[Federal Register Volume 70, Number 184 (Friday, September 23, 2005)]
[Notices]
[Pages 55862-55863]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-18922]



[[Page 55862]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[CMS-2227-PN]


Medicare and Medicaid Programs; Application by the Accreditation 
Commission for Healthcare for Deeming Authority for Home Health 
Agencies

AGENCY: Centers for Medicare and Medicaid Services, HHS.

ACTION: Proposed notice.

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SUMMARY: This proposed notice acknowledges the receipt of an 
application from the Accreditation Commission for Healthcare for 
recognition as a national accreditation program for home health 
agencies that wish to participate in the Medicare or Medicaid programs. 
Section 1865(b)(3)(A) of the Social Security 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: To be assured consideration, comments must be received at the 
appropriate address, as provided below, no later than 5 p.m. on October 
24, 2005.

ADDRESSES: In commenting, please refer to file code CMS-2227-PN. 
Because of staff and resource limitations, we cannot accept comments by 
facsimile (FAX) transmission.
    You may submit comments in one of four 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 regular 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-2227-PN, P.O. Box 8018, Baltimore, MD 21244-8018.
    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 (one 
original and two copies) to the following address ONLY: Centers for 
Medicare & Medicaid Services, Department of Health and Human Services, 
Attention: CMS-2227-PN, Mail Stop C4-26-05, 7500 Security Boulevard, 
Baltimore, MD 21244-1850.
    4. 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 
Yolanda Hayes at 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.)
    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: Cindy Melanson, (410) 786-0310.

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(o) and 1891 of the Social Security 
Act (the Act) establish distinct criteria for facilities seeking 
designation as an HHA. 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 484 specify the conditions that an HHA must 
meet in order to participate in the Medicare program, the scope of 
covered services, and the conditions for Medicare payment for home 
health care.
    Generally, in order to enter into an agreement, an HHA must first 
be certified by a State survey agency as complying with the 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 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 will ``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 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.
    The Joint Commission on Accreditation of Healthcare Organizations 
(JCAHO) and the Community Health Accreditation Program (CHAP) are 
currently the only approved national accreditation organizations for 
HHAs.

II. Approval of Deeming Organizations

    Section 1865(b)(2) of the Act and our regulations at Sec.  488.8(a) 
require that our findings concerning review and reapproval of a 
national accrediting organization's requirements consider, among other 
factors, the applying 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 
us 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 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 the Accreditation Commission for Healthcare's (ACHC's) 
request to become a national accreditation organization for HHAs.

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This notice also solicits public comment on the ability of ACHC 
requirements to meet or exceed the Medicare conditions for 
participation for home health agencies.

III. Evaluation of Deeming Authority Request

    On August 8, 2005, ACHC submitted all the necessary materials to 
enable us to make a determination concerning its request for approval 
as a deeming organization for HHAs. Under section 1865(b)(2) of the Act 
and our regulations at Sec.  488.8 (Federal review of accreditation 
organizations), our review and evaluation of ACHC will be conducted in 
accordance with, but not necessarily limited to, the following factors:
    <bullet> The equivalency of ACHC standards for home health care as 
compared with our comparable home health conditions of participation.
    <bullet> ACHC'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 ACHC processes to those of State agencies, 
including survey frequency, and the ability to investigate and respond 
appropriately to complaints against accredited facilities.
--ACHC's processes and procedures for monitoring providers or suppliers 
found out of compliance with ACHC program requirements. These 
monitoring procedures are used only when ACHC identifies noncompliance. 
If noncompliance is identified through validation reviews, the survey 
agency monitors corrections as specified at Sec.  488.7(d).
--ACHC's capacity to report deficiencies to the surveyed facilities and 
respond to the facility's plan of correction in a timely manner.
--ACHC 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 ACHC's staff and other resources, and its financial 
viability.
--ACHC's capacity to adequately fund required surveys.
--ACHC's policies with respect to whether surveys are announced or 
unannounced.
--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).

IV. Response to Public Comments and Notice Upon Completion of 
Evaluation

    Because of the large number of items of correspondence 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 will publish a final notice in 
the Federal Register announcing the result of our evaluation.

V. Executive Order 12866 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; No. 93.773 Medicare--Hospital Insurance Program; 
and No. 93.774, Medicare--Supplementary Medical Insurance Program)

    Dated: September 14, 2005.
Mark B. McClellan,
Administrator, Centers for Medicare and Medicaid Services.
[FR Doc. 05-18922 Filed 9-22-05; 8:45 am]
BILLING CODE 4120-01-P