Privacy Act of 1974; Report of a New System of Records, 10450-10454 [E8-3678]

Agencies

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

[Federal Register Volume 73, Number 39 (Wednesday, February 27, 2008)]
[Notices]
[Pages 10450-10454]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E8-3678]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services


Privacy Act of 1974; Report of a New System of Records

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

ACTION: Notice of a New System of Records (SOR).

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SUMMARY: In accordance with the requirements of the Privacy Act of 
1974, we are proposing to establish a new system of records titled, 
``Medicare Administrative Issue Tracker and Reporting of Operations 
(MAISTRO) System,'' System No. 09-70-0598. The purpose of the system is 
to capture and track casework/inquiries pertaining to Medicare Part A 
and Part B programs. The system will also provide a mechanism for 
recording data on a national level and will serve as a tool to leverage 
in performing analysis including identification of systemic trends. 
MAISTRO will record, track and monitor beneficiary and provider level 
inquiries & complaints. The system will contain information needed to 
research the inquiries, such as a beneficiary's health insurance claim 
number (HICN) or a Provider Identification Number (NPI).
    The primary purpose of the system is to collect and maintain 
information needed to provide a mechanism for CMS' central and regional 
office to capture, track, manage, report and trend inquiries, 
complaints and issues related to Fee-for-Service (FFS) programs. 
Information maintained in this system 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) facilitate 
research on the quality and effectiveness of care provided, as well as 
epidemiological projects; (4) 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 proposed routine uses, CMS invites 
comments on all portions of this notice. See EFFECTIVE DATES section 
for comment period.

EFFECTIVE DATES: CMS filed a new system report with the Chair of the 
House Committee on Oversight and Government Reform, the Chair of the 
Senate Committee on Homeland Security and Governmental Affairs, and the 
Administrator, Office of Information and Regulatory Affairs, Office of 
Management and Budget (OMB) on 2/11/2008. In any event, we will not 
disclose any information under a routine use until 30 days after 
publication in the Federal Register or 40 days after mailings to 
Congress, which ever is later. We may defer implementation of this 
system or on one or more of the routine uses listed below if we receive 
comments that persuade us to defer implementation.

ADDRESSES: The public should address comments to: CMS Privacy Officer, 
Division of Privacy Compliance, Enterprise Architecture & Strategy 
Group, Office of Information Services, 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 time zone.

FOR FURTHER INFORMATION CONTACT: Michele Livingston, Division of 
Ombudsman Casework and Trends Management, Medicare Ombudsman Group, 
Office of External Affairs, CMS, 7500 Security Boulevard, Mail Stop S1-
20-21, Baltimore, Maryland 21244-1850. The telephone number is 410-786-
6340 or contact Michele.Livingston@cms.hhs.gov.

SUPPLEMENTARY INFORMATION: The CMS Consortium for Financial Management 
and Fee for Service Operations (CFMFFSO) is responsible for handling 
casework/inquiries, but not limited to: (1) Coverage and payment 
policy; (2) audit and reimbursement policy and operations; (3) program 
integrity and medical review policy; (4) Medicare secondary payer and 
coordination of benefits; (5) claims-related hearings, appeals and 
grievances; (6) beneficiary eligibility, enrollment, entitlement, 
rights and protections, premium billing and collection; and (7) dispute 
resolution processes to assure the effective administration of the 
Medicare program. These types of inquiries number in the tens of 
thousands annually across the 10 CMS Regional Offices.
    The Office of the Medicare Ombudsman was established as a result of 
Section 923 of the Medicare

[[Page 10451]]

Modernization Act and is responsible for receiving complaints, 
grievances and requests for information submitted by individuals 
entitled to benefits under Part A or enrolled under Part B, or both, 
with respect to any aspect of the Medicare program and providing 
assistance with respect to complaints. Over the last year the focus of 
inquiry tracking has centered on the implementation of Part D 
reporting.
    Although each regional office has developed its own system to track 
and manage inquiries and complaints, these systems are inconsistent and 
do not utilize standardized operational procedures or processes to 
guide how inquiries are addressed or reported. Standardization will 
improve performance, reduce operating costs, and enable statistical 
analysis of the workload and trends among inquiries. To address these 
issues, the following tasks had to be accomplished: (1) Identifying a 
system to track beneficiary and provider inquiries, complaints and 
issues specific to FFS operations; (2) Ensuring that casework 
throughout each region is consistently captured and managed 
appropriately which ensures the delivery of high quality customer 
service to Medicare Part A and Part B beneficiaries and providers; and 
(3) Producing workload data statistics to both account for the work and 
enable improvement in CMS' policies and procedures.
    When complete, the MAISTRO system will provide a mechanism for CMS' 
central and regional office to capture, track, manage, report and trend 
inquiries, complaints and issues related to Fee-for-Service. 
Additionally, the goal of MAISTRO is to provide an easy to use system 
that will provide consistency when tracking, resolving, and reporting 
FFS inquiries, complaints and issues on a national level such that 
trends, workloads and systemic issues can be identified and managed 
appropriately across the consortium.

I. Description of the Proposed System of Records

A. Statutory and Regulatory Basis for SOR

    Authority for maintenance of this system is given under Sec.  923 
of the Medicare Prescription Drug, Improvement, and Modernization Act 
of 2003 (MMA) (Public Law (Pub. L.) 108-173).

B. Collection and Maintenance of Data in the System

    For purposes of this SOR, the system contains information on 
Medicare beneficiaries, providers and other individuals who have made 
inquiries concerning the fee-for-service program. The system contains 
information such as a beneficiary's name, address data, health 
insurance claim number (HICN), demographic information (gender, date of 
birth), provider name, address data and provider identification number 
(NPI), provider organization information, contact person information, 
employer identification numbers, and certain optional data such as 
Social Security Numbers and other provider identifiers used by these 
health care providers.

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

A. Agency Policies, Procedures, and Restrictions Routine Uses

    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 MAISTRO information that can be 
associated with an individual as provided for under ``Section III. 
Proposed Routine Use Disclosures of Data in the System.'' Both 
individually identifiable and non-individually-identifiable data may be 
disclosed under a routine use.
    We will only disclose the minimum personal data necessary to 
achieve the purpose of MAISTRO. CMS has the following policies and 
procedures concerning disclosures of information that is maintained in 
the system. Disclosure of information from the system will be approved 
only to the extent necessary to accomplish the purpose of the 
disclosure and only after CMS:
    1. Determines that the use or disclosure is consistent with the 
reason the data are being collected; e.g., to collect and maintain 
information needed to provide a mechanism for CMS' central and regional 
office to capture, track, manage, report and trend inquiries, 
complaints and issues related to Fee-for-Service (FFS).
    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 or disclosure of the record;
    b. Remove or destroy at the earliest time all individually-
identifiable information; and
    c. Agree to not use or disclose the information for any purpose 
other than the stated purpose under which the information was 
disclosed.
    4. Determines that the data are valid and reliable.

III. Proposed Routine Use Disclosures of Data in the System

    A. The Privacy Act allows us to disclose information without an 
individual's consent if the information is to be used for a purpose 
that is compatible with the purpose(s) for which the information was 
collected. Any such compatible use of data is known as a ``routine 
use.'' The proposed routine uses in this system meet the compatibility 
requirement of the Privacy Act. We are proposing to establish the 
following routine use disclosures of information maintained in the 
system:
    1. To support Agency contractors, consultants, or CMS grantees that 
have been contracted by the Agency to assist in accomplishment of a CMS 
function relating to the purposes for this system and who need access 
to the records in order to assist CMS.
    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 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 or consultant 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

[[Page 10452]]

fiscal agent pursuant to agreements with CMS to:
    a. Contribute to the accuracy of CMS's proper payment of Medicare 
benefits,
    b. Enable such agency to administer a Federal health benefits 
program, or as necessary to enable such agency to fulfill a requirement 
of a Federal statute or regulation that implements a health benefits 
program funded in whole or in part with Federal funds, and/or
    c. Assist Federal/state Medicaid programs within the state.
    Other Federal or state agencies in their administration of a 
Federal health program may require MAISTRO information for the purposes 
of collecting and maintaining information needed to capture, track, 
manage, report and trend inquiries, complaints and issues related to 
Fee-for-Service (FFS).
    Other Federal or state agencies, in their administration of a 
Federal health program, may require MAISTRO information in order to 
support evaluations and monitoring of Medicaid claims information of 
beneficiaries, including proper reimbursement for services provided.
    3. To an individual or organization for a research project or in 
support of an evaluation project related to the prevention of disease 
or disability, the restoration or maintenance of health, or payment 
related projects.
    The MAISTRO data will provide for research or support of evaluation 
projects and a broader, longitudinal, national perspective of the 
status of Medicaid beneficiaries. CMS anticipates that researchers may 
have legitimate requests to use these data in projects that could 
ultimately improve the care provided to Medicaid beneficiaries and the 
policies that govern their care.
    4. To assist 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, or occasionally when 
another party is involved in litigation and CMS's policies or 
operations could be affected by the outcome of the litigation, CMS 
would be able to disclose information to the DOJ, court, or 
adjudicatory body involved.
    5. To support a CMS contractor 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 programs.
    We contemplate disclosing information under this routine use only 
in situations in which CMS may enter into a contract 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 when doing 
so would contribute to effective and efficient operations. CMS must be 
able to give a contractor or CMS grantee whatever information is 
necessary for the contractor or CMS 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 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 MAISTRO 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 Proposed System of Records on Individual Rights

    CMS proposes to establish this system in accordance with the 
principles and requirements of the Privacy Act and will collect, use, 
and disseminate information only as prescribed therein. Data in this 
system will be subject to the authorized releases in accordance with 
the routine uses identified in this system of records.
    CMS will take precautionary measures to minimize the risks of 
unauthorized access to the records and the potential harm to individual 
privacy or other personal or property rights of patients whose data are 
maintained in 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.


[[Page 10453]]


    Dated: February 20, 2008.
Charlene Frizzera,
Chief Operating Officer, Centers for Medicare & Medicaid Services.
SYSTEM NUMBER: 09-70-0598

SYSTEM NAME:
    ``Medicare Administrative Issue Tracker and Reporting of Operations 
(MAISTRO) System,'' HHS/CMS/OEA.

SECURITY CLASSIFICATION:
    Level Three Privacy Act Sensitive Data.

SYSTEM LOCATION:
    Centers for Medicare & Medicaid Services (CMS) Data Center, 7500 
Security Boulevard, North Building, First Floor, Baltimore, Maryland 
21244.

CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:
    For purposes of this SOR, the system contains information on 
Medicare beneficiaries, providers and other individuals who have made 
inquiries concerning the fee-for-service program.

CATEGORIES OF RECORDS IN THE SYSTEM:
    The system contains information such as a beneficiary's name, 
address data, health insurance claim number (HICN), demographic 
information, (gender, date of birth), provider name, address data and 
provider identification number (NPI), provider organization 
information, contact person information, employer identification 
numbers, and certain optional data such as Social Security Numbers and 
other provider identifiers used by these health care providers.

AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
    Authority for maintenance of this system is given under Sec.  923 
of the Medicare Prescription Drug, Improvement, and Modernization Act 
of 2003 (MMA) (Public Law (Pub. L.) 108-173).

PURPOSE(S) OF THE SYSTEM:
    The primary purpose of the system is to collect and maintain 
information needed to provide a mechanism for CMS' central and regional 
office to capture, track, manage, report and trend inquiries, 
complaints and issues related to Fee-for-Service (FFS) programs. 
Information maintained in this system 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) facilitate 
research on the quality and effectiveness of care provided, as well as 
epidemiological projects; (4) 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:
    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 that 
have been contracted by the Agency to assist in accomplishment of a CMS 
function relating to the purposes for this system and who need access 
to the records in order to assist CMS.
    2. To assist another Federal or state agency, agency of a state 
government, an agency established by state law, or its fiscal agent 
pursuant to agreements with CMS to:
    a. Contribute to the accuracy of CMS's proper payment of Medicare 
benefits,
    b. Enable such agency to administer a Federal health benefits 
program, or as necessary to enable such agency to fulfill a requirement 
of a Federal statute or regulation that implements a health benefits 
program funded in whole or in part with Federal funds, and/or
    c. Assist Federal/state Medicaid programs within the state.
    3. To an individual or organization for a research project or in 
support of an evaluation project related to the prevention of disease 
or disability, the restoration or maintenance of health, or payment 
related projects.
    4. To assist 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 support a CMS contractor 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 programs.
    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 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 magnetic media.

RETRIEVABILITY:
    All records are accessible by individual name or identification 
number.

SAFEGUARDS:
    CMS has safeguards in place for authorized users and monitors such 
users to ensure against excessive or unauthorized use. Personnel having 
access to the system have been trained in the Privacy Act and 
information security requirements. Employees who maintain records in 
this system are instructed not to release data until the intended 
recipient agrees to implement appropriate management, operational and 
technical safeguards sufficient to protect the confidentiality, 
integrity and availability of the information and information systems 
and to prevent unauthorized access.
    This system will conform to all applicable Federal laws and 
regulations and Federal, HHS, and CMS policies and standards as they 
relate to information security and data privacy. These laws and 
regulations may apply but are not limited to: The Privacy Act of 1974; 
the Federal Information Security Management Act of 2002; the Computer 
Fraud and Abuse Act of 1986;

[[Page 10454]]

the Health Insurance Portability and Accountability Act of 1996; the E-
Government Act of 2002, the Clinger-Cohen Act of 1996; the Medicare 
Modernization Act of 2003, and the corresponding implementing 
regulations. OMB Circular A-130, Management of Federal Resources, 
Appendix III, Security of Federal Automated Information Resources also 
applies. Federal, HHS, and CMS policies and standards include but are 
not limited to: All pertinent National Institute of Standards and 
Technology publications; the HHS Information Systems Program Handbook 
and the CMS Information Security Handbook.

RETENTION AND DISPOSAL:
    Records are maintained for a period of six years and three months. 
All claims-related records are encompassed by the document preservation 
order and will be retained until notification is received by DOJ.

SYSTEM MANAGER AND ADDRESS:
    Director, Division of Ombudsman Casework and Trends Management, 
Medicare Ombudsman Group, Office of External Affairs, CMS, 7500 
Security Boulevard, Mail Stop S1-11-21, Baltimore, Maryland 21244-1850.

NOTIFICATION PROCEDURE:
    For purpose of access, the subject individual health care provider 
should write to the system manager who will require the system name, 
National Provider Identifier, address, date of birth, and gender, and 
for verification purposes, the subject individual health care 
provider'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 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 health care provider should contact the 
systems manager named above, and reasonably identify the record and 
specify the information to be contested. State the corrective action 
sought and the reasons for the correction with supporting 
justification. (These procedures are in accordance with department 
regulation 45 CFR 5b.7).

RECORD SOURCE CATEGORIES:
    The data contained in this system of records are obtained from the 
individuals who communicate or correspond with CMS.

SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS OF THE ACT:

    None.
 [FR Doc. E8-3678 Filed 2-26-08; 8:45 am]
BILLING CODE 4120-03-P