9466 Federal Register / Vol. 80, No. 35 / Monday, February 23, 2015 / Notices 

terminated because it has completed its 

mission. 

Meeting Agenda: The meeting agenda 

will include opportunity for the public 

to give oral testimony to HHS and 

USDA officials on the Advisory Report. 

Meeting Registration: The meeting 

will be publicly accessible in-person 

and by webcast on the Internet. 

Registration is required and is expected 

to open on March 9, 2015. To register, 

please go to www.DietaryGuidelines.gov 

and click on the link for meeting 

registration. To register by phone, please 

call National Capitol Contracting, 

Andrea Popp at (703) 243–9696. 

Registration must include name, 

affiliation, and phone number or email 

address. 

Webcast Public Participation: After 

registering, individuals participating by 

webcast will receive webcast access 

information via email. Webcast 

registrants can observe the oral 

testimony; however, testimony can only 

be given in-person. 

In-Person Public Participation and 

Building Access: For in-person 

participants, the meetings will be held 

in the National Institutes of Health 

(NIH) Clinical Center (Building 10), as 

noted above in the Addresses section. 

Directions will be posted on 

www.DietaryGuidelines.gov. For inperson participants, check-in at the 

registration desk onsite at the meeting is 

required and will begin at 8:00 a.m. 

E.S.T. 

Oral Testimony: HHS and USDA 

invite requests from the public to 

present three minutes of oral testimony 

to HHS and USDA officials on the 

Advisory Report at the March 24, 2015 

public meeting. 

Registration capacity is limited to 70 

individuals confirmed to speak and an 

additional 10 who are not confirmed to 

speak but are on stand-by (if time 

remains) to provide oral testimony. 

Capacity will be filled in the order 

received. Confirmation by email will 

include further instructions for 

participation. Requests to present oral 

testimony can be made by going to 

www.DietaryGuidelines.gov and clicking 

on the link for meeting registration and 

must include a written outline of the 

intended testimony not exceeding one 

page in length. In addition, the public 

is encouraged to provide written 

comments (separate from oral 

testimony) submitted electronically 

through the public comments database 

at www.DietaryGuidelines.gov. 

Written Public Comments: Written 

comments on the Advisory Report are 

encouraged from the public and will be 

accepted through April 8, 2015. Written 

public comments can be submitted and/ 

or viewed at www.DietaryGuidelines.gov 

using the ‘‘Submit Comments’’ and 

‘‘Read Comments’’ links, respectively. 

HHS and USDA requests that 

commenters provide a brief (250 words 

or less) summary of the points or issues 

in the comment text box. If commenters 

are providing literature or other 

resources, complete citations or 

abstracts and electronic links to full 

articles or reports are preferred instead 

of attaching these documents to the 

comment. All comments must be 

received by midnight (E.S.T.) on April 

8, 2015, after which the time period for 

submitting written comments to the 

federal government expires. The ability 

to view public comments will continue 

to be available. Please allow until April 

22, 2015, for comment submissions to 

be processed and posted for viewing. 

Meeting Documents: Documents 

pertaining to the meeting, including a 

meeting agenda and webcast recording 

will be available on 

www.DietaryGuidelines.gov. Meeting 

information will continue to be 

accessible online, at the NIH Library 

(see the Addresses section), and upon 

request at the Office of Disease 

Prevention and Health Promotion, 

OASH/HHS; 1101 Wootton Parkway, 

Suite LL100 Tower Building; Rockville, 

MD 20852: Telephone (240) 453–8280; 

Fax: (240) 453–8281. 

Dated: January 13, 2015. 

Don Wright, 

Deputy Assistant Secretary for Health, Office 

of Disease Prevention and Health Promotion, 

Office of the Assistant Secretary for Health, 

U.S. Department of Health and Human 

Services. 

Dated: January 13, 2015. 

Angela Tagtow, 

Executive Director, Center for Nutrition Policy 

and Promotion, U.S. Department of 

Agriculture. 

Dated: January 15, 2015. 

Chavonda Jacobs-Young, 

Administrator, Agricultural Research Service, 

U.S. Department of Agriculture. 

[FR Doc. 2015–03552 Filed 2–20–15; 8:45 am] 

BILLING CODE 4150–32P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–3304–FN] 

Medicare and Medicaid Program; 

Continued Approval of the Joint 

Commission’s Psychiatric Hospital 

Accreditation Program 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Final notice. 

SUMMARY: This final notice announces 

our decision to approve the Joint 

Commission for continued recognition 

as a national accrediting organization 

for psychiatric hospitals that wish to 

participate in the Medicare or Medicaid 

programs. A psychiatric hospital that 

participates in Medicaid must also meet 

the Medicare conditions of participation 

(CoPs) as required by statute. 

DATES: Effective Date: This notice is 

effective February 25, 2015 through 

February 25, 2019. 

FOR FURTHER INFORMATION CONTACT: 

Monda Shaver, (410) 786–3410. 

Cindy Melanson, (410) 786–0310. 

Patricia Chmielewski, (410) 786–6899. 

SUPPLEMENTARY INFORMATION: 

I. Background 

A healthcare provider may enter into 

an agreement with Medicare to 

participate in the program as a 

psychiatric hospital provided certain 

requirements are met. Section 1861(f) of 

the Social Security Act (the Act) 

establishes criteria for facilities seeking 

participation as a psychiatric hospital. 

Regulations concerning Medicare 

provider agreements in general are at 42 

CFR part 489 and those pertaining to the 

survey and certification for Medicare 

participation of providers and certain 

types of suppliers are at 42 CFR part 

488. The regulations at 42 CFR part 482 

subpart E, set forth the specific 

conditions that a provider must meet to 

participate in the Medicare program as 

a psychiatric hospital. 

Generally, to enter into an agreement, 

a psychiatric hospital must first be 

certified by a State Survey Agency as 

complying with the conditions or 

requirements set forth in part 482 

subpart E of our regulations. Thereafter, 

the psychiatric hospital 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 

certification surveys by state agencies. 

Accreditation by a national Medicare 

accreditation program approved by the 

Centers for Medicare & Medicaid 

Services (CMS) may substitute for both 

initial and ongoing state agency 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 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 


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Federal Register / Vol. 80, No. 35 / Monday, February 23, 2015 / Notices 9467 

entity to be in compliance. 

Accreditation by an accrediting 

organization is voluntary and is not 

required for Medicare participation. 

Part 488 subpart A implements the 

provisions of section 1865 of the Act 

and requires that a national accrediting 

organization applying for approval of its 

Medicare accreditation program must 

provide CMS with reasonable assurance 

that its accredited provider entities meet 

requirements that are at least as 

stringent as the Medicare conditions. 

Our regulations concerning the approval 

of accrediting organizations are set forth 

at § 488.4 and § 488.8(d)(3). The 

regulations at § 488.8(d)(3) require an 

accrediting organization to reapply for 

continued approval of its Medicare 

accreditation program every 6 years or 

sooner, as determined by CMS. The 

Joint Commission’s current term of 

approval as a Medicare accreditation 

program for psychiatric hospitals 

expires February 25, 2015. 

II. Application Approval Process 

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

requires that we publish, within 60 days 

of receipt of an organization’s complete 

application, a notice 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. 

III. Provisions of the Proposed Notice 

On September 23, 2014, we published 

a proposed notice in the Federal 

Register (79 FR 56806) entitled 

‘‘Continued Approval of the Joint 

Commission’s Psychiatric Hospital 

Accreditation Program’’ announcing the 

Joint Commission’s request for 

continued approval of its Medicare 

psychiatric hospital accreditation 

program. In the proposed notice, we 

detailed our evaluation criteria. Under 

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

regulations at § 488.4 and § 488.8, we 

conducted a review of the Joint 

Commission’s Medicare psychiatric 

hospital accreditation application in 

accordance with the criteria specified by 

our regulations, which include, but are 

not limited to the following: 

• An onsite administrative review of 

the Joint Commission’s: (1) Corporate 

policies; (2) financial and human 

resources available to accomplish the 

proposed surveys; (3) procedures for 

training, monitoring, and evaluation of 

its psychiatric hospital surveyors; (4) 

ability to investigate and respond 

appropriately to complaints against 

accredited psychiatric hospitals; and (5) 

survey review and decision-making 

process for accreditation. 

• A comparison of the Joint 

Commission’s Medicare accreditation 

program standards to our current 

Medicare psychiatric hospital 

conditions of participations (CoPs). 

• A documentation review of the 

Joint Commission’s survey process to— 

++ Determine the composition of the 

survey team, surveyor qualifications, 

and the Joint Commission’s ability to 

provide continuing surveyor training. 

++ Compare the Joint Commission’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 

psychiatric hospitals. 

++ Evaluate the Joint Commission’s 

procedures for monitoring psychiatric 

hospitals it has found to be out of 

compliance with the Joint Commission’s 

program requirements. (This pertains 

only to monitoring procedures when the 

Joint Commission identifies noncompliance. If non-compliance is 

identified by a State Survey Agency 

through a validation survey, the State 

Survey Agency monitors corrections as 

specified at § 488.7(d).) 

++ Assess the Joint Commission’s 

ability to report deficiencies to the 

surveyed psychiatric hospital and 

respond to the psychiatric hospital’s 

plan of correction in a timely manner. 

++ Establish the Joint Commission’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 the 

Joint Commission’s staff and other 

resources. 

++ Confirm the Joint Commission’s 

ability to provide adequate funding for 

performing required surveys. 

++ Confirm the Joint Commission’s 

policies with respect to surveys being 

unannounced. 

++ Obtain the Joint Commission’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. 

In accordance with section 

1865(a)(3)(A) of the Act, the September 

23, 2014 proposed notice also solicited 

public comments regarding whether the 

Joint Commission’s requirements met or 

exceeded the Medicare CoPs for 

psychiatric hospitals. We received one 

comment in response to our proposed 

notice. The commenter supported our 

approval of the Joint Commission for 

continued recognition as a national 

accrediting organization for psychiatric 

hospitals that wish to participate in the 

Medicare or Medicaid programs. 

IV. Provisions of the Final Notice 

A. Differences Between the Joint 

Commission’s Standards and 

Requirements for Accreditation and 

Medicare Conditions and Survey 

Requirements 

We compared the Joint Commission’s 

psychiatric hospital accreditation 

requirements and survey process with 

the Medicare CoPs in part 482, and the 

survey and certification process 

requirements of parts 488 and 489. Our 

review and evaluation of the Joint 

Commission’s psychiatric hospital 

accreditation program application, 

which were conducted as described in 

section III of this final notice, identified 

a number of areas in which, as of the 

date of this notice, the Joint Commission 

is in the process of, or has completed, 

revising its standards in order to ensure 

that its accredited psychiatric hospitals 

meet the following regulatory 

requirements: 

• Section 482.61(a)(2), requiring that 

the medical record include the 

diagnosis of intercurrent diseases as 

well as the psychiatric diagnoses. 

• Section 482.61(a)(4), requiring that 

social service records include a social 

history and reports of interviews with 

patients, family members, and others. 

• Section 482.61(a)(5), requiring that 

a complete neurological examination be 

recorded at the time of the admission 

physical examination. 

• Section 482.61(b)(4), requiring that 

the psychiatric evaluation includes the 

onset of illness and the circumstances 

leading to admission. 

• Section 482.61(b)(7), requiring that 

the psychiatric evaluation include an 

inventory of the patient’s assets. 

• Section 482.61(c)(1), requiring that 

the individual comprehensive treatment 

plan be based on the patient’s strengths 

and disabilities. 

• Section 482.61(c)(1)(i), requiring 

that the treatment plan contain a 

substantiated diagnosis. 

• Section 482.61(c)(1)(v), requiring 

that the treatment plan contain adequate 

documentation to justify the diagnosis, 

treatment, and rehabilitation activities 

carried out. 

• Section 482.61(c)(2), requiring that 

the treatment plan contain 

documentation of the treatment received 

by the patient, in a way that assures all 

active therapeutic efforts are included. 

• Section 482.61(d), requiring that 

progress notes contain 

recommendations for revisions in the 

treatment plan, as indicated, as well as 

a precise assessment of the patient’s 


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9468 Federal Register / Vol. 80, No. 35 / Monday, February 23, 2015 / Notices 

progress in accordance with the original 

or revised treatment plan. 

• Section 482.61(e), requiring that 

each patient who has been discharged 

has a documented discharge summary. 

• Section 482.62(c), requiring that, if 

medical and surgical diagnostic and 

treatment services are not available 

within the institution, the institution 

have an agreement with an outside 

source of these services to ensure that 

they are immediately available or a 

satisfactory agreement must be 

established for transferring patients to a 

general hospital that participates in the 

Medicare program. 

• Section 482.62(g)(1), requiring that 

therapeutic activities be appropriate to 

the needs and interests of patients and 

be directed toward restoring and 

maintaining optimal levels of physical 

and psychosocial functioning. 

In addition, we determined that the 

Joint Commission is in the process of, or 

has completed, revising its accreditation 

survey processes in order to ensure that 

they meet the following regulatory 

requirements: 

• Section 488.4(a)(3), regarding the 

sample sizes required for medical record 

reviews and the minimum number of 

medical records to be reviewed during 

the survey process. 

• Section 488.8(a)(2)(v), requiring that 

complaint data submitted to CMS be 

accurate. 

• Section 488.8(a)(2)(ii), requiring 

that a process be in place to conduct 

routine second level survey 

documentation review to assure that 

deficiency citations are made at the 

appropriate level when no ‘‘flags’’ have 

been placed on the survey report 

through the automated process of the 

electronic scoring system or the 

surveyor; that surveyors are adequately 

equipped and trained to appropriately 

identify circumstances posing an 

immediate threat to life and safety; that 

medical records and credentialing 

records are sampled appropriately, 

based on services provided and types of 

staff employed; and that medical 

records and credentialing records are 

reviewed thoroughly, in a uniform and 

complete manner by surveyors. 

• Section 488.9, requiring the Joint 

Commission to consistently provide 

CMS access to observe its entire survey 

process, including surveyors’ use of 

resources provided outside of the 

accreditation standards manual (for 

example, discussions with its Standards 

Interpretation Group, as outlined in the 

application). 

• Section 488.26(b), regarding 

surveyors’ abilities to— 

—Accurately and completely 

document instances of non-compliance 

at the appropriate level of citation 

[condition versus standard level 

citations]; 

—Ensure that all instances of 

observed non-compliance are 

documented in the survey report; and, 

—Ensure that surveyors do not 

minimize the importance of compliance 

with regulations. 

B. Term of Approval 

Based on our review and observations 

described in section III of this final 

notice, we approve the Joint 

Commission as a national accrediting 

organization for psychiatric hospitals 

that request participation in the 

Medicare program, effective February 

25, 2015 through February 25, 2019. 

To verify the Joint Commission’s 

continued compliance with the 

provisions of this final notice, CMS will 

conduct a follow-up corporate on-site 

visit and survey observation within 18 

months of the publication date of this 

notice. 

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. 

Dated: February 13, 2015. 

Marilyn Tavenner, 

Administrator, Centers for Medicare & 

Medicaid Services. 

[FR Doc. 2015–03559 Filed 2–20–15; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HOMELAND 

SECURITY 

Coast Guard 

[Docket No. USCG–2015–0023] 

Lower Mississippi River Waterway 

Safety Advisory Committee; Meeting 

AGENCY: Coast Guard, DHS. 

ACTION: Notice of Federal Advisory 

Committee Meeting. 

SUMMARY: The Lower Mississippi River 

Waterway Safety Advisory Committee 

will meet to discuss safe transit of 

vessels and cargoes to and from the 

ports of the Lower Mississippi River. 

This meeting will be open to the public. 

DATES: The Committee will meet on 

Wednesday, March 11, 2015, from 9 

a.m. to 12:00 p.m. Written comments for 

distribution to committee members and 

for inclusion on the Lower Mississippi 

River Waterway Safety Advisory 

Committee Web site must be submitted 

on or before March 2, 2015. Please note 

that this meeting may close early if all 

business is finished. 

ADDRESSES: The Committee will meet at 

the New Orleans Yacht Club, 403 North 

Roadway Street, New Orleans, LA 70124 

http://noyc.org/wordpress/. 

For information on facilities or 

services for individuals with disabilities 

or to request special assistance, please 

contact Lieutenant Junior Grade Colin 

Marquis as indicated in the FOR FURTHER

INFORMATION CONTACT paragraph below. 

To facilitate public participation, we 

are inviting public comment on the 

issues to be considered by the 

committee as listed in the ‘‘Agenda’’ 

section below. Written comments must 

be identified by the Docket No. USCG– 

2015–0023 and submitted by one of the 

following methods: 

• Federal eRulemaking Portal: http:// 

www.regulations.gov. 

Follow the instructions for submitting 

comments (preferred method to avoid 

delays in processing). 

• Fax: 202–493–2251. 

• Mail: Docket Management Facility 

(M–30), U.S. Department of 

Transportation, West Building Ground 

Floor, Room W12–140, 1200 New Jersey 

Avenue SE., Washington, DC 20590– 

0001. 

• Hand Delivery: Same as mail 

address above, between 9 a.m. and 5 

p.m., Monday through Friday, except 

Federal Holidays. The telephone 

number for the Docket Management 

Facility is 202–366–9329. 

Instructions: All submissions must 

include the words ‘‘Department of 

Homeland Security’’ and the docket 

number for this action. Comments 

received will be posted without 

alteration at http://

www.regulations.gov., including any 

personal information provided. You 

may review a Privacy Act notice 

regarding our public dockets in the 

January 17, 2008, issue of the Federal 

Register (73 FR 3316). 

Docket: For access to the docket to 

read documents or comments related to 

this notice, go to http://

www.regulations.gov, enter the docket 

number in the ‘‘Search’’ field and follow 

the instructions on the Web site. 

FOR FURTHER INFORMATION CONTACT: 

Lieutenant Junior Grade Colin Marquis, 

Alternate Designated Federal Officer of 

the Lower Mississippi River Waterway 

Safety Advisory Committee, telephone 

504–365–2280, or at Colin.L.Marquis@

uscg.mil. If you have any questions on 

reviewing or submitting material to the 


Rmajette on DSK2VPTVN1PROD with NOTICES