59136 Federal Register / Vol. 76, No. 185 / Friday, September 23, 2011 / Notices 

medical staff and the person directly 

responsible for operation of the facility 

approve contractual agreements. 

• To meet the requirements at 

§ 485.623(b)(2), the Joint Commission 

revised its crosswalk and survey process 

to address the proper routine storage 

and prompt disposal of trash. 

• To meet the requirements at 

§ 485.631(c)(2), the Joint Commission 

revised its crosswalk to address the 

requirement that physician assistants, 

nurse practitioners, or clinical nurse 

specialists provide services in 

accordance with the CAH’s policies. 

• To meet the requirements at 

§ 485.635(a)(3)(iii), the Joint 

Commission revised its standards to 

include guidelines for the maintenance 

of health care records, and procedures 

for the periodic review and evaluation 

of the services furnished by the CAH. 

• To meet the requirements at 

§ 485.635(f) through (f)(2), the Joint 

Commission revised its crosswalk to 

include the patient visitation right 

standards and related survey process 

revisions. 

• To meet the requirements at 

§ 485.638(a)(2), the Joint Commission 

revised its crosswalk to address the 

requirement that medical records are 

readily accessible. 

• To meet the requirements at 

§ 485.639(b)(1), the Joint Commission 

revised its standards to include the 

requirement that a qualified practitioner 

must examine the patient immediately 

before surgery to evaluate the risk of the 

procedure to be performed. 

• To meet the requirements at 

§ 485.639(b)(2), the Joint Commission 

revised its standards to include the 

requirement that a qualified practitioner 

examine each patient before surgery to 

evaluate the risk of anesthesia. 

• To meet the requirements at 

§ 485.639(b)(3), the Joint Commission 

revised its standards to address the 

requirement that a qualified practitioner 

must evaluate each patient for proper 

anesthesia recovery before discharge 

from the CAH. 

• To meet the requirements at 

§ 485.643(f), the Joint Commission 

revised its glossary to ensure that the 

definition of organ includes ‘‘intestines 

(or multivisceral organs).’’ 

• To meet the requirements at 

§ 485.645(d)(1), the Joint Commission 

revised its crosswalk to include 

standards which address the residents’ 

right to send and receive mail that is not 

opened. 

• To meet the requirements at 

§ 412.27(d)(6)(i), the Joint Commission 

revised its crosswalk to include the 

requirement that programs be directed 

toward restoring and maintaining 

optimal levels of physical and 

psychosocial functioning. 

• To meet the requirements at 

§ 412.29(c), the Joint Commission 

revised it crosswalk to include 

standards to ensure patients receive 

social services, psychological services 

(including neuropsychological services), 

orthotic and prosthetic services, as 

needed. 

• To meet the requirements at 

§ 482.13(h) through (h)(4), the Joint 

Commission revised its crosswalk to 

include the patient visitation right 

standards and related survey process 

revisions. 

• To meet the requirements at 

§ 482.30(d)(3), the Joint Commission 

revised its standards to ensure that 

written notification regarding the 

admission to or continued stay in the 

hospital when it is not medically 

necessary, is given no later than 2 days 

after this determination has been made. 

• To meet the requirements at 

§ 482.41(b)(1)(i), the Joint Commission 

revised its standards to require quarterly 

testing of tamper and water flow 

devices. 

• To meet the requirements at 

§ 482.41(b)(8), the Joint Commission 

revised its standards to ensure the CAH 

maintains written evidence of regular 

inspections and approval by State or 

local fire control agencies for the entire 

CAH. 

• To meet the requirements at 

§ 482.51, the Joint Commission revised 

its standards to ensure that if the 

hospital provides surgical services, the 

services are well organized and 

provided in accordance with acceptable 

standards of practice and if outpatient 

surgical services are offered the services 

must be consistent in quality with 

inpatient care in accordance with the 

complexity of services offered. 

• To meet the requirements at 

§ 488.4(a)(7), the Joint Commission 

revised its survey process to include 

policies and procedures with respect to 

the withholding or removal of 

accreditation status or requirements, 

and other actions taken by the Joint 

Commission in response to 

noncompliance with standards and 

requirements. 

• To meet the requirements at section 

2728 of the State Operations Manual 

(SOM), the Joint Commission modified 

its policies regarding timeframes for 

sending and receiving a plan of 

correction (PoC). 

• To meet the requirements at 

§ 488.12, the Joint Commission modified 

its policies and procedures to ensure its 

survey files are complete. 

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 

CAHs meet or exceed our requirements. 

Therefore, we approve the Joint 

Commission as a national accreditation 

organization for CAHs that request 

participation in the Medicare program, 

effective November 21, 2011 through 

November 21, 2017. 

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). 

Authority: Section 1865 of the Social 

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

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare—Hospital 

Insurance; and Program No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program) 

Dated: August 31, 2011. 

Donald M. Berwick, 

Administrator, Centers for Medicare & 

Medicaid Services. 

[FR Doc. 2011–24496 Filed 9–22–11; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–2377–PN] 

Medicare and Medicaid Programs; 

Application by Community Health 

Accreditation Program for Continued 

Deeming Authority for Home Health 

Agencies 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Proposed notice. 

SUMMARY: This proposed notice with 

comment period acknowledges the 

receipt of a deeming application from 

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. Section 

1865(a)(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 


sroberts on DSK5SPTVN1PROD with NOTICES
Federal Register / Vol. 76, No. 185 / Friday, September 23, 2011 / Notices 59137 

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: To be assured consideration, 

comments must be received at one of 

the addresses provided below, no later 

than 5 p.m. on October 24, 2011. 

ADDRESSES: In commenting, please refer 

to file code CMS–2377–PN. Because of 

staff and resource limitations, we cannot 

accept comments by facsimile (FAX) 

transmission. 

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– 

2377–PN, P.O. Box 8016, Baltimore, 

MD 21244–8010. 

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– 

2377–PN, Mail Stop C4–26–05, 7500 

Security Boulevard, Baltimore, MD 

21244–1850. 

4. By hand or courier. If you prefer, 

you may deliver (by hand or courier) 

your written comments before the close 

of the comment period to either of the 

following addresses: 

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 

for persons wishing to retain a proof of 

filing by stamping in and retaining an 

extra copy of the comments being filed.) 

b. For delivery in Baltimore, MD— 

Centers for Medicare & Medicaid 

Services, Department of Health and 

Human Services, 7500 Security 

Boulevard, Baltimore, MD 21244– 

1850. 

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. 

Comments mailed to the addresses 

indicated as appropriate for hand or 

courier delivery may be delayed and 

received after the comment period. 

For information on viewing public 

comments, see the beginning of the 

SUPPLEMENTARY INFORMATION section. 

FOR FURTHER INFORMATION CONTACT: 

Lillian Williams, (410) 786–8636. 

Patricia Chmielewski, (410) 786–6899. 

SUPPLEMENTARY INFORMATION: 

Inspection of Public Comments: All 

comments received before the close of 

the comment period are available for 

viewing by the public, including any 

personally identifiable or confidential 

business information that is included in 

a comment. We post all comments 

received before the close of the 

comment period on the following Web 

site as soon as possible after they have 

been received: http:// 

www.regulations.gov. Follow the search 

instructions on that Web site to view 

public comments. 

Comments received timely will also 

be available for public inspection as 

they are received, generally beginning 

approximately three weeks after 

publication of a document, at the 

headquarters of the Centers for Medicare 

& Medicaid Services, 7500 Security 

Boulevard, Baltimore, Maryland 21244, 

Monday through Friday of each week 

from 8:30 a.m. to 4 p.m. To schedule an 

appointment to view public comments, 

phone 1–800–743–3951. 

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 

facilities seeking designation as an 

HHA. 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 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 an approved national 

accrediting organization that all 

applicable Medicare conditions are met 

or exceeded, we 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 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 

accrediting organization applying for 

deeming authority under 42 CFR 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 

reapproval 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 deeming authority every 6 

years or sooner as determined by CMS. 

The CHAP’S term of approval as a 

recognized accreditation program for 

HHA’s expires March 31, 2012. 

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 

reapproval of a national accrediting 

organization’s requirements consider, 

among other factors, the applying 

accrediting 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(a)(3)(A) of the Act 

further requires that we publish, within 

60 days of receipt of an organization’s 

complete application, a notice 


sroberts on DSK5SPTVN1PROD with NOTICES
59138 Federal Register / Vol. 76, No. 185 / Friday, September 23, 2011 / Notices 

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. 

The purpose of this proposed notice 

is to inform the public of CHAP’s 

request for 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 

CHAP submitted all the necessary 

materials to enable us to make a 

determination concerning its request for 

reapproval as a deeming organization 

for HHAs. This application was 

determined to be complete on August 

26, 2011. Under section 1865(a)(2) of the 

Act and our regulations at § 488.8 

(Federal review of accrediting 

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’S 

standards for HHA’s as compared with 

CMS’ 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’s 

processes to those 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 HHAs found out of 

compliance with CHAP’s program 

requirements. These 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 § 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’s capacity to provide us 

with electronic data, 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, to assure that surveys are 

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 notice, and, we will respond to the 

comments in a subsequent document. 

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; No. 93.773 Medicare—Hospital 

Insurance Program; and No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program) 

Dated: August 31, 2011. 

Donald M. Berwick, 

Administrator, Centers for Medicare & 

Medicaid Services. 

[FR Doc. 2011–24547 Filed 9–22–11; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–4152–N] 

Medicare Program; Medicare Appeals; 

Adjustment to the Amount in 

Controversy Threshold Amounts for 

Calendar Year 2012 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice announces the 

annual adjustment in the amount in 

controversy (AIC) threshold amounts for 

Administrative Law Judge (ALJ) 

hearings and judicial review under the 

Medicare appeals process. The 

adjustment to the AIC threshold 

amounts will be effective for requests 

for ALJ hearings and judicial review 

filed on or after January 1, 2012. The 

calendar year 2012 AIC threshold 

amounts are $130 for ALJ hearings and 

$1,350 for judicial review. 

DATES: Effective Date: This notice is 

effective on January 1, 2012. 

FOR FURTHER INFORMATION CONTACT: Liz 

Hosna (Katherine.Hosna@cms.hhs.gov), 

(410) 786–4993. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Section 1869(b)(1)(E) of the Social 

Security Act (the Act), as amended by 

section 521 of the Medicare, Medicaid, 

and SCHIP Benefits Improvement and 

Protection Act of 2000 (BIPA), 

established the amount in controversy 

(AIC) threshold amounts for 

Administrative Law Judge (ALJ) hearing 

requests and judicial review at $100 and 

$1000, respectively, for Medicare Part A 

and Part B appeals. Section 940 of the 

Medicare Prescription Drug, 

Improvement, and Modernization Act of 

2003 (MMA), amended section 

1869(b)(1)(E) of the Act to require the 

AIC threshold amounts for ALJ hearings 

and judicial review to be adjusted 

annually. The AIC threshold amounts 

are to be adjusted, as of January 2005, 

by the percentage increase in the 

medical care component of the 

consumer price index for all urban 

consumers (U.S. city average) for July 

2003 to July of the year preceding the 

year involved and rounded to the 

nearest multiple of $10. Section 

940(b)(2) of the MMA provided 

conforming amendments to apply the 

AIC adjustment requirement to 

Medicare Part C Medicare Advantage 

(MA) appeals and certain health 

maintenance organization and 

competitive health plan appeals. Health 

care prepayment plans are also subject 

to MA appeals rules, including the AIC 

adjustment requirement. Section 101 of 

the MMA provides for the application of 

the AIC adjustment requirement to 

Medicare Part D appeals. 

A. Medicare Part A and Part B Appeals 

The statutory formula for the annual 

adjustment to the AIC threshold 

amounts for ALJ hearings and judicial 

review of Medicare Part A and Part B 

appeals, set forth at section 

1869(b)(1)(E) of the Act, is included in 

the applicable implementing 

regulations, 42 CFR 405.1006(b) and (c). 

The regulations require the Secretary of 

the Department of Health and Human 

Services (the Secretary) to publish 

changes to the AIC threshold amounts 

in the Federal Register (405.1006(b)(2)). 

In order to be entitled to a hearing 

before an ALJ, a party to a proceeding 

must meet the AIC requirements at 

§ 405.1006(b). Similarly, a party must 

meet the AIC requirements at 

405.1006(c) at the time judicial review 


sroberts on DSK5SPTVN1PROD with NOTICES