Federal Register / Vol. 78, No. 178 / Friday, September 13, 2013 / Notices 56711 

1Patient Protection and Affordable Care Act; Data 

Collection To Support Standards Related to 

Essential Health Benefits; Recognition of Entities for 

the Accreditation of Qualified Health Plans Final 

Rule 77 FR 42658, 42662–42668 (July 20, 2012) (45 

CFR 156.275(c)). 

2Certain authority under the Affordable Care Act 

has been delegated from the Secretary to the 

Administrator of CMS., 76 FR 53903 through 53906, 

(Aug. 30, 2011). 

3Patient Protection and Affordable Care Act; 

Standards Related to Essential Health Benefits, 

Actuarial Value, and Accreditation; Final Rule, 78 

FR 12834, 12854–12855 (February 25, 2013)(45 CFR 

156.275(c)). 

We, along with the healthcare industry, 

believe that the availability to the 

facility of the type of records and 

general content of records is standard 

medical practice and is necessary in 

order to ensure the well-being and 

safety of patients and professional 

treatment accountability. Form Number: 

CMS–10266 (OCN: 0938–1069); 

Frequency: Yearly; Affected Public: 

Business or other for-profits and Notfor-profit institutions; Number of 

Respondents: 226; Total Annual 

Responses: 528; Total Annual Hours: 

2,523. (For policy questions regarding 

this collection contact Diane Corning at 

410–786–8486.) 

Dated: September 10, 2013. 

Martique Jones, 

Deputy Director, Regulations Development 

Group, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2013–22329 Filed 9–12–13; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–9953–PN] 

Health Insurance Exchanges; 

Application by the Accreditation 

Association for Ambulatory Health 

Care To Be a Recognized Accrediting 

Entity for the Accreditation of Qualified 

Health Plans 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice announces the 

receipt of an application from the 

Accreditation Association for 

Ambulatory Health Care (AAAHC) to be 

a recognized accrediting entity for the 

purposes of fulfilling the accreditation 

requirement as part of qualified health 

plan (QHP) certification. Regulations 

require HHS to publish a notice 

identifying the accrediting entity, 

summarizing its analysis of whether the 

accrediting entity meets certain criteria, 

and providing no less than a 30-day 

public comment period. 

DATES: To be assured consideration, 

comments must be received at one of 

the addresses provided below, no later 

than 5 p.m. on October 15, 2013. 

ADDRESSES: In commenting, please refer 

to file code CMS–9953–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–9953–PN, P.O. Box 8010, 

Baltimore, MD 21244–8010. 

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–9953–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 FURTHER INFORMATION CONTACT: 

Rebecca Zimmermann, at (301) 492– 

4396. 

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 

Regulations at 45 CFR 156.275 require 

qualified health plan (QHP) issuers to be 

accredited on the basis of local 

performance of its QHPs by an 

accrediting entity recognized by the 

Department of Health and Human 

Services (HHS). In a final rule published 

on July 20, 2012,1 we established the 

first phase of an intended two-phase 

approach to recognize accrediting 

entities and proposed both the National 

Committee for Quality Assurance 

(NCQA) and URAC as recognized 

accrediting entities. On November 23, 

2012, we notified the public that NCQA 

and URAC had both met the 

requirements in the final rule to be 

recognized as an accrediting entity (77 

FR 42662 through 42668) and were 

recognized by the Secretary 2 as 

accrediting entities for the purposes of 

QHP certification. 

On February 25, 2013, we published 

a subsequent final rule title, ‘‘Standards 

Related to Essential Health Benefits, 

Actuarial Value, and Accreditation (78 

FR 1283),’’ 3 which amended 

§ 156.275(c) to establish an application 

and review process to allow additional 


tkelley on DSK3SPTVN1PROD with NOTICES
56712 Federal Register / Vol. 78, No. 178 / Friday, September 13, 2013 / Notices 

4 42 CFR 422.157. 5 Interested persons may contact AAAHC to 

request a copy of the handbook. 

accrediting entities to seek recognition. 

The application submitted by an 

accrediting entity must include 

documentation described in 

§ 156.275(c)(4) and demonstrate, in a 

concise and organized fashion how the 

accrediting entity meets the 

requirements of § 156.275 (c)(2) and (3). 

Specifically, to be recognized, an 

accrediting entity must provide current 

accreditation standards and 

requirements, processes and measure 

specifications for performance measures 

to demonstrate via a crosswalk that it 

meets the conditions described in 

§ 156.275 (c)(2) and (c)(3). Further, once 

recognized, § 156.275(c)(4)(ii) requires 

accrediting entities to provide the 

Secretary with any proposed changes or 

updates to the accreditation standards 

and requirements, processes, and 

measure specifications for performance 

measures with 60 days’ notice prior to 

public notification. Lastly, 

§ 156.275(c)(5) requires recognized 

accrediting entities, when authorized by 

an accredited QHP issuer, to provide 

specific QHP issuer accreditation survey 

data elements to the Exchange. 

II. Provisions of the Notice 

The purpose of this notice is to notify 

the public of the Accreditation 

Association for Ambulatory Health 

Care’s (AAAHC) request for recognition 

by the Secretary as an accrediting entity 

for the purposes of QHP certification. As 

part of the application, AAAHC 

submitted all the required 

documentation materials described in 

§ 156.275(c)(4). Below we present, our 

analysis of whether AAAHC meets the 

criteria described in paragraphs 

§ 156.275 (c)(2) and (3). 

1. Summary of CMS’s Analysis 

We are providing the public with an 

analysis of AAAHC’s completed 

application, including a review of the 

current accreditation standards and 

requirements, processes and measure 

specifications for performance 

measures, submitted by AAAHC. 

Currently, AAAHC is an accrediting 

body that has a CMS-approved 

accreditation program to conduct 

surveys for ambulatory surgery centers 

that wish to participate in the Medicare 

program with deemed status. The 

AAAHC has also obtained approval 

from CMS as a deeming entity allowing 

it to survey Medicare Advantage plans.4

The current scope of accreditation as 

described in AAAHC’s 2013 

Accreditation Handbook for Health 

Plans demonstrates that AAAHC will be 

providing accreditation of QHPs within 

the statutorily required categories,5

established in § 156.275(c), including 

reporting on a set of clinical quality 

measures and patient experience ratings 

on a standardized Consumer 

Assessment of Healthcare Providers and 

Systems (CAHPS®) survey; consumer 

access; utilization management; quality 

assurance; provider credentialing; 

complaints and appeals; network 

adequacy and access; and patient 

information programs. 

In addition, CMS evaluated AAAHC’s 

standards relating to network adequacy 

and consider them to be consistent with 

the general requirements for network 

adequacy for QHP issuers (45 CFR 

156.230(a)(2) and (3)). To determine 

health plans’ compliance with network 

adequacy standards, the AAAHC 

accreditation survey includes review of 

areas such as member choice of 

providers, member satisfaction with 

relation to provider access, availability 

of services, provider network 

credentialing and customer complaints, 

appeals, and satisfaction information. 

Upon review of the clinical quality 

measures included in AAAHC’s 

accreditation standards, we have 

assessed that the measures cover a range 

of conditions and domains, include 

adult and child-specific measures, align 

with the priorities in the National 

Strategy for Quality Improvement in 

Health Care, are developed or adopted 

by the National Quality Forum (NQF) or 

are in common use for health plan 

quality measurement, and meet health 

plan industry standards and are 

evidence-based, as required in 

§ 156.275(c)(2)(ii). The following list 

displays the clinical quality measures 

that will be used for QHP accreditation 

by AAAHC, spanning preventive care, 

behavioral health and substance abuse 

disorders, chronic care, and acute care: 

Measure NQF reference 

No. Measure develop/steward 

Mandatory Measures 

Proportion of Days Covered (Drug Therapy ..............................

Adherence) .................................................................................

0541 Pharmacy Quality Alliance (PQA). 

Provider Network Adequacy—Number of Specialists Accepting 

New Patients At End of Reporting Period by Specialist Type.

n/a Centers for Medicare and Medicaid Services (CMS). 

Dyslipidemia New Medication 12-Week Testing ........................ n/a Resolution Health, Inc. 

Drug-Drug Interactions ............................................................... n/a PQA. 

Diabetes Short Term Complications Event ................................

Rate ............................................................................................

0272 Adapted by URAC from Agency for Healthcare Quality and 

Research (AHRQ) measure. 

Diabetes Long Term Complications Admission Rate ................ 0274 Adapted by URAC from AHRQ measure. 

Adult Asthma Event Rate ........................................................... 0283 Adapted by URAC from AHRQ measure. 

Pediatric Asthma Event Rate ..................................................... n/a Adapted by URAC from AHRQ measure. 

Mandatory/Equivalent Measures 

Atherosclerotic Disease—Lipid Panel Monitoring ...................... 0616 Active Health Management. 

Diabetes All-Or-None Process Measure (HbA1c, LDL–C, 

Nephropathy).

n/a Wisconsin Collaborative for Healthcare Quality. 

Provider Network Adequacy—Primary Care .............................. n/a CMS. 

Medication Therapy For Patients With Asthma: Suboptimal 

Asthma Control (SAC), and Absence of Controller Therapy 

(ACT).

0548 PQA. 

Call Center Performance ............................................................ n/a URAC. 

Percentage of Live Births Weighing Less than 2,500 Grams .... 0278 AHRQ. 


tkelley on DSK3SPTVN1PROD with NOTICES
Federal Register / Vol. 78, No. 178 / Friday, September 13, 2013 / Notices 56713 

Measure NQF reference 

No. Measure develop/steward 

Annual Percentage of Asthma Patients 2 through 20 Years 

Old with One or More Asthma-related Emergency Room 

Visits.

1381 Alabama Medicaid. 

Percentage of Female Patients Who Had a Mammogram Performed During the Two-Year Measurement Period.n/a American Medical Association/Physician Consortium Performance Improvement (AMA/PCPI). 

High Risk for Pneumococcal Disease—Pneumococcal Vaccination.0617 ActiveHealth Management. 

Preventive Services: Percentage of Enrolled Members Ages 

Less than or Equal to 18 years Who have had Preventive 

Services, Recommended Risk Factor Reductions and Behavioral Health Change Interventions, Appropriate 

Screenings and Immunizations.

n/a American Academy of Pediatrics/URAC. 

Colorectal Cancer Screening ..................................................... n/a Veterans Health Administration (VHA). 

Tobacco Use: Screening and Cessation .................................... 0028 AMA/PCPI/URAC. 

Prevention and Management of Obesity in Mature Adolescents 

and Adults.

n/a Institute for Clinical Systems Improvement(ICSI)/URAC. 

30 Day Post-Hospital AMI Discharge Care Transition Composite Measure.0698 Centers for Medicare and Medicaid Services (CMS)/URAC. 

Congestive Heart Failure (CHF) Rate ........................................ 0358 AHRQ/URAC. 

Atrial Fibrillation—Warfarin Therapy .......................................... 0264 ActiveHealth Management. 

MRI Lumbar Spine for Low Back Pain ....................................... 0514 CMS. 

All Cause Readmission Index .................................................... 0505 United Health Group/URAC. 

Central Venous Catheter-related Bloodstream Infections (arealevel): Rate per 100,000 Population.n/a AHRQ. 

Depression Readmission ............................................................ n/a Minnesota Community Measurement/URAC. 

Follow-up After Hospitalization for a Mental Illness ................... n/a Florida Agency for Health Care Administration. 

CAHPS®

CAHPS® Adult Health Plan Survey 5.0 ..................................... 0006 AHRQ. 

CAHPS® Child Survey v4.0 Medicaid and Commercial Core 

Survey.

n/a AHRQ. 

CAHPS® Survey for Children With Chronic Conditions ............. 0009 AHRQ. 

Exploratory Measures 

Case Management: Consumer Contact ..................................... n/a URAC. 

Complaint Response Timeliness ................................................ n/a URAC. 

Outpatient Newborn Visit Within One Month of Birth ................ n/a Centene. 

Diabetes: All or None Process Measure: Optimal Results for 

HbA1c, LDL–C, and Blood Pressure.

n/a Wisconsin Collaborative for Healthcare Quality. 

Percentage of Eligible Members that Receive Preventive Dental Services.n/a CMS/URAC. 

Health Risk Assessment Completion Rate ................................ n/a URAC. 

Use of High Risk Medications in the Elderly .............................. n/a PQA. 

The AAAHC documented in its 

application how its measures and 

standards comply with the requirements 

contained in § 156.275. The application 

also clarifies how AAAHC accreditation 

complies with § 156.275(c)(2) and (c)(3). 

Specifically, AAAHC will provide 

accreditation at the required Exchange 

product type level, assuming that 

adequate member numbers and data are 

available, as required by 45 CFR 

156.275(c)(2)(iii). 

CMS evaluated AAAHC’s application 

information regarding accreditation 

survey methodology and processes for 

scoring and consider the standards to be 

methodologically rigorous and 

transparent as required in 

§ 156.275(c)(3). The AAAHC described 

its health plan scoring methodology for 

2013 and documented that the 

collection and reporting of a required 

set of clinical quality measures and 

CAHPS® data will be factored into the 

overall accreditation score. The majority 

of AAAHC accreditation standards are 

rated on a five-point scale of Fully 

Compliant to Non-Compliant and a 

critical set of standards must be fully 

met for successful health plan 

accreditation, including the reporting of 

clinical quality measures. 

2. Public Comment 

This notice solicits public comments 

on the analysis above and the 

conclusion that it is appropriate to 

recognize AAAHC as an accrediting 

entity for the purpose of QHP 

certification. We seek specific 

comments on AAAHC’s accreditation 

standards for QHP issuers including: 

whether the public believes AAAHC’s 

standards meet the requirements in 

§ 156.275; whether there are any 

deficiencies in its standards that should 

be reviewed; the content of the 

proposed clinical quality measures and 

their appropriateness for use in QHP 

accreditation; the rigor of the scoring 

methodology; and if the network 

adequacy standards will ensure 

sufficient network of providers for QHP 

enrollees. 

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 


tkelley on DSK3SPTVN1PROD with NOTICES
56714 Federal Register / Vol. 78, No. 178 / Friday, September 13, 2013 / Notices 

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 before making a 

determination of recognition of an 

accrediting entity. Upon completion of 

our analysis, 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 determination. (Health 

Insurance Exchanges; Application by 

the Accreditation Association for 

Ambulatory Health Care to be a 

Recognized Accrediting Entity for the 

Accreditation of Qualified Health Plans) 

Dated: August 29, 2013. 

Marilyn Tavenner, 

CMS Administrator, Centers for Medicare & 

Medicaid Services. 

[FR Doc. 2013–22369 Filed 9–12–13; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Proposed Information Collection 

Activity; Comment Request 

Title: Permanency Innovations 

Initiative Evaluation: Phase 3. 

OMB No.: 0970–0408. 

Description: The Administration for 

Children and Families (ACF), U.S. 

Department of Health and Human 

Services (HHS) intends to collect data 

for an evaluation of the Permanency 

Innovations Initiative (PII). This 5-year 

initiative, funded by the Children’s 

Bureau (CB) within ACF, is intended to 

build the evidence base for innovative 

interventions that enhance well-being 

and improve permanency outcomes for 

particular groups of children and youth 

who are at risk for long-term foster care 

and who experience the most serious 

barriers to timely permanency. 

Data collection for the PII evaluation 

includes a number of components being 

launched at different points in time. 

Phase 1 (approved August 2012, OMB# 

0970–0408) included data collection for 

a cross-site implementation evaluation 

and site-specific evaluations of two PII 

grantees (Washoe County, Nevada, and 

the State of Kansas). Phase 2 (approved 

August 2013) included data collection 

for two more PII grantees (Illinois DCFS 

and one of two interventions offered by 

the Los Angeles Gay and Lesbian 

Center’s Recognize Intervene Support 

Empower [RISE] project). 

Phase 3 will include data collection 

for evaluations of two PII grantee 

interventions and two additional crosssite PII studies. The two grantee 

interventions are the California 

Department of Social Services’ 

California Partnership for Permanency 

(CAPP) project and a second RISE 

intervention, the Care Coordination 

Team (CCT). The two PII cross-site 

studies are a cost study and an 

administrative data study. The 

administrative data study does not 

impose any new data collection 

requirements and will use data 

currently reported by states through the 

Adoption and Foster Care Analysis and 

Reporting System (AFCARS) (OMB 

Control # 0980–0267) and the National 

Child Abuse and Neglect Data System 

(NCANDS) (OMB Control # 0980–0229), 

as well as data maintained in State 

Automated Child Welfare Information 

Systems (SACWIS). 

Respondents: Youth, foster parents, 

permanency resources, biological 

parents, legal guardians, team 

facilitators, caseworkers, supervisors, 

and state agency workers. 

ANNUAL BURDEN ESTIMATES

Instrument Total number 

of respondents 

Annual 

number 

of respondents 

Number 

of responses 

per respondent 

Average 

burden hours 

per response 

Total 

annual 

burden hours 

CAPP: 

Parent/Guardian Interview ............................................ 1791 597 1 0.5 299 

Caseworker Data Extraction ......................................... 894 298 1 0.5 149 

CAPP annual burden hours .......................................... ........................ ........................ ........................ ........................ 448 

RISE CCT: 

Youth Interview ............................................................. 120 40 2 1.3 104 

Qualitative Youth Interview ........................................... 60 20 1 1.2 24 

Interview with Permanency Resource .......................... 120 40 2 1.0 80 

Interview with Current Caregiver .................................. 120 40 2 0.6 48 

Current Caregiver Qualitative Interview ....................... 60 20 1 1.0 20 

CCT Facilitators Emotional Permanency Pretest ......... 12 4 5 0.2 4 

CCT Facilitators Emotional Permanency Posttest ....... 12 4 5 0.2 4 

CAFAS pretest .............................................................. 12 4 5 1.0 20 

Caseworker discussion for CAFAS pretest completion 60 20 1 0.5 10 

CAFAS posttest ............................................................ 12 4 5 1.0 20 

Caseworker discussion for CAFAS posttest completion ............................................................................. 60 20 1 0.5 10 

CCT Facilitators Permanent Connections Inventory 

Pretest ....................................................................... 12 4 1 0.2 1 

CCT Facilitators Permanent Connections Inventory 

Posttest ..................................................................... 12 4 1 0.2 1 

RISE CCT annual burden hours .................................. ........................ ........................ ........................ ........................ 346 

Cost Study: 

Cost Focus Group ........................................................ 27 9 1 7 63 

Weekly Casework Activity Log ..................................... 369 123 52 0.4 2,558 

Weekly Supervision Activity Log .................................. 117 39 52 0.4 811 

Monthly Management/Administration Log .................... 90 30 12 0.5 180 

Cost Study annual burden hours .................................. ........................ ........................ ........................ ........................ 3,612 

Administrative Data Study: 


tkelley on DSK3SPTVN1PROD with NOTICES