOCATION:
CMS Data Center, 7500 Security Boulevard, North Building, First
Floor, Baltimore, Maryland 21244-1850 and at various co-locations of
CMS agents.
CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:
This system will collect and maintain individually identifiable and
other data collected on Medicare beneficiaries who are potential
participants in the MHS program and their providers who provide
services to such beneficiaries. Data will be collected from Medicare
administrative and claims records, CCIO administrative data systems,
patient medical charts, physician records, and via survey instruments
administered to beneficiaries and providers.
CATEGORIES OF RECORDS IN THE SYSTEM:
The collected information will include, but is not limited to:
Medicare claims and eligibility data, name, address, telephone number,
health insurance claims number, race/ethnicity, gender, date of birth,
provider name, unique provider identification number, medical record
number, as well as clinical, demographic, health/well-being, family
and/or caregiver contact information, and background information
relating to Medicare issues. It will also include chronic care
diagnosis, treatment, program participation, and evaluation, survey,
and research information needed to evaluate the program and develop
research reports on findings.
AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
The statutory authority for this system is given under the
provisions of Section 721 of the Medicare Prescription Drug
Improvement, and Modernization Act of
[[Page 24722]]
2003 and Section 1807(a)(1) of the Social Security Act.
PURPOSE(S) OF THE SYSTEM:
The purpose of this system is to collect and maintain demographic
and health related data on the target population of Medicare
beneficiaries who are potential participants in the MHS program. We
will also collect certain identifying information on Medicare providers
who provide services to such beneficiaries. Information retrieved from
this system may be disclosed to: (1) Support regulatory, reimbursement,
and policy functions performed within the agency or by a contractor,
grantee, consultant or other legal agent; (2) assist another Federal or
state agency with information to contribute to the accuracy of CMS's
proper payment of Medicare benefits, enable such agency to administer a
Federal health benefits program, or to enable such agency to fulfill a
requirement of Federal statute or regulation that implements a health
benefits program funded in whole or in part with Federal funds; (3)
support an individual or organization for a research project or in
support of an evaluation project related to the prevention of disease
or disability, the restoration or maintenance of health, or payment
related projects; (4) support constituent requests made to a
Congressional representative; (5) support litigation involving the
agency; and (6) combat fraud and abuse in certain Federally-funded
health benefits programs.
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, consultants or grantees, who have been
engaged by the agency to assist in the performance of a service related
to this collection and who need to have access to the records in order
to perform the activity.
2. To another Federal or state agency 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; and/or
c. Assist Federal/state Medicaid programs within the state.
3. To an individual or organization for a research project or in
support of an evaluation project related to the prevention of disease
or disability, the restoration or maintenance of health, or payment
related 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 and
that the use of such records by the DOJ, court or adjudicatory body is
compatible with the purpose for which the agency collected the records.
6. To a CMS contractor (including, but not necessarily limited to,
fiscal 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, Subparts A and E) 65 FR 82462 (12-28-00). 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.'' (See 45 CFR
164.512(a)(1)).
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 electronic media.
RETRIEVABILITY:
The collected data are retrieved by an individual identifier; e.g.,
beneficiary name or HICN.
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-
[[Page 24723]]
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 information for a total period not to exceed 25
years. 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 Chronic Care Improvement Programs, Provider
Billing Group, Center for Medicare Management, CMS, Mail Stop C4-10-07,
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, employee
identification number, tax identification number, national provider
number, and for verification purposes, the subject individual's name
(woman's maiden name, if applicable), HICN, and/or SSN (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).
RECORDS SOURCE CATEGORIES:
The data contained in this system of records will be collected from
Medicare administrative and claims records, CCIO administrative data
systems, patient medical charts, physician records, and via survey
instruments administered to beneficiaries and providers.
SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS OF THE ACT:
None.
[FR Doc. E6-6210 Filed 4-25-06; 8:45 am]
BILLING CODE 4120-03-P