83 FR 54755 - Privacy Act of 1974; Matching Program

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Federal Register Volume 83, Issue 211 (October 31, 2018)

In accordance with the Privacy Act of 1974, as amended, the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) is providing notice of a new matching program between CMS and the Department of Defense (DoD), ``Verification of Eligibility for Minimum Essential Coverage Under the Patient Protection and Affordable Care Act Through a Department of Defense Health Benefits Plan.''

[Federal Register Volume 83, Number 211 (Wednesday, October 31, 2018)]
[Notices]
[Pages 54755-54756]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2018-23780]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES


Privacy Act of 1974; Matching Program

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

ACTION: Notice of a new matching program.

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SUMMARY: In accordance with the Privacy Act of 1974, as amended, the 
Department of Health and Human Services (HHS), Centers for Medicare & 
Medicaid Services (CMS) is providing notice of a new matching program 
between CMS and the Department of Defense (DoD), ``Verification of 
Eligibility for Minimum Essential Coverage Under the Patient Protection 
and Affordable Care Act Through a Department of Defense Health Benefits 
Plan.''

DATES: The deadline for comments on this notice is November 30, 2018. 
The re-established matching program will commence not sooner than 30 
days after publication of this notice, provided no comments are 
received that warrant a change to this notice. The matching program 
will be conducted for an initial term of 18 months (from approximately 
December 2018 to June 2020) and within 3 months of expiration may be 
renewed for one additional year if the parties make no change to the 
matching program and certify that the program has been conducted in 
compliance with the matching agreement.

ADDRESSES: Interested parties may submit written comments on this 
notice, by mail or email, to the CMS Privacy Officer, Division of 
Security, Privacy Policy & Governance, Information Security & Privacy 
Group, Office of Information Technology, Centers for Medicare & 
Medicaid Services, Location: N1-14-56, 7500 Security Blvd., Baltimore, 
MD 21244-1850, [email protected].

FOR FURTHER INFORMATION CONTACT: If you have questions about the 
matching program, you may contact Jack Lavelle, Senior Advisor, 
Marketplace Eligibility and Enrollment Group, Centers for Consumer 
Information and Insurance Oversight, CMS, at (410) 786-0639, or by 
email at [email protected], or by mail at 7501 Wisconsin Ave., 
Bethesda, MD 20814.

SUPPLEMENTARY INFORMATION: The Privacy Act of 1974, as amended (5 
U.S.C. 552a) provides certain protections for individuals applying for 
and receiving federal benefits. The law governs the use of computer 
matching by federal agencies when records in a system of records 
(meaning, federal agency records about individuals retrieved by name or 
other personal identifier) are matched with records of other federal or 
non-federal agencies. The Privacy Act requires agencies involved in a 
matching program to:
    1. Enter into a written agreement, which must be prepared in 
accordance with the Privacy Act, approved by the Data Integrity Board 
of each source and recipient federal agency, provided to Congress and 
the Office of Management and Budget (OMB), and made available to the 
public, as required by 5 U.S.C. 552a(o), (u)(3)(A), and (u)(4).
    2. Notify the individuals whose information will be used in the 
matching program that the information they provide is subject to 
verification through matching, as required by 5 U.S.C. 552a(o)(1)(D).
    3. Verify match findings before suspending, terminating, reducing, 
or making a final denial of an individual's benefits or payments or 
taking other adverse action against the individual, as required by 5 
U.S.C. 552a(p).
    4. Report the matching program to Congress and the OMB, in advance 
and annually, as required by 5 U.S.C. 552a(o) (2)(A)(i), (r), and 
(u)(3)(D).
    5. Publish advance notice of the matching program in the Federal 
Register as required by 5 U.S.C. 552a(e)(12).
    This matching program meets these requirements.

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.

Participating Agencies

    Department of Health and Human Services (HHS), Centers for Medicare 
& Medicaid Services (CMS) is the recipient agency, and the Department 
of Defense (DoD), Defense Manpower Data Center (DMDC) is the source 
agency.

Authority for Conducting the Matching Program

    The matching program is authorized under 42 U.S.C. 18001, et seq.

Purpose(s)

    The purpose of the matching program is to provide CMS with DoD data 
verifying individuals' eligibility for coverage under a DoD health 
benefits plan (i.e., TRICARE), when requested by CMS and state-based 
administering entities (AE) for the purpose of determining the 
individuals' eligibility for insurance affordability programs under the 
Affordable Care Act (ACA). CMS and the requesting AE will use the DoD 
data to determine whether an enrollee in private health coverage under 
a qualified health plan through a federally-facilitated or state-based 
health insurance exchange is eligible for coverage under TRICARE, and 
the dates the individual was eligible for TRICARE coverage. DoD health 
benefit plans provide minimum essential coverage (MEC), and eligibility 
for such plans

[[Page 54756]]

usually precludes eligibility for financial assistance in paying for 
private coverage. CMS and AE will use the DoD data to authenticate 
identity, determine eligibility for financial assistance (including an 
advance tax credit and cost-sharing reduction, which are types of 
insurance affordability programs), and determine the amount of the 
financial assistance.

Categories of Individuals

    The categories of individuals whose information is involved in the 
matching program are active duty service members and their family 
members and retirees and their family members whose TRICARE eligibility 
records at DoD match data provided to DoD by CMS (submitted by AEs) 
about individual consumers who are applying for or are enrolled in 
private health insurance coverage under a qualified health plan through 
a federally-facilitated or state-based health insurance exchange.

Categories of Records

    The categories of records used in the matching program are identity 
records and minimum essential coverage period records. The data 
elements are as follows:

A. From CMS to DoD

    For each applicant or enrollee seeking an eligibility 
determination, CMS will submit a request file to DoD that may contain, 
but is not limited to, the following specified data elements in a fixed 
record format: Transaction ID, social security number (SSN), first 
name, middle name, surname, date of birth, gender, requested qualified 
health plan (QHP) coverage effective date, requested QHP coverage end 
date.

B. From DoD to CMS

    For each applicant or enrollee seeking an eligibility 
determination, DoD will provide CMS with data indicating whether or not 
the individual is eligible for MEC through TRICARE during the 
applicable QHP coverage period. The data may contain, but is not 
limited to, the following specified data elements in a fixed record 
format: Insurance end date, person SSN identification, response code, 
response code text.

System(s) of Records

    The records used in this matching program are disclosed from the 
following systems of records, as authorized by routine uses published 
in the System of Records Notices (SORNs) cited below:

A. CMS System of Records

    [square] MCMS Health Insurance Exchanges System (HIX), CMS System 
No. 09-70-0560, last published in full at 78 FR 63211 (Oct. 23, 2013), 
as amended at 83 FR 6591 (Feb. 14, 2018).

B. DoD Systems of Records

    [square] SDMDC 02 DoD, Defense Enrollment Eligibility Reporting 
Systems (DEERS), 80 FR 68304 (Nov. 4, 2015), as amended at 81 FR 49210 
(July 27, 2016).

[FR Doc. 2018-23780 Filed 10-30-18; 8:45 am]
 BILLING CODE 4120-03-P