Federal Register / Vol. 65, No. 203 / Thursday, October 19, 2000 / Proposed Rules 62681

approve pre-existing requirements

under state law and does not impose

any additional enforceable duty beyond

that required by state law, it does not

contain any unfunded mandate or

significantly or uniquely affect small

governments, as described in the

Unfunded Mandates Reform Act of 1995

(Public Law 104–4). For the same

reason, this proposed rule also does not

significantly or uniquely affect the

communities of tribal governments, as

specified by Executive Order 13084 (63

FR 27655, May 10, 1998). This proposed

rule will 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 (64

FR 43255, August 10, 1999), because it

merely proposes to approve a state rule

implementing a federal standard, and

does not alter the relationship or the

distribution of power and

responsibilities established in the Clean

Air Act. This proposed rule also is not

subject to Executive Order 13045 (62 FR

19885, April 23, 1997), because it is not

economically significant. In reviewing

SIP submissions, EPA’s role is to

approve state choices, provided that

they meet the criteria of the Clean Air

Act. In this context, in the absence of a

prior existing requirement for the State

to use voluntary consensus standards

(VCS), EPA has no authority to

disapprove a SIP submission for failure

to use VCS. It would thus be

inconsistent with applicable law for

EPA, when it reviews a SIP submission,

to use VCS in place of a SIP submission

that otherwise satisfies the provisions of

the Clean Air Act. Thus, the

requirements of section 12(d) of the

National Technology Transfer and

Advancement Act of 1995 (15 U.S.C.

272 note) do not apply. As required by

section 3 of Executive Order 12988 (61

FR 4729, February 7, 1996), in issuing

this proposed rule, EPA has taken the

necessary steps to eliminate drafting

errors and ambiguity, minimize

potential litigation, and provide a clear

legal standard for affected conduct. EPA

has complied with Executive Order

12630 (53 FR 8859, March 15, 1988) by

examining the takings implications of

the rule in accordance with the

‘‘Attorney General’s Supplemental

Guidelines for the Evaluation of Risk

and Avoidance of Unanticipated

Takings’’ issued under the Executive

order. This proposed rule to approve the

District of Columbia’s Nitrogen Oxides

Emissions Budget Program regulations

to implement Phase II of the OTC MOU

does not impose an information

collection burden under the provisions

of the Paperwork Reduction Act of 1995

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

List of Subjects in 40 CFR Part 52

Environmental protection, Air

pollution control, Nitrogen dioxide,

Ozone, Reporting and recordkeeping

requirements.

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

Dated: October 13, 2000.

Thomas Voltaggio,

Acting Regional Administrator, Region III.

[FR Doc. 00–26901 Filed 10–18–00; 8:45 am]

BILLING CODE 6560–50–P

ENVIRONMENTAL PROTECTION

AGENCY

40 CFR Part 52

[VA109–5050b; FRL–6887–6]

Approval and Promulgation of Air

Quality Implementation Plans; Virginia;

Approval of Approval of Removal of

TSP Ambient Standards

AGENCY: Environmental Protection

Agency (EPA).

ACTION: Proposed rule.

SUMMARY: EPA proposes to approve a

State Implementation Plan (SIP)

revision submitted by the

Commonwealth of Virginia for the

purpose of removing references to total

suspended particulate (TSP) ambient

standards and levels from its regulations

for ambient air quality standards and for

air pollution episode prevention. In the

Final Rules section of this Federal

Register, EPA is approving the State’s

SIP submittal as a direct final rule

without prior proposal because the

Agency views this as a noncontroversial

submittal and anticipates no adverse

comments. A detailed rationale for the

approval is set forth in the direct final

rule. If no adverse comments are

received in response to this action, no

further activity is contemplated. If EPA

receives adverse comments, the direct

final rule will be withdrawn and all

public comments received will be

addressed in a subsequent final rule

based upon this proposed rule. EPA will

not institute a second comment period.

Any parties interested in commenting

on this action should do so at this time.

DATES: Comments must be received in

writing by November 20, 2000.

ADDRESSES: Written comments should

be addressed to Mr. Denis Lohman,

Acting Chief, Technical Assessment

Branch, Mailcode 3AP22, U.S.

Environmental Protection Agency,

Region III, 1650 Arch Street,

Philadelphia, Pennsylvania 19103.

Copies of the documents relevant to this

action are available for public

inspection during normal business

hours at the Air Protection Division,

U.S. Environmental Protection Agency,

Region III, 1650 Arch Street,

Philadelphia, Pennsylvania 19103; and

Virginia Department of Environmental

Quality, 629 East Main Street,

Richmond, Virginia, 23219.

FOR FURTHER INFORMATION CONTACT:

Ruth E. Knapp, (215) 814–2191, at the

EPA Region III address above, or by email at knapp.ruth@epa.gov.

SUPPLEMENTARY INFORMATION: For

further information on this SIP revision

related to removal of TSP ambient

standards and levels from Virginia’s

regulations, please see the information

provided in the direct final action, with

the same title, that is located in the

‘‘Rules and Regulations’’ section of this

Federal Register publication.

Dated: October 5, 2000.

Bradley M. Campbell,

Regional Administrator, Region III.

[FR Doc. 00–26909 Filed 10–18–00; 8:45 am]

BILLING CODE 6560–50–P

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Care Financing Administration

42 CFR Part 410

[HCFA–1088–P]

RIN 0938–AJ71

Medicare Program; Clinical Social

Worker Services

AGENCY: Health Care Financing

Administration (HCFA), HHS.

ACTION: Proposed rule.

SUMMARY: This proposed rule would

permit separate Medicare Part B

payment for certain psychotherapy

services of clinical social workers

furnished to a skilled nursing facility

resident whose stay is not covered by

Medicare. This rule would benefit

residents of skilled nursing facilities

who receive psychological services from

clinical social workers.

DATES: We will consider comments if

we receive them at the appropriate

address, as provided below, no later

than 5 p.m. on December 18, 2000.

ADDRESSES: Mail written comments (one

original and three copies) to the

following address ONLY: Health Care

Financing Administration, Department

of Health and Human Services,

62682 Federal Register / Vol. 65, No. 203 / Thursday, October 19, 2000 / Proposed Rules

Attention: HCFA–1088–P, P.O. Box

8013, Baltimore, MD 21244–8013.

If you prefer, you may deliver by

courier, your written comments (one

original and three copies) to one of the

following addresses:

Room 443–G, Hubert H. Humphrey

Building, 200 Independence Avenue,

SW., Washington, DC 20201 or

Room C5–14–03, Central Building, 7500

Security Boulevard, Baltimore, MD

21244–1850.

Comments mailed to those addresses

may be delayed and could be

considered late.

Because of staffing and resource

limitations, we cannot accept comments

by facsimile (FAX) transmission. In

commenting, please refer to file code

HCFA–1088–P.

Comments received timely will be

available for public inspection as they

are received, generally beginning

approximately 3 weeks after publication

of a document, in Room 443–G of the

Department’s offices at 200

Independence Avenue, SW,

Washington, DC, 20201 on Monday

through Friday of each week from 8:30

a.m. to 5:00 p.m. (Phone (202) 690–

7890).

FOR FURTHER INFORMATION CONTACT: Paul

W. Kim, (410) 786–7410.

SUPPLEMENTARY INFORMATION:

I. Background

Section 6113 of the Omnibus Budget

Reconciliation Act of 1989 (OBRA 1989)

(Public Law 101–239) amended section

1861(s)(2) of the Social Security Act (the

Act) to provide coverage of clinical

social worker (CSW) services under

Medicare Part B. OBRA 1989 also

amended section 1861(hh) of the Act

and defined CSW services. This

definition included services performed

by a CSW for the diagnosis and

treatment of mental illness but excluded

those services furnished to an inpatient

of a skilled nursing facility (SNF) that

the SNF is required to provide for

participation in Medicare.

On December 29, 1993, we published

a proposed rule (58 FR 68829) on a

number of issues regarding services of

CSWs and clinical psychologists (CPs).

That proposed rule also solicited public

comment to identify any CSW service

that a SNF is not already required to

provide under section 1819(b)(4)(A) of

the Act. Based on the comments we

received at that time, we were unable to

identify any specific service performed

by CSWs for SNF residents that a SNF

was not required to provide.

Consequently, under the final rule (63

FR 20110) on CSW and CP services

published on April 23, 1998, separate

Medicare Part B payment would not be

made for CSW services furnished to

SNF residents beginning June 22, 1998.

We decided to delay implementation of

the new rule.

II. Provisions of the Proposed

Regulations

The SNF certification standards at

section 1819(b)(4)(A)(i) through

(b)(4)(A)(vii) of the Act contain

requirements relating specifically to

social services, along with a broader

mandate for SNFs to furnish a variety of

services to the extent necessary ‘‘* * *

to attain or maintain the highest

practicable physical, mental, and

psychosocial well-being of each resident

* * *.’’ As we observed in the preamble

to the April 23, 1998 final rule, defining

the scope of coverage under the Part B

CSW benefit as excluding the services

required under this more sweeping

mandate would effectively preclude any

CSW coverage whatsoever in the SNF

setting, since this broad mandate could

be interpreted to encompass virtually

any service that a social worker

conceivably could perform in this

setting.

Upon further consideration, however,

we believe that the manner in which

section 1861(hh) was drafted in the

original CSW legislation indicates that

the statute does not require the

exclusion of CSW coverage in this

setting to be so absolute. Instead, we

believe that it is appropriate to draw a

distinction between a set of services that

the SNF certification standards require

social workers to furnish (and which,

thus, fall outside the scope of the CSW

benefit) and other services (which

remain coverable under the CSW

benefit).

We believe one possible approach

would be to distinguish between those

certification standards that, on the one

hand, pertain specifically and

exclusively to social workers—that is,

the ‘‘medically-related social services’’

described in section 1819(b)(4)(A)(ii) of

the Act, and the ‘‘social services’’ for

which section 1819(b)(7) of the Act

requires SNFs with more than 120 beds

to hire a full-time social worker—and,

on the other, those ‘‘specialized

rehabilitative services’’ described in

section 1819(b)(4)(A)(i) of the Act,

which can be furnished by a variety of

different practitioner types that in some

cases may include social workers. We

believe that the psychotherapeutic

services addressed in this proposed rule

belong to the latter category and, as

such, should not be subject to the

coverage exclusion for CSW services

furnished in SNFs.

Under this proposal, we would pay

CSWs for the (Physicians’) Current

Procedural Terminology (CPT) codes

(4th Edition, 1999; copyrighted by the

American Medical Association) which

represent psychotherapy services that

are furnished to SNF residents and

billed by CPs and that the CSWs are

legally authorized to perform under

State law. Specifically, we would pay

for CPT codes 90801, 90802, 90816,

90818, 90821, 90823, 90826, 90828,

90846, 90847, 90853, and 90857.

However, we would not pay under Part

B for any other services that CSWs

furnish to SNF residents, since we

regard these services (for example, care

planning and discharge planning) as

already required to be furnished by

social workers under the SNF

participation requirements.

Further, this proposal would not

affect payment for CSW services

furnished to an SNF resident during the

course of an inpatient stay that is

covered under Medicare Part A. In

accordance with section 1888(e) of the

Act, as established by section 4432(a) of

the Balanced Budget Act of 1997 (BBA

1997, Public Law 105–33), an SNF

receives payment under the prospective

payment system (PPS) for virtually all of

the services that its residents receive

during a covered Part A stay, except for

a short list of excluded services

specified in section 1888(e)(2)(A)(ii) of

the Act. Because CSW services do not

appear on this statutory exclusion list,

they are included within the global per

diem payment that Part A makes to the

SNF for the Medicare-covered stay, and

the CSW must look to the SNF, rather

than to Part B, for payment.

Accordingly, we would not make any

additional payment under the Part B

CSW benefit for services that are

furnished to SNF residents during a

covered Part A stay, because section

1833(d) of the Act expressly prohibits

payment under Part B for any service

that is covered under Part A.

Similarly, this proposal would not

affect the SNF consolidated billing

requirements established by section

4432(b) of the BBA 1997. Under sections

1842(b)(6)(E) and 1862(a)(18) of the Act,

a SNF must bill Medicare for both Part

A and Part B services that are furnished

to its residents, except for those services

that the Act specifically excludes, as

discussed above. Due to systems

constraints in connection with

achieving Year 2000 (Y2K) compliance,

we have delayed the implementation of

SNF consolidated billing with respect to

those SNF residents who are not in a

covered Part A stay. However, once this

aspect of SNF consolidated billing is

implemented, Part B bills for Medicare

Federal Register / Vol. 65, No. 203 / Thursday, October 19, 2000 / Proposed Rules 62683

CSW services furnished to SNF

residents during a noncovered stay

would have to be submitted by the SNF

rather than by the CSW. Exempting

CSW services from the SNF

consolidated billing provision would

require legislation to amend the Act by

adding these services to the list of

statutory exclusions discussed above.

III. Collection of Information

Requirements

This document does not impose any

information collection and record

keeping requirements subject to the

Paperwork Reduction Act of 1995

(PRA). Consequently, it does not need to

be reviewed by the Office of

Management and Budget (OMB) under

the authority of PRA.

IV. Response to Comments

Because of the large number of items

of correspondence we normally receive

on Federal Register documents

published for comment, we are not able

to acknowledge or respond to them

individually. We will consider all

comments we receive by the date and

time specified in the DATES section of

this preamble, and, if we proceed with

a subsequent document, we will

respond to the comments in the

preamble to that document.

V. Regulatory Impact Statement

We have examined the impacts of this

proposed rule as required by Executive

Order (E.O.) 12866 and the Regulatory

Flexibility Act (RFA) (Public Law 96–

354). E.O. 12866 directs agencies to

assess all costs and benefits of available

regulatory alternatives and, if regulation

is necessary, to select regulatory

approaches that maximize net benefits

(including potential economic,

environmental, public health and safety

effects, distributive impacts, and

equity). A regulatory impact analysis

(RIA) must be prepared for major rules

with economically significant effects

($100 million or more annually). We

have determined that this proposed rule

is not a major rule with economically

significant effects. However, we have

prepared a voluntary RFA to furnish

additional information.

The RFA requires agencies to analyze

options for regulatory relief of small

businesses. For purposes of the RFA,

small entities include small businesses,

nonprofit organizations, and

governmental agencies. Most hospitals

and most other providers and suppliers

are small entities, either by nonprofit

status or by having revenues of $5

million or less annually. For purposes of

the RFA, intermediaries and carriers are

not considered to be small entities.

Individuals and States are not included

in the definition of a small entity.

According to estimates provided by the

National Association of Social Workers,

there were approximately 18,000

clinically trained social workers serving

the 1.6 million residents of the nation’s

17,000 nursing homes in 1999. Because

this proposed rule permits

approximately $12 million in annual

payments for CSW services that the final

rule of April 23, 1998 would have

eliminated, this proposed rule would

have a significant positive impact on a

substantial number of small entitites.

This rule would also benefit residents of

SNFs who receive mental health

services from clinical social workers.

In addition, section 1102(b) of the Act

requires us to prepare an RIA if a rule

may have a significant impact on the

operations of a substantial number of

small rural hospitals. This analysis must

conform to the provisions of section 603

of the RFA. For purposes of section

1102(b) of the Act, we define a small

rural hospital as a hospital that is

located outside of a Metropolitan

Statistical Area and has fewer than 50

beds. This proposed rule would not

have a significant impact on the

operations of a substantial number of

small rural hospitals.

Section 202 of the Unfunded

Mandates Reform Act of 1995 also

requires that agencies assess anticipated

costs and benefits before issuing any

rule that may result in an expenditure

in any 1 year by State, local, or tribal

governments, in the aggregate, or by the

private sector, of $100 million or more.

This proposed rule would have no

consequential effect on State, local, or

tribal governments, and the private

sector cost of this rule falls below these

thresholds as well.

For these reasons, we are not

preparing analyses for either the RFA or

section 1102(b) of the Act because we

have determined, and we certify, that

this rule would not have a significant

economic impact on a substantial

number of small entities or a significant

impact on the operations of a substantial

number of small rural hospitals.

In accordance with the provisions of

E.O. 12866, this regulation was

reviewed by OMB.

We have reviewed this proposed rule

under the threshold criteria of E.O.

13132, Federalism. We have determined

that the proposed rule would not

significantly affect the rights, roles, and

responsibilities of States.

List of Subjects in 42 CFR Part 410

Health facilities, Health professions,

Kidney diseases, Laboratories,

Medicare, Rural areas, X-rays.

For the reasons set forth in the

preamble, 42 CFR part 410 is proposed

to be amended as set forth below:

PART 410—SUPPLEMENTARY

MEDICAL INSURANCE (SMI)

BENEFITS

1. The authority citation for part 410

continues to read as follows:

Authority: Secs. 1102 and 1871 of the

Social Security Act (42 U.S.C. 1302 and

1395hh).

2. In § 410.73, paragraph (b)

introductory text and (b)(2) introductory

text are republished, and paragraph

(b)(2)(ii) is revised to read as follows:

§ 410.73 Clinical social worker services.

* * * * *

(b) Covered clinical social worker

services. Medicare Part B covers clinical

social worker services.

* * * * *

(2) Exception. The following services

are not clinical social worker services

for purposes of billing Medicare Part B:

* * * * *

(ii) Services furnished by a clinical

social worker to an inpatient of a

Medicare-participating SNF if the

services are required by the

requirements for participation for SNFs

at §§ 483.15 and 483.45 of this chapter.

* * * * *

(Catalog of Federal Domestic Assistance

Program No. 93.773, Medicare—Hospital

Insurance; and Program No. 93.774,

Medicare—Supplementary Medical

Insurance Program)

Dated: February 7, 2000.

Nancy-Ann Min DeParle,

Administrator, Health Care Financing

Administration.

Approved: March 27, 2000.

Donna E. Shalala,

Secretary.

Editorial Note: This document was

received at the Office of the Federal Register

October 13, 2000.

[FR Doc. 00–26737 Filed 10–18–00; 8:45 am]

BILLING CODE 4120–01–P

FEDERAL COMMUNICATIONS

COMMISSION

47 CFR Part 73

[MM Docket No. 00–168; FCC 00–345]

Standardized and Enhanced

Disclosure of Commercial Television

Station Public Interest Obligations

AGENCY: Federal Communications

Commission.

ACTION: Proposed rule.