Federal regulators plan to protect insurers’ access to long term care data in a revision to their Long Term Care-Minimum Data Set system
The Centers of Medicare & Medicaid Services are tinkering with the MDS system in a new batch of modifications.
The MDS is a system that the CMS, long term care facilities and other organizations can use to format and exchange the information Medicare and other payers need to pay LTC claims.
“This system also contains the individual’s health insurance numbers, name, geographic location, race/ethnicity, sex, and date of birth, hospice election, premium billing and collection, direct billing information, and group health plan enrollment data,” CMS officials say in a notice about the MDS update that appears today in the Federal Register.
The MDS describes a number of “routine uses” that justify access to the MDS data.
CMS officials will be changing the designation of the system to System Number 09-70-0528, from 09-70-1517, and they will be changing references to “peer review organizations” to “quality improvement organizations,” officials say.
The CMS also is modifying language to clarify “routine use” explanations.
But the CMS is leaving routine use 4, which deals with MDS access by insurers, unchanged.
Routine use 4 allows MDS access by a wide variety of payers, including workers’ compensation insurers, no-fault automobile insurers and liability insurers, as well as by ordinary insurance companies, underwriters and third-party administrators.
To get MDS data, insurers and other payers must promise to use the data solely for the purpose of processing an individual’s insurance claim and to safeguard the confidentiality of the data and prevent unauthorized access, officials say.
A copy of the MDS update notice is on the Web at