The Centers for Medicare and Medicaid Services (CMS) has established a program that allows private, national accrediting organizations the opportunity to ensure that Medicare Advantage plans are complaint with the requirements of the Medicare Advantage program. CMS identifies those accrediting organizations as “deemed” entities. On June 28, 2002 CMS announced the approval of the Accreditation Association as a deemed entity, thereby allowing the Accreditation Association the privilege to survey Medicare Advantage HMO and PPO plans.
The six areas which are under the Medicare Advantage deeming authority for the Accreditation Association are: quality assurance, antidiscrimination, access to services, confidentiality and accuracy of enrollee records, information on advance directives, and provider participation rules.
A health plan that participates in the Medicare Advantage program may choose to have its AAAHC survey include a review of the Medicare Advantage requirements. Health Plans requesting this type of survey, should obtain the AAAHC Medicare Advantage Supplemental Guidebook. This guidebook contains the additional Medicare Advantage requirements that will be reviewed for compliance by the Accreditation Association surveyors.
To obtain a copy of the Medicare Advantage Supplemental Guidebook, as well as further details regarding the Medicare Advantage survey process, please contact Tom Tassone, Director of Health Plan Accreditation, at 847.853.6060.