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[Federal Register Volume 77, Number 57 (Friday, March 23, 2012)]
[Notices]
[Pages 17072-17073]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-6598]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-2377-FN]

Medicare and Medicaid Programs; Approval of the Community Health 
Accreditation Program for Continued CMS-Approval of its Home Health 
Agency Accreditation Program

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Final notice.

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SUMMARY: This notice announces our decision to approve the Community 
Health Accreditation Program (CHAP) for recognition as a national 
accreditation program for home health agencies (HHAs) seeking to 
participate in the Medicare or Medicaid programs.

DATES: This final notice is effective March 31, 2012 through March 31, 
2018.

FOR FURTHER INFORMATION CONTACT: Lillian Williams, (410) 786-8636, or 
Patricia Chmielewski, (410) 786-6899.

SUPPLEMENTARY INFORMATION:

I. Background

    Under the Medicare program, eligible beneficiaries may receive 
covered services in a home health agency (HHA) provided certain 
requirements are met. Sections 1861(m) and (o) and 1891 and 1895 of the 
Social Security Act (the Act) establish distinct criteria for 
facilities seeking designation as an HHA. Under this authority, the 
minimum requirements that an HHA must meet to participate in Medicare 
are set forth in regulations at 42 CFR part 484, which determine the 
basis and scope of HHA covered services, and the conditions for 
Medicare payment for home health care. Regulations concerning provider 
agreements are at part 489 and those pertaining to activities relating 
to the survey and certification of facilities are at part 488.
    Generally, in order to enter into a provider agreement with the 
Medicare program, HHAs must first be certified by a State survey agency 
as complying with conditions or requirements set forth in part 484. 
Thereafter, the HHA 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 State compliance surveys. 
Accreditation by a nationally-recognized accreditation program can 
substitute for ongoing State review.
    Section 1865(a)(1) of the Act provides that, if a provider entity 
demonstrates through accreditation by an approved national 
accreditation organization that all applicable Medicare conditions are 
met or exceeded, we may ``deem'' those provider entities as having met 
the requirements. Accreditation by an accreditation organization is 
voluntary and is not required for Medicare participation.
    If an accreditation organization is recognized by the Secretary as 
having standards for accreditation that meet or exceed Medicare 
requirements, a provider entity accredited by the national accrediting 
body's approved program may be deemed to meet the Medicare conditions. 
A national accreditation organization applying for CMS-approval of its 
accreditation program under part 488, subpart A must provide us with 
reasonable assurance that the accreditation organization requires the 
accredited provider entities to meet requirements that are at least as 
stringent as the Medicare conditions. Our regulations concerning the 
reapproval of accreditation organizations are set forth at Sec.  488.4 
and Sec.  488.8(d)(3). Section 488.8(d)(3) requires accreditation 
organizations to reapply for continued CMS-approval of its 
accreditation program every six years, or sooner as determined by us. 
CHAP's term of approval as a recognized accreditation program for HHAs 
expires March 31, 2012.

II. Deeming Applications Approval Process

    Section 1865(a)(3)(A) of the Act provides a statutory timetable to 
ensure that our review of deeming applications is conducted in a timely 
manner. The Act provides us with 210 calendar days after the date of 
receipt of an application to complete our survey activities and 
application review process. Within 60 days of receiving a completed 
application, we must publish a notice in the Federal Register that 
identifies the national accreditation 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 an 
approval or denial of the application.

III. Proposed Notice

    In the September 23, 2011, Federal Register (76 FR 59136), we 
published a proposed notice announcing CHAP's request for continued CMS 
approval of its HHA accreditation program. In the proposed notice, we 
detailed our evaluation criteria. Under section 1865(a)(2) of the Act 
and our regulations at Sec.  488.4 (Application and reapplication 
procedures for accreditation organizations), we conducted a review of 
CHAP's application in accordance with the criteria specified by our 
regulations, which include, but are not limited to the following:
     An onsite 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 surveyors; (4) ability to investigate and respond 
appropriately to complaints against accredited facilities; and, (5) 
survey review and decision-making process for accreditation.
     A comparison of CHAP's HHA accreditation standards to our 
current Medicare HHA conditions for participation.
     A documentation review of CHAP's survey processes to:
    [boxvh][boxvh] Determine the composition of the survey team, 
surveyor qualifications, and the ability of CHAP to provide continuing 
surveyor training.
    [boxvh][boxvh] Compare CHAP's processes to those of State survey 
agencies, including survey frequency, and the ability to investigate 
and respond appropriately to complaints against accredited facilities.
    [boxvh][boxvh] Evaluate CHAP's procedures for monitoring providers 
or suppliers found to be out of compliance with CHAP program 
requirements. The monitoring procedures are used only when the CHAP 
identifies noncompliance. If noncompliance is identified through 
validation reviews, the survey agency monitors corrections as specified 
at Sec.  488.7(d).

[[Page 17073]]

    [boxvh][boxvh] Assess CHAP's ability to report deficiencies to the 
surveyed facilities and respond to the facility's plan of correction in 
a timely manner.
    [boxvh][boxvh] Establish CHAP's ability to provide us with 
electronic data and reports necessary for effective validation and 
assessment of CHAP's survey process.
    [boxvh][boxvh] Determine the adequacy of staff and other resources.
    [boxvh][boxvh] Review CHAP's ability to provide adequate funding 
for performing required surveys.
    [boxvh][boxvh] Confirm CHAP's policies with respect to whether 
surveys are announced or unannounced.
    [boxvh][boxvh] Obtain CHAP's agreement to provide us 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, 2011 proposed notice (76 FR 59136) also solicited public comments 
regarding whether CHAP's requirements met or exceeded the Medicare 
conditions of participation for HHAs. We received no public comments in 
response to our proposed notice.

IV. Provisions of the Final Notice

A. Differences Between CHAP's Standards and Requirements for 
Accreditation and Medicare's Conditions and Survey Requirements

    We compared the standards and survey process contained in CHAP's 
application with the Medicare HHA conditions for participation and our 
State Operations Manual (SOM). Our review and evaluation of CHAP's 
application for continued CMS-approval were conducted as described in 
section III of this final notice, and yielded the following:
     To meet the requirements at Sec.  488.12, CHAP revised its 
accreditation decision letters to ensure that they contain all the 
required elements necessary for the Regional Office (RO) to render a 
decision regarding approval of a provider agreement for participation 
in Medicare.
     To meet the requirements at Chapter Five, section 5075.9 
of the SOM, CHAP revised its policies to ensure all compliant 
investigations are conducted within 45 calendar days, following receipt 
of a complaint that does not rise to the level of immediate jeopardy.
     To meet the clinical records requirements at Appendix B of 
the SOM, CHAP developed and implemented a monitoring plan to ensure the 
minimum number of home visits with clinical record reviews is completed 
during a survey.
     CHAP amended its crosswalk to ensure current CHAP 
standards are clearly crosswalked to the following regulatory 
requirements: Sec. Sec.  484.12(b); 484.12(c); 484.14(b); 484.14(i)(3); 
484.30(a); 484.32; 484.34(a); 486.36(b)(3)(ii); 484.36(d)(4)(ii); 
484.36(d)(4)(iii); 484.36(e); 484.38; 484.48; 484.52; 484.55; 
484.55(a)(1); 485.55(b)(1); and 484.55(d)(2).

B. Term of Approval

    Based on the review and observations described in section III of 
this final notice, we have determined that CHAP's HHA accreditation 
program requirements meet or exceed our requirements. Therefore, we 
approve CHAP as a national accreditation organization for HHAs that 
request participation in the Medicare program, effective March 31, 2012 
through March 31, 2018.

V. Collection of Information Requirements

    This document does not impose information collection and 
recordkeeping requirements. Consequently, it need not be reviewed by 
the Office of Management and Budget under the authority of the 
Paperwork Reduction Act of 1995 (44 U.S.C. 35).

    Authority: Section 1865 of the Social Security Act (42 U.S.C. 
1395bb).

(Catalog of Federal Domestic Assistance Program No. 93.778, Medical 
Assistance Program; No. 93.773 Medicare--Hospital Insurance Program; 
and No. 93.774, Medicare--Supplemental Medical Insurance Program)

    Dated: March 12, 2012.
Marilyn Tavenner,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2012-6598 Filed 3-22-12; 8:45 am]
BILLING CODE 4120-01-P
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