Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Notices 63019 

coordination through links between 

chronic care case-management and 

acute care providers; (3) provision of 

long-term-benefits; and (4) an adjusted 

average per capita costs based riskadjusted payment methodology. Form 

Number: CMS–R–204 (OMB#: 0938–

0709); Frequency: Reporting—yearly; 

Affected Public: Individuals or 

households; Number of Respondents: 

17,624; Total Annual Responses: 

17,624; Total Annual Hours: 3,425. 

2. Type of Information Collection 

Request: New collection; Title of 

Information Collection: Assessing 

Degrees of Health Care Involvement 

Survey; Use: It is not sufficient to 

merely mail information about the 

Medicare program to each beneficiary. 

CMS needs to know that the 

beneficiaries received the information, 

understood the information and found 

the information useful in making 

choices about their Medicare 

participation. To this end, CMS must 

have measure(s) over time of what 

beneficiaries know and understand 

about the Medicare program now to be 

able to quantify and attribute any 

changes to their understanding or 

behavior to information/education 

initiatives. Measuring beneficiary 

information needs and knowledge over 

time will help CMS to evaluate the 

impact of information/education and 

other initiatives, as well as to 

understand how the population is 

changing separate from such initiatives. 

Form Number: CMS–10208 (OMB#: 

0938—NEW); Frequency: Reporting—

weekly; Affected Public: Individuals or 

households; Number of Respondents: 

4,000; Total Annual Responses: 3,500; 

Total Annual Hours: 1,200. 

3. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Certification of 

Medicaid Eligibility Control (MEQC) 

Payment Error Rates and Supporting 

Regulations at 42 CFR 431.800–431.865; 

Use: Medicaid Eligibility Quality 

Control (MEQC) is operated by Title XIX 

agencies to monitor and improve the 

administration of its Medicaid program. 

The traditional MEQC program is based 

on State reviews of Medicaid 

beneficiaries identified through a 

statistically reliable statewide sample of 

cases selected from the eligibility files. 

These reviews are conducted to 

determine whether the sampled cases 

meet applicable Title XIX eligibility 

requirements. State agencies are 

required to submit the Payment Error 

Rate form to their respective CMS 

Regional Office. Regional Office staff 

will review these forms for 

completeness and will forward these 

forms to central office for compilation of 

error rate charts for projected quarterly 

withholdings and/or fiscal 

disallowances. Form Number: CMS–301 

(OMB#: 0938–0246); Frequency: 

Recordkeeping and reporting—semiannually; Affected Public: State, local or 

tribal governments; Number of 

Respondents: 51; Total Annual 

Responses: 102; Total Annual Hours: 

22,515. 

To obtain copies of the supporting 

statement and any related forms for the 

proposed paperwork collections 

referenced above, access CMS’ Web site 

address at http://www.cms.hhs.gov/ 

PaperworkReductionActof1995, or email your request, including your 

address, phone number, OMB number, 

and CMS document identifier, to 

Paperwork@cms.hhs.gov, or call the 

Reports Clearance Office on (410) 786–

1326. 

To be assured consideration, 

comments and recommendations for the 

proposed information collections must 

be received at the address below, no 

later than 5 p.m. on December 26, 2006. 

CMS, Office of Strategic Operations and 

Regulatory Affairs, Division of 

Regulations Development—C, Attention: 

Bonnie L Harkless, Room C4–26–05, 

7500 Security Boulevard, Baltimore, 

Maryland 21244–1850. 

Dated October 19, 2006. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. E6–17910 Filed 10–26–06; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–4126–PN] 

Medicare and Medicaid Programs; 

Reapproval 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 & 

Medicaid Services (CMS), HHS. 

ACTION: Proposed notice. 

SUMMARY: This notice announces our 

proposal to reapprove Medicare 

Advantage Deeming Authority of the 

Accreditation Association for 

Ambulatory Health Care, Inc. for health 

maintenance organizations and local 

preferred provider organizations for a 

term of 6 years. This new term of 

approval begins July 12, 2006, and ends 

July 11, 2012. This notice also 

announces a 30-day period for public 

comments on 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 November 27, 2006. 

ADDRESSES: In commenting, please refer 

to file code CMS–4126–PN. Because of 

staff and resource limitations, we cannot 

accept comments by facsimile (FAX) 

transmission. 

You may submit comments in one of 

three ways (no duplicates, please): 

1. Electronically. You may submit 

electronic comments on specific issues 

in this regulation to http:// 

www.cms.hhs.gov/regulations/ 

ecomments. (Attachments should be in 

Microsoft Word, WordPerfect, or Excel; 

however, we prefer Microsoft Word.) 

2. By mail. You may mail written 

comments (one original and two copies) 

to the following address ONLY: Centers 

for Medicare & Medicaid Services, 

Department of Health and Human 

Services, Attention: CMS–4126–PN, 

P.O. Box 8017, Baltimore, MD 21244–

8017. 

Please allow sufficient time for mailed 

comments to be received before the 

close of the comment period. 

3. By hand or courier. If you prefer, 

you may deliver (by hand or courier) 

your written comments (one original 

and two copies) before the close of the 

comment period to one of the following 

addresses. 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. 

Room 445–G, Hubert H. Humphrey 

Building, 200 Independence Avenue, 

SW., Washington, DC 20201; or 7500 

Security Boulevard, Baltimore, MD 

21244–1850. 

(Because access to the interior of the 

HHH 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.) 

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: 

Shaheen Halim, (410) 786–0641. 

SUPPLEMENTARY INFORMATION: 


jlentini on PROD1PC65 with NOTICES
63020 Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Notices 

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 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 continuing 

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 Social Security Act (the Act) as a 

result of an MA organization’s 

accreditation by a CMS-approved 

accrediting organization (AO). In 

essence, 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. Therefore, 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 the MA 

requirements in the following six areas: 

Quality Improvement, Information on 

Advance Directives, Antidiscrimination, 

Confidentiality and Accuracy of 

Enrollee Records, Access to Services, 

and Provider Participation Rules. At this 

time, Deeming does not include the Part 

D areas of review listed in § 422.156(b). 

Organizations that apply for MA 

deeming authority are generally 

recognized by the industry as entities 

that accredit MCOs that are licensed as 

an HMO or a PPO. 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. 

Accreditation Association for 

Ambulatory Health Care, Inc. (AAAHC) 

was approved as an authorized AO for 

Medicare Advantage deeming on June 

15, 2002. AAAHC was granted a term of 

approval of 4 years beginning June 15, 

2002, and ending on June 14, 2006. On 

June 13, 2006, we issued a letter to 

AAAHC with instructions regarding 

application for a renewal of term. On 

June 14, 2006, AAAHC submitted a 

letter of intent to renew its MA deeming 

authority, and subsequently submitted 

all materials requested by CMS for a 

complete renewal application. The 

materials requested by CMS included 

updates and/or changes to items listed 

in Federal regulations at 42 CFR 

422.158(a) that are prerequisites for 

receiving deeming program approval by 

CMS, and which were furnished to CMS 

by AAAHC as part of its initial 

application for deeming authority in 

2002. 

II. Deeming Applications Approval 

Process 

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. Deeming Approval Review and 

Evaluation 

As set forth in section 1852(e)(4) of 

the Act and our regulations at § 422.158, 

the review and evaluation of the 

AAAHC’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 AAAHC’s application 

for approval of MA deeming authority 

included the following components: 

1. Desk-Top Review 

We conducted a desk-top review of 

updated materials regarding AAAHC’s 

managed care accreditation program, 

including—

• A description of AAAHC’s survey 

process for managed care plans, 

including the frequency of surveys 

performed, whether the surveys are 

announced or unannounced, surveyor 

instructions, the review and 

accreditation status decision-making 

process, procedures used to notify 

accredited MA organizations of 

deficiencies and monitoring of the 

correction of deficiencies, and the 

procedures used to enforce compliance 

with accreditation requirements; 

• Information about the individuals 

who perform network accreditation 

reviews, including the size and 

composition of the survey team, the 

methods of compensation, the education 

and experience requirements, the 

content and frequency of the in-service 

training, the evaluation system used to 

monitor performance, and conflict of 

interest requirements governing AAAHC 

staff and surveyors; 

• A description of the data 

management and analysis system, the 

types (full, partial, or denial) and 

categories (provisional, conditional, 

temporary) of accreditation offered by 

AAAHC, the duration of each category 

of accreditation, and a statement 

identifying the types and categories that 

would serve as a basis for accreditation, 

if we grant AAAHC organization 

deeming authority; 

• The procedures used to respond to 

and investigate complaints or identify 

other problems with accredited 

organizations, including coordination of 

these activities with licensing bodies 

and ombudsmen programs; 

• A description of how AAAHC 

provides accreditation information to 

the general public; 

• The policies and procedures for (1) 

withholding, denying and removing 

accreditation status, and the other 

actions AAAHC may take in response to 

noncompliance with their standards and 

requirements, and (2) how AAAHC 

treats accreditation of organizations that 

are acquired by another organization, 

have merged with another organization, 

or that undergo a change of ownership 

or management; 

• Lists of all AAAHC-accredited MA 

organizations, managed care plans 

surveyed by AAAHC in the past 3 years, 

and managed care plans that were 

scheduled to be surveyed by AAAHC 

within 3 months of submitting their 

application. 


jlentini on PROD1PC65 with NOTICES
Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Notices 63021 

2. Assessment of AAAHC’s Standards 

and Methods of Evaluation 

As part of the application for renewal 

of term, AAAHC submitted a crosswalk 

that compared its standards and 

methods of evaluations with 

corresponding MA audit requirements 

in six areas: Quality Improvement, 

Access to Services, Antidiscrimination, 

Information on Advance Directives, 

Provider Participation Rules, and 

Confidentiality and Accuracy of 

Enrollee Records. 

3. Past Performance and Results of 

Deeming Validation Review (Lookbehind Audit) 

We also considered 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. Results of the Review Process 

Using the information listed in 

section III.A. of this notice, we 

determined that AAAHC’s current 

accreditation program for managed care 

plans continues to be at least as 

stringent as the MA requirements 

contained in the six categories set forth 

in section 1852(e)(4)(C) of the Act and 

our methods of evaluation for those 

areas. 

IV. Term of Approval 

Based on the review and observations 

described in section III of this proposed 

notice, we have determined that 

AAAHC’s requirements for HMOs and 

local PPOs continue to meet or exceed 

our requirements. Therefore, we are 

proposing to recognize AAAHC as a 

national accreditation organization for 

HMOs and PPOs that request 

participation in the Medicare program. 

As a result, we are proposing to approve 

AAAHC’s deeming program effective 

July 12, 2006 through July 11, 2012. 

V. Regulatory Impact Statement 

We have examined the impact of this 

notice as required by Executive Order 

12866 (September 1993, Regulatory 

Planning and Review) and the 

Regulatory Flexibility Act (RFA) 

September 19, 1980 (Pub. L. 96–354). 

Executive Order 12866 directs 

agencies to assess all costs and benefits 

of available regulatory alternatives and, 

when regulation is necessary, to select 

regulatory approaches that maximize 

net benefits (including potential 

economic, environmental, public health 

and safety effects; distributive impacts; 

and equity). A regulatory impact 

analysis (RIA) must be prepared for 

major rules with economically 

significant effects ($100 million or more 

in any 1 year). This notice would not 

reach the economic threshold and thus 

is not considered a major rule. 

The RFA requires agencies to analyze 

options for regulatory relief of small 

businesses. For purposes of the RFA, 

small entities include small businesses, 

nonprofit organizations, and small 

governmental jurisdictions. Most 

hospitals and most other providers and 

suppliers are small entities, either by 

nonprofit status or by having revenues 

of $6 million to $29 million in any 1 

year. Individuals and States are not 

included in the definition of a small 

entity. We are not preparing an analysis 

for the RFA because we have 

determined that this notice would not 

have a significant economic impact on 

a substantial number of small entities. 

In addition, section 1102(b) of the Act 

requires us to prepare a regulatory 

impact analysis if a rule may have a 

significant impact on the operations of 

a substantial number of small rural 

hospitals. This analysis must conform to 

the provisions of section 603 of the 

RFA. For purposes of section 1102(b) of 

the Act, we define a small rural hospital 

as a hospital that is located outside of 

a Metropolitan Statistical Area and has 

fewer than 100 beds. We are not 

preparing an analysis for section 1102(b) 

of the Act because we have determined 

that this notice would not have a 

significant impact on the operations of 

a substantial number of small rural 

hospitals. 

This notice merely recognizes 

AAAHC as a national accreditation 

organization that has approval for 

deeming authority for HMOs or PPOs 

that are participating in the MA 

program. 

Section 202 of the Unfunded 

Mandates Reform Act of 1995 also 

requires that agencies assess anticipated 

costs and benefits before issuing any 

rule whose mandates require spending 

in any 1 year of $100 million in 1995 

dollars, updated annually for inflation. 

That threshold level is currently 

approximately $120 million. This notice 

would have no consequential effect on 

State, local, or tribal governments or on 

the private sector. 

Executive Order 13132 establishes 

certain requirements that an agency 

must meet when it promulgates a 

proposed rule (and subsequent final 

rule) that imposes substantial direct 

requirement costs on State and local 

governments, preempts State law, or 

otherwise has Federalism implications. 

Since this notice would not impose any 

costs on State or local governments, the 

requirements of E.O. 13132 are not 

applicable. 

In accordance with the provisions of 

Executive Order 12866, this notice was 

not reviewed by the Office of 

Management and Budget. 

Authority: Secs. 1851 and 1855 of the 

Social Security Act (42 U.S.C. 1395w–21 and 

42 U.S.C. 1395w–25). 

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare—Hospital 

Insurance; and Program No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program) 

Dated: October 20, 2006. 

Leslie V. Norwalk, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

[FR Doc. E6–18044 Filed 10–26–06; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–3174–N] 

Medicare Program; Meeting of the 

Medicare Coverage Advisory 

Committee—December 13, 2006 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice announces a 

public meeting of the Medicare 

Coverage Advisory Committee 

(‘‘MCAC’’ or ‘‘the Committee’’). MCAC 

provides guidance and advice to CMS 

on specific clinical topics under review 

for Medicare coverage. This meeting 

concerns reconsideration of the 

Medicare clinical trial policy. 

Notice of this meeting is given under 

the Federal Advisory Committee Act (5 

U.S.C. App. 2, section 10(a)). 

DATES: Meeting Date: The public 

meeting will be held on Wednesday, 

December 13, 2006 from 8 a.m. until 

4:30 p.m., e.s.t. 

Registration Deadline: For security 

reasons, registration must be made no 

later than 5 p.m. on November 29, 2006. 

Requests for special accommodations 

must be received by 5 p.m. on 

November 29, 2006. 

Presentation and Written Comments 

Deadline: Written comments and 

presentations must be received by 

November 13, 2006, e.s.t. Presentations 

once submitted are final. No further 

changes to the presentation can be 

accepted after submission. 

ADDRESSES: Meeting Location: The 

meeting will be held in the main 


jlentini on PROD1PC65 with NOTICES