[Federal Register Volume 73, Number 61 (Friday, March 28, 2008)]
[Notices]
[Pages 16688-16690]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-5073]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-2276-FN]


Medicare and Medicaid Programs; Approval of the Community Health 
Accreditation Program for Continued Deeming Authority for Home Health 
Agencies

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

ACTION: Final Notice.

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SUMMARY: This final notice announces our decision to approve the 
Community Health Accreditation Program (CHAP) for recognition as a 
national accreditation program for home health agencies (HHAs) seeking 
to participate in the Medicare or Medicaid programs.

DATES: Effective Date: This final notice is effective March 31, 2008 
through March 31, 2012.

FOR FURTHER INFORMATION CONTACT:

[[Page 16689]]

Cindy Melanson, (410) 786-0310.
Patricia Chmielewski (410) 786-6899.

SUPPLEMENTARY INFORMATION:

I. Background

    Under the Medicare program, eligible beneficiaries may receive 
covered services in a home health agency (HHA) provided certain 
requirements are met. Sections 1861(o), 1891, 1895 and 1861(m) of the 
Social Security Act (the Act) establish distinct criteria for 
facilities seeking designation as an HHA. Under this authority, the 
minimum requirements that an HHA must meet to participate in Medicare 
are set forth in regulations at 42 CFR part 484 and 409, which 
determine the basis and scope of HHA-covered services, and the 
conditions for Medicare payment for home health care. 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.
    Generally, to enter into an agreement with the Medicare program, an 
HHA must first be certified by a State survey agency as complying with 
conditions or requirements set forth in 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 those requirements. However, 
there is an alternative to surveys by State agencies.
    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, we may ``deem'' those provider entities as having met 
the requirements. Accreditation by an accreditation organization is 
voluntary and is not required for Medicare participation.
    If an accreditation organization is recognized by the Secretary as 
having standards for accreditation that meet or exceed Medicare 
requirements, a provider entity accredited by the national accrediting 
body's approved program may be deemed to meet the Medicare conditions. 
A national accreditation organization applying for approval of deeming 
authority under part 488, subpart A, must provide us with reasonable 
assurance that the accreditation organization requires the accredited 
provider entities to meet requirements that are at least as stringent 
as the Medicare conditions. Our regulations concerning re-approval of 
accrediting organizations are set forth at Sec.  488.4 and Sec.  
488.8(d)(3). The regulations at Sec.  488.8(d)(3) require accreditation 
organizations to reapply for continued approval of deeming authority 
every 6 years, or sooner as we determine. The Community Health 
Accreditation Program's (CHAP) term of approval as a recognized 
accreditation program for HHAs expires March 31, 2008.

II. Deeming Applications Approval Process

    Section 1865(b)(3)(A) of the Act provides a statutory timetable to 
ensure that our review of deeming applications is conducted in a timely 
manner. The Act provides us with 210 calendar days after the date of 
receipt of an application to complete our survey activities and 
application review process. Within 60 days of receiving a completed 
application, we must publish a notice in the Federal Register that 
identifies the national accreditation body making the request, 
describes the request, and provides no less than a 30-day public 
comment period. At the end of the 210-day period, we must publish an 
approval or denial of the application.

III. Proposed Notice

    On October 26, 2007, we published a proposed notice (72 FR 60853) 
announcing CHAP's request for re-approval as a deeming organization for 
HHAs. In the proposed notice, we detailed our evaluation criteria. 
Under section 1865(b)(2) of the Act and our regulations at Sec.  488.4 
(Application and reapplication procedures for accreditation 
organizations), we conducted a review of CHAP's application in 
accordance with the criteria specified by our regulation, which 
include, but are not limited to the following:
     An onsite administrative review of CHAP's (1) Corporate 
policies; (2) financial and human resources available to accomplish the 
proposed surveys; (3) procedures for training, monitoring, and 
evaluation of its surveyors; (4) ability to investigate and respond 
appropriately to complaints against accredited facilities; and (5) 
survey review and decision-making process for accreditation.
     A comparison of CHAP's HHA accreditation standards to our 
current Medicare HHA conditions for participation.
     A documentation review of CHAP's survey processes to:
    ++ Determine the composition of the survey team, surveyor 
qualifications, and the ability of CHAP to provide continuing surveyor 
training.
    ++ Compare CHAP's processes to those of State survey agencies, 
including survey frequency, and the ability to investigate and respond 
appropriately to complaints against accredited facilities.
    ++ Evaluate CHAP's procedures for monitoring providers or suppliers 
found to be out of compliance with CHAP program requirements. The 
monitoring procedures are used only when the CHAP identifies 
noncompliance. If noncompliance is identified through validation 
reviews, the survey agency monitors corrections as specified at Sec.  
488.7(d).
    ++ Assess CHAP's ability to report deficiencies to the surveyed 
facilities and respond to the facility's plan of correction in a timely 
manner.
    ++ Establish CHAP's ability to provide us with electronic data in 
ASCII-comparable code and reports necessary for effective validation 
and assessment of CHAP's survey process.
    ++ Determine the adequacy of staff and other resources.
    ++ Review CHAP's ability to provide adequate funding for performing 
required surveys.
    ++ Confirm CHAP's policies with respect to whether surveys are 
announced or unannounced.
    ++ Obtain CHAP'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.
    In accordance with section 1865(b)(3)(A) of the Act, the October 
26, 2007 proposed notice (72 FR 60853) also solicited public comments 
regarding whether CHAP's requirements met or exceeded the Medicare 
conditions of participation for HHAs. We received no public comments in 
response to our proposed notice.

IV. Provisions of the Final Notice

A. Differences Between CHAP's Standards and Requirements for 
Accreditation and Medicare's Conditions and Survey Requirements

    We compared the standards contained in CHAP's accreditation 
requirements for HHAs and its survey process in CHAP's Application for 
Renewal of Deeming Authority for HHA Facilities with the Medicare HHA 
conditions for participation and our State Operations Manual. Our 
review and evaluation of CHAP's deeming application, which were 
conducted as described in section III of this final notice, yielded the 
following:
     In order to meet the requirements at Sec.  484.36(c)(2), 
CHAP added language to its standards to address that home health aide 
services must be ordered by the physician in the plan of care.
     In order to ensure compliance with its own policies and 
procedures related to surveyors and meet the requirements

[[Page 16690]]

of Sec.  488.4(a)(4), CHAP developed a Personnel Audit Tool that will 
be used bi-annually.
     CHAP developed policies and procedures to address 
potential conflict of interest issues that may result for CHAP 
surveyors who also act as consultants.
     In order to comply with the requirements of Sec.  
488.4(a)(3)(iv), CHAP revised its process for notifying facilities of 
accreditation-related decisions and developed a tracking system to 
ensure that deficiencies cited are appropriately addressed.
     CHAP added language to their Complaint Policies and 
Procedures to meet CMS requirements at 42 CFR 488.4(a)(6). This new 
language provides increased clarity for the prioritization of 
complaints, time frames for investigative site visits and/or other 
required activities.
     CHAP revised its complaint policies to be consistent with 
CMS policies listed in Section 5010 of the State Operations Manual 
``(Management of Complaints and Incidents'').
     CHAP updated its list of conditions surveyed during a 
standard survey to include the requirements of Sec.  484.11 and Sec.  
484.55.
     In accordance with Sec.  488.9, CMS will conduct a follow-
up corporate site visit in 1 year, to assess CHAP's compliance with its 
own policies and procedures.

B. Term of Approval

    Based on the review and observations described in section III of 
this final notice, we have determined that CHAP's requirements for HHAs 
meet or exceed our requirements. Therefore, we approve CHAP as a 
national accreditation organization for HHAs that request participation 
in the Medicare program, effective March 31, 2008 through March 31, 
2012.

V. Collection of Information Requirements

    This document does not impose information collection and 
recordkeeping requirements. Consequently, it need not be reviewed by 
the Office of Management and Budget under the authority of the 
Paperwork Reduction Act of 1995 (44 U.S.C. 35).

(Catalog of Federal Domestic Assistance Program No. 93.778, Medical 
Assistance Program; No. 93.773 Medicare--Hospital Insurance Program; 
and No. 93.774, Medicare--Supplemental Medical Insurance Program)

    Dated: January 25, 2008.
Kerry Weems,
Acting Administrator, Centers for Medicare & Medicaid Services
 [FR Doc. E8-5073 Filed 3-27-08; 8:45 am]
BILLING CODE 4120-01-P