Medicare Program; Approval of URAC for Deeming Authority for Medicare Advantage Health Maintenance Organizations and Local Preferred Provider Organizations, 30422-30423 [E6-8135]
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jlentini on PROD1PC65 with NOTICES
30422
Federal Register / Vol. 71, No. 102 / Friday, May 26, 2006 / Notices
two-year demonstration ‘‘to evaluate the
feasibility and advisability of covering
chiropractic services under Medicare’’.
The Demonstration aims to evaluate
both the costs and the benefits of
expanded coverage for chiropractic
services. The evaluation will examine
the achievements as well as the
difficulties inherent in demonstration
implementation. The study includes a
descriptive evaluation of the program, a
survey of a total of 2,000 beneficiaries
using expanded services, analyses of
medical claims to determine service
utilization and expenditures, as well as
the cost impact on the Medicare
program. These data will allow the
researchers to examine use,
effectiveness, and satisfaction of
Medicare beneficiaries with the
chiropractic services they receive in
relation to their demographic and
clinical characteristics. The results will
help CMS to understand the user’s
experience with chiropractic services
and with this Medicare demonstration.;
Form Number: CMS–10187 (OMB#:
0938-New); Frequency: Reporting—
Monthly; Affected Public: Individuals or
Households; Number of Respondents:
2000; Total Annual Responses: 2000;
Total Annual Hours: 667.
5. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Conditions of
Payment of Power Mobility Devices,
including Power Wheelchairs and
Power-Operated Vehicles (CMS–3017–
IFC); Use: CMS–3017–IFC (Conditions
for Payment of Power Mobility Devices,
including Power Wheelchairs and
Power-Operated Vehicles) provides
further guidance with respect to the
prescribing of and payment for Power
Mobility Devices (PMDs). This rule
defines the term power mobility devices
(PMDs) as power wheelchairs and
power operated vehicles (POVs or
scooters). This rule conforms our
regulations to section 302(a)(2)(E)(iv) of
the Medicare Prescription Drug,
Improvement, and Modernization Act of
2003 (MMA). The MMA mandated: (1)
A face-to-face examination of the
individual be conducted by a physician
(as defined in section 1861(r)(1) of the
Social Security Act (the Act)), a
physician assistant, a nurse practitioner
or a clinical nurse specialist (as those
terms are defined in section 1861(aa)(5)
of the Act; and (2) that payment may not
be made for a power wheelchair unless
the physician or treating practitioner
has written a prescription for the item.
With this information collection
request, CMS is seeking approval for the
collection requirements associated with
VerDate Aug<31>2005
16:12 May 25, 2006
Jkt 208001
CMS–3017–IFC (70 FR 50940).; Form
Number: CMS–10116 (OMB#: 0938–
0971); Frequency: Recordkeeping and
Reporting—On occasion; Affected
Public: Business or other for-profit, Notfor-profit institutions, Federal
government, State, Local, or Tribal
governments; Number of Respondents:
17,000; Total Annual Responses:
37,400; Total Annual Hours: 37,400.
To obtain copies of the supporting
statement and any related forms for the
proposed paperwork collections
referenced above, access CMS Web site
address at https://www.cms.hhs.gov/
PaperworkReductionActof1995, or Email your request, including your
address, phone number, OMB number,
and CMS document identifier, to
Paperwork@cms.hhs.gov, or call the
Reports Clearance Office on (410) 786–
1326.
Written comments and
recommendations for the proposed
information collections must be mailed
or faxed within 30 days of this notice
directly to the OMB desk officer: OMB
Human Resources and Housing Branch,
Attention: Carolyn Lovett, New
Executive Office Building, Room 10235,
Washington, DC 20503. Fax Number:
(202) 395–6974.
Dated: May 15, 2006.
Michelle Shortt,
Director, Regulations Development Group,
Office of Strategic Operations and Regulatory
Affairs.
[FR Doc. E6–7944 Filed 5–25–06; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–4117–FN]
Medicare Program; Approval of URAC
for Deeming Authority for Medicare
Advantage Health Maintenance
Organizations and Local Preferred
Provider Organizations
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Final notice.
AGENCY:
SUMMARY: This final notice announces
the approval of URAC for deeming
authority as a national accreditation
organization for health maintenance
organizations and local preferred
provider organizations participating in
the Medicare Advantage program, for a
term of 6 years upon publication of this
notice in the Federal Register. This
notice describes the processes and
criteria used in evaluating the
PO 00000
Frm 00058
Fmt 4703
Sfmt 4703
application. We did not receive any
public comments during the public
comment period, which ended on April
28, 2006.
FOR FURTHER INFORMATION CONTACT:
Shaheen Halim, Ph.D., (410) 786–0641.
I. Background
Under the Medicare program, eligible
beneficiaries may receive covered
services through a managed care
organization (MCO) that has a Medicare
Advantage (MA) (formerly,
Medicare+Choice) 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 MA 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
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 pertaining to the provision of
services by Medicare-certified providers
and suppliers.
Generally, for an organization to enter
into an MA contract, the organization
must be licensed by the State as a riskbearing organization as set forth in part
422 of our regulations. Additionally, the
organization must file an application
demonstrating that it meets other
Medicare requirements in part 422 of
our regulations. Following approval of
the contract, we engage in routine
monitoring and oversight audits of the
MA organization to ensure continuing
compliance. The monitoring and
oversight audit process is
comprehensive and uses a written
protocol that itemizes the Medicare
requirements the MA organization must
meet.
As an alternative for meeting some
Medicare requirements, an MA
organization may be exempt from our
monitoring of certain requirements in
subsets listed in section 1852(e)(4)(B) of
the Act as a result of an MA
organization’s accreditation by a CMSapproved 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.
An organization that applies for MA
deeming authority is generally
recognized by the industry as an entity
that accredits MCOs that are licensed as
a health maintenance organization
(HMO) or a preferred provider
organization (PPO). As we specify at
E:\FR\FM\26MYN1.SGM
26MYN1
Federal Register / Vol. 71, No. 102 / Friday, May 26, 2006 / Notices
§ 422.157(b)(2) of our regulations, the
term for which an AO may be approved
by us may not exceed 6 years. For
continuing approval, the AO must reapply to us.
II. Deeming Application Approval
Process
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 1865(b)(2) 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 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.
Section 1865(b)(3)(A) of the Act
further requires that we publish a notice
identifying receipt of an organization’s
application identifying the national
accreditation body making the request,
and providing at least a 30-day public
comment period. We must publish a
finding of approval or denial of the
application within 210 days from the
receipt of the completed application.
jlentini on PROD1PC65 with NOTICES
III. Provisions of the Proposed Notice
On March 24, 2006, we published a
proposed notice in the Federal Register
(71 FR 14922) announcing URAC’s
October 12, 2005 application for
deeming authority for MA HMOs and
local PPOs in the following six areas:
• Quality improvement.
• Antidiscrimination.
• Access to services.
• Confidentiality and accuracy of
enrollee records.
• Information on advance directives.
• Provider participation rules.
In the proposed notice, we described
our evaluation criteria. Under
§ 422.158(a), this includes but is not
limited to, the following:
• The equivalency of URAC’s
requirements for HMOs and PPOs to our
comparable MA organization
requirements.
• URAC’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—
VerDate Aug<31>2005
16:12 May 25, 2006
Jkt 208001
+ 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 and MA
organizations currently accredited
within those types and categories.
In accordance with § 422.158(b) of our
regulations, 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 § 422.157(c) of our
regulations. We also must have an
opportunity to observe the applicant
using the accreditation processes under
which it intends to deem compliance.
Those observational site visits allow us
to verify that the information presented
in the application is correct and to make
a determination on the application.
In accordance with section
1865(b)(3)(A) of the Act, the proposed
notice solicited public comment on the
ability of URAC’s accreditation program
to meet or exceed the Medicare
requirements for which it seeks
authority to deem. We did not receive
any public comments in response to the
proposed notice.
IV. Evaluation of Application for
Deeming Authority
Following the receipt of URAC’s
application for deeming authority on
October 12, 2005, for MA organizations
that are licensed as either HMOs or
PPOs, we began our review and
evaluation under § 422.158(a) of the
regulations. Our review and evaluation
included, but was not limited to, the
information and criteria provided in
sections II and III of this final notice.
Additionally, we observed on-site
application of URAC’s accreditation
processes twice at two separate
managed care organizations. Following
these two observational opportunities,
PO 00000
Frm 00059
Fmt 4703
Sfmt 4703
30423
we determined that URAC’s criteria and
methods of evaluating MA plans meet or
exceed ours. We grant approval of
URAC’s application for deeming
authority for MA HMOs and local PPOs
for a term of 6 years beginning upon
publication of this final notice.
V. Executive Order 12866 Statement
In accordance with the provisions of
Executive Order 12866, this regulation
was not reviewed by the Office of
Management and Budget.
Authority: Sections 1852 and 1865 of the
Social Security Act (42 U.S.C. 1395w–22 and
1395bb).
(Catalog of Federal Domestic Assistance
Program No. 93.773, Medicare—Hospital
Insurance; and Program No. 93.774,
Medicare—Supplementary Medical
Insurance Program)
Dated: May 17, 2006.
Mark B. McClellan,
Administrator, Centers for Medicare &
Medicare Services.
[FR Doc. E6–8135 Filed 5–25–06; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–1324–N]
Medicare Program; Public Meeting in
Calendar Year 2006 for New Clinical
Laboratory Tests for Payment
Determinations
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice.
AGENCY:
SUMMARY: This notice announces a
public meeting to discuss payment
determinations for specific new
Physicians’ Current Procedural
Terminology (CPT) codes for clinical
laboratory tests. The meeting provides a
forum for interested parties to make oral
presentations and submit written
comments on the new codes that will be
included in Medicare’s Clinical
Laboratory Fee Schedule for calendar
year 2007, which will be effective on
January 1, 2007. Discussion is directed
toward technical issues relating to
payment determinations for a specified
list of new clinical laboratory codes.
The development of the codes for
clinical laboratory tests is performed by
the CPT Editorial Panel and will not be
discussed at the public meeting.
DATES: The public meeting announced
in this notice is scheduled for Monday,
July 17, 2006 from 10 a.m. to 3 p.m.
E:\FR\FM\26MYN1.SGM
26MYN1
]]>Agencies
[Federal Register Volume 71, Number 102 (Friday, May 26, 2006)]
[Notices]
[Pages 30422-30423]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E6-8135]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-4117-FN]
Medicare Program; Approval of URAC for Deeming Authority for
Medicare Advantage Health Maintenance Organizations and Local Preferred
Provider Organizations
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Final notice.
-----------------------------------------------------------------------
SUMMARY: This final notice announces the approval of URAC for deeming
authority as a national accreditation organization for health
maintenance organizations and local preferred provider organizations
participating in the Medicare Advantage program, for a term of 6 years
upon publication of this notice in the Federal Register. This notice
describes the processes and criteria used in evaluating the
application. We did not receive any public comments during the public
comment period, which ended on April 28, 2006.
FOR FURTHER INFORMATION CONTACT: Shaheen Halim, Ph.D., (410) 786-0641.
I. Background
Under the Medicare program, eligible beneficiaries may receive
covered services through a managed care organization (MCO) that has a
Medicare Advantage (MA) (formerly, Medicare+Choice) 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 MA 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 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 pertaining to the provision of
services by Medicare-certified providers and suppliers.
Generally, for an organization to enter into an MA contract, the
organization must be licensed by the State as a risk-bearing
organization as set forth in part 422 of our regulations. Additionally,
the organization must file an application demonstrating that it meets
other Medicare requirements in part 422 of our regulations. Following
approval of the contract, we engage in routine monitoring and oversight
audits of the MA organization to ensure continuing compliance. The
monitoring and oversight audit process is comprehensive and uses a
written protocol that itemizes the Medicare requirements the MA
organization must meet.
As an alternative for meeting some Medicare requirements, an MA
organization may be exempt from our monitoring of certain requirements
in subsets listed in section 1852(e)(4)(B) of the Act as a result of an
MA 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.
An organization that applies for MA deeming authority is generally
recognized by the industry as an entity that accredits MCOs that are
licensed as a health maintenance organization (HMO) or a preferred
provider organization (PPO). As we specify at
[[Page 30423]]
Sec. 422.157(b)(2) of our regulations, the term for which an AO may be
approved by us may not exceed 6 years. For continuing approval, the AO
must re-apply to us.
II. Deeming Application Approval Process
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 1865(b)(2) 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
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.
Section 1865(b)(3)(A) of the Act further requires that we publish a
notice identifying receipt of an organization's application identifying
the national accreditation body making the request, and providing at
least a 30-day public comment period. We must publish a finding of
approval or denial of the application within 210 days from the receipt
of the completed application.
III. Provisions of the Proposed Notice
On March 24, 2006, we published a proposed notice in the Federal
Register (71 FR 14922) announcing URAC's October 12, 2005 application
for deeming authority for MA HMOs and local PPOs in the following six
areas:
Quality improvement.
Antidiscrimination.
Access to services.
Confidentiality and accuracy of enrollee records.
Information on advance directives.
Provider participation rules.
In the proposed notice, we described our evaluation criteria. Under
Sec. 422.158(a), this includes but is not limited to, the following:
The equivalency of URAC's requirements for HMOs and PPOs
to our comparable MA organization requirements.
URAC'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 and MA
organizations currently accredited within those types and categories.
In accordance with Sec. 422.158(b) of our regulations, 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) of our regulations. We also
must have an opportunity to observe the applicant using the
accreditation processes under which it intends to deem compliance.
Those observational site visits allow us to verify that the information
presented in the application is correct and to make a determination on
the application.
In accordance with section 1865(b)(3)(A) of the Act, the proposed
notice solicited public comment on the ability of URAC's accreditation
program to meet or exceed the Medicare requirements for which it seeks
authority to deem. We did not receive any public comments in response
to the proposed notice.
IV. Evaluation of Application for Deeming Authority
Following the receipt of URAC's application for deeming authority
on October 12, 2005, for MA organizations that are licensed as either
HMOs or PPOs, we began our review and evaluation under Sec. 422.158(a)
of the regulations. Our review and evaluation included, but was not
limited to, the information and criteria provided in sections II and
III of this final notice. Additionally, we observed on-site application
of URAC's accreditation processes twice at two separate managed care
organizations. Following these two observational opportunities, we
determined that URAC's criteria and methods of evaluating MA plans meet
or exceed ours. We grant approval of URAC's application for deeming
authority for MA HMOs and local PPOs for a term of 6 years beginning
upon publication of this final notice.
V. Executive Order 12866 Statement
In accordance with the provisions of Executive Order 12866, this
regulation was not reviewed by the Office of Management and Budget.
Authority: Sections 1852 and 1865 of the Social Security Act (42
U.S.C. 1395w-22 and 1395bb).
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: May 17, 2006.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicare Services.
[FR Doc. E6-8135 Filed 5-25-06; 8:45 am]
BILLING CODE 4120-01-P
