[Federal Register Volume 84, Number 206 (Thursday, October 24, 2019)]
[Notices]
[Pages 57021-57023]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-23137]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-3389-PN]


Medicare Program; Application from Utilization Review 
Accreditation Commission for Initial CMS-Approval of Its Home Infusion 
Therapy Accreditation Program

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

ACTION: Proposed notice.

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SUMMARY: This proposed notice acknowledges the receipt of an 
application from Utilization Review Accreditation Commission for 
initial recognition as a national accrediting organization for 
suppliers of home infusion therapy services that wish to participate in 
the Medicare program. Within 60 days of receipt of an organization's 
complete application, the statute requires CMS to 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 November 25, 
2019.

ADDRESSES: In commenting, please refer to file code CMS-3389-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 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-3389-PN, P.O. Box 8016, 
Baltimore, MD 21244-8010.

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    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-3389-PN, Mail 
Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
    For information on viewing public comments, see the beginning of 
the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT: 
    Christina Mister-Ward, (410) 786-2441.
    Shannon Freeland, (410) 786-4348.
    Lillian Williams, (410) 786-8636.

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

    Infusion therapy is a treatment option for Medicare beneficiaries 
with a wide range of acute and chronic conditions. Section 5012 of the 
21st Century Cures Act (Pub. L. 114-255, enacted December 13, 2016) 
added section 1861(iii) to the Social Security Act (the Act), 
establishing a new Medicare benefit for home infusion therapy (HIT) 
services. Section 1861(iii)(1) of the Act defines HIT as professional 
services, including nursing services; training and education not 
otherwise covered under the durable medical equipment (DME) benefit; 
remote monitoring; and other monitoring services. HIT must be furnished 
by a qualified HIT supplier and furnished in the individual's home. The 
individual must be under--
     The care of an applicable provider (that is, physician, 
nurse practitioner, or physician assistant); and
     A plan of care established and periodically reviewed by a 
physician in coordination with the furnishing of home infusion drugs 
under Part B, that prescribes the type, amount, and duration of 
infusion therapy services that are to be furnished.
    Section 1861(iii)(3)(D)(III) of the Act requires that a qualified 
HIT supplier be accredited by an accrediting organization (AO) 
designated by the Secretary in accordance with section 1834(u)(5) of 
the Act. Section 1834(u)(5)(A) of the Act identifies factors for 
designating AOs and in reviewing and modifying the list of designated 
AOs. These statutory factors are as follows:
     The ability of the organization to conduct timely reviews 
of accreditation applications.
     The ability of the organization take into account the 
capacities of suppliers located in a rural area (as defined in section 
1886(d)(2)(D) of the Act).
     Whether the organization has established reasonable fees 
to be charged to suppliers applying for accreditation.
     Such other factors as the Secretary determines 
appropriate.
    Section 1834(u)(5)(B) of the Act requires the Secretary to 
designate AOs to accredit HIT suppliers furnishing HIT not later than 
January 1, 2021. Section 1861(iii)(3)(D) of the Act defines ``qualified 
home infusion therapy suppliers'' as being accredited by a CMS-approved 
AO.
    In the March 1, 2019 Federal Register, we published the ``Medicare 
Program; Solicitation of Independent Accrediting Organizations To 
Participate in the Home Infusion Therapy Supplier Accreditation 
Program'' solicitation notice (84 FR 7057). This notice informed 
national AOs that accredit HIT suppliers of an opportunity to submit 
applications to participate in the HIT supplier accreditation program. 
Complete applications will be considered for the January 1, 2021 
designation deadline if received by February 1, 2020.
    Regulations for the approval and oversight of AOs for HIT 
organizations are located at 42 CFR part 488, subpart L. The 
requirements for HIT suppliers are located at 42 CFR part 486, subpart 
I.

II. Approval of Accreditation Organizations

    Section 1834(u)(5) of the Act and the regulations at 42 CFR 
488.1010 (Application and re-application procedures for national HIT 
AOs) require that our findings concerning review and approval of a 
national AO's requirements consider, among other factors, the applying 
AO'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.
    Section 488.1020(a) requires that we publish, after 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. In 
accordance with Sec.  488.1010(d), 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 the 
Utilization Review Accreditation Commission's (URAC) initial request 
for CMS approval of its HIT accreditation program. This notice also 
solicits public comment on whether URAC's requirements meet or exceed 
the Medicare conditions of participation for HIT services.

III. Evaluation of Deeming Authority Request

    URAC submitted all the necessary materials to enable us to make a 
determination concerning its request for initial approval of its HIT 
accreditation program. This application was determined to be complete 
on August 30, 2019. Under section 1834(u)(5) of the Act and Sec.  
488.1010, our review and evaluation of URAC will be conducted in 
accordance with, but not necessarily limited to, the following factors:
     The equivalency of URAC's standards for HIT as compared 
with CMS' HIT conditions for certification.
     URAC's survey process to determine the following:
    ++ The composition of the survey team, surveyor qualifications, and 
the ability of the organization to provide continuing surveyor 
training.
    ++ The comparability of URAC's to CMS standards and processes, 
including survey frequency, and the ability to investigate and respond 
appropriately to complaints against accredited facilities.
    ++ URAC's processes and procedures for monitoring a HIT supplier 
found out of compliance with URAC's program requirements.
    ++ URAC's capacity to report deficiencies to the surveyed 
facilities and respond to the facility's plan of correction in a timely 
manner.
    ++ URAC's capacity to provide CMS with electronic data and reports 
necessary for effective assessment and interpretation of the 
organization's survey process.
    ++ The adequacy of URAC's staff and other resources, and its 
financial viability.
    ++ URAC's capacity to adequately fund required surveys.

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    ++ URAC's policies with respect to whether surveys are announced or 
unannounced, to assure that surveys are unannounced.
    ++ URAC's policies and procedures to avoid conflicts of interest, 
including the appearance of conflicts of interest, involving 
individuals who conduct surveys, audits or participate in accreditation 
decisions.
    ++ URAC's agreement to provide CMS with a copy of the most current 
accreditation survey together with any other information related to the 
survey as CMS may require (including corrective action plans).
     URAC's agreement or policies for voluntary and involuntary 
termination of suppliers.
     URAC agreement or policies for voluntary and involuntary 
termination of the HIT AO program.

IV. Collection of Information Requirements

    This document does not impose information collection and 
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. Chapter 35).

V. Response to Public 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 notice.
    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 summarizing our response to comments and 
announcing the result of our evaluation.

    Dated: October 10, 2019.
Seema Verma,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2019-23137 Filed 10-23-19; 8:45 am]
 BILLING CODE 4120-01-P