[Federal Register: November 17, 2005 (Volume 70, Number 221)]
[Notices]
[Page 69766-69771]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr17no05-76]
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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).
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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:
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.
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.
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.
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.
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