[Federal Register Volume 74, Number 14 (Friday, January 23, 2009)]
[Notices]
[Pages 4203-4205]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-684]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-2899-FN]


Medicare and Medicaid Programs; Approval of the Accreditation 
Commission for Health Care, Incorporated for Continued Deeming 
Authority for Home Health Agencies

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

ACTION: Final notice.

-----------------------------------------------------------------------

SUMMARY: This notice announces our decision to approve the 
Accreditation Commission for Health Care, Incorporated (ACHC) for 
continued 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 February 24, 2009 
through February 24, 2015.

FOR FURTHER INFORMATION CONTACT: Lillian Williams, (410) 786-8636. 
Patricia Chmielewski, (410) 786-6899.

SUPPLEMENTARY INFORMATION:

I. Background

    Under the Medicare program, eligible beneficiaries may receive 
selected covered services from a home health agency (HHA) provided 
certain requirements are met. Sections 1861(m) and (o), 1891, and 1895 
of the Social Security Act (the Act) authorize the Secretary to 
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 42 CFR 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, 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, however, to surveys by State agencies.
    Section 1865(a)(1) of the Act (as redesignated under section 125 of 
the Medicare Improvements for Patients and Providers Act of 2008 
(MIPPA) (Pub. L. 110-275) 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 
Medicare requirements. (We note that section 125 of MIPPA redesignated 
subsections (b) through (e) of subsection 1865 of the Act as (a) 
through (d) respectively.) Accreditation by an accreditation 
organization is voluntary

[[Page 4204]]

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 reapproval 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 Accreditation Commission 
for Health Care, Incorporated's (ACHC) term of approval as a recognized 
accreditation program for HHAs expires February 24, 2009.

II. Deeming Applications Approval Process

    Section 1865(a)(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 that 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. Provisions of the Proposed Notice

    In the August 22, 2008 Federal Register (73 FR 49681), we published 
a proposed notice announcing the ACHC's request for reapproval as a 
deeming organization for HHAs. In the proposed notice, we detailed our 
evaluation criteria. Under section 1865(a)(2) of the Act and our 
regulations at Sec.  488.4 (Application and reapplication procedures 
for accreditation organizations), we conducted a review of the ACHC 
application in accordance with the criteria specified by our 
regulation, which include, but are not limited to the following:
     An onsite administrative review of ACHC'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 ACHC's HHA accreditation standards to our 
current Medicare HHA conditions of participation (COPs).
     A documentation review of ACHC's survey processes to--
    ++ Determine the composition of the survey team, surveyor 
qualifications, and the ability of ACHC to provide continuing surveyor 
training;
    ++ Compare ACHC'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 ACHC's procedures for monitoring providers or suppliers 
found to be out of compliance with ACHC program requirements. The 
monitoring procedures are used only when ACHC identifies noncompliance. 
If noncompliance is identified through validation reviews, the State 
survey agency monitors corrections as specified at Sec.  488.7(d);
    ++ Assess ACHC's ability to report deficiencies to the surveyed 
facilities and respond to the facility's plan of correction in a timely 
manner;
    ++ Establish ACHC's ability to provide us with electronic data and 
reports necessary for effective validation and assessment of ACHC's 
survey process;
    ++ Determine the adequacy of staff and other resources;
    ++ Review ACHC's ability to provide adequate funding for performing 
required surveys;
    ++ Confirm ACHC's policies with respect to whether surveys are 
announced or unannounced; and,
    ++ Obtain ACHC'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(a)(3)(A) of the Act, the August 22, 
2008 proposed notice (73 FR 49681) solicited public comments regarding 
whether ACHC's requirements met or exceeded the Medicare conditions of 
coverage for HHAs. We received no public comments in response to our 
proposed notice.

IV. Provisions of the Final Notice

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

    We compared the standards contained in ACHC's accreditation 
requirements for HHAs and its survey process in ACHC's application for 
renewal of deeming authority for HHAs with the Medicare HHA conditions 
for participation and our State Operations Manual (SOM). Our review and 
evaluation of ACHC's deeming application, which were conducted as 
described in section III. of this final notice, yielded the following:
     To meet the requirements at Sec.  488.4(a)(3)(iii), ACHC 
revised their record retention policy to require all survey 
documentation be kept for a minimum of 3 years.
     To meet the requirements at Sec.  484.4(a)(4), ACHC 
revised its surveyor training and evaluation policy to include a 
process for addressing unsatisfactory performance.
     To comply with the requirement at Sec.  488.4(b)(3)(i), 
ACHC developed an action plan to resolve issues related to timely data 
submissions.
     ACHC modified its policies regarding timeframe for sending 
and receiving a plan of correction (PoC) to comply with the 
requirements of section 2728 of the SOM.
     To meet the Medicare requirements related to a plan of 
correction (PoC), ACHC amended its policies to ensure approved PoCs 
contain all the required elements specified in section 2728 of the SOM.
     ACHC revised its accreditation decision letters to ensure 
they are accurate and contain all the required elements necessary for 
the CMS Regional Office to render a decision regarding deemed status of 
a provider.

B. Term of Approval

    Based on the review and observations described in section III. of 
this final notice, we have determined that the ACHC requirements for 
HHA meet or exceed our requirements. Therefore, we approve ACHC as a 
national accreditation organization for HHAs that request participation 
in the Medicare program, effective February 24, 2009 through February 
24, 2015.

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

[[Page 4205]]

Budget under the authority of the Paperwork Reduction Act of 1995 (44 
U.S.C. Chapter 35).

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

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

    Dated: November 21, 2008.
Kerry Weems,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. E9-684 Filed 1-22-09; 8:45 am]
BILLING CODE 4120-01-P