[Federal Register Volume 72, Number 52 (Monday, March 19, 2007)]
[Notices]
[Pages 12801-12806]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E7-4889]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services


Privacy Act of 1974: Report of Modified System of Records

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

ACTION: Notice of Modified System of Records (SOR).

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SUMMARY: In accordance with the requirements of the Privacy Act of 
1974, we are proposing to modify a SOR titled, ``Long Term Care-Minimum 
Data Set'' (MDS), System No. 09-70-1517, most recently modified at 67 
FR 6714 (February 13, 2002). We propose to assign a new CMS 
identification number to this system to simplify the obsolete and 
confusing numbering system originally designed to identify the Bureau, 
Office, or Center that maintained information in the Health Care 
Financing Administration systems of records. The new identifying number 
for this system should read: System No. 09-70-0528.
    We propose to modify existing routine use number 1 that permits 
disclosure to agency contractors and consultants to include disclosure 
to CMS grantees who perform a task for the agency. CMS grantees, 
charged with completing projects or activities that require CMS data to 
carry out that activity, are classified separate from CMS contractors 
and/or consultants. The modified routine use will remain as routine use 
number 1. We also propose to modify existing routine use number 3 that 
permits disclosure to Peer Review Organizations (PRO). The name of PROs 
has been changed to read: ``Quality Improvement Organizations (QIO).'' 
QIOs will continue work to implement quality improvement programs, 
provide consultation to CMS, its contractors, and to state agencies. 
The modified routine use will remain as routine use number 3.
    We will delete routine use number 6 authorizing disclosure to 
support constituent requests made to a congressional representative. If 
an authorization for the disclosure has been obtained from the data 
subject, then no routine use is needed. The Privacy Act allows for 
disclosures with the ``prior written consent'' of the data subject.
    We are modifying the language in the remaining routine uses to 
provide a proper explanation as to the need for the routine use and to 
provide clarity to CMS's intention to disclose individual-specific 
information contained in this system. The routine uses will then be 
prioritized and reordered according to their usage. We will also take 
the opportunity to update any sections of the system that were affected 
by the recent reorganization or because of the impact of the Medicare 
Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) 
(Pub. L. 108-173) provisions and to update language in the 
administrative sections to correspond with language used in other CMS 
SORs.
    The primary purpose of the system is to aid in the administration 
of the survey and certification, and payment of Medicare Long Term Care 
services, which include skilled nursing facilities (SNFs), nursing 
facilities (NFs) SNFs/NFs, and hospital swing beds, and to study the 
effectiveness and quality of care given in those facilities. 
Information in this system will also be used to: (1) Support 
regulatory, reimbursement, and policy functions performed within the 
Agency or by a contractor or consultant; (2) assist another Federal or 
state agency, agency of a state government, an agency established by 
state law, or its fiscal agent; (3) support Quality Improvement 
Organizations (QIO); (4) assist other insurers for processing 
individual insurance claims; (5) facilitate research on the quality and 
effectiveness of care provided, as well as payment related projects; 
(6) support litigation involving the Agency; (7) assist national 
accrediting organizations; and (8)

[[Page 12802]]

combat fraud, waste, and abuse in certain health benefits programs. We 
have provided background information about the modified system in the 
SUPPLEMENTARY INFORMATION section below. Although the Privacy Act 
requires only that CMS provide an opportunity for interested persons to 
comment on the proposed routine uses, CMS invites comments on all 
portions of this notice. See ``Effective Dates'' section for comment 
period.

DATES: Effective Dates: CMS filed a modified system report with the 
Chair of the House Committee on Government Reform and Oversight, the 
Chair of the Senate Committee on Homeland Security and Governmental 
Affairs, and the Administrator, Office of Information and Regulatory 
Affairs, Office of Management and Budget (OMB) on February 22, 2007. To 
ensure that all parties have adequate time in which to comment, the 
modified SOR, including routine uses, will become effective 40 days 
from the publication of the notice, or from the date it was submitted 
to OMB and the 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 Privacy Compliance, Enterprise Architecture and Strategy 
Group, Office of Information Services, CMS, Room N2-04-27, 7500 
Security Boulevard, Baltimore, Maryland 21244-1850. Comments received 
will be available for review at this location, by appointment, during 
regular business hours, Monday through Friday from 9 a.m.-3 p.m., 
Eastern Time zone.

FOR FURTHER INFORMATION CONTACT: Tina Miller, Health Insurance 
Specialist, Division of Nursing Homes, Survey and Certification Group, 
Center for Medicaid and State Operations, CMS, Mail stop S2-12-25, 7500 
Security Boulevard, Baltimore, Maryland 21244-1850. The telephone 
number is (410) 786-6735 or e-mail <a href="/cdn-cgi/l/email-protection#ffab96919ed1b29693939a8dbf9c928cd197978cd1989089"><span class="__cf_email__" data-cfemail="5b0f32353a75163237373e291b38362875333328753c342d">[email protected]</span></a>.

SUPPLEMENTARY INFORMATION: 

I. Description of the Modified System

A. Statutory and Regulatory Basis for System

    Authority for maintenance of the system is given under Sec. Sec.  
1102(a), 1819(b) (3)(A), 1819(f), 1919(b)(3)(A), 1919(f), and 1864 of 
the Social Security Act.

B. Collection and Maintenance of Data in the System

    The system contains information on residents in all long-term care 
facilities that are Medicare and/or Medicaid certified, including 
private pay individuals including but not limited to Medicare 
enrollment and entitlement, and Medicare Secondary Payer (MSP) data 
containing other party liability insurance information necessary for 
appropriate Medicare claim payment. The system also contains the 
individual's health insurance numbers, name, geographic location, race/
ethnicity, sex, and date of birth, hospice election, premium billing 
and collection, direct billing information, and group health plan 
enrollment data.

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

    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 MDS information that can be associated 
with an individual as provided for under ``Section III. Proposed 
Routine Use Disclosures of Data in the System.'' Both identifiable and 
non-identifiable data may be disclosed under a routine use. We will 
only disclose the minimum personal data necessary to achieve the 
purpose of MDS.
    CMS has the following policies and procedures concerning 
disclosures of information that will be maintained in the system. 
Disclosure of information from the system will be approved only to the 
extent necessary to accomplish the purpose of the disclosure and only 
after CMS:
    1. Determines that the use or disclosure is consistent with the 
reason that the data is being collected, e.g., to aid in the 
administration of the survey and certification, and payment of Medicare 
Long Term Care services, which include skilled nursing facilities 
(SNFs), nursing facilities (NFs) SNFs/NFs, and hospital swing beds, and 
to study the effectiveness and quality of care given in those 
facilities.
    2. Determines that:
    a. The purpose for which the disclosure is to be made can only be 
accomplished if the record is provided in individually identifiable 
form;
    b. The purpose for which the disclosure is to be made is of 
sufficient importance to warrant the effect and/or risk on the privacy 
of the individual that additional exposure of the record might bring; 
and
    c. There is a strong probability that the proposed use of the data 
would in fact accomplish the stated purpose(s).
    3. Requires the information recipient to:
    a. Establish administrative, technical, and physical safeguards to 
prevent unauthorized use of disclosure of the record;
    b. Remove or destroy at the earliest time all patient-identifiable 
information; and
    c. Agree to not use or disclose the information for any purpose 
other than the stated purpose under which the information was 
disclosed.
    4. Determines that the data are valid and reliable.

III. Modified Routine Use Disclosures of Data in the System

A. Entities Who May Receive Disclosures Under Routine Use

    These routine uses specify circumstances, in addition to those 
provided by statute in the Privacy Act of 1974, under which CMS may 
release information from the MDS 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 have provided a 
brief explanation of the routine uses we are proposing to establish or 
modify for disclosures of information maintained in the system:
    1. To support Agency contractors, consultants, or grantees who have 
been contracted by the Agency to assist in accomplishment of a CMS 
function relating to the purposes for this system 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 CMS functions 
relating to purposes for this system.
    CMS occasionally contracts out certain of its functions when this 
would contribute to effective and efficient operations. CMS must be 
able to give contractors, consultants, or grantees whatever information 
is necessary for contractors, consultants, or grantees to fulfill their 
duties. In these situations, safeguards are provided in the contract 
prohibiting contractors, consultants, or grantees from using or 
disclosing the information for any purpose other than that described in 
the contract and to return or destroy all information at the completion 
of the contract.
    2. To assist another Federal or state agency, agency of a state 
government, an

[[Page 12803]]

agency established by state law, or its fiscal agent to:
    a. Contribute to the accuracy of CMS's proper payment of Medicare 
benefits.
    b. Enable such agency to administer a Federal health benefits 
program, or as necessary to enable such agency to fulfill a requirement 
of a Federal statute or regulation that implements a health benefits 
program funded in whole or in part with Federal funds, and/or
    c. Assist Federal/state Medicaid programs within the state.
    Other Federal or state agencies in their administration of a 
Federal health program may require MDS information in order to support 
evaluations and monitoring of Medicare claims information of 
beneficiaries, including proper reimbursement for services provided.
    In addition, other state agencies in their administration of a 
Federal health program may require MDS information for the purposes of 
determining, evaluating and/or assessing cost, effectiveness, and/or 
the quality of health care services provided in the state.
    The Social Security Administration may require MDS data to enable 
them to assist in the implementation and maintenance of the Medicare 
program.
    Disclosure under this routine use shall be used by state Medicaid 
agencies pursuant to agreements with the HHS for determining Medicaid 
and Medicare eligibility, for quality control studies, for determining 
eligibility of recipients of assistance under Titles IV, XVIII, and XIX 
of the Act, and for the administration of the Medicaid program. Data 
will be released to the state only on those individuals who are 
patients under the services of a Medicaid program within the state or 
who are residents of that state.
    We also contemplate disclosing information under this routine use 
in situations in which state auditing agencies require MDS information 
for auditing state Medicaid eligibility considerations. CMS may enter 
into an agreement with state auditing agencies to assist in 
accomplishing functions relating to purposes for this system.
    3. To assist Quality Improvement Organizations (QIO) in connection 
with review of claims, or in connection with studies or other review 
activities, conducted pursuant to Part B of Title XI of the Act and in 
performing affirmative outreach activities to individuals for the 
purpose of establishing and maintaining their entitlement to Medicare 
benefits or health insurance plans.
    QIOs will work to implement quality improvement programs, provide 
consultation to CMS, its contractors, and to state agencies. QIOs will 
assist state agencies and CMS intermediaries in program integrity 
assessments and preparation of summary information for release to CMS.
    4. To assist insurance companies, underwriters, third party 
administrators (TPA), employers, self-insurers, group health plans, 
health maintenance organizations (HMO), health and welfare benefit 
funds, managed care organizations, other supplemental insurers, non-
coordinating insurers, multiple employer trusts, liability insurers, 
no-fault medical automobile insurers, workers compensation carriers or 
plans, other groups providing protection against medical expenses 
without the beneficiary's authorization, and any entity having 
knowledge of the occurrence of any event affecting (a) an individual's 
right to any such benefit or payment, or (b) the initial right to any 
such benefit or payment, for the purpose of coordination of benefits 
with the Medicare program and implementation of the MSP provision at 42 
U.S.C. 1395y (b). Information to be disclosed shall be limited to 
Medicare utilization data necessary to perform that specific function. 
In order to receive the information, they must agree to:
    a. Certify that the individual about whom the information is being 
provided is one of its insured or employees, or is insured and/or 
employed by another entity for whom they serve as a TPA;
    b. Utilize the information solely for the purpose of processing the 
individual's insurance claims; and
    c. Safeguard the confidentiality of the data and prevent 
unauthorized access.
    Other insurers may require MDS information in order to support 
evaluations and monitoring of Medicare claims information of 
beneficiaries, including proper reimbursement for services provided.
    5. To support an individual or organization for research, 
evaluation, or epidemiological projects related to the prevention of 
disease or disability, the restoration or maintenance of health, or 
payment related projects.
    MDS data will provide research, evaluations and epidemiological 
projects, a broader, longitudinal, national perspective of the status 
of Medicare beneficiaries. CMS anticipates that many researchers will 
have legitimate requests to use these data in projects that could 
ultimately improve the care provided to Medicare beneficiaries and the 
policy that governs the care.
    6. To support the Department of Justice (DOJ), court or 
adjudicatory body when:
    a. The Agency or any component thereof, or
    b. Any employee of the Agency in his or her official capacity, or
    c. Any employee of the Agency in his or her individual capacity 
where the DOJ has agreed to represent the employee, or
    d. The United States Government is a party to litigation or has an 
interest in such litigation, and by careful review, CMS determines that 
the records are both relevant and necessary to the litigation and that 
the use of such records by the DOJ, court or adjudicatory body is 
compatible with the purpose for which the agency collected the records.
    Whenever CMS is involved in litigation, or occasionally when 
another party is involved in litigation and CMS's policies or 
operations could be affected by the outcome of the litigation, CMS 
would be able to disclose information to the DOJ, court or adjudicatory 
body involved.
    7. To support a national accrediting organization whose accredited 
facilities are presumed to meet certain Medicare requirements for 
inpatient hospital (including swing beds) services; e.g., the Joint 
Commission for the Accrediting of Healthcare Organizations (JCAHO). 
Information will be released to accrediting organizations only for 
those facilities that they accredit and that participate in the 
Medicare program.
    CMS anticipates providing those national accrediting organizations 
with MDS information to enable them to target potential or identified 
problems during the organization's accreditation review process of that 
facility.
    8. To assist a CMS contractor (including, but not limited to fiscal 
intermediaries and carriers) that assists in the administration of a 
CMS-administered health benefits program, or to a grantee of a CMS-
administered grant program, when disclosure is deemed reasonably 
necessary by CMS to prevent, deter, discover, detect, investigate, 
examine, prosecute, sue with respect to, defend against, correct, 
remedy, or otherwise combat fraud, waste or abuse in such program.
    We contemplate disclosing information under this routine use only 
in situations in which CMS may enter into a contract or grant with a 
third party to assist in accomplishing CMS functions relating to the 
purpose of combating fraud, waste, and abuse.
    CMS occasionally contracts out certain of its functions when doing 
so would contribute to effective and efficient operations. CMS must be 
able to give a contractor or grantee whatever information is necessary 
for the

[[Page 12804]]

contractor or grantee to fulfill the contractor or grantee 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.
    9. 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 MDS information for the purpose of 
combating fraud, waste, and abuse in such Federally-funded programs.

B. Additional Circumstances Affecting Routine Use Disclosures

    To the extent this system contains Protected Health Information 
(PHI) as defined by HHS regulation ``Standards for Privacy of 
Individually Identifiable Health Information'' (45 CFR parts 160 and 
164, subparts A and E) 65 FR 82462 (12-28-00). Disclosures of such PHI 
that are otherwise authorized by these routine uses may only be made 
if, and as, permitted or required by the ``Standards for Privacy of 
Individually Identifiable Health Information.'' (See 45 CFR 164-
512(a)(1)).
    In addition, our policy will be to prohibit release even of data 
not directly identifiable, except pursuant to one of the routine uses 
or if required by law, if we determine there is a possibility that an 
individual can be identified through implicit deduction based on small 
cell sizes (instances where the patient population is so small that 
individuals could, because of the small size, use this information to 
deduce the identity of the beneficiary).

IV. Safeguards

    CMS has safeguards in place for authorized users and monitors such 
users to ensure against 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 NIST 
publications; the HHS Automated Information Systems Security Handbook 
and the CMS Information Security Handbook.

V. Effect of the Modified System on Individual Rights

    CMS proposes to establish this system in accordance with the 
principles and requirements of the Privacy Act and will collect, use, 
and disseminate information only as prescribed therein. CMS will only 
disclose the minimum personal data necessary to achieve the purposes of 
MDS. 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 high level of security clearance for the information 
maintained in this system in an effort to provide added security and 
protection of data.
    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: February 22, 2007.
Charlene Frizzera,
Acting Chief Operating Officer, Centers for Medicare & Medicaid 
Services.
System No. 09-70-0528

System Name:
    ``Long Term Care-Minimum Data Set (MDS),'' Department of Health and 
Human Services (HHS)/Centers for Medicare & Medicaid Services (CMS)/
Center for Medicaid and State Operations (CMSO).

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 other remote 
locations.

Categories of Individuals Covered by the System:
    The system contains information on residents in all long-term care 
facilities that are Medicare and/or Medicaid certified, including 
private pay individuals including but not limited to Medicare 
enrollment and entitlement, and Medicare Secondary Payer (MSP) data 
containing other party liability insurance information necessary for 
appropriate Medicare claim payment.

Categories of Records in the System:
    The system also contains the individual's health insurance numbers, 
name, geographic location, race/ethnicity, sex, and date of birth, 
hospice election, premium billing and collection, direct billing 
information, and group health plan enrollment data.

Authority for Maintenance of the System:
    Authority for maintenance of the system is given under of 
Sec. Sec.  1102(a), 1819(b)(3)(A), 1819(f), 919(b)(3)(A), 1919(f), and 
1864 of the Social Security Act.

Purpose(s) of the System:
    The primary purpose of the system is to aid in the administration 
of the survey and certification, and payment of Medicare Long Term Care 
services, which include skilled nursing facilities (SNFs), nursing 
facilities (NFs) SNFs/NFs, and hospital swing beds, and to study the 
effectiveness and quality of care given in those facilities. 
Information in this system will also be used to: (1) Support 
regulatory, reimbursement, and policy functions performed within the 
Agency or by a contractor or consultant; (2) assist

[[Page 12805]]

another Federal or state agency, agency of a state government, an 
agency established by state law, or its fiscal agent; (3) support 
Quality Improvement Organizations (QIO); (4) assist other insurers for 
processing individual insurance claims; (5) facilitate research on the 
quality and effectiveness of care provided, as well as payment related 
projects; (6) support litigation involving the Agency; (7) assist 
national accrediting organizations; and (8) combat fraud, waste, and 
abuse in certain health benefits programs.

Routine Uses of Records Maintained in the System, Including Categories 
or Users and the Purposes of Such Uses:
    A. Entities Who May Receive Disclosures under Routine Use
    These routine uses specify circumstances, in addition to those 
provided by statute in the Privacy Act of 1974, under which CMS may 
release information from the MDS 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 have provided a 
brief explanation of the routine uses we are proposing to establish or 
modify for disclosures of information maintained in the system:
    1. To support Agency contractors, consultants, or grantees who have 
been contracted by the Agency to assist in accomplishment of a CMS 
function relating to the purposes for this system and who need to have 
access to the records in order to assist CMS.
    2. To assist another Federal or state agency, agency of a state 
government, an agency established by state law, or its fiscal agent to:
    a. Contribute to the accuracy of CMS's proper payment of Medicare 
benefits.
    b. Enable such agency to administer a Federal health benefits 
program, or as necessary to enable such agency to fulfill a requirement 
of a Federal statute or regulation that implements a health benefits 
program funded in whole or in part with Federal funds, and/or
    c. Assist Federal/state Medicaid programs within the state.
    3. To support Quality Improvement Organizations (QIO) in connection 
with review of claims, or in connection with studies or other review 
activities, conducted pursuant to Part B of Title XI of the Act and in 
performing affirmative outreach activities to individuals for the 
purpose of establishing and maintaining their entitlement to Medicare 
benefits or health insurance plans.
    4. To assist insurance companies, underwriters, third party 
administrators (TPA), employers, self-insurers, group health plans, 
health maintenance organizations (HMO), health and welfare benefit 
funds, managed care organizations, other supplemental insurers, non-
coordinating insurers, multiple employer trusts, liability insurers, 
no-fault medical automobile insurers, workers compensation carriers or 
plans, other groups providing protection against medical expenses 
without the beneficiary's authorization, and any entity having 
knowledge of the occurrence of any event affecting (a) an individual's 
right to any such benefit or payment, or (b) the initial right to any 
such benefit or payment, for the purpose of coordination of benefits 
with the Medicare program and implementation of the MSP provision at 42 
U.S.C. 1395y (b). Information to be disclosed shall be limited to 
Medicare utilization data necessary to perform that specific function. 
In order to receive the information, they must agree to:
    a. Certify that the individual about whom the information is being 
provided is one of its insured or employees, or is insured and/or 
employed by another entity for whom they serve as a TPA;
    b. Utilize the information solely for the purpose of processing the 
individual's insurance claims; and
    c. Safeguard the confidentiality of the data and prevent 
unauthorized access.
    5. To support an individual or organization for research, 
evaluation, or epidemiological projects related to the prevention of 
disease or disability, the restoration or maintenance of health, or 
payment related projects.
    6. To assist the Department of Justice (DOJ), court or adjudicatory 
body when:
    a. The Agency or any component thereof, or
    b. Any employee of the Agency in his or her official capacity, or
    c. Any employee of the Agency in his or her individual capacity 
where the DOJ has agreed to represent the employee, or
    d. The United States Government is a party to litigation or has an 
interest in such litigation, and by careful review, CMS determines that 
the records are both relevant and necessary to the litigation and that 
the use of such records by the DOJ, court or adjudicatory body is 
compatible with the purpose for which the agency collected the records.
    7. To support a national accrediting organization whose accredited 
facilities are presumed to meet certain Medicare requirements for 
inpatient hospital (including swing beds) services; e.g., the Joint 
Commission for the Accrediting of Healthcare Organizations (JCAHO). 
Information will be released to accrediting organizations only for 
those facilities that they accredit and that participate in the 
Medicare program.
    8. To assist CMS contractor (including, but not limited to fiscal 
intermediaries and carriers) that assists in the administration of a 
CMS-administered health benefits program, or to a grantee of a CMS-
administered grant program, when disclosure is deemed reasonably 
necessary by CMS to prevent, deter, discover, detect, investigate, 
examine, prosecute, sue with respect to, defend against, correct, 
remedy, or otherwise combat fraud, waste, or abuse in such program.
    9. To support another Federal agency or to an instrumentality of 
any governmental jurisdiction within or under the control of the United 
States (including any state or local governmental agency), that 
administers, or that has the authority to investigate potential fraud, 
waste, or abuse in a health benefits program funded in whole or in part 
by Federal funds, when disclosure is deemed reasonably necessary by CMS 
to prevent, deter, discover, detect, investigate, examine, prosecute, 
sue with respect to, defend against, correct, remedy, or otherwise 
combat fraud, waste, or abuse in such programs.
    B. Additional Circumstances Affecting Routine Use Disclosures
    To the extent this system contains Protected Health Information 
(PHI) as defined by HHS regulation ``Standards for Privacy of 
Individually Identifiable Health Information'' (45 CFR parts 160 and 
164, subparts A and E) 65 FR 82462 (12-28-00). Disclosures of such PHI 
that are otherwise authorized by these routine uses may only be made 
if, and as, permitted or required by the ``Standards for Privacy of 
Individually Identifiable Health Information.'' (See 45 CFR 164-512 (a) 
(1)).
    In addition, our policy will be to prohibit release even of data 
not directly identifiable, except pursuant to one of the routine uses 
or if required by law, if we determine there is a possibility that an 
individual can be identified through implicit deduction based on small 
cell sizes (instances where the patient population is so small that 
individuals could, because of the small size, use this information to 
deduce the identity of the beneficiary).

[[Page 12806]]

Policies and Practices for Storing, Retrieving, Accessing, Retaining, 
and Disposing of Records in the System:
Storage:
    All records are stored on magnetic media.

Retrievability:
    All Medicare records are accessible by HIC number or alpha (name) 
search. This system supports both online and batch access.

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 NIST 
publications; the HHS Automated Information Systems Security Handbook 
and the CMS Information Security Handbook.

Retention and Disposal:
    <bullet> ``Records will be retained until an approved disposition 
authority is obtained from the National Archives and Records 
Administration.''

System Manager and Address:
    Director, Survey and Certification Group, Center for Medicaid and 
State Operations, CMS, 7500 Security Boulevard, Baltimore, Maryland 
21244-1850.

Notification Procedure:
    For purpose of access, the subject individual should write to the 
system manager who will require the system name, health insurance claim 
number, address, date of birth, and sex, and for verification purposes, 
the subject individual's name (woman's maiden name, if applicable), and 
social security number (SSN). Furnishing the SSN is voluntary, but it 
may make searching for a record easier and prevent delay.

Record Access Procedure:
    For purpose of access, use the same procedures outlined in 
Notification Procedures above. Requestors should also reasonably 
specify the record contents being sought. (These procedures are in 
accordance with department regulation 45 CFR 5b.5 (a) (2)).

Contesting Record Procedures:
    The subject individual 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 data contained in these records are furnished by the 
individual, or in the case of some MSP situations, through third party 
contacts. There are cases, however, in which the identifying 
information is provided to the physician by the individual; the 
physician then adds the medical information and submits the bill to the 
carrier for payment. Updating information is also obtained from the 
Railroad Retirement Board, and the Master Beneficiary Record maintained 
by the Social Security Administration.

Systems Exempted from Certain Provisions of the Act:
    None.
 [FR Doc. E7-4889 Filed 3-16-07; 8:45 am]
BILLING CODE 4120-03-P


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