83_FR_12856 83 FR 12799 - Medicare Program; Announcement of the Approval of the American Association for Laboratory Accreditation (A2LA) as an Accreditation Organization Under the Clinical Laboratory Improvement Amendments of 1988

83 FR 12799 - Medicare Program; Announcement of the Approval of the American Association for Laboratory Accreditation (A2LA) as an Accreditation Organization Under the Clinical Laboratory Improvement Amendments of 1988

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services

Federal Register Volume 83, Issue 57 (March 23, 2018)

Page Range12799-12800
FR Document2018-05892

This notice announces the approval of the application of the American Association for Laboratory Accreditation (A2LA) as an accreditation organization for clinical laboratories under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) program for all specialty and subspecialty areas under CLIA. We have determined that the A2LA meets or exceeds the applicable CLIA requirements. We are announcing the approval and granting the A2LA deeming authority for a period of 4 years.

Federal Register, Volume 83 Issue 57 (Friday, March 23, 2018) 
[Federal Register Volume 83, Number 57 (Friday, March 23, 2018)]
[Notices]
[Pages 12799-12800]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2018-05892]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-3352-N]


Medicare Program; Announcement of the Approval of the American 
Association for Laboratory Accreditation (A2LA) as an Accreditation 
Organization Under the Clinical Laboratory Improvement Amendments of 
1988

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice.

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SUMMARY: This notice announces the approval of the application of the 
American Association for Laboratory Accreditation (A2LA) as an 
accreditation organization for clinical laboratories under the Clinical 
Laboratory Improvement Amendments of 1988 (CLIA) program for all 
specialty and subspecialty areas under CLIA. We have determined that 
the A2LA meets or exceeds the applicable CLIA requirements. We are 
announcing the approval and granting the A2LA deeming authority for a 
period of 4 years.

DATES: Applicable Date: This notice is applicable from March 23, 2018 
to March 23, 2022.

FOR FURTHER INFORMATION CONTACT: Cindy Flacks, (410) 786-6520.

SUPPLEMENTARY INFORMATION: 

I. Background and Legislative Authority

    On October 31, 1988, the Congress enacted the Clinical Laboratory 
Improvement Amendments of 1988 (CLIA) (Pub. L. 100-578). CLIA amended 
section 353 of the Public Health Service Act. We issued a final rule 
implementing the accreditation provisions of CLIA on July 31, 1992 (57 
FR 33992). Under those provisions, we may grant deeming authority to an 
accreditation organization if its requirements for laboratories 
accredited under its program are equal to or more stringent than the 
applicable CLIA program requirements in 42 CFR part 493 (Laboratory 
Requirements). Subpart E of part 493 (Accreditation by a Private, 
Nonprofit Accreditation Organization or Exemption Under an Approved 
State Laboratory Program) specifies the requirements an accreditation 
organization must meet to be approved by CMS as an accreditation 
organization under CLIA.

II. Notice of Approval of the A2LA as an Accreditation Organization

    In this notice, we approve the American Association for Laboratory 
Accreditation (A2LA) as an organization that may accredit laboratories 
for purposes of establishing their compliance with CLIA requirements 
for all specialty and subspecialty areas under CLIA. We have examined 
the initial A2LA application and all subsequent submissions to 
determine the equivalency of its accreditation program with the 
requirements for approval of an accreditation organization under 
subpart E of part 493. We have determined that the A2LA meets or 
exceeds the applicable CLIA requirements. We have also determined that 
the A2LA will ensure that its accredited laboratories will meet or 
exceed the applicable requirements in subparts H, I, J, K, M, Q, and 
the applicable sections of R.
    Therefore, we grant the A2LA approval as an accreditation 
organization under 42 CFR part 493, subpart E for the period stated in 
the DATES section of this notice for all specialty and subspecialty 
areas under CLIA. As a result of this determination, any laboratory 
that is accredited by the A2LA during the time period stated in the 
DATES section of this notice will be deemed to meet the CLIA 
requirements for the listed subspecialties and specialties, and 
therefore, will generally not be subject to routine inspections by a 
State survey agency to determine its compliance with CLIA requirements. 
The accredited laboratory, however, is subject to validation and 
complaint investigation surveys performed by CMS, or its agent(s).

III. Evaluation of the A2LA Request for Approval as an Accreditation 
Organization Under CLIA

    The following describes the process used to determine that the A2LA 
accreditation program meets the necessary requirements to be approved 
by CMS and that, as such, CMS may approve the A2LA as an accreditation 
program with deeming authority under the CLIA program. The A2LA 
formally applied to CMS for approval as an accreditation organization 
under CLIA for all specialties and subspecialties under CLIA. In 
reviewing these materials, we reached the following determinations for 
each applicable part of the CLIA regulations:

A. Subpart E--Accreditation by a Private, Nonprofit Accreditation 
Organization or Exemption Under an Approved State Laboratory Program

    The A2LA submitted its mechanism for monitoring compliance with all 
requirements equivalent to condition-level requirements, a list of all 
its current laboratories and the expiration date of their 
accreditation, and a detailed comparison of the individual 
accreditation requirements with the comparable condition-level 
requirements. The A2LA policies and procedures for oversight of 
laboratories performing laboratory testing for all CLIA specialties and 
subspecialties are equivalent to those of CLIA in the matters of 
inspection, monitoring proficiency testing (PT) performance, 
investigating complaints, and making PT information available. The A2LA 
submitted requirements for monitoring and inspecting laboratories in 
the areas of accreditation organization, data management, the 
inspection process, procedures for removal or withdrawal of 
accreditation, notification requirements, and accreditation 
organization resources. The requirements of the accreditation program 
submitted for approval are equal to or more stringent than the 
requirements of the CLIA regulations.

B. Subpart H--Participation in Proficiency Testing for Laboratories 
Performing Nonwaived Testing

    The A2LA's requirements are equal to or more stringent than the 
CLIA requirements at Sec. Sec.  493.801 through 493.865. For instance, 
the A2LA requires that laboratories conduct proficiency testing 
activities for both primary and secondary test systems for waived and 
non-waived testing. The CLIA requirement at Sec.  493.801(b)(6) 
requires proficiency testing activities for the primary test system and 
for non-waived testing only.

C. Subpart J--Facility Administration for Nonwaived Testing

    The A2LA requirements for the submitted subspecialties and 
specialties are equal to the CLIA requirements at Sec. Sec.  493.1100 
through 493.1105.

[[Page 12800]]

D. Subpart K--Quality System for Nonwaived Testing

    The A2LA requirements are equal to the CLIA requirements at 
Sec. Sec.  493.1200 through 493.1299.

E. Subpart M--Personnel for Nonwaived Testing

    We have determined that the A2LA's requirements are equal to the 
CLIA requirements at Sec. Sec.  493.1403 through 493.1495 for 
laboratories that perform moderate and high complexity testing.

F. Subpart Q--Inspections

    We have determined that the A2LA requirements for the submitted 
subspecialties and specialties are equal to or more stringent than the 
CLIA requirements at Sec. Sec.  493.1771 through 493.1780. The A2LA 
requires annual review of all accredited laboratories. The laboratory 
is required to submit any updates on information about its 
organization, facilities, key personnel and results of any proficiency 
testing. Laboratories may be required to undergo an onsite surveillance 
visit if they do not submit their annual review documentation to the 
A2LA by the established 30 day deadline, if significant changes to the 
facility or organization have occurred, or if proficiency testing 
results have been consistently poor. The CLIA regulations do not have 
this requirement.

G. Subpart R--Enforcement Procedures

    The A2LA meets the requirements of subpart R to the extent that it 
applies to accreditation organizations. The A2LA policy sets forth the 
actions the organization takes when laboratories it accredits do not 
comply with its requirements and standards for accreditation. When 
appropriate, the A2LA will deny, suspend, or revoke accreditation in a 
laboratory accredited by the A2LA and report that action to us within 
30 days. The A2LA also provides an appeals process for laboratories 
that have had accreditation denied, suspended, or revoked.
    We have determined that the A2LA's laboratory enforcement and 
appeal policies are equal to the requirements of part 493, subpart R as 
they apply to accreditation organizations.

IV. Federal Validation Inspections and Continuing Oversight

    The Federal validation inspections of laboratories accredited by 
the A2LA may be conducted on a representative sample basis or in 
response to substantial allegations of noncompliance (that is, 
complaint inspections). The outcome of those validation inspections, 
performed by CMS or our agents, or the State survey agencies, will be 
our principal means for verifying that the laboratories accredited by 
the A2LA remain in compliance with CLIA requirements. This Federal 
monitoring is an ongoing process.

V. Removal of Approval as an Accrediting Organization

    Our regulations provide that we may rescind the approval of an 
accreditation organization, such as that of the A2LA, for cause, before 
the end of the effective date of approval. If we determine that the 
A2LA has failed to adopt, maintain and enforce requirements that are 
equal to, or more stringent than, the CLIA requirements, or that 
systemic problems exist in its monitoring, inspection or enforcement 
processes, we may impose a probationary period, not to exceed 1 year, 
in which the A2LA would be allowed to address any identified issues. 
Should the A2LA be unable to address the identified issues within that 
timeframe, we may, in accordance with the applicable regulations, 
revoke A2LA's deeming authority under CLIA.
    Should circumstances result in our withdrawal of the A2LA's 
approval, we will publish a notice in the Federal Register explaining 
the basis for removing its approval.

VI. Collection of Information Requirements

    This notice does not impose any information collection and record 
keeping requirements subject to the Paperwork Reduction Act (PRA). 
Consequently, it does not need to be reviewed by the Office of 
Management and Budget (OMB) under the authority of the PRA. The 
requirements associated with the accreditation process for clinical 
laboratories under the CLIA program, codified in 42 CFR part 493 
subpart E, are currently approved by OMB under OMB approval number 
0938-0686.

VII. Executive Order 12866 Statement

    In accordance with the provisions of Executive Order 12866, this 
notice was not reviewed by the Office of Management and Budget.

    Dated: March 8, 2018.
Seema Verma,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2018-05892 Filed 3-22-18; 8:45 am]
 BILLING CODE 4120-01-P

Federal Register / Vol. 83, No. 57 / Friday, March 23, 2018 / Notices 12799 Dated: February 20, 2018. stringent than the applicable CLIA accreditation organization under CLIA Seema Verma, program requirements in 42 CFR part for all specialties and subspecialties Administrator, Centers for Medicare & 493 (Laboratory Requirements). Subpart under CLIA. In reviewing these Medicaid Services. E of part 493 (Accreditation by a Private, materials, we reached the following Dated: March 16, 2018. Nonprofit Accreditation Organization or determinations for each applicable part Exemption Under an Approved State of the CLIA regulations: Alex M. Azar II, Laboratory Program) specifies the Secretary, Department of Health and Human A. Subpart E—Accreditation by a requirements an accreditation Services. organization must meet to be approved Private, Nonprofit Accreditation [FR Doc. 2018–05947 Filed 3–22–18; 8:45 am] by CMS as an accreditation organization Organization or Exemption Under an BILLING CODE 4120–01–P under CLIA. Approved State Laboratory Program II. Notice of Approval of the A2LA as The A2LA submitted its mechanism DEPARTMENT OF HEALTH AND an Accreditation Organization for monitoring compliance with all HUMAN SERVICES In this notice, we approve the requirements equivalent to condition- American Association for Laboratory level requirements, a list of all its Centers for Medicare & Medicaid Accreditation (A2LA) as an organization current laboratories and the expiration Services that may accredit laboratories for date of their accreditation, and a [CMS–3352–N] purposes of establishing their detailed comparison of the individual compliance with CLIA requirements for accreditation requirements with the Medicare Program; Announcement of all specialty and subspecialty areas comparable condition-level the Approval of the American under CLIA. We have examined the requirements. The A2LA policies and Association for Laboratory initial A2LA application and all procedures for oversight of laboratories Accreditation (A2LA) as an subsequent submissions to determine Accreditation Organization Under the performing laboratory testing for all the equivalency of its accreditation Clinical Laboratory Improvement CLIA specialties and subspecialties are program with the requirements for Amendments of 1988 approval of an accreditation equivalent to those of CLIA in the organization under subpart E of part matters of inspection, monitoring AGENCY: Centers for Medicare & proficiency testing (PT) performance, Medicaid Services (CMS), HHS. 493. We have determined that the A2LA meets or exceeds the applicable CLIA investigating complaints, and making ACTION: Notice. PT information available. The A2LA requirements. We have also determined SUMMARY: This notice announces the that the A2LA will ensure that its submitted requirements for monitoring approval of the application of the accredited laboratories will meet or and inspecting laboratories in the areas American Association for Laboratory exceed the applicable requirements in of accreditation organization, data Accreditation (A2LA) as an subparts H, I, J, K, M, Q, and the management, the inspection process, accreditation organization for clinical applicable sections of R. procedures for removal or withdrawal of laboratories under the Clinical Therefore, we grant the A2LA accreditation, notification requirements, Laboratory Improvement Amendments approval as an accreditation and accreditation organization of 1988 (CLIA) program for all specialty organization under 42 CFR part 493, resources. The requirements of the and subspecialty areas under CLIA. We subpart E for the period stated in the accreditation program submitted for DATES section of this notice for all approval are equal to or more stringent have determined that the A2LA meets or exceeds the applicable CLIA specialty and subspecialty areas under than the requirements of the CLIA requirements. We are announcing the CLIA. As a result of this determination, regulations. approval and granting the A2LA any laboratory that is accredited by the deeming authority for a period of 4 A2LA during the time period stated in B. Subpart H—Participation in years. the DATES section of this notice will be Proficiency Testing for Laboratories deemed to meet the CLIA requirements Performing Nonwaived Testing DATES: Applicable Date: This notice is for the listed subspecialties and applicable from March 23, 2018 to specialties, and therefore, will generally The A2LA’s requirements are equal to March 23, 2022. not be subject to routine inspections by or more stringent than the CLIA FOR FURTHER INFORMATION CONTACT: a State survey agency to determine its requirements at §§ 493.801 through Cindy Flacks, (410) 786–6520. compliance with CLIA requirements. 493.865. For instance, the A2LA SUPPLEMENTARY INFORMATION: The accredited laboratory, however, is requires that laboratories conduct subject to validation and complaint proficiency testing activities for both I. Background and Legislative investigation surveys performed by primary and secondary test systems for Authority CMS, or its agent(s). waived and non-waived testing. The On October 31, 1988, the Congress CLIA requirement at § 493.801(b)(6) enacted the Clinical Laboratory III. Evaluation of the A2LA Request for Approval as an Accreditation requires proficiency testing activities for Improvement Amendments of 1988 the primary test system and for non- (CLIA) (Pub. L. 100–578). CLIA Organization Under CLIA waived testing only. amended section 353 of the Public The following describes the process Health Service Act. We issued a final used to determine that the A2LA C. Subpart J—Facility Administration amozie on DSK30RV082PROD with NOTICES rule implementing the accreditation accreditation program meets the for Nonwaived Testing provisions of CLIA on July 31, 1992 (57 necessary requirements to be approved FR 33992). Under those provisions, we by CMS and that, as such, CMS may The A2LA requirements for the may grant deeming authority to an approve the A2LA as an accreditation submitted subspecialties and specialties accreditation organization if its program with deeming authority under are equal to the CLIA requirements at requirements for laboratories accredited the CLIA program. The A2LA formally §§ 493.1100 through 493.1105. under its program are equal to or more applied to CMS for approval as an VerDate Sep<11>2014 21:54 Mar 22, 2018 Jkt 244001 PO 00000 Frm 00086 Fmt 4703 Sfmt 4703 E:\FR\FM\23MRN1.SGM 23MRN1

12800 Federal Register / Vol. 83, No. 57 / Friday, March 23, 2018 / Notices D. Subpart K—Quality System for noncompliance (that is, complaint DEPARTMENT OF HEALTH AND Nonwaived Testing inspections). The outcome of those HUMAN SERVICES The A2LA requirements are equal to validation inspections, performed by the CLIA requirements at §§ 493.1200 CMS or our agents, or the State survey Administration for Children and through 493.1299. agencies, will be our principal means Families for verifying that the laboratories E. Subpart M—Personnel for Nonwaived accredited by the A2LA remain in Proposed Information Collection Testing compliance with CLIA requirements. Activity; Comment Request We have determined that the A2LA’s This Federal monitoring is an ongoing requirements are equal to the CLIA process. Proposed Projects: requirements at §§ 493.1403 through V. Removal of Approval as an Title: Initial Medical Exam Form and 493.1495 for laboratories that perform Accrediting Organization Initial Dental Exam Form. moderate and high complexity testing. Our regulations provide that we may OMB No.: 0970–0466. F. Subpart Q—Inspections rescind the approval of an accreditation Description: We have determined that the A2LA organization, such as that of the A2LA, for cause, before the end of the effective The Administration for Children and requirements for the submitted Families’ Office of Refugee Resettlement subspecialties and specialties are equal date of approval. If we determine that the A2LA has failed to adopt, maintain (ORR) places unaccompanied minors in to or more stringent than the CLIA their custody in licensed care provider requirements at §§ 493.1771 through and enforce requirements that are equal to, or more stringent than, the CLIA facilities until reunification with a 493.1780. The A2LA requires annual requirements, or that systemic problems qualified sponsor. Care provider review of all accredited laboratories. The laboratory is required to submit any exist in its monitoring, inspection or facilities are required to provide updates on information about its enforcement processes, we may impose children with services such as organization, facilities, key personnel a probationary period, not to exceed 1 classroom education, mental health and results of any proficiency testing. year, in which the A2LA would be services, and health care. Pursuant to Laboratories may be required to undergo allowed to address any identified issues. Exhibit 1, part A.2 of the Flores an onsite surveillance visit if they do Should the A2LA be unable to address Settlement Agreement (Jenny Lisette not submit their annual review the identified issues within that Flores, et al., v. Janet Reno, Attorney documentation to the A2LA by the timeframe, we may, in accordance with General of the United States, et al., Case established 30 day deadline, if the applicable regulations, revoke No. CV 85–4544–RJK (C.D. Cal. 1996), significant changes to the facility or A2LA’s deeming authority under CLIA. care provider facilities, on behalf of Should circumstances result in our ORR, shall arrange for appropriate organization have occurred, or if withdrawal of the A2LA’s approval, we proficiency testing results have been routine medical and dental care and will publish a notice in the Federal consistently poor. The CLIA regulations emergency health care services, Register explaining the basis for do not have this requirement. including a complete medical removing its approval. G. Subpart R—Enforcement Procedures examination and screening for VI. Collection of Information infectious diseases within 48 hours of The A2LA meets the requirements of Requirements admission, excluding weekends and subpart R to the extent that it applies to holidays, unless the minor was recently This notice does not impose any accreditation organizations. The A2LA information collection and record examined at another facility; policy sets forth the actions the keeping requirements subject to the appropriate immunizations in organization takes when laboratories it Paperwork Reduction Act (PRA). accordance with the U.S. Public Health accredits do not comply with its Consequently, it does not need to be requirements and standards for Service (PHS), Center for Disease reviewed by the Office of Management Control; administration of prescribed accreditation. When appropriate, the and Budget (OMB) under the authority A2LA will deny, suspend, or revoke medication and special diets; of the PRA. The requirements associated appropriate mental health interventions accreditation in a laboratory accredited with the accreditation process for by the A2LA and report that action to when necessary for each minor in their clinical laboratories under the CLIA care. us within 30 days. The A2LA also program, codified in 42 CFR part 493 provides an appeals process for subpart E, are currently approved by The forms are to be used as laboratories that have had accreditation OMB under OMB approval number worksheets for clinicians, medical staff, denied, suspended, or revoked. 0938–0686. and health departments to compile We have determined that the A2LA’s information that would otherwise have laboratory enforcement and appeal VII. Executive Order 12866 Statement been collected during the initial medical policies are equal to the requirements of In accordance with the provisions of or dental exam. Once completed, the part 493, subpart R as they apply to Executive Order 12866, this notice was forms will be given to shelter staff for accreditation organizations. not reviewed by the Office of data entry into ORR’s secure, electronic IV. Federal Validation Inspections and Management and Budget. data repository known as ‘The UAC Continuing Oversight Dated: March 8, 2018. Portal’. Data will be used to record UC The Federal validation inspections of Seema Verma, health on admission and for case amozie on DSK30RV082PROD with NOTICES laboratories accredited by the A2LA Administrator, Centers for Medicare & management of any identified illnesses/ may be conducted on a representative Medicaid Services. conditions. sample basis or in response to [FR Doc. 2018–05892 Filed 3–22–18; 8:45 am] Respondents: Office of Refugee substantial allegations of BILLING CODE 4120–01–P Resettlement Grantee staff. VerDate Sep<11>2014 21:54 Mar 22, 2018 Jkt 244001 PO 00000 Frm 00087 Fmt 4703 Sfmt 4703 E:\FR\FM\23MRN1.SGM 23MRN1


Document Created: 2018-11-01 08:54:10
Document Modified: 2018-11-01 08:54:10
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionNotices
ActionNotice.
DatesApplicable Date: This notice is applicable from March 23, 2018 to March 23, 2022.
ContactCindy Flacks, (410) 786-6520.
FR Citation83 FR 12799 
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