[Federal Register: November 20, 2006 (Volume 71, Number 223)]
[Notices]
[Page 67143-67148]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr20no06-69]
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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, ``Inpatient Rehabilitation
Facilities (IRF) Patient Assessment Instrument (IRF-PAI),'' System No.
09-70-1518, last published at 66 Federal Register 56681 (November 9,
2001). Information maintained in this system will continue to contain
clinical assessment information for all Medicare Part A fee-for-service
patients receiving the services of a Medicare approved IRF. This
information will be useful in developing core measures that provide
meaningful information on patient characteristics and outcomes across
post-acute care settings and will be used by CMS to fulfill its
responsibility for validating surveys conducted by accrediting
agencies. 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. 09-70-0521.
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 contractors
and/or consultants. The modified routine use will remain as routine use
number 1. We will modify existing routine use number 2 that permits
disclosure to Peer Review Organizations (PRO). Organizations previously
referred to as PROs will be renamed to read: Quality Improvement
Organizations (QIO). Information will be disclosed to QIOs relating to
assessing and improving IRF quality of care. The modified routine use
will be renumbered as routine use number 4.
We will delete routine use number 5 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 published routine uses number 7 and 8,
authorizing disclosures to combat fraud and abuse in the Medicare and
Medicaid programs to include combating ``waste'' which refers
increasingly more to specific beneficiary or recipient practices that
result in unnecessary cost to federally-funded health benefit programs.
CMS proposes to broaden the scope of the disclosure requirement for
routine use number 5, authorizing disclosure to national accrediting
organizations that have been approved by CMS for deeming authority for
Medicare requirements for home health services. Information will be
released to these organizations for only those facilities that they
accredit and that participate in the Medicare program and if they meet
the following requirements: (1) Provide identifying information for
IRFs that have an accreditation status with the requesting accrediting
organization that has been granted deeming authority by CMS, (2)
submission of a finder file identifying beneficiaries/patients
receiving IRF services, (3) safeguard the confidentiality of the data
and prevent unauthorized access, and (4) upon completion of a signed
data exchange agreement or a CMS data use agreement.
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 support the IRF
prospective payment system (PPS) for payment of the IRF Medicare Part A
fee-for-services furnished by the IRF to Medicare beneficiaries.
Information maintained in this system will also be disclosed to: (1)
Support regulatory, reimbursement, and policy functions performed
within the Agency or by a contractor, consultant, or a CMS grantee; (2)
assist another Federal and/or state agency, agency of a state
government, an agency established by state law, or its fiscal agent,
for evaluating and monitoring the quality of IRF health care and
contribute to the accuracy of health insurance operations; (3) support
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; (4) support the functions
of Quality Improvement Organizations; (5) assist other insurers; (6)
support the functions of national accrediting organizations; (7)
support litigation involving the Agency; and (8) combat fraud, waste,
and abuse in certain health care 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 Dates: CMS filed a modified or altered system 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 November
14, 2006. To ensure that all parties have adequate time in which to
comment, the modified system, including routine uses, will become
effective 30 days from the publication of the notice, or 40 days from
the date it was submitted to OMB and 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, Enterprise Architecture and Strategy
Group, Office of Information Services, 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 Time zone.
FOR FURTHER INFORMATION CONTACT: Georgia Johnson, Division of
Continuing Care Providers, Survey and Certification Group, Center for
Medicaid and State Operations, CMS, Mail Stop S2-12-25, 7500 Security
Boulevard, Baltimore, Maryland 21244-1850. She can also be reached by
telephone at 410-786-6859,
[[Page 67144]]
or via e-mail at Georgia.Johnson@cms.hhs.gov.
SUPPLEMENTARY INFORMATION:
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 section 1886
(j) (2) (D) of the Social Security Act authorizing the secretary to
collect the data necessary to establish and administer the payment
system.
B. Collection and Maintenance of Data in the System
The IRF-PAI will be completed on all Medicare Part A fee-for-
service patients who receive services under Part A from an IRF, it may
also be completed on Medicare Advantage enrollees. Records in this
system will include, but are not limited to, name, address, date of
birth, gender, ethnicity, social security number, health insurance
claim number, Medicaid number, patient identification number, patient
history, diagnosis, and functional prognosis.
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 IRF-PAI 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 IRF-PAI. 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 support the IRF
prospective payment system (PPS) for payment of the IRF Medicare Part A
fee-for-services furnished by the IRF to Medicare beneficiaries.
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
indivdual'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 and/or state agency, agency of a state
government, an agency established by state law, or its fiscal agent to:
a. Contribute to the accuracy of CMS' 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. Improve the state survey process for investigation of complaints
related to health and safety or quality of care and to implement a more
outcome oriented survey and certification program.
Other Federal or state agencies in their administration of a
Federal health program may require IRF-PAI information in order to
support evaluations and monitoring of Medicare claims information of
beneficiaries, including proper reimbursement for services provided.
3. To an individual or organization for research on the utilization
of inpatient rehabilitation services as well as evaluation or
epidemiological projects related to the prevention of disease or
disability, the restoration or maintenance of health, or for
understanding and improving payment projects.
The IRF-PAI data will provide for research or in support of
evaluation projects, a broader, national perspective of the status of
Medicare 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 beneficiaries and the policy that
governs the care.
4. To support Quality Improvement Organizations (QIO) in connection
with review of claims, or in connection with studies or other review
activities conducted pursuant to Part B of Title XI of the Act, and in
performing affirmative outreach activities to individuals for the
purpose of establishing and maintaining their entitlement to Medicare
benefits or health insurance plans.
The QIO may use this data to support quality improvement activities
and other QIO responsibilities as detailed in Title XI Sec. Sec. 1151-
1164.
The QIO will work to implement quality improvement programs,
provide consultation to CMS, its contractors, and to state agencies.
The QIO will
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assist state agencies in related monitoring and enforcement efforts,
assist CMS and intermediaries in program integrity assessment, and
prepare summary information for release to CMS.
5. To assist insurance companies, third party administrators (TPA),
employers, self-insurers, managed care organizations, other
supplemental insurers, non-coordinating insurers, multiple employer
trusts, group health plans (i.e., health maintenance organization (HMO)
or a competitive medical plan (CMP)) with a Medicare contract, or a
Medicare-approved health care payment plan (HCPP), directly or through
a contractor, and other groups providing protection for their
enrollees. Information to be disclosed shall be limited to Medicare
entitlement data. In order to receive the information, they must agree
to:
a. Certify that the individual about whom the information is being
provided is one of its insured or employees, or is insured and/or
employed by another entity for whom they serve as a third party
administrator;
b. Utilize the information solely for the purpose of processing the
individual's insurance claims; and
c. Safeguard the confidentiality of the data and prevent
unauthorized access.
Other insurers, CMP, HMO and HCPP may require IRF-PAI information
in order to support evaluations and monitoring of Medicare claims
information of beneficiaries, including proper payment for services
provided.
6. To assist national accrediting organization(s) whose accredited
facilities are presumed to meet certain Medicare requirements for
inpatient hospital rehabilitation services (e.g., the Joint Commission
for the Accreditation of Healthcare Organizations, the American
Osteopathic Association, or the Commission on Accreditation of
Rehabilitation Facilities). Information will be released to these
organizations for only those facilities that they accredit and that
participate in the Medicare program and if they meet the following
requirements:
a. Provide identifying information for IRFs that have an
accreditation status with the requesting deemed organization;
b. Submission of a finder file identifying beneficiaries/patients
receiving IRF services;
c. Safeguard the confidentiality of the data and prevent
unauthorized access; and
d. Upon completion of a signed data exchange agreement or a CMS
data use agreement.
At this time, CMS anticipates providing accrediting organizations
with IRF-PAI information to enable them to target potential identified
problems during the organization's accreditation review process of the
facility.
7. 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.
8. To assist 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.
9. To assist 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 IRF-PAI 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 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
[[Page 67146]]
information systems and to prevent unauthorized access.
This system will conform to all applicable Federal laws and
regulations and Federal, HHS, and CMS policies and standards as they
relate to information security and data privacy. These laws and
regulations include but are not limited to: The Privacy Act of 1974;
the Federal Information Security Management Act of 2002; the Computer
Fraud and Abuse Act of 1986; the Health Insurance Portability and
Accountability Act of 1996; the E-Government Act of 2002, the Clinger-
Cohen Act of 1996; the Medicare Modernization Act of 2003, and the
corresponding implementing regulations. OMB Circular A-130, Management
of Federal Resources, Appendix III, Security of Federal Automated
Information Resources also applies. Federal, HHS, and CMS policies and
standards include but are not limited to: All pertinent NIST
publications; the DHHS 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 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: November 8, 2006.
John R. Dyer,
Chief Operating Officer, Centers for Medicare & Medicaid Services.
SYSTEM NO. 09-70-0521
SYSTEM NAME:
``Inpatient Rehabilitation Facilities Patient Assessment Instrument
(IRF-PAI),'' HHS/CMS/CMSO.
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:
The IRF-PAI will be completed on all Medicare Part A fee-for-
service patients who receive services under Part A from an IRF, it may
also be completed on Medicare Advantage enrollees.
CATEGORIES OF RECORDS IN THE SYSTEM:
Records in this system will include, but are not limited to, name,
address, date of birth, gender, ethnicity, social security number
(SSN), health insurance claim number (HICN), Medicaid number, patient
identification number, patient history, diagnosis, and functional
prognosis.
AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
Authority for maintenance of the system is given under section
1886(j)(2)(D) of the Social Security Act authorizing the secretary to
collect the data necessary to establish and administer the payment
system.
PURPOSE(S) OF THE SYSTEM:
The primary purpose of this modified system is to support the IRF
prospective payment system (PPS) for payment of the IRF Medicare Part A
fee-for-services furnished by the IRF to Medicare beneficiaries.
Information maintained in this system will also be disclosed to: (1)
Support regulatory, reimbursement, and policy functions performed
within the Agency or by a contractor, consultant, or a CMS grantee; (2)
assist another Federal and/or state agency, agency of a state
government, an agency established by state law, or its fiscal agent,
for evaluating and monitoring the quality of IRF health care and
contribute to the accuracy of health insurance operations; (3) support
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; (4) support the functions
of Quality Improvement Organizations (QIO); (5) assist other insurers;
(6) support the functions of national accrediting organizations; (7)
support litigation involving the Agency; (8) combat fraud, waste, and
abuse in certain health care 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 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.
2. To assist another Federal and/or state agency, agency of a state
government, an agency established by state law, or its fiscal agent to:
a. Contribute to the accuracy of CMS' 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. Improve the state survey process for investigation of complaints
related to health and safety or quality of care and to implement a more
outcome oriented survey and certification program.
3. To an individual or organization for research on the utilization
of inpatient rehabilitation services as well as evaluation or
epidemiological projects related to the prevention of disease or
disability, the restoration or maintenance of health, or for
understanding and improving payment projects.
4. To support Quality Improvement Organizations (QIO) in connection
with review of claims, or in connection with studies or other review
activities conducted pursuant to Part B of Title XI of the Act, and in
performing affirmative outreach activities to individuals for the
purpose of establishing and maintaining their entitlement to Medicare
benefits or health insurance plans.
5. To assist insurance companies, third party administrators (TPA),
employers, self-insurers, managed care organizations, other
supplemental insurers, non-coordinating insurers, multiple employer
trusts, group health plans (i.e., health maintenance organization (HMO)
or a competitive medical plan (CMP)) with a Medicare
[[Page 67147]]
contract, or a Medicare-approved health care payment plan (HCPP),
directly or through a contractor, and other groups providing protection
for their enrollees. Information to be disclosed shall be limited to
Medicare entitlement data. In order to receive the information, they
must agree to:
a. Certify that the individual about whom the information is being
provided is one of its insured or employees, or is insured and/or
employed by another entity for whom they serve as a third party
administrator;
b. Utilize the information solely for the purpose of processing the
individual's insurance claims; and
c. Safeguard the confidentiality of the data and prevent
unauthorized access.
6. To assist national accrediting organization(s) whose accredited
facilities are presumed to meet certain Medicare requirements for
inpatient hospital rehabilitation services (e.g., the Joint Commission
for the Accreditation of Healthcare Organizations, the American
Osteopathic Association, or the Commission on Accreditation of
Rehabilitation Facilities). Information will be released to these
organizations for only those facilities that they accredit and that
participate in the Medicare program and if they meet the following
requirements:
a. Provide identifying information for IRFs that have an
accreditation status with the requesting deemed organization;
b. Submission of a finder file identifying beneficiaries/patients
receiving IRF services;
c. Safeguard the confidentiality of the data and prevent
unauthorized access; and
d. Upon completion of a signed data exchange agreement or a CMS
data use agreement.
7. 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.
8. To assist 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.
9. To assist 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 magnetic media.
RETRIEVABILITY:
The Medicare records are retrieved by the HICN and SSN.
SAFEGUARDS:
CMS has safeguards in place for authorized users and monitors such
users to ensure against 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 DHHS
Information Systems Program Handbook and the CMS Information Security
Handbook.
RETENTION AND DISPOSAL:
CMS will retain identifiable IRF-PAI data for a total period of 15
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, Survey and Certification Group, Center for Medicaid and
State Operations, CMS, Mail Stop C3-20-01, 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 67148]]
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:
Information for this system is collected from the Inpatient
Rehabilitation Facilities--Patient Assessment Instrument.
SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS OF THE ACT:
None.
[FR Doc. E6-19506 Filed 11-17-06; 8:45 am]
BILLING CODE 4120-03-P