[Federal Register Volume 84, Number 125 (Friday, June 28, 2019)]
[Notices]
[Pages 31068-31070]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-13901]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[CMS-3379-PN]


Medicare and Medicaid Programs: Application by Accreditation 
Commission for Health Care for Continued CMS-Approval of Its Hospice 
Accreditation Program

AGENCY: Centers for Medicare and Medicaid Services, HHS.

ACTION: Proposed notice.

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SUMMARY: This proposed notice acknowledges the receipt of an 
application from the Accreditation Commission for Health Care for 
continued recognition as a national accrediting organization for 
hospices that wish to participate in the Medicare or Medicaid programs. 
The statute requires that within 60 days of receipt of an organizations 
complete application, the Centers for Medicare & Medicaid Services 
publish a notice that identifies the national accrediting body making 
the request, describes the nature of the request, and provides at least 
a 30-day public comment period.

DATES: To be assured consideration, comments must be received at one of 
the addresses provided below, no later than 5 p.m. on July 30, 2019.

ADDRESSES: In commenting, please refer to file code CMS-3379-PN. 
Because of staff and resource limitations, we cannot accept comments by 
facsimile (FAX) transmission.
    Comments, including mass comment submissions, must be submitted in 
one of the following three ways (please choose only one of the ways 
listed):
    1. Electronically. You may submit electronic comments on specific 
issues in this regulation to http://www.regulations.gov. Follow the 
``submit a comment'' instructions.
    2. By regular mail. You may mail written comments to the following 
address ONLY:
    Centers for Medicare & Medicaid Services, Department of Health and 
Human Services, Attention: CMS-3379-

[[Page 31069]]

PN, P.O. Box 8010, Baltimore, MD 21244-8010.
    Please allow sufficient time for mailed comments to be received 
before the close of the comment period.
    3. By express or overnight mail. You may send written comments to 
the following address ONLY:
    Centers for Medicare & Medicaid Services, Department of Health and 
Human Services, Attention: CMS-3379-PN, Mail Stop C4-26-05, 7500 
Security Boulevard, Baltimore, MD 21244-1850.

FOR FURTHER INFORMATION CONTACT:
    Lillian Williams, (410) 786-8636.
    Joy Webb, (410) 786-1667.
    Karen Tritz, (410) 786-0821.

SUPPLEMENTARY INFORMATION: Inspection of Public Comments: All comments 
received before the close of the comment period are available for 
viewing by the public, including any personally identifiable or 
confidential business information that is included in a comment. We 
post all comments received before the close of the comment period on 
the following website as soon as possible after they have been 
received: http://www.regulations.gov. Follow the search instructions on 
that website to view public comments.

I. Background

    Under the Medicare program, eligible beneficiaries may receive 
covered services in a hospice provided certain requirements are met by 
the hospice. Sections 1861(dd) of the Social Security Act (the Act) 
establish distinct criteria for facilities seeking designation as a 
hospice. Regulations concerning provider agreements are at 42 CFR part 
489 and those pertaining to activities related 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 by a State survey agency as complying with the conditions or 
requirements set forth in part 418. Thereafter, the hospice is subject 
to regular surveys by a State survey agency to determine whether it 
continues to meet these requirements.
    However, there is an alternative to surveys by state agencies. 
Section 1865(a)(1) of the Act provides that, if a provider entity 
demonstrates through accreditation by an approved national accrediting 
organization that all applicable Medicare conditions are met or 
exceeded, we will deem those provider entities as having met the 
requirements. Accreditation by an accrediting organization is voluntary 
and is not required for Medicare participation.
    If an accrediting organization is recognized by the Secretary of 
the Department of Health and Human Services 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 accrediting 
organization applying for deeming authority under part 488, subpart A, 
must provide us 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 reapproval of accrediting organizations 
are set forth at Sec.  488.5. The regulations at Sec.  488.5(e)(2)(i) 
require accrediting organizations to reapply for continued deeming 
authority every 6 years or sooner as determined by Centers for Medicare 
and Medicaid Services (CMS).
    The Accreditation Commission for Health Care's (ACHC's) term of 
approval for its hospice accreditation program expires November 27, 
2019.

II. Approval of Deeming Organizations

    Section 1865(a)(2) of the Act and our regulations at Sec.  488.5 
require that our findings concerning review and approval of a national 
accrediting organization's requirements consider, among other factors, 
the applying accrediting organization's requirements for accreditation; 
survey procedures; resources for conducting required surveys; capacity 
to furnish information for use in enforcement activities; monitoring 
procedures for provider entities found not in compliance with the 
conditions or requirements; and ability to provide CMS with the 
necessary data for validation.
    Section 1865(a)(3)(A) of the Act further requires that we publish, 
within 60 days of receipt of an organization's complete application, a 
notice identifying the national accrediting body making the request, 
describing the nature of the request, and providing at least a 30-day 
public comment period. We have 210 days from the receipt of a complete 
application to publish notice of approval or denial of the application.
    The purpose of this proposed notice is to inform the public of 
ACHC's request for continued CMS approval of its hospice accreditation 
program. This notice also solicits public comment on whether ACHC's 
requirements meet or exceed the Medicare conditions for participation 
for hospices.

III. Evaluation of Deeming Authority Request

    ACHC submitted all the necessary materials to enable us to make a 
determination concerning its request for continued approval of its 
hospice accreditation program. This application was determined to be 
complete on May 1, 2019. Under Section 1865(a)(2) of the Act and our 
regulations at Sec.  488.5 (Application and re-application procedures 
for national organizations), our review and evaluation of ACHC will be 
conducted in accordance with, but not necessarily limited to, the 
following factors:
     The equivalency of ACHC's standards for hospices as 
compared with CMS' hospice conditions of participation.
     ACHC's survey process to determine the following:
    ++ ACHC's composition of the survey team, surveyor qualifications, 
and the ability of the organization to provide continuing surveyor 
training.
    ++ ACHC's processes compared to those of State agencies, including 
survey frequency, and the ability to investigate and respond 
appropriately to complaints against accredited facilities.
    ++ ACHC's processes and procedures for monitoring a hospice found 
out of compliance with ACHC's program requirements. These 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.  488.9(c).
    ++ ACHC's capacity to report deficiencies to the surveyed 
facilities and respond to the facility's plan of correction in a timely 
manner.
    ++ ACHC's capacity to provide CMS with electronic data, and reports 
necessary for effective validation and assessment of the organization's 
survey process.
    ++ ACHC's staff adequacy and other resources, and its financial 
viability.
    ++ ACHC's capacity to adequately fund required surveys.
    ++ ACHC's policies with respect to whether surveys are announced or 
unannounced to assure that surveys are unannounced.
    ++ ACHC'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).

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IV. Collection of Information Requirements

    This document does not impose information collection requirements, 
that is reporting, recordkeeping and 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. chapter 35).

V. Response to Comments

    Because of the large number of public comments we normally receive 
on Federal Register documents, we are not able to acknowledge or 
respond to them individually. We will consider all comments we receive 
by the date and time specified in the DATES section of this preamble, 
and, when we proceed with a subsequent document, we will respond to the 
comments in the preamble to that document.
    Upon completion of our evaluation, including evaluation of comments 
received as a result of this notice, we will publish a final notice in 
the Federal Register announcing the result of our evaluation.

    Dated: June 11, 2019.
Seema Verma,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2019-13901 Filed 6-27-19; 8:45 am]
BILLING CODE 4120-01-P