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Privacy Act: [09-70-0536]...
<DOC> [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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