[Federal Register Volume 75, Number 136 (Friday, July 16, 2010)]
[Notices]
[Pages 41503-41505]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-17405]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-2900-FN2]
Medicare and Medicaid Programs; Approval of the Community Health
Accreditation Program for Continued Deeming Authority for Hospices
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Final notice of Removal of Conditional Probationary Status.
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SUMMARY: Based on our review and observations, we have determined that
the standards and processes used by the Community Health Accreditation
Program (CHAP) hospice accreditation program meet or exceed our
requirements. This final notice announces our decision to approve
without condition CHAP's request for continued recognition as a
national accreditation program for hospices seeking to participate in
the Medicare or Medicaid programs.
DATES: Effective Date: This final notice is effective November 20, 2009
through November 20, 2012.
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 hospice, provided certain requirements are met.
Section 1861(dd)(1) of the Social Security Act (the Act) establishes
distinct criteria for entities seeking designation as a hospice
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program. Under this authority, 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. Provider agreement
regulations are located in 42 CFR part 489 and regulations pertaining
to the survey and certification of facilities are located in 42 CFR
part 488.
Generally, in order to enter into an agreement, a hospice facility
must first be certified by a State survey agency as complying with
conditions or requirements set forth in part 418 of our regulations.
Then, 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(a)(1) of the Act provides that, if a provider entity
demonstrates through accreditation by an approved national
accreditation organization (AO) that all applicable Medicare conditions
or requirements are met or exceeded, we may deem those provider
entities as having met the requirements. Accreditation by an AO is
voluntary and is not required for Medicare participation.
A national AO applying for approval of deeming authority under part
488, subpart A, must provide us 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 re-approval of AOs are set forth at Sec. 488.4 and Sec.
488.8(d)(3). The regulations at Sec. 488.8(d)(3) require AOs to
reapply for continued approval of deeming authority every 6 years, or
sooner as determined by CMS. The regulation at Sec. 488.8(f)(3)(i)
provides CMS the authority to grant conditional approval of an AO's
deeming authority, with a probationary period of up to 180 days, if the
AO has not adopted comparable standards during the reapplication
process.
We received a complete application from CHAP for continued
recognition as a national AO for hospices on March 27, 2009. In
accordance with the requirements at Sec. 488.4 and Sec. 488.8(d)(3),
we published a proposed notice on May 22, 2009 (74 FR 24015) and a
final notice announcing our decision to conditionally approve CHAP's
hospice program subject to probationary conditions on October 23, 2009
(74 FR 54832). This final notice provides CMS' final determination in
response to the conditional approval with a 180-day probationary period
granted to CHAP on October 23, 2009. This notice is required to be
published no later than July 18, 2010.
II. Deeming Applications Approval Process
Section 1865(a)(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 a
notice in the Federal Register of our approval or denial of the
application. In accordance with Sec. 488.8(f)(2), if CMS determines
following the deeming authority review that the organization has failed
to adopt requirements comparable to CMS requirements, the AO may be
given a conditional approval of its deeming authority for a
probationary period of up to 180 days to adopt comparable requirements.
Within 60 days after the end of this period, we must make a final
determination as to whether or not the CHAP accreditation program for
hospices is comparable to CMS requirements and issue an appropriate
notice that includes our reasons for our determination.
III. Provisions of the October 23, 2009 Final Notice
Our review of CHAP's renewal application for hospice deeming
authority revealed that CHAP had on-going, serious, widespread areas of
non-compliance. Specifically, CHAP's inability to provide us with
accurate, timely data on deemed providers; lack of complete and
accurate deemed facility survey files; and, failure to ensure that
recertification surveys are conducted on an interval not exceeding 36
months. Due to the significant number of areas of noncompliance
identified during the review of CHAP's deeming authority, we
conditionally approved CHAP's hospice accreditation program with a 180
day probationary period. Under 1865(a)(2) of the Act and our
regulations at Sec. 488.4 and Sec. 488.8, we conducted a
comparability review of CHAP's hospice accreditation program to
determine compliance with Medicare requirements for hospices at 42 CFR
part 418.
IV. Provisions of the Final Notice
A. Differences Between CHAP's Standards and Requirements for
Accreditation and Medicare's Conditions and Survey Requirements
During the 180 day probationary period, we conducted a comparison
of CHAP's accreditation requirements for hospices to our current
Medicare conditions of Participation (CoPs) as outlined in the State
Operations Manual (SOM). We also conducted a corporate onsite visit to
validate proper application of the requirements. Our review and
evaluation of CHAP's deeming application yielded the following:
CHAP's survey files were complete, accurate, and
consistent with the requirements at Sec. 488.6(a).
CHAP's recertification surveys for hospices are conducted
no later than 36 months after the date of the previous standard survey
in accordance with the requirements at Sec. 488.20(a).
CHAP's data submission are accurate, complete and timely
in accordance with the requirements at Sec. 488.4(b).
CHAP met the requirements at section 2728 of the SOM by
developing an electronic plan of correction that specifically addressed
the ``who, what, when, and how'' the hospice would correct each
deficiency cited and ensure ongoing compliance.
CHAP met requirements at Sec. 488.28(a) and section 2728
of the SOM as evidenced by review of the survey files.
CHAP policy regarding establishment of an effective date
for new providers is consistent with the requirements at Sec. 488.13.
B. Term of Approval
Based on the review and observations, we have determined that
CHAP's hospice accreditation program meets or exceeds our requirements.
Therefore, we approve CHAP as a national AO for hospices that request
participation in the Medicare program, effective November 20, 2009
through November 20, 2012. Under Sec. 488.8(f)(4), notice was given to
CHAP on October 23, 2009 (74 FR 54832).
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).
[[Page 41505]]
(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: June 29, 2010.
Marilyn Tavenner,
Acting Administrator and Chief Operating Officer, Centers for Medicare
& Medicaid Services.
[FR Doc. 2010-17405 Filed 7-15-10; 8:45 am]
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