Federal Register / Vol. 74, No. 14 / Friday, January 23, 2009 / Notices 4203 

1. Type of Information Collection 

Request: New collection; Title of 

Information Collection: Evaluation of 

the Medicare Care Management 

Performance Demonstration (MCMP) 

and the Electronic Health Records 

Demonstration (EHRD); Use: The MCMP 

demonstration was authorized under 

Section 649 of the Medicare 

Prescription Drug, Improvement, and 

Modernization Act of 2003. This is a 

three year pay for performance 

demonstration with physicians to 

promote the adoption and use of health 

information technology (HIT) to 

improve the quality of care for eligible 

chronically ill Medicare beneficiaries. 

MCMP targets small to medium sized 

primary care practices with up to 10 

physicians. Practices must provide care 

to at least 50 Medicare beneficiaries. 

Physicians will receive payments for 

meeting or exceeding performance 

standards for quality of care. They will 

also receive an additional incentive 

payment for electronic submission of 

performance measures via their 

electronic health record (EHR) system. 

These payments are in addition to their 

normal payments for providing service 

to Medicare beneficiaries. The Office 

System Survey (OSS) will be used to 

assess progress of physician practices in 

implementation and use of EHRs and 

related HIT functionalities. 

The EHR demonstration is authorized 

under section 402 of the Medicare 

Waiver Authority. The goal of this six 

year pay for performance demonstration 

is to foster the implementation and 

adoption of EHRs and HIT in order to 

improve the quality of care provided by 

physician practices. The EHRD expands 

upon the MCMP Demonstration and 

will test whether performance-based 

financial incentives (1) increase 

physician practices’ adoption and use of 

electronic health records (EHRs), and (2) 

improve the quality of care that 

practices deliver to chronically ill 

patients. The EHRD targets small to 

medium sized primary care practices 

with up to 20 physicians. Practices must 

provide care to at least 50 Medicare 

beneficiaries. Approximately 2,400 

practices will be enrolled in the 

demonstration across 12 sites. Practices 

will be randomly assigned to a 

treatment and control group. The OSS 

will be used to assess progress of 

physician practices in implementation 

and use of EHRs and related HIT 

functionalities, and to determine 

incentive payments for treatment 

practices. In-person and telephone 

discussions with community partners 

and physician practices will be used to 

learn about practices’ experiences and 

strategies in adopting and using EHRs, 

as well as the factors that help or hinder 

their efforts. Form Number: CMS–10273 

(OMB# 0938—New); Frequency: 

Annually, Biennially and Once; 

Affected Public: Business or other forprofit; Number of Respondents: 3434; 

Total Annual Responses: 3434; Total 

Annual Hours: 2586. 

To obtain copies of the supporting 

statement and any related forms for the 

proposed paperwork collections 

referenced above, access CMS’ Web site 

at http://www.cms.hhs.gov/Paperwork

ReductionActof1995, or E-mail your 

request, including your address, phone 

number, OMB number, and CMS 

document identifier, to 

Paperwork@cms.hhs.gov, or call the 

Reports Clearance Office on (410) 786– 

1326. 

In commenting on the proposed 

information collections please reference 

the document identifier or OMB control 

number. To be assured consideration, 

comments and recommendations must 

be submitted in one of the following 

ways by March 24, 2009: 

1. Electronically. You may submit 

your comments electronically to http:// 

www.regulations.gov. Follow the 

instructions for ‘‘Comment or 

Submission’’ or ‘‘More Search Options’’ 

to find the information collection 

document(s) accepting comments. 

2. By regular mail. You may mail 

written comments to the following 

address: CMS, Office of Strategic 

Operations and Regulatory Affairs, 

Division of Regulations Development, 

Attention: Document Identifier/OMB 

Control Number l, Room C4–26–05, 

7500 Security Boulevard, Baltimore, 

Maryland 21244–1850. 

Dated: January 14, 2009. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. E9–1435 Filed 1–22–09; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–2899–FN] 

Medicare and Medicaid Programs; 

Approval of the Accreditation 

Commission for Health Care, 

Incorporated for Continued Deeming 

Authority for Home Health Agencies 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Final notice. 

SUMMARY: This notice announces our 

decision to approve the Accreditation 

Commission for Health Care, 

Incorporated (ACHC) for continued 

recognition as a national accreditation 

program for home health agencies 

(HHAs) seeking to participate in the 

Medicare or Medicaid programs. 

DATES: Effective Date: This final notice 

is effective February 24, 2009 through 

February 24, 2015. 

FOR FURTHER INFORMATION CONTACT: 

Lillian Williams, (410) 786–8636. 

Patricia Chmielewski, (410) 786–6899. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Under the Medicare program, eligible 

beneficiaries may receive selected 

covered services from a home health 

agency (HHA) provided certain 

requirements are met. Sections 1861(m) 

and (o), 1891, and 1895 of the Social 

Security Act (the Act) authorize the 

Secretary to 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 and 42 CFR part 409, which 

determine the basis and scope of HHAcovered services, and the conditions for 

Medicare payment for home health care. 

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. 

Generally, to enter into an agreement, 

an HHA must first be certified by a State 

survey agency as complying with 

conditions or requirements set forth in 

part 484 of our regulations. Then, the 

HHA is subject to regular surveys by a 

State survey agency to determine 

whether it continues to meet those 

requirements. There is an alternative, 

however, to surveys by State agencies. 

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

redesignated under section 125 of the 

Medicare Improvements for Patients and 

Providers Act of 2008 (MIPPA) (Pub. L. 

110–275) 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 

Medicare requirements. (We note that 

section 125 of MIPPA redesignated 

subsections (b) through (e) of subsection 

1865 of the Act as (a) through (d) 

respectively.) Accreditation by an 

accreditation organization is voluntary 

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4204 Federal Register / Vol. 74, No. 14 / Friday, January 23, 2009 / Notices 

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 

approval of deeming authority 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 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 we 

determine. The Accreditation 

Commission for Health Care, 

Incorporated’s (ACHC) term of approval 

as a recognized accreditation program 

for HHAs expires February 24, 2009. 

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 that 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. Provisions of the Proposed Notice 

In the August 22, 2008 Federal 

Register (73 FR 49681), we published a 

proposed notice announcing the 

ACHC’s request for reapproval as a 

deeming organization for HHAs. In the 

proposed notice, we detailed our 

evaluation criteria. Under section 

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

at § 488.4 (Application and 

reapplication procedures for 

accreditation organizations), we 

conducted a review of the ACHC 

application in accordance with the 

criteria specified by our regulation, 

which include, but are not limited to the 

following: 

• An onsite administrative review of 

ACHC’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 decisionmaking process for accreditation. 

• A comparison of ACHC’s HHA 

accreditation standards to our current 

Medicare HHA conditions of 

participation (COPs). 

• A documentation review of ACHC’s 

survey processes to— 

++ Determine the composition of the 

survey team, surveyor qualifications, 

and the ability of ACHC to provide 

continuing surveyor training; 

++ Compare ACHC’s processes to 

those of State survey agencies, including 

survey frequency, and the ability to 

investigate and respond appropriately to 

complaints against accredited facilities; 

++ Evaluate ACHC’s procedures for 

monitoring providers or suppliers found 

to be out of compliance with ACHC 

program requirements. The monitoring 

procedures are used only when ACHC 

identifies noncompliance. If 

noncompliance is identified through 

validation reviews, the State survey 

agency monitors corrections as specified 

at § 488.7(d); 

++ Assess ACHC’s ability to report 

deficiencies to the surveyed facilities 

and respond to the facility’s plan of 

correction in a timely manner; 

++ Establish ACHC’s ability to 

provide us with electronic data and 

reports necessary for effective validation 

and assessment of ACHC’s survey 

process; 

++ Determine the adequacy of staff 

and other resources; 

++ Review ACHC’s ability to provide 

adequate funding for performing 

required surveys; 

++ Confirm ACHC’s policies with 

respect to whether surveys are 

announced or unannounced; and, 

++ Obtain ACHC’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 August 22, 

2008 proposed notice (73 FR 49681) 

solicited public comments regarding 

whether ACHC’s requirements met or 

exceeded the Medicare conditions of 

coverage for HHAs. We received no 

public comments in response to our 

proposed notice. 

IV. Provisions of the Final Notice 

A. Differences Between the ACHC’s 

Standards and Requirements for 

Accreditation and Medicare’s 

Conditions and Survey Requirements 

We compared the standards contained 

in ACHC’s accreditation requirements 

for HHAs and its survey process in 

ACHC’s application for renewal of 

deeming authority for HHAs with the 

Medicare HHA conditions for 

participation and our State Operations 

Manual (SOM). Our review and 

evaluation of ACHC’s deeming 

application, which were conducted as 

described in section III. of this final 

notice, yielded the following: 

• To meet the requirements at 

§ 488.4(a)(3)(iii), ACHC revised their 

record retention policy to require all 

survey documentation be kept for a 

minimum of 3 years. 

• To meet the requirements at 

§ 484.4(a)(4), ACHC revised its surveyor 

training and evaluation policy to 

include a process for addressing 

unsatisfactory performance. 

• To comply with the requirement at 

§ 488.4(b)(3)(i), ACHC developed an 

action plan to resolve issues related to 

timely data submissions. 

• ACHC modified its policies 

regarding timeframe for sending and 

receiving a plan of correction (PoC) to 

comply with the requirements of section 

2728 of the SOM. 

• To meet the Medicare requirements 

related to a plan of correction (PoC), 

ACHC amended its policies to ensure 

approved PoCs contain all the required 

elements specified in section 2728 of 

the SOM. 

• ACHC revised its accreditation 

decision letters to ensure they are 

accurate and contain all the required 

elements necessary for the CMS 

Regional Office to render a decision 

regarding deemed status of a provider. 

B. Term of Approval 

Based on the review and observations 

described in section III. of this final 

notice, we have determined that the 

ACHC requirements for HHA meet or 

exceed our requirements. Therefore, we 

approve ACHC as a national 

accreditation organization for HHAs that 

request participation in the Medicare 

program, effective February 24, 2009 

through February 24, 2015. 

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 

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Federal Register / Vol. 74, No. 14 / Friday, January 23, 2009 / Notices 4205 

Budget under the authority of the 

Paperwork Reduction Act of 1995 (44 

U.S.C. Chapter 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); (Catalog of Federal Domestic 

Assistance Program No. 93.773, Medicare— 

Hospital Insurance; Program No. 93.774, 

Medicare—Supplementary Medical 

Insurance Programs) 

Dated: November 21, 2008. 

Kerry Weems, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

[FR Doc. E9–684 Filed 1–22–09; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–2298–N] 

Medicaid Program; Town Hall Forum 

on Access to Dental Care for MedicaidEligible Children; April 6, 2009 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice of meeting. 

SUMMARY: This notice announces a town 

hall forum to discuss access to dental 

care for Medicaid eligible children. 

Beneficiaries, providers, dentists, 

industry representatives, and other 

interested parties are invited to this 

meeting to present their views, 

concerns, and recommendations related 

to oral health issues. The forum is open 

to the public, but attendance is limited 

to space available. 

DATES: Meeting Date: The town hall 

forum will be held on Monday, April 6, 

2009, from 1 p.m. to 4 p.m., eastern 

daylight time (e.d.t.). 

Deadline for Meeting Registration: 

Registrations must be received by 

Wednesday, April 1, 2009, by 5 p.m., 

e.d.t. 

Deadline for Requesting Special 

Accommodations: Participants requiring 

special accommodations should contact 

Cindy Ruff at the address specified in 

the ADDRESSES section of this notice by 

Friday, March 27, 2009, by 5 p.m., e.d.t. 

ADDRESSES: Meeting Location: The town 

hall forum will be held in the 

auditorium at the Center for Medicare & 

Medicaid Services, 7500 Security 

Boulevard, Baltimore, MD 21244. 

Meeting Registration: Participants 

may register via e-mail at 

Cynthia.Ruff@cms.hhs.gov or by regular 

mail at the Centers for Medicare and 

Medicaid Services, Center for Medicaid 

and State Operations, Family and 

Children’s Health Programs Group, 7500 

Security Boulevard, S2–01–16, 

Baltimore, MD 21244. 

Inquires: Send inquiries about this 

meeting via email to 

Cynthia.ruff@cms.hhs.gov. 

FOR FURTHER INFORMATION CONTACT: 

Cindy Ruff, 410–786–5916. 

SUPPLEMENTARY INFORMATION: 

I. Background 

In response to Congressional hearings 

and Federal studies regarding access to 

dental care for Medicaid eligible 

children, we performed 16 State dental 

reviews in 2008. We recently published 

a National Summary of those State 

reviews and identified several 

opportunities for improving dental care 

for individuals eligible for Medicaid. 

We proposed to have a Town Hall 

Forum to discuss these opportunities. 

The Forum will provide a venue for 

participants to provide feedback to us 

on various oral health issues and to 

discuss best practices and innovative 

delivery models for dental care. We will 

work with co-facilitators, the National 

Association of State Medicaid Directors 

and the American Dental Association, in 

presenting the Forum. 

II. Meeting Format 

The meeting will begin with 

introductions of the individuals 

participating in the meeting and an 

overview of the goal and objectives of 

the meeting. There will be a brief 

overview of the role and functions of 

Federal and State programs in 

delivering dental care to individuals 

eligible for Medicaid. There will be an 

opportunity for several States to briefly 

present information on a promising oral 

health practice in their State. The third 

portion of the Forum will focus on 

discussion of delivery of dental services 

through managed care organizations, 

payment issues, best practices/ 

innovative delivery models, and 

recommendations for education and 

outreach to dental providers and 

Medicaid enrollees. 

Prior to the Town Hall Forum, we will 

distribute information via the CMS Web 

site including an agenda and a set of 

questions to be addressed at the Forum. 

The materials will be posted on the 

CMS web site at http://www.cms.hhs.

gov/MedicaidSCHIPQualPrac/02_whats

newinquality.asp#TopOfPage. 

Registered participants may submit 

additional questions/comments to be 

considered for discussion at the Forum. 

III. Registration Instructions 

There is no registration fee associated 

with attending the meeting. All 

individuals must register to attend. 

Because this meeting will be located on 

Federal property, for security reasons 

any persons wishing to attend must 

register at one of the addresses specified 

in the ADDRESSES section of this notice 

by the date specified in the DATES

section of this notice. Please provide 

your full name (as it appears on your 

State-issued driver’s license), address, 

organization, telephone, fax number(s), 

and e-mail address. You will receive a 

registration confirmation with 

instructions for your arrival at the CMS 

complex or you will be notified the 

seating capacity has been reached. The 

meeting is limited to registered persons, 

and seating capacity is limited to the 

first 250 registrants. 

Individuals requiring sign language 

interpretation for the hearing impaired 

or other special accommodations should 

contact Cindy Ruff at the address listed 

in the ADDRESSES section of this notice 

by the date specified in the DATES

section of this notice. 

IV. Security, Building, and Parking 

Guidelines 

This meeting will be held in a Federal 

government building; therefore, Federal 

security measures are applicable. We 

recommend that confirmed registrants 

arrive at CMS reasonably early, but no 

earlier than 45 minutes prior to the start 

of the meeting, to allow additional time 

to clear security. Security measures 

include the following: 

• Presentation of government-issued 

photographic identification to the 

Federal Protective Service or Guard 

Service personnel. 

• Inspection of vehicle’s interior and 

exterior (this includes engine and trunk 

inspection) at the entrance to the 

grounds. Parking permits and 

instructions will be issued after the 

vehicle inspection. 

• Inspection, via metal detector or 

other applicable means of all persons 

brought entering the building. We note 

that all items brought into CMS, 

whether personal or for the purpose of 

presentation or to support a 

presentation, are subject to inspection. 

We cannot assume responsibility for 

coordinating the receipt, transfer, 

transport, storage, set-up, safety, or 

timely arrival of any personal 

belongings or items used for 

presentation or to support a 

presentation. 

Note: Individuals who are not registered in 

advance will not be permitted to enter the 

building and will be unable to attend the 

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