89014 Federal Register / Vol. 89, No. 218 / Tuesday, November 12, 2024 / Notices 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–3459–FN] 

Medicare and Medicaid Programs; 

Approval of Application by the 

American Association for 

Accreditation of Ambulatory Surgery 

Facilities, dba QUAD A, for Continued 

CMS-Approval of Its Ambulatory 

Surgical Center (ASC) Accreditation 

Program 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice acknowledges the 

approval of an application by the 

American Association for Accreditation 

of Ambulatory Surgery Facilities, dba 

QUAD A, for continued recognition as 

a national accrediting organization for 

Ambulatory Surgical Centers that wish 

to participate in the Medicare or 

Medicaid programs. 

DATES: The decision announced in this 

notice is applicable November 27, 2024, 

to November 27, 2029. 

FOR FURTHER INFORMATION CONTACT: 

Erin Imhoff, (410) 786–2337. 

Joy Webb, (410) 786–1667. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Ambulatory Surgical Centers (ASCs) 

are distinct entities that operate 

exclusively for the purpose of 

furnishing outpatient surgical services 

to patients. Under the Medicare 

program, eligible beneficiaries may 

receive covered services from an ASC 

provided certain requirements are met. 

Section 1832(a)(2)(F)(i) of the Social 

Security Act (the Act) establishes 

distinct criteria for a facility seeking 

designation as an ASC. 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 

416 specify the conditions that an ASC 

must meet in order to participate in the 

Medicare program, the scope of covered 

services, and the conditions for 

Medicare payment for ASCs. 

Generally, to enter into an agreement, 

an ASC must first be certified by a State 

survey agency (SA) as complying with 

the conditions or requirements set forth 

in part 416 of our Medicare regulations. 

Thereafter, the ASC is subject to regular 

surveys by an SA to determine whether 

it continues to meet these requirements. 

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 conditions are met or 

exceeded, we may deem that provider 

entity as having met the 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 as having 

standards for accreditation that meet or 

exceed Medicare requirements, any 

provider entity accredited by the 

national accrediting body’s approved 

program may be deemed to meet the 

Medicare conditions. The AO applying 

for approval of its accreditation program 

under 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 

§ 488.5. 

QUAD A’s current term of approval 

for its ASC program expires November 

27, 2024. 

II. Application Approval Process 

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

regulations at § 488.5 require that our 

findings concerning review and 

approval of an AO’s requirements 

consider, among other factors, the 

applying AO’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 that were not in compliance 

with the conditions or requirements; 

and their ability to provide CMS with 

the necessary data for validation. 

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

provides a statutory timetable to ensure 

that our review of applications for CMSapproval 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 

On June 13, 2024, we published a 

proposed notice in the Federal Register 

(89 FR 50330), announcing QUAD A’s 

request for continued approval of its 

Medicare ASC accreditation program. In 

the June 13, 2024 proposed notice, we 

detailed our evaluation criteria. Under 

section 1865(a)(2) of the Act and in our 

regulations at § 488.5, we conducted a 

review of QUAD A’s Medicare ASC 

accreditation application in accordance 

with the criteria specified by our 

regulations, which include, but are not 

limited to the following: 

• An administrative review of QUAD 

A’s: (1) corporate policies; (2) financial 

and human resources available to 

accomplish the proposed surveys; (3) 

procedures for training, monitoring, and 

evaluation of its ASC surveyors; (4) 

ability to investigate and respond 

appropriately to complaints against 

accredited ASCs; and (5) survey review 

and decision-making process for 

accreditation. 

• The equivalency of QUAD A’s 

standards for ASCs as compared with 

Medicare’s Conditions for Coverage 

(CfCs) for ASCs. 

• QUAD A’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 QUAD A’s 

processes to those of State agencies, 

including survey frequency, and the 

ability to investigate and respond 

appropriately to complaints against 

accredited facilities. 

++ QUAD A’s processes and 

procedures for monitoring an ASC 

found out of compliance with QUAD 

A’s program requirements. These 

monitoring procedures are used only 

when QUAD A identifies 

noncompliance. If noncompliance is 

identified through validation reviews or 

complaint surveys, the State survey 

agency monitors corrections as specified 

at § 488.9(c)(1). 

++ QUAD A’s capacity to report 

deficiencies to the surveyed facilities 

and respond to the facility’s plan of 

correction in a timely manner. 

++ QUAD A’s capacity to provide 

CMS with electronic data and reports 

necessary for the effective validation 

and assessment of the organization’s 

survey process. 

++ The adequacy of QUAD A’s staff 

and other resources, and its financial 

viability. 


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Federal Register / Vol. 89, No. 218 / Tuesday, November 12, 2024 / Notices 89015 

++ QUAD A’s capacity to adequately 

fund required surveys. 

++ QUAD A’s policies with respect to 

whether surveys are announced or 

unannounced, to ensure that surveys are 

unannounced. 

++ QUAD A’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. 

++ QUAD A’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). 

IV. Analysis of and Responses to Public 

Comments on the Proposed Notice 

In accordance with section 

1865(a)(3)(A) of the Act, the June 13, 

2024 proposed notice also solicited 

public comments regarding whether 

QUAD A’s requirements met or 

exceeded the Medicare CfCs for ASCs. 

No public comments were received in 

response to our proposed notice. 

V. Provisions of the Final Notice 

A. Differences Between QUAD A’s 

Standards and Requirements for 

Accreditation and Medicare Conditions 

and Survey Requirements 

We compared QUAD A’s ASC 

accreditation requirements and survey 

process with the Medicare CfCs of parts 

416, and the survey and certification 

process requirements of parts 488 and 

489. Our review and evaluation of 

QUAD A’s ASC 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, 

QUAD A has completed revising its 

standards and certification processes in 

order to do all of the following: 

• Meet the standard’s requirements of 

all of the following regulations: 

++ Section 416.40, to ensure that 

ASCs comply with state licensure 

requirements. 

++ Section 416.44(b)(2), to clarify that 

an AO may recommend a waiver of 

specific provisions of the Life Safety 

Code (LSC), which would result in 

unreasonable hardship upon an ASC, 

but only if the waiver will not adversely 

affect the health and safety of the 

patients. 

We also reviewed QUAD A’s 

comparable survey processes, which 

were conducted as described in section 

III. of this final notice, and yielded the 

following areas where, as of the date of 

this notice, QUAD A has completed 

revising its survey processes in order to 

demonstrate that it uses survey 

processes that are comparable to state 

survey agency processes by: 

++ Updating QUAD A’s survey 

procedures to ensure all areas of the 

Health Care Facilities Code (HCFC) are 

surveyed and reflected in QUAD A’s 

policies and surveyor guides. 

++ Providing clarification to QUAD 

A’s survey scheduling policies to 

explain the number of LSC surveyors 

required for survey teams at small, 

medium, and large ASCs. 

++ Revising QUAD A policy to ensure 

surveyor qualifications include 

experience with the LSC and HCFC. 

++ Providing additional surveyor 

training to ensure that LSC deficiency 

citations contain a sufficient level of 

detail and quantifiable information 

comparable to what is required by the 

CMS Principles of Documentation in 

Chapter 9 of the State Operations 

Manual. 

++ Providing a process to ensure that 

any findings on the ASC surveyor 

infection control worksheet are cited 

appropriately in the final survey report. 

++ Providing a process to ensure the 

appropriate sample of patient records, 

including open and closed records, is 

reviewed during surveys based on the 

ASC’s case volume. 

B. Term of Approval 

Based on our review described in 

section III. and section V. of this final 

notice, we approve QUAD A as a 

national AO for ASCs that request 

participation in the Medicare program. 

The decision announced in this final 

notice is effective November 27, 2024 

through November 27, 2029. In 

accordance with § 488.5(e)(2)(i) the term 

of the approval will not exceed 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 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. 2024–26124 Filed 11–8–24; 8:45 am] 

BILLING CODE 4120–01–P 

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. 

SUMMARY: This notice acknowledges the 

approval of an application by 

Community Health Accreditation 

Partner Inc., for continued CMSapproval 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 


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