Federal Register / Vol. 77, No. 11 / Wednesday, January 18, 2012 / Proposed Rules 2497 

www.regulations.gov is an ‘‘anonymous 

access’’ system, and EPA will not know 

your identity or contact information 

unless you provide it in the body of 

your comment. If you send email 

directly to EPA, your email address will 

be automatically captured and included 

as part of the public comment. If EPA 

cannot read your comment due to 

technical difficulties and cannot contact 

you for clarification, EPA may not be 

able to consider your comment. 

Electronic files should avoid the use of 

special characters, any form of 

encryption, and be free of any defects or 

viruses. 

Docket: Generally, documents in the 

docket for this action are available 

electronically at www.regulations.gov 

and in hard copy at EPA Region IX, 75 

Hawthorne Street, San Francisco, 

California. While all documents in the 

docket are listed at 

www.regulations.gov, some information 

may be publicly available only at the 

hard copy location (e.g., copyrighted 

material, large maps), and some may not 

be publicly available in either location 

(e.g., CBI). To inspect the hard copy 

materials, please schedule an 

appointment during normal business 

hours with the contact listed in the FOR

FURTHER INFORMATION CONTACT section. 

FOR FURTHER INFORMATION CONTACT: 

Idalia Perez, EPA Region IX, (415) 972– 

3248, perez.idalia@epa.gov. 

SUPPLEMENTARY INFORMATION: This 

proposal addresses the following local 

rules: AVAQMD Rule 1134, Stationary 

Gas Turbines and ICAPCD Rule 400.1, 

Stationary Gas Turbine(s)—Reasonably 

Available Control Technology (RACT). 

In the Rules and Regulations section of 

this Federal Register, we are approving 

these local rules in a direct final action 

without prior proposal because we 

believe these SIP revisions are not 

controversial. If we receive adverse 

comments, however, we will publish a 

timely withdrawal of the direct final 

rule and address the comments in 

subsequent action based on this 

proposed rule. Please note that if we 

receive adverse comment on an 

amendment, paragraph, or section of 

this rule and if that provision may be 

severed from the remainder of the rule, 

we may adopt as final those provisions 

of the rule that are not the subject of an 

adverse comment. 

We do not plan to open a second 

comment period, so anyone interested 

in commenting should do so at this 

time. If we do not receive adverse 

comments, no further activity is 

planned. For further information, please 

see the direct final action. 

Dated: December 27, 2011. 

Jared Blumenfeld, 

Regional Administrator, Region IX. 

[FR Doc. 2012–817 Filed 1–17–12; 8:45 am] 

BILLING CODE 6560–50–P 

ENVIRONMENTAL PROTECTION 

AGENCY 

40 CFR Part 1043 

[EPA–HQ–OAR–2011–0928; FRL–9619–1] 

RIN 2060–XXXX 

Great Lakes Steamship Repower 

Incentive Program 

AGENCY: Environmental Protection 

Agency (EPA). 

ACTION: Notice of proposed rulemaking. 

SUMMARY: EPA is proposing to simplify 

an existing provision in our marine 

diesel engine program that is intended 

to encourage owners of Great Lakes 

steamships to repower those steamships 

with cleaner marine diesel engines. The 

simplified program would automatically 

permit the use of residual fuel, through 

December 31, 2025, in a steamship if it 

has been repowered with a certified Tier 

2 or later marine diesel engine, provided 

the steamship was operated exclusively 

on the Great Lakes and was in service 

on October 30, 2009. Steamships are 

powered by old, inefficient steam 

boilers. Voluntary replacement of these 

boilers with modern fuel-efficient 

marine diesel engines would result in 

reductions of particulate matter and 

sulfur oxides, even while the 

replacement diesel engines are operated 

on higher sulfur residual fuel, and 

would provide human health and 

welfare benefits for the people who live 

in the Great Lakes region. Conversion to 

new diesel engines would also result in 

considerable carbon dioxide reductions 

and fuel savings. In the ‘‘Rules and 

Regulations’’ section of this Federal 

Register, we are making this 

modification to the Great Lakes 

steamship incentive program as a direct 

final rule without a prior proposed rule. 

If we receive no adverse comment, we 

will not take further action on this 

proposed rule. 

DATES: Written comments must be 

received by February 17, 2012. 

ADDRESSES: Submit your comments, 

identified by Docket ID No. EPA–HQ– 

OAR–2011–0928, by mail to: 

Environmental Protection Agency, Air 

Docket, Mail-code 6102T, 1200 

Pennsylvania Avenue NW., Washington, 

DC 20460. Comments may also be 

submitted electronically or through 

hand delivery/courier by following the 

detailed instructions in the ADDRESSES

section of the direct final rule located in 

the rules section of this Federal 

Register. 

Public Hearing: If anyone contacts us 

requesting to speak at a public hearing 

on or before February 2, 2012, we will 

hold a public hearing. Additional 

information about the hearing would be 

published in a subsequent Federal 

Register notice. 

FOR FURTHER INFORMATION CONTACT: Jean 

Marie Revelt, Environmental Protection 

Agency, Office of Transportation and 

Air Quality, Assessment and Standards 

Division, 2000 Traverwood Drive, Ann 

Arbor, Michigan 48105; telephone 

number: (734) 214–4822; fax number: 

(734) 214–4816; email address: 

revelt.jean-marie@epa.gov. 

SUPPLEMENTARY INFORMATION: 

I. Why is EPA issuing this proposed 

rule? 

This document proposes to take 

action on our national marine diesel 

emission control program. We have 

published a direct final rule to simplify 

our Great Lakes steamship repower 

incentive program in the ‘‘Rules and 

Regulations’’ section of this Federal 

Register because we view this as a 

noncontroversial action and anticipate 

no adverse comment. We have 

explained our reasons for this action in 

the preamble to the direct final rule. 

If we receive no adverse comment, we 

will not take further action on this 

proposed rule. If we receive adverse 

comment, we will withdraw the direct 

final rule and it will not take effect. We 

would address all public comments in 

any subsequent final rule based on this 

proposed rule. 

We do not intend to institute a second 

comment period on this action. Any 

parties interested in commenting must 

do so at this time. For further 

information, please see the ADDRESSES

section of this document. 

II. Does this action apply to me? 

This action will affect companies that 

own steamships operating exclusively 

on the Great Lakes that were in service 

on October 30, 2009. The following 

table gives some examples of entities 

that may be affected by this rule; 

however, since these are only examples, 

you should carefully examine the 

regulations. You may direct questions 

regarding the applicability of this action 

as noted in FOR FURTHER INFORMATION

CONTACT. 


srobinson on DSK4SPTVN1PROD with PROPOSALS
2498 Federal Register / Vol. 77, No. 11 / Wednesday, January 18, 2012 / Proposed Rules 

1Category 3 marine engines are diesel engines 

with per cylinder displacement at or above 30 liters. 

2For the purpose of this program, ‘‘Great Lakes’’ 

means all the streams, rivers, lakes, and other 

bodies of water that are within the drainage basin 

of the St. Lawrence River, west of Anticosti Island. 

(40 CFR 1043.20). 

3Compliance can be through switching to ECAcompliant fuel or through the installation and use 

of an exhaust gas cleaning system (scrubber) or 

other technology or procedure that achieves 

equivalent sulfur emissions. See Section V.C of the 

preamble for our Category 3 FRM for a discussion 

of compliance strategies. 

Category NAICS Codes a Examples of potentially regulated entities 

Industry .......................................................................................... 483113 Coastal and Great Lakes Freight Transportation. 

Industry .......................................................................................... 483114 Coastal and Great Lakes Passenger Transportation. 

Industry .......................................................................................... 336611 Shipbuilding and repairing. 

Industry .......................................................................................... 811310 Engine repair, remanufacture, and maintenance. 

a North American Industry Classification System (NAICS). 

III. Summary of Rule 

EPA’s final rule for Category 3 marine 

engines 1 and their fuels (75 FR 22896, 

April 30, 2010) exempted steamships 

from the sulfur limits that apply to fuel 

used in ships operating on the Great 

Lakes 2 beginning August 1, 2012 (40 

CFR 1043.95(a)). This means steamships 

can continue to operate indefinitely on 

high sulfur residual fuel. However, 

because steamship engines have high 

emissions and low fuel efficiency, we 

included a provision to encourage 

owners of Great Lakes steamships to 

voluntarily replace their steam boilers 

with cleaner, more fuel-efficient marine 

diesel engines (40 CFR 

1043.95(b)(4)(iv)). The current voluntary 

repower incentive is in the form of relief 

through EPA’s economic hardship 

program, through which an owner may 

apply for a relaxation of the Great Lakes 

fuel sulfur limits for fuel used by the 

repowered diesel ship for a defined 

period of time. The use of lower price, 

higher sulfur residual fuel can help 

offset vessel repower costs. 

EPA believes that the goal of 

repowering the fleet of Great Lakes 

steamships could be achieved more 

effectively by adding a new incentive 

program to provide an automatic, timelimited fuel waiver for repowered 

steamships. Instead of applying for 

relief through the economic hardship 

program, Great Lakes steamship owners 

who voluntarily repower their 

steamships with diesel engines would 

automatically qualify for a waiver that 

would allow the use of residual fuel in 

the replacement diesel engines that 

exceeds the global and ECA sulfur limits 

that otherwise apply to the fuel used in 

marine diesel engines operated on the 

U. S. portions of the Great Lakes. This 

automatic Great Lakes steamship 

repower fuel waiver would be valid 

through December 31, 2025; after that 

date, repowered steamships would be 

required to comply with the Great Lakes 

ECA fuel sulfur limits for diesel 

engines.3 To qualify for this automatic 

fuel sulfur waiver, the steamship must 

be exempt from existing requirements 

pursuant to 40 CFR 1043.95(a) in that it 

must operate exclusively on the Great 

Lakes and must have been in service on 

October 30, 2009, where ‘‘in service’’ 

means operating as a steamship, but is 

not limited to actually performing that 

service on that day. In addition, the 

replacement engine must be a Tier 2 or 

cleaner marine diesel engine as 

specified in 40 CFR 1042.104. 

Voluntary replacement of steam 

engines with cleaner, more efficient Tier 

2 or better marine diesel engines 

through this modification to our 

steamship repower incentive program 

would provide important air quality and 

energy benefits immediately, due to the 

improved fuel efficiency of the diesel 

engines, and even larger benefits in the 

long term, when the repowered ships 

will use fuel that complies with the 

1,000 ppm sulfur limit on the Great 

Lakes. 

For additional discussion of the 

proposed rule changes, see the direct 

final rule EPA has published in the 

‘‘Rules and Regulations’’ section of 

today’s Federal Register. This proposal 

incorporates by reference all the 

reasoning, explanation, and regulatory 

text from the direct final rule. 

V. Statutory and Executive Order 

Reviews 

A. Executive Order 12866: Regulatory 

Planning and Review 

This proposed rule is not a 

‘‘significant regulatory action’’ under 

the terms of Executive Order 12866 (58 

FR 51735, October 4, 1993) and is 

therefore not subject to review under 

Executive Orders 12866 and 13563 (76 

FR 3821, January 21, 2011). This 

proposed rule would merely add an 

automatic waiver provision to 

encourage Great Lakes steamship 

owners to repower their vessels with 

cleaner marine diesel engines. There are 

no costs associated with this proposed 

rule because steamship owners are not 

required to repower their ships. 

B. Paperwork Reduction Act 

The information collection 

requirements in this rule will be 

submitted for approval to the Office of 

Management and Budget (OMB) under 

the Paperwork Reduction Act, 44 U.S.C. 

3501 et seq. The information collection 

requirements are not enforceable until 

OMB approves them. 

The program contained in this rule is 

a voluntary incentive program to 

encourage owners of Great Lakes 

steamship to repower their ships with 

diesel engines. A steamship owner 

taking advantage of the automatic fuel 

waiver is required to notify EPA’s 

designated certification officer of the 

intention to use this provision. The 

notification must include a description 

of the project, the expected timeline, 

and other relevant information. The 

owner is also required to notify EPA’s 

designated certification officer at 

completion of the project. The purpose 

of the reporting is to ensure that a 

repower has taken place, with a 

qualified EPA-certified engine. Because 

this program is voluntary, a steamship 

owner would provide this information 

only if the provision is exercised. When 

the project is completed, EPA will 

provide the owner with a statement that 

the repowered ship is covered by the 

steamship repower incentive program 

fuel sulfur waiver, which is to be kept 

onboard for compliance purposes. 

There are potentially six companies 

affected, which own the twelve 

remaining diesel steamships that 

operate on the Great Lakes. It is not 

known how many of these companies 

will actually take advantage of the 

waiver, or when they would repower. 

However, it is likely that the repowers 

would occur prior to 2015, to maximize 

the fuel savings afforded by the fuel 

sulfur waiver before it expires on 

December 31, 2025. 

The total estimated burden associated 

with the automatic steamship repower 

incentive program is 14.0 hours 

annually. This is based on two 

steamship owners repowering two 

steamships in each of three years and an 

estimated 3.5 annual labor hours for 

each manufacturer to prepare and 

submit the required information for 


srobinson on DSK4SPTVN1PROD with PROPOSALS
Federal Register / Vol. 77, No. 11 / Wednesday, January 18, 2012 / Proposed Rules 2499 

each ship. Burden is defined at 5 CFR 

1320.3(b). 

An agency may not conduct or 

sponsor, and a person is not required to 

respond to, a collection of information 

unless it displays a currently valid OMB 

control number. The OMB control 

numbers for EPA’s regulations in 40 

CFR are listed in 40 CFR part 9. When 

this ICR is approved by OMB, the 

Agency will publish a technical 

amendment to 40 CFR part 9 in the 

Federal Register to display the OMB 

control number for the approved 

information collection requirements 

contained in this final rule. 

C. Regulatory Flexibility Act 

The Regulatory Flexibility Act (RFA) 

generally requires an agency to prepare 

a regulatory flexibility analysis of any 

rule subject to notice and comment 

rulemaking requirements under the 

Administrative Procedure Act or any 

other statute unless the agency certifies 

that the rule will not have a significant 

economic impact on a substantial 

number of small entities. Small entities 

include small businesses, small 

organizations, and small governmental 

jurisdictions. 

For purposes of assessing the impacts 

of today’s proposed rule on small 

entities, small entity is defined as: (1) A 

small business primarily engaged in 

shipbuilding and repairing as defined 

by NAICS code 336611 with 1,000 or 

fewer employees (based on Small 

Business Administration size 

standards); (2) a small business that is 

primarily engaged in freight or 

passenger transportation on the Great 

Lakes as defined by NAICS codes 

483113 and 483114 with 500 or fewer 

employees (based on Small Business 

Administration size standards); (3) a 

small business primarily engaged in 

commercial and industrial machinery 

and equipment repair and maintenance 

with annual receipts less than $7 

million (based on Small Business 

Administration size standards); (4) a 

small governmental jurisdiction that is a 

government of a city, county, town, 

school district or special district with a 

population of less than 50,000; and (5) 

a small organization that is any not-forprofit enterprise which is independently 

owned and operated and is not 

dominant in its field. 

After considering the economic 

impacts of today’s proposed rule on 

small entities, I certify that proposed 

rule would not have a significant 

economic impact on a substantial 

number of small entities. 

In determining whether a rule has a 

significant economic impact on a 

substantial number of small entities, the 

impact of concern is any significant 

adverse economic impact on small 

entities, since the primary purpose of 

the regulatory flexibility analyses is to 

identify and address regulatory 

alternatives ‘‘which minimize any 

significant economic impact of the rule 

on small entities.’’ 5 U.S.C. 603 and 604. 

Thus, an agency may certify that a rule 

will not have a significant economic 

impact on a substantial number of small 

entities if the rule relieves regulatory 

burden, or otherwise has a positive 

economic effect on all of the small 

entities subject to the rule. 

This proposed rule would merely add 

an automatic waiver provision to 

encourage Great Lakes steamship 

owners to repower their vessels with 

cleaner marine diesel engines. There are 

no costs and therefore no regulatory 

burden associated with this rule because 

steamship owners are not required to 

repower their ships and can continue 

using their vessels indefinitely. This 

Great Lakes steamship repower 

incentive program would assist those 

steamship owners who choose to 

voluntarily repower their ships, 

however, by allowing them to use 

lower-price residual fuel in the 

repowered diesel ship for a specified 

period of time, which may help them 

cover the costs of the repower project. 

We have therefore concluded that 

today’s final rule will not increase 

regulatory burden for affected small 

entities. 

D. Unfunded Mandates Reform Act 

This action contains no Federal 

mandates under the provisions of Title 

II of the Unfunded Mandates Reform 

Act of 1995 (UMRA), 2 U.S.C. 1531– 

1538 for State, local, or tribal 

governments or the private sector. The 

action imposes no enforceable duty on 

any State, local or tribal governments or 

the private sector. Therefore, this action 

is not subject to the requirements of 

sections 202 or 205 of the UMRA. 

This action is also not subject to the 

requirements of section 203 of UMRA 

because it contains no regulatory 

requirements that might significantly or 

uniquely affect small governments. This 

proposed rule would merely add an 

automatic waiver provision to 

encourage Great Lakes steamship 

owners to repower their vessels with 

cleaner marine diesel engines. None of 

the thirteen U.S. steamships operating 

on the Great Lakes as of October 30, 

2009 are owned or operated by a State, 

local, or tribal government. 

E. Executive Order 13132: Federalism 

This action does not have federalism 

implications. It would not 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, as specified in 

Executive Order 13132. This proposed 

final rule would merely add an 

automatic waiver provision to 

encourage Great Lakes steamship 

owners to repower their vessels with 

cleaner marine diesel engines. None of 

the thirteen U.S. steamships operating 

on the Great Lakes as of October 30, 

2009 are owned or operated by a State. 

Thus, Executive Order 13132 does not 

apply to this action. 

F. Executive Order 13175: Consultation 

and Coordination With Indian Tribal 

Governments 

This action does not have tribal 

implications, as specified in Executive 

Order 13175 (65 FR 67249, November 9, 

2000). This proposed rule would merely 

add an automatic waiver provision to 

encourage Great Lakes steamship 

owners to repower their vessels with 

cleaner marine diesel engines. None of 

the thirteen U.S. steamships operating 

on the Great Lakes as of October 30, 

2009 are owned or operated by an 

Indian tribal government. Thus, 

Executive Order 13175 does not apply 

to this action. 

G. Executive Order 13045: Protection of 

Children From Environmental Health 

and Safety Risks 

This action is not subject to Executive 

Order 13045 (62 FR 19885, April 23, 

1997) because it is not economically 

significant as defined in Executive 

Order 12866, and because the Agency 

does not believe the environmental 

health or safety risks addressed by this 

action present a disproportionate risk to 

children. This proposed rule would 

merely add an automatic waiver 

provision to encourage Great Lakes 

steamship owners to repower their 

vessels with cleaner marine diesel 

engines. To the extent Great Lakes 

steamship owners take advantage of this 

incentive program, their action would 

provide immediate air quality and 

energy benefits, due to the improved 

fuel efficiency of the diesel engines, and 

even larger benefits in the long term, 

when the repowered ship would use 

fuel that complies with the 1,000 ppm 

sulfur limit on the Great Lakes. These 

emission reductions would improve air 

quality for all people who live in the 

Great Lakes region, including children 

and other sensitive populations. 


srobinson on DSK4SPTVN1PROD with PROPOSALS
2500 Federal Register / Vol. 77, No. 11 / Wednesday, January 18, 2012 / Proposed Rules 

H. Executive Order 13211: Actions That 

Significantly Affect Energy Supply, 

Distribution, or Use 

This action is not subject to Executive 

Order 13211 (66 FR 28355, May 22, 

2001), because it is not a significant 

regulatory action under Executive Order 

12866. 

I. National Technology Transfer 

Advancement Act 

Section 12(d) of the National 

Technology Transfer and Advancement 

Act of 1995 (‘‘NTTAA’’), Public Law 

104–113, 12(d) (15 U.S.C. 272 note) 

directs EPA to use voluntary consensus 

standards in its regulatory activities 

unless to do so would be inconsistent 

with applicable law or otherwise 

impractical. Voluntary consensus 

standards are technical standards (e.g., 

materials specifications, test methods, 

sampling procedures, and business 

practices) that are developed or adopted 

by voluntary consensus standards 

bodies. NTTAA directs EPA to provide 

Congress, through OMB, explanations 

when the Agency decides not to use 

available and applicable voluntary 

consensus standards. 

This action does not involved 

technical standards. Therefore, EPA did 

not consider the use of any voluntary 

consensus standards. 

J. Executive Order 12898: Federal 

Actions To Address Environmental 

Justice in Minority Populations and 

Low-Income Populations 

Executive Order 12898 (59 FR 7629, 

Feb. 16, 1994) establishes federal 

executive policy on environmental 

justice. Its main provision directs 

federal agencies, to the greatest extent 

practicable and permitted by law, to 

make environmental justice part of their 

mission by identifying and addressing, 

as appropriate, disproportionately high 

and adverse human health or 

environmental effects of their programs, 

policies, and activities on minority 

populations and low-income 

populations in the United States. 

EPA has determined that this 

proposed rule would not have 

disproportionately high and adverse 

human health or environmental effects 

on minority or low-income populations 

because it increases the level of 

environmental protection for all affected 

populations without having any 

disproportionately high and adverse 

human health or environmental effects 

on any population, including any 

minority or low-income population. 

This proposed rule would merely add 

an automatic waiver provision to 

encourage Great Lakes steamship 

owners to repower their vessels with 

cleaner marine diesel engines. To the 

extent Great Lakes steamship owners 

take advantage of this incentive 

program, their action would provide 

immediate air quality and energy 

benefits, due to the improved fuel 

efficiency of the diesel engines, and 

even larger benefits in the long term, 

when the repowered ship would use 

fuel that complies with the 1,000 ppm 

sulfur limit on the Great Lakes. These 

emission reductions would improve air 

quality for all people who live in the 

Great Lakes region, including minority 

and low-income populations. 

K. Statutory Authority 

The statutory authority for this action 

comes from section 1903 of the Act to 

Prevent Pollution from Ships (33 U.S.C. 

1901 et seq.). The Act to Prevent 

Pollution from Ships implements Annex 

VI to the International Convention for 

the Prevention of Pollution from Ships 

(MARPOL) and makes those 

requirements enforceable domestically. 

Section 1903 gives the Administrator 

the authority to prescribe any necessary 

or desired regulations to carry out the 

provisions of Regulations 12 through 19 

of MARPOL Annex VI. 

List of Subjects in 40 CFR Part 1043 

Environmental protection, 

Administrative practice and procedure, 

Air pollution control, Confidential 

business information, Economic 

hardship waiver, Great Lakes, North 

American Emission Control Area, 

Reporting and recordkeeping 

requirements, Steamships. 

Dated: January 11, 2012. 

Lisa P. Jackson, 

Administrator. 

[FR Doc. 2012–820 Filed 1–17–12; 8:45 am] 

BILLING CODE 6560–50–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

42 CFR Part 447 

[CMS–2315–P] 

RIN 0938–AQ37 

Medicaid Program; Disproportionate 

Share Hospital Payments—Uninsured 

Definition 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Proposed rule. 

SUMMARY: This proposed rule addresses 

the hospital-specific limitation on 

Medicaid disproportionate share 

hospital (DSH) payments under the 

Social Security Act. Under this 

limitation, DSH payments to a hospital 

cannot exceed the uncompensated costs 

of furnishing hospital services by the 

hospital to individuals who are 

Medicaid-eligible or ‘‘have no health 

insurance (or other source of third party 

coverage) for the services furnished 

during the year.’’ This rule would 

provide that the quoted phrase would 

refer in context to a lack of coverage on 

a service-specific basis, so that the 

calculation of uncompensated care for 

purposes of the hospital-specific DSH 

limit would include the cost of each 

service furnished to an individual who 

had no health insurance or other source 

of third party coverage for that service. 

DATES: To be assured consideration, 

comments must be received at one of 

the addresses provided below, no later 

than 5 p.m. on February 17, 2012. 

ADDRESSES: In commenting, please refer 

to file code CMS–2315–P. Because of 

staff and resource limitations, we cannot 

accept comments by facsimile (Fax) 

transmission. 

You may submit comments in one of 

four ways (please choose only one of the 

ways listed): 

1. Electronically. You may submit 

electronic comments on this regulation 

to http://www.regulations.gov. Follow 

the ‘‘Submit a comment’’ instructions. 

2. By regular mail. You may mail 

written comments to the following 

address ONLY: Centers for Medicare & 

Medicaid Services, Department of 

Health and Human Services, Attention: 

CMS–2315–P, P.O. Box 8016, Baltimore, 

MD 21244–8016. 

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 to the 

following address ONLY: Centers for 

Medicare & Medicaid Services, 

Department of Health and Human 

Services, Attention: CMS–2315–P, Mail 

Stop C4–26–05, 7500 Security 

Boulevard, Baltimore, MD 21244–1850. 

4. By hand or courier. Alternatively, 

you may deliver (by hand or courier) 

your written comments ONLY to the 

following addresses prior to the close of 

the comment period: 

a. For delivery in Washington, DC— 

Centers for Medicare & Medicaid 

Services, Department of Health and 

Human Services, Room 445–G, Hubert 

H. Humphrey Building, 200 

Independence Avenue SW., 

Washington, DC 20201. 


srobinson on DSK4SPTVN1PROD with PROPOSALS