31364 Federal Register / Vol. 77, No. 102 / Friday, May 25, 2012 / Notices 

March 30, 2012. Under section 

1865(a)(2) of the Act and our regulations 

at § 488.8 (Federal review of accrediting 

organizations), our review and 

evaluation of CHAP will be conducted 

in accordance with, but not necessarily 

limited to, the following factors: 

• The equivalency of CHAP’s 

standards for a hospice as compared 

with CMS’ hospice conditions of 

participation. 

• CHAP’s survey process to 

determine the following: 

+ The composition of the survey 

team, surveyor qualifications, and the 

ability of the organization to provide 

continuing surveyor training. 

+ The comparability of CHAP’s 

processes to those of State agencies, 

including survey frequency, and the 

ability to investigate and respond 

appropriately to complaints against 

accredited facilities. 

• CHAP’s processes and procedures 

for monitoring a hospice found out of 

compliance with CHAP’s program 

requirements. These monitoring 

procedures are used only when CHAP 

identifies noncompliance. If 

noncompliance is identified through 

validation reviews or complaint 

surveys, the State survey agency 

monitors corrections as specified at 

§ 488.7(d). 

• CHAP’s capacity to report 

deficiencies to the surveyed facilities 

and respond to the facility’s plan of 

correction in a timely manner. 

• CHAP’s capacity to provide CMS 

with electronic data and reports 

necessary for effective validation and 

assessment of the organization’s survey 

process. 

• The adequacy of CHAP’s staff and 

other resources, and its financial 

viability. 

• CHAP’s capacity to adequately fund 

required surveys. 

• CHAP’s policies with respect to 

whether surveys are announced or 

unannounced, to assure that surveys are 

unannounced. 

• CHAP’s agreement to provide CMS 

with a copy of the most current 

accreditation survey, together with any 

other information related to the survey 

as we may require (including corrective 

action plans). 

IV. 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). 

V. Response to Public 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. 

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. Regulatory Impact Statement 

In accordance with the provisions of 

Executive Order 12866, this proposed 

notice was not reviewed by the Office of 

Management and Budget. 

(Catalog of Federal Domestic Assistance 

Program No. 93.778, Medical Assistance 

Program; No. 93.773 Medicare—Hospital 

Insurance Program; and No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program) 

Dated: May 21, 2012. 

Marilyn Tavenner, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

[FR Doc. 2012–12816 Filed 5–24–12; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–4164–FN] 

Medicare Program; Approved Renewal 

of Deeming Authority of the Utilization 

Review Accreditation Commission for 

Medicare Advantage Health 

Maintenance Organizations and Local 

Preferred Provider Organizations 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Final notice. 

SUMMARY: This notice announces our 

decision to renew the Medicare 

Advantage ‘‘deeming authority’’ of the 

Utilization Review Accreditation 

Commission (URAC) for Health 

Maintenance Organizations and 

Preferred Provider Organizations for a 

term of 6 years. This new term of 

approval would begin May 26, 2012, 

and end May 25, 2018. 

DATES: This final notice is effective May 

26, 2012 through May 25, 2018. 

FOR FURTHER INFORMATION CONTACT: 

Caroline Baker, (410) 786–0116; or 

Edgar Gallardo, (410) 786–0361. 

SUPPLEMENTARY INFORMATION: 

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 

riskbearing 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 AO 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 § 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 

mstockstill on DSK4VPTVN1PROD with NOTICES

Federal Register / Vol. 77, No. 102 / Friday, May 25, 2012 / Notices 31365 

renew its ‘‘deeming authority’’ for a 

subsequent approval period. 

The Utilization Review Accreditation 

Commission (URAC) was approved as a 

CMS approved accreditation 

organization for MA deeming of HMOs 

on May 26, 2006, and that term will 

expire on May 26, 2012. On December 

9, 2011, URAC submitted an application 

to renew its deeming authority. On that 

same date, URAC 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 

approval of its accreditation program 

from CMS, and which were furnished to 

CMS by URAC as a part of their renewal 

applications for HMOs and PPOs. 

II. Deeming Applications Approval 

Process 

Section 1865(a)(3)(A) 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. Within 60 

days of receiving a completed 

application, we must publish a notice in 

the Federal Register that identifies the 

national accreditation body making the 

request, describes the request, and 

provides no less than a 30-day public 

comment period. At the end of the 210- 

day period, we must publish an 

approval or denial of the application. 

III. Proposed Notice 

In the March 30, 2012, Federal 

Register (77 FR 19288), we published a 

proposed notice announcing URAC’s 

request for continued CMS approval of 

its deeming authority for MA HMOs and 

PPOs. In the proposed notice, we 

detailed our evaluation criteria. Under 

section 1852(e)(4) of the Act and our 

regulations at § 422.158 (Federal review 

of accrediting organizations), we 

conducted a review of URAC’s 

application in accordance with the 

criteria specified by our regulations, 

which include, but are not limited to the 

following: 

• 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. 

• 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 also considers URAC’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). 

In accordance with section 

1865(a)(3)(A) of the Act, the March 30, 

2012 proposed notice (77 FR 19288) also 

solicited public comments regarding 

whether URAC’s requirements met or 

exceeded the Medicare conditions of 

participation as an accrediting 

organization for MA HMOs and PPOs. 

We received no public comments in 

response to our proposed notice. 

IV. Provisions of the Final Notice 

A. Differences Between URAC’s 

Standards and Requirements for 

Accreditation and Medicare’s 

Conditions and Survey Requirements 

We compared the standards and 

survey process contained in URAC’s 

application with the Medicare 

conditions for accreditation. Our review 

and evaluation of URAC’s application 

for continued CMS-approval were 

conducted as described in section III of 

this final notice, and yielded the 

following: 

• URAC amended its crosswalk to 

ensure current URAC standards are 

clearly crosswalked to the following 

regulatory requirements: §§ 422.128; 

422.206(b)(2); 422.112(a)(1); 

422.112(a)(2); 422.112(a)(8); 

422.112(b)(3); 422.112(b)(4)(iii); 

422.112(b)(5); 422.118; 422.152; 

422.202(b); and 422.202(c). 

• To meet the amendments made at 

§ 422.156 by the final rule published in 

the April 15, 2011 Federal Register (76 

CFR 21432), URAC removed Quality 

Improvement Projects and Chronic Care 

Improvement Programs from its 

deeming process. 

B. Term of Approval 

Based on the review and observations 

described in section III of this final 

notice, we have determined that URAC’s 

accreditation program requirements 

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31366 Federal Register / Vol. 77, No. 102 / Friday, May 25, 2012 / Notices 

meet or exceed our requirements. 

Therefore, we approve URAC as a 

national accreditation organization with 

deeming authority for MA HMOs and 

PPOs, effective May 26, 2012 through 

May 25, 2018. 

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). 

Authority: Section 1865 of the Social 

Security Act (42 U.S.C. 1395bb). 

(Catalog of Federal Domestic Assistance 

Program No. 93.778, Medical Assistance 

Program; No. 93.773 Medicare—Hospital 

Insurance Program; and No. 93.774, 

Medicare—Supplemental Medical Insurance 

Program) 

Dated: May 21, 2012. 

Marilyn Tavenner, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

[FR Doc. 2012–12812 Filed 5–24–12; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–1595–N] 

Medicare Program; Semi-Annual 

Meeting of the Advisory Panel on 

Hospital Outpatient Payment (HOP 

Panel)—August 27, 28, and 29, 2012 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice announces the 

second semi-annual meeting of the 

Advisory Panel on Hospital Outpatient 

Payment (HOP, the Panel), (the 

Ambulatory Payment Classification 

(APC) Panel) for 2012. The purpose of 

the Panel is to advise the Secretary of 

the Department of Health and Human 

Services (DHHS) (the Secretary) and the 

Administrator of the Centers for 

Medicare & Medicaid Services (CMS) 

(the Administrator) on the clinical 

integrity of the APC groups and their 

associated weights, and hospital 

outpatient therapeutic supervision 

issues. 

DATES: Meeting Date: The second semiannual meeting in 2012 is scheduled for 

the following dates and times. Note: The 

times listed in this notice are Eastern 

Daylight Time (EDT) and are 

approximate times; consequently, the 

meetings may last longer than listed in 

this notice, but will not begin before the 

posted times: 

• Monday, August 27, 2012, 1 p.m. to 

5 p.m. EDT. 

• Tuesday, August 28, 2012, 9 a.m. to 

5 p.m. EDT. 

• Wednesday, August 29, 2012, 9 a.m. 

to 5 p.m. EDT. 

Deadlines 

Deadline for Presentations and 

Comments—5 p.m. EDT, Friday, July 27, 

2012. (See below for submission 

instructions for both hardcopy and 

electronic submissions.) 

Deadline for Meeting Registration—5 

p.m. EDT, Friday, August 17, 2012. 

(Note: Those who do not preregister may 

not be able to attend the meeting since 

seating space is limited). 

Deadline for Requests for Special 

Accommodations—5 p.m. EDT, Friday, 

August 17, 2012. 

Submission Instructions for 

Presentations and Comments 

Because of staffing and resource 

limitations, we cannot accept written 

comments and or presentations by FAX, 

nor can we print written comments and 

presentations received by email for 

dissemination at the meeting. 

Presentations 

Presentations must be based on the 

scope of the Panel designated in the 

Charter. Any presentations outside of 

the scope of this Panel will be returned 

and/or amendments requested. 

Unrelated topics include, but are not 

limited to, the conversion factor, charge 

compression, revisions to the cost 

report, pass-through payments, correct 

coding, new technology applications 

(including supporting information/ 

documentation), provider payment 

adjustments, supervision of hospital 

outpatient diagnostic services and the 

types of practitioners that are permitted 

to supervise hospital outpatient 

services. The Panel may not recommend 

that services be designated as 

nonsurgical extended duration 

therapeutic services. 

All presentations will be considered 

public information and may be posted 

on the CMS web site and will be shared 

with the public. Presenters should not 

send pictures of patients in any of the 

documents (unless their faces have been 

blocked out) or include any examples 

with patient identifiable information. 

In order to consider presentation and/ 

or comment requests, we will need to 

receive the following information: 

1. A hardcopy of your presentation; 

only hardcopy comments and 

presentations can be reproduced for 

public dissemination. We note that all 

presentations are limited to 5 minutes 

per individual or organization. 

2. An email copy of your 

presentations sent to the Designated 

Federal Official’s (DFO) mailbox, 

Raymond.Bulls@cms.hhs.gov. 

3. Form CMS–20017 with complete 

contact information that includes name, 

address, phone, and email addresses for 

all presenters and a contact that can 

answer any questions and or provide 

revisions that are requested for the 

presentation. 

Æ Presenters must clearly explain the 

action(s) that they are requesting CMS to 

take in the appropriate section of the 

form. A presenter’s relationship to the 

organization that they represent must 

also be clearly listed. 

Æ The form is now available through 

the CMS Forms Web site. The Uniform 

Resource Locator (URL) for linking to 

this form is as follows: http://www.cms.

hhs.gov/cmsforms/downloads/

cms20017.pdf. 

ADDRESSES: Meeting Location: The 

meeting will be held in the Auditorium, 

CMS Central Office, 7500 Security 

Boulevard, Woodlawn, Maryland 

21244–1850. 

FOR FURTHER INFORMATION CONTACT: For 

inquiries about the Panel, contact the 

DFO: Raymond Bulls, 7500 Security 

Boulevard, Mail Stop C4–03–12, 

Woodlawn, MD 21244–1850. Phone: 

(410) 786–7267. 

Mail hardcopies and email copies to 

the following addresses: Raymond 

Bulls, DFO, CMS, CM, HAPC, DOC— 

HOPS Panel, 7500 Security Blvd., 

Woodlawn, MD 21244–1850, Mail Stop 

C4–03–12, 

Raymond.Bulls@cms.hhs.gov. 

Note: We recommend that you advise 

couriers of the following information: When 

delivering hardcopies of presentations to 

CMS, if no one answers at the above phone 

number, call (410) 786–4532 or (410) 786– 

7267. 

News Media: Representatives must 

contact our Public Affairs Office at (202) 

690–6145. 

Advisory Committees’ Information 

Lines: The phone numbers for the CMS 

Federal Advisory Committee Hotline are 

1–877–449–5659 (toll free) and (410) 

786–9379 (local). 

Web Sites: For additional information 

on the Panel and updates to the Panel’s 

activities, we refer readers to view our 

Web site at the following: http:// 

www.cms.gov/Regulations-andGuidance/Guidance/FACA/ 

mstockstill on DSK4VPTVN1PROD with NOTICES