[Federal Register Volume 67, Number 30 (Wednesday, February 13, 2002)]
[Notices]
[Pages 6714-6719]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-3451]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services


Privacy Act of 1974; Report of Modified or Altered System

AGENCY: Department of Health and Human Services (HHS), Centers for 
Medicare & Medicaid Services (CMS) (formerly the Health Care Financing 
Administration).

ACTION: Notice of modified or altered System of Records (SOR).

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SUMMARY: In accordance with the requirements of the Privacy Act of 
1974, we are proposing to modify or alter an SOR, ``Long Term Care-
Minimum Data Set' (LTCMDS), System No. 09-70-1516. We propose to assign 
a different CMS sequential identification number this system to correct 
the inadvertent publication of 2 CMS systems with the same system 
identifying number. The new identifying number for this system should 
read: System No. 09-70-1517. We propose to broaden the purpose to 
include the administration of payment for hospital swing bed services. 
To assist in this purpose, we will add a new routine use to permit 
certain disclosures to national accrediting organizations. We will also 
delete published routine use number 2 pertaining to the ``Bureau of the 
Census,'' number 5 pertaining to contractors, number 6 pertaining to an 
agency of a state government or an agency established by state law, 
number 7 pertaining to another Federal agency, number 8 pertaining to 
certain contractors, and numbers 9, 10, and 11 pertaining to 
disclosures to combat fraud and abuse in certain health benefits 
programs.
    Routine use number 2 unnecessarily duplicated Exception 4 of the 
Privacy Act allowing release of data to the Bureau of the Census. 
Disclosures authorized under published routine use number 5 will be 
permitted by proposed routine use number 1. Disclosures permitted under 
routine uses number 6, and 7 will be made a part of proposed routine 
use number 2. The scope of routine use number 2 will be broaden to 
allow for release of information to ``another Federal and/or state 
agency, agency of a state government, an agency established by state 
law, or its fiscal agent.'' Disclosures authorized under published 
routine use number 8 will be permitted by proposed routine use number 4 
authorizing release to Peer Review Organizations (PRO). We propose to 
delete routine use number 11 and modify routine uses number 9 and 10 to 
combat fraud and abuse in certain Federally funded health care 
programs.
    The security classification previously reported as ``None'' will be 
modified to reflect that the data in this system is considered to be 
``Level Three Privacy Act Sensitive.'' We are modifying the language in 
the remaining routine uses 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 and to update 
language in the administrative sections to correspond with language 
used in other CMS SORs.
    The primary purpose of the system is to aid in the administration 
of the survey and certification, and payment of Medicare Long Term Care 
services, which include skilled nursing facilities (SNFs), nursing 
facilities (NFs) SNFs/NFs, and hospital swing beds, and to study the 
effectiveness and quality of care given in those facilities. 
Information in this system will also be used to: (1) Support 
regulatory, reimbursement, and policy functions performed within the 
Agency or by a contractor or consultant; (2) another Federal or state 
agency, agency of a state government, an agency established by state 
law, or its fiscal agent; (3) Peer Review Organizations (PRO); (4) 
other insurers for processing individual insurance claims; (5) 
facilitate research on the quality and effectiveness of care provided, 
as well as payment related projects; (6) support constituent requests 
made to a congressional representative; (7) support litigation 
involving the Agency; (8) combat fraud and abuse in certain health 
benefits programs, and (10) national accrediting organizations. 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 or altered system report with 
the Chair of the House Committee on Government Reform and Oversight, 
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 February 7, 2002. To ensure that all 
parties have adequate time in which to comment, the modified or

[[Page 6715]]

altered 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: Director, Division of 
Data Liaison and Distribution, 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 
daylight time.

FOR FURTHER INFORMATION CONTACT: Helene Fredeking, Director, Division 
of Outcomes and Improvements, Center for Medicaid and State Operations, 
CMS, 7500 Security Boulevard, S2-14-26, Baltimore, Maryland 21244-1850. 
The telephone number is (410) 786-7304.

SUPPLEMENTARY INFORMATION:   

I. Description of the Modified System

A. Background

    CMS published a notice that identified a newly established SOR, 
``Long Term Care Minimum Data Set,'' System No. 09-70-1516 at 63 
Federal Register (FR) 28396 (May 22, 1998). Additional global routine 
uses affecting this system were published at 63 FR 38414 (July 16, 
1998) (added three fraud and abuse uses), and 65 FR 50552 (Aug. 18, 
2000) (deleted one and modified two fraud and abuse uses).

B. Statutory and Regulatory Basis for System

    Authority for maintenance of the system is given under sections 
1102(a), 1819(b)(3)(A), 1819(f), 1919(b)(3)(A), 1919(f), and 1864 of 
the Social Security Act (the Act).

II. Collection and Maintenance of Data in the System

A. Scope of the Data Collected

    The system contains information related to Medicare enrollment and 
entitlement and Medicare Secondary Payer (MSP) data containing other 
party liability insurance information necessary for appropriate 
Medicare claim payment. It contains hospice election, premium billing 
and collection, direct billing information, and group health plan 
enrollment data. The system also contains the individual's health 
insurance numbers, name, geographic location, race/ethnicity, sex, and 
date of birth.

A. Agency Policies, Procedures, and Restrictions on the Routine Use

    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 LTCMDS 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 disclose the minimum personal data necessary to 
achieve the purpose of LTCMDS. CMS has the following policies and 
procedures concerning disclosures of information that will be 
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 that the data is being collected, e.g., developing and refining 
payment systems, determine effectiveness, and monitoring the quality of 
care provided to patients.
    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 of disclosure of the record;
    b. Remove or destroy at the earliest time all patient-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. Entities Who May Receive Disclosures Under Routine Use

    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 LTCMDS 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 have provided a 
brief explanation of the routine uses we are proposing to establish or 
modify for disclosures of information maintained in the system:
    1. To Agency contractors, or consultants who have been engaged by 
the Agency to assist in accomplishment of a CMS function relating to 
the purposes for this system 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 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 or consultant whatever information is 
necessary for the contractor or consultant to fulfill its duties. In 
these situations, safeguards are provided in the contract prohibiting 
the contractor or consultant 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 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.

[[Page 6716]]

    Other Federal or state agencies in their administration of a 
Federal health program may require LTCMDS 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 LTCMDS information for the purposes 
of determining, evaluating and/or assessing cost, effectiveness, and/or 
the quality of health care services provided in the state;
    The Social Security Administration may require LTCMDS data to 
enable them to assist in the implementation and maintenance of the 
Medicare program;
    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 LTCMDS 
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 system.
    3. To PROs in connection with review of claims, or in connection 
with studies or other review activities, conducted pursuant to Part B 
of Title XI of the Act and in performing affirmative outreach 
activities to individuals for the purpose of establishing and 
maintaining their entitlement to Medicare benefits or health insurance 
plans.
    PROs will work to implement quality improvement programs, provide 
consultation to CMS, its contractors, and to state agencies. PROs will 
assist the state agencies in related monitoring and enforcement 
efforts, assist CMS and intermediaries in program integrity assessment, 
and prepare summary information for release to CMS.
    4. To insurance companies, underwriters, third party administrators 
(TPA), employers, self-insurers, group health plans, health maintenance 
organizations (HMO), health and welfare benefit funds, managed care 
organizations, other supplemental insurers, non-coordinating insurers, 
multiple employer trusts, liability insurers, no-fault medical 
automobile insurers, workers compensation carriers or plans, other 
groups providing protection against medical expenses without the 
beneficiary's authorization, and any entity having knowledge of the 
occurrence of any event affecting (a) an individual's right to any such 
benefit or payment, or (b) the initial right to any such benefit or 
payment, for the purpose of coordination of benefits with the Medicare 
program and implementation of the MSP provision at 42 U.S.C. 1395y (b). 
Information to be disclosed shall be limited to Medicare utilization 
data necessary to perform that specific function. 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 
individual's insurance claims; and
    c. Safeguard the confidentiality of the data and prevent 
unauthorized access.
    Other insurers may require LTCMDS information in order to support 
evaluations and monitoring of Medicare claims information of 
beneficiaries, including proper reimbursement for services provided.
    5. To an individual or organization for research, evaluation, or 
epidemiological projects related to the prevention of disease or 
disability, the restoration or maintenance of health, or payment 
related projects.
    LTCMDS data will provide research, evaluations and epidemiological 
projects, a broader, longitudinal, national perspective of the status 
of Medicare beneficiaries. CMS anticipates that many researchers will 
have legitimate requests to use these data in projects that could 
ultimately improve the care provided to Medicare beneficiaries and the 
policy that governs the care.
    6. To a Member of Congress or congressional staff member in 
response to an inquiry of the congressional office made at the written 
request of the constituent about whom the record is maintained.
    Beneficiaries often request the help of a Member of Congress in 
resolving an issue relating to a matter before CMS. The Member of 
Congress then writes CMS, and CMS must be able to give sufficient 
information to be responsive to the inquiry.
    7. To 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.
    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.
    8. To a CMS contractor (including, but not limited to fiscal 
intermediaries 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 or abuse in such program.
    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 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 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.
    9. To 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 
or 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

[[Page 6717]]

against, correct, remedy, or otherwise combat fraud or abuse in such 
programs.
    Other agencies may require LTCMDS information for the purpose of 
combating fraud and abuse in such Federally funded programs.
    10. To a national accrediting organization whose accredited 
facilities are presumed to meet certain Medicare requirements for 
inpatient hospital (including swing beds) services; e.g., the Joint 
Commission for the Accrediting of Healthcare Organizations (JCAHO). 
Information will be released to accrediting organizations only for 
those facilities that they accredit and that participate in the 
Medicare program.
    CMS anticipates providing those national accrediting organizations 
with LTCMDS information to enable them to target potential or 
identified problems during the organization's accreditation review 
process of that facility.

B. Additional Circumstances Affecting Routine Use Disclosures

    This SOR contains Protected Health Information as defined by HHS 
regulation ``Standards for Privacy of Individually Identifiable Health 
Information'' (45 CFR parts 160 and 164, 65 FR 82462 (12-28-00), as 
amended by 66 FR 12434 (2-26-01)). Disclosures of Protected Health 
Information authorized by these routine uses may only be made if, and 
as, permitted or required by the ``Standards for Privacy of 
Individually Identifiable Health Information.''
    In addition, our policy will be to prohibit release even of non-
identifiable data, except pursuant to one of the routine uses, if there 
is a possibility that an individual can be identified through implicit 
deduction based on small cell sizes (instances where the patient 
population is so small that individuals who are familiar with the 
enrollees could, because of the small size, use this information to 
deduce the identity of the beneficiary).

IV. Safeguards

A. Administrative Safeguards

    The LTCMDS system will conform to applicable law and policy 
governing the privacy and security of Federal automated information 
systems. These include but are not limited to: The Privacy Act of 1974, 
Computer Security Act of 1987, the Paperwork Reduction Act (PRA) of 
1995, the Clinger-Cohen Act of 1996, and OMB Circular A-130, Appendix 
III, ``Security of Federal Automated Information Resources.'' CMS has 
prepared a comprehensive system security plan as required by the OMB 
Circular A-130, Appendix III. This plan conforms fully to guidance 
issued by the National Institute for Standards and Technology (NIST) in 
NIST Special Publication 800-18, ``Guide for Developing Security Plans 
for Information Technology Systems.'' Paragraphs A-C of this section 
highlight some of the specific methods that CMS is using to ensure the 
security of this system and the information within it.
    Authorized users: Personnel having access to the system have been 
trained in Privacy Act and systems security requirements. Employees and 
contractors who maintain records in the system are instructed not to 
release any data until the intended recipient agrees to implement 
appropriate administrative, technical, procedural, and physical 
safeguards sufficient to protect the confidentiality of the data and to 
prevent unauthorized access to the data. In addition, CMS is monitoring 
the authorized users to ensure against excessive or unauthorized use. 
Records are used in a designated work area or workstation and the 
system location is attended at all times during working hours.
    To assure security of the data, the proper level of class user is 
assigned for each individual user as determined at the Agency level. 
This prevents unauthorized users from accessing and modifying critical 
data. The system database configuration includes five classes of 
database users:
     Database Administrator class owns the database objects, 
e.g., tables, triggers, indexes, stored procedures, packages, and has 
database administration privileges to these objects;
     Quality Control Administrator class has read and write 
access to key fields in the database;
     Quality Indicator Report Generator class has read-only 
access to all fields and tables;
     Policy Research class has query access to tables, but are 
not allowed to access confidential patient identification information; 
and
     Submitter class has read and write access to database 
objects, but no database administration privileges.

A. Physical Safeguards

    All server sites have implemented the following minimum 
requirements to assist in reducing the exposure of computer equipment 
and thus achieve an optimum level of protection and security for the 
LTCMDS system: Access to all servers is controlled, with access limited 
to only those support personnel with a demonstrated need for access. 
Servers are to be kept in a locked room accessible only by specified 
management and system support personnel. Each server requires a 
specific log-on process. All entrance doors are identified and marked. 
A log is kept of all personnel who were issued a security card, key 
and/or combination which grants access to the room housing the server, 
and all visitors are escorted while in this room. All servers are 
housed in an area where appropriate environmental security controls are 
implemented, which include measures implemented to mitigate damage to 
Automated Information System (AIS) resources caused by fire, 
electricity, water and inadequate climate controls.
    Protection applied to the workstations, servers and databases 
include:
     User Log-ons--Authentication is performed by the Primary 
Domain Controller/Backup Domain Controller of the log-on domain.
     Workstation Names--Workstation naming conventions may be 
defined and implemented at the Agency level.
     Hours of Operation--May be restricted by Windows NT. When 
activated all applicable processes will automatically shut down at a 
specific time and not be permitted to resume until the predetermined 
time. The appropriate hours of operation are determined and implemented 
at the Agency level.
     Inactivity Log-out--Access to the NT workstation is 
automatically logged out after a specified period of inactivity.
     Warnings--Legal notices and security warnings display on 
all servers and workstations.
     Remote Access Services (RAS)--Windows NT RAS security 
handles resource access control. Access to NT resources is controlled 
for remote users in the same manner as local users, by utilizing 
Windows NT file and sharing permissions. Dial-in access can be granted 
or restricted on a user-by-user basis through the Windows NT RAS 
administration tool.

C. Procedural Safeguards

    All automated systems must comply with Federal laws, guidance, and 
policies for information systems security as stated previously in this 
section. Each automated information system should ensure a level of 
security commensurate with the level of sensitivity of the data, risk, 
and magnitude of the harm that may result from the loss, misuse, 
disclosure, or modification of the information contained in the system.

V. Effect of the Modified System on Individual Rights

    CMS proposes to establish this system in accordance with the 
principles and requirements of the Privacy Act and will

[[Page 6718]]

collect, use, and disseminate information only as prescribed therein.
    We will only disclose the minimum personal data necessary to 
achieve the purpose of LTCMDS. Disclosure of information from the 
system will be approved only to the extent necessary to accomplish the 
purpose of the disclosure. CMS has assigned a higher level of security 
clearance for the information maintained in this system in an effort to 
provide added security and protection of data in this system.
    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. 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 the disclosure of information 
relating to individuals.

    Dated: January 30, 2002.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
09-70-1517

System Name:
    ``Long Term Care-Minimum Data Set (LTCMDS),'' Department of Health 
and Human Services (HHS)/Centers for Medicare & Medicaid Services 
(CMS)/Center for Medicaid and State Operations (CMSO).

Security Classification:
    Level Three Privacy Act Sensitive.

System Location:
    CMS Data Center, 7500 Security Boulevard, North Building, First 
Floor, Baltimore, Maryland 21244-1850, and at various other remote 
locations.

Categories of Individuals Covered by the System:
    Residents in all long-term care facilities that are Medicare and/or 
Medicaid certified, including private pay individuals.

Categories of Records in the System:
    The system contains the individual's health insurance numbers, 
name, geographic location, race/ethnicity, sex, date of birth, as well 
as clinical status data.

Authority for Maintenance of the System:
    Authority for maintenance of the system is given under sections 
1102(a), 1819(b)(3)(A), 1819(f), 1919(b)(3)(A), 1919(f), and 1864 of 
the Social Security Act (the Act).

Purpose(s):
    The primary purpose of the system is to aid in the administration 
of the survey and certification, and payment of Medicare Long Term Care 
services, which include skilled nursing facilities (SNFs), nursing 
facilities (NFs) SNFs/NFs, and hospital swing beds, and to study the 
effectiveness and quality of care given in those facilities. 
Information in this system will also be used to: (1) Support 
regulatory, reimbursement, and policy functions performed within the 
Agency or by a contractor or consultant; (2) another Federal or state 
agency, agency of a state government, an agency established by state 
law, or its fiscal agent; (3) Peer Review Organizations (PRO); (4) 
other insurers for processing individual insurance claims; (5) 
facilitate research on the quality and effectiveness of care provided, 
as well as payment related projects; (6) support constituent requests 
made to a congressional representative; (7) support litigation 
involving the Agency; (8) combat fraud and abuse in certain health 
benefits programs, and (10) national accrediting organizations.

Routine Uses of Records Maintained in the System, Including Categories 
or Users and the Purposes of Such Uses:
    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 LTCMDS 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.
    This SOR contains Protected Health Information as defined by HHS 
regulation ``Standards for Privacy of Individually Identifiable Health 
Information'' (45 CFR parts 160 and 164, 65 FR 82462 (12-28-00), as 
amended by 66 FR 12434 (2-26-01)). Disclosures of Protected Health 
Information authorized by these routine uses may only be made if, and 
as, permitted or required by the ``Standards for Privacy of 
Individually Identifiable Health Information.'' In addition, our policy 
will be to prohibit release even of non-identifiable data, except 
pursuant to one of the routine uses, if there is a possibility that an 
individual can be identified through implicit deduction based on small 
cell sizes (instances where the patient population is so small that 
individuals who are familiar with the enrollees could, because of the 
small size, use this information to deduce the identity of the 
beneficiary). We are proposing to establish or modify the following 
routine uses for disclosures of information maintained in the system:
    1. To Agency contractors, or consultants who have been engaged by 
the Agency to assist in accomplishment of a CMS function relating to 
the purposes for this system and who need to have access to the records 
in order to assist CMS.
    2. To 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 PROs in connection with review of claims, or in connection 
with studies or other review activities, conducted pursuant to Part B 
of Title XI of the Act and in performing affirmative outreach 
activities to individuals for the purpose of establishing and 
maintaining their entitlement to Medicare benefits or health insurance 
plans.
    4. To insurance companies, underwriters, third party administrators 
(TPA), employers, self-insurers, group health plans, health maintenance 
organizations (HMO), health and welfare benefit funds, managed care 
organizations, other supplemental insurers, non-coordinating insurers, 
multiple employer trusts, other groups providing protection against 
medical expenses of their enrollees without the beneficiary's 
authorization, and any entity having knowledge of the occurrence of any 
event affecting (a) an individual's right to any such benefit or 
payment, or (b) the initial right to any such benefit or payment, for 
the purpose of coordination of benefits with the Medicare program and 
implementation of the Medicare Secondary Payer (MSP) provision at 42 
U.S.C. 1395y (b). Information to be disclosed shall be limited to 
Medicare utilization data necessary to perform that specific

[[Page 6719]]

function. 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;
    b. Utilize the information solely for the purpose of processing the 
individual's insurance claims; and
    c. Safeguard the confidentiality of the data and prevent 
unauthorized access.
    5. To an individual or organization for a research, evaluation, or 
epidemiological project related to the prevention of disease or 
disability, the restoration or maintenance of health, or payment 
related projects.
    6. To a Member of Congress or to a congressional staff member in 
response to an inquiry of the congressional office made at the written 
request of the constituent about whom the record is maintained.
    7. To 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.
    8. To a CMS contractor (including, but not limited to fiscal 
intermediaries 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 or abuse in such program.
    9. To 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 
or 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 or abuse in such programs.
    10. To a national accrediting organization whose accredited 
facilities are presumed to meet certain Medicare requirements for 
inpatient hospital (including swing beds) services; e.g., the Joint 
Commission for the Accrediting of Healthcare Organizations. Information 
will be released to accrediting organizations only for those facilities 
that they accredit and that participate in the Medicare program.

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 Medicare records are accessible by HIC number or alpha (name) 
search. This system supports both online and batch access.

Safeguards:
    CMS has safeguards 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 systems security 
requirements. Employees who maintain records in the system are 
instructed not to release any data until the intended recipient agrees 
to implement appropriate administrative, technical, procedural, and 
physical safeguards sufficient to protect the confidentiality of the 
data and to prevent unauthorized access to the data.
    In addition, CMS has physical safeguards in place to reduce the 
exposure of computer equipment and thus achieve an optimum level of 
protection and security for the LTCMDS system. For computerized 
records, safeguards have been established in accordance with the 
Department of Health and Human Services (HHS) 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 HHS, Information Resource 
Management Circular #10, Automated Information Systems Security 
Program; CMS Automated Information Systems Guide, Systems Securities 
Policies, and Office of Management and Budget Circular No. A-130 
(revised), Appendix III.

Retention and Disposal:
    Records are maintained indefinitely.

System Manager(s) and Address:
    Director, Division of Outcomes and Improvements, CMSO, CMS, 7500 
Security Boulevard, 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, health insurance claim 
number, address, date of birth, and sex, and for verification purposes, 
the subject individual'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 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).

Record Source Categories:
    The data contained in these records are furnished by the 
individual, or in the case of some MSP situations, through third party 
contacts. There are cases, however, in which the identifying 
information is provided to the physician by the individual; the 
physician then adds the medical information and submits the bill to the 
carrier for payment. Updating information is also obtained from the 
Railroad Retirement Board, and the Master Beneficiary Record maintained 
by the Social Security Administration.

Systems Exempted from Certain Provisions of the Act:
    None.

[FR Doc. 02-3451 Filed 2-12-02; 8:45 am]
BILLING CODE 4120-03-P