Notice2026-04595
Medicare and Medicaid Programs: Application From the American Association for Accreditation of Ambulatory Surgery Facilities for Continued CMS-Approval of its Rural Health Clinic (RHC) Accreditation Program
Primary source
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Published
March 10, 2026
Issuing agencies
Health and Human Services DepartmentCenters for Medicare & Medicaid Services
Abstract
This notice announces our decision to approve the American Association for Accreditation of Ambulatory Surgery Facilities, DBA QUAD A, for continued recognition as a national accrediting organization for rural health clinics that wish to participate in the Medicare or Medicaid programs.
Full Text
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<title>Federal Register, Volume 91 Issue 46 (Tuesday, March 10, 2026)</title>
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[Federal Register Volume 91, Number 46 (Tuesday, March 10, 2026)]
[Notices]
[Pages 11550-11551]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2026-04595]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-3477-FN]
Medicare and Medicaid Programs: Application From the American
Association for Accreditation of Ambulatory Surgery Facilities for
Continued CMS-Approval of its Rural Health Clinic (RHC) Accreditation
Program
AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of
Health and Human Services (HHS).
ACTION: Notice.
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SUMMARY: This notice announces our decision to approve the American
Association for Accreditation of Ambulatory Surgery Facilities, DBA
QUAD A, for continued recognition as a national accrediting
organization for rural health clinics that wish to participate in the
Medicare or Medicaid programs.
DATES: The decision announced in this notice is applicable March 23,
2026 to March 23, 2032.
FOR FURTHER INFORMATION CONTACT: Caecilia Andrews 410-786-2190.
SUPPLEMENTARY INFORMATION:
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 accrediting
organization (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.
If an AO is recognized by the Secretary of Health and Human
Services as having standards for accreditation that meet or exceed
Medicare requirements, any provider entity accredited by the national
accrediting body's approved program would be deemed to meet the
Medicare conditions. A national AO applying for CMS approval of its
accreditation program under 42 CFR part 488, subpart A must provide CMS
with reasonable assurance that the AO requires the accredited provider
entities to meet requirements that are at least as stringent as the
Medicare conditions. Our regulations concerning the approval of AOs are
set forth at Sec. 488.5.
The American Association for Accreditation of Ambulatory Surgery
Facilities (DBA ``QUAD A'') has requested continued approval by CMS for
its RHC program. CMS has reviewed QUAD A's application as described
later in this notice and is hereby announcing QUAD A's term of approval
for a period of 6 years.
II. Application Approval Process
Section 1865(a)(2) of the Act and our regulations at Sec. 488.5
require that our findings concerning review and approval of a national
AO's requirements consider, among other factors, the applying AO'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. We have 210 days from the receipt of a complete
application to publish notice of approval or denial of the application.
III. Provisions of the Proposed Notice
On December 8, 2025, CMS published a proposed notice in the Federal
Register (90 FR 56773), announcing QUAD A's request for continued CMS-
approval of its Medicare RHC accreditation program. CMS approves or
denies an AO's application based on an assessment of the factors listed
in section II. of this final notice and also later in this section,
which may include, but is not limited to, a review of the information
required to be submitted by the AO, interviews with AO staff, an
evaluation of the AO's survey process and findings, or other activities
necessary to determine that the AO meets the requirements set forth at
Sec. Sec. 488.4 and 488.5. Under Section 1865(a)(2) of the Act and in
our regulations at Sec. 488.5 and Sec. 488.8(h), we reviewed QUAD A's
application in accordance with the criteria specified by our
regulations, which included an assessment of the AO's:
<bullet> (1) Corporate policies; (2) financial viability; (3)
ability to investigate and respond appropriately to allegations of
violations of the Medicare program requirements; and (4) survey review
and decision-making process for the purposes of deemed status.
<bullet> Survey process to confirm that it is comparable to State
agencies' survey process and the AO can adequately assess whether a
provider or supplier, under the AO's deeming program, meets
[[Page 11551]]
or exceeds the Medicare program requirements.
<bullet> Composition of the survey team.
<bullet> Procedures for monitoring deemed RHCs it has found to be
out of compliance with the AO's program requirements.
<bullet> Ability to report deficiencies to the surveyed RHC and
respond to the RHC's plan of correction in a timely manner.
<bullet> Verification of the AO's agreement to provide CMS 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. Analysis of and Responses to Public Comments on the Proposed Notice
In accordance with section 1865(a)(3)(A) of the Act, the December
8, 2025 proposed notice solicited public comments regarding whether
QUAD A's requirements met or exceeded the Medicare Conditions for
Certification (CfCs) for RHCs. We received one comment.
In general, the commenter was in support of continued recognition
of QUAD A as a national accrediting organization for RHCs, provided CMS
verifies that QUAD A has established their accreditation requirements,
fully trained its surveyors, and identified deficiencies in a manner
consistent with the actual structures and operations of RHCs that serve
rural communities. This includes those referred to by the commenter as
``Indigenous'' but are commonly known as ``American Indians and Alaska
Natives''.
We appreciate the commenter's input and have considered it when
making our decision. As outlined in the proposed notice, CMS conducts a
thorough review of any AO applying for initial or continued recognition
as a CMS-approved national AO. This includes review of standards to
ensure they meet or exceed the CMS conditions, training and education
of surveyors, as well as comparability of survey processes to those of
the State Survey Agencies.
V. Provisions of the Final Notice
A. Differences Between QUAD A's Standards and Requirements for
Accreditation and Medicare Conditions and Survey Requirements
We compared QUAD A's RHC accreditation requirements and survey
process with the Medicare conditions set forth at 42 CFR part 491,
subpart A, the survey and certification process requirements of parts
488 and 489, and survey process as outlined in the State Operations
Manual (SOM). Our review and evaluation of QUAD A's RHC application,
which was conducted as described in section III. of this final notice,
yielded the following area where, as of the date of this notice, QUAD A
has completed revising its standards and certification processes to--
<bullet> Revise surveyor guidance and training to provide
additional clarity on its procedures to raise standard-level
deficiencies to condition-level deficiencies, consistent with the
regulation at Sec. 488.26(b) and the State Operations Manual, Appendix
G, Task 4.
B. Term of Approval
Based on our review and observations described in section III. and
section V. of this final notice, we find that QUAD A provides
reasonable assurance that accredited entities would meet or exceed the
applicable Medicare conditions and we approve QUAD A as a national
accreditation organization for RHCs that request participation in the
Medicare program. The decision announced in this final notice is
effective March 23, 2026, to March 23, 2032 (6 years).
VI. 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.).
The Administrator of CMS, Mehmet Oz, having reviewed and approved
this document, authorizes Vanessa Garcia, who is the Federal Register
Liaison, to electronically sign this document for purposes of
publication in the Federal Register.
Vanessa Garcia,
Federal Register Liaison, Center for Medicare & Medicaid Services.
[FR Doc. 2026-04595 Filed 3-9-26; 8:45 am]
BILLING CODE 4120-01-P
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</html>Indexed from Federal Register on March 10, 2026.
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