SORN 09-90-0250
System Name: "Early Retirement Reinsurance Program (ERRP)," OCIIO, OS/HHS.
Security Classification: Level Three Privacy Act Sensitive.
System Location: Office of Consumer Information and Insurance Oversight, U.S. Department of Health & Human Services, 200 Independence Avenue, SW., Suite 738F, Washington, DC 20201.
Categories Of Individuals Covered By The System: Information in this system is maintained on individuals associated with plan sponsors who perform key tasks on behalf of the sponsor, so that the sponsor can participate in and get reimbursement under the program. Information in this system is also maintained on early retirees and their spouses, surviving spouses, and dependents that are enrolled in employment-based plans that participate in the program. With respect to medical claims submitted by plan sponsors for reimbursement, information in this system is maintained on early retirees and their spouses, surviving spouses, and dependents with respect to those medical claims, including the health benefit provided, the provider or supplier, the incurred date, the individual for whom the health benefit was provided, the date and amount of payment net any known negotiated price concessions, and the employment-based plan and benefit option under which the health benefit was provided.
Categories Of Records In The System: Information in this system is maintained on early retirees and their spouses, surviving spouses, and dependents that are enrolled in employment-based plans that participate in the program. Information maintained in this system includes, but is not limited to, first name, last name, middle initial, date of birth, Social Security Number (SSN), gender, standard data for identification such as Plan Sponsor Identification Number, Application Identification Number, Benefit Option Identifier, and relationship to early retiree. Information in this system is maintained on individuals associated with plan sponsors who perform key tasks on behalf of the sponsor, so that the sponsor can participate in and get reimbursement under the program. Information maintained in the system regarding these individuals includes, but is not limited to, standard data for identification such as Plan Sponsor Identification Number, Application Identification Number, Benefit Option Identifier, the individual's first name, middle initial, last name, job title, date of birth, social security number, e-mail address, telephone number, fax number, employer name, and business address. With respect to medical claims submitted by plan sponsors for reimbursement, information in this system is maintained on early retirees and their spouses, surviving spouses, and dependents with respect to those medical claims, including the health benefit provided, the provider or supplier, the incurred date, the individual for whom the health benefit was provided, the date and amount of payment net any known negotiated price concessions, and the employment-based plan and benefit option under which the health benefit was provided.
Authority For Maintenance Of The System: Authority for the collection, maintenance, and disclosures from this system is given under provisions of Sec. 1102 of the Affordable Care Act and its implementing regulations codified at Title 45 Code of Federal Regulations (CFR) Part 149.
Purpose(s) Of The System: The purpose of this system is to collect and maintain information on individuals who are early retirees (and spouses, etc.), to collect and maintain information on individuals who are associated with plan sponsors who perform key tasks on behalf of the sponsor, and to collect and maintain information on medical claims submitted to the U.S. Department of Health & Human Services (HHS) for reimbursement, so that accurate and timely reimbursements may be made to plan sponsors who continue to offer qualifying health benefits to such individuals. Information maintained in this system will also be disclosed to: (1)Support regulatory, reimbursement, and policy functions performed by an HHS contractor, consultant or grantee; (2) assist another Federal or State agency, agency of a State government, an agency established by State law, or its fiscal agent; (3) support litigation involving the Department; (4) combat fraud and abuse in certain health benefits programs; and (5) assist efforts to respond to a suspected or confirmed breach of the security or confidentiality of information maintained in this system of records.
Routine Uses Of Records Maintained In The System, Including Categories Or Users And The Purposes Of Such Uses:
B. Entities Who May Receive Disclosures Under Routine Use These routine uses specify circumstances, in addition to those provided by statute in the Privacy Act of 1974, under which HHS may release information from the ERRP without the 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 propose to establish or modify the following routine use disclosures of information maintained in the system:
1. To support Agency contractors, consultants, or HHS grantees who have been engaged by the Agency to assist in accomplishment of an HHS function relating to the purposes for this SOR and who need to have access to the records in order to assist HHS.
2. To assist another Federal or State agency, agency of a State government, an agency established by State law, or its fiscal agent pursuant to agreements with HHS to:
a. Contribute to the accuracy of HHS's reimbursement to sponsors under the ERRP,
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 which may require ERRP information for purposes related to this system.
3. To the Department of Justice (DOJ), court, or adjudicatory body when:
b. The Agency or any component thereof, or
e. Any employee of the Agency in his or her official capacity, or
f. Any employee of the Agency in his or her individual capacity where the DOJ has agreed to represent the employee, or
g. 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 the use of such records by the DOJ, court or adjudicatory body is compatible with the purpose for which the agency collected the records.
4. To assist an HHS contractor (including, but not limited to fiscal intermediaries and carriers) that assists in the administration of an HHS-administered health benefits program, or to a grantee of an HHS-administered grant program, when disclosure is deemed reasonably necessary by HHS 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.
5. To assist 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 or abuse in a health benefits program funded in whole or in part by Federal funds, when disclosure is deemed reasonably necessary by HHS 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 appropriate Federal agencies and Department contractors that have a need to know the information for the purpose of assisting the Department's efforts to respond to a suspected or confirmed breach of the security or confidentiality of information disclosed is relevant and necessary for that assistance.
C. Additional Circumstances Affecting Routine Use Disclosures Our policy will be to prohibit release even of data not directly identifiable, except pursuant to one of the routine uses or if required by law, if we determine there is a possibility that an individual can be identified through implicit deduction based on small cell sizes (instances where the patient population is so small that individuals could, because of the small size, use this information to deduce the identity of the beneficiary).
Policies And Practices For Storing, Retrieving, Accessing, Retaining, And Disposing Of Records In The System:
Storage: We will be storing records in hardcopy files and various electronic storage media (including DB2, Oracle, and other relational data structures).
Retrievability: Information is most frequently retrieved by first name, last name, middle initial, date of birth, or Social Security Number (SSN).
Safeguards: HHS has safeguards in place for authorized users and monitors such users to ensure against unauthorized use. 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. This system will conform to all applicable Federal laws and regulations and Federal, HHS, and HHS policies and standards as they relate to information security and data privacy. These laws and regulations include 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 E-Government Act of 2002, and the Clinger-Cohen Act of 1996. OMB Circular A-130, Management of Federal Resources, Appendix III, Security of Federal Automated Information Resources also applies. Federal, HHS, and HHS policies and standards include but are not limited to: all pertinent National Institute of Standards and Technology publications; and the HHS Information Systems Program Handbook. HHS will give a contractor, consultant, or HHS grantee the information necessary for the contractor or consultant to fulfill its duties. In these situations, safeguards are provided in the contract prohibiting the contractor, consultant, or grantee from using or disclosing the information for any purpose other than that described in the contract and requires the contractor, consultant, or grantee to return or destroy all information at the completion of the contract. Contractors are also required to provide the appropriate management, operational, and technical controls to secure the data.
Retention And Disposal: Records are maintained with identifiers for all transactions after they are entered into the system for a period of 10 years. Records are housed in both active and archival files in accordance with HHS data and document management policies and standards. All sponsor applications, claims, and other program-related records are encompassed by the document preservation order and will be retained until notification is received from the Department of Justice.
System Manager And Address: David Gardner, Acting Director, Early Retiree Reinsurance Division, Office of Insurance Programs, Office of Consumer Information and Insurance Oversight, U.S. Department of Health & Human Services, 200 Independence Avenue, SW., Suite 738F, Washington, DC 20201.
Notification Procedure: For purpose of notification, the subject individual should write to the system manager who will require the system name, and the retrieval selection criteria (e.g., name, SSN, etc.).
Record Access Procedure: For purpose of access, use the same procedures outlined in Notification Procedures above. Requestors 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: The subject individual should contact the system manager named above, and reasonably identify the record and specify the information to be contested. 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: Record source categories include program participants, individuals on whose behalf reimbursements are being sought, and those who voluntarily submit data and personal information for the ERRP program.
Systems Exempted From Certain Provisions Of The Act: None.