Federal Register / Vol. 79, No. 91 / Monday, May 12, 2014 / Notices 26969 

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: 

Patricia Taft, (410) 786–4561. 

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: http://

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 

Organ Procurement Organizations 

(OPOs) are not-for-profit organizations 

that are responsible for the 

procurement, preservation, and 

transport of organs to transplant centers 

throughout the country. Qualified OPOs 

are designated by the Centers for 

Medicare & Medicaid Services (CMS) to 

recover or procure organs in CMSdefined exclusive geographic service 

areas, pursuant to section 371(b)(1) of 

the Public Health Service Act (42 U.S.C. 

273(b)(1)) and our regulations at 42 CFR 

486.306. Once an OPO has been 

designated for an area, hospitals in that 

area that participate in Medicare and 

Medicaid are required to work with that 

OPO in providing organs for transplant, 

pursuant to section 1138(a)(1)(C) of the 

Social Security Act (the Act) and our 

regulations at 42 CFR 482.45. 

Section 1138(a)(1)(A)(iii) of the Act 

provides that a hospital must notify the 

designated OPO (for the service area in 

which it is located) of potential organ 

donors. Under section 1138(a)(1)(C) of 

the Act, every participating hospital 

must have an agreement only with its 

designated OPO to identify potential 

donors. 

However, section 1138(a)(2)(A) of the 

Act provides that a hospital may obtain 

a waiver of the above requirements from 

the Secretary of the Department of 

Health and Human Services (the 

Secretary) under certain specified 

conditions. A waiver allows the hospital 

to have an agreement with an OPO other 

than the one initially designated by 

CMS, if the hospital meets certain 

conditions specified in section 

1138(a)(2)(A) of the Act. In addition, the 

Secretary may review additional criteria 

described in section 1138(a)(2)(B) of the 

Act to evaluate the hospital’s request for 

a waiver. 

Section 1138(a)(2)(A) of the Act states 

that in granting a waiver, the Secretary 

must determine that the waiver—(1) is 

expected to increase organ donations; 

and (2) will ensure equitable treatment 

of patients referred for transplants 

within the service area served by the 

designated OPO and within the service 

area served by the OPO with which the 

hospital seeks to enter into an 

agreement under the waiver. In making 

a waiver determination, section 

1138(a)(2)(B) of the Act provides that 

the Secretary may consider, among 

other factors: (1) Cost-effectiveness; (2) 

improvements in quality; (3) whether 

there has been any change in a 

hospital’s designated OPO due to the 

changes made in definitions for 

metropolitan statistical areas; and (4) 

the length and continuity of a hospital’s 

relationship with an OPO other than the 

hospital’s designated OPO. Under 

section 1138(a)(2)(D) of the Act, the 

Secretary is required to publish a notice 

of any waiver application received from 

a hospital within 30 days of receiving 

the application, and to offer interested 

parties an opportunity to submit 

comments during the 60-day comment 

period beginning on the publication 

date in the Federal Register. 

The criteria that the Secretary uses to 

evaluate the waiver in these cases are 

the same as those described above under 

sections 1138(a)(2)(A) and (B) of the Act 

and have been incorporated into the 

regulations at § 486.308(e) and (f). 

II. Waiver Request Procedures 

In October 1995, we issued a Program 

Memorandum (Transmittal No. A–95– 

11) detailing the waiver process and 

discussing the information hospitals 

must provide in requesting a waiver. We 

indicated that upon receipt of a waiver 

request, we would publish a Federal 

Register notice to solicit public 

comments, as required by section 

1138(a)(2)(D) of the Act. 

According to these requirements, we 

will review the comments received. 

During the review process, we may 

consult on an as-needed basis with the 

Health Resources and Services 

Administration’s Division of 

Transplantation, the United Network for 

Organ Sharing, and our regional offices. 

If necessary, we may request additional 

clarifying information from the applying 

hospital or others. We will then make a 

final determination on the waiver 

request and notify the hospital and the 

designated and requested OPOs. 

III. Hospital Waiver Request 

As permitted by § 486.308(e), the 

following hospital has requested a 

waiver to enter into an agreement with 

a designated OPO other than the OPO 

designated for the service area in which 

the hospital is located: 

Banner Churchill Community 

Hospital, Fallon, Nevada, is requesting a 

waiver to work with: California 

Transplant Donor Network, 1000 

Broadway, Suite 600, Oakland, 

California 94607–4099. 

The Hospital’s Designated OPO is: 

Nevada Donor Network, 2061 E Sahara 

Ave., Las Vegas, Nevada 89104. 

IV. Collection of Information 

Requirements 

This document does not impose 

information collection and 

recordkeeping requirements. 

Consequently, it need not be reviewed 

by the Office of Management and 

Budget under the authority of the 

Paperwork Reduction Act of 1995 (44 

U.S.C. 35). 

V. Response to Public Comments 

We will consider all comments we 

receive by the date and time specified 

in the DATES section of this preamble. 

Dated: May 2, 2014. 

Marilyn Tavenner, 

Administrator, Centers for Medicare & 

Medicaid Services. 

[FR Doc. 2014–10638 Filed 5–9–14; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–1615–NC] 

Medicare Program; Request for an 

Exception to the Prohibition on 

Expansion of Facility Capacity Under 

the Hospital Ownership and Rural 

Provider Exceptions to the Physician 

Self-Referral Prohibition 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 


emcdonald on DSK67QTVN1PROD with NOTICES
26970 Federal Register / Vol. 79, No. 91 / Monday, May 12, 2014 / Notices 

ACTION: Notice with comment period. 

SUMMARY: Under section 1877(i) of the 

Social Security Act (the Act), a 

physician-owned hospital is effectively 

prohibited from expanding facility 

capacity, unless the Secretary grants the 

hospital’s request for an exception to 

that prohibition after considering input 

on the hospital’s request from 

individuals and entities in the 

community where the hospital is 

located. The Centers for Medicare & 

Medicaid Services (CMS) has received a 

request from a physician-owned 

hospital for an exception to the 

prohibition against expansion of facility 

capacity. This notice solicits comments 

on the request from individuals and 

entities in the community in which the 

physician-owned hospital is located. 

Community input may inform our 

determination regarding whether the 

requesting hospital qualifies for an 

exception to the prohibition against 

expansion of facility capacity. 

DATES: Comment Date: To be assured 

consideration, comments must be 

received at one of the addresses 

provided below, no later than 5 p.m. on 

June 11, 2014. 

ADDRESSES: In commenting, please refer 

to file code CMS–1615–NC. Because of 

staff and resource limitations, we cannot 

accept comments by facsimile (FAX) 

transmission. 

You may submit comments in one of 

three ways (please choose only one of 

the ways listed): 

1. Electronically. You may submit 

electronic comments on this exception 

request to http://www.regulations.gov. 

Follow the instructions under the ‘‘More 

Search Options’’ tab. 

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–1615–NC, 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: Department of 

Health and Human Services, Attention: 

CMS–1615–NC, 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: 

Patricia Taft, (410) 786–4561 or Teresa 

Walden, (410) 786–3755. 

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: http://

www.regulations.gov. Follow the search 

instructions on that Web site to view 

public comments. 

We will allow stakeholders 30 days 

from the date of this notice to submit 

written comments. Comments received 

timely will be available for public 

inspection as they are received, 

generally beginning approximately 3 

weeks after publication of this notice, 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, please phone 1– 

800–743–3951. 

I. Background 

Section 1877 of the Social Security 

Act (the Act), also known as the 

physician self-referral law—(1) prohibits 

a physician from making referrals for 

certain ‘‘designated health services’’ 

(DHS) payable by Medicare to an entity 

with which he or she (or an immediate 

family member) has a financial 

relationship (ownership or 

compensation), unless an exception 

applies; and (2) prohibits the entity from 

filing claims with Medicare (or billing 

another individual, entity, or third party 

payer) for those DHS furnished as a 

result of a prohibited referral. 

Section 1877(d)(3) of the Act provides 

an exception, known as the ‘‘whole 

hospital exception,’’ for physician 

ownership or investment interests held 

in a hospital located outside of Puerto 

Rico, provided that the referring 

physician is authorized to perform 

services at the hospital and the 

ownership or investment interest is in 

the hospital itself (and not merely in a 

subdivision of the hospital). 

Section 1877(d)(2) of the Act provides 

an exception for physician ownership or 

investment interests in rural providers 

(the ‘‘rural provider exception’’). In 

order for an entity to qualify for the 

rural provider exception, the DHS must 

be furnished in a rural area (as defined 

in section 1886(d)(2) of the Act) and 

substantially all the DHS furnished by 

the entity must be furnished to 

individuals residing in a rural area. 

Section 6001(a)(3) of the Patient 

Protection and Affordable Care Act 

(Pub. L. 111–148) as amended by the 

Health Care and Education 

Reconciliation Act of 2010 (Pub. L. 111– 

152) (hereafter referred to together as 

‘‘the Affordable Care Act’’) amended the 

whole hospital and rural provider 

exceptions to the physician self-referral 

prohibition to impose additional 

restrictions on physician ownership and 

investment in hospitals and rural 

providers. Since March 23, 2010, a 

physician-owned hospital that seeks to 

avail itself of either exception is 

prohibited from expanding facility 

capacity unless it qualifies as an 

‘‘applicable hospital’’ or ‘‘high Medicaid 

facility’’ (as defined in sections 

1877(i)(3)(E), (F) of the Act and 42 CFR 

411.362(c)(2), (3) of our regulations) and 

has been granted an exception to the 

prohibition by the Secretary. Section 

1877(i)(3)(A)(ii) of the Act provides that 

individuals and entities in the 

community in which the provider 

requesting the exception is located must 

have an opportunity to provide input 

with respect to the provider’s 

application for the exception. For 

further information, visit our Web site 

at: http://www.cms.gov/Medicare/

Fraud-and-Abuse/PhysicianSelf

Referral/Physician_Owned_

Hospitals.html. 

II. Exception Request Process 

On November 30, 2011, we published 

a final rule in the Federal Register (76 

FR 74122, 74517 through 74525) that, 

among other things, finalized 

§ 411.362(c), which specified the 

process for submitting, commenting on, 

and reviewing a request for an exception 

to the prohibition on expansion of 

facility capacity. We specified that prior 

to our review of the request, we will 

solicit community input on the request 

for an exception by publishing a notice 

of the request in the Federal Register 

(see § 411.362(c)(5)). We also stated that 

individuals and entities in the hospital’s 

community have 30 days to submit 

comments on the request. Community 

input must take the form of written 

comments and may include 

documentation demonstrating that the 

physician-owned hospital requesting 

the exception does or does not qualify 

as an ‘‘applicable hospital’’ or ‘‘high 

Medicaid facility,’’ as such terms are 

defined in § 411.362(c)(2) and (3). 

Although we gave examples of 

community input, such as 

documentation demonstrating that the 

hospital does not satisfy one or more of 

the data criteria or that the hospital 

discriminates against beneficiaries of 

Federal health programs, we noted that 


emcdonald on DSK67QTVN1PROD with NOTICES
Federal Register / Vol. 79, No. 91 / Monday, May 12, 2014 / Notices 26971 

these were examples only and that we 

will not restrict the type of community 

input that may be submitted (76 FR 

74522). If we receive timely comments 

from the community, we will notify the 

hospital, and the hospital has 30 days 

after such notice to submit a rebuttal 

statement (§ 411.362(c)(5)(ii)). 

A request for an exception to the 

facility expansion prohibition is 

considered complete and ready for CMS 

review if no comments from the 

community are received by the close of 

the 30-day comment period. If we 

receive timely comments from the 

community, we consider the request to 

be complete 30 days after the hospital 

is notified of the comments. If we grant 

the request for an exception to the 

prohibition on expansion of facility 

capacity, the expansion may occur only 

in facilities on the hospital’s main 

campus and may not result in the 

number of operating rooms, procedure 

rooms, and beds for which the hospital 

is licensed exceeding 200 percent of the 

hospital’s baseline number of operating 

rooms, procedure rooms, and beds 

(§ 411.362(c)(6)). Our decision to grant 

or deny a hospital’s request for an 

exception to the prohibition on 

expansion of facility capacity will be 

published in the Federal Register in 

accordance with our regulations at 

§ 411.362(c)(7). 

III. Hospital Exception Request 

As permitted by section 1877(i)(3) of 

the Act and our regulations at 

§ 411.362(c), the following physicianowned hospital has requested an 

exception to the prohibition on 

expansion of facility capacity: 

Name of Facility: Lake Pointe Medical 

Center 

Location: 6800 Scenic Drive, Rowlett, 

Texas 75088–4552 (Rockwall County) 

Basis for Exception Request: High 

Medicaid Facility 

We seek comments on this request 

from individuals and entities in the 

community in which the hospital is 

located. We encourage interested parties 

to review the hospital’s request, which 

is posted on the CMS Web site at: 

http://www.cms.gov/Medicare/Fraudand-Abuse/PhysicianSelfReferral/

Physician_Owned_Hospitals.html. We 

especially welcome comments regarding 

whether the hospital qualifies as a ‘‘high 

Medicaid facility.’’ Under 

§ 411.362(c)(3), a ‘‘high Medicaid 

facility’’ is a hospital that satisfies all of 

the following criteria: 

• The hospital is not the sole hospital 

in the county in which it is located; 

• The hospital does not discriminate 

against beneficiaries of Federal health 

care programs and does not permit 

physicians practicing at the hospital to 

discriminate against such beneficiaries; 

and 

• With respect to each of the 3 most 

recent fiscal years for which data are 

available as of the date the hospital 

submits its request, the hospital has an 

annual percent of total inpatient 

admissions under Medicaid that is 

estimated to be greater than such 

percent with respect to such admissions 

for any other hospital located in the 

county in which the hospital is located. 

We note that our regulations require 

the requesting hospital to use filed 

hospital cost report discharge data to 

estimate its annual percentage of total 

inpatient admissions under Medicaid 

and the annual percentages of total 

inpatient admissions under Medicaid 

for every other hospital located in the 

county in which the hospital is located. 

Individuals and entities wishing to 

submit comments on the hospital’s 

request should review the DATES and 

ADDRESSES sections above and state 

whether or not they are in the 

community in which the hospital is 

located. 

IV. Collection of Information 

Requirements 

This document does not impose 

information collection and 

recordkeeping requirements. 

Consequently, it need not be reviewed 

by the Office of Management and 

Budget under the authority of the 

Paperwork Reduction Act of 1995 (44 

U.S.C. 35). 

V. Response to Public Comments 

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. 

Dated: May 6, 2014. 

Marilyn Tavenner, 

Administrator, Centers for Medicare & 

Medicaid Services. 

[FR Doc. 2014–10872 Filed 5–9–14; 8:45 am] 

BILLING CODE P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Proposed Information Collection 

Activity; Comment Request Proposed 

Projects: 

Title: Multistate Financial Institution 

Data Match with Federally Assisted 

State Transmitted Levy (FIDM/FAST 

Levy) 

OMB No.: 0970–0196. 

Description: State child support 

enforcement agencies are required to 

attach and seize an obligor’s assets in 

financial institutions to satisfy any 

current support obligation and arrearage 

when the obligor owes past-due 

support. To locate an obligor’s account, 

state child support enforcement 

agencies are required to enter into data 

matching agreements with financial 

institutions doing business in their 

state. State child support enforcement 

agencies use the results of data matches 

to secure information leading to the 

enforcement of the support obligation. 

The federal Office of Child Support 

Enforcement (OCSE) assists states to 

fulfill the data matching requirements 

with multistate financial institutions by 

facilitating matching through the 

Federal Parent Locator Service’s 

Multistate Financial Institution Data 

Match (MSFIDM) program. 

To further assist states to meet this 

statutory requirement, the OCSE 

enhanced the Federal Parent Locator 

Service by developing the Federally 

Assisted State Transmitted (FAST) Levy 

application that provides a secure and 

automated method of collecting and 

disseminating electronic levy notices 

between state child support 

enforcement agencies and multistate 

financial institutions. This increases 

states’ efficiency to secure financial 

assets. 

The FIDM/FAST Levy information 

collection activities are authorized by: 

42 U.S.C. 652(l) which authorizes OCSE, 

through the Federal Parent Locator 

Service, to aid state child support 

agencies and financial institutions doing 

business in two or more states in 

reaching agreements regarding the 

receipt from financial institutions, and 

the transfer to the state child support 

agencies, of information pertaining to 

the location of accounts held by obligors 

who owe past-due support; 42 U.S.C. 

666 (a)(2) and (c)(1)(G)(ii) which require 

state child support agencies in cases in 

which there is an arrearage to establish 

procedures to secure assets to satisfy 

any current support obligation and the 


emcdonald on DSK67QTVN1PROD with NOTICES