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 & Medicare 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 [insert date 30 days after date of publication in the 

Federal Register].

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: 
CMS-4166-PN 2 

 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 
CMS-4166-PN 3 

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 stampin 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. 

 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 
CMS-4166-PN 4 

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; 
CMS-4166-PN 5 

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 §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 §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 §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 §422.158 (Federal review of accrediting 

organizations), our review and evaluation of AAAHC will include, but not necessarily be limited 

to, the following components: 
CMS-4166-PN 6 

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. 
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● 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 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 §422.157(d). 

B. Notice Upon Completion of Evaluation 
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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

BILLING CODE: 4120-01-P 

[FR Doc. 2012-7701 Filed 03/29/2012 at 8:45 am; Publication Date: 03/30/2012]