[Federal Register Volume 70, Number 221 (Thursday, November 17, 2005)]
[Notices]
[Pages 69766-69771]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-22763]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services


Privacy Act of 1974; Report of New System of Records

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

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

-----------------------------------------------------------------------

SUMMARY: In accordance with the requirements of the Privacy Act of 
1974, we are proposing a new SOR titled, ``Medicare Premium Withhold 
System (PWS), No. 09-70-0552.'' On December 8, 2003, Congress passed 
the Medicare Prescription Drug, Improvement, and Modernization Act of 
2003 (MMA) (Public Law (Pub. L.) 108-173). Among other provisions, MMA 
allows Medicare payment to health plans for coverage of outpatient 
prescription drugs under the Medicare Part D benefit. The Social 
Security Act (the Act) provides for four summary payment mechanisms: 
Risk adjusted, federal reinsurance subsidies, risk corridor payments, 
and subsidized coverage for qualified low-income individuals. In 
addition, there is a premium payable by each beneficiary for Part D 
coverage, as well as the pre-existing premium for Part C (now known as 
Medicare Advantage (MA)), created under Title II legislation.
    Beginning January 2006, MMA will provide enrollees in MA, and 
Medicare Advantage Prescription Drug (MAPD) plans an option to have 
Part C and Part D premiums withheld from their monthly retirement 
annuities provided by the Social Security Administration (SSA), 
Railroad Retirement Board (RRB), or Office of Personnel Management 
(OPM). The Medicare Premium Withhold System is the system of record 
(SOR) for maintaining and managing Part C and Part D beneficiary 
premium payment amounts. For 2006, two external agencies, the SSA and 
the RRB, provide this monthly premium withholding through the PWS. The 
Medicare Advantage Prescription Drug System (MARx) notifies SSA and RRB 
of premium amounts to be withheld and applicable periods on a daily 
basis. PWS uses interfaces from MARx to track these premium withholding 
amounts as ``expected.'' PWS also uses interfaces with SSA and RRB to 
record the withheld premium amounts and periods they apply to as 
``actual.'' The PWS notifies the appropriate MA and MAPD of all 
beneficiary withholdings and facilitates the payment of withheld 
premiums via the automated plan payment system (APPS) and the Financial 
Accounting System (FACS) for ultimate payment by the United States 
Treasury.
    The primary purpose of the SOR is to process a monthly premium 
withhold file from SSA and RRB, capture expected premium withholding 
amounts from MARx and compare them to actual withholding amounts, 
produce a reconciliation of the reported withholding amounts with 
amounts transferred via Governmental Payment and Collection (IPAC) 
files from SSA and RRB, and generate plan payment requests to APPS. 
Information in this system will also be disclosed to: (1) Support 
regulatory, reimbursement, and policy functions performed by a 
contractor or consultant contracted by the Agency; (2) support Medicare 
Prescription Drug Plans (PDP) and Medicare Advantage Prescription Drug 
Plans (MAPD) directly or through a CMS contractor for the 
administration of Title XVIII of the Act; (3) support another Federal 
or State agency, agency of a state government, an agency established by 
state law, or its fiscal agent; (4) support constituent requests made 
to a congressional representative; (5) support litigation involving the 
Agency, and (6) combat fraud 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 new system report with the Chair of 
the House Committee on Government Reform and Oversight, the Chair of 
the Senate Committee on Governmental Affairs, and the Administrator, 
Office of Information and Regulatory Affairs, Office of Management and 
Budget (OMB) on November 3, 2005. To ensure that all parties have 
adequate time in which to comment, the 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 Data Development (DPCDD), 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 daylight time.

FOR FURTHER INFORMATION CONTACT: Linda Bosque, Computer Technology 
Information Specialist, Division of Medicare Advantage Payment Systems, 
Information Services Modernization Group, Office of Information 
Services, CMS, Room N3-13-10, 7500 Security Boulevard, Baltimore, 
Maryland 21244-1850. The telephone number is 410-786-0164.

SUPPLEMENTARY INFORMATION: CMS has long realized that the Medicare 
program is in the middle of a rapidly changing health insurance 
industry characterized by an expansion of service delivery models and 
payment options. The managed care provisions of the Balance Budget Act 
(BBA) of 1997 (Public Law 105-33) combined with the MMA have made 
managing beneficiary health choices one of the most critical challenges 
facing CMS and the health industry at large. To be of maximum use, the 
data must be organized and categorized into comprehensive interrelated 
systems.
    The Medicare Premium Withhold System (PWS) is a new system that 
helps remove barriers to beneficiary enrollment in Medicare's new 
prescription drug benefits, which will be offered by MAPDs and PDPs 
effective January 1, 2006. Through the PWS, CMS has extended to both 
Part C and Part D enrollees the option of withholding their monthly 
premium amounts from retirement annuities provided by external 
agencies, including SSA and RRB (and OPM in future releases of the 
system). The PWS builds upon the Enterprise Data Exchange with these 
three agencies, adding data stores and reporting capabilities in order 
to

[[Page 69767]]

facilitate beneficiary cost-sharing. By forwarding withheld premium 
amounts to MAs, MAPDs and PDPs, PWS retrospectively supplements the 
monthly, prospective payment to plans of capitated amounts and low-
income subsidies calculated in MARx. In addition to these components of 
the plan payment transaction, APPS receives from PWS all the premium-
related information required to facilitate the execution of plan 
payments.
    Beginning January 2006, MMA will provide enrollees in MA, and 
Medicare Advantage Prescription Drug (MAPD) plans an option to have 
Part C and Part D premiums withheld from their monthly retirement 
annuities provided by the Social Security Administration (SSA), 
Railroad Retirement Board (RRB) or Office of Personnel Management 
(OPM). The Medicare Premium Withhold System is the system of record 
(SOR) for maintaining and managing Part C and Part D beneficiary 
premium payment amounts. For 2006, two external agencies, the SSA and 
RRB, provide this monthly premium withholding through the PWS.
    The Medicare Advantage Prescription Drug System (MARx) notifies SSA 
and RRB of premium amounts to be withheld and applicable periods on a 
daily basis. PWS uses interfaces from MARx to track these premium 
withholding amounts as ``expected.'' PWS also uses interfaces with SSA 
and RRB to record the withheld premium amounts and periods they apply 
to as ``actual.'' The PWS notifies the appropriate MA and MAPDs of all 
beneficiary withholdings and facilitates the payment of withheld 
premiums via the automated plan payment system (APPS), and the 
Financial Accounting System (FACS) for ultimate payment by the U.S. 
Treasury. The PWS carries out these responsibilities through key 
monthly functions including:
    <bullet> Receiving monthly premium withhold files from SSA and RRB 
that identify premium amounts withheld and the periods they apply to. 
These are used as ``actual'' amounts.
    <bullet> Receiving a monthly premium withhold extract from MARx 
that identifies beneficiaries electing Premium Withhold and the premium 
amounts and the periods they apply to. These are used by PWS as 
``expected'' amounts.
    <bullet> PWS performs monthly reconciliation of the MARx expected 
amounts and the SSA or RRB actual amounts, identifying discrepancies 
and, if necessary, directing MARx to convert a beneficiary whose 
withholding is incorrect to direct bill status. The results of the 
reconciliation are reported to MARx for distribution to the plans.
    <bullet> PWS also performs a reconciliation of the report of funds 
transferred by SSA and RRB to the actual transfer accomplished via the 
Intergovernmental Payment and Collection (IPAC) files from SSA and RRB.
    <bullet> PWS 1 produces a file that is sent to the Automated Plan 
Payment System (APPS) that indicates the proper payment of withheld 
funds to the MA and MAPD plans.
    An independent technical evaluation of CMS' managed care systems 
found that the new premium withhold functionality required by MMA could 
not be supported by existing Medicare systems. The comprehensive review 
of existing systems was necessary in order to proceed with a 
development effort that would ensure the new MMA provisions and future 
customer service and program management objectives were met.

I. Description of System of Records

A. Statutory and Regulatory Basis for the System

    Authority for maintenance of the system is given under Section 101 
of MMA (Pub. L. 108-173) amended the Title XVIII of the Social Security 
Act. Authority for maintenance of the system is also given under the 
provisions of Sec. Sec.  1833(a)(1)(A), 1860, 1866, and 1876 of Title 
XVIII of the Act (42 U.S.C. 1395(A)(1)(a), 1395cc, and 1395mm).

B. Collection and Maintenance of Data in the System

    The Medicare Premium Withhold System creates a PWS Data Mart to 
store data needed for processing and record keeping. The PWS Data Mart 
stores, at the beneficiary level, the expected withholding data and the 
actual withholding data as reported by the withholding agencies.

II. Agency Policies, Procedures, and Restrictions on Routine Uses

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

    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 PWS 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 collect the minimum personal data necessary to achieve the purpose 
of PWS.
    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 process a monthly 
premium withhold file from SSA and RRB, capture expected premium 
withholding amounts from MARx and comparing them to actual withholding 
amounts, produce a reconciliation of the reported withholding amounts 
with amounts transferred via IPAC files from SSA and RRB, and generate 
plan payment requests to APPS.
    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. Proposed Routine Use Disclosures of Data in the System

A. Entities Who May Receive Disclosures Under Routine Use

    These routine uses specify circumstances, in addition to those 
provided by statute in the Privacy Act of 1974, under which CMS may 
release information from the PWS facilitator 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

[[Page 69768]]

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 or modify the 
following routine use disclosures of information maintained in the 
system:
    1. To Agency contractors or consultants who have been contracted 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 or consultant 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 or consultant from using or disclosing the information 
for any purpose other than that described in the contract and requires 
the contractor or consultant to return or destroy all information at 
the completion of the contract.
    2. To Medicare Prescription Drug Plans (PDP) and Medicare Advantage 
Prescription Drug Plans (MAPD) directly or through a CMS contractor for 
the administration of Title XVIII of the Act.
    PDPs and MAPDs require PWS information in order to establish the 
validity of evidence or to verify the accuracy of information presented 
by the individual, as it concerns the individual's entitlement to Part 
D benefits under the Medicare Prescription Drug Benefit Program.
    3. To another Federal or state agency, agency of a state 
government, an agency established by state law, or its fiscal agent 
pursuant to agreements with CMS to:
    a. Contribute to the accuracy of CMS's proper payment of Medicare 
benefits;
    b. Enable such agency to administer a Federal health benefits 
program, or as necessary to enable such agency to fulfill a requirement 
of a Federal statute or regulation that implements a health benefits 
program funded in whole or in part with Federal funds; and/or
    c. Assist Federal/state Medicaid programs within the state.
    Other Federal or state agencies in their administration of a 
Federal health program may require PWS information in order to support 
evaluations and monitoring of Medicare claims information of 
beneficiaries, including proper reimbursement for services provided.
    In addition, state agencies in their administration of a Federal 
health program may require PWS information for the purposes of 
determining, evaluating and/or assessing cost, effectiveness, and/or 
the quality of health care services provided in the state.
    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 PWS 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 SOR.
    4. To a Member of Congress or congressional staff member in 
response to an inquiry of the congressional office made at the written 
request of the constituent about whom the record is maintained.
    Beneficiaries often request the help of a Member of Congress in 
resolving an issue relating to a matter before CMS. The Member of 
Congress then writes CMS, and CMS must be able to give sufficient 
information to be responsive to the inquiry.
    5. To 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.
    6. To 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 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 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 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.
    7. To 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 
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 or abuse in such programs.
    Other agencies may require PWS information for the purpose of 
combating fraud and abuse in such Federally-funded programs.

[[Page 69769]]

B. Additional Circumstances Affecting Routine Use Disclosures

    To the extent this system contains Protected Health Information as 
defined by HHS regulation ``Standards for Privacy of Individually 
Identifiable Health Information'' (45 CFR parts 160 and 164, 65 FR 
82462 (12-28-00), subparts A and E. Disclosures of Protected Health 
Information 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.''
    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 who are familiar with the enrollees 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 excessive or unauthorized use. Personnel having 
access to the system have been trained in the Privacy Act and 
information security requirements. Employees who maintain records in 
this system are instructed not to release data until the intended 
recipient agrees to implement appropriate management, operational and 
technical safeguards sufficient to protect the confidentiality, 
integrity and availability of the information and information systems 
and to prevent unauthorized access.
    This system will conform to all applicable Federal laws and 
regulations and Federal, HHS, and CMS policies and standards as they 
relate to information security and data privacy. These laws and 
regulations may apply but are not limited to: The Privacy Act of 1974; 
the Federal Information Security Management Act of 2002; the Computer 
Fraud and Abuse Act of 1986; the Health Insurance Portability and 
Accountability Act of 1996; the E-Government Act of 2002, the Clinger-
Cohen Act of 1996; MMA, 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. Effect of the Proposed 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. We will only 
disclose the minimum personal data necessary to achieve the purpose of 
PWS. 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: November 3, 2005.
Charlene Frizzera,
Acting Chief Operating Officer, Centers for Medicare & Medicaid 
Services.
System No.: 09-70-0552

System Name
    ``Medicare Premium Withhold System'' (PWS) HHS/CMS/OIS.

Security Classification
    Level Three Privacy Act Sensitive.

System Location
    CMS Data Center, 7500 Security Boulevard, North Building, First 
Floor, Baltimore, Maryland 21244-1850.

Categories of Individuals Covered by the System
    The system will include information on recipients of Medicare 
hospital insurance (Part A) and Medicare medical insurance (Part B) and 
recipients of the Prescription Drug Benefits Program (Part D) enrolled 
in the Medicare Advantage (MA) Program.

Categories of Records in the System
    The system will also include information about a beneficiary's 
entitlement to Medicare benefits and enrollment in Medicare Programs, 
prescription drug coverage and supplementary medical claims 
information. The system will contain identifying information such as 
beneficiary name, health insurance claim number, social security 
number, and other demographic information.

Authority for Maintenance of the System
    Authority for maintenance of the system is given under section 101 
of the MMA (Pub. L. 108-173) amended the Title XVIII of the Social 
Security Act. Authority for maintenance of the system is also given 
under the provisions of Sec. Sec.  1833(a) (1) (A), 1860, 1866, and 
1876 of Title XVIII of the Act (42 CFR parts 417 and 422).

Purpose (s) of the System
    The primary purpose of the SOR is to process a monthly premium 
withhold file from SSA and RRB, capture expected premium withholding 
amounts from MARx and compare them to actual withholding amounts, 
produce a reconciliation of the reported withholding amounts with 
amounts transferred via Governmental Payment and Collection (IPAC) 
files from SSA and RRB, and generate plan payment requests to APPS. 
Information in this system will also be disclosed to: (1) Support 
regulatory, reimbursement, and policy functions performed by a 
contractor or consultant contracted by the Agency; (2) support Medicare 
Prescription Drug Plans (PDP) and Medicare Advantage Prescription Drug 
Plans (MAPD) directly or through a CMS contractor for the 
administration of Title XVIII of the Act; (3) support another Federal 
or State agency, agency of a state government, an agency established by 
state law, or its fiscal agent; (4) support constituent requests made 
to a congressional representative; (5) support litigation involving the 
Agency, and (6) combat fraud 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 PWS facilitator without the consent of the 
individual to whom such information pertains. Each proposed disclosure 
of information

[[Page 69770]]

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 or modify the following routine use disclosures of 
information maintained in the system:
    1. To Agency contractors or consultants who have been contracted 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.
    2. To Medicare Prescription Drug Plans (PDP) and Medicare Advantage 
Prescription Drug Plans (MAPD) directly or through a CMS contractor for 
the administration of Title XVIII of the Act.
    3. To another Federal or state agency, agency of a state 
government, an agency established by state law, or its fiscal agent 
pursuant to agreements with CMS to:
    a. Contribute to the accuracy of CMS's proper payment of Medicare 
benefits;
    b. Enable such agency to administer a Federal health benefits 
program, or as necessary to enable such agency to fulfill a requirement 
of a Federal statute or regulation that implements a health benefits 
program funded in whole or in part with Federal funds; and/or
    c. Assist Federal/state Medicaid programs within the state.
    4. To a Member of Congress or congressional staff member in 
response to an inquiry of the congressional office made at the written 
request of the constituent about whom the record is maintained.
    5. To 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.
    6. To 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 or abuse in such program.
    7. To 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 
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 or abuse in such programs.
B. Additional Circumstances Affecting Routine Use Disclosures
    To the extent this system contains Protected Health Information as 
defined by HHS regulation ``Standards for Privacy of Individually 
Identifiable Health Information'' (45 CFR parts 160 and 164, 65 FR 
82462 (12-28-00), subparts A and E. Disclosures of Protected Health 
Information 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.''
    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 who are familiar with the enrollees could, because of the 
small size, use this information to deduce the identity of the 
beneficiary).

Policies and Practices for Storing, Retrieving, Accessing, Retaining, 
and Disposing of Records in the System
Storage
    Computer diskette and on magnetic storage media.

Retrievability
    Information can be retrieved by name and health insurance claim 
number of the beneficiary.

Safeguards
    CMS has safeguards in place for authorized users and monitors such 
users to ensure against excessive or unauthorized use. Personnel having 
access to the system have been trained in the Privacy Act and 
information security requirements. Employees who maintain records in 
this system are instructed not to release data until the intended 
recipient agrees to implement appropriate management, operational and 
technical safeguards sufficient to protect the confidentiality, 
integrity and availability of the information and information systems 
and to prevent unauthorized access.
    This system will conform to all applicable Federal laws and 
regulations and Federal, HHS, and CMS policies and standards as they 
relate to information security and data privacy.
    These laws and regulations may apply but are not limited to: The 
Privacy Act of 1974; the Federal Information Security Management Act of 
2002; the Computer Fraud and Abuse Act of 1986; the Health Insurance 
Portability and Accountability Act of 1996; the E-Government Act of 
2002, the Clinger-Cohen Act of 1996; MMA, and the corresponding 
implementing regulations. OMB Circular A-130, Management of Federal 
Resources, Appendix III, Security of Federal Automated Information 
Resources also applies. Federal, HHS, and CMS policies and standards 
include but are not limited to: All pertinent National Institute of 
Standards and Technology publications; the HHS Information Systems 
Program Handbook and the CMS Information Security Handbook.

Retention and Disposal:
    Records are maintained with identifiers for all transactions after 
they are entered into the system for a period of 6 years and 3 months. 
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 and Address:
    Director, Division of Medicare Advantage Appeals and Payment 
Systems, Information Services Modernization Group, Office of 
Information Services, CMS, Room N3-16-24, 7500 Security Boulevard, 
Baltimore, Maryland 21244-1850.

Notification Procedure:
    For purpose of access, the subject individual should write to the 
systems manager who will require the system name, SSN, address, date of 
birth, sex, and for verification purposes, the subject individual's 
name (woman's maiden name, if applicable). Furnishing

[[Page 69771]]

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:
    Data for this system is collected from the Medicare Advantage 
Prescription Drug System (MARx) system, the Medicare Beneficiary 
Database (MBD), as well as two external providers of monthly retirement 
annuities, SSA, and RRB, with potentially OPM as the third external 
partner in a future release of the PWS.

Systems Exempted from Certain Provisions of the Act:
    None.
[FR Doc. 05-22763 Filed 11-16-05; 8:45 am]
BILLING CODE 4120-03-P