[Federal Register Volume 78, Number 103 (Wednesday, May 29, 2013)]
[Notices]
[Pages 32257-32258]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-12690]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services


Privacy Act of 1974; Report of a New Routine Use for Selected CMS 
Systems of Records

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

ACTION: Altered System Notice, Adding a New Routine Use for Selected 
CMS Systems of Records.

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SUMMARY: In accordance with the requirements of the Privacy Act of 1974 
(5 U.S.C. 552a), CMS is adding a new routine use to twenty-three CMS 
systems of records to assist in preventing and detecting fraud, waste 
and abuse. The new routine use will authorize CMS to disclose provider 
and beneficiary-identifiable records to representatives of health plans 
for the purpose of preventing and detecting fraud, waste and abuse, 
pursuant to section 1128C(a)(2) of the Social Security Act (``the 
Act''). At section 1128C(c) of the Act, a health plan is defined as a 
plan or program that provides health benefits, whether directly, 
through insurance, or otherwise, and includes: (1) A policy of health 
insurance; (2) a contract of a service benefit organization; and (3) a 
membership agreement with a health maintenance organization or other 
prepaid health plan.
    Disclosures made pursuant to the routine use will be coordinated 
through CMS' Data Sharing and Partnership Group, Center for Program 
Integrity, CMS. CMS has identified twenty-three systems that contain 
the data potentially

[[Page 32258]]

necessary to disclose to health plans for the prevention and detection 
of fraud, waste and abuse. These systems are listed at the end of this 
notice.

DATES: Effective Dates: The new routine use described in this notice 
will become effective without further notice 30 days after publication 
of this notice in the Federal Register (FR), unless comments received 
on or before that date result in revisions to this notice.

ADDRESSES: The public should send comments to: CMS Privacy Officer, 
Division of Privacy Policy, Privacy Policy and Compliance Group, Office 
of E-Health Standards & Services, Office of Enterprise Management, CMS, 
Room S2-24-25, 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 
9:00 a.m.-3:00 p.m., Eastern Time zone.

FOR FURTHER INFORMATION CONTACT: Shantanu Agrawal, MD, MPhil, FAAEM, 
Medical Director, Director, Data Sharing and Partnership Group, CMS 
Center for Program Integrity, 7500 Security Boulevard, Mail Stop AR-18-
50, Baltimore, MD 21244, Office phone: 410.786.1795, Facsimile: 
410.786.0604, Email: [email protected].

SUPPLEMENTARY INFORMATION:  Section 1128C(a)(2) of the Act authorizes 
the Secretary and the Attorney General to consult with, and arrange for 
the sharing of data with, representatives of health plans. At section 
1128C(c) of the Act, a health plan is defined as a plan or program that 
provides health benefits, whether directly, through insurance, or 
otherwise, and includes: (1) A policy of health insurance; (2) a 
contract of a service benefit organization; and (3) a membership 
agreement with a health maintenance organization or other prepaid 
health plan. In order for CMS to disclose data with representatives of 
health plans pursuant to section 1128C(a)(2) of the Act, CMS is 
establishing a new routine use for twenty-three systems identified as 
containing the data that may be used to detect and prevent fraud, 
waste, and abuse. The Secretary's authority under section 1128C(a)(2) 
of the Act has been delegated to the Administrator of CMS. Advance 
notice of the proposed new routine use for the twenty-three systems of 
record was provided to OMB and Congress as required by the Privacy Act 
at 5 U.S.C. 552a(r).
    For the reasons described above, the following routine use is added 
to the twenty-three systems of records listed below:
    ``To disclose to health plans, defined for this purpose as plans or 
programs that provide health benefits, whether directly, through 
insurance, or otherwise, and includes--(1) a policy of health 
insurance; (2) a contract of a service benefit organization; and (3) a 
membership agreement with a health maintenance organization or other 
prepaid health plan 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, waste, or abuse in such programs. Disclosures 
may include provider and beneficiary-identifiable data.''
    1. Health Plan Management System (HPMS), System No. 09-70-0500, 
published at 73 Federal Register (FR) 2257 (January 14, 2008).
    2. Medicare Multi-Carrier Claims System (MCS), System No. 09-70-
0501, published at 71 FR 64968 (November 6, 2006).
    3. Enrollment Database (EDB), System No. 09-70-0502, published at 
73 FR 10249 (February 26, 2008).
    4. Fiscal Intermediary Shared System (FISS), System No. 09-70-0503, 
published at 71 FR 64961 (November 6, 2006).
    5. Inpatient Rehabilitation Facilities--Patient Assessment 
Instrument (IRF-PAI), System No. 09-70-0521, published at 71 FR 67143 
(November 20, 2006).
    6. HHA Outcome and Assessment Information Set (OASIS), System No. 
09-70-0522, published at 72 FR 63906 (November 13, 2007).
    7. Unique Physician/Practitioner Identification Number System 
(UPIN), System No. 09-70-0525, published at 71 FR 66535 (November 15, 
2006).
    8. Common Working File (CWF), System No, 09-70-0526, published at 
71 FR 64955 (November 6, 2006).
    9. Fraud Investigation Database (FID), System No. 09-70-0527, 
published at 71 FR 77759 (December 27, 2006).
    10. Long Term Care MDS (LTC MDS), System No. 09-70-0528, published 
at 72 FR 12801 (March 19, 2007).
    11. Medicare Supplier Identification File (MSIF), System No. 09-70-
0530, published at 71 FR 70404 (December 4, 2006).
    12. Provider Enrollment, Chain and Ownership System (PECOS), System 
No. 09-70-0532, published at 71 FR 60536 (October 13, 2006).
    13. Medicare Exclusion Database (MED), System No. 09-70-0534, 
published at 71 FR 70967 (December 7, 2006).
    14. Medicare Beneficiary Database (MBD), System No. 09-70-0536, 
published at 71 FR 70396 (December 4, 2006).
    15. Medicaid Statistical Information System (MSIS), System No. 09-
70-0541, published at 71 FR 65527 (November 8, 2006).
    16. Medicare Retiree Drug Subsidy Program (RDSP), System No. 09-70-
0550, published at 70 FR 41035 (July 15, 2005).
    17. Medicare Drug Data Processing System (DDPS), System No. 09-70-
0553, published at 73 FR 30943 (May 29, 2008).
    18. National Plan and Provider Enumeration System (NPPES), System 
No. 09-70-0555, published at 75 FR 30411 (June 1, 2010).
    19. National Claims History (NCH), System No. 09-70-0558, published 
at 71 FR 67137 (November 20, 2006).
    20. Integrated Data Repository (IDR) System No. 09-70-0571, 
published at 71 FR 74915 (December 13, 2006).
    21. Chronic Condition Data Repository (CCDR), System No. 09-70-
0573, published at 71 FR 74915 (December 13, 2006).
    22. Medicaid Integrity Program System (MIPS), System No. 09-70-
0599, published at 73 FR 11639 (March 4, 2008).
    23. Medicare Advantage Prescription Drug System (MARx), System No. 
09-70-0588, published at 70 FR 60530 (October 18, 2005).

Michelle Snyder,
Deputy Chief Operating Officer, Centers for Medicare & Medicaid 
Services.
[FR Doc. 2013-12690 Filed 5-28-13; 8:45 am]
BILLING CODE 4120-03-P