[Federal Register Volume 74, Number 58 (Friday, March 27, 2009)]
[Notices]
[Pages 13439-13441]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-6775]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-2294-FN]


Medicare and Medicaid Programs; Approval of the Joint Commission 
for Continued Deeming Authority for Hospices

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

ACTION: Final notice.

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SUMMARY: This final notice announces the approval of a deeming 
application from the Joint Commission for continued recognition as a 
national

[[Page 13440]]

accreditation program for hospices that request participation in the 
Medicare or Medicaid programs.

EFFECTIVE DATE: This final notice is effective June 18, 2009 through 
June 18, 2015.

FOR FURTHER INFORMATION CONTACT:
Alexis Prete, (410) 786-0375.
Patricia Chmielewski, (410) 786-6899.

SUPPLEMENTARY INFORMATION: 

I. Background

    Under the Medicare program, eligible beneficiaries may receive 
covered services in a hospice provided certain requirements are met. 
Section 1861(dd)(1) of the Social Security Act (the Act) establishes 
distinct criteria for facilities seeking designation as a hospice 
program. Under this authority, the regulations at 42 CFR part 418 
specify the conditions that a hospice must meet in order to participate 
in the Medicare program, the scope of covered services, and the 
conditions for Medicare payment for hospice care. Provider agreement 
regulations are located in 42 CFR part 489 and regulations pertaining 
to the survey and certification of facilities are located in 42 CFR 
part 488.
    Generally, in order to enter into an agreement, a hospice facility 
must first be certified by a State survey agency as complying with the 
conditions or requirements set forth in part 418 of our regulations. 
Then, the hospice 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 (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 would ``deem'' those provider entities as having 
met the requirements. (We note that section 125 of MIPPA redesignated 
subsections (b) and (e) of subsection 1865 of the Act as (a) and (d) 
respectively.) 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 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 Sec.  488.4 
and Sec.  488.8(d)(3). The regulations at Sec.  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 
Joint Commission's term of approval as a recognized accreditation 
program for Hospice facilities expires June 18, 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 than a 30 day public 
comment period. At the end of the 210-day period, we must publish a 
notice in the Federal Register of our approval or denial of the 
application.

III. Proposed Notice

    On November 28, 2008 we published a proposed notice (73 FR 72487) 
announcing the Joint Commission's request for reapproval as a deeming 
organization for hospices. In this notice we specified in detail our 
evaluation criteria. Under section 1865(a)(2) of the Act and in our 
regulations at Sec.  488.4 (Application and reapplication procedures 
for accreditation organizations), we conducted a review of the Joint 
Commission's application in accordance with the criteria specified in 
our regulation, which include, but are not limited to the following:
    <bullet> An onsite administrative review of the Joint Commissions--
(1) corporate policies; (2) financial and human resources available to 
accomplish the proposed surveys; (3) procedures for training, 
monitoring, and evaluation of its surveyor; (4) ability to investigate 
and respond appropriately to complaints against accredited facilities; 
and (5) survey review and decision-making process for accreditation.
    <bullet> A comparison of the Joint Commission's hospice 
accreditation standards to our current Medicare conditions for 
participation.
    <bullet> A documentation review of the Joint Commission's survey 
processes to:
    <bullet> Determine the composition of the survey team, surveyor 
qualifications, and the ability of the Joint Commission to provide 
continuing surveyor training.
    <bullet> Compare the Joint Commission's processes to that of State 
survey agencies, including survey frequency, and the ability to 
investigate and respond appropriately to complaints against accredited 
facilities.
    <bullet> Evaluate the Joint Commission's procedures for monitoring 
providers or suppliers found to be out of compliance with the Joint 
Commission program requirements. The monitoring procedures are used 
only with the Joint Commission identifies noncompliance. If 
noncompliance is identified through validation reviews, the survey 
agency monitors corrections as specified at Sec.  488.7(d).
    <bullet> Assess the Joint Commission's ability to report 
deficiencies to the surveyed facilities and respond to the facility's 
plan of correction in a timely manner.
    <bullet> Establish the Joint Commission's ability to provide us 
with electronic data and reports necessary for effective validation and 
assessment of the Joint Commission's survey process.
    <bullet> Determine the adequacy of staff and other resources.
    <bullet> Review the Joint Commission's ability to provide adequate 
funding for performing required surveys.
    <bullet> Confirm the Joint Commission's policies with respect to 
whether surveys are announced or unannounced.
    <bullet> Obtain the Joint Commission'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 November 
28, 2008 proposed notice (73 FR 72487) also solicited public comments 
regarding whether the Joint Commission's requirements met or exceeded 
the Medicare conditions of participation for hospices. We received no 
public comments in response to our proposed notice.

IV. Provisions of the Final Notice

A. Differences Between the Joint Commission Standards and Requirements 
and Medicare's Conditions and Survey Requirements

    We compared the standards contained in the Joint Commission's

[[Page 13441]]

``Comprehensive Accreditation Manual for Home Care'' (CAMHC) and its 
survey process in the ``Surveyor Activity Guide'' with the Medicare 
hospice conditions for participation and our State Operations Manual 
(SOM). Our review and evaluation of the Joint Commission's deeming 
application, which were conducted as described in section III of this 
notice yielded the following:
    <bullet> On June 5, 2008, CMS published a final rule (73 FR 32088) 
that revised the existing conditions of participation that hospices 
must meet to participate in the Medicare and Medicaid Program. In 
accordance with the regulations at Sec.  488.4(a)(3)(iv), the Joint 
Commission updated and revised their standards and survey procedures to 
meet the Medicare requirements.
    <bullet> To meet the Medicare requirements at section 2728 of the 
SOM, the Joint Commission modified its policies for posting the deemed 
status survey results within 10 days onto its extranet site.
    <bullet> The Joint Commission will conduct all for-cause surveys on 
an unannounced basis.
    <bullet> The Joint Commission modified its executive summary 
statement to clearly indicate that providers must meet all 
accreditation standards in order to be recommended for deemed status.

B. Term of Approval

    Based on the review and observations described in section III of 
this final notice, we have determined that the Joint Commission's 
requirements for hospices meet or exceed our requirements. Therefore, 
we recognize the Joint Commission as a national accreditation 
organization for hospices that request participation in the Medicare 
program, effective June 18, 2009 through June 18, 2015.

V. Collection of Information Requirements

    This final notice does not impose any information collection and 
record keeping requirements. Consequently, it does not need to be 
reviewed by the Office of Management and Budget (OMB) under the 
authority of the Paperwork Reduction Act of 1995 (44 U.S.C. 35).

(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 4, 2009.
Charlene Frizzera,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. E9-6775 Filed 3-26-09; 8:45 am]
BILLING CODE 4120-01-P