Privacy Act of 1974; Report of a Modified or Altered System, 60536-60540 [E6-16954]
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60536
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NOTIFICATION PROCEDURE:
For purposes of access, the subject
individual should write to the system
manager who will require the system
name, parking permit number, and for
verification purposes, the subject
individual’s name (woman’s maiden
name, if applicable) and Social Security
number (SSN). Furnishing the SSN is
voluntary, but it may make searching for
a record easier and prevent delay.
RECORD ACCESS PROCEDURE:
For purposes of access, use the same
procedures outlined in Notification
Procedures above. Requestors should
also reasonably specify the record
contents being sought. (These
procedures are in accordance with
Department regulation 45 CFR
5b.5(a)(2)).
CONTESTING RECORD PROCEDURES:
The subject individual should contact
the system manager named above, and
reasonably identify the record and
specify the information to be contested.
State the corrective action sought and
the reasons for the correction with
supporting justification. (These
procedures are in accordance with
Department regulation 45 CFR 5b.7).
RECORD SOURCE CATEGORIES:
Sources of information contained in
this system are received from the
individual requesting parking privileges
on CMS Form 182.
SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS
OF THE ACT:
None.
[FR Doc. E6–16951 Filed 10–12–06; 8:45 am]
BILLING CODE 4120–03–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
Privacy Act of 1974; Report of a
Modified or Altered System
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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AGENCY:
SUMMARY: In accordance with the
requirements of the Privacy Act of 1974,
we are proposing to modify or alter an
existing system of records titled,
‘‘Provider Enrollment, Chain, and
Ownership System (PECOS),’’ System
No. 09–70–0532, established at 66
Federal Register 51961 (October 11,
2001). PECOS will collect information
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provided by the applicant related to
identity, qualifications, practice
locations, ownership, billing agency
information, reassignment of benefits,
electronic funds transfer, the national
provider identifier (NPI), and related
organizations. PECOS will also maintain
information on business owners, chain
home offices and provider/chain
associations, managing/directing
employees, partners, authorized and
delegated representatives, supervising
physicians of the supplier, staffing
companies, ambulance vehicle
information, and/or interpreting
physicians and related technicians.
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 require 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 will delete
routine use number 3 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 propose to add a routine use to
assist an individual or organization for
research, evaluation or epidemiological
projects related to the prevention of
disease or disability, or the restoration
or maintenance of health, and for
payment related projects. The proposed
routine use will be numbered as routine
use number 3. We will 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 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 individualspecific information contained in this
system. The routine uses will then be
prioritized and reordered according to
their usage. We will also take the
opportunity to update any sections of
the system that were affected by the
recent reorganization or because of the
impact of the Medicare Prescription
Drug, Improvement, and Modernization
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Act of 2003 (MMA) (Public Law 108–
173) provisions and to update language
in the administrative sections to
correspond with language used in other
CMS SORs.
The primary purpose of the SOR is to:
(1) Collect information for an applying
provider/supplier and record the
associations between the applicant and
those who have an ownership or control
interest in the entity; (2) permit
informed enrollment decisions to be
made based on past and present
business history, any reported
exclusions, sanctions and felonious
behavior at their location or in multiple
contractor jurisdictions; and, (3) ensure
that correct payments are made under
the Medicare program. Information
retrieved from this SOR will also be
disclosed to: (1) Support regulatory,
reimbursement, and policy functions
performed within the Agency or by a
contractor, consultant, or CMS grantee;
(2) assist another Federal or state
agency, agency of a state government, an
agency established by state law, or its
fiscal agent; (3) assist an individual or
organization for research, evaluation, or
epidemiological projects; (5) support
litigation involving the Agency; and (5)
combat fraud, waste, and abuse in
certain health benefits programs. We
have provided background information
about the modified 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 routine uses, CMS
invites comments on all portions of this
notice. See EFFECTIVE DATES section for
comment period.
DATES: Effective Dates: CMS filed a
modified or altered system 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 October 5, 2006. To ensure
that all parties have adequate time in
which to comment, the modified
system, including routine uses, will
become effective 30 days from the
publication of the notice, or 40 days
from the date it was submitted to OMB
and Congress, whichever is later, unless
CMS receives comments that require
alterations to this notice.
ADDRESSES: The public should address
comments to: CMS Privacy Officer,
Division of Privacy Compliance,
Enterprise Architecture and Strategy
Group, Office of Information Services,
CMS, Room N2–04–27, 7500 Security
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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 zone.
FOR FURTHER INFORMATION CONTACT:
Alisha Banks, Health Insurance
Specialist, Division of Provider/
Supplier Enrollment, Program Integrity
Group, Office of Financial Management,
CMS, C3–02–16, 7500 Security
Boulevard, Baltimore, Maryland 21244–
1850. Ms. Banks can be reached by
telephone at 410–786–0671, or by e-mail
at alisha.banks@cms.hhs.gov.
SUPPLEMENTARY INFORMATION:
I. Description of the Modified or
Altered System of Records
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A. Statutory and Regulatory Basis for
System
The Authority for maintenance of the
system is given under provisions of
sections 1102(a) (Title 42 U.S.C.
1302(a)), 1128 (42 U.S.C. 1320a–7),
1814(a)) (42 U.S.C. 1395f(a)(1), 1815(a)
(42 U.S.C. 1395g(a)), 1833(e) (42 U.S.C.
1395I(3)), 1871 (42 U.S.C. 1395hh), and
1886(d)(5)(F), (42 U.S.C.
1395ww(d)(5)(F) of the Social Security
Act; 1842(r) (42 U.S.C. 1395u(r)); section
1124(a)(1) (42 U.S.C. 1320a–3(a)(1), and
1124A (42 U.S.C. 1320a–3a), section
4313, as amended, of the BBA of 1997;
and section 31001(i) (31 U.S.C. 7701) of
the DCIA (Pub. L. 104–134), as
amended.
B. Collection and Maintenance of Data
in the System
PECOS will collect information
provided by an applicant related to
identity, qualifications, practice
locations, ownership, billing agency
information, reassignment of benefits,
electronic funds transfer, the NPI and
related organizations. PECOS will also
maintain information on business
owners, chain home offices and
provider/chain associations, managing/
directing employees, partners,
authorized and delegated officials,
supervising physicians of the supplier,
staffing companies, ambulance vehicle
information, and/or interpreting
physicians and related technicians.
This system of records will contain
the names, social security numbers
(SSN), date of birth (DOB), and
employer identification numbers (EIN)
and NPI’s for each disclosing entity,
owners, as well as managing/directing
employees, with 5 percent or more
ownership or control interest.
Managing/directing employees include
general manager, business managers,
administrators, directors, and other
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individuals who exercise operational or
managerial control over the provider/
supplier. The system will also contain
Medicare identification numbers (i.e.,
UPIN, OSCAR, PIN and the NPI),
demographic data, professional data,
past and present business history as
well as information regarding any
adverse actions such as exclusions,
sanctions, and felonious behavior.
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 PECOS 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 PECOS. 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 information for an applying
provider/supplier and record the
associations between the applicant and
those who have an ownership or control
interest in the entity.
2. Determines:
a. That the purpose for which the
disclosure is to be made can only be
accomplished if the record is provided
in individually identifiable form;
b. That the purpose for which the
disclosure is to be made is of sufficient
importance to warrant the potential
effect and/or risk on the privacy of the
individual that additional exposure of
the record might bring; and
c. That 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; and
b. Remove or destroy at the earliest
time all patient-identifiable information.
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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 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 assist another Federal or state
agency, agency of a state government, an
agency established by state law, or its
fiscal agent to:
a. Contribute to the accuracy of CMS’s
proper payment of Medicare benefits,
b. Enable such agency to administer a
Federal health benefits program, or as
necessary to enable such agency to
fulfill a requirement of a Federal statute
or regulation that implements a health
benefits program funded in whole or in
part with federal funds, and/or
c. Evaluate and monitor the quality of
home health care and contribute to the
accuracy of health insurance operations.
Other Federal or state agencies in
their administration of a Federal health
program may require PECOS
information in order to support
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evaluations and monitoring of
reimbursement for services provided.
3. To assist an individual or
organization for research, evaluation or
epidemiological projects related to the
prevention of disease or disability, or
the restoration or maintenance of health,
and for payment related projects.
The collected data will provide the
research, evaluation and
epidemiological projects a broader,
longitudinal, national perspective of the
data. CMS anticipates that many
researchers will have legitimate requests
to use these data in projects that could
ultimately improve the care provided to
Medicare patients and the policy that
governs the care. CMS understands the
concerns about the privacy and
confidentiality of the release of data for
a research use. Disclosure of data for
research and evaluation purposes may
involve aggregate data rather than
individual-specific data.
4. To support 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 assist 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,
waste, or abuse in such program.
We contemplate disclosing
information under this routine use only
in situations in which CMS may enter
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into a contractual relationship or grant
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 and makes grants
when doing so would contribute to
effective and efficient operations. CMS
must be able to give a contractor or
grantee whatever information is
necessary for the contractor or grantee to
fulfill its duties. In these situations,
safeguards are provided in the contract
prohibiting the contractor or grantee
from using or disclosing the information
for any purpose other than that
described in the contract and requiring
the contractor or grantee to return or
destroy all information.
6. To assist 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 PECOS
information for the purpose of
combating fraud, waste, and abuse in
such Federally funded programs.
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;
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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 Modified System of
Records on Individual Rights
CMS proposes to modify this system
in accordance with the principles and
requirements of the Privacy Act and will
collect, use, and disseminate
information only as prescribed therein.
Data in this system will be subject to the
authorized releases in accordance with
the routine uses identified in this
system of records.
CMS will take precautionary
measures (see item IV above) to
minimize the risks of unauthorized
access to the records and the potential
harm to individual privacy or other
personal or property rights of patients
whose data are maintained in the
system. CMS will collect only that
information necessary to perform the
system’s functions. In addition, CMS
will make disclosure from the proposed
system only with consent of the subject
individual, or his/her legal
representative, or in accordance with an
applicable exception provision of the
Privacy Act. CMS, therefore, does not
anticipate an unfavorable effect on
individual privacy as a result of
information relating to individuals.
Dated: October 4, 2006.
Charlene Frizzera,
Acting Chief Operating Officer, Centers for
Medicare & Medicaid Services.
System No. 09–70–0532
SYSTEM NAME:
‘‘Provider Enrollment, Chain, and
Ownership System (PECOS), HHS/CMS/
OFM’’
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–
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1850 and South Building, Baltimore,
Maryland 21244–1850.
CATEGORIES OF INDIVIDUALS COVERED BY THE
SYSTEM:
PECOS will collect information
provided by an applicant related to
identity, qualifications, practice
locations, ownership, billing agency
information, reassignment of benefits,
electronic funds transfer, the national
provider identifier (NPI) and related
organizations. PECOS will also maintain
information on business owners, chain
home offices and provider/chain
associations, managing/directing
employees, partners, authorized and
delegated officials, supervising
physicians of the supplier, staffing
companies, ambulance vehicle
information, and/or interpreting
physicians and related technicians.
CATEGORIES OF RECORDS IN THE SYSTEM:
This system of records will contain
the names, social security numbers
(SSN), date of birth (DOB), and
employer identification numbers (EIN)
and NPI’s for each disclosing entity,
owners, as well as managing/directing
employees, with 5 percent or more
ownership or control interest.
Managing/directing employees include
general manager, business managers,
administrators, directors, and other
individuals who exercise operational or
managerial control over the provider/
supplier. The system will also contain
Medicare identification numbers (i.e.,
UPIN, OSCAR, PIN and the NPI),
demographic data, professional data,
past and present business history as
well as information regarding any
adverse actions such as exclusions,
sanctions, and felonious behavior.
AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
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The Authority for maintenance of the
system is given under provisions of
sections 1102(a) (Title 42 U.S.C.
1302(a)), 1128 (42 U.S.C. 1320a–7),
1814(a)) (42 U.S.C. 1395f(a)(1), 1815(a)
(42 U.S.C. 1395g(a)), 1833(e) (42 U.S.C.
1395I(3)), 1871 (42 U.S.C. 1395hh), and
1886(d)(5)(F), (42 U.S.C.
1395ww(d)(5)(F) of the Social Security
Act; 1842(r) (42 U.S.C. 1395u(r)); section
1124(a)(1) (42 U.S.C. 1320a–3(a)(1), and
1124A (42 U.S.C. 1320a–3a), section
4313, as amended, of the BBA of 1997;
and section 31001(i) (31 U.S.C. 7701) of
the DCIA (Pub. L. 104–134), as
amended.
PURPOSE(S) OF THE SYSTEM:
The primary purpose of the SOR is to:
(1) Collect information for an applying
provider/supplier and record the
associations between the applicant and
those who have an ownership or control
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interest in the entity; (2) permit
informed enrollment decisions to be
made based on past and present
business history, any reported
exclusions, sanctions and felonious
behavior at their location or in multiple
contractor jurisdictions; and, (3) ensure
that correct payments are made under
the Medicare program. Information
retrieved from this SOR will also be
disclosed to: (1) Support regulatory,
reimbursement, and policy functions
performed within the Agency or by a
contractor, consultant, or CMS grantee;
(2) assist another Federal or state
agency, agency of a state government, an
agency established by state law, or its
fiscal agent; (3) assist an individual or
organization for research, evaluation, or
epidemiological projects; (5) support
litigation involving the Agency; and (5)
combat fraud, waste, and abuse in
certain health benefits programs.
ROUTINE USES OF RECORDS MAINTAINED IN THE
SYSTEM, INCLUDING CATEGORIES OR USERS AND
THE PURPOSES OF SUCH USES:
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 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 assist another Federal or state
agency, agency of a state government, an
agency established by state law, or its
fiscal agent to:
a. Contribute to the accuracy of CMS’s
proper payment of Medicare benefits,
b. Enable such agency to administer a
Federal health benefits program, or as
necessary to enable such agency to
fulfill a requirement of a Federal statute
or regulation that implements a health
benefits program funded in whole or in
part with federal funds, and/or
c. Evaluate and monitor the quality of
home health care and contribute to the
accuracy of health insurance operations.
3. To assist an individual or
organization for research, evaluation or
epidemiological projects related to the
prevention of disease or disability, or
the restoration or maintenance of health,
and for payment related projects.
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60539
4. To support 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 assist 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,
waste, or abuse in such program.
6. To assist 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.
POLICIES AND PRACTICES FOR STORING,
RETRIEVING, ACCESSING, RETAINING, AND
DISPOSING OF RECORDS IN THE SYSTEM:
STORAGE:
All records are stored on paper and
magnetic disk.
RETRIEVABILITY:
Magnetic media records are retrieved
by the name of the employees or other
authorized individual and/or card key
number. Paper records are retrieved
alphabetically by name.
SAFEGUARDS:
CMS has safeguards in place for
authorized users and monitors such
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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.
RETENTION AND DISPOSAL:
CMS will retain identifiable data for
a total period of 15 years from the date
the information was collected.
SYSTEM MANAGERS AND ADDRESS:
Director, Division of Provider/
Supplier Enrollment, Office of Financial
Management, CMS, 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, SSN, EIN, and for verification
purposes, the subject individual’s name
(woman’s maiden name, if applicable).
ycherry on PROD1PC64 with NOTICES2
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
VerDate Aug<31>2005
15:21 Oct 12, 2006
Jkt 211001
Department regulation 45 CFR
5b.5(a)(2).)
CONTESTING RECORD PROCEDURES:
The subject individual should contact
the system manager named above, and
reasonably identify the record and
specify the information to be contested.
State the corrective action sought and
the reasons for the correction with
supporting justification. (These
procedures are in accordance with
Department regulation 45 CFR 5b.7.)
RECORD SOURCE CATEGORIES:
Information contained in this system
is received from the Form(s) CMS 855A,
‘‘Medicare Enrollment Application for
Institutional Providers,’’ CMS 855B,
‘‘Medicare Enrollment Application for
Clinic/Group Practices and Certain
Other Providers,’’ CMS 855I, ‘‘Medicare
Enrollment Application for Physician
and Non-Physician Practitioners,’’ CMS
855R, ‘‘Medicare Enrollment
Application for Reassignment of
Medicare Benefits,’’ and CMS 855S,
‘‘Medicare Enrollment Application for
Durable Medial Equipment, Prosthetics,
Orthotics, and Supplies (DMEPOS).’’
SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS
OF THE ACT:
None.
[FR Doc. E6–16954 Filed 10–12–06; 8:45 am]
BILLING CODE 4120–03–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
Privacy Act of 1974; Report of a
Modified or Altered System of Records
Department of Health and
Human Services (HHS), Centers for
Medicare & Medicaid Services (CMS).
ACTION: Notice of a Modified or Altered
System of Records (SOR).
AGENCY:
SUMMARY: In accordance with the
Privacy Act of 1974, we are proposing
to modify or alter an existing SOR,
‘‘Evaluations of the Medicaid Reform
Demonstrations (EMRD),’’ System No.
09–70–0068, last published at 67
Federal Register 2216 (January 16,
2002). 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
PO 00000
Frm 00080
Fmt 4703
Sfmt 4703
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.
09–70–0523.
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 require CMS
data to carry out that activity, are
classified separate from CMS contractor
and/or consultants. The modified
routine use will remain as routine use
number 1.
We propose to combine routine uses
2 and 3 to 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. As they were duplicative of each
other.
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 will broaden the scope of routine
uses number 6 and 7, 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 are modifying the language in the
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 individualspecific information contained in this
system. The routine uses will then be
prioritized and reordered according to
their usage. We will also take the
opportunity to update any sections of
the system that were affected by the
recent reorganization 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 provide data
E:\FR\FM\13OCN1.SGM
13OCN1
Agencies
[Federal Register Volume 71, Number 198 (Friday, October 13, 2006)]
[Notices]
[Pages 60536-60540]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E6-16954]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
Privacy Act of 1974; Report of a Modified or Altered System
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).
-----------------------------------------------------------------------
SUMMARY: In accordance with the requirements of the Privacy Act of
1974, we are proposing to modify or alter an existing system of records
titled, ``Provider Enrollment, Chain, and Ownership System (PECOS),''
System No. 09-70-0532, established at 66 Federal Register 51961
(October 11, 2001). PECOS will collect information provided by the
applicant related to identity, qualifications, practice locations,
ownership, billing agency information, reassignment of benefits,
electronic funds transfer, the national provider identifier (NPI), and
related organizations. PECOS will also maintain information on business
owners, chain home offices and provider/chain associations, managing/
directing employees, partners, authorized and delegated
representatives, supervising physicians of the supplier, staffing
companies, ambulance vehicle information, and/or interpreting
physicians and related technicians.
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 require 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 will delete routine use number 3 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 propose to add a routine use to assist an individual or
organization for research, evaluation or epidemiological projects
related to the prevention of disease or disability, or the restoration
or maintenance of health, and for payment related projects. The
proposed routine use will be numbered as routine use number 3. We will
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 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. The routine uses will then be
prioritized and reordered according to their usage. We will also take
the opportunity to update any sections of the system that were affected
by the recent reorganization or because of the impact of the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003 (MMA)
(Public Law 108-173) provisions and to update language in the
administrative sections to correspond with language used in other CMS
SORs.
The primary purpose of the SOR is to: (1) Collect information for
an applying provider/supplier and record the associations between the
applicant and those who have an ownership or control interest in the
entity; (2) permit informed enrollment decisions to be made based on
past and present business history, any reported exclusions, sanctions
and felonious behavior at their location or in multiple contractor
jurisdictions; and, (3) ensure that correct payments are made under the
Medicare program. Information retrieved from this SOR will also be
disclosed to: (1) Support regulatory, reimbursement, and policy
functions performed within the Agency or by a contractor, consultant,
or CMS grantee; (2) assist another Federal or state agency, agency of a
state government, an agency established by state law, or its fiscal
agent; (3) assist an individual or organization for research,
evaluation, or epidemiological projects; (5) support litigation
involving the Agency; and (5) combat fraud, waste, and abuse in certain
health benefits programs. We have provided background information about
the modified 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 routine uses, CMS invites
comments on all portions of this notice. See Effective Dates section
for comment period.
DATES: Effective Dates: CMS filed a modified or altered system 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 October 5,
2006. To ensure that all parties have adequate time in which to
comment, the modified system, including routine uses, will become
effective 30 days from the publication of the notice, or 40 days from
the date it was submitted to OMB and Congress, whichever is later,
unless CMS receives comments that require alterations to this notice.
ADDRESSES: The public should address comments to: CMS Privacy Officer,
Division of Privacy Compliance, Enterprise Architecture and Strategy
Group, Office of Information Services, CMS, Room N2-04-27, 7500
Security
[[Page 60537]]
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
zone.
FOR FURTHER INFORMATION CONTACT: Alisha Banks, Health Insurance
Specialist, Division of Provider/Supplier Enrollment, Program Integrity
Group, Office of Financial Management, CMS, C3-02-16, 7500 Security
Boulevard, Baltimore, Maryland 21244-1850. Ms. Banks can be reached by
telephone at 410-786-0671, or by e-mail at alisha.banks@cms.hhs.gov.
SUPPLEMENTARY INFORMATION:
I. Description of the Modified or Altered System of Records
A. Statutory and Regulatory Basis for System
The Authority for maintenance of the system is given under
provisions of sections 1102(a) (Title 42 U.S.C. 1302(a)), 1128 (42
U.S.C. 1320a-7), 1814(a)) (42 U.S.C. 1395f(a)(1), 1815(a) (42 U.S.C.
1395g(a)), 1833(e) (42 U.S.C. 1395I(3)), 1871 (42 U.S.C. 1395hh), and
1886(d)(5)(F), (42 U.S.C. 1395ww(d)(5)(F) of the Social Security Act;
1842(r) (42 U.S.C. 1395u(r)); section 1124(a)(1) (42 U.S.C. 1320a-
3(a)(1), and 1124A (42 U.S.C. 1320a-3a), section 4313, as amended, of
the BBA of 1997; and section 31001(i) (31 U.S.C. 7701) of the DCIA
(Pub. L. 104-134), as amended.
B. Collection and Maintenance of Data in the System
PECOS will collect information provided by an applicant related to
identity, qualifications, practice locations, ownership, billing agency
information, reassignment of benefits, electronic funds transfer, the
NPI and related organizations. PECOS will also maintain information on
business owners, chain home offices and provider/chain associations,
managing/directing employees, partners, authorized and delegated
officials, supervising physicians of the supplier, staffing companies,
ambulance vehicle information, and/or interpreting physicians and
related technicians.
This system of records will contain the names, social security
numbers (SSN), date of birth (DOB), and employer identification numbers
(EIN) and NPI's for each disclosing entity, owners, as well as
managing/directing employees, with 5 percent or more ownership or
control interest. Managing/directing employees include general manager,
business managers, administrators, directors, and other individuals who
exercise operational or managerial control over the provider/supplier.
The system will also contain Medicare identification numbers (i.e.,
UPIN, OSCAR, PIN and the NPI), demographic data, professional data,
past and present business history as well as information regarding any
adverse actions such as exclusions, sanctions, and felonious behavior.
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 PECOS 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 PECOS. 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 information
for an applying provider/supplier and record the associations between
the applicant and those who have an ownership or control interest in
the entity.
2. Determines:
a. That the purpose for which the disclosure is to be made can only
be accomplished if the record is provided in individually identifiable
form;
b. That the purpose for which the disclosure is to be made is of
sufficient importance to warrant the potential effect and/or risk on
the privacy of the individual that additional exposure of the record
might bring; and
c. That 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; and
b. Remove or destroy at the earliest time all patient-identifiable
information.
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 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 assist another Federal or state agency, agency of a state
government, an agency established by state law, or its fiscal agent to:
a. Contribute to the accuracy of CMS's proper payment of Medicare
benefits,
b. Enable such agency to administer a Federal health benefits
program, or as necessary to enable such agency to fulfill a requirement
of a Federal statute or regulation that implements a health benefits
program funded in whole or in part with federal funds, and/or
c. Evaluate and monitor the quality of home health care and
contribute to the accuracy of health insurance operations.
Other Federal or state agencies in their administration of a
Federal health program may require PECOS information in order to
support
[[Page 60538]]
evaluations and monitoring of reimbursement for services provided.
3. To assist an individual or organization for research, evaluation
or epidemiological projects related to the prevention of disease or
disability, or the restoration or maintenance of health, and for
payment related projects.
The collected data will provide the research, evaluation and
epidemiological projects a broader, longitudinal, national perspective
of the data. CMS anticipates that many researchers will have legitimate
requests to use these data in projects that could ultimately improve
the care provided to Medicare patients and the policy that governs the
care. CMS understands the concerns about the privacy and
confidentiality of the release of data for a research use. Disclosure
of data for research and evaluation purposes may involve aggregate data
rather than individual-specific data.
4. To support 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 assist 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 relationship or
grant 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 and makes
grants when doing so would contribute to effective and efficient
operations. CMS must be able to give a contractor or grantee whatever
information is necessary for the contractor or grantee to fulfill its
duties. In these situations, safeguards are provided in the contract
prohibiting the contractor or grantee from using or disclosing the
information for any purpose other than that described in the contract
and requiring the contractor or grantee to return or destroy all
information.
6. To assist 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 PECOS information for the purpose of
combating fraud, waste, and abuse in such Federally funded programs.
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 Modified System of Records on Individual Rights
CMS proposes to modify this system in accordance with the
principles and requirements of the Privacy Act and will collect, use,
and disseminate information only as prescribed therein. Data in this
system will be subject to the authorized releases in accordance with
the routine uses identified in this system of records.
CMS will take precautionary measures (see item IV above) to
minimize the risks of unauthorized access to the records and the
potential harm to individual privacy or other personal or property
rights of patients whose data are maintained in the system. CMS will
collect only that information necessary to perform the system's
functions. In addition, CMS will make disclosure from the proposed
system only with consent of the subject individual, or his/her legal
representative, or in accordance with an applicable exception provision
of the Privacy Act. CMS, therefore, does not anticipate an unfavorable
effect on individual privacy as a result of information relating to
individuals.
Dated: October 4, 2006.
Charlene Frizzera,
Acting Chief Operating Officer, Centers for Medicare & Medicaid
Services.
System No. 09-70-0532
SYSTEM NAME:
``Provider Enrollment, Chain, and Ownership System (PECOS), HHS/
CMS/OFM''
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-
[[Page 60539]]
1850 and South Building, Baltimore, Maryland 21244-1850.
CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:
PECOS will collect information provided by an applicant related to
identity, qualifications, practice locations, ownership, billing agency
information, reassignment of benefits, electronic funds transfer, the
national provider identifier (NPI) and related organizations. PECOS
will also maintain information on business owners, chain home offices
and provider/chain associations, managing/directing employees,
partners, authorized and delegated officials, supervising physicians of
the supplier, staffing companies, ambulance vehicle information, and/or
interpreting physicians and related technicians.
CATEGORIES OF RECORDS IN THE SYSTEM:
This system of records will contain the names, social security
numbers (SSN), date of birth (DOB), and employer identification numbers
(EIN) and NPI's for each disclosing entity, owners, as well as
managing/directing employees, with 5 percent or more ownership or
control interest. Managing/directing employees include general manager,
business managers, administrators, directors, and other individuals who
exercise operational or managerial control over the provider/supplier.
The system will also contain Medicare identification numbers (i.e.,
UPIN, OSCAR, PIN and the NPI), demographic data, professional data,
past and present business history as well as information regarding any
adverse actions such as exclusions, sanctions, and felonious behavior.
AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
The Authority for maintenance of the system is given under
provisions of sections 1102(a) (Title 42 U.S.C. 1302(a)), 1128 (42
U.S.C. 1320a-7), 1814(a)) (42 U.S.C. 1395f(a)(1), 1815(a) (42 U.S.C.
1395g(a)), 1833(e) (42 U.S.C. 1395I(3)), 1871 (42 U.S.C. 1395hh), and
1886(d)(5)(F), (42 U.S.C. 1395ww(d)(5)(F) of the Social Security Act;
1842(r) (42 U.S.C. 1395u(r)); section 1124(a)(1) (42 U.S.C. 1320a-
3(a)(1), and 1124A (42 U.S.C. 1320a-3a), section 4313, as amended, of
the BBA of 1997; and section 31001(i) (31 U.S.C. 7701) of the DCIA
(Pub. L. 104-134), as amended.
PURPOSE(S) OF THE SYSTEM:
The primary purpose of the SOR is to: (1) Collect information for
an applying provider/supplier and record the associations between the
applicant and those who have an ownership or control interest in the
entity; (2) permit informed enrollment decisions to be made based on
past and present business history, any reported exclusions, sanctions
and felonious behavior at their location or in multiple contractor
jurisdictions; and, (3) ensure that correct payments are made under the
Medicare program. Information retrieved from this SOR will also be
disclosed to: (1) Support regulatory, reimbursement, and policy
functions performed within the Agency or by a contractor, consultant,
or CMS grantee; (2) assist another Federal or state agency, agency of a
state government, an agency established by state law, or its fiscal
agent; (3) assist an individual or organization for research,
evaluation, or epidemiological projects; (5) support litigation
involving the Agency; and (5) combat fraud, waste, and abuse in certain
health benefits programs.
ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM, INCLUDING CATEGORIES
OR USERS AND THE PURPOSES OF SUCH USES:
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 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 assist another Federal or state agency, agency of a state
government, an agency established by state law, or its fiscal agent to:
a. Contribute to the accuracy of CMS's proper payment of Medicare
benefits,
b. Enable such agency to administer a Federal health benefits
program, or as necessary to enable such agency to fulfill a requirement
of a Federal statute or regulation that implements a health benefits
program funded in whole or in part with federal funds, and/or
c. Evaluate and monitor the quality of home health care and
contribute to the accuracy of health insurance operations.
3. To assist an individual or organization for research, evaluation
or epidemiological projects related to the prevention of disease or
disability, or the restoration or maintenance of health, and for
payment related projects.
4. To support 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 assist 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.
6. To assist 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.
POLICIES AND PRACTICES FOR STORING, RETRIEVING, ACCESSING, RETAINING,
AND DISPOSING OF RECORDS IN THE SYSTEM:
STORAGE:
All records are stored on paper and magnetic disk.
RETRIEVABILITY:
Magnetic media records are retrieved by the name of the employees
or other authorized individual and/or card key number. Paper records
are retrieved alphabetically by name.
SAFEGUARDS:
CMS has safeguards in place for authorized users and monitors such
[[Page 60540]]
users to ensure against excessive or unauthorized use. Personnel having
access to the system have been trained in the Privacy Act and
information security requirements. Employees who maintain records in
this system are instructed not to release data until the intended
recipient agrees to implement appropriate management, operational and
technical safeguards sufficient to protect the confidentiality,
integrity and availability of the information and information systems
and to prevent unauthorized access.
This system will conform to all applicable Federal laws and
regulations and Federal, HHS, and CMS policies and standards as they
relate to information security and data privacy. These laws and
regulations may apply but are not limited to: the Privacy Act of 1974;
the Federal Information Security Management Act of 2002; the Computer
Fraud and Abuse Act of 1986; the Health Insurance Portability and
Accountability Act of 1996; the E-Government Act of 2002, the Clinger-
Cohen Act of 1996; the Medicare Modernization Act of 2003, and the
corresponding implementing regulations. OMB Circular A-130, Management
of Federal Resources, Appendix III, Security of Federal Automated
Information Resources also applies. Federal, HHS, and CMS policies and
standards include but are not limited to: all pertinent National
Institute of Standards and Technology publications; the HHS Information
Systems Program Handbook and the CMS Information Security Handbook.
RETENTION AND DISPOSAL:
CMS will retain identifiable data for a total period of 15 years
from the date the information was collected.
SYSTEM MANAGERS AND ADDRESS:
Director, Division of Provider/Supplier Enrollment, Office of
Financial Management, CMS, 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, SSN, EIN, and for
verification purposes, the subject individual's name (woman's maiden
name, if applicable).
RECORD ACCESS PROCEDURE:
For purpose of access, use the same procedures outlined in
Notification Procedures above. Requestors should also reasonably
specify the record contents being sought. (These procedures are in
accordance with Department regulation 45 CFR 5b.5(a)(2).)
CONTESTING RECORD PROCEDURES:
The subject individual should contact the system manager named
above, and reasonably identify the record and specify the information
to be contested. State the corrective action sought and the reasons for
the correction with supporting justification. (These procedures are in
accordance with Department regulation 45 CFR 5b.7.)
RECORD SOURCE CATEGORIES:
Information contained in this system is received from the Form(s)
CMS 855A, ``Medicare Enrollment Application for Institutional
Providers,'' CMS 855B, ``Medicare Enrollment Application for Clinic/
Group Practices and Certain Other Providers,'' CMS 855I, ``Medicare
Enrollment Application for Physician and Non-Physician Practitioners,''
CMS 855R, ``Medicare Enrollment Application for Reassignment of
Medicare Benefits,'' and CMS 855S, ``Medicare Enrollment Application
for Durable Medial Equipment, Prosthetics, Orthotics, and Supplies
(DMEPOS).''
SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS OF THE ACT:
None.
[FR Doc. E6-16954 Filed 10-12-06; 8:45 am]
BILLING CODE 4120-03-P