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[Federal Register: July 16, 2010 (Volume 75, Number 136)]
[Notices]               
[Page 41503-41505]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr16jy10-61]                         

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-2900-FN2]

 
Medicare and Medicaid Programs; Approval of the Community Health 
Accreditation Program for Continued Deeming Authority for Hospices

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Final notice of Removal of Conditional Probationary Status.

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SUMMARY: Based on our review and observations, we have determined that 
the standards and processes used by the Community Health Accreditation 
Program (CHAP) hospice accreditation program meet or exceed our 
requirements. This final notice announces our decision to approve 
without condition CHAP's request for continued recognition as a 
national accreditation program for hospices seeking to participate in 
the Medicare or Medicaid programs.

DATES: Effective Date: This final notice is effective November 20, 2009 
through November 20, 2012.

FOR FURTHER INFORMATION CONTACT:

Cindy Melanson, (410) 786-0310.
Patricia Chmielewski (410) 786-6899.

SUPPLEMENTARY INFORMATION:

I. Background

    Under the Medicare program, eligible beneficiaries may receive 
covered services in a hospice, provided certain requirements are met. 
Section 1861(dd)(1) of the Social Security Act (the Act) establishes 
distinct criteria for entities seeking designation as a hospice

[[Page 41504]]

program. Under this authority, the regulations at 42 CFR part 418 
specify the conditions that a hospice must meet in order to participate 
in the Medicare program, the scope of covered services, and the 
conditions for Medicare payment for hospice care. Provider agreement 
regulations are located in 42 CFR part 489 and regulations pertaining 
to the survey and certification of facilities are located in 42 CFR 
part 488.
    Generally, in order to enter into an agreement, a hospice facility 
must first be certified by a State survey agency as complying with 
conditions or requirements set forth in part 418 of our regulations. 
Then, the hospice is subject to regular surveys by a State survey 
agency to determine whether it continues to meet these requirements. 
There is an alternative, however, to surveys by State agencies.
    Section 1865(a)(1) of the Act provides that, if a provider entity 
demonstrates through accreditation by an approved national 
accreditation organization (AO) that all applicable Medicare conditions 
or requirements are met or exceeded, we may deem those provider 
entities as having met the requirements. Accreditation by an AO is 
voluntary and is not required for Medicare participation.
    A national AO applying for approval of deeming authority under part 
488, subpart A, must provide us with reasonable assurance that the AO 
requires the accredited provider entities to meet requirements that are 
at least as stringent as the Medicare conditions. Our regulations 
concerning re-approval of AOs are set forth at Sec.  488.4 and Sec.  
488.8(d)(3). The regulations at Sec.  488.8(d)(3) require AOs to 
reapply for continued approval of deeming authority every 6 years, or 
sooner as determined by CMS. The regulation at Sec.  488.8(f)(3)(i) 
provides CMS the authority to grant conditional approval of an AO's 
deeming authority, with a probationary period of up to 180 days, if the 
AO has not adopted comparable standards during the reapplication 
process.
    We received a complete application from CHAP for continued 
recognition as a national AO for hospices on March 27, 2009. In 
accordance with the requirements at Sec.  488.4 and Sec.  488.8(d)(3), 
we published a proposed notice on May 22, 2009 (74 FR 24015) and a 
final notice announcing our decision to conditionally approve CHAP's 
hospice program subject to probationary conditions on October 23, 2009 
(74 FR 54832). This final notice provides CMS' final determination in 
response to the conditional approval with a 180-day probationary period 
granted to CHAP on October 23, 2009. This notice is required to be 
published no later than July 18, 2010.

II. Deeming Applications Approval Process

    Section 1865(a)(3)(A) of the Act provides a statutory timetable to 
ensure that our review of deeming applications is conducted in a timely 
manner. The Act provides us with 210 calendar days after the date of 
receipt of an application to complete our survey activities and 
application review process. Within 60 days of receiving a completed 
application, we must publish a notice in the Federal Register that 
identifies the national accreditation body making the request, 
describes the request, and provides no less than a 30-day public 
comment period. At the end of the 210-day period, we must publish a 
notice in the Federal Register of our approval or denial of the 
application. In accordance with Sec.  488.8(f)(2), if CMS determines 
following the deeming authority review that the organization has failed 
to adopt requirements comparable to CMS requirements, the AO may be 
given a conditional approval of its deeming authority for a 
probationary period of up to 180 days to adopt comparable requirements. 
Within 60 days after the end of this period, we must make a final 
determination as to whether or not the CHAP accreditation program for 
hospices is comparable to CMS requirements and issue an appropriate 
notice that includes our reasons for our determination.

III. Provisions of the October 23, 2009 Final Notice

    Our review of CHAP's renewal application for hospice deeming 
authority revealed that CHAP had on-going, serious, widespread areas of 
non-compliance. Specifically, CHAP's inability to provide us with 
accurate, timely data on deemed providers; lack of complete and 
accurate deemed facility survey files; and, failure to ensure that 
recertification surveys are conducted on an interval not exceeding 36 
months. Due to the significant number of areas of noncompliance 
identified during the review of CHAP's deeming authority, we 
conditionally approved CHAP's hospice accreditation program with a 180 
day probationary period. Under 1865(a)(2) of the Act and our 
regulations at Sec.  488.4 and Sec.  488.8, we conducted a 
comparability review of CHAP's hospice accreditation program to 
determine compliance with Medicare requirements for hospices at 42 CFR 
part 418.

IV. Provisions of the Final Notice

A. Differences Between CHAP's Standards and Requirements for 
Accreditation and Medicare's Conditions and Survey Requirements

    During the 180 day probationary period, we conducted a comparison 
of CHAP's accreditation requirements for hospices to our current 
Medicare conditions of Participation (CoPs) as outlined in the State 
Operations Manual (SOM). We also conducted a corporate onsite visit to 
validate proper application of the requirements. Our review and 
evaluation of CHAP's deeming application yielded the following:
     CHAP's survey files were complete, accurate, and 
consistent with the requirements at Sec.  488.6(a).
     CHAP's recertification surveys for hospices are conducted 
no later than 36 months after the date of the previous standard survey 
in accordance with the requirements at Sec.  488.20(a).
     CHAP's data submission are accurate, complete and timely 
in accordance with the requirements at Sec.  488.4(b).
     CHAP met the requirements at section 2728 of the SOM by 
developing an electronic plan of correction that specifically addressed 
the ``who, what, when, and how'' the hospice would correct each 
deficiency cited and ensure ongoing compliance.
     CHAP met requirements at Sec.  488.28(a) and section 2728 
of the SOM as evidenced by review of the survey files.
     CHAP policy regarding establishment of an effective date 
for new providers is consistent with the requirements at Sec.  488.13.

B. Term of Approval

    Based on the review and observations, we have determined that 
CHAP's hospice accreditation program meets or exceeds our requirements. 
Therefore, we approve CHAP as a national AO for hospices that request 
participation in the Medicare program, effective November 20, 2009 
through November 20, 2012. Under Sec.  488.8(f)(4), notice was given to 
CHAP on October 23, 2009 (74 FR 54832).

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).

[[Page 41505]]

(Catalog of Federal Domestic Assistance Program No. 93.778, Medical 
Assistance Program; No. 93.773 Medicare--Hospital Insurance Program; 
and No. 93.774, Medicare--Supplementary Medical Insurance Program)

    Dated: June 29, 2010.
Marilyn Tavenner,
Acting Administrator and Chief Operating Officer, Centers for Medicare 
& Medicaid Services.
[FR Doc. 2010-17405 Filed 7-15-10; 8:45 am]
BILLING CODE 4120-01-P
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