[Federal Register Volume 84, Number 25 (Wednesday, February 6, 2019)]
[Notices]
[Pages 2230-2233]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-01157]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES


Privacy Act of 1974; System of Records

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

ACTION: Notice of a Modified System of Records.

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SUMMARY: The Department of Health and Human Services (HHS), Centers for 
Medicare & Medicaid Services (CMS), proposes to modify an existing 
system of records subject to the Privacy Act, System No. 09-70-0541, 
titled Medicaid Statistical Information System (MSIS). This system of 
records covers the national Medicaid dataset, consisting of 
standardized enrollment, eligibility, and paid claims data about 
Medicaid recipients which is used to administer Medicaid at the federal 
level, produce statistical reports, support Medicaid related research, 
and assist in the detection of fraud and abuse in the Medicare and 
Medicaid programs. CMS is changing the name of the system of records to 
Transformed-Medicaid Statistical Information System (T-MSIS) and making 
other modifications which are explained below.

DATES: In accordance with 5 United States Code (U.S.C.) 552a(e)(4) and 
(11), this notice is applicable February 6, 2019, subject to a 30-day 
period in which to comment on the routine uses. Submit any comments by 
March 8, 2019.

ADDRESSES: Written comments should be submitted by mail or email to: 
CMS Privacy Act Officer, Division of Security, Privacy Policy & 
Governance, Information Security & Privacy Group, Office of Information 
Technology, CMS, Location N1-14-56, 7500 Security Blvd., Baltimore, MD 
21244-1870, or [email protected].

FOR FURTHER INFORMATION CONTACT: General questions about the system of 
records may be submitted to Darlene Anderson, Health Insurance 
Specialist, Data and Systems Group, Center for Medicaid and CHIP 
Services (CMCS), CMS, Mail Stop S2-22-16, 7500 Security Blvd., 
Baltimore, MD 21244; telephone number (410) 786-9828; email address 
[email protected].

SUPPLEMENTARY INFORMATION:

I. Program and IT System Changes Prompting this SORN Modification

    The Transformed Medicaid Statistical Information System (T-MSIS) is 
replacing the Medicaid Statistical Information System (MSIS) as the 
information technology (IT) system that houses the national Medicaid 
dataset. It is a joint effort by the states and CMS to build an 
improved Medicaid dataset that addresses problems identified with 
Medicaid data in MSIS. T-MSIS provides improved program monitoring and 
oversight, technical assistance with states, policy implementation, and 
data-driven and high-quality Medicaid and CHIP programs that ensure 
better care, access to coverage, and improved health.
    To improve Medicaid program oversight, CMS is requiring states to 
submit new files and data elements in T-MSIS which were not collected 
in MSIS, for the purpose of improving the quality of the data extracts 
the states submit to CMS on a quarterly or other periodic basis. 
Following consultation with a wide array of stakeholders, CMS 
established over 1,000 data elements for T-MSIS. This expands on the 
approximately 400 data elements collected in MSIS. T-MSIS builds on the 
original five MSIS files, consisting of eligibility files and four 
types of claims files (inpatient, long-term care, pharmacy, and other), 
by adding files for third-party liability, managed-care plans, and 
Medicaid providers, and by adding T-MSIS analytic files (TAF).
    Currently, each state submits five extracts to CMS on a quarterly 
basis. These data are used by CMS to assist in federal reporting for 
the Medicaid and Children's Health Insurance Program (CHIP). Several 
reasons culminated in the CMS mission to improve the Medicaid dataset 
repository, including incomplete data, questionable results, multiple 
data collections from states, multiple federal data platforms and 
analytic difficulties in interpreting and presenting the results. In 
addition, timeliness issues have prompted CMS to re-evaluate its 
processes and move toward a streamlined delivery, along with an 
enhanced data repository. The new T-MSIS extract format is expected to 
further CMS goals for improved timeliness, reliability and robustness 
through monthly updates and an increase in the amount of data 
requested.

II. Modifications to SORN 09-70-0541

    The following modifications have been made to SORN 09-70-0541 in 
order to reflect changes to the system of records resulting from the IT 
system change from MSIS to T-MSIS and to update the SORN generally:
     The SORN has been reformatted to conform to the revised 
template prescribed in OMB Circular A-108, issued December 23, 2016.

[[Page 2231]]

     The name of the system of records has been changed from 
``Medicaid Statistical Information System (MSIS)'' to ``Transformed--
Medicaid Statistical Information System (T-MSIS), HHS/CMS/CMCS.''
     Address information in the System Location and System 
Manager(s) sections has been updated.
     The Authority section now cites 42 U.S.C. 1396b(r) in 
place of a public law citation and includes one new authority, 42 
U.S.C. 18001, et seq.
     The Purpose section has been revised to omit a summary of 
the routine uses and to include additional purposes for which T-MSIS 
records may be used (``reduce the number of reports CMS requires of the 
states, provide data needed to improve beneficiary quality of care, 
improve program integrity, and support the states, the private market, 
and stakeholders with key information'').
     The Categories of Individuals section, which was 
previously limited to Medicaid recipients and Medicaid providers, now 
also includes non-Medicaid individuals, third party data submitters, 
and contact persons.
     The Categories of Records section now specifies categories 
of records in addition to listing data elements; groups the data 
elements by category of individual; adds name, address, phone number, 
TIN/EIN, NPI, MBI and ``information about health care services the 
clinician provided to Medicaid recipients and the measures and 
activities the clinician used in providing the services;'' and omits 
``information used to determine whether a sanction or suspension is 
warranted.''
     The Record Source Categories section now describes the 
sources as ``state Medicaid agencies or territories, which collect the 
information directly from Medicaid recipients or their providers or 
other authorized representatives'' (instead of as state Medicaid 
agencies and systems and CMS Form 2082).
     The following changes have been made to the Routine Uses 
section:
    [cir] In routine use 2, at c., redundant wording (``within the 
state'') has been removed after the phrase ``assist federal/state 
Medicaid programs.''
    [cir] Routine use 5 has been revised to omit unnecessary wording 
limiting the disclosures to uses ``compatible with the purpose for 
which the agency collected the records.'' (The wording is unnecessary 
because it restates the definition of a routine use.)
    [cir] One new routine use has been added, numbered as 3, which 
permits disclosures to support federally-funded benefit programs.
    [cir] The fraud, waste, and abuse routine use which was added May 
29, 2013 is now numbered as 8.
    [cir] The two breach response-related routine uses which were added 
February 14, 2018 are now numbered as 9 and 10.
     The Storage section now states that records are stored 
``in an information technology (IT) system'' (instead of ``on computer 
diskette and magnetic media'').
     The Retrieval section previously listed these personal 
identifiers: beneficiary identification number, social security number 
(SSN), HICN, and provider identification number. It now groups the 
identifiers by category of individual and includes additional 
identifiers (e.g., MBI and NPI).
     The Retention and Disposal section has been revised to 
state that identifiable ``T-MSIS'' data will be retained ``for a period 
of 10 years'' after the final determination of ``the applicable 
enrollment, eligibility, or claim'' is completed (instead of stating 
that identifiable ``MSIS'' data will be retained ``for a total period 
not to exceed 10 years'' after the final determination of ``the case'' 
is completed).
     The Safeguards section has been updated to list examples 
of applicable safeguards (security guards, badges and cameras, locks, 
limiting user access based on roles and two-factor authentication, 
encryption, firewalls, intrusion detection systems).
     The procedures for making access, correction and 
amendment, and notification requests have been revised. In the previous 
iteration of the SORN, the verification procedures required the 
individual's name (woman's maiden name, if applicable). The individual 
had the option of furnishing the SSN to prevent delay in locating the 
record(s). The new process to verify identity requires a notarized 
signature or a statement under penalty of perjury (instead of requiring 
name and` woman's maiden name if applicable). Additionally, in order to 
locate the record(s), the individual's name and SSN are now required 
(previously, SSN was optional for this purpose).

Barbara Demopulos,
Privacy Advisor, Division of Security, Privacy Policy and Governance, 
Information Security and Privacy Group, Office of Information 
Technology, Centers for Medicare & Medicaid Service.

SYSTEM NAME AND NUMBER:
    Transformed--Medicaid Statistical Information System (T-MSIS), HHS/
CMS/CMCS, System No. 09-07-0541.

SECURITY CLASSIFICATION:
    Unclassified.

SYSTEM LOCATION:
    The address of the agency component responsible for the system of 
records is: The CMS Data Center, 7500 Security Blvd. North Bldg., First 
Floor, Baltimore, MD 21244-1850.

SYSTEM MANAGER(S):
    Director, Data and Systems Group, Center for Medicaid and CHIP 
Services, CMS Mail Stop S2-22-16, 7500 Security Boulevard, Baltimore, 
MD 21244-1850, telephone number (410) 786-9361.

AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
    42 U.S.C. 1396a(a)(6), 1396b(r), and 18001 et seq.

PURPOSE(S) OF THE SYSTEM:
    The primary purpose of the system is to establish an accurate, 
current, and comprehensive database containing standardized enrollment, 
eligibility, and paid claims data about Medicaid recipients to be used 
for the administration of Medicaid at the federal level, produce 
statistical reports, support Medicaid related research, and assist in 
the detection of fraud and abuse in the Medicare and Medicaid programs. 
T-MSIS will also reduce the number of reports CMS requires of the 
states, provide data needed to improve beneficiary quality of care, 
improve program integrity, and support the states, the private market, 
and stakeholders with key information.

CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:
    The records in this system of records are about the following 
categories of individuals:
     Medicaid recipients (including individuals in the dual 
eligible population, individuals enrolled in the CHIP program, and non-
Medicaid individuals);
     Medicaid providers (i.e., physicians and providers of 
healthcare services to the Medicaid and CHIP population);
     Any non-Medicaid individuals whose information is 
contained in a record about a Medicaid recipient or Medicaid provider;
     Third party data submitters; i.e., third party 
administrators or independent insurance company personnel who are 
required to report claims information pertaining to Medicaid 
recipients; and
     Contact persons such as parents and guardians of Medicaid 
recipients who are minors, CHIP recipients, and non-Medicaid 
individuals.

CATEGORIES OF RECORDS IN THE SYSTEM:
    The categories of records are:

[[Page 2232]]

     Original MSIS files:

    [cir] Eligibility files
    [cir] claims files (for inpatient, long-term care, pharmacy, and 
other claims)

     New files added to T-MSIS database:
    [cir] Third-party liability
    [cir] managed care plans
    [cir] Medicaid providers

     New T-MSIS analytic files (TAF):
    [cir] Beneficiary files (monthly beneficiary summary, annual 
beneficiary summary)
    [cir] claims files (for inpatient, long-term care, pharmacy, and 
other claims)
    [cir] providers of healthcare services to the Medicaid and CHIP 
population; and
    [cir] managed care plans

    Data elements about each category of individual may include the 
following:
     Medicaid recipients: Name, address, assigned Medicaid 
identification number, social security number (SSN), Medicare 
beneficiary identifier (MBI), date of birth, gender, ethnicity and 
race, medical services, equipment, and supplies for which Medicaid 
reimbursement is requested, individually identifiable health 
information (i.e., health care utilization and claims data), and health 
insurance claim number (HICN).
     Medicaid providers: Name, address, phone number, email 
address, business address, date of birth, tax identification number/
employer identification number (TIN/EIN), national provider identifier 
(NPI), SSN, prescriber identification number, and other assigned 
clinician numbers, and information about health care services the 
clinician provided to Medicaid recipients and the measures and 
activities the clinician used in providing the services.
     Any non-Medicaid individuals: Name, address, phone number, 
email address, and SSN or other identifying number.
     Third party data submitters: Name, address, phone number, 
and email address.
     Contact persons: Name, address, phone number, email 
address, TIN/EIN, or other identifying number.

RECORD SOURCE CATEGORIES:
    Information in the system of records is obtained from state 
Medicaid agencies or territories, which collect the information 
directly from Medicaid recipients or their providers or other 
authorized representatives (such as parents and guardians of Medicaid 
recipients who are minors).

ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM, INCLUDING CATEGORIES 
OF USERS AND PURPOSES OF SUCH USES:
    The agency may disclose a record about an individual record subject 
from this system of records to parties outside HHS, without the 
individual's prior written consent, pursuant to these routine uses:
    1. To support agency contractors, consultants, or CMS grantees who 
have been engaged by the agency to assist in the performance of a 
service related to the collection and who need to have access to the 
records in order to perform the activity.
    2. To assist another federal or state agency, agency of a state 
government, an agency established by state law, or its fiscal agent to:
    a. Contribute to the accuracy of CMS' proper management of 
Medicare/Medicaid 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.
    3. To assist another federal or state agency, agency of a state 
government, an agency established by state law, or its fiscal agent to 
enable such agency to administer a federal benefits program, or as 
necessary to enable such agency to fulfill a requirement of a federal 
statute or regulation funded in whole or in part with federal funds.
    4. To an individual or organization for a research project or in 
support of an evaluation project related to the prevention of disease 
or disability, the restoration or maintenance of health, or payment 
related projects.
    5. To the Department of Justice (DOJ), court or adjudicatory body 
when:
    a. The agency or any component thereof;
    b. any employee of the agency in his or her official capacity;
    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.
    6. To a CMS contractor (including fiscal intermediaries and 
carriers) assisting 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, 
waste, and abuse in such program.
    7. 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, 
waste, and 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, waste, and abuse in such programs.
    8. To disclose to health plans, defined for this purpose as plans 
or programs that provide health benefits, whether directly, through 
insurance, or otherwise, and including--(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.
    9. To appropriate agencies, entities, and persons when (a) HHS 
suspects or has confirmed that there has been a breach of the system of 
records; (b) HHS has determined that as a result of the suspected or 
confirmed breach there is a risk of harm to individuals, HHS (including 
its information systems, programs, and operations), the federal 
government, or national security; and (c) the disclosure made to such 
agencies, entities, and persons is reasonably necessary to assist in 
connection with HHS' efforts to respond to the suspected or confirmed 
breach or to prevent, minimize, or remedy such harm.
    10. To another federal agency or federal entity, when HHS 
determines that information from this system of records is reasonably 
necessary to assist the recipient agency or entity in (a) responding to 
a suspected or confirmed breach or (b) preventing, minimizing, or 
remedying the risk of harm to individuals, the recipient agency or 
entity (including its information systems, programs, and operations), 
the federal government, or national security, resulting from a 
suspected or confirmed breach.
    Additional Circumstances Affecting Routine Use Disclosures: To the 
extent this system contains Protected Health

[[Page 2233]]

Information (PHI) as defined by HHS regulation ``Standards for Privacy 
of Individually Identifiable Health Information'' (45 CFR parts 160 and 
164, 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'' (see 45 CFR 164.512(a)(1)).
    The disclosures authorized by publication of the above routine uses 
pursuant to 5 U.S.C. 552a(b)(3) are in addition to other disclosures 
authorized directly in the Privacy Act at 5 U.S.C. 552a(b)(2) and 
(b)(4)-(11).

POLICIES AND PRACTICES FOR STORAGE OF RECORDS:
    All records are stored in an information technology (IT) system.

POLICIES AND PRACTICES FOR RETRIEVAL OF RECORDS:
    All data collected on Medicaid recipients, Medicare beneficiaries, 
and any non-Medicaid individuals are retrieved by the individual's 
name, Medicare beneficiary identifier (MBI), health insurance claim 
number (HICN), SSN, address, and date of birth. The data collected on 
Medicaid providers will be retrieved by the provider's name, address, 
National Provider Identifier (NPI), TIN/EIN and other identifying 
provider numbers. Information about third party data submitters who are 
individuals will be retrieved by name, address, and TIN/EIN. Records 
about contact persons will be retrieved by name, email address and 
business address.

POLICIES AND PRACTICES FOR RETENTION AND DISPOSAL OF RECORDS:
    CMS will retain identifiable T-MSIS data for a period of 10 years 
after the final determination of the applicable enrollment, 
eligibility, or claim is completed. Any claims-related records 
encompassed by a document preservation order may be retained longer 
(i.e., until notification is received from the Department of Justice).

ADMINISTRATIVE, TECHNICAL, AND PHYSICAL SAFEGUARDS:
    CMS has safeguards in place to prevent records from being accessed 
by unauthorized persons and monitors authorized users to ensure against 
excessive or unauthorized use. Examples of these safeguards include: 
protecting the facilities where records are stored or accessed with 
security guards, badges and cameras, securing hard-copy records in 
locked file cabinets, file rooms or offices during off-duty hours, 
limiting access to electronic databases to authorized users based on 
roles and two-factor authentication (user ID and password), using a 
secured operating system protected by encryption, firewalls, and 
intrusion detection systems, requiring encryption for records stored on 
removable media, and training personnel in Privacy Act and information 
security requirements. Records that are eligible for destruction are 
disposed of using destruction methods prescribed by NIST SP 800-88. 
Before disclosing records to a party outside CMS, CMS requires the 
intended recipient 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.

RECORD ACCESS PROCEDURES:
    An individual seeking access to a record about him/her in this 
system of records must submit a written request to the System Manager 
indicated above. The request must contain the individual's name and 
particulars necessary to distinguish between records on subject 
individuals with the same name, such as NPI or TIN, and should also 
reasonably specify the record(s) to which access is sought. To verify 
the requester's identity, the signature must be notarized or the 
request must include the requester's written certification that he/she 
is the person he/she claims to be and that he/she understands that the 
knowing and willful request for or acquisition of records pertaining to 
an individual from an agency under false pretenses is a criminal 
offense subject to a $5,000 fine. Additionally, in order to locate the 
record(s), the individual's name and SSN are required.

CONTESTING RECORD PROCEDURES:
    Any subject individual may request that his/her record be corrected 
or amended if he/she believes that the record is not accurate, timely, 
complete, or relevant or necessary to accomplish a Department function. 
A subject individual making a request to amend or correct his record 
shall address his request to the System Manager indicated, in writing, 
must verify his/her identity in the same manner required for an access 
request, and must provide his/her name and SSN for the purpose of 
locating the record. The subject individual shall specify in each 
request: (1) The system of records from which the record is retrieved; 
(2) The particular record and specific portion which he/she is seeking 
to correct or amend; (3) The corrective action sought (e.g., whether 
he/she is seeking an addition to or a deletion or substitution of the 
record); and, (4) His/her reasons for requesting correction or 
amendment of the record. The request should include any supporting 
documentation to show how the record is inaccurate, incomplete, 
untimely, or irrelevant.

NOTIFICATION PROCEDURES:
    Individuals wishing to know if this system contains records about 
them should write to the System Manager indicated above and follow the 
same instructions under Record Access Procedures.

EXEMPTIONS PROMULGATED FOR THE SYSTEM:
    None.

HISTORY:
    71 FR 65527 (Nov. 8, 2006), 78 FR 32257 (May 29, 2013), 83 FR 6591 
(Feb. 14, 2018).

[FR Doc. 2019-01157 Filed 2-5-19; 8:45 am]
BILLING CODE 4120-03-P