[Federal Register Volume 60, Number 144 (Thursday, July 27, 1995)]
[Notices]
[Pages 38565-38567]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-18487]



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

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration


Privacy Act of 1974; Report of New System

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

ACTION: Notice of new system of records.

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

SUMMARY: In accordance with the requirements of the Privacy Act of 
1974, we are proposing to establish a new system of records, 
``Evaluation of, and External Quality Assurance for, the Community 
Nursing Organization (CNO) Demonstration,'' HHS/HCFA/ORD No. 360-94-
30500, 30501. We have provided background information about the 
proposed system in the ``Supplementary Information'' section below. 
Although the Privacy Act requires only that the ``routine uses'' 
portion of the system be published for comment, HCFA invites comments 
on all portions of this notice.

DATES: HCFA filed a new system report with the Chairman of the 
Committee on Government Operations of the House of Representatives, the 
Chairman of the Committee on Governmental Affairs of the Senate, and 
the Administrator, Office of Information and Regulatory Affairs, Office 
of Management and Budget (OMB), on July 21, 1995. To ensure that all 
parties have adequate time in which to comment, the new system of 
records, including routine uses, will become effective 40 days from the 
publication of this notice or from the date the report was submitted to 
OMB and the Congress, whichever is later, unless HCFA receives comments 
which require alterations to this notice.

ADDRESSES: The public should address comments to Richard DeMeo, HCFA 
Privacy Act Officer, Office of the Associate Administrator for External 
Affairs, HCFA, Room C2-01-11, 7500 Security Boulevard, Baltimore, 
Maryland 21244-1850. Comments received will be available for inspection 
at this location.

FOR FURTHER INFORMATION CONTACT: Melissa McNiff, Project Officer for 
the evaluation of the Community Nursing Organization Demonstration and 
the External Quality Assurance Program, Office of Research and 
Demonstrations, HCFA, Room C3-21-06, 7500 Security Boulevard, 
Baltimore, Maryland 21244-1850, Telephone 410-786-8494.

SUPPLEMENTARY INFORMATION: HCFA proposes to initiate a new system of 
records, collecting data under the authority of section 4079 of Pub. L. 
100-203, the Omnibus Budget Reconciliation Act of 1987. The purpose of 
this system is to provide data necessary to test the operational 
feasibility of the CNO and examine whether the combination of capitated 
payment and nurse-case management will promote timely and appropriate 
use of community nursing and ambulatory care services and reduce the 
use of costly acute care services. It will further determine the effect 
of membership in a CNO on a typical beneficiary's use of health 
services covered under the CNO package and on services such as 
physician and inpatient hospital care 

[[Page 38566]]
which are covered by Medicare but which are not part of the CNO plan. 
This system of records will also provide data necessary to monitor the 
quality of home health care and selected ambulatory care services 
furnished by providers participating in the CNO Demonstration.
    The external QA contractor will establish a system of records that 
includes information on the individual patients receiving Medicare 
coverage for this purpose. The system of records will contain 
information concerning a patient's name, Health Insurance Claim Number, 
demographic characteristics, medical diagnoses and conditions, plans of 
treatment, receipt of services, health and functional status, and 
utilization of home health services and certain ambulatory care 
services. HCFA and the QA contractor will collect only that information 
necessary to perform the system's function. The database will contain a 
record for each client enrolled in each CNO. Depending on the size of 
the CNO enrollment, information will be collected on approximately 
7,500 Medicare enrollees.
    In order to fulfill the objectives and complete the tasks of this 
contract, the contractor must have individually identifiable records. 
Since we are proposing to establish this system of records in 
accordance with the requirements and principles of the Privacy Act, it 
will not have an unfavorable effect on the privacy or other personal 
rights of individuals.
    The Privacy Act permits us to disclose information without the 
consent of the individual for a ``routine use''--that is, disclosures 
which are compatible with the purpose for which we collected the 
information. The proposed routine uses in the new system meet the 
compatibility criteria since the information is collected for the 
purpose of administering the Community Nursing Organization 
demonstration for which we are responsible. The disclosures under the 
routine uses will not result in any unwarranted adverse effects on 
personal privacy.

    Dated: July 12, 1995.
Bruce C. Vladeck,
Administrator, Health Care Financing Administration.
09-70-0066
    Evaluation of, and External Quality Assurance for, the Community 
Nursing Organization Demonstration.
    None.
    The system will be maintained by the evaluation/quality assurance 
contractor selected by HCFA. Contact the System Manager for the 
location of the contractor. The system, or portions of the system, may 
also be maintained at the HCFA Data Center located at 7131 Rutherford 
Road, Baltimore, MD 21244.
    Medicare beneficiaries who receive home health care and certain 
ambulatory care services from one of the four CNO project sites (Carle 
Clinic, Mahomet, IL; Carondelet Health Care, Tucson, AZ; Living at 
Home/Block Nurse Program, St. Paul, MN; Visiting Nurse Service of New 
York, New York, NY) chosen to participate in the demonstration.
    The system will contain information concerning a patient's name, 
Health Insurance Claim Number, demographic characteristics (e.g., sex, 
age), medical diagnoses and conditions, receipt of service, health and 
functional status, and utilization of home health services and certain 
ambulatory care services.
    Section 4079(c)(6) of the Omnibus Reconciliation Act of 1987 (Pub. 
L. 100-203).
    To provide data necessary to test the feasibility of a capitated 
nurse-case managed service delivery model and the effect it has on 
patient care. The system will also provide data necessary to assess and 
monitor the quality of home health care and selected ambulatory care 
services rendered by providers participating in the Community Nursing 
Organization Demonstration.
    Disclosures may be made:
    1. To the CNOs that provided the home health and selected 
ambulatory care services in order to verify service utilization rates, 
elicit feedback on evaluation findings, and investigate potential 
quality problems and notify the CNOs of any confirmed quality problems 
that are found.
    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 Bureau of Census for use in processing research and 
statistical data directly related to the administration of programs 
under the Social Security Act.
    4. 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; or
    (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 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 the 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.
    5. To an individual or organization for a research, evaluation, or 
epidemiological 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 a 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:

[[Page 38567]]

    (a) In emergency circumstances affecting the health or safety of 
any individual, or
    (b) For use in another research project, under these same 
conditions, and with written authorization of HCFA, or
    (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 these 
provisions.
    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 an ADP or 
telecommunications system containing or supporting records in the 
system.
    Paper and magnetic media.
    Records are retrieved by beneficiary name and health insurance 
claim number.
    The contractor will maintain all records in secure storage areas 
accessible only to authorized employees and will notify all employees 
having access to records of criminal sanctions for unauthorized 
disclosure of information. 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 authorized personnel. System 
securities are established in accordance with DHHS Information 
Resources Manual, Circular #10, Automated Information Systems Security 
Program; and HCFA Automated Information Systems (AIS) Guide, Systems 
Security Policies.
    Hardcopy data collection forms and magnetic media with identifiers 
will be retained in secure storage areas. These records will be 
retained for 1 year after the termination of the monitoring contract. 
Records are maintaned with identifiers as long as needed for program 
research analysis.


    Director, Office of Research and Demonstrations, HCFA, Room C3-25-
26, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.


    Inquiries and requests for system records should be addressed to 
the system manager at the address indicated above. The requestor must 
specify the name, address, and health insurance number.


    Same as notification procedures. Requestors should also reasonably 
specify the record contents being sought. These access procedures are 
in accordance with Department Regulation (45 CFR 5b.5(a)(2).


    Contact the system manager named above and reasonably identify the 
record and specify the information to be contested. State the 
corrective action being sought and the reasons for the correction with 
supporting justification. These procedures are in accordance with 
Department Regulation (45 CFR 5b.7).


    Sources of information contained in this records system are 
expected to include: Data collected from the Medicare claims files; 
Medicare Statistical Systems; CNO plans of care and related patient 
records; supplemental patient intake forms prepared by the CNOs; and 
results of quality assessments conducted by the contractor.


    None.

[FR Doc. 95-18487 Filed 7-26-95; 8:45 am]

BILLING CODE 4120-03-M