[Federal Register Volume 60, Number 13 (Friday, January 20, 1995)]
[Notices]
[Pages 4176-4179]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-1465]



-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration


Privacy Act of 1974; System of Records

AGENCY: Department of Health and Human Services (HHS), Health Care 
Financing Administration (HCFA).

ACTION: Notice to propose a name change, purpose change, and the 
addition of new routine uses for an existing system of records.

-----------------------------------------------------------------------

SUMMARY: HCFA is proposing to amend the system notice for the 
``Supplemental Medical Insurance'' (SMI) Accounting Collection and 
Enrollment System (SPACE),'' System No. 09-70-0505, by revising the 
system name, revising the purpose, and by adding new routine uses. 
Also, sections of this notice have been updated to reference current 
addresses and appropriate HCFA components.
    HCFA is proposing to change the system name to better reflect the 
current function of the SPACE system, which now processes Medicare 
premium billing information for both Part B, SMI, and Part A, HI. The 
proposed new name is ``Supplementary Medical Insurance (SMI) and 
Hospital Insurance (HI) Premium Accounting, Collection and Enrollment 
System (SPACE).'' Despite the amendment to the system name, the acronym 
SPACE, which refers to this system, will not be changed.
    The purpose of this system of records is being updated to include 
beneficiaries whose HI benefit premiums are paid by a State Medicaid 
agency, the U.S. Office of Personnel Management (OPM), or a formal 
third party group (the latter defined in 42 CFR section 408.80 through 
section 408.92). The purpose originally only references those 
beneficiaries whose SMI was paid by these named parties.
    HCFA is also proposing to add routine uses, which permit the 
disclosure of data without the prior written consent of an individual, 
when the use of a record is for a purpose which is compatible with the 
purpose for which the record was collected. The proposed new routine 
uses would permit the disclosure of information to the following 
parties: OPM, formal third party groups, contractors in connection with 
the maintenance of automated data processing (ADP) software, and an 
individual or organization for research. (SEE SUPPLEMENTARY 
INFORMATION)

EFFECTIVE DATES: HCFA filed an altered system report with the Chair of 
the House Committee on Government Operations, the Chair of the Senate 
Committee on Governmental Affairs, and the Administrator, Office of 
Information and Regulatory Affairs, Office of Management and Budget 
(OMB) on January 13, 1995. To ensure that all parties have adequate 
time in which to comment, the revised system of records, including 
routine uses, will become effective 40 days from the publication of 
this notice or from the date it is submitted to OMB and the Congress, 
whichever is later, unless HCFA receives comments which require 
alterations to this notice.

ADDRESSES: Please address comments to Richard A. DeMeo, HCFA Privacy 
Act Officer, Office of Customer Relations and Communications, Office of 
Beneficiary Services, Health Care Financing Administration, Room 2-H-4 
East High Rise Building, 6325 Security Boulevard, Baltimore, Maryland 
21207- [[Page 4177]] 5187. Comments received will be available at this 
location.

FOR FURTHER INFORMATION CONTACT: Mr. Samuel N. Guida, Bureau of Program 
Operations, Office of Contracting and Financial Management, Division of 
Accounts Management and Collection, Health Care Financing 
Administration, Room 1-E-5, Meadows East Building, 6325 Security 
Boulevard, Baltimore, Maryland 21207-5187. His telephone number is 
(410) 966-7495.

SUPPLEMENTARY INFORMATION: HCFA is proposing to amend the system notice 
for the ``Supplemental Medical Insurance (SMI) Accounting Collection 
and Enrollment System (SPACE),'' System No. 09-70-0505, by revising the 
system name, revising the purpose, and by adding new routine uses.
    HCFA is proposing to change the system name to better reflect the 
current function of the SPACE system, which now processes Medicare 
premium billing information for both Part B, SMI, and Part A, HI. The 
proposed new name is ``Supplementary Medical Insurance (SMI) and 
Hospital Insurance (HI) Premium Accounting, Collection and Enrollment 
System (SPACE).'' Despite the amendment to the system name, the acronym 
SPACE, which refers to this system, will not be changed.
    The SPACE system contains information on Medicare beneficiaries 
whose HI benefit and/or SMI benefit premiums are paid by a State 
Medicaid agency, OPM, or formal third party groups. The purpose of this 
system of records is being updated to include beneficiaries whose HI 
benefit premiums are paid by a State Medicaid agency, the U.S. Office 
of Personnel Management (OPM), or a formal third party group (the 
latter defined in 42 CFR 408.80 through 408.92). The purpose originally 
only references those beneficiaries whose SMI was paid by a State 
Medicaid agency.
    Also, HCFA is proposing to add routine uses which would permit the 
disclosure of information to OPM and formal third party groups when 
necessary to perform monthly premium billing functions, to identify 
annuitants for whom premium collections must be initiated and to 
periodically reconcile third party master records. Formal third party 
groups are defined in 42 CFR 408.80 through 408.92, which discusses the 
formal group billing arrangement. OPM and formal third party groups are 
mandated by law to conduct these activities as detailed in both the 
Social Security Act and the CFR.
    Sections 1818 and 1818A of the Act (42 U.S.C. sections 1395i-2 and 
1395i-2a) provide for the payment premiums for HI. Section 1840 of the 
Act (42 U.S.C. section 1395s) establishes the bases for the payment of 
premiums for SMI. Also, sections 1818(g) and 1843 of the Act (42 U.S.C. 
sections 1395i-2(g) and 1395v) provide that a State may enter into a 
buy-in agreement to secure HI and SMI coverage for certain individuals 
by paying the premiums on their behalf. These statutory provisions are 
implemented in HCFA regulations 42 CFR part 406, subpart C; part 408; 
and part 407, subpart C.
    The first proposed new routine use would permit the release of data 
to OPM when necessary to perform monthly premium billing functions, to 
identify annuitants for whom premium collections must be initiated and 
to periodically reconcile third party master records. The second 
routine use would permit disclosure to formal third party groups for 
the purpose of paying Medicare premiums on behalf of their members. A 
third routine use would permit the disclosure of information to a 
contractor in connection with the maintenance of ADP software. A fourth 
routine use would permit the disclosure of information to an individual 
or organization for research. The latter two routine uses are 
established in all HCFA systems of records and have inadvertently been 
omitted from the SPACE system. Therefore, we are proposing that they be 
added to the system at this time.
    The proposed new routine uses will be numbered (4), (5), (6) and 
(7) and will read as follows:
    (4) To the Office of Personnel Management in order to perform 
monthly premium billing functions, to identify annuitants for whom 
premium collections must be initiated, and to periodically reconcile 
third party master records.
    (5) To formal third party groups pursuant to agreements with the 
Health Care Financing Administration to pay the Medicare premiums on 
behalf of their members.
    (6) To a contractor for the purpose of collating, analyzing, 
aggregating or otherwise refining or processing records in this system 
or for developing, modifying and/or manipulating ADP software. Data 
would also be disclosed to contractors incidental to consultation, 
programming, operation, user assistance, or maintenance for ADP or 
telecommunications systems containing or supporting records in the 
system.
    (7) To an individual or organization for a research, evaluation, or 
epidemiologic project related to the prevention of disease or 
disability, or the restoration or maintenance of health, if HCFA:
    a. Determines that the use or disclosure does not violate legal 
limitations under which the record was provided, collected, or 
obtained:
    b. Determines that the purpose for which the disclosure is to be 
made:
    1. Cannot be reasonably accomplished unless provided in 
individually identifiable form.
    2. 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
    3. There is reasonable probability that the objectives for the use 
would be accomplished:
    c. Requires the information recipient to:
    1. Establish reasonable administrative, technical, and physical 
safeguards to prevent unauthorized use or disclosure of the record, and
    2. Remove or destroy the information that allows the individual to 
be identified at the earliest time at which removal or destruction can 
be accomplished consistent with the purpose of the project, unless the 
recipient presents an adequate justification of a research or health 
nature for retaining such information, and
    3. Make no further use or disclosure of the record except:
    a. In emergency circumstances affecting the health or safety of an 
individual.
    b. For use in another research project, under these same 
conditions, and written authorization of HFCA.
    c. For disclosure to a properly identified person for the purpose 
of an audit related to the research project, if information that would 
enable research subjects to be identified is removed or destroyed at 
the earliest opportunity consistent with the purpose of the audit, or
    d. when required by law
    d. Secures a written statement attesting to the information 
recipient's understanding of and willingness to abide by the 
provisions.
    Data maintained in the SPACE system are collected for the following 
purpose: ``To process changes to HI/SMI premium payments by third 
parties (such as State agencies, private groups, Office of Personnel 
Management) on behalf of Medicare beneficiaries; for billing third 
parties; and for enrolling individuals for HI/SMI coverage under State 
buy-in agreements.'' The proposed new routine uses for the SPACE system 
are compatible with this purpose and are therefore consistent with the 
Privacy Act, 5 U.S.C. 552a.
    In accordance with OMB Guidelines (Circular A-130, 58 Fed. Reg. 
36077 July [[Page 4178]] 2, 1993), this proposed name change, purpose 
change, and addition of routine uses constitutes a significant change 
in the system of records. Accordingly, we have prepared a report of an 
altered system of records under 5 U.S.C. 552a(r). In addition, for the 
convenience of the reader, we are publishing the notice in its entirety 
below.

    Dated: January 10, 1995.
Bruce C. Vladeck,
Administrator, Health Care Financing Administration.
09-70-0505
    Supplementary Medical Insurance (SMI) and Hospital Insurance (HI) 
Premium Accounting, Collection and Enrollment System. HHS/HCFA/BPO
    None.
    Health Care Financing Administration, Bureau of Data Management and 
Strategy, HCFA Data Center, 7131 Rutherford Road, Baltimore, MD 21244.
    Health insurance beneficiaries whose supplementary medical 
insurance (SMI) benefit and/or hospital insurance (HI) benefit premiums 
are paid by a State Medicaid agency, the U.S. Office of Personnel 
Management (OPM), or a formal third party group (the latter defined in 
42 CFR 408.80 through 408.92).
    Beneficiary's name, health insurance claim number, date of birth, 
sex, amount of premium liability, date agency first became liable for 
HI benefit or SMI benefit premiums, last month of agency premium 
liability, agency identification numbers, U.S. Office of Personnel 
Management annuity number.
    Sections 1818(e) and (g), 1840(d) and (e), and 1843 of Title XVIII 
of the Social Security Act (42 U.S.C. 1395i-2(e) and (g), 1395s(d) and 
(e), and 1395v).
    To process changes to HI/SMI premium payments by third parties 
(such as State agencies, OPM, formal third party groups) on behalf of 
Medicare beneficiaries; for billing third parties; and for enrolling 
individuals for HI or SMI coverage under State buy-in agreements.
    Disclosure may be made:
    (1) To State Medicaid agencies pursuant to agreements with the 
Department of Health and Human Services for enrollment of Medicaid 
recipients for medical insurance under section 1843 of the Social 
Security Act.
    (2) To a congressional office from the record of an individual in 
response to an inquiry from the congressional office made at the 
request of that individual.
    (3) To the Department of Justice, to a court or other tribunal, or 
to another party before such tribunal, when:
    (a) HHS, or any component thereof; or
    (b) Any HHS employee in his or her official capacity;
    (c) Any HHS employee in his or her individual capacity where the 
Department of Justice (or HHS, where it is authorized to do so) has 
agreed to represent the employee; or
    (d) The United States or any agency thereof where HHS determines 
that the litigation is likely to affect HHS or any of its components,

is a party to litigation or has an interest in such litigation, and HHS 
determines that the use of such records by the Department of Justice, 
the tribunal, or other party is relevant and necessary to the 
litigation and would help in the effective representation of the 
governmental party, provided, however, that in each case, HHS 
determines that such disclosure is compatible with the purpose for 
which the records were collected.
    (4) To the Office of Personnel Management in order to perform 
monthly premium billing functions, to identify annuitants for whom 
premium collections must be initiated, and to periodically reconcile 
third party master records.
    (5) To formal third party groups pursuant to agreements with the 
Health Care Financing Administration to pay the Medicare premiums on 
behalf of their members.
    (6) To a contractor for the purpose of collating, analyzing, 
aggregating, or otherwise refining or processing records in this system 
or for developing, modifying and/or manipulating ADP software. Data 
would also be disclosed to contractors incidental to consultation, 
programming, operation, user assistance, or maintenance for ADP or 
telecommunications systems containing or supporting records in the 
system.
    (7) To an individual or organization for a research, evaluation, or 
epidemiologic project related to the prevention of disease or 
disability, or the restoration or maintenance of health if HCFA:
    (a) Determines that the use or disclosure does not violate legal 
limitations under which the record was provided, collected, or 
obtained:
    (b) Determines that the purpose for which the disclosure is to be 
made:
    1. Cannot be reasonably accomplished unless the record is provided 
in individually identifiable form.
    2. 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
    3. There is reasonable probability that the objective for the use 
would be accomplished:
    (c) Requires the information recipient to:
    1. Establish reasonable administrative, technical, and physical 
safeguards to prevent unauthorized use or disclosure of the record, and
    2. Remove or destroy the information that allows the individual to 
be identified at the earliest time at which removal or destruction can 
be accomplished consistent with the purpose of the project, unless the 
recipient presents an adequate justification of a research or health 
nature for retaining such information, and
    3. Make no further use or disclosure of the record except:
    a. In emergency circumstances affecting the health or safety of an 
individual;
    b. For use in another research project, under these same 
conditions, and with written authorization of HCFA;
    c. For disclosure to a properly identified person for the purpose 
of an audit related to the research project, if information that would 
enable research subjects to be identified is removed or destroyed at 
the earliest opportunity consistent with the purpose of the audit; or
    d. when required by law.
    (d) Secures a written statement attesting to the information 
recipient's understanding of and willingness to abide by the 
provisions.
    Magnetic media, microfilm.
    The system is indexed by health insurance claim number.
    Only authorized personnel have direct access to information in the 
[[Page 4179]] Third-Party Master Record and all personnel are advised 
that this information is confidential. For computerized records, 
safeguards established in accordance with Departmental standards and 
National Institute of Standards and Technology guidelines (e.g. 
security codes) will be used, limiting access to unauthorized 
personnel. Systems securities are established in accordance with HHS 
Information Resource Management (IRM) Circular #10, Automated 
Information Systems Security Program; and HCFA Automated Information 
Systems (AIS) Guide for Systems Security Policies.
    Tape records are retained for 90 days. Monthly microfilm records 
are destroyed after 3 years.
    Director, Bureau of Program Operations, Health Care Financing 
Administration, 6325 Security Boulevard, Baltimore, MD 21207.
    Inquiries and requests for system records should be addressed to 
the system manager named above and directed to the attention of the 
Office of Program Operations Procedures, Division of Appeals and 
Communications. The individual should furnish his or her health 
insurance claim number and name as shown as Medicare records.
    Same as notification procedures. Requesters should also reasonably 
specify the record contents being sought. (The access procedures are in 
accordance with Department of Health and Human Services (DHHS) 
Regulations (45 CFR 5b.5(a)(2))).
    Contact the official at the address specified under notification 
procedures 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 DHHS Regulations (45 CFR 5b.7.)
    The identifying information contained in these records is obtained 
from third-party agencies, the Social Security Administration's Master 
Beneficiary Record, and the Medicare Enrollment Database.
    None.

[FR Doc. 95-1465 Filed 1-19-95; 8:45 am]
BILLING CODE 4120-03-M