[Federal Register: October 13, 2006 (Volume 71, Number 198)]
[Notices]
[Page 60540-60544]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr13oc06-86]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
Privacy Act of 1974; Report of a Modified or Altered System of
Records
AGENCY: Department of Health and Human Services (HHS), Centers for
Medicare & Medicaid Services (CMS).
ACTION: Notice of a Modified or Altered System of Records (SOR).
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SUMMARY: In accordance with the Privacy Act of 1974, we are proposing
to modify or alter an existing SOR, ``Evaluations of the Medicaid
Reform Demonstrations (EMRD),'' System No. 09-70-0068, last published
at 67 Federal Register 2216 (January 16, 2002). CMS is reorganizing its
databases because of the impact of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (MMA) (Public Law (Pub. L.)
108-173) provisions and the large volume of information the Agency
collects to administer the Medicare program. We propose to assign a new
CMS identification number to this system to simplify the obsolete and
confusing numbering system originally designed to identify the Bureau,
Office, or Center that maintained the system of records. The new
assigned identifying number for this system should read: System No. 09-
70-0523.
We propose to modify existing routine use number 1 that permits
disclosure to agency contractors and consultants to include disclosure
to CMS grantees who perform a task for the agency. CMS grantees,
charged with completing projects or activities that require CMS data to
carry out that activity, are classified separate from CMS contractor
and/or consultants. The modified routine use will remain as routine use
number 1.
We propose to combine routine uses 2 and 3 to assist another
Federal or state agency with information to contribute to the accuracy
of CMS's proper payment of Medicare benefits, enable such agency to
administer a Federal health benefits program, or to enable such agency
to fulfill a requirement of Federal statute or regulation that
implements a health benefits program funded in whole or in part with
Federal funds. As they were duplicative of each other.
We will delete routine use number 4, authorizing disclosure to
support constituent requests made to a Congressional representative. If
an authorization for the disclosure has been obtained from the data
subject, then no routine use is needed. The Privacy Act allows for
disclosures with the ``prior written consent'' of the data subject.
We will broaden the scope of routine uses number 6 and 7,
authorizing disclosures to combat fraud and abuse in the Medicare and
Medicaid programs to include combating ``waste'' which refers to
specific beneficiary/recipient practices that result in unnecessary
cost to all Federally-funded health benefit programs.
We are modifying the language in the routine uses to provide a
proper explanation as to the need for the routine use and to provide
clarity to CMS's intention to disclose individual-specific information
contained in this system. The routine uses will then be prioritized and
reordered according to their usage. We will also take the opportunity
to update any sections of the system that were affected by the recent
reorganization or MMA provisions and to update language in the
administrative sections to correspond with language used in other CMS
SORs.
The primary purpose of this modified system is to collect and
provide data
[[Page 60541]]
necessary to evaluate a series of Medicaid Reform Demonstrations that
rely on waivers of section 1115 of the Social Security Act (the Act).
This system will allow measurement of the effects of the demonstration
on beneficiaries' eligibility, access to care, utilization, health care
costs, satisfaction with care, quality of care and health status. The
information retrieved from this system of records will also be
disclosed to: (1) Support program administration, reporting, and
regulator, reimbursement, and policy functions performed within the CMS
or by a contractor, consultant, or grantee; (2) assist another Federal
or state agency with information to contribute to the accuracy of CMS's
proper payment of Medicare benefits, enable such agency to administer a
Federal health benefits program, or to enable such agency to fulfill a
requirement of Federal statute or regulation that implements a health
benefits program funded in whole or in part with Federal funds; (3)
support an individual or organization for a research project or in
support of an evaluation project related to the prevention of disease
or disability, the restoration or maintenance of health, or payment
related projects; (4) support litigation involving the agency; and (5)
combat fraud, waste, and abuse in a Federally-funded 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 modified or altered routine uses,
CMS invites comments on all portions of this notice. See Effective
Dates section for comment period.
DATES: Effective Date: CMS filed a modified or altered SOR report with
the Chair of the House Committee on Government Reform and Oversight,
the Chair of the Senate Committee on Homeland Security & Governmental
Affairs, and the Administrator, Office of Information and Regulatory
Affairs, Office of Management and Budget (OMB) on October 5, 2006. To
ensure that all parties have adequate time in which to comment, the
modified system will become effective 30 days from the publication of
the notice, or 40 days from the date it was submitted to OMB and the
Congress, whichever is later. We may defer implementation of this
system or one or more of the routine use statements listed below if we
receive comments that persuade us to defer implementation.
ADDRESSES: The public should address comments to the CMS Privacy
Officer, Division of Privacy Compliance, Enterprise Architecture and
Strategy Group, 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: Paul J. Boben, Division of State
Program Research, Research and Evaluation Group, Office of Research,
Development and Information, CMS, Mail Stop C3-19-07, 7500 Security
Boulevard, Baltimore, Maryland 21244-1850. He can also be reached by
telephone at 410-786-6629, or via e-mail at Paul.Boben@cms.hhs.gov.
SUPPLEMENTARY INFORMATION: This system was last published in the
Federal Register (FR) at 67 FR 2216 (January 16, 2002). The EMRD SOR
provides data necessary to evaluate CMS' Evaluation of the Medicaid
Reform Demonstrations, as part of this effort individually identifiable
data will be used to analyze the effects of the demonstration on
beneficiary eligibility, access to care, utilization, health care
costs, satisfaction with care, quality of care, and health status.
I. Description of the Modified or Altered System of Records
A. Statutory and Regulatory Basis for SOR
Authority for maintenance of the system is given under 42 United
States Code (U.S.C.) 1315 Sec. 1115, and 42 U.S.C. 1395ll Sec.
1875(a) of the Social Security Act.
B. Collection and Maintenance of Data in the System
EMRD contains information on demonstration participants and
comparison group members and their experiences in accessing health care
before, during, and after the demonstration period. Information
collected in the EMRD contains, but is not limited to, name, address,
phone number, social security number, health insurance claim number,
Medicaid identification number, gender, ethnicity, date of birth,
employment, health care coverage, diagnostic and health status
information, utilization and cost of health care services, and
responses to survey or other types of data collection methods
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 EMRD 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 EMRD. CMS has the following policies and procedures
concerning disclosures of information that will be maintained in the
system. Disclosure of information from this 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 collect and provide
data necessary to evaluate a series of Medicaid Reform Demonstrations
that rely on waivers of section 1115 of the Act. This system will allow
measurement of the effects of the demonstration on beneficiaries'
eligibility, access to care, utilization, health care costs,
satisfaction with care, quality of care and health status.
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.
[[Page 60542]]
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 support agency contractors, consultants, or grantee who have
been contracted by the agency to assist in the performance of a service
related to this system and who need to have access to the records in
order to perform the activity.
We contemplate disclosing this 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 system.
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, consultant, or grantee whatever information
is necessary for the contractor, consultant, or grantee to fulfill its
duties. In these situations, safeguards are provided in the contract
prohibiting the contractor, consultant, or grantee from using or
disclosing the information for any purpose other than that described in
the contract and requires the contractor, consultant or grantee to
return or destroy all information at the completion of the contract.
2. To enable another Federal or state agency 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.
CMS, and other Federal or state and local agencies, all contribute
data to the databases included in this system, and (both separately and
jointly) have an interest in performing program evaluation, conducting
research and maintaining program integrity.
3. To support an individual or organization for a research project
or in support of an evaluation project related to the prevention of
disease or disability, the restoration or maintenance of health, or
payment related projects.
The EMRD data will provide for research or in support of evaluation
projects, a broader, national perspective of the status of Medicare,
Medicaid and SCHIP beneficiaries. CMS anticipates that many researchers
will have legitimate requests to use these data in projects that could
ultimately improve the care provided to Medicare, Medicaid and SCHIP
beneficiaries and the policy that governs the care.
4. To support the Department of Justice (DOJ), court or
adjudicatory body when:
a. The agency or any component thereof, or
b. Any employee of the agency in his or her official capacity, or
c. Any employee of the agency in his or her individual capacity
where the DOJ has agreed to represent the employee, or
d. The United States Government is a party to litigation or has an
interest in such litigation, and by careful review, CMS determines that
the records are both relevant and necessary to the litigation and that
the use of such records by the DOJ, court or adjudicatory body is
compatible with the purpose for which the agency collected the records.
Whenever CMS is involved in litigation, and occasionally when
another party is involved in litigation and CMS' 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.
5. To support a CMS contractor (including, but not necessarily
limited to fiscal intermediaries and carriers) that assists in the
administration of a CMS-administered health benefits program, or to a
grantee of a CMS-administered grant program, when disclosure is deemed
reasonably necessary by CMS to prevent, deter, discover, detect,
investigate, examine, prosecute, sue with respect to, defend against,
correct, remedy, or otherwise combat fraud, waste, or abuse in such
program.
We contemplate disclosing information under this routine use only
in situations in which CMS may enter into a contractual relationship or
grant with a third party to assist in accomplishing CMS functions
relating to the purpose of combating fraud, waste, and abuse.
CMS occasionally contracts out certain of its functions and makes
grants 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.
6. To support another Federal agency or to an instrumentality of
any governmental jurisdiction within or under the control of the United
States (including any State or local governmental agency), that
administers, or that has the authority to investigate potential fraud,
waste, or abuse in, a health benefits program funded in whole or in
part by Federal funds, when disclosure is deemed reasonably necessary
by CMS to prevent, deter, discover, detect, investigate, examine,
prosecute, sue with respect to, defend against, correct, remedy, or
otherwise combat fraud, waste, or abuse in such programs.
Other agencies may require EMRD information for the purpose of
combating fraud, waste, and abuse in such federally-funded programs.
B. Additional Provisions Affecting Routine Use Disclosures: To the
extent this system contains Protected Health Information (PHI) as
defined by HHS regulation ``Standards for Privacy of Individually
Identifiable Health Information'' (45 CFR parts 160 and 164, Subparts A
and E) 65 FR 82462 (12-28-00). Disclosures of such PHI that are
otherwise authorized by these routine uses may only be made if, and as,
permitted or required by the ``Standards for Privacy of Individually
Identifiable Health Information.'' (See 45 CFR 164.512(a)(1)).
In addition, our policy will be to prohibit release even of data
not directly identifiable, except pursuant to one of the routine uses
or if required by law, if we determine there is a possibility that an
individual can be identified through implicit deduction based on small
cell sizes (instances where the patient population is so small that
individuals could, because of the small size, use this information to
deduce the identity of the beneficiary).
IV. Safeguards
CMS has safeguards in place for authorized users and monitors such
users to ensure against excessive or unauthorized use. Personnel having
[[Page 60543]]
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; 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; the HHS Information
Systems Program Handbook and the CMS Information Security Handbook.
V. Effects of the Modified or Altered System of Records on Individual
Rights
CMS proposes to modify 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 information relating to individuals.
Dated: October 4, 2006.
Charlene Frizzera,
Acting Chief Operating Officer, Centers for Medicare & Medicaid
Services.
System No. 09-70-0523
SYSTEM NAME:
``Evaluations of the Medicaid Reform Demonstrations (EMRD),'' HHS/
CMS/ORDI
SECURITY CLASSIFICATION:
Level Three Privacy Act Sensitive Data
SYSTEM LOCATION:
The Centers for Medicare & Medicaid Services (CMS) Data Center,
7500 Security Boulevard, North Building, First Floor, Baltimore,
Maryland 21244-1850 and at various contractor sites and at CMS Regional
Offices.
CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:
EMRD contains information on demonstration participants and
comparison group members and their experiences in access health care
before, during, and after the demonstration period.
CATEGORIES OF RECORDS IN THE SYSTEM:
Information collected in the EMRD contains, but is not limited to,
name, address, phone number, social security number (SSN), health
insurance claim number (HICN), Medicaid identification number, gender,
ethnicity, date of birth, employment, health care coverage, diagnostic
and health status information, utilization and cost of health care
services, and responses to survey or other types of data collection
methods.
AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
Authority for maintenance of the system is given under 42 United
States Code (U.S.C.) 1315 Sec. 1115, and 42 U.S.C. 1395ll Sec.
1875(a) of the Social Security Act.
PURPOSE(S) OF THE SYSTEM:
The primary purpose of this modified system is to collect and
provide data necessary to evaluate a series of Medicaid Reform
Demonstrations that rely on waivers of section 1115 of the Social
Security Act (the Act). This system will allow measurement of the
effects of the demonstration on beneficiaries' eligibility, access to
care, utilization, health care costs, satisfaction with care, quality
of care and health status. The information retrieved from this system
of records will also be disclosed to: (1) Support program
administration, reporting, and regulator, reimbursement, and policy
functions performed within the CMS or by a contractor, consultant, or
grantee; (2) assist another Federal or state agency with information to
contribute to the accuracy of CMS's proper payment of Medicare
benefits, enable such agency to administer a Federal health benefits
program, or to enable such agency to fulfill a requirement of Federal
statute or regulation that implements a health benefits program funded
in whole or in part with Federal funds; (3) support an individual or
organization for a research project or in support of an evaluation
project related to the prevention of disease or disability, the
restoration or maintenance of health, or payment related projects; (4)
support litigation involving the agency; and (5) combat fraud, waste,
and abuse in a Federally-funded health benefits programs.
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 support agency contractors, consultants, or grantee who have
been contracted by the agency to assist in the performance of a service
related to this system and who need to have access to the records in
order to perform the activity.
2. To enable another Federal or state agency to:
a. Contribute to the accuracy of CMS's proper payment of Medicare
benefits;
b. Enable such agency to administer a Federal health benefits
program, or, as necessary, to enable such agency to fulfill a
requirement of a Federal statute or regulation that implements a health
benefits program funded in whole or in part with Federal funds; and/or
c. Assist Federal/state Medicaid programs within the state.
3. To support an individual or organization for a research project
or in support of an evaluation project related to the prevention of
disease or disability, the restoration or maintenance of health, or
payment related projects.
4. To support the Department of Justice (DOJ), court or
adjudicatory body when:
a. The agency or any component thereof, or
[[Page 60544]]
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.
5. To support a CMS contractor (including, but not necessarily
limited to fiscal intermediaries and carriers) that assists in the
administration of a CMS-administered health benefits program, or to a
grantee of a CMS-administered grant program, when disclosure is deemed
reasonably necessary by CMS to prevent, deter, discover, detect,
investigate, examine, prosecute, sue with respect to, defend against,
correct, remedy, or otherwise combat fraud, waste, or abuse in such
program.
6. To support another Federal agency or to an instrumentality of
any governmental jurisdiction within or under the control of the United
States (including any State or local governmental agency), that
administers, or that has the authority to investigate potential fraud,
waste, or abuse in, a health benefits program funded in whole or in
part by Federal funds, when disclosure is deemed reasonably necessary
by CMS to prevent, deter, discover, detect, investigate, examine,
prosecute, sue with respect to, defend against, correct, remedy, or
otherwise combat fraud, waste, or abuse in such programs.
B. Additional Provisions Affecting Routine Use Disclosures: To the
extent this system contains Protected Health Information (PHI) as
defined by HHS regulation ``Standards for Privacy of Individually
Identifiable Health Information'' (45 CFR parts 160 and 164, Subparts A
and E) 65 FR 82462 (12-28-00). Disclosures of such PHI that are
otherwise authorized by these routine uses may only be made if, and as,
permitted or required by the ``Standards for Privacy of Individually
Identifiable Health Information.'' (See 45 CFR 164.512(a) (1)).
In addition, our policy will be to prohibit release even of data
not directly identifiable, except pursuant to one of the routine uses
or if required by law, if we determine there is a possibility that an
individual can be identified through implicit deduction based on small
cell sizes (instances where the patient population is so small that
individuals could, because of the small size, use this information to
deduce the identity of the beneficiary).
POLICIES AND PRACTICES FOR STORING, RETRIEVING, ACCESSING, RETAINING,
AND DISPOSING OF RECORDS IN THE SYSTEM:
STORAGE:
All records are stored on paper or electronic media.
RETRIEVABILITY:
Information can be retrieved using the beneficiary's name, Medicaid
identification number, HICN, or SSN.
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; 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; the HHS Information
Systems Program Handbook and the CMS Information Security Handbook.
RETENTION AND DISPOSAL:
CMS will retain information for a total period not to exceed 10
years. All claims-related records are encompassed by the document
preservation order and will be retained until notification is received
from DOJ.
SYSTEM MANAGER(S) AND ADDRESS:
Director, Division of State Program Research, Research and
Evaluation Group, Office of Research, Development and Information, CMS,
Mail Stop C3-19-07, 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, address, date of
birth, and gender, and for verification purposes, the subject
individual's name (woman's maiden name, if applicable), and SSN.
Furnishing the SSN is voluntary, but it may make searching for a record
easier and prevent delay.
RECORD ACCESS PROCEDURE:
For purpose of access, use the same procedures outlined in
Notification Procedures above. Requestors should also specify the
record contents being sought. (These procedures are in accordance with
department regulation 45 CFR 5b.5(a)(2)).
CONTESTING RECORDS PROCEDURES:
The subject individual should contact the system manager named
above, and reasonably identify the records 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).
RECORDS SOURCE CATEGORIES:
Sources on information contained in this system include: State
Medicaid Management Information Systems, managed care organizations,
fee-for-service providers, surveys of demonstration participants or
providers and comparison group members, medical records, Social
Security Administration databases, vital statistics and other relevant
data systems.
SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS OF THE ACT:
None.
[FR Doc. E6-16955 Filed 10-12-06; 8:45 am]
BILLING CODE 4120-03-P