[Federal Register Volume 67, Number 43 (Tuesday, March 5, 2002)]
[Notices]
[Pages 9974-9980]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-5140]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services


Privacy Act of 1974; Report of New System

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

ACTION: Notice of new system of records (SOR).

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SUMMARY: In accordance with the requirements of the Privacy Act of 
1974, we are proposing to establish a new system of records. The 
proposed system is titled ``Claims Payment System For Medicare's 
``Healthy Aging'' Demonstration Project (CPS-HA), HHS/CMS/CBC, System 
No. 09-70-0539.'' CMS proposes to establish a new system of records 
containing enrollment and claims payment information plus research-
related survey data, in support of a short-term demonstration project 
testing new potential benefits in the Medicare program.
    The primary purpose of the system of records is to manage and 
maintain information needed to pay Medicare claims under the research 
demonstration program known as the Healthy Aging project (HA) including 
its component known as the Medicare Stop Smoking Program (MSSP). The 
system of records will enable CMS to: enroll and communicate with 
eligible Medicare beneficiaries who volunteer to participate in HA 
initiatives, communicate with clinicians and other providers and 
suppliers who submit claims payable under HA demonstrations, review 
submitted claims and pay those conforming to applicable payment 
criteria and federal law, and develop, maintain, and analyze research 
information showing the

[[Page 9975]]

potential impact of HA interventions on the quality and cost of health 
care services in Medicare. Information retrieved from this system of 
records will also be disclosed to support regulatory, reimbursement, 
and policy functions performed within the agency or by a contractor or 
consultant; assist another Federal or State agency with information to 
enable such agency to administer a Federal health benefits program, or 
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; support constituent requests made to a 
Congressional representative; support litigation involving the agency; 
facilitate research on the quality and effectiveness of care provided; 
and, combat fraud and abuse in certain health benefits programs. We 
have provided background information about the proposed system in the 
``Supplementary Information'' section below. Although the Privacy Act 
requires only that the ``routine use'' portion of the system be 
published for comment, CMS invites comments on all portions of this 
notice. See Effective Dates section for comment period.

EFFECTIVE DATES: CMS filed a new system report with the Chair of the 
House Committee on 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 25, 2002. In any event, we will not disclose any 
information under a routine use until 40 days after publication. We may 
defer implementation of this system of records or one or more of the 
routine use statements listed below if we receive comments that 
persuade us to defer implementation.

ADDRESSES: The public should address comments to: Director, Division of 
Data Liaison and Distribution (DDLD), CMS, Room N2-04-27, 7500 Security 
Boulevard, Baltimore, Maryland 21244-1850. Comments received will be 
available for review at this location, by appointment, during regular 
business hours, Monday through Friday from 9 a.m.-3 p.m., eastern time 
zone.

FOR FURTHER INFORMATION CONTACT: James Coan, Division of Health 
Promotion and Disease Prevention, Center for Beneficiary Choices, CMS, 
Mailstop S3-02-01, 7500 Security Boulevard, Baltimore, Maryland 21244-
1850. The telephone number is (410) 786-9168.

SUPPLEMENTARY INFORMATION:

I. Description of the New System of Records

Statutory and Regulatory Basis For System of Records

    The authority to conduct the demonstration project for which the 
system of records is needed is section 402(a) of Public Law 90-248, as 
amended by section 222(b)(2) of Public Law 92-603, 42 U.S.C. 1395b-1(a)

II. Collection and Maintenance of Data in the System

A. Scope of the Data Collected

    The CPS-HA includes the Medicare Health Insurance Claim (HIC) 
Number, sex, race, age, zip code, state and county. It also includes 
claims information related to HA claims, answers to enrollment 
questionnaires and other information needed to confirm a beneficiary's 
eligibility for enrollment and ongoing participation in the 
demonstration, and other survey and research information needed to pay 
claims, administer the HA program, and develop research reports on the 
study's findings.

B. 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 CPS-HA information that can be 
associated with an individual patient as provided for under ``Section 
III. Entities Who May Receive Disclosures Under Routine Use.'' Both 
identifiable and non-identifiable data may be disclosed under a routine 
use. Identifiable data includes individual records with CPS-HA 
information and identifiers. Non-identifiable data includes individual 
records with CPS-HA information and masked identifiers or CPS-HA 
information with identifiers stripped out of the file.
    We will only disclose the minimum personal data necessary to 
achieve the purpose of the CPS-HA system. CMS has the following 
policies and procedures concerning disclosures of information that will 
be maintained in the system. In general, disclosure of information from 
the SOR will be approved only for the minimum information necessary to 
accomplish the purpose of the disclosure 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 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 CPS-HA 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 are proposing to 
establish the following routine use disclosures of information 
maintained in the system:
    1. To agency contractors, or consultants who have been contracted 
by the agency to assist in the performance of a service related to this 
system of records and who need to have access to the records in order 
to perform the activity.
    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 agency business 
functions relating to purposes for this system of records.

[[Page 9976]]

    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 whatever information is necessary for the 
contractor to fulfill its duties. In these situations, safeguards are 
provided in the contract prohibiting the contractor from using or 
disclosing the information for any purpose other than that described in 
the contract and requires the contractor to return or destroy all 
information at the completion of the contract.
    2. To a Peer Review Organization (PRO) in order to assist the PRO 
to perform Title XI and Title XVIII functions relating to assessing and 
improving HA quality of care. PROs will work to implement quality 
improvement programs, provide consultation to CMS, its contractors, and 
to State agencies.
    The PROs may use these data to support quality improvement 
activities and other PRO responsibilities as detailed in Title XI, 
sections 1151-1164.
    3. To another Federal or State agency:
    a. To contribute to the accuracy of CMS's proper payment of 
Medicare benefits,
    b. To 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, or
    c. To improve the state survey process for investigation of 
complaints related to health and safety or quality of care and to 
implement a more outcome oriented survey and certification program.
    Other Federal or State agencies in their administration of a 
Federal health program may require CPS-HA information in order to 
support evaluations and monitoring of quality of care for special 
populations or special care areas, including proper payment for 
services provided. Releases of information would be allowed if the 
proposed use(s) for the information proved compatible with the purpose 
for which CMS collects the information.
    4. To an individual or organization for research on the utilization 
of inpatient rehabilitation services as well as evaluation or 
epidemiological projects related to the prevention of disease or 
disability, the restoration or maintenance of health, or for 
understanding and improving payment projects.
    The CPS-HA data will provide an opportunity for comprehensive 
research, evaluation and epidemiological projects regarding HA 
patients. CMS anticipates that many researchers will have legitimate 
requests to use these data in projects that could ultimately improve 
the care provided to HA patients and the policy that governs the care.
    5. 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.
    Beneficiaries sometimes request the help of a Member of Congress in 
resolving some 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.
    6. 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. A determination would be made in each instance that, 
under the circumstances involved, the purposes served by the use of the 
information in the particular litigation is compatible with a purpose 
for which CMS collects the information.
    7. To a CMS contractor (including, but not necessarily 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 contractual relationship 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 and makes 
grants 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.
    8. 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.
    Other agencies may require CPS-HA information for the purpose of 
combating fraud and abuse in such Federally funded programs. Releases 
of information would be allowed if the proposed use(s) for the 
information proved compatible with the purposes of collecting the 
information.
    9. To insurance companies, third party administrators (TPA), 
employers, self-insurers, managed care organizations, other 
supplemental insurers, non-coordinating insurers, multiple employer 
trusts, group health plans (i.e., health maintenance organizations 
(HMO) or a competitive medical plan (CMP)) with a Medicare contract, or 
a Medicare-approved health care prepayment plan (HCPP), directly or 
through a contractor, and other groups providing protection for their 
enrollees. Information to be disclosed shall be limited to Medicare 
entitlement data. 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 third party 
administrator; utilize the information solely for the purpose of 
processing the individual's insurance claims; and
    b. Safeguard the confidentiality of the data and prevent 
unauthorized access.

[[Page 9977]]

    Other insurers, CMP, HMO, and HCPP may require CPS-HA information 
in order to support evaluations and monitoring of Medicare claims 
information of beneficiaries, including proper payment for services 
provided.

B. Additional Provisions Affecting Routine Use Disclosures

    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).
    This System of Records contains Protected Health Information as 
defined by the Department of Health and Human Services' regulation 
``Standards for Privacy of Individually Identifiable Health 
Information'' (45 CFR parts 160 and 164, 65 FR 82462 as amended by 66 
FR 12434). 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.''

IV. Safeguards

    The HHS CPS-HA 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 1984, 
Computer Security Act of 1987, the Paperwork Reduction Act 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 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.

A. Authorized Users

    Personnel having access to the system have been trained in Privacy 
Act 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. Records are used 
in a designated work area and system location is attended at all times 
during working hours.
    To ensure security of the data, the proper level of class user is 
assigned for each individual user 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 Index 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.

B. Physical Safeguards

    All server sites will implement 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 CMS system:
    Access to all servers is to be 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 is to require 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 Systems (AIS) resources caused by fire, 
electricity, water and inadequate climate controls.
    Protection applied to the workstations, servers and databases 
include:
     User Log-on--Authentication is to be 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 to be determined and 
implemented at the agency level.
     Inactivity Lockout--Access to the NT workstation is to be 
automatically locked after a specified period of inactivity.
     Warnings--Legal notices and security warnings are to be 
displayed on all servers and workstations.
     Remote Access Security--Windows NT Remote Access Service 
(RAS) security handles resource access control. Access to NT resources 
is to be 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. These include, but are not 
limited to: the Privacy Act of 1974; the Computer Security Act of 1987; 
OMB Circular A-130, revised; Information Resource Management (IRM) 
Circular #10; HHS Automated Information Systems Security Program; the 
CMS Information Systems Security Policy, Standards, and Guidelines 
Handbook; and other CMS systems security policies. 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. Effects of the New System on Individual Rights

    CMS proposes to establish this system in accordance with the 
principles and requirements of the Privacy Act and will collect, use, 
and disseminate information only as prescribed therein. Data in this 
system will be subject to the authorized releases in accordance with 
the routine uses identified in this system of records.
    CMS will monitor the collection and reporting of CPS-HA data. CPS-
HA

[[Page 9978]]

information on patients is submitted to CMS through standard systems. 
Accuracy of the data is important since incorrect information could 
result in the wrong payment for services and a less effective process 
for assuring quality of services. CMS will utilize a variety of onsite 
and offsite edits and audits to increase the accuracy of CPS-HA data.
    CMS will take precautionary measures (see item IV. above) to 
minimize the risks of unauthorized access to the records and the 
potential harm to individual privacy or other personal or property 
rights of patients whose data is maintained in the system. CMS will 
collect only that information necessary to perform the system's 
functions. In addition, CMS will make disclosure from the proposed 
system only with consent of the subject individual, or his/her legal 
representative, or in accordance with an applicable exception provision 
of the Privacy Act.
    CMS, therefore, does not anticipate an unfavorable effect on 
individual privacy as a result of maintaining this system of records.

    Dated: February 20, 2002.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
09-70-0539

System Name:
    Claims Payment System For Medicare's ``Healthy Aging'' 
Demonstration Project (CPS-HA).

Security Classification:
    Level 3, Privacy Act Sensitive.

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

Categories of Individuals Covered by the System:
    This system will contain claims and demographic information on 
Medicare beneficiaries who have volunteered to participate in 
Medicare's Healthy Aging program including specific demonstration 
projects such as the MSSP, as well as claims-related information for 
submissions from providers and suppliers providing services that are 
covered under Medicare exclusively within the HA program and its 
demonstration projects. The system will also retain research 
information such as enrollment questionnaires and survey data from 
participants in the program.

Categories of Records in the system:
    This system of records will contain demographic and claims-related 
information on Medicare beneficiaries who have elected to participate, 
as well as eligibility and enrollment data collected through voluntary 
surveys, payment information for providers and vendors submitting 
claims, and other information designed to support the enrollment, 
claims payment, and research reporting functions of the CPS-HA program.

Authority for Maintenance of the System:
    The authority to conduct the demonstration project for which the 
system of records is needed is section 402(a)(1)(G) and (a)(2) of 
Public Law 90-248, as amended by section 222(b)(2) of Public Law 92-
603, 42 U.S.C. 1395b-1(a)(1)(G) and (a)(2).

Purpose(s):
    The primary purpose of the system of records is to manage and 
maintain information needed to pay Medicare claims under the research 
demonstration program known as the Healthy Aging project (HA) including 
its component known as the Medicare Stop Smoking Program (MSSP). The 
system of records will enable CMS to: Enroll and communicate with 
eligible Medicare beneficiaries who volunteer to participate in CPS-HA 
initiatives, communicate with clinicians and other providers and 
suppliers who submit claims payable under CPS-HA demonstrations, review 
submitted claims and pay those conforming to applicable payment 
criteria and federal law, and develop, maintain, and analyze research 
information showing the potential impact of CPS-HA interventions on the 
quality and cost of health care services in Medicare. Information 
retrieved from this system of records will also be disclosed to support 
regulatory, reimbursement, and policy functions performed within the 
agency or by a contractor or consultant; assist another Federal or 
State agency with information to enable such agency to administer a 
Federal health benefits program, or 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; support 
constituent requests made to a Congressional representative; support 
litigation involving the agency; facilitate research on the quality and 
effectiveness of care provided; and, combat fraud and abuse in certain 
health benefits programs.

Routine Uses of Records Maintained in the System, Including Categories 
Or Users and the Purposes of Such Uses:
    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 CPS-HA 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. 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). Be advised, this System of Records contains Protected 
Health Information as defined by the Department of Health and Human 
Services' regulation ``Standards for Privacy of Individually 
Identifiable Health Information'' (45 CFR parts 160 and 164, 65 FR 8462 
as amended by 66 FR 12434). 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.''
    1. To agency contractors or consultants who have been contracted by 
the agency to assist in the performance of a service related to this 
system of records and who need to have access to the records in order 
to perform the activity.
    2. To a Peer Review Organization (PRO) in order to assist the PRO 
to perform Title XI and Title XVIII functions relating to assessing and 
improving quality of care. PROs will work to implement quality 
improvement programs, provide consultation to CMS, its contractors, and 
to State agencies.
    3. To another Federal or State agency:
    a. To contribute to the accuracy of CMS's proper payment of 
Medicare benefits,
    b. To 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

[[Page 9979]]

funded in whole or in part with Federal funds, or
    c. To improve the state survey process for investigation of 
complaints related to health and safety or quality of care and to 
implement a more outcome oriented survey and certification program.
    4. To an individual or organization for research on the utilization 
of inpatient rehabilitation services as well as evaluation or 
epidemiological projects related to the prevention of disease or 
disability, or the restoration or maintenance of health 
epidemiological, or for understanding and improving payment projects.
    5. 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.
    6. 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 and the 
use of such records by the DOJ, court or adjudicatory body is 
compatible with the purpose for which the agency collected the records.
    7. To a CMS contractor (including, but not necessarily 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.
    8. 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.
    9. To insurance companies, third party administrators (TPA), 
employers, self-insurers, managed care organizations, other 
supplemental insurers, non-coordinating insurers, multiple employer 
trusts, group health plans (i.e., health maintenance organizations 
(HMO) or a competitive medical plan (CMP)) with a Medicare contract, or 
a Medicare-approved health care prepayment plan (HCPP), directly or 
through a contractor, and other groups providing protection for their 
enrollees. Information to be disclosed shall be limited to Medicare 
entitlement data. 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 third party 
administrator;
    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

Policies And Practices for Storing, Retrieving, Accessing, Retaining, 
and Disposing of Records in The System:
Storage:
    All records are stored on magnetic media. Input data arrives as 
paper claims in the case of provider or supplier claims, and 
eligibility and enrollment information such as the enrollment survey 
and follow-up monitoring surveys are recorded in hard copy before 
transcription to magnetic media.

Retrievability:
    The Medicare records are retrieved by health insurance claim (HIC) 
number of the beneficiary. Provider IDs and supplier registration 
numbers are used to facilitate inquiries into specific claims as 
needed.

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 CMS system. For computerized records, 
safeguards have been established in accordance with 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 (IRM) Circular #10, Automated Information Systems 
Security Program; CMS Information Systems Security, Standards 
Guidelines Handbook and OMB Circular No. A-130 (revised) Appendix III.

Retention And Disposal:
    CMS will retain identifiable CPS-HA data for a total period of 25 
years. Data residing with the designated claims payment contractor 
shall be returned to CMS at the end of the third project year, with all 
data then being the responsibility of CMS for adequate storage and 
security.

System Manager(s) and Address:
    Director, Center for Beneficiary Choices, CMS, Mailstop C5-19-16, 
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, and for verification purposes, the subject individual's name 
(woman's maiden name, if applicable), address, age, and sex, 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.)

[[Page 9980]]

Record Source Categories:
    1. Enrollment data on Medicare beneficiaries volunteering to 
participate in CPS-HA projects will come from beneficiaries who report 
the information to CMS officials or contractors, pursuant to 
information collection activities approved at the Office of Management 
and Budget and through an Institutional Review Board as required by 
law. Follow-up surveys and questionnaires for participants will also 
come directly from beneficiaries' voluntary reporting.
    2. Claims data will come through voluntary submissions of 
providers, suppliers, and others seeking reimbursement for covered 
services provided to a Medicare beneficiary, in accordance with the 
provisions of the demonstration and the conditions of participation in 
the Medicare program.
    3. Research analysis and reporting will come from the enrollment 
data, surveys and questionnaires provided by beneficiaries, as well as 
the analysis and compilations of this information developed by CMS 
officials, contractors, research collaborators, and others supporting 
the CPS-HA project and fulfilling the conditions of confidentiality, 
privacy and security outlined in this Notice.
    4. Eligibility information as well as financial or quality 
reporting related to program integrity or other matters may also 
interact with existing CMS registries such as those relating to 
Medicare claims, provider registries, beneficiary enrollment databases, 
national claims histories.
    5. Provider information to document the eligibility of a provider, 
supplier, or other person or entity to submit Medicare claims under the 
CPS-HA program, receive continuing medical education within the scope 
of the CPS-HA program, or for other uses will come from existing 
Medicare records of eligible providers and suppliers (as may be 
modified according to the needs of the CPS-HA program).

Systems Exempted From Certain Provisions of The Act:
     None.
[FR Doc. 02-5140 Filed 3-4-02; 8:45 am]
BILLING CODE 4120-03-P