Federal Register / Vol. 79, No. 211 / Friday, October 31, 2014 / Notices 64801 

Mauritania, Mali, Senegal, Guinea 

Bissau, Ghana, Gambia, Cote d’Ivoire, 

Togo, Benin, Burkina Faso, Niger and 

Nigeria to support the responses of the 

CDC to the outbreak of Ebola virus in 

West Africa. This funding will enable 

the U.S. to provide unified mobilization 

to address a crisis of this magnitude. 

CDC will continue to build partnerships 

and strengthen existing projects to 

respond to Ebola. CDC and its partners 

will help to address the need for 

surveillance, detection, coordination, 

response, and increase eligible 

governments’ capacity to respond to the 

Ebola outbreak. 

Award Information 

Type of Award: Cooperative 

Agreement. 

Approximate Total Current Fiscal 

Year Funding: $10,000,000. 

Anticipated Number of Awards: 

Multiple. 

Fiscal Year Funds: 2015. 

Anticipated Award Date: December 

11, 2014. 

Application Selection Process: 

Funding will be awarded to applicant 

based on results from the technical 

review recommendation. 

Dated: October 28, 2014. 

Ron A. Otten, 

Acting Deputy Associate Director for Science, 

Centers for Disease Control and Prevention. 

[FR Doc. 2014–25920 Filed 10–28–14; 11:15 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–1615–FN] 

Medicare Program; Approval of 

Request for an Exception to the 

Prohibition on Expansion of Facility 

Capacity Under the Hospital 

Ownership and Rural Provider 

Exceptions to the Physician SelfReferral Prohibition 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Final notice. 

SUMMARY: This final notice announces 

our decision to approve the request from 

Lake Pointe Medical Center for an 

exception to the prohibition against 

expansion of facility capacity. 

DATES: Effective Date: This notice is 

effective on October 31, 2014. 

FOR FURTHER INFORMATION CONTACT: 

Patricia Taft, (410) 786–4561 or Teresa 

Walden, (410) 786–3755. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Unless the requirements of an 

applicable exception are satisfied, 

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); and (2) prohibits the 

entity from filing claims with Medicare 

(or billing any individual, third party 

payer, or other entity) 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 

facility expansion 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. 

Section 1877(i)(3)(H) of the Act states 

that the Secretary shall publish in the 

Federal Register the final decision with 

respect to an application for an 

exception to the prohibition against 

facility expansion not later than 60 days 

after receiving a complete application. 

For further information on the 

physician-owned hospital expansion 

exception process, visit our Web site at: 

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

Physician_Owned_Hospitals.html. 

II. Exception Approval 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 care programs, we noted 

that these were examples only and that 

we would 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 


asabaliauskas on DSK5VPTVN1PROD with NOTICES
64802 Federal Register / Vol. 79, No. 211 / Friday, October 31, 2014 / Notices 

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. Public Response to Notice With 

Comment Period 

On May 12, 2014, we published a 

notice in the Federal Register (79 FR 

26969) entitled, 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. In the May 12, 

2014 notice we stated that as permitted 

by section 1877(i)(3) of the Act and our 

regulations at § 411.362(c), the following 

physician-owned hospital 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. 

In the May 12, 2014 notice we also 

solicited comments from individuals 

and entities in the community in which 

Lake Pointe Medical Center is located. 

Eighty-four comments were submitted 

under docket number for the notice 

(CMS–2014–0061). Eighty-three of those 

comments advocated that a different 

physician-owned hospital in another 

county be allowed to expand under the 

expansion exception process. Those 

comments were not relevant to the Lake 

Pointe Medical Center request, and we 

have not considered them in deciding 

the request. The only remaining 

comment urged CMS to evaluate 

whether Lake Pointe Medical Center is 

a ‘‘high Medicaid facility’’ using data 

that our regulations do not permit us to 

consider. 

On August 4, 2014, as required by 

§ 411.362(c)(5)(ii), we notified Lake 

Pointe Medical Center that we received 

comments in response to the May 12, 

2014 notice and that these comments 

were available for public viewing at 

http://www.regulations.gov. Lake Pointe 

Medical Center submitted a rebuttal 

statement on August 13, 2014. The 

statement indicated that the comments 

raised no issues of law or fact that in 

any way contradict Lake Pointe Medical 

Center’s assertion that it meets all of the 

statutory and regulatory requirements to 

qualify as a high Medicaid facility. On 

September 3, 2014, at the close of the 

30-day rebuttal period, CMS deemed the 

request complete pursuant to 

§ 411.362(c)(5)(ii). 

IV. Decision 

This final notice announces our 

decision to approve the request from 

Lake Pointe Medical Center for an 

exception to the prohibition against 

expansion of facility capacity. As set 

forth in our current regulations and 

public guidance documents, Lake Pointe 

Medical Center submitted the data and 

certifications necessary to demonstrate 

that it satisfies the criteria to qualify as 

a high Medicaid facility. Further, our 

regulations do not permit us to consider 

the data recommended by the one 

relevant comment. Therefore, in 

accordance with section 1877(i)(3) of 

the Act, we have granted the request 

from Lake Pointe Medical Center for an 

exception to the expansion of facility 

capacity prohibition based on the 

following criteria: 

• The hospital is not the sole hospital 

in Rockwall, Texas, the county in which 

it is located; 

• The hospital certified that it 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 were 

available as of the date the hospital 

submitted 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 

Rockwall County, Texas, the county in 

which the hospital is located. 

Our approval grants the request of 

Lake Pointe Medical Center to add a 

total of 36 beds. Pursuant to 

§ 411.362(c)(6), 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. Lake 

Pointe Medical Center certified that its 

baseline number of operating rooms, 

procedure rooms, and beds for which it 

was licensed as of March 23, 2010, was 

129. Accordingly, we find that granting 

the additional 36 beds will not result in 

an aggregate number of operating rooms, 

procedure rooms, and beds for which 

the hospital is licensed that exceeds 200 

percent of the hospital’s baseline. 

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). 

Dated: October 22, 2014. 

Marilyn Tavenner, 

Administrator, Centers for Medicare & 

Medicaid Services. 

[FR Doc. 2014–25940 Filed 10–30–14; 8:45 am] 

BILLING CODE P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

Privacy Act of 1974; Report of Modified 

System of Records 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), Department 

of Health and Human Services (HHS). 

ACTION: Notice of a Modified System of 

Records (SOR). 

SUMMARY: In accordance with the 

requirements of the Privacy Act of 1974, 

we are proposing to modify an existing 

SOR titled, ‘‘Chronic Condition Data 

Repository (CCDR), System No. 09–70– 

0573’’ last published at 71 FR 54495, 

September 15, 2006. The current name 

of the SOR, Chronic Condition Data 

Repository, was developed during the 

planning and development stages of the 

system. Upon the implementation and 

throughout the operations and 

maintenance stages of the system, the 

system has been referred to as the 

Chronic Condition Warehouse (CCW) in 

common usage and written references. 

In keeping with this current usage, we 

will modify the name of this SOR to 

read, and from this point forward will 

refer to the system as: ‘‘Chronic 

Condition Warehouse (CCW).’’ 

We propose to broaden the scope of 

the system to include data that can be 

easily linked, at the individual patient 

level, to all Medicare and Medicaid 

claims, enrollment and/or eligibility 

data, nursing home and home health 

assessments, and CMS beneficiary 

survey data. Accordingly, we are 

updating the Authority Section to 

include Title XVIII of the Social 

Security Act as amended (the Act); 

Section 1902(a)(6) of the Act; Section 


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