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Federal Register / Vol. 70, No.

174 / Friday, September 9, 2005 / Notices 53667

which the Secretary may contract with practitioner, provider, and supplier Record File-Claims, Recipient File
eligible entities to conduct a variety of enrollment records of Medicare Layout, Provider File Layout.
program safeguard activities, including beneficiaries, practitioners, providers,
INCLUSIVE DATES OF THE MATCH:
fraud review employing equipment and and suppliers in the State of Florida
software technologies that surpass the against records of Florida Medicaid The CMP shall become effective no
existing capabilities of FIs and carriers beneficiaries, practitioners, providers, sooner than 40 days after the report of
(42 U.S.C. 1395ddd)). The contracting and suppliers in the State of Florida. the Matching Program is sent to OMB
entities are called Program Safeguards and Congress, or 30 days after
DESCRIPTION OF RECORDS TO BE USED IN THE publication in the Federal Register,
Contractors. MATCHING PROGRAM:
Pursuant to § 409.902, Florida which ever is later. The matching
Statutes (F.S.), AHCA is charged with The data for CMS are maintained in program will continue for 18 months
the administration of the Medicaid the following Systems of Records: from the effective date and may be
program in Florida, and is the single National Claims History (NCH), System extended for an additional 12 months
state agency for such purpose. AHCA is No. 09–70–0005 was most recently thereafter, if certain conditions are met.
required to operate a program to oversee published in the Federal Register, at 67
[FR Doc. 05–17846 Filed 9–8–05; 8:45 am]
the activities of Florida Medicaid FR 57015 (September 6, 2002.) NCH
BILLING CODE 4120–03–P
recipients and providers to ensure that contains records needed to facilitate
fraudulent and abusive behavior occurs obtaining Medicare utilization review
to the minimum extent possible data that can be used to study the
DEPARTMENT OF HEALTH AND
(§ 409.913, F.S.). operation and effectiveness of the
HUMAN SERVICES
AHCA’s disclosure of the Medicaid Medicare program. Matched data will be
data pursuant to this agreement is for released to AHCA pursuant to the Centers for Medicare & Medicaid
purposes directly connected with the routine use as set forth in the system Services
administration of the Medicaid program, notice.
in compliance with 42 CFR 431.300 Carrier Medicare Claims Record, Privacy Act of 1974; Report of a New
through 431.307. Those purposes are the System No. 09–70–0501 was published System of Records
detection, prosecution and deterrence of in the Federal Register at 67 FR 54428
(August 22, 2002). Matched data will be AGENCY: Department of Health and
fraud and abuse (F&A) in the Medicaid Human Services (HHS), Centers for
program. released to AHCA pursuant to the
routine use as set forth in the system Medicare & Medicaid Services (CMS).
PURPOSE(S) OF THE MATCHING PROGRAM: notice. ACTION: Notice of a new System of
The purpose of this agreement is to Enrollment Database, System No. 09– Records (SOR).
establish the conditions, safeguards, and 70–0502 was published in the Federal
Register at 67 FR 3203 (January 23, SUMMARY: In accordance with the
procedures under which CMS will
conduct a computer matching program 2002). Matched data will be released to requirements of the Privacy Act of 1974,
with AHCA to study claims, billing, and AHCA pursuant to the routine use set we are proposing to create a new SOR
eligibility information to detect forth in the system notice. titled, ‘‘Data Collection Secondary to
suspected instances of Medicare and Intermediary Medicare Claims Coverage Decision (DCSCD) System,
Medicaid F&A in the State of Florida. Record, System No. 09–70–0503 was HHS/CMS/OCSQ, System No. 09–70–
CMS and AHCA will provide EDS, a published in the Federal Register at 67 0547.’’ National Coverage
CMS contractor (hereinafter referred to FR 65982 (October 29, 2002). Matched Determinations (NCDs) are
as the ‘‘Custodian’’) with Medicare and data will be released to AHCA pursuant determinations by the Secretary with
Medicaid records pertaining to to the routine use as set forth in the respect to whether or not a particular
eligibility, claims, and billing which the system notice. item or service is covered nationally
Custodian will match in order to merge Unique Physician/Provider under title XVIII of the Social Security
the information into a single database. Identification Number, System No. 09– Act (the Act) § 1869(f)(1)(B). In order to
Utilizing fraud detection software, the 70–0525, was most recently published be covered by Medicare, an item or
information will then be used to in the Federal Register at 69 FR 75316 service must fall within one or more
identify patterns of aberrant practices (December 16, 2004). Matched data will benefit categories contained within Part
requiring further investigation. The be released to AHCA pursuant to the A or Part B, and must not be otherwise
following are examples of the type of routine use as set forth in the system excluded from coverage. Moreover, with
aberrant practices that may constitute notice. limited exceptions, the expenses
F&A by practitioners, providers, and Medicare Supplier Identification File, incurred for items or services must be
suppliers in the State of Florida System No. 09–70–0530 was most ‘‘reasonable and necessary for the
expected to be identified in this recently published in the Federal diagnosis or treatment of illness or
matching program: (1) Billing for Register, at 67 FR 48184 (July 23, 2002). injury or to improve the functioning of
provisions of more than 24 hours of Matched data will be released to AHCA a malformed body member,’’
services in one day, (2) providing pursuant to the routine use as set forth § 1862(a)(1)(A). CMS has determined
treatment and services in ways more in the system notice. that the evidence is adequate to
statistically significant than similar Medicare Beneficiary Database, conclude that certain identified
practitioner groups, and (3) up-coding System No. 09–70–0536 was published diagnoses are reasonable and necessary
and billing for services more expensive in the Federal Register at 67 FR 63392 in several patient groups where certain
than those actually performed. (December 6, 2001). Matched data will criteria for these patients have been met.
be released to AHCA pursuant to the The reasonable and necessary
CATEGORIES OF RECORDS AND INDIVIDUALS routine use as set forth in the system determination requires that patients
COVERED BY THE MATCH: notice. meet the criteria and are consistent with
This CMP will enhance the ability of The data for AHCA are maintained in the trials discussed. Collection of these
CMS and AHCA to detect F&A by the following data files: Claims File data elements allows that determination
matching claims data, eligibility, and Layouts HIPAA Version, Download File to be made. We are particularly

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53668 Federal Register / Vol. 70, No. 174 / Friday, September 9, 2005 / Notices

interested in seeing evidence that would below if we receive comments that technology. These additional data may
permit us to make a coverage or non- persuade us to defer implementation. alter the course of patient treatment
coverage decision, i.e., to move a ADDRESSES: The public should address based on the best available evidence,
diagnostic indication from coverage comments to the CMS Privacy Officer, and may lead a physician to reconsider
under a clinical trial or study to Mail Stop N2–04–27, 7500 Security the use of the item or service or
coverage or non-coverage based on Boulevard, Baltimore, Maryland 21244– otherwise alter a patient’s management
definitive evidence of benefit, no 1850. Comments received will be plan, potentially improving health
benefit, or harm. If adequate new available for review at this location, by outcomes. In addition, these additional
evidence is available, the decision may appointment, during regular business data will be made available in some
be changed to either ‘‘coverage based on hours, Monday through Friday from 9 form to providers and practitioners to
evidence of benefit,’’ ‘‘limited coverage’’ a.m.–3 p.m., eastern daylight time. inform their decisions, monitor
or ‘‘non-coverage based on evidence of FOR FURTHER INFORMATION CONTACT: performance quality, benchmark and
harm or no benefit.’’ Rosemarie Hakim, Epidemiologist, identify best practices. Collection of
The purpose of this system is to Office of Clinical Standards and these data elements allows that
collect and maintain data on patients to Quality, CMS, Mail Stop C1–09–06, determination to be made. We will also
review determinations of ‘‘reasonable 7500 Security Boulevard, Baltimore, ensure that any future data collection
and necessary’’ with respect to whether Maryland 21244–1849. Her telephone system is consistent with the Standards
or not a particular item or service is number is (410) 786–3934, or she can be for Privacy of Individually Identifiable
covered nationally under title XVIII of reached via e-mail at
Health Information and that all issues
the Act § 1869(f)(1)(B). Information rhakim@cms.hhs.gov.
retrieved from this system will also be related to patient confidentiality,
SUPPLEMENTARY INFORMATION: In the case privacy, and compliance with other
disclosed to: (1) Support regulatory, of ‘‘limited coverage’’, in NCDs for
reimbursement, and policy functions Federal laws will be resolved prior to
which additional evidence is required, the collection of any data.
performed within the agency or by a CMS has determined that the evidence
contractor or consultant; (2) assist is adequate to conclude that the item or I. Description of the Proposed System of
another Federal or state agency with service improves net health outcomes Records
information to enable such agency to only under specific circumstances. One
administer a Federal health benefits A. Statutory and Regulatory Basis for
of these circumstances is that the
program, or to enable such agency to service is delivered in the context of SOR
fulfill a requirement of Federal statute specific data being collected. Coverage
or regulation that implements a health The statutory authority for linking
may be limited to providers who coverage decisions to the collection of
benefits program funded in whole or in participate in and beneficiaries who are
part with Federal funds; (3) to an additional data is derived from Sec.
enrolled in a defined prospective data
individual or organization for a research 1862 (a)(1)(A) of the Act, which states
collection activity, when this data
project or in support of an evaluation that Medicare may not provide payment
collection activity constitutes part of the
project related to the prevention of evidence required to ensure that the for items and services unless they are
disease or disability, the restoration or item or service provided to that patient ‘‘reasonable and necessary’’ for the
maintenance of health, or payment is reasonable and necessary. treatment of illness or injury. In some
related projects; (4) support constituent CMS is committed to ensuring that cases, CMS will determine that an item
requests made to a congressional advances in medical technology are or service is only reasonable and
representative; (5) support litigation available for its Medicare beneficiaries necessary when specific data collections
involving the agency; and (6) combat while ensuring the care they receive is accompany the provision of the service.
fraud and abuse in certain health reasonable and necessary, which is a In these cases, the collection of data is
benefits programs. We have provided necessary condition for payment. The required to ensure that the care
background information about the new coverage with evidence development provided to individual patients will
system in the SUPPLEMENTARY initiative is intended to enable Medicare improve health outcomes.
INFORMATION section below. Although to provide payment for items and
the Privacy Act requires only that CMS B. Collection and Maintenance of Data
services under conditions that help
provide an opportunity for interested assure significant net benefits of the in the System
persons to comment on the proposed treatment for beneficiaries, and to give
routine uses, CMS invites comments on Information will be collected on
rise to additional information. This individuals where CMS has determined
all portions of this notice. See EFFECTIVE evidence will also assist doctors and
DATES section for comment period. that the evidence is adequate to
patients in better understanding the
conclude that certain identified
EFFECTIVE DATES: CMS filed a new SOR risks, benefits and costs of alternative
diagnoses are reasonable and necessary
report with the Chair of the House diagnostic and treatment options.
Committee on Government Reform and Consequently, the linkage of coverage to in several patient groups where certain
Oversight, the Chair of the Senate data collection will also help to ensure criteria for these patients have been met
Committee on Governmental Affairs, that individual patients are receiving and the criteria are consistent with the
and the Administrator, Office of care that is reasonable and necessary trials reviewed. The collected
Information and Regulatory Affairs, given their specific clinical situation; information will contain, but is not
Office of Management and Budget systematic, protocol-driven data has the limited to, name, address, telephone
(OMB) on 09/01/2005. We will not potential to increase the likelihood of number, health insurance claim (HIC)
disclose any information under a improved health outcomes. Care number, geographic location, race/
routine use until 30 days after provided under these protocols may ethnicity, gender, and date of birth, as
publication. We may defer lead to greater attention to appropriate well as, background information relating
implementation of this SOR or one or patient evaluation and selection, as well to Medicare or Medicaid issues.
more of the routine use statements listed as the appropriate application of the

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Federal Register / Vol. 70, No. 174 / Friday, September 9, 2005 / Notices 53669

II. Agency Policies, Procedures, and III. Proposed Routine Use Disclosures and necessary’’ with respect to whether
Restrictions on the Routine Use of Data in the System or not a particular item or service is
A. The Privacy Act allows us to covered nationally under title XVIII of
A. Agency Policies, Procedures, and
disclose information without an the Act § 1869(f)(1)(B).
Restrictions on the Routine Use 3. To an individual or organization for
individual’s consent if the information
The Privacy Act permits us to disclose a research project or in support of an
is to be used for a purpose that is
information without an individual’s evaluation project related to the
compatible with the purpose(s) for
consent if the information is to be used prevention of disease or disability, the
which the information was collected.
for a purpose that is compatible with the restoration or maintenance of health, or
Any such compatible use of data is
purpose(s) for which the information payment related projects.
known as a ‘‘routine use.’’ The proposed
was collected. Any such disclosure of The DCSCD data will provide for
routine uses in this system meet the
data is known as a ‘‘routine use.’’ The research or in support of evaluation
compatibility requirement of the Privacy
government will only release DCSCD projects, a broader, longitudinal,
Act. We are proposing to establish the
information that can be associated with national perspective of the status of
following routine use disclosures of
an individual as provided for under Medicare beneficiaries. CMS anticipates
information maintained in the system:
‘‘Section III. Proposed Routine Use that many researchers will have
1. To agency contractors or
Disclosures of Data in the System.’’ Both legitimate requests to use this data in
consultants who have been engaged by
identifiable and non-identifiable data projects that could ultimately improve
the agency to assist in the performance
may be disclosed under a routine use. the care provided to Medicare
We will only collect the minimum of a service related to this system of
beneficiaries and the policy that governs
personal data necessary to achieve the records and who need to have access to
the care.
purpose of DCSCD. CMS has the the records in order to perform the 4. To a member of Congress or to a
following policies and procedures activity. congressional staff member in response
We contemplate disclosing to an inquiry of the congressional office
concerning disclosures of information
information under this routine use only made at the written request of the
that will be maintained in the system.
in situations in which CMS may enter constituent about whom the record is
Disclosure of information from the
into a contractual or similar agreement maintained.
system will be approved only to the
with a third party to assist in Beneficiaries sometimes request the
extent necessary to accomplish the
accomplishing CMS function relating to help of a member of Congress in
purpose of the disclosure and only after
purposes for this system of records. resolving an issue relating to a matter
CMS:
1. Determines that the use or CMS occasionally contracts out before CMS. The member of Congress
disclosure is consistent with the reason certain of its functions when doing so then writes CMS, and CMS must be able
that the data is being collected, e.g., to would contribute to effective and to give sufficient information to be
provide reimbursement for NCDs and efficient operations. CMS must be able responsive to the inquiry.
assist in the collection of data on to give a contractor or consultant 5. To the Department of Justice (DOJ),
patients receiving an NCD for primary whatever information is necessary for court or adjudicatory body when:
prevention to a data collection process the contractor or consultant to fulfill its a. The agency or any component
to assure patient safety and protection duties. In these situations, safeguards thereof, or
and to determine that the NCD is are provided in the contract prohibiting b. Any employee of the agency in his
reasonable and necessary. the contractor or consultant from using or her official capacity, or
2. Determines that: or disclosing the information for any c. Any employee of the agency in his
a. The purpose for which the purpose other than that described in the or her individual capacity where the
disclosure is to be made can only be contract and requires the contractor or DOJ has agreed to represent the
accomplished if the record is provided consultant to return or destroy all employee, or
in individually identifiable form; information at the completion of the d. The United States Government is a
b. The purpose for which the contract. party to litigation or has an interest in
disclosure is to be made is of sufficient 2. To another Federal or state agency such litigation, and by careful review,
importance to warrant the effect and/or to: CMS determines that the records are
risk on the privacy of the individual that a. Assist in the review determinations both relevant and necessary to the
additional exposure of the record might of ‘‘reasonable and necessary’’ with litigation and that the use of such
bring; and respect to whether or not a particular records by the DOJ, court or
c. There is a strong probability that item or service is covered nationally adjudicatory body is compatible with
the proposed use of the data would in under title XVIII of the Act the purpose for which the agency
fact accomplish the stated purpose(s). § 1869(f)(1)(B). collected the records.
3. Requires the information recipient b. Contribute to the accuracy of CMS’s Whenever CMS is involved in
to: proper payment of Medicare benefits, litigation, and occasionally when
a. Establish administrative, technical, and/or another party is involved in litigation
and physical safeguards to prevent c. Enable such agency to administer a and CMS’ policies or operations could
unauthorized use of disclosure of the Federal health benefits program, or as be affected by the outcome of the
record; necessary to enable such agency to litigation, CMS would be able to
b. Remove or destroy at the earliest fulfill a requirement of a Federal statute disclose information to the DOJ, court or
time all patient-identifiable information; or regulation that implements a health adjudicatory body involved.
and benefits program funded in whole or in 6. To a CMS contractor (including, but
c. Agree to not use or disclose the part with Federal funds. not necessarily limited to fiscal
information for any purpose other than Other Federal or state agencies in intermediaries and carriers) that assists
the stated purpose under which the their administration of a Federal health in the administration of a CMS-
information was disclosed. program may require DCSCD administered health benefits program,
4. Determines that the data are valid information in order to assist in the or to a grantee of a CMS-administered
and reliable. review determinations of ‘‘reasonable grant program, when disclosure is

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deemed reasonably necessary by CMS to based on small cell sizes (instances personal or property rights of patients
prevent, deter, discover, detect, where the patient population is so small whose data are maintained in the
investigate, examine, prosecute, sue that individuals who are familiar with system. CMS will collect only that
with respect to, defend against, correct, the enrollees could, because of the small information necessary to perform the
remedy, or otherwise combat fraud or size, use this information to deduce the system’s functions. In addition, CMS
abuse in such program. identity of the beneficiary). will make disclosure from the proposed
We contemplate disclosing system only with consent of the subject
information under this routine use only IV. Safeguards
individual, or his/her legal
in situations in which CMS may enter CMS has safeguards in place for representative, or in accordance with an
into a contractual relationship or grant authorized users and monitors such applicable exception provision of the
with a third party to assist in users to ensure against excessive or Privacy Act. CMS, therefore, does not
accomplishing CMS functions relating unauthorized use. Personnel having anticipate an unfavorable effect on
to the purpose of combating fraud and access to the system have been trained individual privacy as a result of
abuse. in the Privacy Act and information information relating to individuals.
CMS occasionally contracts out security requirements. Employees who
certain of its functions and makes grants maintain records in this system are John R. Dyer,
when doing so would contribute to instructed not to release data until the Chief Operating Officer, Centers for Medicare
effective and efficient operations. CMS intended recipient agrees to implement & Medicaid Services.
must be able to give a contractor or appropriate management, operational
SYSTEM NO. 09–70–0547
grantee whatever information is and technical safeguards sufficient to
necessary for the contractor or grantee to protect the confidentiality, integrity and SYSTEM NAME:
fulfill its duties. In these situations, availability of the information and ‘‘Data Collection Secondary to
safeguards are provided in the contract information systems and to prevent Coverage Decision (DCSCD) System,
prohibiting the contractor or grantee unauthorized access. HHS/CMS/OCSQ’’.
from using or disclosing the information This system will conform to all
for any purpose other than that applicable Federal laws and regulations SECURITY CLASSIFICATION:
described in the contract and requiring and Federal, HHS, and CMS policies Level Three Privacy Act Sensitive
the contractor or grantee to return or and standards as they relate to Data.
destroy all information. information security and data privacy.
SYSTEM LOCATION:
7. To another Federal agency or to an These laws and regulations include
instrumentality of any governmental but are not limited to: The Privacy Act Centers for Medicare & Medicaid
jurisdiction within or under the control of 1974; the Federal Information Services (CMS) Data Center, 7500
of the United States (including any State Security Management Act of 2002; the Security Boulevard, North Building,
or local governmental agency), that Computer Fraud and Abuse Act of 1986; First Floor, Baltimore, Maryland 21244–
administers, or that has the authority to the Health Insurance Portability and 1850 and at various co-locations of CMS
investigate potential fraud or abuse in, Accountability Act of 1996; the E- contractors.
a health benefits program funded in Government Act of 2002, the Clinger- CATEGORIES OF INDIVIDUALS COVERED BY THE
whole or in part by Federal funds, when Cohen Act of 1996; the Medicare SYSTEM:
disclosure is deemed reasonably Prescription Drug Improvement, and Individuals where CMS has
necessary by CMS to prevent, deter, Modernization Act (MMA) of 2003, and determined that the evidence is
discover, detect, investigate, examine, the corresponding implementing adequate to conclude that certain
prosecute, sue with respect to, defend regulations. OMB Circular A–130, identified diagnoses are reasonable and
against, correct, remedy, or otherwise Management of Federal Resources, necessary in several patient groups
combat fraud or abuse in such programs. Appendix III, Security of Federal where certain criteria for these patients
Other agencies may require DCSCD Automated Information Resources also have been met and the criteria are
information for the purpose of applies. Federal, HHS, and CMS consistent with the trials reviewed.
combating fraud and abuse in such policies and standards include but are
Federally-funded programs. not limited to: all pertinent National CATEGORIES OF RECORDS IN THE SYSTEM:
Institute of Standards and Technology The data collection should include
B. Additional Provisions Affecting
publications; HHS Information System baseline patient characteristics. The
Routine Use Disclosures
Program Handbook and the CMS collected information will contain, but
This system contains Protected Health Information Security Handbook. is not limited to, name, address,
Information (PHI) as defined by HHS telephone number, health insurance
regulation ‘‘Standards for Privacy of V. Effects of the Proposed System of
claim (HIC) number, geographic
Individually Identifiable Health Records on Individual Rights
location, race/ethnicity, gender, and
Information’’ (45 CFR parts 160 and 164, CMS proposes to establish this system date of birth, as well as, background
65 FR 82462 (12–28–00), subparts A and in accordance with the principles and information relating to Medicare or
E. Disclosures of PHI authorized by requirements of the Privacy Act and will Medicaid issues.
these routine uses may only be made if, collect, use, and disseminate
and as, permitted or required by the information only as prescribed therein. AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
‘‘Standards for Privacy of Individually Data in this system will be subject to the The statutory authority for linking
Identifiable Health Information.’’ authorized releases in accordance with coverage decisions to the collection of
In addition, our policy will be to the routine uses identified in this additional data is derived from Sec.
prohibit release even of not directly system of records. 1862(a)(1)(A) of the Social Security Act
identifiable information, except CMS will take precautionary (the Act), which states that Medicare
pursuant to one of the routine uses or measures (see item IV above) to may not provide payment for items and
if required by law, if we determine there minimize the risks of unauthorized services unless they are ‘‘reasonable and
is a possibility that an individual can be access to the records and the potential necessary’’ for the treatment of illness or
identified through implicit deduction harm to individual privacy or other injury. In some cases, CMS will

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determine that an item or service is only under title XVIII of the Act prosecute, sue with respect to, defend
reasonable and necessary when specific § 1869(f)(1)(B). against, correct, remedy, or otherwise
data collections accompany the b. Contribute to the accuracy of CMS’s combat fraud or abuse in such programs.
provision of the service. In these cases, proper payment of Medicare benefits,
and/or ADDITIONAL PROVISIONS AFFECTING ROUTINE USE
the collection of data is required to
DISCLOSURES:
ensure that the care provided to c. Enable such agency to administer a
individual patients will improve health Federal health benefits program, or as This system contains Protected Health
outcomes. necessary to enable such agency to Information (PHI) as defined by
fulfill a requirement of a Federal statute Department of Health and Human
PURPOSE(S) OF THE SYSTEM: or regulation that implements a health Services (HHS) regulation ‘‘Standards
The purpose of this system is to benefits program funded in whole or in for Privacy of Individually Identifiable
collect and maintain data on patients to part with Federal funds. Health Information’’ (45 Code of Federal
review determinations of ‘‘reasonable 3. To an individual or organization for Regulations (CFR) parts 160 and 164, 65
and necessary’’ with respect to whether a research project or in support of an FR 82462 (12–28–00), subparts A and
or not a particular item or service is evaluation project related to the E). Disclosures of PHI authorized by
covered nationally under title XVIII of prevention of disease or disability, the these routine uses may only be made if,
the Act § 1869(f)(1)(B). Information restoration or maintenance of health, or and as, permitted or required by the
retrieved from this system will also be payment related projects. ‘‘Standards for Privacy of Individually
disclosed to: (1) Support regulatory, 4. To a member of Congress or to a Identifiable Health Information.’’
reimbursement, and policy functions congressional staff member in response In addition, our policy will be to
performed within the agency or by a to an inquiry of the congressional office prohibit release even of not directly
contractor or consultant; (2) assist made at the written request of the identifiable information, except
another Federal or state agency with constituent about whom the record is pursuant to one of the routine uses or
information to enable such agency to maintained. if required by law, if we determine there
administer a Federal health benefits 5. To the Department of Justice (DOJ), is a possibility that an individual can be
program, or to enable such agency to court or adjudicatory body when: identified through implicit deduction
fulfill a requirement of Federal statute a. The agency or any component based on small cell sizes (instances
or regulation that implements a health thereof, or where the complaint population is so
benefits program funded in whole or in b. Any employee of the agency in his small that individuals who are familiar
part with Federal funds; (3) to an or her official capacity, or with the complainants could, because of
individual or organization for a research c. Any employee of the agency in his the small size, use this information to
project or in support of an evaluation or her individual capacity where the deduce the identity of the complainant).
project related to the prevention of DOJ has agreed to represent the
employee, or POLICIES AND PRACTICES FOR STORING,
disease or disability, the restoration or RETRIEVING, ACCESSING, RETAINING, AND
maintenance of health, or payment d. The United States Government is a
party to litigation or has an interest in DISPOSING OF RECORDS IN THE SYSTEM:
related projects; (4) support constituent
requests made to a congressional such litigation, and by careful review, STORAGE:
representative; (5) support litigation CMS determines that the records are All records are stored electronically.
involving the agency; and (6) combat both relevant and necessary to the
litigation and that the use of such RETRIEVABILITY:
fraud and abuse in certain health
benefits programs. records by the DOJ, court or The data is retrieved by an individual
adjudicatory body is compatible with identifier i.e., name of beneficiary.
ROUTINE USES OF RECORDS MAINTAINED IN THE the purpose for which the agency
SYSTEM, INCLUDING CATEGORIES OR USERS AND collected the records. SAFEGUARDS:
THE PURPOSES OF SUCH USES: 6. To a CMS contractor (including, but CMS has safeguards in place for
The Privacy Act allows us to disclose not necessarily limited to fiscal authorized users and monitors such
information without an individual’s intermediaries and carriers) that assists users to ensure against excessive or
consent if the information is to be used in the administration of a CMS- unauthorized use. Personnel having
for a purpose that is compatible with the administered health benefits program, access to the system have been trained
purpose(s) for which the information or to a grantee of a CMS-administered in the Privacy Act and information
was collected. Any such compatible use grant program, when disclosure is security requirements. Employees who
of data is known as a ‘‘routine use.’’ We deemed reasonably necessary by CMS to maintain records in this system are
are proposing to establish the following prevent, deter, discover, detect, instructed not to release data until the
routine use disclosures of information investigate, examine, prosecute, sue intended recipient agrees to implements
maintained in the system. Information with respect to, defend against, correct, appropriate management, operational
will be disclosed: remedy, or otherwise combat fraud or and technical safeguards sufficient to
1. To agency contractors or abuse in such program. protect the confidentiality, integrity and
consultants who have been engaged by 7. To another Federal agency or to an availability of the information and
the agency to assist in the performance instrumentality of any governmental information systems and to prevent
of a service related to this system of jurisdiction within or under the control unauthorized access.
records and who need to have access to of the United States (including any State This system will conform to all
the records in order to perform the or local governmental agency), that applicable Federal laws and regulations
activity. administers, or that has the authority to and Federal, HHS; and CMS policies
2. To another Federal or state agency investigate potential fraud or abuse in, and standards as they relate to
to: a health benefits program funded in information security and data privacy.
a. Assist in the review determinations whole or in part by Federal funds, when These laws and regulations include but
of ‘‘reasonable and necessary’’ with disclosure is deemed reasonably are not limited to: The Privacy Act of
respect to whether or not a particular necessary by CMS to prevent, deter, 1974; the Federal Information Security
item or service is covered nationally discover, detect, investigate, examine, Management Act of 2002; the Computer

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53672 Federal Register / Vol. 70, No. 174 / Friday, September 9, 2005 / Notices

Fraud and Abuse Act of 1986; the and group practices performing the to age of compulsory school attendance,
Health Insurance Portability and procedures, and outside registries and and their families. To help enrolled
Accountability Act of 1996; the E- professional interest groups. children achieve their full potential,
Government Act of 2002; the Clinger- Head Start programs provide
SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS
Cohen Act of 1996; the Medicare OF THE ACT:
comprehensive health, nutritional,
Prescription Drug Improvement, educational, social and other services.
None.
Modernization Act (MMA) of 2003, and Section 650 of the Head Start Act
the corresponding implementing [FR Doc. 05–17845 Filed 9–8–05; 8:45 am] requires that the Secretary publish a
regulations. OMB Circular A–130, BILLING CODE 4120–03–P Biennial Report of the Status of
Management of Federal Resources, Children in Head Start Programs. The
Appendix III, Security of Federal FY 2003 Biennial Report provides
Automated Information Resources also DEPARTMENT OF HEALTH AND information about children enrolled in
applies. Federal, HHS, and CMS HUMAN SERVICES the program and the services they
policies and standards include but are receive. During FY 2003 more than
not limited to: all pertinent National Administration for Children and 909,000 children were enrolled in Head
Institute of Standards and Technology Families Start programs. Head Start operated
publications; HHS Information Systems Notice of Availability of the Biennial 47,000 classrooms in more than 19,000
Program Handbook and the CMS Report to Congress on the Status of Head Start centers at an average annual
Information Security Handbook. Children in Head Start Programs cost per child of $7,092. Over 1,428,000
volunteers contributed their services to
RETENTION AND DISPOSAL:
AGENCY: Administration on Children, Head Start programs.
CMS will retain information for a total Youth and Families (ACYF)
period of 10 years. All claims-related Dated: August 30, 2005.
Administration for Children and
records are encompassed by the Joan E. Ohl,
Families (ACF), Department of Health
document preservation order and will Commissioner, Administration on Children,
and Human Services.
be retained until notification is received Youth and Families.
ACTION: Notice.
from the Department of Justice. [FR Doc. 05–17920 Filed 9–8–05; 8:45 am]
SUMMARY: The Administration for BILLING CODE 4184–01–M
SYSTEM MANAGER AND ADDRESS:
Children and Families announces
Director, Office of Clinical Standards publication of the Biennial Report to
and Quality, CMS, Room S2–26–17, Congress on the Status of Children in DEPARTMENT OF HEALTH AND
7500 Security Boulevard, Baltimore, Head Start Programs, Fiscal Year (FY) HUMAN SERVICES
Maryland 21244–1850. 2003. The report is mandated under
Indian Health Service
NOTIFICATION PROCEDURE: Section 650 of the Head Start Act, as
For the purpose of access, the subject amended, which requires the Secretary National Native American Emergency
individual should write to the system of Health and Human Services to submit Medical Services Association
manager who will require the system a report to Congress at least once during
every two-year period on the status of AGENCY: Indian Health Service, IHS.
name, address, age, gender, and for
verification purposes, the subject children in Head Start programs. During ACTION:Notice of Single Source
individual’s name (woman’s maiden FY 2003 more than 909,000 children Cooperative Agreement with the
name, if applicable). were enrolled in Head Start programs National Native American Emergency
including 62,000 children in Early Head Medical Services Association.
RECORD ACCESS PROCEDURE: Start programs serving children between
SUMMARY: The Indian Health Service
For the purpose of access, use the birth and three years of age.
(IHS) announces the award of a
same procedures outlines in EFFECTIVE DATE: September 9, 2005.
cooperative agreement that will be
Notification Procedures above. ADDRESSES: Persons wishing to receive
funded on a competitive continuing
Requestors should also reasonably a copy of the Biennial Report to basis to the National Native American
specify the record contents being Congress on the Status of Children in Emergency Medical Services
sought. (These procedures are in Head Start Programs, FY 2003 may Association (NNAEMSA) for a
accordance with Department regulation contact the Head Start Publication demonstration project to improve
45 CFR 5b.5). Center on 866–763–6481. Copies of the emergency medical services for Native
CONTESTING RECORDS PROCEDURES:
report may also be obtained by American people by improving
accessing the Head Start Web site at communications between the IHS and
The subject individual should contact
http://www.acf.hhs.gov/programs/hsb/ the Native American Emergency
the system manager named above and
research/index.htm. Medical Services (EMS) providers; by
reasonable identify the records and
FOR FURTHER INFORMATION CONTACT: improving communications and
specify the information to be contested.
State the corrective action sought and Frank Fuentes, Acting Associate information among other federal
the reasons for the correction with Commissioner, Head Start Bureau, agencies, professional organizations and
supporting justification. (These Administration on Children, Youth and Native American EMS providers; and by
Procedures are in accordance with Families, 330 C Street, SW., supporting an Annual Educational
Department regulation 45 CFR 5b.7). Washington, DC 20447. Conference.
SUPPLEMENTARY INFORMATION: The Head Project Period: The cooperative
RECORD SOURCE CATEGORIES: Start and Early Head Start programs are agreement is for a five-year project
Records maintained in this system are authorized under the Head Start Act (42 period effective on or about September
derived from Carrier and Fiscal U.S.C. 9801 et seq.) It is a national 15, 2005 to September 14, 2010.
Intermediary Systems of Records, program providing comprehensive Amount of Award(s): Total funding
Common Working File System of developmental services to low-income for the project is $450,000. Funding in
Records, clinics, institutions, hospitals preschool children, primarily age three the amount of $90,000.00 is available in

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