[Federal Register Volume 64, Number 175 (Friday, September 10, 1999)]
[Notices]
[Pages 49197-49198]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-23624]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[HCFA-2058-PN]
RIN 0938-AJ68


Medicare and Medicaid Programs; Application of the Joint 
Commission for Accreditation of Healthcare Organizations (JCAHO) for 
Continued Approval of Deeming Authority for Home Health Agencies

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

ACTION: Proposed notice.

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SUMMARY: This notice announces the receipt of an application from the 
Joint Commission for Accreditation of Healthcare Organizations (JCAHO) 
for recognition as a national accreditation program for home health 
agencies (HHAs) 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 
for approval, 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 in ADDRESSES section, no later than 5 
p.m. on October 12, 1999.

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-2058-PN, P.O. Box 9010, 
Baltimore, Maryland 21244-9010.
    If you prefer, you may deliver your written comments (one original 
and three copies) to one of the following addresses: Room 445-G, Hubert 
H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 
20201, or Room C5-16-03, 7500 Security Boulevard, Baltimore, Maryland 
21244-1850.

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

SUPPLEMENTARY INFORMATION:

Comments

    Because of staffing and resource limitations, we cannot accept 
comments by facsimile (FAX) transmission. In commenting, please refer 
to file code HCFA-2058-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 445-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. 
(phone: (202) 690-7890).

I. Background

    Under the Medicare program, eligible beneficiaries may receive 
covered services from a home health agency (HHA) provided certain 
requirements are met. Sections 1861(o) and 1891 of the Social Security 
Act (the Act) and part 484 of the Medicare regulations specify the 
conditions that an HHA must meet in order to participate in the 
Medicare program.
    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.
    Generally, in order to enter into an agreement, an HHA must first 
be certified by the State survey agency as complying with the 
conditions or standards set forth in the statute and 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 the 
requirements. There is an alternative, however, to surveys by State 
agencies.
    Section 1865(b)(1) of the Act permits ``accredited'' HHAs 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 HHA. Our 
regulations concerning reapproval of accrediting organizations are set 
forth at Secs. 488.4 and 488.8(d)(3). Section 488.8(d)(3) requires 
reapplication at least every 6 years and permits the Secretary to 
determine the required materials from those enumerated in Sec. 488.4, 
and the deadline to reapply for continued approval of deeming 
authority. The Joint Commission for Accreditation of Healthcare 
Organizations (JCAHO) is a currently recognized accreditation 
organization for HHAs.

II. Approval of Deeming Organizations

    Section 1865(b)(2) of the Act further requires that the Secretary's 
findings concerning review of national accrediting organizations 
consider, among other factors, the accreditation organization's 
requirements for accreditation, its survey procedures, its ability to 
provide adequate resources for conducting required surveys and ability

[[Page 49198]]

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 that identifies the national accreditation body 
making the request, describes the nature of the request, and provides 
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 JCAHO's 
request for reapproval and continuation of its deeming authority on the 
basis that the Secretary find that its separate accreditation programs 
for HHAs meet or exceed the Medicare conditions. This notice also 
solicits public comment on the ability of JCAHO requirements to meet or 
exceed the Medicare conditions of participation for HHAs.

III. Evaluation of Deeming Request

    On July 26, 1999, JCAHO submitted all the necessary information 
concerning its request to be reapproved as a deeming organization for 
HHAs 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:
     The equivalency of JCAHO's requirements for an HHA to our 
comparable HHA conditions of participation.
     JCAHO's survey processes, to determine the following:

--The composition of the survey team, surveyor qualifications, and 
JCAHO's ability to provide continuing surveyor training.
--The comparability of its implemented processes to those of State 
agencies, including survey frequency, and its ability to investigate 
and respond appropriately to complaints against accredited facilities.
--Its procedures for monitoring HHAs found by JCAHO to be out of 
compliance with program requirements. (These procedures are used only 
when JCAHO identifies noncompliance. If noncompliance is identified 
through validation reviews, the survey agency monitors corrections as 
specified at Sec. 488.7(b)(2).)
--Its ability to report deficiencies to the surveyed facilities and 
respond to the facility's plan of correction in a timely manner.
--The ability of JCAHO to provide us with electronic data in ASCII 
comparable code and any reports necessary for effective validation and 
assessment of its survey processes.
--The adequacy of JCAHO's staff and other resources, and its financial 
viability.
--JCAHO's ability to provide adequate funding for performing required 
surveys.
--JCAHO's policies with respect to whether surveys are announced or 
unannounced.
--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: September 1, 1999.
Michael M. Hash
Deputy Administrator,
Health Care Financing Administration.
[FR Doc. 99-23624 Filed 9-9-99; 8:45 am]
BILLING CODE 4120-01-P