13524 Federal Register / Vol. 76, No. 49 / Monday, March 14, 2011 / Rules and Regulations 

GME and IME slots available for 

redistribution to other hospitals. 

D. Alternatives Considered 

Although there may be alternatives, 

the method we are finalizing in this 

interim final rule is the most consistent 

with that of a similar provision for 

hospitals that are members of Medicare 

GME affiliated groups implemented as 

part of section 422 of the MMA. 

E. Conclusion 

The analysis above, together with the 

remainder of this preamble, provides a 

Regulatory Flexibility Analysis as well 

as a Regulatory Impact Analysis. For the 

reasons outlined in the RIA, we are not 

preparing an analysis for either the RFA 

or section 1102(b) of the Act because we 

have determined that this interim final 

rule with comment would not have a 

direct significant economic impact on a 

substantial number of small entities or 

a direct significant impact on the 

operations of a substantial number of 

small rural hospitals. 

In accordance with the provisions of 

Executive Order 12866, this regulation 

was reviewed by the Office of 

Management and Budget. 

List of Subjects in 42 CFR Part 413 

Health facilities, Kidney diseases, 

Medicare, Puerto Rico, Reporting and 

recordkeeping requirements. 

For the reasons set forth in the 

preamble, the Centers for Medicare & 

Medicaid Services amends 42 CFR 

chapter IV as set forth below: 

PART 413—PRINCIPLES OF 

REASONABLE COST 

REIMBURSEMENT; PAYMENT FOR 

END-STAGE RENAL DISEASE 

SERVICES; OPTIONAL 

PROSPECTIVELY DETERMINED 

PAYMENT RATES FOR SKILLED 

NURSING FACILITIES 

■ 1. The authority citation for part 413 

continues to read as follows: 

Authority: Secs. 1102, 1812(d), 1814(b), 

1815, 1833(a), (i), and (n), 1861(v), 1871, 

1881, 1883, and 1886 of the Social Security 

Act (42 U.S.C. 1302, 1395d(d), 1395f(b), 

1395g, 1395l(a), (i), and (n), 1395x(v), 

1395hh, 1395rr, 1395tt, and 1395ww); and 

sec. 124 of Pub. L. 106–133 (113 Stat. 1501A– 

332). 

■ 2. Section 413.79 is amended by 

revising paragraph (m)(7) to read as 

follows: 

§ 413.79 Direct GME payments: 

Determination of the weighted number of 

FTE residents. 

(m) * * * 

(7) Consideration for members of 

Medicare GME affiliated groups. For a 

hospital that is a member of a Medicare 

GME affiliated group at any point 

during any of the hospital’s three most 

recent cost reporting periods ending 

before March 23, 2010 for which a cost 

report has been settled or has been 

submitted to Medicare contractor by 

March 23, 2010, in determining whether 

a hospital’s otherwise applicable 

resident FTE resident cap is reduced 

under paragraph (m) of this section, the 

Medicare contractor determines a 

hospital’s reference cost reporting 

period by finding the cost reporting 

period that results in the smallest 

difference between the reference 

resident level and the otherwise 

applicable resident limit. 

(i) If the reference resident level is 

less than the otherwise applicable 

resident limit in that reference cost 

reporting period, the Medicare 

contractor must then determine if the 

hospital was a member of a Medicare 

GME affiliated group as of the July 1 

that occurs during that reference cost 

reporting period. 

(ii) If the hospital was a member of a 

Medicare GME affiliated group as of the 

July 1 that occurs during that reference 

cost report, the Medicare contractor 

does all of the following: 

(A) Treat the members of the 

Medicare GME affiliated group as a 

group for that reference cost reporting 

period, for the purpose of determining 

a reduction to the particular hospital’s 

FTE resident cap. 

(B) Determine for each hospital in the 

Medicare GME affiliated group 

respectively the FTE resident cap and 

FTE resident count (IME and direct 

GME separately). 

(C) Add each hospital’s FTE resident 

caps (IME and direct GME separately) to 

determine the aggregate FTE resident 

cap. 

(D) Add each hospital’s FTE resident 

count (IME and direct GME separately) 

to determine the aggregate FTE resident 

count. 

(iii) If the aggregate FTE resident 

count is equal to or exceeds the 

aggregate FTE resident cap, then the 

Medicare contractor would make no 

reduction to the particular hospital’s 

otherwise applicable FTE resident cap 

under paragraph (m) of this section, and 

no further steps are necessary for that 

hospital. 

(iv) If the hospitals’ aggregate FTE 

resident count is less than the aggregate 

FTE resident cap, then the Medicare 

contractor would determine on a 

hospital-specific basis whether the 

particular hospital’s FTE resident count 

is less than its otherwise applicable FTE 

resident cap (as adjusted by affiliation 

agreement(s)) in the hospital’s reference 

cost report. 

(v) If the hospital’s FTE resident count 

exceeds its otherwise applicable FTE 

resident cap, the hospital will not have 

its otherwise applicable FTE resident 

cap reduced under paragraph (m) of this 

section. 

(vi) If the particular hospital’s FTE 

resident count is less than its otherwise 

applicable FTE resident cap, the 

Medicare contractor determines a pro 

rata cap reduction amount that is equal, 

in total, to 65 percent of the difference 

between the aggregate FTE resident cap 

and the aggregate FTE resident count for 

the Medicare GME affiliated group. 

(A) The pro rata cap reduction to the 

particular hospital’s otherwise 

applicable FTE resident cap is 

calculated by dividing the difference 

between the hospital’s otherwise 

applicable FTE resident cap and the 

hospital’s FTE resident count, by the 

total amount by which all of the 

hospitals’ individual FTE resident 

counts are below their affiliated FTE 

resident caps, multiplying the quotient 

by the difference between the aggregate 

FTE resident cap and the aggregate FTE 

resident counts for the Medicare GME 

affiliated group, and multiplying that 

result by 65 percent. 

(B) The final reduction takes into 

account the hospital’s FTE resident cap 

as reduced under the provisions of 

paragraph (c)(3) of this section. 

* * * * * 

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare—Hospital 

Insurance; and Program No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program) 

Dated: February 10, 2011. 

Donald M. Berwick, 

Administrator, Centers for Medicare & 

Medicaid Services. 

Approved: March 1, 2011. 

Kathleen Sebelius, 

Secretary. 

[FR Doc. 2011–5960 Filed 3–11–11; 8:45 am] 

BILLING CODE 4120–01–P 

FEDERAL COMMUNICATIONS 

COMMISSION 

47 CFR Part 73 

[DA 11–324; MB Docket No. 10–189; 

RM–11611] 

Radio Broadcasting Services; Willow 

Creek, CA 

AGENCY: Federal Communications 

Commission. 

ACTION: Final rule. 

WReier-Aviles on DSKGBLS3C1PROD with RULES

Federal Register / Vol. 76, No. 49 / Monday, March 14, 2011 / Rules and Regulations 13525 

SUMMARY: The Audio Division, at the 

request of Miriam Media, Inc., allots FM 

Channel 258A at Willow Creek, 

California. Channel 258A can be allotted 

at Willow Creek, consistent with the 

minimum distance separation 

requirements of the Commission’s rules, 

at coordinates 40–57–29 NL and 

123–42–23 WL, with a site restriction of 

6.7 km (4.2 miles) west of the 

community See SUPPLEMENTARY

INFORMATION infra. 

DATES: Effective April 4, 2011. 

FOR FURTHER INFORMATION CONTACT: 

Deborah Dupont, Media Bureau, (202) 

418–2180. 

SUPPLEMENTARY INFORMATION: This is a 

synopsis of the Commission’s Report 

and Order, MB Docket No. 10–189, 

adopted February 16, 2011, and released 

February 18, 2011. The full text of this 

Commission decision is available for 

inspection and copying during normal 

business hours in the FCC Information 

Center, Portals II, 445 12th Street, SW., 

Room CY–A257, Washington, DC 20554. 

The complete text of this decision also 

may be purchased from the 

Commission’s duplicating contractor, 

Best Copy and Printing, Inc., 445 12th 

Street, SW., Room CY–B402, 

Washington, DC 20554, (800) 378–3160, 

or via the company’s Web site, http:// 

www.bcpiweb.com. This document does 

not contain proposed information 

collection requirements subject to the 

Paperwork Reduction Act of 1995, 

Public Law 104–13. In addition, 

therefore, it does not contain any 

proposed information collection burden 

‘‘for small business concerns with fewer 

than 25 employees,’’ pursuant to the 

Small Business Paperwork Relief Act of 

2002, Public Law 107–198, see 44 U.S.C. 

3506 (c)(4). The Commission will send 

a copy of this Report and Order in a 

report to be sent to Congress and the 

Government Accountability Office 

pursuant to the Congressional Review 

Act, see U.S.C. 801(a)(1)(A). 

List of Subjects in 47 CFR Part 73 

Radio, Radio broadcasting. 

For the reasons discussed in the 

preamble, the Federal Communications 

Commission amends 47 CFR part 73 as 

follows: 

PART 73—RADIO BROADCAST 

SERVICES 

■ 1. The authority citation for part 73 

continues to read as follows: 

Authority: 47 U.S.C. 154, 303, 334, 336. 

§ 73.202 [Amended] 

■ 2. Section 73.202(b), the Table of FM 

Allotments under California, is 

amended by adding Channel 258A at 

Willow Creek. 

Federal Communications Commission. 

Nazifa Sawez, 

Assistant Chief, Audio Division, Media 

Bureau. 

[FR Doc. 2011–5089 Filed 3–11–11; 8:45 am] 

BILLING CODE 6712–01–P 

WReier-Aviles on DSKGBLS3C1PROD with RULES