[Federal Register: February 26, 2008 (Volume 73, Number 38)]
[Notices]
[Page 10255-10260]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr26fe08-58]
-----------------------------------------------------------------------
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).
-----------------------------------------------------------------------
SUMMARY: In accordance with the requirements of the Privacy Act of
1974, we are proposing to modify or alter an existing SOR titled, ``1-
800 Medicare Helpline (HELPLINE), System No. 09-70-0535,'' modified at
68 Federal Register 25379 (May 12, 2003). 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 remain as routine use number 1. We will
delete routine use number 6 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.
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 to
specific beneficiary/recipient practices that result in unnecessary
cost to all Federally-funded health benefit programs. Finally, we will
delete the section titled ``Additional Circumstances Affecting Routine
Use Disclosures,'' that addresses ``Protected Health Information
(PHI)'' and ``small cell size.'' The requirement for compliance with
HHS regulation ``Standards for Privacy of Individually Identifiable
Health Information'' does not apply because this system does not
collect or maintain PHI. In addition, our policy to prohibit release if
there is a possibility that an individual can be identified through
``small cell size'' is not applicable to the data maintained in this
system.
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 MMA and to
update language in the administrative sections to correspond with
language used in other CMS SORs.
The primary purpose of the SOR is to provide general information to
[[Page 10256]]
beneficiaries and future beneficiaries so that they can make informed
Medicare decisions, maintain information on Medicare enrollment for the
administration of the Medicare program, including the following
functions: Ensuring proper Medicare enrollment, claims payment,
Medicare premium billing and collection, coordination of benefits by
validating and verifying the enrollment status of beneficiaries, and
validating and studying the characteristics of persons enrolled in the
Medicare program including their requirements for information.
Information retrieved from this SOR will also be disclosed to: (1)
Support regulatory, reimbursement, and policy functions performed
within the Agency or by contractors, consultants, or CMS grantees; (2)
assist another Federal or state agency, agency of a state government,
an agency established by state law, or its fiscal agent; (3) assist
providers and suppliers of services for administration of Title XVIII
of the Act; (4) assist third parties where the contact is expected to
have information relating to the individual's capacity to manage his or
her own affairs; (5) assist other insurers for processing individual
insurance claims; (6) support litigation involving the Agency; and (7)
combat fraud, waste, and abuse in certain health benefits programs. We
have provided background information about the modified system in the
``Supplementary Information'' section below. Although the Privacy Act
requires only that CMS provide an opportunity for interested persons to
comment on the proposed routine uses, CMS invites comments on all
portions of this notice. See ``Effective Dates'' section for comment
period.
EFFECTIVE DATES: CMS filed a modified/altered system report with the
Chair of the House Committee on Oversight and Government Reform, the
Chair of the Senate Committee on Homeland Security and Governmental
Affairs, and the Administrator, Office of Information and Regulatory
Affairs, Office of Management and Budget (OMB) on February 12, 2008. To
ensure that all parties have adequate time in which to comment, the new
SOR, including routine uses, will become effective 40 days from the
publication of the notice, or from the date it was submitted to OMB and
the Congress, whichever is later, unless CMS receives comments that
require alterations to this notice.
ADDRESSES: The public should address comments to: CMS Privacy Officer,
Division of Privacy Compliance, 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: Kenneth Taylor, Division of Call
Center Operations, Customer Teleservice Operations Group, Office of
Beneficiary Information Services, CMS, 7500 Security Boulevard, C2-26-
20, Baltimore, Maryland 21244-1850. The telephone number is 410-786-
6736 or contact by e-mail kenneth.taylor@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 sections
1102, 1804(b), and 1851(d) of the Social Security Act (42 United States
Code (U.S.C.) 1302, 1395b-2(b), and 1395w-21(d)), and OMB Circular A-
123, Internal Control Systems, and Title 42 U.S.C. section 1395w-21 (d)
(Pub. L. 105-3, the Balanced Budget Act of 1997).
B. Collection and Maintenance of Data in the System
Information is collected on individuals age 65 or over who have
been, or currently are, entitled to health insurance (Medicare)
benefits under Title XVIII of the Act or under provisions of the
Railroad Retirement Act, individuals under age 65 who have been, or
currently are, entitled to such benefits on the basis of having been
entitled for not less than 24 months to disability benefits under Title
II of the Act or under the Railroad Retirement Act, individuals who
have been, or currently are, entitled to such benefits because they
have ESRD, individuals age 64 and 8 months or over who are likely to
become entitled to health insurance (Medicare) benefits upon attaining
age 65, and individuals under age 65 who have at least 21 months of
disability benefits who are likely to become entitled to Medicare upon
the 25th month of their being disabled. The collected information will
contain name, address, telephone number, health insurance claim (HIC)
number, geographic location, race/ethnicity, sex, date of birth, as
well as, background information relating to Medicare or Medicaid
issues. The HELPLINE will also maintain a caller history for purposes
of re-contacts by customer service representatives or CMS, contain
information related to Medicare enrollment and entitlement, group
health plan enrollment data, as well as, background information
relating to Medicare or Medicaid issues.
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 HELPLINE 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 HELPLINE. CMS has the following policies and procedures
concerning disclosures of information that will be maintained in the
system. Disclosure of information from the SOR 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 data is being collected; e.g., to provide general information to
beneficiaries and future beneficiaries so that they can make informed
Medicare decisions, maintain information on Medicare enrollment for the
administration of the Medicare program, including the following
functions: Ensuring proper Medicare enrollment, claims payment,
Medicare premium billing and collection, coordination of benefits by
validating and verifying the enrollment status of beneficiaries, and
validating and studying the characteristics of persons enrolled in the
Medicare program including their requirements for information.
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:
[[Page 10257]]
a. Establish administrative, technical, and physical safeguards to
prevent unauthorized use or disclosure of the record;
b. Remove or destroy at the earliest time all individually-
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 These routine uses specify circumstances,
in addition to those provided by statute in the Privacy Act of 1974,
under which CMS may release information from the HELPLINE without the
consent of the individual to whom such information pertains. Each
proposed disclosure of information under these routine uses will be
evaluated to ensure that the disclosure is legally permissible,
including but not limited to ensuring that the purpose of the
disclosure is compatible with the purpose for which the information was
collected. We are proposing to establish or modify the following
routine use disclosures of information maintained in the system:
1. To support Agency contractors, consultants, or CMS grantees who
have been contracted by the Agency to assist in accomplishment of a CMS
function relating to the purposes for this SOR and who need to have
access to the records in order to assist CMS.
We contemplate disclosing information under this routine use only
in situations in which CMS may enter into a contractual or similar
agreement with a third party to assist in accomplishing a CMS function
relating to purposes for this SOR.
CMS occasionally contracts out certain of its functions when doing
so would contribute to effective and efficient operations. CMS must be
able to give contractors, consultants, or CMS grantees whatever
information is necessary for the contractors, consultants, or CMS
grantees to fulfill its duties. In these situations, safeguards are
provided in the contract prohibiting the contractors, consultants, or
CMS grantees from using or disclosing the information for any purpose
other than that described in the contract and requires the contractors,
consultants, or CMS grantees 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,
b. Enable such agency to administer a Federal health benefits
program, or as necessary to enable such agency to fulfill a requirement
of a Federal statute or regulation that implements a health benefits
program funded in whole or in part with Federal funds, and/or
c. Assist Federal/state Medicaid programs within the state.
Other Federal or state agencies in their administration of a
Federal health program may require HELPLINE information in order to
support evaluations and monitoring of Medicare claims information of
beneficiaries, including proper reimbursement for services provided;
In addition, other state agencies in their administration of a
Federal health program may require HELPLINE information for the
purposes of determining, evaluating and/or assessing cost,
effectiveness, and/or the quality of health care services provided in
the state;
Disclosure under this routine use shall be used by state Medicaid
agencies pursuant to agreements with the HHS for determining Medicaid
and Medicare eligibility, for quality control studies, for determining
eligibility of recipients of assistance under Titles IV, XVIII, and XIX
of the Act, and for the administration of the Medicaid program. Data
will be released to the state only on those individuals who are
patients under the services of a Medicaid program within the state or
who are residents of that state.
We also contemplate disclosing information under this routine use
in situations in which state auditing agencies require HELPLINE
information for auditing state Medicaid eligibility considerations. CMS
may enter into an agreement with state auditing agencies to assist in
accomplishing functions relating to purposes for this SOR.
3. To assist providers and suppliers of services directly or
through fiscal intermediaries or carriers for the administration of
Title XVIII of the Social Security Act.
Providers and suppliers of services require HELPLINE information in
order to establish the validity of evidence or to verify the accuracy
of information presented by the individual, as it concerns the
individual's entitlement to benefits under the Medicare program,
including proper reimbursement for services provided.
4. To assist third party contacts in situations where the party to
be contacted has, or is expected to have information relating to the
individual's capacity to manage his or her affairs or to his or her
eligibility for, or an entitlement to, benefits under the Medicare
program and,
a. The individual is unable to provide the information being sought
(an individual is considered to be unable to provide certain types of
information when any of the following conditions exists: The individual
is confined to a mental institution, a court of competent jurisdiction
has appointed a guardian to manage the affairs of that individual, a
court of competent jurisdiction has declared the individual to be
mentally incompetent, or the individual's attending physician has
certified that the individual is not sufficiently mentally competent to
manage his or her own affairs or to provide the information being
sought, the individual cannot read or write, cannot afford the cost of
obtaining the information, a language barrier exists, or the custodian
of the information will not, as a matter of policy, provide it to the
individual), or
b. The data are needed to establish the validity of evidence or to
verify the accuracy of information presented by the individual, and it
concerns one or more of the following: The individual's entitlement to
benefits under the Medicare program, the amount of reimbursement, and
in cases in which the evidence is being reviewed as a result of
suspected fraud and abuse, program integrity, quality appraisal, or
evaluation and measurement of activities.
Third party contacts require HELPLINE information in order to
provide support for the individual's entitlement to benefits under the
Medicare program; to establish the validity of evidence or to verify
the accuracy of information presented by the individual, and assist in
the monitoring of Medicare claims information of beneficiaries,
including proper reimbursement of services provided.
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 organizations
(HMOs) or a competitive medical plan (CMP) with a Medicare contract, or
a Medicare-approved health care prepayment plan (HCPP)), directly or
through a contractor, and other groups providing protection for their
[[Page 10258]]
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 TPA;
b. Utilize the information solely for the purpose of processing the
identified individual's insurance claims; and
c. Safeguard the confidentiality of the data and prevent
unauthorized access.
Other insurers, TPAs, HMOs, and HCPPs may require HELPLINE
information in order to support evaluations and monitoring of Medicare
claims information of beneficiaries, including proper reimbursement for
services provided.
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, or occasionally when
another party is involved in litigation and CMS's policies or
operations could be affected by the outcome of the litigation, CMS
would be able to disclose information to the DOJ, court, or
adjudicatory body involved.
7. To support a CMS contractor (including, but not limited to FIs
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 programs.
We contemplate disclosing information under this routine use only
in situations in which CMS may enter into a contract or grant with a
third party to assist in accomplishing CMS functions relating to the
purpose of combating fraud, waste or abuse.
CMS occasionally contracts out certain of its functions when doing
so would contribute to effective and efficient operations. CMS must be
able to give a contractor or grantee whatever information is necessary
for the contractor or grantee to fulfill its duties. In these
situations, safeguards are provided in the contract prohibiting the
contractor or grantee from using or disclosing the information for any
purpose other than that described in the contract and requiring the
contractor or grantee to return or destroy all information.
8. To assist another Federal agency or 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, and 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, and abuse in such programs.
Other agencies may require HELPLINE information for the purpose of
combating fraud, waste, and abuse in such Federally funded programs.
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: February 13, 2008.
Charlene Frizzera,
Chief Operating Officer, Centers for Medicare & Medicaid Services.
SYSTEM NO. 09-70-0535
SYSTEM NAME:
``1-800 Medicare Helpline (HELPLINE),'' HHS/CMS/CBC.
SECURITY CLASSIFICATION:
Level Three Privacy Act Sensitive Data.
SYSTEM LOCATION:
CMS Data Center, 7500 Security Boulevard, North Building, First
Floor, Baltimore, Maryland 21244-1850 and at various other contractor
locations.
CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:
Information is collected on individuals age 65 or over who have
been, or currently are, entitled to health
[[Page 10259]]
insurance (Medicare) benefits under Title XVIII of the Act or under
provisions of the Railroad Retirement Act, individuals under age 65 who
have been, or currently are, entitled to such benefits on the basis of
having been entitled for not less than 24 months to disability benefits
under Title II of the Act or under the Railroad Retirement Act,
individuals who have been, or currently are, entitled to such benefits
because they have ESRD, individuals age 64 and 8 months or over who are
likely to become entitled to health insurance (Medicare) benefits upon
attaining age 65, and individuals under age 65 who have at least 21
months of disability benefits who are likely to become entitled to
Medicare upon the 25th month of their being disabled.
CATEGORIES OF RECORDS IN THE SYSTEM:
The collected information will contain name, address, telephone
number, health insurance claim (HIC) number, geographic location, race/
ethnicity, sex, date of birth, as well as, background information
relating to Medicare or Medicaid issues. The HELPLINE will also
maintain a caller history for purposes of re-contacts by customer
service representatives or CMS, contain information related to Medicare
enrollment and entitlement, group health plan enrollment data, as well
as, background information relating to Medicare or Medicaid issues.
AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
Authority for maintenance of the system is given under sections
1102, 1804(b), and 1851(d) of the Social Security Act (42 United States
Code (U.S.C.) 1302, 1395b-2(b), and 1395w-21(d)), and OMB Circular A-
123, Internal Control Systems, and Title 42 U.S.C. section 1395w-21(d)
(Pub. L. 105-3, the Balanced Budget Act of 1997).
PURPOSE(S) OF THE SYSTEM:
The primary purpose of the SOR is to provide general information to
beneficiaries and future beneficiaries so that they can make informed
Medicare decisions, maintain information on Medicare enrollment for the
administration of the Medicare program, including the following
functions: Ensuring proper Medicare enrollment, claims payment,
Medicare premium billing and collection, coordination of benefits by
validating and verifying the enrollment status of beneficiaries, and
validating and studying the characteristics of persons enrolled in the
Medicare program including their requirements for information.
Information retrieved from this SOR will also be disclosed to: (1)
Support regulatory, reimbursement, and policy functions performed
within the Agency or by contractors, consultants, or CMS grantees; (2)
assist another Federal or state agency, agency of a state government,
an agency established by state law, or its fiscal agent; (3) assist
providers and suppliers of services for administration of Title XVIII
of the Act; (4) assist third parties where the contact is expected to
have information relating to the individual's capacity to manage his or
her own affairs; (5) assist other insurers for processing individual
insurance claims; (6) support litigation involving the Agency; and (7)
combat fraud, waste, and abuse in certain health benefits programs.
ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM, INCLUDING CATEGORIES
OR USERS AND THE PURPOSES OF SUCH USES:
A. The Privacy Act allows us to disclose information without an
individual's consent if the These routine uses specify circumstances,
in addition to those provided by statute in the Privacy Act of 1974,
under which CMS may release information from the HELPLINE without the
consent of the individual to whom such information pertains. Each
proposed disclosure of information under these routine uses will be
evaluated to ensure that the disclosure is legally permissible,
including but not limited to ensuring that the purpose of the
disclosure is compatible with the purpose for which the information was
collected. We are proposing to establish or modify the following
routine use disclosures of information maintained in the system:
1. To support Agency contractors, consultants, or CMS grantees who
have been contracted by the Agency to assist in accomplishment of a CMS
function relating to the purposes for this SOR and who need to have
access to the records in order to assist CMS.
2. To 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. Assist Federal/state Medicaid programs within the state.
3. To assist providers and suppliers of services directly or
through fiscal intermediaries or carriers for the administration of
Title XVIII of the Social Security Act.
4. To assist third party contacts in situations where the party to
be contacted has, or is expected to have information relating to the
individual's capacity to manage his or her affairs or to his or her
eligibility for, or an entitlement to, benefits under the Medicare
program and,
a. The individual is unable to provide the information being sought
(an individual is considered to be unable to provide certain types of
information when any of the following conditions exists: The individual
is confined to a mental institution, a court of competent jurisdiction
has appointed a guardian to manage the affairs of that individual, a
court of competent jurisdiction has declared the individual to be
mentally incompetent, or the individual's attending physician has
certified that the individual is not sufficiently mentally competent to
manage his or her own affairs or to provide the information being
sought, the individual cannot read or write, cannot afford the cost of
obtaining the information, a language barrier exists or the custodian
of the information will not, as a matter of policy, provide it to the
individual), or
b. The data are needed to establish the validity of evidence or to
verify the accuracy of information presented by the individual, and it
concerns one or more of the following: The individual's entitlement to
benefits under the Medicare program, the amount of reimbursement, and
in cases in which the evidence is being reviewed as a result of
suspected fraud and abuse, program integrity, quality appraisal, or
evaluation and measurement of activities.
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 organizations
(HMOs) or a competitive medical plan (CMP) with a Medicare contract, or
a Medicare-approved health care prepayment 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 TPA;
[[Page 10260]]
b. Utilize the information solely for the purpose of processing the
identified individual's insurance claims; and
c. 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 support a CMS contractor (including, but not limited to FIs
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 programs.
8. To assist another Federal agency or 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, and 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, and abuse in such programs.
POLICIES AND PRACTICES FOR STORING, RETRIEVING, ACCESSING, RETAINING,
AND DISPOSING OF RECORDS IN THE SYSTEM:
STORAGE:
All records are stored on electronic media.
RETRIEVABILITY:
The collected data are retrieved by an individual identifier; e.g.,
beneficiary name or HICN, and unique provider identification 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 information for a total period not to exceed 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 AND ADDRESSES:
Director, Division of Call Center Operations, Customer Teleservice
Operations Group, Office of Beneficiary Information Services, CMS, 7500
Security Boulevard, C2-26-20, 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, employee
identification number, tax identification number, national provider
number, and for verification purposes, the subject individual's name
(woman's maiden name, if applicable), HICN, and/or SSN (furnishing the
SSN is voluntary, but it may make searching for a record easier and
prevent delay).
RECORD ACCESS PROCEDURE:
For purpose of access, use the same procedures outlined in
Notification Procedures above. Requestors should also reasonably
specify the record contents being sought. (These procedures are in
accordance with Department regulation 45 CFR 5b.5(a)(2)).
CONTESTING RECORD PROCEDURES:
The subject individual should contact the system manager named
above, and reasonably identify the record and specify the information
to be contested. State the corrective action sought and the reasons for
the correction with supporting justification. (These procedures are in
accordance with Department regulation 45 CFR 5b.7).
RECORDS SOURCE CATEGORIES:
The data contained in these records are furnished by the
individual, or in the case of some situations, through third party
contacts that make calls to 1-800 Medicare Helpline. Updating
information is also obtained from the following CMS systems of records:
Enrollment Data Base (09-70-0502), Common Working File (09-70-0525),
and the Master Beneficiary Record maintained by the Social Security
Administration (SSA System of Records SSA/ORSIS 60-0090).
SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS OF THE ACT:
None.
[FR Doc. E8-3564 Filed 2-25-08; 8:45 am]
BILLING CODE 4120-03-P