Freedom of Information Act (FOIA)

The Freedom of Information Act (FOIA), Title 5 of the United States Code, Section 552, provides any person the right to request access to non-privileged records/documents maintained by Federal agencies, and those acting on behalf of Federal agencies, e.g., Medicare contractors, and receive a response to the request. Persons are described as individuals, partnerships, corporations, associations and foreign or state government agencies; however, a Federal agency is not included within the definition of "person."

The FOIA does not require agencies to analyze data, to provide clarifications or to answer questions in writing. If the information requested is accessible easily via the Internet, such as, Medicare manual sections and policies, (referred to as reading room material) Noridian's FOIA Staff will refer the requester to the appropriate website(s).

What is a record?

A record is the product(s) of data compilation, including those in electronic form or format, or other documents, made or received by an agency of the United States Government under Federal law in connection with the transaction of public business and in the agency's possession and control at the time the FOIA request is made. A requester is not required to submit separate requests for the same information for each state in the Noridian jurisdiction. Such occurrences are combined in one response for all states.

Commonly received requests considered FOIA.

  • Copies of provider enrollment records, including lists of enrolled providers
  • Contractor priced fees (C-Status) not published on Noridian's website
  • Provider financial information or historical data
  • Medicare coverage criteria not addressed in policies or provider bulletins, e.g., diagnoses codes, units
  • Copies of documents provided to/by the Medicare Administrative Contractor (MAC) from/to providers or beneficiaries for processing in the normal course of business
  • Subpoenas issued by a non-Federal court for records under custody and control of the MAC

Privacy Act of 1974

The Privacy Act of 1974 is a companion to the FOIA. This Act allows individuals to seek access to Federal agency records about themselves. All requests made under the Privacy Act are logged and reported as FOIA requests.

How to Make a FOIA Request

Two Way to Submit a Request. In Writing Only, Verbal Requests not Accepted

  1. Complete/submit a Freedom of Information Act (FOIA) Request form
  2. Create/submit own request doc. Request must include three basic elements
    • State request is made under Freedom of Information Act or Privacy Act
    • Identify records sought. Be as specific as possible.
    • Include requestor name, address and personal signature

Indicate exact title of the requested record(s), if possible. If unsure of title(s), provide a reasonable description of each record. The more record details that can be provided, such as its author, date, subject matter and location, the better. Lack good descriptions may delay our response or prevent us from locating the requested documents. If additional information is required to find the record(s), clarification may be requested.

If requesting records for someone else, include a Health Insurance Portability and Accountability Act (HIPPA) Authorization form Power of Attorney (if applicable), Notification of Appointment of the Administrator of the Estate (if applicable) or the Medicare Authorization to Disclose Personal Health Information. See the CMS Internet Only Manual (IOM), Publication 100-01, Medicare General Information, Eligibility, and Entitlement Manual, Chapter 6, Section 190. Paragraphs H and I for more request details.

Do not include a self-addressed stamped envelope, a check or any type of payment with initial request. If processing fees apply, an invoice will be issued.

FOIA requests are responded to within 20 working days (excluding weekends and legal public holidays); however, some requests may require more time. In this situation, Noridian will contact the requester with an update. If prepayment is required, the request will be completed within 20 days of payment receipt.

Means of Receipt

Charge Levels for Searching for Records

The FOIA permits CMS and its contractors to charge fees to FOIA requesters.

  • Typically, search fees range from $23 - $83 per hour, depending upon salary levels of personnel required for search
  • Charge for photocopied records is 10 cents per page
  • For noncommercial requests, we will not charge for first two hours of search time or for first 100 pages of document copying. Invoices are not prepared for total charges of less than $25. If estimated cost of FOIA request is $250 or more, prepayment is required. Noridian will notify requestor in writing of estimated costs. Once payment is received, request will be fulfilled. If no response is received in 20 days, we will close request
  • A waiver of FOIA processing fees may be requested if it can be shown that records, when disclosed, will contribute significantly to public's understanding of operations or activities of government, and that request is not predominantly commercial in nature. Waiving of fees can only be granted by CMS; Noridian will inform them of payment waiver request. If a waiver is desired, include this in initial request

Additional Information

See the CMS FOIA webpage for more on the Freedom of Information Act and how CMS and its contractors process FOIA requests.

 

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