[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR422.156]



[Page 1007-1008]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 422_MEDICARE ADVANTAGE PROGRAM--Table of Contents

 

                      Subpart D_Quality Improvement

 

Sec. 422.156  Compliance deemed on the basis of accreditation.



    (a) General rule. An MA organization is deemed to meet all of the 

requirements of any of the areas described in paragraph (b) of this 

section if--

    (1) The MA organization is fully accredited (and periodically 

reaccredited) for the standards related to the applicable area under 

paragraph (b) of this section by a private, national accreditation 

organization approved by CMS; and

    (2) The accreditation organization used the standards approved by 

CMS for the purposes of assessing the MA organization's compliance with 

Medicare requirements.

    (b) Deemable requirements. The requirements relating to the 

following areas are deemable:

    (1) Quality improvement.

    (2) Antidiscrimination.

    (3) Access to services.

    (4) Confidentiality and accuracy of enrollee records.

    (5) Information on advance directives.

    (6) Provider participation rules.

    (7) Part D prescription drug benefit programs that are offered by MA 

programs.

    (c) Effective date of deemed status. The date on which the 

organization is deemed to meet the applicable requirements is the later 

of the following:



[[Page 1008]]



    (1) The date on which the accreditation organization is approved by 

CMS.

    (2) The date the MA organization is accredited by the accreditation 

organization.

    (d) Obligations of deemed MA organizations. An MA organization 

deemed to meet Medicare requirements must--

    (1) Submit to surveys by CMS to validate its accreditation 

organization's accreditation process; and

    (2) Authorize its accreditation organization to release to CMS a 

copy of its most recent accreditation survey, together with any survey-

related information that CMS may require (including corrective action 

plans and summaries of unmet CMS requirements).

    (e) Removal of deemed status. CMS removes part or all of an MA 

organization's deemed status for any of the following reasons:

    (1) CMS determines, on the basis of its own investigation, that the 

MA organization does not meet the Medicare requirements for which deemed 

status was granted.

    (2) CMS withdraws its approval of the accreditation organization 

that accredited the MA organization.

    (3) The MA organization fails to meet the requirements of paragraph 

(d) of this section.

    (f) Enforcement authority. CMS retains the authority to initiate 

enforcement action against any MA organization that it determines, on 

the basis of its own survey or the results of an accreditation survey, 

no longer meets the Medicare requirements for which deemed status was 

granted.



[63 FR 35082, June 26, 1998, as amended at 65 FR 40323, June 29, 2000; 

65 FR 59749, Oct. 6, 2000; 70 FR 4724, Jan. 28, 2005]



    Effective Date Note: At 70 FR 52026, Sept. 1, 2005, in Sec. 

422.156, paragraph (b)(7) was suspended, effective September 1, 2005 

through January 1, 2006.