Privacy Act of 1974; Report of a New System of Records, 21373-21378 [2011-9105]
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Federal Register / Vol. 76, No. 73 / Friday, April 15, 2011 / Notices
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II. Criteria for Applicants
We are seeking eligible organizations
which are a subsection (d) hospital, as
defined in section 1886(d)(1)(B) of the
Social Security Act (the Act), with high
readmission rates that partner with
community-based organizations (CBOs)
or CBOs that provide care transition
services. CBOs are defined as
community-based organizations that
provide care transition services across
the continuum of care through
arrangements with subsection (d)
hospitals and whose governing bodies
include sufficient representation of
multiple health care stakeholders,
including consumers.
This program creates a source of
funding for care transition services that
effectively manage transitions from
acute to community-based settings and
report specified process and outcome
measures on their results. CBOs will be
paid on a per eligible discharge basis for
eligible Medicare beneficiaries at high
risk for readmission, including those
with multiple chronic conditions,
depression, or cognitive impairments.
In selecting CBOs to participate in the
program, preference will be given to
eligible entities that are Administration
on Aging (AoA) grantees that provide
concurrent care transition interventions
with multiple hospitals and
practitioners or entities that provide
services to medically-underserved
populations, small communities, and
rural areas. The program will run for 5
years beginning April 11, 2011;
however, participants will be awarded
2-year agreements that may be extended
on an annual basis for the remaining 3
years based on performance.
Applicants must identify root causes
of readmissions and define their target
population and strategies for identifying
high risk patients. Applicants must also
specify care transition interventions
including strategies for improving
provider communications in care
transitions and improving patient
activation. Lastly, applicants will be
required to provide a budget including
a per eligible discharge rate for care
transition services, provide an
implementation plan with milestones,
and demonstrate prior experience with
effectively managing care transition
services and reducing readmissions.
A competitive process will be used to
select eligible organizations. We will
accept proposals on a rolling basis. The
program will continue through 2015.
For specific details regarding the
CCTP and the application process,
please refer to the solicitation on the
CMS Web site at https://www.cms.gov/
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DemoProjectsEvalRpts/MD/
itemdetail.asp?itemID=CMS1239313.
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
III. Application Information
Centers for Medicare & Medicaid
Services
Please refer to file code [CMS–5055–
N2] on the application. Proposals (an
unbound original and 3 copies plus an
electronic copy on CD–ROM) must be
typed for clarity and should not exceed
30 double-spaced pages, exclusive of
cover letter, the executive summary,
resumes, forms, and supporting
documentation. Because of staffing and
resource limitations, we cannot accept
proposals by facsimile (FAX)
transmission. Applicants may, but are
not required to, submit a total of 10
copies to assure that each reviewer
receive a proposal in the manner
intended by the applicant (for example,
collated, tabulated color copies). Hard
copies and electronic copies must be
identical.
IV. Eligible Organizations
As discussed above, subsection (d)
hospitals with high readmission rates
that partner with CBOs or CBOs that
provide care transition services are
eligible to participate in the CCTP. We
anticipate that a wide variety of
interested parties may be eligible to
form a CBO in order to apply in
collaboration with other organizations
to perform the responsibilities specified.
CBOs may be characterized as physician
practices, particularly primary care
practices, a corporate entity that has a
separate quality improvement
organization (QIO) contract with CMS
under Part B of title XI of the Act, in
situations that will not result in or
create the appearance of a conflict of
interest between the QIO’s review tasks
under title XI and the corporate entity’s
role as a CBO, an Aging and Disability
Resource Center, Area Agency on Aging,
or other appropriate organization that
meets the statutory definition at section
3026(b)(1)(B) of the Act.
Authority: Catalog of Federal Domestic
Assistance Program No. 93.773, Medicare—
Hospital Insurance; and Program No. 93.774,
Medicare—Supplementary Medical
Insurance Program.
Dated: December 27, 2010.
Donald M. Berwick,
Administrator, Centers for Medicare &
Medicaid Services.
[FR Doc. 2011–9126 Filed 4–12–11; 11:15 am]
BILLING CODE 4120–01–P
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Privacy Act of 1974; Report of a New
System of Records
Center for Consumer
Information and Insurance Oversight
(CCIIO), Centers for Medicare and
Medicaid Services (CMS), Department
of Health and Human Services (HHS).
ACTION: Notice of a new Privacy Act
system of records.
AGENCY:
In accordance with the
requirements of the Privacy Act of 1974,
the Centers for Medicare and Medicaid
Services (CMS), Center for Consumer
Information and Insurance Oversight
(CCIIO) is establishing a new system of
records (SOR) titled the ‘‘Health
Insurance Assistance Database (HIAD),’’
System No. 09–70–0586. This SOR is
established under the authority of
Sections 2719, 2723, and 2761 of the
Public Health Service Act (PHS Act)
(Public Law (Pub. L.) 97–35) and
§ 1321(c) of the Patient Protection and
Affordable Care Act (Affordable Care
Act) (Pub. L. 111–148). Section 1321(c)
of the Affordable Care Act authorizes
HHS (1) to ensure that States with
Exchanges are substantially enforcing
the Federal standards to be set for the
Exchanges and (2) to set up Exchanges
in States that elect not to do so or are
not substantially enforcing related
provisions. Sections 2723 and 2761 of
the PHS Act authorize HHS to enforce
provisions that apply to non-Federal
governmental plans and to enforce PHS
Act provisions that apply to other health
insurance coverage in States that HHS
has determined are not substantially
enforcing those provisions. The HIAD
database will be maintained by the
Office of Consumer Support Health
Insurance Assistance Team (the Team)
to assist the Office of Oversight with its
compliance activities. HIAD is the
primary tool through which the Team
will track information for the purposes
of oversight.
The primary purpose of this system is
to collect and maintain information on
consumer inquiries and complaints
regarding insurance issuers that will
permit CCIIO to exercise its direct
enforcement authority over non-Federal
governmental health plans, investigate
any inquiries or complaints from
enrollees of those plans, to determine
which States may not be substantially
enforcing the Affordable Care Act and
PHS Act provisions and to determine
whether complaints that indicate
SUMMARY:
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possible noncompliance with Federal
law are resolved by the plans. In
addition, information maintained will
enable CCIIO to develop aggregate
reports that will inform CMS and HHS
about compliance issues. Information in
this system will also be disclosed to: (1)
Support regulatory and programmatic
activities such as investigations and
reporting activities performed by an
Agency contractor, consultants, CMS
grantees, student volunteers, interns and
other workers who do not have the
status of Federal employees; (2) assist
another Federal and/or State agency,
agency of a State government, or an
agency established by State law; (3)
support litigation involving the Agency;
(4) combat fraud, waste, and abuse in
certain health benefits programs, and (5)
assist in a response to a suspected or
confirmed breach of the security or
confidentiality of information. We have
provided background information about
this new 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 information about the
comment period.
DATES: Effective Dates: CMS 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 & Governmental Affairs, and
the Administrator, Office of Information
and Regulatory Affairs, Office of
Management and Budget (OMB) on
April 11, 2011. To ensure that all parties
have adequate time in which to
comment, the new system, including
routine uses, will become effective 30
days from the publication of the notice,
or 40 days from the date it was
submitted to OMB and Congress,
whichever is later, unless CMS receives
comments that require alterations to this
notice.
ADDRESSES: The public should address
comments to: CMS Privacy Officer,
Division of Information Security and
Privacy Management, Enterprise
Architecture and Strategy Group, Office
of Information Services, CMS, Room
N1–24–08, 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: Mr.
Paul Tibbits, Team Leader, Health
Insurance Assistance Team, Office of
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Consumer Support, Center for
Consumer Information and Insurance
Oversight, Centers for Medicare and
Medicaid Services, 7500 Security
Boulevard, Baltimore, Maryland 21244.
His telephone number is 301–492–4229
or via e-mail at paul.tibbits@hhs.gov.
SUPPLEMENTARY INFORMATION: CCIIO has
direct enforcement authority over nonFederal governmental health plans, and
any inquiries or complaints from
enrollees of those plans will be logged
into this database for the purpose of
following up to determine whether
complaints that indicate possible
noncompliance with Federal law are
resolved by the plans. In addition,
consumer inquiries and complaints
regarding insurance issuers will be
logged into the database in order to help
CCIIO determine which States may not
be substantially enforcing Affordable
Care Act and PHS Act provisions, and,
in the event Federal enforcement is
necessary, in order to follow up to
determine whether complaints that
indicate possible noncompliance with
Federal law are resolved by the issuers.
Section 1321(c) of the Affordable Care
Act authorizes HHS (1) to ensure that
States with Exchanges are substantially
enforcing the Federal standards to be set
for the Exchanges and (2) to set up
Exchanges in States that elect not to do
so or are not substantially enforcing
related provisions. Sections 2723 and
2761 of the PHS Act authorize HHS to
enforce PHS Act provisions that apply
to non-Federal governmental plans and
to enforce PHS Act provisions that
apply to other health insurance coverage
in States that HHS has determined are
not substantially enforcing those
provisions.
The database will be maintained by
the Team to help CCIIO Office of
Oversight with its compliance activities
under the Affordable Care Act and PHS
Act. Consumer inquiries and complaints
addressed by the Team will help CCIIO
conduct direct enforcement over nonFederal governmental health plans; the
database will also help CCIIO determine
which States are not substantially
enforcing PHS Act provisions under
HHS’s Federal fallback authority in
sections 2723 and 2761 of the PHS Act.
In the course of its work, the Team
will: (1) Receive consumer inquiries; (2)
respond to consumer inquiries in order
to obtain the necessary information to
determine the best course of action; (3)
refer consumers to appropriate entities;
and (4) when appropriate, gather
information about consumers in order to
assist CCIIO oversight capacity.
When responding to consumer
contacts, the Team will pursue one of
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the following courses of action: (1) If it
is determined that the consumer is
covered by a non-Federal governmental
plan, the Team will obtain enough
information to determine whether the
case merits referral to the Office of
Oversight; (2) if it is determined that
jurisdiction over a consumer’s case lies
with another entity, the Team will refer
consumers to that entity, such as a State
insurance department, the U.S.
Department of Labor, or a State
Consumer Assistance Program; or (3) if
it is determined that the consumer seeks
to file an appeal in a State or territory
without an external appeals process in
place, the Team will refer the consumer
to the appropriate entity carrying out
the Federal external appeals process.
As mentioned, the system will be
used to create reports regarding the
types of consumer inquiries and
Affordable Care Act and PHS Act
compliance issues that are brought to
the attention of CCIIO by consumers.
These reports will assist the Office of
Oversight in identifying areas where
compliance concerns may arise, and
will be stripped of any information in
identifiable form (IIF) and personal
health information when written and
prepared.
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 provided under provisions of
§§ 2719, 2723, and 2761 of the Public
Health Service Act (PHS Act) (Pub. L.
97–35) and § 1321(c) of the Patient
Protection and Affordable Care Act
(AFFORABLE CARE ACT) (Pub. L.
111—148).
B. Collection and Maintenance of Data
in the System
The Health Insurance Assistance
Database (HIAD) contains information
on individuals who contact CCIIO’s
Health Insurance Assistance Team,
complainants or other individuals with
health insurance issues. The HIAD
contains the name, address, State of
residence and zip code; contact
information such as telephone numbers,
e-mail address, demographic
information such as age, gender,
ethnicity, family status, employment
status, income level and veteran’s
status; and health insurance
identification number, health insurance
status, background, recent history and
available options.
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II. Agency Policies, Procedures, and
Restrictions on Routine Uses
III. Proposed Routine Use Disclosures
of Data in the System
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 information collected in the
HIAD that can be associated with an
individual as provided for under
‘‘Section III. Proposed Routine Use
Disclosures of Data in the System.’’
Identifiable data may be disclosed under
a routine use.
CMS 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
CMS:
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 on consumer inquiries and
complaints regarding insurance issuers
that will permit CCIIO to exercise its
direct enforcement authority over nonFederal governmental health plans, if
CMS;
2. Determines that:
a. the purpose of the disclosure can
only be accomplished if the record is
provided in an 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
provider 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.
A. Entities Who May Receive Disclosure
Under Routine Use
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These routine uses specify
circumstances, in addition to those
provided by statute in the Privacy Act
of 1974, under which CMS may release
information from the HIAD 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 Agency contractors,
consultants, CMS grantees, student
volunteers, interns and other workers
who do not have the status of Federal
employees, and who have been engaged
by the Agency to assist in
accomplishment of a CMS function
relating to the purposes for this SOR
and who need to have 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 SOR.
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, CMS
grantees, student volunteers, interns and
other workers who do not have the
status of Federal employees whatever
information is necessary for the
contractor or consultant to fulfill its
duties. In these situations, safeguards
are provided in the contract prohibiting
the contractor, consultant, CMS
grantees, student volunteers, interns and
other workers who do not have the
status of Federal employees from using
or disclosing the information for any
purpose other than that described in the
contract and requires the contractor,
consultant, CMS grantees, student
volunteers, interns and other workers
who do not have the status of Federal
employees 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, or
an agency established by State law
pursuant to agreements with CMS to:
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a. Increase consumer assistance and
accessibility to health care coverage by
identifying insurer noncompliance with
Federal, State and other applicable law,
and
b. Assist Federally funded health
insurance programs in administering
functions tasked to them pursuant to the
Affordable Care Act and other relevant
Federal and State laws which may
require CCIIO Program information
related to this system.
c. Assist other Federal/State agencies
that have the authority to perform
collection of debts owed to the Federal
government.
State Departments of Insurance can
achieve greater regulation and oversight
of the health insurance industry and
strengthen enforcement in areas where
problems arise by identifying trends and
patterns in consumer inquiries and
complaints.
The Internal Revenue Service (IRS),
Department of the Treasury, can use
CCIIO information for the purpose of
resolving difficulties with obtaining
premium tax credits under 36B of the
Internal Revenue Code (IRC) of 1986
and to understand the consumer needs
leading to the State health insurance
Exchanges starting in 2014.
Federal, State, and local law
enforcement agencies and private
security contractors, may require CCIIO
information to protect CCIIO employees
and customers, provide security for
CCIIO facilities or to assist
investigations or prosecutions with
respect to activities that affect such
safety and security or activities that
disrupts the operation of CCIIO
operations and facilities.
3. To support the Department of
Justice (DOJ), court, or adjudicatory
body when:
a. the Agency or any component
thereof, or
b. any employee of the Agency in his
or her official capacity, or
c. any employee of the Agency in his
or her individual capacity where the
DOJ has agreed to represent the
employee, or
d. the United States Government,
is a party to litigation or has an interest
in such litigation, and by careful review,
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
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by the outcome of the litigation, HHS
would be able to disclose information to
the DOJ, court, or adjudicatory body
involved.
4. To assist a CMS contractor
(including, but not limited to Medicare
Administrative Contractors, fiscal
intermediaries, and carriers) that assists
in the administration of a CMSadministered health benefits program,
or to a grantee of a CMS-administered
grant program, when disclosure is
deemed reasonably necessary by CMS to
prevent, deter, discover, detect,
investigate, examine, prosecute, sue
with respect to, defend against, correct,
remedy, or otherwise combat fraud,
waste or abuse in such program.
We contemplate disclosing
information under this routine use only
in situations in which CMS may enter
into a contract or grant with a third
party to assist in accomplishing CMS
functions relating to the purpose of
combating fraud, waste or 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 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 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 CCIIO
Program 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
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of records, and the information
disclosed is relevant and unnecessary
for the assistance.
Other Federal agencies and
contractors may require CCIIO Program
information for the purpose of assisting
in a respond to a suspected or
confirmed breach of the security or
confidentiality of information.
IV. Safeguards
CMS 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, HHS, and CMS 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
Health Insurance Portability and
Accountability Act of 1996; the E–
Government Act of 2002, the ClingerCohen Act of 1996; the Medicare
Modernization Act of 2003, and the
corresponding implementing
regulations. OMB Circular A–130,
Management of Federal Resources,
Appendix III, Security of Federal
Automated Information Resources also
applies. Federal, HHS, and CMS
policies and standards include but are
not limited to: all pertinent National
Institute of Standards and Technology
publications; the HHS Information
Systems Program Handbook and the
CMS Information Security Handbook.
V. Effects of the New System on the
Rights of Individuals
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.
We will only disclose the minimum
personal data necessary to achieve the
purpose of the data collection and the
routine uses contained in this notice.
Disclosure of information from the
system will be approved only to the
extent necessary to accomplish the
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purpose of the disclosure. CMS has
assigned a higher level of security
clearance for the information
maintained in this system in an effort to
provide added security and protection
of data in this system.
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.
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 the
disclosure of information relating to
individuals.
Dated: March 18, 2011.
Steve Larsen,
Director, Center for Consumer Information
and Insurance Oversight, Centers for
Medicare & Medicaid Services.
SYSTEM NUMBER:
09–70–0586.
SYSTEM NAME:
‘‘Health Insurance Assistance
Database’’ (HIAD), HHS/CMS/CCIIO.
SECURITY CLASSIFICATION:
Level Three Privacy Act Sensitive.
SYSTEM LOCATION:
CMS Data Center, 7500 Security
Boulevard, North Building, First Floor,
Baltimore, Maryland 21244–1850 and at
various contractor sites.
Center for Consumer Information and
Insurance Oversight, Centers for
Medicare and Medicaid Services, U.S.
Department of Health & Human
Services, Triple-I Core Site, 12100
Sunrise Valley Drive, Reston, Virginia
20191.
CATEGORIES OF INDIVIDUALS COVERED BY THE
SYSTEM:
Information in this system is
maintained on individuals who contact
the CCIIO Health Insurance Assistance
Team, complainants or other
individuals with health insurance
issues.
CATEGORIES OF RECORDS IN THE SYSTEM:
The HIAD contains the name, address,
State of residence and zip code; contact
information such as telephone numbers,
e-mail address, demographic
information such as age, gender,
ethnicity, family status, employment
status, income level and veteran’s
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status; and health insurance
identification number, health insurance
status, background, recent history and
available options.
AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
Authority for the collection,
maintenance, and disclosures from this
system is provided under provisions of
§§ 2719, 2723, and 2761 of the Public
Health Service Act (PHS Act) (Public
Law (Pub. L.) 97–35) and § 1321(c) of
the Patient Protection and Affordable
Care Act (Affordable Care Act) (Pub. L.
111–148).
PURPOSE(S) OF THE SYSTEM:
The primary purposes of this system
is to collect and maintain information
on consumer inquiries and complaints
regarding insurance issuers that will
permit CCIIO to exercise its direct
enforcement authority over non-Federal
governmental health plans, investigate
any inquiries or complaints from
enrollees of those plans, to determine
which States may not be substantially
enforcing the Affordable Care Act and
PHS Act provisions and to determine
whether complaints that indicate
possible noncompliance with Federal
law are resolved by the plans. In
addition, information maintained will
enable CCIIO to develop aggregate
reports that will inform CMS and HHS
about compliance issues. Information in
this system will also be disclosed to: (1)
Support regulatory and programmatic
activities such as investigations and
reporting activities performed by an
Agency contractor, consultants, CMS
grantees, student volunteers, interns and
other workers who do not have the
status of Federal employees; (2) assist
another Federal and/or State agency,
agency of a State government, or an
agency established by State law; (3)
support litigation involving the Agency;
(4) combat fraud, waste, and abuse in
certain health benefits programs, and (5)
assist in a response to a suspected or
confirmed breach of the security or
confidentiality of information.
srobinson on DSKHWCL6B1PROD with NOTICES
I. PROPOSED ROUTINE USES OF RECORDS
MAINTAINED IN THE SYSTEM, INCLUDING
CATEGORIES OR USERS AND THE PURPOSES OF
SUCH USES:
B. Entities Who May Receive
Disclosure Under Routine Use
These routine uses specify
circumstances, in addition to those
provided by statute in the Privacy Act
of 1974, under which CMS may release
information from the HIAD 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
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16:58 Apr 14, 2011
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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:
3. To support Agency contractors,
consultants, CMS grantees, student,
volunteers, interns and other workers
who do not have the status of Federal
employees, who have been engaged by
the Agency to assist in accomplishment
of a CMS function relating to the
purposes for this SOR and who need to
have access to the records in order to
assist CMS.
4. To assist another Federal or State
agency, agency of a State government, or
an agency established by State law
pursuant to agreements with CMS to:
a. Increase consumer assistance and
accessibility to health care coverage by
identifying insurer noncompliance with
Federal, State and other applicable law,
and
b. Assist Federally funded health
insurance programs in administering
functions tasked to them pursuant to the
Affordable Care Act and other relevant
Federal and State laws which may
require CCIIO Program information
related to this system.
c. Assist other Federal/State agencies
that have the authority to perform
collection of debts owed to the Federal
government.
5. To support the Department of
Justice (DOJ), court, or adjudicatory
body when:
e. The Agency or any component
thereof, or
f. Any employee of the Agency in his
or her official capacity, or
g. Any employee of the Agency 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, 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.
6. To assist a CMS contractor
(including, but not limited to Medicare
Administrative Contractors, fiscal
intermediaries, and carriers) that assists
in the administration of a CMSadministered health benefits program,
or to a grantee of a CMS-administered
grant program, when disclosure is
deemed reasonably necessary by CMS to
prevent, deter, discover, detect,
investigate, examine, prosecute, sue
PO 00000
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Fmt 4703
Sfmt 4703
21377
with respect to, defend against, correct,
remedy, or otherwise combat fraud,
waste or abuse in such program.
7. To assist another Federal agency or
to an instrumentality of any
governmental jurisdiction within or
under the control of the United States
(including any State or local
governmental agency), that administers,
or that has the authority to investigate
potential fraud, waste or abuse in a
health benefits program funded in
whole or in part by Federal funds, when
disclosure is deemed reasonably
necessary by CMS to prevent, deter,
discover, detect, investigate, examine,
prosecute, sue with respect to, defend
against, correct, remedy, or otherwise
combat fraud, waste or abuse in such
programs.
8. 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.
II. SAFEGUARDS:
CMS 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, HHS, and CMS 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
Health Insurance Portability and
Accountability Act of 1996; the EGovernment Act of 2002, the ClingerCohen Act of 1996; the Medicare
Modernization Act of 2003, and the
corresponding implementing
regulations. OMB Circular A–130,
Management of Federal Resources,
Appendix III, Security of Federal
Automated Information Resources also
E:\FR\FM\15APN1.SGM
15APN1
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Federal Register / Vol. 76, No. 73 / Friday, April 15, 2011 / Notices
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.
POLICIES AND PRACTICES FOR STORING,
RETRIEVING, ACCESSING, RETAINING, AND
DISPOSING OF RECORDS IN THE SYSTEM:
STORAGE:
Records are maintained electronically
in the CCIIO developed database for
collection, tracking and storage of
casework information and for reporting
purposes. Any manually maintained
records will be kept in locked cabinets
or otherwise secured areas.
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 identifying information contained
in these records is provided voluntarily
by the individual consumers,
confidential informants, or by reports
received from other sources . Additional
case-relevant information may also be
provided by the individual’s employer
or insurer to assist in achieving
resolution of the specific case.
SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS
OF THE ACT:
None.
RETRIEVABILITY:
[FR Doc. 2011–9105 Filed 4–14–11; 8:45 am]
RETENTION AND DISPOSAL:
Food and Drug Administration
SYSTEM MANAGER(S) AND ADDRESS:
Team Lead, Health Insurance
Assistance Team, Office of Consumer
Support, Center for Consumer
Information and Insurance Oversight,
Centers for Medicare and Medicaid
Services, 7500 Security Boulevard,
Baltimore, Maryland 21244.
srobinson on DSKHWCL6B1PROD with NOTICES
Agency Information Collection
Activities; Proposed Collection;
Comment Request; Request for
Designation as Country Not Subject to
the Restrictions Applicable to Human
Food and Cosmetics Manufactured
From, Processed With, or Otherwise
Containing, Material From Cattle
Food and Drug Administration,
Notice.
The Food and Drug
Administration (FDA) is announcing an
opportunity for public comment on the
proposed collection of certain
information by the Agency. Under the
Paperwork Reduction Act of 1995 (the
PRA), Federal Agencies are required to
publish notice in the Federal Register
concerning each proposed collection of
information, including each proposed
extension of an existing collection of
information, and to allow 60 days for
public comment in response to the
notice. This notice solicits comments on
the information collection provisions of
existing FDA regulations regarding
countries seeking to be designated as
not subject to certain bovine spongiform
encephalopathy (BSE)-related
restrictions applicable to FDA-regulated
human food and cosmetics.
DATES: Submit either electronic or
written comments on the collection of
information by June 14, 2011.
SUMMARY:
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
Jkt 223001
[Docket No. FDA–2011–N–0264]
ACTION:
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, health insurance
claim number, SSN, etc.).
16:58 Apr 14, 2011
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
HHS.
NOTIFICATION PROCEDURE:
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BILLING CODE 4120–03–P
AGENCY:
PO 00000
FOR FURTHER INFORMATION CONTACT:
Denver Presley, Jr., Office of Information
Management, Food and Drug
Administration, 1350 Piccard Dr., PI50–
400B, Rockville, MD 20850, 301–796–
3793.
Under the
PRA (44 U.S.C. 3501–3520), Federal
Agencies must obtain approval from the
Office of Management and Budget
(OMB) for each collection of
information they conduct or sponsor.
‘‘Collection of information’’ is defined in
44 U.S.C. 3502(3) and 5 CFR 1320.3(c)
and includes Agency requests or
requirements that members of the public
submit reports, keep records, or provide
information to a third party. Section
3506(c)(2)(A) of the PRA (44 U.S.C.
3506(c)(2)(A)) requires Federal Agencies
to provide a 60-day notice in the
Federal Register concerning each
proposed collection of information,
including each proposed extension of an
existing collection of information,
before submitting the collection to OMB
for approval. To comply with this
requirement, FDA is publishing notice
of the proposed collection of
information set forth in this document.
With respect to the following
collection of information, FDA invites
comments on these topics: (1) Whether
the proposed collection of information
is necessary for the proper performance
of FDA’s functions, including whether
the information will have practical
utility; (2) the accuracy of FDA’s
estimate of the burden of the proposed
collection of information, including the
validity of the methodology and
assumptions used; (3) ways to enhance
the quality, utility, and clarity of the
information to be collected; and (4)
ways to minimize the burden of the
collection of information on
respondents, including through the use
of automated collection techniques,
when appropriate, and other forms of
information technology.
SUPPLEMENTARY INFORMATION:
The records are retrieved
electronically by a variety of fields,
including but not limited to name, State,
zip code, and health insurance
identification number issued to the
individual.
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. All claimsrelated records are encompassed by the
document preservation order and will
be retained until notification is received
from the Department of Justice.
Submit electronic
comments on the collection of
information to https://
www.regulations.gov. Submit written
comments on the collection of
information to the Division of Dockets
Management (HFA–305), Food and Drug
Administration, 5630 Fishers Lane, rm.
1061, Rockville, MD 20852. All
comments should be identified with the
docket number found in brackets in the
heading of this document.
ADDRESSES:
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15APN1
Agencies
[Federal Register Volume 76, Number 73 (Friday, April 15, 2011)]
[Notices]
[Pages 21373-21378]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-9105]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
Privacy Act of 1974; Report of a New System of Records
AGENCY: Center for Consumer Information and Insurance Oversight
(CCIIO), Centers for Medicare and Medicaid Services (CMS), Department
of Health and Human Services (HHS).
ACTION: Notice of a new Privacy Act system of records.
-----------------------------------------------------------------------
SUMMARY: In accordance with the requirements of the Privacy Act of
1974, the Centers for Medicare and Medicaid Services (CMS), Center for
Consumer Information and Insurance Oversight (CCIIO) is establishing a
new system of records (SOR) titled the ``Health Insurance Assistance
Database (HIAD),'' System No. 09-70-0586. This SOR is established under
the authority of Sections 2719, 2723, and 2761 of the Public Health
Service Act (PHS Act) (Public Law (Pub. L.) 97-35) and Sec. 1321(c) of
the Patient Protection and Affordable Care Act (Affordable Care Act)
(Pub. L. 111-148). Section 1321(c) of the Affordable Care Act
authorizes HHS (1) to ensure that States with Exchanges are
substantially enforcing the Federal standards to be set for the
Exchanges and (2) to set up Exchanges in States that elect not to do so
or are not substantially enforcing related provisions. Sections 2723
and 2761 of the PHS Act authorize HHS to enforce provisions that apply
to non-Federal governmental plans and to enforce PHS Act provisions
that apply to other health insurance coverage in States that HHS has
determined are not substantially enforcing those provisions. The HIAD
database will be maintained by the Office of Consumer Support Health
Insurance Assistance Team (the Team) to assist the Office of Oversight
with its compliance activities. HIAD is the primary tool through which
the Team will track information for the purposes of oversight.
The primary purpose of this system is to collect and maintain
information on consumer inquiries and complaints regarding insurance
issuers that will permit CCIIO to exercise its direct enforcement
authority over non-Federal governmental health plans, investigate any
inquiries or complaints from enrollees of those plans, to determine
which States may not be substantially enforcing the Affordable Care Act
and PHS Act provisions and to determine whether complaints that
indicate
[[Page 21374]]
possible noncompliance with Federal law are resolved by the plans. In
addition, information maintained will enable CCIIO to develop aggregate
reports that will inform CMS and HHS about compliance issues.
Information in this system will also be disclosed to: (1) Support
regulatory and programmatic activities such as investigations and
reporting activities performed by an Agency contractor, consultants,
CMS grantees, student volunteers, interns and other workers who do not
have the status of Federal employees; (2) assist another Federal and/or
State agency, agency of a State government, or an agency established by
State law; (3) support litigation involving the Agency; (4) combat
fraud, waste, and abuse in certain health benefits programs, and (5)
assist in a response to a suspected or confirmed breach of the security
or confidentiality of information. We have provided background
information about this new 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 information about the comment period.
DATES: Effective Dates: CMS 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 & Governmental Affairs, and
the Administrator, Office of Information and Regulatory Affairs, Office
of Management and Budget (OMB) on April 11, 2011. To ensure that all
parties have adequate time in which to comment, the new system,
including routine uses, will become effective 30 days from the
publication of the notice, or 40 days from the date it was submitted to
OMB and Congress, whichever is later, unless CMS receives comments that
require alterations to this notice.
ADDRESSES: The public should address comments to: CMS Privacy Officer,
Division of Information Security and Privacy Management, Enterprise
Architecture and Strategy Group, Office of Information Services, CMS,
Room N1-24-08, 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: Mr. Paul Tibbits, Team Leader, Health
Insurance Assistance Team, Office of Consumer Support, Center for
Consumer Information and Insurance Oversight, Centers for Medicare and
Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244.
His telephone number is 301-492-4229 or via e-mail at
paul.tibbits@hhs.gov.
SUPPLEMENTARY INFORMATION: CCIIO has direct enforcement authority over
non-Federal governmental health plans, and any inquiries or complaints
from enrollees of those plans will be logged into this database for the
purpose of following up to determine whether complaints that indicate
possible noncompliance with Federal law are resolved by the plans. In
addition, consumer inquiries and complaints regarding insurance issuers
will be logged into the database in order to help CCIIO determine which
States may not be substantially enforcing Affordable Care Act and PHS
Act provisions, and, in the event Federal enforcement is necessary, in
order to follow up to determine whether complaints that indicate
possible noncompliance with Federal law are resolved by the issuers.
Section 1321(c) of the Affordable Care Act authorizes HHS (1) to
ensure that States with Exchanges are substantially enforcing the
Federal standards to be set for the Exchanges and (2) to set up
Exchanges in States that elect not to do so or are not substantially
enforcing related provisions. Sections 2723 and 2761 of the PHS Act
authorize HHS to enforce PHS Act provisions that apply to non-Federal
governmental plans and to enforce PHS Act provisions that apply to
other health insurance coverage in States that HHS has determined are
not substantially enforcing those provisions.
The database will be maintained by the Team to help CCIIO Office of
Oversight with its compliance activities under the Affordable Care Act
and PHS Act. Consumer inquiries and complaints addressed by the Team
will help CCIIO conduct direct enforcement over non-Federal
governmental health plans; the database will also help CCIIO determine
which States are not substantially enforcing PHS Act provisions under
HHS's Federal fallback authority in sections 2723 and 2761 of the PHS
Act.
In the course of its work, the Team will: (1) Receive consumer
inquiries; (2) respond to consumer inquiries in order to obtain the
necessary information to determine the best course of action; (3) refer
consumers to appropriate entities; and (4) when appropriate, gather
information about consumers in order to assist CCIIO oversight
capacity.
When responding to consumer contacts, the Team will pursue one of
the following courses of action: (1) If it is determined that the
consumer is covered by a non-Federal governmental plan, the Team will
obtain enough information to determine whether the case merits referral
to the Office of Oversight; (2) if it is determined that jurisdiction
over a consumer's case lies with another entity, the Team will refer
consumers to that entity, such as a State insurance department, the
U.S. Department of Labor, or a State Consumer Assistance Program; or
(3) if it is determined that the consumer seeks to file an appeal in a
State or territory without an external appeals process in place, the
Team will refer the consumer to the appropriate entity carrying out the
Federal external appeals process.
As mentioned, the system will be used to create reports regarding
the types of consumer inquiries and Affordable Care Act and PHS Act
compliance issues that are brought to the attention of CCIIO by
consumers. These reports will assist the Office of Oversight in
identifying areas where compliance concerns may arise, and will be
stripped of any information in identifiable form (IIF) and personal
health information when written and prepared.
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 provided under provisions of Sec. Sec. 2719, 2723, and
2761 of the Public Health Service Act (PHS Act) (Pub. L. 97-35) and
Sec. 1321(c) of the Patient Protection and Affordable Care Act
(AFFORABLE CARE ACT) (Pub. L. 111--148).
B. Collection and Maintenance of Data in the System
The Health Insurance Assistance Database (HIAD) contains
information on individuals who contact CCIIO's Health Insurance
Assistance Team, complainants or other individuals with health
insurance issues. The HIAD contains the name, address, State of
residence and zip code; contact information such as telephone numbers,
e-mail address, demographic information such as age, gender, ethnicity,
family status, employment status, income level and veteran's status;
and health insurance identification number, health insurance status,
background, recent history and available options.
[[Page 21375]]
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 information collected in the HIAD that
can be associated with an individual as provided for under ``Section
III. Proposed Routine Use Disclosures of Data in the System.''
Identifiable data may be disclosed under a routine use.
CMS 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 CMS:
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 on consumer inquiries and complaints regarding
insurance issuers that will permit CCIIO to exercise its direct
enforcement authority over non-Federal governmental health plans, if
CMS;
2. Determines that:
a. the purpose of the disclosure can only be accomplished if the
record is provided in an 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 provider 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 Disclosure Under Routine Use
These routine uses specify circumstances, in addition to those
provided by statute in the Privacy Act of 1974, under which CMS may
release information from the HIAD 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 Agency contractors, consultants, CMS grantees,
student volunteers, interns and other workers who do not have the
status of Federal employees, and who have been engaged by the Agency to
assist in accomplishment of a CMS function relating to the purposes for
this SOR and who need to have 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 SOR.
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, CMS grantees, student
volunteers, interns and other workers who do not have the status of
Federal employees whatever information is necessary for the contractor
or consultant to fulfill its duties. In these situations, safeguards
are provided in the contract prohibiting the contractor, consultant,
CMS grantees, student volunteers, interns and other workers who do not
have the status of Federal employees from using or disclosing the
information for any purpose other than that described in the contract
and requires the contractor, consultant, CMS grantees, student
volunteers, interns and other workers who do not have the status of
Federal employees 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, or an agency established by State law pursuant to
agreements with CMS to:
a. Increase consumer assistance and accessibility to health care
coverage by identifying insurer noncompliance with Federal, State and
other applicable law, and
b. Assist Federally funded health insurance programs in
administering functions tasked to them pursuant to the Affordable Care
Act and other relevant Federal and State laws which may require CCIIO
Program information related to this system.
c. Assist other Federal/State agencies that have the authority to
perform collection of debts owed to the Federal government.
State Departments of Insurance can achieve greater regulation and
oversight of the health insurance industry and strengthen enforcement
in areas where problems arise by identifying trends and patterns in
consumer inquiries and complaints.
The Internal Revenue Service (IRS), Department of the Treasury, can
use CCIIO information for the purpose of resolving difficulties with
obtaining premium tax credits under 36B of the Internal Revenue Code
(IRC) of 1986 and to understand the consumer needs leading to the State
health insurance Exchanges starting in 2014.
Federal, State, and local law enforcement agencies and private
security contractors, may require CCIIO information to protect CCIIO
employees and customers, provide security for CCIIO facilities or to
assist investigations or prosecutions with respect to activities that
affect such safety and security or activities that disrupts the
operation of CCIIO operations and facilities.
3. To support the Department of Justice (DOJ), court, or
adjudicatory body when:
a. the Agency or any component thereof, or
b. any employee of the Agency in his or her official capacity, or
c. any employee of the Agency in his or her individual capacity
where the DOJ has agreed to represent the employee, or
d. the United States Government,
is a party to litigation or has an interest in such litigation, and by
careful review, 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
[[Page 21376]]
by the outcome of the litigation, HHS would be able to disclose
information to the DOJ, court, or adjudicatory body involved.
4. To assist a CMS contractor (including, but not limited to
Medicare Administrative Contractors, fiscal intermediaries, and
carriers) that assists in the administration of a CMS-administered
health benefits program, or to a grantee of a CMS-administered grant
program, when disclosure is deemed reasonably necessary by CMS to
prevent, deter, discover, detect, investigate, examine, prosecute, sue
with respect to, defend against, correct, remedy, or otherwise combat
fraud, waste or abuse in such program.
We contemplate disclosing information under this routine use only
in situations in which CMS may enter into a contract or grant with a
third party to assist in accomplishing CMS functions relating to the
purpose of combating fraud, waste or 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 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 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 CCIIO Program 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 Federal agencies and contractors may require CCIIO Program
information for the purpose of assisting in a respond to a suspected or
confirmed breach of the security or confidentiality of information.
IV. Safeguards
CMS 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, HHS, and CMS 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 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 New System on the Rights of Individuals
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. We will only
disclose the minimum personal data necessary to achieve the purpose of
the data collection and the routine uses contained in this notice.
Disclosure of information from the system will be approved only to the
extent necessary to accomplish the purpose of the disclosure. CMS has
assigned a higher level of security clearance for the information
maintained in this system in an effort to provide added security and
protection of data in this system.
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. 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 the disclosure of information
relating to individuals.
Dated: March 18, 2011.
Steve Larsen,
Director, Center for Consumer Information and Insurance Oversight,
Centers for Medicare & Medicaid Services.
SYSTEM NUMBER:
09-70-0586.
SYSTEM NAME:
``Health Insurance Assistance Database'' (HIAD), HHS/CMS/CCIIO.
SECURITY CLASSIFICATION:
Level Three Privacy Act Sensitive.
SYSTEM LOCATION:
CMS Data Center, 7500 Security Boulevard, North Building, First
Floor, Baltimore, Maryland 21244-1850 and at various contractor sites.
Center for Consumer Information and Insurance Oversight, Centers
for Medicare and Medicaid Services, U.S. Department of Health & Human
Services, Triple-I Core Site, 12100 Sunrise Valley Drive, Reston,
Virginia 20191.
CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:
Information in this system is maintained on individuals who contact
the CCIIO Health Insurance Assistance Team, complainants or other
individuals with health insurance issues.
CATEGORIES OF RECORDS IN THE SYSTEM:
The HIAD contains the name, address, State of residence and zip
code; contact information such as telephone numbers, e-mail address,
demographic information such as age, gender, ethnicity, family status,
employment status, income level and veteran's
[[Page 21377]]
status; and health insurance identification number, health insurance
status, background, recent history and available options.
AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
Authority for the collection, maintenance, and disclosures from
this system is provided under provisions of Sec. Sec. 2719, 2723, and
2761 of the Public Health Service Act (PHS Act) (Public Law (Pub. L.)
97-35) and Sec. 1321(c) of the Patient Protection and Affordable Care
Act (Affordable Care Act) (Pub. L. 111-148).
PURPOSE(S) OF THE SYSTEM:
The primary purposes of this system is to collect and maintain
information on consumer inquiries and complaints regarding insurance
issuers that will permit CCIIO to exercise its direct enforcement
authority over non-Federal governmental health plans, investigate any
inquiries or complaints from enrollees of those plans, to determine
which States may not be substantially enforcing the Affordable Care Act
and PHS Act provisions and to determine whether complaints that
indicate possible noncompliance with Federal law are resolved by the
plans. In addition, information maintained will enable CCIIO to develop
aggregate reports that will inform CMS and HHS about compliance issues.
Information in this system will also be disclosed to: (1) Support
regulatory and programmatic activities such as investigations and
reporting activities performed by an Agency contractor, consultants,
CMS grantees, student volunteers, interns and other workers who do not
have the status of Federal employees; (2) assist another Federal and/or
State agency, agency of a State government, or an agency established by
State law; (3) support litigation involving the Agency; (4) combat
fraud, waste, and abuse in certain health benefits programs, and (5)
assist in a response to a suspected or confirmed breach of the security
or confidentiality of information.
I. PROPOSED ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM, INCLUDING
CATEGORIES OR USERS AND THE PURPOSES OF SUCH USES:
B. Entities Who May Receive Disclosure Under Routine Use
These routine uses specify circumstances, in addition to those
provided by statute in the Privacy Act of 1974, under which CMS may
release information from the HIAD 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:
3. To support Agency contractors, consultants, CMS grantees,
student, volunteers, interns and other workers who do not have the
status of Federal employees, who have been engaged by the Agency to
assist in accomplishment of a CMS function relating to the purposes for
this SOR and who need to have access to the records in order to assist
CMS.
4. To assist another Federal or State agency, agency of a State
government, or an agency established by State law pursuant to
agreements with CMS to:
a. Increase consumer assistance and accessibility to health care
coverage by identifying insurer noncompliance with Federal, State and
other applicable law, and
b. Assist Federally funded health insurance programs in
administering functions tasked to them pursuant to the Affordable Care
Act and other relevant Federal and State laws which may require CCIIO
Program information related to this system.
c. Assist other Federal/State agencies that have the authority to
perform collection of debts owed to the Federal government.
5. To support the Department of Justice (DOJ), court, or
adjudicatory body when:
e. The Agency or any component thereof, or
f. Any employee of the Agency in his or her official capacity, or
g. Any employee of the Agency 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, 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.
6. To assist a CMS contractor (including, but not limited to
Medicare Administrative Contractors, fiscal intermediaries, and
carriers) that assists in the administration of a CMS-administered
health benefits program, or to a grantee of a CMS-administered grant
program, when disclosure is deemed reasonably necessary by CMS to
prevent, deter, discover, detect, investigate, examine, prosecute, sue
with respect to, defend against, correct, remedy, or otherwise combat
fraud, waste or abuse in such program.
7. To assist another Federal agency or to an instrumentality of any
governmental jurisdiction within or under the control of the United
States (including any State or local governmental agency), that
administers, or that has the authority to investigate potential fraud,
waste or abuse in a health benefits program funded in whole or in part
by Federal funds, when disclosure is deemed reasonably necessary by CMS
to prevent, deter, discover, detect, investigate, examine, prosecute,
sue with respect to, defend against, correct, remedy, or otherwise
combat fraud, waste or abuse in such programs.
8. 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.
II. SAFEGUARDS:
CMS 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, HHS, and CMS 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 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
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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.
POLICIES AND PRACTICES FOR STORING, RETRIEVING, ACCESSING, RETAINING,
AND DISPOSING OF RECORDS IN THE SYSTEM:
STORAGE:
Records are maintained electronically in the CCIIO developed
database for collection, tracking and storage of casework information
and for reporting purposes. Any manually maintained records will be
kept in locked cabinets or otherwise secured areas.
RETRIEVABILITY:
The records are retrieved electronically by a variety of fields,
including but not limited to name, State, zip code, and health
insurance identification number issued to the individual.
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. All claims-related records
are encompassed by the document preservation order and will be retained
until notification is received from the Department of Justice.
SYSTEM MANAGER(S) AND ADDRESS:
Team Lead, Health Insurance Assistance Team, Office of Consumer
Support, Center for Consumer Information and Insurance Oversight,
Centers for Medicare and Medicaid Services, 7500 Security Boulevard,
Baltimore, Maryland 21244.
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, health insurance claim number, 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:
The identifying information contained in these records is provided
voluntarily by the individual consumers, confidential informants, or by
reports received from other sources . Additional case-relevant
information may also be provided by the individual's employer or
insurer to assist in achieving resolution of the specific case.
SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS OF THE ACT:
None.
[FR Doc. 2011-9105 Filed 4-14-11; 8:45 am]
BILLING CODE 4120-03-P