§ 423.165 - Compliance deemed on the basis of accreditation.  


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  • § 423.165 Compliance deemed on the basis of accreditation.

    (a) General rule. A Part D sponsor is deemed to meet all of the requirements of any of the areas described in paragraph (b) of this section if—

    (1) The Part D sponsor 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 uses the standards approved by CMS for the purposes of assessing the Part D sponsor's compliance with Medicare requirements.

    (b) Deemable requirements. The requirements relating to the following areas are deemable:

    (1) Access to covered drugs, as provided under §§ 423.120 and 423.124.

    (2) Drug utilization management programs, quality assurance measures and systems, and MTMPs MTM programs as provided under § 423.153.

    (3) Privacy, confidentiality, and accuracy of enrollee records, as provided under § 423.136.

    (c) Effective date of deemed status. The date the Part D sponsor is deemed to meet the applicable requirements is the later of the following:

    (1) The date the accreditation organization is approved by CMS.

    (2) The date the Part D sponsor is accredited by the accreditation organization.

    (d) Obligations of deemed Part D sponsors. A Part D sponsor 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 a Part D sponsor's deemed status for any of the following reasons—

    (1) CMS determines, on the basis of its own investigation, that the Part D sponsor does not meet the Medicare requirements for which deemed status was granted.

    (2) CMS withdraws its approval of the accreditation organization that accredited the Part D sponsor.

    (3) The Part D sponsor fails to meet the requirements of paragraph (d) of this section.

    (f) Authority. Nothing in this section limits CMS' authority under subparts K and O of this part, including, but not limited to the ability to impose intermediate sanctions, civil money penalties, and terminate a contract with a Part D plan sponsor.

    [70 FR 4525, Jan. 28, 2005, as amended at 75 FR 19818, Apr. 15, 2010; 89 FR 30835, Apr. 23, 2024]