Medicare Program; Evaluation Criteria and Standards for Beneficiary and Family Centered Care Quality Improvement Organization Contract, 78439-78440 [2014-30448]
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Federal Register / Vol. 79, No. 249 / Tuesday, December 30, 2014 / Notices
authorization request can be completed
by the (ordering) physician or treating
practitioner and submitted to the
appropriate DME MAC for an initial
decision. The supplier may also submit
the request on behalf of the physician or
treating practitioner. The physician,
treating practitioner or supplier who
submits the request on behalf of the
physician or treating practitioner, is
referred to as the ‘‘submitter.’’ Under
this demonstration, the submitter will
submit to the DME MAC a request for
prior authorization and all relevant
documentation to support Medicare
coverage of the PMD item. Form
Number: CMS–10421 (OMB control
number: 0938–1169); Frequency:
Occasionally; Affected Public: State,
Local or Tribal Governments; Number of
Respondents: 333,750; Total Annual
Responses: 333,750; Total Annual
Hours: 170,060. (For policy questions
regarding this collection contact Daniel
Schwartz at 410–786–4197.)
Dated: December 23, 2014.
Martique Jones,
Director, Regulations Development Group,
Office of Strategic Operations and Regulatory
Affairs.
[FR Doc. 2014–30468 Filed 12–29–14; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–3296–FN]
RIN 0938–ZB14
Medicare Program; Evaluation Criteria
and Standards for Beneficiary and
Family Centered Care Quality
Improvement Organization Contract
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Final notice.
AGENCY:
This final notice announces
the general criteria we will use to
evaluate the effectiveness and efficiency
of Beneficiary and Family Centered Care
(BFCC) Quality Improvement
Organizations (QIOs) that entered into
contracts with CMS under the 11th
Statement of Work (SOW) in May 2014.
The activities for the BFCC–QIO SOW
began August 1, 2014. (This contract
allows for a transition period from the
incumbent QIOs to the successor QIOs.)
In addition, this notice addresses the
public comments received on the July
28, 2014 notice with comment period
entitled, ‘‘Evaluation Criteria and
Standards for Beneficiary and Family
mstockstill on DSK4VPTVN1PROD with NOTICES
SUMMARY:
VerDate Sep<11>2014
21:42 Dec 29, 2014
Jkt 235001
Centered Care Quality Improvement
Organization Contracts.’’
DATES: Effective Dates: August 1, 2014
to July 31, 2019.
FOR FURTHER INFORMATION CONTACT:
Alfreda Staton, (410) 786–4194.
SUPPLEMENTARY INFORMATION:
I. Background
Section 1153(h)(2) of the Social
Security Act (the Act) requires the
Secretary of the Department of Health
and Human Services (the Secretary) to
publish in the Federal Register the
general criteria and standards that will
be used to evaluate the effective and
efficient performance of contract
obligations by the Quality Improvement
Organizations (QIOs) and to provide the
opportunity for public comment with
respect to these criteria and standards.
II. Provisions of the Notice With
Comment Period
On July 28, 2014, we published a
notice with comment period in the
Federal Register (79 FR 43747 through
43749) entitled, ‘‘Evaluation Criteria
and Standards for Beneficiary and
Family Centered Care Quality
Improvement Organization Contracts,’’
announcing the general criteria we
would use to evaluate the effectiveness
and efficiency of Beneficiary and Family
Centered Care (BFCC) Quality
Improvement Organizations (QIOs) that
entered into contracts with CMS under
the 11th Statement of Work (SOW) in
May 2014 (HHSM–500–2014–RFP–
BFCC–QIO). That notice generally
summarized the tasks of the BFCC–QIOs
and the criteria to be used for annual
performance evaluations during the 5year term of the contract. BFCC–QIO
performance under the 11th SOW
contract began on August 1, 2014, after
a transition period.
The tasks of the BFCC–QIOs under
the BFCC–QIO 11th SOW contract are as
follows:
• Quality of care reviews, including
beneficiary complaint and general
quality of care reviews.
• Beneficiary appeals of denials of
hospital admissions discharge and
terminations of services decisions
commonly referred to as Grijalva, BIPA,
and Weichardt appeals.
• Medical necessity reviews.
• Appropriateness of setting reviews.
• Diagnosis Related Group (DRG)
reviews.
• Readmission reviews.
• Reviews under Emergency Medical
Treatment and Active Labor Act
(EMTALA).
• Sanctions.
• Monitoring of Physician
Acknowledgement Statements under
PO 00000
Frm 00059
Fmt 4703
Sfmt 4703
78439
section 1156(a) of the Act and our
regulations at 42 CFR 412.46.
Evaluation of the Tasks Measures
The measures of BFCC–QIO
performance for the 11th SOW are as
follows:
• Quality of Review: Inter-Rater
Reliability.
• 4-day Data Entry Compliance.
• Timeliness of Beneficiary
Complaints and Other Quality of Care
Reviews.
• Timeliness of Discharge/Service
Termination Reviews.
• Timeliness of EMTALA and Higher
Weighted Diagnosis-Related Group
Reviews.
• Complainant Agreement to
Complete Survey.
• Beneficiary Experience with
Quality of Care Complaints.
• Beneficiary Experience with Appeal
Reviews.
Evaluation Criteria
The Annual and 54th Month
Evaluation Criteria for each of these
measures are specifically defined in
Attachment J–10, ‘‘Annual and 54th
Month Evaluation Criteria Measures
Table,’’ of the BFCC–QIO SOW; the
criteria for evaluating each deliverable
are identified in Schedule F of the 11th
SOW. Additional detail is provided in
the notice posted at: https://
www.gpo.gov/fdsys/pkg/FR-2014-07-28/
pdf/2014-17625.pdf.
III. Analysis of and Responses to Public
Comments on the Notice With Comment
Period
Two commenters submitted several
comments concerning the general
criteria we would use to evaluate the
effectiveness and efficiency of BFCC–
QIOs that will enter into contracts with
CMS under the 11th SOW. One
commenter was affiliated with a private
healthcare quality improvement entity
and the other commenter was with a
healthcare quality improvement
association. A summary of the
comments and our responses are as
follows:
Comment: Both commenters
expressed concern with potential public
perception of bias arising from the
evaluation criterion that considers of
beneficiary experience with the quality
of care complaints and appeal reviews
as part of the evaluation of the BFCC–
QIO’s performance of quality-of-care
and other statutory and regulatory
reviews and appeals. The commenters
indicated that consideration of
beneficiary experience with the quality
of care complaints and appeal reviews
as part of the evaluation of the BFCC–
E:\FR\FM\30DEN1.SGM
30DEN1
mstockstill on DSK4VPTVN1PROD with NOTICES
78440
Federal Register / Vol. 79, No. 249 / Tuesday, December 30, 2014 / Notices
QIO’s performance might lead to the
erroneous perception by the public that
reviews or appeals may be biased either
toward the beneficiary (when obtaining
beneficiary feedback), or toward
providers (when obtaining provider
feedback). One commenter encouraged
CMS to carefully consider public
perception of the evaluation criterion of
beneficiary experience with the quality
of care complaints and appeal reviews.
The other commenter suggested
removing customer feedback from the
evaluation criteria.
Response: We appreciate the concern
with maintaining the integrity of public
perception of our oversight of the
performance of numerous statutory and
regulatory review functions to safeguard
beneficiaries. The evaluation criteria
and standards include safeguards to
monitor the quality of the reviews, such
as inter-rater reliability, the QIOs’
timeliness in completing the reviews
and ongoing monitoring of the BFCC–
QIO’s internal quality control program.
The beneficiary satisfaction survey
allows CMS to monitor the QIOs’ ability
to provide superior customer service
while incorporating processes that
engage beneficiaries and their
representatives in ways that are patient
and family centered. With appropriate
monitoring and safeguards, we benefit
from consideration of beneficiaries’
experience with the review and appeals
process while maintaining consistently
high levels of program integrity.
Comment: One commenter agreed
with the importance of instituting
rigorous standards for inter-rater
reliability and suggested that CMS
consider developing evaluation
standards that assess the accuracy as
well as reliability of reviews.
Response: We agree with the
importance of reliable and accurate
reviews relating to the execution of the
numerous statutory and regulatory
review functions to safeguard
beneficiaries. The evaluation criteria
includes annual (and at the 54th month)
assessment of minimum performance
criteria for inter-rater reliability.
Additionally, we will monitor the
quality program in place at each BFCC–
QIO to ensure that the work is both
reliable and accurate. We agree on the
merits of developing more formal
evaluation standards and criteria for
assessing the validity of work by BFCC–
QIO reviewers. We intend to investigate
suitable measures for consideration in
the future.
Comment: Both commenters noted the
potential for external factors and
perhaps the outcome of the review or
appeal itself to influence the
beneficiaries’ experience and their
VerDate Sep<11>2014
21:42 Dec 29, 2014
Jkt 235001
willingness to participate in the survey
process. One commenter stated that
there should be careful consideration of
these factors in the evaluation standards
and criteria; the other commenter
recommended not using beneficiary
participation in the survey as part of the
evaluation.
Response: We believe that the BFCC–
QIOs must exercise diplomacy,
professionalism and compassion in their
performance of numerous statutory and
regulatory review functions to safeguard
beneficiaries. Our monitoring of the
internal quality control processes of the
BFCC–QIOs and ongoing monitoring
activities focuses in part on the
professionalism in their interactions
with beneficiaries and their
representatives. We recognize that
external factors may, to some limited
extent, have an impact on the
beneficiaries’ willingness to participate
in the survey of their experience with
the appeal or review process. However,
based on previous experience with these
surveys, we are confident that the
proficiency of the work by the BFCC–
QIO with beneficiaries or their
representatives will be the dominant
factor that impacts the willingness by
beneficiaries or their representatives to
participate in the survey.
Comment: Both commenters indicated
that although the BFCC–QIO is
primarily responsible for its
performance on the evaluation
standards and criteria, external factors
outside the control of the BFCC–QIO
may also impact performance on
measures such as timeliness (of
Beneficiary Complaints and Other
Quality of Care Reviews, Discharge/
Service Termination Reviews, and
EMTALA and Higher-Weighted
Diagnosis Related Group Reviews). Both
commenters suggested that we consider,
if appropriate, factors outside the
control of the contractors.
Response: We agree with the
commenters that there are certain
factors, such as natural calamities, for
example, hurricanes or earthquakes, in
addition to transitional issues at the
beginning and end of the contract cycle
that may, despite the best mitigating
efforts, have an impact on the BFCC–
QIO’s ability to conduct work in specific
regions. We are confident that these
extraordinary circumstances can be
addressed using our intervention and
evaluation standards and criteria.
Comment: One commenter noted the
importance of the BFCC–QIO’s Internal
Quality Control (IQC) Program but
recommended that we consider only
whether the BFCC–QIO had a process in
place and not the quality and
competence of the execution of the IQC.
PO 00000
Frm 00060
Fmt 4703
Sfmt 4703
Response: We agree with the
importance of the BFCC–QIO instituting
an IQC Program. However, we believe
that it is in the Government’s and
beneficiaries’ best interest to conduct
ongoing monitoring to ensure that the
IQC is kept current and accurately
reflects the competent execution of the
BFCC–QIO’s performance of numerous
statutory and regulatory review
functions to safeguard beneficiaries. We
plan to use ongoing monitoring of the
IQC as a critical element to inform
discussions with the BFCC–QIO on their
improvement efforts.
IV. Provisions of the Final Notice
We have analyzed these comments
and determined that it is appropriate to
finalize without modification the
provisions set forth in the July 28, 2014
notice with comment period entitled,
‘‘Evaluation Criteria and Standards for
Beneficiary and Family Centered Care
Quality Improvement Organization
Contracts.’’ (79 FR 43747 through
43749).
V. Collection of Information
Requirements
This document does not impose
information collection requirements,
that is, reporting, recordkeeping or
third-party disclosure requirements.
Consequently, there is no need for
review by the Office of Management and
Budget under the authority of the
Paperwork Reduction Act of 1995.
VI. Regulatory Impact Statement
In accordance with the provisions of
Executive Order 12866, this notice was
not reviewed by the Office of
Management and Budget.
Dated: November 19, 2014.
Marilyn Tavenner,
Administrator, Centers for Medicare &
Medicaid Services.
[FR Doc. 2014–30448 Filed 12–29–14; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–3300–FN]
RIN 0938–ZB15
Medicare Program; Evaluation Criteria
and Standards for Quality
Improvement Networks Quality
Improvement Program Contracts; Base
and Task Orders
Centers for Medicare &
Medicaid Services (CMS), HHS.
AGENCY:
E:\FR\FM\30DEN1.SGM
30DEN1
]]>Agencies
[Federal Register Volume 79, Number 249 (Tuesday, December 30, 2014)]
[Notices]
[Pages 78439-78440]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-30448]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-3296-FN]
RIN 0938-ZB14
Medicare Program; Evaluation Criteria and Standards for
Beneficiary and Family Centered Care Quality Improvement Organization
Contract
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Final notice.
-----------------------------------------------------------------------
SUMMARY: This final notice announces the general criteria we will use
to evaluate the effectiveness and efficiency of Beneficiary and Family
Centered Care (BFCC) Quality Improvement Organizations (QIOs) that
entered into contracts with CMS under the 11th Statement of Work (SOW)
in May 2014. The activities for the BFCC-QIO SOW began August 1, 2014.
(This contract allows for a transition period from the incumbent QIOs
to the successor QIOs.) In addition, this notice addresses the public
comments received on the July 28, 2014 notice with comment period
entitled, ``Evaluation Criteria and Standards for Beneficiary and
Family Centered Care Quality Improvement Organization Contracts.''
DATES: Effective Dates: August 1, 2014 to July 31, 2019.
FOR FURTHER INFORMATION CONTACT: Alfreda Staton, (410) 786-4194.
SUPPLEMENTARY INFORMATION:
I. Background
Section 1153(h)(2) of the Social Security Act (the Act) requires
the Secretary of the Department of Health and Human Services (the
Secretary) to publish in the Federal Register the general criteria and
standards that will be used to evaluate the effective and efficient
performance of contract obligations by the Quality Improvement
Organizations (QIOs) and to provide the opportunity for public comment
with respect to these criteria and standards.
II. Provisions of the Notice With Comment Period
On July 28, 2014, we published a notice with comment period in the
Federal Register (79 FR 43747 through 43749) entitled, ``Evaluation
Criteria and Standards for Beneficiary and Family Centered Care Quality
Improvement Organization Contracts,'' announcing the general criteria
we would use to evaluate the effectiveness and efficiency of
Beneficiary and Family Centered Care (BFCC) Quality Improvement
Organizations (QIOs) that entered into contracts with CMS under the
11th Statement of Work (SOW) in May 2014 (HHSM-500-2014-RFP-BFCC-QIO).
That notice generally summarized the tasks of the BFCC-QIOs and the
criteria to be used for annual performance evaluations during the 5-
year term of the contract. BFCC-QIO performance under the 11th SOW
contract began on August 1, 2014, after a transition period.
The tasks of the BFCC-QIOs under the BFCC-QIO 11th SOW contract are
as follows:
Quality of care reviews, including beneficiary complaint
and general quality of care reviews.
Beneficiary appeals of denials of hospital admissions
discharge and terminations of services decisions commonly referred to
as Grijalva, BIPA, and Weichardt appeals.
Medical necessity reviews.
Appropriateness of setting reviews.
Diagnosis Related Group (DRG) reviews.
Readmission reviews.
Reviews under Emergency Medical Treatment and Active Labor
Act (EMTALA).
Sanctions.
Monitoring of Physician Acknowledgement Statements under
section 1156(a) of the Act and our regulations at 42 CFR 412.46.
Evaluation of the Tasks Measures
The measures of BFCC-QIO performance for the 11th SOW are as
follows:
Quality of Review: Inter-Rater Reliability.
4-day Data Entry Compliance.
Timeliness of Beneficiary Complaints and Other Quality of
Care Reviews.
Timeliness of Discharge/Service Termination Reviews.
Timeliness of EMTALA and Higher Weighted Diagnosis-Related
Group Reviews.
Complainant Agreement to Complete Survey.
Beneficiary Experience with Quality of Care Complaints.
Beneficiary Experience with Appeal Reviews.
Evaluation Criteria
The Annual and 54th Month Evaluation Criteria for each of these
measures are specifically defined in Attachment J-10, ``Annual and 54th
Month Evaluation Criteria Measures Table,'' of the BFCC-QIO SOW; the
criteria for evaluating each deliverable are identified in Schedule F
of the 11th SOW. Additional detail is provided in the notice posted at:
https://www.gpo.gov/fdsys/pkg/FR-2014-07-28/pdf/2014-17625.pdf.
III. Analysis of and Responses to Public Comments on the Notice With
Comment Period
Two commenters submitted several comments concerning the general
criteria we would use to evaluate the effectiveness and efficiency of
BFCC-QIOs that will enter into contracts with CMS under the 11th SOW.
One commenter was affiliated with a private healthcare quality
improvement entity and the other commenter was with a healthcare
quality improvement association. A summary of the comments and our
responses are as follows:
Comment: Both commenters expressed concern with potential public
perception of bias arising from the evaluation criterion that considers
of beneficiary experience with the quality of care complaints and
appeal reviews as part of the evaluation of the BFCC-QIO's performance
of quality-of-care and other statutory and regulatory reviews and
appeals. The commenters indicated that consideration of beneficiary
experience with the quality of care complaints and appeal reviews as
part of the evaluation of the BFCC-
[[Page 78440]]
QIO's performance might lead to the erroneous perception by the public
that reviews or appeals may be biased either toward the beneficiary
(when obtaining beneficiary feedback), or toward providers (when
obtaining provider feedback). One commenter encouraged CMS to carefully
consider public perception of the evaluation criterion of beneficiary
experience with the quality of care complaints and appeal reviews. The
other commenter suggested removing customer feedback from the
evaluation criteria.
Response: We appreciate the concern with maintaining the integrity
of public perception of our oversight of the performance of numerous
statutory and regulatory review functions to safeguard beneficiaries.
The evaluation criteria and standards include safeguards to monitor the
quality of the reviews, such as inter-rater reliability, the QIOs'
timeliness in completing the reviews and ongoing monitoring of the
BFCC-QIO's internal quality control program. The beneficiary
satisfaction survey allows CMS to monitor the QIOs' ability to provide
superior customer service while incorporating processes that engage
beneficiaries and their representatives in ways that are patient and
family centered. With appropriate monitoring and safeguards, we benefit
from consideration of beneficiaries' experience with the review and
appeals process while maintaining consistently high levels of program
integrity.
Comment: One commenter agreed with the importance of instituting
rigorous standards for inter-rater reliability and suggested that CMS
consider developing evaluation standards that assess the accuracy as
well as reliability of reviews.
Response: We agree with the importance of reliable and accurate
reviews relating to the execution of the numerous statutory and
regulatory review functions to safeguard beneficiaries. The evaluation
criteria includes annual (and at the 54th month) assessment of minimum
performance criteria for inter-rater reliability. Additionally, we will
monitor the quality program in place at each BFCC-QIO to ensure that
the work is both reliable and accurate. We agree on the merits of
developing more formal evaluation standards and criteria for assessing
the validity of work by BFCC-QIO reviewers. We intend to investigate
suitable measures for consideration in the future.
Comment: Both commenters noted the potential for external factors
and perhaps the outcome of the review or appeal itself to influence the
beneficiaries' experience and their willingness to participate in the
survey process. One commenter stated that there should be careful
consideration of these factors in the evaluation standards and
criteria; the other commenter recommended not using beneficiary
participation in the survey as part of the evaluation.
Response: We believe that the BFCC-QIOs must exercise diplomacy,
professionalism and compassion in their performance of numerous
statutory and regulatory review functions to safeguard beneficiaries.
Our monitoring of the internal quality control processes of the BFCC-
QIOs and ongoing monitoring activities focuses in part on the
professionalism in their interactions with beneficiaries and their
representatives. We recognize that external factors may, to some
limited extent, have an impact on the beneficiaries' willingness to
participate in the survey of their experience with the appeal or review
process. However, based on previous experience with these surveys, we
are confident that the proficiency of the work by the BFCC-QIO with
beneficiaries or their representatives will be the dominant factor that
impacts the willingness by beneficiaries or their representatives to
participate in the survey.
Comment: Both commenters indicated that although the BFCC-QIO is
primarily responsible for its performance on the evaluation standards
and criteria, external factors outside the control of the BFCC-QIO may
also impact performance on measures such as timeliness (of Beneficiary
Complaints and Other Quality of Care Reviews, Discharge/Service
Termination Reviews, and EMTALA and Higher-Weighted Diagnosis Related
Group Reviews). Both commenters suggested that we consider, if
appropriate, factors outside the control of the contractors.
Response: We agree with the commenters that there are certain
factors, such as natural calamities, for example, hurricanes or
earthquakes, in addition to transitional issues at the beginning and
end of the contract cycle that may, despite the best mitigating
efforts, have an impact on the BFCC-QIO's ability to conduct work in
specific regions. We are confident that these extraordinary
circumstances can be addressed using our intervention and evaluation
standards and criteria.
Comment: One commenter noted the importance of the BFCC-QIO's
Internal Quality Control (IQC) Program but recommended that we consider
only whether the BFCC-QIO had a process in place and not the quality
and competence of the execution of the IQC.
Response: We agree with the importance of the BFCC-QIO instituting
an IQC Program. However, we believe that it is in the Government's and
beneficiaries' best interest to conduct ongoing monitoring to ensure
that the IQC is kept current and accurately reflects the competent
execution of the BFCC-QIO's performance of numerous statutory and
regulatory review functions to safeguard beneficiaries. We plan to use
ongoing monitoring of the IQC as a critical element to inform
discussions with the BFCC-QIO on their improvement efforts.
IV. Provisions of the Final Notice
We have analyzed these comments and determined that it is
appropriate to finalize without modification the provisions set forth
in the July 28, 2014 notice with comment period entitled, ``Evaluation
Criteria and Standards for Beneficiary and Family Centered Care Quality
Improvement Organization Contracts.'' (79 FR 43747 through 43749).
V. Collection of Information Requirements
This document does not impose information collection requirements,
that is, reporting, recordkeeping or third-party disclosure
requirements. Consequently, there is no need for review by the Office
of Management and Budget under the authority of the Paperwork Reduction
Act of 1995.
VI. Regulatory Impact Statement
In accordance with the provisions of Executive Order 12866, this
notice was not reviewed by the Office of Management and Budget.
Dated: November 19, 2014.
Marilyn Tavenner,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2014-30448 Filed 12-29-14; 8:45 am]
BILLING CODE 4120-01-P
