[Federal Register Volume 63, Number 247 (Thursday, December 24, 1998)]
[Notices]
[Pages 71296-71297]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-34063]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[HCFA-2036-NC]
RIN 0938-AJ25


Medicare and Medicaid Programs; Recognition of the Commission for 
Accreditation of Rehabilitation Facilities

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

ACTION: Notice with comment period.

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SUMMARY: This notice announces and invites comments on the receipt of 
an application from the Commission for Accreditation of Rehabilitation 
Facilities for recognition as a national accreditation organization 
with deemed status authority. The Social Security Act requires us to 
publish this notice in which we identify the national accreditation 
body making the application, describe the nature of the request, and 
provide a 30-day public comment period. The intent of this notice is to 
solicit public comment as to the advisability of recognizing the 
Commission for Accreditation of Rehabilitation Facilities as a national 
accreditation organization with deeming authority to survey and 
accredit comprehensive outpatient rehabilitation facilities for 
participation in the Medicare or Medicaid programs.

DATES: Comments will be considered if we receive them at the 
appropriate address, as provided below, no later than 5 p.m. eastern 
time on January 25, 1999.

ADDRESSES: Mail written comments (1 original and 3 copies) to the 
following addresses: Health Care Financing Administration, Department 
of Health and Human Services, Attention: HCFA-2036-NC, P. O. Box 
26688,Baltimore, MD 21207-0488.
    If you prefer, you may deliver your written comments (1 original 
and 3 copies) to one of the following addresses:

Room 443-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., 
Washington, DC 20201-0001, or
Room C5-16-03, Central Building,7500 Security Boulevard,Baltimore, MD 
21244-1850.

    Because of staffing and resource limitations, we cannot accept 
comments by facsimile (FAX) transmission. In commenting, please refer 
to file code HCFA-2036-NC. Written 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 443-G 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. eastern time (phone: (202) 690-7890).

FOR FURTHER INFORMATION CONTACT: Helaine M. Jeffers, (410) 786-5648.

SUPPLEMENTARY INFORMATION:

I. Background

    Providers of health care services participate in the Medicare and 
Medicaid programs in accordance with provider agreements with us (for 
Medicare) and State Medicaid agencies (for Medicaid). Generally, in 
order to enter into a provider agreement, an entity must first be 
certified by a State survey agency as complying with the conditions, 
requirements or standards set forth in the Social Security Act (the 
Act) and regulations. Providers are subject to routine surveys by State 
survey agencies to determine whether the provider continues to meet 
these requirements.
    There is an alternative, however, to surveys by State agencies. 
Section 1865 of the Act includes a provision that permits providers of 
services to be exempt from routine surveys by State survey agencies to 
determine whether they comply with the definition of hospital services 
in section 1861(e) of the Act. Specifically, section 1865(b)(1) of the 
Act provides that if we find that accreditation of a provider entity by 
a national accreditating body demonstrates that all of the applicable 
Medicare conditions or requirements are met or exceeded, we would 
``deem'' the provider entity as meeting the applicable Medicare 
requirements. If a national accrediting organization applies to us for 
recognition of its provider accrediting program, we examine its 
requirements to determine whether they meet or exceed the Medicare 
conditions as we would have applied them. If we were to approve the 
accrediting organization as having standards that meet or exceed our 
own, providers accredited under the approved program would be 
``deemed'' to meet the Medicare conditions of participation or 
requirements for which the accreditation standards have been 
recognized.
    A deemed status provider is one that has voluntarily applied for 
and has been accredited by a national accreditation organization under 
its approved program that meets or exceeds the applicable Medicare 
conditions or requirements. Federal regulations at 42 CFR part 485, 
subpart B, set forth the conditions that comprehensive outpatient 
rehabilitation facilities (CORFs) must meet to be certified under 
section 1861(cc)(2) of the Act and be accepted for participation in the 
Medicare program in accordance with 42 CFR part 489.

II. Approval of Accreditation Organization's Program

    The purpose of this notice is to notify the public of the receipt 
of the Commission for Accreditation of Rehabilitation Facilities' 
(CARF) application for approval to participate in the Medicare program 
as a national accreditation organization with deemed status authority 
for CORF accreditation. This notice also solicits public comment on the 
ability of CARF's program requirements to meet or exceed the Medicare 
conditions of participation.
    Section 1865(b)(2) of the Act sets forth the requirements for us to 
make a finding among other factors with respect to a national 
accreditation body, as specified in section III. of this notice.
    Section 1865(b)(3)(A) of the Act requires that we publish, no later 
than 60 days after the date of the receipt of a completed application, 
a notice identifying the national accreditation body making the 
request, describing the nature of the request, and providing a period 
of at least 30 days for the public to comment on the request. In 
addition, we have 210 days from the receipt of the request to publish 
an approval or denial of the application.

III. Evaluation of the Application

    On August 10, 1998, CARF submitted the necessary application 
information about its request for our determination that its provider 
accreditation program meets or exceeds the Medicare conditions and 
certification requirements for CORFs.
    Under section 1865(b)(2) of the Act and our regulations at 42 CFR 
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:
     A determination of the equivalency of an accreditation 
organization's requirements for an entity to our requirements for the 
entity.
     A review of the organization's survey process to determine 
the following:
    1. The composition of the survey team, surveyor qualifications, and 
the ability of the organization to provide continuing surveyor 
training.

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    2. The organization's comparability of its processes to that of 
State agencies, including survey frequency, and the ability to 
investigate and respond appropriately to complaints against accredited 
facilities.
    3. The organization's procedures for monitoring providers or 
suppliers found to be out of compliance with program requirements. 
These monitoring procedures are used only when it identifies 
noncompliance. If noncompliance at the condition level is identified 
through validation reviews, the appropriate State survey agency 
monitors corrections as specified at Sec. 488.7(b)(2).
    4. The organization's ability to report deficiencies to the 
surveyed facilities and respond to the facility's plan of correction in 
a timely manner.
     The organization's ability to provide us with electronic 
data in ASCII comparable code and reports necessary for effective 
validation and assessment of its survey process.
     The adequacy of staff and other resources, and its 
financial viability.
     The organization's ability to provide adequate funding for 
performing required surveys.
     The organization's policies with respect to whether 
surveys are announced or unannounced.
     The organization'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 of Evaluation

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

V. Response to Public Comments

    Because of the large number of 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 them in a forthcoming notice 
document.

    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: November 30, 1998.
Nancy-Ann Min DeParle,
Administrator, Health Care Financing Administration.
[FR Doc. 98-34063 Filed 12-23-98; 8:45 am]
BILLING CODE 4120-01-P