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Privacy Act: [09-70-0536]...


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[2001 Privacy Act]
[From the U.S. Government Printing Office via GPO Access]


[Page 51965-15500]



   #.DEPARTMENT OF HEALTH AND HUMAN SERVICES


                 Centers for Medicare & Medicaid Services

                             Table of Contents

         System Number and System Name
         09-70-0005  National Claims History (NCH), HHS/HCFA/BDMS.
         09-70-0008  National Provider System (NPS), HHS/HCFA/OIS.
         09-70-009  Medicare Provider Analysis and Review (MEDPAR), HHS/
   HCFA/OIS.
         09-70-0022  Municipal Health Services Program, HHS/HCFA/ORD.
         09-70-0030  National Long-Term Care Study Follow-up, DHHS/HCFA/
   ORD.
         09-70-0033  Person-Level Medicaid Data System, HHS/HCFA/ORD.
         09-70-0036  Evaluation of Competitive Bidding for Durable 
   Medical Equipment Demonstration, HHS/HCFA/ORD.
         09-70-0039  Evaluation of the Medicare Alzheimer's Disease 
   Demonstration, HHS/HCFA/ORD.
         09-70-0040  Health Care Financing Administration (HCFA) Organ 
   Transplant Data File, HHS/HCFA/BDMS.
         09-70-0042  Medicare Cancer Registry Record System, HHS/HCFA/
   BDMS.
         09-70-0045  Evaluation of the Arizona Health Care Cost 
   Containment and Long -Term Care Systems Demonstration, HHS/HCFA/ORD..
         09-70-0046  Home Health Quality Indicator System (HHQUIS), HHS/
   HCFA/ORD.
         09-70-0048  Monitoring of the Home Health Agency Prospective 
   Payment Demonstration, HHS/HCFA/ORD.
         09-70-0049  Evaluation of the Home Health Agency Prospective 
   Payment Demonstration, HHS/HCFA/ORD.
         09-70-0050  The Medicare/Medicaid Multistate Case-Mix and 
   Quality Data Base for Nursing Home Residents, HHS/HCFA/ORD.
         09-70-0051  Quality Assurance for the Home Health Agency (HHA) 
   Prospective Payment Demonstration, HHS/HCFA/ORD.
         09-70-0052  Posthospitalization Outcomes Studies, HHS/HCFA/ORD.
         09-70-0053  The Medicare Beneficiary Health Status Registry 
   Pilot, HHS/HCFA/ORD.
         09-70-0057  Evaluation of the Medicaid Extension of Eligibility 
   to Certain Low Income Families Not Otherwise Qualified to Receive 
   Medicaid Benefits Demonstration, HHS/HCFA/ORD.
         09-70-0058  Evaluation of the Medicare SELECT Program, HH/HCFA/
   ORD.
         09-70-0059  The Medicaid Necessity, Appropriateness, and 
   Outcomes of Care Study, HHS/HCFA/ORD.
         09-70-0063  Evaluation of the Medicaid Demonstration for 
   Improving Access to Care for Susstance Abusing Pregnant Women, HHS/
   HCFA/ORD.
         09-70-0064  Individuals Authorized Access to the Health Care 
   Financing Administration (HCFA) Data Center.
         09-70-0066  Evaluation of, and External Quality Assurance for, 
   the Community Nursing Organization Demonstration.
         09-70-0067  End-Stage Renal Disease (ESRD) Managed Care 
   Demonstration System, HHS/HCFA/OSP..
         09-70-0069  Links of Social Security Administration (SSA) and 
   Health Care Financing Adminsitration (HCFA) Data Financing (LOD), 
   HHS/HCFA/OSP.
         09-70-0501  Carrier Medicare Claims Records, HHS/HCFA/BPO.
         09-70-0502  Health Insurance Master Record, HHS/HCFA/BPO.
         09-70-0503  Intermediary Medicare Claims Records, HHS/HCFA/BPO.
         09-70-0504  Beneficiary Parts A and B Uncollectible Overpayment 
   File, HHS/HCFA/BPO.
         09-70-0505  Supplemental Medical Insurance Accounting 
   Collection and Enrollment System, HHS/HCFA/BPO.
         09-70-0508  Reconsideration and Hearing Case Files (Part A) 
   Hospital Insurance Program, HHS/HCFA/BPO.
         09-70-0512  Review and Fair Hearing Case Files--Supplementary 
   Medical Insurance Program, HHS/HCFA/BPO.
         09-70-0513  Medicare Benefits Notices (MBN), HHS/HCFA/CBS.
         09-70-0516  Medicare Physican/Supplier Master File, HHS/HCFA/
   BPO.
         09-70-0517  Physician/Supplier 1099 File (Statement for 
   Recipients of Medical and Health Care Payments), HHS/HCFA/BPO.
         09-70-0518  Medicare Clinic Physician/Supplier Master File, 
   HHS/HCFA/BPO.
         09-70-0520  End Stage Renal Disease (ESRD) Program Management 
   and Medical Information System (PMMIS), HHS/HCFA/BDMS.
         09-70-0522  Billing and Collection Master Record System, HHS/
   HCFA/BPO.
         09-70-0524  Intern and Resident Informaiton System, HHS/HCFA/
   BPO.
         09-70-0525  Medicare Physician Identification and Eligibility 
   System (MPIES), HHS/HCFA/BPO.
         09-70-0526  Common Working File (CWF), HHS/HCFA/BPO.
         09-70-0527  HCFA Utilization Review Investigatory Files, HHS/
   HCFA/BPO.
         09-70-0530  Medicare Supplier Identification File, HHS/HCFA/
   BPO.
         09-70-0531  National Emphysema Treatment Trial (NETT) System, 
   HHS/HCFA/CHPP.
         09-70-0532  Provider Enrollment Chain, and Ownership System 
   (PECO), HHS/CMS/OPM.
         09-70-0535  Medicare Choices Helpline (HELPLINE), HHS/HCFA/CBS.
         09-70-0536  Medicare Beneficiary Database, HHS/CMS/CBS.
         09-70-1511  Physical Therapists in Independent Practice 
   (Individuals), HHS/HCFA/HSQB.
         09-70-1512  Pro Data Management Information System (PDMIS), 
   HHS/HCFA/HSQB.
         09-70-1516  Uniform Clinical Data Set (UCDS), HHS/HCFA/HSQS.
         09-70-1516  Long Term Care Minimum Data Set (LTC MDS), HHS/
   HCFA/CMSO.
         09-70-1518  Inpatient Rehabilitation Facilities Patient 
   Assessment Instrument (IRFPAI), HHS/CMS/CMSO.
         09-70-2003  Completion of State Medicaid Quality Control (MQC) 
   Reviews, HHS/HCFA/BQC.
         09-70-2006  Income and Eligibility Verification for Medicaid 
   Eligibility Quality Control (MEQC) Reviews, HHS/HCFA/MB.
         09-70-3001  Record of Individuals Authorized Entry to HCFA 
   Buildings via A Card Key Access System (RICKS), HHS/HCFA/OICS.
         09-70-3002  Health Care Fnancing Administration (HCFA) Employee 
   Building Pass Files, HHS/HCFA/OBA.
         09-70-3004  Record of Individuals Allowed Regular and Special 
   Parking Privileges at the Health Care Financing Administration (HCFA) 
   Building (PRKG), HHS/HCFA/OICS.
         09-70-4001  Group Health Plan System, HHS/HCFA/OPHCOO.
         09-70-4003  Medicare HMO/CMP Beneficiary Reconsideration System 
   (MBRS), HHS/HCFA/OPHCOO.
         09-70-4004  Health Plan Management System (HPMS), HHS/HCFA/
   CHPP.,
         09-70-5001  Medicare Hearings and Appeals System (MHAS), HHS/
   HCFA/AAO.
         09-70-6001  Medicaid Statistical Information System (MSIS), 
   HHS/HCFA/BDMS.
         09-70-6002  Medicare Current Beneficiary Survey (MCBS) System, 
   HHS/HCFA/OSP.
         09-70-9001  Health Care Financing Administration (HCFA) 
   Correspondence and Assignment Tracking and Control System (CATCS), 
   HHS/HCFA/OEO.
         09-70-9002  Home Health Agency Outcome and Assessment 
   Information Set ( HHA OASIS), HHS/CMSO.S-
         09-70-9005  Complaints Against Health Insurance Issuers and 
   Health Plans (CAHII), HHS/HCFA/CMSO.

   #..09-70-0005

   #....System name: 

       National Claims History (NCH), HHS/HCFA/BDMS.
     Security classification: 
       None.
     System location: 
       HCFA Data Center, Lyon Building, 7131 Rutherford Road, Baltimore, 
   Maryland 21207-5187.
     Categories of individuals covered by the system: 
       Persons enrolled in hospital insurance or supplementary medical 
   benefits parts of the Medicare program and their referring and 
   servicing physicians.
     Categories of records in the system: 
       Bill data, demographic and identifying data on the beneficiary; 
   diagnosis and procedural codes; provider characteristics and 
   identifying number (including physicians).
     Authority for maintenance of the system: 
       Section 1874(a) and section 1875 of the Social Security Act (42 
   U.S.C. 139511).
   Purpose(s): 
       To assist in a variety of health care initiatives with other 
   entities, and to study the operation and effectiveness of the 
   Medicare program.
     Routine uses of records maintained in the system, including 
   categories of users and the purposes of such uses: 
       Disclosure may be made:
       (1) To a congressional office from the record of an individual in 
   response to an inquiry from the congressional office made at the 
   request of that individual.
       (2) To the Bureau of Census for use in processing research and 
   statistical data directly related to the administration of Agency 
   programs.
       (3) To the Department of Justice, to a court or other tribunal, 
   or to another party before such tribunal, when:
       (a) HHS, or any component thereof; or
       (b) Any HHS employee in his or her official capacity; or
       (c) Any HHS employee in his or her individual capacity where the 
   Department of Justice (or HHS, where it is authorized to do so) has 
   agreed to represent the employee; or
       (d) The United States or any agency thereof where HHS determines 
   that the litigation is likely to affect HHS or any of its components;

       is party to litigation or has an interest to such litigation, and 
   HHS determines that the use of such records by the Department of 
   Justice, the tribunal, or the other party is relevant and necessary 
   to the litigation and would help in the effective representation of 
   the governmental party, provided, however, that in each case HHS 
   determines that such disclosure is compatible with the purpose for 
   which the records were collected.
       (4) To an individual or organization for a research, evaluation, 
   or epidemiological project related to the prevention of disease or 
   disability, or the restoration or maintenance of health if HCFA:
       (a) Determines that the use or disclosure does not violate legal 
   limitation under which the record was provided, collected, or 
   obtained;
       (b) Determines that the purpose for which the disclosure is to be 
   made:
       (1) Cannot be reasonably accomplished unless the record is 
   provided in individually identifiable form;
       (2) 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) There is reasonable probability that the objective for the 
   use would be accomplished;
       (c) Requires the information recipient to:
       (1) Establish reasonable administrative, technical, and physical 
   safeguards to prevent unauthorized use or disclosure of the record;
       (2) Remove or destroy the information that allows the individual 
   to be identified at the earliest time at which removal or destruction 
   can be accomplished consistent with the purpose of the project unless 
   the recipient presents an adequate justification of a research or 
   health nature for retaining such information; and
       (3) Make no further use or disclosure of the record except;
       (a) In emergency circumstances affecting the health or safety of 
   any individual;
       (b) For use in another research project, under these same 
   conditions, and with written authorization of HCFA;
       (c) For disclosure to a properly identified person for the 
   purpose of an audit related to the research project, if information 
   that would enable research subjects to be identified is removed or 
   destroyed at the earliest opportunity consistent with the purpose of 
   the audit; or
       (d) When required by law.
       (d) Secures a written statement attesting to the recipient's 
   understanding and willingness to abide by the provisions.
       (5) To entities with a legitimate need for data for statistical 
   analyses bearing on Medicare payment policies for inpatient hospital 
   services. Information disclosed for this purpose will not include a 
   beneficiary's health insurance claim number, race, or Medicare status 
   code; the beneficiary's age will be identified only to the extent of 
   stating whether he or she resides in the same State as the provider; 
   the admission and discharge dates will be identified only by calendar 
   quarter; and the date of surgery will be identified only as the 
   number of days after admission. Each of the Medicare Provider 
   Analysis and Review (MEDPAR) files--short-stay hospital services 
   file, long-term hospital services, skilled nursing facility services 
   file, and other provider services files--will be modified in 
   accordance with the foregoing provision for release. The entity must 
   agree:
       (a) Not to try to identify individual beneficiaries;
       (b) Not to disclose raw data to any persons except contractors 
   for data processing and storage (and it must agree to require any 
   such contractor not to release any data and not to retain any data 
   after performing the contract);
       (c) Not to link this information to other beneficiary-specific 
   records;
       (d) Not to publish or otherwise disclose data in a form raising 
   unacceptable possibilities that beneficiaries could be identified; 
   and
       (e) To safeguard the confidentiality of the data and to try to 
   prevent unauthorized access to it.
       (6) To a contractor for the purpose of collating, analyzing, 
   aggregating, or otherwise refining or processing records in this 
   system or for developing, modifying, and/or manipulating automated 
   data processing (ADP) software. Data would also be disclosed to 
   contractors incidental to consultation, programming, operation, user 
   assistance, or maintenance for ADP or telecommunications systems 
   containing or supporting records in the system.
       (7) With respect to the quality of care (QC) MEDPAR file, to 
   entities with a legitimate need for data for the purpose of 
   conducting research or evaluation on the quality and effectiveness of 
   care provided in hospitals. Research or evaluation under this routine 
   use must focus on the improvement of health care or measures for 
   determining, validating, and monitoring the quality and effectiveness 
   of hospital care in such areas as access to care, outcomes of care, 
   and effectiveness of care in improving, restoring, or maintaining the 
   independence and functioning of Medicare beneficiaries. Information 
   disclosed under this routine use will be limited to the data elements 
   described in appendix A.
       The QC MEDPAR file may be released to an entity if HCFA 
   determines:
       a. That the use or disclosure does not violate legal limitations 
   under which the data were provided, collected, or obtained.
       b. That the purpose for which the disclosure is to be made:
       (1) Cannot reasonably be accomplished unless the data are 
   provided in the detailed form described in appendix A;
       (2) Is reasonably likely to be accomplished in view of the 
   capabilities of the requesting entity and other factors; and
       (3) Is of sufficient importance to warrant the possible effect on 
   the privacy of the individual that the disclosure of the data might 
   bring.
       c. In order for HCFA to determine that the requirements in 
   section 7.b. are met, the entity must submit and HCFA must approve:
       (1) A research or evaluation plan specifying the objectives of 
   the research or evaluation, the manner in which the data will be 
   used, the financial support for the plan, and the date the research 
   or evaluation will be completed. Evaluation plans designed to assist 
   specific providers must be supported by letters of commitment to the 
   evaluation by the providers. Values or differences in values that 
   would trigger provider action must be addressed in the evaluation 
   plan as well as the action the provider intends to take; and
       (2) A copy of any report by a panel of recognized experts 
   reviewing the research or evaluation plan (when such review has been 
   performed).
       d. The entity and its contractors, if any, must sign a statement 

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