[Federal Register Volume 77, Number 62 (Friday, March 30, 2012)]
[Notices]
[Pages 19290-19292]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-7701]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-4166-PN]
Medicare and Medicaid Programs; Renewal of Deeming Authority of
the Accreditation Association for Ambulatory Health Care, Inc. for
Medicare Advantage Health Maintenance Organizations and Local Preferred
Provider Organizations
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Proposed notice.
-----------------------------------------------------------------------
SUMMARY: This notice announces our proposal to renew the Medicare
Advantage ``deeming authority'' of the Accreditation Association for
Ambulatory Health Care, Inc. (AAAHC) for Health Maintenance
Organizations and Preferred Provider Organizations for a term of 6
years. This new term of approval would begin July 11, 2012, and end
July 10, 2018. This notice announces a 30-day period for public
comments on the renewal of the application.
DATES: To be assured consideration, comments must be received at one of
the addresses provided below, no later than 5 p.m. on April 30, 2012.
ADDRESSES: In commenting, please refer to file code CMS-4166-PN.
Because of staff and resource limitations, we cannot accept comments by
facsimile (FAX) transmission.
You may submit comments in one of four ways (please choose only one
of the ways listed):
1. Electronically. You may submit electronic comments on this
regulation to http://www.regulations.gov. Follow the ``Submit a
comment'' instructions.
2. By regular mail. You may mail written comments to the following
address ONLY: Centers for Medicare & Medicaid Services, Department of
Health and Human Services, Attention: CMS-4166-PN, P.O. Box 8016,
Baltimore, MD 21244-8016.
Please allow sufficient time for mailed comments to be received
before the close of the comment period.
3. By express or overnight mail. You may send written comments to
the following address ONLY: Centers for Medicare & Medicaid Services,
Department of Health and Human Services, Attention: CMS-4166-PN, Mail
Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
4. By hand or courier. If you prefer, you may deliver (by hand or
courier) your written comments before the close of the comment period
to either of the following addresses:
a. For delivery in Washington, DC--Centers for Medicare & Medicaid
Services, Department of Health and Human Services, Room 445-G, Hubert
H. Humphrey Building, 200 Independence Avenue SW., Washington, DC
20201.
(Because access to the interior of the Hubert H. Humphrey Building
is not readily available to persons without Federal government
identification, commenters are encouraged to leave their comments in
the CMS drop slots located in the main lobby of the building. A stamp-
in clock is available for persons wishing to retain a proof of filing
by stamping in and retaining an extra copy of the comments being
filed.)
b. For delivery in Baltimore, MD--Centers for Medicare & Medicaid
Services, Department of Health and Human Services, 7500 Security
Boulevard, Baltimore, MD 21244-1850.
If you intend to deliver your comments to the Baltimore address,
please call telephone number (410) 786-0361 in advance to schedule your
arrival with one of our staff members.
[[Page 19291]]
Comments mailed to the addresses indicated as appropriate for hand
or courier delivery may be delayed and received after the comment
period.
FOR FURTHER INFORMATION CONTACT: Caroline Baker, (410) 786-0116; or
Edgar Gallardo, (410) 786-0361.
SUPPLEMENTARY INFORMATION:
Inspection of Public Comments: All comments received before the
close of the comment period are available for viewing by the public,
including any personally identifiable or confidential business
information that is included in a comment. We post all comments
received before the close of the comment period on the following Web
site as soon as possible after they have been received: http://www.regulations.gov. Follow the search instructions on that Web site to
view public comments.
Comments received timely will also be available for public
inspection as they are received, generally beginning approximately 3
weeks after publication of a document, at the headquarters of the
Centers for Medicare & Medicaid Services, 7500 Security Boulevard,
Baltimore, Maryland 21244, Monday through Friday of each week from 8:30
a.m. to 4 p.m. To schedule an appointment to view public comments,
phone 1-800-743-3951.
I. Background
Under the Medicare program, eligible beneficiaries may receive
covered services through a Medicare Advantage (MA) organization that
contracts with CMS. The regulations specifying the Medicare
requirements that must be met for a Medicare Advantage Organization
(MAO) to enter into a contract with CMS are located at 42 CFR part 422.
These regulations implement Part C of Title XVIII of the Social
Security Act (the Act), which specifies the services that an MAO must
provide and the requirements that the organization must meet to be an
MA contractor. Other relevant sections of the Act are Parts A and B of
Title XVIII and Part A of Title XI pertaining to the provision of
services by Medicare-certified providers and suppliers. Generally, for
an entity to be an MA organization, the organization must be licensed
by the State as a risk-bearing organization as set forth in part 422.
As a method of assuring compliance with certain Medicare
requirements, an MA organization may choose to become accredited by a
CMS-approved accrediting organization (AO). Once accredited by such a
CMS-approved AO, we deem the MA organization to be compliant in one or
more of six requirements set forth in section 1852(e)(4)(B) of the Act.
For an AO to be able to ``deem'' an MA plan as compliant with these MA
requirements, the AO must prove to CMS that its standards are at least
as stringent as Medicare requirements. Health maintenance organizations
(HMOs) or preferred provider organizations (PPOs) accredited by an
approved accrediting organization may receive, at their request,
``deemed'' status for CMS requirements with respect to the following
six MA criteria: Quality Improvement; Antidiscrimination; Access to
Services; Confidentiality and Accuracy of Enrollee Records; Information
on Advanced Directives; and Provider Participation Rules. (See 42 CFR
422.156(b)). At this time, recognition of accreditation does not
include the Part D areas of review set out at Sec. 423.165(b). AOs
that apply for MA deeming authority are generally recognized by the
health care industry as entities that accredit HMOs and PPOs. As we
specify at Sec. 422.157(b)(2)(ii), the term for which an AO may be
approved by CMS may not exceed 6 years. For continuing approval, the AO
must apply to CMS to renew its ``deeming authority'' for a subsequent
approval period.
The Accreditation Association for Ambulatory Health Care, Inc.
(AAAHC) was approved as a CMS-approved accreditation organization for
MA HMOs and PPOs on July 12, 2006, and that term will expire on July
11, 2012. On December 14, 2011, AAAHC submitted an application to renew
its deeming authority. On that same date, AAAHC submitted materials
requested from CMS which included updates and/or changes to items set
out in Federal regulations at Sec. 422.158(a) that are prerequisites
for receiving accreditation program approval by CMS, and which were
furnished to CMS by AAAHC as a part of their renewal applications for
HMOs and PPOs.
II. Provisions of the Proposed Notice
The purpose of this notice is to notify the public of the AAAHC's
request to renew its Medicare Advantage deeming authority for HMOs and
PPOs. AAAHC submitted all the necessary materials (including its
standards and monitoring protocol) to enable us to make a determination
concerning its request for approval as an accreditation organization
for CMS. This renewal application was determined to be complete on
February 6, 2012. Under section 1852(e)(4) of the Act and our
regulations at Sec. 422.158 (Federal review of accrediting
organizations), our review and evaluation of AAAHC will include, but
not necessarily be limited to, the following components:
A. Components of the Review Process
The types of MA plans that it would review as part of its
accreditation process.
A detailed comparison of the organization's accreditation
requirements and standards with the Medicare requirements (for example,
a crosswalk).
Detailed information about the organization's survey
process, including the following--
++ Frequency of surveys and whether surveys are announced or
unannounced.
++ Copies of survey forms, and guidelines and instructions to
surveyors.
++ Descriptions of--
--The survey review process and the accreditation status decision
making process;
--The procedures used to notify accredited MA organizations of
deficiencies and to monitor the correction of those deficiencies; and
--The procedures used to enforce compliance with accreditation
requirements.
Detailed information about the individuals who perform
surveys for the accreditation organization, including the following--
++ The size and composition of accreditation survey teams for each
type of plan reviewed as part of the accreditation process;
++ The education and experience requirements surveyors must meet;
++ The content and frequency of the in-service training provided to
survey personnel;
++ The evaluation systems used to monitor the performance of
individual surveyors and survey teams; and
++ The organization's policies and practice with respect to the
participation, in surveys or in the accreditation decision process by
an individual who is professionally or financially affiliated with the
entity being surveyed.
A description of the organization's data management and
analysis system with respect to its surveys and accreditation
decisions, including the kinds of reports, tables, and other displays
generated by that system.
A description of the organization's procedures for
responding to and investigating complaints against accredited
organizations, including policies and procedures regarding coordination
of these activities with appropriate licensing bodies and ombudsmen
programs.
A description of the organization's policies and
procedures with respect to
[[Page 19292]]
the withholding or removal of accreditation for failure to meet the
accreditation organization's standards or requirements, and other
actions the organization takes in response to noncompliance with its
standards and requirements.
A description of all types (for example, full, partial)
and categories (for example, provisional, conditional, temporary) of
accreditation offered by the organization, the duration of each type
and category of accreditation and a statement identifying the types and
categories that would serve as a basis for accreditation if CMS
approves the accreditation organization.
A list of all currently accredited MA organizations and
the type, category, and expiration date of the accreditation held by
each of them.
A list of all full and partial accreditation surveys
scheduled to be performed by the accreditation organization as
requested by CMS.
The name and address of each person with an ownership or
control interest in the accreditation organization.
CMS will also consider AAAHC's past performance in the
deeming program and results of recent deeming validation reviews, or
look-behind audits conducted as part of continuing Federal oversight of
the deeming program under Sec. 422.157(d).
B. Notice Upon Completion of Evaluation
Upon completion of our evaluation, including evaluation of comments
received as a result of this notice, we will publish a notice in the
Federal Register announcing the result of our evaluation.
Section 1852(e)(4)(C) of the Act provides a statutory timetable to
ensure that our review of deeming applications is conducted in a timely
manner. The Act provides us with 210 calendar days after the date of
receipt of an application to complete our survey activities and
application review process. At the end of the 210 day period, we must
publish an approval or denial of the application in the Federal
Register.
III. Collection of Information Requirements
This document does not impose information collection and
recordkeeping requirements. Consequently, it need not be reviewed by
the Office of Management and Budget under the authority of the
Paperwork Reduction Act of 1995.
IV. Response to Comments
Because of the large number of public comments we normally receive
on Federal Register documents, we are not able to acknowledge or
respond to them individually. We will consider all comments we receive
by the date and time specified in the DATES section of this preamble,
and, when we proceed with a subsequent document, we will respond to the
comments in the preamble to that document.
(Catalog of Federal Domestic Assistance Program No. 93.773 Medicare-
Hospital Insurance Program; and No. 93.774, Medicare-Supplementary
Medical Insurance Program)
Dated: March 23, 2012.
Marilyn Tavenner,
Acting CMS Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2012-7701 Filed 3-29-12; 8:45 am]
BILLING CODE 4120-01-P