[Federal Register: October 16, 2006 (Volume 71, Number 199)]
[Notices]
[Page 60726-60730]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr16oc06-44]
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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: Centers for Medicare & Medicaid Services (CMS), Department of
Health and Human Services (HHS).
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, ``Person-Level Medicaid Data System
(PMDS),'' System No. 09-70-0033, established at 49 Federal Register
(FR) 47573 (December 5, 1984) and last modified at 65 FR 37792 (June
16, 2000). We propose to assign a new CMS identification number to this
system to simplify the obsolete and confusing numbering system
originally designed to identify the Bureau, Office, or Center that
maintained information in the Health Care Financing Administration
systems of records. The new assigned identifying number for this system
should read: System No. 09-70-0507.
We propose to modify existing routine use number 2 that permits
disclosure to agency contractors and consultants to include disclosure
to CMS grantees who perform a task for the agency. CMS grantees,
charged with completing projects or activities that require CMS data to
carry out that activity, are classified separate from CMS contractors
and/or consultants. The modified routine use will be renumbered as
routine use number 1.
We will delete routine use number 3 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 propose to broaden the scope of the disclosure provisions of
this system by adding a routine use to permit the release of
information to other Federal and State agencies to: (1) Contribute to
the accuracy of CMS' proper payment of Medicare benefits; and (2)
enable such agency to administer a Federal health benefits program,
and/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.
We are modifying the language in the remaining routine uses to
provide a proper explanation as to the need for the routine use and to
provide clarity to CMS's intention to disclose individual-specific
information contained in this system. The routine uses will then be
prioritized and reordered according to their usage. We will also take
the opportunity to update any sections of the system that were affected
by the recent reorganization or because of the impact of the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003 (MMA)
(Pub. L 108-173) provisions and to update language in the
administrative sections to correspond with language used in other CMS
SORs.
The primary purpose of this modified system is to collect and
maintain individually-identifiable data to study Medicaid use and
expenditures in order to increase CMS' understanding of the Medicaid
and Medicare programs and to improve CMS' ability to conduct program
evaluation, strengthen program management, evaluate policy
alternatives, conduct and evaluate demonstration projects, and advise
States in the area of Medicaid financing. The information retrieved
from this system of records will also be disclosed to: (1) Support
regulatory, reimbursement, and policy functions performed within the
Agency or by a contractor, consultant, or grantee; (2) assist another
Federal and/or State agency; (3) support an individual or organization
for research, evaluation or epidemiological projects; and (4) support
litigation involving the agency. 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 Date section for comment period.
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
[[Page 60727]]
October 6, 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, Office of Information Services, 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: Dave Baugh, Division of State Program
and Research, Research and Evaluation Group, Office of Research,
Development and Information, CMS, Mail Stop C3-20-17, 7500 Security
Boulevard, Baltimore, Maryland 21244-1850. He can also be reached by
telephone at 410-786-7716, or via e-mail at David.Baugh@cms.hhs.gov.
SUPPLEMENTARY INFORMATION: Enacted under the authority of section
1902(a)(6) of the Social Security Act (the Act) (42 United States Code
(U.S.C.) 1396(a)(6)), this section provides that a State plan for
medical assistance must provide that the State agency will make such
report, in such form and containing such information, as the Secretary
may from time to time require, and comply with such provisions as the
Secretary may from time to time find necessary to assure the
correctness and verification of such reports. To this end we have
created a records system using Medicaid data which has greatly improved
CMS' ability to conduct program evaluation and has strengthened program
management.
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 Sec.
1902(a)(6) of the Act (42 U.S.C. 1396(a)(6)).
B. Collection and Maintenance of Data in the System
PMDS contains information on persons enrolled in the Medicaid
program under either Federal or State provisions. Information collected
includes but is not limited to data from 5 State Medicaid agencies
(California, Georgia, Michigan, New York, and Tennessee) showing claims
submitted for covered medical services, provider characteristics, name,
address, phone number, date of birth, social security number, health
insurance claim number, gender and ethnicity.
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 PMDS 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 PMDS. 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 study Medicaid use
and expenditures in order to increase CMS' understanding of the
Medicaid and Medicare programs and to improve CMS' ability to conduct
program evaluation, strengthen program management, evaluate policy
alternatives, conduct and evaluate demonstration projects, and advise
States in the area of Medicaid financing.
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 support agency contractors, consultants, or grantees, who
have been engaged by the agency to assist in the performance of a
service related to this collection and who need to have access to the
records in order to perform the activity.
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 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 or consultant 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 assist another Federal or State agency:
a. To contribute to the accuracy of CMS's proper payment of
Medicare benefits,
b. To 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
[[Page 60728]]
implements a health benefits program funded in whole or in part with
Federal funds.
Other Federal or State agencies in their administration of a
Federal health program may require PMDS information in order to support
evaluations and monitoring of reimbursement for services provided.
3. To assist an individual or organization for research, evaluation
or epidemiological projects related to the prevention of disease or
disability, or the restoration or maintenance of health, and for
payment related projects.
The collected data will provide the research, evaluation and
epidemiological projects a broader, longitudinal, national perspective
of the data. CMS anticipates that many researchers will have legitimate
requests to use these data in projects that could ultimately improve
the care provided to Medicare patients and the policy that governs the
care. CMS understands the concerns about the privacy and
confidentiality of the release of data for a research use. Disclosure
of data for research and evaluation purposes may involve aggregate data
rather than individual-specific data.
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.
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
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 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 (see item IV above) 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. 09-70-0507
SYSTEM NAME:
``Person-Level Medicaid Data System (PMDS),'' 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:
PMDS contains information on persons enrolled in the Medicaid
program under either Federal or State provisions, as well as health
care providers.
CATEGORIES OF RECORDS IN THE SYSTEM:
Information collected includes but is not limited to data from 5
State Medicaid agencies (California, Georgia, Michigan, New York, and
Tennessee) showing claims submitted for covered medical services,
provider characteristics, name, address, phone number, date of birth,
social security number (SSN), health insurance claim number (HICN),
unique provider identification number, gender and ethnicity.
[[Page 60729]]
AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
Authority for maintenance of the system is given under section
1902(a)(6) of the Social Security Act (42 United States Code
1396(a)(6)).
PURPOSE(S) OF THE SYSTEM:
The primary purpose of this modified system is to collect and
maintain individually-identifiable data to study Medicaid use and
expenditures in order to increase CMS' understanding of the Medicaid
and Medicare programs and to improve CMS' ability to conduct program
evaluation, strengthen program management, evaluate policy
alternatives, conduct and evaluate demonstration projects, and advise
States in the area of Medicaid financing. The information retrieved
from this system of records will also be disclosed to: (1) Support
regulatory, reimbursement, and policy functions performed within the
Agency or by a contractor, consultant, or grantee; (2) assist another
Federal and/or State agency; (3) support an individual or organization
for research, evaluation or epidemiological projects; and (4) support
litigation involving the agency.
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:
5. To support agency contractors, consultants, or grantees, who
have been engaged by the agency to assist in the performance of a
service related to this collection and who need to have access to the
records in order to perform the activity.
6. To assist another Federal or State agency:
a. To contribute to the accuracy of CMS's proper payment of
Medicare benefits,
b. To 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.
7. To assist an individual or organization for research, evaluation
or epidemiological projects related to the prevention of disease or
disability, or the restoration or maintenance of health, and for
payment related projects.
8. 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.
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 magnetic tape and computer disk.
RETRIEVABILITY:
Enrollment records are retrieved by Medicaid and Medicare
identification numbers. Provider records are retrieved by Medicaid and
Medicare provider identification numbers. Claims records contain both
enrollee and provider identification numbers.
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 of 6 years and 3
months. 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:
Deputy Director, Office of Research, Development and Information,
CMS, Mail Stop C3-20-11, 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
[[Page 60730]]
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:
Medicaid and Medicare enrollment, claims, and provider records.
SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS OF THE ACT:
None.
[FR Doc. E6-17058 Filed 10-13-06; 8:45 am]
BILLING CODE 4120-03-P