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

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.

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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:

I. 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.

II. 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.

III. 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:

A determination of the equivalency of an accreditation

organization's requirements for an entity to our requirements for the

entity.

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.

[[Page 71297]]

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.

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.

The adequacy of staff and other resources, and its

financial viability.

The organization's ability to provide adequate funding for

performing required surveys.

The organization's policies with respect to whether

surveys are announced or unannounced.

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).

IV. 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.

V. 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. 98-34063 Filed 12-23-98; 8:45 am]

BILLING CODE 4120-01-P