Federal Register / Vol. 78, No. 205 / Wednesday, October 23, 2013 / Notices 63211 

Use: The Secretary is required to 

establish a prospective payment system 

(PPS) for hospital outpatient services. 

Successful implementation of an 

outpatient PPS (OPPS) requires that we 

distinguish facilities or organizations 

that function as departments of 

hospitals from those that are 

freestanding. In this regard, we will be 

able to determine: Which services 

should be paid under the OPPS, the 

clinical laboratory fee schedule, or other 

payment provisions applicable to 

services furnished to hospital 

outpatients. Information from 42 CFR 

413.65(b)(3) and (c) reports is needed to 

make these determinations. 

Additionally, hospitals and other 

providers are authorized to impose 

deductible and coinsurance charges for 

facility services, but it does not allow 

such charges by facilities or 

organizations which are not providerbased. This provision requires that we 

collect information from the required 

reports so it can determine which 

facilities are provider-based. Form 

Number: CMS–R–240 (OCN: 0938– 

0798); Frequency: Occasionally; 

Affected Public: Private sector (business 

or other for-profits and not-for-profit 

institutions); Number of Respondents: 

905; Total Annual Responses: 500,405; 

Total Annual Hours: 26,563. (For policy 

questions regarding this collection 

contact Daniel Schroder at 410–786– 

7452.) 

Dated: October 18, 2013. 

Martique Jones, 

Deputy Director, Regulations Development 

Group, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2013–24851 Filed 10–22–13; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

Privacy Act of 1974; Report of an 

Altered CMS System of Records Notice 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), Department 

of Health and Human Services (HHS). 

ACTION: Altered System of Records 

Notice (SORN). 

SUMMARY: In accordance with the 

requirements of the Privacy Act of 1974 

(5 U.S.C. 552a), CMS proposes several 

alterations to the existing system of 

records titled, ‘‘Health Insurance 

Exchanges (HIX) Program’’ (No. 09–70– 

0560), published at 78 FR 8538 

(February 6, 2013) and amended and 

published at 78 FR 32256 (May 29, 

2013). The alterations affect the 

‘‘Purposes of the System’’, ‘‘Categories 

of Individuals Covered by the System’’, 

‘‘Categories of Records in the System’’, 

‘‘Authority for Maintenance of the 

System’’, ‘‘System Location’’, 

‘‘Retention and Disposal’’, ‘‘System 

Manager and Address’’, ‘‘Routine Uses 

of Records Maintained in the System’’, 

and ‘‘Record Source Categories’’ 

sections of the accompanying System of 

Records Notice, as more fully explained 

in the Supplementary Information 

section. 

DATES: The proposed modifications will 

be effective immediately, with 

exception of the new and revised 

Routine Uses which will be effective 30 

days after publication of this notice in 

the Federal Register unless comments 

received on or before that date result in 

revisions to this notice. 

ADDRESSES: The public should send 

comments to: CMS Privacy Officer, 

Division of Privacy Policy, Privacy 

Policy and Compliance Group, Office of 

E-Health Standards & Services, Office of 

Enterprise Management, CMS, Room 

S2–24–25, 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 9:00 a.m.–3:00 

p.m., Eastern Time zone. 

For Information on Health Insurance 

Exchanges Contact: Karen Mandelbaum, 

JD, MHA, Office of Health Insurance 

Exchanges, Exchange Policy and 

Operations Group, Center for Consumer 

Information and Insurance Oversight, 

7210 Ambassador Road, Baltimore, MD 

21244, Office Phone: (410) 786–1762, 

Facsimile: (301) 492–4353, Email: 

karen.mandelbaum@cms.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

I. Proposed Alterations 

By way of background, this system of 

records was established to be a global 

system of records to cover all data 

activities in support of the HIX Program 

at the Federal level. The Health 

Insurance Exchanges (HIX) Program is a 

new way to find health insurance 

coverage for people who do not 

currently have coverage or who want to 

find options for health insurance 

coverage. The HIX Program includes 

Federally-facilitated Exchanges (FFEs) 

operated by CMS, CMS support and 

services provided to all Exchanges and 

state agencies administering Medicaid 

programs, Children’s Health Insurance 

Programs (CHIPs) and Basic Health 

Programs (BHPs), and CMS 

administration of advance payments of 

the premium tax credit and cost-sharing 

reductions associated with enrollment 

in QHPs through an Exchange. The 

system stores personal, financial, 

employment and demographic 

information about individuals who 

participate in or are involved with the 

HIX Program. The proposed 

modifications to the system of records 

and the affected sections of the System 

of Records Notice are identified and 

described below. 

Use Limitations on Federal Tax Return 

Information 

CMS proposes to amend item No. 1 in 

the Categories of Records section to 

clarify that Federal tax return 

information may be used or disclosed 

only as authorized by 26 U.S.C. 6103. 

Discussion of Reporting 

CMS proposes to amend the Purpose 

of the System section to explicitly 

mention the oversight and reporting 

functions required by the Patient 

Protection and Affordable Care Act 

(PPACA) (Pub. L. 111–148) as amended 

by the Health Care and Education 

Reconciliation Act of 2010 (Pub. L. 111– 

152), collectively referred to as the 

Affordable Care Act. 

Individuals Providing Consumer 

Assistance 

CMS proposes to include, in the 

Purpose and Categories of Records 

sections, a description of the 

information resulting from registering, 

training and/or certifying individuals 

who will assist consumers, applicants 

and enrollees in states where an FFE 

and/or an FF–SHOP will operate. Such 

individuals include Navigators (as 

defined by 45 CFR155.210), nonNavigator Assistance Personnel (as 

allowed for under 45 CFR155.205; also 

known as In-Person Assisters), Certified 

application counselors (as defined by 45 

CFR155.225), Agents and Brokers, and 

any other individuals that are required 

to register with an Exchange prior to 

assisting qualified individuals, 

employees and employers to enroll in 

QHPs through the Exchange. Upon 

completing the registration form and 

successfully completing the training and 

testing program and certification 

process, CMS will certify these 

individuals to provide consumers, 

applicants, and enrollees with outreach, 

education, and assistance in obtaining 

access to health care coverage through 

an FFE or FF–SHOP. 

CMS proposes to amend Routine Use 

No. 2 to clarify that CMS may disclosure 

information about Navigators, nonNavigator Assistance Personnel, 

Certified application counselors, and 


emcdonald on DSK67QTVN1PROD with NOTICES
63212 Federal Register / Vol. 78, No. 205 / Wednesday, October 23, 2013 / Notices 

Agents and Brokers to the appropriate 

state agency or agencies in the state in 

which they have registered and will 

provide outreach, education and 

assistance to consumers, applicants and 

enrollees through the FFE or FF–SHOP. 

Additionally, CMS proposes a new 

Routine Use, Number 11, specifically 

related to the information of Agents and 

Brokers who have completed 

registration and training. Pursuant to 45 

CFR 155.220(b), CMS proposes Routine 

Use number 11 so that CMS may display 

on the FFE and FF–SHOP Web sites 

information regarding these Agents and 

Brokers who have completed 

registration and training for the 

convenience of consumers looking for 

assistance from an Agent or Broker that 

is familiar with the Exchange policies 

and application process. 

Identity Proofing 

CMS proposes to include a 

description of the identity proofing 

process within the Purpose of the 

System section. Identity proofing refers 

to a process through which the 

Exchange, state Medicaid agency, or 

state CHIP agency obtains a level of 

assurance through a third party data 

verification source regarding an 

individual’s identity that is sufficient to 

allow access to electronic systems that 

include sensitive state and Federal data. 

This process will be performed at the 

time (A) an application for an eligibility 

determination in the individual market 

and Small Business Health Options 

Program (SHOP) is submitted to an 

Exchange and (B) an Agent or Broker 

registers with the Federally-facilitated 

Exchange (FFE) and completes the FFE 

training and certification processes. 

Identity proofing must be completed 

by several categories of individuals. 

Each adult application filer (as defined 

at 45 CFR 155.20) submitting either an 

on-line application or a telephonic 

application for an eligibility 

determination or enrollment in a QHP 

through an Exchange in the individual 

market, advance payments of the 

premium tax credit, cost-sharing 

reductions, Medicaid and CHIP must 

complete the identity proofing process. 

The adult application filer is required to 

complete identity proofing prior to 

filing an on-line or telephonic 

application and prior to the disclosure 

of any information covered under this 

system of records back to the 

application filer. Application filers 

submitting paper applications regardless 

of type (including exemptions) will be 

identity proofed only if they elect to 

move into an electronic process. In 

addition, for the FF–SHOP Employer 

applications, the primary employer 

contact must complete identity proofing 

and if a secondary employer contacts is 

identified on the application, the 

secondary employer contact may have 

to complete identity proofing as well. 

Identity proofing will also be performed 

on Agents and Brokers when they 

register with the FFE to become certified 

to assist consumers, individuals, 

applicants and enrollees in the 

individual market Marketplace and 

SHOP Marketplace in a state in which 

the Agent or Broker is licensed to sell 

health insurance. 

Clarification of Meanings of Terms 

CMS also proposes to clarify the 

intended meaning of the term 

‘‘application filer’’ as it is used in the 

current version of the SORN. CMS also 

proposes to add a new Category of 

Records describing the information 

maintained about this group of 

individuals. As used in the existing 

Category of Records and Routine Use 

Number 8, this terms was intended to be 

inclusive of the following: an 

application filer, as defined by 45 

CFR155.20 (which includes authorized 

representatives); individuals or their 

authorized representative applying for 

exemption from the individual shared 

responsibility payment; a SHOP 

application filer as defined by 45 

CFR155.700; Agents and Brokers; and 

QHP issuers performing application 

assistance functions. 

To ensure clarity of the meaning of 

terms used with the SORN, beginning 

with this version of the SORN, CMS 

proposes to align the use of terms with 

the definitions provided within HIX 

program regulations. Therefore, CMS is 

proposing changes to the Categories of 

Records and Routine Use number 8 to 

itemize all of the populations included 

within the meaning of the current use of 

the term application filer. In general, 

additional small wording adjustments 

have been made throughout all sections 

to provide consistent use of terms and 

more specificity throughout the SORN. 

Health Insurance Casework System 

(HICS) 

CMS proposes to update the Purpose 

of the System, the Authority for 

Maintenance of the System, and 

Categories of Records sections and add 

a new Routine Use to include a 

description of the consumer complaint 

tracking system known as the Health 

Insurance Casework System (HICS). 

Section 1311(c)(3) of the Affordable 

Care Act requires HHS to ‘‘develop a 

rating system that would rate qualified 

health plans offered through an 

Exchange in each benefits level on the 

basis of the relative quality and price.’’ 

Additionally, Section 1321(c) of the 

Affordable Care Act authorizes HHS to 

ensure that states with Exchanges are 

substantially enforcing the federal 

standards to be set for the Exchanges. 

Sections 2723 and 2761 of the Public 

Health Service Act (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. By 

collecting consumer complaint 

information, HICS will help HHS carry 

out all of the above mentioned 

functions. 

Routine Uses 

CMS proposes the following Routine 

Use modifications. 

■ Routine Use No. 2: Modify to 

permit CMS to disclose information to 

an Appeals Entity as defined under 45 

CFR 155.500 in the event that an 

applicant or enrollee exercises his or her 

appeal right under 45 CFR 155.505. 

Modify to permit CMS to disclose 

information about Navigators, nonNavigator Assistance Personnel, 

Certified application counselors, and 

Agents and Brokers who have been 

trained and certified by CMS to provide 

consumer assistance to the appropriate 

state agency or agencies for oversight 

and monitoring of these individuals. 

■ Routine Use No. 4: Modify to 

remove unnecessary example related to 

contractors. 

■ Routine Use No. 8: Modify to 

clarify the meaning intended with the 

use of term application filer to allow 

information about applicants and 

Relevant Individuals to be disclosed to 

Agents, Brokers, and QHP issuers. 

■ Routine Use No. 9: Modify to 

expand the disclosure of information to 

QHP issuers to include the disclosure of 

(A) applicant/enrollee and Relevant 

Individual information as necessary for 

individuals to be enrolled in a QHP, 

regardless of eligibility for advance 

payments of the premium tax credit or 

cost-sharing reductions and (B) 

consumer information for those that 

contact CMS to file a complaint or to 

seek resolution of an issue with the QHP 

issuer. 

CMS proposes adding the following 

Routine Uses. 

■ Routine Use No. 10: Provide for 

disclosures of employee information to 

employers when an employee 

submitting an application for an 

eligibility determination has been 

determined eligible for advance 

payments of the premium tax credit and 

cost-sharing reductions, or as needed to 


emcdonald on DSK67QTVN1PROD with NOTICES
Federal Register / Vol. 78, No. 205 / Wednesday, October 23, 2013 / Notices 63213 

verify whether an applicant is enrolled 

in an eligible employer sponsored plan. 

D Routine Use No.11: Permit the 

public disclosure of information to the 

appropriate state agency, and members 

of the public, about Agents and Brokers 

that have registered with, successfully 

completed CMS training, and are 

certified by an FFE or FF–SHOP, and to 

disclose Agent and Broker information 

to the appropriate state agency to assist 

states with oversight, monitoring and 

enforcement activities over agents and 

brokers and allow states to provide 

outreach and education resources to 

consumers about obtaining health care 

coverage in their states. 

D Routine Use No. 12: Permit the 

disclosure of information from the HICS 

system to other government agencies for 

the purposes of resolving complaints 

and assisting states with issuer oversight 

and monitoring. 

D Routine Use No. 13: To assist a CMS 

contractor that is engaged to perform a 

function or provide administrative, 

technical or physical support to the 

FFEs (including FF–SHOPs) or to a 

grantee of a CMS-administered grant 

program, when the 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. 

II. The Privacy Act 

The Privacy Act (5 U.S.C. 552a) 

governs the means by which the United 

States Government collects, maintains, 

and uses PII in a system of records. A 

‘‘system of records’’ is a group of any 

records under the control of a Federal 

agency from which information about 

individuals is retrieved by name or 

other personal identifier. The Privacy 

Act requires each agency to publish in 

the Federal Register a system of records 

notice (SORN) identifying and 

describing each system of records the 

agency maintains, including the 

purposes for which the agency uses PII 

in the system, the routine uses for 

which the agency discloses such 

information outside the agency, and 

how individual record subjects can 

exercise their rights under the Privacy 

Act (e.g., to determine if the system 

contains information about them). 

SYSTEM NUMBER: 

09–70–0560. 

SYSTEM NAME: 

Health Insurance Exchanges (HIX) 

Program, HHS/CMS/CCIIO. 

SECURITY CLASSIFICATION: 

Unclassified 

SYSTEM LOCATION: 

CMS Data Center, 7500 Security 

Boulevard, North Building, First Floor, 

Baltimore, Maryland 21244–1850, 

Health Insurance Exchanges Program 

(HIX) locations, and at various 

contractor sites. 

CATEGORIES OF INDIVIDUALS COVERED BY THE

SYSTEM: 

The system will contain personally 

identifiable information (PII) about the 

following categories of individuals who 

participate in or are involved with the 

CMS Health Insurance Exchanges (HIX) 

Program: (1) Any applicant/enrollee 

who applies and any application filer 

(an application filer, as defined by 45 

CFR155.20 (which includes authorized 

representatives); individuals or their 

authorized representative applying for 

exemption from the individual shared 

responsibility payment; a SHOP 

application filer as defined by 45 

CFR155.700; Agents and Brokers; and 

QHP issuers performing application 

assistance functions) who files an 

application on behalf of an applicant/ 

enrollee, for an eligibility determination 

for enrollment in a qualified health plan 

(QHP) through an Exchange, for one or 

more insurance affordability programs, 

for a certificate of exemption from the 

shared responsibility requirement, or an 

appeal; (2) Navigators, non-Navigator 

Assistance Personnel (also known as InPerson Assisters), Certified application 

counselors, Agents and Brokers, and all 

other individuals or entities that are 

required to register with an Exchange 

prior to assisting qualified individuals, 

employees and employers to enroll in 

QHPs through the Exchange; (3) officers, 

employees and contractors of the 

Exchange; (4) employees and 

contractors of CMS (e.g. eligibility 

support workers, appeals staff, etc.); (5) 

contact information and business 

identifying information of 

representatives, officers, agents, and 

employees of QHPs seeking 

certification; (6) persons employed by or 

contracted with an Exchange 

organization who provide home or 

personal contact information; (7) any 

qualified employer and the qualified 

employees whose enrollment in a QHP 

is facilitated through a Small Business 

Health Options Program (SHOP), 

including authorized representatives of 

such individuals; and (8) Individuals, 

including non-applicant household 

members/family members, nonapplicant tax payers or tax filers, and 

spouses and parents of applicants, who 

are listed on the application and whose 

PII may bear upon a determination of 

the eligibility of an individual for an 

insurance affordability program and for 

certifications of exemption from the 

individual responsibility requirement. 

Such individuals will hereafter be 

referred to as ‘‘Relevant Individual(s)’’. 

CATEGORIES OF RECORDS IN THE SYSTEM: 

Information maintained in this system 

for individual applicant/enrollees 

includes, but may not be limited to, the 

applicant’s first name, last name, 

middle initial, mailing address or 

permanent residential address (if 

different from the mailing address), date 

of birth, Social Security Number (if the 

applicant/enrollee has one), taxpayer 

status, gender, ethnicity, residency, 

email address, telephone number, 

employment status and employer if 

applicable. The system will also 

maintain information from the 

verification process of the information 

provided by the applicant/enrollee or by 

the application filer (an application 

filer, as defined by 45 CFR 155.20 

(which includes authorized 

representatives); individuals or their 

authorized representative applying for 

exemption from the individual shared 

responsibility payment; a SHOP 

application filer as defined by 45 CFR 

155.700; Agents and Brokers; and QHP 

issuers performing application 

assistance functions) on behalf of the 

applicant that will enable a 

determination about the applicant’s or 

enrollee’s eligibility. The system will 

collect and maintain information that 

the applicant/enrollee or the application 

filer (an application filer, as defined by 

45 CFR 155.20 (which includes 

authorized representatives); individuals 

or their authorized representative 

applying for exemption from the 

individual shared responsibility 

payment; a SHOP application filer as 

defined by 45 CFR 155.700; Agents and 

Brokers; and QHP issuers performing 

application assistance functions) on 

behalf of the applicant submits, 

information that is obtained from other 

federal agencies through the computer 

matching programs verifying applicant 

information and information obtained 

from federal and state sources through 

the Information Exchange Agreements 

with IRS and State Medicaid and CHIP 

agencies and State-based Exchanges 

pertaining to (1) the applicant or 

enrollee’s citizenship or immigration 

status, because only individuals who are 

citizens or nationals of the U.S. or 

lawfully present are eligible to enroll; 

(2) enrollment in Federally funded 

minimum essential health coverage (e.g. 

Medicare, Medicaid, Federal Employees 

Health Benefit Program (FEHBP), 

Veterans Health Administration (Champ 

VA), Children’s Health Insurance 

Program (CHIP), Department of Defense 


emcdonald on DSK67QTVN1PROD with NOTICES
63214 Federal Register / Vol. 78, No. 205 / Wednesday, October 23, 2013 / Notices 

(TRICARE), Peace Corps); (3) 

incarceration status; (4) Indian status; 

(5) enrollment in employer-sponsored 

coverage; (6) requests for and 

accompanying documentation to justify 

receipt of individual responsibility 

exemptions, including membership in a 

certain type of recognized religious sect 

or health care sharing ministry; (7) 

employer information; (8) status as a 

veteran; (9) pregnancy status; (10) 

blindness and/or disability status; (11) 

smoking status; and (12) household 

income, including tax return 

information from the IRS, income 

information from the Social Security 

Administration, and financial 

information from other third party 

sources. Federal tax return information 

can only be used or disclosed as 

authorized by 26 U.S.C. 6103. 

Information will also be maintained 

with respect to the applicant’s 

enrollment in a QHP through the 

Exchange, the premium amounts and 

payment history. The system will 

collect and maintain information 

pertaining to Relevant Individual(s) that 

includes the following: First name, last 

name, middle initial, permanent 

residential address, date of birth, SSN (if 

the Relevant Individual has one or is 

required to provide it as specified in 45 

CFR 155.305(f)(6)), taxpayer status, 

gender, residency, relationship to 

applicant, employer information, and 

household income, including tax 

information from the IRS, income 

information from the Social Security 

Administration, and financial 

information from other third party 

sources. Additionally, should an 

applicant file an appeal, information 

related to the appeal and any associated 

documentation and decision will be 

maintained in the system. 

With respect to qualified employers 

and qualified employees utilizing the 

SHOP, the information maintained in 

the system includes but may not be 

limited to the name and address of the 

employer, number of employees, 

Employer Identification Number (EIN), 

and list of qualified employees and their 

Social Security Numbers. 

Information maintained in this system 

for application filers (an application 

filer, as defined by 45 CFR 155.20 

(which includes authorized 

representatives); individuals or their 

authorized representative applying for 

exemption from the individual shared 

responsibility payment; a SHOP 

application filer as defined by 45 CFR 

155.700; Agents and Brokers; and QHP 

issuers performing application 

assistance functions) may include, but 

not be limited to, the individual’s first 

name, middle name, last name, address, 

city, state, zip code, telephone number, 

organization name, identification 

number, and association with or 

relationship to an applicant. 

Information maintained in this system 

for Agents and Brokers includes, but 

may not be limited to, the Agent or 

Broker’s log-in ID, password, first name, 

middle name, last name, email address, 

user type, National Producer Number, 

occupation type, organization type, job 

title, manager, primary language, region, 

time zone, state, zip code, phone 

number. Information maintained in this 

system for assisters such as Navigators, 

non-Navigator Assistance Personnel 

(including In-Person Assisters), and 

Certified application counselors, 

includes, but may not be limited to, the 

assister individual’s or entity’s user 

name (user name/ID), first name, last 

name, email address, phone number, 

state, zip code, user type, employer or 

grantee organization (if applicable). 

Information in the Health Insurance 

Casework System (HICS) includes but is 

not limited to, complainant’s contact 

information, such as, name, telephone 

number, email address, state of 

residence, zip code; demographic 

information, such as, age, gender, 

ethnicity, family status, employment 

status, income level, veteran’s status 

and health insurance status, health 

insurance background and recent 

history, and available health insurance 

options. The PII in HICS will include 

but not be limited to, the consumers, 

applicants/enrollees, and/or their 

authorized representatives that have 

contacted CMS to file a complaint about 

a QHP offered through the FFE or the 

issuer of such a QHP, or to seek 

resolution of a particular issue with 

such a QHP or issuer. Therefore, we 

anticipate that in addition to the PII 

listed above, to the extent complainants 

share health information with CMS as 

part of their complaints, PHI may also 

be included in HICS. Any HICS data 

published will be in aggregate form and 

will not contain any personally 

identifiable data elements. 

Information maintained in this system 

for (i) officers, employees and 

contractors of the Exchange; (ii) 

employees and contractors of CMS; (iii) 

representatives, officers, agents, and 

employees of QHPs seeking 

certification; and (iv) persons employed 

by or contracted with an Exchange 

organization will include contact and 

identifying information (such as first 

and last name, address, telephone 

number, email address, employer, or 

similar information), relationship to the 

Exchange or CMS (such as status as 

contractor, employee, etc.), and, as 

applicable, log-in IDs and passwords. 

AUTHORITY FOR MAINTENANCE OF THE SYSTEM: 

The HIX program implements health 

care reform provisions of the Patient 

Protection and Affordable Care Act 

(PPACA) (Pub. L. 111–148) as amended 

by the Health Care and Education 

Reconciliation Act of 2010 (Pub. L. 111– 

152) collectively referred to as the 

Affordable Care Act. Title 42 U.S.C. 

18031, 18041, 18081, 18083, and 

sections 2723, 2761 of the Public Health 

Service Act (PHS Act). 

PURPOSE(S) OF THE SYSTEM: 

Health Insurance Exchanges are 

established by the Patient Protection 

and Affordable Care Act of 2010 as 

amended by the Health Care and 

Education Reconciliation Act of 2010. 

They provide competitive marketplaces 

for individuals and small employers to 

directly compare available private 

health insurance options on the basis of 

price, quality, and other factors. The 

Exchanges will help enhance 

competition in the health insurance 

market, improve choice of affordable 

health insurance, and give small 

businesses the same purchasing clout as 

large businesses. 

The purpose of this system is to 

collect, create, use and disclose PII 

about individuals who apply for 

eligibility determinations or appeal 

eligibility determinations for enrollment 

in a QHP, including stand-alone dental 

plans, through an Exchange, for 

insurance affordability programs, and 

for certifications of exemption from the 

individual responsibility requirement. 

The purpose of this system is also to 

collect, create, use and disclose PII 

about Relevant Individual(s) whose PII 

may bear upon a determination of the 

eligibility of an individual for an 

insurance affordability program or for 

certifications of exemption from the 

individual responsibility requirement. 

An additional purpose of the system is 

to collect, create, use and disclose PII 

for the identity proofing of application 

filers as defined in 45 CFR 155.20, 

primary and secondary employer 

contacts filing applications to a FF– 

SHOP, and Agents and Brokers 

registering with the FFE. 

The system will collect, create, use 

and disclose PII about individuals and 

entities that register with and are 

certified by CMS. The CMS-registered 

and -certified individuals include, but 

are not limited to, Agents and Brokers, 

Navigators, non-Navigator Assistance 

personnel (also known as In-Person 

Assisters), and Certified application 

counselors. CMS may display the 

contact information of Agents and 

Brokers that register, and successfully 

complete the CMS training and are 


emcdonald on DSK67QTVN1PROD with NOTICES
Federal Register / Vol. 78, No. 205 / Wednesday, October 23, 2013 / Notices 63215 

certified by CMS, on the FFE and on the 

FF–SHOP Web sites for the convenience 

of consumers looking for an agent or 

broker that is familiar with the FFE 

policies, the QHPs being offered, the 

eligibility determination application 

process and who are active in the FFE 

market. Because CMS training is 

optional for Agents and Brokers offering 

assistance in the FF–SHOP, only the 

contact information of those Agents and 

Brokers who have successfully 

completed CMS developed training and 

testing, will be made available to the 

public (e.g. displayed on a CMS Web 

site). 

Another purpose of the system is 

tracking and compiling consumer 

complaints about QHPs offered through 

an FFE or FF–SHOP or issuers that offer 

such QHPs. This enables the program to 

ensure that consumers receive timely 

assistance and to build a QHP rating 

system based on complaints. An 

additional purpose of the system is to 

perform required legal functions related 

to oversight and reporting for the HIX 

Program and its components and to 

provide necessary analysis and 

reporting capabilities. The PII described 

within this SORN will be used for these 

purposes. 

ROUTINE USES OF RECORDS MAINTAINED IN THE

SYSTEM

A. ENTITIES WHO MAY RECEIVE DISCLOSURES

UNDER ROUTINE USES

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 HIX SOR without 

the affirmative 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 are establishing the 

following routine use disclosures of 

information maintained in the system: 

1. To support Agency contractors, 

consultants, or CMS grantees who have 

been engaged by the Agency to assist in 

accomplishment of a CMS function 

relating to the purposes for this 

collection and who need to have access 

to the records in order to assist CMS. 

2. To disclose information to another 

Federal agency, agency of a State 

government, a non-profit entity 

operating an Exchange for a State, an 

agency established by State law, or its 

fiscal agent, or an Appeals Entity as 

defined by 45 CFR 155.500 to (A) make 

eligibility determinations for enrollment 

in a QHP through an Exchange, 

insurance affordability programs, 

certifications of exemption from the 

individual responsibility requirement, 

and to coordinate and resolve requests 

for appeals; (B) to carry out the HIX 

Program; (C) to perform functions of an 

Exchange described in 45 CFR 155.200, 

including notices to employers under 

section 1411(f) of the Affordable Care 

Act; and (D) permit the disclosure of 

Navigator, non-Navigator Assistance 

Personnel, Certified application 

counselor, and Agent and Broker 

information who have completed CMS 

training, testing and certification to 

provide consumer assistance to the 

appropriate state agency or agencies to 

assist states with oversight, monitoring 

and enforcement activities, because both 

CMS and states will be responsible for 

overseeing, monitoring and regulating 

these individuals. 

3. To disclose information about 

applicants and Relevant Individual(s) in 

order to obtain information from other 

Federal agencies and State agencies and 

third party data sources that provide 

information to CMS, pursuant to 

agreements with CMS, for purposes of 

determining the eligibility of applicants 

to enroll in QHPs through an Exchange, 

in insurance affordability programs, or 

for a certification of exemption from the 

individual responsibility requirement. 

4. To assist a CMS contractor that 

assists in the administration of a CMS 

administered health benefits program, 

or to a grantee of a CMS-administered 

grant program, when disclosure is 

deemed reasonably necessary by CMS to 

prevent, deter, discover, detect, 

investigate, examine, prosecute, sue 

with respect to, defend against, correct, 

remedy, or otherwise combat fraud, 

waste or abuse in such program or to 

provide oversight of FFE operations. 

5. To assist another Federal agency or 

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. 

6. To assist appropriate Federal 

agencies and CMS contractors and 

consultants that have a need to know 

the information for the purpose of 

assisting CMS’ efforts to respond to a 

suspected or confirmed breach of the 

security or confidentiality of 

information maintained in this system 

of records, provided that the 

information disclosed is relevant and 

necessary for that assistance. 

7. To assist the U.S. Department of 

Homeland Security (DHS) cyber security 

personnel, if captured in an intrusion 

detection system used by HHS and DHS 

pursuant to the Einstein 2 program. 

8. To provide information about 

applicants, enrollees, appellants, and 

Relevant Individual(s) to applicants/ 

enrollees, application filers as defined 

by 45 CFR 155.20, individuals or their 

authorized representative applying for 

exemption from the individual shared 

responsibility payment; a SHOP 

application filer as defined by 45 CFR 

155.700; appellants, Agents Brokers, 

and QHP issuers who are authorized or 

certified by CMS to assist applicants/ 

enrollees, when relevant and necessary 

to determine eligibility for enrollment in 

a QHP, insurance affordability 

programs, or a certification of 

exemption from the individual 

responsibility requirement through the 

FFEs. 

9. To provide applicant/enrollee and 

Relevant Individual information to QHP 

issuers for purposes of enrollment in a 

qualified health plan and for the 

administration of the advance payments 

of premium tax credit and cost-sharing 

reductions. To provide information 

about consumers that contact CMS to 

file a complaint or to seek resolution of 

a particular issue (that is, to initiate a 

‘‘case’’) to the issuer of a QHP in an FFE 

or FF–SHOP, which issuer or which 

issuer’s QHP is the subject of the case. 

10. To assist employers identified on 

applications for eligibility 

determinations submitted to an 

Exchange to provide (A) notification to 

the employer that an employee has been 

determined eligible for advanced 

payments of the premium tax credit or 

cost sharing reductions, (B) notice to the 

applicant indicating that the Exchange 

will be contacting any employer 

identified on the application for the 

applicant and the members of his or her 

household, as defined in 26 CFR 1.36B– 

1(d), to verify whether the applicant is 

enrolled in an eligible employersponsored plan or is eligible for 

qualifying coverage in an eligible 

employer-sponsored plan for the benefit 

year for which coverage is requested, 

and (C) notice to the employer 

requesting verification of an employee’s 

eligibility or enrollment in an eligible 

employer-sponsored plan for the benefit 

year for which coverage is requested. 

11. To permit the public disclosure of 

information to the appropriate state 

agency, and members of the public, 


emcdonald on DSK67QTVN1PROD with NOTICES
63216 Federal Register / Vol. 78, No. 205 / Wednesday, October 23, 2013 / Notices 

about Agents and Brokers that have 

registered with, successfully completed 

CMS training, and are certified by an 

FFE or FF–SHOP to provide outreach 

and education resources to consumers 

about obtaining health care coverage in 

their states,. 

12. To provide information regarding 

complaints to other Federal agencies 

and agencies of a state government for 

the purpose of resolving complaints and 

identifying insurer non-compliance 

with Federal, state, and other applicable 

law. 

13. To assist a CMS contractor that is 

engaged to perform a function or 

provide administrative, technical or 

physical support to the FFEs (including 

FF–SHOPs) or to a grantee of a CMSadministered grant program, when the 

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. 

POLICIES AND PRACTICES FOR STORING, 

RETRIEVING, ACCESSING, RETAINING, AND

DISPOSING OF RECORDS IN THE SYSTEM

STORAGE: 

Electronic records will be stored on 

both tape cartridges (magnetic storage 

media) and in a relational database 

management environment (DASD data 

storage media). Any hard copies of 

program related records containing PII 

at CMS and contractor locations will be 

kept in secure hard-copy file folders 

locked in secure file cabinets during 

non-duty hours. 

RETRIEVABILITY: 

The records will be retrieved 

electronically by a variety of fields, 

including but not limited to first name, 

last name, middle initial, date of birth, 

or Social Security Number (SSN). 

SAFEGUARDS: 

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. 

Access to records in the HIX Program 

system will be limited to authorized 

CMS personnel and contractors through 

password security, encryption, 

firewalls, and secured operating system. 

Any electronic or hard copies of records 

containing PII at CMS, Exchanges and 

contractor locations will be kept in 

secure electronic files or in hard-copy 

file folders locked in secure file cabinets 

during non-duty hours. 

RETENTION AND DISPOSAL: 

These records will be maintained 

until they become inactive, at which 

time they will be retired or destroyed in 

accordance with published records 

schedules of the Centers for Medicare & 

Medicaid Services as approved by the 

National Archives and Records 

Administration. 

SYSTEM MANAGER AND ADDRESS: 

Director of Operations, Center for 

Consumer Information and Insurance 

Oversight, 7501 Wisconsin Avenue, 

Bethesda, Maryland 20814. 

NOTIFICATION PROCEDURE: 

An individual record subject who 

wishes to know if this system contains 

records about him or her should write 

to the system manager who will require 

the system name, and for verification 

purposes, the subject individual’s name 

(individual’s former name(s) name, if 

applicable), and SSN (furnishing the 

SSN is voluntary, but it may make 

searching for a record easier and prevent 

delay). 

RECORD ACCESS PROCEDURE: 

An individual seeking access to 

records about him or her in this system 

should use the same procedures 

outlined in Notification Procedures 

above. The requestor 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: 

To contest a record, the subject 

individual should contact the system 

manager named above, and reasonably 

identify the record and specify the 

information being contested. The 

individual should 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: 

Personally identifiable information in 

this database is obtained from the 

application submitted by or on behalf of 

applicants, enrollees, and appellants 

seeking eligibility determinations, from 

qualified employers and other 

employers who provide employersponsored coverage, from CMS and 

other Federal and state agencies as part 

of verifications and information 

retrievals to make eligibility 

determinations, from Marketplace 

assisters facilitating the eligibility and 

enrollment processes, from QHPs, from 

State-based Exchanges that provide 

information to perform the statutory 

functions, from states participating in 

State Partnership Exchanges pursuant to 

Conditional Approval Decision letters, 

and from third party data sources to 

determine eligibility as described in this 

notice. 

EXEMPTIONS CLAIMED FOR THIS SYSTEM: 

None. 

Dated: October 18, 2013. 

Michelle Snyder, 

Chief Operating Officer, Centers for Medicare 

& Medicaid Services. 

[FR Doc. 2013–24861 Filed 10–22–13; 8:45 am] 

BILLING CODE 4120–03–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

[CFDA Number: 93.508] 

Announcing the Award of Four SingleSource Expansion Supplement Grants 

Under the Tribal Maternal, Infant, and 

Early Childhood Home Visiting 

(MIECHV), Tribal Early Learning 

Initiative Program 

AGENCY: Office of Child Care, ACF, 

HHS. 

ACTION: Notice of the award of four 

single-source program expansion 

supplement grants to Tribal Maternal, 

Infant, and Early Childhood Home 

Visiting (MIECHV) grantee participants 

in the Tribal Early Learning Initiative. 

SUMMARY: This announces the award of 

single-source program expansion 

supplement grants to the following 

Tribal Maternal, Infant, and Early 

Childhood Home Visiting (MIECHV) 

grantees to support their ongoing 

participation in the Tribal Early 

Learning Initiative, by the Office of 

Child Care, a program of the 

Administration for Children and 

Families. 

Choctaw Nation of Oklahoma ................................................................................................ Durant, OK ...................................... $25,000 

Pueblo of San Felipe ............................................................................................................. San Felipe, NM ............................... 25,000 


emcdonald on DSK67QTVN1PROD with NOTICES