[Federal Register Volume 83, Number 222 (Friday, November 16, 2018)]
[Notices]
[Pages 57727-57728]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-25066]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-3360-FN]


Medicare and Medicaid Programs; Continued Approval of the 
Community Health Accreditation Partner's Hospice Accreditation Program

AGENCY: Centers for Medicare & Medicaid Services, HHS.

ACTION: Final notice.

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SUMMARY: This final notice announces our decision to approve the 
Community Health Accreditation Partner (CHAP) for continued recognition 
as a national accrediting organization for hospices that wish to 
participate in the Medicare or Medicaid programs. A hospice that 
participates in Medicaid must also meet the Medicare Conditions for 
Participation (CoPs).

DATES: The approval is effective November 20, 2018 through November 20, 
2024.

FOR FURTHER INFORMATION CONTACT: Lillian Williams, (410) 786-8636, or 
Monda Shaver, (410) 786-3410.

SUPPLEMENTARY INFORMATION:

I. Background

    Under the Medicare program, eligible beneficiaries may receive 
covered services in a hospice, provided certain requirements are met by 
the hospice. Section 1861(dd) of the Social Security Act (the Act) 
establishes distinct criteria for facilities seeking designation as a 
hospice. 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. The regulations at 
42 CFR part 418 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 hospices.
    Generally, to enter into an agreement, a hospice must first be 
certified as complying with the conditions set forth in part 418 and 
recommended to the Centers for Medicare & Medicaid Services (CMS) for 
participation by a state survey agency. Thereafter, the hospice is 
subject to periodic surveys by a state survey agency to determine 
whether it continues to meet these conditions. However, there is an 
alternative to certification surveys by state agencies. Accreditation 
by a nationally recognized Medicare accreditation program approved by 
CMS may substitute for both initial and ongoing state review.
    Section 1865(a)(1) of the Act provides that, if the Secretary of 
the Department of Health and Human Services (the Secretary) finds that 
accreditation of a provider entity by an approved national accrediting 
organization meets or exceeds all applicable Medicare conditions, CMS 
may treat the provider entity as having met those conditions, that is, 
we may ``deem'' the provider entity to be in compliance. Accreditation 
by an accrediting organization is voluntary and is not required for 
Medicare participation.
    If an accrediting 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 organization's approved program may be deemed to meet the 
Medicare conditions. A national accrediting organization applying for 
CMS approval of their accreditation program under 42 CFR part 488, 
subpart A, must provide CMS with reasonable assurance that the 
accrediting organization requires the accredited provider entities to 
meet requirements that are at least as stringent as the Medicare 
conditions. Our regulations concerning the approval of accrediting 
organizations are set forth at Sec.  488.5. Section 488.5(e)(2)(i) 
requires accrediting organizations to reapply for continued approval of 
its Medicare accreditation program every 6 years or sooner as 
determined by CMS. The Community Health Accreditation Partner's 
(CHAP'S) term of approval as a recognized accreditation program for its 
hospice accreditation program expires November 20, 2018.

II. Application Approval Process

    Section 1865(a)(3)(A) of the Act provides a statutory timetable to 
ensure that our review of applications for CMS-approval of an 
accreditation program is conducted in a timely manner. The Act provides 
us 210 days after the date of receipt of a complete application, with 
any documentation necessary to make the determination, to complete our 
survey activities and application process. Within 60 days after 
receiving a complete application, we must publish a notice in the 
Federal Register that identifies the national accrediting 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 a notice in the Federal Register approving or denying the 
application.

[[Page 57728]]

III. Provisions of the Proposed Notice

    On June 15, 2018, we published a proposed notice (83 FR 27992) in 
the Federal Register announcing CHAP's request for continued approval 
of its Medicare hospice accreditation program. In the June 15, 2018 
proposed notice, we detailed our evaluation criteria. Under section 
1865(a)(2) of the Act and in our regulations at Sec.  488.5, we 
conducted a review of CHAP's Medicare hospice accreditation application 
in accordance with the criteria specified by our regulations, 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 hospice surveyors; (4) ability to investigate and 
respond appropriately to complaints against accredited hospices; and 
(5) survey review and decision-making process for accreditation.
     A comparison of CHAP's Medicare hospice accreditation 
program standards to our current Medicare hospice Conditions of 
Participation (CoPs).
     A documentation review of CHAP's survey process to:
    ++ Determine the composition of the survey team, surveyor 
qualifications, and CHAP's ability to provide continuing surveyor 
training.
    ++ Compare CHAP's processes to those we require of state survey 
agencies, including periodic resurvey and the ability to investigate 
and respond appropriately to complaints against accredited hospices.
    ++ Evaluate CHAP's procedures for monitoring hospices found to be 
out of compliance with CHAP's program requirements. This pertains only 
to monitoring procedures when CHAP identifies non-compliance. If 
noncompliance is identified by a state survey agency through a 
validation survey, the state survey agency monitors corrections as 
specified at Sec.  488.9(c).
    ++ Assess CHAP's ability to report deficiencies to the surveyed 
hospice and respond to the hospice's plan of correction in a timely 
manner.
    ++ Establish CHAP's ability to provide CMS with electronic data and 
reports necessary for effective validation and assessment of the 
organization's survey process.
    ++ Determine the adequacy of CHAP's staff and other resources.
    ++ Confirm CHAP's ability to provide adequate funding for the 
completion of required surveys.
    ++ Confirm CHAP's policies to surveys being unannounced.
    ++ Obtain CHAP's agreement to provide CMS 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 June 15, 
2018 proposed notice also solicited public comments regarding whether 
CHAP's requirements met or exceeded the Medicare CoPs for hospices. No 
comments were received in response to our proposed notice.

IV. Provisions of the Final Notice

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

    We compared CHAP's hospice accreditation requirements and survey 
process with the Medicare CoPs of part 418, and the survey and 
certification process requirements of parts 488 and 489. Our review and 
evaluation of CHAP's hospice application, which were conducted as 
described in section III of this final notice, yielded the following 
areas where, as of the date of this notice, CHAP has completed revising 
its standards and certification processes in order to ensure that 
hospices accredited by CHAP meet the requirements at:
     Sec.  418.64(d)(2), to ensure the dietary needs of 
patients are met.
     Sec.  418.76(b)(1), to ensure training is conducted by a 
registered nurse, or a licensed practical nurse under the supervision 
of a registered nurse.
     Sec.  418.76(b)(3)(xiii), to ensure that any other task 
that the hospice may choose to have an aide perform must be included in 
the content of the hospice aide classroom and supervised practical 
training.
     Sec.  418.76(d)(1), to ensure that in-service training is 
supervised by a registered nurse.
     Sec.  418.76(h)(3)(iv) and (v), to address the requirement 
that the supervising nurse must assess an aide's ability to demonstrate 
initial and continued satisfactory performance in meeting outcome 
criteria for the hospice's infection control policy and procedures and 
for reporting changes in the patient's conditions.
     Sec.  418.76(k)(3), to address the requirement for 
homemakers to report concerns to the member of the interdisciplinary 
group who is responsible for coordinating homemaker services.
     Sec.  418.104, to address the requirement allowing medical 
records to be maintained electronically.
     Sec.  418.110(d)(3), to address the requirement that 
provisions of the adopted edition of the Life Safety Code do not apply 
in a state if CMS finds that a fire and safety code imposed by state 
law adequately protects patients in hospices.
     Sec.  418.113, to ensure compliance with all applicable 
federal, state, and local emergency preparedness requirements.
     Sec.  488.5(a)(7) through (9), to ensure that new 
surveyors receive the required initial orientation training, and that 
all new surveyors receive an evaluation of performance, in accordance 
with CHAP policies.
     Sec.  488.5(a)(12), to ensure that complaint surveys are 
conducted in a manner that meets or exceeds the processes and 
investigation practices of CMS; that the rationale for the decision 
whether to conduct an onsite survey or not, is clearly documented in 
the complaint file, according to CHAP policy; and, to ensure that 
complaints are closed out properly with appropriate notification to 
complainants.

B. Term of Approval

    Based on our review and observations described in section III of 
this final notice, we approve CHAP as a national accreditation 
organization for hospices that request participation in the Medicare 
program, effective November 20, 2018 through November 20, 2024.

V. Collection of Information Requirements

    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).

    Dated: November 7, 2018.
Seema Verma,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2018-25066 Filed 11-15-18; 8:45 am]
BILLING CODE 4120-01-P