[Federal Register Volume 65, Number 248 (Tuesday, December 26, 2000)]
[Notices]
[Pages 81572-81575]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-32876]


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DEPARTMENT OF VETERANS AFFAIRS


Privacy Act of 1974; System of Records

AGENCY: Department of Veterans Affairs (VA).

ACTION: Amendment of system of records notice ``veteran's spouse or 
dependent civilian health and medical care records-VA''.

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SUMMARY: As required by the Privacy Act of 1974, 5 U.S.C. 552a(e), 
notice is hereby given that the Department of Veterans Affairs (VA) is 
amending the system of records currently known as ``Veteran's Spouse or 
Dependent Civilian Health and Medical Care Records-VA (54VA136)'' as 
set forth in the Federal Register 88 FR 14242 (6/24/88). VA is amending 
the system by revising the paragraphs for System Name; System Location; 
Categories of individuals covered by the system; Categories of records 
in the system; Routine uses or records maintained in the system, 
including categories of users and the purposes of such uses; Policies 
and practices for storing, retrieving, accessing, retaining and 
disposing of records in the system; the location of the records and 
revising routine use statements; Safeguards; System manager(s) and 
address; Notification procedure; Record access procedures; Record 
source categories. VA is republishing the system notice in its entirety 
at this time.

DATES: Comments on the amendment of this system of records must be 
received no later than January 25, 2001. If no public comment is 
received, the new system will become effective January 25, 2001.

ADDRESSES: Written comments concerning the proposed new system of 
records may be submitted to the Office of Regulations Management (02D), 
Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 
20420. Comments will be available for public inspection at the above 
address in the Office of Regulations Management, Room 1158, between the 
hours of 8:00 a.m. and 4:30 p.m., Monday through Friday (except 
holidays).

FOR FURTHER INFORMATION CONTACT: VHA Privacy Act Officer, Department of 
Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420, 
telephone (727) 320-1839.

SUPPLEMENTARY INFORMATION: The name and number of the system is changed 
from ``Veteran's Spouse or Dependent Civilian Health and Medical Care 
Records-VA'' (54VA136) to ``Health Administration Center Civilian 
Health and Medical program Records-VA'' (54VA17) to reflect 
organizational changes. The system location has been amended to reflect 
the current address of the Health Administration Center in this system. 
The Authority Section has been amended to reflect the current legal 
authority to maintain these records. Wording has been revised in this 
system to reflect that Civilian Health and Medical Program of the 
Uniformed Services (CHAMPUS) has been renamed by the Department of 
Defense as TRICARE. The categories of individuals covered by the system 
has been amended to include the health care providers who treat CHAMPVA 
beneficiaries. The categories of records in the system has been amended 
to include other health insurance information collected and the type of 
medical services provided in order to process claims for payment.
    Title 38, United States Code, section 1713 requires VA to 
administer health care benefits for the dependents of certain veterans. 
This program is known as the Civilian Health and Medical Program of the 
Department of Veterans Affairs (CHAMPVA). VHA established the CHAMPVA 
Center in 1988 as the organization responsible for management of the 
CHAMPVA program. The CHAMPVA Center was recently renamed the Health 
Administration Center (HAC). The HAC administers all activities of the 
CHAMPVA program, including claims processing and an automated call 
center. In the process of daily activities, HAC is required to obtain 
and disclose certain information to make determinations of eligibility, 
issue authorization for medical services and provide payment and 
benefit data. This information is disclosed to health care providers, 
trading partners and contractors, CHAMPVA sponsors, beneficiaries and 
their representatives.
    The following terms used in this System of Records are defined as 
follows:

     Trading Partners and Contractors--A trading partner or 
contractor is a third party organization that submits claims to CHAMPVA 
for payment consideration under either a formal Memorandum of 
Understanding or contractual agreement with HAC.
     CHAMPVA Sponsors, Beneficiaries and their 
Representatives--A CHAMPVA sponsor is the veteran whose dependents are 
eligible for CHAMPVA benefits. A CHAMPVA beneficiary refers to the 
eligible children and spouse of a CHAMPVA sponsor. A representative is 
an individual designated by a CHAMPVA beneficiary to act in their 
behalf or in the case of a minor, his or her parent or guardian.

    Several routine use disclosures have been amended, as described 
below, to enable efficient administration of the program and granting 
of medical benefits to eligible beneficiaries.

     Routine use one (1) has been revised and amended to enable 
disclosure of claimant information in this system of records to health 
care providers, trading partners, contractors, and CHAMPVA 
beneficiaries contacting the HAC. Generally, the purpose of these 
contacts is to verify eligibility for benefits, obtain benefit 
information, obtain benefit assistance, resolve claim issues, verify 
payment for services, obtain authorization for medical

[[Page 81573]]

services, and obtain financial and billing information for accounting 
purposes.
     Routine use 23 has been added to enable the exchange of 
certain information in this system of records to validate CHAMPVA 
beneficiary social security numbers and Medicare eligibility. Medicare 
information is required by Statute to determine beneficiary eligibility 
for CHAMPVA benefit. In order to obtain Medicare information, the 
beneficiary's social security number must be valid.
     Federal regulation (38 CFR part 17, Secs. 17.270 through 
17.278) requires health care providers who deliver medical services to 
CHAMPVA beneficiaries to accept the CHAMPVA determined allowable 
reimbursement rate as payment in full for rendered services. Since 
implementation of this regulation on October 9, 1998, some health care 
providers have elected not to provide medical services to CHAMPVA 
beneficiaries. Thus, routine use 24 has been added to enable VA to 
disclose the name and address of health care providers who provide 
medical services to CHAMPVA beneficiaries.
     Routine uses 11 and 12 have been revised to eliminate 
disclosure of information in this system as a result of Federal, State 
and municipal subpoenas.
    The paragraph ``Policies and Practices for Storing, Retrieving, 
Accessing, Retaining and Disposing of Records'' has been amended to 
reflect that some paper documents and those received electronically are 
maintained electronically. The wording in the paragraph ``Safeguards'' 
has been revised to reflect current practices. The paragraph 
``Retention and Disposal'' has been amended to reflect that those paper 
documents that are scanned onto optical disk for electronic storage are 
destroyed after scanning.
    The purpose of this system of records is to establish and monitor 
eligibility and process medical claims for payment for certain 
beneficiaries of eligible veterans. Information submitted by health 
care providers that is included in this System of Records is used to 
process claims and may be used as a provider referral source to CHAMPVA 
beneficiaries.
    The notice of intent to publish and an advance copy of the system 
notice have been sent to the appropriate Congressional committees and 
to the Director of the Office of Management and Budget (OMB) as 
required by 5 U.S.C. 522a(r) (Privacy Act) and guidelines issued by OMB 
(61 FR 6428), February 20, 1996.

    Approved: December 12, 2000.
Hershel W. Gober,
Acting Secretary of Veterans Affairs.
54VA17

SYSTEM NAME:
    Health Administration Center Civilian Health and Medical Program 
Records-VA.

SYSTEM LOCATION:
    Records are maintained at the Health Administration Center, 300 
South Jackson Street, Denver, Colorado 80209.

CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:
    1. Individuals who seek health care under Title 38, United States 
Code, section 1713, including:
    a. The spouse or child of a veteran who has a total disability, 
permanent in nature, resulting from a service-connected disability;
    b. The surviving spouse or child of a veteran who died as a result 
of a service-connected disability or who at the time of death had a 
total disability, permanent in nature, resulting from a service-
connected disability;
    c. The surviving spouse or child of a person who died in the active 
military, naval, or air service in the line of duty and not due to such 
person's own misconduct; and who are not eligible for medical care 
under TRICARE or Medicare.
    2. The veteran sponsor of the spouse or child.
    3. Health care providers treating individuals who receive care 
under Title 38, United States Code, section 1713.

CATEGORIES OF RECORDS IN THE SYSTEM:
    Records maintained in the system include medical benefit 
application and eligibility information concerning the spouse and/or 
dependent(s) and the veteran sponsor, other health insurance 
information correspondence concerning individuals and documents 
pertaining to claims for medical services, information related to 
claims processing and third party liability recovery actions taken by 
VA and/or TRICARE. The record may include the name, address and other 
identifying information concerning health care providers, services 
provided, amounts claimed and paid for health care services, medical 
records, and treatment and payment dates. Additional information may 
include veteran, spouse and/or dependent identifying information (e.g., 
name, address, social security number, VA claims file number, date of 
birth), and military service information concerning the veteran sponsor 
(e.g., dates, branch and character of service, medical information).

AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
    Title 38, United States Code, Chapter 5, section 501(a) and 501(b), 
and Chapter 17, section 1713.

PURPOSE:
    Records may be used for purposes of establishing and monitoring 
eligibility to receive CHAMPVA benefits; and process medical claims for 
payment for eligible beneficiaries of certain veterans.

ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM, INCLUDING CATEGORIES 
OF USERS AND THE PURPOSES OF SUCH USES:
    1. Eligibility and claim information from this system of records 
may be disclosed as a useful purpose in response to an inquiry made by 
the claimant, claimant's guardian, health care provider or trading 
partner or contractor. Purposes of these disclosures are to assist the 
provider or claimant in obtaining reimbursement for claimed medical 
services, facilitate billing processes, to verify beneficiary 
eligibility for requested services and to provide payment information 
regarding claimed services. Eligibility or entitlement information 
disclosed may include the name, CHAMPVA authorization number (social 
security number), effective dates of eligibility, the reasons for any 
period of ineligibility and other health insurance information of the 
named individual. Claim information disclosed may include payment 
information such as payment identification number, date of payment, 
date of service, amount billed, amount paid, name and address of payee 
or reasons for non-payment.
    2. Transfer of statistical and other data to Federal, State, and 
local government agencies and national health organizations to assist 
in the development of programs that will be beneficial to health care 
recipients, to protect their rights under the law, and to assure that 
they are receiving all health benefits to which they are entitled.
    3. In the event that a system of records maintained by this agency 
to carry out its functions indicates a violation or potential violation 
of law, whether civil, criminal or regulatory in nature, and whether 
arising by general statute or particular program statute, or by 
regulation, rule or order issued pursuant thereto, the relevant records 
in the system of records may be referred, as a routine use, to the 
appropriate agency, whether Federal, State, local or foreign, charged 
with the responsibility of investigating or prosecuting such

[[Page 81574]]

violation or charged with enforcing or implementing the statute, or 
rule, regulation or order issued pursuant thereto.
    4. A record from this system of records may be disclosed to a 
Federal agency, in the issuance of a security clearance, the reporting 
of an investigation of an employee, the letting of a contract, or the 
issuance of a license, grant or other benefit by the requesting agency, 
to the extent that the information is relevant and necessary to the 
requesting agency's decision on the matter.
    5. A record from this system of records may be disclosed as a 
``routine use'' to a Federal, State or local agency maintaining civil, 
criminal or other relevant information, such as current licenses, if 
necessary to obtain information relevant to an agency decision 
concerning the hiring or retention of an employee, the issuance of a 
security clearance, the letting of a contract, or the issuance of a 
license, grant or other health, educational or welfare benefit.
    6. Relevant information from this system of records, including the 
nature and amount of a financial obligation, may be disclosed as a 
routine use, in order to assist VA in the collection of unpaid 
financial obligations owed to the VA, to a debtor's employing agency or 
commanding officer so that the debtor-employee may be counseled by his 
or her Federal employer or commanding officer. This purpose is 
consistent with 5 U.S.C. 5514, 4 CFR 102.5, and section 206 of 
Executive Order 11222 of May 8, 1965 (30 FR 6469).
    7. Disclosure may be made 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.
    8. Disclosure may be made to National Archives and Records 
Administration (NARA), General Services Administration (GSA) in records 
management inspections conducted under authority of 44 United States 
Code.
    9. Any relevant information in this system of records may be 
disclosed to attorneys, insurance companies, employers, and to courts, 
boards, or commissions; such disclosures may be made only to the extent 
necessary to aid VA in preparation, presentation, and prosecution of 
claims authorized under Federal, State, or local laws, and regulations 
promulgated thereunder.
    10. Any information in this system of records may be disclosed to 
the United States Department of Justice or United States Attorneys in 
order for the foregoing parties to prosecute or defend litigation 
involving or pertaining to the United States.
    11. Any information in this system of records may be disclosed to a 
Federal grand jury, a Federal court or a party in litigation, or a 
Federal agency or party to an administrative proceeding being conducted 
by a Federal agency, in order for VA to respond to and comply with the 
issuance of a Federal court order.
    12. Any information in this system of records may be disclosed to a 
State or municipal grand jury, a State or municipal court or a party in 
litigation, or to a State or municipal administrative agency 
functioning in a quasi-judicial capacity or a party to a proceeding 
being conducted by such agency, in order for VA to respond to and 
comply with issuance of a State court order; provided that any 
disclosure of claimant information made under this routine use must 
comply with the provisions of 38 CFR 1.511.
    13. Any information concerning the claimant's indebtedness to the 
United States by virtue of a person's participation in a benefits 
program administered by VA, including personal information obtained 
from other Federal agencies through computer matching programs, may be 
disclosed to any third party, except consumer reporting agencies, in 
connection with any proceeding for the collection of any amount owed to 
the United States. Purposes of these disclosures may be to assist VA in 
collection of costs of services provided individuals not entitled to 
such services and to initiate legal actions for prosecuting individuals 
who willfully or fraudulently obtain Title 38 benefits without 
entitlement. This disclosure is consistent with 38 U.S.C. 5701(b)(6).
    14. Any relevant information from this system of records may be 
disclosed to TRICARE, Department of Defense and the Defense Eligibility 
Enrollment Reporting System (DEERS) to the extent necessary to 
determine eligibility for CHAMPVA or TRICARE benefits, to develop and 
process CHAMPVA or TRICARE claims, and to develop cost recovery actions 
for claims involving individuals not eligible for the services or 
claims involving potential third party liability.
    15. The name and address of a veteran or dependent, and other 
information as is reasonably necessary to identify such individual, may 
be disclosed to a consumer reporting agency for the purpose of locating 
the individual or obtaining a consumer report to determine the ability 
of the individual to repay an indebtedness to the United States by 
virtue of the individual's participation in a benefits program 
administered by VA, provided that the requirements of 38 U.S.C. 
5701(g)(2) have been met.
    16. the name and address of a veteran or dependent, and other 
information as is reasonably necessary to identify such individual, 
including personal information obtained from other Federal agencies 
through computer matching programs, and any information concerning the 
individual's indebtedness to the United States by virtue of the 
individual's participation in a benefits program administered by VA, 
may be disclosed to a consumer reporting agency for purposes of 
assisting in the collection of such indebtedness, provided that the 
requirements of 38 U.S.C. 5701(g)(4) have been met.
    17. In response to an inquiry about a named individual from a 
member of the general public, disclosure of information may be made 
from this system of records to report the amount of VA monetary 
benefits being received by the individual. This disclosure is 
consistent with 38 U.S.C. 5701(c)(1).
    18. The name and address of a veteran or dependent may be disclosed 
to another Federal agency or to a contractor of that agency, at the 
written request of the head of that agency or designee of the head of 
that agency for the purpose of conducting government research necessary 
to accomplish a statutory purpose of that agency.
    19. Any information in this system of records relevant to a claim 
of a veteran or dependent, such as the name, address, the basis and 
nature of a claim, amount of benefit payment information, medical 
information and military service and active duty separation information 
may be disclosed at the request of the claimant to accredited service 
organizations, VA-approved claim agents and attorneys acting under a 
declaration of representation so that these individuals can aid 
claimants in the preparation, presentation and prosecution of claims 
under the laws administered by VA. The name and address of a claimant 
will not, however, be disclosed to these individuals under this routine 
use if the claimant has not requested the assistance of an accredited 
service organization, claims agent or an attorney.
    20. Any information in this system including medical information, 
the basis and nature of claim, the amount of benefits and personal 
information may be disclosed to a VA Federal fiduciary or a guardian ad 
litem in relation to his or her representation of a claimant only to 
the extent necessary to fulfill the duties of the VA Federal fiduciary 
or the guardian ad litem.

[[Page 81575]]

    21. The individual's name, address, social security number and the 
amount (excluding interest) of any indebtedness which is waived under 
38 U.S.C. 3102, compromised under 4 CFR Part 103, otherwise forgiven, 
or for which the applicable statute of limitations for enforcing 
collection has expired, may be disclosed to the Treasury Department, 
Internal Revenue Service, as a report of income under 26 U.S.C. 
61(a)(12).
    22.The name of a veteran or dependent, other information as is 
reasonably necessary to identify such individual, and any other 
information concerning the individual's indebtedness by virtue of a 
person's participation in a benefits program administered by VA, may be 
disclosed to the Treasury Department, Internal Revenue Service, for the 
collection of Title 38, U.S.C. benefit overpayments, overdue 
indebtedness, and/or costs of services provided to an individual not 
entitled to such services, by the withholding of all or a portion of 
the person's Federal income tax refund.
    23. The name, date of birth and social security number of a 
veteran, spouse or dependent, and other identifying information as is 
reasonably necessary may be disclosed to Social Security Administration 
and Health Care Financing Administration, Department of Health and 
Human Services, for the purpose of validating social security numbers 
and Medicare information.
    24. The name and address of any health care provider in this system 
of records who has received payment for claimed services in behalf of a 
CHAMPVA beneficiary may be disclosed in response to an inquiry from a 
member of the general public.

POLICIES AND PRACTICES FOR STORING, RETRIEVING, ACCESSING, RETAINING 
AND DISPOSING OF RECORDS IN THE SYSTEM:
STORAGE:
    Records are stored electronically, in paper folders, magnetic 
discs, and magnetic tape. Paper documents may be scanned/digitized and 
stored for viewing electronically.

RETRIEVABILITY:
    Paper records are retrieved by name or VA claims file number or 
social security number of the veteran sponsor. Computer records are 
retrieved by name or social security number of the veteran sponsor, 
spouse, and/or dependent, or VA claims file number of the veteran 
sponsor.

SAFEGUARDS:
    Working spaces and record storage areas at HAC are secured during 
all business and non-business hours. All entrance doors require an 
electronic passcard for entry. The HAC Security Officer issues 
electronic passcards. HAC staff control visitor entry by door release 
and escort. The building is equipped with an intrusion alarm system 
monitored by HAC security staff during business hours and by a security 
service vendor during non-business hours. Records are stored in an 
electronic controlled storage filing area. Records in work areas are 
stored in locked file cabinets or locked rooms. Access to record 
storage areas is restricted to VA employees on a ``need-to-know'' 
basis. Access to the computer room is generally limited by appropriate 
locking devices and restricted to authorized VA employees and vendor 
personnel. ADP peripheral devices are generally placed in secure areas 
or are otherwise protected. Authorized VA employees may access 
information in the computer system by a series of individually unique 
passwords/codes.

RETENTION AND DISPOSAL:
    Records are maintained and disposed of in accordance with record 
disposition authority approved by the Archivist of the United States. 
Paper records that are scanned/digitized for viewing electronically are 
destroyed after they have been scanned onto optical disks.

SYSTEM MANAGER(S) AND ADDRESS:
    Chief Financial Officer (17), Department of Veterans Affairs, 
Veterans Health Administration, VA Central Office, 810 Vermont Avenue, 
NW, Washington, DC 20420.

Official maintaining the system:
    Director, Department of Veterans Affairs, Health Administration 
Center, PO Box 65020, Denver, CO 80206-9020.

NOTIFICATION PROCEDURE:
    Any individual who wishes to determine whether a record is being 
maintained in this system under his or her name or other personal 
identifier, or wants to determine the contents of such record, should 
submit a written request to Director, VA Health Administration Center, 
PO Box 65020, Denver, Colorado 80206-9020, or apply in person to the 
Director, VA Health Administration Center, 300 South Jackson Street, 
Denver, Colorado 80209. Inquiries should include the veteran sponsor's 
full name and social security and VA claims file numbers, and the 
spouse or department's name, social security number and return address.

RECORD ACCESS PROCEDURES:
    An individual who seeks access to records maintained under his or 
her name in this system may write or visit the Director, VA Health 
Administration Center.

CONTESTING RECORD PROCEDURES:
    (See Record Access Procedures above.)

RECORD SOURCE CATEGORIES:
    The veteran sponsor, spouse and/or dependent, military service 
departments, private medical facilities and health care professionals, 
electronic trading partners, contractors, Department of Defense (DoD), 
TRICARE, DoD Defense Eligibility Enrollment Reporting System (DEERS), 
other Federal agencies, VA regional offices, Veterans Benefits 
Administration automated record systems.
[FR Doc. 00-32876 Filed 12-22-00; 8:45 am]
BILLING CODE 8320-01-M