[Federal Register Volume 63, Number 176 (Friday, September 11, 1998)]
[Notices]
[Pages 48735-48736]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-24555]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[HCFA-2029-PN]
RIN 0938-AI69


Medicare and Medicaid Programs; Recognition of the Community 
Health Accreditation Program, Inc. (CHAP) and Joint Commission for 
Accreditation of Healthcare Organizations (JCAHO) for Hospices

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: Proposed notice.

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SUMMARY: This notice announces the receipt of applications from CHAP 
and JCAHO for recognition as national accreditation programs for 
hospices that wish to participate in the Medicare or Medicaid programs. 
The Social Security Act requires that the Secretary publish a notice 
identifying the national accreditation body making the request, 
describing the nature of the request, and providing a 30-day public 
comment period.

DATES: Written comments will be considered if we receive them at the 
appropriate address, as provided below, no later than 5 p.m. on or 
before October 13, 1998.

ADDRESSES: Mail written comments (one original and three copies) to the 
following address: Health Care Financing Administration, Department of 
Health and Human Services,
    Attention: HCFA-2029-PN, 7500 Security Boulevard, Baltimore, 
Maryland 21244-1850.
    If you prefer, you may deliver your written comments (one original 
and three copies) to one of the following addresses:

Room 309-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., 
Washington, DC 20201, or
Room C5-09-26, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.

    Because of staffing and resource limitations, we cannot accept 
audio, visual, or facsimile (FAX) copies of comments. In commenting, 
please refer to file code HCFA-2029-PN. Comments received timely will 
be available for public inspection as they are received, generally 
beginning approximately 3 weeks after publication of a document, in 
room 309G of the Department's offices at 200 Independence Avenue, SW., 
Washington, DC, on Monday through Friday of each week from 8:30 a.m. to 
5 p.m. (Phone: (202) 690-7890).

FOR FURTHER INFORMATION CONTACT: Joan C. Berry, (410) 786-7233.

SUPPLEMENTARY INFORMATION:

I. Background

    Under the Medicare program, eligible beneficiaries may receive 
covered services in a hospice provided certain requirements are met. 
The regulations specifying the Medicare conditions of participation for 
hospice care are located in 42 CFR part 418. These conditions implement 
section 1861(dd) of the Social Security Act (the Act), which specifies 
services covered as hospice care and the conditions that a hospice 
program must meet in order to participate in the Medicare program. 
Other relevant sections of the Act are sections 1812(a)(4) and (d) 
which specify eligibility requirements for the individual and the 
benefit periods; section 1813(a)(4) which specifies coinsurance 
amounts; sections 1814(a)(7) and 1814 (i)(1)(A) which contain 
conditions and limitation on coverage of, and payment for, hospice 
care; and sections 1862(a)(1), (6), (9) which establish limits on 
hospice coverage.
    Regulations concerning provider agreements are at 42 CFR part 489 
and those pertaining to the activities relating to the survey and 
certification of facilities are at 42 CFR part 488. Our 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 facility 
services.
    Generally, in order to enter into an agreement, a hospice must 
first be certified by a State survey agency as complying with the 
conditions or standards 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(b)(1) of the Act permits ``accredited'' hospices to be 
exempt from routine surveys by State survey agencies to determine 
compliance with Medicare conditions of participation. Section 
1865(b)(1) of the Act provides that if the Secretary finds that 
accreditation of a provider entity by a national accreditation body 
demonstrates that all applicable conditions are met or exceeded, the 
Secretary ``deems'' those requirements to be met by the hospice. Our 
regulations concerning approval of accrediting organizations are set 
forth at Secs. 488.6 and 488.8. To date, we have not recognized any 
organization as an accreditation organization for hospices.

II. Approval of Deeming Organizations

    Section 1865(b)(2) of the Act further requires that the Secretary's 
findings concerning review and approval of national accrediting 
organizations consider, among other factors, the applying accreditation 
organization's requirements for accreditation, its survey procedures, 
its ability to provide adequate resources for conducting required 
surveys and ability to supply information for use in enforcement 
activities, its monitoring procedures for provider entities found out 
of compliance with the conditions or requirements, and its ability to 
provide the Secretary with necessary data for validation.
    Section 1865(b)(3)(A) of the Act requires that the Secretary 
publish, within 60 days of the 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. Subsequently, the Secretary 
has 210 days from the receipt of the request to publish a finding of 
approval or denial of the application.
    The purpose of this notice is to notify the public of the request 
of CHAP and of JCAHO for approval of their requests that the Secretary 
find that their separate accreditation programs for hospice care meet 
or exceed the Medicare conditions. This notice also solicits public 
comment on the ability of each body's requirements to meet or exceed 
the Medicare conditions of participation.

III. Evaluation of Deeming Request

    On July 6, 1998, CHAP and JCAHO submitted all the necessary 
information concerning their request to be approved as deeming 
organizations for hospices to permit us to make a determination. 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 a national accreditation organization will be conducted 
in accordance with, but not necessarily limited to, the following 
factors:

[[Page 48736]]

     The equivalency of CHAP's and JCAHO's requirements for a 
hospice to our comparable hospice requirements.
     CHAP's and JCAHO's survey processes, to determine the 
following:

--The composition of the survey team, surveyor qualifications, and 
CHAP's and JCAHO's ability to provide continuing surveyor training.
--The comparability of their processes to those of State agencies, 
including survey frequency, and their ability to investigate and 
respond appropriately to complaints against accredited facilities.
--Their procedures for monitoring providers or suppliers found by CHAP 
or JCAHO to be out of compliance with program requirements. (These 
procedures are used only when CHAP or JCAHO identifies noncompliance. 
If noncompliance is identified through validation reviews, the survey 
agency monitors corrections as specified at Sec. 488.7(b)(3).)
--Their ability to report deficiencies to the surveyed facilities and 
respond to the facility's plan of correction in a timely manner.

     The ability of CHAP and JCAHO to provide us with 
electronic data in ASCII comparable code and any reports necessary for 
effective validation and assessment of their survey processes.
     The adequacy of CHAP's and JCAHO's staff and other 
resources, and their financial viability.
     CHAP's and JCAHO's ability to provide adequate funding for 
performing required surveys.
     CHAP's and JCAHO's policies with respect to whether 
surveys are announced or unannounced.
    CHAP's and JCAHO'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. Notice Upon Completion of Evaluation

    Upon completion of our evaluation, including evaluation of comments 
received as a result of this notice, we will publish a notice in the 
Federal Register announcing the result of our evaluation.

(Authority: Sec. 1865(b)(3)(A) of the Social Security Act (42 U.S.C. 
1395bb(b)(3)(A)).

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance)

    Dated: August 19, 1998.
Nancy-Ann Min DeParle,
Administrator, Health Care Financing Administration.
[FR Doc. 98-24555 Filed 9-10-98; 8:45 am]
BILLING CODE 4120-01-P