[Federal Register Volume 89, Number 1 (Tuesday, January 2, 2024)]
[Notices]
[Pages 80-82]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-28831]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-3446-FN]


Medicare and Medicaid Programs; Application from the Community 
Health Accreditation Program (CHAP) for Continued Approval of Its Home 
Health Agency Accreditation Program

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

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ACTION: Notice.

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SUMMARY: This notice announces our decision to approve the Community 
Health Accreditation Program (CHAP) for continued recognition as a 
national accrediting organization for home health agencies (HHAs) that 
wish to participate in the Medicare or Medicaid programs.

DATES: The decision announced in this notice is applicable March 31, 
2024, to March 31, 2030.

FOR FURTHER INFORMATION CONTACT: Caecilia Andrews, (410) 786-2190.

SUPPLEMENTARY INFORMATION: 

I. Background

    Under the Medicare program, eligible beneficiaries may receive 
covered services from a home health agency (HHA), provided certain 
requirements are met. Sections 1861(m) and (o), 1891 and 1895 of the 
Social Security Act (the Act) establish distinct criteria for an entity 
seeking designation as an HHA. Regulations concerning provider 
agreements are at 42 Code of Federal Regulations (CFR) part 489 and 
those pertaining to activities relating to the survey and certification 
of facilities and other entities are at 42 CFR part 488. The 
regulations at 42 CFR parts 409 and 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 a provider agreement with the Medicare 
program, an HHA must first be certified by a state survey agency as 
complying with the conditions or requirements set forth in 42 CFR part 
484 of our regulations. Thereafter, the HHA 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. 
Section 1865(a)(1) of the Act provides that, if a provider entity 
demonstrates through accreditation by a Centers for Medicare & Medicaid 
Services (CMS) approved national accrediting organization (AO) that all 
applicable Medicare requirements are met or exceeded, we will deem 
those provider entities as having met such requirements. Accreditation 
by an AO is voluntary and is not required for Medicare participation.
    If an AO is recognized by the Secretary of the Department of Health 
and Human Services (HHS) (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 requirements. A national AO 
applying for approval of its accreditation program under 42 CFR part 
488, subpart A, must provide CMS with reasonable assurance that the AO 
requires the accredited provider entities to meet requirements that are 
at least as stringent as the Medicare requirements.
    Our regulations concerning the approval of AOs are at Sec. Sec.  
488.4 and 488.5. The regulations at Sec.  488.5(e)(2)(i) require an AO 
to reapply for continued approval of its accreditation program every 6 
years or sooner, as determined by CMS. This notice is to announce our 
continued approval of CHAP's HHA accreditation program for a period of 
6 years.

II. Application Approval Process

    Section 1865(a)(3)(A) of the Act provides a statutory timetable to 
ensure that our review of applications for CMS-approval 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

    In the August 8, 2023 Federal Register (88 FR 53489), we published 
a proposed notice announcing CHAP's request for continued approval of 
its Medicare HHA accreditation program. In the August 2023 proposed 
notice (88 FR 53489), we detailed our evaluation criteria. Under 
section 1865(a)(2) of the Act and in our regulations at Sec.  488.5, we 
conducted a review of CHAP's Medicare HHA accreditation application in 
accordance with the criteria specified by our regulations, which 
include, but are not limited to the following:
    <bullet> An administrative review of CHAP's--
    ++ Corporate policies;
    ++ Financial and human resources available to accomplish the 
proposed surveys;
    ++ Procedures for training, monitoring, and evaluation of its 
surveyors;
    ++ Ability to investigate and respond appropriately to complaints 
against accredited facilities; and
    ++ Survey review and decision-making process for accreditation.
    <bullet> A comparison of CHAP's accreditation to our current 
Medicare HHA conditions of participation (CoPs).
    <bullet> A documentation review of CHAP's survey process to do the 
following:
    ++ Determine the composition of the survey team, surveyor 
qualifications, and CHAP's ability to provide continuing surveyor 
training.
    ++ Compare CHAP's processes to those of state survey agencies, 
including survey frequency, and the ability to investigate and respond 
appropriately to complaints against accredited facilities.
    ++ Evaluate CHAP's procedures for monitoring HHAs out of compliance 
with CHAP's program requirements. The monitoring procedures are used 
only when CHAP identifies noncompliance. If noncompliance is identified 
through validation reviews, the state survey agency monitors 
corrections as specified at Sec.  488.7(d).
    ++ Assess CHAP's ability to report deficiencies to the surveyed 
facilities and respond to the facility's plan of correction in a timely 
manner.
    ++ Establish CHAP's ability to provide CMS with electronic data and 
reports necessary for effective validation and assessment of the 
organization's survey process.
    ++ Determine the adequacy of staff and other resources.
    ++ Confirm CHAP's ability to provide adequate funding for 
performing required surveys.
    ++ Confirm CHAP's policies with respect to whether surveys are 
unannounced.
    ++ Obtain CHAP'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.
    ++ Review CHAP's policies and procedures to avoid conflicts of 
interest, including the appearance of conflicts of interest, involving 
individuals who conduct surveys or participate in accreditation 
decisions.

IV. Analysis of and Responses to Public Comments on the Proposed Notice

    In accordance with section 1865(a)(3)(A) of the Act, the August 8, 
2023 proposed notice also solicited public comments regarding whether 
CHAP's requirements met or exceeded the Medicare CoPs for HHAs. We 
received no comments in response to our proposed notice.

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V. Provisions of the Final Notice

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

    We compared CHAP's HHA requirements and survey process with the 
Medicare CoPs and survey process as outlined in the State Operations 
Manual (SOM). Our review and evaluation of CHAP's HHA application were 
conducted as described in section III. of this notice and have yielded 
the following areas where, as of the date of this notice, CHAP has 
completed revising its standards and certification processes to meet 
the standard's requirements of all the following regulations:
    <bullet> Section 484.50(c)(8), to clarify under Patient Right's 
that the HHA must also comply with the requirements of 42 CFR 405.1200 
through 405.1204 when providing the patient with written notice, in 
advance of a specific service being furnished.
    <bullet> Section 484.75(c)(2), to specify that when rehabilitative 
therapy services are provided under the supervision of an occupational 
therapist or physical therapist, the qualified professional meets the 
requirements of Sec.  484.115(f) or (h), respectively.
    <bullet> Section 484.75(c)(3), to specify that when medical social 
services are provided under the supervision of a social worker, the 
requirements of Sec.  484.115(m) are met.
    <bullet> Section 484.100(a), to appropriately cross-reference the 
Medicare conditions of Sec. Sec.  420.201, 420.202, and 420.206 or 
corresponding comparable CHAP standards.
    <bullet> Section 484.102(d)(2)(iii), to include the requirement for 
HHAs to analyze the HHA's response to and maintain documentation of all 
drills, tabletop exercises, and emergency events, and revise the HHA's 
emergency plan, as needed.
    <bullet> Section 484.105(g), to appropriately cross-reference the 
Medicare conditions of Sec. Sec.  485.713, 485.715, 485.719, 485.723, 
and 485.727 or corresponding comparable CHAP standards.
    In addition to the standards review, CMS also reviewed CHAP's 
comparable survey processes, which were conducted as described in 
section III. of this notice, and yielded the following areas where, as 
of the date of this notice, CHAP has completed revising its survey 
processes, in order to demonstrate that it uses survey processes that 
are comparable to state survey agency processes by removing references 
to ``blackout dates,'' by allowing facilities to select dates which 
suggested the facility would be unavailable for surveys, as CMS expects 
all Medicare-participating facilities to be survey ready at all times.

B. Term of Approval

    Based on our review and observations described in sections III. and 
V. of this notice, we approve CHAP as a national AO for HHAs that 
request participation in the Medicare program. The decision announced 
in this final notice is effective March 31, 2024, through March 31, 
2030 (6 years).

VI. Collection of Information Requirements

    This document does not impose information collection requirements, 
that is, reporting, recordkeeping, or third-party disclosure 
requirements. Consequently, there is no need for review by the Office 
of Management and Budget under the authority of the Paperwork Reduction 
Act of 1995 (44 U.S.C. 3501 et seq.).
    The Administrator of the Centers for Medicare & Medicaid Services 
(CMS), Chiquita Brooks-LaSure, having reviewed and approved this 
document, authorizes Chyana Woodyard, who is the Federal Register 
Liaison, to electronically sign this document for purposes of 
publication in the Federal Register.

Chyana Woodyard,
Federal Register Liaison, Centers for Medicare & Medicaid Services.
[FR Doc. 2023-28831 Filed 12-29-23; 8:45 am]
BILLING CODE 4120-01-P