[Federal Register Volume 78, Number 246 (Monday, December 23, 2013)]
[Notices]
[Pages 77470-77471]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-30522]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-9953-FN]


Health Insurance Exchanges; Approval of an Application by the 
Accreditation Association for Ambulatory Health Care (AAAHC) To Be a 
Recognized Accrediting Entity for the Accreditation of Qualified Health 
Plans

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

ACTION: Final notice.

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SUMMARY: This final notice announces our decision to approve the 
Accreditation Association for Ambulatory Health Care (AAAHC) for 
recognition as an accrediting entity for the purposes of fulfilling the 
accreditation requirement as part of qualified health plan (QHP) 
certification.

DATE: This notice is effective on December 23, 2013.

FOR FURTHER INFORMATION CONTACT: Rebecca Zimmermann, (301) 492-4396.

SUPPLEMENTARY INFORMATION: 

I. Background

    Regulations at 45 CFR 156.275(c) require qualified health plan 
(QHP) issuers to be accredited on the basis of local performance of its 
QHPs by an accrediting entity recognized by the Secretary (the 
Secretary) of the Department of Health and Human Services (HHS). In a 
final rule published on July 20, 2012 titled, ``Data Collection To 
Support Standards Related to Essential Health Benefits; Recognition of 
Entities for the Accreditation of Qualified Health Plans (77 FR 
42658),'' we established the first phase of an intended two-phase 
approach to recognize accrediting entities and proposed both the 
National Committee for Quality Assurance (NCQA) and URAC as recognized 
accrediting entities. On November 23, 2012, we notified the public that 
NCQA and URAC had both met the requirements in the July 2012 final rule 
to be recognized as accrediting entities (Sec.  156.275(c)(1)(iv)) and 
were recognized by the Secretary \1\ as accrediting entities for the 
purposes of QHP certification.
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    \1\ Certain authority under the Affordable Care Act has been 
delegated from the Secretary to the Administrator of CMS. 76 FR 
53903 through 53906, (August 30, 2011).
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    On February 25, 2013, we published a subsequent final rule, titled, 
``Standards Related to Essential Health Benefits, Actuarial Value, and 
Accreditation'' (78 FR 12834),\2\ which amended Sec.  156.275(c) to 
establish an application and review process to allow additional 
accrediting entities to seek recognition. The application submitted by 
an accrediting entity must include documentation described in Sec.  
156.275(c)(4) and demonstrate, in a concise and organized fashion, how 
the accrediting entity meets the requirements of Sec.  156.275(c)(2) 
and (3). Specifically, to be recognized, an accrediting entity must 
provide current accreditation standards and requirements, processes, 
and measure specifications for performance measures to demonstrate via 
a crosswalk that it meets the conditions described in Sec.  
156.275(c)(2) and (c)(3). Further, once recognized, Sec.  
156.275(c)(4)(ii) requires accrediting entities to provide the 
Secretary with any proposed changes or updates to the accreditation 
standards and requirements, processes, and measure specifications for 
performance measures with 60 days' notice prior to public notification. 
Lastly, Sec.  156.275(c)(5) requires recognized accrediting entities, 
when authorized by an accredited QHP issuer, to provide specific QHP 
issuer accreditation survey data elements, other than personally 
identifiable information, to the Exchange in which the issuer plans to 
operate one or more QHPs during the annual certification or as changes 
occur in the data elements throughout the coverage year.
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    \2\ Patient Protection and Affordable Care Act; Standards 
Related to Essential Health Benefits, Actuarial Value, and 
Accreditation; Final Rule, 78 FR 12834, 12854-12855 (February 25, 
2013) (45 CFR 156.275(c)).
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II. Provisions of the Proposed Notice

    On September 13, 2013, we published in the Federal Register a 
proposed notice \3\ announcing the receipt of an application from the 
Accreditation Association for Ambulatory Health Care (AAAHC) to be a 
recognized accrediting entity for the purposes of fulfilling the 
accreditation requirement as part of qualified health plan 
certification. In the proposed notice, we provided a detailed analysis 
of whether AAAHC meet the requirements as specified in our regulations 
at Sec.  156.275. In addition, we solicited public comments on whether 
it was appropriate to recognize AAAHC as an accrediting entity for the 
purpose of QHP certification; AAAHC's accreditation standards for QHP 
issuers including whether or not AAAHC's standards meet the 
requirements in Sec.  156.275; whether AAAHC had any deficiencies in 
its standards; the content of the proposed clinical quality measures 
and their appropriateness for use in QHP accreditation; the rigor of 
the scoring methodology; and if the network adequacy standards will 
ensure sufficient network of providers for QHP enrollees.
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    \3\ Health Insurance Exchanges; Application by the Accreditation 
Association for Ambulatory Health Care To Be a Recognized 
Accrediting Entity for the Accreditation of Qualified Health Plans; 
78 FR 56711-56714 (September 13, 2013).
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III. Analysis of and Response to Public Comments on the Proposed Notice

    We received nine public comments in response to the September 13, 
2013 proposed notice. Five commenters supported the recommendation to 
recognize AAAHC as an accrediting entity for the purposes of QHP 
accreditation; whereas two commenters did not support the proposal to 
recognize AAAHC as an accrediting entity. Two commenters provided 
comments that were outside the scope of the proposed notice.
    One commenter questioned the comparability of AAAHC's standards to 
other HHS-recognized accrediting entities. Another commenter requested 
that more child measures be included in the clinical quality metrics. 
Both of these commenters thought that the accreditation standards were 
not sufficiently transparent.

[[Page 77471]]

    While there may be some instances where AAAHC's standards differ 
from other recognized accrediting entities, AAAHC has met the criteria 
to be recognized by HHS based on our standards in Sec.  156.275(c). We 
believe there is a sufficient number of measures applicable to children 
included in the proposed clinical quality metrics and further note that 
the AAAHC's measure set is identical to the set used by a different 
HHS-recognized accrediting entity (that is, URAC). Lastly, the 
accreditation standards are propriety documents and we have not 
required any of the recognized accrediting entities to make their 
standards public. Therefore, we cannot require AAAHC to make their 
standards public.
    In addition, we have previously indicated that we may, at a later 
date, modify the recognition process of accrediting entities and will 
solicit comments on any proposed future rulemaking that time.

IV. Provisions of the Final Notice

    Upon completion of our analysis, including evaluation of comments 
received as a result of the proposed notice, we have determined that 
the AAAHC meets the requirements and criteria described in the July 20, 
2012 final rule, titled ``Data Collection To Support Standards Related 
to Essential Health Benefits; Recognition of Entities for the 
Accreditation of Qualified Health Plans'' (77 FR 42658) to be 
recognized as an accrediting entity. This final notice acknowledges the 
approval of AAAHC's application. The AAAHC is now recognized by the 
Secretary of HHS \4\ as an accrediting entity for the purposes of QHP 
certification.
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    \4\ Delegated to CCIIO, 76 FR 53903 through 53906 (August 30, 
2011).
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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.

    Dated: December 17, 2013.
Marilyn Tavenner,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2013-30522 Filed 12-20-13; 8:45 am]
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