[Federal Register: November 8, 2005 (Volume 70, Number 215)]
[Notices]
[Page 67709-67713]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr08no05-42]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
Privacy Act of 1974; Report of a New System of Records
AGENCY: Department of Health and Human Services (HHS) Centers for
Medicare & Medicaid Services (CMS).
ACTION: Notice of a New System of Records (SOR).
-----------------------------------------------------------------------
SUMMARY: In accordance with the requirements of the Privacy Act of
1974, we are proposing to establish a new
[[Page 67710]]
SOR titled, ``Medicare Prescription Drug Plan Finder (MPDPF) System,
HHS/CMS/CBC, System No. 09-70-0564.'' Under the provisions of Section
101 of the Medicare Prescription Drug, Improvement, and Modernization
Act of 2003 (MMA) (Pub. L. 108-173), CMS has provided the participants
of eligibility transactions a query and response solution in a single
data center using a three-tier architecture. Enterprise Business
Services (EBS), the user interface, will have the responsibility of
receiving identifying information on Medicare beneficiaries for
processing eligibility requests and enrollment assistance with the
Medicare Prescription Drug Benefit Program. These inbound messages will
be sent to EBS for processing of the eligibility request and for
securing the information from the CMS Community Based Organization/
Customer Service Representative (CBO/CSR) Data Store, and for sending
an available plan option response back via the internet. EBS will
capture the identifying information and enrollment selection, and
transmit it to the selected Medicare Prescription Drug Plan (PDP) or
Medicare Advantage Prescription Drug Plan (MAPD). This initiative will
streamline and facilitate drug benefit eligibility determination and
the enrollment process.
The primary purpose of this system is to provide a Web accessible
inquiry system that will provide a mechanism to support an individual
beneficiary's efforts in performing drug benefit eligibility queries
and to enroll them into selected plans. Information in this system will
also be used to: (1) Support regulatory and policy functions performed
within the Agency or by a contractor or consultant; (2) assist PDPs and
MAPDs directly or through the Enterprise Business Services; (3) support
constituent requests made to a Congressional representative; and (4)
support litigation involving the Agency related to this system. We have
provided background information about the proposed system in the
``Supplementary Information'' section below. Although the Privacy Act
requires only that the Aroutine use'' portion of the system be
published for comment, CMS invites comments on all portions of this
notice. See EFFECTIVE DATES section for comment period.
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 1, 2005. To ensure that all parties have adequate
time in which to comment, the new 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, CMS, Mail Stop 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: Thomas Dudley, Division of Website
Project Management, Beneficiary Information Services Group, Center for
Beneficiary Choices, CMS, Mail Stop S1-01-26, 7500 Security Boulevard,
Baltimore, Maryland, 21244-1850. His telephone number is 410-786-1442,
or e-mail at Thomas.Dudley@cms.hhs.gov.
SUPPLEMENTARY INFORMATION: The public version of the toll will use
knowledge based authentication (KBA), to provide the end user access to
personalized information about their drug benefit eligibility and
enrollment. KBA allows a user to access the system based on what they
know without the need for a user id/password. To successfully
authenticate, the user will need to provide the following information:
Health Insurance Claim Number (HICN), Date of Birth, Last Name, Type of
Enrollment, Effective date of enrollment, and Zip Code. This
information will then be validated in the CMS Data Center. All data
elements must match to successfully authenticate the user. If the
authentication fails, the user will be taken directly to the default
route and asked to respond to a series of questions in lieu of
authentication. They will not be provided with ``retry'' options. If
successfully authenticated, Part D and Part C information will be
retrieved from the data center and passed to MPDPF.
CMS has planned to provide the participants of eligibility
transactions a query and response solution in a single data center
using a three-tier architecture. EBS, the user interface, will have the
responsibility of receiving identifying information on Medicare
beneficiaries for processing eligibility requests and enrollment
assistance with the Medicare Prescription Drug Benefit Program. These
inbound messages will be sent to EBS for processing of the eligibility
request and for securing the information from the CMS CBO/CSR Data
Store, and for sending a response back via the internet.
The drug benefit itself is very complex. The user must self-
identify him/herself into one of 4 categories in order to get the
options applicable in his/her circumstances (full dual subsidy
eligible; full subsidy eligible; partial subsidy eligible; no subsidy
eligible). CMS knows from prior education and consumer research efforts
that it is extremely difficult for persons with Medicare to understand
the nuances of these options and to accurately categorize them. This
presents a challenge for both the direct beneficiary user and those
assisting the beneficiary (CSRs and CBOs). However, CMS data systems
contain information that can easily provide the user's categorization
and then enable the drug benefit tool to accurately present only those
options that are applicable to his/her unique circumstances. This is
the primary driver for the development of the eligibility query.
A secondary, but also essential, driver is to provide an efficient
means for users to explore their drug benefit choices. We need to
ensure that we provide tools that can encourage the maximum number of
Medicare beneficiaries to use self-service options given the volume of
inquiries we are projecting and the extraordinary costs for servicing
those calls. To meet the varying needs of different end-users, two
different versions of the MPDPF will be developed: one tool will be
used for the Public (including CBOs, and beneficiaries) and the other
tool will be dedicated to CSR staffing the call centers that service 1-
800-Medicare.
I. Description of the Proposed System of Records
A. Statutory and Regulatory Basis for the System
Authority for this system is given under the provisions of Section
101 of the Medicare Prescription Drug, Improvement, and Modernization
Act of 2003 (MMA) (Public Law 108-173). This new prescription drug
benefit program was enacted into law on December 8, 2003, amended Title
XVIII of the Social Security Act (the Act), and codified at Title 42
Code of Federal Regulations (CFR) Parts 403, 411, 417 and 423 by
establishing a new Medicare ``Part D'' Prescription Drug Benefit
program. Part D of Title XVIII of the Act, as amended by the MMA, and
its implementing regulations at 42 CFR Parts 403, 411, 417 and 423.
[[Page 67711]]
B. Collection and Maintenance of Data in the System
Information collected for this system will include but is not
limited to, individuals who voluntarily access and who successfully
validate information required by the Web-based Application Systems
maintained by CMS. Information collected for this system will include,
but is not limited to, last name, gender, HICN, telephone number,
geographic location, type of enrollment (Medicare Part A or Part B),
and effective date of enrollment in Part A and Part B.
II. Agency Policies, Procedures, and Restrictions on the Routine Use
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 MPDPF 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 MPDPF. 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 provide a Web
accessible inquiry system that will provide a mechanism to support an
individual beneficiary's efforts in performing drug benefit eligibility
queries and to enroll them into selected plans.
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. The Privacy Act allows 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 compatible use of data is known as a ``routine
use.'' The proposed routine uses in this system meet the compatibility
requirement of the Privacy Act. We are proposing to establish 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 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 a contractor whatever information is necessary for the
contractor to fulfill its duties. In these situations, safeguards are
provided in the contract prohibiting the contractor 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 Medicare Prescription Drug Plans (PDP) and Medicare Advantage
Prescription Drug Plans (MAPD) directly or through the Enterprise
Business Services, a CMS intermediary for the administration of Title
XVIII of the Act.
PDPs and MAPDs require MPDPF 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 a Member of Congress or to a 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.
Individuals sometimes request the help of a Member of Congress in
resolving some 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.
4. 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. 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. A determination would be made in each
instance that, under the circumstances involved, the purposes served by
the use of the information in the particular litigation is compatible
with a purpose for which CMS collects the information.
B. Additional Provisions Affecting Routine Use Disclosures. 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 PHI 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 not
directly identifiable information, 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
[[Page 67712]]
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 include but are not limited to: The Privacy Act of 1974;
the Federal Information Security Management Act of 2002; the Computer
Fraud and Abuse Act of 1986; the Health Insurance Portability and
Accountability Act of 1996; the E-Government Act of 2002, the Clinger-
Cohen Act of 1996; the Medicare Modernization Act of 2003, and the
corresponding implementing regulations. OMB Circular A-130, Management
of Federal Resources, Appendix III, Security of Federal Automated
Information Resources also applies. Federal, HHS, and CMS policies and
standards include but are not limited to: All pertinent National
Institute of Standards and Technology publications; HHS Information
Systems Program Handbook and the CMS Information Security Handbook.
V. Effects of the Proposed System of Records 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. Data in this
system will be subject to the authorized releases in accordance with
the routine uses identified in this system of records.
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 of patients whose data are
maintained in the system. 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: October 27, 2005.
Charlene Frizzera,
Deputy Chief Operating Officer, Centers for Medicare & Medicaid
Services.
09-70-0564
SYSTEM NAME:
``Medicare Prescription Drug Plan Finder (MPDPF) System, HHS/CMS/
CBC''
SECURITY CLASSIFICATION:
Level 3 Privacy Act Sensitive
SYSTEM LOCATION:
Centers for Medicare & Medicaid Services (CMS) Data Center, 7500
Security Boulevard, North Building, First Floor, Baltimore, Maryland
21244-1850, and at various contractor locations.
CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:
Information collected for this system will include but is not
limited to, individuals who voluntarily access and who successfully
validate information required by the Web-based Application Systems
maintained by CMS.
CATEGORIES OF RECORDS IN THE SYSTEM:
Information collected for this system will include, but is not
limited to, last name, gender, Health Insurance Claim Number (HICN),
telephone number, geographic location, type of enrollment (Medicare
Part A or Part B), and effective date of enrollment in Part A and Part
B.
AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
Authority for this system is given under the provisions of Section
101 of the Medicare Prescription Drug, Improvement, and Modernization
Act of 2003 (MMA) (Public Law 108-173). This new prescription drug
benefit program was enacted into law on December 8, 2003, amended Title
XVIII of the Social Security Act (the Act), and codified at Title 42
Code of Federal Regulations (CFR) parts 403, 411, 417 and 423 by
establishing a new Medicare ``Part D'' Prescription Drug Benefit
program. Part D of Title XVIII of the Act, as amended by the MMA, and
its implementing regulations at 42 CFR Parts 403, 411, 417 and 423.
PURPOSE(S) OF THE SYSTEM:
The primary purpose of this system is to provide a Web accessible
inquiry system that will provide a mechanism to support an individual
beneficiary's efforts in performing drug benefit eligibility queries
and to enroll them into selected plans. Information in this system will
also be used to: (1) Support regulatory and policy functions performed
within the Agency or by a contractor or consultant; (2) assist PDPs and
MAPDs directly or through the Enterprise Business Services; (3) support
constituent requests made to a Congressional representative; and (4)
support litigation involving the Agency related to this system.
ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM, INCLUDING CATEGORIES
OR USERS AND THE PURPOSES OF SUCH USES:
A. The Privacy Act allows 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 compatible use of data is known as a ``routine
use.'' The proposed routine uses in this system meet the compatibility
requirement of the Privacy Act. We are proposing to establish 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 system 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 the Enterprise
Business Services, a CMS intermediary for the administration of Title
XVIII of the Act.
3. To a Member of Congress or to a 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.
4. 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
[[Page 67713]]
records are both relevant and necessary to the litigation.
B. Additional Provisions Affecting Routine Use Disclosures. 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 Fed.
Reg. 82462 (12-28-00)). Disclosures of PHI 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 not
directly identifiable information, 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 the individual identifiable
information 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 include but are not limited to: the Privacy Act of 1974;
the Federal Information Security Management Act of 2002; the Computer
Fraud and Abuse Act of 1986; the Health Insurance Portability and
Accountability Act of 1996; the E-Government Act of 2002, the Clinger-
Cohen Act of 1996; the Medicare Modernization Act of 2003, and the
corresponding implementing regulations. OMB Circular A-130, Management
of Federal Resources, Appendix III, Security of Federal Automated
Information Resources also applies. Federal, HHS, and CMS policies and
standards include but are not limited to: all pertinent National
Institute of Standards and Technology publications; HHS Information
Systems Program Handbook and the CMS Information Security Handbook.
RETENTION AND DISPOSAL:
Records are maintained in a secure storage area with identifiers.
Disposal occurs 6 years and 3 months from the time the individual
accesses the MPDPF.
SYSTEM MANAGER AND ADDRESS:
Director, Beneficiary Information Services Group, Center for
Beneficiary Choices, CMS, Mail Stop S1-01-26, 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, HICN, and for
verification purposes, the subject individual's name (woman's maiden
name, if applicable).
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:
Sources of information contained in this records system include
data collected from the initial voluntary inquiry made by or on behalf
of the individual and validated through the Medicare Beneficiary
Database.
SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS OF THE ACT:
None.
[FR Doc. 05-22192 Filed 11-7-05; 8:45 am]
BILLING CODE 4120-03-P