Privacy Act of 1974; Report of a Modified or Altered System of Records, 54489-54495 [E6-15128]

Agencies

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

[Federal Register Volume 71, Number 179 (Friday, September 15, 2006)]
[Notices]
[Pages 54489-54495]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E6-15128]


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

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

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SUMMARY: In accordance with the Privacy Act of 1974, we are proposing 
to modify or alter an existing SOR, ``Medicare Appeals System (MAS),'' 
System No. 09-70-5001, last published at 69 Federal Register (FR) 75323 
(December 16, 2004). CMS is reorganizing its databases because of the 
impact of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (MMA) (Public Law (Pub.L.) 108-173) 
provisions and the large volume of information the Agency collects to 
administer the Medicare program. We propose to assign a new CMS 
identification number to this system to simplify the obsolete and 
confusing numbering system originally designed to identify the Bureau, 
Office, or Center that maintained the system of records. The new 
assigned identifying number for this system should read: System No. 09-
70-0566.
    We propose to broaden the scope of this system with the inclusion 
of support for two additional appeals processes: documenting policies 
and procedures relating to National Coverage Determinations and 
Prescription Drug Coverage appeals. These new processes are added to 
the current appeals process that include appeals of Medicare claims 
decisions, Administrative Law Judge hearings, and Medicare Advantage 
service decisions.
    We propose to modify existing routine use number 1 that permits 
disclosure to agency contractors and consultants to include disclosure 
to CMS grantees who perform a task for the agency. CMS grantees, 
charged with completing projects or activities that requires CMS data 
to carry out that activity, are classified separate from CMS 
contractors and/or consultants. The modified routine use will remain as 
routine use number 1.
    We propose to broaden the scope of routine uses number 5 and 6, 
authorizing disclosures to combat fraud and abuse in the Medicare and 
Medicaid programs to include combating ``waste'' which refers to 
specific beneficiary/recipient practices that result in unnecessary 
cost to all federally funded health benefit programs.
    We will delete routine use number 4, authorizing disclosure to 
support constituent requests made to a Congressional representative. If 
an authorization for the disclosure has been obtained from the data 
subject, then no routine use is needed. The Privacy Act allows for 
disclosures with the ``prior written consent'' of the data subject.
    We are modifying the language in the remaining routine uses to 
provide a proper explanation as to the need for the routine use and to 
provide clarity to CMS's intention to disclose individual-specific 
information contained in this system. We will also take the opportunity 
to update any sections of the system that were affected by the recent 
reorganization or MMA provisions and to update language in the 
administrative sections to correspond with language used in other CMS 
SORs.
    The primary purpose of this modified system is to collect and 
maintain information necessary to: (1) Process level two and level 
three appeal requests made by an appellant or appealing party; (2) 
track appeal data, including: status, type, history, timeliness, and 
decisions; and (3) respond to future correspondence related to the 
case. The information retrieved from this system of records will also 
be disclosed to: (1) Support regulatory and policy functions performed 
within the agency or by a contractor, consultant, or grantee; (2) 
another Federal agency; (3) assist Quality Improvement Organizations; 
(4) support litigation involving the agency; and (5) combat fraud, 
waste, and abuse. We have provided background information about the 
modified system in the SUPPLEMENTARY INFORMATION section below. 
Although the Privacy Act

[[Page 54490]]

requires only that CMS provide an opportunity for interested persons to 
comment on the modified or altered routine uses, CMS invites comments 
on all portions of this notice. See ``Effective Dates'' section for 
comment period.

DATES: 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 Homeland Security & Governmental 
Affairs, and the Administrator, Office of Information and Regulatory 
Affairs, Office of Management and Budget (OMB) on September 6, 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 comments to the CMS Privacy 
Officer, Division of Privacy Compliance, Enterprise Architecture and 
Strategy Group, CMS, 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: Aaron Pleines, Division of Appeals 
Operations, Medicare Enrollment and Appeals Group, Center for 
Beneficiary Choices, CMS, Mail Stop S1-05-06, 7500 Security Boulevard, 
Baltimore, Maryland 21244-1850. He can also be reached by telephone at 
410-786-2137, or via e-mail at Aaron.Pleines@cms.hhs.gov.

SUPPLEMENTARY INFORMATION: In 1987, CMS established this SOR under the 
authority of sections 205, 1155, 1156, 1869, and 1872 of the Social 
Security Act. Notice of this system, ``Medicare Hearings and Appeals 
System (MHAS) System No. 09-70-5001,'' was published at 52 FR 34846 
(September 15, 1987), an unnumbered routine use for disclosure to the 
Social Security Administration (SSA) was added at 61 FR 6645 (February 
21, 1996), an unnumbered routine use for SSA was deleted, a routine use 
for Quality Improvement Organizations and two routine uses for 
combating fraud and abuse were added at 69 FR 75323 (December 16, 
2004).

I. Description of the Modified or Altered System of Records

A. Statutory and Regulatory Basis for SOR

    Authority for maintenance of the system is given under Sec.  205 of 
Title II, Sec. Sec.  1155 and 1156 of Title XI, Sec. Sec.  1812, 1814, 
1816, 1842, 1869, and 1872 of Title XVIII of the Social Security Act 
(the Act), as amended (42 United States Code (U.S.C.) sections 405, 
1320c-4, 1320c-5, 1395d, 1395f, 1395h, 1395u, 1395ff, and 1395ii). 
Additional authority for this system is given under the Medicare 
Prescription Drug, Improvement, and Modernization Act of 2003 (Public 
Law (Pub. L.) 108-173).

B. Collection and Maintenance of Data in the System

    MAS contains information concerning Medicare beneficiaries, 
physicians, providers, practitioners, suppliers and other persons 
involved in furnishing items and services to health insurance 
beneficiaries. Information on beneficiaries includes, but is not 
limited to: name, address, social security number, health insurance 
claim number, medical services, equipment and supplies for which 
Medicare reimbursement is requested, and materials used to determine 
the amount of benefits allowable under Medicare. Information on 
appellants, physicians, and other persons include, but is not limited 
to: name, work address, work phone number, and assigned provider 
identification number, specialty, medical services for which Medicare 
reimbursement is requested, and materials used to determine amounts of 
benefits allowable under Medicare.

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 MAS 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 MAS. 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 is being collected, e.g., to collect and maintain 
information necessary to: (1) Process level two and level three appeal 
requests made by an appellant or appealing party; (2) track appeal 
data, including: status, type, history, timeliness, and decisions; and 
(3) respond to future correspondence related to the case.
    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 support agency contractor, consultant, or grantee who have 
been engaged by the agency to assist in the accomplishment of a CMS 
function relating to the purposes for this system and who need to have 
access to the records in order to assist CMS.

[[Page 54491]]

    We contemplate disclosing this 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 a 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, consultant or grantee 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 assist another Federal agency in the accomplishment of a CMS 
function relating to the purposes for this system and who need to have 
access to the records in order to support CMS.
    DOJ may require MAS data to assist them in investigating and 
prosecuting violations of the Act to which criminal penalties attach, 
or other criminal statutes as they pertain to certain programs 
authorized by the Act, and for representing the Secretary of the 
Department of Health and Human Services.
    We contemplate disclosing information under this routine use only 
in situations in which CMS may enter into a contractual or similar 
agreement with another Federal agency to assist in accomplishing CMS 
functions relating to purposes for this system.
    3. To assist Quality Improvement Organizations (QIO) in connection 
with the review of claims, or in connection with studies or other 
review activities, conducted pursuant to Part B of Title XI of the Act 
and in performing affirmative outreach activities to individuals for 
the purpose of establishing and maintaining their entitlement to 
Medicare benefits or health insurance plans.
    QIOs will work to implement quality improvement programs, provide 
consultation to CMS, its contractors, and to ensure that payment is 
only made for medically necessary services. QIOs will assist in related 
monitoring and enforcement efforts, assist CMS and intermediaries in 
program integrity assessment, investigate beneficiary complaints about 
quality of care, and prepare summary information for release to CMS.
    4. 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'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.
    5. 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, waste, 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, waste, 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.
    6. 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, 
waste, 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, waste, or abuse in such programs.
    Other agencies may require MAS information for the purpose of 
combating fraud, waste, 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 an 
individual could, because of the small size of the information 
provided, 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

[[Page 54492]]

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 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: September 1, 2006.
Charlene Frizzera,
Acting Chief Operating Officer, Centers for Medicare & Medicaid 
Services.
System No.: 09-70-0566

System Name:
    ``Medicare Appeals System (MAS),'' HHS/CMS/CBC.

Security Classification:
    Level Three Privacy Act Sensitive Data.

System Location:
    The Centers for Medicare & Medicaid Services (CMS) Data Center, 
7500 Security Boulevard, North Building, First Floor, Baltimore, 
Maryland 21244-1850. This system is also located in locations listed in 
Appendix A.

Categories of Individuals Covered by the System:
    MAS contains information concerning Medicare beneficiaries, 
physicians, providers, practitioners, suppliers and other persons 
involved in furnishing items and services to health insurance 
beneficiaries.

Categories of Records in the System:
    Information on beneficiaries includes, but is not limited to: Name, 
address, social security number (SSN), health insurance claim number 
(HICN), medical services, equipment and supplies for which Medicare 
reimbursement is requested, and materials used to determine the amount 
of benefits allowable under Medicare. Information on appellants, 
physicians, and other persons includes, but is not limited to: name, 
work address, work phone number, and assigned provider identification 
number, specialty, medical services for which Medicare reimbursement is 
requested, and materials used to determine amounts of benefits 
allowable under Medicare.

Authority For Maintenance of the System:
    Authority for maintenance of the system is given under Sec.  205 of 
Title II, Sec. Sec.  1155 and 1156 of Title XI, Sec. Sec.  1812, 1814, 
1816, 1842, 1869, and 1872 of Title XVIII of the Social Security Act 
(the Act), as amended (42 United States Code (U.S.C.) sections 405, 
1320c-4, 1320c-5, 1395d, 1395f, 1395h, 1395u, 1395ff, and 1395ii). 
Additional authority for this system is given under the Medicare 
Prescription Drug, Improvement, and Modernization Act of 2003 (Public 
Law (Pub. L.) 108-173).

Purpose(s) of the System:
    The primary purpose of this modified system is to collect and 
maintain information necessary to: (1) Process level two and level 
three appeal requests made by an appellant or appealing party; (2) 
track appeal data, including: status, type, history, timeliness, and 
decisions; and (3) respond to future correspondence related to the 
case. The information retrieved from this system of records will also 
be disclosed to: (1) Support regulatory and policy functions performed 
within the agency or by a contractor, consultant, or grantee; (2) 
another Federal agency; (3) assist Quality Improvement Organizations; 
(4) support litigation involving the agency; and (5) combat fraud, 
waste, and abuse.

Routine Uses of Records Maintained in the System, Including Categories 
of 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 support agency contractor, consultant, or grantee who have 
been engaged by the agency to assist in the accomplishment of a CMS 
function relating to the purposes for this system and who need to have 
access to the records in order to assist CMS.
    2. To assist another Federal agency in the accomplishment of a CMS 
function relating to the purposes for this system and who need to have 
access to the records in order to support CMS.
    3. To assist Quality Improvement Organizations (QIO) in connection 
with the review of claims, or in connection with studies or other 
review activities, conducted pursuant to Part B of Title XI of the Act 
and in performing affirmative outreach activities to individuals for 
the purpose of establishing and maintaining their entitlement to 
Medicare benefits or health insurance plans.
    4. 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.
    5. 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 54493]]

remedy, or otherwise combat fraud, waste, or abuse in such program.
    6. 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, 
waste, 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, waste, 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 an 
individual could, because of the small size of the information 
provided, 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 computer diskette and magnetic storage 
media.

Retrievability:
    Information can be retrieved by the name, SSN, HICN, and assigned 
provider number.

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:
    Records are maintained in a secure storage area with identifiers. 
Disposal occurs ten years after the final determination of the case is 
completed. All claims-related records are encompassed by the document 
preservation order and will be retained until notification is received 
from DOJ.

System Manager(s) and Address:
    Director, Division of Appeals Operations, Medicare Enrollment and 
Appeals Group, Center for Beneficiary Choices, CMS, Mail Stop S1-05-06, 
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, HICN, address, date of 
birth, and gender, and for verification purposes, the subject 
individual's name (woman's maiden name, if applicable), and 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 specify the 
record contents being sought. (These procedures are in accordance with 
department regulation 45 CFR 5b.5(a)(2)).

Contesting Records Procedures:
    The subject individual should contact the system manager named 
above, and reasonably identify the records and specify the information 
to be contested. In addition the individual should 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:
    Sources on information contained in this records system include 
data collected from the individual on the completed form requesting a 
Medicare hearing or appeal. In addition, information contained in this 
system may be obtained from Medicare carriers or intermediaries and 
Quality Improvement Organizations' records.

Systems Exempted from Certain Provisions of the Act:
    None.

Appendix A. Health Insurance Claims

    Medicare records are maintained at the CMS Central Office (see 
section 1 below for the address). Health Insurance Records of the 
Medicare program can also be accessed through a representative of 
the CMS Regional Office (see section 2 below for addresses). 
Medicare claims records are also maintained by private insurance 
organizations that share in administering provisions of the health 
insurance programs. These private insurance organizations, referred 
to as carriers and intermediaries, are under contract to the Centers 
for Medicare & Medicaid Services to perform specific task in the 
Medicare program (see section 3 below for addresses for 
intermediaries, section 4 for addresses for carriers, and section 5 
for addresses for the Payment Safeguard Contractors).

1. Central Office Address

    CMS Data Center, 7500 Security Boulevard, North Building, First 
Floor, Baltimore, Maryland 21244-1850.

2. CMS Regional Offices

     Boston Region--Connecticut, Maine, Massachusetts, New 
Hampshire, Rhode Island, Vermont. John F. Kennedy Federal Building, 
Room 1211, Boston, Massachusetts 02203. Office Hours: 8:30 a.m.-5 
p.m.
     New York Region--New Jersey, New York, Puerto Rico, 
Virgin Islands. 26 Federal Plaza, Room 715, New York, New York 
10007. Office Hours: 8:30 a.m.-5 p.m.
     Philadelphia Region--Delaware, District of Columbia, 
Maryland, Pennsylvania, Virginia, West Virginia. Post Office Box 
8460, Philadelphia, Pennsylvania 19101. Office Hours: 8: 30 a.m.-5 
p.m.
     Atlanta Region--Alabama, North Carolina, South 
Carolina, Florida, Georgia,

[[Page 54494]]

Kentucky, Mississippi, Tennessee. 101 Marietta Street, Suite 702, 
Atlanta, Georgia 30223. Office Hours: 8:30 a.m.-4:30 p.m.
     Chicago Region--Illinois, Indiana, Michigan, Minnesota, 
Ohio, Wisconsin. Suite A--824, Chicago, Illinois 60604. Office 
Hours: 8 a.m.-4:45 p.m.
     Dallas Region--Arkansas, Louisiana, New Mexico, 
Oklahoma, Texas. 1200 Main Tower Building, Dallas, Texas. Office 
Hours: 8 a.m.-4:30 p.m.
     Kansas Region--Iowa, Kansas, Missouri, Nebraska. New 
Federal Office Building, 601 East 12th Street--Room 436, Kansas 
City, Missouri 64106. Office Hours: 8 a.m.-4:45 p.m.
     Denver Region--Colorado, Montana, North Dakota, South 
Dakota, Utah, Wyoming. Federal Office Building, 1961 Stout St--Room 
1185, Denver, Colorado 80294. Office Hours: 8 a.m.-4:30 p.m.
     San Francisco Region--American Samoa, Arizona, 
California, Guam, Hawaii, Nevada. Federal Office Building, 10 Van 
Ness Avenue, 20th Floor, San Francisco, California 94102. Office 
Hours: 8 a.m.-4:30 p.m.
     Seattle Region--Alaska, Idaho, Oregon, Washington. 1321 
Second Avenue, Room 615, Mail Stop 211, Seattle, Washington 98101. 
Office Hours: 8 a.m.-4:30 p.m.

3. Intermediary Addresses (Hospital Insurance)

     Medicare Coordinator, Assoc. Hospital Serv. Main (ME 
BC), 2 Gannett Drive, South Portland, ME 04106-6911.
     Medicare Coordinator, Anthem New Hampshire, 300 Goffs 
Falls Road, Manchester, NH 03111-0001.
     Medicare Coordinator, BC/BS Rhode Island (RI BC), 444 
Westminster Street, Providence, RI 02903-3279.
     Medicare Coordinator, Empire Medicare Services, 400 S. 
Salina Street, Syracuse, NY 13202.
     Medicare Coordinator, Cooperativa, P.O. Box 363428, San 
Juan, PR 00936-3428.
     Medicare Coordinator, Maryland B/C, P.O. Box 4368, 1946 
Greenspring Ave., Timonium, MD 21093.
     Medicare Coordinator, Highmark, P5103, 120 Fifth Avenue 
Place, Pittsburgh, PA 15222-3099.
     Medicare Coordinator, United Government Services, 1515 
N. Rivercenter Dr., Milwaukee, WI 53212.
     Medicare Coordinator, Alabama B/C, 450 Riverchase 
Parkway East, Birmingham, AL 35298.
     Medicare Coordinator, Florida B/C, 532 Riverside Ave., 
Jacksonville, FL 32202-4918.
     Medicare Coordinator, Georgia B/C, P.O. Box 9048, 2357 
Warm Springs Road, Columbus, GA 31908.
     Medicare Coordinator, Mississippi B/C B MS, P.O. Box 
23035, 3545 Lakeland Drive, Jackson, MI 9225-3035.
     Medicare Coordinator, North Carolina B/C, P.O. Box 
2291, Durham, NC 27702-2291.
     Medicare Coordinator, Palmetto GBA A/RHHI, 17 
Technology Circle, Columbia, SC 29203-0001.
     Medicare Coordinator, Tennessee B/C, 801 Pine Street, 
Chattanooga, TN 37402-2555.
     Medicare Coordinator, Anthem Insurance Co. (Anthem IN), 
P.O. Box 50451, 8115 Knue Road, Indianapolis, IN 46250-1936.
     Medicare Coordinator, Arkansas B/C, 601 Gaines Street, 
Little Rock, AR 72203.
     Medicare Coordinator, Group Health of Oklahoma, 1215 
South Boulder, Tulsa, OK 74119-2827.
     Medicare Coordinator, Trailblazer, P.O. Box 660156, 
Dallas, TX 75266-0156.
     Medicare Coordinator, Cahaba GBA, Station 7, 636 Grand 
Avenue, Des Moines, IA 50309-2551.
     Medicare Coordinator, Kansas B/C, P.O. Box 239, 1133 
Topeka Ave., Topeka, KS 66629-0001.
     Medicare Coordinator, Nebraska B/C, P.O. Box 3248, Main 
PO Station, Omaha, NE 68180-0001.
     Medicare Coordinator, Mutual of Omaha, P.O. Box 1602, 
Omaha, NE 68101.
     Medicare Coordinator, Montana B/C, P.O. Box 5017, Great 
Falls Div., Great Falls, MT 59403-5017.
     Medicare Coordinator, Noridian, 4510 13th Avenue S.W., 
Fargo, ND 58121-0001.
     Medicare Coordinator, Utah B/C, P.O. Box 30270, 2455 
Parleys Way, Salt Lake City, UT 84130-0270.
     Medicare Coordinator, Wyoming B/C, 4000 House Avenue, 
Cheyenne, WY 82003.
     Medicare Coordinator, Arizona B/C, P.O. Box 37700, 
Phoenix, AZ 85069.
     Medicare Coordinator, UGS, P.O. Box 70000, Van Nuys, CA 
91470-0000.
     Medicare Coordinator, Regents BC, P.O. Box 8110 M/S D-
4A, Portland, OR 97207-8110.
     Medicare Coordinator, Premera BC, P.O. Box 2847, 
Seattle, WA 98111-2847.

4. Medicare Carriers

     Medicare Coordinator, NHIC, 75 Sargent William Terry 
Drive, Hingham, MA 02044.
     Medicare Coordinator, B/S Rhode Island (RI BS), 444 
Westminster Street, Providence, RI 02903-2790.
     Medicare Coordinator, Trailblazer Health Enterprises, 
Meriden Park, 538 Preston Ave., Meriden, CT 06450.
     Medicare Coordinator, Upstate Medicare Division, 11 
Lewis Road, Binghamton, NY 13902.
     Medicare Coordinator, Empire Medicare Services, 2651 
Strang Blvd., Yorktown Heights, NY 10598.
     Medicare Coordinator, Empire Medicare Services, NJ, 300 
East Park Drive, Harrisburg, PA 17106.
     Medicare Coordinator, Triple S, 1441 F.D., 
Roosevelt Ave., Guaynabo, PR 00968.
     Medicare Coordinator, Group Health Inc., 4th Floor, 88 
west End Avenue, New York, NY 10023.
     Medicare Coordinator, Highmark, P.O. Box 89065, 1800 
Center Street, Camp Hill, PA 17089-9065.
     Medicare Coordinator, Trailblazers Part B, 11150 
McCormick Drive, Executive Plaza 3 Suite 200, Hunt Valley, MD 21031.
     Medicare Coordinator, Trailblazer Health Enterprises, 
Virginia, P.O. Box 26463, Richmond, VA 23261-6463. United Medicare 
Coordinator, Tricenturion, 1 Tower Square, Hartford, CT 06183.
     Medicare Coordinator, Alabama B/S, 450 Riverchase 
Parkway East, Birmingham, AL 35298.
     Medicare Coordinator, Cahaba GBA, 12052 Middleground 
Road, Suite A, Savannah, GA 31419.
     Medicare Coordinator, Florida B/S, 532 Riverside Ave., 
Jacksonville, FL 32202-4918.
     Medicare Coordinator, Administar Federal, 9901 
Linnstation Road, Louisville, KY 40223.
     Medicare Coordinator, Palmetto GBA, 17 Technology 
Circle, Columbia, SC 29203-0001.
     Medicare Coordinator, CIGNA, 2 Vantage Way, Nashville, 
TN 37228.
     Medicare Coordinator, Railroad Retirement Board, 2743 
Perimeter Parkway, Building 250, Augusta, GA 30999.
     Medicare Coordinator, Cahaba GBA, Jackson Miss., P.O. 
Box 22545, Jackson, MI 39225-2545.
     Medicare Coordinator, Administar Federal (IN), 8115 
Knue Road, Indianapolis, IN 46250-1936.
     Medicare Coordinator, Wisconsin Physicians Service, 
P.O. Box 8190, Madison, WI 53708-8190.
     Medicare Coordinator, Nationwide Mutual Insurance Co., 
P.O. Box 16788, 1 Nationwise Plaza, Columbus, OH 3216-6788.
     Medicare Coordinator, Arkansas B/S, 601 Gaines Street, 
Little Rock, AR 72203.
     Medicare Coordinator, Arkansas-New Mexico, 601 Gaines 
Street, Little Rock, AR 72203.
     Medicare Coordinator, Palmetto GBA--DMERC, 17 
Technology Circle, Columbia SC 29203-0001.
     Medicare Coordinator, Trailblazer Health Enterprises, 
901 South Central Expressway, Richardson, TX 75080.
     Medicare Coordinator, Nordian, 636 Grand Avenue, Des 
Moines, IA 50309-2551.
     Medicare Coordinator, Kansas B/S, P.O. Box 239, 1133 
Topeka Ave., Topeka, KS 66629.
     Medicare Coordinator, Kansas B/S--NE, P.O. Box 239, 
1133 Topeka Ave., Topeka, KS 66629.
     Medicare Coordinator, Montana B/S, P.O. Box 4309, 
Helena, MT 59601.
     Medicare Coordinator, Nordian, 4305 13th Avenue South, 
Fargo, ND 58103-3373.
     Medicare Coordinator, Noridian BCBSND (CO), 730 N. 
Simms 100, Golden, CO 80401-4730.
     Medicare Coordinator, Noridian BCBSND (WY), 4305 13th 
Avenue South, Fargo, ND 58103-3373.
     Medicare Coordinator, Utah B/S, P.O. Box 30270, 2455 
Parleys Way, Salt Lake City, UT 84130-0270.
     Medicare Coordinator, Transamerica Occidental, P.O. Box 
54905, Los Angeles, CA 90054-4905.
     Medicare Coordinator, NHIC--California, 450 W. East 
Avenue, Chico, CO 95926.
     Medicare Coordinator, Cigna, Suite 254, 3150 
Lakeharbor, Boise, ID 83703.
     Medicare Coordinator, Cigna, Suite 506, 2 Vantage Way, 
Nashville, TN 37228.

[[Page 54495]]

5. Payment Safeguard Contractors

     Medicare Coordinator, Aspen Systems Corporation, 2277 
Research Blvd., Rockville, MD 20850.
     Medicare Coordinator, DynCorp Electronic Data Systems 
(EDS), 11710 Plaza America Drive 5400 Legacy Drive, Reston, VA 
20190-6017.
     Medicare Coordinator, Lifecare management Partners 
Mutual of Omaha Insurance Co., 6601 Little Rive Turnpike, Suite 300 
Mutual of Omaha Plaza, Omaha, NE 68175.
     Medicare Coordinator, Reliance Safeguard Solutions, 
Inc., P.O. Box 30207 400 South Salina Street, 2890 East Cottonwood 
Parkway, Syracuse, NY 13202.
     Medicare Coordinator, Science Applications 
International Inc., 6565 Arlington Blvd. P.O. Box 100282, Falls 
Church, VA.
     Medicare Coordinator, California Medical Review, Inc., 
Integriguard Division Federal Sector Civil Group One Sansome Street, 
San Francisco, CA 94104-4448.
     Medicare Coordinator, Computer Sciences Corporation 
Suite 600 3120 Timanus Lane, Baltimore, MD 21244.
     Medicare Coordinator, Electronic Data System (EDS), 
11710 Plaza American Drive, 5400 Legacy Drive, Plano, TX 75204.
     Medicare Coordinator, TriCenturion, L.L.C., P.O. Box 
100282, Columbia, SC 29202.

6. Qualified Independent Contractors

     Medicare Contractor, Maximus Federal Services, Inc., 
1040 First Avenue, Suite 400, King of Prussia, PA 19406.
     Medicare Contractor, Maximus Federal Services, Inc., 50 
Square Drive, Victor, NY 19406.
     Medicare Contractor, Q2 Administrators, 17 
Technology Circle, Columbia, SC 29203.
     Medicare Contractor, Q2 Administrators, 5150 
East Dublin-Granville Road, Suite 200, Westerville, OH 43081.
     Medicare Contractor, First Coast Service Options, 532 
Riverside Avenue, Jacksonville, FL 32202.

[FR Doc. E6-15128 Filed 9-14-06; 8:45 am]
BILLING CODE 4120-03-P