Notice2025-22219
Medicare and Medicaid Programs; Continued Approval of the American Association for Accreditation of Ambulatory Surgery Facilities' Rural Health Clinic Accreditation Program
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
December 8, 2025
Issuing agencies
Health and Human Services DepartmentCenters for Medicare & Medicaid Services
Abstract
This notice acknowledges the receipt of an application from the American Association for Accreditation of Ambulatory Surgery Facilities (DBA "QUAD A") for continued recognition as a national accrediting organization (AO) for rural health clinics that wish to participate in the Medicare or Medicaid programs. The statute requires that, within 60 days of receipt of an organization's complete application, the Secretary, through the Centers for Medicare & Medicaid Services (CMS), publishes a notice that identifies the AO making the request, describes the nature of the request, and provides at least a 30-day public comment period.
Full Text
<html>
<head>
<title>Federal Register, Volume 90 Issue 233 (Monday, December 8, 2025)</title>
</head>
<body><pre>
[Federal Register Volume 90, Number 233 (Monday, December 8, 2025)]
[Notices]
[Pages 56773-56775]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2025-22219]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-3477-PN]
Medicare and Medicaid Programs; Continued Approval of the
American Association for Accreditation of Ambulatory Surgery
Facilities' Rural Health Clinic Accreditation Program
AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of
Health and Human Services (HHS).
ACTION: Notice with request for comment.
-----------------------------------------------------------------------
SUMMARY: This notice acknowledges the receipt of an application from
the American Association for Accreditation of Ambulatory Surgery
Facilities (DBA ``QUAD A'') for continued recognition
[[Page 56774]]
as a national accrediting organization (AO) for rural health clinics
that wish to participate in the Medicare or Medicaid programs. The
statute requires that, within 60 days of receipt of an organization's
complete application, the Secretary, through the Centers for Medicare &
Medicaid Services (CMS), publishes a notice that identifies the AO
making the request, describes the nature of the request, and provides
at least a 30-day public comment period.
DATES: To be assured consideration, comments must be received at one of
the addresses provided below, by January 7, 2026.
ADDRESSES: In commenting, refer to file code CMS-3477-PN. Comments,
including mass comment submissions, must be submitted in one of the
following three ways (please choose only one of the ways listed):
1. Electronically. You may submit electronic comments on this
regulation to <a href="http://www.regulations.gov">http://www.regulations.gov</a>. 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-3477-PN, P.O. Box 8013, Baltimore, MD
21244-8013.
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-3477-PN, Mail Stop C4-26-05, 7500
Security Boulevard, Baltimore, MD 21244-1850.
For information on viewing public comments, see the beginning of
the SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT: Caecilia Andrews (410) 786-2190.
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
website as soon as possible after they have been received: <a href="http://www.regulations.gov">http://www.regulations.gov</a>. Follow the search instructions on that website to
view public comments. CMS will not post on <a href="http://Regulations.gov">Regulations.gov</a> public
comments that make threats to individuals or institutions or suggest
that the commenter will take actions to harm an individual. CMS
continues to encourage individuals not to submit duplicative comments.
We will post acceptable comments from multiple unique commenters even
if the content is identical or nearly identical to other comments.
I. Background
Under the Medicare program, eligible beneficiaries may receive
covered services in a rural health clinic (RHC) provided certain
requirements are met. Sections 1861(aa) and 1905(l)(1) of the Social
Security Act (the Act), establish distinct criteria for facilities
seeking designation as an RHC. Regulations concerning provider
agreements are at 42 CFR part 489 and those pertaining to activities
relating to the general provisions for survey and certification of
facilities are at 42 CFR part 488, subpart A. The regulations at 42 CFR
part 491, subpart A specify the conditions that an RHC must meet to
participate in the Medicare program, and 42 CFR 405, subpart X sets
forth the scope of covered services and the conditions for Medicare
payment for RHCs.
Generally, to enter into an agreement with Medicare, an RHC must
first be certified by a State survey agency as complying with the
conditions or requirements set forth in 42 CFR part 491. Thereafter,
the RHC is subject to regular surveys by a State survey agency to
determine whether it continues to meet these requirements.
However, there is an alternative to surveys by State agencies.
Section 1865(a)(1)(A) of the Act provides that, if a provider entity
demonstrates through accreditation by an approved national AO that all
applicable Medicare conditions are met or exceeded, we must deem that
provider entity as having met the requirements. Accreditation by an AO
is voluntary and is not required for Medicare participation.
Our regulations concerning the approval of accrediting
organizations are set forth at 42 CFR 488.5 (Application and re-
application procedures for national accrediting organizations).
The QUAD A is requesting continued CMS-approval for its RHC
program. QUAD A's current term of approval expires March 23, 2026.
II. Approval of Deeming Organization
Section 1865(a)(2) of the Act and our regulations at Sec. 488.5
require that our review and approval of a national accrediting
organization's application consider, among other factors, the applying
accrediting organization's requirements for accreditation; survey
procedures; resources for conducting required surveys; capacity to
furnish information for use in enforcement activities; monitoring
procedures for provider entities found not in compliance with the
conditions or requirements; and ability to provide us with the
necessary data for validation.
Section 1865(a)(3)(A) of the Act further requires that we publish,
within 60 days of receipt of an organization's complete application, a
notice identifying the national accrediting body making the request,
describing the nature of the request, and providing at least a 30-day
public comment period. Due to the Federal lapse in appropriated
funding, certain parts of CMS operations were temporarily halted on
September 30, 3025. Therefore, this notice was impacted and did not
publish on or before October 24, 2025 (60 days of the receipt of the
complete application). We have 210 days from the receipt of a complete
application to publish notice of approval or denial of the application.
The purpose of this proposed notice is to inform the public of QUAD
A's request for continued CMS-approval for its RHC accreditation
program. This notice also solicits public comments on whether QUAD A's
requirements meet or exceed the Medicare conditions for certification
(CfCs) for RHCs.
III. Evaluation of Deeming Authority Request
QUAD A submitted all the necessary materials to enable us to make a
determination concerning its request for continued approval of its RHC
accreditation program. This application was determined to be complete
on August 25, 2025. Under section 1865(a)(2) of the Act and our
regulations at Sec. 488.5, our review and evaluation of QUAD A may
include:
<bullet> The equivalency of QUAD A's standards for RHCs as compared
with CMS' RHC CfCs.
<bullet> QUAD A's survey process to determine the following:
++ QUAD A's capacity to adequately fund the required surveys.
++ The comparability of QUAD A's processes to those of State
agencies, including survey frequency, and the ability to investigate
and respond appropriately to complaints against accredited RHCs.
++ QUAD A's processes and procedures for monitoring RHCs found out
of compliance with QUAD A's program requirements. These monitoring
procedures are used only when QUAD A identifies noncompliance. If
noncompliance is
[[Page 56775]]
identified through validation reviews or complaint surveys, the State
survey agency monitors corrections as specified at 42 CFR 488.9(c).
++ QUAD A's capacity to report deficiencies to the surveyed RHCs
and respond to the RHC's plan of correction in a timely manner.
++ QUAD A's capacity to provide us with electronic data and reports
necessary for effective validation and assessment of the organization's
survey process.
++ The adequacy of QUAD A's staff and other resources, and its
financial viability.
++ QUAD A's policies with respect to whether surveys are announced
or unannounced, to ensure that surveys are unannounced.
++ QUAD A's policies and procedures to avoid conflicts of interest,
including the appearance of conflicts of interest, involving
individuals who conduct surveys or participate in accreditation
decisions.
++ QUAD A'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. 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.).
V. 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.
The Administrator of CMS, Mehmet Oz, having reviewed and approved
this document, authorizes Trenesha Fultz-Mimms, who is the Federal
Register Liaison, to electronically sign this document for purposes of
publication in the Federal Register.
Trenesha Fultz-Mimms,
Federal Register Liaison, Center for Medicare & Medicaid Services.
[FR Doc. 2025-22219 Filed 12-5-25; 8:45 am]
BILLING CODE 4120-01-P
</pre></body>
</html>Indexed from Federal Register on December 8, 2025.
This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.