21244 Federal Register / Vol. 80, No. 74 / Friday, April 17, 2015 / Notices 

proposal also involves the acquisition of 

a nonbanking company, the review also 

includes whether the acquisition of the 

nonbanking company complies with the 

standards in section 4 of the BHC Act 

(12 U.S.C. 1843). Unless otherwise 

noted, nonbanking activities will be 

conducted throughout the United States. 

Unless otherwise noted, comments 

regarding each of these applications 

must be received at the Reserve Bank 

indicated or the offices of the Board of 

Governors not later than May 14, 2015. 

A. Federal Reserve Bank of San 

Francisco (Gerald C. Tsai, Director, 

Applications and Enforcement) 101 

Market Street, San Francisco, California 

94105–1579: 

1. Western Alliance Bancorporation, 

Phoenix, Arizona; to merge with Bridge 

Capital Holdings, and thereby indirectly 

acquire its subsidiary bank, Bridge 

Bank, National Association, both in San 

Jose, California. 

Board of Governors of the Federal Reserve 

System, April 14, 2015. 

Michael J. Lewandowski, 

Associate Secretary of the Board. 

[FR Doc. 2015–08860 Filed 4–16–15; 8:45 am] 

BILLING CODE 6210–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–3305–FN] 

Medicare and Medicaid Programs; 

Continued Approval of the American 

Association for Accreditation of 

Ambulatory Surgery Facilities’ 

Accreditation Program for 

Organizations That Provide Outpatient 

Physical Therapy and Speech 

Language Pathology Services 

AGENCY: Centers for Medicare & 

Medicaid Services, HHS. 

ACTION: Final notice. 

SUMMARY: This final notice announces 

our decision to approve the American 

Association for Accreditation of 

Ambulatory Surgery Facilities for 

continued recognition as a national 

accrediting organization for 

organizations that provide outpatient 

physical therapy and speech language 

pathology (OPT) services that wish to 

participate in the Medicare or Medicaid 

programs. An OPT that participates in 

Medicaid must also meet the Medicare 

Conditions of Participation. 

DATES: This final notice is effective 

April 22, 2015 through April 22, 2019. 

FOR FURTHER INFORMATION CONTACT: 

Cindy Melanson, (410) 786–0310, or 

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 an 

outpatient physical therapy and speech 

language pathology (OPT) provided 

certain requirements are met. Section 

1861(p)(4) of the Social Security Act 

(the Act), establish distinct criteria for 

facilities seeking designation as an OPT. 

Regulations concerning Medicare 

provider agreements 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 485, 

subpart H specify the specific 

conditions that a provider must meet to 

participate in the Medicare program as 

an OPT. 

Generally, to enter into a Medicare 

provider agreement, a facility must first 

be certified by a State Survey Agency as 

complying with the conditions or 

requirements set forth in part 485, 

subpart H of our Medicare regulations. 

Thereafter, the OPT is 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 national Medicare 

accreditation program approved by the 

Center 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 

accreditation organization meets or 

exceeds all applicable Medicare 

conditions or requirements, we may 

‘‘deem’’ the provider 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 the CMS. The 

American Association for Accreditation 

of Ambulatory Surgery Facilities 

(AAAASF’s) current term of approval as 

a Medicare accreditation program for 

OPTs expires April 22, 2015. 

II. Application Approval Process 

Section 1865(a)(3)(A) of 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 of receipt of an 

organization’s complete application, we 

must publish a notice that identifies the 

national accrediting body making the 

request, describes the nature of the 

request, and provide at least a 30-day 

public comment period. At the end of 

the 210-day period, we must publish a 

notice announcing our approval or 

denial of an application. 

III. Provisions of the Proposed Notice 

On November 21, 2014, we published 

a proposed notice in the Federal 

Register (79 FR 69481) entitled 

‘‘Application from the American 

Association for Accreditation of 

Ambulatory Surgery Facilities for 

Continued Approval of its Accreditation 

Program for Organizations that Provide 

Outpatient Physical Therapy and 

Speech Language Pathology Services’’ 

announcing AAAASF’s request for 

continued approval of its Medicare OPT 

accreditation program. In that 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 AAAASF’s 

Medicare OPT 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 

AAAASF’s: (1) Corporate policies; (2) 

financial and human resources available 

to accomplish the proposed surveys; (3) 

procedures for training, monitoring, and 

evaluation of its OPT surveyors; (4) 

ability to investigate and respond 

appropriately to complaints against 

accredited OPTs; and (5) survey review 

and decision-making process for 

accreditation. 

• The comparison of AAAASF’s 

Medicare accreditation program 

standards to our current Medicare OPT 

Conditions of Participation (CoPs). 

• A documentation review of 

AAAASF’s survey process to: 

++ Determine the composition of the 

survey team, surveyor qualifications, 


tkelley on DSK3SPTVN1PROD with NOTICES
Federal Register / Vol. 80, No. 74 / Friday, April 17, 2015 / Notices 21245 

and AAAASF’s ability to provide 

continuing surveyor training. 

++ Compare AAAASF’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 OPTs. 

++ Evaluate AAAASF’s procedures 

for monitoring OPTs it has found to be 

out of compliance with AAAASF’s 

program requirements. (This pertains 

only to monitoring procedures when 

AAAASF 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 

§ 488.7(d). 

++ Assess AAAASF’s ability to report 

deficiencies to the surveyed OPT and 

respond to the OPT’s plan of correction 

in a timely manner. 

++ Establish AAAASF’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 

AAAASF’s staff and other resources. 

++ Confirm AAAASF’s ability to 

provide adequate funding for 

performing required surveys. 

++ Confirm AAAASF’s policies with 

respect to surveys being unannounced. 

++ Obtain AAAASF’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 November 

21, 2014 proposed notice also solicited 

public comments regarding whether 

AAAASF’s requirements met or 

exceeded the Medicare CoPs for OPTs. 

We received no public comments in 

response to our proposed notice. 

IV. Provisions of the Final Notice 

A. Differences Between AAAASF’s 

Standards and Requirements for 

Accreditation and Medicare Conditions 

and Survey Requirements 

We compared AAAASF’s OPT 

accreditation requirements and survey 

process with the Medicare CoPs of part 

485, subpart H and the survey and 

certification process requirements of 

parts 488 and 489. Our review and 

evaluation of AAAASF’s OPT 

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, 

AAAASF has completed revising its 

standards and certification processes in 

order to meet the requirements at: 

• Section 488.4(a)(3)(ii), to ensure 

surveyors are provided the necessary 

tools to evaluate compliance with the 

Medicare conditions. 

• Section 488.4(a)(3)(iii), to ensure 

the accreditation review process and 

accreditation decision making process 

meets the Medicare requirements, the 

following was modified: 

++ Policy related to how AAAASF 

verifies an organization without a CMS 

certification number (CCN) seeking an 

initial survey has completed the 

Medicare enrollment application prior 

to receiving an accreditation survey; 

++ Policy for establishing an effective 

date for renewal surveys; 

++ Policy for withdrawals and 

terminations; and 

++ Guidance and instructions on how 

plans of correction are handled when 

they are not adequate. 

• Section 488.4(a)(6), to address the 

requirement where complaints that do 

not rise to the level of requiring an 

onsite investigation are tracked and 

trended for potential focus areas during 

the next onsite survey. 

• Section 488.9, to address the 

number of medical records reviews that 

must be completed onsite. 

• Section 488.26(b), to ensure survey 

reports contain the appropriate level of 

deficiency (that is, standard versus 

condition). 

• Section 488.28(a), to ensure plans of 

correction correct the cited deficiencies, 

include thresholds of compliance and 

are sent timely. 

B. Term of Approval 

Based on our review and observations 

described in section III of this final 

notice, we approve AAAASF as a 

national accreditation organization for 

OPTs that request participation in the 

Medicare program, effective April 22, 

2015 through April 22, 2019. 

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: April 13, 2015. 

Andrew M. Slavitt, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

[FR Doc. 2015–08917 Filed 4–16–15; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Proposed Information Collection 

Activity; Comment Request 

Proposed Projects 

Title: Initial Medical Exam Form and 

Initial Dental Exam Form. 

OMB No.: New. 

Description 

Pursuant to Exhibit 1, part A.2 of the 

Flores Settlement Agreement (Jenny 

Lisette Flores, et al., v. Janet Reno, 

Attorney General of the United States, et 

al., Case No. CV 85–4544–RJK (C.D. Cal. 

1996), licensed programs, on behalf of 

the Administration for Children and 

Families’ Office of Refugee Resettlement 

(ORR), shall arrange for appropriate 

routine medical and dental care, family 

planning services, and emergency 

health care services, including a 

complete medical examination 

(including screening for infectious 

disease) within 48 hours of admission, 

excluding weekends and holidays, 

unless the minor was recently examined 

at another facility; appropriate 

immunizations in accordance with the 

U.S. Public Health Service (PHS), Center 

for Disease Control; administration of 

prescribed medication and special diets; 

appropriate mental health interventions 

when necessary for each minor in its 

care. 

The forms are to be used as 

worksheets for clinicians, medical staff, 

and the health department to compile 

information that would otherwise have 

been collected during the initial medical 

or dental exam. Once completed, the 

forms will be given to shelter staff for 

data entry into ORR’s electronic data 

repository known as ‘The Portal.’ Data 

will be used to record UC health on 

admission and for case management of 

any identified illnesses/conditions. 

Respondents: Clinicians, Health 

Department staff, Office of Refugee 

Resettlement Grantee staff. 


tkelley on DSK3SPTVN1PROD with NOTICES