Federal Register / Vol. 75, No. 242 / Friday, December 17, 2010 / Rules and Regulations 78915 

List of Subjects in 38 CFR Part 17 

Administrative practice and 

procedure, Alcohol abuse, Alcoholism, 

Claims, Day care, Dental health, Drug 

abuse, Foreign relations, Government 

contracts, Grant programs-health, 

Government programs-veterans, Health 

care, Health facilities, Health 

professions, Health records, Homeless, 

Medical and dental schools, Medical 

devices, Medical research, Mental 

health programs, Nursing homes, 

Philippines, Reporting and 

recordkeeping requirements, 

Scholarships and fellowships, Travel 

and transportation expenses, Veterans. 

Dated: December 12, 2010. 

Robert C. McFetridge, 

Director, Regulation Policy and Management, 

Office of the General Counsel, Department 

of Veterans Affairs. 

■ For the reasons set forth in the 

preamble, VA amends 38 CFR part 17 as 

follows: 

PART 17—MEDICAL 

■ 1. The authority citation for part 17 

continues to read as follows: 

Authority: 38 U.S.C. 501, 1721, and as 

noted in specific sections. 

■ 2. Revise paragraph (a) introductory 

text of § 17.52 to read as follows: 

§ 17.52 Hospital care and medical services 

in non-VA facilities. 

(a) When VA facilities or other 

government facilities are not capable of 

furnishing economical hospital care or 

medical services because of geographic 

inaccessibility or are not capable of 

furnishing care or services required, VA 

may contract with non-VA facilities for 

care in accordance with the provisions 

of this section. When demand is only for 

infrequent use, individual 

authorizations may be used. Care in 

public or private facilities, however, 

subject to the provisions of §§ 17.53, 

17.54, 17.55 and 17.56, will only be 

authorized, whether under a contract or 

an individual authorization, for— 

* * * * * 

■ 3. Revise § 17.56 to read as follows: 

§ 17.56 VA payment for inpatient and 

outpatient health care professional services 

at non-departmental facilities and other 

medical charges associated with non-VA 

outpatient care. 

(a) Except for health care professional 

services provided in the state of Alaska 

(see paragraph (b) of this section) and 

except for non-contractual payments for 

home health services and hospice care, 

VA will determine the amounts paid 

under §§ 17.52 or 17.120 for health care 

professional services, and all other 

medical services associated with nonVA outpatient care, using the applicable 

method in this section: 

(1) If a specific amount has been 

negotiated with a specific provider, VA 

will pay that amount. 

(2) If an amount has not been 

negotiated under paragraph (a)(1) of this 

section, VA will pay the lowest of the 

following amounts: 

(i) The applicable Medicare fee 

schedule or prospective payment system 

amount (‘‘Medicare rate’’) for the period 

in which the service was provided 

(without any changes based on the 

subsequent development of information 

under Medicare authorities), subject to 

the following: 

(A) In the event of a Medicare waiver, 

the payment amount will be calculated 

in accordance with such waiver. 

(B) In the absence of a Medicare rate 

or Medicare waiver, payment will be the 

VA Fee Schedule amount for the period 

in which the service was provided. The 

VA Fee Schedule amount is determined 

by the authorizing VA medical facility, 

which ranks all billings (if the facility 

has had at least eight billings) from nonVA facilities under the corresponding 

procedure code during the previous 

fiscal year, with billings ranked from the 

highest to the lowest. The VA Fee 

Schedule amount is the charge falling at 

the 75th percentile. If the authorizing 

facility has not had at least eight such 

billings, then this paragraph does not 

apply. 

(ii) The amount negotiated by a 

repricing agent if the provider is 

participating within the repricing 

agent’s network and VA has a contract 

with that repricing agent. For the 

purposes of this section, repricing agent 

means a contractor that seeks to connect 

VA with discounted rates from non-VA 

providers as a result of existing 

contracts that the non-VA provider may 

have within the commercial health care 

industry. 

(iii) The amount that the provider 

bills the general public for the same 

service. 

(b) For physician and non-physician 

professional services rendered in 

Alaska, VA will pay for services in 

accordance with a fee schedule that uses 

the Health Insurance Portability and 

Accountability Act mandated national 

standard coding sets. VA will pay a 

specific amount for each service for 

which there is a corresponding code. 

Under the VA Alaska Fee Schedule, the 

amount paid in Alaska for each code 

will be 90 percent of the average amount 

VA actually paid in Alaska for the same 

services in Fiscal Year (FY) 2003. For 

services that VA provided less than 

eight times in Alaska in FY 2003, for 

services represented by codes 

established after FY 2003, and for unitbased codes prior to FY 2004, VA will 

take the Centers for Medicare and 

Medicaid Services’ rate for each code 

and multiply it times the average 

percentage paid by VA in Alaska for 

Centers for Medicare and Medicaid 

Services-like codes. VA will increase 

the amounts on the VA Alaska Fee 

Schedule annually in accordance with 

the published national Medicare 

Economic Index (MEI). For those years 

where the annual average is a negative 

percentage, the fee schedule will remain 

the same as the previous year. Payment 

for non-VA health care professional 

services in Alaska shall be the lesser of 

the amount billed or the amount 

calculated under this subpart. 

(c) Payments made by VA to a nonVA facility or provider under this 

section shall be considered payment in 

full. Accordingly, the facility or 

provider or agent for the facility or 

provider may not impose any additional 

charge for any services for which 

payment is made by VA. 

(d) In a case where a veteran has paid 

for emergency treatment for which VA 

may reimburse the veteran under 

§ 17.120, VA will reimburse the amount 

that the veteran actually paid. Any 

amounts due to the provider but unpaid 

by the veteran will be reimbursed to the 

provider under paragraphs (a) and (b) of 

this section. 

(Authority: 38 U.S.C. 1703, 1728) 

[FR Doc. 2010–31629 Filed 12–16–10; 8:45 am] 

BILLING CODE 8320–01–P 

POSTAL SERVICE 

39 CFR Part 232 

Conduct on Postal Property 

AGENCY: Postal Service. 

ACTION: Final rule. 

SUMMARY: The U.S. Postal Service is 

updating its regulations concerning 

Conduct on Postal Property (COPP) to 

correct or eliminate outdated citations, 

obviate the need for continuous updates 

of such citations by harmonizing the 

regulations with federal law, and make 

certain other minor, editorial revisions. 

DATES: Effective date: December 17, 

2010. 

FOR FURTHER INFORMATION CONTACT: 

Christy Noel, Attorney, U.S. Postal 

Service, 202–268–3484. 

SUPPLEMENTARY INFORMATION: The 

current rules governing Conduct on 

Postal Property contain a number of 

outdated or confusing references to nonpostal statutes, and in some cases do not 


srobinson on DSKHWCL6B1PROD with RULES
78916 Federal Register / Vol. 75, No. 242 / Friday, December 17, 2010 / Rules and Regulations 

appear to harmonize clearly with 

Federal law. As discussed in more detail 

below, this final rule is intended to 

remedy those shortcomings, as well as 

make certain minor editorial revisions 

to the COPP regulations set forth in 39 

CFR 232.1. 

1. Paragraph (f) Gambling: The 

prohibition of lottery ticket sales 

contains an exception for RandolphSheppard vendors. This exception is 

amended to replace obsolete citations to 

Postal Service regulations with the 

statutory basis for the exception 

contained in the Randolph-Sheppard 

Act Amendments of 1974. Subsection 

(a)(5) of 20 U.S.C. 107a requires that 

blind vendors licensed to conduct 

vending operations on federal property 

be permitted to sell tickets ‘‘for any 

lottery authorized by State law and 

conducted by an agency of a State’’. This 

amendment harmonizes Postal Service 

regulations with the RandolphSheppard Act by citing 20 U.S.C. 107a 

(a)(5) as the statutory basis for the 

exception. 

2. Paragraph (m) Nondiscrimination: 

The nondiscrimination provision is 

amended to remove inappropriate 

references to employment policy. The 

Postal Service has determined that 

facilities regulations governing public 

access to and use of Postal Service 

property are not the appropriate venue 

for articulating employment policy. This 

amendment is necessary to eliminate 

potential conflict or redundancy with 

regard to employment regulations, and 

to correct the scope of the 

nondiscrimination provision of the 

COPP regulations, which governs the 

use of Postal Service facilities ‘‘of a 

public nature’’. 

3. Paragraph (o) Depositing Literature: 

The exception to the prohibition against 

depositing literature for posting of 

notices by U.S. Government-related 

organizations is amended to correct an 

outdated citation to title 36 of the 

United States Code. This amendment is 

necessary for consistency with title 36, 

which was revised in 1998 without 

substantive change (Pub. L. 105–225, 

section 501, 112 Stat. 1253). The 

amended regulation updates the 

statutory definition for U.S. 

Government-related organizations such 

as the Inaugural Committee, which is 

currently defined in 36 U.S.C. 501. 

4. Paragraph (p) Penalties and other 

law: The penalty provision is amended 

to incorporate the procedures for a 

sentence of a fine under title 18 of the 

United States Code. This amendment is 

necessary for consistency with title 18, 

which authorizes the Postal Service to 

promulgate regulations for the 

administration and protection of 

property under its charge and control 

and of any persons on such property. 18 

U.S.C. 3061. The Postal Accountability 

and Enhancement Act (Pub. L. 109–435, 

section 1001, 120 Stat. 3198) contains a 

penalty provision for violations of such 

regulations, codified at 18 U.S.C. 

3061(c). This penalty provision provides 

that ‘‘a person violating a regulation 

prescribed under this subsection 

[authorizing Postal Service 

promulgation of regulations for the 

protection of its property and persons 

on such property] shall be fined under 

[title 18].’’ 18 U.S.C. 3061(c)(4)(B). Title 

18 sets forth procedures for sentences of 

a fine for defendants found guilty of a 

criminal offense. 18 U.S.C. 3571. This 

amendment harmonizes Postal Service 

regulations with the Postal 

Accountability and Enhancement Act by 

citing 18 U.S.C. 3571 as the statutory 

basis for the penalty provision of the 

regulations. 

List of Subjects in 39 CFR Part 232 

Authority designations (Government 

agencies), Crime, Federal buildings and 

facilities, Government property, Law 

enforcement officers, Postal Service, 

Security measures. 

■ In view of the considerations 

discussed above, the Postal Service 

adopts the following amendments to 39 

CFR Part 232: 

PART 232—[Amended] 

■ 1. The authority citation for Part 232 

is revised to read as follows: 

Authority: 18 U.S.C. 13, 3061, 3571; 21 

U.S.C. 802, 844; 39 U.S.C. 401, 403(b)(3), 

404(a)(7), 1201(2). 

■ 2. In § 232.1, paragraphs (f), (m), 

(o)(3), and (p)(2) are revised to read as 

follows: 

§ 232.1 Conduct on postal property. 

* * * * * 

(f) Gambling. Participating in games 

for money or other personal property, 

the operation of gambling devices, the 

conduct of a lottery or pool, or the 

selling or purchasing of lottery tickets, 

is prohibited on postal premises. In 

accordance with 20 U.S.C. 107a(a)(5), 

this prohibition does not apply to the 

vending or exchange of State Lottery 

tickets at vending facilities operated by 

licensed blind persons where such 

lotteries are authorized by state law. 

* * * * * 

(m) Nondiscrimination. There must be 

no discrimination by segregation or 

otherwise against any person or persons 

because of race, color, religion, national 

origin, sex, or disability, in furnishing, 

or by refusing to furnish to such person 

or persons the use of any facility of a 

public nature, including all services, 

privileges, accommodations, and 

activities provided on postal property. 

* * * * * 

(o) * * * 

(3) Posting of notices by U.S. 

Government-related organizations, such 

as the Inaugural Committee as defined 

in 36 U.S.C. 501. 

(p) * * * 

(2) Whoever shall be found guilty of 

violating the rules and regulations in 

this section while on property under the 

charge and control of the Postal Service 

is subject to a fine as provided in 18 

U.S.C. 3571 or imprisonment of not 

more than 30 days, or both. Nothing 

contained in these rules and regulations 

shall be construed to abrogate any other 

Federal laws or regulations or any State 

and local laws and regulations 

applicable to any area in which the 

property is situated. 

* * * * * 

Stanley F. Mires, 

Chief Counsel, Legislative. 

[FR Doc. 2010–31775 Filed 12–16–10; 8:45 am] 

BILLING CODE 7710–12–P 

ENVIRONMENTAL PROTECTION 

AGENCY 

40 CFR Part 62 

[EPA–R03–OAR–2010–0859; FRL -9240–2] 

Approval and Promulgation of State 

Air Quality Plans for Designated 

Facilities and Pollutants, 

Commonwealth of Virginia; Control of 

Emissions From Existing Hospital/ 

Medical/Infectious Waste Incinerator 

(HMIWI) Units, Negative Declaration 

and Withdrawal of EPA Plan Approval 

AGENCY: Environmental Protection 

Agency (EPA). 

ACTION: Direct final rule. 

SUMMARY: EPA is taking direct final 

action to approve the Commonwealth of 

Virginia’s negative declaration and 

request for EPA withdrawal of its 

section 111(d)/129 plan (the plan) 

approval for HMIWI units. 

DATES: This rule is effective February 

15, 2011 without further notice, unless 

EPA receives adverse written comment 

by January 18, 2011. If EPA receives 

such comments, it will publish a timely 

withdrawal of the direct final rule in the 

Federal Register and inform the public 

that the rule will not take effect. 

ADDRESSES: Submit your comments, 

identified by Docket ID Number EPA– 

R03–OAR–2010–0859 by one of the 

following methods: 


srobinson on DSKHWCL6B1PROD with RULES