Federal Register / Vol. 79, No. 48 / Wednesday, March 12, 2014 / Notices 14049 

meetings and other committee 

management activities, for both the 

Centers for Disease Control and 

Prevention and the Agency for Toxic 

Substances and Disease Registry. 

Gary Johnson, 

Acting Director, Management Analysis and 

Services Office, Centers for Disease Control 

and Prevention. 

[FR Doc. 2014–05378 Filed 3–11–14; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Disease Control and 

Prevention 

Request for Nominations of 

Candidates To Serve on the World 

Trade Center Health Program 

Scientific/Technical Advisory 

Committee (the STAC or the 

Committee), Centers for Disease 

Control and Prevention, Department of 

Health and Human Services 

Correction: This notice was originally 

published in the Federal Register on 

January 30, 2014 Volume 79, Number 

20, page 4911. This notice is to 

announce the extension of submission 

for potential nominees. 

Nominations must be submitted 

(postmarked or electronically received) 

by March 31, 2014. Please submit 

written nominations (one original and 

two copies) to the following address 

only: NIOSH Docket 229–B, c/o Zaida 

Burgos, Committee Management 

Specialist, National Institute for 

Occupational Safety and Health, Centers 

for Disease Control and Prevention, 

1600 Clifton Rd. NE., MS: E–20, Atlanta, 

Georgia 30333 or electronic nominations 

to: nioshdocket@cdc.gov. Attachments 

in Microsoft Word are preferred. 

Telephone and facsimile submissions 

cannot be accepted. 

For further information, please 

contact: Paul Middendorf, Senior Health 

Scientist, 1600 Clifton Rd. NE., MS: E– 

20, Atlanta, GA 30333; Telephone (404) 

498–2500 (this is not a toll-free 

number); email pmiddendorf@cdc.gov. 

The Director, Management Analysis 

and Services Office, has been delegated 

the authority to sign Federal Register 

notices pertaining to announcements of 

meetings and other committee 

management activities for both the 

Centers for Disease Control and 

Prevention and the Agency for Toxic 

Substances and Disease Registry. 

Gary Johnson, 

Acting Director, Management Analysis and 

Services Office, Centers for Disease Control 

and Prevention (CDC). 

[FR Doc. 2014–05377 Filed 3–11–14; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–3286–FN] 

Medicare and Medicaid Programs; 

Application From the Joint 

Commission for Continued Approval of 

Its Home Health Agency (HHA) 

Accreditation Program 

AGENCY: Centers for Medicare and 

Medicaid Services, HHS. 

ACTION: Final Notice. 

SUMMARY: This notice announces our 

decision to approve the Joint 

Commission for continued recognition 

as a national accreditation program for 

Home Health Agencies (HHAs) seeking 

to participate in the Medicare or 

Medicaid programs. An HHA that 

participates in Medicaid must, in 

accordance with § 440.70(d) meet the 

Medicare participation requirements, 

and may demonstrate compliance 

through deemed status, as provided for 

under § 488.6(b), with the exception of 

the capitalization requirements at 

§ 489.28. 

DATES: Effective Date: This final notice 

is effective March 31, 2014 through 

March 31, 2020. 

FOR FURTHER INFORMATION CONTACT: 

Lillian Williams, (410) 786–8636, 

Patricia Chmielewski, (410) 786–6899, 

or Monda Shaver, (410) 786–3410. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Under the Medicare program, eligible 

beneficiaries may receive covered 

services from a HHA provided certain 

requirements are met. Sections 1861(o) 

and 1891 of the Social Security Act (the 

Act), establish distinct criteria for 

facilities seeking to participate in 

Medicare as an HHA. Regulations 

concerning Medicare provider 

agreements are at part 489 and those 

pertaining to activities relating to the 

survey and certification of facilities are 

at part 488. The regulations at part 484 

specify the minimum conditions that a 

HHA must meet to be certified to 

participate in the Medicare program. 

Generally, to enter into a Medicare 

agreement, a HHA must first be certified 

by a state survey agency as complying 

with the conditions set forth in part 484 

of the Medicare regulations. Thereafter, 

the HHA 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) of the Act provides 

that, if an accrediting organization is 

recognized by the Secretary as having 

standards for accreditation that meet or 

exceed all applicable Medicare 

conditions or requirements, as well as 

comparable survey procedures, a 

provider entity accredited under the 

national accrediting body’s approved 

Medicare accreditation program would 

be deemed to meet the Medicare 

conditions or requirements. 

Accreditation under an approved 

Medicare accreditation program of an 

accrediting organization is voluntary 

and is not required for Medicare 

participation. 

A national accrediting organization 

applying for approval of its 

accreditation program in accordance 

with section 1865(a)(2) and (3) of the 

Act and our implementing regulations at 

part 488, subpart A, must provide us 

with reasonable assurance that the 

accrediting organization requires the 

accredited provider entities to meet 

requirements that are at least as 

stringent as all of the applicable 

Medicare conditions or requirements. 

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 a Medicare 

accreditation program every 6 years or 

sooner, as determined by us. 

The Joint Commission’s current term 

of approval for its HHA accreditation 

program expires March 31, 2014. 

II. Approval of Deeming Organizations 

Section 1865(a)(2) of the Act and our 

regulations at § 488.8(a) require that our 

findings concerning review and 

approval of a national accrediting 

organization’s requirements consider, 

among other factors, the applying 

accrediting organization’s requirements 

for accreditation; its survey procedures; 

its ability to provide adequate resources 

for conducting required surveys and to 

furnish us information for use in 

enforcement activities; its monitoring 

procedures for provider entities found 

not in compliance with the conditions 

or requirements; and its ability to 

provide us with the necessary data for 

validation. 


tkelley on DSK3SPTVN1PROD with NOTICES
14050 Federal Register / Vol. 79, No. 48 / Wednesday, March 12, 2014 / Notices 

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

further requires that we publish, within 

60 days of receipt of an organization’s 

complete application, a notice 

identifying the national accrediting 

body making the request, describing the 

nature of the request, and providing at 

least a 30-day public comment period. 

We have 210 days from the receipt of a 

complete application to publish notice 

of approval or denial of the application. 

III. Proposed Notice 

On October 25, 2013, we published a 

proposed notice (78 FR 63984) 

announcing the Joint Commission’s 

request for re-approval of its Medicare 

accreditation program for HHAs. In the 

proposed notice, we detailed our 

evaluation criteria. Under section 

1865(a)(2) of the Act and our regulations 

at § 488.4 (Application and 

reapplication procedures for 

accreditation organizations), we 

conducted a review of the Joint 

Commission’s application in accordance 

with the criteria specified by our 

regulation, which include, but are not 

limited to the following: 

• An onsite administrative review of 

the Joint Commission’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. 

• A comparison of the Joint 

Commission’s HHA accreditation 

standards to our current Medicare HHA 

conditions of participation. 

• A documentation review of the 

Joint Commission’s survey processes to: 

++ Determine the composition of the 

survey team, surveyor qualifications, 

and the ability of the Joint Commission 

to provide continuing surveyor training. 

++ Compare the Joint Commission’s 

processes to those we require of State 

survey agencies, including survey 

frequency, and the ability to investigate 

and respond appropriately to 

complaints against accredited facilities. 

++ Evaluate the Joint Commission’s 

procedures for monitoring providers or 

suppliers found to be out of compliance 

with the Joint Commission HHA 

program requirements. The monitoring 

procedures are required only when the 

Joint Commission identifies 

noncompliance. If substantial 

noncompliance is identified through a 

state validation survey, the state survey 

agency monitors corrections as specified 

at § 488.7(d). 

++ Assess the Joint Commission’s 

ability to report deficiencies to the 

surveyed facility and respond to the 

facility’s plan of correction in a timely 

manner. 

++ Establish the Joint Commission’s 

ability to provide us with electronic 

data and reports in requested format 

necessary for effective validation and 

assessment of the Joint Commission’s 

survey process. 

++ Review the Joint Commission’s 

ability to provide adequate funding for 

performing required surveys. 

++ Confirm the Joint Commission’s 

policies with respect to whether surveys 

are announced or unannounced. 

++ Obtain the Joint Commission’s 

agreement to provide us with a copy of 

the most recent 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 October 25, 

2013 proposed notice (78 FR 63984) also 

solicited public comments regarding 

whether the Joint Commission’s 

requirements meet or exceed the 

Medicare conditions of participation for 

HHAs. We received no public comments 

in response to our proposed notice. 

IV. Provisions of the Final Notice 

A. Differences Between the Joint 

Commission’s Standards and 

Requirements for Accreditation and 

Medicare’s Conditions and Survey 

Requirements 

We compared the standards contained 

in the Joint Commission’s Medicare 

program accreditation requirements for 

HHAs and its survey process in the Joint 

Commission’s Application for Renewal 

of Deeming Authority for HHA Facilities 

with the Medicare HHA conditions for 

participation and our State Operations 

Manual. Our review and evaluation of 

the Joint Commission’s accreditation 

application, which were conducted as 

described in section III. of this final 

notice, yielded the following: 

• To meet the requirements at § 484.2, 

the Joint Commission revised its 

glossary to include all HHA definitions. 

• To meet the requirements at 

§ 484.4(a)(1), the Joint Commission 

revised it’s glossary to include the 

required qualifications for an 

Occupational Therapist and 

Occupational Therapy assistant. 

• To meet the requirements at § 484.4, 

the Joint Commission revised it’s 

glossary to include the required 

qualifications for a Physical Therapist 

and Physical Therapy Assistant. 

• To meet the requirements at 

§ 484.10, the Joint Commission revised 

its standards to address the requirement 

that the HHA protect and promote the 

exercise of a patient’s rights. 

• To meet the requirements at 

§ 484.10(b)(5), the Joint Commission 

revised its standards to address the 

requirement that the HHA ‘‘must’’ 

investigate complaints. 

• To meet the requirements at 

§ 484.10(d), the Joint Commission 

modified its standards to ensure the 

patient’s right to confidentiality of the 

medical record. 

• To meet the requirements at 

§ 484.10(f), the Joint Commission 

revised its standards to address the 

patient’s right to use the HHA hotline to 

lodge complaints concerning the 

implementation of the advance 

directives requirements. 

• To meet the requirements at 

§ 484.36(c)(1), the Joint Commission 

revised its policies and procedures to 

ensure patient care instructions 

provided to the home health aide are 

clearly written and do not include the 

use of visit ranges and other 

assignments at the discretion of the 

aide. 

• To meet the requirements at 

§ 484.14(b), the Joint Commission 

revised its standards to address the 

governing body’s responsibility to adopt 

and periodically review written bylaws 

or an acceptable equivalent and oversee 

fiscal affairs. 

• To meet the requirements at 

§ 484.16, the Joint Commission modified 

its standards to require that the group of 

professional personnel establish and 

annually review policies governing 

medical supervision, plans of care, and 

personnel qualifications. 

• To meet the requirements at 

§ 484.18, the Joint Commission revised 

its standards to require the plan of care 

be established by a doctor of medicine, 

osteopathy, or podiatric medicine. 

• To meet the requirements at 

§ 484.18(c), the Joint Commission 

revised its standards to require ‘‘an 

assessment for contraindications’’ be 

conducted prior to administration of 

drugs and treatment. 

• To meet the requirements at 

§ 484.32(a), the Joint Commission 

revised its standards to address the 

requirement that a physical therapy 

assistant or occupational therapy 

assistant can perform services planned, 

delegated, and supervised by the 

therapist. 

• To meet the requirements at 

§ 484.36, the Joint Commission modified 

its standards to ensure the home health 

aide’s competence in providing care. 

• To meet the requirements at 

§ 484.36(a)(2)(i)(B), the Joint 

Commission revised its standards to 


tkelley on DSK3SPTVN1PROD with NOTICES
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