Federal Register / Vol. 74, No. 167 / Monday, August 31, 2009 / Rules and Regulations 44755 

Executive Order 13132, ‘‘Federalism’’ 

This rule has been examined for its 

impact under E.O. 13132. It does not 

contain policies that have federalism 

implications that would have 

substantial direct effects on the States, 

on the relationship between the national 

Government and the States, or on the 

distribution of power and 

responsibilities among the various 

levels of government; therefore, 

consultation with State and local 

officials is not required. 

List of Subjects in 32 CFR Part 199 

Claims, Dental health, Health care, 

Health insurance, Individuals with 

disabilities, Military personnel. 

■ Accordingly, 32 CFR Part 199 is 

amended as follows: 

PART 199—[AMENDED] 

■ 1. The authority citation for Part 199 

continues to read as follows: 

Authority: 5 U.S.C. 301; 10 U.S.C. Chapter 

55. 

■ 2. In § 199.2, paragraph (b) is amended 

by adding a definition for ‘‘CAHs’’ in 

alphabetical order to read as follows: 

§ 199.2 Definitions. 

* * * * * 

(b) * * * 

CAHs. A small facility that provides 

limited inpatient and outpatient 

hospital services primarily in rural areas 

and meets the applicable requirements 

established by § 199.6(b)(4)(xvi). 

* * * * * 

■ 3. Section 199.6 is amended by adding 

new paragraph (b)(4)(xvi). 

§ 199.6 TRICARE—authorized providers. 

(b) * * * 

(4) * * * 

(xvi) CAHs. CAHs must meet all 

conditions of participation under 42 

CFR 485.601 through 485.645 in relation 

to TRICARE beneficiaries in order to 

receive payment under the TRICARE 

program. If a CAH provides inpatient 

psychiatric services or inpatient 

rehabilitation services in a distinct part 

unit, these distinct part units must meet 

the conditions of participation in 42 

CFR 485.647, with the exception of 

being paid under the inpatient 

prospective payment system for 

psychiatric facilities as specified in 42 

CFR 412.1(a)(2) or the inpatient 

prospective payment system for 

rehabilitation hospitals or rehabilitation 

units as specified in 42 CFR 412(a)(3). 

* * * * * 

■ 4. Section 199.14 is amended by: 

■ a. Redesignating paragraphs (a)(3) 

through (a)(5) as (a)(4) through (a)(6), 

respectively; 

■ b. Revising newly redesignated 

paragraph (a)(4) introductory text and 

the first sentence of paragraph (d)(1); 

and 

■ c. Adding new paragraphs 

(a)(1)(ii)(D)(10), (a)(3), and (a)(6)(iii) and 

(iv). 

The revisions and additions read as 

follows: 

§ 199.14 Provider reimbursement 

methods. 

(a) * * * 

(1) * * * 

(ii) * * * 

(D) * * * 

(10) CAHs. Effective December 1, 

2009, any facility which has been 

designated and certified as a CAH as 

contained in 42 CFR Part 485.606 is 

exempt from the CHAMPUS DRG-based 

payment system. 

* * * * * 

(3) Reimbursement for inpatient 

services provided by a CAH. For 

admissions on or after December 1, 

2009, inpatient services provided by a 

CAH, other than services provided in 

psychiatric and rehabilitation distinct 

part units, shall be reimbursed at 101 

percent of reasonable cost. This does not 

include any costs of physician services 

or other professional services provided 

to CAH inpatients. Inpatient services 

provided in psychiatric distinct part 

units would be subject to the 

CHAMPUS mental health per diem 

payment system. Inpatient services 

provided in rehabilitation distinct part 

units would be subject to billed charges 

or set rates. 

(4) Billed charges and set rates. The 

allowable costs for authorized care in all 

hospitals not subject to the CHAMPUS 

Diagnosis Related Group-based payment 

system, the CHAMPUS mental health 

per diem system, or the reasonable cost 

method for CAHs, shall be determined 

on the basis of billed charges or set 

rates. Under this procedure the 

allowable costs may not exceed the 

lower of: 

* * * * * 

(6) * * * 

(iii) Outpatient Services Subject to 

CAH Reasonable Cost Method. For 

services on or after December 1, 2009, 

outpatient services provided by a CAH, 

shall be reimbursed at 101 percent of 

reasonable cost. This does not include 

any costs of physician services or other 

professional services provided to CAH 

outpatients. 

(iv) CAH Ambulance Services. 

Effective for services provided on or 

after December 1, 2009, payment for 

ambulance services furnished by a CAH 

or an entity that is owned and operated 

by a CAH is the reasonable costs of the 

CAH or the entity in furnishing those 

services, but only if the CAH or the 

entity is the only provider or supplier of 

ambulance services located within a 35- 

mile drive of the CAH or the entity as 

specified under 42 CFR part 

413.70(b)(5)(ii). 

* * * * * 

(d) * * * 

(1) In general. CHAMPUS pays 

institutional facility costs for 

ambulatory surgery on the basis of 

prospectively determined amounts, as 

provided in this paragraph, with the 

exception of ambulatory surgery 

procedures performed in hospital 

outpatient departments or in CAHs, 

which are to be reimbursed in 

accordance with the provisions of 

paragraph (a)(6)(ii) or (a)(6)(iii) 

respectively, of this section. * * * 

* * * * * 

Dated: August 21, 2009. 

Patricia L. Toppings, 

OSD Federal Register Liaison Officer, 

Department of Defense. 

[FR Doc. E9–20682 Filed 8–28–09; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF HOMELAND 

SECURITY 

Coast Guard 

33 CFR Part 165 

[Docket No. USCG–2009–0646] 

RIN 1625–AA00 

Safety Zone; Upper Mississippi River, 

Mile 427.2 to 427.6, Keithsburg, IL 

AGENCY: Coast Guard, DHS. 

ACTION: Temporary final rule. 

SUMMARY: The Coast Guard is 

establishing a temporary safety zone for 

all waters of the Upper Mississippi 

River, mile 427.2 to 427.6, extending the 

entire width of the river near 

Keithsburg, Illinois. This safety zone is 

needed to protect persons and vessels 

from safety hazards associated with a 

fireworks display occurring over a 

portion of the Upper Mississippi River. 

Entry into this zone is prohibited unless 

specifically authorized by the Captain of 

the Port Upper Mississippi River or a 

designated representative. 

DATES: This rule is effective from 8 p.m. 

until 10:30 p.m. CDT on September 5, 

2009. 

ADDRESSES: Documents indicated in this 

preamble as being available in the 


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44756 Federal Register / Vol. 74, No. 167 / Monday, August 31, 2009 / Rules and Regulations 

docket are part of docket USCG–2009– 

0646 and are available online by going 

to http://www.regulations.gov, inserting 

USCG–2009–0646 in the ’’Keyword’’ 

box, and then clicking ‘‘Search.’’ They 

are also available for inspection or 

copying at the Docket Management 

Facility (M–30), U.S. Department of 

Transportation, West Building Ground 

Floor, Room W12–140, 1200 New Jersey 

Avenue SE., Washington, DC 20590, 

between 9 a.m. and 5 p.m., Monday 

through Friday, except Federal holidays. 

FOR FURTHER INFORMATION CONTACT: If 

you have questions on this temporary 

rule, call or e-mail Lieutenant 

Commander (LCDR) Matthew Barker, 

Sector Upper Mississippi River 

Response Department at telephone (314) 

269–2540, e-mail 

Matthew.P.Barker@uscg.mil. If you have 

questions on viewing the docket, call 

Renee V. Wright, Program Manager, 

Docket Operations, telephone 202–366– 

9826. 

SUPPLEMENTARY INFORMATION: 

Regulatory Information 

The Coast Guard is issuing this 

temporary final rule without prior 

notice and opportunity to comment 

pursuant to authority under section 4(a) 

of the Administrative Procedure Act 

(APA) (5 U.S.C. 553(b)). This provision 

authorizes an agency to issue a rule 

without prior notice and opportunity to 

comment when the agency for good 

cause finds that those procedures are 

‘‘impracticable, unnecessary, or contrary 

to the public interest.’’ Under 5 U.S.C. 

553(b)(B), the Coast Guard finds that 

good cause exists for not publishing a 

notice of proposed rulemaking (NPRM) 

because doing so and delaying the rule’s 

effective date would be contrary to 

public interest. Immediate action is 

needed to protect vessels and mariners 

from the safety hazards associated with 

a fireworks display. 

For the same reasons, the Coast Guard 

also finds under 5 U.S.C. 553(d)(3) that 

good cause exists for making this rule 

effective less than 30 days after 

publication in the Federal Register. 

Background and Purpose 

On September 5, 2009, the City of 

Keithsburg, Illinois will be conducting a 

land based fireworks show between 

mile 427.2 and 427.6 on the Upper 

Mississippi River. This event presents 

safety hazards to the navigation of 

vessels between mile 427.2 and 427.6, 

extending the entire width of the river. 

The Captain of the Port Upper 

Mississippi River will inform the public 

of all safety zone changes through 

broadcast notice to mariners. 

Discussion of Rule 

The Coast Guard is establishing a 

safety zone for all waters of the Upper 

Mississippi River, mile 427.2 to 427.6, 

extending the entire width of the river. 

Entry into this zone is prohibited to all 

vessels and persons except participants 

and those persons and vessels 

specifically authorized by the Captain of 

the Port Upper Mississippi River. This 

rule is effective from 8 p.m. until 10:30 

p.m. CDT on September 5, 2009. The 

Captain of the Port Upper Mississippi 

River will inform the public through 

broadcast notice to mariners of all safety 

zone changes and enforcement periods. 

Regulatory Analyses 

We developed this rule after 

considering numerous statutes and 

executive orders related to rulemaking. 

Below we summarize our analyses 

based on 13 of these statutes or 

executive orders. 

Regulatory Planning and Review 

This rule is not a significant 

regulatory action under section 3(f) of 

Executive Order 12866, Regulatory 

Planning and Review, and does not 

require an assessment of potential costs 

and benefits under section 6(a)(3) of that 

Order. The Office of Management and 

Budget has not reviewed it under that 

Order. This safety zone is expected to 

have minimal economic impact because 

of its small size and short duration. 

Small Entities 

Under the Regulatory Flexibility Act 

(5 U.S.C. 601–612), we have considered 

whether this rule would have a 

significant economic impact on a 

substantial number of small entities. 

The term ‘‘small entities’’ comprises 

small businesses, not-for-profit 

organizations that are independently 

owned and operated and are not 

dominant in their fields, and 

governmental jurisdictions with 

populations of less than 50,000. 

The Coast Guard certifies under 5 

U.S.C. 605(b) that this rule will not have 

a significant economic impact on a 

substantial number of small entities. 

This rule will affect the following 

entities, some of which may be small 

entities: The owners or operators of 

vessels intending to transit the Upper 

Mississippi River, mile 427.2 to 427.6 

between 8 p.m. and 10:30 p.m. CDT on 

September 5. This safety zone will not 

have a significant economic impact on 

a substantial number of small entities 

because the zone covers a small area 

and will only be in effect for a short 

period of time. In addition, notifications 

to the marine community will be made 

through broadcast notice to mariners 

and the River Industry Bulletin Board 

(RIBB) at http://www.ribb.com. 

If you are a small business entity and 

are significantly effected by this 

regulation, please contact LCDR 

Matthew Barker, Sector Upper 

Mississippi River at (314) 269–2540. 

Assistance for Small Entities 

Under section 213(a) of the Small 

Business Regulatory Enforcement 

Fairness Act of 1996 (Pub. L. 104–121), 

we offer to assist small entities in 

understanding the rule so they could 

better evaluate its effects on them and 

participate in the rulemaking process. 

Small businesses may send comments 

on the actions of Federal employees 

who enforce, or otherwise determine 

compliance with, Federal regulations to 

the Small Business and Agriculture 

Regulatory Enforcement Ombudsman 

and the Regional Small Business 

Regulatory Fairness Boards. The 

Ombudsman evaluates these actions 

annually and rates each agency’s 

responsiveness to small businesses. If 

you wish to comment on actions by 

employees of the Coast Guard, call 1– 

888–REG–FAIR (1–888–734–3247). The 

Coast Guard will not retaliate against 

small entities that question or complain 

about this rule or any policy or action 

of the Coast Guard. 

Collection of Information 

This rule calls for no new collection 

of information under the Paperwork 

Reduction Act of 1995 (44 U.S.C. 3501– 

3520). 

Federalism 

A rule has implications for federalism 

under Executive Order 13132, 

Federalism, if it has a substantial direct 

effect on State or local governments and 

would either preempt State law or 

impose a substantial direct cost of 

compliance on them. We have analyzed 

this rule under that Order and have 

determined that it does not have 

implications for federalism. 

Unfunded Mandates Reform Act 

The Unfunded Mandates Reform Act 

of 1995 (2 U.S.C. 1531–1538) requires 

Federal agencies to assess the effects of 

their discretionary regulatory actions. In 

particular, the Act addresses actions 

that may result in the expenditure by a 

State, local, or tribal government, in the 

aggregate, or by the private sector of 

$100,000,000 or more in any one year. 

Though this rule will not result in such 

an expenditure, we do discuss the 

effects of this rule elsewhere in this 

preamble. 


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Federal Register / Vol. 74, No. 167 / Monday, August 31, 2009 / Rules and Regulations 44757 

Taking of Private Property 

This rule will not effect a taking of 

private property or otherwise have 

taking implications under Executive 

Order 12630, Governmental Actions and 

Interference with Constitutionally 

Protected Property Rights. 

Civil Justice Reform 

This rule meets applicable standards 

in sections 3(a) and 3(b)(2) of Executive 

Order 12988, Civil Justice Reform, to 

minimize litigation, eliminate 

ambiguity, and reduce burden. 

Protection of Children 

We have analyzed this rule under 

Executive Order 13045, Protection of 

Children from Environmental Health 

Risks and Safety Risks. This rule is not 

an economically significant rule and 

does not create an environmental risk to 

health or risk to safety that may 

disproportionately affect children. 

Indian Tribal Governments 

This rule does not have tribal 

implications under Executive Order 

13175, Consultation and Coordination 

with Indian Tribal Governments, 

because it does not have a substantial 

direct effect on one or more Indian 

tribes, on the relationship between the 

Federal Government and Indian tribes, 

or on the distribution of power and 

responsibilities between the Federal 

Government and Indian tribes. 

Energy Effects 

We have analyzed this rule under 

Executive Order 13211, Actions 

Concerning Regulations That 

Significantly Affect Energy Supply, 

Distribution, or Use. We have 

determined that it is not a ‘‘significant 

energy action’’ under that Order because 

it is not a ‘‘significant regulatory action’’ 

under Executive Order 12866 and is not 

likely to have a significant adverse effect 

on the supply, distribution, or use of 

energy. The Administrator of the Office 

of Information and Regulatory Affairs 

has not designated it as a significant 

energy action. Therefore, it does not 

require a Statement of Energy Effects 

under Executive Order 13211. 

Technical Standards 

The National Technology Transfer 

and Advancement Act (NTTAA) (15 

U.S.C. 272 note) directs agencies to use 

voluntary consensus standards in their 

regulatory activities unless the agency 

provides Congress, through the Office of 

Management and Budget, with an 

explanation of why using these 

standards would be inconsistent with 

applicable law or otherwise impractical. 

Voluntary consensus standards are 

technical standards (e.g., specifications 

of materials, performance, design, or 

operation; test methods; sampling 

procedures; and related management 

systems practices) that are developed or 

adopted by voluntary consensus 

standards bodies. 

This rule does not use technical 

standards. Therefore, we did not 

consider the use of voluntary consensus 

standards. 

Environment 

We have analyzed this rule under 

Department of Homeland Security 

Management Directive 023–01 and 

Commandant Instruction M16475.lD, 

which guides the Coast Guard in 

complying with the National 

Environmental Policy Act of 1969 

(NEPA) (42 U.S.C. 4321–4370f), and 

have concluded this action is one of a 

category of actions which do not 

individually or cumulatively have a 

significant effect on the human 

environment. This rule is categorically 

excluded, under figure 2–1, paragraph 

(34)(g), of the Instruction, because the 

rule establishes a safety zone. 

An environmental analysis checklist 

and a categorical exclusion 

determination are available in the 

docket where indicated under 

ADDRESSES. 

List of Subjects in 33 CFR Part 165 

Harbors, Marine safety, Navigation 

(water), Reporting and recordkeeping 

requirements, Security measures, 

Waterways. 

■ For the reasons discussed in the 

preamble, the Coast Guard amends 33 

CFR Part 165 as follows: 

PART 165—REGULATED NAVIGATION 

AREAS AND LIMITED ACCESS AREAS 

■ 1. The authority citation for part 165 

continues to read as follows: 

Authority: 33 U.S.C. 1226, 1231; 46 U.S.C. 

Chapter 701, 3306, 3703; 50 U.S.C. 191, 195; 

33 CFR 1.05–1, 6.04–1, 6.04–6, and 160.5; 

Pub. L. 107–295, 116 Stat. 2064; Department 

of Homeland Security Delegation No. 0170.1. 

■ 2. Add temporary § 165.T09–0646 to 

read as follows: 

§ 165.T09–0646 Safety Zone; Upper 

Mississippi River, Mile 427.2 to 427.6. 

(a) Location. The following area is a 

safety zone: All waters of the Upper 

Mississippi River, from surface to 

bottom and from Mile 427.2 to 427.6 

extending the entire width of the 

waterway. 

(b) Effective date. This rule is effective 

from 8 p.m. until 10:30 p.m. CDT on 

September 5, 2009. 

(c) Periods of Enforcement. This rule 

is effective from 8 p.m. until 10:30 p.m. 

CDT on September 5, 2009. The Captain 

of the Port Upper Mississippi River will 

inform the public through broadcast 

notice to mariners of all safety zone 

changes and enforcement periods. 

(d) Regulations. (1) In accordance 

with the general regulations in § 165.23 

of this part, entry into this zone is 

prohibited unless authorized by the 

Captain of the Port Upper Mississippi 

River or a designated representative. 

(2) Persons or vessels requiring entry 

into or passage through the zone must 

request permission from the Captain of 

the Port Upper Mississippi River or a 

designated representative. The Captain 

of the Port Upper Mississippi River 

representative may be contacted at (314) 

269–2332. 

(3) All persons and vessels must 

comply with the instructions of the 

Captain of the Port Upper Mississippi 

River or a designated representative. 

Designated Captain of the Port 

representatives include United States 

Coast Guard commissioned, warrant, 

and petty officers of the U.S. Coast 

Guard. 

Dated: July 17, 2009. 

S.L. Hudson, 

Captain, U.S. Coast Guard, Captain of the 

Port Upper Mississippi River. 

[FR Doc. E9–20861 Filed 8–28–09; 8:45 am] 

BILLING CODE 4910–15–P 

POSTAL REGULATORY COMMISSION 

39 CFR Part 3020 

[Docket Nos. MC2009–35 and CP2009–54; 

Order No. 277] 

Priority Mail Contract 

AGENCY: Postal Regulatory Commission. 

ACTION: Final rule. 

SUMMARY: The Commission is adding 

the Priority Mail Contract 15 to the 

Competitive Product List. This action is 

consistent with changes in a recent law 

governing postal operations. 

Republication of the lists of market 

dominant and competitive products is 

also consistent with new requirements 

in the law. 

DATES: Effective August 31, 2009 and is 

applicable beginning August 14, 2009. 

FOR FURTHER INFORMATION CONTACT: 

Stephen L. Sharfman, General Counsel, 

at 202–789–6820 or 

stephen.sharfman@prc.gov. 

SUPPLEMENTARY INFORMATION: Regulatory 

History, 74 FR 39121 (August 5, 2009). 

I. Introduction 

II. Background 

III. Comments 


sroberts on DSKD5P82C1PROD with RULES