[Federal Register Volume 71, Number 226 (Friday, November 24, 2006)]
[Notices]
[Pages 67875-67876]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E6-19799]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-4128-N]
Medicare Program; Decisions Affecting Medicare Advantage Plans
Deemed by Joint Commission for the Accreditation of Health Care
Organizations
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: This notice announces our decisions regarding deemed status of
Joint Commission for the Accreditation of Health Care Organization-
accredited Medicare Advantage plans. These decisions follow business
decisions made by Joint Commission for the Accreditation of Health Care
Organization in late 2005 which affect its deeming operations beginning
January 1, 2006 and continue until Joint Commission for the
Accreditation of Health Care Organization's deeming authority expires
on March 24, 2008.
DATES: Effective January 1, 2006 through March 24, 2008.
FOR FURTHER INFORMATION CONTACT: Shaheen Halim, (410) 786-0641.
I. Background on Medicare Advantage Deeming Program
Under the Medicare program, eligible beneficiaries may receive
covered services through a managed care organization (MCO) that has a
Medicare Advantage (MA) (formerly, Medicare+Choice) contract with the
Centers for Medicare & Medicaid Services (CMS). The regulations
specifying the Medicare requirements that must be met in order for an
MCO to enter into an MA contract with CMS are located at 42 CFR part
22. These regulations implement Part C of Title XVIII of the Social
Security Act (the Act), which specifies the services that an MCO 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.
[[Page 67876]]
Generally, for an MCO to be an MA organization, the MCO must be
licensed by the State as a risk bearing organization as set forth in
part 422 of our regulations. Additionally, the MCO must file an
application demonstrating that it meets other Medicare requirements in
part 422 of our regulations. Following approval of the MA contract, we
engage in routine monitoring and oversight audits of the MA
organization to ensure continued compliance. The monitoring and
oversight audit process is comprehensive and uses a written protocol
that itemizes the Medicare requirements the MA organization must meet.
As an alternative for meeting some Medicare requirements, an MA
organization may be exempt from CMS monitoring of certain requirements
in subsets listed in section 1852(e)(4)(B) of the Act as a result of an
MA organization's accreditation by a CMS-approved accrediting
organization (AO). We ``deem'' that the Medicare requirements are met
based on a determination that the AO's standards are at least as
stringent as Medicare requirements.
Organizations that apply for MA deeming authority are generally
recognized by the industry as entities that accredit MCO's that are
licensed as a health maintenance organization (HMO) or a preferred
provider organization (PPO). As we specify at Sec. 422.157(b)(2) of
our regulations, the term for which an AO may be approved by CMS may
not exceed 6 years. For continuing approval, the AO must re-apply to
CMS. The Joint Commission for the Accreditation of Health Care
Organizations (JCAHO) was granted deeming authority for Medicare
Advantage HMOs and PPOs on March 22, 2002 in all six of the deemable
areas set forth in 42 CFR 422.156(b) at the time. JCAHO was granted
approval for deeming authority through March 24, 2008, and to date
JCAHO has deemed 2 MA plans via accreditation.
II. JCAHO Termination of Deeming Activities
On November 9, 2005, JCAHO notified us of its decision to
discontinue its network accreditation program and that, beginning
January 1, 2006, it would not provide new accreditation to any MA
organizations. JCAHO indicated that it intended to continue to provide
technical support and monitoring for the two MA organizations that
received JCAHO accreditation prior to January 1, 2006, until each
plan's current term of JCAHO accreditation expires.
III. CMS Decisions Regarding JCAHO and its Deemed MA Plans
We decided to allow JCAHO's deeming authority to expire, as it
normally would, on March 24, 2008. Thus, MA plans currently accredited
by JCAHO under its network accreditation program will retain their
deemed status until their current terms of accreditation expire.
However, the period of time between January 1, 2006 and March 24, 2008,
JCAHO will not accept new requests to deem MA plans.
Authority: Section 1852(e)(4) of the Social Security Act.
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program (42 U.S.C. 1395w-22(e)(4))
Dated: November 9, 2006.
Leslie V. Norwalk,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. E6-19799 Filed 11-21-06; 8:45 am]
BILLING CODE 4120-01-P