[Federal Register Volume 78, Number 205 (Wednesday, October 23, 2013)]
[Notices]
[Pages 63211-63216]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-24861]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
Privacy Act of 1974; Report of an Altered CMS System of Records
Notice
AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of
Health and Human Services (HHS).
ACTION: Altered System of Records Notice (SORN).
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SUMMARY: In accordance with the requirements of the Privacy Act of 1974
(5 U.S.C. 552a), CMS proposes several alterations to the existing
system of records titled, ``Health Insurance Exchanges (HIX) Program''
(No. 09-70-0560), published at 78 FR 8538 (February 6, 2013) and
amended and published at 78 FR 32256 (May 29, 2013). The alterations
affect the ``Purposes of the System'', ``Categories of Individuals
Covered by the System'', ``Categories of Records in the System'',
``Authority for Maintenance of the System'', ``System Location'',
``Retention and Disposal'', ``System Manager and Address'', ``Routine
Uses of Records Maintained in the System'', and ``Record Source
Categories'' sections of the accompanying System of Records Notice, as
more fully explained in the Supplementary Information section.
DATES: The proposed modifications will be effective immediately, with
exception of the new and revised Routine Uses which will be effective
30 days after publication of this notice in the Federal Register unless
comments received on or before that date result in revisions to this
notice.
ADDRESSES: The public should send comments to: CMS Privacy Officer,
Division of Privacy Policy, Privacy Policy and Compliance Group, Office
of E-Health Standards & Services, Office of Enterprise Management, CMS,
Room S2-24-25, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.
Comments received will be available for review at this location, by
appointment, during regular business hours, Monday through Friday from
9:00 a.m.-3:00 p.m., Eastern Time zone.
For Information on Health Insurance Exchanges Contact: Karen
Mandelbaum, JD, MHA, Office of Health Insurance Exchanges, Exchange
Policy and Operations Group, Center for Consumer Information and
Insurance Oversight, 7210 Ambassador Road, Baltimore, MD 21244, Office
Phone: (410) 786-1762, Facsimile: (301) 492-4353, Email:
[email protected].
SUPPLEMENTARY INFORMATION:
I. Proposed Alterations
By way of background, this system of records was established to be
a global system of records to cover all data activities in support of
the HIX Program at the Federal level. The Health Insurance Exchanges
(HIX) Program is a new way to find health insurance coverage for people
who do not currently have coverage or who want to find options for
health insurance coverage. The HIX Program includes Federally-
facilitated Exchanges (FFEs) operated by CMS, CMS support and services
provided to all Exchanges and state agencies administering Medicaid
programs, Children's Health Insurance Programs (CHIPs) and Basic Health
Programs (BHPs), and CMS administration of advance payments of the
premium tax credit and cost-sharing reductions associated with
enrollment in QHPs through an Exchange. The system stores personal,
financial, employment and demographic information about individuals who
participate in or are involved with the HIX Program. The proposed
modifications to the system of records and the affected sections of the
System of Records Notice are identified and described below.
Use Limitations on Federal Tax Return Information
CMS proposes to amend item No. 1 in the Categories of Records
section to clarify that Federal tax return information may be used or
disclosed only as authorized by 26 U.S.C. 6103.
Discussion of Reporting
CMS proposes to amend the Purpose of the System section to
explicitly mention the oversight and reporting functions required by
the Patient Protection and Affordable Care Act (PPACA) (Pub. L. 111-
148) as amended by the Health Care and Education Reconciliation Act of
2010 (Pub. L. 111-152), collectively referred to as the Affordable Care
Act.
Individuals Providing Consumer Assistance
CMS proposes to include, in the Purpose and Categories of Records
sections, a description of the information resulting from registering,
training and/or certifying individuals who will assist consumers,
applicants and enrollees in states where an FFE and/or an FF-SHOP will
operate. Such individuals include Navigators (as defined by 45
CFR155.210), non-Navigator Assistance Personnel (as allowed for under
45 CFR155.205; also known as In-Person Assisters), Certified
application counselors (as defined by 45 CFR155.225), Agents and
Brokers, and any other individuals that are required to register with
an Exchange prior to assisting qualified individuals, employees and
employers to enroll in QHPs through the Exchange. Upon completing the
registration form and successfully completing the training and testing
program and certification process, CMS will certify these individuals
to provide consumers, applicants, and enrollees with outreach,
education, and assistance in obtaining access to health care coverage
through an FFE or FF-SHOP.
CMS proposes to amend Routine Use No. 2 to clarify that CMS may
disclosure information about Navigators, non-Navigator Assistance
Personnel, Certified application counselors, and
[[Page 63212]]
Agents and Brokers to the appropriate state agency or agencies in the
state in which they have registered and will provide outreach,
education and assistance to consumers, applicants and enrollees through
the FFE or FF-SHOP.
Additionally, CMS proposes a new Routine Use, Number 11,
specifically related to the information of Agents and Brokers who have
completed registration and training. Pursuant to 45 CFR 155.220(b), CMS
proposes Routine Use number 11 so that CMS may display on the FFE and
FF-SHOP Web sites information regarding these Agents and Brokers who
have completed registration and training for the convenience of
consumers looking for assistance from an Agent or Broker that is
familiar with the Exchange policies and application process.
Identity Proofing
CMS proposes to include a description of the identity proofing
process within the Purpose of the System section. Identity proofing
refers to a process through which the Exchange, state Medicaid agency,
or state CHIP agency obtains a level of assurance through a third party
data verification source regarding an individual's identity that is
sufficient to allow access to electronic systems that include sensitive
state and Federal data. This process will be performed at the time (A)
an application for an eligibility determination in the individual
market and Small Business Health Options Program (SHOP) is submitted to
an Exchange and (B) an Agent or Broker registers with the Federally-
facilitated Exchange (FFE) and completes the FFE training and
certification processes.
Identity proofing must be completed by several categories of
individuals. Each adult application filer (as defined at 45 CFR 155.20)
submitting either an on-line application or a telephonic application
for an eligibility determination or enrollment in a QHP through an
Exchange in the individual market, advance payments of the premium tax
credit, cost-sharing reductions, Medicaid and CHIP must complete the
identity proofing process. The adult application filer is required to
complete identity proofing prior to filing an on-line or telephonic
application and prior to the disclosure of any information covered
under this system of records back to the application filer. Application
filers submitting paper applications regardless of type (including
exemptions) will be identity proofed only if they elect to move into an
electronic process. In addition, for the FF-SHOP Employer applications,
the primary employer contact must complete identity proofing and if a
secondary employer contacts is identified on the application, the
secondary employer contact may have to complete identity proofing as
well. Identity proofing will also be performed on Agents and Brokers
when they register with the FFE to become certified to assist
consumers, individuals, applicants and enrollees in the individual
market Marketplace and SHOP Marketplace in a state in which the Agent
or Broker is licensed to sell health insurance.
Clarification of Meanings of Terms
CMS also proposes to clarify the intended meaning of the term
``application filer'' as it is used in the current version of the SORN.
CMS also proposes to add a new Category of Records describing the
information maintained about this group of individuals. As used in the
existing Category of Records and Routine Use Number 8, this terms was
intended to be inclusive of the following: an application filer, as
defined by 45 CFR155.20 (which includes authorized representatives);
individuals or their authorized representative applying for exemption
from the individual shared responsibility payment; a SHOP application
filer as defined by 45 CFR155.700; Agents and Brokers; and QHP issuers
performing application assistance functions.
To ensure clarity of the meaning of terms used with the SORN,
beginning with this version of the SORN, CMS proposes to align the use
of terms with the definitions provided within HIX program regulations.
Therefore, CMS is proposing changes to the Categories of Records and
Routine Use number 8 to itemize all of the populations included within
the meaning of the current use of the term application filer. In
general, additional small wording adjustments have been made throughout
all sections to provide consistent use of terms and more specificity
throughout the SORN.
Health Insurance Casework System (HICS)
CMS proposes to update the Purpose of the System, the Authority for
Maintenance of the System, and Categories of Records sections and add a
new Routine Use to include a description of the consumer complaint
tracking system known as the Health Insurance Casework System (HICS).
Section 1311(c)(3) of the Affordable Care Act requires HHS to ``develop
a rating system that would rate qualified health plans offered through
an Exchange in each benefits level on the basis of the relative quality
and price.'' Additionally, Section 1321(c) of the Affordable Care Act
authorizes HHS to ensure that states with Exchanges are substantially
enforcing the federal standards to be set for the Exchanges. Sections
2723 and 2761 of the Public Health Service Act (PHS Act) authorize HHS
to enforce PHS Act provisions that apply to non-Federal governmental
plans and to enforce PHS Act provisions that apply to other health
insurance coverage in states that HHS has determined are not
substantially enforcing those provisions. By collecting consumer
complaint information, HICS will help HHS carry out all of the above
mentioned functions.
Routine Uses
CMS proposes the following Routine Use modifications.
[squf] Routine Use No. 2: Modify to permit CMS to disclose
information to an Appeals Entity as defined under 45 CFR 155.500 in the
event that an applicant or enrollee exercises his or her appeal right
under 45 CFR 155.505. Modify to permit CMS to disclose information
about Navigators, non-Navigator Assistance Personnel, Certified
application counselors, and Agents and Brokers who have been trained
and certified by CMS to provide consumer assistance to the appropriate
state agency or agencies for oversight and monitoring of these
individuals.
[squf] Routine Use No. 4: Modify to remove unnecessary example
related to contractors.
[squf] Routine Use No. 8: Modify to clarify the meaning intended
with the use of term application filer to allow information about
applicants and Relevant Individuals to be disclosed to Agents, Brokers,
and QHP issuers.
[squf] Routine Use No. 9: Modify to expand the disclosure of
information to QHP issuers to include the disclosure of (A) applicant/
enrollee and Relevant Individual information as necessary for
individuals to be enrolled in a QHP, regardless of eligibility for
advance payments of the premium tax credit or cost-sharing reductions
and (B) consumer information for those that contact CMS to file a
complaint or to seek resolution of an issue with the QHP issuer.
CMS proposes adding the following Routine Uses.
[squf] Routine Use No. 10: Provide for disclosures of employee
information to employers when an employee submitting an application for
an eligibility determination has been determined eligible for advance
payments of the premium tax credit and cost-sharing reductions, or as
needed to
[[Page 63213]]
verify whether an applicant is enrolled in an eligible employer
sponsored plan.
[ssquf] Routine Use No.11: Permit the public disclosure of
information to the appropriate state agency, and members of the public,
about Agents and Brokers that have registered with, successfully
completed CMS training, and are certified by an FFE or FF-SHOP, and to
disclose Agent and Broker information to the appropriate state agency
to assist states with oversight, monitoring and enforcement activities
over agents and brokers and allow states to provide outreach and
education resources to consumers about obtaining health care coverage
in their states.
[ssquf] Routine Use No. 12: Permit the disclosure of information
from the HICS system to other government agencies for the purposes of
resolving complaints and assisting states with issuer oversight and
monitoring.
[ssquf] Routine Use No. 13: To assist a CMS contractor that is
engaged to perform a function or provide administrative, technical or
physical support to the FFEs (including FF-SHOPs) or to a grantee of a
CMS-administered grant program, when the 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 or abuse in such
program.
II. The Privacy Act
The Privacy Act (5 U.S.C. 552a) governs the means by which the
United States Government collects, maintains, and uses PII in a system
of records. A ``system of records'' is a group of any records under the
control of a Federal agency from which information about individuals is
retrieved by 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
PII 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 (e.g., to determine if the
system contains information about them).
SYSTEM NUMBER:
09-70-0560.
SYSTEM NAME:
Health Insurance Exchanges (HIX) Program, HHS/CMS/CCIIO.
SECURITY CLASSIFICATION:
Unclassified
SYSTEM LOCATION:
CMS Data Center, 7500 Security Boulevard, North Building, First
Floor, Baltimore, Maryland 21244-1850, Health Insurance Exchanges
Program (HIX) locations, and at various contractor sites.
CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:
The system will contain personally identifiable information (PII)
about the following categories of individuals who participate in or are
involved with the CMS Health Insurance Exchanges (HIX) Program: (1) Any
applicant/enrollee who applies and any application filer (an
application filer, as defined by 45 CFR155.20 (which includes
authorized representatives); individuals or their authorized
representative applying for exemption from the individual shared
responsibility payment; a SHOP application filer as defined by 45
CFR155.700; Agents and Brokers; and QHP issuers performing application
assistance functions) who files an application on behalf of an
applicant/enrollee, for an eligibility determination for enrollment in
a qualified health plan (QHP) through an Exchange, for one or more
insurance affordability programs, for a certificate of exemption from
the shared responsibility requirement, or an appeal; (2) Navigators,
non-Navigator Assistance Personnel (also known as In-Person Assisters),
Certified application counselors, Agents and Brokers, and all other
individuals or entities that are required to register with an Exchange
prior to assisting qualified individuals, employees and employers to
enroll in QHPs through the Exchange; (3) officers, employees and
contractors of the Exchange; (4) employees and contractors of CMS (e.g.
eligibility support workers, appeals staff, etc.); (5) contact
information and business identifying information of representatives,
officers, agents, and employees of QHPs seeking certification; (6)
persons employed by or contracted with an Exchange organization who
provide home or personal contact information; (7) any qualified
employer and the qualified employees whose enrollment in a QHP is
facilitated through a Small Business Health Options Program (SHOP),
including authorized representatives of such individuals; and (8)
Individuals, including non-applicant household members/family members,
non-applicant tax payers or tax filers, and spouses and parents of
applicants, who are listed on the application and whose PII may bear
upon a determination of the eligibility of an individual for an
insurance affordability program and for certifications of exemption
from the individual responsibility requirement. Such individuals will
hereafter be referred to as ``Relevant Individual(s)''.
CATEGORIES OF RECORDS IN THE SYSTEM:
Information maintained in this system for individual applicant/
enrollees includes, but may not be limited to, the applicant's first
name, last name, middle initial, mailing address or permanent
residential address (if different from the mailing address), date of
birth, Social Security Number (if the applicant/enrollee has one),
taxpayer status, gender, ethnicity, residency, email address, telephone
number, employment status and employer if applicable. The system will
also maintain information from the verification process of the
information provided by the applicant/enrollee or by the application
filer (an application filer, as defined by 45 CFR 155.20 (which
includes authorized representatives); individuals or their authorized
representative applying for exemption from the individual shared
responsibility payment; a SHOP application filer as defined by 45 CFR
155.700; Agents and Brokers; and QHP issuers performing application
assistance functions) on behalf of the applicant that will enable a
determination about the applicant's or enrollee's eligibility. The
system will collect and maintain information that the applicant/
enrollee or the application filer (an application filer, as defined by
45 CFR 155.20 (which includes authorized representatives); individuals
or their authorized representative applying for exemption from the
individual shared responsibility payment; a SHOP application filer as
defined by 45 CFR 155.700; Agents and Brokers; and QHP issuers
performing application assistance functions) on behalf of the applicant
submits, information that is obtained from other federal agencies
through the computer matching programs verifying applicant information
and information obtained from federal and state sources through the
Information Exchange Agreements with IRS and State Medicaid and CHIP
agencies and State-based Exchanges pertaining to (1) the applicant or
enrollee's citizenship or immigration status, because only individuals
who are citizens or nationals of the U.S. or lawfully present are
eligible to enroll; (2) enrollment in Federally funded minimum
essential health coverage (e.g. Medicare, Medicaid, Federal Employees
Health Benefit Program (FEHBP), Veterans Health Administration (Champ
VA), Children's Health Insurance Program (CHIP), Department of Defense
[[Page 63214]]
(TRICARE), Peace Corps); (3) incarceration status; (4) Indian status;
(5) enrollment in employer-sponsored coverage; (6) requests for and
accompanying documentation to justify receipt of individual
responsibility exemptions, including membership in a certain type of
recognized religious sect or health care sharing ministry; (7) employer
information; (8) status as a veteran; (9) pregnancy status; (10)
blindness and/or disability status; (11) smoking status; and (12)
household income, including tax return information from the IRS, income
information from the Social Security Administration, and financial
information from other third party sources. Federal tax return
information can only be used or disclosed as authorized by 26 U.S.C.
6103.
Information will also be maintained with respect to the applicant's
enrollment in a QHP through the Exchange, the premium amounts and
payment history. The system will collect and maintain information
pertaining to Relevant Individual(s) that includes the following: First
name, last name, middle initial, permanent residential address, date of
birth, SSN (if the Relevant Individual has one or is required to
provide it as specified in 45 CFR 155.305(f)(6)), taxpayer status,
gender, residency, relationship to applicant, employer information, and
household income, including tax information from the IRS, income
information from the Social Security Administration, and financial
information from other third party sources. Additionally, should an
applicant file an appeal, information related to the appeal and any
associated documentation and decision will be maintained in the system.
With respect to qualified employers and qualified employees
utilizing the SHOP, the information maintained in the system includes
but may not be limited to the name and address of the employer, number
of employees, Employer Identification Number (EIN), and list of
qualified employees and their Social Security Numbers.
Information maintained in this system for application filers (an
application filer, as defined by 45 CFR 155.20 (which includes
authorized representatives); individuals or their authorized
representative applying for exemption from the individual shared
responsibility payment; a SHOP application filer as defined by 45 CFR
155.700; Agents and Brokers; and QHP issuers performing application
assistance functions) may include, but not be limited to, the
individual's first name, middle name, last name, address, city, state,
zip code, telephone number, organization name, identification number,
and association with or relationship to an applicant.
Information maintained in this system for Agents and Brokers
includes, but may not be limited to, the Agent or Broker's log-in ID,
password, first name, middle name, last name, email address, user type,
National Producer Number, occupation type, organization type, job
title, manager, primary language, region, time zone, state, zip code,
phone number. Information maintained in this system for assisters such
as Navigators, non-Navigator Assistance Personnel (including In-Person
Assisters), and Certified application counselors, includes, but may not
be limited to, the assister individual's or entity's user name (user
name/ID), first name, last name, email address, phone number, state,
zip code, user type, employer or grantee organization (if applicable).
Information in the Health Insurance Casework System (HICS) includes
but is not limited to, complainant's contact information, such as,
name, telephone number, email address, state of residence, zip code;
demographic information, such as, age, gender, ethnicity, family
status, employment status, income level, veteran's status and health
insurance status, health insurance background and recent history, and
available health insurance options. The PII in HICS will include but
not be limited to, the consumers, applicants/enrollees, and/or their
authorized representatives that have contacted CMS to file a complaint
about a QHP offered through the FFE or the issuer of such a QHP, or to
seek resolution of a particular issue with such a QHP or issuer.
Therefore, we anticipate that in addition to the PII listed above, to
the extent complainants share health information with CMS as part of
their complaints, PHI may also be included in HICS. Any HICS data
published will be in aggregate form and will not contain any personally
identifiable data elements.
Information maintained in this system for (i) officers, employees
and contractors of the Exchange; (ii) employees and contractors of CMS;
(iii) representatives, officers, agents, and employees of QHPs seeking
certification; and (iv) persons employed by or contracted with an
Exchange organization will include contact and identifying information
(such as first and last name, address, telephone number, email address,
employer, or similar information), relationship to the Exchange or CMS
(such as status as contractor, employee, etc.), and, as applicable,
log-in IDs and passwords.
AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
The HIX program implements health care reform provisions of the
Patient Protection and Affordable Care Act (PPACA) (Pub. L. 111-148) as
amended by the Health Care and Education Reconciliation Act of 2010
(Pub. L. 111-152) collectively referred to as the Affordable Care Act.
Title 42 U.S.C. 18031, 18041, 18081, 18083, and sections 2723, 2761 of
the Public Health Service Act (PHS Act).
PURPOSE(S) OF THE SYSTEM:
Health Insurance Exchanges are established by the Patient
Protection and Affordable Care Act of 2010 as amended by the Health
Care and Education Reconciliation Act of 2010. They provide competitive
marketplaces for individuals and small employers to directly compare
available private health insurance options on the basis of price,
quality, and other factors. The Exchanges will help enhance competition
in the health insurance market, improve choice of affordable health
insurance, and give small businesses the same purchasing clout as large
businesses.
The purpose of this system is to collect, create, use and disclose
PII about individuals who apply for eligibility determinations or
appeal eligibility determinations for enrollment in a QHP, including
stand-alone dental plans, through an Exchange, for insurance
affordability programs, and for certifications of exemption from the
individual responsibility requirement. The purpose of this system is
also to collect, create, use and disclose PII about Relevant
Individual(s) whose PII may bear upon a determination of the
eligibility of an individual for an insurance affordability program or
for certifications of exemption from the individual responsibility
requirement. An additional purpose of the system is to collect, create,
use and disclose PII for the identity proofing of application filers as
defined in 45 CFR 155.20, primary and secondary employer contacts
filing applications to a FF-SHOP, and Agents and Brokers registering
with the FFE.
The system will collect, create, use and disclose PII about
individuals and entities that register with and are certified by CMS.
The CMS-registered and -certified individuals include, but are not
limited to, Agents and Brokers, Navigators, non-Navigator Assistance
personnel (also known as In-Person Assisters), and Certified
application counselors. CMS may display the contact information of
Agents and Brokers that register, and successfully complete the CMS
training and are
[[Page 63215]]
certified by CMS, on the FFE and on the FF-SHOP Web sites for the
convenience of consumers looking for an agent or broker that is
familiar with the FFE policies, the QHPs being offered, the eligibility
determination application process and who are active in the FFE market.
Because CMS training is optional for Agents and Brokers offering
assistance in the FF-SHOP, only the contact information of those Agents
and Brokers who have successfully completed CMS developed training and
testing, will be made available to the public (e.g. displayed on a CMS
Web site).
Another purpose of the system is tracking and compiling consumer
complaints about QHPs offered through an FFE or FF-SHOP or issuers that
offer such QHPs. This enables the program to ensure that consumers
receive timely assistance and to build a QHP rating system based on
complaints. An additional purpose of the system is to perform required
legal functions related to oversight and reporting for the HIX Program
and its components and to provide necessary analysis and reporting
capabilities. The PII described within this SORN will be used for these
purposes.
ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM
A. Entities Who May Receive Disclosures Under Routine Uses
These routine uses specify circumstances, in addition to those
provided by statute in the Privacy Act of 1974, under which CMS may
release information from the HIX SOR without the affirmative consent of
the individual to whom such information pertains. Each proposed
disclosure of information under these routine uses will be evaluated to
ensure that the disclosure is legally permissible, including but not
limited to ensuring that the purpose of the disclosure is compatible
with the purpose for which the information was collected. We are
establishing the following routine use disclosures of information
maintained in the system:
1. To support Agency contractors, consultants, or CMS grantees who
have been engaged by the Agency to assist in accomplishment of a CMS
function relating to the purposes for this collection and who need to
have access to the records in order to assist CMS.
2. To disclose information to another Federal agency, agency of a
State government, a non-profit entity operating an Exchange for a
State, an agency established by State law, or its fiscal agent, or an
Appeals Entity as defined by 45 CFR 155.500 to (A) make eligibility
determinations for enrollment in a QHP through an Exchange, insurance
affordability programs, certifications of exemption from the individual
responsibility requirement, and to coordinate and resolve requests for
appeals; (B) to carry out the HIX Program; (C) to perform functions of
an Exchange described in 45 CFR 155.200, including notices to employers
under section 1411(f) of the Affordable Care Act; and (D) permit the
disclosure of Navigator, non-Navigator Assistance Personnel, Certified
application counselor, and Agent and Broker information who have
completed CMS training, testing and certification to provide consumer
assistance to the appropriate state agency or agencies to assist states
with oversight, monitoring and enforcement activities, because both CMS
and states will be responsible for overseeing, monitoring and
regulating these individuals.
3. To disclose information about applicants and Relevant
Individual(s) in order to obtain information from other Federal
agencies and State agencies and third party data sources that provide
information to CMS, pursuant to agreements with CMS, for purposes of
determining the eligibility of applicants to enroll in QHPs through an
Exchange, in insurance affordability programs, or for a certification
of exemption from the individual responsibility requirement.
4. To assist a CMS contractor 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 or abuse in such program or to
provide oversight of FFE operations.
5. To assist another Federal agency or 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 or 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 or abuse in such programs.
6. To assist appropriate Federal agencies and CMS contractors and
consultants that have a need to know the information for the purpose of
assisting CMS' efforts to respond to a suspected or confirmed breach of
the security or confidentiality of information maintained in this
system of records, provided that the information disclosed is relevant
and necessary for that assistance.
7. To assist the U.S. Department of Homeland Security (DHS) cyber
security personnel, if captured in an intrusion detection system used
by HHS and DHS pursuant to the Einstein 2 program.
8. To provide information about applicants, enrollees, appellants,
and Relevant Individual(s) to applicants/enrollees, application filers
as defined by 45 CFR 155.20, individuals or their authorized
representative applying for exemption from the individual shared
responsibility payment; a SHOP application filer as defined by 45 CFR
155.700; appellants, Agents Brokers, and QHP issuers who are authorized
or certified by CMS to assist applicants/enrollees, when relevant and
necessary to determine eligibility for enrollment in a QHP, insurance
affordability programs, or a certification of exemption from the
individual responsibility requirement through the FFEs.
9. To provide applicant/enrollee and Relevant Individual
information to QHP issuers for purposes of enrollment in a qualified
health plan and for the administration of the advance payments of
premium tax credit and cost-sharing reductions. To provide information
about consumers that contact CMS to file a complaint or to seek
resolution of a particular issue (that is, to initiate a ``case'') to
the issuer of a QHP in an FFE or FF-SHOP, which issuer or which
issuer's QHP is the subject of the case.
10. To assist employers identified on applications for eligibility
determinations submitted to an Exchange to provide (A) notification to
the employer that an employee has been determined eligible for advanced
payments of the premium tax credit or cost sharing reductions, (B)
notice to the applicant indicating that the Exchange will be contacting
any employer identified on the application for the applicant and the
members of his or her household, as defined in 26 CFR 1.36B-1(d), to
verify whether the applicant is enrolled in an eligible employer-
sponsored plan or is eligible for qualifying coverage in an eligible
employer-sponsored plan for the benefit year for which coverage is
requested, and (C) notice to the employer requesting verification of an
employee's eligibility or enrollment in an eligible employer-sponsored
plan for the benefit year for which coverage is requested.
11. To permit the public disclosure of information to the
appropriate state agency, and members of the public,
[[Page 63216]]
about Agents and Brokers that have registered with, successfully
completed CMS training, and are certified by an FFE or FF-SHOP to
provide outreach and education resources to consumers about obtaining
health care coverage in their states,.
12. To provide information regarding complaints to other Federal
agencies and agencies of a state government for the purpose of
resolving complaints and identifying insurer non-compliance with
Federal, state, and other applicable law.
13. To assist a CMS contractor that is engaged to perform a
function or provide administrative, technical or physical support to
the FFEs (including FF-SHOPs) or to a grantee of a CMS-administered
grant program, when the 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 or abuse in such program.
POLICIES AND PRACTICES FOR STORING, RETRIEVING, ACCESSING, RETAINING,
AND DISPOSING OF RECORDS IN THE SYSTEM
STORAGE:
Electronic records will be stored on both tape cartridges (magnetic
storage media) and in a relational database management environment
(DASD data storage media). Any hard copies of program related records
containing PII at CMS and contractor locations will be kept in secure
hard-copy file folders locked in secure file cabinets during non-duty
hours.
RETRIEVABILITY:
The records will be retrieved electronically by a variety of
fields, including but not limited to first name, last name, middle
initial, date of birth, or Social Security Number (SSN).
SAFEGUARDS:
Personnel having access to the system have been trained in the
Privacy Act and information security requirements. Employees who
maintain records in this 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. Access to
records in the HIX Program system will be limited to authorized CMS
personnel and contractors through password security, encryption,
firewalls, and secured operating system. Any electronic or hard copies
of records containing PII at CMS, Exchanges and contractor locations
will be kept in secure electronic files or in hard-copy file folders
locked in secure file cabinets during non-duty hours.
RETENTION AND DISPOSAL:
These records will be maintained until they become inactive, at
which time they will be retired or destroyed in accordance with
published records schedules of the Centers for Medicare & Medicaid
Services as approved by the National Archives and Records
Administration.
SYSTEM MANAGER AND ADDRESS:
Director of Operations, Center for Consumer Information and
Insurance Oversight, 7501 Wisconsin Avenue, Bethesda, Maryland 20814.
NOTIFICATION PROCEDURE:
An individual record subject who wishes to know if this system
contains records about him or her should write to the system manager
who will require the system name, and for verification purposes, the
subject individual's name (individual's former name(s) name, if
applicable), and SSN (furnishing the SSN is voluntary, but it may make
searching for a record easier and prevent delay).
RECORD ACCESS PROCEDURE:
An individual seeking access to records about him or her in this
system should use the same procedures outlined in Notification
Procedures above. The requestor should also reasonably specify the
record contents being sought. (These procedures are in accordance with
Department regulation 45 CFR 5b.5(a)(2).)
CONTESTING RECORD PROCEDURES:
To contest a record, the subject individual should contact the
system manager named above, and reasonably identify the record and
specify the information being contested. The individual should state
the corrective action sought and the reasons for the correction with
supporting justification. (These procedures are in accordance with
Department regulation 45 CFR 5b.7.)
RECORD SOURCE CATEGORIES:
Personally identifiable information in this database is obtained
from the application submitted by or on behalf of applicants,
enrollees, and appellants seeking eligibility determinations, from
qualified employers and other employers who provide employer-sponsored
coverage, from CMS and other Federal and state agencies as part of
verifications and information retrievals to make eligibility
determinations, from Marketplace assisters facilitating the eligibility
and enrollment processes, from QHPs, from State-based Exchanges that
provide information to perform the statutory functions, from states
participating in State Partnership Exchanges pursuant to Conditional
Approval Decision letters, and from third party data sources to
determine eligibility as described in this notice.
EXEMPTIONS CLAIMED FOR THIS SYSTEM:
None.
Dated: October 18, 2013.
Michelle Snyder,
Chief Operating Officer, Centers for Medicare & Medicaid Services.
[FR Doc. 2013-24861 Filed 10-22-13; 8:45 am]
BILLING CODE 4120-03-P