[Federal Register: November 13, 2007 (Volume 72, Number 218)]
[Notices]
[Page 63906-63911]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr13no07-60]
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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
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 requirements of the Privacy Act of
1974, we are proposing to modify or alter an SOR titled ``Home Health
Agency (HHA) Outcome and Assessment Information Set (OASIS),'' System
No. 09-70-9002, last modified at 66 Federal Register 66903 (December
27, 2001). 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. 09-70-0522.
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 4 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 HHA quality of care. The modified routine use
will remain as routine use number 4.
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
HHAs that have an accreditation status with the requesting deemed
organization, (2) submission of a finder file identifying
beneficiaries/patients receiving HHA 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 will delete routine use number 7 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 8 and 9,
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.
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 purposes of the SOR are to collect and maintain
information to: (1) Study and help ensure the quality of care provided
by home health agencies (HHA); (2) aid in administration of the survey
and certification of Medicare/Medicaid HHAs; (3) enable regulators to
provide HHAs with data for their internal quality improvement
activities; (4) support agencies of the state government to determine,
evaluate and assess overall effectiveness and quality of HHA services
provided in the state; (5) provide for the validation, and refinements
of the Medicare Prospective Payment System; (6) aid in the
administration of Federal and state HHA programs within the state; and
(7) monitor the continuity of care for patients who reside temporarily
outside of the state. 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 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 home 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) support
the functions of national accrediting organizations; (6) support
litigation involving the Agency; (7) 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 routine uses, CMS
invites comments on all portions of this notice. See Effective Dates
section for comment period.
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 6, 2007. 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
[[Page 63907]]
hours, Monday through Friday from 9 a.m.-3 p.m., eastern time zone.
FOR FURTHER INFORMATION CONTACT: Patricia Sevast, Nurse Consultant,
Division of Continuing Care Providers, Survey and Certification Group,
Center for Medicaid and State Operations, CMS, 7500 Security Boulevard,
S2-12-25, Baltimore, Maryland 21244-1850. The telephone number is (410)
786-8135, or via e-mail at patricia.sevast@cms.hhs.gov.
SUPPLEMENTARY INFORMATION:
I. Description of the Modified or Altered System of Records
A. Statutory and Regulatory Basis for System
Authority for maintenance of this system is given under Sections
1102(a), 1154, 1861(m), 1861(o), 1861(z), 1863, 1864, 1865, 1866, 1871,
1891, and 1902 of the Social Security Act. These provisions of the Act
authorize the Administrator of CMS to require HHAs participating in the
Medicare and Medicaid programs to complete a standard, valid, patient
assessment data set; i.e., the OASIS, as part of their comprehensive
assessments and updates when evaluating adult, non-maternity patients
as required by section 484.55 of the Conditions of Participation.
Authority is also given under section 951 of the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003 (Pub. L. 108-173).
B. Collection and Maintenance of Data in the System
The system collects and maintains information on all patients,
except those in a category exempted by administrative policies and
procedures, who receive services from an HHA certified for Medicare and
Medicaid payments. The OASIS data set includes identifiers. It also
includes information on: (1) Patient History, (2) Living Arrangements,
(3) Supportive Assistance, (4) Sensory Status, (5) Integumentary
Status, (6) Respiratory Status, (7) Elimination Status, (8) Neuro/
Emotional/Behavioral Status, (9) Activities of Daily Living/
Instrumental Activities of Daily Living (ADL/IADL), (10) Medications,
(11) Equipment Management, (12) Emergent Care, and (13) Discharge.
Identifiers are patient name, social security number, Medicare number
and Medicaid number. A masked identifier is one in which an encrypted
value is permanently substituted for an identifier to prevent
recipients of the information from identifying the individual.
The OASIS information will be submitted by the HHA to the
government for all patients, except pre-partum and postpartum patients,
patients under 18 years of age, and patients receiving other than
personal care or health care services; i.e., housekeeping services and
chore services. Identifiers will be included for all patients receiving
services paid for by Medicare traditional fee-for-service, Medicaid
traditional fee-for-service, Medicare HMO/managed care or Medicaid HMO/
managed care. For patients with only a non-Medicare or non-Medicaid
payment source, the HHA will submit OASIS information with masked
identifiers and will retain the identifier and masked identifier at the
HHA. In other words, the patient identifier for non-Medicare and non-
Medicaid patients will only be known and retained by the HHA and not by
the government.
II. Agency Policies, Procedures, and Restrictions on Routine Uses
A. 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 OASIS 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 OASIS. 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 evaluate and monitor
the quality of home health care and contribute to the accuracy of
health insurance operations.
2. Determines:
a. That the purpose for which the disclosure is to be made can only
be accomplished if the record is provided in individually identifiable
form;
b. That the purpose for which the disclosure is to be made is of
sufficient importance to warrant the potential effect and/or risk on
the privacy of the individual that additional exposure of the record
might bring; and
c. That 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; and
b. Remove or destroy at the earliest time all patient-identifiable
information.
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, agency of a state
government, an agency established by state law, or its fiscal agent to:
a. Contribute to the accuracy of CMS's proper payment of Medicare
benefits,
[[Page 63908]]
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. Evaluate and monitor the quality of home health care and
contribute to the accuracy of health insurance operations.
Other Federal or state agencies in their administration of a
Federal health program may require OASIS 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 Quality Improvement Organizations (QIO) in order to
assist the QIO to perform Title XI and Title XVIII functions relating
to assessing and improving HHA quality of care.
QIOs will work with HHAs to implement quality improvement programs,
provide consultation to CMS, its contractors, and to state agencies.
The QIOs will provide a supportive role to HHAs in their endeavors to
comply with Medicare Conditions of Participation; will assist the state
agencies in related monitoring and enforcement efforts; assist CMS and
help regional home health intermediaries in home health program
integrity assessment; and prepare summary information about the
nation's home health care for release to beneficiaries.
5. To support national accrediting organizations with approval for
deeming authority for Medicare requirements for home health services
(i.e., the Joint Commission on Accreditation of Healthcare
Organizations, Accreditation Commission for Health Care, Inc., and the
Community Health Accreditation Program). Information will be released
to these organizations upon specific request, and only for those
facilities that they accredit and that participate in the Medicare
program and if they meet the following requirements:
a. Provide identifying information for HHAs that have an
accreditation status with the requesting deemed organization,
b. submit a finder file identifying beneficiaries/patients
receiving HHA services,
c. complete a signed data exchange agreement or a CMS data use
agreement, and
d. safeguard the confidentiality of the data and prevent
unauthorized access.
CMS anticipates providing these national accrediting organizations
with OASIS information to enable them to target potential or identified
problems during the organization's accreditation review process of that
facility.
6. 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.
7. 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.
8. 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 OASIS 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 Fed. Reg. 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).
[[Page 63909]]
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 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: November 7, 2007.
Charlene Frizzera,
Chief Operating Officer, Centers for Medicare & Medicaid Services.
SYSTEM NO. 09-70-0522
System Name:
``Home Health Agency (HHA) Outcome and Assessment Information Set
(OASIS),'' 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 South Building, Baltimore, Maryland 21244-1850.
Categories of Individuals Covered by the System:
The system of records (SOR) will contain clinical assessment
information (OASIS) for all patients receiving the services of a
Medicare and/or Medicaid approved HHA, except pre-partum and post-
partum patients, patients under 18 years of age, and patients receiving
other than personal care or health care services; i.e., housekeeping
services and chore services. Identifiable information will be
maintained in the SOR only for those individuals whose payments come
from Medicare or Medicaid.
Categories of Records in the System:
This SOR will contain individual-level demographic and identifying
data, as well as clinical status data for patients with the payment
sources of Medicare traditional fee for service, Medicaid traditional
fee for service, Medicare HMO/managed care or Medicaid HMO/managed
care.
Authority for Maintenance of the System:
Authority for maintenance of this system is given under Sections
1102(a), 1154, 1861(m), 1861(o), 1861(z), 1863, 1864, 1865, 1866, 1871,
1891, and 1902 of the Social Security Act. These provisions of the Act
authorize the Administrator of CMS to require HHAs participating in the
Medicare and Medicaid programs to complete a standard, valid, patient
assessment data set; i.e., the OASIS, as part of their comprehensive
assessments and updates when evaluating adult, non-maternity patients
as required by section 484.55 of the Conditions of Participation.
Authority is also given under section 951 of the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003 (Pub. L. 108-173).
Purpose(s) of the System:
The primary purposes of the SOR are to collect and maintain
information to: (1) Study and help ensure the quality of care provided
by home health agencies (HHA); (2) aid in administration of the survey
and certification of Medicare/Medicaid HHAs; (3) enable regulators to
provide HHAs with data for their internal quality improvement
activities; (4) support agencies of the state government to determine,
evaluate and assess overall effectiveness and quality of HHA services
provided in the state; (5) provide for the validation, and refinements
of the Medicare Prospective Payment System; (6) aid in the
administration of Federal and state HHA programs within the state; and
(7) monitor the continuity of care for patients who reside temporarily
outside of the state. 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 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 home 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) support
the functions of national accrediting organizations; (6) support
litigation involving the Agency; (7) 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
[[Page 63910]]
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 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'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. evaluate and monitor the quality of home health care and
contribute to the accuracy of health insurance operations.
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.
4. To support Quality Improvement Organizations (QIO) in order to
assist the QIO to perform Title XI and Title XVIII functions relating
to assessing and improving HHA quality of care.
5. To support national accrediting organizations with approval for
deeming authority for Medicare requirements for home health services
(i.e., the Joint Commission on Accreditation of Healthcare
Organizations, Accreditation Commission for Health Care, Inc., and the
Community Health Accreditation Program). Information will be released
to these organizations upon specific request, and only for those
facilities that they accredit and that participate in the Medicare
program and if they meet the following requirements:
a. Provide identifying information for HHAs that have an
accreditation status with the requesting deemed organization,
b. Submit a finder file identifying beneficiaries/patients
receiving HHA services,
c. Complete a signed data exchange agreement or a CMS data use
agreement, and
d. Safeguard the confidentiality of the data and prevent
unauthorized access.
6. 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.
7. 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.
8. 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 Fed. Reg. 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 and magnetic disk.
Retrievability:
The Medicare and Medicaid records are retrieved by health insurance
claim number, Social Security number (SSN) or by state assigned
Medicaid number.
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 HHS Information
Systems Program Handbook and the CMS Information Security Handbook.
Retention and Disposal:
CMS will retain identifiable OASIS assessment data for a total
period not to exceed fifteen (15) years.
System Manager and Address:
Director, Division of Continuing Care Providers, Survey and
Certification
[[Page 63911]]
Group, Center for Medicaid and State Operations, CMS, 7500 Security
Boulevard, S2-12-25, 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, health insurance claim
number, and for verification purposes, the subject individual's name
(woman's maiden name, if applicable), SSN (furnishing the SSN is
voluntary, but it may make searching for a record easier and prevent
delay), address, date of birth, and sex.
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:
The data contained in this system of records are obtained from The
Outcome and Assessment Information Set.
Systems Exempted from Certain Provisions of the Act:
None.
[FR Doc. E7-22083 Filed 11-9-07; 8:45 am]
BILLING CODE 4120-03-P