[Federal Register Volume 76, Number 58 (Friday, March 25, 2011)]
[Notices]
[Pages 16793-16795]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-6222]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare and Medicaid Services
[CMS-4154-FN]
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 and Medicaid Services (CMS), HHS.
ACTION: Final notice.
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SUMMARY: This final notice announces the decision to renew the Medicare
Advantage Deeming Authority of the National Committee for Quality
Assurance (NCQA) for Health
[[Page 16794]]
Maintenance Organizations and Preferred Provider Organizations for a
term of 4 years. The new term of approval began October 19, 2010, and
ends October 18, 2014.
DATES: Effective Date: This notice is effective on April 25, 2011.
FOR FURTHER INFORMATION CONTACT: Caroline L. Baker, (410) 786-0116.
SUPPLEMENTARY INFORMATION:
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)
provided certain requirements are met under 42 CFR part 422. Part C of
Title XVIII of the Social Security Act (the Act), specifies the
services that an MA organization 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.
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 the
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 6 MA survey areas: (1) Quality Improvement; (2)
Antidiscrimination; (3) Access to Services; (4) Confidentiality and
Accuracy of Enrollee Records; (5) Information on Advanced Directives;
and (6) Provider Participation Rules. (See 42 CFR 422.156(b).) We note
that at this 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.
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. Provisions of the Proposed Notice and Response to Comments
On November 29, 2010, we published a proposed notice (75 FR 73087)
in the Federal Register announcing re-approval of Medicare Advantage
Deeming Authority of the National Committee for Quality Assurance
(NCQA). In the proposed notice, we detailed our evaluation criteria. As
set forth in section 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.
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.
++ 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).
No comments were received in response to the proposed notice
published November 29, 2010.
[[Page 16795]]
Therefore, based on the review and observations described in section
III of this final notice, we have determined that NCQA's requirements
for HMOs and local PPOs continue to meet or exceed our requirements. We
renew the MA deeming authority of the NCQA for HMOS and PPOs for a term
of 4 years. The new term of approval began October 19, 2010, and ends
October 18, 2014.
IV. Results of the Review Process
Using the information listed in section III of this final 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 6 categories specified in section 1852(e)(4)(C) of the
Act and our methods of evaluation for those areas.
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. Chapter 35).
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. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: March 9, 2011.
Donald M. Berwick,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2011-6222 Filed 3-24-11; 8:45 am]
BILLING CODE 4120-01-P