42036 Federal Register / Vol. 83, No. 161 / Monday, August 20, 2018 / Rules and Regulations 

PART 81—DESIGNATION OF AREAS 

FOR AIR QUALITY PLANNING 

PURPOSES 

■ 1. The authority citation for part 81 

continues to read as follows: 

Authority: 42.U.S.C. 7401 et seq. 

■ 2. In § 81.318, the table entitled 

‘‘Kentucky-2012 Annual PM2.5 NAAQS’’ 

is amended under the heading 

‘‘Louisville, KY-IN:’’ by revising the 

entries for ‘‘Bullitt County (part)’’ and 

‘‘Jefferson County’’ to read as follows: 

§ 81.318 Kentucky. 

* * * * * 

KENTUCKY—2012 ANNUAL PM2.5 NAAQS 

[Primary] 

Designated area 1

Designation Classification 

Date 2 Type Date 2 Type 

Louisville, KY-IN: 

Bullitt County (part) .............................................. August 20, 2018 ............... Unclassifiable/Attainment. 

2010 Census tracts: 201.01, 201.02, 

201.03, 202.01, 202.02, 203, 204, 205, 

206.01, 206.02, 207.01, 207.02, 208, 

211.01 and 211.02.

Jefferson County .................................................. August 20, 2018 ............... Unclassifiable/Attainment. 

* * * * * * * 

1 Includes areas of Indian country located in each county or area, except as otherwise specified. 

2This date is April 15, 2015, unless otherwise noted. 

* * * * * 

[FR Doc. 2018–17935 Filed 8–17–18; 8:45 am] 

BILLING CODE 6560–50–P 

ENVIRONMENTAL PROTECTION 

AGENCY 

40 CFR Part 271 

[EPA–R03–RCRA–2017–0553; FRL–9982– 

19—Region 3] 

District of Columbia: Final 

Authorization of District Hazardous 

Waste Management Program 

Revisions 

AGENCY: Environmental Protection 

Agency (EPA). 

ACTION: Final authorization. 

SUMMARY: The EPA is granting the 

District of Columbia (the District) final 

authorization for revisions to its 

hazardous waste management program 

under the Resource Conservation and 

Recovery Act (RCRA). The Agency 

published a proposed rule on June 11, 

2018 and provided for public comment. 

No comments relevant to the proposed 

revisions were received. No further 

opportunity for comment will be 

provided. 

DATES: This final authorization is 

effective on August 20, 2018. 

ADDRESSES: EPA has established a 

docket for this action under Docket ID 

No. EPA–R03–RCRA–2017–0553. All 

documents in the docket are listed in 

the www.regulations.gov index. 

Although listed in the index, some of 

the information is not publicly 

available, e.g., Confidential Business 

Information or other information whose 

disclosure is restricted by statute. 

Certain other material, such as 

copyrighted material, will be publicly 

available only in hard copy. Publicly 

available docket materials are available 

either electronically through 

www.regulations.gov or in hard copy. 

You may view and copy the District’s 

application from 9:00 a.m. to 5:00 p.m., 

Monday through Friday at the following 

locations: District of Columbia 

Department of Energy and Environment, 

Environmental Services Administration, 

Hazardous Waste Branch, 1200 First 

Street NE, 5th Floor, Washington, DC, 

Phone number: (202) 654–6031, Attn: 

Barbara Williams; and EPA Region III, 

Library, 2nd Floor, 1650 Arch Street, 

Philadelphia, PA 19103–2029, Phone 

number: (215) 814–5254. 

FOR FURTHER INFORMATION CONTACT: Sara 

Kinslow, U.S. EPA Region III, RCRA 

Waste Branch, Mailcode 3LC32, 1650 

Arch Street, Philadelphia, PA 19103– 

2029, phone number: (215) 814–5577, 

email: kinslow.sara@epa.gov. 

SUPPLEMENTARY INFORMATION: 

A. What revisions is EPA authorizing 

with this action? 

On August 15, 2012, the District 

submitted a final complete program 

revision application (with subsequent 

corrections) seeking authorization of 

revisions to its hazardous waste 

management program in accordance 

with 40 CFR 271.21. EPA now makes a 

final decision that the District’s 

hazardous waste management program 

revisions are equivalent to, consistent 

with, and no less stringent than the 

Federal program, and therefore satisfy 

all of the requirements necessary to 

qualify for final authorization. For a list 

of District rules that are being 

authorized with this final authorization 

please see the proposed rule published 

in the June 11, 2018 Federal Register at 

83 FR 26917. 

B. What is codification and is EPA 

codifying the District of Columbia’s 

hazardous waste program as 

authorized in this authorization? 

Codification is the process of placing 

a state’s statutes and regulations that 

comprise that state’s authorized 

hazardous waste program into the Code 

of Federal Regulations. EPA does this by 

referencing the authorized state rules in 

40 CFR part 272. EPA is not codifying 

the authorization of the District’s 

revisions at this time. However, EPA 

reserves the amendment of 40 CFR part 

272, subpart J, for codification of this 

authorization of the District’s hazardous 

waste management program until a later 

date. 

C. Statutory and Executive Order 

Reviews 

This final authorization revises the 

District’s authorized hazardous waste 

management program pursuant to 

section 3006 of RCRA and imposes no 

requirements other than those currently 

imposed by District law. For further 

information on how this authorization 

complies with applicable executive 

orders and statutory provisions, please 

see the proposed rule published in the 

June 11, 2018 Federal Register at 83 FR 

26917. 


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Federal Register / Vol. 83, No. 161 / Monday, August 20, 2018 / Rules and Regulations 42037 

1Effective July 29, 2016, CMS lifted the moratoria 

on Part B emergency ground ambulance suppliers 

in all locations. (81 FR 51120) In addition, effective 

September 1, 2017, CMS lifted the moratoria on Part 

B non-emergency ground ambulance suppliers in 

Texas. (82 FR 51274) These actions also applied to 

Medicaid and CHIP. 

List of Subjects in 40 CFR Part 271 

Environmental protection, 

Administrative practice and procedure, 

Confidential business information, 

Hazardous materials transportation, 

Hazardous waste, Indians—lands, 

Intergovernmental relations, Penalties, 

Reporting and recordkeeping 

requirements. 

Authority: This action is issued under the 

authority of sections 2002(a), 3006 and 

7004(b) of the Solid Waste Disposal Act, as 

amended, 42 U.S.C. 6912(a), 6926, and 

6974(b). 

Dated: July 31, 2018. 

Cosmo Servidio, 

Regional Administrator, U.S. EPA Region III. 

[FR Doc. 2018–17921 Filed 8–17–18; 8:45 am] 

BILLING CODE 6560–50–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

42 CFR Parts 405, 424, 455, and 498 

[CMS–6073–N2] 

Medicare, Medicaid, and Children’s 

Health Insurance Programs: 

Announcement of Revisions to the 

Provider Enrollment Moratoria Access 

Waiver Demonstration for Part B NonEmergency Ground Ambulance 

Suppliers and Home Health Agencies 

in Moratoria-Designated Geographic 

Locations 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Revisions of the waiver 

demonstration. 

SUMMARY: This document announces 

revisions to the Provider Enrollment 

Moratoria Access Waiver Demonstration 

(PEWD) for Part B Non-Emergency 

Ground Ambulance Suppliers and 

Home Health Agencies. The 

demonstration was implemented in 

accordance with section 402(a)(1)(J) of 

the Social Security Amendments of 

1967 and, as revised, gives CMS the 

authority to grant waivers to the 

statewide enrollment moratoria on a 

case-by-case basis in response to access 

to care issues and previously denied 

enrollment applications because of 

statewide moratoria implementation, 

and to subject providers and suppliers 

enrolling via such waivers to heightened 

screening, oversight, and investigations. 

DATES: The revisions to the waiver 

demonstration are effective August 20, 

2018. 

FOR FURTHER INFORMATION CONTACT: Jung 

Kim, (410) 786–9370. News media 

representatives must contact CMS’ 

Public Affairs Office at (202) 690–6145 

or email them at press@cms.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

I. Background 

The Social Security Act (the Act) 

provides CMS with tools and resources 

to combat fraud, waste, and abuse in 

Medicare, Medicaid, and the Children’s 

Health Insurance Program (CHIP), 

including the authority to place a 

temporary moratorium on provider 

enrollment in these programs, 

402(a)(1)(J) of the Social Security 

Amendments of 1967 (42 U.S.C. 1395b– 

1(a)(1)(J)). CMS uses quantitative and 

qualitative data to determine whether 

there is a need for a moratorium, such 

as reviewing whether the area under 

consideration for a moratorium has 

significantly higher than average billing 

per beneficiary or provider per 

beneficiary ratios. CMS first used its 

moratoria authority on July 30, 2013, to 

prevent enrollment of new Home Health 

Agencies (HHAs) in the Chicago, Illinois 

and Miami, Florida areas, as well as Part 

B ground ambulance suppliers in the 

Houston, Texas area (see the July 31, 

2013 Federal Register (78 FR 46339)). 

These moratoria also applied to 

Medicaid and CHIP. CMS exercised this 

authority again on January 30, 2014, to 

extend the existing moratoria for 6 

months and expand them to include 

HHAs in Fort Lauderdale, Florida; 

Detroit, Michigan; Houston, Texas; and 

Dallas, Texas; as well as Medicaid, CHIP 

and Medicare Part B ground ambulance 

suppliers in Philadelphia, Pennsylvania 

and nearby New Jersey counties (see the 

February 4, 2014 Federal Register (79 

FR 6475)). Since the moratoria were 

expanded, they remained in place and 

were extended in 6-month intervals. On 

July 29, 2016, CMS extended the 

existing moratoria for 6 months and 

expanded them to statewide in the 

impacted states (see the August 3, 2016 

Federal Register (81 FR 51120)). The 

statewide moratoria have since been 

extended at 6-month intervals and to 

date, largely remain in place in all of the 

previously-mentioned locations.1

Since initial implementation of the 

moratoria, CMS has monitored the 

program and identified several 

operational challenges. Because the 

moratoria were initially geographically 

defined by county, the moratoria did not 

prohibit existing providers and 

suppliers from opening a branch 

location in, or moving a currentlyenrolled business into, a moratoria area. 

Moreover, CMS was unable to prevent 

existing providers and suppliers 

enrolled outside of a moratoria area 

from servicing beneficiaries within the 

moratoria area. In fact, CMS discovered 

providers and suppliers who were 

located several hundred miles outside of 

a moratorium area that were billing for 

services furnished to beneficiaries 

located within the moratorium area. 

As noted previously, on July 29, 2016, 

CMS implemented statewide moratoria 

on newly enrolling HHAs in Medicare, 

Medicaid, and CHIP, and nonemergency ground ambulance suppliers 

in Medicare Part B, Medicaid, and CHIP 

in order to mitigate the vulnerabilities 

identified and described previously 

regarding the prior county-based 

moratoria. Concurrently, CMS 

implemented this Demonstration in 

order to improve methods for the 

investigation and prosecution of fraud, 

and to ensure that program integrity 

enforcement actions did not impact 

beneficiary access to care; in particular, 

all of the states impacted by the 

expanded statewide moratoria have 

rural areas that could be impacted by 

the statewide expansion. By 

implementing this Demonstration, CMS 

created a process that allows for needbased waivers to the moratoria in areas 

with access to care issues. Recently, 

CMS re-evaluated the continued need 

for statewide moratoria on the 

enrollment of new Part B, Medicaid, and 

CHIP non-emergency ground ambulance 

suppliers in New Jersey and 

Pennsylvania, and HHAs in Florida, 

Illinois, Michigan, and Texas, and 

determined that the conditions that 

caused CMS to implement the moratoria 

have not abated. As a result, on July 29, 

2018 (see the August 2, 2018 Federal 

Register (83 FR 37747), we extended the 

statewide moratoria on Part B, 

Medicaid, and CHIP non-emergency 

ground ambulance suppliers and HHAs 

in the impacted states. 

A. Operational Challenges 

Since expanding statewide, a new 

statutory provision affecting the 

moratoria areas has taken effect. In 

December 2016, Congress enacted the 

21st Century Cures Act (Cures Act). 

Section 17004 of the Cures Act provides 

authority to address issues of 

circumvention of the prior county-based 

moratoria by prohibiting payment for 

items or services furnished within 

moratoria areas by any newly enrolled 

provider or supplier that is of a provider 


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