Federal Register / Vol. 65, No. 221 / Wednesday, November 15, 2000 / Proposed Rules 68957

it is determined that this proposal

would not have federalism implications

under Executive Order 13132.

For the reasons discussed above, I

certify that this proposed regulation (1)

is not a ‘‘significant regulatory action’’

under Executive Order 12866; (2) is not

a ‘‘significant rule’’ under the DOT

Regulatory Policies and Procedures (44

FR 11034, February 26, 1979); and (3) if

promulgated, will not have a significant

economic impact, positive or negative,

on a substantial number of small entities

under the criteria of the Regulatory

Flexibility Act. A copy of the draft

regulatory evaluation prepared for this

action is contained in the Rules Docket.

A copy of it may be obtained by

contacting the Rules Docket at the

location provided under the caption

ADDRESSES.

List of Subjects in 14 CFR Part 39

Air transportation, Aircraft, Aviation

safety, Safety.

The Proposed Amendment

Accordingly, pursuant to the

authority delegated to me by the

Administrator, the Federal Aviation

Administration proposes to amend part

39 of the Federal Aviation Regulations

(14 CFR part 39) as follows:

PART 39—AIRWORTHINESS

DIRECTIVES

1. The authority citation for part 39

continues to read as follows:

Authority: 49 U.S.C. 106(g), 40113, 44701.

§ 39.13 [Amended]

2. Section 39.13 is amended by

adding the following new airworthiness

directive:

Boeing: Docket 2000–NM–285–AD.

Applicability: Model 777 series airplanes,

line numbers 1 through 155 inclusive,

certificated in any category.

Note 1: This AD applies to each airplane

identified in the preceding applicability

provision, regardless of whether it has been

modified, altered, or repaired in the area

subject to the requirements of this AD. For

airplanes that have been modified, altered, or

repaired so that the performance of the

requirements of this AD is affected, the

owner/operator must request approval for an

alternative method of compliance in

accordance with paragraph (c) of this AD.

The request should include an assessment of

the effect of the modification, alteration, or

repair on the unsafe condition addressed by

this AD; and, if the unsafe condition has not

been eliminated, the request should include

specific proposed actions to address it.

Compliance: Required as indicated, unless

accomplished previously. To prevent loose or

missing nuts on the clevis assemblies that

support the auxiliary tracks of the inboard

leading edge slats, which could cause the

slats to be loose or in an incorrect position

and result in partial or total failure or loss of

the slats, accomplish the following:

Replacement

(a) Within 18 months after the effective

date of this AD, replace nuts having part

number NAS1805–5L on the clevis

assemblies that support the auxiliary tracks

(outboard, center, and inboard) of the inboard

leading edge slats with new nuts purchased

from the airplane manufacturer after October

31, 1999, in accordance with Boeing Special

Attention Service Bulletin 777–57–0038,

dated February 24, 2000.

Spares

(b) As of the effective date of this AD, no

person shall install any nut having part

number NAS1805–5L on any airplane unless

it was purchased from the airplane

manufacturer after October 31, 1999.

Alternative Methods of Compliance

(c) An alternative method of compliance or

adjustment of the compliance time that

provides an acceptable level of safety may be

used if approved by the Manager, Seattle

Aircraft Certification Office (ACO), FAA.

Operators shall submit their requests through

an appropriate FAA Principal Maintenance

Inspector, who may add comments and then

send it to the Manager, Seattle ACO.

Note 2: Information concerning the

existence of approved alternative methods of

compliance with this AD, if any, may be

obtained from the Seattle ACO.

Special Flight Permits

(d) Special flight permits may be issued in

accordance with sections 21.197 and 21.199

of the Federal Aviation Regulations (14 CFR

21.197 and 21.199) to operate the airplane to

a location where the requirements of this AD

can be accomplished.

Issued in Renton, Washington, on

November 8, 2000.

Donald L. Riggin,

Acting Manager, Transport Airplane

Directorate, Aircraft Certification Service.

[FR Doc. 00–29214 Filed 11–14–00; 8:45 am]

BILLING CODE 4910–13–P

DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

Civilian Health and Medical Program of

the Uniformed Service (CHAMPUS):

Enuretic Devices, Breast

Reconstructive Surgery, PFPWD Valid

Authorization Period, Early

Intervention Services

AGENCY: Office of the Secretary, DoD.

ACTION: Proposed rule.

SUMMARY: This proposed rule amends

CHAMPUS to remove the exclusion of

enuresis alarms, to correct contradictory

language as it relates to breast

reconstructive surgery, to change the

valid period of an authorization for

services and items under the Program

for Persons with Disabilities (PFPWD),

to establish the CHAMPUS payment

relationship for IDEA Part C services

and items, and to provide for early

intervention services.

DATES: Written comments will be

accepted until January 16, 2001.

ADDRESSES: Forward comments to the

Office of CHAMPUS Management

Activity, 16401 East Centretech

Parkway, Aurora, CO. 80011–9043.

FOR FURTHER INFORMATION CONTACT:

Margaret Brown and Michael Kottyan,

Office of Medical Benefits and

Reimbursement Systems, telephone

(303) 676–3581 and (303) 676–3520

respectively.

SUPPLEMENTARY INFORMATION: The

Civilian Health and Medical Program of

the Uniformed Services (CHAMPUS)

supplements the availability of health

care in military hospitals and clinics.

This proposed rule removes the

exclusion of enuresis alarms, corrects

contradictory language as it relates to

breast reconstructive surgery, changes

the valid period of an authorization for

services and items under the Program

for Persons with Disabilities (PFPWD),

and establishes the CHAMPUS payment

relationship for IDEA Part C services

and items, and revises a statement to the

paragraph at 32 CFR 199.4(g)(15)(i)(D).

Enuretic Device

The CHAMPUS Management Activity

received a request from the medical

community that we re-evaluate our

policy regarding enuretic devices,

which currently are excluded from cost

sharing under the CHAMPUS Basic

Program. Recent literature review

indicates that the medical community

considers enuresis alarms the most

effective method for treating enuresis.

Having found no contradictory

evidence, we agree that enuretic devices

should be removed from the exclusions

in the regulation. The removal of this

exclusion will allow physicians to select

rational treatment options and insure

that CHAMPUS pays only for the most

appropriate and highest quality medical

care possible.

Enuretic conditioning programs are

also specifically excluded from

CHAMPUS cost sharing. Enuretic

conditioning programs will continue to

be excluded. The basis for excluding

enuretic conditioning programs is to

restrict the payment for professional

guidance on the use of these devices to

an attending physician.

68958 Federal Register / Vol. 65, No. 221 / Wednesday, November 15, 2000 / Proposed Rules

Breast Reconstructive Surgery

Benefits under the basic program are

not available for cosmetic,

reconstructive, or plastic surgery.

However, the regulation provides

exceptions for procedures that are

essentially cosmetic when performed in

response to a congenital anomaly, post

mastectomy breast reconstruction for

malignancy, fibrocystic disease, or other

covered mastectomies, an accidental

injury or disfiguring scars resulting from

neoplastic surgery.

The regulation currently contains

contradictory provisions relating to post

mastectomy breast reconstruction. 32

CFR 199.4(e)(8)(i)(D) specifically

authorizes post mastectomy breast

reconstruction. However, 32 CFR

199.4(e)(8)(ii)(D) excludes breast

augmentation mammoplasty even when

performed as a part of post mastectomy

breast reconstruction procedure.

Because an augmentation mammoplasty

is an integral part of most post

mastectomy breast reconstruction

procedures, it is inconsistent to exclude

it as a part of that procedure.

Further, in the context of post

mastectomy breast reconstruction,

reduction mammoplasty may be

performed to achieve symmetry of the

collateral breast. This too is an integral

part of the post mastectomy breast

reconstruction process and should not

be excluded from cost sharing by

CHAMPUS. We are adding language to

clarify the rule that reduction

mammoplasty on the collateral breast is

an authorized part of the post

mastectomy breast reconstruction

procedure. Cosmetic, reconstructive or

plastic surgery that is performed to

reshape normal structures of the body in

order to improve the patient’s

appearance and self-esteem remains an

exclusion.

PFPWD Valid Authorization Period

The regulation currently provides that

a valid authorization for receipt of

services and items under the Program

for Persons with Disabilities (PFPWD)

shall not exceed six consecutive

months. For services that are required

for more than six months, and for

durable equipment and durable medical

equipment that are prorated for more

than six months, this requirement

places unnecessary hardship on the

family of an individual with a disability

and additional administrative workload

on the managed care support

contractors. Changing the valid period

of a PFPWD authorization to a

maximum of twelve months enhances

the PFPWD without compromising its

accountability.

Early Intervention Services

Part C of the Individuals with

Disabilities Education Act (IDEA)

Amendments of 1997, Public Law 105–

17, enacted June 4, 1997, provides

financial assistance to States to, among

other provisions, facilitate the

coordination of payment for early

intervention services from Federal,

State, local, and private sectors

(including public and private insurance

coverage). Early intervention services

are developmental services provided to

individuals under age three (3) who

have a developmental delay or who

would be at risk of experiencing a

substantial developmental delay if those

services were not provided.

Part C, Section 640, Payer of Last

Resort, establishes that funds provided

in accordance with the Act may not be

used to satisfy a financial commitment

for services that would have been paid

for from another public or private

source, including any medical program

administered by the Secretary of

Defense. This language establishes

CHAMPUS as first payer for medical

services and items provided as early

intervention services in accordance with

Part C and that are otherwise allowable

under the CHAMPUS Basic Program or

the Program for Persons with

Disabilities.

Statement at the Paragraph 32 CFR

199.4(g)(15)(i)(D)

The revised statement clarifies that

the consensus among experts must be

based on reliable evidence.

Regulatory Procedures

Executive Order (EO) 12866 requires

that a comprehensive regulatory impact

analysis be performed on any

economically significant regulatory

action, defined as one that would result

in an annual effect of $100 million, or

more on the national economy or which

would have other substantial impacts.

The Regulatory Flexibility Act (RFA)

requires that each Federal Agency

prepare and make available for public

comment, a regulatory flexibility

analysis when the agency issues a

Regulation which would have a

significant impact on a substantial

number of small entities.

This is neither a significant regulatory

action under Executive Order 12886,

nor would it have a significant impact

on small entities. The changes set forth

in the proposed rule are minor revisions

to the existing regulation. In addition,

this proposed rule does not impose new

information collection requirements for

purposes of the Paperwork Reduction

Act of 1995 (44 U.S.C. 3501–3511).

Paperwork Reduction Act

The changes set forth in this proposed

rule are minor revisions to the existing

regulation. This rule, as written,

imposes no burden as defined by the

Paperwork Reduction Act of 1995. It

will be seen as an enhancement of

military benefits. It will provide greater

parallel between CHAMPUS benefits

and the standards of care now offered in

the health care community. If however,

any program implemented under this

rule causes such a burden to be

imposed, approval therefore will be

sought of the Office of Management and

Budget in accordance with the Act,

before implementation. All public

comments are invited.

List of Subjects in 32 CFR Part 199

Claims, Health insurance, Individuals

with disabilities, Military personnel.

Accordingly, 32 CFR part 199 is

amended as follows:

PART 199—[AMENDED]

Civilian Health and Medical Program

of the Uniformed Service (CHAMPUS)

1. The authority citation for part 199

continues to read as follows:

Authority: 5 U.S.C. 301; 10 U.S.C. chapter

55.

2. Section 199.2 is proposed to be

amended by adding at the end of the

definition for Double coverage plan a

new paragraph (v) to read as follows:

§ 199.2 Definitions.

* * * * *

Double coverage plan. * * *

(v) Part C of the Individuals with

Disabilities Education Act for medical

services and items provided in

accordance with the Individualized

Family Service Plan and that are

otherwise allowable under the

CHAMPUS Basic Program or the

Program for Persons with Disabilities.

3. Section 199.4 is proposed to be

amended by removing paragraph

(e)(8)(ii)(D); amending paragraph

(g)(15)(i)(D) by adding ‘‘the reliable

evidence shows that the’’ after the word

‘‘If’’; and by revising paragraphs

(e)(8)(iv)(C), (e)(8)(iv)(E), and (g)(58) to

read as follows:

§ 199.4 Basic program benefits.

* * * * *

(e) * * *

(8) * * *

(iv) * * *

(C) Augmentation mammoplasties.

Augmentation mammoplasties, except

for breast reconstruction following a

covered mastectomy and those

Federal Register / Vol. 65, No. 221 / Wednesday, November 15, 2000 / Proposed Rules 68959

specifically authorized in paragraph

(e)(8)(i) of this section.

* * * * *

(E) Reduction mammoplasties.

Reduction mammoplasties unless there

is medical documentation of intractable

pain, not amenable to other forms of

treatment) resulting from large,

pendulous breasts) or unless performed

as an integral part of an authorized

breast reconstruction procedure under

paragraph (e)(8)(i)(C) of this section,

including reduction of the collateral

breast for purposes of ensuring breast

symmetry.

* * * * *

(g) * * *

(58) Enuretic. Enuretic conditioning

programs, but enuretic alarms may be

cost-shared when determined to be

medically necessary in the treatment of

enuresis.

* * * * *

4. Section 199.5 is proposed to be

amended by revising paragraph

(a)(4)(iii) and adding a new paragraph

(a)(5)(v) to read as follows:

§ 199.5 Program for Persons with

Disabilities (PFPWD).

(a) * * *

(4) * * *

(iii) Valid period. An authorization for

a PFPWD service or item shall not

exceed twelve consecutive months.

(5) * * *

(v) The requirements of paragraph

(a)(5) of this section notwithstanding, no

Public Facility Use Certification is

required for medical services and items

that are provided under Part C of the

Individuals with Disabilities Education

Act in accordance with the

Individualized Family Service Plan and

that are otherwise allowable under the

CHAMPUS Basic Program or the

PFPWD.

* * * * *

5. Section 199.8 is proposed to be

amended by adding paragraph (d)(5) to

read as follows:

§ 199.8 Double coverage.

* * * * *

(d) * * *

(5) The requirements of paragraph

(d)(4) of this section notwithstanding,

CHAMPUS is a primary payer for

medical services and items that are

provided under Part C of the Individuals

with Disabilities Education Act in

accordance with the Individualized

Family Service Plan and that are

otherwise allowable under the

CHAMPUS Basic Program or the

Program for Persons with Disabilities.

* * * * *

Dated: November 7, 2000.

L.M. Bynum,

Alternate OSD Federal Register Liaison

Officer, Department of Defense.

[FR Doc. 00–29013 Filed 11–14–00; 8:45 am]

BILLING CODE 5001–10–M

ENVIRONMENTAL PROTECTION

AGENCY

40 CFR Parts 52 and 81

[WI96–01–7327b; FRL–6901–4]

Approval and Promulgation of State

Implementation Plans; Wisconsin

AGENCY: Environmental Protection

Agency.

ACTION: Proposed rule.

SUMMARY: We are approving a request

from the Wisconsin Department of

Natural Resources (WDNR) submitted to

the Environmental Protection Agency

(EPA) on November 5, 1999 to

redesignate a portion of the City of

Rhinelander (Oneida County) Wisconsin

from a primary sulfur dioxide (SO2)

nonattainment area to attainment. EPA

designated a portion of the City of

Rhinelander as a primary SO2

nonattainment area on October 12, 1984.

In the final rules section of this Federal

Register, we are approving the SIP

revision as a direct final rule without

prior proposal, because we view this as

a noncontroversial revision amendment

and anticipate 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 proposed rule, no

further activity is contemplated in

relation to this proposed rule. If we

receive adverse comments, the direct

final rule will be withdrawn and all

public comments received will be

addressed in a subsequent final rules

based on this proposed rule. We will not

institute a second comment period on

this action. Any parties interested in

commenting on this action should do so

at this time.

DATES: Comments on this proposed

action must be received by December

15, 2000.

ADDRESSES: Written comments should

be sent to: Carlton T. Nash, Chief,

Regulations Development Section, Air

Programs Branch (AR–18J), EPA Region

5, 77 West Jackson Boulevard, Chicago,

Illinois 60604–3590.

FOR FURTHER INFORMATION CONTACT:

Christos Panos, Regulation Development

Section (AR–18J), Air Programs Branch,

EPA Region 5, 77 West Jackson

Boulevard, Chicago, Illinois 60604,

(312) 353–8328.

SUPPLEMENTARY INFORMATION: For

additional information, see the Direct

Final notice which is located in the

Rules section of this Federal Register.

Copies of the request and the EPA’s

analysis are available for inspection at

the above address.

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

Dated: October 27, 2000.

Gary Gulezian,

Acting Regional Administrator, Region 5.

[FR Doc. 00–29222 Filed 11–14–00; 8:45 am]

BILLING CODE 6560–50–P

ENVIRONMENTAL PROTECTION

AGENCY

40 CFR Part 62

[FL–86–200028(b); FRL–6902–3]

Approval and Promulgation of State

Plans For Designated Facilities and

Pollutants: Florida

AGENCY: Environmental Protection

Agency (EPA).

ACTION: Proposed rule.

SUMMARY: EPA proposes to approve the

Section 111(d) Plan for the State of

Florida submitted by the Florida

Department of Environmental Protection

(DEP) on September 16, 1999, for

implementing and enforcing the

Emissions Guidelines applicable to

existing Hospital/Medical/Infectious

Waste Incinerators. The Plan was

submitted by the Florida DEP to satisfy

certain Federal Clean Air Act

requirements. In the Final Rules Section

of this Federal Register, EPA is

approving the Florida State Plan

submittal as a direct final rule without

prior proposal because the Agency

views this as a noncontroversial

submittal and anticipates that it will not

receive any significant, material, and

adverse comments. A detailed rationale

for the approval is set forth in the direct

final rule published in this Federal

Register. If no significant, material, and

adverse comments are received in

response to this proposed rule, no

further activity is contemplated in

relation to this proposed rule. 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 on this proposed rule. EPA will

not institute a second comment period

on this action.

DATES: Comments must be received in

writing by December 15, 2000.

ADDRESSES: Written comments should

be addressed to Joey Levasseur at the