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, 56711-56714 [2013-22369]
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Federal Register / Vol. 78, No. 178 / Friday, September 13, 2013 / Notices
We, along with the healthcare industry,
believe that the availability to the
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medical practice and is necessary in
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Dated: September 10, 2013.
Martique Jones,
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Regulatory Affairs.
[FR Doc. 2013–22329 Filed 9–12–13; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–9953–PN]
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
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice.
AGENCY:
This notice announces 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 (QHP) certification. Regulations
require HHS to publish a notice
identifying the accrediting entity,
summarizing its analysis of whether the
accrediting entity meets certain criteria,
and providing no less than a 30-day
public comment period.
DATES: To be assured consideration,
comments must be received at one of
the addresses provided below, no later
than 5 p.m. on October 15, 2013.
ADDRESSES: In commenting, please refer
to file code CMS–9953–PN. Because of
staff and resource limitations, we cannot
accept comments by facsimile (FAX)
transmission.
tkelley on DSK3SPTVN1PROD with NOTICES
SUMMARY:
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You may submit comments in one of
four ways (please choose only one of the
ways listed):
1. Electronically. You may submit
electronic comments on this regulation
to https://www.regulations.gov. Follow
the ‘‘Submit a comment’’ instructions.
2. By regular mail. You may mail
written comments to the following
address ONLY: Centers for Medicare &
Medicaid Services, Department of
Health and Human Services, Attention:
CMS–9953–PN, P.O. Box 8010,
Baltimore, MD 21244–8010.
Please allow sufficient time for mailed
comments to be received before the
close of the comment period.
3. By express or overnight mail. You
may send written comments to the
following address ONLY: Centers for
Medicare & Medicaid Services,
Department of Health and Human
Services, Attention: CMS–9953–PN,
Mail Stop C4–26–05, 7500 Security
Boulevard, Baltimore, MD 21244–1850.
4. By hand or courier. If you prefer,
you may deliver (by hand or courier)
your written comments before the close
of the comment period to either of the
following addresses:
a. For delivery in Washington, DC—
Centers for Medicare & Medicaid
Services, Department of Health and
Human Services, Room 445–G, Hubert
H. Humphrey Building, 200
Independence Avenue SW.,
Washington, DC 20201
(Because access to the interior of the
Hubert H. Humphrey Building is not
readily available to persons without
Federal government identification,
commenters are encouraged to leave
their comments in the CMS drop slots
located in the main lobby of the
building. A stamp-in clock is available
for persons wishing to retain a proof of
filing by stamping in and retaining an
extra copy of the comments being filed.)
b. For delivery in Baltimore, MD—
Centers for Medicare & Medicaid
Services, Department of Health and
Human Services, 7500 Security
Boulevard, Baltimore, MD 21244–1850.
If you intend to deliver your
comments to the Baltimore address,
please call telephone number (410) 786–
9994 in advance to schedule your
arrival with one of our staff members.
Comments mailed to the addresses
indicated as appropriate for hand or
courier delivery may be delayed and
received after the comment period.
FOR FURTHER INFORMATION CONTACT:
Rebecca Zimmermann, at (301) 492–
4396.
SUPPLEMENTARY INFORMATION:
Inspection of Public Comments: All
comments received before the close of
PO 00000
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56711
the comment period are available for
viewing by the public, including any
personally identifiable or confidential
business information that is included in
a comment. We post all comments
received before the close of the
comment period on the following Web
site as soon as possible after they have
been received: https://
www.regulations.gov. Follow the search
instructions on that Web site to view
public comments.
Comments received timely will also
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 1–800–743–3951.
I. Background
Regulations at 45 CFR 156.275 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
Department of Health and Human
Services (HHS). In a final rule published
on July 20, 2012,1 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 final rule to be
recognized as an accrediting entity (77
FR 42662 through 42668) and were
recognized by the Secretary 2 as
accrediting entities for the purposes of
QHP certification.
On February 25, 2013, we published
a subsequent final rule title, ‘‘Standards
Related to Essential Health Benefits,
Actuarial Value, and Accreditation (78
FR 1283),’’ 3 which amended
§ 156.275(c) to establish an application
and review process to allow additional
1 Patient Protection and Affordable Care Act; Data
Collection To Support Standards Related to
Essential Health Benefits; Recognition of Entities for
the Accreditation of Qualified Health Plans Final
Rule 77 FR 42658, 42662–42668 (July 20, 2012) (45
CFR 156.275(c)).
2 Certain authority under the Affordable Care Act
has been delegated from the Secretary to the
Administrator of CMS., 76 FR 53903 through 53906,
(Aug. 30, 2011).
3 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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Federal Register / Vol. 78, No. 178 / Friday, September 13, 2013 / Notices
accrediting entities to seek recognition.
The application submitted by an
accrediting entity must include
documentation described in
§ 156.275(c)(4) and demonstrate, in a
concise and organized fashion how the
accrediting entity meets the
requirements of § 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
§ 156.275 (c)(2) and (c)(3). Further, once
recognized, § 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,
§ 156.275(c)(5) requires recognized
accrediting entities, when authorized by
an accredited QHP issuer, to provide
specific QHP issuer accreditation survey
data elements to the Exchange.
II. Provisions of the Notice
The purpose of this notice is to notify
the public of the Accreditation
Association for Ambulatory Health
Care’s (AAAHC) request for recognition
by the Secretary as an accrediting entity
for the purposes of QHP certification. As
part of the application, AAAHC
submitted all the required
documentation materials described in
§ 156.275(c)(4). Below we present, our
analysis of whether AAAHC meets the
criteria described in paragraphs
§ 156.275 (c)(2) and (3).
1. Summary of CMS’s Analysis
We are providing the public with an
analysis of AAAHC’s completed
application, including a review of the
current accreditation standards and
requirements, processes and measure
specifications for performance
measures, submitted by AAAHC.
Currently, AAAHC is an accrediting
body that has a CMS-approved
accreditation program to conduct
surveys for ambulatory surgery centers
that wish to participate in the Medicare
program with deemed status. The
AAAHC has also obtained approval
from CMS as a deeming entity allowing
it to survey Medicare Advantage plans.4
The current scope of accreditation as
described in AAAHC’s 2013
Accreditation Handbook for Health
Plans demonstrates that AAAHC will be
providing accreditation of QHPs within
the statutorily required categories,5
established in § 156.275(c), including
reporting on a set of clinical quality
measures and patient experience ratings
on a standardized Consumer
Assessment of Healthcare Providers and
Systems (CAHPS®) survey; consumer
access; utilization management; quality
assurance; provider credentialing;
NQF reference
No.
Measure
complaints and appeals; network
adequacy and access; and patient
information programs.
In addition, CMS evaluated AAAHC’s
standards relating to network adequacy
and consider them to be consistent with
the general requirements for network
adequacy for QHP issuers (45 CFR
156.230(a)(2) and (3)). To determine
health plans’ compliance with network
adequacy standards, the AAAHC
accreditation survey includes review of
areas such as member choice of
providers, member satisfaction with
relation to provider access, availability
of services, provider network
credentialing and customer complaints,
appeals, and satisfaction information.
Upon review of the clinical quality
measures included in AAAHC’s
accreditation standards, we have
assessed that the measures cover a range
of conditions and domains, include
adult and child-specific measures, align
with the priorities in the National
Strategy for Quality Improvement in
Health Care, are developed or adopted
by the National Quality Forum (NQF) or
are in common use for health plan
quality measurement, and meet health
plan industry standards and are
evidence-based, as required in
§ 156.275(c)(2)(ii). The following list
displays the clinical quality measures
that will be used for QHP accreditation
by AAAHC, spanning preventive care,
behavioral health and substance abuse
disorders, chronic care, and acute care:
Measure develop/steward
Mandatory Measures
Proportion of Days Covered (Drug Therapy ..............................
Adherence) .................................................................................
Provider Network Adequacy—Number of Specialists Accepting
New Patients At End of Reporting Period by Specialist Type.
Dyslipidemia New Medication 12-Week Testing ........................
Drug-Drug Interactions ...............................................................
Diabetes Short Term Complications Event ................................
Rate ............................................................................................
Diabetes Long Term Complications Admission Rate ................
Adult Asthma Event Rate ...........................................................
Pediatric Asthma Event Rate .....................................................
0541
n/a
n/a
n/a
0272
0274
0283
n/a
Pharmacy Quality Alliance (PQA).
Centers for Medicare and Medicaid Services (CMS).
Resolution Health, Inc.
PQA.
Adapted by URAC from Agency for Healthcare Quality and
Research (AHRQ) measure.
Adapted by URAC from AHRQ measure.
Adapted by URAC from AHRQ measure.
Adapted by URAC from AHRQ measure.
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Mandatory/Equivalent Measures
Atherosclerotic Disease—Lipid Panel Monitoring ......................
Diabetes All-Or-None Process Measure (HbA1c, LDL–C,
Nephropathy).
Provider Network Adequacy—Primary Care ..............................
Medication Therapy For Patients With Asthma: Suboptimal
Asthma Control (SAC), and Absence of Controller Therapy
(ACT).
Call Center Performance ............................................................
Percentage of Live Births Weighing Less than 2,500 Grams ....
4 42
CFR 422.157.
VerDate Mar<15>2010
18:23 Sep 12, 2013
0616
n/a
Active Health Management.
Wisconsin Collaborative for Healthcare Quality.
n/a
0548
CMS.
PQA.
n/a
0278
URAC.
AHRQ.
5 Interested persons may contact AAAHC to
request a copy of the handbook.
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Federal Register / Vol. 78, No. 178 / Friday, September 13, 2013 / Notices
NQF reference
No.
Measure
Annual Percentage of Asthma Patients 2 through 20 Years
Old with One or More Asthma-related Emergency Room
Visits.
Percentage of Female Patients Who Had a Mammogram Performed During the Two-Year Measurement Period.
High Risk for Pneumococcal Disease—Pneumococcal Vaccination.
Preventive Services: Percentage of Enrolled Members Ages
Less than or Equal to 18 years Who have had Preventive
Services, Recommended Risk Factor Reductions and Behavioral
Health
Change
Interventions,
Appropriate
Screenings and Immunizations.
Colorectal Cancer Screening .....................................................
Tobacco Use: Screening and Cessation ....................................
Prevention and Management of Obesity in Mature Adolescents
and Adults.
30 Day Post-Hospital AMI Discharge Care Transition Composite Measure.
Congestive Heart Failure (CHF) Rate ........................................
Atrial Fibrillation—Warfarin Therapy ..........................................
MRI Lumbar Spine for Low Back Pain .......................................
All Cause Readmission Index ....................................................
Central Venous Catheter-related Bloodstream Infections (arealevel): Rate per 100,000 Population.
Depression Readmission ............................................................
Follow-up After Hospitalization for a Mental Illness ...................
1381
n/a
0617
n/a
56713
Measure develop/steward
Alabama Medicaid.
American Medical Association/Physician Consortium Performance Improvement (AMA/PCPI).
ActiveHealth Management.
American Academy of Pediatrics/URAC.
n/a
0028
n/a
Veterans Health Administration (VHA).
AMA/PCPI/URAC.
Institute for Clinical Systems Improvement(ICSI)/URAC.
0698
Centers for Medicare and Medicaid Services (CMS)/URAC.
0358
0264
0514
0505
n/a
AHRQ/URAC.
ActiveHealth Management.
CMS.
United Health Group/URAC.
AHRQ.
n/a
n/a
Minnesota Community Measurement/URAC.
Florida Agency for Health Care Administration.
CAHPS®
CAHPS® Adult Health Plan Survey 5.0 .....................................
CAHPS® Child Survey v4.0 Medicaid and Commercial Core
Survey.
CAHPS® Survey for Children With Chronic Conditions .............
0006
n/a
AHRQ.
AHRQ.
0009
AHRQ.
Exploratory Measures
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Case Management: Consumer Contact .....................................
Complaint Response Timeliness ................................................
Outpatient Newborn Visit Within One Month of Birth ................
Diabetes: All or None Process Measure: Optimal Results for
HbA1c, LDL–C, and Blood Pressure.
Percentage of Eligible Members that Receive Preventive Dental Services.
Health Risk Assessment Completion Rate ................................
Use of High Risk Medications in the Elderly ..............................
The AAAHC documented in its
application how its measures and
standards comply with the requirements
contained in § 156.275. The application
also clarifies how AAAHC accreditation
complies with § 156.275(c)(2) and (c)(3).
Specifically, AAAHC will provide
accreditation at the required Exchange
product type level, assuming that
adequate member numbers and data are
available, as required by 45 CFR
156.275(c)(2)(iii).
CMS evaluated AAAHC’s application
information regarding accreditation
survey methodology and processes for
scoring and consider the standards to be
methodologically rigorous and
transparent as required in
§ 156.275(c)(3). The AAAHC described
its health plan scoring methodology for
2013 and documented that the
collection and reporting of a required
set of clinical quality measures and
VerDate Mar<15>2010
18:23 Sep 12, 2013
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n/a
n/a
n/a
n/a
URAC.
URAC.
Centene.
Wisconsin Collaborative for Healthcare Quality.
n/a
CMS/URAC.
n/a
n/a
URAC.
PQA.
CAHPS® data will be factored into the
overall accreditation score. The majority
of AAAHC accreditation standards are
rated on a five-point scale of Fully
Compliant to Non-Compliant and a
critical set of standards must be fully
met for successful health plan
accreditation, including the reporting of
clinical quality measures.
2. Public Comment
This notice solicits public comments
on the analysis above and the
conclusion that it is appropriate to
recognize AAAHC as an accrediting
entity for the purpose of QHP
certification. We seek specific
comments on AAAHC’s accreditation
standards for QHP issuers including:
whether the public believes AAAHC’s
standards meet the requirements in
§ 156.275; whether there are any
deficiencies in its standards that should
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be reviewed; 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.
III. 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.
IV. Response to Comments
Because of the large number of public
comments we normally receive on
Federal Register documents, we are not
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Federal Register / Vol. 78, No. 178 / Friday, September 13, 2013 / Notices
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 before making a
determination of recognition of an
accrediting entity. Upon completion of
our analysis, including evaluation of
comments received as a result of this
notice, we will publish a final notice in
the Federal Register announcing the
result of our determination. (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)
Dated: August 29, 2013.
Marilyn Tavenner,
CMS Administrator, Centers for Medicare &
Medicaid Services.
[FR Doc. 2013–22369 Filed 9–12–13; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Administration for Children and
Families
Proposed Information Collection
Activity; Comment Request
Title: Permanency Innovations
Initiative Evaluation: Phase 3.
OMB No.: 0970–0408.
Description: The Administration for
Children and Families (ACF), U.S.
Department of Health and Human
Services (HHS) intends to collect data
for an evaluation of the Permanency
Innovations Initiative (PII). This 5-year
initiative, funded by the Children’s
Bureau (CB) within ACF, is intended to
build the evidence base for innovative
interventions that enhance well-being
and improve permanency outcomes for
particular groups of children and youth
who are at risk for long-term foster care
and who experience the most serious
barriers to timely permanency.
Data collection for the PII evaluation
includes a number of components being
launched at different points in time.
Phase 1 (approved August 2012, OMB#
0970–0408) included data collection for
a cross-site implementation evaluation
and site-specific evaluations of two PII
grantees (Washoe County, Nevada, and
the State of Kansas). Phase 2 (approved
August 2013) included data collection
for two more PII grantees (Illinois DCFS
and one of two interventions offered by
the Los Angeles Gay and Lesbian
Center’s Recognize Intervene Support
Empower [RISE] project).
Phase 3 will include data collection
for evaluations of two PII grantee
interventions and two additional crosssite PII studies. The two grantee
interventions are the California
Department of Social Services’
California Partnership for Permanency
(CAPP) project and a second RISE
intervention, the Care Coordination
Team (CCT). The two PII cross-site
studies are a cost study and an
administrative data study. The
administrative data study does not
impose any new data collection
requirements and will use data
currently reported by states through the
Adoption and Foster Care Analysis and
Reporting System (AFCARS) (OMB
Control # 0980–0267) and the National
Child Abuse and Neglect Data System
(NCANDS) (OMB Control # 0980–0229),
as well as data maintained in State
Automated Child Welfare Information
Systems (SACWIS).
Respondents: Youth, foster parents,
permanency resources, biological
parents, legal guardians, team
facilitators, caseworkers, supervisors,
and state agency workers.
ANNUAL BURDEN ESTIMATES
Total number
of respondents
tkelley on DSK3SPTVN1PROD with NOTICES
Instrument
CAPP:
Parent/Guardian Interview ............................................
Caseworker Data Extraction .........................................
CAPP annual burden hours ..........................................
RISE CCT:
Youth Interview .............................................................
Qualitative Youth Interview ...........................................
Interview with Permanency Resource ..........................
Interview with Current Caregiver ..................................
Current Caregiver Qualitative Interview .......................
CCT Facilitators Emotional Permanency Pretest .........
CCT Facilitators Emotional Permanency Posttest .......
CAFAS pretest ..............................................................
Caseworker discussion for CAFAS pretest completion
CAFAS posttest ............................................................
Caseworker discussion for CAFAS posttest completion .............................................................................
CCT Facilitators Permanent Connections Inventory
Pretest .......................................................................
CCT Facilitators Permanent Connections Inventory
Posttest .....................................................................
RISE CCT annual burden hours ..................................
Cost Study:
Cost Focus Group ........................................................
Weekly Casework Activity Log .....................................
Weekly Supervision Activity Log ..................................
Monthly Management/Administration Log ....................
Cost Study annual burden hours ..................................
Administrative Data Study:
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19:46 Sep 12, 2013
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Annual
number
of respondents
Number
of responses
per respondent
Average
burden hours
per response
1791
894
........................
597
298
........................
1
1
........................
0.5
0.5
........................
299
149
448
120
60
120
120
60
12
12
12
60
12
40
20
40
40
20
4
4
4
20
4
2
1
2
2
1
5
5
5
1
5
1.3
1.2
1.0
0.6
1.0
0.2
0.2
1.0
0.5
1.0
104
24
80
48
20
4
4
20
10
20
60
20
1
0.5
10
12
4
1
0.2
1
12
........................
4
........................
1
........................
0.2
........................
1
346
27
369
117
90
........................
9
123
39
30
........................
1
52
52
12
........................
7
0.4
0.4
0.5
........................
63
2,558
811
180
3,612
Frm 00069
Fmt 4703
Sfmt 4703
E:\FR\FM\13SEN1.SGM
13SEN1
Total
annual
burden hours
]]>Agencies
[Federal Register Volume 78, Number 178 (Friday, September 13, 2013)]
[Notices]
[Pages 56711-56714]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-22369]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-9953-PN]
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
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: This notice announces 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 (QHP)
certification. Regulations require HHS to publish a notice identifying
the accrediting entity, summarizing its analysis of whether the
accrediting entity meets certain criteria, and providing no less than a
30-day public comment period.
DATES: To be assured consideration, comments must be received at one of
the addresses provided below, no later than 5 p.m. on October 15, 2013.
ADDRESSES: In commenting, please refer to file code CMS-9953-PN.
Because of staff and resource limitations, we cannot accept comments by
facsimile (FAX) transmission.
You may submit comments in one of four ways (please choose only one
of the ways listed):
1. Electronically. You may submit electronic comments on this
regulation to https://www.regulations.gov. Follow the ``Submit a
comment'' instructions.
2. By regular mail. You may mail written comments to the following
address ONLY: Centers for Medicare & Medicaid Services, Department of
Health and Human Services, Attention: CMS-9953-PN, P.O. Box 8010,
Baltimore, MD 21244-8010.
Please allow sufficient time for mailed comments to be received
before the close of the comment period.
3. By express or overnight mail. You may send written comments to
the following address ONLY: Centers for Medicare & Medicaid Services,
Department of Health and Human Services, Attention: CMS-9953-PN, Mail
Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
4. By hand or courier. If you prefer, you may deliver (by hand or
courier) your written comments before the close of the comment period
to either of the following addresses:
a. For delivery in Washington, DC--Centers for Medicare & Medicaid
Services, Department of Health and Human Services, Room 445-G, Hubert
H. Humphrey Building, 200 Independence Avenue SW., Washington, DC 20201
(Because access to the interior of the Hubert H. Humphrey Building
is not readily available to persons without Federal government
identification, commenters are encouraged to leave their comments in
the CMS drop slots located in the main lobby of the building. A stamp-
in clock is available for persons wishing to retain a proof of filing
by stamping in and retaining an extra copy of the comments being
filed.)
b. For delivery in Baltimore, MD--Centers for Medicare & Medicaid
Services, Department of Health and Human Services, 7500 Security
Boulevard, Baltimore, MD 21244-1850.
If you intend to deliver your comments to the Baltimore address,
please call telephone number (410) 786-9994 in advance to schedule your
arrival with one of our staff members.
Comments mailed to the addresses indicated as appropriate for hand
or courier delivery may be delayed and received after the comment
period.
FOR FURTHER INFORMATION CONTACT: Rebecca Zimmermann, at (301) 492-4396.
SUPPLEMENTARY INFORMATION:
Inspection of Public Comments: All comments received before the
close of the comment period are available for viewing by the public,
including any personally identifiable or confidential business
information that is included in a comment. We post all comments
received before the close of the comment period on the following Web
site as soon as possible after they have been received: https://www.regulations.gov. Follow the search instructions on that Web site to
view public comments.
Comments received timely will also 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 1-800-743-3951.
I. Background
Regulations at 45 CFR 156.275 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 Department of Health and
Human Services (HHS). In a final rule published on July 20, 2012,\1\ 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 final rule to be recognized
as an accrediting entity (77 FR 42662 through 42668) and were
recognized by the Secretary \2\ as accrediting entities for the
purposes of QHP certification.
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\1\ Patient Protection and Affordable Care Act; Data Collection
To Support Standards Related to Essential Health Benefits;
Recognition of Entities for the Accreditation of Qualified Health
Plans Final Rule 77 FR 42658, 42662-42668 (July 20, 2012) (45 CFR
156.275(c)).
\2\ Certain authority under the Affordable Care Act has been
delegated from the Secretary to the Administrator of CMS., 76 FR
53903 through 53906, (Aug. 30, 2011).
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On February 25, 2013, we published a subsequent final rule title,
``Standards Related to Essential Health Benefits, Actuarial Value, and
Accreditation (78 FR 1283),'' \3\ which amended Sec. 156.275(c) to
establish an application and review process to allow additional
[[Page 56712]]
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 to the Exchange.
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\3\ 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 Notice
The purpose of this notice is to notify the public of the
Accreditation Association for Ambulatory Health Care's (AAAHC) request
for recognition by the Secretary as an accrediting entity for the
purposes of QHP certification. As part of the application, AAAHC
submitted all the required documentation materials described in Sec.
156.275(c)(4). Below we present, our analysis of whether AAAHC meets
the criteria described in paragraphs Sec. 156.275 (c)(2) and (3).
1. Summary of CMS's Analysis
We are providing the public with an analysis of AAAHC's completed
application, including a review of the current accreditation standards
and requirements, processes and measure specifications for performance
measures, submitted by AAAHC. Currently, AAAHC is an accrediting body
that has a CMS-approved accreditation program to conduct surveys for
ambulatory surgery centers that wish to participate in the Medicare
program with deemed status. The AAAHC has also obtained approval from
CMS as a deeming entity allowing it to survey Medicare Advantage
plans.\4\ The current scope of accreditation as described in AAAHC's
2013 Accreditation Handbook for Health Plans demonstrates that AAAHC
will be providing accreditation of QHPs within the statutorily required
categories,\5\ established in Sec. 156.275(c), including reporting on
a set of clinical quality measures and patient experience ratings on a
standardized Consumer Assessment of Healthcare Providers and Systems
(CAHPS[supreg]) survey; consumer access; utilization management;
quality assurance; provider credentialing; complaints and appeals;
network adequacy and access; and patient information programs.
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\4\ 42 CFR 422.157.
\5\ Interested persons may contact AAAHC to request a copy of
the handbook.
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In addition, CMS evaluated AAAHC's standards relating to network
adequacy and consider them to be consistent with the general
requirements for network adequacy for QHP issuers (45 CFR 156.230(a)(2)
and (3)). To determine health plans' compliance with network adequacy
standards, the AAAHC accreditation survey includes review of areas such
as member choice of providers, member satisfaction with relation to
provider access, availability of services, provider network
credentialing and customer complaints, appeals, and satisfaction
information.
Upon review of the clinical quality measures included in AAAHC's
accreditation standards, we have assessed that the measures cover a
range of conditions and domains, include adult and child-specific
measures, align with the priorities in the National Strategy for
Quality Improvement in Health Care, are developed or adopted by the
National Quality Forum (NQF) or are in common use for health plan
quality measurement, and meet health plan industry standards and are
evidence-based, as required in Sec. 156.275(c)(2)(ii). The following
list displays the clinical quality measures that will be used for QHP
accreditation by AAAHC, spanning preventive care, behavioral health and
substance abuse disorders, chronic care, and acute care:
------------------------------------------------------------------------
NQF reference Measure develop/
Measure No. steward
------------------------------------------------------------------------
Mandatory Measures
------------------------------------------------------------------------
Proportion of Days Covered (Drug 0541 Pharmacy Quality
Therapy. Alliance (PQA).
Adherence)........................
Provider Network Adequacy--Number n/a Centers for Medicare
of Specialists Accepting New and Medicaid
Patients At End of Reporting Services (CMS).
Period by Specialist Type.
Dyslipidemia New Medication 12- n/a Resolution Health,
Week Testing. Inc.
Drug-Drug Interactions............ n/a PQA.
Diabetes Short Term Complications 0272 Adapted by URAC from
Event. Agency for
Rate.............................. Healthcare Quality
and Research (AHRQ)
measure.
Diabetes Long Term Complications 0274 Adapted by URAC from
Admission Rate. AHRQ measure.
Adult Asthma Event Rate........... 0283 Adapted by URAC from
AHRQ measure.
Pediatric Asthma Event Rate....... n/a Adapted by URAC from
AHRQ measure.
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Mandatory/Equivalent Measures
------------------------------------------------------------------------
Atherosclerotic Disease--Lipid 0616 Active Health
Panel Monitoring. Management.
Diabetes All-Or-None Process n/a Wisconsin
Measure (HbA1c, LDL-C, Collaborative for
Nephropathy). Healthcare Quality.
Provider Network Adequacy--Primary n/a CMS.
Care.
Medication Therapy For Patients 0548 PQA.
With Asthma: Suboptimal Asthma
Control (SAC), and Absence of
Controller Therapy (ACT).
Call Center Performance........... n/a URAC.
Percentage of Live Births Weighing 0278 AHRQ.
Less than 2,500 Grams.
[[Page 56713]]
Annual Percentage of Asthma 1381 Alabama Medicaid.
Patients 2 through 20 Years Old
with One or More Asthma-related
Emergency Room Visits.
Percentage of Female Patients Who n/a American Medical
Had a Mammogram Performed During Association/
the Two-Year Measurement Period. Physician
Consortium
Performance
Improvement (AMA/
PCPI).
High Risk for Pneumococcal 0617 ActiveHealth
Disease--Pneumococcal Vaccination. Management.
Preventive Services: Percentage of n/a American Academy of
Enrolled Members Ages Less than Pediatrics/URAC.
or Equal to 18 years Who have had
Preventive Services, Recommended
Risk Factor Reductions and
Behavioral Health Change
Interventions, Appropriate
Screenings and Immunizations.
Colorectal Cancer Screening....... n/a Veterans Health
Administration
(VHA).
Tobacco Use: Screening and 0028 AMA/PCPI/URAC.
Cessation.
Prevention and Management of n/a Institute for
Obesity in Mature Adolescents and Clinical Systems
Adults. Improvement(ICSI)/
URAC.
30 Day Post-Hospital AMI Discharge 0698 Centers for Medicare
Care Transition Composite Measure. and Medicaid
Services (CMS)/
URAC.
Congestive Heart Failure (CHF) 0358 AHRQ/URAC.
Rate.
Atrial Fibrillation--Warfarin 0264 ActiveHealth
Therapy. Management.
MRI Lumbar Spine for Low Back Pain 0514 CMS.
All Cause Readmission Index....... 0505 United Health Group/
URAC.
Central Venous Catheter-related n/a AHRQ.
Bloodstream Infections (area-
level): Rate per 100,000
Population.
Depression Readmission............ n/a Minnesota Community
Measurement/URAC.
Follow-up After Hospitalization n/a Florida Agency for
for a Mental Illness. Health Care
Administration.
------------------------------------------------------------------------
CAHPS[supreg]
------------------------------------------------------------------------
CAHPS[supreg] Adult Health Plan 0006 AHRQ.
Survey 5.0.
CAHPS[supreg] Child Survey v4.0 n/a AHRQ.
Medicaid and Commercial Core
Survey.
CAHPS[supreg] Survey for Children 0009 AHRQ.
With Chronic Conditions.
------------------------------------------------------------------------
Exploratory Measures
------------------------------------------------------------------------
Case Management: Consumer Contact. n/a URAC.
Complaint Response Timeliness..... n/a URAC.
Outpatient Newborn Visit Within n/a Centene.
One Month of Birth.
Diabetes: All or None Process n/a Wisconsin
Measure: Optimal Results for Collaborative for
HbA1c, LDL-C, and Blood Pressure. Healthcare Quality.
Percentage of Eligible Members n/a CMS/URAC.
that Receive Preventive Dental
Services.
Health Risk Assessment Completion n/a URAC.
Rate.
Use of High Risk Medications in n/a PQA.
the Elderly.
------------------------------------------------------------------------
The AAAHC documented in its application how its measures and
standards comply with the requirements contained in Sec. 156.275. The
application also clarifies how AAAHC accreditation complies with Sec.
156.275(c)(2) and (c)(3). Specifically, AAAHC will provide
accreditation at the required Exchange product type level, assuming
that adequate member numbers and data are available, as required by 45
CFR 156.275(c)(2)(iii).
CMS evaluated AAAHC's application information regarding
accreditation survey methodology and processes for scoring and consider
the standards to be methodologically rigorous and transparent as
required in Sec. 156.275(c)(3). The AAAHC described its health plan
scoring methodology for 2013 and documented that the collection and
reporting of a required set of clinical quality measures and
CAHPS[supreg] data will be factored into the overall accreditation
score. The majority of AAAHC accreditation standards are rated on a
five-point scale of Fully Compliant to Non-Compliant and a critical set
of standards must be fully met for successful health plan
accreditation, including the reporting of clinical quality measures.
2. Public Comment
This notice solicits public comments on the analysis above and the
conclusion that it is appropriate to recognize AAAHC as an accrediting
entity for the purpose of QHP certification. We seek specific comments
on AAAHC's accreditation standards for QHP issuers including: whether
the public believes AAAHC's standards meet the requirements in Sec.
156.275; whether there are any deficiencies in its standards that
should be reviewed; 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.
III. 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.
IV. Response to Comments
Because of the large number of public comments we normally receive
on Federal Register documents, we are not
[[Page 56714]]
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 before making a determination of recognition
of an accrediting entity. Upon completion of our analysis, including
evaluation of comments received as a result of this notice, we will
publish a final notice in the Federal Register announcing the result of
our determination. (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)
Dated: August 29, 2013.
Marilyn Tavenner,
CMS Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2013-22369 Filed 9-12-13; 8:45 am]
BILLING CODE 4120-01-P
