Medicare and Medicaid Programs; Recognition of the Community Health Accreditation Program, Inc. (CHAP) and Joint Commission for Accreditation of Healthcare Organizations (JCAHO) for Hospices

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

[HCFA-2029-PN]

RIN 0938-AI69

Medicare and Medicaid Programs; Recognition of the Community

Health Accreditation Program, Inc. (CHAP) and Joint Commission for

Accreditation of Healthcare Organizations (JCAHO) for Hospices

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

ACTION: Proposed notice.

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SUMMARY: This notice announces the receipt of applications from CHAP

and JCAHO for recognition as national accreditation programs for

hospices that wish to participate in the Medicare or Medicaid programs.

The Social Security Act requires that the Secretary publish a notice

identifying the national accreditation body making the request,

describing the nature of the request, and providing a 30-day public

comment period.

DATES: Written comments will be considered if we receive them at the

appropriate address, as provided below, no later than 5 p.m. on or

before October 13, 1998.

ADDRESSES: Mail written comments (one original and three copies) to the

following address: Health Care Financing Administration, Department of

Health and Human Services,

Attention: HCFA-2029-PN, 7500 Security Boulevard, Baltimore,

Maryland 21244-1850.

If you prefer, you may deliver your written comments (one original

and three copies) to one of the following addresses:

Room 309-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW.,

Washington, DC 20201, or

Room C5-09-26, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.

Because of staffing and resource limitations, we cannot accept

audio, visual, or facsimile (FAX) copies of comments. In commenting,

please refer to file code HCFA-2029-PN. 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 309G 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. (Phone: (202) 690-7890).

FOR FURTHER INFORMATION CONTACT: Joan C. Berry, (410) 786-7233.

SUPPLEMENTARY INFORMATION:

I. Background

Under the Medicare program, eligible beneficiaries may receive

covered services in a hospice provided certain requirements are met.

The regulations specifying the Medicare conditions of participation for

hospice care are located in 42 CFR part 418. These conditions implement

section 1861(dd) of the Social Security Act (the Act), which specifies

services covered as hospice care and the conditions that a hospice

program must meet in order to participate in the Medicare program.

Other relevant sections of the Act are sections 1812(a)(4) and (d)

which specify eligibility requirements for the individual and the

benefit periods; section 1813(a)(4) which specifies coinsurance

amounts; sections 1814(a)(7) and 1814 (i)(1)(A) which contain

conditions and limitation on coverage of, and payment for, hospice

care; and sections 1862(a)(1), (6), (9) which establish limits on

hospice coverage.

Regulations concerning provider agreements are at 42 CFR part 489

and those pertaining to the activities relating to the survey and

certification of facilities are at 42 CFR part 488. Our 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 facility

services.

Generally, in order to enter into an agreement, a hospice must

first be certified by a State survey agency as complying with the

conditions or standards 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(b)(1) of the Act permits ``accredited'' hospices to be

exempt from routine surveys by State survey agencies to determine

compliance with Medicare conditions of participation. Section

1865(b)(1) of the Act provides that if the Secretary finds that

accreditation of a provider entity by a national accreditation body

demonstrates that all applicable conditions are met or exceeded, the

Secretary ``deems'' those requirements to be met by the hospice. Our

regulations concerning approval of accrediting organizations are set

forth at Secs. 488.6 and 488.8. To date, we have not recognized any

organization as an accreditation organization for hospices.

II. Approval of Deeming Organizations

Section 1865(b)(2) of the Act further requires that the Secretary's

findings concerning review and approval of national accrediting

organizations consider, among other factors, the applying accreditation

organization's requirements for accreditation, its survey procedures,

its ability to provide adequate resources for conducting required

surveys and ability to supply information for use in enforcement

activities, its monitoring procedures for provider entities found out

of compliance with the conditions or requirements, and its ability to

provide the Secretary with necessary data for validation.

Section 1865(b)(3)(A) of the Act requires that the Secretary

publish, within 60 days of the receipt of an organization's complete

application, a notice identifying the national accreditation body

making the request, describing the nature of the request, and providing

at least a 30-day public comment period. Subsequently, the Secretary

has 210 days from the receipt of the request to publish a finding of

approval or denial of the application.

The purpose of this notice is to notify the public of the request

of CHAP and of JCAHO for approval of their requests that the Secretary

find that their separate accreditation programs for hospice care meet

or exceed the Medicare conditions. This notice also solicits public

comment on the ability of each body's requirements to meet or exceed

the Medicare conditions of participation.

III. Evaluation of Deeming Request

On July 6, 1998, CHAP and JCAHO submitted all the necessary

information concerning their request to be approved as deeming

organizations for hospices to permit us to make a determination. Under

section 1865(b)(2) of the Act and our regulations at Sec. 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:

[[Page 48736]]

The equivalency of CHAP's and JCAHO's requirements for a

hospice to our comparable hospice requirements.

CHAP's and JCAHO's survey processes, to determine the

following:

--The composition of the survey team, surveyor qualifications, and

CHAP's and JCAHO's ability to provide continuing surveyor training.

--The comparability of their processes to those of State agencies,

including survey frequency, and their ability to investigate and

respond appropriately to complaints against accredited facilities.

--Their procedures for monitoring providers or suppliers found by CHAP

or JCAHO to be out of compliance with program requirements. (These

procedures are used only when CHAP or JCAHO identifies noncompliance.

If noncompliance is identified through validation reviews, the survey

agency monitors corrections as specified at Sec. 488.7(b)(3).)

--Their ability to report deficiencies to the surveyed facilities and

respond to the facility's plan of correction in a timely manner.

The ability of CHAP and JCAHO to provide us with

electronic data in ASCII comparable code and any reports necessary for

effective validation and assessment of their survey processes.

The adequacy of CHAP's and JCAHO's staff and other

resources, and their financial viability.

CHAP's and JCAHO's ability to provide adequate funding for

performing required surveys.

CHAP's and JCAHO's policies with respect to whether

surveys are announced or unannounced.

CHAP's and JCAHO'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).

IV. Notice Upon Completion of Evaluation

Upon completion of our evaluation, including evaluation of comments

received as a result of this notice, we will publish a notice in the

Federal Register announcing the result of our evaluation.

(Authority: Sec. 1865(b)(3)(A) of the Social Security Act (42 U.S.C.

1395bb(b)(3)(A)).

(Catalog of Federal Domestic Assistance Program No. 93.773,

Medicare--Hospital Insurance)

Dated: August 19, 1998.

Nancy-Ann Min DeParle,

Administrator, Health Care Financing Administration.

[FR Doc. 98-24555 Filed 9-10-98; 8:45 am]

BILLING CODE 4120-01-P