Privacy Act of 1974; Report of Modified or Altered System

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

Privacy Act of 1974; Report of Modified or Altered System

AGENCY: Health Care Financing Administration (HCFA), Department of

Health and Human Services (HHS).

ACTION: Notice of Modified or Altered System of Records (SOR).

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SUMMARY: In accordance with the requirements of the Privacy Act of

1974, we are proposing to modify or alter a SOR, ``Explanation of

Medicare Benefits Records (EOMB), HHS/HCFA/BPO, System No. 09-70-

0513.'' We are proposing to change the name of the SOR to ``Medicare

Benefits Notices (MBN), HHS/HCFA/CBS, System No. 09-70-0513.'' We are

also proposing to add one new routine use for contractors and

consultants, update any sections of the SOR that were affected by the

recent reorganization, and to update language in the administrative

sections to correspond with language used in other HCFA SOR. The

primary purpose of the SOR to provide an explanation of Medicare claims

processed and to advise beneficiaries of supplemental insurance,

deductible status, appeals information and general Medicare

information. Information retrieved from this SOR will be used to

support regulatory and policy functions performed within the agency or

by a contractor or consultant, support constituent requests made to a

congressional representative, and to support litigation involving the

agency related to this SOR. We have provided background information

about the proposed system in the ``Supplementary Information'' section

below. Although the Privacy Act requires only that HCFA provide an

opportunity for interested persons to comment on the proposed routine

uses, HCFA invites comments on all portions of this notice. See

``Effective Dates'' section for comment period.

EFFECTIVE DATES: HCFA filed a modified or altered 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 July 18, 2000. To ensure that all

parties have adequate time in which to comment, the modified or altered

SOR, including routine uses, will become effective 40 days from the

publication of the notice, or from the date it was submitted to OMB and

the Congress, whichever is later, unless HCFA receives comments that

require alterations to this notice.

ADDRESSES: The public should address comments to: Director, Division of

Data Liaison and Distribution (DDLD), HCFA, Room 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 time zone.

FOR FURTHER INFORMATION CONTACT: Maria Ramirez, Division of Contractor

Customer Service Operations, Center for Beneficiary Services, HCFA, C2-

02-10, 7500 Security Boulevard, Baltimore, Maryland, 21244-1850. The

telephone number is 410-786-1122.

SUPPLEMENTARY INFORMATION:

I. Description of the Modified SOR

Statutory and Regulatory Basis for SOR

In 1981, HCFA established a SOR under the authority of sections

205, 226, 1811, and 1832 of Title XVIII of the Social Security Act (42

U.S.C. 405, 426, 1395c, and 1395k). Notice of this system,

``Explanation of Medicare Benefits Records, (EOMB),'' HHS/HCFA/BPO,

System No. 09-70-0513, was published in the Federal Register on October

27, 1981 (46 FR 52706). These regulations established the requirement

that an explanation of Medicare benefits be sent to beneficiaries

advising them of Medicare benefits remaining, and whether the various

deductible requirements have been satisfied.

II. Collection and Maintenance of Data in the System.

A. Scope of the Data Collected

The system includes Medicare hospital insurance benefits records,

Part B benefits records, home health benefits records, and Medicare

hospital benefits records. These are notices of utilization and

explanation of Medicare benefits. They also advise beneficiaries of

supplementary insurance, deductible status, appeals information, and

general Medicare information.

B. Agency Policies, Procedures, and Restrictions on the Routine Use

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 MBN information as provided for under

``Section III. Entities Who May Receive Disclosures Under Routine

Use.''

We will only disclose the minimum personal data necessary to

achieve the purpose of MBN. HCFA has the following policies and

procedures concerning disclosures of information which will be

maintained in the system. In general, disclosure of information from

the SOR will be approved only for the minimum information necessary to

accomplish the purpose of the disclosure after HCFA:

(a) Determines that the use or disclosure is consistent with the

reason that the data is being collected, e.g.,

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provide an explanation of Medicare claims processed to beneficiaries.

(b) Determines:

(1) That the purpose for which the disclosure is to be made can

only be accomplished if the record is provided in individually

identifiable form;

(2) That 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

(3) That there is a strong probability that the proposed use of the

data would in fact accomplish the stated purpose(s).

(c) Requires the information recipient to:

(1) Establish administrative, technical, and physical safeguards to

prevent unauthorized use of disclosure of the record;

(2) Remove or destroy at the earliest time all individual-

identifiable information; and

(3) Agree to not use or disclose the information for any purpose

other than the stated purpose under which the information was

disclosed.

(d) Determines that the data are valid and reliable.

III. Proposed Routine Use Disclosures of Data in the System

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 HCFA may

release information from the MBN 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. In addition, our

policy will be to prohibit release even of non-identifiable data,

except pursuant to one of the routine uses, if 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). We are proposing to establish the following routine use

disclosures of information maintained in the system:

1. To agency contractors, or consultants who have been engaged by

the agency to assist in the performance of a service related to this

system of records and who need to have access to the records in order

to perform the activity.

We contemplate disclosing information under this routine use only

in situations in which HCFA may enter into a contractual or similar

agreement with a third party to assist in accomplishing HCFA functions

relating to purposes for this SOR.

HCFA occasionally contracts out certain of its functions when this

would contribute to effective and efficient operations. HCFA must be

able to give contractors or consultants 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 to return

or destroy all information at the completion of the contract.

2. To a Member of Congress or to 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.

Beneficiaries sometimes request the help of a Member of Congress in

resolving an issue relating to a matter before HCFA. The Member of

Congress then writes HCFA, and HCFA must be able to give sufficient

information to be responsive to the inquiry.

3. 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, HCFA 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 HCFA is involved in litigation, and occasionally when

another party is involved in litigation and HCFA's policies or

operations could be affected by the outcome of the litigation, HCFA

would be able to disclose information to the DOJ, court or adjudicatory

body involved.

IV. Safeguards

A. Authorized Users

Personnel having access to the system have been trained in Privacy

Act requirements. Employees who maintain records in the system are

instructed not to release any data until the intended recipient agrees

to implement appropriate administrative, technical, procedural, and

physical safeguards sufficient to protect the confidentiality of the

data and to prevent unauthorized access to the data. Records are used

in a designated work area or work station and the system location is

attended at all times during working hours.

To ensure security of the data, the proper level of class user is

assigned for each individual user. This prevents unauthorized users

from accessing and modifying critical data. The system database

configuration includes five classes of database users:

Database Administrator class owns the database objects,

e.g., tables, triggers, indexes, stored procedures, packages, and has

database administration privileges to these objects;

Quality Control Administrator class has read and write

access to key fields in the database;

Quality Indicator (QI) Report Generator class has read-

only access to all fields and tables;

Policy Research class has query access to tables, but are

not allowed to access confidential patient identification information;

and

Submitter class has read and write access to database

objects, but no database administration privileges.

B. Physical Safeguards

All server sites have implemented the following minimum

requirements to assist in reducing the exposure of computer equipment

and thus achieve an optimum level of protection and security for the

MBN system:

Access to all servers is controlled, with access limited to only

those support personnel with a demonstrated need for access. Servers

are to be kept in a locked room accessible only by specified management

and system support personnel. Each server requires a specific log-on

process. All entrance doors are identified and marked. A log is kept of

all personnel who were issued a security card, key and/or combination

which grants access to the room housing the server, and all visitors

are escorted while in this room. All servers are housed in an area

where appropriate environmental security controls are implemented,

which include measures implemented to mitigate damage to Automated

Information System (AIS)

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resources caused by fire, electricity, water and inadequate climate

controls.

Protection applied to the workstations, servers and databases

include:

User Log-ons--Authentication is performed by the Primary

Domain Controller/Backup Domain Controller of the log-on domain.

Workstation Names--Workstation naming conventions may be

defined and implemented at the agency level.

Hours of Operation--May be restricted by Windows NT. When

activated all applicable processes will automatically shut down at a

specific time and not be permitted to resume until the predetermined

time. The appropriate hours of operation are determined and implemented

at the agency level.

Inactivity Log-out--Access to the NT workstation is

automatically logged-out after a specified period of inactivity.

Warnings--Legal notices and security warnings display on

all servers and workstations.

Remote Access Security (RAS)--Windows NT RAS security

handles resource access control. Access to NT resources is controlled

for remote users in the same manner as local users, by utilizing

Windows NT file and sharing permissions. Dial-in access can be granted

or restricted on a user-by-user basis through the Windows NT RAS

administration tool.

There are several levels of security found in the MBN system.

Windows NT provides much of the overall system security. The Windows NT

security model is designed to meet the C2-level criteria as defined by

the U.S. Department of Defense's Trusted Computer System Evaluation

Criteria document (DoD 5200.28-STD, December 1985). Netscape Enterprise

Server is the security mechanism for all MBN transmission connections

to the system. As a result, Netscape controls all MBN information

access requests. Anti-virus software is applied at both the workstation

and NT server levels.

Access to different areas on the Windows NT server is maintained

through the use of file, directory and share level permissions. These

different levels of access control provide security that is managed at

the user and group level within the NT domain. The file and directory

level access controls rely on the presence of an NT File System (NTFS)

hard drive partition. This provides the most robust security and is

tied directly to the file system. Windows NT security is applied at

both the workstation and NT server levels.

C. Procedural Safeguards

All automated systems must comply with Federal laws, guidance, and

policies for information systems security. These include, but are not

limited to: the Privacy Act of 1974, the Computer Security Act of 1987,

OMB Circular A-130, revised, Information Resource Management (IRM)

Circular #10, HHS Automated Information Systems Security Program, the

HCFA Information Systems Security Policy and Program Handbook, and

other HCFA systems security policies. Each automated information system

should ensure a level of security commensurate with the level of

sensitivity of the data, risk, and magnitude of the harm that may

result from the loss, misuse, disclosure, or modification of the

information contained in the system.

V. Effect of the Proposed SOR on Individual Rights

HCFA 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 SOR.

HCFA will monitor the collection and reporting of MBN data. HCFA

will take precautionary measures (see item IV. above) to minimize the

risks of unauthorized access to the records and the potential harm to

individual privacy or other personal or property rights. HCFA will

collect only that information necessary to perform the system's

functions. In addition, HCFA 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.

HCFA, therefore, does not anticipate an unfavorable effect on

individual privacy as a result of the disclosure of information

relating to individuals.

Dated: July 7, 2000.

Nancy-Ann Min DeParle,

Administrator, Health Care Financing Administration.

SYSTEM NAME:

Medicare Benefits Notices (MBN), HHS/HCFA/CBS.

SECURITY CLASSIFICATION:

Level Three Privacy Act Sensitive Data.

SYSTEM LOCATION:

HCFA Data Center, 7500 Security Boulevard, North Building, First

Floor, Baltimore, Maryland 21244-1850, and Medicare intermediaries and

carriers and agents at various locations.

CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:

All recipients of Medicare Part A and Part B services and supplies.

CATEGORIES OF RECORDS IN THE SYSTEM:

The system includes the following information for each beneficiary:

Name; address; health insurance claims number (HIC); dates of service;

and the contractor assigned claim control number.

AUTHORITY FOR MAINTENANCE OF THE SYSTEM:

Sections 205, 226, 1811, and 1832 of Title XVIII of the Social

Security Act (42 USC 405, 426, 1395c, and 1395k).

PURPOSE(S):

The primary purpose of the system of records is to provide an

explanation of Medicare claims processed and to advise beneficiaries of

supplemental insurance, deductible status, appeals information and

general Medicare information. Information retrieved from this system of

records will be used to support regulatory and policy functions

performed within the agency or by a contractor or consultant, support

constituent requests made to a congressional representative, and to

support litigation involving the agency related to this system of

records.

ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM, INCLUDING CATEGORIES

OR USERS AND THE PURPOSES OF SUCH USES:

The Privacy Act allows 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 compatible use of data is known as a ``routine

use.'' The proposed routine use in this system meets the compatibility

requirement of the Privacy Act. We are proposing to establish the

following routine use disclosures of information that will be

maintained in the system:

1. To agency contractors, or consultants who have been engaged by

the agency to assist in the performance of a service related to this

system of records and who need to have access to the records in order

to perform the activity.

2. To a Member of Congress or to a congressional staff member in

response to an inquiry of the congressional office made at the written

request of the

[[Page 48003]]

constituent about whom the record is maintained.

3. 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, HCFA 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.

POLICIES AND PRACTICES FOR STORING, RETRIEVING, ACCESSING, RETAINING,

AND DISPOSING OF RECORDS IN THE SYSTEM:

STORAGE:

Computer diskette and on magnetic storage media.

RETRIEVABILITY:

Information can be retrieved by the beneficiary's health insurance

claims number or a contractor assigned claim control number.

SAFEGUARDS:

HCFA has safeguards 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 systems security

requirements. Employees who maintain records in the system are

instructed not to release any data until the intended recipient agrees

to implement appropriate administrative, technical, procedural, and

physical safeguards sufficient to protect the confidentiality of the

data and to prevent unauthorized access to the data.

In addition, HCFA has physical safeguards in place to reduce the

exposure of computer equipment and thus achieve an optimum level of

protection and security for the MBN system. For computerized records,

safeguards have been established in accordance with HHS standards and

National Institute of Standards and Technology guidelines, e.g.,

security codes will be used, limiting access to authorized personnel.

System securities are established in accordance with HHS, Information

Resource Management (IRM) Circular #10, Automated Information Systems

Security Program; HCFA Automated Information Systems (AIS) Guide,

Systems Securities Policies, and OMB Circular No. A-130 (revised),

Appendix III.

RETENTION AND DISPOSAL:

Records are maintained in a secure storage area with identifiers.

Records are placed in an inactive status at the close of the calendar

year in which the benefit was paid, held two more years, transferred to

a federal records center and destroyed after another six years.

SYSTEM MANAGER:

Director, Division of Contractor Customer Service Operations,

Center for Beneficiary Services, HCFA, C2-26-21, 7500 Security

Boulevard, Baltimore, Maryland, 21244-1850. The telephone number is

410-786-2133.

NOTIFICATION PROCEDURE:

For purpose of access, the subject individual should write to the

system manager who will require the system name, health insurance claim

number, address, date of birth and sex, and for verification purposes,

the subject individual's name (woman's maiden name, if applicable) and

social security number (SSN). 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:

Sources of information contained in this records system are

provided by the beneficiary when applying for benefits or requesting

payment, the physician or provider of services when requesting payment,

and computations for amounts of payments and remaining benefits

provided by the carriers and intermediaries.

SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS OF THE ACT:

None.

FR Doc. 00-18549 Filed 8-3-00; 8:45 am]

BILLING CODE 4120-03-P