[Federal Register Volume 67, Number 102 (Tuesday, May 28, 2002)]
[Notices]
[Pages 36892-36897]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-13190]


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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, called the 
``Non-Medicare Beneficiary Workers'' Compensation (WC) Set-aside File 
(WCSAF),'' HHS/CMS/CMM No. 09-70-0537. The primary purpose of the non-
Medicare beneficiary WCSAF is to maintain a file of individuals who 
were injured while employed, are not currently Medicare beneficiaries, 
and received a WC Set-aside Arrangement, as part of a WC settlement, 
that is intended to pay for future medical expenses in place of future 
Medicare benefits. The information retrieved from this system of 
records will be used to support regulatory, reimbursement, and policy 
functions performed within the agency or by a contractor or consultant; 
to another Federal or State agency to contribute to the accuracy of 
CMS' proper payment of Medicare benefits, 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; and support 
research, evaluation, and for payment related projects; and to disclose 
individual-specific information for the purpose of combating fraud and 
abuse in health benefits programs administered by CMS.
    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 May 8, 2002. In any event, we will not disclose any 
information under a routine use until forty (40) calendar 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: Donna Kettish, Division of Benefit 
Coordination, Benefits Operations Group, Center for Medicare 
Management, CMS, S1-05-06, 7500 Security Boulevard, Baltimore, Maryland 
21244-1850. The telephone number is (410) 786-5462.

SUPPLEMENTARY INFORMATION:

I. Description of the New System of Records

A. Statutory and Regulatory Basis for System of Records

    Section 1862 (b) (2) of the Social Security Act (the Act), requires 
that Medicare payment may not be made for any item or service to the 
extent that payment has been made under a WC law or plan. This section 
of the Act and 42 CFR 411.46 require CMS to exclude payments once the 
injured individual becomes a Medicare beneficiary when payment should 
be made from WC funds which are always primary to Medicare payment.

B. Background

    CMS is responsible for safeguarding the fiscal integrity of the 
Medicare Program. The Health Insurance Portability and Accountability 
Act of 1996 (HIPAA) established the ``Medicare Integrity Program,'' 
enabling CMS to competitively award contracts with entities to promote 
the integrity of the Medicare Program. The Coordination of Benefit 
Contractor (COBC) is one of those specialized contractors hired to 
increase efficiency and effectiveness by ensuring that benefit payments 
are made by the appropriate payer by coordinating Medicare and other 
benefit payments.

[[Page 36893]]

    The Electronic Correspondence Referral System (ECRS) is currently 
used to transfer data between CMS's Medicare contractors and the COBC 
to establish Medicare Secondary Payer periods of coverage on CMS's 
Common Working File (CWF). The CWF is a CMS system, containing Medicare 
beneficiary eligibility information, that is used for verification and 
validation purposes to ensure Medicare claims are paid properly and by 
the appropriate payer. ECRS is being enhanced to transfer WC Set-aside 
Arrangement data from CMS Regional Offices (RO) to the COBC for 
Medicare beneficiaries and non-Medicare beneficiaries who have an 
approved WC Set-aside Arrangement to cover future medical costs 
resulting from an injury incurred while employed. If the injury results 
in disability payments from the Social Security Administration (SSA), 
there is a reasonable expectation that the injured individual will also 
be eligible for Medicare benefits some time after the WC settlement is 
made.
    The ROs will transfer the WC Set-aside Arrangement information via 
ECRS for non-Medicare beneficiaries once they approve the arrangement. 
The COBC will maintain ECRS transferred data in the WCSAF for future 
matching purposes. The COBC will ``match'' non-beneficiary WCSAF data 
against the file it receives each month of new Medicare eligibles to 
identify any non-beneficiaries with impending Medicare entitlement. 
Once a match occurs, the existence of a WC Set-aside Arrangement will 
be reflected on the new beneficiary's CWF record and a Lead Medicare 
Contractor will be assigned for coordination of the expenditures from 
the WC Set-aside Arrangement.
    CMS is drawn into a civil action resulting from a WC claim in a 
consulting position to ensure that a legal settlement involving an 
injured worker considers Medicare's interest with respect to future 
claims. CMS RO approval of a Medicare Set-aside Arrangement helps 
direct the treatment of future disorders or health claims by the 
injured worker, ensuring he/she is adequately covered for long-term 
care resulting from their WC injury, first by the Medicare Set-aside 
Arrangement and then by Medicare if necessary.

II. Collection and Maintenance of Data in the System

A. Scope of the Data Collected

    The WCSAF includes standard data for identification including the 
name, address, date of birth, Social Security Number, date of the WC 
injury/incident, injury diagnosis code(s), effective date and amount of 
the WC Set-aside Arrangement. In addition, data will be included to 
enable CMS to manage the WC Set-aside Arrangement information when it 
becomes part of the beneficiary's record on the CWF. These data include 
the WC carrier, the administrator of the Set-aside Arrangement, and the 
attorney that prepared the arrangement.

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 WCSAF information that can be 
associated with an individual 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 WCSAF 
information and identifiers. Non-identifiable data includes individual 
records with WCSAF information and masked identifiers or WCSAF 
information with identifiers stripped out of the file.
    CMS will only disclose the minimum personal data necessary to 
achieve the purpose of the WCSAF. 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 are being collected; e.g., ensuring that benefit 
payments are made by the appropriate payer by coordinating Medicare and 
other benefit payments.
    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 individually, 
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 That 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 WCSAF 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.
    CMS proposes to establish the following routine use disclosures of 
information maintained in the system:
    1. To agency contractors, or consultants that have been contracted 
by the agency to assist in the performance of a service related to this 
system of records and that need to have access to the records in order 
to perform the activity.
    CMS contemplates 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.
    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 the agency of a State government, or established by State 
law,

[[Page 36894]]

for purposes of ensuring that benefit payments are made by the 
appropriate payer by coordinating Medicare and other benefit payments.
    WCSAF data may be released to the State only on those injured 
individuals who are not currently Medicare beneficiaries but receive a 
WC Set-aside Arrangement that is intended to pay for future medical 
expenses in place of future Medicare benefits.
    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.
    Other Federal or State agencies in their administration of a 
Federal health program may require WCSAF information in order to 
support evaluations and monitoring of Medicare claims information of 
beneficiaries, 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, 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 WCSAF data will provide the research and evaluations a broader, 
longitudinal, national perspective of the status of injured individuals 
that are not currently Medicare beneficiaries but receive a WC Set-
aside Arrangement that is intended to pay for future medical expenses 
in place of future Medicare benefits
    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.
    Individuals 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 
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.
    CMS contemplates 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 CMS functions 
relating to the purpose of combating fraud and abuse.
    CMS occasionally contracts out certain of its functions when this 
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 (like 
ensuring that 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 those stated in II.B, above), 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 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 State agencies in their administration of a Federal health 
program may require WCSAF information for the purpose of preventing, 
deterring, discovering, detecting, investigating, examining, 
prosecuting, suing with respect to, defending against, correcting, 
remedying, or otherwise combating such fraud and abuse in such 
programs. 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.

B. Additional Provisions Affecting Routine Use Disclosures

    In addition, CMS 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 WCSAF 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 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

[[Page 36895]]

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:
    [rtrif] Database Administrator class owns the database objects 
(e.g., tables, triggers, indexes, stored procedures, packages) and has 
database administration privileges to these objects.
    [rtrif] Quality Control Administrator class has read and write 
access to key fields in the database;
    [rtrif] Quality Index Report Generator class has read-only access 
to all fields and tables;
    [rtrif] Policy Research class has query access to tables, but are 
not allowed to access confidential patient identification information; 
and
    [rtrif] 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:
    [rtrif] User Log-on--Authentication is to be performed by the 
Primary Domain Controller/Backup Domain Controller of the log-on 
domain.
    [rtrif] Workstation Names--Workstation naming conventions may be 
defined and implemented at the agency level.
    [rtrif] 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.
    [rtrif] Inactivity Lockout--Access to the NT workstation is to be 
automatically locked after a specified period of inactivity.
    [rtrif] Warnings--Legal notices and security warnings are to be 
displayed on all servers and workstations.
    [rtrif] 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 Circular 
#10; HHS AIS 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 WCSAF data. WCSAF 
information is submitted to CMS through standard systems. CMS will use 
a variety of onsite and offsite edits and audits to increase the 
accuracy of WCSAF 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 are 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: May 9, 2002.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
09-70-0537

System Name:
    Non-Medicare Beneficiary Workers' Compensation (WC) Set-aside File, 
(WCSAF).

Security Classification:
    Level 3, Privacy Act Sensitive.

System Location:
    Group Health Incorporated, 25 Broadway, NY, NY 10004.

Categories of Individuals Covered by the System:
    The system of records will contain data on non-Medicare 
beneficiaries that receive a WC Set-aside Arrangement, as part of a WC 
settlement, that is intended to pay for future medical expenses in 
place of future Medicare benefits.

[[Page 36896]]

Categories of Records in the System:
    This system of records will contain the individual-level 
identifying data including such as the name, address, date of birth, 
Social Security Number (SSN), date of the WC injury/incident, injury 
diagnosis code(s), effective date and amount of the WC Set-aside 
Arrangement. In addition, data will be included to enable CMS to manage 
the WC Set-aside Arrangement information when it becomes part of a 
beneficiary's record on the Common Working File (CWF). These data 
include the WC carrier, the administrator of the WC Set-aside 
Arrangement, and the attorney that prepared the arrangement.

Authority for Maintenance of the System:
    Sec. 1862(b)(2) of the Social Security Act (the Act) and 42 CFR 
411.46.

Purpose(s):
    The primary purpose of the non-Medicare beneficiary WCSAF is to 
maintain a file about individuals who were injured while employed, are 
not currently Medicare beneficiaries, and received a WC Set-aside 
Arrangement, as part of a WC settlement, that is intended to pay for 
future medical expenses in place of future Medicare benefits. The 
information retrieved from this system of records will be used to 
support regulatory, reimbursement, and policy functions performed 
within the agency or by a contractor or consultant; to another Federal 
or State agency to contribute to the accuracy of CMS' proper payment of 
Medicare benefits, 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; and support research, evaluation, and 
for payment related projects; and to disclose individual-specific 
information for the purpose of combating fraud and abuse in health 
benefits programs administered by CMS.

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 WCSAF 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, CMS 
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' (HHS) 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 that have been contracted 
by the agency to assist in the performance of a service related to this 
system of records and that need to have access to the records in order 
to perform the activity.
    2. To the agency of a State government, or established by State 
law, for purposes of ensuring that benefit payments are made by the 
appropriate payer by coordinating Medicare and other benefit payments.
    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.
    4. To an individual or organization for research, evaluation or 
epidemiological projects related to the prevention of disease or 
disability, or the restoration or maintenance of health, 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 
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.

Policies and Practices for Storing, Retrieving, Accessing, Retaining, 
and Disposing of Records in the System:
Storage:
    All records are stored on magnetic media.

Retrievability:
    The Social Security Number retrieves the records.

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

[[Page 36897]]

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 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 WCSAF data for a period of 6 years and 
3 months unless the injured individual becomes a Medicare beneficiary 
prior to that period of time. When either of these criteria is met, the 
information stored on the injured individual will be deleted from the 
WCSAF.

System Manager(s) and Address:
    CMS, Center for Medicare Management, Benefits Operations Group, 
Director, Division of Benefit Coordination, S1-05-06, 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, and for verification 
purposes, the subject individual's name (woman's maiden name, if 
applicable), address, date of birth, date of WC injury/incident, 
diagnosis, effective date and amount of the WC Set-aside Arrangement. 
(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 Electronic Correspondence Referral System (ECRS), Medicare 
contractors and the Coordination of Benefit Contractor (COBC), Common 
Working File, CMS Regional Offices (RO), Medicare beneficiaries and 
non-Medicare beneficiaries that have an approved WC Set-aside 
Arrangement to cover future medical costs resulting from an injury 
incurred while employed and the Social Security Administration (SSA).

Systems Exempted from Certain Provisions of the Act:
    None.
[FR Doc. 02-13190 Filed 5-24-02; 8:45 am]
BILLING CODE 4120-03-P