[Federal Register Volume 66, Number 148 (Wednesday, August 1, 2001)]
[Notices]
[Pages 39773-39774]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-19189]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-4023-PN]
ZRIN 0938--ZA16


Medicare Program; Medicare+Choice Organizations--Application by 
the Accreditation Association for Ambulatory Health Care, Inc. (AAAHC) 
for Approval of Deeming Authority for Medicare+Choice Organizations 
That Are Licensed as a Health Maintenance Organization (HMO) or a 
Preferred Provider Organization (PPO)

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Proposed notice.

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SUMMARY: This proposed notice announces the receipt of an application 
from the Accreditation Association for Ambulatory Health Care, Inc. 
(AAAHC) for recognition as a national accreditation program for health 
maintenance organizations (HMOs) and Preferred Provider Organizations 
(PPOs) that wish to participate in the Medicare+Choice program. 
Regulations set forth at 42 CFR 422.157(b)(1) specify that a Federal 
Register notice will announce our receipt of the accreditation 
organization's application for approval, describe the criteria we will 
use in evaluating the application, and provide at least a 30-day public 
comment period.

DATES: We will consider comments if we receive them at the appropriate 
address, as provided below, no later than 5 p.m. on August 31, 2001.

ADDRESSES: In commenting, please refer to file code CMS-4023-PN. 
Because of staff and resource limitations, we cannot accept comments by 
facsimile (FAX) transmission. Mail written comments (one original and 
three copies) to the following address ONLY:
    Centers for Medicare & Medicaid Services, Department of Health and 
Human Services, Attention: CMS-4023-PN, P.O. Box 8013,Baltimore, MD 
21244-8013.
    Please allow sufficient time for mailed comments to be timely 
received in the event of delivery delays.
    If you prefer, you may deliver (by hand or courier) your written 
comments (one original and three copies) to one of the following 
addresses:
    Room 443-G, Hubert H. Humphrey Building, 200 Independence Avenue, 
SW., Washington, DC 20201, or Room C5-16-03, 7500 Security Boulevard, 
Baltimore, MD 21244-1850.
    Comments mailed to the addresses indicated as appropriate for hand 
or courier delivery may be delayed and could be considered late.
    For information on viewing public comments, see the beginning of 
the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT: Patricia Kurtz, (410) 786-4670.

SUPPLEMENTARY INFORMATION:
    Inspection of Public Comments: Comments received timely will 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 (410) 786-7197.
    Copies: To order copies of the Federal Register containing this 
document, send your request to: New Orders, Superintendent of 
Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. Specify the date 
of the issue requested and enclose a check or money order payable to 
the Superintendent of Documents, or enclose your Visa or Master Card 
number and expiration date. Credit card orders can also be placed by 
calling the order desk at (202) 512-1800 or by faxing to (202) 512-
2250. The cost for each copy is $9. As an alternative, you can view and 
photocopy the Federal Register document at most libraries designated as 
Federal Depository Libraries and at many other public and academic 
libraries throughout the country that receive the Federal Register.
    This Federal Register document is also available from the Federal 
Register online database through GPO Access, a service of the U.S. 
Government Printing Office. The Website address is: http://www.access.gpo.gov/nara/index.html.

I. Background

    Under the Medicare program, eligible beneficiaries may receive 
covered services through a managed care organization (MCO) that has a 
Medicare+Choice (M+C) contract with the Centers for Medicare & Medicaid 
Services (CMS). The regulations specifying the Medicare requirements 
that must be met in order for an MCO to enter into an M+C 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 MCO must provide and the requirements that the 
organization must

[[Page 39774]]

meet to be an M+C 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 organization to enter into an M+C contract, the 
organization must be licensed by the State as a risk bearing 
organization as set forth in part 422. Additionally, the organization 
must file an application demonstrating that other Medicare requirements 
in part 422 are met. Following approval of the contract, CMS engages in 
routine monitoring of the M+C organization to ensure continuing 
compliance. The monitoring process is comprehensive and uses a written 
protocol that itemizes the Medicare requirements the M+C organization 
must meet.
    As an alternative for meeting some Medicare requirements, an M+C 
organization may be exempt from CMS monitoring of certain requirements 
in subsets listed in section 1852(e)(4)(C) of the Act as a result of an 
M+C organization's accreditation by a CMS-approved accrediting 
organization (AO). In essence, the Secretary ``deems'' that the 
Medicare requirements are met based on a determination that the AO's 
standards are at least as stringent as Medicare requirements. The term 
for which an AO may be approved by CMS may not exceed 6 years as stated 
in Sec. 422.157(b)(2). For continuing approval, the AO will have to re-
apply to CMS.
    The applicant organization is generally recognized as an entity 
that accredits MCOs that are licensed as an HMO or a PPO.

II. Approval of Deeming Organizations

    Section 1852(e)(4)(C) of the Act requires that within 210 days of 
receipt of an application, the Secretary shall determine whether the 
applicant meets criteria specified in section 1852(e)(4) of the Act. 
Under these criteria, the Secretary will consider for a national 
accreditation body, its requirements for accreditation, its survey 
procedures, its ability to provide adequate resources for conducting 
required surveys and supplying information for use in enforcement 
activities, its monitoring procedures for provider entities found out 
of compliance with the conditions or requirements, and its ability to 
provide the Secretary with necessary data for validation.
    The purpose of this proposed notice is to inform the public of our 
consideration of AAAHC's application for approval of deeming authority 
of M+C organizations that are licensed as HMOs or PPOs for the 
following six categories:
     Quality assurance.
     Access to services.
     Antidiscrimination.
     Information on advance directives.
     Provider participation rules.
     Confidentiality and accuracy of enrollees' records.
    This notice also solicits public comment on the ability of the 
applicant's accreditation program to meet or exceed the Medicare 
requirements for which it seeks authority to deem.

III. Evaluation of Deeming Request

    On June 20, 2001, AAAHC submitted all the necessary information to 
permit us to make a determination concerning its request for approval 
as a deeming authority for M+C organizations that are licensed as an 
HMO or a PPO. Under Sec. 422.158(a), our review and evaluation of a 
national accreditation organization will consider, but not necessarily 
be limited to, the following information and criteria:
     The equivalency of AAAHC's requirements for HMOs and PPOs 
to CMS's comparable M+C organization requirements.
     AAAHC's survey process, to determine the following:
     The frequency of surveys.
     The types of forms, guidelines and instructions used by 
surveyors.
     Descriptions of the accreditation decision making process, 
deficiency notification and monitoring process, and compliance 
enforcement process.
     Detailed information about individuals who perform 
accreditation surveys including--
     Size and composition of the survey team;
     Education and experience requirements for the surveyors;
     In-service training required for surveyor personnel;
     Surveyor performance evaluation systems; and
     Conflict of interest policies relating to individuals in 
the survey and accreditation decision process.
     Descriptions of the organization's--
     Data management and analysis system;
     Policies and procedures for investigating and responding 
to complaints against accredited organizations;
     Types and categories of accreditation offered andM+C 
organizations currently accredited within those types and categories.
    In accordance with Sec. 422.158(b), the applicant must provide 
documentation relating to--
     Its ability to provide data in a CMS-compatible format;
     The adequacy of personnel and other resources necessary to 
perform the required surveys and other activities; and
     Assurances that it will comply with ongoing responsibility 
requirements specified in Sec. 422.157(c).
    Additionally, the accrediting organization must provide CMS the 
opportunity to observe its accreditation process for managed care 
organizations and must provide other information required by CMS to 
prepare for an onsite visit to the AO's offices to verify 
representations made in the application and to make a determination on 
the application.

IV. Response to Comments and Notice Upon Completion of Evaluation

    Because of the large number of items of correspondence we normally 
receive on Federal Register documents published for comment, 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, if we proceed with a subsequent 
document, we will respond to the major 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 notice in the 
Federal Register announcing the result of our evaluation.
    In accordance with the provisions of E.O. 12866, this proposed 
notice was not reviewed by the Office of Management and Budget.
    Section 1853(a)(1)(B) of the Social Security Act (42 U.S.C. 1395w-
23(a)(1)(B)).

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare-Hospital Insurance; and Program No. 93.774, Medicare-
Supplementary Medical Insurance Program)

    Dated: July 26, 2001.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services
[FR Doc. 01-19189 Filed 7-31-01; 8:45 am]
BILLING CODE 4120-01-P