[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