[Federal Register Volume 64, Number 175 (Friday, September 10, 1999)]
[Notices]
[Pages 49199-49201]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-23626]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[HCFA-2057-PN]


Medicare and Medicaid Programs; Reapplication of the American 
Osteopathic Association (AOA) for Continued Approval of Deeming 
Authority for Hospitals

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

ACTION: Proposed notice.

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SUMMARY: This notice announces the receipt of a renewal application 
from the American Osteopathic Association (AOA) for continued 
recognition as a national accreditation program for hospitals that wish 
to participate in the Medicare or Medicaid programs. Section 
1865(b)(3)(A) of the Social Security Act (the Act) requires the 
Secretary to publish a notice within 60 days of the receipt of an 
organization's complete application, 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 October 
12, 1999.


[[Page 49200]]


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-2057-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 443-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., 
Washington, DC 20201, or
Room C5-16-03, 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-2057-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 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. (Phone: (202) 690-7890).

FOR FURTHER INFORMATION CONTACT: Janice Adams-King, (410) 786-8354.

SUPPLEMENTARY INFORMATION:

I. Background

    Under the Medicare program, eligible beneficiaries may receive 
covered services in a hospital provided certain requirements are met. 
The regulations specifying the Medicare conditions of participation for 
hospital care are located in 42 CFR part 482. These conditions 
implement section 1861(e) of the Social Security Act (the Act), which 
specifies services covered as hospital care and the conditions that a 
hospital must meet in order to participate in the Medicare program. 
Other relevant sections of the Act are section 1811, which specifies 
eligibility requirements for the individual and the amount of benefits; 
and sections 1814(l), 1876(h)(2), and 1886(c)(6) of the Act, which 
contain conditions of payment for hospitals.
    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 482 specify the conditions that a hospital must meet in 
order to participate in the Medicare program, the scope of covered 
services, and the conditions for Medicare payment for hospital 
services.
    Generally, in order to enter into an agreement, a hospital must 
first be certified by a State survey agency as complying with the 
conditions or standards set forth in part 482 of our regulations. Then, 
the hospital 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'' hospitals 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 a provider entity by a national 
accreditation body demonstrates that all applicable conditions are met 
or exceed the Medicare conditions, the Secretary can ``deem'' the 
hospital as having met the requirements.
    Our regulations concerning reapproval of accrediting organizations 
are set forth at Secs. 488.4 and 488.8(d)(3). The regulations at 
Sec. 488.8(d)(3) require reapplication at least every 6 years and 
permit HCFA to determine the required materials from those enumerated 
in Sec. 488.4, and the deadline to reapply for continued approval of 
deeming authority.
    This organization is currently a recognized accreditation 
organization for hospitals.

II. Approval of Deeming Organizations

    Section 1865(b)(2) of the Act further requires that the Secretary's 
findings concerning review and reapproval of national accrediting 
organizations consider, among other factors, the reapplying 
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 
reapplication, 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 reapplication.
    The purpose of this notice is to notify the public of the request 
of AOA for reapproval and continuation of its deeming authority on the 
basis that the Secretary find that its separate accreditation programs 
for hospital 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 ???1999, AOA submitted all the necessary information concerning 
its request for reapproval as a deeming organization for hospitals 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 criteria:
     The equivalency of AOA's requirements for a hospital to 
HCFA's comparable hospital requirements.
     AOA's survey process, to determine the following:

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

     The ability of AOA 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 AOA staff and other resources, and their 
financial viability.
     AOA's ability to provide adequate funding for performing 
required surveys.
     AOA's policies with respect to whether surveys are 
announced or unannounced.
     AOA's agreement to provide us with a copy of its most 
current

[[Page 49201]]

accreditation survey with any other information related to the survey 
as we may require (including corrective action plans).

IV. Response to 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.
    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. 99-23626 Filed 9-9-99; 8:45 am]
BILLING CODE 4120-01-P