57308 Federal Register / Vol. 69, No. 185 / Friday, September 24, 2004 / Notices 

The purpose of this proposed notice 

is to inform the public of our 

consideration of CHAP’s request for 

approval of continued deeming 

authority for HHAs. This notice also 

solicits public comment on whether 

CHAP’s requirements meet or exceed 

the Medicare conditions for 

participation for HHAs. 

III. Evaluation of Deeming Authority 

Request 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Evaluation of Deeming Authority 

Request’’ at the beginning of your 

comments.]

On June 30, 2004, CHAP submitted all 

the necessary materials to enable us to 

make a determination concerning its 

request for reapproval as a deeming 

organization for HHAs. Under section 

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

at § 488.8 (Federal review of 

accreditation organizations), our review 

and evaluation of CHAP will be 

conducted in accordance with, but not 

necessarily limited to, the following 

factors: 

• The equivalency of CHAP standards 

for HHAs as compared with our 

comparable HHA conditions of 

participation. 

• CHAP’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 CHAP 

processes to that of State agencies, 

including survey frequency, and the 

ability to investigate and respond 

appropriately to complaints against 

accredited facilities. 

+ CHAP’s processes and procedures 

for monitoring providers or suppliers 

found out of compliance with CHAP 

program requirements. These 

monitoring procedures are used only 

when CHAP identifies noncompliance. 

If noncompliance is identified through 

validation reviews, the survey agency 

monitors corrections as specified at 

§ 488.7(d). 

+ CHAP’s capacity to report 

deficiencies to the surveyed facilities 

and respond to the facility’s plan of 

correction in a timely manner. 

+ CHAP capacity to provide us with 

electronic data in ASCII comparable 

code, and reports necessary for effective 

validation and assessment of the 

organization’s survey process. 

+ The adequacy of CHAP’s staff and 

other resources, and its financial 

viability. 

+ CHAP’s capacity to adequately 

fund required surveys. 

+ CHAP’s policies with respect to 

whether surveys are announced or 

unannounced. 

+ 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). 

IV. Response to 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. 

Upon completion of our evaluation, 

including evaluation of comments 

received as a result of this notice, we 

will publish a final notice in the Federal 

Register announcing the result of our 

evaluation. 

V. Regulatory Impact Statement 

In accordance with the provisions of 

Executive Order 12866, this regulation 

was not reviewed by the Office of 

Management and Budget.

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)

Dated: September 10, 2004. 

Mark B. McClellan, 

Administrator, Centers for Medicare & 

Medicaid Services.

[FR Doc. 04–21194 Filed 9–23–04; 8:45 am] 

BILLING CODE 4120–01–P

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–2208–PN] 

RIN 0938–AZ59 

Medicare and Medicaid Programs; 

Application by the American 

Osteopathic Association for Continued 

Approval of Deeming Authority for 

Hospitals

AGENCY: Centers for Medicare & 

Medicaid Services, HHS.

ACTION: Proposed notice.

SUMMARY: This proposed notice with 

comment period acknowledges the 

receipt of an application from the 

American Osteopathic Association 

(AOA) for continued recognition as a 

national accreditation program for 

hospitals that wish to participate in the 

Medicare or Medicaid programs. Section 

1865(b)(3)(A) of the Social Security Act 

(the Act) 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: We will consider comments if 

we receive them at the appropriate 

address, as provided below, no later 

than 5 p.m. on October 25, 2004.

ADDRESSES: In commenting, please refer 

to file code CMS–2208–PN. Because of 

staff and resource limitations, we cannot 

accept comments by facsimile (FAX) 

transmission. 

You may submit comments in one of 

three ways (no duplicates, please): 

1. Electronically. You may submit 

electronic comments on specific issues 

in this regulation to http://

www.cms.hhs.gov/regulations/

ecomments. (Attachments should be in 

Microsoft Word, WordPerfect, or Excel; 

however, we prefer Microsoft Word.) 

2. By mail. You may mail written 

comments (one original and two copies) 

to the following address ONLY: Centers 

for Medicare & Medicaid Services, 

Department of Health and Human 

Services, Attention: CMS–2208–PN, 

P.O. Box 8016, Baltimore, MD 21244–

8016. 

Please allow sufficient time for mailed 

comments to be received before the 

close of the comment period. 

3. By hand or courier. If you prefer, 

you may deliver (by hand or courier) 

your written comments (one original 

and two copies) before the close of the 

comment period to one of the following 

addresses. If you intend to deliver your 

comments to the Baltimore address, 

please call telephone number (410) 786–

7195 in advance to schedule your 

arrival with one of our staff members; 

Room 445–G, Hubert H. Humphrey 

Building, 200 Independence Avenue, 

SW., Washington, DC 20201; or 7500 

Security Boulevard, Baltimore, MD 

21244–1850. 

(Because access to the interior of the 

HHH 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.) 

Federal Register / Vol. 69, No. 185 / Friday, September 24, 2004 / Notices 57309

Comments mailed to the addresses 

indicated as appropriate for hand or 

courier delivery may be delayed and 

received after the comment period.

FOR FURTHER INFORMATION CONTACT:

Marjorie Eddinger (410) 786–0375. 

I. Background 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Background’’ at the beginning of your 

comments.]

Under the Medicare program, eligible 

beneficiaries may receive covered 

services in a hospital facility provided 

certain requirements are met. Sections 

1861(e) of the Social Security Act (the 

Act) establishes distinct criteria for 

facilities seeking designation as a 

hospital. 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 482 specify 

the conditions that a Hospital must meet 

to participate in the Medicare program. 

Generally, to enter into an agreement, 

a hospital provider must first be 

certified by a State survey agency as 

complying with the conditions or 

standards set forth in part 482 of our 

regulations. Then, the hospital 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(b)(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 would ‘‘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, any 

provider entity accredited by the 

national accrediting body’s approved 

program would be deemed to meet the 

Medicare conditions. A national 

accreditation organization applying for 

approval of deeming authority under 42 

CFR 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 reapproval 

of accrediting organizations are set forth 

at § 488.4 and § 488.8(d)(3). The 

regulations at § 488.8(d)(3) require 

accreditation organizations to reapply 

for continued approval of deeming 

authority every 6 years or sooner as 

determined by CMS. 

The AOA’s term of approval as a 

recognized accreditation program for 

hospitals expires March 31, 2005. 

II. Approval of Deeming Organizations 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘Approval of Deeming 

Organizations’’ at the beginning of your 

comments.]

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

regulations at § 488.8(a) require that our 

findings concerning review and 

reapproval of a national accrediting 

organization’s requirements consider, 

among other factors, the reapplying 

accreditation 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 

CMS with the necessary data for 

validation. 

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

further requires that we publish, within 

60 days of receipt of an accreditation 

organization’s complete application, a 

notice identifying the national 

accreditation 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 our receipt of a completed 

application to publish approval or 

denial of the application. 

The purpose of this proposed notice 

is to inform the public of our 

consideration of AOA’s request for 

approval of continued deeming 

authority for hospitals. This notice also 

solicits public comment on whether 

AOA requirements meet or exceed the 

Medicare conditions for participation 

for hospitals. 

III.Evaluation of Deeming Authority 

Request 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Evaluation of Deeming Request’’ at the 

beginning of your comments.]

On June 30, 2004, AOA submitted all 

the necessary materials to enable us to 

make a determination concerning its 

request for reapproval as a deeming 

organization for hospitals. Under 

section 1865(b)(2) of the Act and our 

regulations at § 488.8 (Federal review of 

accreditation organizations), our review 

and evaluation of AOA will be 

conducted in accordance with, but not 

necessarily limited to, the following 

factors: 

• The equivalency of AOA standards 

for hospitals as compared with our 

comparable hospital conditions of 

participation. 

• AOA’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 AOA 

processes to those of State agencies, 

including survey frequency, and the 

ability to investigate and respond 

appropriately to complaints against 

accredited facilities. 

+ AOA’s processes and procedures 

for monitoring providers or suppliers 

found out of compliance with AOA 

program requirements. These 

monitoring procedures are used only 

when AOA identifies noncompliance. If 

noncompliance is identified through 

validation reviews, the survey agency 

monitors corrections as specified at 

§ 488.7(d). 

+ AOA’s capacity to report 

deficiencies to the surveyed facilities 

and respond to the facility’s plan of 

correction in a timely manner. 

+ AOA capacity to provide us with 

electronic data in ASCII comparable 

code, and reports necessary for effective 

validation and assessment of the 

organization’s survey process. 

+ The adequacy of AOA’s staff and 

other resources, and its financial 

viability. 

+ AOA’s capacity to adequately fund 

required surveys. 

+ AOA’s policies with respect to 

whether surveys are announced or 

unannounced. 

+ AOA’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). 

IV. Response to Public Comments and 

Notice Upon Completion of Evaluation 

Because of the large number of public 

comments we normally receive on 

Federal Register documents published 

for comment, 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 will respond to the 

public comments in the preamble to that 

document. 

Upon completion of our evaluation, 

including evaluation of comments 

received as a result of this notice, we 

57310 Federal Register / Vol. 69, No. 185 / Friday, September 24, 2004 / Notices 

will publish a final notice in the Federal 

Register announcing the result of our 

evaluation. In accordance with the 

provisions of Executive Order 12866, 

the Office of Management and Budget 

did not review this proposed notice. 

V. Regulatory Impact Statement 

In accordance with Executive Order 

12866, this notice was not reviewed by 

the Office of Management and Budget.

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—Supplementary Medical 

Insurance Program)

Dated: September 10, 2004. 

Mark B. McClellan, 

Administrator, Centers for Medicare & 

Medicaid Services.

[FR Doc. 04–21196 Filed 9–23–04; 8:45 am] 

BILLING CODE 4120–01–P

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–4077–PN] 

RIN 0928–ZA59 

Medicare and Medicaid Programs; 

Application by the National Committee 

for Quality Assurance Preferred 

Provider Organization for Deeming 

Authority for Medicare Advantage

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS.

ACTION: Proposed notice.

SUMMARY: This proposed notice 

announces the receipt of an application 

from the National Committee for Quality 

Assurance for recognition as a national 

accreditation program for preferred 

provider organizations that wish to 

participate in the Medicare Advantage 

program. The statute requires that 

within 60 days of receipt of an 

organization’s complete application, we 

will announce our receipt of the 

accreditation organization’s application 

for approval, describe the criteria we 

will use in evaluating the application, 

and provide 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 October 25, 2004.

ADDRESSES: In commenting, please refer 

to file code CMS–4077–PN. Because of 

staff and resource limitations, we cannot 

accept comments by facsimile (FAX) 

transmission. 

You may submit comments in one of 

three ways (no duplicates, please): 

1. Electronically. You may submit 

electronic comments on specific issues 

in this regulation to http://

www.cms.hhs.gov/regulations/

ecomments. (Attachments should be in 

Microsoft Word, WordPerfect, or Excel; 

however, we prefer Microsoft Word.) 

2. By mail. You may mail written 

comments (one original and two copies) 

to the following address ONLY: Centers 

for Medicare & Medicaid Services, 

Department of Health and Human 

Services, Attention: CMS–4077–PN, 

P.O. Box 8016, Baltimore, MD 21244–

8016. 

Please allow sufficient time for mailed 

comments to be received before the 

close of the comment period. 

3. By hand or courier. If you prefer, 

you may deliver (by hand or courier) 

your written comments (one original 

and two copies) before the close of the 

comment period to one of the following 

addresses. If you intend to deliver your 

comments to the Baltimore address, 

please call telephone number (410) 786–

3159 in advance to schedule your 

arrival with one of our staff members; 

Room 445–G, Hubert H. Humphrey 

Building, 200 Independence Avenue, 

SW., Washington, DC 20201; or 7500 

Security Boulevard, Baltimore, MD 

21244–1850. 

(Because access to the interior of the 

HHH 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.) 

Comments 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:

Heidi Adams, (410) 786–1094.

SUPPLEMENTARY INFORMATION:

Submitting Comments: We welcome 

comments from the public on all issues 

set forth in this proposed notice to assist 

us in fully considering issues and 

developing policies. You can assist us 

by referencing the file code CMS–4077–

PN and the specific ‘‘issue identifier’’

that precedes the section on which you 

choose to comment. 

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. After the close of the 

comment period, CMS posts all 

electronic comments received before the 

close of the comment period on its 

public website. Comments received 

timely will 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 (410) 

786–7195. 

This Federal Register document is 

available from the Federal Register

online database through GPO Access, a 

service of the U.S. Government Printing 

Office. The web site address is: http://

www.gpoaccess.gov/fr/index.html.

I. Background 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Background’’ at the beginning of your 

comments.]

Under the Medicare program, eligible 

beneficiaries may receive covered 

services through a managed care 

organization (MCO) that has a Medicare 

Advantage (MA) (formerly, 

Medicare+Choice) contract with the 

Centers for Medicare & Medicaid 

Services (CMS). The regulations 

specifying the Medicare requirements 

that must be met in order for an MCO 

to enter into an MA contract with CMS 

are located at 42 CFR part 422. These 

regulations implement part C of Title 

XVIII of the Social Security Act (the 

Act), which specifies the services that 

an MCO must provide and the 

requirements that the organization must 

meet to be an MA contractor. Other 

relevant sections of the Act are parts A 

and B of Title XVIII and part A of Title 

XI pertaining to the provision of 

services by Medicare certified providers 

and suppliers. 

Generally, for an organization to enter 

into an MA contract, the organization 

must be licensed by the State as a risk 

bearing organization as set forth in part 

422 of our regulations. Additionally, the 

organization must file an application 

demonstrating that it meets other 

Medicare requirements in part 422 of 

our regulations. Following approval of 

the contract, we engage in routine 

monitoring and oversight audits of the 

MA organization to ensure continuing 

compliance. The monitoring and