[Federal Register Volume 89, Number 218 (Tuesday, November 12, 2024)]
[Notices]
[Pages 89015-89017]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-26123]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-3457-FN]


Medicare and Medicaid Programs; Approval of Application by 
Community Health Accreditation Partner (CHAP) Inc. for Continued CMS-
Approval of Its Hospice Accreditation Program

AGENCY: Centers for Medicare & Medicaid Services, HHS.

ACTION: Notice.

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SUMMARY: This notice acknowledges the approval of an application by 
Community Health Accreditation Partner Inc., for continued CMS-approval 
as a national accrediting organization for its hospice programs that 
wish to participate in the Medicare or Medicaid programs.

DATES: The decision announced in this notice is applicable November 20, 
2024 through November 20, 2029.

FOR FURTHER INFORMATION CONTACT: 
    Lillian Williams, (410) 786-8636.
    Erin Imhoff, (410) 786-2337.

SUPPLEMENTARY INFORMATION:

I. Background

    Under the Medicare program, eligible beneficiaries may receive 
covered services in a hospice provided certain requirements are met by 
the hospice. 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 in 
order 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 as complying with the conditions set forth in part 418 and 
recommended to the Centers for Medicare & Medicaid (CMS) for 
participation by a state survey agency. Thereafter, the hospice is

[[Page 89016]]

subject to periodic surveys by a state survey agency to determine 
whether it continues to meet these conditions. However, there is an 
alternative to certification surveys by state agencies. Accreditation 
by a nationally recognized Medicare accreditation program approved by 
CMS may substitute for both initial and ongoing state review.
    Section 1865(a)(1) of the Act provides that, if the Secretary of 
the Department of Health and Human Services (the Secretary) finds that 
accreditation of a provider entity by an approved national accrediting 
organization (AO) meets or exceeds all applicable Medicare conditions, 
we may treat the provider entity as having met those conditions; that 
is, we may ``deem'' the provider entity to be in compliance. 
Accreditation by an AO is voluntary and is not required for Medicare 
participation.
    If an AO is recognized by the Secretary as having standards for 
accreditation that meet or exceed Medicare requirements, any provider 
entity accredited by the national AO's approved program may be deemed 
to meet the Medicare conditions. A national AO applying for CMS 
approval of their 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 conditions. Our regulations concerning the 
approval of AOs are set forth at Sec.  488.5. Section 488.5(e)(2)(i) 
requires AOs to reapply for continued approval of its Medicare 
accreditation program every 6 years or sooner as determined by CMS. The 
Community Health Accreditation Partner's (CHAP'S) term of approval as a 
recognized accreditation program for its hospice accreditation program 
expires November 20, 2024.

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 June 7, 2024, Federal Register (89 FR 48646), we published a 
proposed notice announcing CHAP's request for continued approval of its 
Medicare hospice accreditation program. In the June 7, 2024, proposed 
notice, 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 hospice accreditation application in accordance with 
the criteria specified by our regulations, which include, but are not 
limited to the following:
    <bullet> A virtual administrative review of CHAP's: (1) corporate 
policies; (2) financial and human resources available to accomplish the 
proposed surveys; (3) procedures for training, monitoring, and 
evaluation of its hospice surveyors; (4) ability to investigate and 
respond appropriately to complaints against accredited hospices; and 
(5) survey review and decision-making process for accreditation.
    <bullet> The comparison of CHAP's Medicare hospice accreditation 
program standards to our current Medicare hospice CoPs.
    <bullet> A documentation review of CHAP's survey process to--
    ++ Determine the composition of the survey team, surveyor 
qualifications, and CHAP's ability to provide continuing surveyor 
training.
    ++ Compare CHAP's processes to those we require of state survey 
agencies, including periodic resurvey and the ability to investigate 
and respond appropriately to complaints against accredited hospices.
    ++ Evaluate CHAP's procedures for monitoring hospices it has found 
to be out of compliance with CHAP's program requirements. (This 
pertains only to monitoring procedures when CHAP identifies non-
compliance. If noncompliance is identified by a state survey agency 
through a validation survey, the state survey agency monitors 
corrections as specified at Sec.  488.9(c)).
    ++ Assess CHAP's ability to report deficiencies to the surveyed 
hospice and respond to the hospice'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 CHAP's staff and other resources.
    ++ Confirm CHAP's ability to provide adequate funding for 
performing required surveys.
    ++ Confirm CHAP's policies with respect to surveys being 
unannounced.
    ++ Confirm 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.
    ++ 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 CMS may require, including corrective action 
plans.
    In accordance with section 1865(a)(3)(A) of the Act, the June 7, 
2024 proposed notice also solicited public comments regarding whether 
CHAP's requirements met or exceeded the Medicare CoPs for hospices. We 
received one comment, which was out of the scope of the proposed 
notice.

IV. 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 hospice accreditation requirements and survey 
process with the Medicare CoPs of part 418, and the survey and 
certification process requirements of parts 488 and 489. Our review and 
evaluation of CHAP's hospice application, which were conducted as 
described in section III. of this final notice, yielded the following 
areas where, as of the date of this notice, CHAP has completed revising 
its standards and certification processes in order to meet the 
requirements at:
    <bullet> Section 418.52(c)(5), to include reference to 45 CFR parts 
160 and 164.
    <bullet> Section 418.62(a), to include reference to Sec.  418.114.
    <bullet> Section 418.64(b)(2), to address the requirement that 
state law permits registered nurses to see, treat, and write orders for 
patients, then registered nurses may provide services to beneficiaries 
receiving hospice care.
    <bullet> Section 418.64(c), to indicate that services are not only 
provided under the direction of a physician but also by a qualified 
social worker.
    <bullet> Section 418.66(a)(3)(i) through (iv), to include all the 
requirements that are entailed in ``good faith efforts'' to hire 
nurses.
    <bullet> Section 418.74(d), to address the requirement that if a 
hospice wishes to receive a 1-year extension, it must submit a request 
to CMS before the expiration of the waiver period and certify that 
conditions under which it originally requested the waiver have not 
changed since the initial waiver was granted.

[[Page 89017]]

    <bullet> Section 418.76(k)(2), to address the requirement for 
instructions to be prepared by the interdisciplinary group.
    <bullet> Section 418.104(c), to include reference to 45 CFR parts 
160 and 164.
    <bullet> Section 418.106(b)(1)(iii), to address this requirement to 
allow a physician assistant to order drugs in accordance with state 
scope of practice requirements and hospice policy.
    <bullet> Section 418.110(d)(2), to address the regulatory Life 
Safety Code (LSC) waiver requirement.
    <bullet> Section 418.110(d)(3), to address the requirement that the 
provisions of the adopted edition of the LSC do not apply in a State if 
we find that a fire and safety code imposed by State law adequately 
protects patients in hospices.
    <bullet> Section 418.110(e)(2), to address the Health Care 
Facilities Code waiver allowance.
    In addition to the standards review, we 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 to demonstrate that it uses survey processes that are 
comparable to state survey agency processes by:
    <bullet> Revising CHAP's surveyor guide to include comparable 
guidance relating to situations that might require discontinuation or 
refusal to conduct exit conference activities or share with CMS 
additional materials that are used by CHAP hospice program surveyors.
    <bullet> Revising CHAP's surveyor guidance to be comparable with 
Appendix M related to inpatient hospice care.
    <bullet> Revising CHAP's surveyor guide to include comparable 
guidance on reviewing personnel records for training requirements.
    <bullet> Revising CHAP's Hospice Accreditation Processes and 
resources to include the applicable sections of the Health Care 
Facilities Code (HCFC) and National Fire Protection Agency (NFPA 101) 
in accordance with Sec.  418.110.
    <bullet> Ensuring that all Hospice LSC surveyors have received 
comparable, adequate training or have sufficient experience to make 
them qualified to survey health care facilities to both the 2012 
editions of LSC and HCFC, and 2013 edition of the Fire Safety 
Evaluation System NFPA 101A Fire Safety for Health Care Occupancies.
    <bullet> Revising CHAP's survey process to require pre-survey 
preparation to include review of the 2012 editions of the LSC and HCFC.
    <bullet> Revising CHAP's LSC Survey Checklist and LSC citation 
documentation process to ensure all applicable regulations, LSC/HCFC 
sections, and CHAP standards are referenced in the survey report and 
provide surveyor training, as necessary.

B. Term of Approval

    Based on our review and observations described in section III. of 
this final notice, we approve CHAP as a national accreditation 
organization for hospices that request participation in the Medicare 
program, effective November 20, 2024 through November 20, 2029.

V. 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 Vanessa Garcia, who is the Federal Register 
Liaison, to electronically sign this document for purposes of 
publication in the Federal Register.

Vanessa Garcia,
Federal Register Liaison, Centers for Medicare & Medicaid Services.
[FR Doc. 2024-26123 Filed 11-8-24; 8:45 am]
BILLING CODE 4120-01-P