83 FR 46951 - Privacy Act of 1974; System of Records

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services

Federal Register Volume 83, Issue 180 (September 17, 2018)

The Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), proposes to modify or alter an existing system of records subject to the Privacy Act, System No. 09- 70-0541, titled ``Medicaid Statistical Information System (MSIS).'' This system of records covers the Medicaid dataset. The dataset includes standardized enrollment, eligibility, and paid claims of Medicaid recipients and is used to administer Medicaid at the Federal level, produce statistical reports, support Medicaid related research, and assist in the detection of fraud and abuse in the Medicare and Medicaid programs. CMS is adding two new routine use as numbers three and 10. CMS is including two routine uses that were published on February 14, 2018, and are numbered as eight and nine in the routine use section below. In addition, CMS is changing the name of the system of records to: Transformed-Medicaid Statistical Information System (T- MSIS) and making other modifications which are explained below.

[Federal Register Volume 83, Number 180 (Monday, September 17, 2018)]
[Notices]
[Pages 46951-46954]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2018-20063]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services


Privacy Act of 1974; System of Records

AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of 
Health and Human Services (HHS).

ACTION: Notice of a modified system of records.

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SUMMARY: The Department of Health and Human Services (HHS), Centers for 
Medicare & Medicaid Services (CMS), proposes to modify or alter an 
existing system of records subject to the Privacy Act, System No. 09-
70-0541, titled ``Medicaid Statistical Information System (MSIS).'' 
This system of records covers the Medicaid dataset. The dataset 
includes standardized enrollment, eligibility, and paid claims of 
Medicaid recipients and is used to administer Medicaid at the Federal 
level, produce statistical reports, support Medicaid related research, 
and assist in the detection of fraud and abuse in the Medicare and 
Medicaid programs. CMS is adding two new routine use as numbers three 
and 10. CMS is including two routine uses that were published on 
February 14, 2018, and are numbered as eight and nine in the routine 
use section below. In addition, CMS is changing the name of the system 
of records to: Transformed-Medicaid Statistical Information System (T-
MSIS) and making other modifications which are explained below.

DATES: In accordance with 5 U.S.C. 552a(e)(4) and (11), this notice is 
applicable September 17, 2018, subject to a 30-day period in which to 
comment on the routine uses. Submit any comments by October 17, 2018.

ADDRESSES: Written comments should be submitted by mail or email to: 
CMS Privacy Act Officer, Division of Security, Privacy Policy & 
Governance, Information Security & Privacy Group, Office of Information 
Technology, CMS, Location N1-14-56, 7500 Security Boulevard, Baltimore, 
MD 21244-1870, or [email protected].

FOR FURTHER INFORMATION CONTACT: General questions about the system of 
records may be submitted to Darlene Anderson, Health Insurance 
Specialist, Data and Systems Group, Center for Medicaid and CHIP 
Services (CMCS), CMS, Mail Stop S2-22-16, 7500 Security Boulevard, 
Baltimore, MD 21244, Telephone 410-786- 9828 or email to 
[email protected].

SUPPLEMENTARY INFORMATION: 

I. Program and IT System Changes Prompting This SORN Modification

    The Transformed Medicaid Statistical Information System (T-MSIS) is 
replacing the Medicaid Statistical Information System (MSIS) as the 
information technology (IT) system housing the national Medicaid 
dataset. It is a joint effort by the States and CMS to build a Medicaid 
dataset that addresses problems identified with Medicaid data in MSIS. 
T-MSIS provides improved program monitoring and oversight, technical 
assistance with states, policy implementation and data-driven and high-
quality Medicaid program and Children's Health Insurance Program (CHIP) 
that ensure better care, access to coverage, and improved health.
    To improve Medicaid program oversight, CMS is requiring States to 
submit new files and data elements in T-MSIS which were not collected 
in MSIS, for the purpose of improving the quality of the data extracts 
the States submit to CMS on a quarterly or other periodic basis. 
Following consultation with a wide array of stakeholders, CMS 
established over 1,000 data elements for T-MSIS. This expands on the 
approximately 400 data elements collected in MSIS. T-MSIS builds on the 
original five MSIS files (eligibility and four types of claims: 
Inpatient, long-term care, pharmacy, and other) by adding files for 
third-party liability, information from managed-care plans, and 
providers. New T-MSIS Analytic Files (TAF) include: Beneficiary Files: 
Monthly beneficiary summary, annual beneficiary summary, Claims Files: 
Inpatients, long-term care, pharmacy and other files: Provider and 
Managed Care Files.
    Currently, each state submits five extracts to CMS on a quarterly 
basis. These data are used by CMS to assist in federal reporting for 
the Medicaid and CHIP. Several reasons culminated in the CMS mission to 
improve the Medicaid dataset repository, including incomplete data, 
questionable results, multiple data collections from states, multiple 
federal data platforms and analytic difficulties in interpreting and 
presenting the results. In addition, timeliness issues have prompted 
CMS to re-evaluate its processes and move toward a streamlined 
delivery, along with an enhanced data repository. The new T-MSIS 
extract format is expected to further CMS goals for improved 
timeliness, reliability and robustness through monthly updates and an 
increase in the amount of data requested.

II. Modifications to SORN 09-70-0541

    The following modifications have been made to SORN 09-70-0541 in 
order to reflect changes to the system of records resulting from the IT 
system change from MSIS to T-MSIS and to update the SORN generally:
     The SORN has been reformatted to conform to the revised 
template prescribed in Office of Management and Budget (OMB) Circular 
A-108, issued December 23, 2016.
     The name of the system of records has been changed from 
``Medicaid Statistical Information System (MSIS)'' to ``Transformed--
Medicaid Statistical Information System (T-MSIS), HHS/CMS/CMCS.''
     Address information in the System Location and System 
Manager(s) sections has been updated.
     The Authority section now cites applicable U.S. Code 
provisions instead of public laws.
     The Purpose section added information collecting over 1000 
new data elements to perform expanded data analytics. The T-MSIS data 
set contains: enhanced information about beneficiary eligibility, 
beneficiary and provider enrollment, service utilization, claims and 
managed care data, and expenditure data for Medicaid and CHIP.
     The categories of individuals have not changed, but they 
are now more clearly delineated as Medicaid recipients and Medicaid 
providers.
     The Categories of Records section now specifies categories 
of records, in addition to a listing data elements. Including these 
categories for the existing five categories, the list has been expanded 
to add new categories (i.e., files for third-party liability, 
information from managed-care plans, and providers.) and additional 
examples of data elements (such as tax identification number/employer 
identification number (TIN/EIN), national provider identifier (NPI), 
Social Security Number (SSN), prescriber identification number, and 
other assigned clinician numbers).
     The Record Source Categories section has added non-
Medicare individuals, third party data submitter who are individuals; 
i.e., Third Party Administrators (TPA); contact persons and authorized 
representatives (such as parents and guardians of Medicare

[[Page 46952]]

recipients who are minors) as sources of information.
     The following changes have been made to the Routine Uses 
section:
    [cir] Two new routine uses have been added, numbered as three and 
10.
    [cir] The two breach response-related routine uses which were added 
February 14, 2018, are now numbered as eight and nine, and
    [cir] CMS grantees were removed from routine use number one.
     There are no changes to the Storage section.
     The Retrieval section now indicates that information will 
be retrieved by name, address, and Tax Identification Number (TIN)/
Employer Identification Number (EIN) pertaining to third party data 
submitters. Records about contact persons will be retrieved by name, 
email address and business address.
     The Retention and Disposal section changes retention of 
Medicaid record to a period of 10 years after the final determination 
of the case is completed. In addition, any claims-related records 
encompassed by a document preservation order may be retained longer 
(i.e., until notification is received from the Department of Justice).
     The Safeguards section has been updated to reflect most 
recent publications and guidance governing the use and protections of 
the data maintained in this SOR.
     Records Access, Contesting, and Notification procedures 
sections has been expanded to provide clarity and better understanding 
of procedures to follow.

Barbara Demopulos,
CMS Privacy Advisor, Division of Security, Privacy Policy and 
Governance, Information Security and Privacy Group, Office of 
Information Technology, Centers for Medicare& Medicaid Services.
SYSTEM NAME AND NUMBER
    Transformed--Medicaid Statistical Information System (T-MSIS), HHS/
CMS/CMCS, System No. 09-07-0541.

SECURITY CLASSIFICATION:
    Unclassified.

SYSTEM LOCATION:
    The address of the agency component responsible for the system of 
records is: The CMS Data Center, 7500 Security Boulevard, North 
Building, First Floor, Baltimore, Maryland 21244-1850 and at various 
contractor sites.

SYSTEM MANAGER(S):
    Director, Data and Systems Group, Center for Medicaid and CHIP 
Services, CMS Mail Stop S2-22-16, 7500 Security Boulevard, Baltimore, 
Maryland 21244-1850.

AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
    The specific authority that authorizes the maintenance of the 
records in the system is given under Sec.  1902(a)(6) of the Social 
Security Act (the Act) (42 United States Code (U.S.C.) 1396a (a)(6)), 
Sec.  4753(a) (1396a (i)(1)(B)) of the Balanced Budget Act of 1997 
(Public Law (Pub. L. 105- 33)), Sec.  4201 of the American Reinvestment 
and Recovery Act of 2009 (ARRA) (Pub. L. 111-5), and in accordance with 
Sec. Sec.  402(c), 1561, 2602, 4302, 6402(c), 6504(a), 6504(b) of the 
Patient Protection and Affordable Care Act (ACA) (Pub. L. 111-148).

PURPOSE(S) OF THE SYSTEM:
    The primary purpose of the system is to establish an accurate, 
current, and comprehensive database containing standardized enrollment, 
eligibility, and paid claims of Medicaid recipients to be used for the 
administration of Medicaid at the Federal level, produce statistical 
reports, support Medicaid related research, and assist in the detection 
of fraud and abuse in the Medicare and Medicaid programs. T-MSIS will 
also provide benefits to the states by reducing the number of reports 
CMS requires of the states, provides data needed to improve beneficiary 
quality of care, assess beneficiary to care and enrollment, improve 
program integrity, and support our states, the private market, and 
stakeholders with key information.

CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:
    The records in this system of records are about the following 
categories of individuals:
     Medicaid recipients (including individuals in the dual 
eligible population, individuals enrolled in the CHIP program, and non-
Medicare individuals);
     Medicaid providers (i.e., physicians and providers of 
healthcare services to the Medicaid and CHIP population);
     Any non-Medicare individuals whose information is 
contained in a record about a Medicaid recipient or Medicaid provider;
     Third party data submitters; i.e., third party 
administrators or independent insurance company personnel who are 
required to report claims information pertaining to Medicaid 
recipients, and
     Contact persons such as parents and guardians of Medicare 
recipients who are minors, CHIP recipients, and non-Medicare 
individuals.

CATEGORIES OF RECORDS IN THE SYSTEM:
    A. The system of records consists of the following categories of 
records, which contain information about Medicaid recipients and 
Medicaid providers, and non-Medicaid individuals and contact persons 
for CHIP recipients and non-Medicare population.
     Original MSIS files:
    [cir] Eligibility files
    [cir] Claims files (for inpatient claims, long-term care claims, 
pharmacy claims, and other claims).
     New Files added to T-MSIS database:
    [cir] Third-party liability
    [cir] information from managed care plans
    [cir] providers
     New T-MSIS analytic files (TAF):
    [cir] Beneficiary files (monthly beneficiary summary, annual 
beneficiary summary);
    [cir] claims files (for inpatients claims, long-term care claims, 
pharmacy claims, and other claims);
    [cir] providers of healthcare services to the Medicaid and CHIP 
population); and
    [cir] Managed Care Plans
    B. Information about Medicaid recipients, includes data elements 
such as name, address, assigned Medicaid identification number, SSN, 
Medicare beneficiary identifier (MBI), date of birth, gender, ethnicity 
and race, medical services, equipment, and supplies for which Medicaid 
reimbursement is requested. Information will also include the 
recipient's individually identifiable health information, i.e., health 
care utilization and claims data, health insurance claim number (HICN), 
Medicare beneficiary identifier (MBI), and SSN.
    Information about Medicaid providers in the above records includes 
data elements such as contact information (such as the provider's name, 
address, phone number, email address, date of birth, business address, 
Tin/EIN, national provider identifier (NPI), SSN, prescriber 
identification number, and other assigned clinician numbers) and 
information about health care services the clinician provided to 
Medicare recipients and the measures and activities the clinician used 
in providing the services.
    Information about any non-Medicaid individuals would include data 
elements such as those listed above for Medicaid recipients such as 
name, address, phone number, email address, and SSN or other 
identifying number.
    Information about contact persons for CHIP recipients and non-
Medicare individuals includes data elements such as name, address, 
phone number, email address, TIN/EIN, or other identifying number.

[[Page 46953]]

RECORD SOURCE CATEGORIES:
    Information in the system of records is obtained from State 
Medicaid agencies or Territories, which collect the information 
directly from Medicaid recipients or their authorized representatives 
(such as parents and guardians of Medicare recipients who are minors or 
from Medicaid providers).

ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM, INCLUDING CATEGORIES 
OF USERS AND PURPOSES OF SUCH USES:
    A. The agency may disclose a record about an individual Medicaid 
recipient or Medicaid provider from this system of records to parties 
outside HHS, without the individual's prior written consent, pursuant 
to these routine uses:
    1. To support agency contractors, and consultants who have been 
engaged by the agency to assist in the performance of a service related 
to the collection and who need to have access to the records in order 
to perform the activity.
    2. To assist another Federal or state agency, agency of a state 
government, an agency established by state law, or its fiscal agent to:
    a. Contribute to the accuracy of CMS' proper management of 
Medicare/Medicaid benefits;
    b. Enable such agency to administer a Federal health benefits 
program, or as necessary to enable such agency to fulfill a requirement 
of a Federal statute or regulation that implements a health benefits 
program funded in whole or in part with Federal funds; and/or
    c. Assist Federal/state Medicaid programs.
    3. To assist another Federal or state agency, agency of a state 
government, an agency established by state law, or its fiscal agent to 
enable such agency to administer a Federal benefits program, or as 
necessary to enable such agency to fulfill a requirement of a Federal 
statute or regulation funded in whole or in part with Federal funds.
    4. To an individual or organization for a research project or in 
support of an evaluation project related to the prevention of disease 
or disability, the restoration or maintenance of health, or payment 
related projects.
    5. To the Department of Justice (DOJ), court or adjudicatory body 
when:
    a. The agency or any component thereof;
    b. Any employee of the agency in his or her official capacity;
    c. Any employee of the agency in his or her individual capacity 
where the DOJ has agreed to represent the employee; or
    d. The United States Government is a party to litigation or has an 
interest in such litigation, and by careful review, CMS determines that 
the records are both relevant and necessary to the litigation and that 
the use of such records by the DOJ, court or adjudicatory body is 
compatible with the purpose for which the agency collected the records.
    6. To a CMS contractor (including, but not necessarily limited to 
fiscal intermediaries and carriers) that assists in the administration 
of a CMS-administered health benefits program, or to a grantee of a 
CMS-administered grant program, when disclosure is deemed reasonably 
necessary by CMS to prevent, deter, discover, detect, investigate, 
examine, prosecute, sue with respect to, defend against, correct, 
remedy, or otherwise combat fraud, waste, and abuse in such program.
    7. To another Federal agency or to an instrumentality of any 
governmental jurisdiction within or under the control of the United 
States (including any State or local governmental agency), that 
administers, or that has the authority to investigate potential fraud, 
waste, and abuse in, a health benefits program funded in whole or in 
part by Federal funds, when disclosure is deemed reasonably necessary 
by CMS to prevent, deter, discover, detect, investigate, examine, 
prosecute, sue with respect to, defend against, correct, remedy, or 
otherwise combat fraud, waste, and abuse in such programs.
    8. Records may be disclosed to appropriate agencies, entities, and 
persons when (a) HHS suspects or has confirmed that there has been a 
breach of the system of records; (b) HHS has determined that as a 
result of the suspected or confirmed breach there is a risk of harm to 
individuals, HHS (including its information systems, programs, and 
operations), the Federal government, or national security; and (c) the 
disclosure made to such agencies, entities, and persons is reasonably 
necessary to assist in connection with HHS' efforts to respond to the 
suspected or confirmed breach or to prevent, minimize, or remedy such 
harm.
    9. Records may be disclosed to another Federal agency or Federal 
entity, when HHS determines that information from this system of 
records is reasonably necessary to assist the recipient agency or 
entity in (a) responding to a suspected or confirmed breach or (b) 
preventing, minimizing, or remedying the risk of harm to individuals, 
the recipient agency or entity (including its information systems, 
programs, and operations), the Federal government, or national 
security, resulting from a suspected or confirmed breach.
    10. Records may be disclosed to the U.S. Department of Homeland 
Security (DHS) if captured in an intrusion detection system used by HHS 
and DHS pursuant to a DHS cybersecurity program that monitors internet 
traffic to and from Federal government computer networks to prevent a 
variety of types of cybersecurity incidents.
    B. Additional Circumstances Affecting Routine Use Disclosures: To 
the extent this system contains Protected Health Information (PHI) as 
defined by HHS regulation ``Standards for Privacy of Individually 
Identifiable Health Information'' (45 Code of Federal Regulations (CFR) 
Parts 160 and 164, Subparts A and E), disclosures of such PHI that are 
otherwise authorized by these routine uses may only be made if, and as, 
permitted or required by the ``Standards for Privacy of Individually 
Identifiable Health Information'' (see 45 CFR 164.512(a)(1)).
    The disclosures authorized by publication of the above routine uses 
pursuant to 5 U.S.C. 552a(b)(3) are in addition to other disclosures 
authorized directly in the Privacy Act at 5 U.S.C. 552a(b)(2) and 
(b)(4)-(11).

POLICIES AND PRACTICES FOR STORAGE OF RECORDS:
    All records are stored on computer diskette, and magnetic media.

POLICIES AND PRACTICES FOR RETRIEVAL OF RECORDS:
    The data collected on Medicaid recipients, Medicare beneficiaries 
(and any non-Medicare individuals) are retrieved by the individual's 
name, Medicare beneficiary identifier (MBI), health insurance claim 
number (HICN), SSN, address, and date of birth. The data collected on 
physicians or providers of services will be retrieved by the provider's 
name, address, NPI, TIN/EIN and other identifying provider numbers. 
Information about third party data submitters who are individuals will 
be retrieved by name, address, and TIN/EIN. Records about contact 
persons will be retrieved by name, email address and business address.

POLICIES AND PRACTICES FOR RETENTION AND DISPOSAL OF RECORDS:
    CMS will retain identifiable T-MSIS data for a total period not to 
exceed 10 years after the final determination of the case is completed. 
The final determination decision encompass the potential timeframe it 
takes for a claims to be finalized as States can sometimes send 
incomplete claims data or claims not yet fully covered due to dispute 
or other considerations for Medicaid eligibility. Any claims-related 
records encompassed by a document

[[Page 46954]]

preservation order may be retained longer (i.e., until notification is 
received from the Department of Justice).

ADMINISTRATIVE, TECHNICAL, AND PHYSICAL SAFEGUARDS:
    CMS has safeguards in place to prevent records from being accessed 
by unauthorized persons and monitors authorized users to ensure against 
excessive or unauthorized use. Examples of these safeguards include but 
not limited to: Protecting the facilities where records are stored or 
accessed with security guards, badges and cameras, securing hard-copy 
records in locked file cabinets, file rooms or offices during off-duty 
hours, limiting access to electronic databases to authorized users 
based on roles and two-factor authentication (user ID and password), 
using a secured operating system protected by encryption, firewalls, 
and intrusion detection systems, requiring encryption for records 
stored on removable media, and training personnel in Privacy Act and 
information security requirements. Records that are eligible for 
destruction are disposed of using destruction methods prescribed by 
NIST SP 800-88. Personnel having access to the system have been trained 
in the Privacy Act and information security requirements. Employees who 
maintain records in the system are instructed not to release data 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.
    The Information Technology (IT) system used to house the records 
conforms to all applicable Federal laws and regulations and Federal, 
HHS, and CMS 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 Federal Information Security 
Modernization Act of 2014; 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, and Security 
of Federal Automated Information Resources also applies to the SOR. 
Federal, HHS, and CMS policies and standards include but are not 
limited to: All pertinent National Institute of Standards and 
Technology publications; the HHS Information Security and Privacy 
Policy Handbook (IS2P), the CMS Acceptable Risk Safeguards (ARS), and 
the CMS Information Security and Privacy Policy (IS2P2).

RECORD ACCESS PROCEDURES:
    An individual seeking access to a record about him/her in this 
system of records must submit a written request to the System Manager 
indicated above. The request must contain the individual's name and 
particulars necessary to distinguish between records on subject 
individuals with the same name, such as NPI or TIN, and should also 
reasonably specify the record(s) to which access is sought. To verify 
the requester's identity, the signature must be notarized or the 
request must include the requester's written certification that he/she 
is the person he/she claims to be and that he/she understands that the 
knowing and willful request for or acquisition of records pertaining to 
an individual under false pretenses is a criminal offense subject to a 
$5,000 fine.

CONTESTING RECORD PROCEDURES:
    Any subject individual may request that his/her record be corrected 
or amended if he/she believes that the record is not accurate, timely, 
complete, or relevant or necessary to accomplish a Department function. 
A subject individual making a request to amend or correct his record 
shall address his request to the-System Manager indicated, in writing, 
and must verify his/her identity in the same manner required for an 
access request. The subject individual shall specify in each request: 
(1) The system of records from which the record is retrieved; (2) The 
particular record and specific portion which he/she is seeking to 
correct or amend; (3) The corrective action sought (e.g., whether he/
she is seeking an addition to or a deletion or substitution of the 
record); and, (4) His/her reasons for requesting correction or 
amendment of the record. The request should include any supporting 
documentation to show how the record is inaccurate, incomplete, 
untimely, or irrelevant.

NOTIFICATION PROCEDURES:
    Individuals wishing to know if this system contains records about 
them should write to the System Manager indicated above and follow the 
same instructions under Record Access Procedures.

EXEMPTIONS PROMULGATED FOR THE SYSTEM:
    None.

HISTORY:
     Medicaid Statistical Information System (MSIS), System No. 
09-07-0541 last published in full at 71 FR 65527 (Nov. 8, 2006), as 
amended 78 FR 32257 (May 29, 2013), and updated 83 FR 6591 (Feb. 14, 
2018).

[FR Doc. 2018-20063 Filed 9-14-18; 8:45 am]
 BILLING CODE 4120-03-P