Privacy Act of 1974; Report of a Modified or Altered System of Records, 60540-60544 [E6-16955]
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60540
Federal Register / Vol. 71, No. 198 / Friday, October 13, 2006 / Notices
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).
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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
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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
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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
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necessary to evaluate a series of
Medicaid Reform Demonstrations that
rely on waivers of section 1115 of the
Social Security Act (the Act). This
system will allow measurement of the
effects of the demonstration on
beneficiaries’ eligibility, access to care,
utilization, health care costs,
satisfaction with care, quality of care
and health status. The information
retrieved from this system of records
will also be disclosed to: (1) Support
program administration, reporting, and
regulator, reimbursement, and policy
functions performed within the CMS or
by a contractor, consultant, or grantee;
(2) assist another Federal or state agency
with information to contribute to the
accuracy of CMS’s proper payment of
Medicare benefits, enable such agency
to administer a Federal health benefits
program, or to enable such agency to
fulfill a requirement of Federal statute
or regulation that implements a health
benefits program funded in whole or in
part with Federal funds; (3) support an
individual or organization for a research
project or in support of an evaluation
project related to the prevention of
disease or disability, the restoration or
maintenance of health, or payment
related projects; (4) support litigation
involving the agency; and (5) combat
fraud, waste, and abuse in a Federallyfunded 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 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 October 5, 2006. To ensure
that all parties have adequate time in
which to comment, the modified 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,
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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.
Paul
J. Boben, Division of State Program
Research, Research and Evaluation
Group, Office of Research, Development
and Information, CMS, Mail Stop C3–
19–07, 7500 Security Boulevard,
Baltimore, Maryland 21244–1850. He
can also be reached by telephone at
410–786–6629, or via e-mail at
Paul.Boben@cms.hhs.gov.
FOR FURTHER INFORMATION CONTACT:
This
system was last published in the
Federal Register (FR) at 67 FR 2216
(January 16, 2002). The EMRD SOR
provides data necessary to evaluate
CMS’ Evaluation of the Medicaid
Reform Demonstrations, as part of this
effort individually identifiable data will
be used to analyze the effects of the
demonstration on beneficiary eligibility,
access to care, utilization, health care
costs, satisfaction with care, quality of
care, and health status.
SUPPLEMENTARY INFORMATION:
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 42 United States
Code (U.S.C.) 1315 § 1115, and 42
U.S.C. 1395ll § 1875(a) of the Social
Security Act.
B. Collection and Maintenance of Data
in the System
EMRD contains information on
demonstration participants and
comparison group members and their
experiences in accessing health care
before, during, and after the
demonstration period. Information
collected in the EMRD contains, but is
not limited to, name, address, phone
number, social security number, health
insurance claim number, Medicaid
identification number, gender, ethnicity,
date of birth, employment, health care
coverage, diagnostic and health status
information, utilization and cost of
health care services, and responses to
survey or other types of data collection
methods
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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 EMRD
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 EMRD. 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 provide data necessary to
evaluate a series of Medicaid Reform
Demonstrations that rely on waivers of
section 1115 of the Act. This system
will allow measurement of the effects of
the demonstration on beneficiaries’
eligibility, access to care, utilization,
health care costs, satisfaction with care,
quality of care and health status.
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.
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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 grantee who have been
contracted by the agency to assist in the
performance of a service related to this
system and who need to have access to
the records in order to perform the
activity.
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 enable another Federal or state
agency to:
a. Contribute to the accuracy of CMS’s
proper payment of Medicare benefits;
b. Enable such agency to administer a
Federal health benefits program, or, as
necessary, to enable such agency to
fulfill a requirement of a Federal statute
or regulation that implements a health
benefits program funded in whole or in
part with Federal funds; and/or
c. Assist Federal/state Medicaid
programs within the state.
CMS, and other Federal or state and
local agencies, all contribute data to the
databases included in this system, and
(both separately and jointly) have an
interest in performing program
evaluation, conducting research and
maintaining program integrity.
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3. To support an individual or
organization for a research project or in
support of an evaluation project related
to the prevention of disease or
disability, the restoration or
maintenance of health, or payment
related projects.
The EMRD data will provide for
research or in support of evaluation
projects, a broader, national perspective
of the status of Medicare, Medicaid and
SCHIP beneficiaries. CMS anticipates
that many researchers will have
legitimate requests to use these data in
projects that could ultimately improve
the care provided to Medicare, Medicaid
and SCHIP beneficiaries and the policy
that governs the care.
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’ 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 support 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
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.
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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 support 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 EMRD
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
individuals could, because of the small
size, use this information to deduce the
identity of the beneficiary).
IV. Safeguards
CMS has safeguards in place for
authorized users and monitors such
users to ensure against excessive or
unauthorized use. Personnel having
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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 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 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.
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Dated: October 4, 2006.
Charlene Frizzera,
Acting Chief Operating Officer, Centers for
Medicare & Medicaid Services.
System No. 09–70–0523
SYSTEM NAME:
‘‘Evaluations of the Medicaid Reform
Demonstrations (EMRD),’’ HHS/CMS/
ORDI
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 and at various contractor sites and
at CMS Regional Offices.
CATEGORIES OF INDIVIDUALS COVERED BY THE
SYSTEM:
EMRD contains information on
demonstration participants and
comparison group members and their
experiences in access health care before,
during, and after the demonstration
period.
CATEGORIES OF RECORDS IN THE SYSTEM:
Information collected in the EMRD
contains, but is not limited to, name,
address, phone number, social security
number (SSN), health insurance claim
number (HICN), Medicaid identification
number, gender, ethnicity, date of birth,
employment, health care coverage,
diagnostic and health status
information, utilization and cost of
health care services, and responses to
survey or other types of data collection
methods.
AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
Authority for maintenance of the
system is given under 42 United States
Code (U.S.C.) 1315 § 1115, and 42
U.S.C. 1395ll § 1875(a) of the Social
Security Act.
PURPOSE(S) OF THE SYSTEM:
The primary purpose of this modified
system is to collect and provide data
necessary to evaluate a series of
Medicaid Reform Demonstrations that
rely on waivers of section 1115 of the
Social Security Act (the Act). This
system will allow measurement of the
effects of the demonstration on
beneficiaries’ eligibility, access to care,
utilization, health care costs,
satisfaction with care, quality of care
and health status. The information
retrieved from this system of records
will also be disclosed to: (1) Support
program administration, reporting, and
regulator, reimbursement, and policy
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60543
functions performed within the CMS or
by a contractor, consultant, or grantee;
(2) assist another Federal or state agency
with information to contribute to the
accuracy of CMS’s proper payment of
Medicare benefits, enable such agency
to administer a Federal health benefits
program, or to enable such agency to
fulfill a requirement of Federal statute
or regulation that implements a health
benefits program funded in whole or in
part with Federal funds; (3) support an
individual or organization for a research
project or in support of an evaluation
project related to the prevention of
disease or disability, the restoration or
maintenance of health, or payment
related projects; (4) support litigation
involving the agency; and (5) combat
fraud, waste, and abuse in a Federallyfunded health benefits programs.
ROUTINE USES OF RECORDS MAINTAINED IN THE
SYSTEM, INCLUDING CATEGORIES OR USERS AND
THE PURPOSES OF SUCH USES:
A. The Privacy Act allows us to
disclose information without an
individual’s consent if the information
is to be used for a purpose that is
compatible with the purpose(s) for
which the information was collected.
Any such compatible use of data is
known as a ‘‘routine use.’’ The proposed
routine uses in this system meet the
compatibility requirement of the Privacy
Act. We are proposing to establish the
following routine use disclosures of
information maintained in the system:
1. To support agency contractors,
consultants, or grantee who have been
contracted by the agency to assist in the
performance of a service related to this
system and who need to have access to
the records in order to perform the
activity.
2. To enable another Federal or state
agency to:
a. Contribute to the accuracy of CMS’s
proper payment of Medicare benefits;
b. Enable such agency to administer a
Federal health benefits program, or, as
necessary, to enable such agency to
fulfill a requirement of a Federal statute
or regulation that implements a health
benefits program funded in whole or in
part with Federal funds; and/or
c. Assist Federal/state Medicaid
programs within the state.
3. To support an individual or
organization for a research project or in
support of an evaluation project related
to the prevention of disease or
disability, the restoration or
maintenance of health, or payment
related projects.
4. To support the Department of
Justice (DOJ), court or adjudicatory body
when:
a. The agency or any component
thereof, or
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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 support 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 support 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
VerDate Aug<31>2005
15:21 Oct 12, 2006
Jkt 211001
patient population is so small that
individuals could, because of the small
size, use this information to deduce the
identity of the beneficiary).
POLICIES AND PRACTICES FOR STORING,
RETRIEVING, ACCESSING, RETAINING, AND
DISPOSING OF RECORDS IN THE SYSTEM:
SYSTEM MANAGER(S) AND ADDRESS:
Director, Division of State Program
Research, Research and Evaluation
Group, Office of Research, Development
and Information, CMS, Mail Stop C3–
19–07, 7500 Security Boulevard,
Baltimore, Maryland 21244–1850.
STORAGE:
All records are stored on paper or
electronic media.
RETRIEVABILITY:
Information can be retrieved using the
beneficiary’s name, Medicaid
identification number, HICN, or SSN.
SAFEGUARDS:
CMS has safeguards in place for
authorized users and monitors such
users to ensure against excessive or
unauthorized use. Personnel having
access to the system have been trained
in the Privacy Act and information
security requirements. Employees who
maintain records in this system are
instructed not to release data until the
intended recipient agrees to implement
appropriate management, operational
and technical safeguards sufficient to
protect the confidentiality, integrity and
availability of the information and
information systems and to prevent
unauthorized access.
This system will conform to all
applicable Federal laws and regulations
and Federal, HHS, and CMS policies
and standards as they relate to
information security and data privacy.
These laws and regulations may apply
but are not limited to: the Privacy Act
of 1974; the Federal Information
Security Management Act of 2002; the
Computer Fraud and Abuse Act of 1986;
the Health Insurance Portability and
Accountability Act of 1996; the EGovernment Act of 2002, the ClingerCohen Act of 1996; the Medicare
Modernization Act of 2003, and the
corresponding implementing
regulations. OMB Circular A–130,
Management of Federal Resources,
Appendix III, Security of Federal
Automated Information Resources also
applies. Federal, HHS, and CMS
policies and standards include but are
not limited to: all pertinent National
Institute of Standards and Technology
publications; the HHS Information
Systems Program Handbook and the
CMS Information Security Handbook.
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.
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 system include: State Medicaid
Management Information Systems,
managed care organizations, fee-forservice providers, surveys of
demonstration participants or providers
and comparison group members,
medical records, Social Security
Administration databases, vital statistics
and other relevant data systems.
SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS
OF THE ACT:
None.
[FR Doc. E6–16955 Filed 10–12–06; 8:45 am]
BILLING CODE 4120–03–P
RETENTION AND DISPOSAL:
CMS will retain information for a total
period not to exceed 10 years. All
claims-related records are encompassed
by the document preservation order and
will be retained until notification is
received from DOJ.
PO 00000
Frm 00084
Fmt 4703
Sfmt 4703
E:\FR\FM\13OCN1.SGM
13OCN1
Agencies
[Federal Register Volume 71, Number 198 (Friday, October 13, 2006)]
[Notices]
[Pages 60540-60544]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E6-16955]
-----------------------------------------------------------------------
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).
-----------------------------------------------------------------------
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 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 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 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
[[Page 60541]]
necessary to evaluate a series of Medicaid Reform Demonstrations that
rely on waivers of section 1115 of the Social Security Act (the Act).
This system will allow measurement of the effects of the demonstration
on beneficiaries' eligibility, access to care, utilization, health care
costs, satisfaction with care, quality of care and health status. The
information retrieved from this system of records will also be
disclosed to: (1) Support program administration, reporting, and
regulator, reimbursement, and policy functions performed within the CMS
or by a contractor, consultant, or grantee; (2) assist another Federal
or state agency with information to contribute to the accuracy of CMS's
proper payment of Medicare benefits, enable such agency to administer a
Federal health benefits program, or to enable such agency to fulfill a
requirement of Federal statute or regulation that implements a health
benefits program funded in whole or in part with Federal funds; (3)
support an individual or organization for a research project or in
support of an evaluation project related to the prevention of disease
or disability, the restoration or maintenance of health, or payment
related projects; (4) support litigation involving the agency; and (5)
combat fraud, waste, and abuse in a Federally-funded 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 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 October 5, 2006. To
ensure that all parties have adequate time in which to comment, the
modified 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: Paul J. Boben, Division of State
Program Research, Research and Evaluation Group, Office of Research,
Development and Information, CMS, Mail Stop C3-19-07, 7500 Security
Boulevard, Baltimore, Maryland 21244-1850. He can also be reached by
telephone at 410-786-6629, or via e-mail at Paul.Boben@cms.hhs.gov.
SUPPLEMENTARY INFORMATION: This system was last published in the
Federal Register (FR) at 67 FR 2216 (January 16, 2002). The EMRD SOR
provides data necessary to evaluate CMS' Evaluation of the Medicaid
Reform Demonstrations, as part of this effort individually identifiable
data will be used to analyze the effects of the demonstration on
beneficiary eligibility, access to care, utilization, health care
costs, satisfaction with care, quality of care, and health status.
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 42 United
States Code (U.S.C.) 1315 Sec. 1115, and 42 U.S.C. 1395ll Sec.
1875(a) of the Social Security Act.
B. Collection and Maintenance of Data in the System
EMRD contains information on demonstration participants and
comparison group members and their experiences in accessing health care
before, during, and after the demonstration period. Information
collected in the EMRD contains, but is not limited to, name, address,
phone number, social security number, health insurance claim number,
Medicaid identification number, gender, ethnicity, date of birth,
employment, health care coverage, diagnostic and health status
information, utilization and cost of health care services, and
responses to survey or other types of data collection methods
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 EMRD 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 EMRD. 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 provide
data necessary to evaluate a series of Medicaid Reform Demonstrations
that rely on waivers of section 1115 of the Act. This system will allow
measurement of the effects of the demonstration on beneficiaries'
eligibility, access to care, utilization, health care costs,
satisfaction with care, quality of care and health status.
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.
[[Page 60542]]
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 grantee who have
been contracted by the agency to assist in the performance of a service
related to this system and who need to have access to the records in
order to perform the activity.
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 enable another Federal or state agency to:
a. Contribute to the accuracy of CMS's proper payment of Medicare
benefits;
b. Enable such agency to administer a Federal health benefits
program, or, as necessary, to enable such agency to fulfill a
requirement of a Federal statute or regulation that implements a health
benefits program funded in whole or in part with Federal funds; and/or
c. Assist Federal/state Medicaid programs within the state.
CMS, and other Federal or state and local agencies, all contribute
data to the databases included in this system, and (both separately and
jointly) have an interest in performing program evaluation, conducting
research and maintaining program integrity.
3. To support an individual or organization for a research project
or in support of an evaluation project related to the prevention of
disease or disability, the restoration or maintenance of health, or
payment related projects.
The EMRD data will provide for research or in support of evaluation
projects, a broader, national perspective of the status of Medicare,
Medicaid and SCHIP beneficiaries. CMS anticipates that many researchers
will have legitimate requests to use these data in projects that could
ultimately improve the care provided to Medicare, Medicaid and SCHIP
beneficiaries and the policy that governs the care.
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' 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 support 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 support 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 EMRD 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
individuals could, because of the small size, use this information to
deduce the identity of the beneficiary).
IV. Safeguards
CMS has safeguards in place for authorized users and monitors such
users to ensure against excessive or unauthorized use. Personnel having
[[Page 60543]]
access to the system have been trained in the Privacy Act and
information security requirements. Employees who maintain records in
this system are instructed not to release data until the intended
recipient agrees to implement appropriate management, operational and
technical safeguards sufficient to protect the confidentiality,
integrity and availability of the information and information systems
and to prevent unauthorized access.
This system will conform to all applicable Federal laws and
regulations and Federal, HHS, and CMS policies and standards as they
relate to information security and data privacy. These laws and
regulations may apply but are not limited to: the Privacy Act of 1974;
the Federal Information Security Management Act of 2002; the Computer
Fraud and Abuse Act of 1986; the Health Insurance Portability and
Accountability Act of 1996; the E-Government Act of 2002, the Clinger-
Cohen Act of 1996; the Medicare Modernization Act of 2003, and the
corresponding implementing regulations. OMB Circular A-130, Management
of Federal Resources, Appendix III, Security of Federal Automated
Information Resources also applies. Federal, HHS, and CMS policies and
standards include but are not limited to: all pertinent National
Institute of Standards and Technology publications; the HHS Information
Systems Program Handbook and the CMS Information Security Handbook.
V. Effects of the Modified or Altered System of Records on Individual
Rights
CMS proposes to modify this system in accordance with the
principles and requirements of the Privacy Act and will collect, use,
and disseminate information only as prescribed therein. Data in this
system will be subject to the authorized releases in accordance with
the routine uses identified in this system of records.
CMS will take precautionary measures 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. 09-70-0523
SYSTEM NAME:
``Evaluations of the Medicaid Reform Demonstrations (EMRD),'' HHS/
CMS/ORDI
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 and at various contractor sites and at CMS Regional
Offices.
CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:
EMRD contains information on demonstration participants and
comparison group members and their experiences in access health care
before, during, and after the demonstration period.
CATEGORIES OF RECORDS IN THE SYSTEM:
Information collected in the EMRD contains, but is not limited to,
name, address, phone number, social security number (SSN), health
insurance claim number (HICN), Medicaid identification number, gender,
ethnicity, date of birth, employment, health care coverage, diagnostic
and health status information, utilization and cost of health care
services, and responses to survey or other types of data collection
methods.
AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
Authority for maintenance of the system is given under 42 United
States Code (U.S.C.) 1315 Sec. 1115, and 42 U.S.C. 1395ll Sec.
1875(a) of the Social Security Act.
PURPOSE(S) OF THE SYSTEM:
The primary purpose of this modified system is to collect and
provide data necessary to evaluate a series of Medicaid Reform
Demonstrations that rely on waivers of section 1115 of the Social
Security Act (the Act). This system will allow measurement of the
effects of the demonstration on beneficiaries' eligibility, access to
care, utilization, health care costs, satisfaction with care, quality
of care and health status. The information retrieved from this system
of records will also be disclosed to: (1) Support program
administration, reporting, and regulator, reimbursement, and policy
functions performed within the CMS or by a contractor, consultant, or
grantee; (2) assist another Federal or state agency with information to
contribute to the accuracy of CMS's proper payment of Medicare
benefits, enable such agency to administer a Federal health benefits
program, or to enable such agency to fulfill a requirement of Federal
statute or regulation that implements a health benefits program funded
in whole or in part with Federal funds; (3) support an individual or
organization for a research project or in support of an evaluation
project related to the prevention of disease or disability, the
restoration or maintenance of health, or payment related projects; (4)
support litigation involving the agency; and (5) combat fraud, waste,
and abuse in a Federally-funded health benefits programs.
ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM, INCLUDING CATEGORIES
OR USERS AND THE PURPOSES OF SUCH USES:
A. The Privacy Act allows us to disclose information without an
individual's consent if the information is to be used for a purpose
that is compatible with the purpose(s) for which the information was
collected. Any such compatible use of data is known as a ``routine
use.'' The proposed routine uses in this system meet the compatibility
requirement of the Privacy Act. We are proposing to establish the
following routine use disclosures of information maintained in the
system:
1. To support agency contractors, consultants, or grantee who have
been contracted by the agency to assist in the performance of a service
related to this system and who need to have access to the records in
order to perform the activity.
2. To enable another Federal or state agency to:
a. Contribute to the accuracy of CMS's proper payment of Medicare
benefits;
b. Enable such agency to administer a Federal health benefits
program, or, as necessary, to enable such agency to fulfill a
requirement of a Federal statute or regulation that implements a health
benefits program funded in whole or in part with Federal funds; and/or
c. Assist Federal/state Medicaid programs within the state.
3. To support an individual or organization for a research project
or in support of an evaluation project related to the prevention of
disease or disability, the restoration or maintenance of health, or
payment related projects.
4. To support the Department of Justice (DOJ), court or
adjudicatory body when:
a. The agency or any component thereof, or
[[Page 60544]]
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 support 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 support 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
individuals could, because of the small size, use this information to
deduce the identity of the beneficiary).
POLICIES AND PRACTICES FOR STORING, RETRIEVING, ACCESSING, RETAINING,
AND DISPOSING OF RECORDS IN THE SYSTEM:
STORAGE:
All records are stored on paper or electronic media.
RETRIEVABILITY:
Information can be retrieved using the beneficiary's name, Medicaid
identification number, HICN, or SSN.
SAFEGUARDS:
CMS has safeguards in place for authorized users and monitors such
users to ensure against excessive or unauthorized use. Personnel having
access to the system have been trained in the Privacy Act and
information security requirements. Employees who maintain records in
this system are instructed not to release data until the intended
recipient agrees to implement appropriate management, operational and
technical safeguards sufficient to protect the confidentiality,
integrity and availability of the information and information systems
and to prevent unauthorized access.
This system will conform to all applicable Federal laws and
regulations and Federal, HHS, and CMS policies and standards as they
relate to information security and data privacy. These laws and
regulations may apply but are not limited to: the Privacy Act of 1974;
the Federal Information Security Management Act of 2002; the Computer
Fraud and Abuse Act of 1986; the Health Insurance Portability and
Accountability Act of 1996; the E-Government Act of 2002, the Clinger-
Cohen Act of 1996; the Medicare Modernization Act of 2003, and the
corresponding implementing regulations. OMB Circular A-130, Management
of Federal Resources, Appendix III, Security of Federal Automated
Information Resources also applies. Federal, HHS, and CMS policies and
standards include but are not limited to: all pertinent National
Institute of Standards and Technology publications; the HHS Information
Systems Program Handbook and the CMS Information Security Handbook.
RETENTION AND DISPOSAL:
CMS will retain information for a total period not to exceed 10
years. 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 State Program Research, Research and
Evaluation Group, Office of Research, Development and Information, CMS,
Mail Stop C3-19-07, 7500 Security Boulevard, Baltimore, Maryland 21244-
1850.
NOTIFICATION PROCEDURE:
For purpose of access, the subject individual should write to the
system manager who will require the system name, 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. 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 system include: State
Medicaid Management Information Systems, managed care organizations,
fee-for-service providers, surveys of demonstration participants or
providers and comparison group members, medical records, Social
Security Administration databases, vital statistics and other relevant
data systems.
SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS OF THE ACT:
None.
[FR Doc. E6-16955 Filed 10-12-06; 8:45 am]
BILLING CODE 4120-03-P