[Federal Register Volume 75, Number 228 (Monday, November 29, 2010)]
[Notices]
[Pages 73086-73088]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-29959]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-4154-PN]
Medicare and Medicaid Programs; Renewal of Deeming Authority of
the National Committee for Quality Assurance for Medicare Advantage
Health Maintenance Organizations and Local Preferred Provider
Organizations
AGENCY: Centers for Medicare & Medicaid Services, HHS.
ACTION: Proposed notice.
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SUMMARY: This proposed notice announces the receipt of an application
to renew the Medicare Advantage Deeming Authority of the National
Committee for Quality Assurance (NCQA) for Health Maintenance
Organizations and Preferred Provider Organizations for a term of 4
years. The new term of approval would begin October 19, 2010, and would
end October 18, 2014. In addition, this proposed notice announces a 30-
day public comment period 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 January 28, 2011.
ADDRESSES: In commenting, please refer to file code CMS-4154-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-4154-PN, P.O. Box 8010,
Baltimore, MD 21244-1850.
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-4154-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 information on viewing public comments, see the beginning of
the SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT: Caroline L. Baker (410) 786-0116.
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 the Centers for Medicare & Medicaid Services (CMS). The
regulations specifying the Medicare requirements that must be met in
order for an 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 of the Act 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 of our regulations.
To assure compliance with certain Medicare requirements, an MA
organization may chose to become accredited by a CMS approved
accrediting organization (AO). By doing so, the MA organization may be
``deemed'' compliant in one or more of 6 requirements set forth in
section 1852(e)(4)(B) of the Act. In order 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. 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 CMS requirements in the
following six MA survey areas: (1) Quality Improvement, (2)
Antidiscrimination, Access to Services, (3) Confidentiality and
Accuracy of Enrollee Records, (4) Information on Advanced Directives,
and Provider Participation Rules. (See 42 CFR 422.156(b).) We note that
at this
[[Page 73087]]
time, deeming does not include the Part D areas of review listed in
Sec. 422.156(b).
Organizations that apply for MA deeming authority are generally
recognized by the health care industry as entities that accredit HMOs
and PPOs. As we specified in Sec. 422.157(b)(2), the term for which an
AO may be approved by CMS may not exceed 6 years. For continuing
approval, the AO must renew their application with CMS.
The National Committee for Quality Assurance (NCQA) was approved as
an accrediting organization for MA deeming of HMOs from January 19,
2002 through January 18, 2008. The NCQA was reapproved as an
accrediting organization for MA deeming of HMOs on January 18, 2008,
for a term of 6 years, which was set to expire on January 17, 2014.
The NCQA was approved for MA deeming of PPOs from October 20, 2004
through October 19, 2010. On July 20, 2010, the NCQA submitted an
application to renew their deeming authority which, at the request of
CMS for administrative simplification purposes, combined their HMO and
PPO deeming authority. On July 20, 2010, the NCQA also submitted all of
the prerequisite materials as specified in Sec. 422.158(a) for
receiving CMS deeming program approval. This information was previously
submitted to CMS by NCQA as a part of their initial HMO and PPO
applications.
II. Approval of Deeming Organizations
Section 1852(e)(4)(C) of the Act provides a statutory timetable to
ensure that our review of deeming applications in 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. Evaluation of Deeming Authority Request
As set forth in Sec. 1852(e)(4) of the Act and our regulations at
Sec. 422.158, the review and evaluation of NCQA'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 NCQA's application for approval of MA deeming
authority included the following components:
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--
++ Frequency of surveys and whether surveys are announced or
unannounced.
++ Copies of survey forms, and guidelines and instructions to
surveyors.
++ Description 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 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.
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 and partial)
and categories (for example, provisional, conditional, and 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.
The NCQA'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. Results of the Review Process
Using the information listed in section III.A. of this proposed
notice, we determined that NCQA's current accreditation program for HMO
and PPO MA plans continues to be at least as stringent as the MA
requirements contained in the six categories specified in section
1852(e)(4)(C) of the Act and our methods of evaluation for those areas.
IV. Response to Public Comments and Notice Upon Completion of
Evaluation
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 notice,
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. 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).
[[Page 73088]]
VI. Regulatory Impact Statement
In accordance with the provisions of Executive Order 12866, this
regulation was not reviewed by the Office of Management and Budget.
(Catalog of Federal Domestic Assistance Program No. 93.778, Medical
Assistance Program).
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: November 18, 2010.
Donald M. Berwick,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2010-29959 Filed 11-26-10; 8:45 am]
BILLING CODE 4120-01-P