[Federal Register Volume 77, Number 62 (Friday, March 30, 2012)]
[Notices]
[Pages 19290-19292]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-7701]


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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 & Medicaid Services (CMS), HHS.

ACTION: Proposed notice.

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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 April 30, 2012.

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: 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 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) 786-0361 in advance to schedule your 
arrival with one of our staff members.

[[Page 19291]]

    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 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; 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 Sec.  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 Sec.  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 Sec.  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 Sec.  422.158 (Federal review of accrediting 
organizations), our review and evaluation of AAAHC will include, but 
not necessarily be limited to, the following components:

A. Components of the Review Process

    <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 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.
    <bullet> 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.
    <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

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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, 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.
    <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> 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 Sec.  422.157(d).

B. Notice Upon Completion of Evaluation

    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.
[FR Doc. 2012-7701 Filed 3-29-12; 8:45 am]
BILLING CODE 4120-01-P