42 C.F.R. § 422.156 Compliance deemed on the basis of accreditation.
Title 42 - Public Health
(a) General rule. An MA organization is deemed to meet all of the requirements of any of the areas described in paragraph (b) of this section if— (1) The MA organization is fully accredited (and periodically reaccredited) for the standards related to the applicable area under paragraph (b) of this section by a private, national accreditation organization approved by CMS; and (2) The accreditation organization used the standards approved by CMS for the purposes of assessing the MA organization's compliance with Medicare requirements. (b) Deemable requirements. The requirements relating to the following areas are deemable: (1) Quality improvement. (2) Antidiscrimination. (3) Access to services. (4) Confidentiality and accuracy of enrollee records. (5) Information on advance directives. (6) Provider participation rules. (7) Part D prescription drug benefit programs that are offered by MA programs. (c) Effective date of deemed status. The date on which the organization is deemed to meet the applicable requirements is the later of the following: (1) The date on which the accreditation organization is approved by CMS. (2) The date the MA organization is accredited by the accreditation organization. (d) Obligations of deemed MA organizations. An MA organization deemed to meet Medicare requirements must— (1) Submit to surveys by CMS to validate its accreditation organization's accreditation process; and (2) Authorize its accreditation organization to release to CMS a copy of its most recent accreditation survey, together with any survey-related information that CMS may require (including corrective action plans and summaries of unmet CMS requirements). (e) Removal of deemed status. CMS removes part or all of an MA organization's deemed status for any of the following reasons: (1) CMS determines, on the basis of its own investigation, that the MA organization does not meet the Medicare requirements for which deemed status was granted. (2) CMS withdraws its approval of the accreditation organization that accredited the MA organization. (3) The MA organization fails to meet the requirements of paragraph (d) of this section. (f) Enforcement authority. CMS retains the authority to initiate enforcement action against any MA organization that it determines, on the basis of its own survey or the results of an accreditation survey, no longer meets the Medicare requirements for which deemed status was granted. [63 FR 35082, June 26, 1998, as amended at 65 FR 40323, June 29, 2000; 65 FR 59749, Oct. 6, 2000; 70 FR 4724, Jan. 28, 2005]
Title 42: Public Health
PART 422—MEDICARE ADVANTAGE PROGRAM
Subpart D—Quality Improvement
§ 422.156 Compliance deemed on the basis of accreditation.
