80_FR_63764 80 FR 63562 - Privacy Act of 1974; System of Records Notice

80 FR 63562 - Privacy Act of 1974; System of Records Notice

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of the Secretary

Federal Register Volume 80, Issue 202 (October 20, 2015)

Page Range63562-63564
FR Document2015-26631

In accordance with the requirements of the Privacy Act of 1974, as amended (5 U.S.C. 552a), the Office of Medicare Hearings and Appeals (OMHA) within the Office of the Secretary of Health and Human Services (HHS) is establishing a new system of records, System No. 09- 90-1501, entitled ``Administrative Law Judge (ALJ) Working File, Office of Medicare Hearings and Appeals,'' to cover OMHA ALJ working files previously maintained as part of the Social Security Administration's (SSA) ALJ Working File system of records 60-0005 (last published at 74 FR 19617). The working files covered under new System of Records Notice (SORN) 09-90-1501 are created and used by OMHA ALJs and members of their staffs for internal purposes, to document actions taken by OMHA at the hearing level in each Medicare appeal case that OMHA reviews. The working files are separate from the official case files, which are covered under other SORNs (i.e., HHS SORN 09-70-0566 covers case files on Medicare claims appeals, and SSA SORN 60-0089 covers case files on Medicare entitlement appeals).

Federal Register, Volume 80 Issue 202 (Tuesday, October 20, 2015)
[Federal Register Volume 80, Number 202 (Tuesday, October 20, 2015)]
[Notices]
[Pages 63562-63564]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2015-26631]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the Secretary


Privacy Act of 1974; System of Records Notice

AGENCY: Office of the Secretary (OS), Department of Health and Human 
Services (HHS).

ACTION: Notice to establish a new Privacy Act system of records.

-----------------------------------------------------------------------

SUMMARY: In accordance with the requirements of the Privacy Act of 
1974, as amended (5 U.S.C. 552a), the Office of Medicare Hearings and 
Appeals (OMHA) within the Office of the Secretary of Health and Human 
Services (HHS) is establishing a new system of records, System No. 09-
90-1501, entitled ``Administrative Law Judge (ALJ) Working File, Office 
of Medicare Hearings and Appeals,'' to cover OMHA ALJ working files 
previously maintained as part of the Social Security Administration's 
(SSA) ALJ Working File system of records 60-0005 (last published at 74 
FR 19617). The working files covered under new System of Records Notice 
(SORN) 09-90-1501 are created and used by OMHA ALJs and members of 
their staffs for internal purposes, to document actions taken by OMHA 
at the hearing level in each Medicare appeal case that OMHA reviews. 
The working files are separate from the official case files, which are 
covered under other SORNs (i.e., HHS SORN 09-70-0566 covers case files 
on Medicare claims appeals, and SSA SORN 60-0089 covers case files on 
Medicare entitlement appeals).

DATES: This system notice is effective immediately, with the exception 
of the routine uses. The routine uses will be effective 30 days after 
publication, unless HHS receives comments that warrant a revision to 
this Notice.

ADDRESSES: Send public comments by mail or email to: Andrea Monson, 
Director, Division of Information Management and Systems, 1700 North 
Moore Street, Suite 1800, Arlington, VA 22209, 703-235-0635, 
[email protected]. Comments will be available for public inspection 
and copying at the above location.

FOR FURTHER INFORMATION CONTACT: Andrea Monson, Director, Division of 
Information Management and Systems, 1700 North Moore Street, Suite 
1800, Arlington, VA 22209, 703-235-0635, [email protected].

SUPPLEMENTARY INFORMATION:

I. Background on New System of Records

    The Medicare claims appeals process consists of four levels of 
administrative review within HHS, and a fifth level of review with the 
federal district courts after administrative remedies within HHS have 
been exhausted. The first two levels of review are administered by the 
Centers for Medicare & Medicaid Services (CMS) and conducted by 
Medicare contractors. The third level of review is administered by OMHA 
and is conducted by ALJs. Subsequent reviews are conducted at the 
fourth level of appeal within the Departmental Appeals Board (DAB), and 
at the fifth level by the federal district courts.
    The Medicare entitlement and premium appeals process consists of 
three levels of administrative review, and a fourth level of review 
with the federal district courts after administrative remedies have 
been exhausted. The first level is the reconsideration level conducted 
by SSA. The second level of review is administered by OMHA and is 
conducted by ALJs. Subsequent reviews are conducted at the third level 
of appeal within the DAB and at the fourth level by the federal 
district courts.
    The Department established OMHA in June, 2005, pursuant to section 
931 of the Medicare Prescription Drug, Improvement, and Modernization 
Act of 2003 (Pub. L. 108-173) (MMA), which required the transfer of 
responsibility for the ALJ hearing function of the Medicare claims and 
entitlement appeals process from SSA to HHS. The MMA requires a unified 
case tracking system that facilitates the maintenance and transfer of 
case-specific data across both the fee-for-service and managed care 
components of the Medicare program. HHS' CMS operates the unified case 
tracking system required by MMA, which is covered by CMS System of 
Record Notice No. 09-70-0566, entitled ``Medicare Appeals System'' (MAS 
SORN).
    OMHA's adjudication process uses a ``case file'' comprising the 
official agency record, and an ALJ working file. The case file will 
continue to be covered by CMS' MAS SORN for Medicare claims appeals. 
The case file for Medicare entitlement and premium appeals will 
continue to be covered by the SSA Claims Folders System, Social 
Security Administration Claims Folders System, Social Security 
Administration, Office of the General Counsel, Office of Public 
Disclosure (60-0089). The case file is used throughout the 
administrative appeals process by the various levels of review.
    Only OMHA's ALJ working files will now be covered in the new system 
of records established by this Notice, to reflect that they are used 
only by OMHA.

II. The Privacy Act

    The Privacy Act (5 U.S.C. 552a) governs the means by which the U.S. 
Government collects, maintains, and uses information about individuals 
in a system of records. A ``system of records'' is a group of any 
records under the control of a federal agency from

[[Page 63563]]

which information about an individual is retrieved by the individual's 
name or other personal identifier. The Privacy Act requires each agency 
to publish in the Federal Register a system of records notice (SORN) 
identifying and describing each system of records the agency maintains, 
including the purposes for which the agency uses the information about 
individuals in the system, the routine uses for which the agency 
discloses such information outside the agency, and how individual 
record subjects can exercise their rights under the Privacy Act (for 
example, to seek access to their records in the system).

SYSTEM NUMBER: 09-90-1501
SYSTEM NAME:
    Administrative Law Judge (ALJ) Working File, Office of Medicare 
Hearings and Appeals (OMHA).

SECURITY CLASSIFICATION:
    Unclassified.

SYSTEM LOCATION:
    Records are maintained at OMHA headquarters and field offices. 
Address information is available by accessing the OMHA Web site: http://www.hhs.gov/omha/. Electronic records will be stored in a secured, 
FedRAMP-compliant, cloud service provider. Source documents will be 
destroyed once they are scanned and converted to electronic records.

CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:
    Records pertain to individuals involved in Medicare appeals 
adjudicated by OMHA, including Medicare beneficiaries or enrollees; 
physicians; providers; practitioners; suppliers; State Medicaid 
agencies; other individuals involved in furnishing items and services 
to health insurance beneficiaries or enrollees; and authorized or 
appointed representatives of such individuals.

CATEGORIES OF RECORDS IN THE SYSTEM:
    OMHA administers nationwide ALJ hearings for appeals of Medicare 
Part A and Part B claim determinations, Part C organization 
determinations, Part D coverage determinations that are made by CMS 
contractors, and appeals of Medicare entitlement and monthly premium 
determinations made by SSA.
    OMHA establishes ALJ working files as a record of actions taken on 
each particular appeal. The file may contain copies of information from 
the administrative record, such as the request for hearing, hearing 
recording, notice of hearing, decision, and exhibit list, as well as 
copies of post-adjudicative material received and any responses made. 
Official copies of these materials are placed in the official agency 
record (case file). The ALJ working file also may contain deliberative 
working papers such as notes taken during the hearing by the ALJ; case 
analyses prepared by field office employees; attorney work product; 
working papers of field office staff; and other case developmental and 
decision-related notes and instructional sheets. Information in these 
records that could pertain to individuals includes protected health 
information; Health Insurance Claim Number (HICN); Social Security 
Number (SSN); Provider Number, name, address, and other contact 
information; and billing, tax, and other financial information.

AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
    Authority for maintenance of the system is given under Sec.  205 of 
Title II, Sec. Sec.  1155 and 1156 of Title XI, Sec. Sec.  1812, 1814, 
1816, 1842, 1869, and 1872 of Title XVIII of the Social Security Act 
(the Act), as amended (42 United States Code (U.S.C.) sections 405, 
1320c-4, 1320c-5, 1395d, 1395f, 1395h, 1395u, 1395ff, and 1395ii). 
Additional authority for this system is given under Title IX, Subtitle 
D of the Medicare Prescription Drug, Improvement, and Modernization Act 
of 2003 (Public Law (Pub. L.) 108-173).

PURPOSE(S):
    OMHA uses the records in this system of records to reference the 
actions OMHA takes in a particular case at the hearing level. For 
example, during the course of adjudication at the ALJ hearing level, 
ALJs and members of their staff often construct documents for internal 
purposes only regarding the evidence, testimony, legal theories, merits 
of the case, and opinions and advice regarding other factors involved 
in the case.

ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM OF RECORDS, INCLUDING 
CATEGORIES OF USERS AND THE PURPOSES OF SUCH USES:
    Relevant information about an individual may be disclosed from this 
system of records to parties outside HHS, without the individual's 
prior, written consent, pursuant to these routine uses.
    Note: Any information defined as ``return or return information'' 
under 26 U.S.C. 6103 of the Internal Revenue Code (IRC) will not be 
disclosed unless authorized by the IRC, the Internal Revenue Service 
(IRS), or IRS regulations.
    1. To a Member of Congress or to a Congressional staffer in 
response to a written inquiry of the Congressional office made at the 
written request of the constituent about whom the record is maintained. 
The Member of Congress does not have any greater authority to obtain 
records than the individual would have if requesting the records 
directly.
    2. To the Department of Justice (DOJ), a court or other tribunal, 
or 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 DOJ 
(or HHS where it is authorized to do so) 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, HHS determines that the records are both relevant 
and necessary to the litigation and that, therefore, the use of such 
records by DOJ, the court or other tribunal, or another party before 
such tribunal is deemed by HHS to be compatible with the purpose for 
which HHS collected the records.
    3. To IRS, as necessary, for the purpose of auditing HHS's 
compliance with safeguard provisions of the IRC, as amended.
    4. To contractors and other federal agencies that have been engaged 
by HHS to assist in accomplishment of an HHS function relating to the 
purposes of the system of records and that have a need to have access 
to the records in order to assist HHS in performing the activity. Any 
contractor will be required to comply with the requirements of the 
Privacy Act of 1974.
    5. To the National Archives and Records Administration (NARA) in 
records inspections conducted under the authority of 44 U.S.C. 2901 et 
seq.
    6. To student volunteers and other workers performing functions for 
HHS but technically not having the status of agency employees, if they 
need access to the records in order to perform their assigned 
functions.
    7. To federal, state, and local law enforcement agencies and 
private security contractors, as appropriate, if information is 
necessary
    (a) to enable them to protect the safety of HHS employees and 
customers, the security of the HHS workplace, and the operation of HHS 
facilities; or
    (b) to assist investigations or prosecutions with respect to 
activities that affect such safety and security or activities that 
disrupt the operation of HHS facilities.
    8. To appropriate federal agencies and Department contractors that 
have a need to know the information for the purpose

[[Page 63564]]

of assisting the Department's efforts to respond to a suspected or 
confirmed breach of the security or confidentiality of information 
maintained in this system of records, when the information disclosed is 
relevant and necessary for that assistance.
    Information about an individual may also be disclosed to parties 
outside HHS without the individual's prior, written consent for any of 
the uses authorized directly in the Privacy Act at 5 U.S.C. 552a(b)(2) 
and (b)(4)-(11).

POLICIES AND PRACTICES FOR STORING, RETRIEVING, ACCESSING, RETAINING, 
AND DISPOSING OF RECORDS IN THE SYSTEM--
    STORAGE: Records are maintained in electronic and paper form. 
Currently, OMHA headquarters and field offices keep ALJ working files 
in paper form. New technology will allow OMHA to store information 
electronically in the Electronic Case Adjudication and Processing 
Environment (ECAPE). As a result, records in this system may be paper 
and electronic.
    RETRIEVABILITY: Information is retrieved by name, Social Security 
Number (SSN), Health Insurance Claim Number (HICN), and assigned 
provider number or appeal number.
    SAFEGUARDS: Only authorized OMHA personnel that have a need for the 
information in the performance of their official duties are permitted 
access to the information.
    Security measures for electronic access include a minimum of a two-
factor authentication solution (such as the use of a Personal Identity 
Verification (PIV) Card and Personal Identification Number (PIN)) to 
enter the computer system that will maintain the data, and storage of 
the computerized records in secured areas that are accessible only to 
employees who require the information in performing their official 
duties. Manually maintained records are kept in locked cabinets or in 
otherwise secure areas.
    Personnel allowed access to the records have been trained in the 
Privacy Act and information security requirements. Employees who 
maintain records in this system of records are instructed not to 
release data to an authorized recipient until the intended recipient 
agrees to implement appropriate management, operational and technical 
safeguards sufficient to protect the confidentiality, integrity and 
availability of the information and information systems and to prevent 
unauthorized access.
    This system will conform to all applicable federal laws and 
regulations and federal and HHS policies and standards as they relate 
to information security and data privacy. These laws and regulations 
may apply but are not limited to: The Privacy Act of 1974; the Federal 
Information Security Management Act of 2002; the Computer Fraud and 
Abuse Act of 1986; the Health Insurance Portability and Accountability 
Act of 1996; the E-Government Act of 2002, the Clinger-Cohen Act of 
1996; the Medicare Modernization Act of 2003, and the corresponding 
implementing regulations. OMB Circular A-130, Management of Federal 
Resources, Appendix III, Security of Federal Automated Information 
Resources also applies. Federal and HHS policies and standards include 
but are not limited to: All pertinent National Institute of Standards 
and Technology publications; the HHS Information Systems Program 
Handbook and the CMS Information Security Handbook.
    RETENTION AND DISPOSAL: OMHA will destroy electronic and paper 
records by deleting or shredding them 3 years after the final action is 
taken (see NARA-approved records schedule DAA-0468-2012-0003).

SYSTEM MANAGER AND ADDRESS:
    Andrea Monson, Director, Division of Information Management and 
Systems, 1700 North Moore Street, Suite 1800, Arlington, VA 22209.

NOTIFICATION PROCEDURE:
    An individual can determine if this system contains a record about 
him or her by making a written notification request to the System 
Manager, showing proof of identity, and providing the system name, the 
subject individual's name, HICN, address, date of birth, and gender. 
Furnishing the SSN is voluntary.

RECORD ACCESS PROCECURE:
    An individual can obtain access to a record about him or her by 
using the same procedures outlined in Notification Procedures above and 
specifying the record contents sought.

CONTESTING RECORD PROCEDURE:
    The requesting individual should contact the System Manager named 
above, and reasonably identify the records and specify the information 
contested. In addition, the individual should state the corrective 
action sought and the reasons for the correction and provide supporting 
justification.

RECORD SOURCE CATEGORIES:
    Information in this system of records is obtained from individuals 
who complete a form requesting a Medicare hearing or appeal, from CMS 
and its contractors, and from SSA.

SYSTEM EXEMPTED FROM CERTAIN PROVISIONS OF THE PRIVACY ACT:
    This system of records is not a type of system eligible to be 
exempted from certain Privacy Act requirements under subsections (j) 
and (k) of the Privacy Act (5 U.S.C. 552a(j)(k)); however, to the 
extent that records contained in the ALJ working files constitute 
material compiled in reasonable anticipation of a civil action or 
proceeding, they will be exempt from the Privacy Act's access 
requirement under 5 U.S.C. 552a(d)(5).

    Dated: October 13, 2015.
Eileen McDaniel,
Director of Programs, Office of Medicare Hearings and Appeals.
[FR Doc. 2015-26631 Filed 10-19-15; 8:45 am]
BILLING CODE 4152-01-P



                                                  63562                               Federal Register / Vol. 80, No. 202 / Tuesday, October 20, 2015 / Notices

                                                                                                                          ESTIMATED ANNUALIZED BURDEN TABLE
                                                                                                                                                                                                      Number of                   Average
                                                                                                                                                                           Number of                                                                      Total burden
                                                                       Forms                                            Type of respondent                                                          responses per               burden hours
                                                                                                                                                                          respondents                                                                        hours
                                                                                                                                                                                                      respondent                per response

                                                  Civil Rights Complaint Form .............                Individuals or households, Not-for-                                          3493                              1                  45/60                2620
                                                                                                             profit institutions.
                                                  Health Information             Privacy       Com-        Individuals or households, Not-for-                                        10,286                              1                  45/60                7715
                                                    plaint Form.                                             profit institutions.

                                                       Total ...........................................   ...........................................................   ........................   ........................   ........................         10,335



                                                    OS specifically requests comments on                                  from the official case files, which are                                       SSA. The second level of review is
                                                  (1) the necessity and utility of the                                    covered under other SORNs (i.e., HHS                                          administered by OMHA and is
                                                  proposed information collection for the                                 SORN 09–70–0566 covers case files on                                          conducted by ALJs. Subsequent reviews
                                                  proper performance of the agency’s                                      Medicare claims appeals, and SSA                                              are conducted at the third level of
                                                  functions, (2) the accuracy of the                                      SORN 60–0089 covers case files on                                             appeal within the DAB and at the fourth
                                                  estimated burden, (3) ways to enhance                                   Medicare entitlement appeals).                                                level by the federal district courts.
                                                  the quality, utility, and clarity of the                                DATES: This system notice is effective                                           The Department established OMHA in
                                                  information to be collected, and (4) the                                immediately, with the exception of the                                        June, 2005, pursuant to section 931 of
                                                  use of automated collection techniques                                  routine uses. The routine uses will be                                        the Medicare Prescription Drug,
                                                  or other forms of information                                           effective 30 days after publication,                                          Improvement, and Modernization Act of
                                                  technology to minimize the information                                  unless HHS receives comments that                                             2003 (Pub. L. 108–173) (MMA), which
                                                  collection burden.                                                      warrant a revision to this Notice.                                            required the transfer of responsibility
                                                                                                                          ADDRESSES: Send public comments by
                                                                                                                                                                                                        for the ALJ hearing function of the
                                                  Darius Taylor,
                                                                                                                          mail or email to: Andrea Monson,                                              Medicare claims and entitlement
                                                  Information Collection Clearance Officer.                                                                                                             appeals process from SSA to HHS. The
                                                  [FR Doc. 2015–26604 Filed 10–19–15; 8:45 am]
                                                                                                                          Director, Division of Information
                                                                                                                          Management and Systems, 1700 North                                            MMA requires a unified case tracking
                                                  BILLING CODE 4153–01–P
                                                                                                                          Moore Street, Suite 1800, Arlington, VA                                       system that facilitates the maintenance
                                                                                                                          22209, 703–235–0635, andrea.monson@                                           and transfer of case-specific data across
                                                                                                                          hhs.gov. Comments will be available for                                       both the fee-for-service and managed
                                                  DEPARTMENT OF HEALTH AND                                                                                                                              care components of the Medicare
                                                  HUMAN SERVICES                                                          public inspection and copying at the
                                                                                                                                                                                                        program. HHS’ CMS operates the
                                                                                                                          above location.
                                                                                                                                                                                                        unified case tracking system required by
                                                  Office of the Secretary                                                 FOR FURTHER INFORMATION CONTACT:
                                                                                                                                                                                                        MMA, which is covered by CMS System
                                                                                                                          Andrea Monson, Director, Division of                                          of Record Notice No. 09–70–0566,
                                                  Privacy Act of 1974; System of                                          Information Management and Systems,
                                                  Records Notice                                                                                                                                        entitled ‘‘Medicare Appeals System’’
                                                                                                                          1700 North Moore Street, Suite 1800,                                          (MAS SORN).
                                                  AGENCY:  Office of the Secretary (OS),                                  Arlington, VA 22209, 703–235–0635,                                               OMHA’s adjudication process uses a
                                                  Department of Health and Human                                          andrea.monson@hhs.gov.                                                        ‘‘case file’’ comprising the official
                                                  Services (HHS).                                                         SUPPLEMENTARY INFORMATION:                                                    agency record, and an ALJ working file.
                                                  ACTION: Notice to establish a new                                       I. Background on New System of                                                The case file will continue to be covered
                                                  Privacy Act system of records.                                          Records                                                                       by CMS’ MAS SORN for Medicare
                                                                                                                                                                                                        claims appeals. The case file for
                                                  SUMMARY:    In accordance with the                                         The Medicare claims appeals process                                        Medicare entitlement and premium
                                                  requirements of the Privacy Act of 1974,                                consists of four levels of administrative                                     appeals will continue to be covered by
                                                  as amended (5 U.S.C. 552a), the Office                                  review within HHS, and a fifth level of                                       the SSA Claims Folders System, Social
                                                  of Medicare Hearings and Appeals                                        review with the federal district courts                                       Security Administration Claims Folders
                                                  (OMHA) within the Office of the                                         after administrative remedies within                                          System, Social Security Administration,
                                                  Secretary of Health and Human Services                                  HHS have been exhausted. The first two                                        Office of the General Counsel, Office of
                                                  (HHS) is establishing a new system of                                   levels of review are administered by the                                      Public Disclosure (60–0089). The case
                                                  records, System No. 09–90–1501,                                         Centers for Medicare & Medicaid                                               file is used throughout the
                                                  entitled ‘‘Administrative Law Judge                                     Services (CMS) and conducted by                                               administrative appeals process by the
                                                  (ALJ) Working File, Office of Medicare                                  Medicare contractors. The third level of                                      various levels of review.
                                                  Hearings and Appeals,’’ to cover OMHA                                   review is administered by OMHA and is                                            Only OMHA’s ALJ working files will
                                                  ALJ working files previously maintained                                 conducted by ALJs. Subsequent reviews                                         now be covered in the new system of
                                                  as part of the Social Security                                          are conducted at the fourth level of                                          records established by this Notice, to
                                                  Administration’s (SSA) ALJ Working                                      appeal within the Departmental Appeals                                        reflect that they are used only by
                                                  File system of records 60–0005 (last                                    Board (DAB), and at the fifth level by                                        OMHA.
                                                  published at 74 FR 19617). The working                                  the federal district courts.
                                                                                                                                                                                                        II. The Privacy Act
mstockstill on DSK4VPTVN1PROD with NOTICES




                                                  files covered under new System of                                          The Medicare entitlement and
                                                  Records Notice (SORN) 09–90–1501 are                                    premium appeals process consists of                                              The Privacy Act (5 U.S.C. 552a)
                                                  created and used by OMHA ALJs and                                       three levels of administrative review,                                        governs the means by which the U.S.
                                                  members of their staffs for internal                                    and a fourth level of review with the                                         Government collects, maintains, and
                                                  purposes, to document actions taken by                                  federal district courts after                                                 uses information about individuals in a
                                                  OMHA at the hearing level in each                                       administrative remedies have been                                             system of records. A ‘‘system of
                                                  Medicare appeal case that OMHA                                          exhausted. The first level is the                                             records’’ is a group of any records under
                                                  reviews. The working files are separate                                 reconsideration level conducted by                                            the control of a federal agency from


                                             VerDate Sep<11>2014       17:55 Oct 19, 2015        Jkt 238001      PO 00000        Frm 00065        Fmt 4703        Sfmt 4703       E:\FR\FM\20OCN1.SGM               20OCN1


                                                                               Federal Register / Vol. 80, No. 202 / Tuesday, October 20, 2015 / Notices                                           63563

                                                  which information about an individual                   list, as well as copies of post-                      written inquiry of the Congressional
                                                  is retrieved by the individual’s name or                adjudicative material received and any                office made at the written request of the
                                                  other personal identifier. The Privacy                  responses made. Official copies of these              constituent about whom the record is
                                                  Act requires each agency to publish in                  materials are placed in the official                  maintained. The Member of Congress
                                                  the Federal Register a system of records                agency record (case file). The ALJ                    does not have any greater authority to
                                                  notice (SORN) identifying and                           working file also may contain                         obtain records than the individual
                                                  describing each system of records the                   deliberative working papers such as                   would have if requesting the records
                                                  agency maintains, including the                         notes taken during the hearing by the                 directly.
                                                  purposes for which the agency uses the                  ALJ; case analyses prepared by field                     2. To the Department of Justice (DOJ),
                                                  information about individuals in the                    office employees; attorney work                       a court or other tribunal, or another
                                                  system, the routine uses for which the                  product; working papers of field office               party before such tribunal, when:
                                                  agency discloses such information                       staff; and other case developmental and                  (a) HHS or any component thereof; or
                                                  outside the agency, and how individual                  decision-related notes and instructional                 (b) any HHS employee in his or her
                                                  record subjects can exercise their rights               sheets. Information in these records that             official capacity; or
                                                  under the Privacy Act (for example, to                  could pertain to individuals includes                    (c) any HHS employee in his or her
                                                  seek access to their records in the                     protected health information; Health                  individual capacity where DOJ (or HHS
                                                  system).                                                Insurance Claim Number (HICN); Social                 where it is authorized to do so) has
                                                                                                          Security Number (SSN); Provider                       agreed to represent the employee; or
                                                  SYSTEM NUMBER: 09–90–1501                               Number, name, address, and other                         (d) the United States Government,
                                                  SYSTEM NAME:                                            contact information; and billing, tax,                   is a party to litigation or has an
                                                                                                          and other financial information.                      interest in such litigation and, by careful
                                                   Administrative Law Judge (ALJ)
                                                                                                                                                                review, HHS determines that the records
                                                  Working File, Office of Medicare                        AUTHORITY FOR MAINTENANCE OF THE SYSTEM:              are both relevant and necessary to the
                                                  Hearings and Appeals (OMHA).                               Authority for maintenance of the                   litigation and that, therefore, the use of
                                                  SECURITY CLASSIFICATION:                                system is given under § 205 of Title II,              such records by DOJ, the court or other
                                                                                                          §§ 1155 and 1156 of Title XI, §§ 1812,                tribunal, or another party before such
                                                     Unclassified.
                                                                                                          1814, 1816, 1842, 1869, and 1872 of                   tribunal is deemed by HHS to be
                                                  SYSTEM LOCATION:                                        Title XVIII of the Social Security Act                compatible with the purpose for which
                                                    Records are maintained at OMHA                        (the Act), as amended (42 United States               HHS collected the records.
                                                  headquarters and field offices. Address                 Code (U.S.C.) sections 405, 1320c–4,                     3. To IRS, as necessary, for the
                                                  information is available by accessing the               1320c–5, 1395d, 1395f, 1395h, 1395u,                  purpose of auditing HHS’s compliance
                                                  OMHA Web site: http://www.hhs.gov/                      1395ff, and 1395ii). Additional                       with safeguard provisions of the IRC, as
                                                  omha/. Electronic records will be stored                authority for this system is given under              amended.
                                                  in a secured, FedRAMP-compliant,                        Title IX, Subtitle D of the Medicare                     4. To contractors and other federal
                                                  cloud service provider. Source                          Prescription Drug, Improvement, and                   agencies that have been engaged by HHS
                                                  documents will be destroyed once they                   Modernization Act of 2003 (Public Law                 to assist in accomplishment of an HHS
                                                  are scanned and converted to electronic                 (Pub. L.) 108–173).                                   function relating to the purposes of the
                                                  records.                                                PURPOSE(S):                                           system of records and that have a need
                                                                                                            OMHA uses the records in this system                to have access to the records in order to
                                                  CATEGORIES OF INDIVIDUALS COVERED BY THE
                                                                                                          of records to reference the actions                   assist HHS in performing the activity.
                                                  SYSTEM:                                                                                                       Any contractor will be required to
                                                                                                          OMHA takes in a particular case at the
                                                     Records pertain to individuals                                                                             comply with the requirements of the
                                                                                                          hearing level. For example, during the
                                                  involved in Medicare appeals                                                                                  Privacy Act of 1974.
                                                                                                          course of adjudication at the ALJ
                                                  adjudicated by OMHA, including                                                                                   5. To the National Archives and
                                                                                                          hearing level, ALJs and members of
                                                  Medicare beneficiaries or enrollees;                                                                          Records Administration (NARA) in
                                                                                                          their staff often construct documents for
                                                  physicians; providers; practitioners;                                                                         records inspections conducted under
                                                                                                          internal purposes only regarding the
                                                  suppliers; State Medicaid agencies;                                                                           the authority of 44 U.S.C. 2901 et seq.
                                                                                                          evidence, testimony, legal theories,                     6. To student volunteers and other
                                                  other individuals involved in furnishing
                                                                                                          merits of the case, and opinions and                  workers performing functions for HHS
                                                  items and services to health insurance
                                                                                                          advice regarding other factors involved               but technically not having the status of
                                                  beneficiaries or enrollees; and
                                                                                                          in the case.                                          agency employees, if they need access to
                                                  authorized or appointed representatives
                                                  of such individuals.                                    ROUTINE USES OF RECORDS MAINTAINED IN THE             the records in order to perform their
                                                                                                          SYSTEM OF RECORDS, INCLUDING CATEGORIES               assigned functions.
                                                  CATEGORIES OF RECORDS IN THE SYSTEM:                    OF USERS AND THE PURPOSES OF SUCH USES:                  7. To federal, state, and local law
                                                    OMHA administers nationwide ALJ                          Relevant information about an                      enforcement agencies and private
                                                  hearings for appeals of Medicare Part A                 individual may be disclosed from this                 security contractors, as appropriate, if
                                                  and Part B claim determinations, Part C                 system of records to parties outside                  information is necessary
                                                  organization determinations, Part D                     HHS, without the individual’s prior,                     (a) to enable them to protect the safety
                                                  coverage determinations that are made                   written consent, pursuant to these                    of HHS employees and customers, the
                                                  by CMS contractors, and appeals of                      routine uses.                                         security of the HHS workplace, and the
                                                  Medicare entitlement and monthly                           Note: Any information defined as                   operation of HHS facilities; or
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                                                  premium determinations made by SSA.                     ‘‘return or return information’’ under 26                (b) to assist investigations or
                                                    OMHA establishes ALJ working files                    U.S.C. 6103 of the Internal Revenue                   prosecutions with respect to activities
                                                  as a record of actions taken on each                    Code (IRC) will not be disclosed unless               that affect such safety and security or
                                                  particular appeal. The file may contain                 authorized by the IRC, the Internal                   activities that disrupt the operation of
                                                  copies of information from the                          Revenue Service (IRS), or IRS                         HHS facilities.
                                                  administrative record, such as the                      regulations.                                             8. To appropriate federal agencies and
                                                  request for hearing, hearing recording,                    1. To a Member of Congress or to a                 Department contractors that have a need
                                                  notice of hearing, decision, and exhibit                Congressional staffer in response to a                to know the information for the purpose


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                                                  63564                        Federal Register / Vol. 80, No. 202 / Tuesday, October 20, 2015 / Notices

                                                  of assisting the Department’s efforts to                standards as they relate to information               hearing or appeal, from CMS and its
                                                  respond to a suspected or confirmed                     security and data privacy. These laws                 contractors, and from SSA.
                                                  breach of the security or confidentiality               and regulations may apply but are not
                                                  of information maintained in this                       limited to: The Privacy Act of 1974; the              SYSTEM EXEMPTED FROM CERTAIN PROVISIONS
                                                                                                                                                                OF THE PRIVACY ACT:
                                                  system of records, when the information                 Federal Information Security
                                                  disclosed is relevant and necessary for                 Management Act of 2002; the Computer                    This system of records is not a type
                                                  that assistance.                                        Fraud and Abuse Act of 1986; the                      of system eligible to be exempted from
                                                    Information about an individual may                   Health Insurance Portability and                      certain Privacy Act requirements under
                                                  also be disclosed to parties outside HHS                Accountability Act of 1996; the E-                    subsections (j) and (k) of the Privacy Act
                                                  without the individual’s prior, written                 Government Act of 2002, the Clinger-                  (5 U.S.C. 552a(j)(k)); however, to the
                                                  consent for any of the uses authorized                  Cohen Act of 1996; the Medicare                       extent that records contained in the ALJ
                                                  directly in the Privacy Act at 5 U.S.C.                 Modernization Act of 2003, and the                    working files constitute material
                                                  552a(b)(2) and (b)(4)–(11).                             corresponding implementing                            compiled in reasonable anticipation of a
                                                                                                          regulations. OMB Circular A–130,                      civil action or proceeding, they will be
                                                  POLICIES AND PRACTICES FOR STORING,
                                                                                                          Management of Federal Resources,                      exempt from the Privacy Act’s access
                                                  RETRIEVING, ACCESSING, RETAINING, AND
                                                                                                          Appendix III, Security of Federal                     requirement under 5 U.S.C. 552a(d)(5).
                                                  DISPOSING OF RECORDS IN THE SYSTEM—
                                                                                                          Automated Information Resources also                    Dated: October 13, 2015.
                                                    STORAGE: Records are maintained in
                                                                                                          applies. Federal and HHS policies and                 Eileen McDaniel,
                                                  electronic and paper form. Currently,
                                                                                                          standards include but are not limited to:             Director of Programs, Office of Medicare
                                                  OMHA headquarters and field offices
                                                                                                          All pertinent National Institute of                   Hearings and Appeals.
                                                  keep ALJ working files in paper form.
                                                                                                          Standards and Technology publications;
                                                  New technology will allow OMHA to                                                                             [FR Doc. 2015–26631 Filed 10–19–15; 8:45 am]
                                                                                                          the HHS Information Systems Program
                                                  store information electronically in the                                                                       BILLING CODE 4152–01–P
                                                                                                          Handbook and the CMS Information
                                                  Electronic Case Adjudication and
                                                                                                          Security Handbook.
                                                  Processing Environment (ECAPE). As a
                                                  result, records in this system may be                     RETENTION AND DISPOSAL: OMHA                        DEPARTMENT OF HEALTH AND
                                                  paper and electronic.                                   will destroy electronic and paper                     HUMAN SERVICES
                                                    RETRIEVABILITY: Information is                        records by deleting or shredding them 3
                                                  retrieved by name, Social Security                      years after the final action is taken (see            National Institutes of Health
                                                  Number (SSN), Health Insurance Claim                    NARA-approved records schedule
                                                                                                          DAA–0468–2012–0003).                                  National Center for Complementary &
                                                  Number (HICN), and assigned provider
                                                                                                                                                                Integrative Health; Notice of Closed
                                                  number or appeal number.                                SYSTEM MANAGER AND ADDRESS:                           Meeting
                                                    SAFEGUARDS: Only authorized
                                                                                                            Andrea Monson, Director, Division of
                                                  OMHA personnel that have a need for                                                                             Pursuant to section 10(d) of the
                                                                                                          Information Management and Systems,
                                                  the information in the performance of                                                                         Federal Advisory Committee Act, as
                                                                                                          1700 North Moore Street, Suite 1800,
                                                  their official duties are permitted access                                                                    amended (5 U.S.C. App.), notice is
                                                                                                          Arlington, VA 22209.
                                                  to the information.                                                                                           hereby given of the following meeting.
                                                    Security measures for electronic                      NOTIFICATION PROCEDURE:                                 The meeting will be closed to the
                                                  access include a minimum of a two-                        An individual can determine if this                 public in accordance with the
                                                  factor authentication solution (such as                 system contains a record about him or                 provisions set forth in sections
                                                  the use of a Personal Identity                          her by making a written notification                  552b(c)(4) and 552b(c)(6), Title 5 U.S.C.,
                                                  Verification (PIV) Card and Personal                    request to the System Manager, showing                as amended. The grant applications and
                                                  Identification Number (PIN)) to enter                   proof of identity, and providing the                  the discussions could disclose
                                                  the computer system that will maintain                  system name, the subject individual’s                 confidential trade secrets or commercial
                                                  the data, and storage of the                            name, HICN, address, date of birth, and               property such as patentable material,
                                                  computerized records in secured areas                   gender. Furnishing the SSN is                         and personal information concerning
                                                  that are accessible only to employees                   voluntary.                                            individuals associated with the grant
                                                  who require the information in                                                                                applications, the disclosure of which
                                                  performing their official duties.                       RECORD ACCESS PROCECURE:                              would constitute a clearly unwarranted
                                                  Manually maintained records are kept                      An individual can obtain access to a                invasion of personal privacy.
                                                  in locked cabinets or in otherwise                      record about him or her by using the
                                                  secure areas.                                                                                                   Name of Committee: National Center for
                                                                                                          same procedures outlined in                           Complementary and Integrative Health
                                                    Personnel allowed access to the                       Notification Procedures above and                     Special Emphasis Panel; Training and
                                                  records have been trained in the Privacy                specifying the record contents sought.                Education.
                                                  Act and information security                                                                                    Date: November 19, 2015.
                                                  requirements. Employees who maintain                    CONTESTING RECORD PROCEDURE:                            Time: 12:00 p.m. to 4:00 p.m.
                                                  records in this system of records are                     The requesting individual should                      Agenda: To review and evaluate grant
                                                  instructed not to release data to an                    contact the System Manager named                      applications.
                                                  authorized recipient until the intended                 above, and reasonably identify the                      Place: National Institutes of Health, Two
                                                  recipient agrees to implement                           records and specify the information                   Democracy Plaza, 6707 Democracy
                                                  appropriate management, operational                                                                           Boulevard, Bethesda, MD 20892, (Virtual
                                                                                                          contested. In addition, the individual                Meeting).
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                                                  and technical safeguards sufficient to                  should state the corrective action sought               Contact Person: Martina Schmidt, Ph.D.,
                                                  protect the confidentiality, integrity and              and the reasons for the correction and                Scientific Review Officer, Office of Scientific
                                                  availability of the information and                     provide supporting justification.                     Review, National Center for Complementary
                                                  information systems and to prevent                                                                            & Integrative Health, NIH, 6707 Democracy
                                                  unauthorized access.                                    RECORD SOURCE CATEGORIES:                             Blvd., Suite 401, Bethesda, MD 20892, 301–
                                                    This system will conform to all                          Information in this system of records              594–3456, schmidma@mail.nih.gov.
                                                  applicable federal laws and regulations                 is obtained from individuals who                      (Catalogue of Federal Domestic Assistance
                                                  and federal and HHS policies and                        complete a form requesting a Medicare                 Program Nos. 93.213, Research and Training



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Document Created: 2015-12-14 15:25:25
Document Modified: 2015-12-14 15:25:25
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionNotices
ActionNotice to establish a new Privacy Act system of records.
DatesThis system notice is effective immediately, with the exception of the routine uses. The routine uses will be effective 30 days after publication, unless HHS receives comments that warrant a revision to this Notice.
ContactAndrea Monson, Director, Division of Information Management and Systems, 1700 North Moore Street, Suite 1800, Arlington, VA 22209, 703-235-0635, [email protected]
FR Citation80 FR 63562 

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