[Federal Register Volume 73, Number 61 (Friday, March 28, 2008)]
[Notices]
[Pages 16690-16691]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-5074]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-2277-FN]


Medicare and Medicaid Programs; Approval of the Joint Commission 
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 Joint 
Commission 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, 2014.

FOR FURTHER INFORMATION CONTACT: 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 part 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.
    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, any provider entity accredited by the national 
accrediting body's approved program would 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 section 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 
Joint Commission's 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 in 
the Federal Register, a final notice of approval or denial of the 
application.

III. Provisions of the Proposed Notice

    On October 26, 2007, we published in the Federal Register, a 
proposed notice (72 FR 60855) announcing The Joint Commission's request 
for re-approval as

[[Page 16691]]

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 The Joint 
Commission'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 The Joint Commission'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 The Joint Commission's HHA accreditation 
standards to our current Medicare HHA conditions for participation.
     A documentation review of The Joint Commission's survey 
processes to:
    ++ Determine the composition of the survey team, surveyor 
qualifications, and the ability of The Joint Commission to provide 
continuing surveyor training.
    ++ Compare The Joint Commission'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 The Joint Commission's procedures for monitoring 
providers or suppliers found to be out of compliance with The Joint 
Commission program requirements. The monitoring procedures are used 
only when The Joint Commission identifies noncompliance. If 
noncompliance is identified through validation reviews, the survey 
agency monitors corrections as specified at Sec.  488.7(d).
    ++ Assess The Joint Commission's ability to report deficiencies to 
the surveyed facilities and respond to the facility's plan of 
correction in a timely manner.
    ++ Establish The Joint Commission's ability to provide us with 
electronic data in ASCII-comparable code and reports necessary for 
effective validation and assessment of The Joint Commission's survey 
process.
    ++ Determine the adequacy of staff and other resources.
    ++ Review The Joint Commission's ability to provide adequate 
funding for performing required surveys.
    ++ Confirm The Joint Commission's policies with respect to whether 
surveys are announced or unannounced.
    ++ Obtain The Joint Commission'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 60855) also solicited public comments 
regarding whether The Joint Commission'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 the Joint Commission's Standards and 
Requirements for Accreditation and Medicare's Conditions and Survey 
Requirements

    We compared the standards contained in The Joint Commission's 
Comprehensive Accreditation Manual for Home Care and its survey process 
in The Joint Commission's Application for Continued Home Health Deeming 
Authority with the Medicare HHA conditions for participation and our 
State Operations Manual (SOM). Our review and evaluation of The Joint 
Commission's deeming application, which were conducted as described in 
section III of this final notice, yielded the following:
     To meet the requirements for initial home health 
certification surveys listed in the SOM at 2200A5, The Joint Commission 
revised its standards to reflect the requirement that HHAs must have 
provided care to a minimum of ten patients and at least seven of the 
ten patients are receiving care at the time of the initial survey.
     To meet the requirements for initial certification surveys 
listed in the SOM at 2200A5, The Joint Commission revised it standards 
to reflect the requirement that HHAs must provide nursing and at least 
one other therapeutic service.
     To meet the requirements listed in the SOM at 2200C4, The 
Joint Commission updated its home care surveyor activity guide to 
reflect that all patients (private pay and Medicare beneficiaries) are 
included in the clinical record review or selection of home visits for 
a Medicare certification survey.
     To meet the requirements of Sec.  488.28(a), The Joint 
Commission will no longer issue supplemental findings for HHAs seeking 
deemed status. All deficiencies identified during a certification 
survey will be cited as requirements for improvement which the HHA will 
be required to submit a written plan of correction.
     To meet the requirements at 488.8(a)(3), The Joint 
Commission has agreed to provide CMS with a copy of its most current 
accreditation survey along with any other related information that CMS 
requires, including corrected action plans, when requested.

B. Term of Approval

    Based on the review and observations described in section III of 
this final notice, we have determined that The Joint Commission's 
requirements for HHAs meet or exceed our requirements. Therefore, we 
approve The Joint Commission as a national accreditation organization 
for HHAs that request participation in the Medicare program, effective 
March 31, 2008 through March 31, 2014.

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. E8-5074 Filed 3-27-08; 8:45 am]
BILLING CODE 4120-01-P