[Federal Register: November 28, 2008 (Volume 73, Number 230)]
[Notices]
[Page 72487-72489]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr28no08-85]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare and Medicaid Services
[CMS-2294-PN]
Medicare and Medicaid Programs; Application by the Joint
Commission for Continued Deeming Authority for Hospices
AGENCY: Centers for Medicare & Medicaid Services, (CMS), HHS.
ACTION: Proposed notice.
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SUMMARY: This proposed notice with comment period acknowledges the
receipt of a deeming 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.
Section 1865(b)(3)(A) of the Act, recodified under the Medicare
Improvement for Patients and Providers Act of 2008 (Pub. L. 110-275,
July 15, 2008) (MIPPA) as section 1865(a)(3)(A) requires that within 60
days of receipt of an organization's complete application, we 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: Comment Date: To be assured consideration, comments must be
received at one of the addresses provided below, no later than 5 p.m.
on December 29, 2008.
ADDRESSES: In commenting, please refer to file code CMS-2294-PN.
Because of staff and resource limitations, we cannot accept comments by
facsimile (FAX) transmission.
You may submit comments in one of four ways (no duplicates,
please):
1. Electronically. You may submit electronic comments on specific
issues in this regulation to http://www.regulation.gov. Follow the
instructions for ``Comment or Submission'' and enter the filecode to
find the document accepting comments.
2. By regular mail. You may mail written comments (one original and
two copies) to the following address only: Centers for Medicare &
Medicaid Services, Department of Health and Human Services, Attention:
CMS-2294-PN, P.O. Box 8016, Baltimore, MD 21244-8016.
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 (one
original and two copies) to the following address only: Centers for
Medicare & Medicaid Services, Department of Health and Human Services,
Attention: CMS-2294-PN, Mail Stop C4-26-05, 7500 Security Boulevard,
Baltimore, MD 21244-1850.
4. By hand or courier. If you prefer, you may deliver (by hand or
courier) your written comments (one original and two copies) before the
close of the comment period to either of the following addresses.
a. Room 445-G, Hubert H. Humphrey Building, 200 Independence
Avenue, SW., Washington, DC 20201; or
(Because access to the interior of the HHS Building is not readily
available to persons without Federal Government identification,
commenters are encouraged to leave their comments in the CMS drop slots
located in the main lobby of the building. A stamp-in clock is
available for persons wishing to retain a proof of filing by stamping
in and retaining an extra copy of the comments being filed.)
b. 7500 Security Boulevard, Baltimore, MD 21244-1850.
If you intend to deliver your comments to the Baltimore address,
please call telephone number (410) 786-9994 in advance to schedule your
arrival with one of our staff members.
Comments mailed to the addresses indicated as appropriate for hand
or courier delivery may be delayed and received after the comment
period.
For information on viewing public comments, see the beginning of
the SUPPLEMENTARY INFORMATION section.
[[Page 72488]]
FOR FURTHER INFORMATION CONTACT: Alexis Prete, (410) 786-0375. Patricia
Chmielewski, (410) 786-6899.
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 Web
site as soon as possible after they have been received: http://
www.regulations.gov. Follow the search instructions on that Web site to
view public comments.
Comments received timely will also be available for public
inspection as they are received, generally beginning approximately 3
weeks after publication of a document, at the headquarters of the
Centers for Medicare & Medicaid Services, 7500 Security Boulevard,
Baltimore, Maryland 21244, Monday through Friday of each week from 8:30
a.m. to 4 p.m. To schedule an appointment to view public comments,
phone 1-800-743-3951.
I. Background
Under the Medicare program, eligible beneficiaries may receive
covered services from a hospice provided certain requirements are met.
Sections 1861(dd)(1) 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 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 care.
Generally, in order to enter into a provider agreement with the
Medicare program, a hospice must first be certified by a State survey
agency as complying with the conditions or requirements set forth in
part 418 of our CMS regulations. Thereafter, the hospice is subject to
regular surveys by a State survey agency to determine whether it
continues to meet these requirements. There is an alternative, however,
to surveys by State agencies.
Section 1865(b)(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 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. 488.4
and 488.8(d)(3). The regulations at Sec. 488.8(d)(3) require
accrediting organizations to reapply for continued deeming authority
every six years or sooner as determined by CMS.
The Joint Commission's term of approval as a recognized
accreditation program for hospice's expires March 31, 2009.
II. Approval of Deeming Organizations
Section 1865(b)(2) of the Act (now section 1865(a)(2)) and our
regulations at Sec. 488.8(a) require that our findings concerning
review and reapproval 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 us with the necessary data for
validation.
Section 1865(b)(3)(A) of the Act (now 1865(a)(3)(A)) 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 deeming authority for
hospices. This notice also solicits public comment on whether the Joint
Commission's requirements meet or exceed the Medicare conditions for
participation 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 reapproval
as a deeming organization for hospices. This application was determined
to be complete on October 24, 2008. Under section 1865(b)(2) of the Act
(now 1865(a)(2)) and our regulations at Sec. 488.8 (Federal review of
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 conditions of participation.
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 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, the State survey agency monitors
corrections as specified at Sec. 488.7(d).
--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 us 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 assure that surveys are unannounced.
--The Joint Commission's agreement to provide us with a copy of the
most current accreditation survey together
[[Page 72489]]
with any other information related to the survey as we may require
(including corrective action plans).
IV. Response to Public Comments and Notice Upon Completion of
Evaluation
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.
V. Collection of Information Requirements
This document does not impose information collection and
recordkeeping requirements. Consequently, it need not be reviewed by
the Office of Management and Budget under the authority of the
Paperwork Reduction Act of 1995 (44 U.S.C. 35).
VI. Regulatory Impact Statement
In accordance with the provisions of Executive Order 12866, the
Office of Management and Budget did not review this proposed notice.
In accordance with Executive Order 13132, we have determined that
this proposed notice would not have a significant effect on the rights
of States, local or tribal governments.
(Catalog of Federal Domestic Assistance Program No. 93.778, Medical
Assistance Program; No. 93.773 Medicare--Hospital Insurance Program;
and No. 93.774, Medicare--Supplementary Medical Insurance Program)
Dated: November 7, 2008.
Kerry Weems,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. E8-28178 Filed 11-26-08; 8:45 am]
BILLING CODE 4120-01-P