[Federal Register Volume 85, Number 217 (Monday, November 9, 2020)]
[Notices]
[Pages 71343-71344]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-24859]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-3404-PN]


Medicare and Medicaid Programs: Application From the Joint 
Commission for Continued Approval of Its Hospice Accreditation Program

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

ACTION: Notice with request for comment.

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SUMMARY: This proposed notice acknowledges the receipt of an 
application from the Joint Commission for continued recognition as a 
national accrediting organization for hospices that wish to participate 
in the Medicare or Medicaid programs.

DATES: To be assured consideration, comments must be received at one of 
the addresses provided below, no later than 5 p.m. on December 9, 2020.

ADDRESSES: In commenting, refer to file code CMS-3404-PN.
    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-3404-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-3404-PN, Mail 
Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
    Submission of comments on paperwork requirements. You may submit 
comments on this document's paperwork requirements by following the 
instructions at the end of the ``Collection of Information 
Requirements'' section in this document. For information on viewing 
public comments, see the beginning of the SUPPLEMENTARY INFORMATION 
section.

FOR FURTHER INFORMATION CONTACT:  Caecilia Blondiaux, (410) 786-2190.

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. CMS will not post on Regulations.gov public 
comments that make threats to individuals or institutions or suggest 
that the individual will take actions to harm the individual. CMS 
continues to encourage individuals not to submit duplicative comments. 
We will post acceptable comments from multiple unique commenters even 
if the content is identical or nearly identical to other comments.

I. Background

    Under the Medicare program, eligible beneficiaries may receive 
covered services in a hospice, provided that 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 hospice services.
    Generally, to enter into an agreement, a hospice must first be 
certified by a State survey agency (SA) 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, section 1865(a)(1) of the Act provides that, if a provider 
entity demonstrates through accreditation by a Centers for Medicare & 
Medicaid Services (CMS) approved national Accrediting Organization (AO) 
that all applicable Medicare conditions are met or exceeded, we will 
deem those provider entities as having met the requirements. 
Accreditation by an AO is voluntary and is not required for Medicare 
participation.
    If an AO 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 AO applying for approval of its 
accreditation program under part 488, subpart A, must provide CMS with 
reasonable assurance that the AO requires the accredited provider 
entities to meet requirements that are at least as stringent as the 
Medicare conditions. Our regulations concerning the approval of AOs are 
set forth at Sec. Sec.  488.4 and 488.5. The regulations at Sec.  
488.5(e)(2)(i) require AOs to reapply for continued approval of its 
accreditation program every 6 years or sooner as determined by CMS.
    The Joint Commission's current term of approval for their hospice 
accreditation program expires June 18, 2021.

II. Approval of Deeming Organizations

    Section 1865(a)(2) of the Act and regulations at Sec.  488.5 
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;

[[Page 71344]]

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 the 
Joint Commission's request for continued approval of its hospice 
accreditation program. This notice also solicits public comment on 
whether the Joint Commission's requirements meet or exceed the Medicare 
conditions of participation (CoPs) for hospices.

III. Evaluation of Deeming Authority Request

    The Joint Commission submitted all the necessary materials to 
enable us to make a determination concerning its request for continued 
approval of its hospices accreditation program. This application was 
determined to be complete on August 26, 2020. Under section 1865(a)(2) 
of the Act and our regulations at Sec.  488.5 (Application and re-
application procedures for national accrediting organizations), our 
review and evaluation of the Joint Commission will be conducted in 
accordance with, but not necessarily limited to, the following factors:
     The equivalency of the Joint Commission's standards for 
hospices as compared with CMS' hospice CoPs.
     The Joint Commission'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 the Joint Commission's processes to those 
of state agencies, including survey frequency, and the ability to 
investigate and respond appropriately to complaints against accredited 
facilities.
    ++ The Joint Commission's processes and procedures for monitoring 
hospices, which are found out of compliance with the Joint Commission's 
program requirements. These monitoring procedures are used only when 
the Joint Commission identifies noncompliance. If noncompliance is 
identified through validation reviews or complaint surveys, the SA 
monitors corrections as specified at Sec.  488.9.
    ++ The Joint Commission's capacity to report deficiencies to the 
surveyed facilities and respond to the facility's plan of correction in 
a timely manner.
    ++ The Joint Commission's capacity to provide CMS with electronic 
data and reports necessary for effective validation and assessment of 
the organization's survey process.
    ++ The adequacy of the Joint Commission's staff and other 
resources, and its financial viability.
    ++ The Joint Commission's capacity to adequately fund required 
surveys.
    ++ The Joint Commission's policies with respect to whether surveys 
are announced or unannounced, to ensure that surveys are unannounced.
    ++ The Joint Commission's policies and procedures to avoid 
conflicts of interest, including the appearance of conflicts of 
interest, involving individuals who conduct surveys or participate in 
accreditation decisions.
    ++ The Joint Commission'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).

IV. 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.).

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.
    The Administrator of the Centers for Medicare & Medicaid Services 
(CMS), Seema Verma, having reviewed and approved this document, 
authorizes Lynette Wilson, who is the Federal Register Liaison, to 
electronically sign this document for purposes of publication in the 
Federal Register.

    Dated: October 29, 2020.
Lynette Wilson,
Federal Register Liaison, Department of Health and Human Services.
[FR Doc. 2020-24859 Filed 11-6-20; 8:45 am]
BILLING CODE 4120-01-P