[Federal Register Volume 73, Number 61 (Friday, March 28, 2008)]
[Notices]
[Pages 16690-16691]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-5074]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-2277-FN]
Medicare and Medicaid Programs; Approval of the Joint Commission
for Continued Deeming Authority for Home Health Agencies
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Final Notice.
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SUMMARY: This final notice announces our decision to approve The Joint
Commission for recognition as a national accreditation program for home
health agencies (HHAs) seeking to participate in the Medicare or
Medicaid programs.
DATES: Effective Date: This final notice is effective March 31, 2008
through March 31, 2014.
FOR FURTHER INFORMATION CONTACT: Cindy Melanson, (410) 786-0310.
Patricia Chmielewski (410) 786-6899.
SUPPLEMENTARY INFORMATION:
I. Background
Under the Medicare program, eligible beneficiaries may receive
covered services in a home health agency (HHA) provided certain
requirements are met. Sections 1861(o) , 1891, 1895 and 1861(m) of the
Social Security Act (the Act) establish distinct criteria for
facilities seeking designation as an HHA. Under this authority, the
minimum requirements that an HHA must meet to participate in Medicare
are set forth in regulations at 42 CFR part 484 and part 409, which
determine the basis and scope of HHA-covered services, and the
conditions for Medicare payment for home health care. 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.
Generally, to enter into an agreement with the Medicare program, an
HHA must first be certified by a State survey agency as complying with
conditions or requirements set forth in part 484 of our regulations.
Then, the HHA is subject to regular surveys by a State survey agency to
determine whether it continues to meet those requirements.
There is an alternative 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 accreditation
organization that all applicable Medicare conditions are met or
exceeded, we may ``deem'' those provider entities as having met the
requirements. Accreditation by an accreditation organization is
voluntary and is not required for Medicare participation.
If an accreditation 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 accreditation organization applying for
approval of deeming authority under part 488, subpart A must provide us
with reasonable assurance that the accreditation organization requires
the accredited provider entities to meet requirements that are at least
as stringent as the Medicare conditions. Our regulations concerning re-
approval of accrediting organizations are set forth at section Sec.
488.4 and Sec. 488.8(d)(3). The regulations at Sec. 488.8(d)(3)
require accreditation organizations to reapply for continued approval
of deeming authority every 6 years, or sooner as we determine. The
Joint Commission's term of approval as a recognized accreditation
program for HHAs expires March 31, 2008.
II. Deeming Applications Approval Process
Section 1865(b)(3)(A) of the Act provides a statutory timetable to
ensure that our review of deeming applications is conducted in a timely
manner. The Act provides us with 210 calendar days after the date of
receipt of an application to complete our survey activities and
application review process. Within 60 days of receiving a completed
application, we must publish a notice in the Federal Register that
identifies the national accreditation 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 in
the Federal Register, a final notice of approval or denial of the
application.
III. Provisions of the Proposed Notice
On October 26, 2007, we published in the Federal Register, a
proposed notice (72 FR 60855) announcing The Joint Commission's request
for re-approval as
[[Page 16691]]
a deeming organization for HHAs. In the proposed notice, we detailed
our evaluation criteria. Under section 1865(b)(2) of the Act and our
regulations at Sec. 488.4 (Application and reapplication procedures
for accreditation organizations), we conducted a review of The Joint
Commission's application in accordance with the criteria specified by
our regulation, which include, but are not limited to the following:
An onsite administrative review of The Joint Commission's
(1) Corporate policies; (2) financial and human resources available to
accomplish the proposed surveys; (3) procedures for training,
monitoring, and evaluation of its surveyors; (4) ability to investigate
and respond appropriately to complaints against accredited facilities;
and (5) survey review and decision-making process for accreditation.
A comparison of The Joint Commission's HHA accreditation
standards to our current Medicare HHA conditions for participation.
A documentation review of The Joint Commission's survey
processes to:
++ Determine the composition of the survey team, surveyor
qualifications, and the ability of The Joint Commission to provide
continuing surveyor training.
++ Compare The Joint Commission's processes to those of State
survey agencies, including survey frequency, and the ability to
investigate and respond appropriately to complaints against accredited
facilities.
++ Evaluate The Joint Commission's procedures for monitoring
providers or suppliers found to be out of compliance with The Joint
Commission program requirements. The monitoring procedures are used
only when The Joint Commission identifies noncompliance. If
noncompliance is identified through validation reviews, the survey
agency monitors corrections as specified at Sec. 488.7(d).
++ Assess The Joint Commission's ability to report deficiencies to
the surveyed facilities and respond to the facility's plan of
correction in a timely manner.
++ Establish The Joint Commission's ability to provide us with
electronic data in ASCII-comparable code and reports necessary for
effective validation and assessment of The Joint Commission's survey
process.
++ Determine the adequacy of staff and other resources.
++ Review The Joint Commission's ability to provide adequate
funding for performing required surveys.
++ Confirm The Joint Commission's policies with respect to whether
surveys are announced or unannounced.
++ Obtain The Joint Commission's agreement to provide us 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(b)(3)(A) of the Act, the October
26, 2007 proposed notice (72 FR 60855) also solicited public comments
regarding whether The Joint Commission's requirements met or exceeded
the Medicare conditions of participation for HHAs. We received no
public comments in response to our proposed notice.
IV. Provisions of the Final Notice
A. Differences Between the Joint Commission's Standards and
Requirements for Accreditation and Medicare's Conditions and Survey
Requirements
We compared the standards contained in The Joint Commission's
Comprehensive Accreditation Manual for Home Care and its survey process
in The Joint Commission's Application for Continued Home Health Deeming
Authority with the Medicare HHA conditions for participation and our
State Operations Manual (SOM). Our review and evaluation of The Joint
Commission's deeming application, which were conducted as described in
section III of this final notice, yielded the following:
To meet the requirements for initial home health
certification surveys listed in the SOM at 2200A5, The Joint Commission
revised its standards to reflect the requirement that HHAs must have
provided care to a minimum of ten patients and at least seven of the
ten patients are receiving care at the time of the initial survey.
To meet the requirements for initial certification surveys
listed in the SOM at 2200A5, The Joint Commission revised it standards
to reflect the requirement that HHAs must provide nursing and at least
one other therapeutic service.
To meet the requirements listed in the SOM at 2200C4, The
Joint Commission updated its home care surveyor activity guide to
reflect that all patients (private pay and Medicare beneficiaries) are
included in the clinical record review or selection of home visits for
a Medicare certification survey.
To meet the requirements of Sec. 488.28(a), The Joint
Commission will no longer issue supplemental findings for HHAs seeking
deemed status. All deficiencies identified during a certification
survey will be cited as requirements for improvement which the HHA will
be required to submit a written plan of correction.
To meet the requirements at 488.8(a)(3), The Joint
Commission has agreed to provide CMS with a copy of its most current
accreditation survey along with any other related information that CMS
requires, including corrected action plans, when requested.
B. Term of Approval
Based on the review and observations described in section III of
this final notice, we have determined that The Joint Commission's
requirements for HHAs meet or exceed our requirements. Therefore, we
approve The Joint Commission as a national accreditation organization
for HHAs that request participation in the Medicare program, effective
March 31, 2008 through March 31, 2014.
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).
(Catalog of Federal Domestic Assistance Program No. 93.778, Medical
Assistance Program; No. 93.773 Medicare--Hospital Insurance Program;
and No. 93.774, Medicare--Supplemental Medical Insurance Program)
Dated: January 25, 2008.
Kerry Weems,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. E8-5074 Filed 3-27-08; 8:45 am]
BILLING CODE 4120-01-P