16630 Federal Register / Vol. 78, No. 52 / Monday, March 18, 2013 / Proposed Rules 

the U.S. Department of the Interior, 

Bureau of Indian Affairs, Osage 

Negotiated Rulemaking Committee will 

meet as indicated below. 

DATES: Meeting: The meeting will be 

held on Tuesday, April 2, 2013, from 9 

a.m. to 5 p.m. 

ADDRESSES: Wah Zha Zhi Cultural 

Center, 1449 W. Main, Pawhuska, 

Oklahoma 74056. 

FOR FURTHER INFORMATION CONTACT: Mr. 

Eddie Streater, Designated Federal 

Officer, Bureau of Indian Affairs, 

Wewoka Agency, P.O. Box 1540, 

Seminole, OK 74818; telephone (405) 

257–6250; fax (405) 257–3875; or email 

osageregneg@bia.gov. Additional 

Committee information can be found at: 

http://www.bia.gov/osageregneg. 

SUPPLEMENTARY INFORMATION: On 

October 14, 2011, the United States and 

the Osage Nation (formerly known as 

the Osage Tribe) signed a Settlement 

Agreement to resolve litigation 

regarding alleged mismanagement of the 

Osage Nation’s oil and gas mineral 

estate, among other claims. As part of 

the Settlement Agreement, the parties 

agreed that it would be mutually 

beneficial ‘‘to address means of 

improving the trust management of the 

Osage Mineral Estate, the Osage Tribal 

Trust Account, and Other Osage 

Accounts.’’ Settlement Agreement, 

Paragraph 1.i. The parties agreed that a 

review and revision of the existing 

regulations is warranted to better assist 

the Bureau of Indian Affairs (BIA) in 

managing the Osage Mineral Estate. The 

parties agreed to engage in a negotiated 

rulemaking for this purpose. Settlement 

Agreement, Paragraph 9.b. After the 

Committee submits its report, BIA will 

develop a proposed rule to be published 

in the Federal Register. 

Meeting Agenda: The morning session 

will include: Final Committee thoughts 

on proposed final revised regulations 

and public comment on final proposed 

revised regulations. The afternoon 

session will include: Responses by the 

Committee on public comments and 

final vote by Committee on final 

proposed revised regulations. The final 

agenda will be posted on www.bia.gov/ 

osagenegreg prior to each meeting. 

Public Input: Committee meetings are 

open to the public. Interested members 

of the public may present, either orally 

or through written comments, 

information for the Committee to 

consider during the public meeting. 

Written comments should be submitted, 

prior to, during, or after the meeting, to 

Mr. Eddie Streater, Designated Federal 

Officer, preferably via email, at 

osagenegneg@bia.gov, or by U.S. mail 

to: Mr. Eddie Streater, Designated 

Federal Officer, Bureau of Indian 

Affairs, Wewoka Agency, P.O. Box 1540, 

Seminole, OK 74818. Due to time 

constraints during the meeting, the 

Committee is not able to read written 

public comments submitted into the 

record. 

Individuals or groups requesting to 

make oral comments at the public 

Committee meeting will be limited to 5 

minutes per speaker. Speakers who 

wish to expand their oral statements, or 

those who had wished to speak, but 

could not be accommodated during the 

public comment period, are encouraged 

to submit their comments in written 

form to the Committee after the meeting 

at the address provided above. There 

will be a sign-up sheet at the meeting for 

those wishing to speak during the 

public comment period. 

The meeting location is open to the 

public. Space is limited, however, so we 

strongly encourage all interested in 

attending to preregister by submitting 

your name and contact information via 

email to Mr. Eddie Streater at 

osageregneg@bia.gov. Persons with 

disabilities requiring special services, 

such as an interpreter for the hearing 

impaired, should contact Mr. Streater at 

(405) 257–6250 at least seven calendar 

days prior to the meeting. We will do 

our best to accommodate those who are 

unable to meet this deadline. 

Dated: March 8, 2013. 

Michael S. Black, 

Director, Bureau of Indian Affairs. 

[FR Doc. 2013–06175 Filed 3–15–13; 8:45 am] 

BILLING CODE 4310–02–P 

ENVIRONMENTAL PROTECTION 

AGENCY 

40 CFR Part 35 

[EPA–R09–0AR–2013–0052; FRL–9788–5] 

Clean Air Act Grant: South Coast Air 

Quality Management District; 

Opportunity for Pubic Hearing 

AGENCY: Environmental Protection 

Agency (EPA). 

ACTION: Proposed action; determination 

with request for comments and notice of 

opportunity for public hearing. 

SUMMARY: The U.S. EPA has made a 

proposed determination that the 

reduction in expenditures of nonFederal funds for the South Coast Air 

Quality Management District 

(SCAQMD) in support of its continuing 

air program under section 105 of the 

Clean Air Act (CAA), for the calendar 

year 2012 is a result of non-selective 

reductions in expenditures. This 

determination, when final, will permit 

the SCAQMD to receive grant funding 

for FY 2013 from the EPA, under section 

105 of the Clean Air Act. 

DATES: Comments and/or requests for a 

public hearing must be received by EPA 

at the address stated below by April 17, 

2013. 

ADDRESSES: Submit comments, 

identified by docket ID No. EPA–R09– 

OAR–2013–0052, by one of the 

following methods: 

1. Federal Portal: 

www.regulations.gov. Follow the online 

instructions. 

2. Email: lance.gary@epa.gov or 

3. Mail: Gary Lance (Air–8), U.S. 

Environmental Protection Agency 

Region IX, 75 Hawthorne Street, San 

Francisco, CA 94105–3901. 

FOR FURTHER INFORMATION CONTACT: Gary 

Lance, EPA Region IX, Grants & Program 

Integration Office, Air Division, 75 

Hawthorne Street, San Francisco, CA 

94105; phone: (415) 972–3992,fax: (415) 

947–3579 or email address at 

lance.gary@epa.gov. 

SUPPLEMENTARY INFORMATION: Section 

105 of the Clean Air Act (CAA) provides 

grant support for the continuing air 

programs of eligible state, local, and 

tribal agencies. In accordance with 40 

CFR 35.145(a), the Regional 

Administrator may provide air pollution 

control agencies up to three-fifths of the 

approved costs of implementing 

programs for the prevention and control 

of air pollution. Section 105 contains 

two cost-sharing provisions which 

recipients must meet to qualify for a 

CAA section 105 grant. An eligible 

entity must meet a minimum 40% 

match. In addition, to remain eligible for 

section 105 funds, an eligible entity 

must continue to meet the minimum 

match requirement as well as meet a 

maintenance of effort (MOE) 

requirement under section 105(c)(1) of 

the CAA, 42 U.S.C. 7405. 

Program activities relevant to the 

match consist of both recurring and 

non-recurring (unique,one-time only) 

expenses. The MOE provision requires 

that a state or local agency spend at least 

the same dollar level of funds as it did 

in the previous grant year, but only for 

the costs of recurring activities. 

Specifically, section 105(c)(1), 42 U.S.C. 

7405(c)(1), provides that ‘‘No agency 

shall receive any grant under this 

section during any fiscal year when its 

expenditures of non-Federal funds for 

recurrent expenditures for air pollution 

control programs will be less than its 

expenditures were for such programs 

during the preceding fiscal year.’’ 

Pursuant to CAA section 105(c)(2), 

however, EPA may still award a grant to 


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Federal Register / Vol. 78, No. 52 / Monday, March 18, 2013 / Proposed Rules 16631 

an agency not meeting the requirements 

of section 105(c)(1), ‘‘if the 

Administrator, after notice and 

opportunity for public hearing, 

determines that a reduction in 

expenditures is attributable to a nonselective reduction in the expenditures 

in the programs of all Executive branch 

agencies of the applicable unit of 

Government.’’ These statutory 

requirements are repeated in EPA’s 

implementing regulations at 40 CFR 

35.140–35.148. EPA issued additional 

guidance to recipients on what 

constitutes a nonselective reduction on 

September 30, 2011. In consideration of 

legislative history, the guidance 

clarified that a non-selective reduction 

does not necessarily mean that each 

Executive branch agency need be 

reduced in equal proportion. However, 

it must be clear to EPA, from the weight 

of evidence, that a recipient’s CAArelated air program is not being 

disproportionately impacted or singled 

out for a reduction. 

A section 105 recipient must submit 

a final financial status report no later 

than 90 days from the close of its grant 

period that documents all of its federal 

and non-federal expenditures for the 

completed period. The recipient seeking 

an adjustment to its MOE for that period 

must provide the rationale and the 

documentation necessary to enable EPA 

to make a determination that a 

nonselective reduction has occurred. In 

order to expedite that determination, the 

recipient must provide details of the 

budget action and the comparative fiscal 

impacts on all the jurisdiction’s 

executive branch agencies, the recipient 

agency itself, and the agency’s air 

program. The recipient should identify 

any executive branch agencies or 

programs that should be excepted from 

comparison and explain why. The 

recipient must provide evidence that the 

air program is not being singled out for 

a reduction or being disproportionately 

reduced. Documentation in two key 

areas will be needed: Budget data 

specific to the recipient’s air program 

and comparative budget data between 

the recipient’s air program, the agency 

containing the air program, and the 

other executive branch agencies. EPA 

may also request information from the 

recipient about how impacts on its 

program operations will affect its ability 

to meet its CAA obligations and 

requirements; and documentation 

which explains the cause of the 

reduction, such as legislative changes or 

the issuance of a new executive order. 

In FY2012, EPA awarded the 

SCAQMD $5,234,193, which 

represented approximately 5% of the 

SCAQMD budget. In FY–2013, EPA will 

award the SCAQMD an estimate of 

$4,538,613, which represents 

approximately 4% of the SCAQMD 

budget. 

SCAQMD’s final Federal Financial 

Report for FY–2011 indicated that 

SCAQMD’s maintenance of effort (MOE) 

level was $113,142,559. SCAQMD’s 

final Federal Financial Report for FY– 

2012 indicates that SCAQMD’s 

maintenance of effort (MOE) level is at 

$108,291,832. 

The projected MOE is not sufficient to 

meet the MOE requirements under the 

CAA section 105 because it is not equal 

to or greater than the MOE for the 

previous fiscal year. In order for the 

SCAQMD to be eligible to receive its 

FY2013 CAA section 105 grant, EPA 

must make a determination (after notice 

and an opportunity for a public hearing) 

that the reduction in expenditures is 

attributable to a non-selective reduction 

in the expenditures in the programs of 

the South Coast Air Quality 

Management District. The shortfall 

stems from a decline of 12.4% in 

stationary sources revenue from 

FY2008–09 to FY–2011–12 as reflected 

in the table below: 

The SCAQMD is a single-purpose 

agency whose primary source of funding 

is emission fee revenue. It is the ‘‘unit 

of government for section 105(c)(2) 

purposes.’’ 

The decline in stationary source 

revenues would have been even more 

pronounced had it not been for the 

SCAQMD Governing Board-adopted fee 

increases totaling 5.9% over the last 

three years. The net loss of stationary 

revenues has given SCAQMD no choice 

but to reduce its budget and find less 

costly ways to meet its mandate. Over 

the past several years actions were 

undertaken by SCAQMD to balance its 

budget by reducing overall 

expenditures, including deleting or not 

funding vacant positions, implementing 

a hiring freeze, enacting pension reform, 

reducing services and supplies 

expenditures, and utilizing reserves. 

Since FY2009–10, SCAQMD has 

supplemented revenues with $18.5 

million in reserves to balance the budget 

and meet program requirements. 

In addition to the conditions 

described above, an increase in 

expenditures relating to permitting 

activities under Title V of CAA, 42 

U.S.C. 7661–7661–f and an increase in 

non-recurrent capital expenditures in 

the amount of $1,406,240 have resulted 

in a reduction in the non-federal share 

which also contributed to a decrease in 

the FY12 MOE level. 

Based on: (1) SCAQMD’s inability to 

levy taxes, (2) regulated and voluntary 

emissions reductions, (3) the general 

economic downturn, (4) voter approval 

of Proposition 26, (5) an overall decline 

in stationary source revenue, (6) 

expenditure cuts, (7) use of financial 

reserves to balance the budget, 

(8)increased Title V permitting 

activities, and (9) an increase in nonrecurrent capital expenditures, the 

request for a reset of SCAQMD’s MOE 

meets the criteria for a non-selective 

reduction determination. 

Although SCAQMD receives less than 

5 percent of its support from the section 

105 grant, the loss of that funding would 

seriously impact SCAQMD’s ability to 

carry out its clean air program. The 

revenue generated from Stationary 

Sources over the last 10 years is detailed 

below. 

Year Stationary 

sources (1) 

2003 ...................................... 62,835,710 

2004 ...................................... 61,461,482 

2005 ...................................... 64,613,635 

2006 ...................................... 68,483,189 

2007 ...................................... 75,200,253 

2008 ...................................... 82,800,004 

2009 ...................................... 91,472,243 


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16632 Federal Register / Vol. 78, No. 52 / Monday, March 18, 2013 / Proposed Rules 

Year Stationary 

sources (1) 

2010 ...................................... 81,097,647 

2011 ...................................... 78,787,371 

2012 ...................................... 79,815,562 

The SCAQMD’s MOE reduction 

resulted from a loss of revenues due to 

circumstances beyond its control. EPA 

proposes to determine that the 

SCAQMD lower the FY2012 MOE level 

to $108,291,832 to meet the CAA 

section 105(c)(2) criteria as resulting 

from a non-selective reduction of 

expenditures. 

This notice constitutes a request for 

public comment and an opportunity for 

public hearing as required by the Clean 

Air Act. All written comments received 

by April 17, 2013 on this proposal will 

be considered. EPA will conduct a 

public hearing on this proposal only if 

a written request for such is received by 

EPA at the address above by April 17, 

2013. If no written request for a hearing 

is received, EPA will proceed to the 

final determination. While notice of the 

final determination will not be 

published in the Federal Register, 

copies of the determination can be 

obtained by sending a written request to 

Gary Lance at the above address. 

Dated: March 6, 2013. 

Jared Blumenfeld, 

Regional Administrator, Region IX. 

[FR Doc. 2013–05923 Filed 3–15–13; 8:45 am] 

BILLING CODE P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

42 CFR Parts 414 and 419 

[CMS–1455–P] 

RIN 0938–AR73 

Medicare Program; Part B Inpatient 

Billing in Hospitals 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Proposed rule. 

SUMMARY: The proposed rule would 

revise Medicare Part B billing policies 

when a Part A claim for an hospital 

inpatient admission is denied as not 

medically reasonable and necessary. 

DATES: To be assured consideration, 

comments must be received at one of 

the addresses provided below, no later 

than 5 p.m. on May 17, 2013. 

ADDRESSES: In commenting, please refer 

to file code CMS–1455–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 document 

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–1455–P, P.O. Box 8013, Baltimore, 

MD 21244–8013. 

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–1455–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. 

(Because access to the interior of the 

Hubert H. Humphrey 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.) 

b. For delivery in Baltimore, MD— 

Centers for Medicare & Medicaid 

Services, Department of Health and 

Human Services, 7500 Security 

Boulevard, Baltimore, MD 21244–1850. 

If you intend to deliver your 

comments to the Baltimore address, call 

telephone number (410) 786–7195 in 

advance to schedule your arrival with 

one of our staff members. 

Comments erroneously 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. 

FOR FURTHER INFORMATION CONTACT: Ann 

Marshall, (410) 786–3059, for issues 

related to payment of Part B inpatient 

and Part B outpatient services. 

David Danek, (617) 565–2682, for 

issues related to hospital or beneficiary 

appeals. 

Fred Grabau, (410) 786–0206, for 

issues related to time limits for filing 

claims. 

Twi Jackson, (410) 786–1159, for 

information on all other issues. 

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 Web 

site as soon as possible after they have 

been received: http:// 

www.regulations.gov. Follow the search 

instructions 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. 

I. Summary and Background 

A. Executive Summary 

1. Purpose 

In the Calendar Year (CY) 2013 

Hospital Outpatient Prospective 

Payment System (OPPS)/Ambulatory 

Surgical Center (ASC) proposed rule 

(July 30, 2012, 77 FR 45155 through 

45157) and final rule with comment 

period (November 15, 2012, 77 FR 

68426 through 68433), we expressed our 

ongoing concern about recent increases 

in the length of time that Medicare 

beneficiaries spend as hospital 

outpatients receiving observation 

services. (In this proposed rule, 

‘‘hospital’’ means hospital as defined at 

section 1861(e) of the Social Security 

Act (the Act), but includes critical 

access hospitals (CAHs) unless 

otherwise specified. Although the term 

‘‘hospital’’ does not generally include 

CAHs, section 1861(e) of the Act 

provides that the term ‘‘hospital’’ 


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