[Federal Register Volume 75, Number 192 (Tuesday, October 5, 2010)]
[Notices]
[Pages 61532-61533]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-24927]


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OFFICE OF PERSONNEL MANAGEMENT


Privacy Act of 1974: New System of Records

AGENCY: U.S. Office of Personnel Management (OPM).

ACTION: Notice of a new system of records.

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SUMMARY: OPM proposes to add OPM/Central-15, Health Claims Data 
Warehouse to its inventory of records systems subject to the Privacy 
Act of 1974 (5 U.S.C. 552a), as amended. This action is necessary to 
meet the requirements of the Privacy Act to publish in the Federal 
Register notice of the existence and character of records maintained by 
the agency. 5 U.S.C. 552a(e)(4).

DATES: This action will be effective without further notice on November 
15, 2010 unless comments are received that would result in a contrary 
determination.

ADDRESSES: Send written comments to the Office of Personnel Management, 
ATTN: Gary A. Lukowski, Ph.D., Manager, Data Analysis, U. S. Office of 
Personnel Management, 1900 E Street, NW., Room 7439, Washington, DC 
20415.

FOR FURTHER INFORMATION CONTACT: Gary A. Lukowski, Ph.D., Manager, Data 
Analysis, 202-606-1449.

SUPPLEMENTARY INFORMATION: The purpose of this system of records is to 
provide a central and comprehensive database from which OPM may analyze 
Federal Employee Health Benefit Program (FEHBP), National Pre-Existing 
Condition Insurance Program (program commencing August 2010), and 
Multi-State Option Plan (program commencing January 2014), costs and 
actively manage the programs to ensure the best value for both 
enrollees and tax-payers. OPM will collect, manage and analyze health 
services data on an ongoing basis by establishing regular data feeds 
for each of three programs. In many instances, the data will be de-
identified for specific analyses that provide flexible queries of the 
data set for general demographic queries, risk-adjusted profiles, and 
comparison of chronically ill patients and other useful analytics; and 
engage in econometric modeling of, among other things, health trends, 
risk adjustment methodologies, pharmacy pricing, and negotiation.

U.S. Office of Personnel Management.
John Berry,
Director.
OPM CENTRAL-15

SYSTEM NAME:
    Health Claims Data Warehouse.

SYSTEM LOCATION:
    Office of Personnel Management, 1900 E Street, NW., Washington, DC 
20415.

CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:
    This system contains or will subsequently contain records on three 
major health insurance programs including the Federal Employee Health 
Benefit Program (FEHBP); the National Pre-Existing Condition Insurance 
Program (NPECIP), and the Multi-State Option Plan. The FEHBP includes 
Federal employees, Postal employees, uniformed service members, 
retirees, and their family members who voluntarily participate in the 
Program. This system will also contain records on individuals eligible 
for and enrolled in the NPECIP in accordance with the Patient 
Protection and Affordable Care Act (Affordable Care Act) and 
implementing rules promulgated by the Department of Health and Human 
Services (DHHS). Through an interagency agreement, OPM will support 
DHHS in the development and operation of the NPECIP. This system will 
also contain information on individuals subsequently enrolled in the 
Multi-State Options also in accordance with the Affordable Care Act.

CATEGORIES OF RECORDS IN THE SYSTEM:
    The records in the system may contain the following types of 
information on a participating enrollees:
    a. Personal Identifying Information (Name, Social Security Number, 
Date of Birth, Gender, Phone number etc)
    b. Address (Current, Mailing)
    c. Dependent Information (Spouse, Dependents and their addresses)
    d. Employment information
    e. Health Care Provider information including debarred provider 
information
    f. Health care coverage information.
    g. Health care procedure information.
    h. Health care diagnosis information.
    i. Provider charges and reimbursement information on the above 
coverage, procedures and diagnoses.

AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
    Authority is provided by 5 U.S.C. 8910 and the Patient Protection 
and Affordable Care Act of 2010.

PURPOSE:
    The purpose of this system of records is to provide a central and 
comprehensive database from which OPM may analyze Federal Employee 
Health Benefit Program (FEHBP), National Pre-Existing Condition 
Insurance Program (program commencing August 2010), and Multi-State 
Option Plan (program commencing January 2014), and actively manage all 
three programs to ensure the best value for the enrollees and 
taxpayers. OPM will collect, manage, and analyze health services data 
on an ongoing basis by establishing regular data feeds from the various 
plans. In many instances, the data will be de-identified for specific 
analyses that provide flexible queries of the data set for general 
demographic queries, risk-adjusted profiles, and comparison of 
chronically ill patients and other useful analytics; and engage in 
econometric modeling of, among other things, health trends, risk 
adjustment methodologies, pharmacy pricing, and negotiation.

ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM, INCLUDING CATEGORIES 
OF USERS AND THE PURPOSES OF SUCH USES:
    Routine uses 1, 3 through 7 of the Prefatory Statement at the 
beginning of OPM's system notices apply to the records maintained 
within this system.
    1. For Law Enforcement Purposes--To disclose pertinent information 
to the appropriate Federal, State, or local agency responsible for 
investigating, prosecuting, enforcing, or implementing a statute, rule, 
regulation, or order, where OPM becomes aware of an

[[Page 61533]]

indication of a violation or potential violation of civil or criminal 
law or regulation.
    3. For Congressional Inquiry--To provide information to a 
congressional office from the record of an individual in response to an 
inquiry from that congressional office made at the request of that 
individual.
    4. For Judicial/Administrative Proceedings--To disclose information 
to another Federal agency, to a court, or a party in litigation before 
a court or in an administrative proceeding being conducted by a Federal 
agency, when the Government is a party to the judicial or 
administrative proceeding. In those cases where the Government is not a 
party to the proceeding, records may be disclosed if a subpoena has 
been signed by a judge.
    5. For National Archives and Records Administration--To disclose 
information to the National Archives and Records Administration for use 
in records management inspections.
    6. Within OPM for Statistical/Analytical Studies--By OPM in the 
production of summary descriptive statistics and analytical studies in 
support of the function for which the records are collected and 
maintained, or for related workforce studies. While published studies 
do not contain individual identifiers, in some instances the selection 
of elements of data included in the study may be structured in such a 
way as to make the data individually identifiable by inference.
    7. For Litigation--To disclose information to the Department of 
Justice or in a proceeding before a court, adjudicative body, or other 
administrative body before which OPM is authorized to appear, when:
    (1) OPM, or any component thereof; or
    (2) Any employee of OPM in his or her official capacity; or
    (3) Any employee of OPM in his or her individual capacity where the 
Department of Justice or OPM has agreed to represent the employee; or
    (4) The United States, when OPM determines that litigation is 
likely to affect OPM or any of its components; is a party to litigation 
or has an interest in such litigation, and the use of such records by 
the Department of Justice or OPM is deemed by OPM to be relevant and 
necessary to the litigation provided, however, that the disclosure is 
compatible with the purpose for which records were collected.
    The routine uses listed below are specific to this system of 
records only:
    1. To disclose to program and policy staff at the Office of 
Personnel Management to compile and analyze claims utilization data to 
identify sources of benefit and utilization costs and other information 
and to formulate health care program changes and enhancements to reduce 
cost increases, improve outcomes, improve efficiency in program 
administration and for other purposes.
    2. To disclose to researchers and analysts inside and outside the 
Federal Government for the purpose of conducting research on health 
care and health insurance trends and topical issues.

POLICIES AND PRACTICES OF STORING, RETRIEVING, SAFEGUARDING, RETAINING, 
AND DISPOSING OF RECORDS IN THE SYSTEM:
STORAGE:
    These records will be maintained in electronic systems.

RETRIEVABILITY:
    These records are retrieved by a combination of name and social 
security number of the individual on whom they are maintained.

SAFEGUARDS:
    OPM restricts access to the records on the databases to employees 
who have the appropriate clearance and need-to-know to perform their 
official duties. Computerized records are located in a secured database 
on a secured system.

RETENTION AND DISPOSAL:
    We maintain the records for 7 years. Computer records are destroyed 
by electronic erasure. A records retention schedule is currently being 
established with NARA.

SYSTEM MANAGER AND ADDRESS:
    Gary A. Lukowski, Ph.D., Manager, Data Analysis, U. S. Office of 
Personnel Management, 1900 E Street, NW., Room 7439, Washington, DC 
20415.

NOTIFICATION AND RECORD ACCESS PROCEDURE:
    Individuals wishing to determine whether this system of records 
contains information about them may do so by writing to the U.S. Office 
of Personnel Management, FOIA Requester Service Center, 1900 E Street, 
NW., Room 5415, Washington, DC 20415-7900 or by e-mailing [email protected].
    Individuals must furnish the following information for their 
records to be located:
    1. Full name.
    2. Date and place of birth.
    3. Social Security Number.
    4. Signature.
    5. Available information regarding the type of information 
requested.
    6. The reason why the individual believes this system contains 
information about him/her.
    7. The address to which the information should be sent.
    Individuals requesting access must also comply with OPM's Privacy 
Act regulations regarding verification of identity and access to 
records (5 CFR 297).

CONTESTING RECORD PROCEDURE:
    Individuals wishing to request amendment of records about them 
should write to the Office of Personnel Management, ATTN: Gary A. 
Lukowski, Ph.D., Manager, Data Analysis, Room 7439, Washington, DC 
20415, and furnish the following information for their records to be 
located:
    1. Full name.
    2. Date and place of birth.
    3. Social Security Number.
    4. City, state and zip code of their Federal Agency
    5. Signature.
    6. Precise identification of the information to be amended.
    Individuals requesting amendment must also follow OPM's Privacy Act 
regulations regarding verification of identity and amendment to records 
(5 CFR 297).

RECORD SOURCE CATEGORIES:
    Information in this system of records is obtained from health care 
providers used by the U. S. Office of Personnel Management to manage 
the FEHBP and high risk pools.

SYSTEM EXEMPTIONS:
    None.
[FR Doc. 2010-24927 Filed 10-4-10; 8:45 am]
BILLING CODE 6325-46-P