[Federal Register Volume 70, Number 165 (Friday, August 26, 2005)]
[Notices]
[Pages 50373-50374]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-16799]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-4106-PN]


Medicare Program; Changes in Medicare Advantage Deeming Authority

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

ACTION: Proposed notice.

-----------------------------------------------------------------------

SUMMARY: This proposed notice announces that on September 26, 2005, we 
will begin to accept revisions from private accrediting organizations 
(AOs) who seek to modify their deeming authority.

EFFECTIVE DATE: This proposed notice is effective on September 26, 
2005.

FOR FURTHER INFORMATION CONTACT: Shaheen Halim, 410-786-0641.

SUPPLEMENTARY INFORMATION:

I. Background

    Section 4001 of the Balanced Budget Act of 1997 (BBA) (Pub. L. 105-
33), enacted on August 5, 1987, added section 1852(e)(4) to the Social 
Security Act (the Act), which gives us the authority to determine that 
a Medicare Advantage (MA) organization is deemed to be in compliance 
with certain Medicare requirements if the MA organization has been 
accredited (and is periodically reaccredited) by an accrediting 
organization that we have determined applies and enforces requirements 
at least as stringent as those the MA organization would be deemed to 
meet. Section 518 of the Balanced Budget Refinement Act of 1999 (BBRA) 
(Pub. L. 106-113), enacted on November 29, 1999, amended section 
1852(e)(4) of the Act to expand the scope of deeming from two to six 
areas. Accrediting organizations may seek authority for any of the 
categories. The BBRA specified that we cannot require an accrediting 
entity to be able to certify plans for all the deeming categories. It 
also required us to determine, within 210 days from the day the 
application is determined to be complete, the eligibility of the 
accrediting organizations to be granted deeming authority. Conditions 
and procedures for granting deeming authority to accrediting 
organizations are outlined in Sec.  422.157 and Sec.  422.158 of title 
42 of the Code of Federal Regulations.
    Since the start of the Medicare Deeming program, we have approved 
three organizations to be AOs. These consist of the National Committee 
for Quality Assurance, the Joint Commission on the Accreditation of 
Healthcare Organizations, and Accreditation Association for Ambulatory 
Health Care (AAAHC).
    Section 722 of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (MMA) (Pub. L. 108-173) revised section 
1852(e)(4) of the Act. When we published the final rule of the Medicare 
Advantage program on January 28, 2005 (70 FR 4588), we made further 
changes to several sections of the rules that apply to the AOs. These 
changes consisted of the addition of the Chronic Care Improvement 
Program requirements (Sec.  422.152), and the deletion of some 
requirements in the areas of access and quality improvement projects. 
(Sec.  422.112 and Sec.  422.152). Furthermore, it added prescription 
drug program requirements to the deemable areas. These areas include:
     Access to covered drugs, as provided under Sec.  423.120 
and Sec.  423.124.
     Drug utilization management programs, quality assurance 
measures and systems, and Medication Therapy Management Programs as 
provided under Sec.  423.153.
     Privacy, confidentiality, and accuracy of enrollee 
records, as provided under Sec.  423.136.
     A program to protect against fraud, waste and abuse, as 
described in Sec.  423.504(b)(4)(vi)(H).

II. Provisions of the Proposed Notice

    This proposed notice announces that 30 days after publication, we 
will begin to accept applications from national private AOs who seek to 
modify their deeming authority. The application will consist of a 
letter stating how the applicant will modify their

[[Page 50374]]

accreditation program to address the changes to the Medicare Advantage 
rule. At this time, we will not be adding the prescription drug program 
requirements to the deemable areas. Those requirements will be added at 
a later time. The letters should be sent to Shaheen Halim, Centers for 
Medicare & Medicaid Services, Mailstop C4-23-07, 7500 Security Blvd, 
Baltimore, MD 21244.

    Authority: Section 1852(e)(4) of the Social Security Act

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance Program; and No. 93.774, Medicare--
Supplementary Medical Insurance Program (42 U.S.C. 1395w-22(e)(4)).

    Dated: July 6, 2005.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 05-16799 Filed 8-25-05; 8:45 am]
BILLING CODE 4121-01-P