78444 Federal Register / Vol. 69, No. 250 / Thursday, December 30, 2004 / Notices 

Dated: March 31, 2004. 

Mark B. McClellan, 

Administrator, Centers for Medicare & 

Medicaid Services.

Approved: August 6, 2004. 

Tommy G. Thompson, 

Secretary.

[FR Doc. 04–28158 Filed 12–29–04; 8:45 am] 

BILLING CODE 4120–01–P

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–4077–FN] 

RIN 0928–ZA59 

Medicare Program; Approval of the 

National Committee for Quality 

Assurance Deeming Authority for 

Medicare Advantage Local Preferred 

Provider Organizations

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS.

ACTION: Final notice.

SUMMARY: This final notice announces 

the approval of the National Committee 

for Quality Assurance for deeming 

authority as a national accreditation 

program for local preferred provider 

organizations that wish to participate in 

the Medicare Advantage program.

FOR FURTHER INFORMATION CONTACT:

Gwyneveyre Pasquale, (410) 786–7701. 

I. Background 

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 422. 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. 

Generally, for an organization to enter 

into an MA contract, the organization 

must be licensed by the State as a risk 

bearing organization as set forth in part 

422 of our regulations. Additionally, the 

organization must file an application 

demonstrating that it meets other 

Medicare requirements in part 422 of 

our regulations. Following approval of 

the contract, we engage in routine 

monitoring and oversight audits of the 

MA organization to ensure continuing 

compliance. The monitoring and 

oversight audit process is 

comprehensive and incorporates 

ongoing analysis of various performance 

data in addition to biennial audits by 

CMS staff who use a written protocol 

that itemizes the Medicare requirements 

the MA organization must meet. 

As an alternative for 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); that is, 

the Secretary deems that the Medicare 

requirements are met based on a 

determination that the AO’s standards 

are at least as stringent as Medicare 

requirements. As we specify at 

§ 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 reapply to CMS. 

The applicant organization is 

generally recognized as an entity that 

accredits MCOs that are licensed as a 

health maintenance organization (HMO) 

or a preferred provider organization 

(PPO). 

II. Deeming Application Approval 

Process 

Section 1852(e)(4)(C) of the Act 

requires that within 210 days of receipt 

of an application, the Secretary shall 

determine whether the applicant meets 

criteria specified in section 1865(b)(2) of 

the Act. Under these criteria, the 

Secretary will consider for a national 

accreditation body, its requirements for 

accreditation, its survey procedures, its 

ability to provide adequate resources for 

conducting required surveys and 

supplying information for use in 

enforcement activities, its monitoring 

procedures for provider entities found 

out of compliance with the conditions 

or requirements, and its ability to 

provide the Secretary with necessary 

data for validation. 

Section 1865(b)(3)(A) of the Act 

further requires that we publish, within 

60 days of receipt of an organization’s 

complete application, a notice 

identifying the national accreditation 

body making the request, describing the 

nature of the request, and providing at 

least a 30-day public comment period. 

We must publish a finding of approval 

or denial of the application within 210 

days from the receipt of the completed 

application. 

III. Provisions of the Proposed Notice 

On September 24, 2004, we published 

a proposed notice in the Federal 

Register (69 FR 57310) announcing the 

National Committee for Quality 

Assurance’s (NCQA’s) request for 

recognition as a national accreditation 

program for PPOs that wish to 

participate in the MA program. This 

notice informed the public of our 

consideration of NCQA’s application for 

approval as a deeming authority for MA 

organizations that are licensed as a PPO 

for the following six categories: 

• Quality improvement. 

• Access to services. 

• Antidiscrimination. 

• Information on advance directives. 

• Provider participation rules.

• Confidentiality and accuracy of 

enrollees’ records. 

In the notice, we described our 

evaluation criteria. Under § 422.158(a), 

we conducted a review of NCQA’s 

application in accordance with the 

criteria specified by our regulations, 

which include, but are not limited to, 

the following: 

• The equivalency of NCQA’s 

requirements for PPOs to CMS’

comparable MA organization 

requirements. 

• NCQA’s survey process, to 

determine the following: 

+ The frequency of surveys. 

+ The types of forms, guidelines, and 

instructions used by surveyors. 

+ Descriptions of the accreditation 

decision making process, deficiency 

notification and monitoring process, 

and compliance enforcement process. 

• Detailed information about 

individuals who perform accreditation 

surveys including—

+ Size and composition of the survey 

team; 

+ Education and experience 

requirements for the surveyors; 

+ In-service training required for 

surveyor personnel; 

+ Surveyor performance evaluation 

systems; and 

+ Conflict of interest policies relating 

to individuals in the survey and 

accreditation decision process. 

• Descriptions of the organization’s—

+ Data management and analysis 

system; 

+ Policies and procedures for 

investigating and responding to 

complaints against accredited 

organizations; and 

+ Types and categories of 

accreditation offered and MA 

organizations currently accredited 

within those types and categories. 

Federal Register / Vol. 69, No. 250 / Thursday, December 30, 2004 / Notices 78445

In accordance with § 422.158(b) of our 

regulations, the applicant must provide 

documentation relating to—

• Its ability to provide data in a CMS–

compatible format; 

• The adequacy of personnel and 

other resources necessary to perform the 

required surveys and other activities; 

and 

• Assurances that it will comply with 

ongoing responsibility requirements 

specified in § 422.157(c) of our 

regulations. 

In accordance with section 

1865(b)(3)(A) of the Act, the proposed 

notice also solicited public comment on 

the ability of the NCQA’s accreditation 

program to meet or exceed the Medicare 

requirements for which it seeks 

authority to deem. We did not receive 

any public comment in response to the 

proposed notice. 

IV. Provisions of the Final Notice 

On August 4, 2004, NCQA submitted 

all the necessary information to permit 

us to make a determination concerning 

its request for approval as a deeming 

authority for MA organizations that are 

licensed as a PPO. 

We compared the standards contained 

in NCQA’s PPO crosswalk and its 

survey process with the Medicare 

regulations and the PPO survey 

monitoring guide. Our review and 

evaluation of NCQA’s deeming 

application determined that the NCQA 

standards meet or exceed those 

established by the Medicare program. 

Therefore, we recognize NCQA as a 

national accreditation organization for 

local preferred provider organizations 

that wish to participate in the Medicare 

Advantage program, effective October 

20, 2004 through October 20, 2010. 

V. Collection of Information 

Requirements 

This final notice does not impose any 

information collection and record 

keeping requirements subject to the 

Paperwork Reduction Act (PRA). 

Consequently, it does not need to be 

reviewed by the Office of Management 

and Budget (OMB) under the authority 

of the PRA. 

VI. Executive Order 12866 Statement 

In accordance with the provisions of 

Executive Order 12866, this notice was 

not reviewed by the Office of 

Management and Budget.

Authority: Sections 1852 and 1865 of the 

Social Security Act (42 U.S.C. 1395w–23 and 

1395bb) (Catalog of Federal Domestic 

Assistance Program No. 93.773, Medicare—

Hospital Insurance; and Program No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program)

Dated: November 24, 2004. 

Mark B. McClellan, 

Administrator, Centers for Medicare & 

Medicaid Services.

[FR Doc. 04–28154 Filed 12–29–04; 8:45 am] 

BILLING CODE 4120–01–P

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–1249–CN2] 

RIN 0938–AM46 

Medicare Program; Prospective 

Payment System and Consolidated 

Billing for Skilled Nursing Facilities; 

Corrections

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS.

ACTION: Correction notice.

SUMMARY: This document corrects 

technical errors that appeared in the 

July 30, 2004 Federal Register, entitled 

‘‘Medicare Program; Prospective 

Payment System and Consolidated 

Billing for Skilled Nursing Facilities—

Update—Notice.’’

EFFECTIVE DATE: This correction is 

effective October 1, 2004, except for 

certain wage index corrections that are 

effective January 1, 2005.

FOR FURTHER INFORMATION CONTACT:

Jeanette Kranacs, (410) 786–9385, Bill 

Ullman, (410) 786–5667, or Sheila 

Lambowitz, (410) 786–7605.

SUPPLEMENTARY INFORMATION: 

I. Background 

On October 7, 2004, we published a 

correction notice (FR Doc. 04–22399, 69 

FR 60158) to correct a number of 

technical errors that had appeared in the 

FY 2005 SNF PPS update notice 

published on July 30, 2004 (FR Doc. 04–

17443, 69 FR 45775). In that notice we 

indicated that the corrected wage tables 

and other tables were being posted on 

the CMS Web site at http://

www.cms.hhs.gov/providers/snfpps, and 

we also expressed our intent to publish 

them in a forthcoming Federal Register

notice. In this notice we are fulfilling 

that intent, as well as correcting certain 

additional technical errors in wage 

index values that have been recently 

identified. The corrections appear in 

this document under the heading 

‘‘Correction of Errors.’’ The provisions 

in this correction notice are effective as 

if they had been included in the 

document published in the Federal 

Register on July 30, 2004, that is, as of 

October 1, 2004, except for those wage 

index value corrections that we 

specifically note to be effective as of 

January 1, 2005. 

In this notice, we hereby set forth the 

corrected versions of Tables 8, 9, 10, 

and 12 that were referenced in FR Doc. 

04–22399 (69 FR 60158). 

In addition, Table 8 is further revised 

to reflect the following additional 

corrections, which become effective as 

of January 1, 2005: 

1. The entry of ‘‘0.7959’’ for 

Metropolitan Statistical Area (MSA) 

3960 (Lake Charles, LA) is revised by 

adding ‘‘(0.7972, effective January 1, 

2005)’’. 

2. The entry of ‘‘0.8053’’ for MSA 

4280 (Lexington, KY) is revised by 

adding ‘‘(0.9219, effective January 1, 

2005)’’. 

3. The entry of ‘‘1.0025’’ for MSA 

5000 (Miami, FL) is revised by adding 

‘‘(0.9870, effective January 1, 2005)’’. 

4. The entry of ‘‘1.2921’’ for MSA 

5380 (Nassau-Suffolk, NY) is revised by 

adding ‘‘(1.2907, effective January 1, 

2005)’’. 

5. The entry of ‘‘1.3587’’ for MSA 

5600 (New York, NY) is revised by 

adding ‘‘(1.3586, effective January 1, 

2005)’’. 

6. The entry of ‘‘1.0975’’ for MSA 

6780 (Riverside-San Bernardino, CA) is 

revised by adding ‘‘(1.0970, effective 

January 1, 2005)’’. 

7. The entry of ‘‘0.9964’’ for MSA 

8780 (Visalia-Tulare-Porterville, CA) is 

revised by adding ‘‘(0.9975, effective 

January 1, 2005)’’. 

8. The entry of ‘‘1.0059’’ for MSA 

8960 (West Palm Beach-Boca Raton, FL) 

is revised by adding ‘‘(1.0362, effective 

January 1, 2005)’’. 

9. The entry of ‘‘0.9472’’ for MSA 

9040 (Wichita, KS) is revised by adding 

‘‘(0.9468, effective January 1, 2005)’’. 

II. Correction of Errors 

In FR Doc. 04–17443 (69 FR 45775), 

make the following corrections: 

1. On pages 45787 through 45814, in 

Table 8—Wage Index for Rural Areas 

the table is corrected to read as follows: