52014 Federal Register / Vol. 71, No. 170 / Friday, September 1, 2006 / Proposed Rules 

review of any determination made by 

FCIC may be brought. 

Environmental Evaluation 

This action is not expected to have a 

significant economic impact on the 

quality of the human environment, 

health, and safety. Therefore, neither an 

Environmental Assessment nor an 

Environmental Impact Statement is 

needed. 

Background 

FCIC proposes to amend 7 CFR part 

457 (Common Crop Insurance 

Regulations) by revising 7 CFR 457.162 

(Nursery Crop Insurance Provisions) 

and 7 CFR 457.163 (Nursery Peak 

Inventory Endorsement). The provisions 

will be effective for the 2008 and 

succeeding crop years. The changes to 

the provisions for insuring nursery 

production are as follows: 

Section 457.162 Nursery Crop 

Insurance Provisions 

Section 1—FCIC is proposing to 

amend the definition of ‘‘liners’’ to 

remove language that specifies an 

established root system for a liner plant 

must reach the sides of the container 

and to remove language regarding the 

firm root ball. This change is necessary 

because liners are also known as starter 

plants, which often have not developed 

a root system that reaches the sides of 

the containers. While no one 

commented on this when the provisions 

regarding liners were first proposed, 

RMA has since received complaints 

from the nursery industry advising the 

cited language is agronomically 

incorrect and could adversely affect 

insurability of liners. By the time most 

liners have reached the point where the 

root system reaches the side of the 

container, they have already been sold 

or are ready to be sold. Therefore, 

without this change, most liners would 

be uninsurable while they are in the 

nursery and during the period of 

greatest risk of loss. 

7 CFR 457.163 Nursery Peak Inventory 

Endorsement 

Section 7—FCIC is proposing to 

amend provisions to clarify that the 

maximum increase in the amount of 

insurance under the Nursery Peak 

Inventory Endorsement is limited to 

twice the amount of insurance under the 

Nursery Crop Insurance Provisions. As 

stated, the peak amount of insurance is 

limited to 200 percent of the basic unit 

value. This means that if a basic unit 

value is $50 and the producer had 50 

percent coverage, the amount of 

insurance would be $25. Under the 

current language, the producer could 

increase the peak amount of insurance 

to $100 (200 percent of $50 basic unit 

value), which is a four fold increase in 

liability. FCIC never intended to allow 

more than a two fold increase in 

liability because to allow a larger 

increase could encourage insureds to 

carry minimum year-round coverage 

and maximize coverage under Peak 

Inventory Endorsement during high-risk 

periods. This could adversely affect 

indemnities paid and amount of 

premium owed to maintain an 

actuarially sound program. 

List of Subjects in 7 CFR Part 457 

Crop insurance, Nursery, Reporting 

and recordkeeping requirements. 

Accordingly, as set forth in the 

preamble, the Federal Crop Insurance 

Corporation proposes to amend 7 CFR 

part 457 the Common Crop Insurance 

Regulations effective for the 2008 and 

succeeding crop years, to read as 

follows: 

PART 457—COMMON CROP 

INSURANCE REGULATIONS 

1. The authority citation for 7 CFR 

part 457 continues to read as follows: 

Authority: 7 U.S.C. 1506(l), 1506(p). 

2. Revise the definition of ‘‘liners’’ in 

paragraph 1 of § 457.162 to read as 

follows: 

§ 457.162 Nursery crop insurance 

provisions. 

* * * * * 

1. Definitions. 

* * * * * 

Liners. Plants produced in standard 

nursery containers that are equal to or 

greater than 1 inch in diameter 

(including trays containing 200 or fewer 

individual cells, unless specifically 

provided by the Special Provisions) but 

less than 3 inches in diameter at the 

widest point of the container or cell 

interior, have an established root 

system, and meet all other conditions 

specified in the Special Provisions. 

* * * * * 

3. Amend paragraph 7 of § 457.163 to 

read as follows: 

§ 457.163 Nursery peak inventory 

endorsement. 

* * * * * 

7. Liability Limit. 

The peak amount of insurance is 

limited to 200 percent of the amount of 

insurance established under the Nursery 

Crop Insurance Provisions. 

Signed in Washington, DC, on August 21, 

2006. 

Eldon Gould, 

Manager, Federal Crop Insurance 

Corporation. 

[FR Doc. E6–14364 Filed 8–31–06; 8:45 am] 

BILLING CODE 3410–08–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

42 CFR Part 422 

[CMS–4121–P] 

RIN 0938–AO54 

Medicare Program; Prohibition of 

Midyear Benefit Enhancements for 

Medicare Advantage Organizations 

Offering Plans in Calendar Year 2007 

and Subsequent Calendar Years 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Proposed rule. 

SUMMARY: This proposed rule would 

prohibit Medicare Advantage (MAs) 

organizations, including organizations 

offering employer/union group health 

plans (EGHPs) (that is, plans that enroll 

both beneficiaries and employer/union 

members (plans open to general 

enrollment) and plans that are not open 

to general enrollment), from making 

midyear changes to nondrug benefits, 

premiums, and cost-sharing submitted 

in their approved bids for a given 

contract year. Programs of all-inclusive 

care for elderly (PACE) would not be 

subject to the provisions of this 

proposed rule and could continue to 

offer enhanced benefits as specified in 

our guidance for PACE plans. 

DATES: To be assured consideration, 

comments must be received at one of 

the addresses provided below, no later 

than 5 p.m. on October 31, 2006. 

ADDRESSES: In commenting, please refer 

to file code CMS–4121–P. Because of 

staff and resource limitations, we cannot 

accept comments by facsimile (FAX) 

transmission. 

You may submit comments in one of 

four ways (no duplicates, please): 

1. Electronically. You may submit 

electronic comments on specific issues 

in this regulation to http:// 

www.cms.hhs.gov/eRulemaking. Click 

on the link ‘‘Submit electronic 

comments on CMS regulations with an 

open comment period.’’ (Attachments 

should be in Microsoft Word, 

WordPerfect, or Excel; however, we 

prefer Microsoft Word.) 


sroberts on PROD1PC70 with PROPOSALS
Federal Register / Vol. 71, No. 170 / Friday, September 1, 2006 / Proposed Rules 52015 

2. By regular mail. You may mail 

written comments (one original and two 

copies) to the following address only: 

Centers for Medicare & Medicaid 

Services, Department of Health and 

Human Services, Attention: CMS–4121–

P, P.O. Box 1850, 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 (one 

original and two copies) to the following 

address only: Centers for Medicare & 

Medicaid Services, Department of 

Health and Human Services, Attention: 

CMS–4121–P, Mail Stop C4–26–05, 

7500 Security Boulevard, Baltimore, MD 

21244–1850. 

4. By hand or courier. If you prefer, 

you may deliver (by hand or courier) 

your written comments (one original 

and two copies) before the close of the 

comment period to one of the following 

addresses. If you intend to deliver your 

comments to the Baltimore address, 

please call telephone number (410) 786–

9994 in advance to schedule your 

arrival with one of our staff members. 

Room 445–G, Hubert H. Humphrey 

Building, 200 Independence Avenue, 

SW., Washington, DC 20201; or 7500 

Security Boulevard, Baltimore, MD 

21244–1850. 

(Because access to the interior of the 

HHH Building is not readily available to 

persons without Federal Government 

identification, commenters are 

encouraged to leave their comments in 

the CMS drop slots located in the main 

lobby of the building. A stamp-in clock 

is available for persons wishing to retain 

a proof of filing by stamping in and 

retaining an extra copy of the comments 

being filed.) 

Comments 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. 

SUPPLEMENTARY INFORMATION: 

Submitting Comments: We welcome 

comments from the public on all issues 

set forth in this rule to assist us in fully 

considering issues and developing 

policies. You can assist us by 

referencing the file code CMS–4121–P 

and the specific ‘‘issue identifier’’ that 

precedes the section on which you 

choose to comment. 

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.cms.hhs.gov/ 

eRulemaking. Click on the link 

‘‘Electronic Comments on CMS 

Regulations’’ 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. 

FOR FURTHER INFORMATION CONTACT: 

Christopher McClintick (410) 786–4682. 

I. Background 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘Background’’ at the beginning 

of your comments.] 

Title II of the Medicare Prescription 

Drug, Improvement, and Modernization 

Act of 2003 (MMA) (Pub. L. 108–173) 

made important changes to the 

Medicare+Choice (M+C) program under 

Part C of Medicare and renamed the 

program Medicare Advantage (MA). In 

the August 3, 2004 Federal Register (69 

FR 46866), we published a proposed 

rule that set forth the provisions that 

would implement Title II of the MMA. 

Subsequently, in the January 28, 2005 

Federal Register (70 FR 4588), we 

published a final rule to implement our 

proposals. The changes that MMA made 

to the MA program—

• Provided for regional plans that 

have made private plan options 

available to many more beneficiaries, 

especially those in rural areas. 

• Expanded the number and type of 

plans provided for, so that more 

beneficiaries can choose from Health 

Maintenance Organizations (HMOs), 

Preferred Provider Organization (PPO) 

plans, and Private Fee-for-Service (FFS) 

plans, and further authorized Medical 

Savings Account (MSA) plans, if 

available where the beneficiary lives. 

• Enriched the range of benefit 

choices available to enrollees including 

improved prescription drug benefits 

under the new Medicare Part D. 

• Provided incentives to contracting 

health plans to create specialized plans 

to coordinate and manage care in ways 

that comprehensively serve those with 

complex and disabling diseases and 

conditions. 

• Used competition among MA plans 

to improve service, improve benefits, 

invest in preventive care, and hold costs 

down in ways that attract enrollees. 

• Enhanced and stabilized payments 

to contracting organizations, improved 

program design, introduced new 

flexibility for plans, and reduced 

impediments to plan participation. 

• Advanced the goal of improving 

quality and increasing efficiency in the 

overall health care system. 

Over time, organizations offering MA 

plans will be under continued 

competitive pressure to improve 

benefits, reduce premiums and cost 

sharing, and improve networks and 

services in order to gain or retain 

enrollees. In addition, we expect MA 

organizations offering plans to use 

integrated health plan approaches such 

as disease prevention, disease 

management, and other care 

coordination techniques. In doing so, 

integrated plans that combine the 

original Parts A and B of Medicare and 

the new Part D drug benefit and apply 

these innovative techniques must pass 

on savings that may result from these 

care coordination techniques to the 

enrollee through reduced premiums or 

additional benefits. 

In conjunction with the new Part D 

drug benefit required under Title I of 

MMA, which was finalized in the 

January 28, 2005 Federal Register (70 

FR 4194), changes made in the MMA to 

the MA program are intended to bring 

about broad-based improvements to the 

Medicare program’s benefit structure, 

including improved prescription drug 

coverage under the MA program. 

Organizations offering local and 

regional coordinated care MA plans 

must offer at least one plan with the 

Medicare prescription drug benefit or an 

actuarially equivalent drug benefit. 

Beginning in 2006, payments for local 

and regional MA plans are based on 

amounts submitted in bids rather than 

on a statutory formula. MA 

organizations offering health plans 

submit an annual aggregate bid amount 

for each MA plan. An aggregate plan bid 

is based upon the MA organization’s 

determination of expected costs in the 

plan’s service area for the national 

average beneficiary for providing 

nondrug benefits (that is, original 

Medicare (Part A and Part B) benefits), 

Part D basic prescription drugs, and 

supplemental benefits (including 

reductions in cost sharing). For an MA 

plan’s coverage of original Medicare 

benefits, our payment to an MA 

organization depends on the 

relationship of the plan’s basic A/B bid 

to a ‘‘benchmark’’ amount determined 

through a statutory formula (for regional 


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52016 Federal Register / Vol. 71, No. 170 / Friday, September 1, 2006 / Proposed Rules 

plans the benchmark is based in part on 

bids submitted in the region). For a plan 

with a basic A/B bid below its 

benchmark, we pay the MA organization 

the basic A/B bid amount, adjusted by 

the individual enrollee’s risk factor, 

plus the rebate amount. (The rebate is 

75 percent of the difference between the 

plan bid and benchmark, and is used to 

provide mandatory supplemental 

benefits or reductions in Part B or Part 

D premiums. The government retains 

the other 25 percent.) For a plan with 

a bid equal to or above its benchmark, 

we pay the MA organization the plan 

benchmark, adjusted by the individual 

enrollee’s risk factor. The MA 

organization is required to charge any 

difference between its bid and the 

benchmark in the form of a premium. 

II. Provisions of the Proposed Rule 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘Provisions of the Proposed 

Regulations’’ at the beginning of your 

comments.] 

In the August 3, 2004 Federal 

Register (69 FR 46866), we proposed to 

prohibit MA organizations from offering 

midyear benefit enhancements (MYBEs) 

that is, enhanced benefits or reductions 

in premiums or cost-sharing amounts 

not specified in the approved bid for the 

calendar year (CY) in question. In 

commenting on the August 3, 2004 

proposed rule, several commenters 

objected to our proposal to eliminate 

MYBEs. These commenters believed 

that we could allow MYBEs without 

affecting the integrity of the bidding 

process. 

In the January 28, 2005 final rule (70 

FR 4639), we noted that under the 

previous M+C program, we permitted 

M+C organizations to offer new plans 

midyear and to offer MYBEs to existing 

benefit packages. In the final rule (70 FR 

4640), we also noted that MYBEs 

‘‘* * * would be a de facto adjustment 

to the benefit packages from which bids 

were submitted earlier in the year.’’ In 

our related final rule (published January 

28, 2005 (70 FR 4301)) implementing 

the Medicare prescription drug benefit 

(Part D regulations), we stated that 

MYBEs ‘‘* * * would be de facto 

acknowledgement that the revenue 

requirements submitted by the plan 

were overstated.’’ We also note that the 

Part D regulations do not permit MYBEs 

under any circumstances. Although we 

acknowledged that MYBEs could 

threaten the integrity of the bidding 

process, in response to comments on the 

August 3, 2004 proposed rule, we 

decided to permit them on an interim 

basis under limited circumstances. 

Therefore, in the January 28, 2005 final 

rule (70 FR 4640), we stated that we 

would permit MYBEs to nondrug 

benefits only under the following 

circumstances: 

• An MYBE can be effective no earlier 

than July 1 of the contract year, and no 

later than September 1 of the contract 

year; 

• MA organizations cannot submit 

MYBE applications later than July 31 of 

the contract year; and 

• Twenty-five percent of the value of 

the MYBE will be retained by the 

government. 

If the MYBE meets the circumstances 

described above, the requesting MA 

organization—

• Must ‘‘submit, for each plan or 

segment, a revised bid and any 

supporting documentation related to the 

enhancement, including information on 

where the revenue requirements were 

overstated in the annual June bid 

submission;’’ and 

• Would be subject to CMS 

consideration of ‘‘whether there is a 

current year MYBE request when 

analyzing a plan’s bid for the following 

year.’’

In the final rule, we exempted the 

program of all-inclusive care for the 

elderly (PACE) plans and employer/ 

union group health plans (EGHPs) that 

are not open to general enrollment (that 

is, both the ‘‘800 series’’ employer-only 

plans and group plans where we 

contract directly with the employer/ 

union offering an MA product, now 

referred to collectively as employer/ 

union-only group waiver plans 

(EGWPs)) from the new restrictions on 

MYBEs. As stated in the final rule (70 

FR 4640), we exempted PACE plans in 

order to promote coordination of Part C 

and Part D benefits with the benefits 

PACE plans are required to offer under 

section 1894 of the Act. In the January 

28, 2005 final rule, we also noted that 

we did not believe that the competitive 

nature of the bidding process was 

affected if benefit packages for PACE 

organizations or EGHPs not open to 

general enrollment were adjusted 

midyear in accordance with our 

guidance. 

In addition, we stated (70 FR 4640) 

that we considered this policy to be an 

interim policy ‘‘for the initial years’’ of 

the competitive bidding system, and 

indicated we would ‘‘review whether 

there is a continuing need for this 

policy.’’ We have reevaluated our MYBE 

policy over the course of the first 

contract year of the new bidding 

process, and believe that there is no 

longer a need for this interim policy. We 

note that this policy was intended to 

assist MA organizations during the 

initial phase of the new bidding process, 

while ensuring that beneficiaries have a 

choice of plans. We believe the focus 

should now be solely on ensuring the 

integrity of the bidding process 

established by statute so that there will 

be an even playing field for 

organizations and, as a result, a choice 

of health plan options for beneficiaries. 

We believe that continuing the 

current MYBE policy would threaten 

the integrity of the competitive bidding 

process established by the MMA. Under 

the bidding process, MA organizations 

compete with one another by submitting 

plan bids that specify the revenue 

requirements for offering the various 

components of their health plans. We 

believe that permitting MYBEs could 

undermine the integrity of the 

competitive bidding process as MA 

organizations, knowing that they could 

alter their benefit packages after the 

bidding process was complete, could 

misrepresent their actual costs to 

provide benefits (overbid) and 

noncompetitively revise their benefit 

packages later in the year. More 

specifically, we believe that MYBEs 

offered in July or September of the 

contract year would be offered in a way 

primarily to attract individuals in their 

initial coverage election period (ICEP). 

We believe that such individuals are 

very attractive to MA organizations 

because of their relatively low 

utilization (they are new to the program 

and tend to be healthier) and because of 

their numbers (nationally, over 100,000 

individuals per month ‘‘age-in’’ to 

Medicare). Additionally, we estimate 

that organizations planning on revising 

their bids through MYBEs could overbid 

by approximately 2–3 percent in order 

to distinguish themselves from other 

plans later in the year and attract ICEP 

beneficiaries. 

Using the MYBE process in this 

manner would undermine the 

competitive nature of the bidding 

process in two ways. First, it would 

encourage overbidding, and second, it 

would penalize MA organizations that 

do not attempt to ‘‘game the system’’

and which instead offer a bid that more 

accurately represents their costs to offer 

benefits over the full course of a 

contract year. 

While it is too early in the MA 

program to quantify the percentage of 

plans that we believe would use MYBEs 

to bolster plans later in the year, we will 

gather data and incorporate our findings 

in our response to public comment, as 

appropriate. We believe, however, that 

allowing MYBEs in 2006 has served its 

purpose to ease the transition to the 

new, more competitive MA program. 

We are equally convinced that our 


sroberts on PROD1PC70 with PROPOSALS
Federal Register / Vol. 71, No. 170 / Friday, September 1, 2006 / Proposed Rules 52017 

primary goal going forward must be to 

ensure, as mandated by statute, that 

plans compete on an even playing field 

and that beneficiaries will gain in terms 

of cost, plan choices, and generosity of 

benefits. We believe we can help 

achieve this goal only if MYBEs are not 

permitted in subsequent years. 

Furthermore with respect to MYBEs, 

we do not believe that nondrug benefits 

should be treated differently than Part D 

benefits. Similarly, with respect to all 

EGHPs including EGWPs, we believe 

that the integrity of the competitive 

bidding process overrides any possible 

program benefit from MYBEs. Therefore 

beginning with CY 2007, we are 

proposing that MA organizations, 

including all organizations offering 

EGHPs, would not be permitted to make 

any midyear changes in benefits, 

premiums, or cost-sharing, even under 

the circumstances in which these types 

of changes were permitted in CY 2006. 

This includes EGHPs that enroll both 

beneficiaries and employer/union 

members (in other words plans open to 

general enrollment) and plans not open 

to general enrollment. We note that 

programs of all-inclusive care for the 

elderly (PACE) would be able to 

continue to offer MYBEs in accordance 

with our guidance for PACE plans. 

III. Response to Comments 

Because of the large number of items 

of correspondence we normally receive 

on Federal Register documents 

published for comment, we are not able 

to acknowledge or respond to them 

individually. 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. 

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. 

V. Regulatory Impact Statement 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘Regulatory Impact Statement’’

at the beginning of your comments.] 

We have examined the impact of this 

rule as required by Executive Order 

12866 (September 1993, Regulatory 

Planning and Review), the Regulatory 

Flexibility Act (RFA) (September 19, 

1980, Pub. L. 96–354), section 1102(b) of 

the Social Security Act, the Unfunded 

Mandates Reform Act of 1995 (Pub. L. 

104–4), and Executive Order 13132. 

Executive Order 12866 directs 

agencies to assess all costs and benefits 

of available regulatory alternatives and, 

if regulation is necessary, to select 

regulatory approaches that maximize 

net benefits (including potential 

economic, environmental, public health 

and safety effects, distributive impacts, 

and equity). A regulatory impact 

analysis (RIA) must be prepared for 

major rules with economically 

significant effects ($100 million or more 

in any 1 year). This rule does not reach 

the economic threshold and thus is not 

considered a major rule. However, we 

are requesting comments regarding the 

possible impact of our proposal to 

prohibit MYBEs. 

The RFA requires agencies to analyze 

options for regulatory relief of small 

businesses. For purposes of the RFA, 

small entities include small businesses, 

nonprofit organizations, and small 

governmental jurisdictions. Most 

hospitals and most other providers and 

suppliers are small entities, either by 

nonprofit status or by having revenues 

of $6 million to $29 million in any 1 

year. Individuals and States are not 

included in the definition of a small 

entity. The MA program, by having both 

regional and local plans, provides an 

opportunity for health insurance entities 

of all types and most sizes (but probably 

not below the ‘‘small’’ insurance entity 

cutoff level defined by the SBA ($6 

million), which is lower than appears 

viable for a comprehensive, risk-bearing 

insurance plan) to participate. 

Therefore, we are not preparing an 

analysis for the RFA because we have 

determined that this rule will not have 

a significant economic impact on a 

substantial number of small entities. 

In addition, section 1102(b) of the Act 

requires us to prepare a regulatory 

impact analysis if a rule may have a 

significant impact on the operations of 

a substantial number of small rural 

hospitals. This analysis must conform to 

the provisions of section 603 of the 

RFA. For purposes of section 1102(b) of 

the Act, we define a small rural hospital 

as a hospital that is located outside of 

a Metropolitan Statistical Area and has 

fewer than 100 beds. We are not 

preparing an analysis for section 1102(b) 

of the Act because we have determined 

that this rule will not have a significant 

impact on the operations of a substantial 

number of small rural hospitals. 

Section 202 of the Unfunded 

Mandates Reform Act of 1995 also 

requires that agencies assess anticipated 

costs and benefits before issuing any 

rule whose mandates require spending 

in any 1 year of $100 million in 1995 

dollars, updated annually for inflation. 

That threshold level is currently 

approximately $120 million. This rule 

will have no consequential effect on 

State, local, or tribal governments or on 

the private sector. 

Executive Order 13132 establishes 

certain requirements that an agency 

must meet when it promulgates a 

proposed rule (and subsequent final 

rule) that imposes substantial direct 

requirement costs on State and local 

governments, preempts State law, or 

otherwise has Federalism implications. 

Since this regulation does not impose 

any costs on State or local governments, 

the requirements of E.O. 13132 are not 

applicable. 

In accordance with the provisions of 

Executive Order 12866, this regulation 

was reviewed by the Office of 

Management and Budget. 

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare—Hospital 

Insurance; and Program No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program) 

Dated: May 5, 2006. 

Mark B. McClellan, 

Administrator, Centers for Medicare & 

Medicaid Services. 

Approved: June 12, 2006. 

Michael O. Leavitt, 

Secretary. 

[FR Doc. 06–7394 Filed 8–31–06; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF TRANSPORTATION 

Pipeline and Hazardous Materials 

Safety Administration 

49 CFR Parts 171, 172, 173, 174, and 

178 

[Docket No. PHMSA–06–25736 (HM–231)] 

RIN 2137–AD89 

Hazardous Material; Miscellaneous 

Packaging Amendments 

AGENCY: Pipeline and Hazardous 

Materials Safety Administration 

(PHMSA), DOT. 

ACTION: Notice of proposed rulemaking 

(NPRM). 

SUMMARY: In this NPRM, PHMSA is 

proposing to make miscellaneous 

amendments to the Hazardous Materials 

Regulations (HMR) based on changes to 

packaging requirements in the United 

Nations Recommendations on the 

Transport of Dangerous Goods, petitions 

for rulemaking received in accordance 

with requirements specified in 49 CFR 


sroberts on PROD1PC70 with PROPOSALS