[Federal Register Volume 83, Number 213 (Friday, November 2, 2018)]
[Rules and Regulations]
[Pages 55105-55106]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-23922]



[[Page 55105]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 482, 484, and 485

[CMS-3317-RCN]
RIN 0938-AS59


Medicare and Medicaid Programs; Revisions to Requirements for 
Discharge Planning for Hospitals, Critical Access Hospitals, and Home 
Health Agencies; Extension of Timeline for Publication of Final Rule

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

ACTION: Extension of timeline for publication of a final rule.

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SUMMARY: This document announces the extension of the timeline for 
publication of the ``Medicare and Medicaid Program; Revisions to 
Requirements for Discharge Planning for Hospitals, Critical Access 
Hospitals, and Home Health Agencies'' final rule. We are issuing this 
document in accordance with section 1871(a)(3)(B) of the Social 
Security Act (the Act), which requires notice to be provided in the 
Federal Register if there are exceptional circumstances that cause us 
to publish a final rule more than 3 years after the publication date of 
the proposed rule. In this case, the complexity of the rule and scope 
of public comments warrants the extension of the timeline for 
publication.

DATES: This extension is effective on November 2, 2018.

FOR FURTHER INFORMATION CONTACT: Alpha-Banu Wilson, (410) 786-8687.

SUPPLEMENTARY INFORMATION:

I. Background

    Section 1871(a)(3)(A) of the Social Security Act (the Act) requires 
the Secretary of the Department of Health and Human Services (the 
Secretary), in consultation with the Director of the Office of 
Management and Budget (OMB), to establish a regular timeline for the 
publication of a final rule based on the previous publication of a 
proposed rule or an interim final rule. Section 1871(a)(3)(B) of the 
Act allows the timeline for publishing Medicare final regulations to 
vary based on the complexity of the regulation, number and scope of 
comments received, and other related factors. The timeline for 
publishing the final regulation, however, cannot exceed 3 years from 
the date of publishing the proposed regulation unless there are 
exceptional circumstances. The Secretary may extend the initial 
targeted publication date of the final regulation, if the Secretary 
provides public notice including a brief explanation of the 
justification for the variation no later than the regulation's 
previously established proposed publication date.
    After consultation with the Director of OMB, the Department, 
through the Centers for Medicare & Medicaid Services (CMS), published a 
notice in the Federal Register on December 30, 2004 (69 FR 78442) 
establishing a general 3-year timeline for publishing Medicare final 
rules after the publication of a proposed or interim final rule.

II. Notification of Continuation

    Section 1861(e)(1) through (9), section 1861(m), section 1861(mm), 
section 1861(o), section 1891, and section 1820(e) of the Act list the 
requirements that hospitals, home health agencies (HHAs), and critical 
access hospitals (CAHs) must meet to be eligible for Medicare and 
Medicaid participation. The Medicare Conditions of Participation (CoPs) 
and Conditions for Coverage (CfCs) set forth the federal health and 
safety standards that providers and suppliers must meet to participate 
in the Medicare and Medicaid programs. The purposes of these conditions 
are to protect patient health and safety and to ensure that quality 
care is furnished to all patients in Medicare and Medicaid-
participating facilities. The statute also specifies that the Secretary 
may establish other requirements as necessary in the interest of the 
health and safety of patients.
    On November 3, 2015, we published a proposed rule in the Federal 
Register titled, ``Medicare and Medicaid Program; Revisions to 
Requirements for Discharge Planning for Hospitals, Critical Access 
Hospitals, and Home Health Agencies'' (80 FR 68126) that would update 
the discharge planning requirements for hospitals, CAHs, and HHAs. We 
also proposed to implement the discharge planning requirements of the 
Improving Medicare Post-Acute Care Transformation Act of 2014 (Pub. L. 
113-185), that requires hospitals, including, but not limited to, 
short-term acute care hospitals, CAHs and certain post-acute care (PAC) 
providers, including long term care hospitals, inpatient rehabilitation 
facilities, HHAs, and skilled nursing facilities, to take into account 
quality measures and resource use measures to assist patients and their 
families during the discharge planning process in order to encourage 
patients and their families to become active participants in the 
planning of their transition to the PAC setting (or between PAC 
settings). In response to the proposed rule, we received 299 public 
comments. Commenters included individuals, health care professionals 
and corporations, national associations and coalitions, state health 
departments, patient advocacy organizations, and individual facilities 
that would be impacted by the rule. The commenters presented procedural 
and cost information related to their specific circumstances, and the 
information presented requires additional analysis.
    This document announces an extension of the timeline for 
publication of the final rule based on the following exceptional 
circumstances, which we believe, justify such an extension. Based on 
both public comments received and stakeholder feedback, we have 
determined that there are significant policy issues that need to be 
resolved in order to address all of the issues raised by public 
comments to the proposed rule and to ensure appropriate coordination 
with other government agencies. Specifically, the development of the 
final rule requires collaboration with the Department of Health and 
Human Services' Office of the National Coordinator for Health 
Information Technology.
    We, therefore, are not able to meet the 3-year timeline for 
publication of the final rule and are instead extending the timeline 
for publication of the final rule.
    Our decision to extend the timeline for issuing a final rule that 
would update the CoPs should not be viewed as a diminution of the 
Department's commitment to timely and effective rulemaking in this 
area. We are committed to publishing a final rule that provides clear 
health and safety standards for hospitals, HHAs, and CAHs. At this 
time, we believe we can best achieve this balance by issuing this 
notification of continuation.
    This document extends the timeline for publication of the final 
rule until November 3, 2019.

III. Collection of Information

    This document does not impose information collection requirements, 
that is, reporting, recordkeeping or third-party disclosure 
requirements. Consequently, there is no need for review by the Office 
of Management and Budget under the authority of the Paperwork Reduction 
Act of 1995 (44 U.S.C. 3501 et seq.).


[[Page 55106]]


    Dated: October 24, 2018.
Ann C. Agnew,
Executive Secretary to the Department, Department of Health and Human 
Services.
[FR Doc. 2018-23922 Filed 10-30-18; 4:15 pm]
BILLING CODE 4120-01-P