Federal Register / Vol. 79, No. 48 / Wednesday, March 12, 2014 / Notices 14051 

include a reference to the personnel 

qualifications at § 484.4. 

• To meet the requirements at 

§ 484.38, the Joint Commission revised 

its standards to address the additional 

health and safety requirements set forth 

in § 485.711, § 485.713, § 485.715, 

§ 485.719, § 485.723, and § 485.727 of 

the Code of Federal Regulations (CFR) to 

implement section 1861(p) of the Act. 

• To meet the requirements at 

§ 484.48(b), the Joint Commission 

revised its standards to ensure clinical 

record information is ‘‘safeguarded 

against loss.’’ 

• To meet the requirements at 

§ 484.52, the Joint Commission revised 

its standards to ensure the HHA’s 

required annual self-evaluation assess 

the extent to which the agency’s 

program is appropriate, adequate, 

effective and efficient. 

• To meet the requirements at 

§ 484.52(b), the Joint Commission 

revised its standards to ensure the HHA 

include appropriate health professionals 

that represent ‘‘the scope of the 

program’’ in the required quarterly 

internal HHA review of a sample of 

clinical records. 

• To meet the requirements at 

§ 488.4(b)(3)(iii) and § 488.8(d)(1), the 

Joint Commission revised its policies to 

ensure that CMS is notified in advance 

of any proposed changes in its approved 

Medicare HHA accreditation program. 

• To meet the requirements of the 

Joint Commission’s Appendix L 

‘‘Addendum for Home Health Deemed 

Status Surveys’’, the Joint Commission 

modified its policy to ensure surveyors 

conduct the required number of case 

reviews that include observing home 

visits. 

• The Joint Commission amended its 

policy to clearly state that follow-up 

surveys following identification of 

condition-level non-compliance are 

conducted within 45 ‘‘calendar’’ days of 

the survey end date. 

• During the review of the Joint 

Commission’s application, CMS issued 

notice to the Joint Commission with 

respect to all of its CMS-approved 

Medicare accreditation programs, in 

connection with its citation practices 

and its use of standards that are 

frequency-based and require a minimum 

frequency of observations of deficient 

practices before a citation will be made, 

so-called ‘‘C- weighted’’ standards. Due 

to the fact that this letter was released 

late in the review of the Joint 

Commission’s current HHA application, 

there was not sufficient time for the 

Joint Commission to fully implement 

and provide evidence of sustained 

compliance with the provisions of this 

notice. To verify compliance in this 

area, CMS will conduct a follow-up 

survey observation and corporate onsite 

within one year of the date of 

publication of this notice. 

B. Term of Approval 

Based on the review and observations 

described in section III. of this final 

notice, we have determined that the 

Joint Commission’s requirements for 

HHAs meet or exceed our requirements. 

Therefore, we approve the Joint 

Commission as a national accreditation 

organization for HHAs that request 

participation in the Medicare program, 

effective March 31, 2014 through March 

31, 2020. 

V. Collection of Information 

Requirements 

This document does not impose 

information collection and 

recordkeeping requirements. 

Consequently, it need not be reviewed 

by the Office of Management and 

Budget under the authority of the 

Paperwork Reduction Act of 1995 (44 

U.S.C. 35). 

Dated: March 6, 2014. 

Marilyn Tavenner, 

Administrator, Centers for Medicare & 

Medicaid Services. 

[FR Doc. 2014–05328 Filed 3–11–14; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF THE TREASURY 

Internal Revenue Service 

DEPARTMENT OF LABOR 

Employee Benefits Security 

Administration 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–9942–NC] 

Request for Information Regarding 

Provider Non-Discrimination 

AGENCY: Internal Revenue Service, 

Department of the Treasury; Employee 

Benefits Security Administration, 

Department of Labor; Centers for 

Medicare & Medicaid Services, 

Department of Health and Human 

Services. 

ACTION: Request for information. 

SUMMARY: This document is a request for 

information regarding provider nondiscrimination. The Departments of 

Labor, Health and Human Services 

(HHS), and the Treasury (collectively, 

the Departments) invite public 

comments via this request for 

information. 

DATES: Comments must be submitted on 

or before June 10, 2014. 

ADDRESSES: Written comments may be 

submitted to HHS. Any comment that is 

submitted will be shared with the other 

Departments. Please do not submit 

duplicates. All comments will be made 

available to the public. Warning: Please 

do not include any personally 

identifiable information (such as name, 

address, or other contact information) or 

confidential business information that 

you do not want publicly disclosed. All 

comments are posted on the Internet 

exactly as received and can be retrieved 

by most Internet search engines. No 

deletions, modifications, or redactions 

will be made to the comments received, 

as they are public records. Comments 

may be submitted anonymously. 

You may submit comments in one of 

four ways (please choose only one of the 

ways listed): 

1. Electronically. You may submit 

electronic comments on this regulation 

to http://www.regulations.gov. Follow 

the ‘‘Submit a comment’’ instructions. 

2. By regular mail. You may mail 

written comments to the following 

address only: Centers for Medicare & 

Medicaid Services, Department of 

Health and Human Services, Attention: 

CMS–9942–NC, P.O. Box 8016, 

Baltimore, MD 21244–8016. 

Please allow sufficient time for mailed 

comments to be received before the 

close of the comment period. 

3. By express or overnight mail. You 

may send written comments to the 

following address only: Centers for 

Medicare & Medicaid Services, 

Department of Health and Human 

Services, Attention: CMS–9942–NC, 

Mail Stop C4–26–05, 7500 Security 

Boulevard, Baltimore, MD 21244–1850. 

4. By hand or courier. Alternatively, 

you may deliver (by hand or courier) 

your written comments only to the 

following addresses prior to the close of 

the comment period: 

a. For delivery in Washington, DC— 

Centers for Medicare & Medicaid 

Services, Department of Health and 

Human Services, Room 445–G, Hubert 

H. Humphrey Building, 200 

Independence Avenue SW., 

Washington, DC 20201 

(Because access to the interior of the 

Hubert H. Humphrey Building is not 

readily available to persons without 

Federal government identification, 

commenters are encouraged to leave 

their comments in the CMS drop slots 

located in the main lobby of the 

building. A stamp-in clock is available 


tkelley on DSK3SPTVN1PROD with NOTICES
14052 Federal Register / Vol. 79, No. 48 / Wednesday, March 12, 2014 / Notices 

1PHS Act section 2706(a) also is incorporated 

into section 715(a)(1) of the Employee Retiree 

Income Security Act (ERISA) and section 9815(a)(1) 

of the Internal Revenue Code (the Code). 

Accordingly, the Departments have concurrent 

jurisdiction over the implementation of PHS Act 

section 2706(a). 

2See FAQs about Affordable Care Act 

Implementation Part XV, available at http:// 

www.dol.gov/ebsa/faqs/faq-aca15.html and http:// 

www.cms.gov/CCIIO/Resources/Fact-Sheets-andFAQs/aca_implementation_faqs15.html. 

3S. Rep. No. 113–71, at 126 (2013). 

4S. Rep. No. 113–71, at 126 (2013). Additionally, 

in Title I of the report, regarding the Department of 

Labor Employee Benefits Security Administration, 

the Committee ‘‘directs the Department to work 

with HHS and the Department of the Treasury to 

revise their joint FAQ regarding section 2706 of the 

ACA, as explained in the HHS title of this report.’’ 

S. Rep. No. 113–71, at 27 (2013). 

for persons wishing to retain a proof of 

filing by stamping in and retaining an 

extra copy of the comments being filed.) 

b. For delivery in Baltimore, MD— 

Centers for Medicare & Medicaid 

Services, Department of Health and 

Human Services, 7500 Security 

Boulevard, Baltimore, MD 21244–1850. 

If you intend to deliver your 

comments to the Baltimore address, call 

telephone number (410) 786–7195 in 

advance to schedule your arrival with 

one of our staff members. 

Comments erroneously mailed to the 

addresses indicated as appropriate for 

hand or courier delivery may be delayed 

and received after the comment period. 

For information on viewing public 

comments, see the beginning of the 

SUPPLEMENTARY INFORMATION section. 

FOR FURTHER INFORMATION CONTACT: Beth 

Baum or Amy Turner, Employee 

Benefits Security Administration, 

Department of Labor, at (202) 693–8335; 

Karen Levin, Internal Revenue Service, 

Department of the Treasury, at (202) 

317–6846; Cam Moultrie Clemmons, 

Centers for Medicare & Medicaid 

Services (CMS), Department of Health 

and Human Services, at (410) 786–1565. 

Customer Service Information: 

Individuals interested in obtaining 

information from the Department of 

Labor concerning employment-based 

health coverage laws may call the EBSA 

Toll-Free Hotline at 1–866–444–EBSA 

(3272) or visit the Department of Labor’s 

Web site (http://www.dol.gov/ebsa). In 

addition, information from HHS on 

private health insurance for consumers 

can be found on the CMS Web site 

(www.cciio.cms.gov), and information 

on health reform can be found at http:// 

www.HealthCare.gov. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Section 2706(a) of the Public Health 

Service Act (PHS Act),1 as added by 

section 1201 of the Affordable Care Act, 

states that a ‘‘group health plan and a 

health insurance issuer offering group or 

individual health insurance coverage 

shall not discriminate with respect to 

participation under the plan or coverage 

against any health care provider who is 

acting within the scope of that 

provider’s license or certification under 

applicable state law.’’ Section 2706(a) of 

the PHS Act does not require ‘‘that a 

group health plan or health insurance 

issuer contract with any health care 

provider willing to abide by the terms 

and conditions for participation 

established by the plan or issuer,’’ and 

nothing in section 2706(a) of the PHS 

Act prevents ‘‘a group health plan, a 

health insurance issuer, or the Secretary 

from establishing varying 

reimbursement rates based on quality or 

performance measures.’’ 

On April 29, 2013, the Departments 

issued a Frequently Asked Question 

(FAQ),2 that states that section 2706(a) 

of the PHS Act is applicable to nongrandfathered group health plans and 

health insurance issuers offering group 

or individual coverage for plan years (in 

the individual market, policy years) 

beginning on or after January 1, 2014 

and stated that until further guidance is 

issued, plans and issuers are expected to 

implement the requirements of section 

2706(a) of the PHS Act using a good 

faith, reasonable interpretation of the 

law. The FAQ states that, for this 

purpose, to the extent an item or service 

is a covered benefit under the plan or 

coverage, and consistent with 

reasonable medical management 

techniques specified under the plan 

with respect to the frequency, method, 

treatment or setting for an item or 

service, a plan or issuer shall not 

discriminate based on a provider’s 

license or certification, to the extent the 

provider is acting within the scope of 

the provider’s license or certification 

under applicable state law. The FAQ 

also states that section 2706(a) of the 

PHS Act does not require plans or 

issuers to accept all types of providers 

into a network and also does not govern 

provider reimbursement rates, which 

may be subject to quality, performance, 

or market standards and considerations. 

The Senate Committee on 

Appropriations Report dated July 11, 

2013 (to accompany S. 1284) 3 states 

that section 2706 of the PHS Act 

‘‘prohibits certain types of health plans 

and issuers from discriminating against 

any healthcare provider who is acting 

within the scope of that provider’s 

license or certification under applicable 

State law, when determining networks 

of care eligible for reimbursement. The 

goal of this provision is to ensure that 

patients have the right to access covered 

health services from the full range of 

providers licensed and certified in their 

State. The Committee is therefore 

concerned that the FAQ document 

issued by HHS, DOL and the 

Department of Treasury on April 29, 

2013, advises insurers that this 

nondiscrimination provision allows 

them to exclude from participation 

whole categories of providers operating 

under a State license or certification. In 

addition, the FAQ advises insurers that 

section 2706 allows discrimination in 

the reimbursement rates based on broad 

‘market considerations’ rather than the 

more limited exception cited in the law 

for performance and quality measures. 

Section 2706 was intended to prohibit 

exactly these types of discrimination. 

The Committee believes that insurers 

should be made aware of their 

obligation under section 2706 before 

their health plans begin operating in 

2014. The Committee directs HHS to 

work DOL and the Department of 

Treasury to correct the FAQ to reflect 

the law and congressional intent within 

30 days of enactment of this act.’’ 4

II. Solicitation of Comments 

Pursuant to this report, the 

Departments are requesting comments 

on all aspects of the interpretation of 

section 2706(a) of the PHS Act. This 

includes but is not limited to comments 

on access, costs, other federal and state 

laws, and feasibility. 

Signed at Washington, DC, this 6th day of 

March, 2014. 

Victoria A. Judson, 

Division Counsel/Associate Chief Counsel, 

Tax Exempt and Government Entities, 

Internal Revenue Service, Department of the 

Treasury. 

Signed at Washington, DC, this 6th day of 

March, 2014. 

George H. Bostick, 

Benefits Tax Counsel, Department of the 

Treasury. 

Signed this 5th day of March 2014. 

Phyllis C. Borzi, 

Assistant Secretary, Employee Benefits 

Security Administration, Department of 

Labor. 

Dated: March 6, 2014. 

Marilyn Tavenner, 

Administrator, Centers for Medicare & 

Medicaid Services. 

Dated: March 6, 2014. 

Kathleen Sebelius, 

Secretary, Department of Health and Human 

Services. 

[FR Doc. 2014–05348 Filed 3–7–14; 4:15 pm] 

BILLING CODE 4510–29–P 


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