66364 Federal Register / Vol. 78, No. 214 / Tuesday, November 5, 2013 / Notices 

Leroy A. Richardson, 

Chief, Information Collection Review Office, 

Office of Scientific Integrity, Office of the 

Associate Director for Science, Office of the 

Director, Centers for Disease Control and 

Prevention. 

[FR Doc. 2013–26469 Filed 11–4–13; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–3110–FN] 

Medicare & Medicaid Programs: 

Application From the Accreditation 

Commission for Health Care for 

Continued CMS-Approval of Its 

Hospice Accreditation Program 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Final notice. 

SUMMARY: This final notice announces 

our decision to approve the 

Accreditation Commission for Health 

Care (ACHC) for continued recognition 

as a national accrediting organization 

for hospices that wish to participate in 

the Medicare or Medicaid programs. 

DATES: Effective: This final notice is 

effective November 27, 2013 through 

November 27, 2019. 

FOR FURTHER INFORMATION CONTACT: 

Valarie Lazerowich, (410) 786–4750. 

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) 

of the Social Security Act (the Act) 

establishes distinct criteria for facilities 

seeking designation as a hospice. 

Regulations concerning provider 

agreements are at 42 CFR part 489 and 

those pertaining to activities relating to 

the survey and certification of facilities 

are at 42 CFR part 488. The regulations 

at 42 CFR part 418 specify the 

conditions that a hospice must meet to 

participate in the Medicare program, the 

scope of covered services, and the 

conditions for Medicare payment for 

hospices. 

Generally, to enter into an agreement, 

a hospice must first be certified by a 

state survey agency as complying with 

the conditions or requirements set forth 

in part 418. Thereafter, the hospice is 

subject to regular surveys by a state 

survey agency to determine whether it 

continues to meet these requirements. 

However, there is an alternative to 

surveys by state agencies. Certification 

by a nationally recognized accreditation 

program can substitute for ongoing state 

review. 

Section 1865(a)(1) of the Act provides 

that, if a provider entity demonstrates 

through accreditation by an approved 

national accrediting organization that all 

applicable Medicare conditions are met 

or exceeded, CMS will deem those 

provider entities as having met the 

requirements. Accreditation by an 

accrediting organization is voluntary 

and is not required for Medicare 

participation. 

If an accrediting organization is 

recognized by the Secretary of the 

Department of Health and Human 

Services as having standards for 

accreditation that meet or exceed 

Medicare requirements, any provider 

entity accredited by the national 

accrediting body’s approved program 

would be deemed to have met the 

Medicare conditions. A national 

accrediting organization applying for 

approval of its accreditation program 

under part 488, subpart A, must provide 

CMS with reasonable assurance that the 

accrediting organization requires the 

accredited provider entities to meet 

requirements that are at least as 

stringent as the Medicare conditions. 

Our regulations concerning the 

approval of accrediting organizations 

are set forth at § 488.4 and § 488.8(d)(3). 

The regulations at § 488.8(d)(3) require 

accrediting organizations to reapply for 

continued approval of its accreditation 

program every 6 years or sooner as 

determined by CMS. 

The ACHC’s current term of approval 

for their hospice accreditation program 

expires November 27, 2013. 

II. Application Approval Process 

Section 1865(a)(3)(A) of the Act 

provides a statutory timetable to ensure 

that our review of applications for CMSapproval of an accreditation program is 

conducted in a timely manner. The Act 

provides us 210 days after the date of 

receipt of a complete application, with 

any documentation necessary to make 

the determination, to complete our 

survey activities and application 

process. Within 60 days after receiving 

a complete application, we must 

publish a notice in the Federal Register 

that identifies the national accrediting 

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 

approving or denying the application. 

III. Provisions of the Proposed Notice 

On May 3, 2013, we published a 

proposed notice in the Federal Register 

(78 FR 26036) announcing Accreditation 

Commission for Health Care’s request 

for approval of its hospice accreditation 

program. In the proposed notice, we 

detailed our evaluation criteria. Under 

section 1865(a)(2) of the Act and in our 

regulations at § 488.4 and § 488.8, we 

conducted a review of ACHC’s 

application in accordance with the 

criteria specified by our regulations, 

which include, but are not limited to the 

following: 

• An onsite administrative review of 

ACHC’s: (1) Corporate policies; (2) 

financial and human resources available 

to accomplish the proposed surveys; (3) 

procedures for training, monitoring, and 

evaluation of its surveyors; (4) ability to 

investigate and respond appropriately to 

complaints against accredited facilities; 

and (5) survey review and decisionmaking process for accreditation. 

• The comparison of ACHC’s 

accreditation requirements to our 

current Medicare hospice conditions of 

participation. 

• A documentation review of ACHC’s 

survey process to determine the 

following: 

++ The composition of the survey 

team, surveyor qualifications, and 

ACHC’s ability to provide continuing 

survey or training. 

++ Comparability of ACHC’s 

processes to those of state survey 

agencies, including survey frequency, 

and the ability to investigate and 

respond appropriately to complaints 

against accredited facilities. 

++ ACHC’s procedures for 

monitoring hospices out of compliance 

with ACHC’s program requirements. 

The monitoring procedures are used 

only when ACHC identifies 

noncompliance. If noncompliance is 

identified through validation reviews, 

the State survey agency monitors 

corrections as specified at § 488.7(d). 

++ ACHC’s ability to report 

deficiencies to the surveyed facilities 

and respond to the facility’s plan of 

correction in a timely manner. 

++ ACHC’s ability to provide CMS 

with electronic data and reports 

necessary for effective validation and 

assessment of the organization’s survey 

process. 

++ The adequacy of staff and other 

resources. 

++ ACHC’s ability to provide 

adequate funding for performing 

required surveys. 

++ ACHC’s policies with respect to 

whether surveys are announced or 

unannounced. 


wreier-aviles on DSK5TPTVN1PROD with NOTICES
Federal Register / Vol. 78, No. 214 / Tuesday, November 5, 2013 / Notices 66365 

++ ACHC’s agreement to provide 

CMS with a copy of the most current 

accreditation survey together with any 

other information related to the survey 

as we may require, including corrective 

action plans. 

In accordance with section 

1865(a)(3)(A) of the Act, the May 3, 

2013 proposed notice also solicited 

public comments regarding whether 

ACHC’s requirements met or exceeded 

the Medicare conditions of participation 

for hospices. We received no comments 

in response to our proposed notice. 

IV. Provisions of the Final Notice 

A. Differences Between ACHC’s 

Standards and Requirements for 

Accreditation and Medicare’s 

Conditions and Survey Requirements 

We compared ACHC’s hospice 

requirements and survey process with 

the Medicare conditions of participation 

and survey process as outlined in the 

State Operations Manual (SOM). Our 

review and evaluation of ACHC’s 

hospice application, which were 

conducted as described in section III of 

this final notice, yielded the following: 

• To meet the requirement at 

§ 418.3(2), ACHC amended its crosswalk 

and standards to accurately reflect the 

current regulatory language that the 

attending physician is identified by the 

individual, at the time he or she elects 

to receive hospice care, as having the 

most significant role in the 

determination and delivery of the 

individual’s medical care. 

• To meet the requirement at 

§ 418.24(c)(3), ACHC amended its 

preamble to accurately reflect the 

current regulatory language that an 

election to receive hospice care will be 

considered to continue through the 

initial election period and through the 

subsequent election periods without a 

break in care as long as the individual 

is not discharged from the hospice 

under the provisions in § 418.26. 

• To meet the requirement at 

§ 418.70, ACHC revised its standard to 

accurately address the care/services 

provided directly and those provided 

under arrangement. 

• To meet the requirement at 

§ 418.76(c), ACHC revised its standards 

to address the requirement that hospice 

aide services can be provided by an 

individual only after the successful 

completion of a competency evaluation 

program. 

• To meet the requirement at 

§ 418.78, ACHC revised its standard to 

reflect that the hospice must use 

volunteers in defined roles. 

• To meet the requirement at 

§ 418.104(d), ACHC revised its standard 

to reflect that if the hospice 

discontinues operation, hospice policies 

must provide for retention and storage 

of clinical records. 

• To meet the requirement at 

§ 418.106(e)(2)(i)(A), ACHC revised its 

standard to reflect that the hospice will 

provide a copy of the hospice’s written 

policies and procedures on the 

management and disposal of controlled 

drugs to the patient representative. 

• To meet the requirement at 

§ 418.106(e)(2)(i)(B), ACHC revised its 

standard to reflect the discussion of the 

hospice’s policies and procedures 

managing the safe use and disposal of 

controlled drugs to the patient 

representative. 

• To meet the requirement at 

§ 418.108(b)(1)(ii), ACHC revised its 

standard to allow for pain control, 

symptom management, and respite 

purposes in a Medicare or Medicaidcertified nursing facility, in addition to 

a Medicare or Medicaid-certified 

hospice or hospital that also meets the 

standards specified in § 418.110(e). 

• To meet the requirement at 

§ 418.110(n)(2)(i), ACHC revised its 

standard to address techniques to 

identify staff behaviors, events, and 

environmental factors that may trigger 

circumstances that require the use of a 

restraint or seclusion. 

• To meet the requirement at 

§ 418.112(c), ACHC provided a clear 

definition of the management of crisis 

situations and temporary emergencies. 

• To meet the requirement at 

§ 418.202(g), ACHC amended its 

preamble to accurately reflect the 

requirement that homemaker services 

may include assistance in maintenance 

of a safe and healthy environment and 

services to enable the individual to 

carry out the treatment plan. 

• To meet the requirements of 

Appendix M of the SOM, ACHC 

instituted processes and audits to 

ensure that the Medicare Enrollment 

Application Form CMS–855A is verified 

by the assigned Medicare 

Administrative Contractor (MAC) prior 

to conducting an initial survey. 

B. Term of Approval 

Based on our review and observations 

described in section III of this final 

notice, we have determined that ACHC’s 

hospice accreditation program 

requirements meet or exceed our 

requirements. Therefore, we approve 

ACHC as a national accreditation 

organization for hospices that request 

participation in the Medicare program, 

effective November 27, 2013 through 

November 27, 2019. 

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. 

(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: October 29, 2013. 

Marilyn Tavenner, 

Administrator, Centers for Medicare & 

Medicaid Services. 

[FR Doc. 2013–26374 Filed 11–4–13; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Proposed Information Collection 

Activity; Comment Request 

Proposed Projects: 

Title: DRA TANF Final Rule. 

OMB No.: 0970–0338. 

Description: When the Deficit 

Reduction Act of 2005 (DRA) 

reauthorized the Temporary Assistance 

for Needy Families (TANF) program, it 

imposed a new data requirement that 

States prepare and submit data 

verification procedures and replaced 

other data requirements with new 

versions including: the TANF Data 

Report, the SSP–MOE Data Report, the 

Caseload Reduction Documentation 

Process, and the Reasonable Cause/

Corrective Compliance Documentation 

Process. The Continuing Appropriations 

Act, 2014 (Pub. L. 113–46) provides 

federal funds to operate Temporary 

Assistance for Needy Families (TANF) 

programs in the states, DC, Guam, 

Puerto Rico, the U.S. Virgin Islands, and 

for approved federally recognized tribes 

and Alaskan Native Villages through 

January 15, 2014. We are proposing to 

continue these information collections 

without change. 

Respondents: The 50 States of the 

United States, the District of Columbia, 

Guam, Puerto Rico, and the Virgin 

Islands. 


wreier-aviles on DSK5TPTVN1PROD with NOTICES