[Federal Register Volume 75, Number 228 (Monday, November 29, 2010)]
[Notices]
[Pages 73086-73088]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-29959]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-4154-PN]


Medicare and Medicaid Programs; Renewal of Deeming Authority of 
the National Committee for Quality Assurance for Medicare Advantage 
Health Maintenance Organizations and Local Preferred Provider 
Organizations

AGENCY: Centers for Medicare & Medicaid Services, HHS.

ACTION: Proposed notice.

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SUMMARY: This proposed notice announces the receipt of an application 
to renew the Medicare Advantage Deeming Authority of the National 
Committee for Quality Assurance (NCQA) for Health Maintenance 
Organizations and Preferred Provider Organizations for a term of 4 
years. The new term of approval would begin October 19, 2010, and would 
end October 18, 2014. In addition, this proposed notice announces a 30-
day public comment period 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 January 28, 2011.

ADDRESSES: In commenting, please refer to file code CMS-4154-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-4154-PN, P.O. Box 8010, 
Baltimore, MD 21244-1850.
    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-4154-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) 786-9994 in advance to schedule your 
arrival with one of our staff members.
    Comments mailed to the addresses indicated as appropriate for hand 
or courier delivery may be delayed and received after the comment 
period.
    For information on viewing public comments, see the beginning of 
the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT: Caroline L. Baker (410) 786-0116.

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 the Centers for Medicare & Medicaid Services (CMS). The 
regulations specifying the Medicare requirements that must be met in 
order for an 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 of the Act 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 of our regulations.
    To assure compliance with certain Medicare requirements, an MA 
organization may chose to become accredited by a CMS approved 
accrediting organization (AO). By doing so, the MA organization may be 
``deemed'' compliant in one or more of 6 requirements set forth in 
section 1852(e)(4)(B) of the Act. In order 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. MA organizations that are licensed as health 
maintenance organizations (HMOs) or preferred provider organizations 
(PPOs) and are accredited by an approved accrediting organization may 
receive, at their request, deemed status for CMS requirements in the 
following six MA survey areas: (1) Quality Improvement, (2) 
Antidiscrimination, Access to Services, (3) Confidentiality and 
Accuracy of Enrollee Records, (4) Information on Advanced Directives, 
and Provider Participation Rules. (See 42 CFR 422.156(b).) We note that 
at this

[[Page 73087]]

time, deeming does not include the Part D areas of review listed in 
Sec.  422.156(b).
    Organizations that apply for MA deeming authority are generally 
recognized by the health care industry as entities that accredit HMOs 
and PPOs. As we specified in Sec.  422.157(b)(2), the term for which an 
AO may be approved by CMS may not exceed 6 years. For continuing 
approval, the AO must renew their application with CMS.
    The National Committee for Quality Assurance (NCQA) was approved as 
an accrediting organization for MA deeming of HMOs from January 19, 
2002 through January 18, 2008. The NCQA was reapproved as an 
accrediting organization for MA deeming of HMOs on January 18, 2008, 
for a term of 6 years, which was set to expire on January 17, 2014.
    The NCQA was approved for MA deeming of PPOs from October 20, 2004 
through October 19, 2010. On July 20, 2010, the NCQA submitted an 
application to renew their deeming authority which, at the request of 
CMS for administrative simplification purposes, combined their HMO and 
PPO deeming authority. On July 20, 2010, the NCQA also submitted all of 
the prerequisite materials as specified in Sec.  422.158(a) for 
receiving CMS deeming program approval. This information was previously 
submitted to CMS by NCQA as a part of their initial HMO and PPO 
applications.

II. Approval of Deeming Organizations

    Section 1852(e)(4)(C) of the Act provides a statutory timetable to 
ensure that our review of deeming applications in 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. Evaluation of Deeming Authority Request

    As set forth in Sec.  1852(e)(4) of the Act and our regulations at 
Sec.  422.158, the review and evaluation of NCQA's accreditation 
program (including its standards and monitoring protocol) were compared 
to the requirements set forth in part 422 for the MA program.

A. Components of the Review Process

    The review of NCQA's application for approval of MA deeming 
authority included the following components:
    <bullet> The types of MA plans that it would review as part of its 
accreditation process.
    <bullet> A detailed comparison of the organization's accreditation 
requirements and standards with the Medicare requirements (for example, 
a crosswalk).
    <bullet> Detailed information about the organization's survey 
process, including--
    ++ Frequency of surveys and whether surveys are announced or 
unannounced.
    ++ Copies of survey forms, and guidelines and instructions to 
surveyors.
    ++ Description 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.
    <bullet> Detailed information about the individuals who perform 
surveys for the accreditation organization, including--
    ++ 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.
    <bullet> 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.
    <bullet> 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.
    <bullet> 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.
    <bullet> A description of the organization's policies and 
procedures with respect to 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.
    <bullet> A description of all types (for example, full and partial) 
and categories (for example, provisional, conditional, and 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.
    <bullet> A list of all currently accredited MA organizations and 
the type, category, and expiration date of the accreditation held by 
each of them.
    <bullet> A list of all full and partial accreditation surveys 
scheduled to be performed by the accreditation organization as 
requested by CMS.
    <bullet> The name and address of each person with an ownership or 
control interest in the accreditation organization.
    <bullet> The NCQA'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. Results of the Review Process

    Using the information listed in section III.A. of this proposed 
notice, we determined that NCQA's current accreditation program for HMO 
and PPO MA plans continues to be at least as stringent as the MA 
requirements contained in the six categories specified in section 
1852(e)(4)(C) of the Act and our methods of evaluation for those areas.

IV. Response to Public Comments and Notice Upon Completion of 
Evaluation

    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 notice, 
and, when we proceed with a subsequent document, we will respond to the 
comments in the preamble to that document.
    Upon completion of our evaluation, including evaluation of comments 
received as a result of this notice, we will publish a final notice in 
the Federal Register announcing the result of our evaluation.

V. 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 (44 U.S.C. 35).

[[Page 73088]]

VI. Regulatory Impact Statement

    In accordance with the provisions of Executive Order 12866, this 
regulation was not reviewed by the Office of Management and Budget.

(Catalog of Federal Domestic Assistance Program No. 93.778, Medical 
Assistance Program).
(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)

    Dated: November 18, 2010.
Donald M. Berwick,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2010-29959 Filed 11-26-10; 8:45 am]
BILLING CODE 4120-01-P