Medicare and Medicaid Programs; Application of the Community Health Accreditation Program, Incorporated (CHAP) for Continued Approval of Deeming Authority for Home Health Agencies

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

[HCFA-2059-PN]

RIN 0938-AJ69

Medicare and Medicaid Programs; Application of the Community

Health Accreditation Program, Incorporated (CHAP) for Continued

Approval of Deeming Authority for Home Health Agencies

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

ACTION: Proposed notice.

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SUMMARY: This notice announces the receipt of an application from the

Community Health Accreditation Program, Incorporated (CHAP) for

recognition as a national accreditation program for home health

agencies (HHAs) 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

for approval, 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 in ADDRESSES section, no later than 5

p.m. on October 12, 1999.

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-2059-PN, P.O. Box 9010,

Baltimore, Maryland 21244-9010.

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

and three copies) to one of the following addresses:

Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW.,

Washington, D.C. 20201, or

Room C5-16-03, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.

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

SUPPLEMENTARY INFORMATION:

Comments

Because of staffing and resource limitations, we cannot accept

comments by facsimile (FAX) transmission. In commenting, please refer

to file code HCFA-2059-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 445-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.

(phone: (202) 690-7890).

I. Background

Under the Medicare program, eligible beneficiaries may receive

covered services from a home health agency (HHA) provided certain

requirements are met. Sections 1861(o) and 1891 of the Social Security

Act (the Act)and part 484 of the Medicare regulations specify the

conditions that an HHA must meet in order to participate in the

Medicare program.

Regulations concerning provider agreements are at 42 CFR part 489

and those pertaining to the activities relating

[[Page 49199]]

to the survey and certification of facilities are at 42 CFR part 488.

Generally, in order to enter into an agreement, an HHA must first

be certified by the State survey agency as complying with the

conditions or standards set forth in the statute and 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 the

requirements. There is an alternative, however, to surveys by State

agencies.

Section 1865(b)(1) of the Act permits ``accredited'' HHAs 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 HHA. Our

regulations concerning reapproval of accrediting organizations are set

forth at Secs. 488.4 and 488.8(d)(3). Section 488.8(d)(3) requires

reapplication at least every 6 years and permits the Secretary to

determine the required materials from those enumerated in Sec. 488.4,

and the deadline to reapply for continued approval of deeming

authority. The Community Health Accreditation Program, Incorporated

(CHAP) is a currently recognized accreditation organization for HHAs.

II. Approval of Deeming Organizations

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

findings concerning review of national accrediting organizations

consider, among other factors, the 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 that identifies the national accreditation body

making the request, describes the nature of the request, and provides

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 CHAP's

request for reapproval and continuation of its deeming authority on the

basis that the Secretary find that its separate accreditation programs

for HHAs meet or exceed the Medicare conditions. This notice also

solicits public comment on the ability of CHAP's requirements to meet

or exceed the Medicare conditions of participation for HHAs.

III. Evaluation of Deeming Request

On July 15, 1999, CHAP submitted all the necessary information

concerning its request to be reapproved as a deeming organizations for

HHAs 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:

The equivalency of CHAP's requirements for an HHA to our

comparable HHA conditions of participation.

CHAP's survey processes, to determine the following:

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

CHAP's ability to provide continuing surveyor training.

--The comparability of its implemented processes to those of State

agencies, including survey frequency, and its ability to investigate

and respond appropriately to complaints against accredited facilities.

--Its procedures for monitoring HHAs found by CHAP to be out of

compliance with program requirements. (These procedures are used only

when CHAP identifies noncompliance. If noncompliance is identified

through validation reviews, the survey agency monitors corrections as

specified at Sec. 488.7(b)(2).)

--Its 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 to provide us with electronic data in ASCII

comparable code and any reports necessary for effective validation and

assessment of its survey processes.

--The adequacy of CHAP's staff and other resources, and its financial

viability.

--CHAP's ability to provide adequate funding for performing required

surveys.

--CHAP's policies with respect to whether surveys are announced or

unannounced.

--CHAP'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: September 1, 1999.

Michael M. Hash,

Deputy Administrator, Health Care Financing Administration.

[FR Doc. 99-23625 Filed 9-9-99; 8:45 am]

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