Medicare and Medicaid Programs; Conditions of Participation for Home Health Agencies; Delay of Effective Date, 16150-16152 [2017-06540]
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16150
Federal Register / Vol. 82, No. 62 / Monday, April 3, 2017 / Proposed Rules
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
42 CFR Parts 409, 410, 418, 440, 484,
485 and 488
[CMS–3819–P2]
RIN 0938–AG81
Medicare and Medicaid Programs;
Conditions of Participation for Home
Health Agencies; Delay of Effective
Date
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Proposed rule.
AGENCY:
This proposed rule would
delay the effective date for the final rule
entitled ‘‘Medicare and Medicaid
Programs: Conditions of Participation
for Home Health Agencies’’ published
in the Federal Register on January 13,
2017. The current effective date for the
final rule is July 13, 2017, and this rule
proposes to delay the effective date for
an additional 6 months until January 13,
2018. This proposed rule would also
make two conforming changes to dates
that are included in the regulations text.
DATES: To be assured consideration,
comments must be received at one of
the addresses provided below, no later
than 5 p.m. on June 2, 2017.
ADDRESSES: In commenting, please refer
to file code CMS–3819–P2. Because of
staff and resource limitations, we cannot
accept comments by facsimile (FAX)
transmission.
You may submit comments in one of
four ways (please choose only one of the
ways listed):
1. Electronically. You may submit
electronic comments on this regulation
to https://www.regulations.gov. Follow
the ‘‘Submit a comment’’ instructions.
2. By regular mail. You may mail
written comments to the following
address ONLY: Centers for Medicare &
Medicaid Services, Department of
Health and Human Services, Attention:
CMS–3819–P2, P.O. Box 8010,
Baltimore, MD 21244–1850.
Please allow sufficient time for mailed
comments to be received before the
close of the comment period.
3. By express or overnight mail. You
may send written comments to the
following address ONLY: Centers for
Medicare & Medicaid Services,
Department of Health and Human
Services, Attention: CMS–3819–P2,
Mail Stop C4–26–05, 7500 Security
Boulevard, Baltimore, MD 21244–1850.
4. By hand or courier. Alternatively,
you may deliver (by hand or courier)
mstockstill on DSK3G9T082PROD with PROPOSALS
SUMMARY:
VerDate Sep<11>2014
16:05 Mar 31, 2017
Jkt 241001
your written comments ONLY to the
following addresses prior to the close of
the comment period:
a. For delivery in Washington, DC—
Centers for Medicare & Medicaid
Services, Department of Health and
Human Services, Room 445–G, Hubert
H. Humphrey Building, 200
Independence Avenue SW.,
Washington, DC 20201.
(Because access to the interior of the
Hubert H. Humphrey Building is not
readily available to persons without
Federal government identification,
commenters are encouraged to leave
their comments in the CMS drop slots
located in the main lobby of the
building. A stamp-in clock is available
for persons wishing to retain a proof of
filing by stamping in and retaining an
extra copy of the comments being filed.)
b. For delivery in Baltimore, MD—
Centers for Medicare & Medicaid
Services, Department of Health and
Human Services, 7500 Security
Boulevard, Baltimore, MD 21244–1850.
If you intend to deliver your
comments to the Baltimore address, call
telephone number (410) 786–9994 in
advance to schedule your arrival with
one of our staff members.
Comments erroneously mailed to the
addresses indicated as appropriate for
hand or courier delivery may be delayed
and received after the comment period.
For information on viewing public
comments, see the beginning of the
SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT:
Danielle Shearer (410) 786–6617. Mary
Rossi-Coajou (410) 786–6051. Maria
Hammel (410) 786–1775.
SUPPLEMENTARY INFORMATION: Inspection
of Public Comments: All comments
received before the close of the
comment period are available for
viewing by the public, including any
personally identifiable or confidential
business information that is included in
a comment. We post all comments
received before the close of the
comment period on the following Web
site as soon as possible after they have
been received: https://www.regulations.
gov. Follow the search instructions on
that Web site to view public comments.
Comments received timely will also
be available for public inspection as
they are received, generally beginning
approximately 3 weeks after publication
of a document, at the headquarters of
the Centers for Medicare & Medicaid
Services, 7500 Security Boulevard,
Baltimore, Maryland 21244, Monday
through Friday of each week from 8:30
a.m. to 4 p.m. To schedule an
appointment to view public comments,
phone 1–800–743–3951.
PO 00000
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Fmt 4702
Sfmt 4702
I. Background
On October 9, 2014, we published the
proposed rule ‘‘Medicare and Medicaid
Programs: Conditions of Participation
for Home Health Agencies’’ (hereinafter
‘‘October 2014 HHA CoPs proposed
rule’’) in the Federal Register (79 FR
61164) and provided a 60 day comment
period. On December 1, 2014, in
response to public comments requesting
additional time to respond to the
proposed rule, we published a notice of
extension of the comment period (79 FR
71081), which extended the public
comment period for the October 2014
HHA CoPs proposed rule an additional
30 days, from December 8, 2014 to
January 7, 2015. The vast majority of
commenters on the October 2014 HHA
CoPs proposed rule made suggestions
related to the effective date of the final
rule (‘‘Medicare and Medicaid
Programs; Conditions of Participation
for Home Health Agencies’’, January 13,
2017, (82 FR 4504), hereinafter ‘‘January
2017 HHA CoPs final rule’’).
Commenters strongly expressed a need
for a significant period of time to
prepare for implementation of the new
rules, noting that HHAs would need to
adjust resource allocation, staffing, and
potentially even infrastructure.
Recommended effective date time
frames ranged from 6 months after
publication of the final rule to 5 years
after publication of the final rule. The
most frequent recommendation received
was to finalize an effective date that was
1 year after the publication of the final
rule. We agreed with commenters that it
was appropriate to allow additional
time for HHAs to prepare for the
changes being set forth in the HHA CoPs
final rule. Therefore, when we
published the January 2017 HHA CoPs
final rule in the Federal Register on
January 13, 2017, we finalized an
effective date of July 13, 2017 (that is,
6 months after the final rule was
published in the Federal Register).
The January 2017 HHA CoPs final
rule revised the CoPs that HHAs must
meet in order to participate in the
Medicare and Medicaid programs. The
requirements focus on the care
delivered to patients by HHAs, reflect
an interdisciplinary view of patient
care, allow HHAs greater flexibility in
meeting quality care standards, and
eliminate unnecessary procedural
requirements. These changes are an
integral part of our overall effort to
achieve broad-based, measurable
improvements in the quality of care
furnished through the Medicare and
Medicaid programs, while at the same
time eliminating unnecessary
procedural burdens on providers. We
E:\FR\FM\03APP1.SGM
03APP1
Federal Register / Vol. 82, No. 62 / Monday, April 3, 2017 / Proposed Rules
mstockstill on DSK3G9T082PROD with PROPOSALS
believe that the overall approach of the
CoPs provides HHAs with greatly
enhanced flexibility. At the same time,
we believe the new requirements help
HHAs achieve needed and desired
outcomes for patients, increasing patient
satisfaction with the services provided.
II. Provisions of the Proposed
Regulations
Following publication of the January
2017 HHA CoPs final rule, we received
inquiries that represented a large
number of HHAs requesting that the
agency delay the effective date for the
new HHA CoPs. The inquiries asserted
that HHAs were not able to effectively
implement the new CoPs until CMS
issued its revised Interpretive
Guidelines (State Operations Manual,
CMS Pub. 100–07, Appendix B). In
addition, one of the inquiries stated that
HHAs were unable to effectively
implement the new CoPs until CMS
issued further sub-regulatory guidance
related to converting subunits to
branches or independent HHAs, which
would impact 216 HHAs nationwide.
One of the inquiries cited the estimated
$300 million cost to implement the new
requirements as a reason for delaying
the effective date.
We believe that the concerns
expressed in the inquiries have merit, so
in response to the concerns summarized
above, we propose to delay the effective
date of the January 2017 HHA CoPs final
rule for an additional 6 months. The
effective date for the January 2017 HHA
CoPs final rule, which is currently set to
become effective on July 13, 2017,
would be delayed until January 13,
2018.
We also propose to make two
conforming changes to dates that appear
in the regulations text of the January
2017 HHA CoPs final rule. First, we
included a phase-in date for the
requirements at § 484.65(d)—‘‘Standard:
Performance improvement projects.’’
This phase-in date allowed HHAs an
additional 6 months after the January
2017 HHA CoPs final rule became
effective to collect data before
implementing data-driven performance
improvement projects. We continue to
believe that it is appropriate to phasein the performance improvement project
requirement 6 months after the
provisions of the January 2017 HHA
CoPs final rule become effective.
Therefore, we propose to revise the
phase-in date for the requirements at
§ 484.65(d) by replacing the January 13,
2018 date with a July 13, 2018 date.
Second, we propose to revise
§ 484.115(a)—‘‘Standard: Administrator,
home health agency.’’ In this provision,
we grandfathered in all administrators
VerDate Sep<11>2014
16:05 Mar 31, 2017
Jkt 241001
employed by HHAs prior to the effective
date of the January 2017 HHA CoPs final
rule, meaning that those administrators
employed by an HHA prior to July 13,
2017 would not have to meet the new
personnel requirements. We propose to
replace the July 13, 2017 effective date
at § 484.115(a)(1) and (2) with the
proposed effective date of January 13,
2018.
III. Collection of Information
Requirements
This document does not impose
information collection requirements,
that is, reporting, recordkeeping or
third-party disclosure requirements.
Consequently, there is no need for
review by the Office of Management and
Budget under the authority of the
Paperwork Reduction Act of 1995 (44
U.S.C. 3501 et seq.).
IV. Response to Comments
Because of the large number of public
comments we normally receive on
Federal Register documents, 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, when we proceed
with a subsequent document, we will
respond to the comments in the
preamble to that document.
V. Regulatory Impact Statement
We have examined the impact of this
rule as required by Executive Order
12866 on Regulatory Planning and
Review (September 30, 1993), Executive
Order 13563 on Improving Regulation
and Regulatory Review (January 18,
2011), the Regulatory Flexibility Act
(RFA) (September 19, 1980, Pub. L. 96–
354), section 1102(b) of the Social
Security Act, section 202 of the
Unfunded Mandates Reform Act of 1995
(March 22, 1995; Pub. L. 104–4),
Executive Order 13132 on Federalism
(August 4, 1999), the Congressional
Review Act (5 U.S.C. 804(2), and
Executive Order 13771 on Reducing
Regulation and Controlling Regulatory
Costs (January 30, 2017).
Executive Orders 12866 and 13563
direct agencies to assess all costs and
benefits of available regulatory
alternatives and, if regulation is
necessary, to select regulatory
approaches that maximize net benefits
(including potential economic,
environmental, public health and safety
effects, distributive impacts, and
equity). A regulatory impact analysis
(RIA) must be prepared for major rules
with economically significant effects
($100 million or more in any 1 year).
This rule does not reach the economic
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16151
threshold and thus is not considered a
major rule.
The RFA requires agencies to analyze
options for regulatory relief of small
entities. For purposes of the RFA, small
entities include small businesses,
nonprofit organizations, and small
governmental jurisdictions. Most
hospitals and most other providers and
suppliers are small entities, either by
nonprofit status or by having revenues
of less than $7.5 million to $38.5
million in any 1 year. Individuals and
States are not included in the definition
of a small entity. We are not preparing
an analysis for the RFA because we have
determined, and the Secretary certifies,
that this proposed rule would not have
a significant economic impact on a
substantial number of small entities.
In addition, section 1102(b) of the
Social Security Act requires us to
prepare a regulatory impact analysis if
a rule may have a significant impact on
the operations of a substantial number
of small rural hospitals. This analysis
must conform to the provisions of
section 603 of the RFA. For purposes of
section 1102(b) of the Act, we define a
small rural hospital as a hospital that is
located outside of a Metropolitan
Statistical Area for Medicare payment
regulations and has fewer than 100
beds. We are not preparing an analysis
for section 1102(b) of the Act because
we have determined, and the Secretary
certifies, that this proposed rule would
not have a significant impact on the
operations of a substantial number of
small rural hospitals.
Section 202 of the Unfunded
Mandates Reform Act of 1995 also
requires that agencies assess anticipated
costs and benefits before issuing any
rule whose mandates require spending
in any 1 year of $100 million in 1995
dollars, updated annually for inflation.
Currently, that threshold is
approximately $146 million. This rule
will have no consequential effect on
state, local, or tribal governments or on
the private sector.
Executive Order 13132 establishes
certain requirements that an agency
must meet when it promulgates a
proposed rule (and subsequent final
rule) that imposes substantial direct
requirement costs on state and local
governments, preempts state law, or
otherwise has Federalism implications.
Since this regulation does not impose
any costs on state or local governments,
the requirements of Executive Order
13132 are not applicable.
Executive Order 13771, entitled
‘‘Reducing Regulation and Controlling
Regulatory Costs,’’ was issued on
January 30, 2017 (82 FR 9339, February
3, 2017). Section 2(a) of Executive Order
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03APP1
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Federal Register / Vol. 82, No. 62 / Monday, April 3, 2017 / Proposed Rules
13771 requires an agency, unless
prohibited by law, to identify at least
two existing regulations to be repealed
when the agency publicly proposes for
notice and comment or otherwise
promulgates a new regulation. In
furtherance of this requirement, section
2(c) of Executive Order 13771 requires
that the new incremental costs
associated with new regulations shall, to
the extent permitted by law, be offset by
the elimination of existing costs
associated with at least two prior
regulations. OMB’s interim guidance,
issued on February 2, 2017, https://
www.whitehouse.gov/the-press-office/
2017/02/02/interim-guidanceimplementing-section-2-executive-orderjanuary-30-2017, explains that for Fiscal
Year 2017 the above requirements only
apply to each new ‘‘significant
regulatory action that imposes costs.’’ It
has been determined that this proposed
rule is not a ‘‘significant regulatory
action that imposes costs’’ and thus
does not trigger the above requirements
of Executive Order 13771.
In accordance with the provisions of
Executive Order 12866, this regulation
was reviewed by the Office of
Management and Budget.
42 CFR Part 410
Health facilities, Health professions,
Kidney diseases, Laboratories,
Medicare, Reporting and recordkeeping
requirements, Rural areas, X-rays.
42 CFR Part 418
Health facilities, Hospice care,
Medicare, Reporting and recordkeeping
requirements.
42 CFR Part 440
Grant programs—health, Medicaid.
Authority: Secs. 1102 and 1871 of the
Social Security Act (42 U.S.C. 1302 and
1395(hh)) unless otherwise indicated.
§ 484.65
[Amend]
2. In § 484.65, amend paragraph (d) by
removing the date ‘‘January 13, 2018’’
and adding in its place ‘‘July 13, 2018’’.
■
§ 484.115
[Amend]
3. In § 484.115, amend paragraphs
(a)(1) and (2) by removing the date ‘‘July
13, 2017’’ and adding in its place
‘‘January 13, 2018’’.
■
Dated: March 28, 2017.
Seema Verma,
Administrator, Centers for Medicare &
Medicaid Services.
Dated: March 28, 2017.
Thomas E. Price,
Secretary, Department of Health and Human
Services.
42 CFR Part 485
Grant programs—health, Health
facilities, Medicaid, Medicare,
Reporting and recordkeeping
requirements.
42 CFR Part 488
Administrative practice and
procedure, Health facilities, Medicare,
Reporting and recordkeeping
requirements.
For the reasons set forth in the
preamble, the Centers for Medicare &
Medicaid Services proposes to delay the
Jkt 241001
FEDERAL COMMUNICATIONS
COMMISSION
47 CFR Part 36
[CC Docket No. 80–286; FCC 17–22]
Jurisdictional Separations and Referral
to the Federal-State Joint Board
Federal Communications
Commission.
ACTION: Proposed rule.
AGENCY:
The Commission proposes a
further eighteen month extension of the
current freeze of category relationships
and allocation factors for price cap
carriers and all allocation factors for
rate-of-return carriers and seeks
comment on several issues regarding the
potential effects of the freeze extension.
DATES: Comments are due on or before
April 17, 2017. Reply comments are due
on or before April 24, 2017.
ADDRESSES: Federal Communications
Commission, 445 12th St. SW.,
Washington, DC 20554.
FOR FURTHER INFORMATION CONTACT:
Rhonda Lien, Wireline Competition
Bureau, Pricing Policy Division at (202)
418–1540 or at rhonda.lien@fcc.gov.
SUPPLEMENTARY INFORMATION: This a
summary of the Commission Further
SUMMARY:
42 CFR Part 484
Health facilities, Health professions,
Medicare, Reporting and recordkeeping
requirements.
mstockstill on DSK3G9T082PROD with PROPOSALS
1. The authority citation for part 484
continues to read as follows:
■
BILLING CODE 4120–01–P
42 CFR Part 409
Health facilities, Medicare.
16:05 Mar 31, 2017
PART 484—HOME HEALTH SERVICES
[FR Doc. 2017–06540 Filed 3–31–17; 8:45 am]
List of Subjects
VerDate Sep<11>2014
effective date for the final rule
published on January 13, 2017 (82 FR
4504) and to further amend 42 CFR
chapter IV as set forth below:
PO 00000
Frm 00015
Fmt 4702
Sfmt 4702
Notice of Proposed Rulemaking released
on March 20, 2017. The full text of this
document may be accessed at the
following internet address: https://
apps.fcc.gov/edocs_public/attachmatch/
FCC-17-22A1.docx.
Pursuant to sections 1.415 and 1.419
of the Commission’s rules, 47 CFR
1.415, 1.419, interested parties may file
comments and reply comments on or
before the dates indicated on the first
page of this document. Comments may
be filed using the Commission’s
Electronic Comment Filing System
(ECFS). See Electronic Filing of
Documents in Rulemaking Proceedings,
63 FR 24121 (1998). Section 1.415(b) of
the Commission’s rules does not
establish a minimum time period for the
Commission to receive comments on
proposed rules. Rather, the rule states
that a ‘‘reasonable time will be provided
for submission of comments.’’ In this
proceeding, because the current
separations freeze will otherwise expire
on June 30, 2017, and because we
expect our proposal to extend the freeze
will not generate controversy, we find
that it is reasonable to allow 14 days
after Federal Register publication for
the filing of comments and seven days
after that for the filing of any reply
comments.
D Electronic Filers: Comments may be
filed electronically using the Internet by
accessing the ECFS: https://
fjallfoss.fcc.gov/ecfs2/.
D Paper Filers: Parties who choose to
file by paper must file an original and
one copy of each filing. If more than one
docket or rulemaking number appears in
the caption of this proceeding, filers
must submit two additional copies for
each additional docket or rulemaking
number.
D Filings can be sent by hand or
messenger delivery, by commercial
overnight courier, or by first-class or
overnight U.S. Postal Service mail. All
filings must be addressed to the
Commission’s Secretary, Office of the
Secretary, Federal Communications
Commission.
D All hand-delivered or messengerdelivered paper filings for the
Commission’s Secretary must be
delivered to FCC Headquarters at 445
12th St. SW., Room TW–A325,
Washington, DC 20554. The filing hours
are 8:00 a.m. to 7:00 p.m. All hand
deliveries must be held together with
rubber bands or fasteners. Any
envelopes and boxes must be disposed
of before entering the building.
D Commercial overnight mail (other
than U.S. Postal Service Express Mail
and Priority Mail) must be sent to 9300
East Hampton Drive, Capitol Heights,
MD 20743.
E:\FR\FM\03APP1.SGM
03APP1
Agencies
[Federal Register Volume 82, Number 62 (Monday, April 3, 2017)]
[Proposed Rules]
[Pages 16150-16152]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-06540]
[[Page 16150]]
=======================================================================
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 409, 410, 418, 440, 484, 485 and 488
[CMS-3819-P2]
RIN 0938-AG81
Medicare and Medicaid Programs; Conditions of Participation for
Home Health Agencies; Delay of Effective Date
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Proposed rule.
-----------------------------------------------------------------------
SUMMARY: This proposed rule would delay the effective date for the
final rule entitled ``Medicare and Medicaid Programs: Conditions of
Participation for Home Health Agencies'' published in the Federal
Register on January 13, 2017. The current effective date for the final
rule is July 13, 2017, and this rule proposes to delay the effective
date for an additional 6 months until January 13, 2018. This proposed
rule would also make two conforming changes to dates that are included
in the regulations text.
DATES: To be assured consideration, comments must be received at one of
the addresses provided below, no later than 5 p.m. on June 2, 2017.
ADDRESSES: In commenting, please refer to file code CMS-3819-P2.
Because of staff and resource limitations, we cannot accept comments by
facsimile (FAX) transmission.
You may submit comments in one of four ways (please choose only one
of the ways listed):
1. Electronically. You may submit electronic comments on this
regulation to https://www.regulations.gov. Follow the ``Submit a
comment'' instructions.
2. By regular mail. You may mail written comments to the following
address ONLY: Centers for Medicare & Medicaid Services, Department of
Health and Human Services, Attention: CMS-3819-P2, P.O. Box 8010,
Baltimore, MD 21244-1850.
Please allow sufficient time for mailed comments to be received
before the close of the comment period.
3. By express or overnight mail. You may send written comments to
the following address ONLY: Centers for Medicare & Medicaid Services,
Department of Health and Human Services, Attention: CMS-3819-P2, Mail
Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
4. By hand or courier. Alternatively, you may deliver (by hand or
courier) your written comments ONLY to the following addresses prior to
the close of the comment period:
a. For delivery in Washington, DC--Centers for Medicare & Medicaid
Services, Department of Health and Human Services, Room 445-G, Hubert
H. Humphrey Building, 200 Independence Avenue SW., Washington, DC
20201.
(Because access to the interior of the Hubert H. Humphrey Building
is not readily available to persons without Federal government
identification, commenters are encouraged to leave their comments in
the CMS drop slots located in the main lobby of the building. A stamp-
in clock is available for persons wishing to retain a proof of filing
by stamping in and retaining an extra copy of the comments being
filed.)
b. For delivery in Baltimore, MD-- Centers for Medicare & Medicaid
Services, Department of Health and Human Services, 7500 Security
Boulevard, Baltimore, MD 21244-1850.
If you intend to deliver your comments to the Baltimore address,
call telephone number (410) 786-9994 in advance to schedule your
arrival with one of our staff members.
Comments erroneously mailed to the addresses indicated as
appropriate for hand or courier delivery may be delayed and received
after the comment period.
For information on viewing public comments, see the beginning of
the SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT: Danielle Shearer (410) 786-6617. Mary
Rossi-Coajou (410) 786-6051. Maria Hammel (410) 786-1775.
SUPPLEMENTARY INFORMATION: Inspection of Public Comments: All comments
received before the close of the comment period are available for
viewing by the public, including any personally identifiable or
confidential business information that is included in a comment. We
post all comments received before the close of the comment period on
the following Web site as soon as possible after they have been
received: https://www.regulations.gov. Follow the search instructions on
that Web site to view public comments.
Comments received timely will also be available for public
inspection as they are received, generally beginning approximately 3
weeks after publication of a document, at the headquarters of the
Centers for Medicare & Medicaid Services, 7500 Security Boulevard,
Baltimore, Maryland 21244, Monday through Friday of each week from 8:30
a.m. to 4 p.m. To schedule an appointment to view public comments,
phone 1-800-743-3951.
I. Background
On October 9, 2014, we published the proposed rule ``Medicare and
Medicaid Programs: Conditions of Participation for Home Health
Agencies'' (hereinafter ``October 2014 HHA CoPs proposed rule'') in the
Federal Register (79 FR 61164) and provided a 60 day comment period. On
December 1, 2014, in response to public comments requesting additional
time to respond to the proposed rule, we published a notice of
extension of the comment period (79 FR 71081), which extended the
public comment period for the October 2014 HHA CoPs proposed rule an
additional 30 days, from December 8, 2014 to January 7, 2015. The vast
majority of commenters on the October 2014 HHA CoPs proposed rule made
suggestions related to the effective date of the final rule (``Medicare
and Medicaid Programs; Conditions of Participation for Home Health
Agencies'', January 13, 2017, (82 FR 4504), hereinafter ``January 2017
HHA CoPs final rule''). Commenters strongly expressed a need for a
significant period of time to prepare for implementation of the new
rules, noting that HHAs would need to adjust resource allocation,
staffing, and potentially even infrastructure. Recommended effective
date time frames ranged from 6 months after publication of the final
rule to 5 years after publication of the final rule. The most frequent
recommendation received was to finalize an effective date that was 1
year after the publication of the final rule. We agreed with commenters
that it was appropriate to allow additional time for HHAs to prepare
for the changes being set forth in the HHA CoPs final rule. Therefore,
when we published the January 2017 HHA CoPs final rule in the Federal
Register on January 13, 2017, we finalized an effective date of July
13, 2017 (that is, 6 months after the final rule was published in the
Federal Register).
The January 2017 HHA CoPs final rule revised the CoPs that HHAs
must meet in order to participate in the Medicare and Medicaid
programs. The requirements focus on the care delivered to patients by
HHAs, reflect an interdisciplinary view of patient care, allow HHAs
greater flexibility in meeting quality care standards, and eliminate
unnecessary procedural requirements. These changes are an integral part
of our overall effort to achieve broad-based, measurable improvements
in the quality of care furnished through the Medicare and Medicaid
programs, while at the same time eliminating unnecessary procedural
burdens on providers. We
[[Page 16151]]
believe that the overall approach of the CoPs provides HHAs with
greatly enhanced flexibility. At the same time, we believe the new
requirements help HHAs achieve needed and desired outcomes for
patients, increasing patient satisfaction with the services provided.
II. Provisions of the Proposed Regulations
Following publication of the January 2017 HHA CoPs final rule, we
received inquiries that represented a large number of HHAs requesting
that the agency delay the effective date for the new HHA CoPs. The
inquiries asserted that HHAs were not able to effectively implement the
new CoPs until CMS issued its revised Interpretive Guidelines (State
Operations Manual, CMS Pub. 100-07, Appendix B). In addition, one of
the inquiries stated that HHAs were unable to effectively implement the
new CoPs until CMS issued further sub-regulatory guidance related to
converting subunits to branches or independent HHAs, which would impact
216 HHAs nationwide. One of the inquiries cited the estimated $300
million cost to implement the new requirements as a reason for delaying
the effective date.
We believe that the concerns expressed in the inquiries have merit,
so in response to the concerns summarized above, we propose to delay
the effective date of the January 2017 HHA CoPs final rule for an
additional 6 months. The effective date for the January 2017 HHA CoPs
final rule, which is currently set to become effective on July 13,
2017, would be delayed until January 13, 2018.
We also propose to make two conforming changes to dates that appear
in the regulations text of the January 2017 HHA CoPs final rule. First,
we included a phase-in date for the requirements at Sec. 484.65(d)--
``Standard: Performance improvement projects.'' This phase-in date
allowed HHAs an additional 6 months after the January 2017 HHA CoPs
final rule became effective to collect data before implementing data-
driven performance improvement projects. We continue to believe that it
is appropriate to phase-in the performance improvement project
requirement 6 months after the provisions of the January 2017 HHA CoPs
final rule become effective. Therefore, we propose to revise the phase-
in date for the requirements at Sec. 484.65(d) by replacing the
January 13, 2018 date with a July 13, 2018 date.
Second, we propose to revise Sec. 484.115(a)--``Standard:
Administrator, home health agency.'' In this provision, we
grandfathered in all administrators employed by HHAs prior to the
effective date of the January 2017 HHA CoPs final rule, meaning that
those administrators employed by an HHA prior to July 13, 2017 would
not have to meet the new personnel requirements. We propose to replace
the July 13, 2017 effective date at Sec. 484.115(a)(1) and (2) with
the proposed effective date of January 13, 2018.
III. Collection of Information Requirements
This document does not impose information collection requirements,
that is, reporting, recordkeeping or third-party disclosure
requirements. Consequently, there is no need for review by the Office
of Management and Budget under the authority of the Paperwork Reduction
Act of 1995 (44 U.S.C. 3501 et seq.).
IV. Response to Comments
Because of the large number of public comments we normally receive
on Federal Register documents, 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, when we proceed with a subsequent document, we will respond to the
comments in the preamble to that document.
V. Regulatory Impact Statement
We have examined the impact of this rule as required by Executive
Order 12866 on Regulatory Planning and Review (September 30, 1993),
Executive Order 13563 on Improving Regulation and Regulatory Review
(January 18, 2011), the Regulatory Flexibility Act (RFA) (September 19,
1980, Pub. L. 96-354), section 1102(b) of the Social Security Act,
section 202 of the Unfunded Mandates Reform Act of 1995 (March 22,
1995; Pub. L. 104-4), Executive Order 13132 on Federalism (August 4,
1999), the Congressional Review Act (5 U.S.C. 804(2), and Executive
Order 13771 on Reducing Regulation and Controlling Regulatory Costs
(January 30, 2017).
Executive Orders 12866 and 13563 direct agencies to assess all
costs and benefits of available regulatory alternatives and, if
regulation is necessary, to select regulatory approaches that maximize
net benefits (including potential economic, environmental, public
health and safety effects, distributive impacts, and equity). A
regulatory impact analysis (RIA) must be prepared for major rules with
economically significant effects ($100 million or more in any 1 year).
This rule does not reach the economic threshold and thus is not
considered a major rule.
The RFA requires agencies to analyze options for regulatory relief
of small entities. For purposes of the RFA, small entities include
small businesses, nonprofit organizations, and small governmental
jurisdictions. Most hospitals and most other providers and suppliers
are small entities, either by nonprofit status or by having revenues of
less than $7.5 million to $38.5 million in any 1 year. Individuals and
States are not included in the definition of a small entity. We are not
preparing an analysis for the RFA because we have determined, and the
Secretary certifies, that this proposed rule would not have a
significant economic impact on a substantial number of small entities.
In addition, section 1102(b) of the Social Security Act requires us
to prepare a regulatory impact analysis if a rule may have a
significant impact on the operations of a substantial number of small
rural hospitals. This analysis must conform to the provisions of
section 603 of the RFA. For purposes of section 1102(b) of the Act, we
define a small rural hospital as a hospital that is located outside of
a Metropolitan Statistical Area for Medicare payment regulations and
has fewer than 100 beds. We are not preparing an analysis for section
1102(b) of the Act because we have determined, and the Secretary
certifies, that this proposed rule would not have a significant impact
on the operations of a substantial number of small rural hospitals.
Section 202 of the Unfunded Mandates Reform Act of 1995 also
requires that agencies assess anticipated costs and benefits before
issuing any rule whose mandates require spending in any 1 year of $100
million in 1995 dollars, updated annually for inflation. Currently,
that threshold is approximately $146 million. This rule will have no
consequential effect on state, local, or tribal governments or on the
private sector.
Executive Order 13132 establishes certain requirements that an
agency must meet when it promulgates a proposed rule (and subsequent
final rule) that imposes substantial direct requirement costs on state
and local governments, preempts state law, or otherwise has Federalism
implications. Since this regulation does not impose any costs on state
or local governments, the requirements of Executive Order 13132 are not
applicable.
Executive Order 13771, entitled ``Reducing Regulation and
Controlling Regulatory Costs,'' was issued on January 30, 2017 (82 FR
9339, February 3, 2017). Section 2(a) of Executive Order
[[Page 16152]]
13771 requires an agency, unless prohibited by law, to identify at
least two existing regulations to be repealed when the agency publicly
proposes for notice and comment or otherwise promulgates a new
regulation. In furtherance of this requirement, section 2(c) of
Executive Order 13771 requires that the new incremental costs
associated with new regulations shall, to the extent permitted by law,
be offset by the elimination of existing costs associated with at least
two prior regulations. OMB's interim guidance, issued on February 2,
2017, https://www.whitehouse.gov/the-press-office/2017/02/02/interim-guidance-implementing-section-2-executive-order-january-30-2017,
explains that for Fiscal Year 2017 the above requirements only apply to
each new ``significant regulatory action that imposes costs.'' It has
been determined that this proposed rule is not a ``significant
regulatory action that imposes costs'' and thus does not trigger the
above requirements of Executive Order 13771.
In accordance with the provisions of Executive Order 12866, this
regulation was reviewed by the Office of Management and Budget.
List of Subjects
42 CFR Part 409
Health facilities, Medicare.
42 CFR Part 410
Health facilities, Health professions, Kidney diseases,
Laboratories, Medicare, Reporting and recordkeeping requirements, Rural
areas, X-rays.
42 CFR Part 418
Health facilities, Hospice care, Medicare, Reporting and
recordkeeping requirements.
42 CFR Part 440
Grant programs--health, Medicaid.
42 CFR Part 484
Health facilities, Health professions, Medicare, Reporting and
recordkeeping requirements.
42 CFR Part 485
Grant programs--health, Health facilities, Medicaid, Medicare,
Reporting and recordkeeping requirements.
42 CFR Part 488
Administrative practice and procedure, Health facilities, Medicare,
Reporting and recordkeeping requirements.
For the reasons set forth in the preamble, the Centers for Medicare
& Medicaid Services proposes to delay the effective date for the final
rule published on January 13, 2017 (82 FR 4504) and to further amend 42
CFR chapter IV as set forth below:
PART 484--HOME HEALTH SERVICES
0
1. The authority citation for part 484 continues to read as follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395(hh)) unless otherwise indicated.
Sec. 484.65 [Amend]
0
2. In Sec. 484.65, amend paragraph (d) by removing the date ``January
13, 2018'' and adding in its place ``July 13, 2018''.
Sec. 484.115 [Amend]
0
3. In Sec. 484.115, amend paragraphs (a)(1) and (2) by removing the
date ``July 13, 2017'' and adding in its place ``January 13, 2018''.
Dated: March 28, 2017.
Seema Verma,
Administrator, Centers for Medicare & Medicaid Services.
Dated: March 28, 2017.
Thomas E. Price,
Secretary, Department of Health and Human Services.
[FR Doc. 2017-06540 Filed 3-31-17; 8:45 am]
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