[Federal Register: February 27, 2008 (Volume 73, Number 39)]
[Notices]
[Page 10450-10454]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr27fe08-55]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
Privacy Act of 1974; Report of a New System of Records
AGENCY: Department of Health and Human Services (HHS), Centers for
Medicare & Medicaid Services (CMS).
ACTION: Notice of a New System of Records (SOR).
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SUMMARY: In accordance with the requirements of the Privacy Act of
1974, we are proposing to establish a new system of records titled,
``Medicare Administrative Issue Tracker and Reporting of Operations
(MAISTRO) System,'' System No. 09-70-0598. The purpose of the system is
to capture and track casework/inquiries pertaining to Medicare Part A
and Part B programs. The system will also provide a mechanism for
recording data on a national level and will serve as a tool to leverage
in performing analysis including identification of systemic trends.
MAISTRO will record, track and monitor beneficiary and provider level
inquiries & complaints. The system will contain information needed to
research the inquiries, such as a beneficiary's health insurance claim
number (HICN) or a Provider Identification Number (NPI).
The primary purpose of the system is to collect and maintain
information needed to provide a mechanism for CMS' central and regional
office to capture, track, manage, report and trend inquiries,
complaints and issues related to Fee-for-Service (FFS) programs.
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 CMS grantee; (2)
assist another Federal or state agency, agency of a state government,
an agency established by state law, or its fiscal agent; (3) facilitate
research on the quality and effectiveness of care provided, as well as
epidemiological projects; (4) support litigation involving the Agency;
and (5) 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 new 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 2/11/2008. In any event, we will not
disclose any information under a routine use until 30 days after
publication in the Federal Register or 40 days after mailings to
Congress, which ever is later. We may defer implementation of this
system or on one or more of the routine uses listed below if we receive
comments that persuade us to defer implementation.
ADDRESSES: The public should address comments to: CMS Privacy Officer,
Division of Privacy Compliance, Enterprise Architecture & Strategy
Group, Office of Information Services, CMS, Mail Stop N2-04-27, 7500
Security Boulevard, Baltimore, Maryland 21244-1850. Comments received
will be available for review at this location, by appointment, during
regular business hours, Monday through Friday from 9 a.m.-3 p.m.,
eastern time zone.
FOR FURTHER INFORMATION CONTACT: Michele Livingston, Division of
Ombudsman Casework and Trends Management, Medicare Ombudsman Group,
Office of External Affairs, CMS, 7500 Security Boulevard, Mail Stop S1-
20-21, Baltimore, Maryland 21244-1850. The telephone number is 410-786-
6340 or contact Michele.Livingston@cms.hhs.gov.
SUPPLEMENTARY INFORMATION: The CMS Consortium for Financial Management
and Fee for Service Operations (CFMFFSO) is responsible for handling
casework/inquiries, but not limited to: (1) Coverage and payment
policy; (2) audit and reimbursement policy and operations; (3) program
integrity and medical review policy; (4) Medicare secondary payer and
coordination of benefits; (5) claims-related hearings, appeals and
grievances; (6) beneficiary eligibility, enrollment, entitlement,
rights and protections, premium billing and collection; and (7) dispute
resolution processes to assure the effective administration of the
Medicare program. These types of inquiries number in the tens of
thousands annually across the 10 CMS Regional Offices.
The Office of the Medicare Ombudsman was established as a result of
Section 923 of the Medicare
[[Page 10451]]
Modernization Act and is responsible for receiving complaints,
grievances and requests for information submitted by individuals
entitled to benefits under Part A or enrolled under Part B, or both,
with respect to any aspect of the Medicare program and providing
assistance with respect to complaints. Over the last year the focus of
inquiry tracking has centered on the implementation of Part D
reporting.
Although each regional office has developed its own system to track
and manage inquiries and complaints, these systems are inconsistent and
do not utilize standardized operational procedures or processes to
guide how inquiries are addressed or reported. Standardization will
improve performance, reduce operating costs, and enable statistical
analysis of the workload and trends among inquiries. To address these
issues, the following tasks had to be accomplished: (1) Identifying a
system to track beneficiary and provider inquiries, complaints and
issues specific to FFS operations; (2) Ensuring that casework
throughout each region is consistently captured and managed
appropriately which ensures the delivery of high quality customer
service to Medicare Part A and Part B beneficiaries and providers; and
(3) Producing workload data statistics to both account for the work and
enable improvement in CMS' policies and procedures.
When complete, the MAISTRO system will provide a mechanism for CMS'
central and regional office to capture, track, manage, report and trend
inquiries, complaints and issues related to Fee-for-Service.
Additionally, the goal of MAISTRO is to provide an easy to use system
that will provide consistency when tracking, resolving, and reporting
FFS inquiries, complaints and issues on a national level such that
trends, workloads and systemic issues can be identified and managed
appropriately across the consortium.
I. Description of the Proposed System of Records
A. Statutory and Regulatory Basis for SOR
Authority for maintenance of this system is given under Sec. 923
of the Medicare Prescription Drug, Improvement, and Modernization Act
of 2003 (MMA) (Public Law (Pub. L.) 108-173).
B. Collection and Maintenance of Data in the System
For purposes of this SOR, the system contains information on
Medicare beneficiaries, providers and other individuals who have made
inquiries concerning the fee-for-service program. The system contains
information such as a beneficiary's name, address data, health
insurance claim number (HICN), demographic information (gender, date of
birth), provider name, address data and provider identification number
(NPI), provider organization information, contact person information,
employer identification numbers, and certain optional data such as
Social Security Numbers and other provider identifiers used by these
health care providers.
II. Agency Policies, Procedures, and Restrictions on the Routine Use
A. Agency Policies, Procedures, and Restrictions Routine Uses
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 MAISTRO information that can be
associated with an individual as provided for under ``Section III.
Proposed Routine Use Disclosures of Data in the System.'' Both
individually identifiable and non-individually-identifiable data may be
disclosed under a routine use.
We will only disclose the minimum personal data necessary to
achieve the purpose of MAISTRO. CMS has the following policies and
procedures concerning disclosures of information that is maintained in
the system. Disclosure of information from the 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 the data are being collected; e.g., to collect and maintain
information needed to provide a mechanism for CMS' central and regional
office to capture, track, manage, report and trend inquiries,
complaints and issues related to Fee-for-Service (FFS).
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 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 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 CMS grantees that
have been contracted by the Agency to assist in accomplishment of a CMS
function relating to the purposes for this system and who need 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 system.
CMS occasionally contracts out certain of its functions when doing
so would contribute to effective and efficient operations. CMS must be
able to give a contractor, consultant, or grantee whatever information
is necessary for the contractor, consultant, or grantee to fulfill its
duties. In these situations, safeguards are provided in the contract
prohibiting the contractor, consultant, or grantee from using or
disclosing the information for any purpose other than that described in
the contract and requires the contractor or consultant 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
[[Page 10452]]
fiscal agent pursuant to agreements with CMS 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 MAISTRO information for the purposes
of collecting and maintaining information needed to capture, track,
manage, report and trend inquiries, complaints and issues related to
Fee-for-Service (FFS).
Other Federal or state agencies, in their administration of a
Federal health program, may require MAISTRO information in order to
support evaluations and monitoring of Medicaid claims information of
beneficiaries, including proper reimbursement for services provided.
3. To an individual or organization for a research project or in
support of an evaluation project related to the prevention of disease
or disability, the restoration or maintenance of health, or payment
related projects.
The MAISTRO data will provide for research or support of evaluation
projects and a broader, longitudinal, national perspective of the
status of Medicaid beneficiaries. CMS anticipates that researchers may
have legitimate requests to use these data in projects that could
ultimately improve the care provided to Medicaid beneficiaries and the
policies that govern their care.
4. To assist 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.
5. To support a CMS contractor 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, and 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 CMS grantee whatever information is
necessary for the contractor or CMS grantee to fulfill its duties. In
these situations, safeguards are provided in the contract prohibiting
the contractor or grantee from using or disclosing the information for
any purpose other than that described in the contract and requiring the
contractor or grantee to return or destroy all information.
6. To support another Federal agency or to an instrumentality of
any governmental jurisdiction within or under the control of the United
States (including any state or local governmental agency), that
administers, or that has the authority to investigate potential fraud,
waste, or abuse in a 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 MAISTRO 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 excessive or unauthorized use. Personnel having
access to the system have been trained in the Privacy Act and
information security requirements. Employees who maintain records in
this system are instructed not to release data until the intended
recipient agrees to implement appropriate management, operational and
technical safeguards sufficient to protect the confidentiality,
integrity and availability of the information and information systems
and to prevent unauthorized access.
This system will conform to all applicable Federal laws and
regulations and Federal, HHS, and CMS policies and standards as they
relate to information security and data privacy. These laws and
regulations may apply but are not limited to: The Privacy Act of 1974;
the Federal Information Security Management Act of 2002; the Computer
Fraud and Abuse Act of 1986; the Health Insurance Portability and
Accountability Act of 1996; the E-Government Act of 2002, the Clinger-
Cohen Act of 1996; the Medicare Modernization Act of 2003, and the
corresponding implementing regulations. OMB Circular A-130, Management
of Federal Resources, Appendix III, Security of Federal Automated
Information Resources also applies. Federal, HHS, and CMS policies and
standards include but are not limited to: All pertinent National
Institute of Standards and Technology publications; the HHS Information
Systems Program Handbook and the CMS Information Security Handbook.
V. Effects of the Proposed System of Records on Individual Rights
CMS proposes to establish 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.
[[Page 10453]]
Dated: February 20, 2008.
Charlene Frizzera,
Chief Operating Officer, Centers for Medicare & Medicaid Services.
SYSTEM NUMBER: 09-70-0598
SYSTEM NAME:
``Medicare Administrative Issue Tracker and Reporting of Operations
(MAISTRO) System,'' HHS/CMS/OEA.
SECURITY CLASSIFICATION:
Level Three Privacy Act Sensitive Data.
SYSTEM LOCATION:
Centers for Medicare & Medicaid Services (CMS) Data Center, 7500
Security Boulevard, North Building, First Floor, Baltimore, Maryland
21244.
CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:
For purposes of this SOR, the system contains information on
Medicare beneficiaries, providers and other individuals who have made
inquiries concerning the fee-for-service program.
CATEGORIES OF RECORDS IN THE SYSTEM:
The system contains information such as a beneficiary's name,
address data, health insurance claim number (HICN), demographic
information, (gender, date of birth), provider name, address data and
provider identification number (NPI), provider organization
information, contact person information, employer identification
numbers, and certain optional data such as Social Security Numbers and
other provider identifiers used by these health care providers.
AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
Authority for maintenance of this system is given under Sec. 923
of the Medicare Prescription Drug, Improvement, and Modernization Act
of 2003 (MMA) (Public Law (Pub. L.) 108-173).
PURPOSE(S) OF THE SYSTEM:
The primary purpose of the system is to collect and maintain
information needed to provide a mechanism for CMS' central and regional
office to capture, track, manage, report and trend inquiries,
complaints and issues related to Fee-for-Service (FFS) programs.
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 CMS grantee; (2)
assist another Federal or state agency, agency of a state government,
an agency established by state law, or its fiscal agent; (3) facilitate
research on the quality and effectiveness of care provided, as well as
epidemiological projects; (4) support litigation involving the Agency;
and (5) 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 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 that
have been contracted by the Agency to assist in accomplishment of a CMS
function relating to the purposes for this system and who need 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
pursuant to agreements with CMS 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 an individual or organization for a research project or in
support of an evaluation project related to the prevention of disease
or disability, the restoration or maintenance of health, or payment
related projects.
4. To assist 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.
5. To support a CMS contractor 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.
6. To support another Federal agency or to an instrumentality of
any governmental jurisdiction within or under the control of the United
States (including any state or local governmental agency), that
administers, or that has the authority to investigate potential fraud,
waste, or abuse in a 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.
POLICIES AND PRACTICES FOR STORING, RETRIEVING, ACCESSING, RETAINING,
AND DISPOSING OF RECORDS IN THE SYSTEM:
STORAGE:
All records are stored on magnetic media.
RETRIEVABILITY:
All records are accessible by individual name or identification
number.
SAFEGUARDS:
CMS has safeguards in place for authorized users and monitors such
users to ensure against excessive or unauthorized use. Personnel having
access to the system have been trained in the Privacy Act and
information security requirements. Employees who maintain records in
this system are instructed not to release data until the intended
recipient agrees to implement appropriate management, operational and
technical safeguards sufficient to protect the confidentiality,
integrity and availability of the information and information systems
and to prevent unauthorized access.
This system will conform to all applicable Federal laws and
regulations and Federal, HHS, and CMS policies and standards as they
relate to information security and data privacy. These laws and
regulations may apply but are not limited to: The Privacy Act of 1974;
the Federal Information Security Management Act of 2002; the Computer
Fraud and Abuse Act of 1986;
[[Page 10454]]
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:
Records are maintained for a period of six years and three months.
All claims-related records are encompassed by the document preservation
order and will be retained until notification is received by DOJ.
SYSTEM MANAGER AND ADDRESS:
Director, Division of Ombudsman Casework and Trends Management,
Medicare Ombudsman Group, Office of External Affairs, CMS, 7500
Security Boulevard, Mail Stop S1-11-21, Baltimore, Maryland 21244-1850.
NOTIFICATION PROCEDURE:
For purpose of access, the subject individual health care provider
should write to the system manager who will require the system name,
National Provider Identifier, address, date of birth, and gender, and
for verification purposes, the subject individual health care
provider's name (woman's maiden name, if applicable), and Social
Security number (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 health care provider should contact the
systems 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).
RECORD SOURCE CATEGORIES:
The data contained in this system of records are obtained from the
individuals who communicate or correspond with CMS.
SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS OF THE ACT:
None.
[FR Doc. E8-3678 Filed 2-26-08; 8:45 am]
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