Federal Register / Vol. 79, No. 225 / Friday, November 21, 2014 / Notices 69481 

otherwise contribute to the stability of 

coverage offered by the CO-OP. By 

increasing competition in the health 

insurance market and operating with a 

strong consumer focus, the CO-OP 

program will provide consumers more 

choices, greater plan accountability, 

increased competition to lower prices, 

and better models of care, benefiting all 

consumers, not just CO-OP members. 

The CO-OP program will provide 

nonprofits with loans to fund start-up 

costs and State reserve requirements, in 

the form of Start-up Loans and Solvency 

Loans. An applicant may apply for (1) 

Joint Start-up and Solvency Loans; or (3) 

only a Solvency Loan. Planning Loans 

are intended to help loan recipients 

determine the feasibility of operating a 

CO-OP in a target market. Start-up 

Loans are intended to assist loan 

recipients with the many start-up costs 

associated with establishing a new 

health insurance issuer. Solvency Loans 

are intended to assist loan recipients 

with meeting the solvency requirements 

of States in which the applicant seeks to 

be licensed to issue qualified health 

plans. Form Number: CMS–10392 (OMB 

control number: 0938–1139); Frequency: 

Occasionally; Affected Public: Private 

sector—not-for-profit institutions; 

Number of Respondents: 23; Total 

Annual Responses: 583; Total Annual 

Hours: 11,621. (For policy questions 

regarding this collection contact Deepti 

Loharikar (301–492–4126.) 

Dated: November 18, 2014. 

Martique Jones, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2014–27640 Filed 11–20–14; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–3305–PN] 

Medicare and Medicaid Programs: 

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 

AGENCY: Centers for Medicare & 

Medicaid Services, HHS. 

ACTION: Proposed notice. 

SUMMARY: This proposed notice 

acknowledges the receipt of an 

application from 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 services that wish to 

participate in the Medicare or Medicaid 

programs. The statute requires that 

within 60 days of receipt of an 

organization’s complete application, we 

publish a notice that 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 December 22, 2014. 

ADDRESSES: In commenting, refer to file 

code CMS–3305–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–3305–PN, P.O. Box 8016, 

Baltimore, MD 21244–1850. 

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–3305–PN, 

Mail Stop C4–26–05, 7500 Security 

Boulevard, Baltimore, MD 21244–1850. 

4. By hand or courier. Alternatively, 

you may deliver (by hand or courier) 

your written only to 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, call 

telephone number (410) 786–9994 in 

advance to schedule your arrival with 

one of our staff members. 

Comments erroneously 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: 

Cindy Melanson, (410) 786–0310. 

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 3 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 an outpatient physical 

therapy and speech language pathology 

service (OPT) provided certain 

requirements are met. Section 1861(p) of 

the Social Security Act (the Act) 

establishes distinct criteria for facilities 

seeking designation as an OPT. 

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 

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69482 Federal Register / Vol. 79, No. 225 / Friday, November 21, 2014 / Notices 

at 42 CFR part 485, subpart H specify 

the minimum conditions that an OPT 

must meet to participate in the Medicare 

program. 

Generally, to enter into an agreement, 

an OPT 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 regular surveys by a state 

survey agency to determine whether it 

continues to meet these requirements. 

There is an alternative, however, to 

surveys by state agencies. 

Section 1865(a)(1) of the Act provides 

that, if a provider entity demonstrates 

through accreditation by a CMSapproved national accrediting 

organization that all applicable 

Medicare conditions are met or 

exceeded, we may 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 of the 

Department of Health and Human 

Services (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 may be deemed to meet the 

Medicare conditions. A national 

accrediting organization applying for 

approval of its accreditation program 

under 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 approval 

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 approval of its accreditation 

program every 6 years or sooner as 

determined by CMS. 

The American Association for 

Accreditation of Ambulatory Surgery 

Facilities (AAAASF’s) current term of 

approval for their OPT accreditation 

program expires April 22, 2015. 

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 

approval 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 

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 AAAASF’s 

request for continued approval of its 

OPT accreditation program. This notice 

also solicits public comment on whether 

AAAASF’s requirements meet or exceed 

the Medicare conditions of participation 

(CoPs) for OPTs. 

III. Evaluation of Deeming Authority 

Request 

AAAASF submitted all the necessary 

materials to enable us to make a 

determination concerning its request for 

continued approval of its OPT 

accreditation program. This application 

was determined to be complete on 

September 29, 2014. Under Section 

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

at § 488.8 (Federal review of accrediting 

organizations), our review and 

evaluation of AAAASF will be 

conducted in accordance with, but not 

necessarily limited to, the following 

factors: 

• The equivalency of AAAASF’s 

standards for OPTs as compared with 

Medicare’s OPT CoPs. 

• AAAASF’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 AAAASF’s 

processes to those of state agencies, 

including survey frequency, and the 

ability to investigate and respond 

appropriately to complaints against 

accredited facilities. 

—AAAASF’s processes and procedures 

for monitoring a OPT found out of 

compliance with AAAASF’s program 

requirements. These monitoring 

procedures are used only when 

AAAASF identifies noncompliance. If 

noncompliance is identified through 

validation reviews or complaint 

surveys, the state survey agency 

monitors corrections as specified at 

§ 488.7(d). 

—AAAASF’s capacity to report 

deficiencies to the surveyed facilities 

and respond to the facility’s plan of 

correction in a timely manner. 

—AAAASF’s capacity to provide CMS 

with electronic data and reports 

necessary for effective validation and 

assessment of the organization’s 

survey process. 

—The adequacy of AAAASF’s staff and 

other resources, and its financial 

viability. 

—AAAASF’s capacity to adequately 

fund required surveys. 

—AAAASF’s policies to assure that 

surveys are unannounced. 

—AAAASF’s agreement to provide CMS 

with a copy of the most current 

accreditation survey together with any 

other information related to the 

survey that CMS may request 

(including corrective action plans). 

IV. 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. 

V. Response to Public 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 preamble, and, when we proceed 

with a subsequent document, we will 

respond to the comments in the 

preamble to that document. 

Dated: November 5, 2014. 

Marilyn Tavenner, 

Administrator, Centers for Medicare & 

Medicaid Services. 

[FR Doc. 2014–27649 Filed 11–20–14; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–3301–FN] 

Medicare and Medicaid Programs; 

Continued Approval of DNV GL— 

Healthcare (DNV GL) Critical Access 

Hospital (CAH) Accreditation Program 

AGENCY: Centers for Medicare & 

Medicaid Services, HHS. 

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