[Federal Register Volume 68, Number 16 (Friday, January 24, 2003)]
[Notices]
[Pages 3532-3534]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-1589]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-2177-PN]
RIN 0938-AM38


Medicare and Medicaid Programs; Application by the Joint 
Commission on Accreditation of Healthcare Organizations (JCAHO) for 
Hospices

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Proposed notice.

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SUMMARY: This proposed notice announces the receipt of an application 
from the Joint Commission on Accreditation of Healthcare Organizations 
(JCAHO) for continued recognition as a national accreditation program 
for hospices that wish to participate in the Medicare or Medicaid 
programs. The Social Security Act requires that within 60 days of 
receipt of an organization's complete application, the Secretary 
publish 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.

DATES: We will consider comments if we receive them at the appropriate 
address, as provided below, no later than 5 p.m. on February 24, 2003.

ADDRESSES: In commenting, please refer to file code CMS-2177-PN.
    Because of staff and resource limitations, we cannot accept 
comments by facsimile (FAX) transmission. Mail written comments (one 
original and three copies) to the following address only: Centers for 
Medicare & Medicaid Services, Department of Health and Human Services, 
Attention: CMS-2177-PN, P.O. Box 8013, Baltimore, MD 21244-8013.
    Please allow sufficient time for mailed comments to be timely 
received in the event of delivery delays.
    If you prefer, you may deliver (by hand or courier) 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 C5-14-03, 7500 Security 
Boulevard, Baltimore, MD 21244-1850.
    Comments mailed to the addresses indicated as appropriate for hand 
or courier delivery may be delayed and could be considered late.
    For information on viewing public comments, see the beginning of 
the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT: Cindy Melanson, (410) 786-0310.

SUPPLEMENTARY INFORMATION:
    Inspection of Public Comments: Comments received timely will be 
available for public inspection as they are received, generally 
beginning approximately 3 weeks after publication of a document, at the 
headquarters of the Centers for Medicare & Medicaid Services, 7500 
Security Boulevard, Baltimore, Maryland 21244, Monday through Friday of 
each week from 8:30 a.m. to 4 p.m. To schedule an appointment to view 
public comments, phone (410) 786-7197.
    Copies: To order copies of the Federal Register containing this 
document, send your request to: New Orders, Superintendent of 
Documents, PO Box 371954, Pittsburgh, PA 15250-7954. Specify the date 
of the issue requested and enclose a check or money order payable to 
the Superintendent of Documents, or enclose your Visa or Master Card 
number and expiration

[[Page 3533]]

date. Credit card orders can also be placed by calling the order desk 
at (202) 512-1800 or by faxing to (202) 512-2250. The cost for each 
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Register document at most libraries designated as Federal Depository 
Libraries and at many other public and academic libraries throughout 
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    This Federal Register document is also available from the Federal 
Register online database through GPO Access, a service of the U.S. 
Government Printing Office. The Web site address is: http://www.access.gpo.gov/nara/index.html.

I. Background

    Under the Medicare program, eligible beneficiaries may receive 
covered services in a hospice provided certain requirements are met. 
Section 1861 (dd)(1) of the Social Security Act (the Act) establishes 
distinct criteria for facilities seeking designation as a hospice 
program. 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. In 42 CFR part 418, 
we 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 hospice care.
    Generally, to enter into an agreement, a hospice facility must 
first be certified by a State survey agency as complying with our 
conditions or requirements. Following that certification, the hospice 
is subject to routine monitoring by a State survey agency to ensure 
continuing compliance. As an alternative to surveys by State agencies, 
section 1865(b)(1) of the Act provides that, if the Secretary finds 
that, through accreditation by a national accreditation body, a 
provider entity demonstrates that all of our applicable conditions and 
requirements are met or exceeded, the Secretary will deem that the 
provider entity has met the applicable Medicare requirements. 
Accreditation by an accreditation organization is voluntary and is not 
required for Medicare participation.
    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, CMS shall ``deem'' those provider entities as having 
met the requirements. Section 1865(b)(2) of the Act further requires 
that the Secretary's findings concerning review and reapproval as a 
recognized accreditation program for hospices consider the reapplying 
accreditation organization's--
    [sbull] Requirements for accreditation;
    [sbull] Survey procedures;
    [sbull] Ability to provide adequate resources for conducting 
required surveys;
    [sbull] Ability to supply information for use in enforcement 
activities;
    [sbull] Monitoring procedures for provider entities found out of 
compliance with the conditions or requirements; and
    [sbull] Ability to provide the Secretary with necessary data for 
validation.
    Section 1865(b)(3)(A) of the Act requires that the Secretary 
publish a notice within 60 days of receipt of a written request; the 
notice must--
    [sbull] Identify the national accreditation body making the 
request;
    [sbull] Describe the nature of the request; and
    [sbull] Provide at least a 30-day public comment period.
    In addition, we must publish a finding of approval or denial of the 
application within 210 days from the receipt of the completed request.
    Our regulations concerning reapproval of accrediting organizations 
are set forth at Sec.  488.4 and Sec.  488.8(d)(3). Our regulations 
require accreditation organizations to reapply for continued approval 
of deeming authority every 6 years or sooner, as we determine.
    JCAHO's term of approval as a recognized accreditation program for 
hospices expires June 18, 2003.
    The purpose of this proposed notice is to inform the public of our 
consideration of JCAHO's request for approval of continued deeming 
authority for hospices. This notice also solicits public comment on the 
ability of JCAHO requirements to meet or exceed the Medicare conditions 
for participation for hospices.

II. Evaluation of Deeming Authority Request

    On November 26, 2002, JCAHO submitted all the necessary materials 
to enable us to make a determination concerning its request for 
reapproval as a deeming organization for hospices. 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 
JCAHO will be conducted in accordance with, but not necessarily limited 
to, the following factors:
    [sbull] The equivalency of JCAHO standards for hospice care as 
compared with our comparable hospice conditions of participation as 
described in our regulations at Sec.  418.1 through Sec.  418.405.
    [sbull] JCAHO'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 JCAHO processes to those of State agencies, 
including survey frequency, and the ability to investigate and respond 
appropriately to complaints against accredited facilities.
--JCAHO's processes and procedures for monitoring providers or 
suppliers found out of compliance with JCAHO program requirements. 
These monitoring 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 (d).
--JCAHO's capacity to report deficiencies to the surveyed facilities 
and respond to the facility's plan of correction in a timely manner.
--JCAHO's 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 JCAHO's staff and other resources, and its financial 
viability.
--JCAHO's capacity to adequately fund 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).

III. 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.
    In accordance with the provisions of Executive Order 12866, the 
Office of Management and Budget did not review this proposed notice.

    Authority: Section 1865 of the Social Security Act (42 U.S.C. 
1395bb)


[[Page 3534]]


(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: January 16, 2003.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 03-1589 Filed 1-23-03; 8:45 am]
BILLING CODE 4121-PN-P