Office of Consumer Information and Insurance Oversight: Privacy Act of 1974; Report of a New System of Records, 38526-38530 [2010-16167]
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38526
Federal Register / Vol. 75, No. 127 / Friday, July 2, 2010 / Notices
ESTIMATED ANNUALIZED BURDEN TABLE—Continued
Average
burden per
response
(in hrs.)
Type of
respondent
Program progress report ................................
State government or Qualified State Designated Entity.
56
2
8
896
Total .........................................................
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........................
........................
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20,496
Seleda Perryman,
Office of the Secretary, Paperwork Reduction
Act Clearance Officer.
[FR Doc. 2010–16165 Filed 7–1–10; 8:45 am]
BILLING CODE 4150–45–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Office of Consumer Information and
Insurance Oversight: Privacy Act of
1974; Report of a New System of
Records
emcdonald on DSK2BSOYB1PROD with NOTICES
AGENCY: Department of Health and
Human Services (HHS).
ACTION: Notice of a New System of
Records.
SUMMARY: In accordance with the
requirements of the Privacy Act of 1974,
the U.S. Department of Health and
Human Services’ (HHS) Office of
Consumer Information and Insurance
Oversight (OCIIO) is proposing to
establish a new system of records (SOR)
titled ‘‘Pre-Existing Condition Insurance
Plan (PCIP),’’ System No. 09–90–0275.
Section 1101 of Title I of the Patient
Protection and Affordable Care Act of
2010 (Affordable Care Act) requires that
the Secretary of Health and Human
Services establish, either directly or
through contracts with States and
nonprofit private entities, a temporary
high risk health insurance pool program
to make health insurance coverage
available at standard rates to uninsured
individuals with pre-existing
conditions. This program will continue
until January 1, 2014, when American
Health Benefit Exchanges established
under sections 1311 and 1321 of the
Affordable Care Act will be available for
individuals to obtain health insurance
coverage. HHS provided each State or
its designated nonprofit entity the
opportunity to contract with HHS to
establish this program. However, to the
extent that HHS does contract with a
State to administer the program, HHS
will make available a Pre-Existing
Insurance Plan in such State under
arrangements with the U.S. Office of
Personnel Management, the U.S.
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Number of
respondents
Number of
responses per
respondent
Forms (if necessary)
Department of Agriculture’s National
Finance Center (NFC), and one or more
nonprofit entities to serve as a thirdparty administrator (TPA) responsible
for maintaining a network of health care
providers and adjudicating claims for
covered services.
The purpose of this system of records
is to collect and maintain information
on individuals who apply for
enrollment in the program. This
information will enable HHS acting
through NFC, OPM, and any third-party
administrator(s) to determine
applicants’ eligibility, enroll eligible
individuals into the program, adjudicate
appeals of eligibility and coverage
determinations, bill and collect
premium payments, and process and
pay claims for covered health care items
and services furnished to eligible
individuals. Information maintained in
this system will also be disclosed to: (1)
Support regulatory, reimbursement, and
policy functions performed by an HHS
contractor, consultant or grantee; (2)
assist another Federal or State agency,
agency of a State government, an agency
established by State law, or its fiscal
agent; (3) support litigation involving
the Department; (4) combat fraud and
abuse in certain health benefits
programs; and (5) assist efforts to
respond to a suspected or confirmed
breach of the security or confidentiality
of information maintained in this
system of records. We have provided
background information about the
modified system in the ‘‘Supplementary
Information’’ section below. Although
the Privacy Act requires only that HHS
provide an opportunity for interested
persons to comment on the proposed
routine uses, HHS invites comments on
all portions of this notice. See EFFECTIVE
DATES section for comment period.
DATES: Effective: HHS filed a new
system report with the Chair of the
House Committee on Government
Reform and Oversight, 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 June
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Total burden
hours
28, 2010. The system of records, except
the routine uses, will become effective
upon publication in the Federal
Register. To ensure that all parties have
adequate time in which to comment on
the routine uses, the routine uses will
become effective 30 days from the
publication of the notice, or 40 days
from the date it was submitted to OMB
and Congress, whichever is later, unless
HHS receives comments that require
alterations to the routine uses.
ADDRESSES: The public should address
comments to: HHS Privacy Officer,
Office of the Secretary, Office of the
Assistant Secretary for Public Affairs
(ASPA), Freedom of Information/
Privacy Acts Division, 330 ‘‘C’’ Street,
SW., Washington, DC 20201. Telephone
number: (202) 690–7453. 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. e.t.
FOR FURTHER INFORMATION CONTACT: Jill
Gotts, Office of Consumer Information
and Insurance Oversight (OCIIO), Office
of the Secretary, Department of Health
and Human Services. She can be
reached at (202) 690–5894, or contact
via e-mail at jill.gotts@cms.hhs.gov.
SUPPLEMENTARY INFORMATION:
Individuals who have a pre-existing
condition are often unable to obtain
insurance coverage in the individual
market and in many cases are denied
coverage entirely, are offered coverage
with a rider that excludes coverage for
the pre-existing condition, or are offered
coverage at an unaffordable premium.
The Pre-Existing Condition Insurance
Plan will enable eligible individuals
with pre-existing conditions to purchase
coverage without any pre-existing
condition coverage exclusions at
standard individual insurance market
rates. Section 1101 of the Act requires
that the Secretary of the Department of
Health and Human Services (HHS)
establish, either directly or through
contracts with States or nonprofit
private entities, a temporary high risk
pool program to provide access to
affordable insurance for uninsured
Americans with pre-existing conditions.
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02JYN1
emcdonald on DSK2BSOYB1PROD with NOTICES
Federal Register / Vol. 75, No. 127 / Friday, July 2, 2010 / Notices
This transitional program is intended to
remain in place from the time of its
establishment until the American
Health Benefit Exchanges established
under sections 1311 or 1321 of the Act
go into effect on January 1, 2014.
Eligible individuals may access
coverage through a Pre-Existing
Condition Insurance Plan that will be
established in each State by HHS, either
directly or through a contract with the
State or a non-profit entity. Individuals
are eligible to enroll in a qualified high
risk pool if they are citizens or nationals
of the 50 States or District of Columbia,
or are otherwise lawfully present; have
not been covered under creditable
coverage during the 6-month period
prior to applying for coverage through
this program; and have a pre-existing
condition.
Individuals who enroll in qualified
high risk pools are entitled under
section 1101 of the Act to coverage that
has an actuarial value of at least 65
percent of total allowed costs, and has
a limit on enrollee out-of-pocket
expenses that does not exceed the
amount available to individuals with a
high deductible health plan linked to a
tax-preferred health savings account.
The Pre-Existing Condition Insurance
Plan will be available to eligible
individuals for a premium that is no
more than 100 percent of the standard
individual market rate for that coverage.
Premiums charged in the pool may vary
only on the basis of the type of coverage
(individual or family), age (by a factor
no greater than 4 to 1).
The statute appropriates $5 billion in
funding for the program, and specifies
that these funds are available for the
payment of claims and administrative
costs that are in excess of the premiums
collected from enrollees in the program.
The Secretary is given broad authority
to make adjustments needed to comply
with this funding limitation, including
limiting applications for participation in
the program. The Secretary may carry
out this program either directly or
through contracts with eligible entities,
including States and nonprofit private
entities. To the extent that States meet
the requirements described in the Act,
HHS will contract with them to
administer the new program. If a State
declined to contract with HHS, or does
not submit an application
demonstrating the capability to meet the
requirements of this program, HHS will
administer that program in that State
through a contract with a nonprofit
private entity.
The Affordable Care Act also requires
that the Secretary establish criteria to
protect against ‘‘dumping risk’’ by
insurers; the Act spells out criteria
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associated with these anti-dumping
rules, and sets forth remedies when
such situations occur. We are also
required to establish oversight
procedures, including appeals
procedures and protections against
fraud, waste, and abuse.
Finally, the statute specifies that
coverage of eligible individuals under
the high risk pool program will
terminate on January 1, 2014. The
Secretary is charged with developing
procedures to transition qualified high
risk pool enrollees to the American
Health Benefit Exchanges, established
under sections 1311 or 1321 of the Act,
to ensure that there are no lapses in
health coverage.
I. Description of the Proposed System of
Records
A. Statutory and Regulatory Basis for
System
Authority for the collection,
maintenance, and disclosures from this
system is given under provisions of
Section 1101 of the Affordable Care Act.
B. Collection and Maintenance of Data
in the System
Information in this system is
maintained on individuals who apply to
enroll in the Pre-Existing Condition
Insurance Plan. Information maintained
in this system includes, but is not
limited to, the applicant’s first name,
last name, middle initial, address, date
of birth, Social Security Number (SSN),
gender, state of residence, information
about prior coverage, information about
the citizenship or lawful presence, and
information about prior denials of
insurance coverage or exclusions.
II. Agency Policies, Procedures, and
Restrictions on Routine Uses
A. The Privacy Act permits us to
disclose information without an
individual’s consent if the information
is to be used for a purpose that is
compatible with the purpose(s) for
which the information was collected.
Any such disclosure of data is known as
a ‘‘routine use.’’ The government will
only release PCIP 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 disclose the minimum
personal data necessary to achieve the
purpose of PCIP. HHS has the following
policies and procedures concerning
disclosures of information that will be
maintained in the system. In general,
disclosure of information from the
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system will be approved only for the
minimum information necessary to
accomplish the purpose of the
disclosure and only after HHS:
1. Determines that the use or
disclosure is consistent with the reason
that the data is being collected, e.g., to
collect, maintain, and process
information necessary to effectively and
efficiently administer the PCIP;
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 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. Entities Who May Receive
Disclosures Under Routine Use
These routine uses specify
circumstances, in addition to those
provided by statute in the Privacy Act
of 1974, under which HHS may release
information from the PCIP without the
consent of the individual to whom such
information pertains. Each proposed
disclosure of information under these
routine uses will be evaluated to ensure
that the disclosure is legally
permissible, including but not limited to
ensuring that the purpose of the
disclosure is compatible with the
purpose for which the information was
collected. We propose to establish the
following routine use disclosures of
information maintained in the system:
1. To support HHS contractors,
consultants, or HHS grantees who have
been engaged by HHS to assist in
accomplishment of an HHS function
relating to the purposes for this SOR
and who need to have access to the
records in order to assist HHS.
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We contemplate disclosing
information under this routine use only
in situations in which HHS may enter
into a contractual or similar agreement
with a third party to assist in
accomplishing an HHS function relating
to purposes for this SOR. HHS
occasionally contracts out certain of its
functions when doing so would
contribute to effective and efficient
operations. HHS will give a contractor,
consultant, or HHS grantee the
information necessary for the contractor
or consultant to fulfill its duties. In
these situations, safeguards are provided
in the contract prohibiting the
contractor, consultant, or grantee from
using or disclosing the information for
any purpose other than that described in
the contract and requires the contractor,
consultant, or grantee to return or
destroy all information at the
completion of the contract. Contractors
are also required to provide the
appropriate management, operational,
and technical controls to secure the
data.
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
HHS to determine applicants’ eligibility
for the Pre-existing Condition Insurance
Plan, enroll eligible individuals into the
plan, adjudicate appeals of eligibility
and coverage determinations, bill and
collect premium payments, and process
and pay claims for covered health care
items and services furnished to eligible
individuals.
Other Federal or state agencies in
their administration of the Pre-existing
Condition Insurance Plan may require
PCIP information in order to carry out
their functions pursuant to their
agreements with HHS.
3. To support the Department of
Justice (DOJ), court, or adjudicatory
body when:
a. The Department or any component
thereof, or
b. Any employee of HHS in his or her
official capacity, or
c. Any employee of HHS 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,
HHS 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 HHS is involved in
litigation, or occasionally when another
party is involved in litigation and HHS’s
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policies or operations could be affected
by the outcome of the litigation, HHS
would be able to disclose information to
the DOJ, court, or adjudicatory body
involved.
4. To assist an HHS contractor that
assists in the administration of an HHSadministered health benefits program,
or to a grantee of an HHS-administered
grant program, when disclosure is
deemed reasonably necessary by HHS 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 HHS may enter
into a contract or grant with a third
party to assist in accomplishing HHS
functions relating to the purpose of
combating fraud, waste or abuse. HHS
occasionally contracts out certain of its
functions when doing so would
contribute to effective and efficient
operations. HHS 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.
5. To assist another Federal agency or
to an instrumentality of any
governmental jurisdiction within or
under the control of the United States
(including any state or local
governmental agency), that administers,
or that has the authority to investigate
potential fraud, waste or abuse in a
health benefits program funded in
whole or in part by Federal funds, when
disclosure is deemed reasonably
necessary by HHS 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 PCIP
information for the purpose of
combating fraud, waste or abuse in such
Federally-funded programs.
6. To assist appropriate Federal
agencies and Department contractors
that have a need to know the
information for the purpose of assisting
the Department’s efforts to respond to a
suspected or confirmed breach of the
security or confidentiality of
information maintained in this system
of records, and the information
disclosed is relevant and unnecessary
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for the assistance. Other agencies may
require PCIP information for the
purpose of assisting the Department’s
efforts to respond to a suspected or
confirmed breach of the security or
confidentiality of information
maintained in this system of records.
B. Additional Circumstances Affecting
Routine Use Disclosures
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 individual).
IV. Safeguards
HHS has safeguards in place for
authorized users and monitors such
users to ensure against 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 and HHS policies and
standards as they relate to information
security and data privacy. These laws
and regulations include 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 E–
Government Act of 2002, and the
Clinger-Cohen Act of 1996; OMB
Circular A–130, Management of Federal
Resources, Appendix III, Security of
Federal Automated Information
Resources also applies. Federal and
HHS policies and standards include but
are not limited to: all pertinent National
Institute of Standards and Technology
publications; and the HHS Information
Systems Program Handbook.
V. Effects of the New System on the
Rights of Individuals
HHS 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.
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We will only disclose the minimum
personal data necessary to achieve the
purpose of PCIP. Disclosure of
information from the system will be
approved only to the extent necessary to
accomplish the purpose of the
disclosure.
HHS 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. HHS will
collect only that information necessary
to perform the system’s functions. In
addition, HHS 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.
HHS, therefore, does not anticipate an
unfavorable effect on individual privacy
as a result of the disclosure of
information relating to individuals.
Dated: June 25, 2010.
Richard Popper,
Deputy Director.
09–90–0275.
SYSTEM NAME:
PURPOSE(S) OF THE SYSTEM:
‘‘Pre-Existing Condition Insurance
Plan (PCIP),’’ OCIIO, OS/HHS.
SECURITY CLASSIFICATION:
None.
SYSTEM LOCATION:
Office of Consumer Information and
Insurance Oversight, U.S. Department of
Health & Human Services, 200
Independence Avenue, SW., Suite 738F,
Washington, DC 20201.
CATEGORIES OF INDIVIDUALS COVERED BY THE
SYSTEM:
Information in this system is
maintained on individuals who apply to
enroll in the Pre-Existing Condition
Insurance Plan.
emcdonald on DSK2BSOYB1PROD with NOTICES
CATEGORIES OF RECORDS IN THE SYSTEM:
Information in this system is
maintained on individuals who enroll
in the Pre-Existing Condition Insurance
Plan. Information maintained in this
system includes, but is not limited to,
the applicant’s first name, last name,
middle initial, mailing address or
permanent residential address (if
different than the mailing address), date
of birth, Social Security Number (if the
applicant has one), gender, email
address, telephone number. The system
will also maintain information to make
a decision about an applicant’s
eligibility. We collect and maintain
information that the applicant submits
18:27 Jul 01, 2010
AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
Authority for the collection,
maintenance, and disclosures from this
system is given under provisions of
Section 1101 of the Patient Protection
and Affordable Care Act (Pub. L. 111–
148).
SYSTEM NUMBER:
VerDate Mar<15>2010
pertaining to (1) his or her citizenship
or immigration status, since only
individuals who are citizens or
nationals of the U.S. or lawfully present
are eligible to enroll; (2) coverage an
individual had during the prior twelve
months from the date of application in
order to establish that such individual
has been without creditable coverage for
at least six months are eligible to enroll
and to assess whether insurers are
discouraging an individual from
remaining enrolled in prior coverage
due to health status; and (3) an
insurance company’s denial of coverage,
offer of coverage with a medical
condition exclusion rider, or, for an
applicant is guaranteed an offer of
coverage, coverage that is medically
underwritten. Information will also be
maintained with respect to the
applicant’s premium amount and
payment history.
Jkt 220001
The purpose of this system of records
is to collect and maintain information
on individuals who apply for
enrollment in the program. This
information will enable HHS acting
through NFC, OPM, and any third-party
administrator(s) to determine
applicants’ eligibility, enroll eligible
individuals into the program, adjudicate
appeals of eligibility and coverage
determinations, bill and collect
premium payments, and process and
pay claims for covered health care items
and services furnished to eligible
individuals. Information maintained in
this system will also be disclosed to: (1)
Support regulatory, reimbursement, and
policy functions performed by an HHS
contractor, consultant or grantee; (2)
assist another Federal or State agency,
agency of a State government, an agency
established by State law, or its fiscal
agent; (3) support litigation involving
the Department; (4) combat fraud and
abuse in certain health benefits
programs; and (5) assist efforts to
respond to a suspected or confirmed
breach of the security or confidentiality
of information maintained in this
system of records.
ROUTINE USES OF RECORDS MAINTAINED IN THE
SYSTEM, INCLUDING CATEGORIES OR USERS AND
THE PURPOSES OF SUCH USES:
B. Entities Who May Receive
Disclosures Under Routine Use
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38529
These routine uses specify
circumstances, in addition to those
provided by statute in the Privacy Act
of 1974, under which HHS may release
information from the PCIP without the
consent of the individual to whom such
information pertains. Each proposed
disclosure of information under these
routine uses will be evaluated to ensure
that the disclosure is legally
permissible, including but not limited to
ensuring that the purpose of the
disclosure is compatible with the
purpose for which the information was
collected. We propose to establish the
following routine use disclosures of
information maintained in the system:
1. To support HHS contractors,
consultants, or HHS grantees who have
been engaged by HHS to assist in
accomplishment of an HHS function
relating to the purposes for this SOR
and who need to have access to the
records in order to assist HHS.
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
HHS to determine applicants’ eligibility
for the Pre-existing Condition Insurance
Plan, enroll eligible individuals into the
plan, adjudicate appeals of eligibility
and coverage determinations, bill and
collect premium payments, and process
and pay claims for covered health care
items and services furnished to eligible
individuals.
3. To support the Department of
Justice (DOJ), court, or adjudicatory
body when:
e. The Department or any component
thereof, or
f. Any employee of HHS in his or her
official capacity, or
g. Any employee of HHS in his or her
individual capacity where the DOJ has
agreed to represent the employee, or
h. The United States Government, is
a party to litigation or has an interest in
such litigation, and by careful review,
HHS 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.
4. To assist an HHS contractor that
assists in the administration of an HHSadministered health benefits program,
or to a grantee of an HHS-administered
grant program, when disclosure is
deemed reasonably necessary by HHS 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.
E:\FR\FM\02JYN1.SGM
02JYN1
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Federal Register / Vol. 75, No. 127 / Friday, July 2, 2010 / Notices
5. To assist another Federal agency or
to an instrumentality of any
governmental jurisdiction within or
under the control of the United States
(including any state or local
governmental agency), that administers,
or that has the authority to investigate
potential fraud, waste or abuse in a
health benefits program funded in
whole or in part by Federal funds, when
disclosure is deemed reasonably
necessary by HHS 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 assist appropriate Federal
agencies and Department contractors
that have a need to know the
information for the purpose of assisting
the Department’s efforts to respond to a
suspected or confirmed breach of the
security or confidentiality of
information maintained in this system
of records, and the information
disclosed is relevant and unnecessary
for the assistance.
C. Additional Circumstances
Affecting Routine Use Disclosures
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).
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 and HHS policies and
standards as they relate to information
security and data privacy. These laws
and regulations include 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 E–
Government Act of 2002, and the
Clinger-Cohen Act of 1996; OMB
Circular A–130, Management of Federal
Resources, Appendix III, Security of
Federal Automated Information
Resources also applies. Federal and
HHS policies and standards include but
are not limited to: all pertinent National
Institute of Standards and Technology
publications; and the HHS Information
Systems Program Handbook.
RETENTION AND DISPOSAL:
Records are maintained with
identifiers for all transactions after they
are entered into the system for a period
of 10 years. Records are housed in both
active and archival files in accordance
with HHS data and document
management policies and standards.
SYSTEM MANAGER AND ADDRESS:
POLICIES AND PRACTICES FOR STORING,
RETRIEVING, ACCESSING, RETAINING, AND
DISPOSING OF RECORDS IN THE SYSTEM:
Anthony Culotta, High Risk Pool
Program Division, Office of Insurance
Programs, Office of Consumer
Information and Insurance Oversight,
U.S. Department of Health & Human
Services, 200 Independence Avenue,
SW., Suite 738F, Washington, DC
20201.
STORAGE:
NOTIFICATION PROCEDURE:
We will be storing records in
hardcopy files and various electronic
storage media (including DB2, Oracle,
and other relational data structures).
For purpose of notification, the
subject individual should write to the
system manager who will require the
system name, and the retrieval selection
criteria (e.g., name, SSN, etc.).
RETRIEVABILITY:
Information is most frequently
retrieved by first name, last name,
middle initial, date of birth, or Social
Security Number (SSN).
RECORD ACCESS PROCEDURE:
emcdonald on DSK2BSOYB1PROD with NOTICES
SAFEGUARDS:
HHS has safeguards in place for
authorized users and monitors such
users to ensure against 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
VerDate Mar<15>2010
18:27 Jul 01, 2010
Jkt 220001
For purpose of access, use the same
procedures outlined in Notification
Procedures above. Requestors should
also reasonably specify the record
contents being sought. (These
procedures are in accordance with
Department regulation 45 CFR
5b.5(a)(2)).
CONTESTING RECORD PROCEDURES:
The subject individual should contact
the system manager named above, and
reasonably identify the record and
specify the information to be contested.
State the corrective action sought and
PO 00000
Frm 00075
Fmt 4703
Sfmt 4703
the reasons for the correction with
supporting justification. (These
procedures are in accordance with
Department regulation 45 CFR 5b.7).
RECORD SOURCE CATEGORIES:
Record source categories include
applicants who voluntarily submit data
and personal information for the PCIP
program.
SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS
OF THE ACT:
None.
[FR Doc. 2010–16167 Filed 7–1–10; 8:45 am]
BILLING CODE 4150–65–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–R–297 and
CMS–10209]
Agency Information Collection
Activities: Submission for OMB
Review; Comment Request
AGENCY: Centers for Medicare &
Medicaid Services.
In compliance with the requirement
of section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the
Centers for Medicare & Medicaid
Services (CMS), Department of Health
and Human Services, is publishing the
following summary of proposed
collections for public comment.
Interested persons are invited to send
comments regarding this burden
estimate or any other aspect of this
collection of information, including any
of the following subjects: (1) The
necessity and utility of the proposed
information collection for the proper
performance of the Agency’s function;
(2) the accuracy of the estimated
burden; (3) ways to enhance the quality,
utility, and clarity of the information to
be collected; and (4) the use of
automated collection techniques or
other forms of information technology to
minimize the information collection
burden.
1. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Request for
Employment Information; Use: Section
1837(i) of the Social Security Act
provides for a special enrollment period
for individuals who delay enrolling in
Medicare Part B because they are
covered by a group health plan based on
their own or a spouse’s current
employment status. When these
individuals apply for Medicare Part B,
E:\FR\FM\02JYN1.SGM
02JYN1
Agencies
[Federal Register Volume 75, Number 127 (Friday, July 2, 2010)]
[Notices]
[Pages 38526-38530]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-16167]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of Consumer Information and Insurance Oversight: Privacy
Act of 1974; Report of a New System of Records
AGENCY: Department of Health and Human Services (HHS).
ACTION: Notice of a New System of Records.
-----------------------------------------------------------------------
SUMMARY: In accordance with the requirements of the Privacy Act of
1974, the U.S. Department of Health and Human Services' (HHS) Office of
Consumer Information and Insurance Oversight (OCIIO) is proposing to
establish a new system of records (SOR) titled ``Pre-Existing Condition
Insurance Plan (PCIP),'' System No. 09-90-0275. Section 1101 of Title I
of the Patient Protection and Affordable Care Act of 2010 (Affordable
Care Act) requires that the Secretary of Health and Human Services
establish, either directly or through contracts with States and
nonprofit private entities, a temporary high risk health insurance pool
program to make health insurance coverage available at standard rates
to uninsured individuals with pre-existing conditions. This program
will continue until January 1, 2014, when American Health Benefit
Exchanges established under sections 1311 and 1321 of the Affordable
Care Act will be available for individuals to obtain health insurance
coverage. HHS provided each State or its designated nonprofit entity
the opportunity to contract with HHS to establish this program.
However, to the extent that HHS does contract with a State to
administer the program, HHS will make available a Pre-Existing
Insurance Plan in such State under arrangements with the U.S. Office of
Personnel Management, the U.S. Department of Agriculture's National
Finance Center (NFC), and one or more nonprofit entities to serve as a
third-party administrator (TPA) responsible for maintaining a network
of health care providers and adjudicating claims for covered services.
The purpose of this system of records is to collect and maintain
information on individuals who apply for enrollment in the program.
This information will enable HHS acting through NFC, OPM, and any
third-party administrator(s) to determine applicants' eligibility,
enroll eligible individuals into the program, adjudicate appeals of
eligibility and coverage determinations, bill and collect premium
payments, and process and pay claims for covered health care items and
services furnished to eligible individuals. Information maintained in
this system will also be disclosed to: (1) Support regulatory,
reimbursement, and policy functions performed by an HHS contractor,
consultant or grantee; (2) assist another Federal or State agency,
agency of a State government, an agency established by State law, or
its fiscal agent; (3) support litigation involving the Department; (4)
combat fraud and abuse in certain health benefits programs; and (5)
assist efforts to respond to a suspected or confirmed breach of the
security or confidentiality of information maintained in this system of
records. We have provided background information about the modified
system in the ``Supplementary Information'' section below. Although the
Privacy Act requires only that HHS provide an opportunity for
interested persons to comment on the proposed routine uses, HHS invites
comments on all portions of this notice. See EFFECTIVE DATES section
for comment period.
DATES: Effective: HHS filed a new system report with the Chair of the
House Committee on Government Reform and Oversight, 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 June 28, 2010. The system of records,
except the routine uses, will become effective upon publication in the
Federal Register. To ensure that all parties have adequate time in
which to comment on the routine uses, the routine uses will become
effective 30 days from the publication of the notice, or 40 days from
the date it was submitted to OMB and Congress, whichever is later,
unless HHS receives comments that require alterations to the routine
uses.
ADDRESSES: The public should address comments to: HHS Privacy Officer,
Office of the Secretary, Office of the Assistant Secretary for Public
Affairs (ASPA), Freedom of Information/Privacy Acts Division, 330 ``C''
Street, SW., Washington, DC 20201. Telephone number: (202) 690-7453.
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. e.t.
FOR FURTHER INFORMATION CONTACT: Jill Gotts, Office of Consumer
Information and Insurance Oversight (OCIIO), Office of the Secretary,
Department of Health and Human Services. She can be reached at (202)
690-5894, or contact via e-mail at jill.gotts@cms.hhs.gov.
SUPPLEMENTARY INFORMATION: Individuals who have a pre-existing
condition are often unable to obtain insurance coverage in the
individual market and in many cases are denied coverage entirely, are
offered coverage with a rider that excludes coverage for the pre-
existing condition, or are offered coverage at an unaffordable premium.
The Pre-Existing Condition Insurance Plan will enable eligible
individuals with pre-existing conditions to purchase coverage without
any pre-existing condition coverage exclusions at standard individual
insurance market rates. Section 1101 of the Act requires that the
Secretary of the Department of Health and Human Services (HHS)
establish, either directly or through contracts with States or
nonprofit private entities, a temporary high risk pool program to
provide access to affordable insurance for uninsured Americans with
pre-existing conditions.
[[Page 38527]]
This transitional program is intended to remain in place from the time
of its establishment until the American Health Benefit Exchanges
established under sections 1311 or 1321 of the Act go into effect on
January 1, 2014.
Eligible individuals may access coverage through a Pre-Existing
Condition Insurance Plan that will be established in each State by HHS,
either directly or through a contract with the State or a non-profit
entity. Individuals are eligible to enroll in a qualified high risk
pool if they are citizens or nationals of the 50 States or District of
Columbia, or are otherwise lawfully present; have not been covered
under creditable coverage during the 6-month period prior to applying
for coverage through this program; and have a pre-existing condition.
Individuals who enroll in qualified high risk pools are entitled
under section 1101 of the Act to coverage that has an actuarial value
of at least 65 percent of total allowed costs, and has a limit on
enrollee out-of-pocket expenses that does not exceed the amount
available to individuals with a high deductible health plan linked to a
tax-preferred health savings account. The Pre-Existing Condition
Insurance Plan will be available to eligible individuals for a premium
that is no more than 100 percent of the standard individual market rate
for that coverage. Premiums charged in the pool may vary only on the
basis of the type of coverage (individual or family), age (by a factor
no greater than 4 to 1).
The statute appropriates $5 billion in funding for the program, and
specifies that these funds are available for the payment of claims and
administrative costs that are in excess of the premiums collected from
enrollees in the program. The Secretary is given broad authority to
make adjustments needed to comply with this funding limitation,
including limiting applications for participation in the program. The
Secretary may carry out this program either directly or through
contracts with eligible entities, including States and nonprofit
private entities. To the extent that States meet the requirements
described in the Act, HHS will contract with them to administer the new
program. If a State declined to contract with HHS, or does not submit
an application demonstrating the capability to meet the requirements of
this program, HHS will administer that program in that State through a
contract with a nonprofit private entity.
The Affordable Care Act also requires that the Secretary establish
criteria to protect against ``dumping risk'' by insurers; the Act
spells out criteria associated with these anti-dumping rules, and sets
forth remedies when such situations occur. We are also required to
establish oversight procedures, including appeals procedures and
protections against fraud, waste, and abuse.
Finally, the statute specifies that coverage of eligible
individuals under the high risk pool program will terminate on January
1, 2014. The Secretary is charged with developing procedures to
transition qualified high risk pool enrollees to the American Health
Benefit Exchanges, established under sections 1311 or 1321 of the Act,
to ensure that there are no lapses in health coverage.
I. Description of the Proposed System of Records
A. Statutory and Regulatory Basis for System
Authority for the collection, maintenance, and disclosures from
this system is given under provisions of Section 1101 of the Affordable
Care Act.
B. Collection and Maintenance of Data in the System
Information in this system is maintained on individuals who apply
to enroll in the Pre-Existing Condition Insurance Plan. Information
maintained in this system includes, but is not limited to, the
applicant's first name, last name, middle initial, address, date of
birth, Social Security Number (SSN), gender, state of residence,
information about prior coverage, information about the citizenship or
lawful presence, and information about prior denials of insurance
coverage or exclusions.
II. Agency Policies, Procedures, and Restrictions on Routine Uses
A. The Privacy Act permits us to disclose information without an
individual's consent if the information is to be used for a purpose
that is compatible with the purpose(s) for which the information was
collected. Any such disclosure of data is known as a ``routine use.''
The government will only release PCIP 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 disclose the minimum personal data necessary to
achieve the purpose of PCIP. HHS has the following policies and
procedures concerning disclosures of information that will be
maintained in the system. In general, disclosure of information from
the system will be approved only for the minimum information necessary
to accomplish the purpose of the disclosure and only after HHS:
1. Determines that the use or disclosure is consistent with the
reason that the data is being collected, e.g., to collect, maintain,
and process information necessary to effectively and efficiently
administer the PCIP;
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 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. Entities Who May Receive Disclosures Under Routine Use
These routine uses specify circumstances, in addition to those
provided by statute in the Privacy Act of 1974, under which HHS may
release information from the PCIP without the consent of the individual
to whom such information pertains. Each proposed disclosure of
information under these routine uses will be evaluated to ensure that
the disclosure is legally permissible, including but not limited to
ensuring that the purpose of the disclosure is compatible with the
purpose for which the information was collected. We propose to
establish the following routine use disclosures of information
maintained in the system:
1. To support HHS contractors, consultants, or HHS grantees who
have been engaged by HHS to assist in accomplishment of an HHS function
relating to the purposes for this SOR and who need to have access to
the records in order to assist HHS.
[[Page 38528]]
We contemplate disclosing information under this routine use only
in situations in which HHS may enter into a contractual or similar
agreement with a third party to assist in accomplishing an HHS function
relating to purposes for this SOR. HHS occasionally contracts out
certain of its functions when doing so would contribute to effective
and efficient operations. HHS will give a contractor, consultant, or
HHS grantee the information necessary for the contractor or consultant
to fulfill its duties. In these situations, safeguards are provided in
the contract prohibiting the contractor, consultant, or grantee from
using or disclosing the information for any purpose other than that
described in the contract and requires the contractor, consultant, or
grantee to return or destroy all information at the completion of the
contract. Contractors are also required to provide the appropriate
management, operational, and technical controls to secure the data.
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 HHS to determine applicants' eligibility
for the Pre-existing Condition Insurance Plan, enroll eligible
individuals into the plan, adjudicate appeals of eligibility and
coverage determinations, bill and collect premium payments, and process
and pay claims for covered health care items and services furnished to
eligible individuals.
Other Federal or state agencies in their administration of the Pre-
existing Condition Insurance Plan may require PCIP information in order
to carry out their functions pursuant to their agreements with HHS.
3. To support the Department of Justice (DOJ), court, or
adjudicatory body when:
a. The Department or any component thereof, or
b. Any employee of HHS in his or her official capacity, or
c. Any employee of HHS 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, HHS 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 HHS is involved in litigation, or occasionally when
another party is involved in litigation and HHS's policies or
operations could be affected by the outcome of the litigation, HHS
would be able to disclose information to the DOJ, court, or
adjudicatory body involved.
4. To assist an HHS contractor that assists in the administration
of an HHS-administered health benefits program, or to a grantee of an
HHS-administered grant program, when disclosure is deemed reasonably
necessary by HHS 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 HHS may enter into a contract or grant with a
third party to assist in accomplishing HHS functions relating to the
purpose of combating fraud, waste or abuse. HHS occasionally contracts
out certain of its functions when doing so would contribute to
effective and efficient operations. HHS 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.
5. To assist another Federal agency or to an instrumentality of any
governmental jurisdiction within or under the control of the United
States (including any state or local governmental agency), that
administers, or that has the authority to investigate potential fraud,
waste or abuse in a health benefits program funded in whole or in part
by Federal funds, when disclosure is deemed reasonably necessary by HHS
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 PCIP information for the purpose of
combating fraud, waste or abuse in such Federally-funded programs.
6. To assist appropriate Federal agencies and Department
contractors that have a need to know the information for the purpose of
assisting the Department's efforts to respond to a suspected or
confirmed breach of the security or confidentiality of information
maintained in this system of records, and the information disclosed is
relevant and unnecessary for the assistance. Other agencies may require
PCIP information for the purpose of assisting the Department's efforts
to respond to a suspected or confirmed breach of the security or
confidentiality of information maintained in this system of records.
B. Additional Circumstances Affecting Routine Use Disclosures
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 individual).
IV. Safeguards
HHS has safeguards in place for authorized users and monitors such
users to ensure against 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 and HHS policies and standards as they relate
to information security and data privacy. These laws and regulations
include 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 E-Government Act of 2002, and the Clinger-Cohen
Act of 1996; OMB Circular A-130, Management of Federal Resources,
Appendix III, Security of Federal Automated Information Resources also
applies. Federal and HHS policies and standards include but are not
limited to: all pertinent National Institute of Standards and
Technology publications; and the HHS Information Systems Program
Handbook.
V. Effects of the New System on the Rights of Individuals
HHS 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.
[[Page 38529]]
We will only disclose the minimum personal data necessary to achieve
the purpose of PCIP. Disclosure of information from the system will be
approved only to the extent necessary to accomplish the purpose of the
disclosure.
HHS 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. HHS will collect only
that information necessary to perform the system's functions. In
addition, HHS 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.
HHS, therefore, does not anticipate an unfavorable effect on
individual privacy as a result of the disclosure of information
relating to individuals.
Dated: June 25, 2010.
Richard Popper,
Deputy Director.
SYSTEM NUMBER:
09-90-0275.
System Name:
``Pre-Existing Condition Insurance Plan (PCIP),'' OCIIO, OS/HHS.
Security Classification:
None.
System Location:
Office of Consumer Information and Insurance Oversight, U.S.
Department of Health & Human Services, 200 Independence Avenue, SW.,
Suite 738F, Washington, DC 20201.
Categories of Individuals Covered by the System:
Information in this system is maintained on individuals who apply
to enroll in the Pre-Existing Condition Insurance Plan.
Categories of Records in the System:
Information in this system is maintained on individuals who enroll
in the Pre-Existing Condition Insurance Plan. Information maintained in
this system includes, but is not limited to, the applicant's first
name, last name, middle initial, mailing address or permanent
residential address (if different than the mailing address), date of
birth, Social Security Number (if the applicant has one), gender, email
address, telephone number. The system will also maintain information to
make a decision about an applicant's eligibility. We collect and
maintain information that the applicant submits pertaining to (1) his
or her citizenship or immigration status, since only individuals who
are citizens or nationals of the U.S. or lawfully present are eligible
to enroll; (2) coverage an individual had during the prior twelve
months from the date of application in order to establish that such
individual has been without creditable coverage for at least six months
are eligible to enroll and to assess whether insurers are discouraging
an individual from remaining enrolled in prior coverage due to health
status; and (3) an insurance company's denial of coverage, offer of
coverage with a medical condition exclusion rider, or, for an applicant
is guaranteed an offer of coverage, coverage that is medically
underwritten. Information will also be maintained with respect to the
applicant's premium amount and payment history.
Authority for Maintenance of the System:
Authority for the collection, maintenance, and disclosures from
this system is given under provisions of Section 1101 of the Patient
Protection and Affordable Care Act (Pub. L. 111-148).
Purpose(s) of the System:
The purpose of this system of records is to collect and maintain
information on individuals who apply for enrollment in the program.
This information will enable HHS acting through NFC, OPM, and any
third-party administrator(s) to determine applicants' eligibility,
enroll eligible individuals into the program, adjudicate appeals of
eligibility and coverage determinations, bill and collect premium
payments, and process and pay claims for covered health care items and
services furnished to eligible individuals. Information maintained in
this system will also be disclosed to: (1) Support regulatory,
reimbursement, and policy functions performed by an HHS contractor,
consultant or grantee; (2) assist another Federal or State agency,
agency of a State government, an agency established by State law, or
its fiscal agent; (3) support litigation involving the Department; (4)
combat fraud and abuse in certain health benefits programs; and (5)
assist efforts to respond to a suspected or confirmed breach of the
security or confidentiality of information maintained in this system of
records.
Routine Uses of Records Maintained in the System, Including Categories
or Users and the Purposes of Such Uses:
B. Entities Who May Receive Disclosures Under Routine Use
These routine uses specify circumstances, in addition to those
provided by statute in the Privacy Act of 1974, under which HHS may
release information from the PCIP without the consent of the individual
to whom such information pertains. Each proposed disclosure of
information under these routine uses will be evaluated to ensure that
the disclosure is legally permissible, including but not limited to
ensuring that the purpose of the disclosure is compatible with the
purpose for which the information was collected. We propose to
establish the following routine use disclosures of information
maintained in the system:
1. To support HHS contractors, consultants, or HHS grantees who
have been engaged by HHS to assist in accomplishment of an HHS function
relating to the purposes for this SOR and who need to have access to
the records in order to assist HHS.
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 HHS to determine applicants' eligibility
for the Pre-existing Condition Insurance Plan, enroll eligible
individuals into the plan, adjudicate appeals of eligibility and
coverage determinations, bill and collect premium payments, and process
and pay claims for covered health care items and services furnished to
eligible individuals.
3. To support the Department of Justice (DOJ), court, or
adjudicatory body when:
e. The Department or any component thereof, or
f. Any employee of HHS in his or her official capacity, or
g. Any employee of HHS in his or her individual capacity where the
DOJ has agreed to represent the employee, or
h. The United States Government, is a party to litigation or has an
interest in such litigation, and by careful review, HHS 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.
4. To assist an HHS contractor that assists in the administration
of an HHS-administered health benefits program, or to a grantee of an
HHS-administered grant program, when disclosure is deemed reasonably
necessary by HHS 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.
[[Page 38530]]
5. To assist another Federal agency or to an instrumentality of any
governmental jurisdiction within or under the control of the United
States (including any state or local governmental agency), that
administers, or that has the authority to investigate potential fraud,
waste or abuse in a health benefits program funded in whole or in part
by Federal funds, when disclosure is deemed reasonably necessary by HHS
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 assist appropriate Federal agencies and Department
contractors that have a need to know the information for the purpose of
assisting the Department's efforts to respond to a suspected or
confirmed breach of the security or confidentiality of information
maintained in this system of records, and the information disclosed is
relevant and unnecessary for the assistance.
C. Additional Circumstances Affecting Routine Use Disclosures
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:
We will be storing records in hardcopy files and various electronic
storage media (including DB2, Oracle, and other relational data
structures).
Retrievability:
Information is most frequently retrieved by first name, last name,
middle initial, date of birth, or Social Security Number (SSN).
Safeguards:
HHS has safeguards in place for authorized users and monitors such
users to ensure against 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 and HHS policies and standards as they relate
to information security and data privacy. These laws and regulations
include 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 E-Government Act of 2002, and the Clinger-Cohen
Act of 1996; OMB Circular A-130, Management of Federal Resources,
Appendix III, Security of Federal Automated Information Resources also
applies. Federal and HHS policies and standards include but are not
limited to: all pertinent National Institute of Standards and
Technology publications; and the HHS Information Systems Program
Handbook.
Retention and Disposal:
Records are maintained with identifiers for all transactions after
they are entered into the system for a period of 10 years. Records are
housed in both active and archival files in accordance with HHS data
and document management policies and standards.
System Manager and Address:
Anthony Culotta, High Risk Pool Program Division, Office of
Insurance Programs, Office of Consumer Information and Insurance
Oversight, U.S. Department of Health & Human Services, 200 Independence
Avenue, SW., Suite 738F, Washington, DC 20201.
Notification Procedure:
For purpose of notification, the subject individual should write to
the system manager who will require the system name, and the retrieval
selection criteria (e.g., name, SSN, etc.).
Record Access Procedure:
For purpose of access, use the same procedures outlined in
Notification Procedures above. Requestors should also reasonably
specify the record contents being sought. (These procedures are in
accordance with Department regulation 45 CFR 5b.5(a)(2)).
Contesting Record Procedures:
The subject individual should contact the system manager named
above, and reasonably identify the record and specify the information
to be contested. State the corrective action sought and the reasons for
the correction with supporting justification. (These procedures are in
accordance with Department regulation 45 CFR 5b.7).
Record Source Categories:
Record source categories include applicants who voluntarily submit
data and personal information for the PCIP program.
Systems Exempted From Certain Provisions of the Act:
None.
[FR Doc. 2010-16167 Filed 7-1-10; 8:45 am]
BILLING CODE 4150-65-P