Medicare and Medicaid: Hospices; national accreditation programs; application, etc.— Commission for Accreditation of Rehabilitation Facilities,

[Federal Register: December 24, 1998 (Volume 63, Number 247)]

[Notices]

[Page 71296-71297]

From the Federal Register Online via GPO Access [wais.access.gpo.gov]

[DOCID:fr24de98-84]

[[Page 71296]]

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

[HCFA-2036-NC]

RIN 0938-AJ25

Medicare and Medicaid Programs; Recognition of the Commission for Accreditation of Rehabilitation Facilities

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: Notice with comment period.

SUMMARY: This notice announces and invites comments on the receipt of an application from the Commission for Accreditation of Rehabilitation Facilities for recognition as a national accreditation organization with deemed status authority. The Social Security Act requires us to publish this notice in which we identify the national accreditation body making the application, describe the nature of the request, and provide a 30-day public comment period. The intent of this notice is to solicit public comment as to the advisability of recognizing the Commission for Accreditation of Rehabilitation Facilities as a national accreditation organization with deeming authority to survey and accredit comprehensive outpatient rehabilitation facilities for participation in the Medicare or Medicaid programs.

DATES: Comments will be considered if we receive them at the appropriate address, as provided below, no later than 5 p.m. eastern time on January 25, 1999.

ADDRESSES: Mail written comments (1 original and 3 copies) to the following addresses: Health Care Financing Administration, Department of Health and Human Services, Attention: HCFA-2036-NC, P. O. Box 26688,Baltimore, MD 21207-0488.

If you prefer, you may deliver your written comments (1 original and 3 copies) to one of the following addresses:

Room 443-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201-0001, or Room C5-16-03, Central Building,7500 Security Boulevard,Baltimore, MD 21244-1850.

Because of staffing and resource limitations, we cannot accept comments by facsimile (FAX) transmission. In commenting, please refer to file code HCFA-2036-NC. Written comments received timely will be available for public inspection as they are received, generally beginning approximately 3 weeks after publication of a document, in Room 443-G of the Department's offices at 200 Independence Avenue, SW., Washington, DC, on Monday through Friday of each week from 8:30 a.m. to 5 p.m. eastern time (phone: (202) 690-7890).

FOR FURTHER INFORMATION CONTACT: Helaine M. Jeffers, (410) 786-5648.

SUPPLEMENTARY INFORMATION:

1. Background

   Providers of health care services participate in the Medicare and Medicaid programs in accordance with provider agreements with us (for Medicare) and State Medicaid agencies (for Medicaid). Generally, in order to enter into a provider agreement, an entity must first be certified by a State survey agency as complying with the conditions, requirements or standards set forth in the Social Security Act (the Act) and regulations. Providers are subject to routine surveys by State survey agencies to determine whether the provider continues to meet these requirements.

   There is an alternative, however, to surveys by State agencies. Section 1865 of the Act includes a provision that permits providers of services to be exempt from routine surveys by State survey agencies to determine whether they comply with the definition of hospital services in section 1861(e) of the Act. Specifically, section 1865(b)(1) of the Act provides that if we find that accreditation of a provider entity by a national accreditating body demonstrates that all of the applicable Medicare conditions or requirements are met or exceeded, we would ``deem'' the provider entity as meeting the applicable Medicare requirements. If a national accrediting organization applies to us for recognition of its provider accrediting program, we examine its requirements to determine whether they meet or exceed the Medicare conditions as we would have applied them. If we were to approve the accrediting organization as having standards that meet or exceed our own, providers accredited under the approved program would be ``deemed'' to meet the Medicare conditions of participation or requirements for which the accreditation standards have been recognized.

   A deemed status provider is one that has voluntarily applied for and has been accredited by a national accreditation organization under its approved program that meets or exceeds the applicable Medicare conditions or requirements. Federal regulations at 42 CFR part 485, subpart B, set forth the conditions that comprehensive outpatient rehabilitation facilities (CORFs) must meet to be certified under section 1861(cc)(2) of the Act and be accepted for participation in the Medicare program in accordance with 42 CFR part 489.

2. Approval of Accreditation Organization's Program

   The purpose of this notice is to notify the public of the receipt of the Commission for Accreditation of Rehabilitation Facilities' (CARF) application for approval to participate in the Medicare program as a national accreditation organization with deemed status authority for CORF accreditation. This notice also solicits public comment on the ability of CARF's program requirements to meet or exceed the Medicare conditions of participation.

   Section 1865(b)(2) of the Act sets forth the requirements for us to make a finding among other factors with respect to a national accreditation body, as specified in section III. of this notice.

   Section 1865(b)(3)(A) of the Act requires that we publish, no later than 60 days after the date of the receipt of a completed application, a notice identifying the national accreditation body making the request, describing the nature of the request, and providing a period of at least 30 days for the public to comment on the request. In addition, we have 210 days from the receipt of the request to publish an approval or denial of the application.

3. Evaluation of the Application

   On August 10, 1998, CARF submitted the necessary application information about its request for our determination that its provider accreditation program meets or exceeds the Medicare conditions and certification requirements for CORFs.

   Under section 1865(b)(2) of the Act and our regulations at 42 CFR 488.8 (``Federal review of accreditation organizations''), our review and evaluation of a national accreditation organization will be conducted in accordance with, but not necessarily limited to, the following factors:

   ‹bullet› A determination of the equivalency of an accreditation organization's requirements for an entity to our requirements for the entity.

   ‹bullet› A review of the organization's survey process to determine the following:

   1. The composition of the survey team, surveyor qualifications, and the ability of the organization to provide continuing surveyor training.

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   2. The organization's comparability of its processes to that of State agencies, including survey frequency, and the ability to investigate and respond appropriately to complaints against accredited facilities.

   3. The organization's procedures for monitoring providers or suppliers found to be out of compliance with program requirements. These monitoring procedures are used only when it identifies noncompliance. If noncompliance at the condition level is identified through validation reviews, the appropriate State survey agency monitors corrections as specified at Sec. 488.7(b)(2).

   4. The organization's ability to report deficiencies to the surveyed facilities and respond to the facility's plan of correction in a timely manner.

      ‹bullet› The organization's ability to provide us with electronic data in ASCII comparable code and reports necessary for effective validation and assessment of its survey process.

      ‹bullet› The adequacy of staff and other resources, and its financial viability.

      ‹bullet› The organization's ability to provide adequate funding for performing required surveys.

      ‹bullet› The organization's policies with respect to whether surveys are announced or unannounced.

      ‹bullet› The organization'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).

4. Notice of Evaluation

   Upon completion of our evaluation, including the evaluation of public comments received as a result of this notice, we will publish a notice in the Federal Register announcing the result of our evaluation.

5. Response to Public Comments

   Because of the large number of comments we normally receive on Federal Register documents published for comment, 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 will respond to them in a forthcoming notice document.

   Authority: Section 1865 of the Social Security Act (42 U.S.C. 1395bb).

   (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 30, 1998. Nancy-Ann Min DeParle, Administrator, Health Care Financing Administration.

   [FR Doc. 98-34063Filed12-23-98; 8:45 am]

   BILLING CODE 4120-01-P