Federal Register / Vol. 69, No. 185 / Friday, September 24, 2004 / Notices 57307

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare and Medicaid 

Services 

[CMS–2256–PN] 

RIN 0938–ZA60 

Medicare and Medicaid Programs; 

Application by the Community Health 

Accreditation Program (CHAP) for 

Home Health Agencies

AGENCY: Centers for Medicare and 

Medicaid Services, HHS.

ACTION: Proposed notice.

SUMMARY: This proposed notice with 

comment period acknowledges the 

receipt of an application from the 

Community Health Accreditation 

Program for continued recognition as a 

national accreditation program for 

Home Health Agencies that wish to 

participate in the Medicare or Medicaid 

programs. The statute requires that 

within 60 days of receipt of an 

organization’s complete application, we 

will publish a notice that will announce 

our receipt of the accreditation 

organization’s application for approval, 

describe the criteria we will use in 

evaluating the application, and provide 

at least a 30-day public comment 

period.

DATES: To be assured consideration, 

comments must be received at one of 

the addresses provided below, no later 

than 5 p.m. on October 25, 2004.

ADDRESSES: In commenting, please refer 

to file code CMS–2256–PN. Because of 

staff and resource limitations, we cannot 

accept comments by facsimile (FAX) 

transmission. 

You may submit comments in one of 

three ways (no duplicates, please): 

1. Electronically. You may submit 

electronic comments on specific issues 

in this regulation to http://www.cms.

hhs.gov/regulations/ecomments.

(Attachments should be in Microsoft 

Word, WordPerfect, or Excel; however, 

we prefer Microsoft Word.) 

2. By mail. You may mail written 

comments (one original and two copies) 

to the following address only: Centers 

for Medicare & Medicaid Services, 

Department of Health and Human 

Services, Attention: CMS–2256–PN, 

P.O. Box 8017, Baltimore, MD 21244–

8017. 

Please allow sufficient time for mailed 

comments to be received before the 

close of the comment period. 

3. By hand or courier. If you prefer, 

you may deliver (by hand or courier) 

your written comments (one original 

and two copies) before the close of the 

comment period to one of the following 

addresses. If you intend to deliver your 

comments to the Baltimore address, 

please call telephone number (410) 786–

7195 in advance to schedule your 

arrival with one of our staff members.

Room 445–G, Hubert H. Humphrey 

Building, 200 Independence Avenue, 

SW., Washington, DC 20201;

or

7500 Security Boulevard, Baltimore, MD 

21244–1850.

(Because access to the interior of the 

HHH 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 for persons wishing to retain 

a proof of filing by stamping in and 

retaining an extra copy of the comments 

being filed.) 

Comments mailed to the addresses 

indicated as appropriate for hand or 

courier delivery may be delayed and 

received after the comment period.

FOR FURTHER INFORMATION CONTACT:

Cindy Melanson, (410) 786–0310.

SUPPLEMENTARY INFORMATION: 

I. Background 

[If you choose to comment on issues in 

this section, please include caption 

‘‘Background’’ at the beginning of your 

comments.]

Under the Medicare program, eligible 

beneficiaries may receive covered 

services in a Home Health Agency 

(HHA) provided certain requirements 

are met. Sections 1861(o) and 1891 of 

the Social Security Act (the Act) 

establish distinct criteria for facilities 

seeking designation as HHAs. 

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 484 specify the conditions 

that an HHA must meet to participate in 

the Medicare program, the scope of 

covered services, and the conditions for 

Medicare payment for home health care. 

Generally, to enter into an agreement, 

an HHA must first be certified by a State 

survey agency as complying with the 

conditions or requirements set forth in 

part 484 of our regulations. Then, 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(b)(1) of the Act provides 

that, if a provider entity demonstrates 

through accreditation by an approved 

national accreditation organization that 

all applicable Medicare conditions are 

met or exceeded, we would ‘‘deem’’

those provider entities as having met the 

requirements. Accreditation by an 

accreditation organization is voluntary 

and is not required for Medicare 

participation. 

If an accreditation organization is 

recognized by the Secretary 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 meet the 

Medicare conditions. A national 

accreditation organization applying for 

approval of deeming authority under 

part 488, subpart A must provide us 

with reasonable assurance that the 

accreditation organization requires the 

accredited provider entities to meet 

requirements that are at least as 

stringent as the Medicare conditions. 

Our regulations concerning reapproval 

of accrediting organizations are set forth 

at § 488.4 and § 488.8(d)(3). The 

regulations at § 488.8(d)(3) require 

accreditation organizations to reapply 

for continued approval of deeming 

authority every 6 years or sooner, as 

determined by CMS. CHAP’s term of 

approval as a recognized accreditation 

program for HHAs expires March 31, 

2005. 

II. Approval of Deeming Organizations 

[If you choose to comment on this 

section, please include the caption 

‘‘Approval of Deeming Organizations’’

at the beginning of your comments.]

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

regulations at § 488.8(a) require that our 

findings concerning review and 

reapproval of a national accrediting 

organization’s requirements consider, 

among other factors, the reapplying 

accreditation organization’s: 

Requirements for accreditation; survey 

procedures; resources for conducting 

required surveys; capacity to furnish 

information for use in enforcement 

activities; monitoring procedures for 

provider entities found not in 

compliance with the conditions or 

requirements; and ability to provide us 

with the necessary data for validation. 

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

further requires that we publish, within 

60 days of receipt of an accreditation 

organization’s complete application, a 

notice identifying the national 

accreditation 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 our receipt of a completed 

application to publish approval or 

denial of the application. 

57308 Federal Register / Vol. 69, No. 185 / Friday, September 24, 2004 / Notices 

The purpose of this proposed notice 

is to inform the public of our 

consideration of CHAP’s request for 

approval of continued deeming 

authority for HHAs. This notice also 

solicits public comment on whether 

CHAP’s requirements meet or exceed 

the Medicare conditions for 

participation for HHAs. 

III. Evaluation of Deeming Authority 

Request 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Evaluation of Deeming Authority 

Request’’ at the beginning of your 

comments.]

On June 30, 2004, CHAP submitted all 

the necessary materials to enable us to 

make a determination concerning its 

request for reapproval as a deeming 

organization for HHAs. Under section 

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

at § 488.8 (Federal review of 

accreditation organizations), our review 

and evaluation of CHAP will be 

conducted in accordance with, but not 

necessarily limited to, the following 

factors: 

• The equivalency of CHAP standards 

for HHAs as compared with our 

comparable HHA conditions of 

participation. 

• CHAP’s survey process to 

determine the following: 

+ The composition of the survey 

team, surveyor qualifications, and the 

ability of the organization to provide 

continuing surveyor training. 

+ The comparability of CHAP 

processes to that of State agencies, 

including survey frequency, and the 

ability to investigate and respond 

appropriately to complaints against 

accredited facilities. 

+ CHAP’s processes and procedures 

for monitoring providers or suppliers 

found out of compliance with CHAP 

program requirements. These 

monitoring procedures are used only 

when CHAP identifies noncompliance. 

If noncompliance is identified through 

validation reviews, the survey agency 

monitors corrections as specified at 

§ 488.7(d). 

+ CHAP’s capacity to report 

deficiencies to the surveyed facilities 

and respond to the facility’s plan of 

correction in a timely manner. 

+ CHAP capacity to provide us with 

electronic data in ASCII comparable 

code, and reports necessary for effective 

validation and assessment of the 

organization’s survey process. 

+ The adequacy of CHAP’s staff and 

other resources, and its financial 

viability. 

+ CHAP’s capacity to adequately 

fund required surveys. 

+ CHAP’s policies with respect to 

whether surveys are announced or 

unannounced. 

+ CHAP’s agreement to provide us 

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). 

IV. Response to Comments 

Because of the large number of public 

comments we normally receive on 

Federal Register documents, we are not 

able to acknowledge or respond to them 

individually. We will consider all 

comments we receive by the date and 

time specified in the DATES section of 

this preamble, and, when we proceed 

with a subsequent document, we will 

respond to the comments in the 

preamble to that document. 

Upon completion of our evaluation, 

including evaluation of comments 

received as a result of this notice, we 

will publish a final notice in the Federal 

Register announcing the result of our 

evaluation. 

V. Regulatory Impact Statement 

In accordance with the provisions of 

Executive Order 12866, this regulation 

was not reviewed by the Office of 

Management and Budget.

Authority: Section 1865 of the Social 

Security Act (42 U.S.C. 1395bb).

(Catalog of Federal Domestic Assistance 

Program No. 93.778, Medical Assistance 

Program)

Dated: September 10, 2004. 

Mark B. McClellan, 

Administrator, Centers for Medicare & 

Medicaid Services.

[FR Doc. 04–21194 Filed 9–23–04; 8:45 am] 

BILLING CODE 4120–01–P

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–2208–PN] 

RIN 0938–AZ59 

Medicare and Medicaid Programs; 

Application by the American 

Osteopathic Association for Continued 

Approval of Deeming Authority for 

Hospitals

AGENCY: Centers for Medicare & 

Medicaid Services, HHS.

ACTION: Proposed notice.

SUMMARY: This proposed notice with 

comment period acknowledges the 

receipt of an application from the 

American Osteopathic Association 

(AOA) for continued recognition as a 

national accreditation program for 

hospitals that wish to participate in the 

Medicare or Medicaid programs. Section 

1865(b)(3)(A) of the Social Security Act 

(the Act) requires that within 60 days of 

receipt of an organization’s complete 

application, we publish a notice that 

identifies the national accrediting body 

making the request, describes the nature 

of the request, and provides at least a 

30-day public comment period.

DATES: We will consider comments if 

we receive them at the appropriate 

address, as provided below, no later 

than 5 p.m. on October 25, 2004.

ADDRESSES: In commenting, please refer 

to file code CMS–2208–PN. Because of 

staff and resource limitations, we cannot 

accept comments by facsimile (FAX) 

transmission. 

You may submit comments in one of 

three ways (no duplicates, please): 

1. Electronically. You may submit 

electronic comments on specific issues 

in this regulation to http://

www.cms.hhs.gov/regulations/

ecomments. (Attachments should be in 

Microsoft Word, WordPerfect, or Excel; 

however, we prefer Microsoft Word.) 

2. By mail. You may mail written 

comments (one original and two copies) 

to the following address ONLY: Centers 

for Medicare & Medicaid Services, 

Department of Health and Human 

Services, Attention: CMS–2208–PN, 

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 hand or courier. If you prefer, 

you may deliver (by hand or courier) 

your written comments (one original 

and two copies) before the close of the 

comment period to one of the following 

addresses. If you intend to deliver your 

comments to the Baltimore address, 

please call telephone number (410) 786–

7195 in advance to schedule your 

arrival with one of our staff members; 

Room 445–G, Hubert H. Humphrey 

Building, 200 Independence Avenue, 

SW., Washington, DC 20201; or 7500 

Security Boulevard, Baltimore, MD 

21244–1850. 

(Because access to the interior of the 

HHH 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 for persons wishing to retain 

a proof of filing by stamping in and 

retaining an extra copy of the comments 

being filed.)