[Federal Register Volume 80, Number 207 (Tuesday, October 27, 2015)]
[Notices]
[Pages 65720-65722]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-27230]


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DEPARTMENT OF DEFENSE

Office of the Secretary

[Docket ID: DoD-2015-HA-0106]


Privacy Act of 1974; System of Records

AGENCY: Defense Health Agency, DoD.

ACTION: Notice to alter a System of Records.

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SUMMARY: The Defense Health Agency proposes to alter an existing system 
of records, EDTMA 04, entitled ``Medical/Dental Claim History Files'' 
in its inventory of record systems subject to the Privacy Act of 1974, 
as amended.
    The Defense Health Agency and its contractors and DoD staff 
(including Military Treatment Facilities, clinics and TRICARE Regional 
Offices Staff) use the information to control and process health care 
benefits available under TRICARE and the Civilian Health and Medical 
Program of the Department of Veterans Affairs (CHAMPVA), including the 
processing of medical or dental claims, the control and approval of 
medical or dental treatments, issuance of deductible certificates, and 
necessary interface with providers of health care. The system also 
supports audits of contractor-processed claims to determine payment and 
occurrence accuracy of the contractor's adjudication process.

DATES: Comments will be accepted on or before November 27, 2015. This 
proposed action will be effective the date following the end of the 
comment period unless comments are received which result in a contrary 
determination.

ADDRESSES: You may submit comments, identified by docket number and 
title, by any of the following methods:
    * Federal Rulemaking Portal: http://www.regulations.gov. Follow the 
instructions for submitting comments.
    * Mail: Department of Defense, Office of the Deputy Chief 
Management Officer, Directorate of Oversight and Compliance, Regulatory 
and Audit Matters Office, 9010 Defense Pentagon, Washington, DC 20301-
9010.
    Instructions: All submissions received must include the agency name 
and docket number for this Federal Register document. The general 
policy for comments and other submissions from members of the public is 
to make these submissions available for public viewing on the Internet 
at http://www.regulations.gov as they are received without change, 
including any personal identifiers or contact information.

FOR FURTHER INFORMATION CONTACT: Ms. Linda S. Thomas, Chief, Defense 
Health Agency Privacy and Civil Liberties Office, Defense Health 
Agency, 7700 Arlington Boulevard, Suite 5101, Falls Church, VA 22042-
5101, or by phone at (703) 681-7500.

SUPPLEMENTARY INFORMATION: The Defense Health Agency notices for 
systems of records subject to the Privacy Act of 1974 (5 U.S.C. 552a), 
as amended, have been published in the Federal Register and are 
available from the address in FOR FURTHER INFORMATION CONTACT or at the 
Defense Privacy and Civil Liberties Division Web site at http://dpcld.defense.gov/.
    The proposed system report, as required by 5 U.S.C. 552a(r) of the 
Privacy Act of 1974, as amended, was submitted on May 6, 2015 to the 
House Committee on Oversight and Government Reform, the Senate 
Committee on Governmental Affairs, and the Office of Management and 
Budget (OMB) pursuant to paragraph 4c of Appendix I to OMB Circular No. 
A-130, ``Federal Agency Responsibilities for Maintaining Records About 
Individuals,'' dated February 8, 1996 (February 20, 1996, 61 FR 6427).

    Dated: October 21, 2015.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
EDTMA 04

System name:
    Medical/Dental Claim History Files (November 18, 2013, 78 FR 69076)

Changes:
* * * * *

System location:
    Delete entry and replace with ``Records Management, Administration 
and Management Directorate, 16401 East Centretech Parkway, Aurora, CO 
80011-9066, and contractors under contract to the Defense Health 
Agency.
    A listing of Managed Care Support contractors maintaining these 
records is available from the system manager.''

Categories of individuals covered by the system:
    Delete entry and replace with ``Eligible beneficiaries and all 
individuals who seek health care under TRICARE and the Civilian Health 
and Medical Program of the Department of Veterans Affairs (CHAMPVA).''

Categories of records in the system:
    Delete entry and replace with ``File contains claims, billings for 
services, applications or approval forms, enrollment and disenrollment 
files, recoupment files, third-party liability files, fraud and abuse 
files, the name, Social Security Number (SSN) and/or DoD Identification 
Number (DoD ID Number) of the sponsor and/or beneficiary; beneficiary's 
relationship to sponsor, case management files, resource sharing files, 
utilization management/quality assurance files, payment files, medical/
dental records, family history files, records of grievances with a 
medical/dental provider, appeals, hearings, or any other 
correspondence, memoranda, or reports which are acquired or utilized in 
the development and processing of TRICARE or CHAMPVA claims.
    Records are also maintained on health care demonstration projects, 
including enrollment and authorization agreements, correspondence, 
memoranda, forms and reports, which are acquired or utilized during the 
projects.''

Authority for maintenance of the system:
    Delete entry and replace with ``10 U.S.C. Chapter 55, Medical and 
Dental Care; 38 U.S.C. Chapter 17, Hospital, Nursing Home, Domiciliary, 
and Medical Care; 32 CFR part 199, Civilian Health and Medical Program 
of the Uniformed Services (CHAMPUS); and E.O. 9397 (SSN), as amended.''

Purpose(s):
    Delete entry and replace with ``Defense Health Agency and its 
contractors and DoD staff (including Military Treatment Facilities, 
clinics and TRICARE Regional Offices Staff) use the information to 
control and process health care benefits available under TRICARE and 
CHAMPVA, including the processing of medical or dental claims, the 
control and approval of medical or dental treatments, issuance of 
deductible certificates, and

[[Page 65721]]

necessary interface with providers of health care. The system also 
supports audits of contractor-processed claims to determine payment and 
occurrence accuracy of the contractor's adjudication process.''

Routine uses of records maintained in the system, including categories 
of users and the purposes of such uses:
    Delete entry and replace with ``In addition to those disclosures 
generally permitted under 5 U.S.C. 552a(b) of the Privacy Act of 1974, 
as amended, these records may specifically be disclosed outside the DoD 
as a routine use pursuant to 5 U.S.C. 552a(b)(3) as follows:
    To the Departments of Health and Human Services and Veterans 
Affairs consistent with their statutory administrative responsibilities 
under TRICARE and CHAMPVA pursuant to 10 U.S.C. Chapter 55; and 38 
U.S.C. Chapter 17.
    Referral to Federal, state, local, or foreign governmental 
agencies, and to private business entities, including individual 
providers of care (participating and non-participating), on matters 
relating to eligibility, claims pricing and payment, fraud, program 
abuse, utilization review, quality assurance, peer review, program 
integrity, third-party liability, coordination of benefits, and civil 
or criminal litigation related to the operation of TRICARE.
    Disclosure to the Department of Justice and the United States 
Attorneys in situations where the matter directly or indirectly 
involves the TRICARE program.
    Disclosure to third-party contacts in situations where the party to 
be contacted has, or is expected to have, information necessary to 
establish the validity of evidence or to verify the accuracy of 
information presented by the individual concerning his or her 
entitlement, the amount of benefit payments, any review of suspected 
abuse or fraud, or any concern for program integrity or quality 
appraisal.
    The DoD Blanket Routine Uses set forth at the beginning of the 
Defense Health Agency compilation of systems of records notices may 
apply to this system. The complete list of DoD Blanket Routine Uses can 
be found online at: http://dpcld.defense.gov/Privacy/SORNsIndex/BlanketRoutineUses.aspx.
    NOTE 1: This system of records contains individually identifiable 
health information. The DoD Health Information Privacy Regulation (DoD 
6025.18-R) or any successor DoD issuances implementing the Health 
Insurance Portability and Accountability Act of 1996 (HIPAA) and 45 CFR 
parts 160 and 164, Health and Human Services, General Administrative 
Requirements and Security & Privacy, respectively, applies to most such 
health information. DoD 6025.18-R or a successor issuance may place 
additional procedural requirements on uses and disclosures of such 
information beyond those found in the Privacy Act of 1974, as amended, 
or mentioned in this system of records notice.
    NOTE 2: Except as provided under 42 U.S.C. 290dd-2, records of 
identity, diagnosis, prognosis or treatment information of any patient 
maintained in connection with the performance of any program or 
activity relating to substance abuse education, prevention, training, 
treatment, rehabilitation, or research, which is conducted, regulated, 
or directly or indirectly assisted by a department or agency of the 
United States will be treated as confidential and disclosed only for 
the purposes and under the circumstances expressly authorized under 42 
U.S.C. 290dd-2.''

Policies and practices for storing, retrieving, accessing, retaining, 
and disposing of records in the system:
Storage:
    Delete entry and replace with ``Paper records and/or electronic 
storage media.''

Retrievability:
    Delete entry and replace with ``Information is retrieved by the 
name, SSN and/or DoD ID Number of the sponsor or beneficiary; name and 
SSN and/or Tax Identification Number of the provider; internal control 
number; classification of medical diagnosis; procedure code; 
geographical location of care provided; and selected utilization 
limits.''

Safeguards:
    Delete entry and replace with ``Electronic media, data and/or 
electronic records are maintained in a controlled area. Records are 
maintained in a secure, limited access, or monitored area. The computer 
system is accessible only to authorized personnel. Entry into these 
areas is restricted to those personnel with a valid requirement and 
authorization to enter. Physical entry is restricted by the use of 
locks, passwords which are changed periodically, and administrative 
procedures.
    The system provides two-factor authentication through user IDs/
passwords. Access to personal information is restricted to those who 
require the data in the performance of their official duties. All 
personnel whose official duties require access to the information are 
trained in the proper safeguarding and use of the information.
    All of the records must be properly secured for the duration of 
their life cycle. The safeguards in place for the paper records include 
placing the documents in locked file cabinets and storage rooms with 
limited access and electronic security measures. In addition, some of 
the records are housed in secure facilities monitored by security 
guards and video surveillance.''

Retention and disposal:
    Delete entry and replace with ``Close out at end of the calendar 
year in which received. Destroy 10 years after cutoff. When subject to 
one or more Litigation Holds, preserve records in compliance with the 
time constraints of the hold(s).''

System manager(s) and address:
    Delete entry and replace with ``Manager, Records Management, 
Administration and Management Directorate, 16401 East Centretech 
Parkway, Aurora, CO 80011-9066.''

Notification procedure:
    Delete entry and replace with ``Individuals seeking to determine 
whether information about themselves is contained in this system of 
records should address written inquiries to Chief, Freedom of 
Information Act (FOIA) Service Center, Defense Health Agency Privacy 
and Civil Liberties Office, 7700 Arlington Boulevard, Suite 5101, Falls 
Church, VA 22042-5101.
    Requests should contain the full name and signature of the sponsor 
or beneficiary.
    If requesting information about a minor or legally incompetent 
person, the request must be made by the custodial parent, legal 
guardian, or party acting in loco parentis of such individual. Written 
proof of that status may be required before the existence of any 
information will be confirmed.''

Record access procedures:
    Delete entry and replace with ``Individuals seeking access to 
records about themselves contained in this system of records should 
address written inquiries to the Chief, FOIA Service Center, Defense 
Health Agency Privacy and Civil Liberties Office, 7700 Arlington 
Boulevard, Suite 5101, Falls Church, VA 22042-5101.
    Written requests for information should include the full name and 
signature of the sponsor or beneficiary.
    If requesting records about a minor or legally incompetent person, 
the request

[[Page 65722]]

must be made by the custodial parent, legal guardian, or party acting 
in loco parentis of such individual. Written proof of that status may 
be required before any records will be provided.''

Contesting record procedures:
    Delete entry and replace with ``The Office of the Secretary of 
Defense (OSD) rules for accessing records, for contesting contents and 
appealing initial agency determinations are published in OSD 
Administrative Instruction 81, 32 CFR part 311, or may be obtained from 
the system manager.''

Record source categories:
    Delete entry and replace with ``Contractors, Beneficiary Counseling 
and Assistance Coordinators, other Components of the Department of 
Defense, all branches of the Uniformed Services, Congressional offices, 
providers of care, consultants, and sponsor and/or beneficiary.''
* * * * *
[FR Doc. 2015-27230 Filed 10-26-15; 8:45 am]
BILLING CODE 5001-06-P