Federal Register / Vol. 88, No. 225 / Friday, November 24, 2023 / Notices 82375 

95Participants are charged the Securities Lending 

Position Maintenance Fee for both a Securities 

Borrowed balance and a Securities Lent balance. 

These fees will be assessed every business day. 

Securities lending positions will be available when 

Phase 2 of the ACAP enhancement project is 

implemented. For information about the ACAP 

enhancement project, please visit: https://

www.frbservices.org/resources/financial-services/ 

securities/acap/. 

96This fee is set by and remitted to the 

Government National Mortgage Association 

(GNMA). 

97The Federal Reserve Banks charge participants 

a Joint Custody Origination Surcharge for both 

Agency and Treasury securities. 

98These fees are set by the Federal Reserve Banks. 

99These fees are set by the Federal Reserve Banks. 

100FedComplete packages are all-electronic 

service options that bundle payment services with 

an access solution for one monthly fee. 

101FedComplete customers that use the email 

service would be charged the FedMail Email a la 

carte fee and for all FedMail-FedLine Exchange 

Subscriber 5-packs. 

102Packages with an ‘‘A’’ include the FedLine 

Advantage channel. 

103Per-item surcharges are in addition to the 

standard fees listed in the applicable priced 

services fee schedules. 

104FedComplete customers will be charged $4 for 

each FedForward cash letter over the monthly 

package threshold. This activity will appear under 

billing code 51998 in Service Area 1521 on a 

month-lagged basis. 

105FedMail and FedLine Exchange packages do 

not include user credentials, which are required to 

access priced services and certain informational 

services. Credentials are sold separately in packs of 

five via the FedMail-FedLine Exchange Subscriber 

5-pack. 

106FedLine Web and Advantage packages do not 

include user credentials, which are required to 

access priced services and certain informational 

services. Credentials are sold separately in packs of 

five via the FedLine Subscriber 5-pack. 

107FedLine Solutions package fees associated 

with establishing a new connection or upgrading a 

current connection to FedLine Advantage® for the 

FedNow® Service will be credited up to twelve 

months. 

108Early termination fees and/or expedited order 

fees may apply to all FedLine Direct packages and 

FedLine Direct a` la carte options. 

109These add-on services can be purchased only 

with a FedLine Solution. 

110Additional VPNs are available for FedLine 

Advantage, FedLine Command, and FedLine Direct 

packages only. All customers will need to replace 

their existing VPN device with the new VPN device. 

Effective October 1, 2023, customers who have not 

started migration will be assessed a $400 monthly 

fee under billing code 22411 until migration is 

complete. 

111Fee is in addition to the FedLine Direct 

package fees or Additional 2Mbps WAN Connection 

fee. 

112The FedLine Custom Implementation Fee is 

$2,500 or $5,000 based on the complexity of the 

setup. 

113Available only to customers with a priced 

FedLine package. 

114Five download codes are included at no cost 

in all Plus and Premier packages. 

115Available for FedLine Web Plus, FedLine Web 

Premier, FedLine Advantage Plus, and FedLine 

Advantage Premier packages. It is also available for 

no extra fee in FedLine Command Plus and Direct 

packages. 

116The End of Day Financial Institution 

Reconcilement Data (FIRD) and Statement of 

Account Spreadsheet File (SASF) are available for 

Master accounts only. 

117Available with FedLine® Plus and Premier 

packages. 

118Available for FedLine Web Plus and Premier 

packages. Available for no extra fee in FedLine 

Advantage and higher packages. 

119Charging the $10 Replacement Copy Fee is at 

the discretion of Reserve Banks. 

By order of the Board of Governors of the 

Federal Reserve System. 

Ann E. Misback, 

Secretary of the Board. 

[FR Doc. 2023–25925 Filed 11–22–23; 8:45 am] 

BILLING CODE 6210–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–1817–NC] 

Medicare and Medicaid Programs; 

Announcement of Application From a 

Hospital Requesting Waiver for Organ 

Procurement Service Area 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice with request for 

comment. 

SUMMARY: This notice acknowledges the 

receipt of an application from a hospital 

that has requested a waiver of statutory 

requirements that would otherwise 

require the hospital to enter into an 

agreement with its designated organ 

procurement organization (OPO). This 

notice requests comments from OPOs 

and the general public for our 

consideration in determining whether 

we should grant the requested waiver. 

DATES: Comment date: To be assured 

consideration, comments must be 

received at one of the addresses 

provided below, by January 23, 2024. 

ADDRESSES: In commenting, refer to file 

code CMS–1817–NC. 

Comments, including mass comment 

submissions, must be submitted in one 

of the following three ways (please 

choose only one of the ways listed): 

1. Electronically. You may submit 

electronic comments on this regulation 

to https://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–1817–NC, P.O. Box 8010, 

Baltimore, MD 21244–8010. 

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–1817–NC, 

Mail Stop C4–26–05, 7500 Security 

Boulevard, Baltimore, MD 21244–1850. 

For information on viewing public 

comments, see the beginning of the 

SUPPLEMENTARY INFORMATION section. 

FOR FURTHER INFORMATION CONTACT: 

Randy Throndset, (410) 786–0131. 

SUPPLEMENTARY INFORMATION: 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 

website as soon as possible after they 

have been received: https://

www.regulations.gov. Follow the search 

instructions on that website to view 

public comments. CMS will not post on 

Regulations.gov public comments that 

make threats to individuals or 

institutions or suggest that the 

individual will take actions to harm the 

individual. CMS continues to encourage 

individuals not to submit duplicative 

comments. We will post acceptable 

comments from multiple unique 

commenters even if the content is 

identical or nearly identical to other 

comments. 

I. Background 

Organ Procurement Organizations 

(OPOs) are not-for-profit organizations 

that are responsible for the 

procurement, preservation, and 

transport of organs to transplant centers 

throughout the country. Qualified OPOs 

are designated by the Centers for 

Medicare & Medicaid Services (CMS) to 

recover or procure organs in CMSdefined exclusive geographic service 

areas, pursuant to section 371(b)(1) of 

the Public Health Service Act (42 U.S.C. 

273(b)(1)) and our regulations at 42 CFR 

486.306. Once an OPO has been 

designated for an area, hospitals in that 

area that participate in Medicare and 

Medicaid are required to work with that 

OPO in providing organs for transplant, 

pursuant to section 1138(a)(1)(C) of the 

Social Security Act (the Act) and our 

regulations at 42 CFR 482.45. 

Section 1138(a)(1)(A)(iii) of the Act 

provides that a hospital must establish 

protocols, which require the hospital to 

notify the designated OPO (for the 

service area in which it is located) of 

potential organ donors. Under section 

1138(a)(1)(C) of the Act, every hospital 

must have an agreement only with its 


ddrumheller on DSK120RN23PROD with NOTICES1
82376 Federal Register / Vol. 88, No. 225 / Friday, November 24, 2023 / Notices 

designated OPO to identify potential 

donors. 

However, section 1138(a)(2)(A) of the 

Act provides that a hospital may obtain 

a waiver of the above requirements from 

the Secretary of the Department of 

Health and Human Services (the 

Secretary) under certain specified 

conditions. A waiver allows the hospital 

to have an agreement with an OPO other 

than the one designated by CMS, if the 

hospital meets certain conditions 

specified in section 1138(a)(2)(A) of the 

Act. In addition, the Secretary may 

review additional criteria described in 

section 1138(a)(2)(B) of the Act to 

evaluate the hospital’s request for a 

waiver. 

Section 1138(a)(2)(A) of the Act states 

that in granting a waiver, the Secretary 

must determine that the waiver—(1) is 

expected to increase organ donations; 

and (2) will ensure equitable treatment 

of patients referred for transplants 

within the service area served by the 

designated OPO and within the service 

area served by the OPO with which the 

hospital seeks to enter into an 

agreement under the waiver. In making 

a waiver determination, section 

1138(a)(2)(B) of the Act provides that 

the Secretary may consider, among 

other factors: (1) cost-effectiveness; (2) 

improvements in quality; (3) whether 

there has been any change in a 

hospital’s designated OPO due to the 

changes made in definitions for 

metropolitan statistical areas; and (4) 

the length and continuity of a hospital’s 

relationship with an OPO other than the 

hospital’s designated OPO. Under 

section 1138(a)(2)(D) of the Act, the 

Secretary is required to publish a notice 

of any waiver application received from 

a hospital within 30 days of receiving 

the application, and to offer interested 

parties an opportunity to submit 

comments during the 60-day comment 

period beginning on the publication 

date in the Federal Register. 

The criteria that the Secretary uses to 

evaluate the waiver in these cases are 

the same as those described above under 

section 1138(a)(2)(A) and (B) of the Act 

and have been incorporated into the 

regulations at § 486.308(e) and (f). 

II. Waiver Request Procedures 

In October 1995, we issued a Program 

Memorandum (Transmittal No. A–95– 

11) detailing the waiver process and 

discussing the information hospitals 

must provide in requesting a waiver. We 

indicated that upon receipt of a waiver 

request, we would publish a Federal 

Register notice to solicit public 

comments, as required by section 

1138(a)(2)(D) of the Act. 

According to these requirements, we 

will review the comments received. 

During the review process, we may 

consult on an as-needed basis with the 

Health Resources and Services 

Administration’s Division of 

Transplantation, the United Network for 

Organ Sharing, and our regional offices. 

If necessary, we may request additional 

clarifying information from the applying 

hospital or others. We will then make a 

final determination on the waiver 

request and notify the hospital and the 

designated and requested OPOs. 

III. Hospital Waiver Request 

As permitted by § 486.308(e), the 

following hospital has requested a 

waiver to enter into an agreement with 

a designated OPO other than the OPO 

designated for the service area in which 

the hospital is located: 

Renown Regional Medical Center, 

Reno, Nevada, is requesting a waiver to 

work with: 

Nevada Donor Network, Inc, 2055 E 

Sahara Ave., Las Vegas, NV 89104 

The Hospital’s Designated OPO is: 

Donor Network West, 12667 Alcosta 

Blvd. #500, San Ramon, CA 94583 

IV. Collection of Information 

Requirements 

This document does not impose 

information collection requirements, 

that is, reporting, recordkeeping or 

third-party disclosure requirements. 

Consequently, there is no need for 

review by the Office of Management and 

Budget under the authority of the 

Paperwork Reduction Act of 1995 (44 

U.S.C. 3501 et seq.). 

V. Response to Comments 

We will consider all comments we 

receive by the date specified in the 

DATES section of this document. 

The Administrator of the Centers for 

Medicare & Medicaid Services (CMS), 

Chiquita Brooks-LaSure, having 

reviewed and approved this document, 

authorizes Chyana Woodyard, who is 

the Federal Register Liaison, to 

electronically sign this document for 

purposes of publication in the Federal 

Register. 

Dated: November 17, 2023. 

Chyana Woodyard, 

Federal Register Liaison, Centers for Medicare 

& Medicaid Services. 

[FR Doc. 2023–25902 Filed 11–22–23; 8:45 am] 

BILLING CODE P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–1818–NC] 

Medicare and Medicaid Programs; 

Announcement of Application From a 

Hospital Requesting Waiver for Organ 

Procurement Service Area 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice with request for 

comment. 

SUMMARY: This notice acknowledges the 

receipt of an application from a hospital 

that has requested a waiver of statutory 

requirements that would otherwise 

require the hospital to enter into an 

agreement with its designated organ 

procurement organization (OPO). This 

notice requests comments from OPOs 

and the general public for our 

consideration in determining whether 

we should grant the requested waiver. 

DATES: Comment date: To be assured 

consideration, comments must be 

received at one of the addresses 

provided below, by January 23, 2024. 

ADDRESSES: In commenting, refer to file 

code CMS–1818–NC. 

Comments, including mass comment 

submissions, must be submitted in one 

of the following three ways (please 

choose only one of the ways listed): 

1. Electronically. You may submit 

electronic comments on this regulation 

to https://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–1818–NC, P.O. Box 8010, 

Baltimore, MD 21244–8010. 

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–1818–NC, 

Mail Stop C4–26–05, 7500 Security 

Boulevard, Baltimore, MD 21244–1850. 

For information on viewing public 

comments, see the beginning of the 

SUPPLEMENTARY INFORMATION section. 

FOR FURTHER INFORMATION CONTACT: 

Randy Throndset, (410) 786–0131. 

SUPPLEMENTARY INFORMATION: Inspection 

of Public Comments: All comments 

received before the close of the 


ddrumheller on DSK120RN23PROD with NOTICES1