[Federal Register Volume 70, Number 225 (Wednesday, November 23, 2005)]
[Notices]
[Pages 70849-70855]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-23239]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services


Privacy Act of 1974; Report of a New System of Records

AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of 
Health and Human Services (HHS).

ACTION: Notice of a new System of Records (SOR).

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SUMMARY: In accordance with the requirements of the Privacy Act of 
1974, we are proposing a new SOR titled, ``National Disaster Medical 
System (NDMS) Claims Processing System (CPS), No. 09-70-0572.'' CMS is 
responsible for establishing and administering a payment mechanism for 
definitive medical care provided under the National Disaster Medical 
System (NDMS) in accordance with section 2811 of the Public Health 
Service Act, 42 United States Code (U.S.C.) 300hh-11, a Memorandum of 
Agreement (MOA) entered into by the NDMS Partners--the Departments of 
Homeland Security, Health and Human Services, Defense, and Veteran's 
Affairs, and an Inter-Agency Agreement between CMS and the Federal 
Emergency Management Agency (FEMA). Reimbursement to NDMS-participating 
hospitals (and practitioners furnishing medical services to NDMS-
authorized patients during inpatient stays in those hospitals) for 
definitive medical care will be administered through the NDMS-CPS. The 
new system will collect data relating to individuals who receive NDMS-
authorized medical treatment or services in NDMS hospitals for illness 
or injury resulting from a specified public health emergency or non-
deferrable medical treatment or services to maintain health when such 
are temporarily not available as a result of the public health 
emergency. Data on individuals will be submitted by the Departments of 
Defense and Veteran's Affairs, staffed Federal Coordinating Centers 
activated by the NDMS, NDMS hospitals, and practitioners within NDMS 
hospitals that furnish medical treatment or services to NDMS patients.
    The primary purpose of the system is to justify and document 
payments for inpatient hospital and related practitioner services 
provided in connection to the NDMS. Information in this system will 
also be disclosed to: (1) Support regulatory, reimbursement, and policy 
functions performed by CMS and the NDMS Partners, contractors 
(including the NDMS claims contractor), and consultants contracted by 
the Agency; (2) support another Federal (including the NDMS Partners) 
agency of a state government, an agency established by state law, or 
its fiscal agent; (3) assist NDMS-participating hospitals (and 
practitioners within those hospitals) who have furnished services to 
individuals evacuated and placed by the NDMS; (4) assist third party 
contacts in situations where the party to be contacted has, or is 
expected to have information relating to the individual's capacity to 
manage his or her affairs; (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, and (8) 
combat fraud and abuse in certain Federal health benefits programs. We 
have provided background information about the new 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 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 November 17, 2005. To ensure that all parties have adequate 
time in which to comment, the new SOR and the routine uses, will become 
effective 30 days from the publication of the notice, provided OMB 
grants CMS' request for a 10-day waiver of the review period, unless 
CMS receives comments that require alterations to this notice. If OMB 
does not grant CMS' request for a 10-day waiver of the review period, 
the new SOR and the routine uses, will become effective 30 days from 
the publication of the notice, or 40 days from the date it was mailed

[[Page 70850]]

to OMB and Congress, whichever is later, unless CMS receives comments 
that require alterations to this notice.

ADDRESSES: The public should address comments to: CMS Privacy Officer, 
Division of Privacy Compliance Data Development (DPCDD), 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: Chris Klots, Technical Advisor, 
Medicare Contractor Management Group, Center for Medicare Management, 
CMS, Mail Stop S1-14-17, 7500 Security Boulevard, Baltimore, MD 21244-
1850. He can also be contacted by telephone at 410-786-3348, or e-mail 
at [email protected].

SUPPLEMENTARY INFORMATION: The NDMS is a partnership of four Federal 
agencies--HHS, Department of Defense, Department of Veteran's Affairs 
and the Department of Homeland Security. In a disaster situation, the 
NDMS augments the public health and health care activities of State and 
local governments. NDMS has three key functions to which each of the 
Partners contribute: Medical response, patient evacuation, and 
definitive medical care.
    The medical response function of NDMS relates to the deployment of 
NDMS response teams, comprised of trained medical and logistical 
personnel from the NDMS Federal Partners, to assess the health and 
medical needs of disaster victims and to respond to these needs and 
patients. The patient evacuation function of NDMS relates to the 
establishment of a communications, transportation and medical 
regulating system to evacuate patients from a mobilization center near 
the disaster site, to patient reception capabilities known as Federal 
Coordinating Centers. The Departments of Defense and Veteran's Affairs 
are responsible for activating and staffing the Federal Coordinating 
Centers. The Federal Coordinating Centers have the authority to arrange 
for referral and inpatient admission of NDMS-evacuated patients in 
acute care hospitals for definitive medical care. The definitive 
medical care is provided by hospitals that are part of the NDMS and 
have agreed to provide this inpatient care to NDMS evacuees on an as-
needed basis.
    CMS is responsible for establishing and administering a payment 
mechanism for definitive medical care provided under the NDMS in 
accordance with section 2811 of the Public Health Service Act, 42 
U.S.C. 300hh-11, a MOA entered into by the NDMS Partners--the 
Departments of Homeland Security, Health and Human Services, Defense, 
and Veteran's Affairs, and an Inter-Agency Agreement between CMS and 
FEMA. Reimbursement to NDMS-participating hospitals (and practitioners 
furnishing medical services to NDMS-authorized patients during 
inpatient stays in those hospitals) for definitive medical care will be 
administered through the NDMS-CPS. The new system will collect data 
relating to individuals who receive NDMS-authorized medical treatment 
or services in NDMS hospitals for illness or injury resulting from a 
specified public health emergency or non-deferrable medical treatment 
or services to maintain health when such are temporarily not available 
as a result of the public health emergency. Data on individuals will be 
submitted by the Departments of Defense and Veteran's Affairs, staffed 
Federal Coordinating Centers activated by the NDMS, NDMS hospitals, and 
practitioners within NDMS hospitals that furnish medical treatment or 
services to NDMS patients.
    The NDMS MOA defines NDMS definitive medical care as follows: to 
the extent authorized by NDMS in a particular public health emergency, 
medical treatment or services beyond emergency medical care, initiated 
upon inpatient admission to an NDMS treatment facility and provided for 
injuries or illnesses resulting directly from a specified public health 
emergency, or for injuries, illnesses and conditions requiring non-
deferrable medical treatment or services to maintain health when such 
medical treatment and services are temporarily not available as a 
result of the public health emergency. Other provisions of the NDMS MOA 
make clear that NDMS coverage ends when the indicated medical treatment 
is completed, the patient refuses care, the patient is returned home, 
or thirty days elapse.
    Accordingly, in order to provide expeditious processing and 
adjudication of NDMS definitive medical claims from NDMS hospitals and 
licensed providers arising from NDMS-authorized medical treatment and 
services for victims of a public health emergency, a contractor will 
collect and process NDMS patient data gathered by the Federal 
Coordinating Centers during the emergency evacuations against NDMS 
claims data, with CMS subsequently making payment on appropriate claims 
in keeping with NDMS policies. Subject to the availability of funds, a 
similar solution will be employed to address NDMS definitive medical 
care reimbursement requirements that may arise in future emergency 
situations.

I. Description of the New System of Records

A. Statutory and Regulatory Basis for the System

    Authority for reimbursement of providers is found under section 
102(a) of the Public Health Security and Bioterrorism Preparedness and 
Response Act of 2002, Public Law 107-188, which added section 2811 of 
the Public Health Service Act, 42 U.S.C. 300hh-11, as transferred to 
the Department of Homeland Security under the Homeland Security Act of 
2002, Pub. L. 107-296, 6 U.S.C. 313(5), and the Economy Act, 31 U.S.C. 
1535.

B. Collection and Maintenance of Data in the System

    The new system will collect data from individuals who receive 
treatment for services in an NDMS hospital for illness or injury 
resulting from a specified public health emergency or non-deferrable 
medical treatment or services to maintain health when such are 
temporarily not available as a result of the public health emergency. 
Patient data will be collected by the Federal Coordinating Centers and 
claims data on medical treatment and services furnished to NDMS-
authorized patients will be reported by NDMS-participating hospitals 
(and practitioners within those facilities) to a CMS-contracted claims 
processor who will process claims under the NDMS-CPS. The system will 
also include, but is not limited to, name, social security number, 
address, dates of care, Diagnostic Related Group/Current Procedure 
Terminology (DRG/CPT) data, provider name, provider address, provider 
number, amount billed, amount allowed, other insurance payment, amount 
to be paid, and applicable Employer Identification Number.

[[Page 70851]]

II. Agency Policies, Procedures, and Restrictions on Routine Uses

A. 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 NDMS-CPS 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 collect the minimum personal data necessary to achieve 
the purpose of NDMS-CPS. 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 data is being collected; e.g., to justify and document payments 
for inpatient hospital and related practitioner services provided in 
connection to the NDMS.
    2. Determines that the purpose for which the disclosure is to be 
made can only be accomplished if the record is provided in individually 
identifiable form;
    a. 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
    b. 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. 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 NDMS-CPS 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 CMS contractors (including the NDMS claims contractor), or 
consultants who have been contracted 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 an NDMS claims 
processing function or other 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 agency (including any of the NDMS Partner 
Agencies), an 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.
    Other Federal or State agencies in their administration of a 
Federal health program may require NDMS-CPS information in order to 
support evaluations and monitoring of the NDMS program, including 
proper reimbursement for services provided.
    In addition, other State agencies in their administration of a 
Federal health program may require NDMS-CPS information for the 
purposes of determining, evaluating and/or assessing cost, 
effectiveness, and/or the quality of health care services provided in 
the state.
    Disclosure under this routine use shall be used by State Medicaid 
agencies pursuant to agreements with the HHS for determining Medicaid 
eligibility, for quality control studies, for determining eligibility 
of recipients of assistance under Titles IV, and XIX of the Social 
Security Act (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 NDMS-CPS 
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 providers and practitioners who have furnished NDMS-
authorized medical treatment and/or services to individuals evacuated 
and placed for NDMS definitive medical care by the NDMS.
    Providers and suppliers of services may require NDMS-CPS 
information in order to establish the validity of evidence or to verify 
the accuracy of information presented by the individual, as it concerns 
the individual's entitlement to benefits under the NDMS program, 
including proper reimbursement for services provided.
    4. To third party contacts in situations where the party to be 
contacted has, or is expected to have information relating to the 
individual's capacity to manage his or her affairs or to his or her 
eligibility for, or an entitlement to, benefits under the NDMS program 
and,
    a. The individual is unable to provide the information being sought 
(an individual is considered to be unable to provide certain types of 
information when any of the following conditions

[[Page 70852]]

exists: the individual is confined to a mental institution, a court of 
competent jurisdiction has appointed a guardian to manage the affairs 
of that individual, a court of competent jurisdiction has declared the 
individual to be mentally incompetent, or the individual's attending 
physician has certified that the individual is not sufficiently 
mentally competent to manage his or her own affairs or to provide the 
information being sought, the individual cannot read or write, cannot 
afford the cost of obtaining the information, a language barrier exist, 
or the custodian of the information will not, as a matter of policy, 
provide it to the individual), or
    b. The data are needed to establish the validity of evidence or to 
verify the accuracy of information presented by the individual, and it 
concerns one or more of the following: the individual's entitlement to 
benefits under the NDMS program, the amount of reimbursement, and in 
cases in which the evidence is being reviewed as a result of suspected 
fraud and abuse, program integrity, quality appraisal, or evaluation 
and measurement of activities.
    Third party contacts may require NDMS-CPS information in order to 
provide support for the individual's entitlement to benefits under the 
NDMS program; to establish the validity of evidence or to verify the 
accuracy of information presented by the individual, and assist in the 
monitoring of NDMS claims-related information for NDMS evacuees, 
including proper reimbursement of services provided.
    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.
    NDMS-CPS data may be provided for research, evaluation, and 
epidemiological projects, in order to contribute to a broader, 
longitudinal, national perspective of the status of NDMS patients. CMS 
anticipates that many researchers may have legitimate requests to use 
these data in projects that could ultimately improve the care provided 
to disaster victims and the policy that governs the care.
    6. To a Member of Congress or 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 often 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 in response 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 and 
that the use of such records by the DOJ, court or adjudicatory body is 
compatible with the purpose for which the agency collected the records.
    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 FIs 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 programs.
    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 against, correct, remedy, or otherwise combat 
fraud or abuse in such programs.
    Other agencies may require NDMS-CPS information for the purpose of 
combating fraud and abuse in such federally-funded programs.

B. Additional Circumstances Affecting Routine Use Disclosures:

    To the extent this system contains Protected Health Information 
(PHI) 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), subparts A and E). Disclosures of such PHI 
that are otherwise 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 data 
not directly identifiable, except pursuant to one of the routine uses 
or if required by law, if we determine 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

    CMS has safeguards in place 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 
information security requirements. Employees who maintain records in 
this system are instructed not to release data until the intended 
recipient agrees to implement appropriate management, operational and 
technical safeguards sufficient to protect the confidentiality, 
integrity and availability of the information and information systems 
and to prevent unauthorized access.
    This system will conform to all applicable Federal laws and 
regulations and Federal, HHS, and CMS policies and standards as they 
relate to information security and data privacy. These laws and 
regulations may apply but are not limited to: the Privacy Act of 1974; 
the Federal Information Security Management Act of 2002; the

[[Page 70853]]

Computer Fraud and Abuse Act of 1986; the Health Insurance Portability 
and Accountability Act of 1996; the E-Government Act of 2002, the 
Clinger-Cohen Act of 1996; the Medicare Modernization Act of 2003, and 
the corresponding implementing regulations. OMB Circular A-130, 
Management of Federal Resources, Appendix III, Security of Federal 
Automated Information Resources also applies. Federal, HHS, and CMS 
policies and standards include but are not limited to: All pertinent 
National Institute of Standards and Technology publications; the HHS 
Information Systems Program Handbook and the CMS Information Security 
Handbook.

V. Effects of the 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 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 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 the disclosure of information relating to individuals.

    Dated: November 7, 2005.
Charlene Frizzera,
Acting Chief Operating Officer, Centers for Medicare & Medicaid 
Services.
System No. 09-70-0572

System Name:
    ``National Disaster Medical System Claims Processing System (NDMS-
CPS)'' HHS/CMS/CMM.

Security Classification:
    Level Three Privacy Act Sensitive.

System Location:
    CMS Data Center, 7500 Security Boulevard, North Building, First 
Floor, Baltimore, Maryland 21244-1850.

Categories of Individuals Covered By The System:
    The new system will collect data from individuals who receive 
treatment for services in an NDMS hospital for illness or injury 
resulting from a specified public health emergency or non-deferrable 
medical treatment or services to maintain health when such are 
temporarily not available as a result of the public health emergency. 
Patient data will be collected by the Federal Coordinating Centers and 
claims data on medical treatment and services furnished to NDMS-
authorized patients will be reported by NDMS-participating hospitals 
(and practitioners within those facilities) to a CMS-contracted claims 
processor who will process claims under the NDMS-CPS.

Categories Of Records In The System:
    The system will include, but is not limited to, name, social 
security number (SSN), address, dates of care, Diagnostic Related 
Group/Current Procedure Terminology (DRG/CPT) data, provider name, 
provider address, provider number, amount billed, amount allowed, other 
insurance payment, amount to be paid, and applicable Employer 
Identification Number.

Authority For Maintenance Of The System:
    Authority for reimbursement of providers is found under section 
102(a) of the Public Health Security and Bioterrorism Preparedness and 
Response Act of 2002, Pub. L. 107-188, which added Sec.  2811 of the 
Public Health Service Act, 42 U.S.C. 300hh-11, as transferred to the 
Department of Homeland Security under the Homeland Security Act of 
2002, Pub. L. 107-296, 6 U.S.C. 313(5), and the Economy Act, 31 U.S.C. 
1535.

Purpose(s) Of The System:
    The primary purpose of the system is to justify and document 
payments for inpatient hospital and related practitioner services 
provided in connection to the NDMS. Information in this system will 
also be disclosed to: (1) Support regulatory, reimbursement, and policy 
functions performed by CMS and the NDMS Partners, contractors 
(including the NDMS claims contractor), and consultants contracted by 
the Agency; (2) support another Federal (including the NDMS Partners), 
agency of a State government, an agency established by state law, or 
its fiscal agent; (3) assist NDMS-participating hospitals (and 
practitioners within those hospitals) who have furnished services to 
individuals evacuated and placed by the NDMS; (4) assist third party 
contacts in situations where the party to be contacted has, or is 
expected to have information relating to the individual's capacity to 
manage his or her affairs; (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, and (8) 
combat fraud and abuse in certain Federal health benefits programs.

Routine Uses Of Records Maintained In The System, Including Categories 
Or Users And The Purposes Of Such Uses:
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 NDMS-CPS 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 (including the NDMS claims contractor), or 
consultants who have been contracted 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 agency (including any of the NDMS Partner 
Agencies), an 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 providers and practitioners who have furnished NDMS-
authorized medical treatment and/or services to individuals evacuated 
and placed for NDMS definitive medical care by the NDMS.
    4. To third party contacts in situations where the party to be 
contacted has, or is expected to have information relating to the 
individual's capacity to manage his or her affairs or to his or her

[[Page 70854]]

eligibility for, or an entitlement to, benefits under the NDMS program 
and,
    a. The individual is unable to provide the information being sought 
(an individual is considered to be unable to provide certain types of 
information when any of the following conditions exists: The individual 
is confined to a mental institution, a court of competent jurisdiction 
has appointed a guardian to manage the affairs of that individual, a 
court of competent jurisdiction has declared the individual to be 
mentally incompetent, or the individual's attending physician has 
certified that the individual is not sufficiently mentally competent to 
manage his or her own affairs or to provide the information being 
sought, the individual cannot read or write, cannot afford the cost of 
obtaining the information, a language barrier exist, or the custodian 
of the information will not, as a matter of policy, provide it to the 
individual), or
    b. The data are needed to establish the validity of evidence or to 
verify the accuracy of information presented by the individual, and it 
concerns one or more of the following: The individual's entitlement to 
benefits under the NDMS program, the amount of reimbursement, and in 
cases in which the evidence is being reviewed as a result of suspected 
fraud and abuse, program integrity, quality appraisal, or evaluation 
and measurement of activities.
    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 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: The Agency or any component thereof, or
    a. Any employee of the Agency in his or her official capacity, or
    b. Any employee of the Agency in his or her individual capacity 
where the DOJ has agreed to represent the employee, or
    c. 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 
that the use of such records by the DOJ, court or adjudicatory body is 
compatible with the purpose for which the agency collected the records.
    8. To a CMS contractor (including, but not limited to FIs 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 programs.
    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.

B. Additional Circumstances Affecting Routine Use Disclosures:
    To the extent this system contains Protected Health Information 
(PHI) 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), subparts A and E. Disclosures of such PHI 
that are otherwise 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 data 
not directly identifiable, except pursuant to one of the routine uses 
or if required by law, if we determine 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).

Policies And Practices For Storing, Retrieving, Accessing, Retaining, 
And Disposing Of Records In The System:
Storage:
    Computer diskette, magnetic storage media, and paper claims.

Retrievability:
    Information will be retrieved by patient's name and SSN; and may be 
sorted by geographical area or medical provider.

Safeguards:
    CMS has safeguards in place 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 
information security requirements. Employees who maintain records in 
this system are instructed not to release data until the intended 
recipient agrees to implement appropriate management, operational and 
technical safeguards sufficient to protect the confidentiality, 
integrity and availability of the information and information systems 
and to prevent unauthorized access.
    This system will conform to all applicable Federal laws and 
regulations and Federal, HHS, and CMS policies and standards as they 
relate to information security and data privacy. These laws and 
regulations may apply but are not limited to: the Privacy Act of 1974; 
the Federal Information Security Management Act of 2002; the Computer 
Fraud and Abuse Act of 1986; the Health Insurance Portability and 
Accountability Act of 1996; the E-Government Act of 2002, the Clinger-
Cohen Act of 1996; the Medicare Modernization Act of 2003, and the 
corresponding implementing regulations. Office of Management and Budget 
Circular A-130, Management of Federal Resources, Appendix III, Security 
of Federal Automated Information Resources also applies. Federal, HHS, 
and CMS policies and standards include but are not limited to: all 
pertinent National Institute of Standards and Technology publications; 
the HHS Information Systems Program Handbook and the CMS Information 
Security Handbook.

Retention And Disposal:
    Records are maintained in a secure storage area with identifiers. 
Disposal occurs five years from the last action on the hospital's cost 
report, and should be coordinated with disposal of the reports. All 
claims-related records are encompassed by the document preservation 
order and will be retained until notification is received from DOJ.

System Manager And Address:
    Director, Medicare Contractor Management Group, Center for Medicare 
Management, CMS, 7500 Security Boulevard, Baltimore, Maryland 21244-
1850.

Notification Procedure:
    For purpose of access, the subject individual should write to the 
systems manager who will require the system name, SSN, address, date of 
birth, sex,

[[Page 70855]]

and for verification purposes, the subject individual's name (woman's 
maiden name, if applicable). 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:
    Information contained in this system will be submitted by NDMS 
hospitals, other providers, and States.

Systems Exempted From Certain Provisions Of The Act:
    None.

[FR Doc. 05-23239 Filed 11-22-05; 8:45 am]
BILLING CODE 4120-03-P