Medicare Managed Care Manual (Pub. 100-16), Ch. 5 § 40.2.2

Removal of an MAO’s Deemed Status

Last amended: 2014Year: 2014Length: 221 wordsOfficial source
40.2.2 - Removal of an MAO’s Deemed Status (Rev. 117, Issued: 08-08-14, Effective: 08-08-14, Implementation: 08-08-14) 42 CFR §422.156(e) CMS will remove part or all of an MAO’s deemed status if: 1. CMS determines, based on its own evaluation, that the MAO does not meet the Medicare requirements for which deemed status was granted; 2. CMS withdraws its approval of the AO that accredited the MAO; and/or 3. The MAO fails to meet the obligations of a deemed MAO, which are 2 Please note that only 6 of the 9 deeming requirements have been implemented into the deeming program. addressed in section 40.2.2 of this chapter. CMS will not overrule an AO’s decision without doing its own investigation. However, if CMS’ evaluation reveals that a condition is not met, CMS reserves the right to remove deemed status even though the AO has not removed accreditation with respect to that condition. Additionally, if CMS withdraws its approval of deeming authority from an AO, all MAOs with deemed status provided by that AO, will also be withdrawn. The MAO will be notified of the withdrawal of deemed status via a public notice. The AO must notify all its accredited MAOs within 10 days. Upon removal of an MAO’s deemed status, CMS immediately resumes responsibility for ensuring that the organization meets Medicare program requirements.
Medicare Managed Care Manual (Pub. 100-16), Ch. 5 § 40.2.2: Removal of an MAO’s Deemed Status | Justis AI